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Sheff 3a > Exam Questions I Got Wrong > Flashcards

Exam Questions I Got Wrong Flashcards

1
Q

Pharmacological mx of RDS

A

Sufactant - curosurf or Survanta [brands]

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2
Q

Define cyanosis

A

> 5/dL of deoxygenated haemoglobin

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3
Q

Blood in urine post IE cause?

A

Immune complex nephritis

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4
Q

3 clinical examination findings in polyhydroaminos

A

Indistinct fetal parts
Ballotable fetal parts
Indistinct fetal heart by auscultation
Overdistended uterus
Symphyseal-fundal height larger than dates

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5
Q

Factors leading to polyhydroaminos ? Ix for these?

A

Fetal infection
Oesophageal / duodenal atresia
Macrosomia
Maternal diabetes

Ix
Detailed ultrasound
GGT
TORCH screen

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6
Q

3 main complications of polyhydroaminos

A

Pre-term labour
Malpresentation
Prolapsed cord

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7
Q

Screening test for CF?
Phynketonuria?
Congenital hypothyroidism?

A

Immunoreactive trypsin
Phenylalanine
TSH

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8
Q

Outcomes of phenylketonuria

A

Severe developmental delay
Seizures
Mouse odour

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9
Q

What should GP give if suspects meningitis before sending to secondary care?

A

IM benzylpenicillin

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10
Q

Most likely cause of meningitis in 14 yr old

A

Group B neisseria meningitides

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11
Q

2 reasons to screen urine for delirium

A

Elicit drugs

Infection / renal problems

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12
Q

Why do you get acute dystonic reaction?

A

Blockage of dopamine receptors

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13
Q

Schitz lobe most affected?

A

Temporal

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14
Q

Blood tests for pre-eclampsia

A

FBC
Platelets
Ruin acid
Liver function tests

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15
Q

3 treatments to alleviate pre-eclampsia

A

Delivery
Labetalol
Mgso4

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16
Q

Pre eclampsia pre dispose

A

Nulliparity
First baby with new partner
Twin pregnancy
Chronic hypertension
SLE
Renal disease
Strong family history

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17
Q

A 55 year old man is admitted to the psychiatric ward for a routine
detoxification from alcohol. He lives alone and he has had epileptic seizures
in the past when being detoxified and so admission is thought to be prudent.
He has neglected himself for several months living on lager alone. He arrives
thin and dishevelled. He is started on benzodiazepine drug therapy to
alleviate his symptoms. He feels very anxious with some nausea.
1. State the name of one other drug you would prescribe (do not give
doses) and give the reason

A

Thiamine

He is likely to be depleted of Vitamin B1 and it is
given to prevent the development of Wernicke’s
encephalopathy or Korsakov’s syndrome. Also
prevent heart failure developing.

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18
Q

3 markers in blood for heavy drinking up to admission?

A

MCV
Gamma GT
Blood alcohol levels

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19
Q

Alcoholic develops severe abdo pain

Likely complication and test?

A

Pancreatitis

Serum amylase

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20
Q

Man given disulfiram

What dangerous side-effect may occur (possibly resulting in death) if he
drinks alcohol whilst taking this drug, which enzyme does antabuse
block and what biochemical product accumulates in the blood to cause
this side-effect?

A

Hypotension
Alcohol dehydrogenase
Acetaldehyde

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21
Q

A 22 year old man is admitted to the psychiatric ward complaining of auditory
hallucinations and is clearly paranoid. He agrees to stay for help and
assessment

If this is a drug problem, which illicit drug is likely to be responsible,
which neurotransmitter does it affect, and in what way does it affect this
neurotransmitter?

A

Amphetamine
Dopamine
Increase dopamine levels

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22
Q

2 blood markers neuroleptic malignant syndrome

A

WWC

Creatine kinase

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23
Q

Most likely cause of death in neuroleptic malignant syndrome

A

Pneumonia

pulmonary embolism

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24
Q

Nephrotic syndrome with
The child is admitted to hospital for investigation. Examination of the chest
reveals stony dullness to percussion at both chest bases, with reduced air entry.
Why?

Why do you get prolonged cap refill?

4 blood tests to assess nephrotic ?

Develops ascites and fever what is cause?
Organism is gram positive lanceolate?

2 CV complications and treatment?

Prophylactic medication ?

A

Pleural effusions due to hypoalbuminaemia

Reduced plasma volume

Urea and creatinine
Plasma proteins/albumin
Haemoglobin
Cholesterol

Peritonitis
Strep pneumoniae

HTN - atenolol 
Pericardial effusion (due to low albumin -> water leaves vessels) - Diuretics Or plasma expanders Eg Albumin (Human albumin solution)

Penicillin

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25
Q

Good histological prognosis vs bad in nephrotic

A

Good - minimal change

Bad - membranous glomerulonephritis

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26
Q

Sx of hypertension in preggo

A

Headache
Visual disturbances
Nausea/vomiting
Photophobia
Epigastric pain
Oedema
Fits
Poor urinary output

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27
Q

3 signs of eclampsia on physical exam

A

Hypereflexia
Papilloedema
Peripheral oedema
Clonus

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28
Q

Blood for pre eclampsia bar FBC / U+E

A

Uric acid
LFTs
Clotting screen

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29
Q

2 microbial causes of tonsillitis

A

Ebsteins Barr
Strep pyogenes
Adenovirus

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30
Q

Reaction in anaphylaxis

A

Type 1 hypersensitivity

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31
Q

2 drugs administered in emergency anaphylaxis

A

Oxygen
Hydrocortisone
Adrenaline

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32
Q

Name one macrolide

A

Erythromycin
Clarithromycin
Azithromycin

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33
Q

Patient with post strep glomerulonephritis
5th day has
He is managed with careful fluid balance for a few days. On the fifth day of
admission urea and electrolytes are:
Urea 18mmol/l (< 7)
Creatinine 315 μmol/l (73-109)
Sodium 140 mmol/l (135-144)
Potassium 7.2 mmol/l (3.5-4.7)

What has happened?
Which is life threatening and how to manage?

A

Renal failure with hyperkalaemia

Dextrose and insulin

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34
Q

Internal and external boundaries of epidural space

A

Dura matter and ligamentum flavum

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35
Q

2 drug therapies that would be CI for epidural

A

Anticoagulant Eg warfarin

Anti-platelet Eg aspirin

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36
Q

2 obstetric reasons to be denied epidural

A

Fetal distress

Antepartum haemorrhage

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37
Q

Percentage of epidurals work?

A

85-92%

38
Q

3 complications of epidural

A

Failure to achieve analgesia
Hypotension
Urinary retention
Headache due to dural tap
Delay of second stage

39
Q

2 causes of recurrence of intussusseption

Usual diagnosis using?

A

USS

Anatomical abnormality acting as intussusseption
Meckel’s diverticulum
Polyp

40
Q

Depression in 69 yr old

3 blood tests bar FBC, ESR, CRP, LFT, Ca, Glucose

A

TFT
U+E
B12 folate
VRDL

41
Q

What are neurofibrillary tangles

A

Paired helical axons of degenerated neurones

42
Q

Mechanism of donepezil

A

ACETYLcholinersterase inhibitors

43
Q

Why is vascular dementia related to cardiac problems

A

Infants occur in all parts of body including MI

44
Q

Blood tests for chronic alcohol use

A

LFT - GGT (AST, ALT)
Prothrombin
Low albumin
High bilirubin

45
Q

What is Delirim Tremens

A

o Acute alcohol withdrawal reaction
o Peaks at 72hr
Acute confusional state and hallucinations

46
Q

Describe wernicke s / Korsakoffs ?

A

• Description of Wernicke’s encephalopathy [1]
o Confusion
o Ataxia
o opthalmaplegia

Description of Korsakoff’s syndrome [1]
o Confabulation
o Retro and ante grade Amneasia
o Personality changes

47
Q

4 pre op blood tests and why

A

o FBC – anaemia
o U&Es – renal function
o Cross match + group and save – in case of blood loss
o Clotting screen – risk of bleeding

48
Q

Test for downs at 15 weeks

A

Quad test

49
Q

• Man has diarrhoea, sweating, tremor, weight loss etc. GP believes he has hyperthyroidism, name three blood tests for thyroid disease and give rational [3]
• Name three treatments you would give and rational [3]
o
• List three important things that you would do next [3]
• Description of thyrotoxicosis, what would you do [1]

A 
o	TFTs – to see T4 and TSH levels (split into two)
o	Antibodies (TSH receptor antibody) – possible see the causegraves disease
o	U&amp;Es – if the diarrhea is affecting him

• Name three treatments you would give and rational [3]
o Radio active iodine – to destroy the overactive thyroid cells
o Thyroxine – to replace the thyroid not being reduced
o Propranolol – symptomatic relief
Carbimazole•
List three important things that you would do next [3]
o Repeat T3 and t4 levels
o Regular ECG
o Eye tests
• Description of thyrotoxicosis, what would you do [1]
o IV propranolol
o corticosteroids
o carbimazole PO
o ?fluid

50
Q

Supplied but not needed or demanded

A

o Over 75 health check by GP

 Proven not to help and they don’t ask for it need to be reminded

51
Q

Supplied and needed but not demanded ? Why?

A

o Baby guthries testing

 Mother would rather their babies weren’t harmed but needed for early diagnosis of conditions

52
Q

• Child has fever/malaise, limp, hepatosplenomegaly etc. what two conditions do you want to rule out [2]
o
Name two blood tests you would perform [2]
• What initial imaging would you request [3]
• Name three classes of drugs for arthritis (not biologics) and give example [3]

A

o Leukaemia
o Septic arthritis

• Name two blood tests you would perform [2]
o FBC
o LFTs

•	What initial imaging would you request [3]
o	Uss of the abdomen
o	X-ray of the hip
o	Uss hip
•	
Name three classes of drugs for arthritis (not biologics) and give example [3]
o	NSAIDs – ibuprofen
o	DMARDS – methotrexate
o	Corticosteroids - pred
53
Q
  • 9 month old child presents with redness in the creases of neck, axilla and groin, his skin is peeling, what is the diagnosis [1]
  • What is the causing organism [1]
  • Why does the skin peel [1]
  • The child becomes unresponsive, what three things would you do immediately [3]
  • Child weighs 9kg, calculate maintenance fluid over 24 hours [1]
  • Child is 5% dehydrated, calculate total fluid given over 24 hours [1]
  • What two systems would you monitor after giving gentamycin [2]
A

• 9 month old child presents with redness in the creases of neck, axilla and groin, his skin is peeling, what is the diagnosis [1]
o Scalded skin syndrome

• What is the causing organism [1]
o Staph aureaus

• Why does the skin peel [1]
o Staph releases endotoxin, between layers of skin
•
The child becomes unresponsive, what three things would you do immediately [3]
o Call for help
o Assess ABCDE
o Perform simple airways manove / give O2

• Child weighs 9kg, calculate maintenance fluid over 24 hours [1]
o 900

• Child is 5% dehydrated, calculate total fluid given over 24 hours [1]
o 1350

• What two systems would you monitor after giving gentamycin [2]
o Ears and kidneys

54
Q

2 drugs that aggravate Parkinson’s?

How does writing look?

A

Metoclopramide
Olazipine

Micrographia that tails off

55
Q
  • Elderly man with COPD admitted for acute exacerbation and receives treatment, 4 days later he wishes to discharge himself, what four pieces of information are required to plan his discharge [4]
  • 3 days later (and not back to full health) he is adamant he wants to go home, what assessment would you perform [2]
  • Where could he be discharged to that is not his own home [2]
  • What type of support could he receive at home [2]
A 
o	Drugs
o	OT
o	Physio
o	F/U appointment
o	Letter GP

• 3 days later (and not back to full health) he is adamant he wants to go home, what assessment would you perform [2]
o Mental Capacity assessment for self-discharge

• Where could he be discharged to that is not his own home [2]
o Rehabilitation hospital
o Nursing home

• What type of support could he receive at home [2]
o Respite care
o Social workers
o Community nurses

56
Q

4 principles of couples therapy

A 
o	Promote communication
o	Change views of relastionship
o	Modifies dysfunctional behavior
o	Decreases emotional avoidance
o	Promotes strength
57
Q

3 interventions for orgasmic disorder

A

o Sensate focus
o Lube
o Eros device
o Kegel exercises

58
Q

4 tests of negligence

A

o Does dr have duty of care
o Was there a breach duty of care broken
o Did the patient come to harm
o Did the breach cause the harm

59
Q

Hello

A

Suck my balls

60
Q

Boy sore throat, petichae on soft palate, exudate on tonsils, tender lymphadenopathy
Diagnostic ix?

A

Mono spot test (EBV)

61
Q

Post strep tender noodles on shins ? When else do you get them?

A

Erythema nodosum

TB and IBD

62
Q

Difference between chlamydia and gon on gram stain

A

Gram negative
Gon - diplococcus
Clam - rod / cocci

63
Q

Cause of gynacomastia in male drugs

A

Antipsychotics

Spironolactone

64
Q

Test to determine gonn and sensitivity

Symptomatic

A

Urethral swab and culture sensitivity

65
Q

medication for acute alcohol withdrawal

A

Chlordiazepoxide

66
Q

Blood tests in paracetamol overdose

A 
U+e
LFTs
Glucose - due to hepatic necrosis 
Clotting screen 
ABG - acidosis can occur
67
Q

Paracetamol overdose presentation

A

24hrs asx
-> hepatic necrosis -> RUQ pain and jaundice
[Encepalopathy, oliguria, hypoglycaemia, lactic acidosis].

68
Q

Septic screen

A 
FBC 
Cultures 
X-ray 
Urine sample 
LP
69
Q

3 components of child emergency assessment

A

Appearance
Work of breathing
Circulation to skin

70
Q

Parts of appearance in paeds ?

A

TICS

Tone, irritability, consolability, look, speech

71
Q

4 things to know for discharge planning

A

Details of patients condition
Info on their medicines
Contact information after discharge
Arrangements for continuing social care support
Arrangements for continuing health support

72
Q

What is the rule of rescue

A

Perceived duty to saved endangered life where possible, regardless of cost, even if the money could be spent better elsewhere

73
Q

Seconds of nice traffic light

A

Colour -pale, mottled, ashen, blue

Activity- No response to ques, does not wake, weak high pitched cry

Respiratory - Grunting, RR>60,

Circulation and hydration - reduced skin turgor

Other - Eg temp, rash, seizure, focal neuro

74
Q

Score system for DVT ? Ix? Mx?

A

Wells

Ultrasound
D-diner test

LMWH

75
Q

3 supportive measures on discharge

A

Carers
Caterers
Care package

76
Q

2 psychosocial measures for post discharge of schitz

A

Family psychoeducation

Social skills training

77
Q

Anaemia in alcohol abuse

A

Macrocytosis

MCV

78
Q

Features of moderate, severe life threatening asthma

A

Moderate - PEF 50-75%, increased Sx, Sa02 >92%

Severe - PEF 50-75, Sa02 <92%, inability to complete sentences

Life threatening - PEF <50%, Sa02<92%, silent lungs, not talking, lethargy

79
Q

2 drugs that worsen Parkinson’s

A

Metoclopramide - dopamine receptor antagonist

Antipsychotics - Dopamine receptor antagonists

80
Q

Must score

A

1 being under 20 BMI, 2 being under 18.5 BMI
1 5% unplanned weight loss, 2 for >10% weight loss past 6 months
2 acutely unwell / not eating for 5 days

Out of 6

0 low risk, 1 medium risk, 2 high risk

81
Q

Specialist investigation for fetal growth

A

Uterine artery Doppler

82
Q

6 questions for asthma control

A
  • How many times a day does he need his blue inhaler
  • Does he get out of breath/how many times a day
  • Asthma attacks
  • Days of school
  • Waking up in night
  • Coughing
  • Technique
83
Q

4 qualitative methods for evaluating healthcare

A
  • Focus groups
  • Observation
  • Interviews
  • Document review
84
Q

Man who is about to undergo a palliative shunt as a result of a cholangiocarcinoma. He also has diagnosed advanced COPD. Prior to the operation, he signed a DNACPR.

Beneficence and non-maleficence apply

A
  1. What is beneficence and apply this principle to this patient (2)
    Whether or not an intervention would be of benefit to the patient in this case would rescussitation would not help his long term condition / cure him
  2. What is non-maleficence and apply this principle to this patient (2)
    That do no harm is to occur to the patient – going against patient’s wishes is causing harm goes against wishes
85
Q

Report to who in never events

A

GMC
Patient and family
CQC

86
Q

20 year old female who broke up with boyfriend 2 weeks ago. Taken 12 paracetamol tablets with 500ml vodka. Had previously gone to GP for low mood, feeling empty and worthless. Sent message to ex-boyfriend saying ‘bye cruel world’. Superficial cuts on forearm, old scars.
a. 4 blood tests (apart from paracetamol levels) (4m)

A

LFT
U+e
FBC
Clotting

87
Q

6 screening dementia

A 
Glucose 
B12 folate 
FBC 
Alcohol 
Calcium 
Medication / toxic screen

All the mental tests Eg MMSE ….

88
Q

CI for heparin

A

Peptic ulcers

89
Q

2 things to help intention become a behaviour

A

perceived control (back pain heavy task) anticipated regret, prep actions, implementation intentions (what If – need a fag ), relevance to self

90
Q
  1. Crying infant 6 month old, apyrexial, petechial rash on neck, immobile left arm, crying when left arm moved. Crying throughout assessment.
    a. 3 initial investigations
A

Blood and culture
X-ray arm
MSU / culture

91
Q

ABG: high pH, low CO2, normal O2, normal HCO3 and base excess. Interpretation of blood gases – what does it show and what is the cause?

A

Respiratory alkalosis - hyperventilation

= low co2 and high ph

92
Q

3 aspects following hyperthyroid treatment

A

USS of neck, repeat levels, regular ECG and eye tests

Sheff 3a (30 decks)

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