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Miscellaneous > DUMES Y3 Q's > Flashcards

DUMES Y3 Q's Flashcards

1
Q

What medications are used for aborting a migraine?

A

Ibuprofen

Paracetamol

Sumatriptan

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2
Q

What medications can be used for migraine prophylaxis (preventing a migraine)?

A

Amitriptyline

Propranolol

Topiramate

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3
Q

What migraine prophylaxis should NOT be used in patients with asthma?

A

Beta blockers in this case propranolol which is a non-selective beta blocker.

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4
Q

What migraine prophylaxis should NOT be used in patients who are trying to or are already pregnant?

A

Topiramate

This is can cause major congenital malformations and foetal growth restriction when used during pregnancy.

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5
Q

Characteristic features of a tension headache?

A

Bilateral with a “band” like feeling around the head.

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6
Q

Characteristic features of a migraine headache?

A

Unilateral throbbing headache with nausea and vomiting.

Other features include aura.

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7
Q

Characteristic features of a cluster headache?

A

More common in men

Present in those aged around 34 yrs old however can vary.

Usually unilateral, can present as a pain behind the eye.

Potentially triggered by emotional stress and physical exertion

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8
Q

Characteristic features of subarachnoid headache?

A

Acute presentation

Characterised by a severe “thunderclap” headache

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9
Q

What is a symptom experienced during the prodromal period of Parkinson’s disease?

A

Hyposmia (decreased sense of smell).

Prodromal period = the period that occurs between first appearance of the disease and affected movement.

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10
Q

What are the main triad of symptoms for Parkinson’s?

A

Cogwheel rigidity

Bradykinesia

Resting tremor

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11
Q

What are late stage features of Parkinson’s?

A

Dysphagia (difficulty/discomfort in swallowing)

Postural instability

Urinary symptoms

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12
Q

What is a late complication of Parkinson’s?

A

Psychosis

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13
Q

Beta blockers are typically given in cluster headache prophylaxis. True/false?

A

False

Beta blockers are usually given in migraine headache prophylaxis.

Verapamil (a CCB) along with lithium can be given as prophylaxis for cluster headaches.

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14
Q

What are the risk factors for a cluster headache?

A

Male gender

Age of more than 30

Consumption of alcohol

Prior brain surgery or trauma

Family history

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15
Q

What medications are used first line for cluster headache prophylaxis?

A

Verapamil (a calcium channel blocker) and lithium

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16
Q

What autonomic symptoms are associated with cluster headaches?

A

Conjunctival injection or lacrimation

Nasal congestion or rhinorrhoea

Eyelid oedema or forehead/facial swelling

Miosis (excessive pupil constriction) or ptosis (drooping of the upper eyelid).

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17
Q

What are potential triggers for cluster headaches?

A

Watching television

Alcohol

Hot weather

Stress

Use of nitroglycerin

Sexual activity

Glare

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18
Q

What is given for acute treatment of cluster headaches?

A

Oxygen therapy and triptans

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19
Q

What is an essential tremor?

A

A tremor that occurs during voluntary movements, such as holding objects, writing, or performing tasks that require fine motor skills.

The tremor typically worsens with stress, fatigue, or caffeine consumption and improves with rest.

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20
Q

What would be a typical presentation of MND?

A

Patient would present with mixed upper and motor neurone signs.

No sensory symptoms

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21
Q

What are the 4 main types of MND? Which are UMN and which are LMN?

A

Amyotrophic lateral sclerosis - Both UMN and LMN

Primary lateral sclerosis - UMN only

Progressive muscular atrophy - LMN only

Progressive bulbar palsy - LMN only

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22
Q

Characteristic CSF finding for multiple sclerosis?

A

Oligoclonal bands in the CSF

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23
Q

What is levodopa?

A

A precursor to dopamine

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24
Q

What is the mechanism of action for levodopa?

A

Increases levels of dopamine to combat reduction of substantia nigra degeneration.

This results in TRAP symptoms.

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25
Q

What are TRAP symptoms that occur due to the degeneration of the substantia nigra?

A

Tremor (resting)
Rigidity (cogwheel)
Akinesia (loss of power/voluntary movement).
Postural instability

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26
Q

What is riluzole?

A

Used in MND to prolong life by around 3 months.

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27
Q

What is selegiline?

A

A MAO-B inhibitor used in major depressive disorder and can be used in Parkinson’s however there is less improvement in motor symptoms and would not be used before levodopa.

28
Q

What is ropinirole?

A

A dopamine agonist agonist used to treat Parkinson’s by triggering dopamine D2 receptors.

Associated with side-effects of impulsivity i.e. impulse gambling.

29
Q

Common side-effects of ropinirole?

A

Sleepiness

Vomiting

Dizziness

30
Q

Serious side-effects of ropinirole?

A

Pathological gambling

Low blood pressure with standing

Hallucinations

31
Q

What is pyrocyclidine used for?

A

An anticholinergic used to treat drug-induced Parkinson’s.

32
Q

What drugs lead to drug-induced Parkinson’s?

A

1st gen (typical) antipsychotics i.e. haloperidol, chlorpromazine.

33
Q

What is carbamazepine used for?

A

It is an anti-convulsant medication used to treat epilepsy

34
Q

When should a patient switch drug class if SSRI’s prove ineffective?

A

2 SSRI’s should be trialled before switching to another drug class.

35
Q

It is suitable for immediately switch citalopram with sertraline. True/false?

A

True

Citalopram is fine to switch with sertraline (same with most SSRI’s).

36
Q

Which SSRI should be withdrawn completely before starting another SSRI and why?

A

Fluoxetine

This is because it has a longer half-life, so should be withdrawn before starting another SSRI in order to reduce risk of serotonin syndrome.

37
Q

What is serotonin syndrome?

A

Serotonin syndrome is a potentially life-threatening condition caused by excessive levels of serotonin in the body.

38
Q

What are the main causes of serotonin syndrome?

A

Taking certain medications that increase serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and certain pain medications i.e. triptans.

Combining multiple medications or supplements that affect serotonin levels.

Overdose of a single medication that affects serotonin levels.

39
Q

What are the clinical symptoms of serotonin syndrome?

A

Agitation, restlessness, or confusion.

Rapid heart rate, high blood pressure, or sweating.

Dilated pupils and muscle rigidity.

Tremors or twitching.

Nausea, vomiting, or diarrhea.

Seizures or loss of consciousness in severe cases.

40
Q

What is the gold-standard medication for bipolar disorder?

A

Lithium

41
Q

What can be used in bipolar disorder if lithium is not tolerated?

A

Sodium valproate can be used second line if lithium is not tolerated.

42
Q

What are characteristic features of haemorrhoids?

A

Feeling of lumps/pain/itching in the anus and bleeding from the anus.

43
Q

What are characteristic features of cystoceles?

A

Shown by urinary symptoms (e.g. incomplete emptying and urinary frequency).

44
Q

What are characteristic features of rectoceles?

A

Characterised by bowel symptoms (i.e. incomplete emptying and difficulty during bowel movements).

45
Q

Uterovaginal prolapse cannot occur in women who have undergone a hysterectomy. True/false?

A

True

Since the uterus is removed in a hysterectomy.

46
Q

What is first line for treatment for a prolactinoma of 4mm?

A

Cabergoline

Usually first line in prolactinoma and for patients to achieve normal prolactin levels.

Bromocriptine is not as effective however can be used as management during surgery.

47
Q

Sandostatin and lanreotide can be used for prolactinoma treatment. True/false?

A

False

These are examples of somatostatin analogues, typically used for acromegaly.

48
Q

When is transsphenoidal surgery used for a pituitary mass?

A

Never usually used as first line.

Usually done when there is neurological involvement.

Also done for macroadenomas, which are benign tumours exceeding 10mm (1cm).

49
Q

What warrants an urgent referral for triple assessment in the breast clinic for suspected breast cancer?

A

Aged 30 and over

Family history of breast cancer

Fast growing palpable lump and lymphadenopathy.

50
Q

What are the components of the triple assessment?

A

Clinical assessment (including history and examination).

Imaging (mammogram or ultrasound of breasts - dependant on age).

Biopsy (core needle biopsy or fine needle aspiration biopsy)

51
Q

Difference between a fine needle aspiration biopsy and core needle biopsy?

A

A fine-needle aspiration (FNA) biopsy is often used to take cell samples from organs or from lumps that are below the surface of the skin.

If a larger sample is needed, a core needle biopsy (CNB) will be used instead.

52
Q

How is the fusion gene known as BCR-ABL produced?

A

This fusion gene results from a translocation (exchange of genetic material) between chromosomes 9 and 22, known as the Philadelphia chromosome (Ph chromosome).

53
Q

How does the BCR-ABL fusion gene lead to CML?

A

The BCR-ABL protein produced by the fusion gene has constitutively activated tyrosine kinase activity, meaning it is constantly “turned on” and promotes uncontrolled cell growth and division.

This abnormal protein drives the proliferation of immature white blood cells (myeloid cells) in the bone marrow, leading to the characteristic features of CML.

54
Q

The BCR-ABL fusion gene encodes a protein with abnormal tyrosine kinase activity.
True/false?

A

True

55
Q

What is the gold standard investigation for CML?

A

Bone marrow aspiration and cytogenic sampling to find the Philadelphia chromosome.

56
Q

When should an endoscopy be carried out in iron-deficiency anaemia?

A

Mainly carried out in older patients for presence of suspected bowel cancer.

57
Q

What clotting factors does warfarin inhibit to provide therapeutic anticoagulation?

A

Factors II, VII, IX and X

Remember the mnemonic: 2+7 = 9 not 10 which is a reminder of ALL the clotting factors that are vitamin K dependant.

58
Q

Key features of CLL (chronic lymphocytic leukaemia)?

A

Smudge cells

Mature lymphocytes

Richter’s transformation

59
Q

What is Richter’s transformation in CLL?

A

A rare complication of chronic lymphocytic leukemia (CLL), where the disease transforms into an aggressive form of non-Hodgkin lymphoma, typically diffuse large B-cell lymphoma (DLBCL).

60
Q

Key features of ALL (acute lymphoblastic leukaemia)?

A

Immature lymphocytes (lymphoblasts)

Associated with prevalence in children + Down syndrome

61
Q

Key features of AML (acute myeloid leukaemia)?

A

Auer rods

Can occur as a complication from myeloproliferative disorders i.e. primary myelofibrosis.

62
Q

Key features of CML (chronic myeloid leukaemia)?

A

Philadelphia chromosome (translocation of chromosome 9 and 22)

Consists of 3 phases (chronic phase, blast phase and accelerated phase).

63
Q

Appearance of primary myelofibrosis on blood film?

A

Tear drop poikilocytes

Remember: myelo-cry-brosis

64
Q

What is done for a patient with INR of 8.5 on Warfarin due to mitral valve replacement?

A

Stop warfarin until INR < 5 and administer oral vitamin K.

65
Q

What is the protocol for Warfarin reversal in the presence of major bleeding?

A

Prothrombin concentrate and IV vitamin K

Miscellaneous (22 decks)

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