General Questions Flashcards by James Adams

How would the airway of a patient with a serious traumatic brain injury be managed? (GCS <8)

Intubated and artificially ventilate
Risk at any time of brain damage leading to loss of respiratory drive so this is prophylactic
(Also likely to require surgery)

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A patient has loss of movement on the L side following a traumatic head injury to the R fronto-temporal area, why?

Precentral gyrus (in post frontal lobe) damaged

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What is hemiparesis?

Weakness of either L or R side of body

Hemiplegia is most severe form (full paralysis of that side)

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What is quadraplegia (aka tetraplegia), paraplegia and quadriparesis?

Loss of motor/ sensory in all 4 limbs and torso
Paraplegia is the same but arms not affected
Quadriparesis is weakness of the above

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A patient is about to go in for complex surgery, what types of drugs will be used in the anaesthetic process?

Anaesthetic (rapid induction)- IV Propofol
Maintance: Inhaled isoflurane
Perioperative analgesic- Fentanyl
Muscle relaxant- Atracurium
To reverse: Anticholinesterase (neostigmine with glycopyyrolate)

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What are the components of the GCS and what are the minimum/ maximum scores?

Motor response: 1-6pts
Verbal response: 1-5pts
Eye opening response: 1-4pts
3 is lowest, 15 is highest 
(13= Mild)

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What is the definition of concussion?

Mild Traumatic Brain Injury
Head injury with temporary loss of function, symptoms usually clear within 3 weeks
Impact so great it couldn’t be cushioned by CSF

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What is a depressed skull fracture?

From blunt force trauma to head (e.g. hammer or kick), often also compound and comminuted, if dura mater also torn high infection risk. High risk of post traumatic epilepsy

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What is a linear skull fracture?

Transverses full thickness of skull but no displacement, often from blunt force trauma where energy spread over a wide region. Can often be left untreated

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What is a diastatic skull fracture?

Fracture line transverses skull suture causing widening of suture. Most commonly seen under 3 years although lambdoid suture doesn’t close until age 60

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What is a basilar skull fracture?

Fracture to the base of skull (cranial vault). Often blood in sinuses and CSF running out of nose or ears

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What is the babinski sign and what does it indicate?

Dorsiflexion when you stroke the lateral sole of the foot (heel to toe)- normal response is plantarflexion.
Dorsiflexion (babinski sign) indicates UMN lesion

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What are osteophytes?

Bone spurs (projections) which form on joint margins, using following repair process post (arthritis, fracture etc). Can cause pain (if nerves impinged) and restricted movement

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Name the diagnostic criteria for a dependence syndrome?

3 of:
Compulsion to take, tolerance, physical withdrawal sympt, can’t control use, neglect other interests, persistence despite side effects

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How do cocaine, alcohol, opiates and nicotine increased dopamine levels?

Cocaine: Blocks 5-HT reuptake transporter
Alcohol + Opiates: Inhibit GABA (which causes less inhibition of dopaminergic neurons)
Nicotine: Decreases MOA enzyme activity

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What is the effect of age on the composition of the inter vertebral discs?

Age results in disc water loss so easier cracking (herniated discs account for 90% of sciatica cases)

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What is a visually evoked potentials test?

Electrode placed 2.5cm below inion (inf occipital lobe) and stimulus shown. Delay between stimulus (usually bars) and evoked response can show diseases such as optic neuritis (early sign of MS)

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What % of women have postnatal depression?

10-20%

Usually within 2-8 weeks post birth

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What difference would be seen on a CT scan between an extradural and a subdural haematoma, what causes each?

Extradural- Convex shape, caused by meningeal arterial blood between skull and endosteal dura
Subdural- Concave shape on scan, caused by leaking of venous blood (from cerebral veins going to dural venous sinus’)

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What is glue ear?

Otitis media with effusion
Often caused by eustachian tube blocking (often secondary to adenoid infection)
Treat with grommits if <3mth or reoccurring problem

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What are the most common causes of tonsilitis?

Viral: adenovirus, rhinovirus, influenza
If bacterial (no cough, white spots, fever, swollen LN's) then probably streptococcus

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What is dysarthria?

Speech disorder caused by disturbance of muscular control, slurred, stacato, dysrythmic voice. Caused by disruption of UMN (in hemispheres or brain stem- stroke). Treat with SLT to improve muscle tone

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What is the MRC scale for muscle power assesment?

0- No movement
1- Flicker
2- Movement if gravity eliminated
3- Moves against gravity
4- Moves against gravity and light resistance
5- Normal

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What are maximum and minimum NIH stroke scale scores?

0- No symptoms
1-4: Minor stroke
5-15: Moderate stroke
16-20: Mod/Severe stroke
21-42: Severe stroke

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What is 1 unit of alcohol equivalent to? How do you work out units per drink? What are the unit weekly guidelines?

10ml of pure ethanol Strength (ABV) x Volume (ml) /1000 = no units Weekly: M-21pw F-14pw

What vitamin deficiency causes degeneration of the cerebral cortex, what group of patients is it common in?

Thiamine (Vit B1) | Alcoholics

What is osteomyelitis?

Infection of bone (usually bacterial)

A patient has fractured the neck of their femur, which artery is most likely to be ruptured?

Medial circumflex branch of femoral | Supplies head and neck of femur

What is the most common complication of chronic pancreatitis?

Pancreatic pseudocyst (risk of rupture, bleed or infection)

You are reviewing an x-ray and see a break in the ulna shaft across the long axis of the bone, what do you diagnose?

``` Transverse fracture (Break across shaft of long bone) ```

A patient presents following a fall on which they landed on their feet, with severe pain in their back, you x-ray the spine to find what type of fracture of one of the vertebrae?

Compression fracture | (Only seen in vertebrae)- Subject to extreme stresses

You are reviewing an x-ray of a patient who twisted a leg whilst landing on it and see a break in the shaft of the tibia, diagonally going down across the long axis of the bone, what do you diagnose?

Spiral fracture | Produced by twisting stresses

You are reviewing an x-ray and see fragments of bone from the shaft of the femur in the soft tissue, what do you diagnose?

Comminuted fracture | Bone has shattered

A child presents after falling on their wrist, you x-ray the wrist to find a fracture on one side of the radial shaft and a bending on the other side, what kind of fracture is this?

Greenstick fracture | Radius where one side is broke, the other is bent

A child presents after falling on their wrist, you x-ray the wrist to find a fracture at the end of the radial shaft, what kind of fracture is this?

Colles fracture | Break in the distal portion of the radius

A patient presents after being tackled playing football. An x-ray reveals breaks at the ankle, with both the tibia and fibula broken, this is likely to be what type of fracture?

A pott's fracture | At ankle, involves both bones of the leg

What is most likely to happen with venous vs arterial thrombi?

Venous- goes to lungs and cause PE | Arterial- Go to organs, causes MI, stroke etc

A 30yoF presents with his first seizure. What are the most likely underlying causes which must be checked for?

``` Brain lesion (>50% first time seizures) Eclampsia (check Preg status) ```

A 37yoM presents with excertional breathlessness, chronic cough and wheeze. He reports smoking 40/day since he was 16. During the history he reveals his father died of emphysema at age 41. What else in the family history, other than respiratory problems may you want to ask about and why?

Family history of liver problems - As two very early onset possible COPD diagnosis in same family suspect ATA1 deficiency. This not only causes damage in the lungs but can damage the liver as it doesn't remove the ATA1 protein properly

What are the most frequent bacteria responsible for lower respiratory infections in a patient known to have COPD?

Haemophilus influenzae

A 69yoF with COPD becomes very unwell with severe breathlessness and is taken urgently to the local A&E department. She looks drowsy, sweaty and is not responding to verbal commands, even though she responds briskly to pain. The arterial blood gas results in the A&E Department are as follows: pH: 7.19 PaO₂: 7.9 kPa PaCO₂: 14 kPa cHCO₃-: 42mmol.l-1 Na+: 163mmol.l-1 K+: 4.5mmol.l-1 Lactate: 1.7mmol.l-1 Base Excess: 9.2 mmol.l-1 What is the most likely cause of her confusion?

CO2 narcosis | - CO2 crosses BBB, goes into CSF and stimulates resp centre then causes delirium and eventually confusion and coma

What is the difference between CPAP and BIPAP?

CPAP stands for continuous positive airway pressure. BiPAP refers to Bilevel or two level positive airway pressure. While CPAP generally delivers a single pressure, BiPAP delivers an inhale pressure and an exhale pressure.

Name the main symptoms and 3 key signs to indicate RHF:

SOB Ankle or sacral oedema Elevated JVP Enlarged liver- the liver may be tender to palpation in patients with acute right ventricular failure because of stretching of the liver capsule (where the pain fibres are).

Name what may be seen on a PA CXR in patient with COPD? (NB: often these CXR's are normal in COPD, but are helpful to exclude other pathology)

- Hyperinflation and increased radiolucency - Local 1-2cm areas of increased radiolucency= bullae - Low flat diaphragm and thin mediastinum - If pulmonary HTN then large pulmonary vessels in centre which quickly taper

What are the indications for NIV?

PaO2 under8 kPa pH under 7.35 RespRate over 30 And can't be managed with 02 to achieve required balance

What organism is the most common cause of UTI's?

E Coli

Most common cause of Pneumonia in those with the Flu?

Staph aureus

What organism is the most common cause of CAP?

Streptococcus Pneumoniae

What organism is the most common cause of HAP if the patient has been in hospital less than 4days?

Strep Pneumonia & Haemophilus influenzae

What organism is the most common cause of HAP if the patient has been in hospital longer than 4days?

Staph aureus

What organism is the most common cause of Pneumonia in COPD?

Haemophilus Influenzae

What organism is the most common cause of Pneumonia in someone who's been on holiday, with a long duration of symptoms and a dry cough?

Legionella

How can AAA's be classed according to anatomical location?

90% of AAAs occur below the renal arteries. These are called an infra-renal abdominal aortic aneurysms. They carry a better prognosis than supra-renal aneurysms as renal function may not be compromised both before or after surgery. - Aneurysms located above the origins of the renal arteries are referred to as supra-renal AAA. Such aneurysms account for approximately 10% of the cases and in general have a worse prognosis.

What is the most common organism responsible for UTI in females?

Trimethoprim

Name 4 symptoms which can be signs of vitamin B12 deficiency?

Paraesthesia, numbness, cognitive changes or visual disturbance. (General neurological defects)

``` On a blood film, Howell-Jolly bodies is/are associated with which of the following? Megaloblastic anaemia G6PD Disseminated intravascular coagulation Myelofibrosis Thalassaemia Hyposplenism ```

Hyposplenism (e.g. post splenectomy)

Hypersegmented neutrophils on a blood film are caused by?

Megaloblastic anaemia

Tear drop poikilocytes seen on a blood film indicate what disease?

Myelofibrosis

What would be shown on the blood gas of a patient with a PE?

Respiratory alkalosis

What is the most common cause of a third heart sound?

Heart failure | LVF

What valve problem would cause a loud S1?

Mitral stenosis

What valve problem would cause a quiet S1?

Mitral regurgitation

What is the most common infection to get secondary to treatment for a HAP where the patient receive a macrolide. Presenting 1 week later with diarrhoea. How is it treated?

C.diff | Treat with metronidazole

What is the best treatment for MRSA infections?

IV Vancomycin

What is the best treatment for an atypical pneumonia, which after treatment with amoxicillin for 3 days but the symptoms of her productive cough and joint and muscle aches are getting worse?

Clarithromycin or erythromycin

What is the most common infective organism in chest infections of patient sight cystic fibrosis?

Pseudomonas aeruginosa

What is the most common infective organism for chest infections with patients who have HIV?

PCP | Pneumocystis jiroveci pneumonia

Impertigo gives a honey coloured crusting with red areas. What is the most common organism and treatment?

Staph aureus Fucidic acid Then flucloxacillin if no relief

What is the first line antibiotic for meningitis?

In GP give benzylpenicillin prophylactic | In hospital give cefotaxime

Which organism causes 75% of meningitis in the developed world?

Streptococcus pneumonia

Name two antibiotic drugs which can cause drug induced cholestasis? (Itchiness and painless jaundice)

Flucloxacillin and erythromycin

Which class of antibiotics cause the most problems with warfarin?

Metronidazole, clarithromycin, ciprofloxacin

What drug, used to treat gram positive bacteria most commonly causes red man syndrome (an anaphylactic reaction) from rapid infusion rate. Causing itchy erythematous rash over face, neck and upper torso. Normally dissapear after infusion stopped.

Vancomycin

What do J waves on an ECG indicate?

Hypothermia

What d U waves on an ECG indicate?

Hypokalaemia

Klebsiella pneumoniae is classical in what group of patients?

Alcoholics

A patient is investigated for lymphocytosis. Cytogenetic analysis shows the presence of the following translocation: t(9;22)(q34;q11), known as the philadelphia translocation. Which haematological malignancy is most strongly associated with this translocation?

Chronic myeloid leukaemia (95% of CML has the philedelphia translocation) - It's also a very poor prognostic indicator in ALL

A 39 year old athlete attends his team doctor for an annual physical. Which of the following features on his ECG would be a cause for concern? ``` Sinus bradycardia Left bundle branch block Type 1 atrioventricular block Incomplete right bundle branch block Wenckebach phenomenon ```

LBBB Left bundle branch block is never normal and is usually associated with underlying ischaemic or structural heart disease.

Right bundle branch block can be normal when seen on an ECG, true or false?

True

Left bundle branch block can be normal when seen on an ECG, true or false?

False

What is the referral criteria for visible protein in the urine?

Always refer for visible protein in urine

Painless, visible haematuria in anyone over 40, what is the first step to take?

Refer as suspected bladder cancer

A patient who is pregnant has a UTI, what advice regarding the first line AB's must you follow?

Trimethoprim: Avoid in 1st trimester Nitrofurantoin: Avoid in 3rd trimester

A male patient has a UTI, what is the treatment?

2 week Quinolone | Levofloxacin or coprofloxacin

What is the most common cause of minimal change disease in children (75%)?

Minimal change disease

Deafness and renal disease in a young person that is X-linked dominant is most likely to be?

Alports Syndrome

What analgesia do you give to a patient with renal stones?

Diclofenac

On a blood film, target cells and pencil poikilocytes are associated with...

Iron Deficiency Anemia

On a blood film, schistocytes ('helmet cells') and spherocytes are associated with...

Intravascular haemolysis

On a blood film, Heinz bodies are associated with what?

Glucose-6-phosphate dehydrogenase deficiency | Almost exclusively male

At what HbA1c would NICE suggest making changes to diabetes medication?

>6.5%

What is the most diagnostic sign of pericarditis on an ECG?

PR depression | Widespread ST elevation

A 34-year-old man who is HIV positive is starting treatment for Burkitt's lymphoma. His chemotherapy regime includes cyclophosphamide, vincristine, methotrexate and prednisolone. Around 24 hours after starting chemotherapy he becomes confused and complains of muscle cramps in his legs. What is most likely to have occurred?

Tumour Lysis Syndrome | - Very common with Burkitt's lymphoma

You are reviewing the medications of a 38-year-old woman in the surgical ward admitted for an elective open cholecystectomy. You notice the patient is currently prescribed the combined oral contraceptive pill (COCP) and she tells you she had not been instructed to stop taking this prior to the planned operation. A- No action required B- Reschedule operation until combined oral contraceptive pill has been omitted for 4 weeks C- Prescribe compression hosiery only D- Prescribe thromboprophylaxis E- Switch to a progestogen only contraceptive

Oestrogen-containing contraceptives should preferably be discontinued (and adequate alternative contraceptive arrangements made) 4 weeks before major elective surgery and all surgery to the legs or surgery which involves prolonged immobilisation of a lower limb; they should normally be recommenced at the first menses occurring at least 2 weeks after full mobilisation. When discontinuation of an oestrogen-containing contraceptive is not possible, e.g. after trauma or if a patient admitted for an elective procedure is still on an oestrogen-containing contraceptive (as in this case), thromboprophylaxis (with unfractionated or low molecular weight heparin and graduated compression hosiery) is advised.

A 65-year-old man presents with severe epigastric pain radiating to his back. He states that the pain is 9/10 severity. He has associated nausea and vomiting. Serum amylase is raised. You suspect a diagnosis of acute pancreatitis. How would you initially manage his acute pain? A- IV morphine in 1-2mg boluses until comfortable B -IM pethidine C- IV morphine 10mg STAT D- Regular paracetamol E- Regular paracetamol and ibuprofen

A This patient has severe pain which will likely need an opiate to settle. IV morphine titrated in 1-2mg boluses until comfortable would be a sensible first choice. Regular paracetamol would also be sensible as this would be opioid sparing, however this would not be the first choice for initially managing severe acute pain.

An 82-year-old woman with long-standing rheumatoid arthritis presents with a history of recurrent chest infections over the past 6 months. On examination she is found to have splenomegaly. Her current medications include methotrexate and sulphasalazine. Blood results demonstrate: ``` Hb 96 g/l WBC 3.6 * 109/l Neuts 0.8 * 109/l Lymphs 1.6 * 109/l Eosin 0.6 * 109/l ``` What is the most likely cause of the neutropenia?

Felty's syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis. Hypersplenism results in destruction of blood cells which classically results in neutropenia but can also cause pancytopenia. Although methotrexate use can certainly cause neutropaenia, we would not expect splenomegaly.

General Questions Flashcards

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