General revision - everything Flashcards
1
Q
Which compound is released from damaged vessel walls and initiates the coagulation cascade?
A
Tissue factor
2
Q
What drug class are used to manage the somatic symptoms of anxiety? Eg sweating, palpitations & hand tremors.
Name a contraindication to this drug class.
A
Beta blockers
Asthma & heart block
3
Q
What is eclampsia?
A
Seizures that occur as a result of pre-eclampsia
4
Q
Ferroportin is vital for what?
What compound blocks the action of ferroportin & what is the consequence of this?
Which organ produces this compound and in response to what 2 things?
A
Ferroportin is vital for iron absorption from gut & iron storage in cells, mainly liver
Hepcidin blocks ferroportin preventing further iron absorption
Liver produces hepcidin in response to:
1) high iron stores (when they are full and the body doesn’t need any more iron)
2) inflammation
5
Q
State the 5 criteria of the Bishops Score:
~ state the characteristics seen in each criteria that indicate onset of labour
What is the Bishops Score used for?
A
→ Position of the cervix (anterior)
→ Effacement of the cervix (length - shorter = better)
→ Consistency of the cervix (soft)
→ Dilatation of the cervix (bigger = better)
→ Station of the presenting part (distance in cm in relation to the ischial spines)
Bishops score is used to assess whether induction of labour would be successful
6
Q
What examination findings would be seen in a neck of femur #? (5)
A
Affected leg is shorter
Affected leg is externally rotated
Palpation of hip is painful
Patient cannot perform a straight leg raise
Bruising/soft tissue swelling in/around the hip area
7
Q
Which electrolyte abnormality can blood transfusions cause?
Why does this happen?
A
Hypocalcaemia
When blood is donated, it’s mixed with sodium citrate to prevent it from coagulating. → The citrate in the blood can bind to the patient’s circulating calcium resulting in a decreased amount of free calcium = symptoms of hypocalcaemia
8
Q
What is the definition of sepsis?
A
Life threatening organ dysfunction caused by a dysregulated host response to an infection
9
Q
What are the common symptoms of a migraine? (5)
A
Unilateral, throbbing headache that’s aggravated by movement
Photophobia (light makes it worse)
Phonophobia (loud noises make it worse)
Nausea / vomiting
+/- Aura
10
Q
Name 2 serious complications with the use of MAOI’s:
What are MAOIs mainly used to treat?
A
Hypertensive crisis (cheese reaction) Serotonin syndrome
Depression
11
Q
What is the physiological cause of the menopause?
A
Ovarian failure* which results in oestrogen deficiency
* Decreased ovarian function due to very few follicles remaining
12
Q
What are the 2 1st line investigations of prostate cancer?
What blood test can also be requested?
What imaging is best initially?
A
Digital rectal examination to examine the prostate
Urine dip
Prostate specific antigen (PSA)
MRI
13
Q
If a patient presents with “the worst headache they’ve ever had”, what diagnosis is this suggestive of?
A
Subarachnoid haemorrhage
Commonly presents with a thunderclap headache
14
Q
What is the function of the trigeminal nerve?
A
Motor function to muscles of mastication
Sensation of face
15
Q
List some common symptoms/signs seen in pericarditis: (5)
A
Chest pain (pleuritic)
→ Worse when lying down / deep breaths
→ Better sitting forwards
Fever
Pericardial rub
Raised troponin
ECG changes: widespread, saddleshaped ST elevation
16
Q
What type of dementia is characterised by a step wise decline?
A
Vascular dementia
17
Q
Describe what nociceptive pain is:
Describe what neuropathic pain is:
Note whether they have a protective function or not.
A
Nociceptive pain = pain when there is tissue injury or illness (eg when you cut yourself)
~ has a protective function (the pain causes you to stop whatever is causing the pain)
Neuropathic pain = pain caused by nervous system damage / abnormality
~ no protective function, often occurs long after there has been trauma!
18
Q
Which antidepressant class should be avoided in patients with suicidal ideation?
A
Tricyclic antidepressants - they are lethal in overdose
19
Q
What is the function of the trochlear nerve?
Which muscle does it innervate?
A
Eye movement
Superior oblique muscle
20
Q
What is the 1st line investigation in SUFE?
What is the management of SUFE?
A
Xray of hip
Surgery: correction of femoral head positon PLUS screw fixation
~ Prophylactic fixation of contralateral hip may be done
21
Q
What is the typical presentation of someone with an extradural haemorrhage? (symptoms)
A
Head trauma +/- unconsciousness followed by lucid period (as the blood is pooling)
Progressive headache
Nausea / vomiting
Decreasing GCS
22
Q
What xray findings are seen in heart failure? (ABCDEF)
A
A: alveolar oedema
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly
D: Upper lobe diversion (increased blood through the smaller blood vessels in the upper lobes - looks like cloudiness on xray)
E: Pleural Effusions
F: Fluid in the horizontal fissure
23
Q
Give an example of a commonly used tricyclic antidepressant.
A
Amitriptyline
24
Q
Which neurotransmitter do antipsychotics decrease?
A
Dopamine
25
What is the 1st line treatment of non-bacterial pericarditis?
What is the treatment of bacterial pericarditis?
NSAIDs (reduces the inflammation of the pericardium)
IV antibiotics
26
At what age does the menopause typically occur?
50y
27
What is urge incontinence?
What is stress incontinence?
What is functional incontinence?
**Urge** incontinence = incontinence of urine caused by a **_sudden_** need to urinate (caused by an overactive bladder)
**Stress** incontinence = incontinence of urine caused by increased abdominal pressure, eg coughing, laughing, exercise
**Functional** incontinence = incontinence of urine caused by not being able to access a toilet
28
What is the textbook cause of an extradural haematoma?
Trauma to the head, eg car crash/baseball bat to the head
29
A baby is considered non-viable before which gestational week?
Week 23
30
What is aortic dissection?
A tear in the tunica intima of the aorta allows blood to flow between the inner & outer layers of the walls of the aorta
31
What questionairre is used in general practice to grade the severity of a patient's depression?
PHQ-9 questionairre
32
What is the prophylaxis management of haemophilia?
How is an acute episode of bleeding treated? (3)
Replacement of clotting factors via IV transfusions (VIII - A, IX - B)
1) Infusions of affected clotting factor (VIII or IX)
2) Desmopressin (DDAVP) - to stimulate VWF release
3) Tranexamic acid - reduces the rate of fibrinolysis so that clot remains for longer
33
What is a subdural haematoma?
Damage to which blood vessels cause a subdural haematoma?
A collection of blood between the dura mater and arachnoid mater
Tear in the bridging veins between the cortex and dura mater
34
List some common presentations of von Willebrand disease: (5)
→ nose bleeds
→ menorrhagia
→ bleeding gums when brushing teeth
→ prolonged, heavy bleeding during surgery/ trauma
→ easy bruising
35
Name the 3 types of emergency contraception available **and**:
* *a)** state the timeframe in which they are effective after UPSI
* *b)** state their mechanism of action against pregnancy
List 2 contraindictations of EllaOne
* *EllaOne**
a) effective up to 5 days after UPSI
b) delays ovulation
c) asthma, breastfeeding should be avoided for 1 week
* *IUD (copper coil)**
a) effective up to 5 days after UPSI
b) copper is spermicidal + prevents implantation
c) insertion may cause PID
* *Levonorgestrel**
a) effective up to 3 days after UPSI
b) delays ovulation
36
List some symptoms of opiate withdrawl: (8)
Aggitation
Anxiety
Runny nose
Runny eyes
Sweating
Diarrhoea
Insomnia
Uncontrollable yawning!
Increased BP & HR
37
What timeframe does postnatal depression occur within?
Within 6 months of giving birth
38
What is an extradural haemorrhage?
A collection of blood between the skull and the dura mater
39
What symptoms might PID present with? (5)
Bilateral abdominal pain
Vaginal discharge
Post coital bleeding
Fever
Adnexal tenderness
40
If premature delivery is likely, what should be given to the mother & why?
Corticosteroids - to encourage maturation of the fetal lungs
41
What are some common triggers of trigeminal neuralgia? (5)
Cold
Wind
Chewing
Talking
Touching face
42
Treatment of delirium is mainly managed pharmacologically: TRUE/FALSE
What does the management of delirium involve?
**False** - mainly non-pharmacological management:
→ Re-orientate the patient
→ Help them mobilise as much as possible
→ Normalise sleep-wake cycle
→ Discharge asap !!
43
A testicle that has a 'bag of worms' texture indicates what?
What is the underlying cause of this?
If this occurs on the left side (testicle), what should you be suspicous about?
Varicocele
Enlargement/dilation of the testicular veins
***Renal cell carcinoma*** - causing compression of the left renal/ left testicular vein
44
List some risk factors for septic arthritis. (6)
IV drug users
Unprotected sex
Diabetes Mellitus
Underlying joint disease (OA/RA)
Immunosuppression
Older age
45
What is Budd-Chiari syndrome?
What is the classic presenting triad of this syndrome?
A syndrome in which there is hepatic vein obstruction
1) severe abdominal pain
2) ascites
3) tender, hepatomegaly
46
How long should someone continue their antidepressants for if they presented with their third+ episode of depression?
Life long
47
Name the most commonly used SSRI.
Sertraline
48
How is Binge Eating Disorder different from Bulimia Nervosa?
In Binge Eating Disorder, patient's don't purge themselves after eating
49
List 3 complications of HRT.
1. Increased risk of breast cancer
2. increased risk of venous thromboembolism
3. Increased risk of endometrial cancer if oestrogen is given alone
50
List some symptoms of anorexia (7)
Lanugo hair
Cold intolerance
Blue hands / feet
Amenorrhoea
Dry skin
Hypotension
Weakness / fatigue
51
What classification system is used for aortic dissections?
Stanford classification
52
What is a common presentation of a cluster headache? (6)
Male with sudden onset, severe pain, behind one eye
Associated with:
~ watery, bloodshot eye
~ lacrimation
~ ptosis
~ miosis
~ runny nose (rhinorrhea)
53
What does SCID stand for?
Which immune cells are affected in SCID?
What are the 2 treatment options for SCID?
Severe combined immunodeficiency
Development of B cells & T cells is affected producing dysfunctional B & T cells
1st line = stem cell transplant
If not available: gene therapy
54
What screening tool is used to assess the likelihood of anorexia nervosa?
SCOFF questionairre
55
Anaphylaxis is what type of hypersensitivity reaction?
This type of reaction is mediated by what?
**Type 1** hypersensitivity reaction
**IgE** mediated mast cell degranulation
56
What 2 tests can be performed to assess the level of cognitive impairment/ ability?
MMSE (mini mental state exam)
MOCA
57
Falls onto an outstretched hand commonly # which carpal bone?
Scaphoid bone
58
What is the 1st line medication for Parkinson's disease?
What is this medication usually given with & why?
Levodopa
Co-administered with **Carbidopa** - prevents L-dopa being converted into it's active form in the systemic circulation thus more reaches the brain
59
Does 1st degree heart block need to be treated?
No
60
What is the peri-menopause?
The period of time from when symptoms of the menopause start, until 12 months after the last menstrual period
61
List some common symptoms of anaemia: (5)
→ Fatigue
→ SOB
→ Headaches
→ Pre-syncope / syncope
→ Palpitations
62
What medication is commonly used to treat oestrogen receptor positive breast cancers?
What drug class is this?
Tamoxifen
SERM - selective oestrogen receptor modulator
63
The Philadelphia chromosome is associated with what haematological condition?
The philadelphia chromosome (a mix of 2 chromosomes) results in what oncogenic gene?
Chronic myeloid leukaemia
BCR-ABL gene
64
Which 2 neurotransmitters do atypical antipsychotics affect?
Dopamine & serotonin
65
List some indications to induce labour: (6)
Prelabour rupture of membranes
Pre-eclampsia
Diabetes
Intrauterine fetal death
Obstetric cholestasis
Fetal growth restriction
66
List 2 methods of prophylaxis of preterm labour:
Vaginal progesterone pessary/gel - this prevents cervical ripening & decreases activity of the myometrium
Cervical cerclage - a stitch is put into the cervix to keep it closed until nearer term date
67
Interpret the following:
G3 P1
3 pregnancies of which only 1 has been delivered past 24 weeks gestation
68
What is a nihilistic delusion?
What condition is it usually a feature of?
A negative delusion (belief) of something decaying/missing - commonly people think they are rotting internally/ their organs are missing
Severe depression
69
What side effect is commonly associated with Olanzapine?
Weight gain
70
What is the management of an acute cluster headache attack?
100% oxygen through a mask
71
What are the key clinical features in lewy body dementia? (3)
Fluctuating confusion throughout the day
Visual hallucinations
Parkinsonism symptoms (poor mobility, tremor)
72
List some signs of respiratory distress: (8)
~ Raised respiratory rate
~ Using accessory muscles of breathing
~ Intercostal & subcostal recession
~ Nasal flaring
~ Tracheal tugging
~ Cyanosis
~ Abnormal airway nosies
~ Head bobbing
73
What is the treatment of von Willebrand disease?
List 2 contraindictations to the use of DDAVP:
* There is no day-to-day treatment. Treatment is given after a bleed or in preparation for surgery*
1) VWF concentrate IV
2) Desmopressin - stimulates the release of VWF
3) Tranexamic acid - inhibits fibrinolysis (clot breakdown)
Contraindictations: youung children, people with high cardiovascular risk
74
What grading system is used in prostate cancer?
The gleason score
75
What are 2 common complications of pericarditis?
Recurrent episodes of pericarditis can cause what?
Cardiac tamponade & pericardial effusion (fluid inbetween the 2 layers of pericardium)
Constrictive pericarditis
76
Interpret the following:
G2 P1
This lady has been pregnant twice but has only had 1 delivery past 24 weeks gestation
77
What is the typical presentation of someone with Legg-Calve-Perthes disease?
Gradual\* onset limb & hip pain
Referred pain to the knee
Pain persists for \>4 weeks
\* Gradual due to the femoral head becoming increasingly ischaemic
78
What type of antipsychotic is Haloperidol?
Typical antipsychotic
79
What type of antipsychotic is Olanzapine?
Atypical antipsychotic
80
Name a criteria used to diagnose depression.
ICD-10
81
Which vessels remove deoxygenated blood from the brain?
Where do these veins drain into?
Bridging veins
Drain into venous sinuses → internal jugular vein
82
What features are seen in HELLP syndrome?
H - haemolysis
EL - elevated liver enzymes
LP - low platelets
83
What is the function of the facial nerve? (3)
Supplies muscles of facial expression
Taste to anterior 2/3 of tongue
Innervates submandibular & sublingual glands
84
What type of medication is used 1st line if someone presents with an acute manic episode with *no* aggitation?
An antipsychotic
85
What is the 1st line medication used to treat trigeminal neurlagia?
Carbamazepine
86
What are the 2 commonest causes of a subarachnoid haemorrhage?
Ruptured aneurysm, commonly in the cirle of willis
Severe head injury
87
What medication is used for treatment resistant Schizophrenia?
Clozapine
88
What is the 1st line investigation of a red, hot, swollen joint? (Suspicion of septic arthritis)
Aspiration of synovial fluid for cell count, gram stain & culture
89
What actually is delirium?
An acute confusional state
90
What is the function of the vestibulocochlear nerve?
Vestibular = hearing
Cochlear = balance
91
In what condition is there *reversible* airway obstruction?
What class of medications are used to treat this?
Name the medication used.
Asthma
Short acting beta agonists
Salbutamol
92
Name the 3 commonest drug classes to treat depression.
SSRI;s
SNRI's
Tricyclic antidepressants
93
Name the 2 ways that anaemia can be categorised by:
1. Looking at the mean corpuscular volume (MCV) of the RBCs
2. The mechanism of cause of anaemia
| (RBC size!)
94
Name the drug classes used in each of the 3 steps of the WHO pain ladder. Give an example of a drug in each class.
Explain how to use the WHO pain ladder.
**Step 1:** NSAIDs & paracetemol
~ Aspirin, Ibuprofen, Diclofenac
**Step 2:** Mild opioids (codeine) +/- NSAIDs/ paracetemol
**Step 3:** Strong opiods (morphine) +/- NSAIDs/ paracetemol
Start with step 1, if pain not tolerated, add in mild opioid. If not tolerated, swap mild opioid fo strong one with NSAID/ paracetemol still
95
What is pre-eclampsia?
Pregnancy-induced hypertension occurring after 20 weeks gestation with proteinuria.
96
When starting someone on an SSRI, what should you warn them about?
What is the name given to this?
They may feel worse for the first 10 days, but after this they should feel better
Activation syndrome
97
List some common symptoms of menopause. (6)
Hot flushes
Night sweats
Vaginal dryness
Reduced libido
Mood swings
Fatigue
98
What happens in Morbitz I (2nd degree heart block)?
Progressive lengthening of the PR interval until a beat is dropped (there is no QRS complex following 1 P wave)
99
Describe what coarctation of the aorta is:
List the clinical signs/ symptoms of coarctation of aorta: (3)
How would a child with coarctation of aorta usually present?
Narrowing of the descending aorta
1) Weak/ absent femoral pulse
2) Radio-femoral delay
3) Systolic murmur that's loudest at the back
Presentation: sudden deterioration & collapse
100
What are the positive symptoms of schizophrenia? (3)
Hallucinations
Delusion
Disordered thinking
101
What tool is used to assess for alcohol use & problems?
FAST (fast alcohol screening tool)
102
A patient taking MAOI's should be told to avoid what, & why?
Avoid tyramine-rich foods as tyramine reacts with the MAOI's causing a hypertensive crisis
= cheese reaction
103
What medication would you start someone on if they present with their 1st episode of mania?
What contraindications are there to this medicine?
Lithium
Not ideal for women of child bearing age - discuss contraception with them
104
What is the management of PID?
Antibiotics: ofloxacin & metronidazole
Analgesia if severe pain
105
What are the clinical features of chorioamnionitis? (6)
Fever
Abdominal pain
Offensive vaginal discharge
Preterm rupture of membranes
Uterine tenderness
Maternal & foetal tachycardia
106
What type of pain will the WHO pain ladder be successful at helping?
What is the treatment for the other type of pain? (name 2 examples of drugs used)
Nociceptive pain = use WHO pain ladder
Neuropathic pain - WHO pain ladder doesn't work
~ amitriptylline
~ gabapentin
~ duloxetine
107
What is the 1st line management of pre-eclampsia?
Labetolol (anti-hypertensive)
108
List 4 common causes of pathological #'s.
1. Osteoporosis
2. Tumours (within the bone)
3. Hyperparathyroidism (causes bone thinning = weak bone)
4. Paget's disease (abnormal bone turnover = weak bone)
109
What are the 2 commonest causes of PID?
Gonorrhoea
Chlamydia
110
What side effects are commonly experienced after initiating metformin?
GI upset: nausea, vomiting, diarrhoea, bloating
111
You are working in A&E and a patient is hypotensive. What do you do to increase the BP?
How much of this would you give and over what time?
IV fluid resuscitation
500ml saline or plasmalyte bolus over 15 mins
112
Which cranial nerves are responsible for the afferent & efferent pathways of the corneal reflex?
Afferent = V1 nerve (ophthalmic)
Efferent = VII nerve (facial)
113
What is the function of the optic nerve?
Vision
114
What type of antipsychotic is Risperidone?
Atypical antipsychotic
115
Which cranial nerves are responsible for the afferent & efferent pathways of the gag reflex?
Afferent = IX nerve (glossopharyngeal)
Efferent = X nerve (vagus)
116
What are the 4 abnormalities seen in Tetralogy of Fallot?
What xray finding is seen in this condition?
What clinical sign may be seen on examination? - Why does this happen?
What is the definitive treatment and when does it occur?
1) Pulmonary valve stenosis
2) R ventricle hypertrophy
3) Ventricularseptal defect
4) Overriding aorta (L & R ventricle drain into aorta)
Boot shaped heart seen on xray
**Central cyanosis** - high pressure in R ventricle due to hypertrophy causes R→L shunt through ventricularseptal defect - less oxygenated blood enters systemic circulation
Surgical correction: performed when baby is 5kg (~ 6 months)
117
What investigation is used to diagnose an aortic dissection?
CT angiogram
118
Between which meningeal layers does a subarachnoid haemorrhage occur?
Between the arachnoid mater & pia mater
119
Which electrolyte imbalance is seen in anorexia nervosa?
Hypokalaemia (low K)
120
What are the 5 domains of development?
1) Gross motor skills
2) Fine motor skills
3) Speech & language skills
4) Social & self help skills
5) Hearing & vision
121
In haemotology, what is the function of G6PD?
What is the result of a G6PD deficiency?
List some common triggers of this: (3)
What ar the common clinical features seen? (3)
G6PD is an enzyme that attaches onto RBCs to protect them against oxidative stress
G6PD deficiency causes haemolysis of RBC when there is oxidative stress → haemolytic anaemia
1) Infection
2) Broad beans (fava beans)
3) Drugs (antimalarials, nitrofurantoin, aspirin)
1) Anaemia
2) Jaundice
3) Splenomegaly
122
What abnormality is seen in haemophilia A?
What abnormality is seen in haemophilia B?
What is the mode of inheritance of haemophilia?
What tests would you do to diagnose haemophilia and what results would you expect in haemophilia? (3)
Haemophilia A: deficiency of clotting factor VIII
Haemophilia B: deficiency of clotting factor IX
X linked recessive
1) Clotting factor tests - to look at levels of factors VIII & IX (low VIII in haemophila A & low IX in haemophilia B)
2) Blood test APTT\*: prolonged
3) Blood test prothrombin: normal
\* APTT = blood test that measures time taken for blood to clot
123
List the 4 treatment options for mania.
Antipsychotics
Mood stabilisers
Lithium
ECT (electro convulsive therapy)
124
What does this CT show?
Subdural haematoma
125
List some risk factors for transitional cell carcinoma of the *bladder* (3)
Smoking
Aromatic amines (rubber, dyes and chemicals)
Cyclophosphamide (chemo drug)
126
What are the 3 pathological features seen in the brains of patients with Alzheimers disease?
Amyloid plaques
Tau protein tangles
Reduced Ach
127
What is Perthes disease? (Legg-Calve-Perthes)
Avascular necrosis of the femoral head in children which is caused by disruption to the blood flow of the femoral head
128
Name the condition described:
"Episodes of binge eating with a sense of loss of control, followed by purging behaviour" - *normal BMI*
Bulimia nervosa
129
Interpet the following:
G2 P2
2 pregnancies of which both have been delivered past 24 weeks gestation
130
What is the Bishop Score used to assess?
It assess whether someone should have their labour induced
131
What monitoring does Clozapine require & why?
Weekly blood tests - associated with agranulocytosis
132
What hormone stimulates milk production?
What hormone stimulates milk contraction? (*by contracting myoepithelial cells within the breast*)
Prolactin
Oxytocin
133
What are the signs of hypercalcaemia?
*"Stones, bones, abdominal moans & psychiatric groans"*
Renal stones
Painful bones
GI: nausea, vomiting, constipation, indigestion
Neuro: fatigue, memory loss, depression, psychosis
134
Amitriptyline is used to treat which 2 clinical conditions?
```
Depression
Mild pain (neuropathic)
```
135
What is a 3rd degree heart block in relation to the electical activity?
What would you see on an ECG?
No impulses are conducted between the atria & ventricles but both still contract independently at different rates
On the ECG: P waves & QRS complexes are out of sync & not related to each other at all
136
What is the 1st line medication used in pre-eclampsia to control blood pressure?
What is the 2nd line medication?
Labetalol
Nifedipine
137
What common hallucination is associated with delirium tremens?
Visual hallucinations involving insects
138
What is the 1st line medication used in mild/moderate Alzheimers?
Donepezil
139
Give 3 examples of foods/drinks patients on MAOI's should avoid.
Cheese
Beer
Red wine
140
What is the main action of a statin?
To lower cholesterol
141
What 2 common features would you see on an ECG to indicate AF?
Absent P waves
Irregularly irregular rhytm
142
What type of formula is used to treat CMPA?
If the child still can't tolerate this formula, what would they be swapped to?
Hydrolysed formula
An amino acid formula
143
What is lactate a marker of?
Is a high or low lactate good?
Hypoperfusion (reduced O2 reaching the tissues)
LOW lactate - the higher the lactate, the more tissues are without O2!
144
A diagnosis of pre-eclampsia requires what? (1 + 3)
BP 140/90 +
PLUS any of:
Proteinuria
Organ dysfunction (raised creatinine / elevated LFTs / seizures)
Placental dysfunction (eg, foetal growth restriction)
145
Which cranial nerves are responsible for the afferent & efferent pathways of the pupillary reflex?
Afferent = II nerve (optic)
Efferent = III nerve (oculomotor)
146
What genetic mode of inheritance is seen in haemophilia A & B?
Which sex is haemophilia more common in?
X linked recessive inheritance!
Males
147
What type of antipsychotic is Clozapine?
Atypical antipsychotic
148
List some clinical features of hypoglycaemia: (7)
Shaking
Sweating
Palpitations
Headache
Blurred vision
Hunger
Confusion
149
For a diagnosis of severe depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
8
150
Between which weeks gestation is the combined test usually performed?
Weeks 11 - 13
151
Name the 3 hormones that stimulate RBC production in the bone marrow:
Erythropoietin
Thyroid hormone
Androgens
152
What side effects are more likely with typical antipsychotics compared to atypical antipsychotics?
Extra-pyramidal symptoms (eg, parkinsonism symptoms, tremor, slurred speech, inability to stay still)
153
What are the core symptoms of depression according to the ICD-10 criteria?
1. A depressed mood for most of the day that has been present for 2+ weeks
2. Loss of interest or pleasure (anhedonia)
3. Decreased energy
154
Capacity is decision specific: TRUE/FLASE?
True
155
What are some common side effects of Valproic acid? (3)
Which 2 conditions is valproic acid (sodium valproate) used to treat?
Nausea
Vomiting
Weight gain
1) Epilepsy
2) Bipolar disorder
156
What immunological mechanism is responsible for type 3 hypersensitivity reactions?
Give an example of a disease that is caused by type 3 hypersensitivity.
Immune complex deposition
SLE
157
What is the definition of psychosis?
The inability to distinguish the symptoms of hallcuinations, delusions and disordered thinking from that of reality
158
Around what week gestation should a booking appointment occur in?
Week 10
159
If someone presents with a thunderclap headache, what is the most likely diagnosis?
Subarachnoid haemorrhage
160
What is the function of the vagus nerve?
Motor & sensory innervation to pharynx (back of throat), heart, resp tract, GIT
161
Name the 4 main types of # & describe what they would look like.
```
1. Transverse #
# is straight across the bone
```
```
2. Oblique #
# is diagonally across the bone
```
```
3. Spiral #
# that winds around the bone in a spiral manner
```
```
4. Complex/comminuted #
# into lots of fragments of bone
```
162
A blood sugar below what is considered as hypoglycaemia?
4mmol/L
163
What Bishop Score would indicate induction of labour would be successful?
8 or more
164
What are fibroids?
Benign, smooth muscle tumours of the myometrium of the uterus
165
What is the difference between mania & hypomania?
In hypomania there are *no* psychotic symptoms & the episode isn't severe enough to impact on their social / occupational functioning.
166
What is the 1st line investigation of suspected endometrial cancer?
What investigation is needed to diagnose & stage endometrial cancer?
Trans-vaginal ultrasound - to look for abnormal thickening of endometrium
Hysteroscopy with biopsy
167
Give examples of conditions that cause a macrocytic anaemia: (5)
What initial investigation would you do after identifying macrocytic anaemia & what would a high / low result suggest?
What blood test would also be useful?
1) B12 deficiency
2) folate deficiency
3) Bone marrow infiltration
4) Alcohol
5) Hypothyroidism
***Blood film***
Megaloblastic cells = B12, folate deficiency
Non-megaloblastic cells = Bone marrow infiltration, alcohol, hypothyroidism
Blood test: B12/folate assay
168
What condition may SGLT2 inhibitors be prescribed to manage?
What is the mechanism of action of SGLT2 inhibitors?
Type 2 Diabetes
Increase the **excretion of glucose** from the body
169
What treatment (if any) is required for a Morbitz I heart block?
No treatment needed unless symptomatic - often benign
170
What is often the first clinical feature seen in vascular dementia?
Aphasia (problems with communication)
\* Memory is often spared until advanced disease
171
What is the definition of psychosis?
The inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality - they have a lack of insight into their condition
172
List 3 clinical features of bladder cancer:
Painless, frank haematuria
Recurrent UTIs
Hydronephrosis
173
What is the classic triad of symptoms seen in normal pressure hydrocephalus?
Urinary incontinence
Dementia
Gait abnormality
174
List the 5 most prevelant types of dementia:
Alzheimers disease
Vascular dementia
Lewy body dementia
Mixed dementia (when someone has a mixture of 2 dementia's)
Frontotemporal dementia
175
What is the medical word for the inability to experience pleasure in things that you used to enjoy?
Anhedonia
176
Which 2 antipsychotics are associated with weight gain?
Olanzapine & Clozapine
177
What is a stanford type A and stanford type B aortic dissection?
Stanford type A: tear is within the ascending aorta or the arch of the aorta
Stanford type B: tear is within the descending aorta
178
# It is performed in preterm labour with intact membranes
What is tocolysis?
When medications are used to stop uterine contractions.
179
What blood levels of Hb would indicate anaemia in:
* a -* females
* b -* males
Females: \< 120 g/L
Males: \< 140 g/L
180
Which diagnosis must you rule out if someone presents with post-menopausal bleeding?
Endometrial cancer
181
What are the 3 categories of symptoms of depression?
Psychological
Physical
Social
182
What symptoms does COPD commonly present with? (4)
Chronic SOB
Productive cough
Wheeze
Recurrent respiratory tract infections
183
What is the management of a baby with symptomatic patent ductus arteriosus? - what is the mechanism behind this?
When would this management not be used and why?
In these babies, what would the management be? - what is the timeframe for this?
Indomethacin (an NSAID) - it is a prostagland inhibitor so causes closure of ductus arteriosus
Not used in **term** babies as their patent ductus arteriosus isnt prostaglandin sensitive!
Watch & wait - most will close spontaneously within 1y. IF symptomatic, can be surgically ligated
184
What is the difference between petechiae & purpura?
What is ecchymoses?
* *Petechiae** \< 3mm
* *Purpura** 4 - 10mm
Ecchymoses is bleeding under the skin that is larger than 1cm!
185
What do the 3 stages of labour consist of?
First stage - from the onset of labour (contractions) until 10cm cervical dilatation
Second stage - from 10cm dilatation until the baby is delivered
Third stage - from delivery of the baby to delivery of the placenta
186
What are the negative symptoms of schizophrenia? (4)
Apathy (lack of interest/ motivation)
Social withdrawal
Emotional blunting
Poverty of speech/ psychomotor retardation
187
What is priapism?
What is the biggest risk factor for it?
A painful erection that lasts for longer than 2 hours.
Sickle cell disease
188
What drug class is used for the treatment of Alzheimers disease & Lewy Body dementia?
Give an example of a medication from this class.
Acetylcholinesterase inhibitors
Donepezil
189
Give examples of conditions that cause a microcytic anaemia: (3)
What initial investigation would you do after identifying microcytic anaemia & what would high / low results suggest?
1) Iron deficiency
2) Thalassaemia
3) Secondary anaemia (anything that causes chronic inflammation)
***Measure serum ferritin:***
→ Low = iron deficiency anaemia
→ Normal/ high = thalassaemia / secondary anaemia
190
What treatment (if any) is required for 3rd degree heart block?
Permanent pacemaker
191
List 5 signs of an LMN lesion:
Muscle weakness
Muscle wasting
Hypo-reflexia
Hypotonia
Fasiculations
192
What symptoms would be seen in moderate/severe aortic stenosis in children? (3)
What symptoms would be seen in moderate/severe pulmonary stenosis in children? (2)
Reduced exercise tolerance, exertional chest pain & syncope
Exertional SOB & fatigue
193
What is the management of Stanford type A aortic dissections?
Surgical management (aortic graft)
194
Between which weeks gestation is considered as a 'term' delivery?
37 - 42 weeks
195
What is an open #?
When there is direct communication between the external environment and the #
196
What changes occur at birth regarding the foetal circulation? (6)
1) foramen ovale closes
2) ductus arteriosus closes
3) ductus venosus closes (blood vessel connecting umbilical vein→IVC)
4) Pulmonary vascular resistance falls
5) Pulmonary blood flow increases
6) Systemic vascular resistance increases
197
Give examples of conditions that cause a normocytic anaemia: (4)
What initial investigation would you do after identifying normocytic anaemia & what would high / low results suggest?
1) Blood loss
2) Haemolysis of RBC (aka, haemolytic anaemia)
3) Bone marrow disease (failure/ cancer infiltration)
4) Secondary anaemia (eg, inflammation)
***Reticulocyte count:***
High reticulocyte = Blood loss, haemolysis
Low reticulocyte = Bone marrow disease, secondary anaemia
198
Which ethnic group is sepsis most common within?
Asians
199
What is chorioamnionitis?
Infection of the membranes in the uterus
200
What is the function of the abducens nerve?
What muscle does it innervate?
Eye movements
Lateral rectus muscle
201
What skills would you expect to see from each developmental domain in an 24m toddler?
* Gross motor (1)
* Fine motor (1)
* Language (1)
* Social (1)
* Self help (1)
**Gross motor:** climbs on play equipment (eg, slides)
**Fine motor:** scribbles with circular motion
**Language:** vocabulary of 30-50 words
**Social:** helps with simple household tasks
**Self help****:** opens door by turning knob
202
What are the most common symptoms of a UTI? (6)
Dysuria
Increased frequency
Urgency
Foul smelling urine
Suprapubic pain
+/- haematuria
203
What is the physiological cause of pre-eclampsia?
Abnormal formation of the spiral arteries to the placenta resulting in high vascular resistance between placenta and maternal circulation
204
What medication should be prescribed with methotrexate to avoid toxicity?
Folic acid
205
What route is Dalteparin administered?
Subcutaneous injection
206
What are the 6 components of sepsis 6?
| (take 3, give 3)
→ Take blood cultures
→ Measure blood lactate
→ Measure urine output
→ Give O2 if sats are below 94%
→ Give IV antibiotics
→ Fluid challenge (give IV fluids)
207
Why does the dose of Lamotrigine have to be titrated up SLOWLY?
High risk of developing Stevens Johnson's syndrome (nasty, necrolysing rash)
208
What type of antipsychotic is Risperidone?
atypical antipsychotic
209
What is found within the subarachnoid space?
CSF (cerebralspinal fluid)
210
What is the medical word used to describe: 'a loss of interest/motivation'
Apathy
211
What would you hear when ascultating someone with an atrial septal defect? (2)
Explain why you would hear these things!
**Fixed, split 2nd heart sound** → as blood is being shunted from L→R atria, there is more blood to flow through the pulmonary valve. This causes a delay in the valve closing compared to closing of aortic valve = split 2nd heart sound
Pulmonary flow murmur (ejection systolic murmur) → due to increased blood flowing through the valve
212
What immunological mechanism is responsible for type 2 hypersensitivity reactions?
Auto-antibody mediated receptor activation
213
Ventricular-septal defects are associated with which 2 genetic conditions?
What type of murmur is heard when there is a ventricular-septal defect?
Down syndrome, Turner's syndrome
Pan-systolic murmur
214
What does SIRS stand for?
What clinical features would a patient have, to be diagnosed with SIRS?
Systemic inflammatory response syndrome
→ High/low temperature
→ HR \> 90
→ RR \> 20
→ High CO2
→ High WBC's
215
What week of gestation is considered 'term'? (and thus before this is 'preterm')
Week 37
216
Which anticonvulsant should be avoided in women of child bearing age & why?
Valproic acid - it causes neural tube defects
217
What are the 1st and 2nd line drug classes used for depression?
1st line: SSRI's
2nd line: SNRI's
218
List some clinical features seen in haemophilia: (5)
Haemarthrosis (bleeding into the joints)
Muscle haematoma
CNS bleeding
Prolonged bleeding after surgery/ trauma
Menorrhagia
219
What is a pathological #?
A # that didn't require force/impact as the bone was diseased and thus weaker.
220
In utero, oxygenated blood enters the foetus through what vessel?
What is the course of this vessel to the heart?
Through what mechanism does most foetal blood bypass the lungs?
Most blood that does enter the pulmonary artery still bypasses the lungs - how?
What does this drain into?
Umbilical vein
Umbilical vein→ductus venosus (through liver)→IVC→R atrium
Foramen ovale inbetween 2 atria
Through the ductus arteriosus
Ductus arteriosus drains into aorta
221
In which age group is a subdural haematoma most common?
What is the most common cause of a subdural haematoma?
Older population
Common cause is a minor head injury
222
What are common signs of raised ICP? (4)
Headache that is worse in the morning & when bending over/coughing
Headache that is relieved by lying down
Papillodema
Vomiting
223
What is the prophylaxis used against pre-eclampsia?
Aspirin from 12 weeks gestation
224
What is the management of tension headaches?
Simple analgesia: NSAIDs / paracetemol
225
What happens in Morbitz II (2nd degree heart block)?
Each PR interval is normal lenght but occasionally the P wave isn't followed by a QRS complex - dropped beat
226
What is receptive dysphasia?
Damage to which area of the brain results in receptive dysphasia?
When someone is unable to comprehend language but is able to physically say words (as a result they often say things that don't make sense)
Wernicke's area
227
A collapsing pulse is indicative of which valvular disease?
Aortic regurgitation
228
How long should someone continue their antidepressants for if they presented with their second episode of depression?
2 years
229
List some common causes of delirium (12)
(CHIMPS PHONED)
C - Constipation / urinary retention
H - Hypoxia
I - Infection
M - Metabolic disturbance
P - Pain
S - Sleeplessness (lack of sleep)
P - Prescriptions (anti-cholinergics, opiates)
H - Hypothermia/pyrexia
O - Organ dysfunction (hepatic or renal impairment)
N - Nutrition (poor)
E - Environmental changes
D - Drugs (over the counter, illicit, alcohol and smoking)
230
Between which weeks does labour & delivery usually occur?
37 - 42 weeks
231
Hyperprolactinaemia is a potential side effect of which class of psychiatric drugs?
What clinical features might males & females present with?
Antipsychotics
Males:
→ Erectile dysfunction
→ Gynaecomastia
→ Galactorrhoea
Females:
→ Galactorrhoea
→ Menstrual dysfunction
232
What is the cellular pathology that results in pernicious anaemia?
Autoimmune attack against intrinsic factor → B12 cannot be absorbed without intrinsic factor and patient becomes anaemic
233
What investigation is used to diagnose coarctation of aorta?
What is the initial management of coarctation of aorta? What does this do physiologically to help?
What are the 2 definitive managements of coarctation of aorta?
ECHO
**Give prostaglandin E** - this reopens the ductus arteriosis which increases cardiac ouput & relieves the strain on the L ventricle
Surgical repair (narrowed part is resected and the 2 ends are anastamosed together) *or* stent insertion
234
What 3 symptoms are characteristic of asthma?
WHEEZE
Cough
SOB
235
What is a complication of pre-eclampsia & eclampsia?
HELLP syndrome
236
What drug is given to rapidly reverse an opioid overdose?
Naloxone
237
What is pelvic inflammatory disease?
PID occurs when an infection spreads from the vagina into the cervix and up into the upper genital tract
238
What is cushings syndrome?
Name the hormonal control underlying the release of this compound, & the locations where each hormone are released from:
List the 4 main causes of cushings syndrome:
Excess cortisol
CRH (hypothalamus) → ACTH (anterior pituitary) → cortisol (adrenal cortex: zona fasiculata)
1) Long term steroid use (commonest cause)
2) Cushings disease (ACTH producing pituitary adenoma)
3) Adrenal adenoma
4) Ectopic ACTH secreting tumour (eg, small cell lung cancer)
239
What condition does the following statement indicate a diagnosis of?
" 50y with gradual change in behaviour over past 2 years. Clear personality change & quite withdrawn "
Frontotemporal dementia
240
What is the qSOFA score used for?
What 3 variables does the qSOFA consider?
A score of what suggests a poor prognosis?
Used on patients with a suspected/ confirmed infection to predict the patients who would likely require a higher level of care & have a poorer prognosis
→ BP
→ Mental state (level of conscousness)
→ Respiratory rate
Score of 2 or more
241
A patient with a DVT that suddenly has a large stroke is indicitive of what pathology?
An atrial septal defect - the clot from the leg passed through the septum and into the brain!
242
What is the normal range of platelets in blood?
150 - 400 x109/L
243
For a diagnosis of mild depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
4
244
What is the 1st line investigation in the diagnosis of fibroids?
Trans-vaginal ultrasound
245
What is the 1st line investigation of Cushing's Syndrome?
Explain how this is conducted and the potential results:
What is the treatment of Cushing's syndrome?
**Dexamethasone suppression test**
Patient takes low dose of dexamethasone at night & cortisol & ACTH levels are measured in the morning. If cortisol is high, test is repeated with a high dose of dexamethasone to work out the cause.
* _Low dose dexamethasone results:_*
1) low cortisol & ACTH → normal (no cushings)
2) normal/ high cortisol → cushing's syndrome
* _High dose dexamethasone results:_*
1) low cortisol & ACTH → pituitary adenoma
2) low ACTH, normal/ high cortisol → adrenal adenoma
3) normal/ high cortisol & ACTH → ectopic ACTH secreting tumour
Surgical removal of the tumour!
~ trans-sphenoidal resection of pituitary adenoma
246
What is the effect of opioid's on someone's pupils?
Pin prick pupils
247
What is the classic traid of clinical features seen in Wernicke's encephalopathy?
Ataxia (lack of coordination of movements)
Ophthalmoplegia (paralysis of the eye muscles)
Encephalopathy (brain damage)
248
Explain the pathology in each miscarriage & say whether miscarriage is certain or not:
a) Threatened miscarriage
b) Inevitable miscarriage
c) Complete miscarriage
d) Missed miscarriage
**a) Threatened miscarriage:**
Mild bleeding, mild/ no pain, cervical os is closed, foetus present intrauterine - Miscarriage may or may not occurr
**b) Inevitable miscarriage:**
Heavy bleeding, pain, cevical os is open, foetus currently present intrauterine - Miscarriage is inevitable
**c) Complete miscarriage**
+/- bleeding/ pain, cevical os closed, NO products of conception intrauterine anymore (all have been expelled) - Miscarriage has already occurred
**d) Missed miscarriage**
Asymptomatic, cevical os closed, foetus currently present intrauterine but is *dead*
249
What skills would you expect to see from each developmental domain in an 18m toddler?
* Gross motor (2)
* Fine motor (2)
* Language (1)
* Social (2)
* Self help (1)
* *Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball
* *Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks
**Language:** 1) starts to join words into sentences
* *Social****:** 1) early pretend play
2) says no when interfered with
**Self help:** 1) eats with fork
250
What are the common side effects after starting Lithium?
GI upset: nausea / vomiting, diarrhoea, decreased appetite
251
What would you expect to see in the blood results of a patient diagnosed with anorexia nervosa in regards to:
1. K levels
2. Cholesterol levels
3. Sex hormone levels (FSH, LH, Oestrogen, Testosterone)
4. GH levels
5. Cortisol levels
1. Hypokalaemia
2. Hypercholesterolaemia
3. Low sex hormones
4. Raised GH
5. Raised cortisol
252
What direction is blood shunted in a ventricular-septal defect?
What pathology can occur over time if a ventricular-septal defect isnt corrected? What causes this?
What condition does this result in and why?
What clinical sign will be seen when this happens?
L→R ventricle
Increased blood in R ventricle → increased blood (and thus pressure) in pulmonary circulation → **pulmonary hypertension**
Pulmonary hypertension causes **Eisenmenger syndrome:** pressure in R ventricle is higher than L which causes blood to be shunted from R→L
Central cyanosis (more blood is bypassing the lungs)
253
Very high levels of bilirubin in infants can cause what serious condition?
What type of bilirubin causes this condition & why?
What is the treatment of raised unconjugated bilirubin levels?
Kernicterus
Unconjugated bilirubin - it's fat soluble so can cross the BBB whereas conjugated bilirubin is water soluble and thus cannot cross the BBB
Phototherapy (babies are placed under blue light)
254
How long does a migraine attack usually last for?
4 - 72 hours
255
What type of dementia is most common in the under 65's age group?
Alcohol related brain damage (ARBD)
256
If there is a lesion on the R accessory nerve, which way would the tongue deviate towards?
Right deviation
(The tongue deviates TOWARDS the side of the lesion)
257
What is the function of the glossopharyngeal nerve? (3)
Taste to posterior 1/3 of tongue
Sensation from pharynx & tonsils
Movement of throat muscles (stylopharyngeus muscles)
258
An extradural haemorrhage is commonly caused by a tear in which artery?
A # in which part of the skull usually causes this tear?
Middle meningeal artery
A # of the pterion - the pterion is weakest part of the skull & lies above the middle meningeal artery
259
How long after starting the following contraception is additional protection (condom's) needed?
a) combined contraceptive pill
b) progesterone-only pill
a) 7 days
b) 2 days
260
Which lobes of the brain are usually affected first in Alzheimers disease?
Parietal & temporal lobes
261
What is the difference between Hodgkins and Non-Hodgkins lymphoma?
Hodgkins lymphoma is characterised by the presence of Reed-Sternberg cells → Non-Hodgkins lymphoma does *not* have these cells.
\* Reed-Sternberg cells are abnormally large lymphocytes that usually have multiple nuclei
262
List some risk factors of pre-eclampsia. (8)
Pre-existing hypertension
Previous pre-eclampsia / FH
Diabetes
Chronic kidney disease
Autoimmune conditions (eg SLE)
\>40y
BMI \>35
Multiple pregnancy
263
What are the clinical features of an amniotic fluid embolism? (5)
High RR
Tachycardia
Hypotension
Hypoxia
Disseminated intravascular coagulopathy
264
What valvular disease is indicated by a slow rising carotid pulse?
Aortic stenosis
265
To be diagnosed with dementia, what type of imaging is required?
None. Dementia is a ***clinical diagnosis*** - imaging is done occasionally to confirm the diagnosis
266
In haematology, what 3 things are considered as 'B symptoms'?
Night sweats, weight loss, fever
267
List some clincial features seen in someone with bulimia nervosa (6)
Swollen parotid glands
Poor dentition (from the acid in the vomit)
Mouth sores
Eosophageal tears → haematemesis
Heart burn
Impulsivity: stealing, alcohol/drugs, smoking
268
What drug can be given to help someone withdraw from opiates?
Methadone
269
What are the 2 antibiotics used to treat UTI's?
Which one is more favourable in pregnancy?
Nitrofurantoin - used in pregnancy
Trimethoprim
270
When looking at the mean corpuscular volume of RBCs (size), what are the 3 types that may be seen?
Microcytic anaemia (small size)
Normocytic anaemia (normal size)
Macrocytic anaemia (large size)
271
What drug class is the 1st line treatment of hypertension in:
1. Caucasian people under 55y
2. People over 55y OR black/Caribbean people of any age
* Give an example of a drug that may be used in each.*
What is a contraindictation to the drug class used in 1. & what would be used instead?
1. ACEi - ramipril
2. Calcium channel blocker - amlodipine
Contraindictation to ACEi = pregnancy! Use an ARB instead
272
What drug class are used as the 1st line treatment for depression?
SSRI's
273
What is the function of the accessory nerve?
Innervates trapezius & sternocleidomastoid muscles
274
What medication is given in ARI as post-surgical prophylaxis of VTE & what drug class is it?
How long is it given for post-surgery?
Dalteparin - LMWH
30 days
275
Describe a cluster headache.
How long do they usually last for?
Sudden onset, unilateral pain behind one eye
Typically last between 15 mins - 3 hours
276
List some common signs of anaemia: (4)
→ Pallor of skin
→ Pallor of conjunctiva
→ Tachycardia
→ Raised respiratory rate
277
What pathology is seen in the condition: "transposition of the great arteries"?
What needs to occur postnatally to make it temporarily compatible with life? - Give examples of 3 things that could occur:
This condition is usually detected antenatally. What is given immediately after birth before the baby is transferred for surgical correction? - What does this do?
The pulmonary artery arises from the left ventricle & the aorta arises from the right ventricle (*they've swapped)*
There needs to be a shunt between R & L ventricles so that oxygenated blood goes to systemic circulation
1) patent ductus arteriosus (connection between pulmonary trunk & aorta)
2) atrioseptal defect
3) ventriculoseptal defect
Prostaglandin E is given - prevents the ductus arteriosus from closing
278
What are the typical triad of features seen in pre-eclampsia?
Hypertension that occurs after 20 weeks gestation
Proteinuria
Oedema (usually ankle)
279
What 3 things are measured in the combined test during pregnancy?
Nuchal translucency
PAPP-A hormone
Beta-hCG hormone
280
What is the function of the hypoglossal nerve?
Movement of the tongue
281
What is the management of Stanford type B aortic dissections?
Conservative management with BP control
282
What test would be used to test for an autoimmune cause of haemolytic anaemia?
What result would suggest an autoimmune cause & what would be seen in the lab?
DAT test (direct antiglobulin test) / coombs test (old name)
Positive result = immune mediated
Agglutination of RBCs (they clunp together)
283
What criteria is used to diagnose infective endocarditis?
Modified dukes criteria
284
What are the 3 divisions of the trigeminal nerve & what numbers are they given? (eg V1, V2, V3)
V1 = ophthalmic nerve
V2 = maxillary nerve
V3 = mandibular nerve
285
What type of medication is used for the maintenance of someone that has mania / bipolar disorder?
Mood stabilisers
Lithium
286
What are the main features of myeloma? (CRAB)
→ Hyper**_C_**alcaemia
→ **_R_**enal failure
→ **_A_**naemia
→ **_B_**one disease
287
Roughly how long after stopping alcohol intake does delirium tremens present?
72 hours
288
Name all of the 12 pairs of cranial nerves and state their numbers.
I = olfactory nerve
II = optic nerve
III = oculomotor nerve
IV = trochlear nerve
V = trigeminal nerve
→ V1 = ophthalmic nerve
→ V2 = maxillary nevre
→ V3 = mandibular nerve
VI = abducens nerve
VII = facial nerve
VIII = vestibulocochlear nerve
IX = glossopharyngeal nerve
X = vagus nerve
XI = accessory nerve
XII = hypoglossal nerve
289
What murmur is heard in aortic stenosis & where would you heart it?
What murmur is heard in pulmonary stenosis & where would you hear it?
Ejection systolic murmur heard over right sternal border - radiates to carotids
Ejection systolic murmur heard over left sternal border - radiates to back
290
What is haemolytic uraemic syndrome (HUS)?
What disease does HUS usually follow from?
What is the commonest organism that causes HUS & what investigation is used to identify it's presence?
What are the characteristic triad of features seen with HUS?
→ What invstigations would be done for each feature to identify them?
HUS occurs when there is **thrombosis** in **small blood vessels** throughout the body
Gastroenteritis
E.coli - stool sample will identify it
1) Haemolytic anaemia → FBC, blood film
2) AKI → U&E's to measure serum urea
3) Thrombocytopenia → FBC
291
What is expressive dysphasia?
Damage to which area of the brain causes expressive dysphasia?
When someone has comprehension of language (they know what they want to say) but they are unable to physically say the words
Broca's area
292
What type of hallucinations are common in lewy body dementia?
Visual hallucinations:
→ animals in the house
→ faces in the wallpaper
293
What is the commonest causative organism of septic arthritis?
Staphylococcus aureus
294
A deficiency in which vitamin can result in Korsakoff's syndrome?
Thiamine - B1
295
Can clozapine be used whilst actively breastfeeding?
No
296
How might someone describe a tension headache?
Bilateral, non-pulsatile headache
"Feels like a tight band around my forehead"
297
Before starting someone on an antipsychotic, which bloods would you want to do? (4)
FBC
LFT
Lipid profile
Fasting blood sugar
298
What type of antipsychotic is Chlopromazine?
Typical antipsychotic
299
What is the typical presentation of a subdural haematoma? (5)
Older person had a fall days-weeks ago
Progressive headache
Nausea / vomiting
Confusion
Reduced GCS
300
What is the normal range of haemoglobin in:
1. Males
2. Females
Males: 140 - 180 g/L
Females: 120 - 160 g/L
301
What syndrome is a complication associated with PID?
Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule which forms adhesions with the anterior abdominal wall)
302
What is the name given for premature RBCs? (*these are the RBCs just before they are released into the circulaton*)
Reticulocytes
303
What is the function of haptoglobins?
They remove free haemoglobin from the circulation
304
Give an example of a commonly used sulfonylurea. - What condition are they commonly used to manage?
What is the mechanism of action of sulfonylureas?
Gliclazide - Type 2 Diabetes
Increase insulin release from the pancreas
305
Name the 3 meninges from the skull inwards.
Dura mater (underneath skull)
Arachnoid mater
Pia mater
306
What type of headache is associated with autonomic symptoms? (Ptosis, miosis, lacrimation, nasal congestion)
Cluster headache
307
The results of a womans cervical smear screening identifies the presence of high-risk human papillomavirus (hrHPV). What should happen next?
If the next step is positive, what should be done?
If the step was negative, what should be done?
The sample should be sent for cytology.
Cytology positive: Woman should be sent for colposcopy
Cytology negative: Woman should have another smear in 12 months
308
After starting an antidepressant, roughly how long does it take for the patient to notice it start working?
2-4 weeks
309
What is the function of the oculomotor nerve?
Eye movements
310
What are the steps of the 2nd stage of labour? (The steps/ movements of the baby as it moves along the birth canal) (7)
1) Engagement: foetus head is fully engaged with pelvis
2) Descent: foestus starts to descend along birth canal
3) Flexion: foetus head flexes towards chest
4) Internal rotation: foetus internally rotates to face mothers back
5) Extension: foetal head extends & is delivered
6) Restitution: foetus externally rotates to face anteriorly
7) Expulsion: anterior shoulder is delivered, followed by the rest of body
311
What is the 1st line treatment in all eating disorders?
CBT
312
How long should someone continue their antidepressants for if they presented with their first episode of depression?
6 months
313
Between which weeks of gestation would an induction of labour be offered?
Between weeks 41 - 42 gestation
314
Give the medical name for a red blood cell.
What is the name given to the production of RBCs?
What hormone is responsible for stimulation of RBC production?
Where is this hormone secreted from & why is it secreted?
Erythrocyte
Erythropoesis
Erythropoietin
Kidney in response to hypoxia
315
Name the 4 lobes of the brain.
Frontal lobe
Temporal lobe
Parietal lobe
Occipital lobe
316
What is the normal range of WBC in blood?
4 - 10 x109/L
317
Which class of antidepressants are used in treatment resistant depression?
MAOI's
318
Women that are at high risk of having a baby with down's syndrome are offered 2 tests to provide a definitive answer. What are these tests?
Chorionic villus sampling
Amniocentesis
319
List 5 signs of an UMN lesion:
Muscle weakness
Hyper-reflexia
Hypertonia
Positive clonus
Positive babinski sign (big toe moves up)
320
List some causes of intravascular haemolysis: (3)
List some causes of extravascular haemolysis: (4)
**Intravascular:**
→ Mechanical heart valve
→ Acute tranfusion reaction (if blood transfused is mis-matched)
→ Infections, eg malaria
**Extravascular:**
→ Hypersplenism (spleen works harder than normal)
→ Haemoglobinopathys (eg thalassaemia, sickle cell)
→ G6PD deficiency
→ Autoimmune haemolytic anaemia
321
What does 'confabulation' mean?
Occurs when there is memory loss & the brain fills in the gap of the missing information
322
What is the 1st line medication for hyperthyroidism?
When would this drug be contraindicated & what would be used instead?
Carbimazole
Contraindicated in pregnancy - Propylthiouracil used instead
323
For a diagnosis of moderate depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
6
324
What is the classical presentation of an aortic dissection?
Sudden onset 'tearing' chest pain (or interscapular pain) that radiates to the back
325
What is the main blood vessel that supplies the femoral head?
Femoral circumflex artery
326
What muscle helps to maintain continence?
Pelvic floor (pelvic diaphragm)
327
What condition are biguanised used to treat?
What is the most commonly used biguanide?
What is the mechanism of action of biguanides?
Type 2 Diabetes
Metformin
They increase sensitivity to insulin in the peripheries PLUS increase glucose uptake in the liver
328
What are the 5 main characteristic features of Cushing's Syndrome?
What 4 clinical conditions/ signs can Cushing's Syndrome cause?
1) Moon face
2) Central obesity
3) Proximal limb muscle wasting
4) Abdominal striae
5) Buffalo hump
1) Hypertension
2) Insulin resistance (hyperglycaemia → T2DM)
3) Osteoporosis
4) Easy bruising
329
What condition would be indicated by: *"a child with a 3 day history of vomiting & diarrhoea"*
What is the investigation of this condition?
If the diarrhoea was *bloody*, what would be the likely causative organism?
This organism increases the risk of developing what condition?
What are the 3 characteristic features of this condition?
What is the management of this condition?
Gastroenteritis
**Stool sample** sent for microscopy, culture & sensitivies (MCS)
E. Coli
Haemolytic Uraemic Syndrome (HUS)
1) Haemolytic anaemia
2) Thrombocytopenia
3) AKI
Supportive management as it self resolves - monitor fluid balance to detect a worsening AKI
330
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
331
Name the condition that is a non-reversible memory disorder often seen in alcoholics.
Korsakoff's syndrome
332
There are 3 types of von Willebrand Disease, describe the problem associated with each type:
Which type(s) presents with the most severe symptoms?
Type 1: there isn't enough VWF in the body
Type 2: there is enough VWF, however it is dysfunctional
Type 3: almost complete deficiency of VWF
Types 2 & 3 are more severe
333
A lesion at the optic chiasm produces what visual defect?
Bitemporal hemianopia
334
There are 2 types of 2nd degree heart block. What are they called?
What is the common pathology in a 2nd degree block?
Morbitz I & Morbitz II
In each type, a beat is dropped occasionally (missing QRS complex)
335
If someone presents to A&E with a psychotic episode (with no previous psychiatric diagnosis), what investigation should you do immediately & why?
Urinary toxicology - to rule out the use of illicit drugs as the cause
336
What is the 2nd line management of pre-eclampsia?
Nifedipine (anti-hypertensive)
337
What is the first line treatment approach in a newly diagnosed T2D?
If HbA1C fails to improve, what is the next step?
Lifestyle modification (diet, exercise, smoking, alcohol etc)
Metformin = 1st line medication
338
What does 'akathisia' mean?
Unpleasant sensation of restlessness
339
What is the gold standard treatment of *non-*muscle invasive bladder cancer?
What is the gold standard treatment of muscle invasive bladder cancer?
TURBT (transurethral resection of bladder cancer) + mitomycin C (chemo)
Cystectomy with urinary diversion (bladder is removed & the ureters are diverted)
340
What is otitis media?
List some symptoms of otitis media: (4)
What will you see on examination?
What is the 1st line management?
What is a concerning complication of otitis media?
Infection of the middle ear
~ ear pain (young children may tug at their ear)
~ reduced hearing in affected ear
~ URTI symptoms: fever, cough, sore throat, blocked nose (otitis media commonly follows from an URTI)
~ discharge if tympanic membrane perforates
~ bulging, red, inflammed tympanic membrane
~ if perforation: discharge & hole in the tympanic membrane
Simple analgesics
Mastoiditis
341
What is the 1st line treatment of fibroids under 3cm in size if the patient doesn't need to remain fertile?
IUS (Mirena coil)
342
What is SUFE?
What age group & sex is it most common in?
What is the biggest RF for SUFE?
List some features seen in someone with SUFE: (3)
It's when the head of femur is displaced along the growth plate (it looks like it has slipped off)
Teenage boys
Obesity
~ Hip/ groin/ knee pain with **insidious** onset
~ Restricted ROM of hip
~ Painful limp
343
What are 3 commonest pathogens responsible for causing neonatal sepsis?
What antibiotics are used in the 1st line management of neonatal sepsis?
1) Group-B strep
2) E.Coli
3) Listeria
IV penicillin & gentamicin
344
On an ECG, what is the normal lenght of the PR interval?
120 - 200ms
345
What are the 3 symptoms of Murphy's Triad?
What condition do these symtpoms point towards?
List 3 complications of this condition:
What is the definitive management of this condition?
Abdominal pain, vomiting, fever
Appendicitis
1) Abscess formation
2) mass
3) peritonitis
Surgical removal of appendix
346
Name the condition described:
"Episodes of binge eating with a sense of loss of control, followed by purging behaviour" - *BMI less than 17.5*
Anorexia nervosa: binge purge subtype
347
What are the main risk factors associated with aortic dissection? (4)
Hypertension
Connective tissue diseases (eg, Marfans)
Cocaine use
Valvular heart disease
348
What neuropathological features would be seen on imaging of someone with Alzheimer's disease? (2)
Amyloid plaques
Tau protein tangles
349
After starting an antipsychotic, roughly how long does it take for the patient to notice it start working?
Up to 8 weeks
350
What antipsychotic is used in treatment resistant patients?
Clozapine
351
Methotrexate is commonly used to treat what conditon?
Rheumatoid arthritis
352
Which STI is associated with septic arthritis?
Neisseria gonorrhoeae
353
List some symptoms of pre-eclampsia. (5)
Headache
Changes in vision (commonly blurred vision)
Nausea / vomiting
Ankle oedema
Upper abdominal pain
354
What medication is used in chronic bipolar disorder?
Lithium
355
Name the rotator cuff muscles.
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
356
List some risk factors for squamous cell carcinoma of the *bladder* (2)
Schistosomiasis infection
Long term catheterisation (10+ years)
357
What are the first 2 clinical features to show in Alzheimers disease?
Loss of memory
Loss of executive function
358
What is Immune Thrombocytopenic Purpura (ITP)?
What blood abnormality does it result in?
What is the 1st line treatment for ITP?
If this doesn't work, what do you add to the treatment?
Autoimmune attack of platelets (antibodies are made against platelets)
Results in thrombocytopenia (low platelet count)
1st line treatment: steroids
If steroids don't work, add in IV IgG (immunoglobulins)
359
What are the 6 components of sepsis 6?
| (take 3, give 3)
→ Take blood cultures
→ Measure blood lactate
→ Measure urine output
→ Give O2 if sats are below 94%
→ Give IV antibiotics
→ Fluid challenge (give IV fluids)
360
What is Tetralogy of Fallot also known as by leymans?
Physiologically, what is it & what are the 4 components to it?
"Hole in the heart"
A congenital heart condition that has 4 components:
1. Ventricular septal defect
2. Pulmonary valve stenosis
3. Right ventricular hypertrophy
4. "Over-riding aorta" - aorta arises from *both* ventricles
361
What drug class is used as the 1st line treatment to manage an acute migraine attack?
Give an example of a commonly used drug from this class.
Triptan
Sumatriptan
362
What is the treatment of aortic / pulmonary valve stenosis in children?
What is a common complication of this procedure?
Balloon valvoplasty
Valve regurgitation due to damage of the cusps of the valve
363
Which class of drugs can be used to treat extra-pyramidal side effects of antipsychotics?
Anti-cholinergics
364
What does this CT show?
Extradural haematoma
365
List some causes for a decreased production of RBC's in the bone marrow (4)
Bone marrow disorder
Chronic kidney disease (reduced secretion of erthyropoietin reduces RBC production!)
Hypothyroidism (thyroid hormones also stimulate RBC production)
Iron & vitamin B12 deficiency (these are needed for functional RBC production)
366
```
What investigation(s) are done for a UTI in:
1. Young women
```
2. Children/ men/ women that are pregnant/ with recurrent infections
1. Urine dip only
2. MSSU sent for MC&S
367
If there is a lesion on the Right accessory nerve, which side would the uvula deviate towards?
Left deviation
(The uvula deviates away from the side of the lesion)
368
Women with a RF for gestational diabetes are investigated for gestational diabetes at what gestational week?
How is this investigated?
What additional investigation are women with a history of gestational diabetes given?
Week 24-28
OGTT
Women with a history of GD are given an OGTT at their booking appointment (~10 weeks) - if this is normal, it is repeated at weeks 24-28
369
Name the 2 types of lymphocytes and name where they each mature
T cells - thymus
B cells - bone marrow
370
In what part of the GIT is vitamin B12 absorbed?
What molecule is needed for the absorption of B12?
Which cells secrete this molecule?
Ileum
Intrinsic factor
Parietal cells within the stomach
371
A diagnosis of COPD is based upon the results of what? (2)
Clinical presentation (symptoms + history)
Spirometry
372
What test is commonly used to screen for down's syndrome during pregnancy?
The combined test
373
Which muscles compose the pelvic diaphragm?
```
Levator ani (puborectalis, pubococcygeus, iliococcygeus)
& coccygeus
```
374
What is the commonest cause of post partum haemorrhage?
What are the other causes of PPH? (the 4 T's)
Atony of the uterus (failure of the uterus to contract)
→ Tone (atony of the uterus)
→ Tissue (retained placenta)
→ Trauma
→ Thrombosis
375
List some common symptoms of depression.
Low mood - often worse in the morning
Poor sleep (difficulty falling asleep, EMW, excessive sleep)
Fatigue
Changes in appetite & weight
Poor concentration / focus
Suicidal thoughts & planning
Anxiousness
Low libido
Psychomotor retardation
Social withdrawal
376
Define what dementia is.
Dementia is a syndrome (a collection of different symptoms) associated with an progressive decline in brain functioning
377
What age group is Perthes disease most common in?
Children aged 4-10y
378
What muscles does the oculomotor nerve innervate? (7)
Superior rectus muscle
Inferior rectus muscle
Medial rectus muscle
Inferior oblique muscle
Leveator palpebrae superioris muscle (eyelid)
Ciliary muscle (accomodation of pupils)
Constrictor pupillae (pupil size)
379
What traid of symptoms are associated with aortic stenosis?
1. Heart failure
2. Syncope
3. Angina
380
What is the function of Von Willebrand Factor?
What abnormality results in von Willebrand disease?
What is the mode of inheritance of VWD?
VWF is vital for clot formation: • links platelets to the exposed, damaged vessel wall • stabilises factor VIII so that it can work for longer
A deficiency of, or dysfunctional VWF
Autosomal dominant
381
What tool is used to assess the severity of a pneuminia?
CURB-65 score
382
What is the average lifespan of a RBC?
How are RBCs removed from the circulation?
Which 2 organs are involved in this process?
120 days
The reticuloendothelial system removes RBCs from the circulation
Spleen & liver
383
What is a common trigger of tension headaches?
Stress
384
What are some common triggers for a migraine? (5)
Stress
Combined contraceptive pill
Chocolate
Sleep deprivation
Changes in the weather
385
What medication is used to treat a seizure in eclampsia?
IV magnesium sulphate
386
What is the 1st line medication used for tocolysis?
(A medication that is used to stop uterine contractions)
Nifedipine - a calcium channel blocker
387
Delirium can present in 2 extremes, what are these called?
List some common features of each type.
**Hyper**active & **hypo**active delirium
***Hyperactive*** delirium:
→ aggitated / aggressive
→ disorganised thoughts
→ hallucinations
→ restlessness
***Hypoactive*** delirium:
→ abnormal drowsiness
→ fatigue
→ less reactive
→ withdrawn
388
What symptoms are seen in lithium toxicity? (4)
Coarse tremor
Arrhythmias
Visual disturbances
CNS disturbances: seizures, slurred speech, confusion
389
What are 2 common triggers of cluster headaches?
Smoking
Alcohol
390
What are the 5 commonest in-utero causes of infection? (TORCH)
T - toxoplasmosis
O- other (syphilis & chickenpox (varicella-zooster virus))
R - rubella
C - cytomegalovirus
H - herpes simplex virus (HSV)
391
What is epididymo-orchitis?
What are the 2 commonest causes of it developing?
Inflammation of the epididymus & testis
STI's (commonly chlamydia & gonorrhoea) & UTI's (commonly E.coli)
392
Name a complication if a scaphoid # is left untreated.
Avascular necrosis of the scaphoid bone.
393
List the main clinical features of septic arthritis. (4)
Hot, painful, swollen joint
Usually only a single joint affected
Restricted movement in affected joint
Systemic features: fever & fatigue
394
What are the 1st rank symptoms of Schizophrenia? (ABCD)
A - Auditory Hallucinations
B - Broadcasting of Thought
C - Controlled Thought (delusions of control)
D - Delusional Perception
395
What are the 6 components of sepsis 6?
| (take 3, give 3)
→ Take blood cultures
→ Measure blood lactate
→ Measure urine output
→ Give O2 if sats are below 94%
→ Give IV antibiotics
→ Fluid challenge (give IV fluids)
396
What is the medical word that describes the inability to feel pleasure?
What condition is this a key feature of?
Anhedonia
Depression
397
List the 4 signs of labour:
Rupture of membranes
Regular, painful contractions
'Show' (mucus plug covering the cervix)
Dilating cervix (on examination)
398
What 5 factors are assessed using the Bishop Score for induction of labour?
Fetal station (this is how far down into the pelvis the babies head is palpated in relation to the ischial spines)
Cervical position (as the cervix ripens, it moves more anteirorly)
Cervical dilatation (as the cervix ripens, it dilates)
Cervical effacement (as the cervix ripens, it becomes shorter)
Cervical consistency (as the cervix ripens, it becomes softer)
399
What are hypersensitivity reactions?
Exaggerated immune responses that cause damage to tissues/ blood
400
Name the 2 divisions of the immune system:
Innate & adaptive immune systems
401
What are the fertility sparing surgical managements for fibroids? (3)
Myomectomy (removes the fibroid from the uterine wall)
Radiofrequency ablation (induces necrosis of the fibroid so that it no longer bleeds)
Uterine artery embolism
402
What does 'dystonia' mean?
What psychiatric drug class can cause dystonia?
Involuntary muscle spasms/contractions (hypertonia)
Antipsychotics
403
What's a common side effect of SSRI's that causes poor patient compliance?
Sexual dysfunction
404
What clinical signs would be seen in someone with an aortic dissection?
Radio-radial delay
Radio-femoral delay
BP is different between L & R arms
405
What common side effect should all patients be advised about when starting Carbamazepine?
What 2 conditions is carbamazepine commonly used to treat?
A rash
Epilepsy & neuropathic pain
406
In a psychotic patient, too much dopamine results in what?
Positive symptoms: hallucinations, delusions, thought disorders
407
What is the difference between pre-eclampsia and gestational hypertension (pregnancy-induced hypertension)?
Gestational hypertension occurs after 20 weeks gestation without proteinuria
Pre-eclampsia is when hypertension occurs after 20 weeks gestation with proteinuria
408
What is a life-threatening side effect of clozapine?
What monitoring does clozapine need for early detection of this side effect?
Agranulocytosis
Weekly FBC
409
What is the initial management of an open #?
1. Tetanus & antibiotic prophylaxis
2. Photograph the wound, cover it and stabilise the limb (photo so that the wound isn't uncovered every time a new clinician assesses the patient)
3. Operate within 24h\*
\* If there is neurovascular compromise, operate within 6h!
410
If a T2D cannot tolerate metformin, what class of drugs are they switched to instead? (These are usually the 2nd line treatment option)
Give an example of a drug within this class.
What is the mechanism of action of these drugs?
What is a severe side effect that needs to be monitored?
Sulfonylureas
Gliclazide
They increase insulin secretion from the pancreas
Hypoglycaemia
411
What is the medical word for a high platelet count?
What is the medical word for a low platelet count?
Thrombocytosis
Thrombocytopenia
412
List the triad of symptoms that Parkinsons Disease presents with.
Bradykinesia
Tremor (pin-rolling)
Rigidity (cog-wheel)
413
Name a serious complication of a neck of femur #.
Avascular necrosis of the femoral head.
414
If a woman is \*Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood?
Why does this happen?
When should this be checked for during pregnancy?
What can be given as prophylaxis for this?
\*Rh = rhesus
The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)
If someone is rhesus negative, they don't have the D antigen on their RBC's so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.
Rh status of mother & baby is checked at the booking appointment (week 10)
If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events
415
What condition is methotrexate predominantly used to treat?
What birth defects are associated with methotrexate use? (2)
Rheumatoid arthritis
Cleft palate
Hydrocephalus
416
If a # is displaced, what 2 things are required in the management of it?
Reduction of the # (to put it back into the correct place)
Immobilisation of the bone (for healing)
417
What investigations should you do to diagnose PID? (5)
Pelvic examination
Pregnancy test (to rule out ectopic)
STI swabs
Transvaginal ultrasound
Bloods
418
When would the ventricles release BNP?
A high BNP suggests what condition?
BNP is secreted in response to ventricular stretching
A high BNP suggests heart failure
419
SIRS + infection = ?
What is the condition called if a patient has end organ damage as a result of sepsis?
What is the difference between severe sepsis & septic shock?
Sepsis
Severe sepsis
In septic shock, the patient has ***hypotension*** as well as severe sepsis
420
How do you diagnose a UTI in older people (65y +) in hospital?
Why do we do this?
Urine sample → lab analysis of urine culture *(NOT URINE DIP)*
Older people commonly have asymptomatic bacteriuria which would show as a false positive for infection on a urine dip
421
What ECG finding is seen in hyperkalaemia?
Peaked T waves
422
In bundle branch blocks, are the QRS complexes wider or narrower than usual?
What is the normal time/num. of boxes of a QRS complex?
Wider than usual
Normally, QRS complexes are no wider than: 120ms = 3 small boxes
423
Interpret the following:
G1 P1
This woman has been pregnant once & has delivered one baby after 24 weeks gestation
424
What is the screening tool for delirium?
A score of what indicates possible delirium?
Who should be screened for delirium upon admission to hospital?
4AT
4 or more
Anyone over 65y!
425
What skills would you expect to see from each developmental domain in a 12m toddler?
* Gross motor (2)
* Fine motor (2)
* Language (2)
* Social (1)
* Self help (2)
* *Gross motor:** 1) stands without support
2) starts to walk without help (by 18m)
* *Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand
* *Language:** 1) know's the meaning of 1 or 2 words
2) uses mama / dada specifically for parents
**Social:** 1) points to things of interest
* *Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks
426
Below which BMI is considered as anorexic?
Below BMI of 17.5
427
In a centrifuge, what 3 components will blood separate into?
Name some cells that will be found in each component.
**_Plasma_**
→ Clotting factors
→ Albumin (& other proteins)
→ Antibodies
**_Buffy coat_**
→ Platelets
→ WBC's (leucocytes)
**_Red blood cells_**
428
What is the typical presentation of trigeminal neuralgia?
Recurrent, short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution (usually V2 / V3)
429
What is the function of the olfactory nerve?
Sense of smell
430
Is a ductal carcinoma in-situ (DCIS) an invasive/non-invasive form or breast cancer?
Non-invasive
431
What is mixed state delirium?
It's when someone fluctuates between **hyper**active delirium & **hypo**active delirium
432
What does thrombocytopenia mean?
List some common presentations of thrombocytopenia: (5)
Low platelet count
→ Petechiae
→ Ecchymosis (bruising)
→ Nose bleeds
→ Bleeding gums
→ Menorrhagia
433
What clinical finding is seen when the scaphoid bone is fractured?
Pain on palpation of the anatomical snuffbox
434
What is Kawasaki disease?
What are the 6 common features of Kawasaki disease? CREAM
What is the main complication of Kawasaki disease? - What investigation is done to screen for this?
What is the treatment of Kawasaki disease?
A systemic medium vessel vasculitis
* *Fever for 5+ days** PLUS
* *C** - conjunctivitis (red eyes)
* *R** - rash
* *E** - oedema/ erythema of *hands & feet*
* *A** - adenopathy (usually cervical)
* *M** - mucosal invovlement (strawberry tongue, cracked lips)
Coronary artery aneurysm - ECHO
Treatment: **aspirin** (to reduce risk of thrombosis) & **IV immunoglobulins IVIg)** (to reduce risk of coronary artery aneurysms)
435
What condition presents with rapid onset confusion that is precipitated by alcohol withdrawal?
Delirium tremens
436
What is 1st degree heart block?
A continually prolonged PR interval of more than 200ms
437
What investigations are done initially if bladder cancer is suspected? (3)
Urine culture (to rule out UTI)
CT urogram (contrast CT of the urinary tract)
Flexible cytoscopy
438
List 4 risk factors for Hodkins lymphoma:
→ Smoking
→ Epstein barr virus
→ HIV
→ Immunosuppression
439
What is the classic triad that suggests a renal cell carcinoma?
Flank pain
Haematuria
Mass in the flank area
440
What skills would you expect to see from each developmental domain in a 6m infant?
* Gross motor (2)
* Fine motor (2)
* Language (2)
* Social (2)
* Self help (1)
* *Gross motor**: 1) rolls over
2) starts to sit without support
* *Fine motor:** 1) uses 2 hands to pick up large objects
2) transfers toy from 1 hand to another
* *Language:** 1) responds to name
2) 2 syllable babble
* *Social:** 1) reaches for familiar people
2) pushes things they don't want away
**Self help:** 1) feeds self small food
441
The following would be **red flags** in a child's development if they hadn't achieved them by what age?
1) Social smile
2) Sitting unsupported
3) Walking unsupported
4) Words
1) No social smile by **2 months**
2) Not sitting unsupported by **9 months**
3) Not walking unsupported by **18 months**
4) No words by **2 years**
442
What is a delusional perception?
When someone see's/hear's something and associates it with something unrelated.
Eg, someone see's a street lamp flicker and then believes that they are destined to be the next king
443
Delayed puberty & *anosmia* (lack of smell) would suggest what condition?
What is the physiological cause behind delayed puberty in this condition?
Kallmann's syndrome
**Hypogonadotropic hypogonadism:** hypothalamus doesn't secrete enough GnRH to stimulate anterior pituitary to secrete LH & FSH → little testosterone/ oestrogen secreted
444
What the are diagnostic values of type 2 DM:
1) Random blood glucose
2) Fasting plasma glucose
3) 2h glucose tolerance
4) HbA1C
What is required for a T2DM diagnosis in:
a) symptomatic patient
b) asymptomatic patient
1) Random blood glucose: **11.1 mmol/l**
2) Fasting plasma glucose: **7 mmol/l**
3) 2h glucose tolerance: **11.1 mmol/l**
4) HbA1C: **\> 48 mmol/mol**
a) 1 of the above criteria + *symptoms*
b) 2 of the above criteria from 2 days (*if asymptomatic*)
445
A 65 year old man with diabetes has developed painful peripheral diabetic neuropathy.
Name a medication & it's drug class, used as 1st line in treating this.
Amitriptylline - tricyclic antidepressant
446
What is the 1st line management of an ovulatory cause of infertility?
What is the 2nd line management if the above doesn't help?
What is the 3rd line management if the woman is still unable to get pregnant?
If all of the above fail, what is the final management to assist in successful pregnancy?
**Lifestyle modification:** weight loss, exercise, diet
**2nd line:** Clomiphene
**3rd line:** Laparoscopic ovarian drilling
Assisted conception
447
Describe the damage involved in each degree of perineal tears:
~ First degree tear
~ Second degree tear
~ Third degree tear: 3A, 3B, 3C
Fourth degree tear
What is the management of the various tears?
**First degree:** Tear limited to the superficial perineal skin or vaginal mucosa *only*
~ Don't reqire treatment
**Second degree:** Tear extends to perineal muscles and fascia, but the anal sphincter is intact
~ Require a simple stitch (midwife can do this)
**Third degree:** tear involves the external anal sphincter
*3A* - less than 50% thickeness of sphincter is torn
*3B* - more than 50% thickeness of sphincter is torn
*3C* - External & internal anal sphincters torn
~ Requires surgical correction
**Fourth degree:** tear extends to the rectal mucosa
~ Requires surgical correction
448
The drugs below are antidotes to overdoses of what substances?
a) Naloxone
b) Flumazenil
c) N-acetyecysteine
a) Opioids
b) Benzodiazepines
c) Paracetemol
449
What is the classic triad of presenting symptoms seen in normal pressure hydrocephalus?
Dementia, urinary incontinence, gait disturbance
450
What is the medical management of an abortion? - Between which weeks can this be done?
What is the surgical management of abortion? - Between which weeks can this be done?
*Medical management: 5-25+5 weeks*
1) **_Mifepristone_** (progesterone antagonist → degeneration of endometirum & increases uterine sensitivity to prostaglandins)
2) 36-48h later, give **_Misoprostol_** (prostagland analogue → contraction of myometrium & expulsion of uterine contents)
*Surgical management: 5-12 weeks*
**_Misoprostol_** given to woman before procedure to 'prime' the uterus → transcervical **_suction_** of uterin contents!
451
In PCOS, would you expect the following to be low, normal or high?
1) Testosterone
2) Sex hormone binding globulin
3) LH
4) FSH
5) Insulin
6) LH:FSH ratio
1) Testosterone - **high** (insulin promotes release of androgens)
2) Sex hormone binding globulin - **low** (insulin decreases SHBG production)
3) LH - **high**
4) FSH - **low** (low FSH results in follicles not maturing and turning into cysts)
5) Insulin - **high** (insulin resistance is a feature of PCOS)
6) LH:FSH ratio - **high** (High LH & low FSH)
452
Describe the discharge associated with each condition below:
1) Bacterial vaginosis
2) Candidiasis
3) Chlamydia
4) Gonorrhoea
5) Trichomoniasis
1) Watery, FISHY discharge
2) Thick, white discharge (cottage cheese)
3) Watery, odourless discharge
4) Yellow discharge
5) Frothy, green discharge
453
What is the most likely **diagnosis** of the following:
Unvaccinated child presents with a fever, sore throat & difficulty swallowing. The child is sitting forward and drooling.
What is the management of this?
Epiglottitis
1) Secure airway!!!!!
2) IV antibiotics (ceftriaxone) + Steroids (dexamethasone)
454
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