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Incorrect qs Flashcards

1
Q

What is the triad of shaken bby syndrome?

A

retinal haemorrhage
subdural haematoma
encephalopathy

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2
Q

What CN palsy can uncontrolled diabetes present in? Which feature is missing in the presentation?

A

III
no involvement of pupils

due to small vessel damage supplying the nerve

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3
Q

What are the causes of microcephaly?

A

normal variation
familial

congenital infection
perinatal brain injury e.g. HIE
fetal alcohol syndrome
Patau syndrome
craniosynostosis

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4
Q

What is a craniopharyngioma? What can is cause? What visual field defect is it a/w?

A

benign tumour which grows near the pit gland

can cause diabetes insipidus
a/w lower bitemporal hemianopia

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5
Q

What does an acute on chronic subdural haematoma look like on CT?

A

swirl sign of dark blood surrounded by bright blood

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6
Q

What is a complication of chickenpox? How does it present? How is it managed?

A

invasive group A streptococcal soft tissue infections eg necrotising fasciitis

rapidly evolving rash with disproportionate pain +/- blue discolouration of skin

very broad spec abx until sensitivities known

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7
Q

How often should lithium be monitored?

A

when started/dose changed: once a week
once established: 3 monthly

always 12hrs after last dose

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8
Q

What levels should be monitored in a patient taking lithium?

A

U&Es + TFTs every 6mo

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9
Q

How is acute stress disorder and PTSD differentiated? What is the difference in 1st line tx?

A

PTSD >4wks after the event

acute stress disorder > trauma focussed CBT
PTSD > EMDRT

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10
Q

1st line tx for microcytic anaemia during pregnancy?

A

trial of oral iron

further ivx if no rise in Hb in 2wks

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11
Q

What is the preferred imaging modality for a suspected TIA?

A

if RFs for bleeding eg anti-coag/bleeding disorder > urgent CT

most-sensitive otherwise = diffusion weighted MRI
as likely no infarction just ischaemic changes

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12
Q

How is post-partum thyroiditis managed?

A

= self-resolving

if in the thyrotoxic phase > symptomatic tx > propanolol

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13
Q

What lifestyle factors can increase clozapine blood levels?

A

smoking cessation
alcohol binges

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14
Q

Which blood thinning medications are CI in pregnancy? What is the only alternative?

A

NOAC eg rivaroxaban (placental haemorrhage)
warfarin (warfarin embryopathy)

alternative = LMWH

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15
Q

What fasting plasma glucose levels trigger what treatment for GD?

A

7+ = insulin +/- metformin
<7 = trial of diet and exercise first, review in 1-2 weeks

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16
Q

What is a teratoma? What is the key US sign of one?

A

benign neoplasms derived from multiple germ cell layers
range of tissues can be produced within them eg skin, hair, blood, fat, bone, nails, teeth
inner lining contains white shiny masses projecting from the wall toward the centre of the cyst = Rokitansky protuberance seen on US

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17
Q

What is the triad of DKA?

A

acidaemia (metabolic acidosis)
hyperglycaemia
ketonaemia

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18
Q

What is the monospot test?

A

tests for infectious mononucleosis caused by EBV

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19
Q

Where are the sanctuary sites from chemotherapy in the body?

A

CNS (due to BBB) + testes

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20
Q

What is the management of sickle cell disease?

A

prophylactic penicillin (most will have had a splenectomy)
hydroxycarbamide (prevent vaso-occlusive complications)
blood transfusions (if severely anaemic/reduce proportion of Hbs)

stem cell transplant = curative (but high risk)

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21
Q

What is included in a clotting screen?

A

PT
APTT (activated partial thromboplastin time)
fibrinogen

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22
Q

How does Haemophilia A/B present in a child?

A

x-linked recessive > only boys

easy bruising
bleeding into muscles/joints
extensive bleeding after surgery

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23
Q

How does VWD present in a child?

A

boys + girls

bleeding from mucous membranes eg gums, nosebleeds, menorrhagia

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24
Q

When there is cellular injury, what part of the clotting cascade is released?

A

tissue factor (1st component of extrinsic pathway)

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25
What can cause septic arthritis?
most commonly - bacterial infection with haematological spread can occur following a skin would eg chickenpox scar
26
Systemic B symptoms are seen in which 2 conditions? What are they?
night sweats + weight loss + unexplained fever lymphoma + HIV
27
What are the 5 key RFs for DDH?
female high birth weight prematurity breech birth oligohydramnios
28
Which 2 bowel conditions is Down's a/w?
duodenal atresia Hirschsprung's
29
Patients cannot eat cheese when taking which drugs? Why?
MAOi eg phenelzine CHEESE EFFECT > high in tyramine which interacts with MAOi > acute attack of HTN
30
What is the tx for bipolar disorder in a) acute manic/mixed episode b) depressive episode and c) long-term maintenance and d) long-term maintenance has not worked?
a) atypical antipsychotic b) atypical antipsychotic + SSRI, usually olanzapine or fluoxetine c) lithium d) lithium + valproate (except in child-bearing age women)
31
What drugs are used for a) alcohol detox and b) maintenance of detox?
a) long acting benzo eg chlorodiazepoxide b) acamprosate + disulfiram 6-12mo after abstinence started to prevent relapse + thiamine to replenish B1
32
Name short, intermediate and long acting benzos?
<5hrs: ATOM - alprazolam, triazolam, oxazepam, midazolam 5-24hrs: TLC - temazepam, lorazepam, clonazepam >24hrs: CDeF - clorazepate, chlorodiazepoxide, diazepam, flurazepam
33
What is the triad of serotonin syndrome?
neuromuscular excitability autonomic dysfunction (hypo/hypertension) altered mental state
34
Which ADs are best avoided in a patient with depression and a hx of overdose?
tricyclics + venlafaxine = very toxic in overdose
35
Patients with depression are referred to psych when?
unresponsive to tx high suicide risk recurrent depression unsuccessfully managed in primary care
36
Which drugs are stimulants? What are their main effects?
cocaine MDMA (ecstasy) methamphetamine khat nicotine increase pulse/RR/BP, dilate pupils, decrease appetite
37
Which drugs are hallucinogens?
LSD ketamine magic mushrooms peyote cactus (Cannabis + ecstasy can also have hallucinogenic properties)
38
What is the action of antipsychotics?
block postsynaptic dopamine D2 receptors > block the 4 dopaminergic pathways > blockage of mesolimbic pathway = antipsychotic effect on other pathways = SEs
39
What is a threatened miscarriage?
ongoing pregnancy with vaginal bleeding closed cervix
40
What is an inevitable miscarriage?
vaginal bleeding with open cervical os
41
When is early and late miscarriage defined?
<12 wks = early 12-24 wks = late
42
How is PID managed?
start 14d abx immediately before return of swabs treat broad spec: doxycycline, metronidazole + IM ceftriaxone leave in recently inserted coil - remove after 72hrs if no improvement and give other emergency contraceptive
43
What is the best way of monitoring fetal growth on US?
abdominal circumference
44
When is symphysis fundal height a useful measure of fetal growth?
after 24wks in singleton pregnancies
45
How is stress incontinence treated?
1. 3 months of pelvic floor training 2. duloxetine (lots of MH SEs) or surgery eg retropubic mid-urethral tape
46
How is urge incontinence treated?
1. bladder retraining 2. oxybutynin
47
What is the treatment pathway for endometriosis?
1. COCP 2. IUS 3. GnRH antagonist to suppress ovarian oestrogen production 4. laparoscopy/hysterectomy
48
What is the first step in management of a pregnancy of unknown location?
repeat bHCG in 48hrs
49
How would bHCG change in an intrauterine pregnancy, ectopic and miscarriage?
bHCG doubles > intrauterine rises but doesn't double > ectopic falls by half+ > miscarriage
50
What are the fetal complications of maternal chlamydia infection?
chorioamnionitis > PROM vaginal delivery > neonatal conjunctivitis + pneumonia
51
What are the infectious causes of neonatal meningoencephalitis?
group B strep (vaginal commensal in mother) herpes
52
How does pseudogout and gout present differently on aspiration?
pseudogout = positively birefringent crystals gout = negatively birefringent needles
53
Define acute liver failure
encephalopathy + deranged coagulation in a person with a previously normal liver
54
What are some causes of acute liver failure?
viruses eg VZV, HSV, Hep A (never bacterial) paracetamol overdose pre-eclampsia developed into HELLP syndrome fructose intolerance
55
Define postural hypotension
systolic drop >20mmHg lay/sit still for 5 minutes and then stand measure at 1 and 3 mins
56
How is an MI and aortic dissection distinguished?
AD: maximally painful at time of onset, migration of pain caudally, weak L sided pulse, HTN is biggest RF MI: builds in intensity from onset
57
How does heart block present?
chest pain presyncopal sx, syncope SoB
58
What are the signs of a PE on CXR and ECG?
fleischner sign - dilated central pulmonary vessel westermark sign - collapse of vasculature distal to PE hampton's hump - wedge shaped infarct sinus tachycardia +/- ST depression
59
How does pericarditis present?
rapid onset severe sharp pleuritic chest pain in L anterior chest and radiating down arm, relieved by sitting forward and made worse lying down SoB illness preceeding
60
How is pericarditis treated?
NSAIDs +/- low dose colchicine if recurrent/continued for >14 days
61
How does pericarditis present?
rapid onset severe sharp pleuritic chest pain in L anterior chest and radiating down arm, relieved by sitting forward and made worse lying down SoB illness preceding
62
How does B12 deficiency anaemia present?
low Hb, high MCV + MCH a/w thrombocytopenia + leukopenia, in severe cases = pancytopaenia MCV can be normal if there is co-existing IDA
63
How does sickle cell anaemia present?
possibly raised MCV due to reticulocytosis high WCC
64
What is the treatment for each type of epilepsy?
generalised tonic-clonic: males - sodium valproate females - lamotrigine/levetiracetam focal: lamotrigine/levetiracetam 2nd line: carbamazepine/zonisamide absence: ethosuximide 2nd line: males - SV, females - lam/lev myoclonic: males - SV females - lev tonic/atonic: males - SV females - lam
65
Which anti-epileptic can exacerbate absence seizures?
carbamazepine
66
What is the most common type of brain tumour?
mets from bronchi (most common), breast, bowel, bin, bidney
67
What are the two most common type of primary brain tumour in adults? How do they present on imaging?
1. glioblastoma = poor prognosis solid tumour with central necrosis + contrast-enhancing rim 2. meningioma = benign extra-axial with well-defined border between tumour + parenchyma, often at falx cerebri/superior sagittal sinus/convexity/skull base
68
What are 3 paediatric brain tumours
1. pilocytic astrocytoma - benign, most common histology - rosenthal fibres 2. craniopharnygioma - benign solid/cystic tumour of the sellar region from Rathke's pouch, presents with hormonal disturbance/ disturbance
69
How should a child with DKA who is clinically dehydrated be treated?
IV fluids (0.9% NaCl 10ml/kg) over 48hrs (rapid correction can lead to cerebral oedema) + SC insulin (0.1 units/kg/hr)
70
How will bloods and urine in DKA present?
hyperglycaemia metabolic acidosis ketonaemia hyperkalaemia (comes down with fluids/insulin - monitor for low K+) mildly elevated Na + creatinine if dehydrated
71
What are the 4C's of measles?
cranky cough coryza conjunctivitis Koplik spots - on buccal mucosa
72
Where does a measles rash generally start?
behind ears and spreads downwards
73
Which medications can cause SJS?
abx allopurinol anti-epileptics + viral infections
74
What is juvenile myoclonic epilepsy?
myoclonic jerks up to 2hrs after waking periods of absence which disrupt schooling, learning normal 10-20yrs at onset
75
What is benign rolandic epilepsy?
focal seizures with abnormal sensation in tongue/face interferes with speech, drooling may also happen in sleep - these often progress to tonic clonic seizures
76
What is Lennox-Gastaut syndrome?
age of onset 1-3yrs mix of seizures, especially atonic and tonic neuro-developmental arrest or aggression
77
How to investigate a child with first-time seizures?
EEG and follow up MRI if unclear/atypical features (then CT) Don't start anti-epileptics before knowing sub-type
78
What are the 4 key complications of chickenpox?
bacterial superinfection cerebellitis DIC progressive disseminated disease
79
How does bacterial versus viral meningitis present on LP?
Bacterial meningitis - turbid appearance, raised polymorphs, raised protein, low glucose Viral meningitis - clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose
80
What are the 2 cardinal sx of wilm's tumour?
abdominal mass painless haematuria
81
How does Kallman syndrome present?
delayed onset puberty + no facial/pubic hair small penis and testes reduced sense of smell poor balance learning disabilities
82
What are the extra-pyramidal side effects caused by anti-psychotics?
due to D2 receptor blockade in the nigrostriatal pathways parkinsonism acute dystonia (long-term = tardive dyskinesia) - bizarre body movements eg tongue protrusion, torticollis, oculogyric crisis akasthisia - restlessness
83
How can EPSEs of anti-psychotics be treated?
anti-cholinergic (due to increased cholinergic neurotransmission) eg procyclidine tardive dyskinesia treated with tetrabenazine
84
Which APs cause EPSEs?
do not occur with clozapine less likely + less prominent with atypical APs
85
What are the time scales for PTSD tx?
1st line = trauma focussed CBT (at least 1mo after trauma) active monitoring if present <1mo after trauma EMDR = presented between 1 and 3mo, non-combat trauma, prefer EMDR over CBT
86
What drugs are used for opiate detoxification?
methadone or buprenorphine 2nd line = lofexidine (preference or mild/uncertain dependance)
87
How is delirium tremends managed
hospital admission 1st = oral lorazepam 2nd = haloperidol or IV lorazepam
88
What is the 2nd line pharmacological tx for OCD?
1. SSRI 2. another ssri or clomipramine (TCA with anti-obsessional properties - if had adequate trial of 1+ SSRI and has preference for/against trying another SSRI)
89
How are PHQ scores interpreted?
5, 10, 15, 20 cut offs for mild, mod, mod severe and severe
90
How are GAD scores interpreted?
5, 10, 15 cut offs for mild, mod and severe
91
What are the side effects of SSRIs?
hyponatraemia (due to SIADH) long QT syndrome short term increase in risk of suicide - monitor every 2-4 weeks for first 3 mo
92
What is considered an adequate trial of an SSRI before changing?
4 weeks
93
For how long after a depressive episode should a patient continue taking ADs?
1st time = 6 mo 2+ episodes = 2 years
94
How often should people on clozapine after blood tests initially?
every week for 18wks then fortnightly until 1 yr monthly after this

Phase 3a (11 decks)

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