passmed Flashcards
(377 cards)
1
Q
SHORT STATURE AND AMEONNORHEA”?
A
TURNERS
2
Q
FSH AND LH levels in amenorrhea
A
both will be raised
3
Q
Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency?
A
uterine fibroids
4
Q
cocp are ci with ?
A
migraines with aura
5
Q
how to differentiate between endometriosis and fibroids
A
endo pain is cyclical - ie before and during period
fibroids can be all the time and more likely to feel a palpable mass
6
Q
typical history of ectopic pregnancy patient
A
female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
Shoulder tip pain and cervical excitation may be seen
7
Q
typical history of UTI patient
A
Dysuria and frequency are common but women may experience suprapubic burning secondary to cystitis
8
Q
typical history of PID patient
A
Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities may occur
Cervical excitation may be found on examination
9
Q
typical history of ovarian torsion patient
A
Usually sudden onset unilateral lower abdominal pain. Onset may coincide with exercise.
Nausea and vomiting are common
Unilateral, tender adnexal mass on examination
10
Q
typical history of patient with miscarriage
A
vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoe
11
Q
Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility
?
A
endometriosis
12
Q
typical history of patient with ovarian cyst
A
Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder
13
Q
most common side effect of progesterone only pill
A
irregular vaginal bleeding
14
Q
why is the cocp CI in post natal women
A
in women whoa re breastfeeding increased DVT risk in 6-8 weeks
15
Q
Stereotypical PCOS results
A
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low
16
Q
what happens with mirena coil
A
initially irregular bleeding followed by light menses or amenorrhea
17
Q
what is first line drug for infertility in PCOS
A
clomifine
18
Q
what is a common cause of recurrent first trimester miscarriage
A
anti phospholipid syndrome
19
Q
PCOS should be diagnosed if 2/3 of the following criteria are present:
A
-infrequent or no ovulation (thus oligomenorrhoea is the correct answer in this scenario)
-Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone (no mention of ‘low levels of oestrogen’)
-Polycystic ovaries on ultrasonography or increased ovarian volume
20
Q
what is androgen insensitivity
A
genetically XY but are phenotypically female due to reduced/absent testosterone receptors in target tissues.
21
Q
features of androgen insensitivity
A
‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol
22
Q
management of androgen insensitivity
A
counselling - raise child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy
23
Q
how to diagnose androgen insensitivity
A
buccal smear or chromosomal analysis to reveal 46XY genotype
24
Q
effects of the COCP on cancer
A
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
25
two differentiating factors of levy body dementia
fluctuating cognition
hallucinations
26
Urinary incontinence + gait abnormality + dementia
normal pressure hydrocephalus
27
motor neuron disease is associated with that type of dementia
front-temporal
28
how would progressive supra nuclear palsy present
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
29
what group of medications to avoid in Lewy body dementia and why
neuroleptics
such as haloperidol as it may cause irreversible Parkinsonism
30
secondary stroke management for pt with af?
aspirin for 2 weeks then life long anti coagulant
31
SE of mirtazipine
increased appetite
32
Obese, young female with headaches / blurred vision?
idiopathic intracranial htn
33
what virus is croup
parainfluenza
34
Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity
left posterior cerebral artery
35
Headaches, amenorrhoea, visual field defects
prolactinoma
36
Posterior inferior cerebellar artery stroke would present as?
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
37
basilar artery stroke?
locked in syndrome
38
amaurosis fugal stroke ?
retinal / ophthalmic artery
ipsilateral - same side
curtain coming down
39
similarities and differences between PICA and AICA
Ataxia, nystagmus
Pain and temperature loss: ipsilateral for face (trochlear nerve), contralateral for limbs (spinothalamic tract)
BOTH HAVE^^
AICA ONLY --Deafness
Facial paralysis (branches can compress the facial nerve)
40
FIRST LINE TX for croup
oral dexamethasone
41
coco increases risk of what cancer
cervical
breast
42
webers presentation ?
down and out
ipsilateral
43
Fluctuating consciencousness, behaving out of character, confusion would indicate what type of haemorrhage
subdural
44
long term side effect od levodopa
at peak dose it can cause chorea, dystonia after pt has been taking it for a few years
45
Middle-aged, personality changes, involuntary movements?
huntingtons
46
a headache linked to valsalva manouverus would indicate ?
raised ICP so a lumbar puncture would be CI
47
what class of medication can lead to medication overuse headache
opioids such as co cocodamol
48
what class of medications are mostly linked to behaviour changes for patients with Parkinson's
dopamine receptor agonists such as ropinorole
49
what medication for bipolar can cause , diminished tendon reflexes excess thirst, feeling cold, and weight loss
lithium
50
when are seri's contraindicated for patient with depression
if patient is on warfarin
manic episodes
ischaemic heart disease
51
what ssris are safe to use during breastfeeding
sertraline
paroxetine
52
first rank symptoms of schizophrenia
auditory hallucinations
delusional disorder
thought disorders, broadcasting insertion
passivity phenomena
53
how can we differentiate between posterior circulation stroke and vestibular neuronotis
HinTS exam
54
is hearing loss in Menderes unilateral or bilateral
unilateral
will also causie tinnitus
55
at what bmi does the use of coco outweighs the benefits
bmi over 35
56
what medication is used in Menieres to prevent attacks
betahistine
57
viral labrynthitis typical history ?
recently developed an upper respiratory tract infection presents with vertigo and vomiting. Hearing is also affected. The symptoms came on suddenly
horizontal nystagmus
58
a patient has a feeling of 'fullness' and 'pressure' in ears what does this indicate
menieres disease
59
low calcium low phosphate and bone pain and raised alp think ??
OSTEOMALACIA
60
what biochemistry would pagets show
raised alp
normal ca and phosphate
61
what symptom of croup would make you want to admit a child to hospital ?
stridor at rest
62
why should you not examine the throat in croup
if stridor is found it can cause further airway obstruction
63
most common cause of stridor in children
laryngomalacia
64
if mycoplasma pneumonia is found what abx would you give to a child ?
erythromycin
65
what is a common side effect of saba
tremor
66
what would constitute life threatening asthma
bradycardia
dysrhythmia
hypotension
92% or lower
silent chest
67
what would constitute severe asthma
can't complete sentences
rr>25/min
PEFR 33-50
68
non resp related features of cystic fibrosis
short stature
dm
delayed puberty
rectal prolapse
nasal polyps
male infertility
69
drug contraindications for asthma
beta blockers
adenosine
70
what is the target o2 sat in acute asthma
94-98
71
acute epiglottis is caused by what /
Haemophillis influenzai b
72
next steps for adult suspected asthma after presenting at gp
fractional exhaled nitric oxide + spirometry/bronchodilator reversibility test
73
strongest risk factor for developing a bells palsy?
pregnancy
74
who should be given ipratropium bromide
patients with severe or life threatening asthma , or in patients who have not responded to beta agonist and corticosteroid treatment
75
a normal pco2 of a patient with an asthma attack would indicate ?
life threatening as it is a sign of tiring respiratory effort as the high rr driven by hypoxia should result in a low pco2
76
what is the adult criteria to be met for asthma
- exhaled Reno of 40 parts per billion
-post bronchodilator improvement of more than 200ml
-post - bronchodilator improvement in FEV1 of 12 % or more
-
77
what monoclonal antibody is used to prevent babies from getting rsv
palivizumab
78
what is eczema herpeticum described as
monomorphic punched out erosions usually 1-3cm in diameter
79
difference of distribution of eczema rash of infants and older children
infants- extensor surfaces knees and elbows
older- elbow crease, knee crease , face and neck creases
80
how does seborrhoea dermatitis present in infants
greasy, yellow rash with flaky scales most common on scalp
81
Oral ulcers + genital ulcers + anterior uveitis
Behcets
82
first line medication for mild urticaria w sleep sx
chlorophenamine
83
severe or resistant urticaria you would give ?
oral prednisolone
84
how would erytheme multiforme present
giant non itchy target lesions
target lesions- dark centre with a blister, a ring around this that is pale pinkand raised with bright red outermost ring
85
what drugs commonly cause urticria
aspirin
penicllin
nsaids
opiates
86
how would lichen sclerosus present
itchy white patches on genitals
intense itching
thinning of vulvar skin
87
first line tx for mild urticaria
non sedating anti histamine like loratadine
88
what is nikolsly sign positive
blisters and erosions on gently rubbing the skin
89
what is pompholyx eczema characterised by
acute eruptions of deep seated vesicles in the palms and fingers
90
what is the main side effect of using topical decongestants for prolonger periods
tachyophylaxis
91
patients feel that their eyes are gritty and sometimes stick in the morning, what is this?
blepharitis
92
what are the first rank symptoms of schizophrenia
passivity phenomena
thought disorders
delusional perceptions
3rd person auditory hallucinations
93
how to differentiate acute stress disorder vs PTSD
Acute stress - first 4 weeks sx
ptsd- after 4 weeks
94
what should patients be warned about before taking pregablin
increased risk of suicidal thinking and self harm
weekly follow up is recommended for the first month
95
define obsession
intrusive, unpleasant and unwanted thought
95
body dysmorphia ocd medication
fluoxetine
96
define compulsion
senseless action taken to reduce the anxiety caused by the obsession
97
if first line SSRI is ineffttive in GAD what is second line
duloxetine or
98
If patient w ocd feels better with sertraline and wants to stop what is the guideline
to continue for 12 months
99
what part of the brain is involved in the flight or fight response
amygdala
100
what is the system to assess pressure sores
Waterlow score
101
when can orthostatic htn be diagnosed
after lying standing bp if the systolic drops below 20mmhg or more
a drop to below 90 even if less than 20
102
first line management for alzheimers
donepzil
acetylcholinesterase inhibitor
103
what medication/s are CI in patients with parkinsins
haloperidol
104
what is commonly prescribed when patients are in an acute confusional state and become aggressive
haloperidol
if Parkinson's then lorazepam
105
typical history of a myasthenia graves patient
40yr old woman with muscle weakness, affecting her legs , double vision but better with rest
106
management of myasthenic crisis?
iv immunoglobulin + plasmapharesis
107
what is polymyositis
inflammatory disorder causing symmetrical proximal muscle weakness
associated with malignancy
108
features of polymyositis
-proximal muscle weakness +/- tenderness
-raynauds
- rest weakness (COPD hx)
109
what would investigations show
increased CK
AST AND ALT may also be raised
110
what is Lambert eaton syndrome
in association with small cell lung cancer
limb girdle weakness
111
What are the features of anorexia
Reduced bmi
Bradycardia
Hypotension
Enlarged salivary glands
112
Physiological abnormalities of anorexia ?
Hypokalaemia
Low fsh lh oestrogens testosterone
Raised cortisol and growth hormone
Impaired glucose tolerance
Low t3
113
bullimia vs binge eating disorder ?
bullimia = binge eating followed by compensatory mechanisms , vomitting, laxatives
binge eating = binge but no compensation
114
first line tx for anorexia?
anorexia focused family therapy
115
what are the indications for surgical management of ectopic pregnancy
- ruptured ectopic
-signs of infection ie fever
- fatal heartbeat on uss
-significant pain
>35mm mass
-hcg above 5000
116
expectant management of ectopic is used if ?
-unruptured embryo
- \<35mm in size
- no heartbeat
- asymptomatic
- hcg <1000
117
first line medical management of ectopic
methotrexate
118
when should salpingostomy be used instead of salpingectomy in ectopic ?
when woman has risk factors for tube damage such as PID
119
How will a threatened miscarriage present
painless vaginal bleeding and closed cervical os
120
management for incomplete miscarriage
single dose misoprostol
121
If bishop score is above 8 what is the management
Cervix is ripe or favourable , high chance of spontaneous labour
122
If bishop score is above 8 what is the management
Cervix is ripe or favourable , high chance of spontaneous labour
123
Management if bishop score is below 6
Vaginal prostaglandin or oral misoprostol
124
First line investigation for PROM
Sterile speculum examination
125
Main complication of induction of Labour ?
Uterine hyper stimulation
126
is respiratory depression occurs in pregnancy with mag sulph what would you give
calcium gluconate
127
what position would woman be in for mcroberts manouvere
supine with both hips fully flexed and abducted
128
correct position for women who have cord prolapse?
all four
knees and elbows
129
how long should magsulphate be given for eclampsia
24 hours after delivery/ last seizure
130
first line medication for eclampsia
labetalol
131
main features of encephalitis
fever headache psychiatric symptoms seizures vomitting aphasia
132
where does encephalitis typically affect
temporal and inferior frontal lobes
133
what are the contraindications of a lumbar puncture
focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation
134
what is the most common complication of meningitis
sensorineural hearing loss
135
how would you differentiate between meningitis rash and meninigoccal septicaemia rash
meningitis- non blanching rash
meningococcal- purpuric rash - more purple and black
136
what do you give close contacts of someone infected with meningitis
oral ciprofloxacin
137
what is a life threatening effects of clozapine
agranulocytosis need to monitor FBC
138
drug used for patients with alcohol withdrawal ?
chlorodiazepoxide
139
what test results would you expect t o find in downs syndrome
increase in bHCG
decrease in PaPPA
Thick nuchal translucency
140
what are the clinical features of downs ?
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced 'sandal gap' between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung's disease
141
weak femoral pulses on a baby in a 6 week check would make you think ?
coarctation of the aorta
142
use of indomethacin and prostaglinds post birth for neonates is used for what purpose ?
indomethacin- inhibits prostaglandins so will shut things
prostalgandins- to keep things open until corrective surgery can be performed
143
left subclavicular thrill, a heaving apex beat, and a continuous 'machinery like' murmur?
patent ductus arteriosus
144
what murmur do you hear in tetralogy of fallout?
ejection systolic murmur
145
lack of milk production and amenorrhea post birth would indicate ?
Sheehans syndrome
ischaemic necrosis of the pititutary gland
146
first line surgical management for pph
intrauterine balloon tamponade
147
alternative to oxybutinin in frail old women with dementia ?
meragabnon
148
what medication is used to treat alcohol addiction that causes them to violently vomit
disulfiram
149
what drug is used for anti craving in alcohol
acamprostate
150
what medication commonly caused serotonin syndrome
tramadol
151
what can cause necrotising fasciitis in pt with chicken pox
beta- haemolytic group a streptococcus
152
what is an indication for high dose aspirin in childrn
Kawasaki disease
153
elderly patient with unilateral rash that is macular then vesicular and also painful ?
shingles
154
where can shingles be reactivated
dorsal root ganglion
cranial nerve ganglion
155
what form of contraception is completely CI in breastfeeding women
COcP
156
UKMEC4 for cocp
-more than 35 years old and -smoking more than 15 cigarettes/day
-migraine with aura
-history of thromboembolic -disease or thrombogenic -mutation
-history of stroke or --ischaemic heart disease
-breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
157
contraceptives and their time until effectiveness ?
IUD- instant
POP- 2 days
COC, IUS,Injection, implant - 7 days
158
what contraception is safe in breastfeeding women
progesterone only pill
159
which form of contraception has a proven link to weight gain
depo injection
160
what is the guideline regarding going back to school with Scarlett fever
can return 24 hrs after the first dose of ABX which is oral penicillin
161
most common complaint in crohns, adult vs child
adult = bloody diarhhoea
child= abdominal pain
162
first Line medication for spasticity in multiple sclerosis
gabapentin
baclofen
163
typical MS history
30-40 YO woman with visual issues, tingling, relapsing and remitting
164
typical history of child w intusuccesption
inconsolable crying child, currant / red stools/ knees to chest , billions vomitting
165
first line management of hirschprungs
bowel irrigation/ wash out
166
A 6-week-old baby boy presents with 'projectle' vomiting 30 minutes after feeding. On examination he is mildy dehydrated and has a small palpable mass in the upper abdomen is a stereotypical history of
pyloric stenosis
167
necrotising enterocolitis typical history ?
1 week old with feeding intolerance , dark urine and pale stools
x ray shows gas cysts/ bubbles
168
a patient comes into the ER with acute chest pain, fever, dyspnoea and cough with px admission of joint pains what are you thinking
sickle cell crisis
169
long term management of sickle cell
hydroxyurea - increases hbf levels
170
Isolated rise in GGT in the context of a macrocytic anaemia should suggest
alcohol excess
171
blood film for megaloblastic anaemia would show ?
hyper - segmented neutrophil polymorphs
172
psych patient believes they are dead what is this phenomenon
cotard syndrome
173
psych patient repeating questions back to you
echolalia
174
capgras syndrome
irrational delusion of misidentification where patients believe that a relative has been replaced by an identical imposter
175
Charles bonnet syndrome?
patients with significant vision loss have vivid, often recurrent visual hallucinations
176
endocrine disorder linked to chronic lithium toxicity
hypothyroidism
177
what SSRI is most likely to lead to qt prolongation
citalopram
178
how long should antidepressants be taken once patients wants to stop
6 months
179
what examinations must you do before starting lithium
ecg- prolongeg QT syndrome
U and E
TFT
180
what are some effects of lithium toxicity
seizures
coma
tremor
convulsions
181
mechanism of tamsulosin
a-antagonist
182
mechanism of finasteride
5 alpha reductase inhibitor
183
mediation for UTi in non pregnant women and men
non pregnant women - nitrofurantoin or trimethoroim for 3 days
men- same but for 7 days
184
for what reason would you send a urine culture in suspected UTI
-OVER 65 female
-pregnany
-visible or non visible haematuria
-men
185
common side effect of tamsulosin
dizziness and postural hypotension
186
uti treatment for pregnant woman
nitrofurantoin for 7 days
187
what would a blood film show in myeloma
rouleax formation
188
burrkits lymphoma is associated with what mutation
translocation of c myc gene
189
characteristic blood film finding of CLL
SMEAR/ SMUDGE CELLS
190
Where would you find auer rods
acute myeloid leukaemia
191
common causative organism for Haemolytic uraemic syndrome and its sx
E coli 0157
bloody diarrhoea preceding gastroenteritis
192
what is hypospadias
ventral urethral meatus
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms
193
nephrotic syndrome is associated with a hyper coagulable state due to ?
loss of antithrombin 3 and plasminogen via the kidneys
194
Membranous glomerulonephritis histology:
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
195
causes of acute interstitial nephritis
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
systemic disease: SLE, sarcoidosis, and Sjogren's syndrome
infection: Hanta virus , staphylococci
196
features of acute interstitial nephritis
-fever,
-rash,
-arthralgia
-eosinophilia
-mild renal impairment
-hypertension
197
psgn vs iga nephropathy timeframe
psgn- 1-2 weeks after strep infection
iga- 1-2 days after iga ifection
198
tetracyclines for acne management should be avoided in what patient population
breastfeeding
under 12
pregnant
199
what is first line for moderate acne
tetracycline + retinoid/ benzyl peroxide
doxycycline
200
safe medication for acne in pregnancy
oral erythromycin
201
what medication needs a dermatologist referral and what warrants it
topical isotretinoin
scarring , pitting severe acne
202
first line mx for non bullous impetigo
1% hydrogen peroxide cream
203
second line mx for impetigo
topical fusidic acid
204
what syndrome must you look out for with olanzapine/clozapine
acute dystonic reaction
205
how long does a section 2 last
28 dasy
206
how long Is a section 3
6 months
207
how long is a section 136
24hrs so the police can take someoen from a public place to a place of safety
208
what murmur would you expect in turners
ejection systolic murmur due to bicupsid aortic valvw
209
potential complication of fragile x
mitral valve prolapse
210
long term cardiac complication of turners
aortic dissection and dilatation n
211
common cardiac pathology with Duchenne muscular dystrophy
dilated cardiomyopathy
212
diet advice for cystic fibrosus
high fat high calorie with pancreatic enzymes with every meal
213
presenting features of cystic fibrosis
neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
recurrent chest infections (40%)
malabsorption (30%): steatorrhoea, failure to thrive
other features (10%): liver disease
214
what is used for peri and pre menopausal woman in breast cancer
tamoxifen
215
what is used for post menopausal women in breast cancer
anastrozole
216
side effects of tamoxifen
vte
endometrial cancer
217
when is excision of fibroadenoma indicated
more than 3cm
218
hormone levels and management for patient with subclinical hypothyroidsim
normal t4 but low raised tsh
give thyroxine
219
what is tangentiality
Tangentiality refers to wandering from a topic without returning to it.
220
what is circumstantiality
Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.
221
young obese boy with groin pain and limp?
management?
slipped capital femoral epiphysis
in situ fixation with cannulated screw
222
blood test results for osteogenesis imperfecta
normal path, calcium, calcitril, calcidiol
223
most common benign ovarian tumour in women under 25
dermoid cyst - teratoma
224
Most common type of ovarian pathology associated with Meigs' syndrome
fibroma
225
ovarian torsion would show what on ultrasound?
whirlpool sign
226
why should metaclopramide not be used for more than 5 days in hyperemesis gravid arum
risk of extra pyramidical effects such as tremor
227
how would you confirm ovulation
take progesterone levels 7 days before next period
228
most common cause of post coital bleeding
cervical ectropion
229
first line menorrhagia tx?
mirena ius
230
first line tx for gonorrhoea
1g im ceftriaxone
231
first line tx for bv and tv
ORAL METRONIDAZOLE
232
how to diagnose premature ovarian insufficiency and tx
raised fish on two account
HRT till 51 or combined oral contraceptive till 51
233
how to diagnose complete miscarriage on us
-The crown-rump length is greater than 7mm OR
-The gestational sack is greater than 25mm
234
thrush first line mx
oral fluconazole - not pregnant
pregnant - clomitrazole pessary
235
most common se of ivf
ovarian hyperstimulation syndrome
236
what does adding progesterone to HRT do
increase risk of breast cancer
237
most common cause of post menopausal bleeding
vaginal atrophy
238
prophylaxis for infantile spasms
buccal midazolam
rectal diazepam
239
most common cause of horners
pan coast tumir
240
pregnant woman with jaundice and itchy skin would indicate ?
obstetric cholestasis
241
presentation of molar pregnancy
painless vaginal bleeding
excessive morning sickness
SOB
242
BY what week should mother feel feral movements at the latest ?
24 weeks if not then refer to FMU
243
Immediate management if pregnant women has confirmed DVT
LMWH
244
first line management for reduced fetal movements ?
handheld doppler to confirm heartbeat
245
how does blood pressure change throughout pregnancy
blood pressure falls in the first trimester
till 24 weeks then begins to increase till term
246
define pregnancy induced htn
hypertension post 20 weeks gestation
no proteinuria or oedema
140/90 +
247
most common cause of fever/ infection of post partum woman
endometriosis with c section
248
biggest risk factor for PPH
placenta accreta
249
guidance on folic acid during pregnancy
women should take 4mg before conception
women with raised BMI, epilepsy , fh of neural tube defect to take 5
250
management for acute pulmonary oedema
iv furosemide
251
what vaccine should all heart failure have
annual influenza
252
what combination therapy is not recommended in heart failure patients
ace inhibitor and arb
use spironolactone instead
253
women collapses after PROM? what is the most likely diagnosis
Amniotic fluid embolism
254
first line management for mastitis
oral flucoxacillin for 10-14 days
continue breastfeeding and expressing
255
what drugs should be avoided in breastfeeding ?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
256
medication of choice to suppress breast feeding
cabergoline
257
how would you assess SGA
Symphysis fundal height should correlate to gestation by 1-2cm
258
what is HELPP syndrome and how does it present
severe pre eclampsia
presents as malaise, headaches, vomiting
259
most important prognostic factor in paracetamol overdose
arterial blood gas ph
260
main point for liver transplant in paracetamol overdose
ph less than 7.3
261
typical MS patient history
young person with relapsing remitting sx
balance issues, increased tone and clonus
pupillary defect
262
what is the alternative to clopidogrel in stroke treatment if it is CI
ASPIRIN AND DIPYRIDAMOLE
263
mechanism of ondansetron
5 HT3 ANTAGONIST
264
vision worse going down stairs ?
4th nerve palsy
265
MANAGEMENT Of brain abscess
cephalosporin + metronidazole
266
what blood test will differentiate between true seizure and pseudoseizue
prolactin
267
what obstetric condition would cause painless vaginal bleeding
placenta previa-
placenta completely or partially covers the cervix
268
chorionic villi invade the myometrium but not the perimetrium
placenta accrete
269
timeframe for cat 1 c section
30 mins
270
presentation of chorioamnionitis
uterine tenderness and foul smelling discharge
271
scale for post natal depression
Edinburgh scale
272
what would variable decelerations indicate
cord compression
273
what would early decelerations indicate
head compression
274
what would late declarations indicate
placental insufficiency
275
adrenaline doses for anaphylaxis
under 6 months - 100-150mcg
6m-6yrs- 150mcg
6-12- 300mcg
12+ -500mcg
276
most useful test to establish anaphylaxis
serum tryptase
277
define threatened miscarriage
painless vaginal bleeding , cervical os is closed
278
define missed miscarriage
gestational sac contains a dead foetus but remaining utero
279
define inevitable miscarriage
cervix is dilated, heavy bleeding , clots and pain
280
define incomplete miscarriage
not all products have been expelled , pain and vaginal bleeding
281
ectopic pregnancy RF
damage to tubes- pID
previous ectopic
IUCD
progesterone pill
IVF
282
wha measurement would make you consider hydratiform mole
excess bhcg 300,000
283
typical px of hand foot and mouth
fever then ulcers in mouth
red spots on hands and feet
284
what is hand foot and mouth caused by
coxsackie a16
more rare enterovirus 71
285
biggest risk factor for toxic shock syndrome
use of tampons
286
hormone findings in kallman syndrome
low fhs/lh
low testoerone
287
key unique finding of pt with kallman syndrome
taller than average
anosmia - no smell
288
post MI drugs
Ace inhibitor
Beta blocker
statin
aspirin
ticagrelor
289
reasons for PCI with NSTEMI/ UNSTABLE ANGINA
IMMEDIATE- patient is hypotensive or clinically unstable
within 72 hrs- if GRACE score is above 3%
290
a patient develops acute HF 5 days post MI ? what is this and what is heard
Ventricular septal defect
new pan systolic murmur
raised JVP
bi basal crackles
291
characteristics of acute epiglottis and its cause
tripod position - neck extended
haemophillus influenzae
292
main points about polymyalgia rheumatica
ESR is raised
shoulder and neck pain
difficulty getting out of chair
morning stiffness
ORAL PREDNOSOLONE
293
management of stroke if pt presents within 4.5hrs and no evidence of haemorrhagic stroke
aspirin 300mg
thrombolysis with alteplase within 4.5h and thrombectomy within 6h
294
does amaurosis fugax cause ipsilateral or contralateral vision problems
ipsilateral
295
After what period of time would continued lochia warrant further investigation with ultrasound?
loch
296
what is bhcg secreted by
syncitiotrophoblasts
297
guidance regarding methotrexate in conception
both men and women should stop for 6 months
298
classic triad of sx for vasa previa
painless vaginal bleeding
rupture of membranes
bradycardia
299
normal pregnancy lab findings
Reduced urea, reduced creatinine, increased urinary protein loss
300
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers is typical for ?
edwards
301
most common fracture in childhood abuse
humeral fracture
302
neonatal causes for jaundice
rubella
syhphillis
G6PD def
haematome
303
possible complication If biliary atresia is not sorted
kernicketerus
304
treatment for neonatal jaundice
phototherapy
exchange transfusion
305
signs of cyanotic heart disease
poor feeding, dyspnoea, tachycardia, weak pulse, engorged neck veins, sweating, gallop
306
risk factors for respiratory distress syndrome in neonates
maternial diabetes
c section
second twins
males
hypothermia
perinatal asphyxia
307
what cells produce surfactant
type 2 pneumocytes
308
patient loses conciosunes sbrifefly regains then loses again is what type of stroke
SUBDURAL HAEMATOMA
309
what medication commonly causes Steven Johnson syndrome
carbamezapine
used in epilepsy, trigeminal neuralgia
310
DVLA rules on epilepsy
6months no driving with first unprovoked sezure
12 months seizure free for epileptics
311
nerve root for biceps reflex
c5-c6
312
cushings triad ?
widening pulse pressure
hypertension
bradycardia
313
how would a pontine haemorrhage present
reduced GCS
paralysis
pinpoint pupils
314
medications for neuropathic pain
amitryptyline
duloxetine
gabapentin
pregablin
315
what is de clerambaults syndrome
erotomania - delusion that someone famous is in love w th them
316
what is de fregoli syndrome
delusion that identifying a familiar person in various people they encounter
317
indications for catatonia
treatment resistant severe depression
manic episodes
life threatening catatonia
318
what is conversion disorder
functional neurological disorder
319
what is somatosisation disorder
patient feels multiple sx but ni tests can provide any answer
320
what is a common SE of nexplanon and how can it be treated
irregular menstrual bleeding
three month course of COCP
321
what are the common extra pyramidal se of typical antipsychotics
Parkinsonism
acute dystonia
tardily dyskinesia
akathisia
322
what is tardive dyskinesia
repetitive involuntary movement such as pouting mouth
323
what are the feature of acute dystonia
torticollis
oculogyric crisis
mouth open
pain and distress
324
what is neologism
making up new words
325
what is perseveration
repeating the same words/ answers
326
what is catatonia
Stopping of voluntary movement or staying still in an unusual position
327
drug related Parkinson would present how?
with a bilateral resting tremor
328
management for acute dystonia
IM PROCYCLIDINE
329
management for tardike dyskinesia
tetrabenezine
330
what is akathisia and management
restlessness
propranolol
331
what is a section 2
admission for up to 28 days
APHM on the recommendation of two doctors
tx can be given without wishes
332
what is a section 3
6 months - can be renewed
pt must have been seen within past 24hrs
tx can be given against wishes
333
what is a section 4
72hr assessment
used as an emergency
often changed to a section 2 once at hospital
334
what is a section 5(2) and 5(4)
5,2 doctor can detain patient in hispital for up to 72hrs to assess and determine if further tx necessary
5,4 nurse or mhp can detain for 6 hours only id doc cant do so
335
section 136
24hrs
someone found in public space can be taken to a place of safety by the police
336
what do you give to a pt who presents with confusion agitation with liver cirrhosis/ without
with liver cirrhosis-lorazepam
without- chlordiazepoxide
337
most common cause of IE within 2 months of valve replacement and after 2 months
within 2 months - s epidermis
after2 months - s aureus
338
mc location site of infective endocarditis
IVDU- tricupsid
MITRAL FOR EVERYONE ELSE
339
treatment for acute relapse, first line tx and preventing relapses of multiple sclerosis
acute relapse = methyl prednisolone
first line - baclofen or gabapentin
relapse prevent- natalizumab , monoclonal AB
340
first line tx for myasthenia gravis
pryridostigmine
341
first line for most dementias
donepzil - ach inhibitor
342
Triad of symptoms for haemolytic uraemic syndrome
AKI
THROMBOCYTOPENIA
normocytic anaemia
343
Tx for delirium tremens in alcohol withdrawal
Iv pabrinex and high dose benzo
344
acute treatment and prophylaxis of cluster headaches
acute- high flow oxygen and subcutaneous sumatriptan
prophylaxis - verapamil
345
How would you manage post partum thyroiditis
propranolol not thyroid medication
can present up to a yr after birth
346
what is the post partum cut off for iron therapy regards to hb
100
347
most common cause of post partum pyrexia
endometritis
mx- send to hospital
348
what would blood film for HELPP syndrome show
shistocytes and polychromasia
349
causes of oligohydramniosis
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
350
by what week should lack of fetal movements concern you
24 weeks
351
what would indicate viral meningitis over bacterial
csf would show normal glucose and normal protein
bacterial - reduced glucose and increased protein
352
most common complication following meningitis
sensorineural hearing loss
353
first rank sx of schizophrenia
delusional disorder
passivity phenomena
auditory hallucinatiins
thought disorders
354
typical history for anterior uveitis and the management
pt who has history of chrons or UC or ankylosing spondiltits has sudden onset eye pain with redness and lacrimation and photophobia
steroid eye drops and cycloplegic eye drops
355
what is the significance of fetal fibronectin in women
protein that is released from gestational sac
can indicate that labour is soon but women can also end up being full term
356
planned VBAC Is CI in what patients
vertical c section scar
prior uterine rupture
placenta previa
357
highest morbidity and mortality position for baby to be born
footling position
358
what is placenta increta
chorionic villi invade into the myometrium but not the perimetrium
359
blood results for molar pregnancy
hig bhcg
low tsh
high thyroxine
360
most common treatment plan for termination of pregnancy
mifepristone + misoprostol 48hrs later and multi level pregnancy test 14 days later
361
how to confirm PROM
sterile speculum
if no pooling of liquid then test placental alpha microglobulin or insulin like growth factor
362
typical hx of patient with a vesicovaginal fistula
continuous urine dribbling not linked to sneezing or coughing after a prolonged labour
363
what is a myelopathy and radiculopathy
r- compression of nerve root
m- compression of spinal cord
364
how may a radiculogpthy present c7
arm pain
sensory loss
motor loss- weakness
diminished or absent reflexes
no tricep reflex
365
how may a c7 myelopathy present
umm and lmm signs and compression will affect discs below
- arm pain
reduced power
- leg pain
- tripping over
-positve Hoffman test
366
what Is an ataxic gait
can't walk heel to toe and a wide gait
367
first line for idiopathic intracranial hypertension
acetozolamide
368
how would IIH oresent
worse headache on postural movements
intermittent visual loss
young fat female
369
drugs that increase the risk of idiopathic intracranial hen
COMAAR - ciclosporin, oral contraceptives, mineralocorticoids, amiodarone, antibiotics (tetracyclines, sulphonamides), retinoic acid.
370
triad of sx for wernickes
confusion, ataxia and nystagmus
give iv pabrinex
371
normal pressure hydrocephalus imaging findings
ventrucomegaly witout sulcal enlargement
372
what cranial nerves are affected in vestibular schwannoma
5 7 8
373
loss of corneal reflex think ?
acoustic neuroma
374
lateral medullary syndrome or wallenberg syndrome is also known as .
posterior inferior cerebellear artery stroke
375
lateral pontine syndrome is also known as
anterior inferior cerebellar artery stroke
376
