Passmed Mock 1 corrections Flashcards
(52 cards)
3 organisms that cause post-splenectomy sepsis;
Haemophilus influenzae
Strep pneumoniae
Meningococci
Small isolated fragments of splenic tissue can implant following splenic rupture in trauma, or be surgically implanted at time of splenectomy. This can cause the sepsis.
What is the standard criteria for stroke thrombolysis, and what is given instead if these criteria are not met?
Exclude haemorrhage (urgent CT)
Within 4.5 hours of symptom onset
Thrombolysis would be alteplase if these criteria are met, and then 24 hours later 300mg aspirin.
If not, they should be treated with aspirin 300mg.
Isolated motor loss ?
Lacunar stroke - e.g. contralateral dense hemiplegia
Which score is used to identify patients at risk of pressure sores?
Waterlow score
A patient has a left homonymous hemianopia. Where would the lesion be?
RIGHT optic tract
How to remember homonymous quadrantanopias?
PITS
Parietal - inferior
Temporal - superior
i.e. surgery to left temporal lobe; RIGHT SUPERIOR homonymous quadrantanopia
A patient presents with sudden PAINLESS loss of vision and severe retinal haemorrhages on fundoscopy. What has happened?
Central retinal vein occlusion.
Optic disc will be swollen
Blot and flame shaped haemorrhages
How would central retinal ARTERY occlusion present?
Sudden painless loss of vision (as in vein occlusion) BUT cherry-red spot on fovea would be present.
Blood flow to retina is obstructed, leading to ischaemia and subsequent infarction of the retina.
Ischaemic optic neuropathy is similar, but would have a pale swollen optic disc instead.
What is the minimum amount of time that a patient should leave between 1st and 2nd puff of an inhaler?
30 seconds
What is first line in mild/moderate cellulitis? And what is the option in cases of allergy?
What is indicated if severe cellulitis is present?
Flucloxacillin
Clarithromycin / erythromycin (pregnancy) / doxycycline
IV ceftriaxone
Which vaccine should MSM be offered?
Which other at-risk groups should be offered this?
Hepatitis A
Close contacts of HAV +ve
Travellers
Chronic liver disease
IVDU
Haemophilia
Occupational exposure e.g. sewage workers, primates
What is the classic presentation of anterior uveitis? What is used to treat it?
Photophobia
Small irregularly shaped pupils
Red eye
Steroids to reduce inflammation
Cycloplegic (mydriatic) eye drops e.g. atropine dilate the pupil and help with pain relief and photophobia
All men with ED should have what checked?
Morning testosterone
What acid-base disturbance does diarrhoea cause, and why?
Metabolic acidosis (low HCO3 and normal CO2) with a NORMAL anion gap.
The anion gap is normal because the GI loss of bicarb causes a reciprocal increase in serum chloride.
(Vomiting causes an alkalosis, as gastric secretions which are acidic are lost, compared to GI contents.)
Give 3 causes of metabolic acidosis with a RAISED anion gap, and discuss why it is raised.
Sepsis
DKA
Methanol poisoning
All of these lead to generation of an anion that is NOT included in the anion gap calculation:
Septic shock = rise in lactic acid
DKA = ketones
Methanol = formic acid
Corticosteroids are indicated in the management of severe alcoholic hepatitis to limit inflammation. What score is used to indicate whether steroids will be of benefit?
Maddrey’s Discriminant Function
What are the conservative management options for anal fissures? What might be considered for cases that do not respond to these?
High fibre diet
Laxatives
Lubricants
Topical GTN
Sphincterotomy might be considered if it is not managed by these methods.
Which type of stoma can be used to defunction the colon after e.g. rectal cancer surgery to protect an anastomosis?
Loop ileostomy
Can be reversed
A child has URTI symptoms and is treated with amoxicillin. They subsequently develop a widespread maculopapular rash. What are you suspicious of, and how should you test for it?
Glandular fever!
Check with a monospot test.
Caused by EBV - heterophil antibodies are detected on the monospot test.
Symptoms include enlarged tonsils, red throat, fever and lymphadenopathy.
What would be seen on a FBC in a patient with glandular fever?
Lymphocytosis
What is the key diagnostic test in GBS?
Lumbar puncture, demonstrating high protein levels and normal WCC.
What is used to prevent vasospasm in aneurysmal SAH?
Nimodipine - given as a 21 day course.
It is a dihydropyridine CCB that targets brain vasculature.
State some triggers that can worsen plaque psoriasis.
Alcohol
Smoking
Stress
Beta blockers
Discontinuing steroids
Initiating NSAIDs
Lithium
Antimalarials
Which lobes are Broca’s and Wernicke’s areas in?
Broca = frontal (nearer to the mouth that produces FLUENT SPEECH)
Wernicke = temporal (near the EAR, where speech is HEARD to comprehend what was said)
