Past papers Flashcards
(205 cards)
1
Q
DDx depression in 45yo with Down’s syndrome ( 6 mo Hx agitation, incontinence of urine, aggression)
A
Alzheimer’s
Hyperthyroidism
Trauma?
Also: hypothyroidism, cushing’s disease
2
Q
Ix for depression
A
CT head
TFT
3
Q
Bowel-related complications of NEC
A
Strictures
? malabsorption
4
Q
Radiological findings suggestive of NEC
A
Distended bowel loops
Thickened bowel wall
Intramural gas
5
Q
2 immediate non-surgical interventions for NEC
A
Stop oral feeding
Broad spectrum Abx
6
Q
Two causes of irregular cycle?
A
PCOS
Excessive weight loss or gain
7
Q
What two non hormonal interventions to control dysmenorrhoea and menorrhagia?
A
NSAIDs - for dysmenorrhoea (mefenamic acid)
Anti-fibrinolytics- for menorrhagia (tranexamic acid)
8
Q
Ix PCOS
A
Serum testosterone
USS abdomen
9
Q
List 6 causes (2 endocrine, 2 neuro, 2 medicated side effects) of failure to ejaculate
A
Endrocrine: low testosterone, low thyroid
Neuro: stroke, neuropathy
Medicated: antidepressants e.g. fluoxetine - SSRI, Beta-blocker - propranolol
10
Q
Psychosocial reasons for failure to ejaculate
A
Anxiety +/- depression that can –> suppress sexual desire
Cultural or religious taboos
Trauma
11
Q
Psychological interventions for failure to ejaculate
A
Psychological counselling
Sex therapy
12
Q
Most common delusions in someone with paranoid schizophrenia?
A
Persecutory delusion
13
Q
Schizophrenic started on haloperidol and gets contractions in muscles straight away, what is this?
A
Acute dystonic reaction
14
Q
Rx Acute dystonic reaction
A
IM/IV Benztropine
Alternative: procyclidine
15
Q
Pt saw a traffic light turn red and then realised he was being followed: what is this?
A
Delusional perception
A 1st rank symptom
others: aud hal, delusions of thought interference, passivity phenomenon/delusions of control
16
Q
3 neurological signs of lithium toxicity
A
coarse tremor
seizures
coma
hyper-reflexia
17
Q
Physical signs hypothyroidism
A
Bradycardia brittle nails dry skin delayed relaxation of deep tendon reflexes goitre
18
Q
Why induce labour at 42 weeks?
A
to preven IU fetal death
19
Q
Methods to induce labour
A
prostaglandin pessary
IV oxytocin
amniotomy (AROM)
20
Q
What are the elements of the Bishop’s score?
A
Cervical Position Cervical Consistency Cervcial Effacement Cervical Dilation Station
21
Q
Ix for ectopic pregnany (if HCG and ultrasound scan already done)
A
Laparoscopy
22
Q
3 treatments avaliable for ectopic pregnancy
A
methotrexate
salphinectomy
salphinotomy
23
Q
Name 3 reassuring features on CTG
A
Fetal HR 110-160
Fetal variability >5bmp
No fetal deceleration
24
Q
RFs ectopic pregnancy
A
Submucosal fibroids IUD Chlamydia PID Previous surgery Asherman's
25
what is the incidence of ectopic pregnancy?
1%
26
What is the recurrence rate of an ectopic pregnancy?
10%
27
Parents of a child who has had a febrile convulsion, what should they do if he has another fit?
1. Recovery position
| 2. Buccal midazolam
28
Baby jaundiced at day 3 but otherwise well, likely Dx?
Physiological jaundice
29
If baby has jaundice for 3 weeks, what 2 signs would lead you to think underlying pathology?
Dark urine
Pale stools
(biliary atresia)
30
2 nursing strategies for confused agitated patient
Reality orientation
| Correct sensory impairment
31
What Rx would you presribe for confused agitation patient for use as required?
An antipsychotic e.g. haloperidol
NOT a benzodiazepine as may worsen condition
32
3 chronic conditions that may lead to erectile dysfunction in 20yr old man
DM
MS
Anxiety
PTSD
33
What is a never event?
A significant, largely preventable event that would not occur if the relevant safety guidelines are followed
34
Give an example of a never event
Misidentification
35
When investigating a never event, what is the personal approach and what is the systems approach. Which should you use?
Personal approach: holding 1 person responsible for the event
Systems approach: identifying there are latent errors in the system and that latent + active causes come together to cause error
**The latter eliminates blame culture**
36
What is the principle neuroreceptor that anti-psychotics work on?
Dopamine D2 receptor (antagonist)
37
What is characterised by a feeling of inner restlessness and inability to stay still?
Akathisia
38
What antihypertensives for pregnant women with mild-->moderate hypertension?
Labetalol
| Nifedipine
39
When should folic acid be taken?
From trying to get pregnant up until 12 weeks pregnant
40
List 2 early pregnancy risks and 3 fetal/neonatal complications with uncontrolled diabetes?
Pregnancy risks: miscarriage, stillbirth, preterm delivery
Fetal complications: macrosomia, shoulder dystocia, neonatal hypoglycaemia, congenital defects, SFD, fetal RDS
41
Routine antenatal Ix to check risk of uncontrolled maternal diabetes?
```
GTT
BP
Blood glucose
Urinalysis
Uterine Doppler artery
```
42
Blood tests for chronic alcoholism
GGT (gamma-glutamyl transferase
RBC MCV
AST+ALT
Carbohydrate-deficient transferrin (CDT)
43
What tests would you do to check someone is ovulating?
Day 21 mid-luteral progesterone
(should be 7 days before end of their cycle)
Day 5 FSH
44
What 2 tests for tubal patency (infertility)
Laparoscopy plus dye + HSG (hysterosalphingogram)
HyCoSy
45
which is the preferred test to test tubal patency and why?
HyCoSy - no use of radioactive contrast
46
In a couple struggling to conceive, what tests can the male undergo?
Sperm analysis
FSH/LH levels
47
45 y/o woman sweaty hands, heart racing. Snappy and irritable. What would make u think hyperthyroidism?
```
increased appetite
wt loss
diarrhoea
neck swelling
resting tremor
thin hair
palmar erythema
exopthalmos
```
48
45 y/o woman sweaty hands, heart racing. Snappy and irritable. What would make u think menopause?
```
hot flushes
night sweats
vaginal dryness
skin + breast atrophy
atrophic vaginitis
```
49
45 y/o woman sweaty hands, heart racing. Snappy and irritable. What would make u think anxiety disorder?
insomnia
feeling of impending doom
anxious feeling across various situations / env
hyperventilation
50
Treatments for adjustment/ anxiety disorder following grievance?
```
CBT
SSRI: paroxetine
Mindfulness
Short term BDZ
Beta blocker
```
51
What 2 treatments to give child with severe asthma attack?
O2
| Nebulised salbutamol
52
If child with acute asthma attack not responding to O2 and nebulised salbutamol, what do you give?
IV hydrocortisone
oral prednisolone
?IV salbutamol
53
6 questions to ask parents to asses how well controlled his asthma is?
1. wake up breathless,
2. exercise limitations
3. how often does he use his inhaler
4. inhaler technique
5. recent hospital admissions for exacerbations
6. daytime symptoms
7. use of oral steroids
54
3 intestinal signs of IBD?
INTESTINAL:
Diarrhoea (more likely to be bloody in UC)
Perianal disease (abscess, fistulae, anal skin tags)
Abdo masses, abdo pain
55
3 extra intestinal signs of IBD?
EXTRA-INTESTINAL: clubbing, mouth ulcers, uveitis, conjunctivitis, arthritis, erythema nodosum, pyoderma, gangrenosum
Diarrhoea (more likely to be bloody in UC) and weight loss
56
3 histopathological features on biopsy of Crohn's
(inflam in all layers from mucosa to serosa)
*(CAGCGMLflirt)
1. crypt abscesses
2. Goblet cell depletion
3. Microscopic granulomas
4. Lymphocyte infiltration
57
Side effects of steroids
```
Weight gain
osteoporosis
increased chance of infections
thinning of the skin
puffiness around the face
easy bruises
predispose to DM
increased risk of stomach ulcers
```
58
What might cause EPSE out of metoclopramide, aspirin, statin, amlopipine?
Metoclopramide
It is a Dopamine receptor antagonist
59
Which neurotransmitter does parkinsons affect?
Dopamine D1 and D2
60
What parkinsons med might cause sleepiness and gambling?
Ropinirole
(a dopamine agonist that causes compulsive behaviour)
Rope-in- a- role!!
61
RFs that predispose to pressure ulcers (not age)
```
Hx of vascular disease
immobility
poor nutrition and dehydration
bowel incontinuence
medical conditions affecting blood flow (e.g. diabetes, vascular disease)
```
62
What 3 actions can be done to stop old immobile lady getting pressure ulcer?
Regular turns
Reesablish mobility by strengthening leg/hip muscles
Check and possibly treat cause of incontinence
Adequate nourishment
63
Treatment that can improve bone health in a lady who has had a hip fracture as a result of reduced bone density?
Bisphosphonates
Vitamin D supplements
Calcium supplements
64
Old lady hip fracture MFFD and mobilising with a zimmer frame, 2 more things you'd ask about before sending home
Carers?
Assessment of home situ by OT and rectify any issues, if any
65
Give 4 qualitative methods for evaluating healthcare
Observational
Focus group
Reviewing documents
Interview
66
Lady having first cervical smear, very anxious. What needs to be done before the examination?
Full sexual history
Offer of chaperone
Explain to pt the process of the examination
Enquire if there are any traumatic sexual experiences
67
4 approaches to psychosocial therapy
CBT
Psychodynamic
Systemic
Integrated
68
Vaginismus treatment options
```
Indv psychosexual therapy
Integrated CBT
Behaviour interventions:
- breathing control and relaxation
- kegel exercises
- vaginal trainers
```
69
Pt has cancer and lots of comorbidities, want to put in place a DNACPR - what is beneficence and how does it relate to this case?
Best interest: QoL : S/E > benefits
70
Pt has cancer and lots of comorbidities, want to put in place a DNACPR - what is non-maleficence and how does it relate to this case?
Do no harm - preventing rib fractures from CPR
71
Who should the trust report a never event to?
National Reporting and Learning System (NRLS)
Strategic Executive Information System (STEIS)
72
Treatment for paracetamol overdose
N-acetylcysteine
73
What treatment is recommended for mild-moderate alzheimer's disease?
Acetylcholinesterase inhibitors:
- Donepezil, rivastigmine, galantamine
74
Screening bloods in Alzheimers?
FBC, ESR, CRP ; TFT ; serum B12 and folate levels
75
Pre-eclampsia: high BP, feeling puffy, flashing lights, headache... one additional test for diagnosis?
Urine protein measurement (+2)
76
What are the elements of HELLP syndrome?
Haemolysis (low Hb)
Elevated liver enzymes e.g. ALT
Low platelet count
77
4 further clinical and lab Ix to assess severity of pre-eclampsia, (after HELLP ones) and why?
1. CXR: pulm oedema
2. Fundoscopy
3. U&E (renal failure)
4. CT head - CVS haemorrhage
78
Complications of pre-eclampsia?
```
Seizures (eclampsia)
CVA
Renal or liver failure
Pulmonary oedema
DIC
HELLP
```
79
29 yo with 6 month history of PCB/IMB. Sexually active, no regular sexual partner, no pain, smoker. 4 DDx? + 2Ix?
```
Cervical cancer (HPV)
Chlamydia
Cervical ectropian
Vaginitis
Cervical polyps
Uterus: fibroids/cysts
```
2 Ix: colposcopy
high-vaginal swab and endocervical swab
Blood test: HPV
80
2 tests/Ix for DVT?
Wells' clinical probability tool
Quantitative D-dimer level
Venous duplex ultrasound (DUS)
81
3 anticoagulants and their contraindications
LMWH - kidney disease
Warfarin - haemorrhagic stroke
Rivaroxaban - significant hepatic impairment
82
2 likely reasons for bulky uterus / IMB in 58yo female?
Fibroids
| Adenomyosis
83
Normal heart rate range at rest?
60-100bpm
84
On ECG, whats the space between 2 dark vertical lines, and how long does it represent?
5mm = 0.2
85
How to calculate rate on ECG
Rate = 60 / (R-R interval)
86
Crying infant 6mo old, apyrexial, petechial rash on neck, immobile left arm, crying when left arm moved. crying throughout assessment. 3 initial Ix?
Bloods: CRP, ESR. Blood cultures
| Should and elbow Xray
87
6 month old become unresponsive with bulging fontanelle - 3 parts of emergency assessment?
A - airway - patent
B - breathing, RR and pattern
C - pulse, CRT, BP
88
CSF features bacterial meningitis?
Turbid
Polymorphs (neutrophils)
High protein
Low glucose
89
What can cause respiratory alkalosis?
Hyperventilation
90
3 antenatal factors that increase the risk of infection in a baby
```
PROM
Chorioamnionitis
TORCH infections
Maternal UTI
Group B strep carrier
```
91
What is PROM?
Rupture of membranes AFTER 37 weeks and before the onset of labour
92
Bulging fontanelle and pyrexial, what investigation to do?
LP
| don't even have to wait for them to be pyrexial
93
Commonest cause of bacterial meningitis in 0-3mo olds?
Group B Streptococcus
| Gram +ve cocci in chains
94
Long-term effect of bacterial meningitis?
Hearing loss
95
29 year old lady who collapsed while waiting for the bus on a hot day. Also complains of episodes of dejavu, confusion, difficulty speaking and understanding speech, lasting 1 or 2 minutes, 3-4 episodes a month.
Which lobe likely to be abnormal on MRI?
Which hemisphere?
Temporal lobe
Dominant
96
Tx for partial/focal seizure (consciousness not lost from the start)
Carbamazepine
97
AMT, what is it? And how would drowsiness affect the score?
The abbreviated mental test (the 10 quick questions)
Score would be lower
98
4 things to know before discharge planning
Care package
OT review
PT review
Social worker, support worker
99
Pt insistent on going home but nurses worried. 3 supportive measure upon discharge
1. Community team
| 2. OT - modification of housing
100
2 licensed medical / physical treatments rapid ejaculation
Topical local anaesthetic e.g. Stud 100 spray
Dapoxetine (short acting SSRI)
Kegel exercises
101
2 behavioural interventions for rapid ejaculation
stop-start technique
| practice 'point of inevitability'
102
3 behaviour interventions for weight loss?
Exercise
Healthy Diet
Cut down alcohol
103
Libertarian principle for resource allocation, and give an example
Each is responsible for their own health, wellbeing and fulfilment of life plan e.g. the German Health Incentive Scheme
104
What is the rule of rescue? and who made it up?
Jonsen: The perceived duty to save an endangered life where possible
105
Weekly alcohol unit limit men and women?
14 units
106
Define the swiss cheese model
The swiss cheese model of adverse events
- Each slice of cheese is a barrier to propagation (of an adverse event)
- Holes represent failures in the barriers
107
Criteria for negligence
1. There was a DUTY of care
2. This was BREACHED
3. The pt came to HARM
4. The harm was CAUSED by the breach in duty of care
108
8 endocrine tests for female orgasmic disorder?
1. testosterone,
2. sex hormone binding globulin,
3. dihydrotestosterone,
4. LH,
5. FSH,
6. estradiol,
7. progesterone,
8. prolactin,
9. TSH
109
Four types of couples therapy ?
CBT
Psychodynamic
Systemic
Integrated
(Also stuff like sensate-focused, new sexual routines)
110
Behavioural interventions for female orgasmic disorder?
Kegel exercises
| Guided mastrubation
111
Causative organism Toxic Shock Syndrome and Scalded skin syndrome
Gram positive coccus: staphylococcus aureus
112
What CFs for TSS?
Fever >39
Hypotension
Diffuse, erythematous, macular rash
(if no fever, its staphylococcal scalded skin syndrome)
113
Mx TSS
ITU for support for shock
Surgical debridement of areas of infection
IV immunoglobulin
114
What is Juvenile Idiopathic Arthritis?
Persistent joint swelling (of >6 wks duration) without infection or any other cause
115
Histopathological features Coeliac disease
- villous atrophy
- crypt hyperplasia
- increase in intraepithelial lymphocytes
- lamina propria infiltration with lymphocytes
116
ICD-10 OCD?
Obsessive thoughts
| Compulsive acts
117
What are 3 themes in obsessional ideas in OCD?
Often unpleasant
Repetitive
Intrusive
Irrational
Recognised as patients own thoughts
118
Alcoholic pt went from drinking wine, whisky and Beer to only drinking Wine, what symptom
of dependence Is this?
Narrowed repetoire
119
What blood tests do you do for alcohol dependence?
FBC, MCV
Gamma-glutamyl transferase
Carbohydrate Deficient Transferrin
120
Pt withdrawing gets delirium tremons, name 2 key CFs that would make you think it had developed to Wernicke's ecephalopathy
Confusion
Opthalmoplegia (paralysis of the muscles within or surrounding the eye)
121
Define Korsakoff syndrome
A chronic memory disorder caused by severe deficiency of thiamine (Vitamin B-1)
122
Whats in the combined test?
Nucheal Translucency
PAPP-A
bHCG
123
Whats in the quadruple test?
Inhibin A
Alpha-fetoprotein
hCG (human chorionic gonadotropin)
Estriol
124
4 risks amniocentesis
Miscarriage
Infection
Perforation of placenta
Rhesus D sensitisation
125
What drug do you give before amniocentesis?
Anti-D immunoglobulin
126
Apart from Down's, name 3 chromosomal abnormalities you can test for antenatally and their name
Patau's - Chromosome 13
Edwards- ch 18
Angelman syndrome - chr 15
127
65 year old woman comes in with abdominal mass, GP examines her. What 4 features would you find on ultrasound that would indicate a malignant lesion rather than a benign one?
```
Irregular,
Ascites,
Multi-occular cyst,
Solid area,
Metastasis,
Bilateral lesions
```
128
~ What 4 blood tests would you do pre-operatively and why? ~
```
FBC- Hb,
platelets- cross match,
group and save,
clotting screen- coagulation- risk of thrombosis/bleed,
?? not sure
```
129
Operation for early stage ovarian cancer?
Bilateral hysterosalpingectomy
130
What intraoperative investigation would you do to determine if an ovarian mass is malignant?
biopsy the malignant tissue
131
How does the organism in Staphylococcal Scalded Skin Syndrome cause skin to peel?
Exfoliative Staphylococcus epidermolytic exotoxin
132
Kid becomes unresponsive, what three things would you do on initial management?
Airway- patent, head tilt and chin lift- if not- intubate, Breathing- decreased- Oxygen,
Circulation- IV
Fluids
133
Ix JIA
ANA may be +ve, esp in oligoarticular JIA
Rheumatoid factor is usually negative
FBC: microcytic anaemia in chronic disease
XR/USS to define inflammation
134
Mx JIA?
NSAIDs
Steroid injections
DMARDs e.g. methotrexate
Biological agents - infliximab
135
What antibodies are present in most of pts with Grave's disease?
TSH receptor antibodies
136
What drugs to treat symptoms of thyrotoxicosis?
Carbimazole: blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
Propanolol: for tremor
Diarrhoea: immodium
137
Symptoms of thyroid storm?
| And what should GP do?
Fever of 38.9, palpitations, increased heart rate,
sweating.
Refer to hospital urgently
138
Describe the pathophysiology of parkinson's disease including the histological changes, neurotransmitter and part of the brain affected
Neurological disease characterised by the loss of dopaminergic neurons in the substantia nigra of the basal ganglia. Lewy bodies also develop
139
Treatment for PD
Levodopa + carbidopa
Ropinirole (dopamine agonist) / bromocriptine
Selegiline (MOA-B inhibitors)
Tolcapone (COMT inhibitor)
140
Drugs contraindicated in PD
Typical antipsychotics e.g. haloperidol
Some anti-emetics e.g. metoclopramide
141
What is a reversible cause of dementia?
Normal pressure hydrocephalus
142
Classical triad of features seen in normal pressure hydrocephalus?
a. urinary incontinence
b. dementia and bradyphrenia (slowness of thought)
c. gait abnormality (may be similar to Parkinson's disease)
143
If joint sense and vibration are spared in a spinal cord lesion, what column has been spared?
Dorsal column
144
3 histopathological features on biopsy of UC
Similar to Crohns,
No inflammation beyond submucosa
Inflammatory cells infiltrate in lamina propria
- and granulomas are infrequent
145
Ix for TB
```
Sputum
Tissue
X-ray
Mantoux
IFN gamma blood tests
```
146
3 signs on CXR Tb
1. Consolidation
2. Cavities
3. Pleural effusion
4. Hilar or mediastinal lymphadenopathy
147
Causative organism TB
Mycobacterium tuberculosis
148
Rx TB:
RIPE
- rifampicin
- isoniazid
- pyrazinamide
- ethambutol
149
How to calculate relative risk
Probability of outcome in exposed group
/
Probability of outcome in unexposed group
(very similar to odds ratio, but is using % instead of ratios)
150
An example of a non-causal variable (not confounding)
Number of churches in a town and number of deaths from cancer
(its actually cause larger towns have more people- decreasing number of churches in town won't reduce the number of cancer deaths)
151
6 symptoms of depression (not including anergia or social WD)
```
Anhedonia
Loss of libido
Poor appetite
Weight loss
Early morning waking
Loss of concentration
```
(guilt, hopelessness)
152
3 cognitive symptoms of depresion
```
Memory loss
Difficulty concentrating
Negative thinking
Distractibility
Indecisiveness
```
153
Depression screening tool
the Patient Health Questionnaire (PHQ-9)
Hospital Anxiety and Depression (HAD) scale
154
3 management strategies depression
SSRI
| CBT, interpersonal therapy
155
Signs of preterm labour
Before 37 weeks
1. Contractions >4 per hour
2. Low cramps
3. Change in quantity or quality of vaginal discharge, esp gush or leak of fluid
156
Tender uterus, bleed and pain - Dx?
Placental Abruption
157
Ix placental abruption
Cardiotocography
FBC
clotting
USS (to exclude vasa praevia)
158
Mx placental abruption
IV fluids
| Consider blood transfusion
159
What is agoraphobia?
Fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong
160
Two treatments for panic disorder
SSRIs
| CBT
161
Endocrine disorder that also makes ppl feel like they're about to die
Pheochromocytoma
162
Define depersonalisation
An unpleaseant subjective experience where the patient feels as if they have become 'unreal'
163
Define derealisation
An unpleaseant subjective experience where the patient feels as if the whole world has become unreal
164
List 3 features of dependence syndrome
1. Strong desire or compulsion to use
2. Difficulties in controlling substance-taking behaviour (onset, termination, or level)
3. Physiological withdrawal state when reduce use (or substitution to avoid withdrawal )
4. Tolerance (more for same effect)
5. Progressive neglect of pleasures/interests, increased time spent using
6. Persistent use despite evidence of harmful consequences (physical health, mood, cognition
165
2 treatments for detox from opiates
Buprenorphine
| Methadone
166
One investigation before treating opiate addiction
Urine or oral fluid drug test
167
What is the name given for when the eyes roll back into the head on antipsychotics?
Oculogyric crisis
168
What is the name given for when the neck painfully twists and tilts on antipsychotics?
Torticollic crsis
169
Name 2 other atypical antipsychotics (other than clozapine and risperidone)
Olanzapine
| Quetiapine
170
What drug classes can cause delirium?
Sedative hypnotics (e.g. benzodiazepines).
Anticonvulsants (e.g. barbiturates).
Antiparkinsonian agents (e.g. the anticholinergic, benztropine)
171
6 Cardiovascular risk factors for a TIA
- smoking
- HTN
- DM
- hypercholesterolaemia
- AF
- Thrombophilia
172
2 Ex for TIA (other than take BP)
CN examination
| UL and LL neuro exam
173
2 Ix for TIA
1. Serum FBC, U&E, fasting lipids and glucose, ESR, LFT &TSH
2. ECG
174
TIA pt: scans carried out show no abnormalities and pt is discharged. What treatment, if any, would you provide?
1. Calculate ABCD2 score
2. Control CV risk factors
3. 2 weeks 300mg aspirin
4. Clopidogrel 75mg
5. Simvastatin 40mg
Advise not to drive for at least 4 weeks following a TIA
175
What happens to sensitivity and PPV if the prevalence increases?
Sensitivity stays the same
PPV increases
176
How does increased prevalence impact NPV?
It decreases NPV
177
Give 3 psychosexual and 2 medical causes of rapid ejaculation
Psychosexual:
1. Anxiety
2. Relationship issues
3. Lack of sexual experience
Med:
1. Penile hypersensitivity
2. Hypothyroidism
178
3 non-ogranic causes for female dyspareunia
1. previous experience of pain
2. insufficient relaxation
3. fear of intimacy
179
4 possible treatments for rapid ejaculation
1. Stud 100 spray (topical anaesthetic)
2. Dapoxetine (short acting SSRI)
3. Couples psychosexual therapy
4. Practice 'point of inevitability'
180
Questions to ask to assess if there is pressure in the pelvis?
- Urinary symptoms Urgency + Freq
- Early satiety
- Diarrhoea
181
Abdominal mass, low Hb, menorrhagia, afro-caribbean descent. What is Dx?
Uterine fibroid
182
Pressure effects of uterine fibroids
Freq/urg (bladder)
Hydronephrosis (swelling of kidney if ureter blocked)
Infertility (tubal ostia)
183
Dx uterine fibroids
TVUSS
184
Mx uterine fibroids
1. IUS / COCP
2. tranexamic acid
3. GnRH analogues
4. Surgery (hysterectomy, myomectomy
5. Uterine artery embolization
185
2 routinely administered childhood vaccines which help prevent meningitis?
Meningococcal C
| Haemophilis Influenza B
186
2 Abx for prophylactic treatment of meningitis patient's close contacts?
Rifampicin
Ciprofloxacin
187
most common malignant neoplasm to affect the breast?
Invasive ductal carcinoma in situ
188
2 genes responsible for familial causes of breast cancer
BRCA 1
| BRCA 2
189
Which 5 common tumours typically metastasise to bone?
```
Breast
Prostate
Lung
Kidney
Thyroid
```
190
2 special laboratory tests which should be carried out on
| the originally excised tissue in breast Ca in order to plan the patient’s therapy.
HER-2 status (+ve status is bad)
Oestrogen receptor status (-ve is bad)
191
MOA of fluoextine, what neurotransmitter does it affect to lessen depression and in what part of brain does this occur predominantly
Blockade of re-uptake of serotonin (5-HT)
Downregulate the number of 5-HT receptors
Pre-frontal cortex
192
How long to take SSRIs before benefit is felt usually?
2-4 weeks
speak to gp if no benefit after 6-8wks
Should continue for at least 6 months as relapse is high in this time
193
How to stop an SSRI
Dose gradually reduced over 4 weeks (not the case with fluoxetine- has a longer half-life)
194
What receptors do tricyclic antidepressants also unfortunately block (as well as inhibiting the reuptake of seratonin and noradrenaline?
Muscarinic Acetylcholine Receptors (AChR) are blocked
SE: dry mouth, constipation, urinary retention, blurred vision
195
Early features of tricyclic overdose
Relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.
196
Features of severe tricyclic poisoning:
arrhythmias
seizures
metabolic acidosis
coma
197
Inheritence pattern in early onset alzheimer's disease (before age 65)
15% increased chance if have a parent with it
AD
APOE E4 gene
198
Diuretics that cause postural hypotension
```
Thiazide diuretic (chlorothiazide)
Loop diuretic (furosemide)
```
199
Causes of postural hypotension
1. hypovolaemia
2. autonomic dysfunction: diabetes, Parkinson's
3. drugs: **diuretics**, antihypertensives, **L-dopa**, phenothiazines, antidepressants, sedatives
4. alcohol
200
Behavioural ways to lessen dizziness when getting out of bed in elderly lady w postural hypotension
Sit still for a bit
| Raise and lower arms 5 times before standing
201
A non-pharmacological measure to imrpvoe dizzy episodes throughout day on standing in elderly lady w postural hypotension
Stockings
202
How to increased chance of eliciting cog-wheel rigidity?
Reinforcement
203
Likely RBC abnormality in alcoholic? And reason why
Macrocytosis
| Folate deficiency
204
Causes of haematemesis in alcoholic
Mallory Weiss tear
Bleeding varices
Gastritis
PUD
205
Rx seizures in delirium tremens
IV diazepam
