Past Qs Flashcards
1
Q
2 key features of early dementia
A
Memory lapses Forgetting names of people and places Difficulty finding words for things Inability to remember recent events Forgetting appointments
2
Q
Other than RSV other organisms causing bronchiolitis
A
Human metapneumovirus (second most common)
Adenovirus
Parainfluenza virus
3
Q
2 auscultation signs of bronchiolitis
A
Widespread fine inspiratory crackles
Expiratory wheeze
4
Q
When cxr On bronchiolitia
A
Should only be performed if there is diagnostic uncertainty or atypical course
5
Q
2 bits of advice for parent on bringing child back after discharge of bronchiolitis
A
To return if develops any signs of respiratory distress
If not tolerating fluids
If there is any history of apnoea
Worsening
6
Q
Endocarditis usual valve
A
tricuspid
[Think IVDU -> return of blood to RIGHT side of heart]
7
Q
Why JVP in IE tricuspid
A
tricuspid regurge -> not able to prevent backflow of blood
-> rise in RA pressure
8
Q
Why long term abx in IE
A
Neither the heart valves nor the vegetations adherent to them are supplied by blood vessels.
9
Q
IE develops PE
Mx
A
Drug Heparin
Route Subcutaneous
Oxygen 100%
Route of O2 Non-rebreather mask with reservoir
Analgesia Morphine
10
Q
Electrolyte abnormalities in DKA
A
hyperK - (overal stores low)
High anion gap
Low Na (if dehydrated) -also raised urea / creatinine
11
Q
Hydrocele
2 causes
Where is fluid
what test for GP
3 things you feel for on scrotal exam
A
Trauma
Tumour
Epididymo-orchitis
tunica vaginalis
transilluminate
Epididymis, testis, vas deferens
12
Q
3ix and 2 drugs for MS
A
3 Ix
Evoked potential testing (e.g. visual, auditory, somatosensory)
MRI scan of brain/spinal cord
LP for CSF analysis showing oligoclonal bands
Management
Beta-interferon, natalizumab
13
Q
3 components of bishops score
A
length, position, dilatation, consistency of cervix. Head station
14
Q
Who can you give PSA
A
over 50 with lower urinary Sx / request
Monitoring of prostate cancer resection
Suspicious PR findings
15
Q
young guy wants PSA - what Should you do ?
A
Reassure + educate about PSA
PR exam
Urine dip for blood
16
Q
high Ca - 1st Ix?
A
ECG - Short QT
17
Q
Initial Mx of hyper Ca - 2nd line?
A
IV Fluids (+furosemide if volume overload) Bisphosphonates
calcitonin
Dialysis
18
Q
Mx of old post stroke with constipation
A
Improve fibre
Increase fluid intake
Avoid meds which could constipate
Bulk formin lax - Eg Fibrogel
19
Q
4 meds - > constipaton
A
Opiates
iron tablets
Calcium
Anticholinergics
20
Q
2 key Ix in pregnant with spotting
A
BHCG
USS
21
Q
2 drug Mx if incomplete miscarriagre
A
Mifepristone / misoprostol
anti D
22
Q
Rheum A pre surg 2 physical pre for anaethetics 2 radiological 2 Anaesthetic techniques Which should you do? Specific comps post op for RheumA on lots of meds
A
Neck extension
Malapati
CXR - Chest
Neck CT / XR
Spinal, Epidural, volatile gas, Total IV anasthetics
IV - Q she was bleeding (no spinal) dont want haematoma there
-Also RheumA may affect Spine
Infection - immunosuppressed
RA = hypercoagulable - VTE
Steroids - poor healing
Steroids - increased risk of pressure ulcer
Comps with intubation due to neck involvement
-may have fibrosed lungs - resp difficulty
23
Q
Mx intermittent claudication
A
RF modification
Antiplatelet -clopidogrel 1st line
Supervised exercise
Patient education
24
Q
How to Ix intermittent claudication ? Levels are significant?
A
ABPI
Lie pt flat
Use doppler probe to test bracial and medial maleola arteries
Extringuish with cuff
<0.9 = some arterial disease <0.5 = critical ischemia
25
Why trismus in quinsy
muscle spasm caused by abscess
26
Mx of quinsy
IV fluids - probs dehydrated
Analgesia
ABx - clindamycin / metronidazole
Drain pus
27
Lymph node in quinsy
jugulodigastric node
28
Signs to differentiate torsion and eppididimoorchiditis. Initial Ix
Torsion - red, swollen, transverse lie, vomiting / nausea
Absent cremaster
Epi - Prehn's sign [lift testi and -> eases pain]
Retrotesticular pain
USS - see if torsion
29
CURB65 points
```
Confusion
Urea >7
Respiratory rate of 30 or more
Blood pressure less than 90 mmHg systolic or diastolic 60 mmHg or less
Age 65 or older
```
30
When to transfer pneumonia -> ITU
Uraemic - Kidney failure / ureamic encephalopathy
septic shock
Resp failure - requirement for mechanical ventilation
Multi organ support needed
31
CAP levels of Mx
Mx in community - Amox
Mx in hosp - Amox + macrolide Eg erythromycin
Severe in cost - CoAmox + macrolide
32
Young sporty - develops clicking and pain in hip
| 3DDx
OA, Trochanitc bursitis, femoroacetablar impringement
33
Pyelonephritis initial mx
- adequate fluid intake and analgesia
| - Start empirical Abx eg Cipro while waiting MC+S
34
Name 3 viral causes of meningitis
HIV, Mumps, HSV, ebv
35
How to NSAIDs / Acei cause kidney failure
nsaids - inhibit prostaglandin -> constrict aferent arteriole - hypoperfusion
ACEI - reduce angiotensin 2 -> less tone of efferent arteriole -> more blood flows out
36
Signs an infant is sick
pale/mottled/ashen/blue skin, lips or tongue
no response to social cues[3]
appearing ill to a healthcare professional
does not wake or if roused does not stay awake
weak, high-pitched or continuous cry
grunting
respiratory rate greater than 60 breaths per minute
moderate or severe chest indrawing
reduced skin turgor
bulging fontanelle
37
2 key ways to monitor Renal function in hosp
Urine output
| u+e
38
4 ways to have successful consultation with interpreter
```
Speak to pt not interpreter
Avoid jargon
Short simple sentances
Not multiple Questions
clarify
Allow plenty of time
```
39
Bar capcity 2 things needed for consent
Free from coercion/voluntary participation
Use understandable terms
Give sufficient time for careful decision-making
Give thorough information
Allow questions and comments
40
Mx asthma emergency?
| If life threatening ?
Sit up and give 15L of O2 via non-rebreathing bag
Salbutamol 5mg + ipratropium bromide 0.5mg nebulised with O2.
Hydrocortisone IV or prednisolone PO
CXR to exclude pneumothorax
If life-threatening:
o Inform ITU
o Add iv magnesium sulphate
o IV salbutamol
41
Immediate actions in PEA ?
Drug and route?
```
Ensure airway is patent
Call crash team
Commence CPR
Gain IV access
Attach defibrillator
```
1mL adrenaline 1:10,000 IV
42
Why might asthma get VT/VF
VT – salbutamol – long QT
| Hypoxia
43
Why do you get acanthrosis nigricans
Increased circulating insulin.
This activates keratinocyte ILG-F 1receptors
. Increased circulating IGF may lead to keratinocyte and dermal fibroblast proliferation.
44
Pathophys of sickle cell veno-occlusive
Deoxygenated HbS molecules are insoluble and polymerize.
RBCs become rigid and take up their characteristic sickle appearance.
Sickling leads to
1) decreased red cell survival and
2) impaired passage of cells through the microcirculation, leading to obstruction of small vessels and tissue infarction.
45
Sickle long term Mx
Hydroxycarbamide (hydroxyurea)
| Antibiotic prophylaxis / vaccines due to hyposplenism
46
Name 2 lymph nodes around bladder
```
Primary lymphatic drainage of BCa extends into the
internal iliac LNs
external iliac LNs
obturator LNs
presacral LNs
Secondary drainage progresses into the
common iliac LNs
para-aortic LNs
interaortocaval LNs
paracaval LNs
```
47
Bloood supply to bladder
Superior and inferior vesical arteries which arise form the iternal iliac artery
48
Key observation I forget in TURP
temperature (hypothermia)
49
4 things that could cause shock post TURP
```
TUR syndrome (absorption of washout causing hyponatraemia)
Sepsis
Bleeding
Clot retention
Pulmonary embolism
```
50
1st rank Sx of schitz
Delusions of thought interference: thought withdrawal, insertion, or blocking
Delusional perception
Auditory hallucinations (commentary, made in third person)
Delusion of control (passivity of affect, passivity of impulse, passivity of volitions, somatic passivity)
51
Gallstones -> pancreatitis mx
NBM
NG tube
Set up IVI
Analgesia: pethidine or morphine
ERCP + gallstone removal may be needed if there is progressive jaundice
52
2 Psych Mx for eating disorders
Cognitive behavioural therapy (CBT)
| Family-based treatment (FBT)
53
2 eye Sx of optic neuritis
Decreased visual acuity
Painful eye movements
Blurred vision on having a hot bath (Uhtoff’s phenomenon)
Decrease in colour vision
54
MS - weak legs
| 4 other signs
Hypertonia (spasticity)
Increased reflexes
Upgoing plantars
Clonus
55
3 signs of pailloedema on opthalmoscope
venous engorgement - usually first
hemorrhages over and / or adjacent to the optic disc
blurring of optic margins
elevation of optic disc
56
Where does klebsiella live normally
Nose, mouth, GI tract.
57
Which Valve most common in IE and why
Tricuspid valve – most commonly infected valve in IVDU as first valve that bugs come into contact with
58
Most common IE bug? if IVDU?
Alpha haemolytic streptococcus – Streptococcus viridans
| Staph aureus is commonest in IVDU
59
puritis due to liver failure mx?>
Cholestyramine
60
2 esrly signs dementia
amnesia, decreased cognitive function, constructional apraxia, Aphasia
61
2 reasons you would surgically drain SUBDURAL
Comps of this?
Focal neurology
Riased ICP
Seizures
Infection, haemorrhage, brain tissue injury, brain oedema, seizures
62
Endocarditis
What valve lesion would you see on ECHO?
Raised JVP - what abnormality in the wave would you see?
vegetation on the valve
Raised V wave
63
Erectile dysfunction 22 male
4 chronic causes
3 Blood tests
3 mx performance anxiety
Diabetes, hypertension, depression, MS
Prolactin, testosterone, FSH, LH, SHBG
CBT, Sex therapy, Sildenafil
64
Bony landmark on top of scrotum
pubic tubercle
65
Hydrocoele comes from
Processus vaginalis
66
SEVERE UC remission
Initial Mx drug and route
If failing
Remission if Mild?
IV hydrocortisone
Cyclosporin / infliximab
Sulphasalazine Oral
67
Drug in SAH
nimodipine
68
4 features of brainstem death
No respiratory effort in reaction to turning off ventilator
2. Fixed Pupils unreactive to light
3. No corneal reflex
4. No cough reflex
5. No response to supra orbital pressure.
69
Pericarditis auscultation?
4Ix
2mx
pericardial rub
```
Chest x ray
Bloods esr/crp/WBC
ECG
echo
biopsy
```
NSAIDS - colchicine
steroids
70
Cancer in right hilum smoker =
How to biopsy
Squamous cell
CT guided
71
Lung Ca features of types
Squamous
- Smokers, Hilum
- PTH
Adeno
-Periphery
Small cell - bronchus
- ADH
- ACTH
- LEM
72
2 causes and 4 mechanisms for abdo distension
a. bowel obstruction
i. adhesions/ recent surgery – most common
ii. cancer
iii. constipation
iv. diverticulitis
v. autonomic dysfunction bowel control
vi. hernias
b. Ascities
-Cardiac / liver failure
meigs
-hypoalbuminaemia
73
3 slit lamp findings anterior uveitis
Keratic Precipitates, Hypopyon, strange shaped pupil
74
Anterior uveitis rare infective cause
HSV
75
Advice when given GTN to pt
headache, call 999 if not relieved after 3 goes
76
Small bowel obstruction XR
Multiple loops
central
coniventes (full thickness muscular rings)
No gas in large bowel
77
Large bowel obstruction
peripheral
larger than small bowel
presence of haustra
78
Obstruction following surgery top 3 ddx
Adhesions = most likely
Hernia
Volvulus
79
IBD 2 AXR findings
thumb printing
| lead pipe colon
80
2 enzyme inducers (decrease effect of other drugs)
phenytoin
rifampicin
carbamazepine
alcohol
[CARP]- Carbamazepine also has CAR at start
81
2 enzyme inhibitors (increase effect of other drugs)
```
SSRIs
ciprofloxacin
amiodarone
diltazem / verapamil
Smoking
```
[Can Andy Stop Smoking] -
82
Ipatropium class
SAMA
83
Reversal of heparin
protamine
84
Stroke vessles and Sx
MCA - hemiplegia (especially face/arm)
-Can getoptic involvement too
Anterior - Weak leg
- Siminar / mild arm
- SPARES FACE
Posterior - Homonymous hemaniopia with macular sparing
85
1 year bleeding risk
H Hypertension: (uncontrolled, >160 mmHg systolic)
A Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal
S Stroke: Prior history of stroke
B Bleeding: Prior Major Bleeding or Predisposition to Bleeding
L Labile INR: (Unstable/high INR), Time in Therapeutic Range 65 years
D Prior Alcohol or Drug Usage History (≥ 8 drinks/week)
Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs)
86
-Hypokalaemia – 1x symptom and 1x sign o/e
weakness
| hypOrelfexia / hypotonia
87
Score post TIA
```
ABCD²
age >60
BP > 140/90
Cliical features - speech / unilateral weakness(2)
Duration >10mins >1hr (2)
Diabetes
```
88
Score for stroke post AF
C Congestive heart failure (or Left ventricular systolic dysfunction)
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)
A2 Age ≥75 years
D Diabetes Mellitus
S2 Prior Stroke or TIA or thromboembolism
V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)
A Age 65–74 years
Sc Sex category (i.e. female sex)
89
Dx of thalassaemia
Microcytic hypochromic anaemia- FBC
Haemoglobin electrophoresis
DNA testing
90
Most common lung cancer
squamous (in smokers)
91
Allergy physiology
type 1 hypersensitivity- degranulation of mast cells releasing histamine.
IgE medicated
92
4 things to check before heparin
U&E, FBC ( platlet count), LFT, accurate weight
, HASBLED
93
melanoma tumor marker
s-100
94
vit d metabolism
VIT D skin -> Hydroxylated by liver 25 hydroxy vit D
| -> Hydroxylated by kidney 1,25 hydroxy vit D
95
What PTH binds to for bone resorption
RANK-L
96
Why vit D lack -> osteomalacia
lack of Vit D -> reduces Ca
| -> Increases PTH which increases osteoclastic activity and bones become undermineralised- i.e osteo malacia
97
Gout 1st line acute ? Long term and class
Naproxen
(colchicine if CI)
Allopurinol - xanthine oxidase inhibitor
-> reduces serum uric acid
98
coealiac rash? tumour risk
dermatitis herpetiformis
| MALT Lymphoma
99
Define economic evaluation
Assessment of efficiency, in other words it’s the comparative study of the cost and effectiveness/benefits of a health care intervention
100
What makes a QALY
Quality and Quanity (age) of life lived
101
2 things which make an economic evaluation
Cost and effectiveness
102
2 types of economic evaluation
cost benefit analysis, cost utility analysis, cost effectiveness
analysis, cost minimization analysis
103
Define efficiency
When resources are allocated between activates in such a way as to maximize benefits for a given budget.
104
Identify opportunity cost
to spend resources on one activity means a sacrifice in terms of
lost opportunity elsewhere
105
Identify equity
fairness and justice in distribution of cost and benefits
106
3 reasons for prophlyaxis failure
Compliance, resistance,
Interactions
D+V
107
Malaria Dx Ix
GIEMSA thick and thin blood film
108
Malaria drug
artesunate
109
3 neuro signs lithium
coarse tremor, hyperreflexia, coma, ataxia, decreased conciousness, seizures
110
lithium teratogenicity
ebsteins - Cardiac
111
what is an advabced directive
An advance directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions.
112
Present with obstruction 4 immediate Mx IF STABLE(ish). 2 other to consdier
IV fluids
NG tube + suction
Catheter for urine output
Analgesia
Consider:
Antibiotics
Antiemetics (if vomiting)
113
1. Lady falls off her horse lands on left flank, now has blood in urine
a. 4 immediate management ?
b Imaging -?
c. 3 other non-renal injuries to look out for?
d. She is found to have grade 2 renal laceration, state what you would monitor and what is your management
e. She is later discharged to GP, what advice would you give to GP on follow-up
U+E (Cr baseline), Analgesia, Lower limb neuro, clotting
CT KUB
Fracture – spine / pelvis, Ruptured spleen, Cord compression eg haematoma -> Cauda equina, pneumothorax
all grade 1 and 2 and most grade 3 and 4 injuries, can be safely treated without active intervention.
Monitor - Monitor U+E(Cr especially) , Urine output, BP / signs of shock
Monitor renal function – if persists / gets worse to re admit
114
What is compartnemnt syndrome
b. What is the most important symptom and most important sign that will make you suspect compartment syndrome
What happens if left untreated ?
Bleeding into a closed space
Increased pressure within one of the body’s anatomical compartments – leading to decreased blood supply of those tissues
Sx - Pain out of proportion
Sign - Pain on passive stretch
ischemia, necrosis of muscle -> renal failure / amputation
115
4 mx of fracture
Conservative - Cast
Internal fixation - intramedullary nail
Open reduction internal fixation with plate
Externa fixation
116
3. 50 year old man with viral conjunctivitis
a. 4 symptoms that would aid in your diagnosis of viral conjunctivitis
B 4 signs
Red eye, watery discharge, slight discomfort, burning senation
Pre-auricular lymph nodes, conjunctival follicles, Lid oedema, acuity unaffected, normal pupil reponse
117
6. Some guy found in the park, he appears to be breathing, GCS of 9/15. No evidence of alcohol or dug use
a. What are 4 initial management steps on taking over care of patient?
b - Deteriorates to GCS 7/15 4 Mx now
ABCDE, Glucose, ECG, Examine for head injury
Contact ICU, Secure Airway / provide O2, CT head, ABG
118
7. 20 year old girl has central abdominal pain, which then migrates to right iliac fossa, you suspect acute appendicitis. Her last period ended 3 days ago.
a. What 2 physical signs would help you in your diagnosis
b. What 2 common laboratory investigations would help you in your diagnosis
c - 2 other Dx
d. She then complains that pain is now widespread across abdomen and looks unwell, what 2 immediate actions would you take
Rosvigs, the psoas test, rebound tenderness
CRP, WCC
Renal colic, ovarian torsion, ovarian cyst
Contact theatres, group and save
(Antibiotics and fluid)
119
What is selction bias
Systematic error either: in the selection of participants; or, In the allocation of participants to different study groups
120
8 blood tests for dementia
FBC, ESR, U&E, TFTs, Glucose, Lipids, Calcium & B12, syphilis
121
3 aspects of initial management of dementia
[Higher functioning, cognition, memory ]
refer to a memory assessment service
treat any risk factors for cognitive impairment
Patient education
122
2 causes for acute deteriation in dementia
Vascular - stepwise
| Delerium - UTI / other causes
123
Mallory weiss mech
Excessive wretching / vomiting -> laceration of mucosa at junction of stomach / oesophagus
124
Stressed - over use meds and tension headaches
Make a 4 point management plan to ensure holistic care
organisational changes?
IAPT
Address stress, relaxation techniques
Exercise
When / how much to use meds - don't overdo -> overuse headache
Increased GP follow up
Shorter prescription time
125
4 features of Delerium tremens
seizures, agitation, sweating, fever, hallucinations, tremor
126
2 questions to ask self for capacity assessment
Is there an impairment in their cognition
| Is the patient unable to make a decision
Understand, retain, weigh up, communicate
127
Anaphylaxis antihistamine you can never quite get right
chlorphenamine
128
1 blood test for anaphylaxis Dx
Mast cell triptase
129
Anaphylaxis pathophys
histamine mediated T1 HS reaction with mast cell degranulation
130
4 locations of endometriosis
lungs, ovaries, pouch of douglas, umbilicus
131
Management of endometreosis
COCP mirena
tranexamic acid + mefanamic acid
Gosrelin
Ablation
Hysterectomy
132
2 Mx acromegaly
Transphenoidal surgery – removal
| Octreotide – somatostatin analogue
133
Surgical safety
4x pre-procedure checks
2x post-procedure checks
2x actions on incorrect swab count
2x DVT prophylaxis
Patient identifying features, consent form, do you have your own teeth? Patient knows purpose of operation? Site of operations/specifics, previous exposure to anaesthetics, allergies, anticipated blood loss, GS + crossmatch completed
fluid balance, specimens for culture, equipment check – retained products, completion of anaesthetic chart, pain relief prescribed, anti-emetics prescribed
re-count, re-open patient as never event (check floor, check operating table etc
TED, LMWH, early mobilisation, good hydration
134
diagnose DIC from blood results
low plts, low fibrinogen, high aPTT, high PT, high thrombin time, high D dimer
135
DIC blood products to transfuse (no RBCs)
platelets
cryoprecipitate - fibrinogen
FFP - clotting factors
136
Bone marrow aspirate of AML
blast cells of myeloid precursors >20%
Hypercellularity
Auer rods
137
When not to give bulk-forming laxatives
in opioid constipation
| [lactulose - like post hernia]
138
2 drugs for miss carriage
Anti-D, misoprostol
139
Abx for pyelonephritis , length?
Cipro IV 48hrs - review to step down for oral to complete 7 days
140
Grading of liver failure
child pugh
```
[Album
encephalopathy
bilirubin
ascites
INR ]
```
141
AKI stages
compare to Cr baseline:
x1.5 - stage 1
x 2 - stage 2
x 3 - stage 3 (or over 354)
142
eGFR when not to use
doesn't work for extremes of age or weight
Not applicable to AKI
Cr clearance is more specific
143
bullus pemphigoid
describe rash
2 comps
Dx
Mx
tense fluid-filled blisters on the trunk and limbs
Erythematous - some burst?
Size
Antigens in epidermis
Infection
Complications of treatment
Skin biopsy
Serum autoantibodies
High dose steroids, immunosuppression
144
Pemphigus vulgaris describe
Rash with flaccid eaisy ruptured blistered with erosions and crusts
MUCOSAL involvement
145
Transfer co-efficient in asthma
normal / Increase
146
Decrease cause of transfer coefficient
```
Affects alveolar surface area
COPD
Anaemia
Heart failure
PE
Fibrosis
```
147
Increase transfe coeffecicent
polycythemia
| Asthma - maybe
148
2 interventions for food debis in oesophagus
capsule of Creon dissolved in 30 mL coke
Endoscopic retreval
149
Addisons crisis 2 cat ions and 1 wcc
Q2: 3 initial management points
hyperK, HypoNa,
Eosinophilia
ABCDE, IV fluid, IV hydrocortisone, O2
Don’t need fludrocortisone as high doses hydrocorsitone have mineralcorticoid effects
150
synacth test explain
Initial cortisol / give synacth IM – wait 30 mins – if cortisol rises = exclude addisons
151
Full term baby which deteriorated gradually over a few months. Turns out that she has an a severe genetic disorder. Parents want her to try on an experimental treatment. Her medical team has applied to the family division of the high court to withdraw life support.
Q1: What 3 things would you like to ask the medical team and/or family about the patient’s condition and treatment before deciding on a course of action?
Q2: 2 ethical principles when the medical team and the family disagree over the treatment of an infant.
Q3: If the patient was an adult who wanted to try out a novel treatment and the medical team was supporting him, would you grant him wish? Use an ethical principle/existing legislation to explain your answer.
Q4: Using deontology, explain the doctors decision to withdraw care for this baby
Suffering with treatment ?
Benefits / evidence base of treatment?
Cost of treatment ?
Beneficence
Non maleficicence
Yes capacity and autonomy
Based on action itself not consequences
If give treatment – prolong unnecessary suffering
152
What is utalitarism ?
Ultaritarism – outcome (term is near enough synonymous with consequentialism)
153
5. Young gentleman injuries his right leg while playing football. It is painful and he has already received gas and air while in the ambulance. Leg deformed, but no open wound
Q1: How else can you control his pain?
Boxplint
| IV morphone
154
3 other benefits of a ‘box splint’.
less pain
immobilise injury
decrease swelling
Helps maintain neurovascular status
155
Post cast compartment - 2 ways to have prevented
backslab instead of cast
| reduce early
156
Q1: Genetic inheritance of sickle cell disease
Q2: Symptoms of chest crisis. What is your initial management
Q3: Why does he get gallstones
Q4: What are other treatment would you offer alongside a routine cholecystectomy to reduce the likelihood of post op crisis.
Q5: Has lots of painful crises What medications do you give and mechanism
AR HbS
O2, iv fluids, pain relief, warmth, Abx
Increeased haemolysis -> increased bilirubin -> gallstones
RBC transfusion
Hydroxycarbamide -> increases foetal Hb / less HbS production / less platlet
Penicillin -> less infection -> less crisis
157
MCA
```
Assume capacity
help them make decisions
allow to make unwise decision
Best interests
Least restrictive option
```
[assume helping interesting, restricted, unwise decisions]
158
Why measure lactate in sepsis
Prognostic indicator and marker of anaerobic resp
| monitor improvement
159
Chronic HF mx
Acei, Bblocker
Furosemide - Sx
Spirolactolone
160
Q1: 4 questions to assess the general fitness of a patient for surgery/anaesthetic
Weight, CVD, exercise tolerance, lung disease
161
ASA scores
```
1 – healthy
2 – mild disease (doesn’t impact )
3 – disease severe -/ impacts =====this is her
4 – incapacitating disease
5 – not expected to survive
```
162
Q3: How do you predict a difficult intubation? (3)
anaesthetic record
Lack of neck extension
Lack of jaw opening
Malampati score
163
Q4: What from the WHO checklist do you do once the patient has arrived for surgery before anaesthetic (4)
```
Confirm patient
Confirm procedure
Any allergies
Team brief
Recovery location
Equipment check
Confirm consent
Medications taken this morning / NBM
Are you diabetic
```
164
Venous occlusion in eye what do you see
Flame hemorrages
cotton wool spots
Tortuous veins
165
MRSA Mx
Vanc
166
3 mechanisms of shoulder injury and how to manage
Rotator cuff tear – immobilise
Dislocation – reduce and XR to make sure in right place
Fracture – reduce and immobilise
167
Q3. 2 blood tests for someone with palpitations + what are you looking for?
TFT - hyper
U+E – CA / K
FBC - anaemia
Catecholamines – phaeo
168
SVT Mx steps
```
vagal manoeuvres
Adenosine
Bblockers
amiodarone
shock
```
[can go adenosine -> shock if unstable]
169
Why hyperacusis in facial nerve palsy
Paralysis of stapedius
170
4 routes and drug for analgesia
i) Oral – paracetamol
ii) IV – morphine
iii) Inhaled -nos
iv) Intranasal - fentanyl
Sub cut - fentanyl
171
Parkland formula
4 x kg x %burn
½ in first 8hrs ½ over next 16hr
172
How thick should endometrium be post menopausal
mx if CT Pelvis - stage 3 disease
Q4. Which treatment / combination of treatments is best?
in post menopausal <5mm (or <8mm if receiving HRT)
TAH + BSO + LN clearance + chemo if stage 3
173
Nephrotic syndrome Dx?
In children?
3.5g protein / 24 hrs [in children is 1g]
Oedema
Hypoalbumin <30g/dL [<25 in children]
174
Lymphoma classification? staging?
WHO
| Ann arbour
175
5 tests for haematuria
Dip, u+E, urinalysis, PSA, Autoantibodies, clotting
| US KUB, MC + S
176
Leigonella mx
fluoroquinolone + clarithromycin
177
4 ways to gilick competency
he young person will understand the professional's advice;
the young person cannot be persuaded to inform their parents;
the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;
unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer;
the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent.
178
2 classes of drug to improve prognosis angina
statin – simvastatin,
| Aspirin- Antiplatelet - cox 2 inhibitor
179
d) What is the area that connects a tendon/ligament to a bone?
e) What is the name given to inflammation of an entire digit?
Enthesis
Dactylitis
180
f) What anatomical area is inflamed in the joints of an inflammatory arthritis?
Synovium
181
ann arbour staging
1 – 1 node, 2 -2 nodes same side of diaphragm, 3 both sides, 4 wide spread and other organs
182
Mx of lymphoma in remission who have relapse
Peripheral stem cell transplant
183
Cushings
b. GP sends her to endocrinologist - which 2 tests would confirm suspicion of Cushing’s syndrome
c. Which test would tell you location of lesion?[not imaging]
The above test comes back with low levels of analyte, what is your next choice of investigation
Imaging to confirm
24hr urinary cortisol, dexamethasone suppression test
Plasma - ACTH
High dose dexamethasone still
If high ACTH still - lung, low = pit –
Chest/abdo CT
Pit MRI
184
2 ECG Angina
ST depression and T wave inversion/flattening
185
3 Areas of HELLP mX
Deliver baby
MgSO4 - prevent seizures
IV steroids
Mange BP if raised
186
How is audiogram carried out
sound proof room, headphones, sounds of variable vol and pitch in one ear, press button when hear it
187
What is a tympanogram
graphic representation of the relationship between the air pressure in the ear canal and the movement of the eardrum,
