peer teaching Flashcards

Question

What ix if used for monitoring progress in cancer?

Answer 1

a positron emission tomography (PET) scan. This uses a radioactive tracer to show the areas of high uptake and therefore areas of active malignancy.

Answer 2

unexplained fever, unexplained weight loss, and drenching sweats (particularly at night)

Answer 3

Females are 6x more likely to have developmental dysplasia of the hip (DDH). Breech birth, high birth weight, oligohydramnios, and prematurity are all risk factors.

Answer 4

This is to avoid the ‘cheese effect’ of eating tyramine-rich foods with a Monoamine oxidase inhibitor antidepressant, as it can lead to a build up of tyramine and hypertension. Phenelzine is an example of a MAO inhibitor.

Answer 5

The first line treatment for an acute manic or mixed episode in BAD is an atypical antipsychotic. For a depressive episode it’s an atypical antipsychotic plus an SSRI, usually Olanzapine and Fluoxetine. However, for long term maintenance, Lithium is the first line. Valproate, carbamazepine, Chlorpromazine can be added in if this doesn’t work.

Answer 6

A fine tremor is generally regarded as a side effect of Lithium in the therapeutic range, whereas a coarse tremor would develop if it was in the toxic range. Ataxia, Seizure, Slurred speech, Vomiting

Answer 7

Chlordiazepoxide + can also give thiamine (pabrinex) in detox

Answer 8

1. ) Impairment of consciousness and attention 2. ) Global disturbance in cognition 3. ) Psychomotor disturbance 4. ) Disturbance of sleep-wake cycle 5. ) Emotional disturbances

Answer 9

Raised CK (creatine kinase) --> due to muscle rigidity ● Raised white cell count ● Deranged LFT’s ● Acute renal failure --> abnormal U&E’s ● Metabolic acidosis --> low pH, low HCO3

Answer 10

Start antibiotics immediately - Prescribe doxycycline, metronidazole, and IM ceftriaxone (broad-spectrum management) - Leave in a recently inserted coil. If there is no response within 48hrs to the antibiotics, remove the coil and prescribe any other necessary emergency contraceptives

Answer 11

Nitrofurantoin should be avoided in the 3rd trimester as there is a risk of haemolytic anaemia in neonate with G6PD deficiency Trimethoprim is a folate antagonist and so can cause neural tube defects if used in the 1st trimester cephalosporins and amoxicillin safe at any point in pregnancy

Answer 12

Duloxetine

Answer 13

1st: NSAIDs 2nd: COCP 3rd: IUD

Answer 14

needs to be managed conservatively. Most cysts presenting acutely will present with lower abdominal pain, but without signs of peritonism or systemic upset. The absence of vomiting, peritonism, and a fever make torsion and appendicitis unlikely, therefore no need to refer to the surgeons at this stage.

Answer 15

antibiotics should be given for 10 days following premature preterm rupture of membranes, or until the woman is in established labour, whichever is sooner.

Answer 16

-Doxycycline 100mg PO BD for 7 days -gonorrhoea, unlike chlamdyia, classically causes ‘purulent’ vaginal discharge, and doesn’t normally cause intermenstrual or post-coital bleeding -Clotrimazole

Answer 17

Cardiolipin based tests (eg VDRL) and Specific treponemal antibody tests (TPHA)

Answer 18

typical eg haloperidol

Answer 19

Drop in blood pressure of at least 20 systolic or 10 diastolic within 3 minutes of standing

Answer 20

Aortic dissection and myocardial infarction share many common features (e.g. sudden severe central chest pain, sites of radiation, sweaty appearance). However, aortic dissection is usually maximally painful at the time of onset, whereas MI tends to build in intensity from the onset. Migration of the pain caudally is also more suggestive of aortic dissection. A weak left-sided pulse suggests aortic dissection (this occurs due to involvement of the subclavian artery). While hypertension can be a risk factor for MI, it is the single biggest risk factor for aortic dissection (on examination, the patient may remain hypertensive, or may become hypotensive due to blood loss).

Answer 21

Protamine can be used to reverse heparin. It is fully effective against unfractionated heparin, and partially effective against LMWH. Beriplex is used for most DOACs

Answer 22

Bisoprolol, clopidogrel, and LMWH | STEMIs presenting >12 hours from onset should be given streptokinase too.

Answer 23

Ileocolonoscopy (taking biopsies from terminal ileum and affected colonic areas)

Answer 24

hyperglycaemia, metabolic acidosis and ketonaemia hyperkalaemia mildly raised creatinine (sign dehdydration)

Answer 25

papules > vesicles > pustules > crusts

Answer 26

Clozapine, an atypical antipsychotic, carries a significant risk of agranulocytosis.

Answer 27

Clomipramine

Answer 28

Every week for 18 weeks

Answer 29

Secondary (metastatic) Vaginal cancer

Answer 30

increased parity

Answer 31

Polyhydramnios is usually diagnosed at an AFI of >24cm (or 2000ml+). Oligohydramnios is usually diagnosed with an AFI of <5cm (or under 200ml)

Answer 32

Confirm presence of bacteriuria with second culture and then begin culture dependent antibiotic

Answer 33

stress incontinence

Answer 34

dilated pupil

Answer 35

constricted

Answer 36

Corticobasal degeneration and progressive supranuclear palsy are Parkinson plus syndromes- corticobasal degeneration would have alien hand syndrome (limbs moving on their own), apraxia and aphasia as well as Parkinsonism; progressive supranuclear palsy would have supranuclear opthalmoplegia (can’t look down to begin with, then progresses to inability to look left and right), pseudobulbar palsy (inability to control facial movements), neck dystonia, balance issues with lots of falls, behavioural and cognitive impairment as well as the Parkinsonism. Multi-system atrophy causes autonomic symptoms as well as Parkinsonism e.g. postural hypotension, erectile dysfunction or bladder disturbance.

Answer 37

Use 0.9% sodium chloride with 20 mmol potassium chloride in 500 ml (40 mmol per litre) until blood glucose levels are less than 14 mmol/l

Answer 38

``` fever past 24 hrs no cough or coryzal sx sx in last 3 days purulent tonsils severe tonsil inflamm ``` score is 2 you would consider a delayed prescription for antibiotics. should be advised to use the prescription if there is no improvement in his symptoms in 3 to 5 days or if his symptoms worsen. If someone scores a FeverPAIN of 4 or 5 you would consider an immediate antibiotic prescription or a back-up antibiotic prescription. Phenoxymethylpenicillin is often prescribed for tonsillitis

Answer 39

port wine stain - t it is due to a vascular malformation of the capillaries in the dermis

Answer 40

A disimpaction regimen involves a macrogol laxative (C) e.g. polyethylene glycol and electrolytes (Movicol Paediatric Plain). If this doesn’t work, a stimulant laxative (E) e.g. senna can be added. If the macrogol laxative is not tolerated, an osmotic laxative e.g. lactulose (D) can be used instead.

Answer 41

First line treatment for a patient under 2 years of age with bilateral acute otitis media is a 5-day course of amoxicillin, – Consideration of antibiotics if symptoms have not resolved by day 5 is applicable when there are no indications for immediate antibiotic prescribing (e.g. AOM in only hearing ear, cochlear implant present, AOM in both ears in children <2 and perforated TM)

Answer 42

Meckel’s diverticulum –

Answer 43

If a patient has a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission to reduce the risk of relapse

Answer 44

Women are offered a blood test to screen for anaemia in their booking visit (8-12 weeks – ideally under 10 weeks) and at 28 weeks gestation.

Answer 45

Section 136 allows a police office to section a person suspected of having a mental disorder in a public place. They can be held for 72 hours and should be seen by a doctor or AMHP. Section 135 can be used to section a person within their home and remove them to a place of safety. The other sections are less clinically relevant.

Answer 46

Prednisolone Concerns this may be Temporal arteritis with amaurosis fugax of the eye causing visual loss. Risk of total visual loss therefore give high dose steroids urgently. Temporal artery biopsy is diagnostic. Also at risk of aortic aneurysm in the condition would want to do a CTA.

Answer 47

A convergent squint is the commonest form of childhood quint. Hypermetropia or long sightedness causes the image to focus behind the retina when the eye is at rest. excessive accommodation can bring the image into focus but also causes a convergent squint in children. convex lenses can counteract the refractory error and remove the squint in most cases.

Answer 48

endoscopy NOT colonsocopy | add blds here:

Answer 49

make careless mistake, trouble paying attention, does not listen, fails instructions/ task follow through, disorganised, loses things, forgetful, easily distracted fidgets, leaves seat, runs inapporpriately, loud, on the go, talks excessively, answers before questions completed, trouble waiting turn, interrupts others <12 yrs, 2+ settings

Answer 50

Lisdexamfetamine

Answer 51

Dilated Bowel Loops Bowel wall oedema Pneumotitis Intestinalis: gas within the wall of the intestine

Answer 52

watch and wait, autoinflate (balloon nose), hearing aid and if bad grommets

Answer 53

``` septicaemia = positive blood cultures - therefore has the purpuric rash caused by bleeding into skin and mucus membranes meningitis = positive LP culture ```

Answer 54

Hormonal testing and karyotyping

Answer 55

Signs of lithium toxicity include increasing diarrhoea, vomiting, anorexia, muscle weakness, lethargy, dizziness, ataxia, lack of coordination, tinnitus, blurred vision, coarse tremor of the extremities and lower jaw, muscle hyper-irritability, choreoathetoid movements, dysarthria, and drowsiness. Severe lithium toxicity occurs at serum lithium concentrations of approximately 2 mmol/L and above. Signs include, hyper-reflexia and hyperextension of limbs, syncope, toxic psychosis, seizures, polyuria, renal failure, electrolyte imbalance, dehydration, circulatory failure, coma, and occasionally death.

Answer 56

disulfarim = deterrent drug which results in an increase in serum acetaldehyde if alcohol is consumed --> unpleasane sx (think disulfarim makes you want to DIe) naltrexone = helps reduce cravings

Answer 57

weight, urea and electrolytes (U&E), estimated glomerular filtration rate (eGFR), calcium, and thyroid function tests (TFT)

Answer 58

Do AUDIT to assess whether they need it They drink over 30 units of alcohol per day, have a score of more than 30 on the SADQ, have a history of epilepsy, or past experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes, need concurrent withdrawal from alcohol and benzodiazepines, regularly drink between 15 and 30 units of alcohol per day AND have significant psychiatric or physical comorbidities (for example, chronic severe depression, psychosis, malnutrition, congestive cardiac failure, unstable angina, chronic liver disease) or a significant learning disability or cognitive impairment

Answer 59

``` the combination of a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine with a mono-amine oxidase inhibitor (MAOI) such as phenelzine is most associated with serotonin syndrome ```

Answer 60

Cyproheptadine

Answer 61

16-24 weeks - with a TVUS cervical length of <25mm and no previous preterm birth/trauma needs vaginal progesterone. OR if the patient had a previous preterm birth or any cervical trauma cervical cerclage stitch >24 weeks - TVUS <15mm tocolytic eg nifedipine + steroids

Answer 62

red with white bit in middle

Answer 63

PHQ-9 test

Answer 64

ice test or tensilon test

Answer 65

hydrocortisone

Answer 66

if sats are less than 94%

Answer 67

irregularly irregular rhythm, and no distinct p waves

Answer 68

In primary prevention, the intervention aims to remove or reduce a risk factor or introduce a protective factor (in this case folic acid) to prevent a disease before it has developed (in this case neural tube defects). Secondary prevention aims to intervene to prevent progression of a disease whilst it is asymptomatic or in the early stages (e.g. screening) or to prevent recurrence (e.g. after a myocardial infarction), whereas in tertiary prevention the disease is already established and the aim is to minimise disability and other negative effects of the disease and reduce complications.

Answer 69

Weight falls across 1 or more weight centile spaces and birthweight was below the 9th centile or Weight falls across 2 or more weight centile spaces and birthweight was between the 9th and 91st centiles or Weight falls across 3 or more weight centile spaces and birthweight was above the 91st centile or Current weight is below the 2nd centile for age, regardless of birthweight

Answer 70

NMS develops over days to weeks, whereas serotonin syndrome develops over 24 hours. NMS is more characterised by rigidity and bradyreflexia. Hyperreflexia and myoclonus are rare in NMS. Leucocytosis, increased CK in NMS

Answer 71

Risk factors for endometriosis include factors that would prolong the amount of bleeding a woman has in her lifetime e.g. early menarche, late menopause, delayed childbearing, and nulliparity. Other risk factors include family history, vaginal outflow obstruction, white ethnicity, low body mass index and autoimmune disease.

Answer 72

FBC Mirena is first line for management of menorrhagia and COCP is second line. For women who don’t want contraception, either tranexamic acid or mefenamic acid can be used. Further investigations, such as a TVUS, are only indicated if there is suspected underlying pathology such as fibroids, polyps or adenomyosis

Answer 73

Azithromycin 1g stat can be used for both the treatment of gonorrhoea & chlamydia.

Answer 74

This is “high-dose Dex”, an easy and quick way of reducing malignant compression, because it reduces the oedema around the tumour site, in this case reducing compression on the Cauda Equina Then referred for surgical mx

Answer 75

CT head is the best answer, they are quick and easily | available, helping us decide if this lady requires urgent admission or if she can wait a little longer.