Peer Teaching mock learning points Flashcards
1
Q
Causes of infectious mononucleosis
A
(glandular fever)
EBV is most common
Also: CMV and HHV-6
2
Q
Management of infectious mononucleosis?
A
Rest, fluids, avoid alcohol, avoid contact sports for 8 weeks
3
Q
What happens if you give specific antibiotic (which?) in glandular fever?
A
Amoxicillin= causes a rash in over 99% of patients
Morbilliform eruption
4
Q
Risk factors for DDH?
A
Breech presentation, high birth weight, female, oligohydramnios, prematurity
5
Q
Associated conditions of trisomy 21
A
Bowel: Duodenal atresia, oesophageal atresia, hirschpung’s disease, coeliac
Heart: tetralogy of fallot, AVSD, ASD, VSD
Visual: cataracts, strabismus, keratoconus
Malignancy: AML, ALL
Hearing loss, alzheimer’s disease, hypothyroid
6
Q
Early signs of lithium toxicity?
A
Coarse tremor of extremities and lower jaw, ataxia, seizure, slurred speech, vomiting, diarrhoea, anorexia, choreoathetoid movements, drowsiness, muscle weakness, lethargy, dizziness, blurred vision, tinnitus
7
Q
Signs of severe lithium toxicity?
A
Hyperreflexia, hyperextension of limbs, syncope, toxic psychosis, seizures, polyuria, renal failure, electrolyte imbalance, dehydration, circulatory failure, coma, occasionally death
8
Q
Normal lithium levels? Level for severe toxicity?
A
Normal titrated to 0.6-1.0 mmol/L
Severe at over 2.0mmol/L
9
Q
What monitoring for lithium therapy?
A
Weight, U+Es, eGFR, calcium, TFTs every 6 months (more if needed)
10
Q
Long term adverse effects of lithium?
A
Hypothyroid, hyperthyroid, hyperparathyroid, nephrotoxicity, renal tumours, rhabdomyolysis
11
Q
What type of tremor is “normal” when on lithium?
A
Fine
12
Q
How does neuroleptic malignant syndrome present?
A
Change in mental state, rigidity, fever, autonomic dysfunction (tachycardia and hypertension, sweating)
13
Q
What is seen on bloods in neuroleptic malignant syndrome?
A
Raised CK, raised WCC, deranged LFTs, acute renal failure with abnormal U+Es, metabolic acidosis
14
Q
How to manage PID?
A
Mild= start abx immediately before swab results, can leave in recently inserted coil, but if no response by 48-72 hours, remove coil and prescribe any necessary emergency contraceptives
Abx= doxycyline, metronidazole, IM ceftriaxone
15
Q
What antibiotic safe during whole pregnancy for uti?
A
Cephalosporins eg ceftriaxone
16
Q
When to avoid nitro and trimethroprim in pregnancy?
A
Nitro= avoid in 3rd trimester Trimeth= folate antagonist so avoid in 1st trimester
17
Q
How long to try pelvic floor muscles for before going 2nd/3rd line for incontinence?
A
3 months
18
Q
What raises CA125?
A
Adenomyosis, ascites, endometriosis, menstruation, breast cancer, ovarian cancer, endometrial cancer, ovarian torsion, liver disease, metastatic lung cancer
19
Q
Management of fibroids?
A
1st= mirena coil for under 3cm
Can uses COCP for under 3cm but CI for use before, during and after surgery
Endometrial ablation
Uterine artery embolisation
GnRH agonists used before surgery to reduce size and make them less likely to bleed
20
Q
How do GnRH agonists work for before fibroid surgery?
A
Induce menopause like state, reduce amount of oestrogen maintaining the fibroid
21
Q
What tests can show active infection and treatment received for syphilis?
A
VDRL positive = active infection
TPHA positive= received treatment (looking for IgG)
22
Q
How can congenital syphilis present?
A
Generalised lymphadenopathy, hepatosplenomegaly, rash, skeletal malformations
23
Q
Tertiary syphilis psych presentation?
A
Similar to psychosis
24
Q
What causes syphilis?
A
Spirochaete bacterium= treponema pallidum
25
What counts as orthostatic hypotension?
Systolic drop of at least 30 and diastolic drop of at least 15 after 3 minutes of standing
26
How does N-acetylcysteine work?
Replenishes glutathione stores so that NAPQI (intermediary product of paracetamol metabolism) can be converted to less toxic product and prevent hepatocyte damage
27
How can you reverse heparin?
Protamine
28
How much KCl in management of DKA in children?
How much insulin?
What fluids?
KCl: 20mmol/500ml or 40mmol/1000ml
Insulin: 0.1units/kg/hr SC
0.9% NaCl 10ml/kg
29
What is seen in bloods of a child in DKA?
Hyperglycaemia, acidosis, ketonaemia, increased creatinine (mild), decreased bicarb
30
What do you see in juvenile idiopathic arthritis?
Salmon coloured rash at times of fever
31
Treatment of oligoarticular JIA?
Intra-articular steroid injection under USS guidance is first line
Early use of methotrexate reduces joint damage (more effective in polyarthritis)
Paracetamol as antipyretuc
NB/ anti-tnf costly, needs strict supervision
32
What optical complication highly associated with JIA? What to do about it?
Anterior uveitis in up to 1/3 of children with JIA, but commonly silent form
National screening programme for children with JIA to have eyes screened every 3 months
33
What is stephen johnson syndrome?
Multisystemic; start with flu like symptoms then red/purple target like rash spreads and forms blisters. The affected skin eventually dies and peels off
Mucous membranes of mouth, throat, eyes and genital tract can become blistered and ulcerated
34
Common causes of stephen johnson syndrome?
Drugs: allopurinol, lamotrigine, penicillin, phenytoin
Viral: mumps, flu, HSV, EBV
35
What are EPSEs?
Extrapyramidal side effects
parkinsonism, dystonia, tardive dyskinesia, akathisia
36
What is tardive dyskinesia?
Involuntary neurological movement disorder eg lip smacking, facial grimacing, tongue protrusion, excessive eye blinking
37
What is akathisia?
Restlessness leading to compelling need to move/rock/pace
38
What can be used to reverse sedating effects of benzos?
Flumazenil
39
What is knight's move thinking? What is it seen in?
Seen in schizophrenia and psychosis
Patient's thoughts move from one topic to another, without any logical connections between them
40
Management of OCD?
Trial combination of SSRI and exposure response prevention CBT for at least 12 weeks
Then try different SSRI or switch the SSRI to clomipramine (TCA)
41
Signs of hyponatraemia? What drug likely to happen with?
Drowsiness, confusion or convulsions
Antidepressants but especially SSRIs
42
Complications of chickenpox?
Bacterial superinfection, cerebellitis, DIC, progressive disseminated disease
43
CSF for bacterial meningitis?
Turbid appearance, raised polymorphs (neutrophils) raised protein, low glucose
44
CSF for viral meningitis?
Clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose
45
CSF for encephalitis?
Clear appearance, normal/raised lymphocytes, normal/raise protein, normal/low glucose
46
CSF for TB meningitis?
Turbid/clear appearance, raised lymphocytes, raised protein, low glucose
47
Features of fragile X?
Learning difficulties, large ears, long thin face, high arched palate, macroorchidism, autism, add, hypotonia, mitral valve prolapse
48
Features of prader-willi?
Hypotonia, faltering growth, developmental delay, learning difficulties, almond shaped eyes, narrow nasal bridge, narrowing of forehead at temples, thin upper lip
49
Features of noonan syndrome?
Mild learning difficulties, short webbed neck, pectus excavatum, short stature, congenital heart disease, broad forehead, drooping eyelids, wide distance between eyes
50
Features of Down's syndrome?
Learning difficulty, hypotonia, small chin, flat nasal bridge, single palmar crease, protruding tongue, AVSD, tetralogy of fallot
51
Features of williams syndrome?
Short stature, congenital heart disease, mild-mod learning difficulties, broad forehead, short nose, full cheeks, wide mouth
52
Features of turner's syndrome?
Primary amenorrhoea, short stature, webbed neck, bicuspid aortic valve, coarctation of the aorta, infertility
53
How is clozapine monitored?
1 blood test per week for first 18 weeks
Reduced to fortnightly between 18-52 weeks
Then monthly
All if non concerning results not found
54
How does placental abruption present?
Abdominal pain with mild vaginal bleeding
Shock signs inconsistent with external loss (can be concealed), ,severe pain, often dark bleeding
Woody uterus
55
Management of placental abruption?
If both stable; dexamethasone to promote lung maturation
Any signs of distress under 34 weeks needs C section
If stable and over 34 weeks, can have a vaginal delivery
56
How does placenta praevia present?
Shock consistent with external loss, painless, occasional contractions, red and often profuse bleeding, often has history of small APHs, no uterine tenderness, foetal lie normally high/abnormal, FHR normal usually
57
Risk factors for placenta praevia?
Increased age, IVF, maternal smoking, previous C section
58
How does vasa praevia present?
Typically occurs with rupture of membranes
Painless bleeding with severe foetal distress
Up to 50% cases detected antenatally and require C section
59
Difference between placental abruption and placenta praevia?
```
Painful= abruption
Painless= praevia
```
```
Praevia= shock consistent with external loss
Abruption= inconsistent (may be concealed)
```
60
Difference between placenta praevia and vasa praevia?
```
Placenta= FHR normal usually
Vasa= severe foetal distress
```
61
How to manage CIN1 from screening?
No need for treatment but follow up in 12 months
62
If treating CIN with lletz, when to screen again?
6 months as test of cure
63
Types of vaginal cancer
80% metastatic (mostly from cervix or endometrium)
| 10% of primary is adenocarcinoma, rest is scc
64
Who is clear cell adenocarcinoma of vagina associated with?
Mothers who took diethylstilbestrol (DES) (synthetic oestrogen) during pregnancy between 1940s and 1971
65
Mechanism of delivery of foetus?
Descent, engagement, flexion, internal rotation, crowning, extension of presenting part, external rotation of head, delivery
66
Management of asx bacteriuria in pregnancy?
Contamination of first culture is positive so second test should be done to confirm
Treat! Risk of pyelonephritis, a/w premature labour and ROM if untreated
67
Numbers for polyhydramnios? Cause?
Most causes=idiopathic
Others= macrosomnia, maternal diabetes, structural deformities of foetus, viral infections
AFI over 24cm (2000ml plus)
68
Numbers for oligohydramnios?
AFI under 5cm (under 200ml)
69
Criteria for total anterior circulation stroke?
All 3 of unilateral weakness of face/arm/leg, high cerebral dysfunction and homonymous hemianopia
70
Features of Horner's syndrome?
Unilateral anhidrosis, enophthalmos, miosis, ptosis
71
What does mydriasis mean?
Dilated pupil
72
Causes of horner's syndrome?
Pancoast tumour, MS, brain tumour, large goitre
| Anything that can press on the sympathetic chain
73
Triggers for migraine?
CHOCOLATE: chocolate, hangover, orgasm, cheese, oral contraceptive, lie in, alcohol, tumult, exercise
Also: periods, injury, certain sensory triggers, being hungry, smoking
74
Prophylactics for migraine with CIs for each?
Topiramate- teratogenic
Propranolol- asthmatics
If both above are contraindicated can use acupuncture
Botox is last line
75
Rotterdam criteria?
PCOS is at least 2: polycystic ovaries, oligo/anovulation, clinical and/or biochemical signs of hyperandrogenism
76
What warrants a polycystic ovary?
12 or more follicles
or
Increased ovarian volume over 10cm3
77
How does metformin work in PCOS?
decrease appetite, decrease androgen production, decrease LH release, decrease SHBG in liver
78
Bloods on PCOS?
Normal/low FSH
High LH
Decreased SHBG
Raised testosterone
79
What is HELLP syndrome?
Haemolysis, elevated liver enzymes, low platelets
Severe variant of pre-eclampsia, warrants immediate delivery
80
How does HELLP syndrome present?
```
Epigastric pain and abnormal clotting (elevated liver enzymes)
Anaemia (due to haemolysis, also raised lactate dehydrogenase)
Low fibrinogen (DIC likely to occur)
```
81
How to manage gestational diabetes if fasting glucose is under 7?
Trial of diet and exercise, if targets not met within 1-2 weeks, start metformin
Insulin can be used if metformin not tolerated or as an add in if still not controlled
82
How to manage gestational diabetes if fasting glucose is over 7?
Immediate insulin +/- metformin,and diet and exercise
83
Levels for diagnosis of gestational diabetes?
Fasting plasma glucose over 5.6
or
2-hour plasma glucose level over 7.8
84
What is Conn syndrome?
Primary hyperaldosteronism
Aldosterone acts on kidney to increase sodium absorption and thus increase potassium excretion
Hypernatraemia and hypokalaemia
85
What to treat Conn syndrome with?
Spironolactone
86
investigating renal colic?
USS is first line
| CTKUB allows a diagnosis
87
Stage 1 of AKI?
Stage 1: creatinine 1.5-1.9 times higher than baseline or urine output under 0.5ml/kg for over 6 consecutive hours
88
Stage 2 AKI?
Creatinine 2-2.9 times higher than baseline or urine output under 0.5ml/kg for over 12 consecutive hours
89
Stage 3 AKI?
Creatinine over 3 times higher than baseline or urine output under 0.5 ml/kg for over 24 consecutive hours or anuria for over 12 hours
90
Drug causes of AKI?
NSAIDs, ACEi, CCBs, alpha blockers, beta blockers, opioids, diuretics, aciclovir, trimethroprim, lithium
91
Complications of nephrotic syndrome?
Frequent relapses, hypovolaemia, infection, thrombosis, hypercholesterolaemia
92
How do adults present with nephrotic syndrome?
Generalised pitting oedema, heavy proteinuria, hyperlipidaemia
93
Step wise management of formula fed baby with GORD?
Feed thickener eg carobel
Alginate therapy eg gaviscon
H2 receptor anatagonist eg ranitidine
PPI eg omeprazole
Can try d2 antagonists to enhance gastric emptying eg domperidone
Nissen fundoplication is last line surgery option
94
When do naevus flammeus present?
From birth (port wine stain)
95
When do cavernous haemangioma present?
In first month of life, but not from birth (strawberry naevus)
96
What is ITP?
Idiopathic thrombocytopenic purpura (low platelets)= excessive bruising and bleeding
May develop after a viral infection in kids
In adults, a long term condition
97
Management of ITP?
Majority of cases spontaneously resolve within 6-8 weeks and require no further treatment
Advise: avoid NSAIDs, aspirin and contact sports
May require prednisolone if platelet count is too low
98
When would a splenectomy for ITP be indicated?
Life threatening bleeding
| Severe chronic and unremitting ITP for 12-24 months with sever symptoms
99
What surgical procedure for Hirschprungs?
Swenson procedure= remove section of affected bowel and anastomose remaining bowel together
100
What surgical procedure for Meckel's diverticulum if symptomatic?
Wedge excision
101
Features of tetralogy of fallot?
Large VSD, overriding aorta, right ventricular hypertrophy, pulmonary valve stenosis (aka right ventricular outflow obstruction)
102
VSD murmur and where?
pansystolic over lower left sternal edge (tricuspid area)
103
ASD murmur and where?
Ejection systolic murmur over upper left sternal border (pulmonary)
104
PDA murmur and where?
continuous machinery murmur over upper left sternal angle
105
Coarctation of aorta murmur where?
On back between scapula
106
Which is trisomy 13?
Patau syndrome- remember polydactyly
107
Which is trisomy 18?
Edward's syndrome, remember macrognathia (undersized jaw)
108
How to manage paracetamol od ?
If within 1 hour of ingestion= activated charcoal
| If within 8 hours= n-acetylcysteine
109
How to give n acetylcysteine?
Infusion in 3 divided doses over 21 hours
1st= done over an hour
2nd= over 4 hours straight after
3rd= over 16 hours straight after
110
When do delirium tremens occur?
48-72 hours following alcohol withdrawal
111
Describe progression of alcohol withdrawal
6-12 hours after withdrawal= tremor, sweating, tachycardia, nausea, headache and anxiety
Seizures peak incidence at 36 hours
112
Phases of cocaine withdrawal?
First phase= first 24 hours (increased hunger and cravings)
Second phase can last for up to 10 weeks
Final phase show decrease in most withdrawal symptoms but low mood can persist for 6 months
113
Symptoms of cocaine withdrawal
Hunger, cravings, anxiety, fatigue, irritability, lack of motivation, low mood
114
Features of pre-eclampsia?
Defining features= hypertension and proteinuria
Epigastric pain, facial oedema, hypertension, hyperreflexia, papilloedema
115
Management of preeclampsia?
Labetalol first line
| If asthmatic/heart failure/heart block, then nifedipine
116
How to control seizures in eclampsia?
Magnesium sulfate
117
RFs for pre-eclampsia?
long birth interval (over 10 years), BMI over 31, maternal antiphospholipid syndrome, multiple pregnancy, previous pre-eclampsia
118
What is foetal hydrops?
Abnormal accumulation of serous fluid in at least 2 foetal compartments (pleural, pericardial, ascites, skin oedema, polyhydramnios, placental oedema)
119
Causes of foetal hydrops?
Immune causes (blood group incompatability)
Non immune causes: severe anaemia (parvovirus B19, alpha thalassaemia major, massive materno-foetal haemorrhage), cardiac abnormalities, twin-twin transfusion syndrome, chromosomal (trisomies, turners), infection (toxoplasmosis, rubella, cmv, varicella), chorionagioma
120
Methods of induction of labour?
Membrane sweeping
Vaginal PGE2 is first line pharm
Oxytocin can be used as well (not alone)
121
RFs for obstetric cholestasis?
Hepatitis C, multiple pregnancy, obstetric cholestasis in previous pregnancy, presence of gallstones
122
When can you offer external cephalic version?
From 36 weeks in nulliparous
| From 37 weeks in multiparous
123
What is QRISK? what is in it?
Risk of having a stroke or heart attack in the next 10 years
Fxs: age, sex, smoking, diabetes, angina, ckd, AF, BP treatment, migraines, SLE, mental illness, steroids, erectile dysfunction
124
What is error of over attachment?
Conduction of tests to confirm what we expect/want to see and not ruling out other causes
125
What is error due to failure to consider the alternative?
One abnormality found that fits particular diagnosis so stop searching for other potential clues that could change diagnosis
126
What is error of bravado?
Working above competence
127
What is error of inheriting thinking?
When working diagnosis handed over and accepted without pause for consideration and determining whether it has been substantially proved
128
What is error of ignorance?
Unconscious incompetence
129
2 ethical frameworks to assess ethical dilemmas?
Four quadrants
| Seedhouse ethical grid
130
Describe the four quadrants to assess ethical dilemmas?
```
Medical indications (beneficence and non maleficence)
Patient preferences (autonomy)
Quality of life (beneficence and nonmaleficence)
Contextual features (loyalty and fairness)
```
131
Describe seedhouse ethical grid
Central conditions, key principles (deontology), consequences then external considerations
132
Presentation of gastric cancer?
Palpable mass in abdomen, ascites, dysphagia, weight loss
133
Medications for ADHD?
Methylphenidate first line
Lisdexamfetamine second line
Dexamfetamine if patient intolerant to side effects of lisdexamfetamine
134
How can necrotising enterocolitis present?
Abdominal distension, vomiting, visible intestine loops lacking peristalsis, rectal bleeding, lethargy, feeding intolerance
135
What can be seen in advanced NEC?
Metabolic acidosis
136
How to diagnose NEC?
Abdominal Xray shows dilated bowel loops, bowel wall oedema, pneumonitis intestinalis
Abdo USS can be used if XRay inconclusive
137
Management of NEC?
Broad spectrum antibiotics
138
Asthma management pathway?
Regular ICS and PRN short acting b2 agonist
If uncontrolled add a leukotriene receptor antagonist eg montelukast
If montelukast not working, increase ICS
LABA can be added if child is over 5 years
139
How does intussuscpetion present?
Paroxysmal episodes of colicky abdo pain, inconsolable, drawing legs up to abdomen, features of intestinal obstruction
Distension of abdomen, vomiting, constipation, redcurrant jelly stool (late sign)
140
Who is intussusception most common in?
Between 3 months and 2 years
141
Where is the most common site for intussusception?
Ileum telescoping into caecum
142
Investigating intussusception?
USS abdomen, look for target sign or doughnut sign
143
How to manage intussusception?
IV fluids and rectal air insufflation
Only need operative reduction if peritonitis or rectal air insufflation failed
144
Prophylactics in bipolar affective disorder?
Lithium (first line)
Valproate
Olanzapine (if responsive to this in previous manic phase)
Carbamazepine (if patients unresponsive to combination of other prophylactic drugs, used inpatients with rapid cycling disease)
145
Organic causes of GAD?
```
Anaemia
Hyperthyroid
Pheochromocytoma
Temporal lobe epilepsy
Hypoglycaemia
Tachycardia
```
146
Hallucination seen in delirium tremens?
Lilliputian (seeing lots of tiny people)
147
Hallucination type seen in psychosis?
Extracampine (beyond the realm of physical possibility)
148
What combination of drugs makes serotonin syndrome most likely?
SSRI and MAOI eg phenelzine
149
When does it count as premature ovarian insufficiency?
Menopausal symptoms and secondary ammenorrhoea under 40 years old
No negative feedback from ovaries so FSH and LH levels very high
150
What is a first degree tear?
Into perineal skin only
151
What is a second degree tear?
Fascia and muscles of perineum affected
152
What is third degree (A) tear?
fascia and muscles of perineum, and <50% of external anal sphincter involved
153
What is a third degree (B) tear?
fascia and muscles of perineum and over 50% of external anal sphincter involved
154
What is a third degree (C) tear?
fascia and muscles of perineum and both external and internal anal sphincters involved
155
What is a fourth degree tear?
Both external and internal anal sphincters completely torn and anal epithelium involved
156
What is Erbs palsy?
c5-c6 injury
Arm paralysis or weakness after birth trauma, typically shoulder dystocia
Can resolve by itself or need physio or surgery
157
What is Klumpke's palsy
Injury of C8-T1
| Generally from difficult birth
158
Termination of pregnancy options
For gestation under 7 weeks use medical methods: mifepristone first then misoprostol 36-48 hours later
Dilatation and evacuation performed above 13 weeks, but would still prefer medical mx
Suction curettage between 7 and 13 weeks
159
What can ovarian neoplasms cause
hirsutism (testosterone secretion), acute abdomen (torsion), rupture or haemorrhage, thyrotoxicosis, amenorrhoea
160
Cervical cancer management options
Fertility preserving= cone biopsy
CIN= laser ablation
Non fertility preserving= radical trachelectomy, hysterectomy with lymph node clearance
Cisplatin and radio used for later staged cancers
161
What is ovarian hyperthecosis?
Luteinised theca cell nests in ovarian stroma
Closely related to PCOS but a/w more severe hyperandrogenism and virilisation
Accounts for most cases of hyperandrogenaemia in postmenopausal women, but prevalence much lower in younger women
162
Signs of heart failure on CXR?
```
ABCDE
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe veins
Pleural effusion
```
163
Presentation of cluster headaches?
Sudden unilateral severe headache, ptosis, miosis, conjunctival infection, excessive lacrimation
Headaches in clusters of 6-12 weeks then period of remission
164
How to manage cluster headaches?
Acute attack= sumatriptan and high flow oxygen
| Verapamil for prophylaxis
165
Who is sumatriptan contraindicated in?
Those with history of coronary artery disease
166
how can normal pressure hydrocephalus present?
Urinary incontinence, dementia, gait disturbance
167
Path of flow for CSF
Two lateral ventricles, foramina of monro, third ventricle, cerebral aqueduct, fourth ventricle, formaina of luschka and magendie, subarachnoid space
168
How does C diff infection present?
Soft abdomen, epigastric tenderness, diarrhoea
169
Management of c diff?
Take stool cultures
Rehydration
Metronidazole or vancomycin
170
What is primary biliary cholangitis?
Inflammation of bile ducts, related to autoimmune conditions, antimitochondrial antibodies in up to 98% of cases
Px: fatigue, jaundice, pruritus
171
Diagnosis of acromegaly?
Oral glucose tolerance test
172
Why do we not use GH in testing for acromegaly?
GH released in a pulsatile manner, non specific, raised in stress, anorexia, sleep, puberty, pregnancy
173
What are the sick day rules for someone on hydrocortisone and fludrocortisone for primary adrenal insufficiency?
Double hydrocortisone in febrile illness, breaking bone, bodily stressors eg cold/diarrhoea
Don't need to do anything to fludrocortisone
174
RFs for subarachnoid haemorrhage?
Ehler danlos syndrome, smoking, excessive alcohol intake, PKD, coarctation of aorta, cocaine use
175
Presentation of varicocele
Most asx
Some patients may have dull ache
15% of boys around puberty and more likely to be left testicle
176
What part of management of DKA in adults which may be considered is never used in children?
IV sodium bicarb if pH were uner 6.9
177
How does scarlet fever present?
Sandpaper rash, strawberry tongue
178
Biggest cause of scarlet fever?
Strep pyogenes
179
How to manage scarlet fever?
PO phenoxymethylpenicillin for 10 days
| Notify PHE
180
How does acamprosate work?
Enhances GABA transmission and reduces cravings
181
How does clomethiazole work?
Enhances GABA transmission, but cannot be used if continuing to drink
182
How does disulfiram work?
Causes build up of acetaldehyde on consumption of alcohol causing unpleasant symptoms like flushing, headache and anxiety
183
How does naltrexone work?
Reduces pleasurable effect of alcohol by acting as opioid antagonist
184
Absolute contraindication to ECT?
Raised intracranial pressure
185
Relative contraindications to ECT?
Cerebral tumour/aneurysm, phaeochromocytoma, pregnancy, recent MI
186
5 causes of drug induced psychosis?
Alcohol, cocaine, amphetamine, MDMA, cannabis, mephedrone, LSD, ketamine, anti-malarail, bromocriptine, levodopa, steroids
187
What is the edinburgh scale used for?
Screening for postnatal depression
188
What is the beck depression inventory used for?
To measure severity of depression
189
What is the hamilton depression rating scale?
indication of depression and guide to evaluate recovery
190
What is the PHQ4 for?
Brief screening tool for anxiety and depression
191
What is the PHQ9 for?
Diagnoses depression and grades severity of symptoms
192
Which type of benzos are likely to cause behavioural disinhibition?
Short acting
193
What's a good alternative to short acting benzos?
Hydroxyzine (sedating antihistamine)
194
Which class of antidepressants should be used with caution in benzo use and why?
SSRIs increase the plasma concentration of benzos
195
First line pharm option for delirium?
| Repeat options?
Haloperidol 0.5mg PO or IM
If PO, dosing can be repeated every 4 hours
0.5mg IM can be repeated hourly
196
What is second line pharm option for delirium?
Lorazepam
197
Carbamazepine interactions with methylphenidate?
Decreases levels of methylphenidate
198
Isocarboxazid class, and how does it interact with methylphenidate?
MAOI
| Increases risk of a hypertensive crisis
199
Risperidone interactions with methylphenidate?
Increased risk of dyskinesias
200
How does linezolid (which class?) interact with methylphenidate?
Antibiotic
| Increases risk of elevated blood pressure
201
Emergency contraception options and time limits?
Within 72 hours: levonelle (levonorgestrel 1.5mg)
Within 120 hour: ellaone (ulipristal acetate 30mg) and copper coil IUD
202
When should you not use copper coil as emergency contraception?
Copper allergy or Wilsons disease
| Untreated STI or pelvic infection
203
Complications of gestational diabetes?
Polyhydramnios, high birth weight, preterm delivery, stillbirth, shoulder dystocia, high blood pressure, preeclampsia
204
Teratogenic effects of sodium valproate, in order of occurrence?
```
Hypospadias most likely
Spina bifida
ASD
Cleft palate
Polydactyly
```
205
Inheritance of marfans syndrome? Main risk of this condition?
Autosomal dominant
| Aortic dissection and rupture
206
Management of PPH due to uterine atony?
Meds first: oxytocin, ergometrine, carboprost, misoprostol
Then intrauterine balloon tamponade
Then haemostatic suturing (B lynch)
Then hysterectomy as last resort
207
What antibiotic for preterm PROM?
Oral erythromycin, continue for maximum of 10 days or until woman is in established labour (whichever comes first)
208
What antibiotic for women in labour with a fever or have had previous GBS infection in pregnancy?
IV benyzlpenicillin
209
Risk factors for ectopic pregnancy?
Anything slowing down passage of ovum
| POP, IVF, endometriosis, adhesions
210
What is first line management for confirmed miscarriage?
Expectant management for 7 to 14 days
211
When do you consider alternative management options for confirmed miscarriage?
Woman at increased risk of haemorrhage eg late in first trimester, coagulopathies, can not have blood transfusion
Woman has had previous adverse/traumatic experience in pregnancy eg stillbirth, miscarriage, APH
Evidence of infection
212
What is the combined test, when conducted?
Between 11 and 13+6 weeks, standard screening test for Down syndrome
Nuchal translucency measurement, serum beta hcg, pregnancy associated plasma protein A (PAPP-A)
213
What combined test result would suggest down syndrome?
Raised hcg, low PAPP-A and thickened nuchal translucency
214
What tests can be offered instead in woman past the threshold of combined test?
Triple or quadruple test
215
What does triple test look at?
AFP (alpha fetoprotein), unconjugated oestradiol, hcg
216
What does quadruple test look at?
AFP, unconjugated oestriol, hcg, inhibin A
217
What are risk factors for endometriosis?
Anything prolonging amount of bleeding a woman has
Early menarche, late menopause, delayed childbearing, nulliparity
Also, family history, vaginal outflow obstruction, white ethnicity, low BMI, autoimmune disease
218
How to manage cauda equina?
Medical decompression first with high dose dexamethasone
Surgeon review and surgical decompression
219
How does brown sequard syndrome present?
Hemisection of cord on one side
Paralysis, loss of proprioception and vibration on ipsilateral side of lesion
Contralateral side= lack of pain and temperature sensation
220
What shape can the heart have on CXR in tetralogy of fallot?
Boot shaped (upturned cardiac apex) due to RVH and flat/concave pulmonary trunk (due to pulmonary stenosis)
221
Contraindications to joint aspiration?
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Relative= joint prosthesis (only done by ortho surgeon in theatre due to risk of infection)
Others= bacteraemia, inaccessible joints, overlying infection in soft tissue
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222
Absolute vs relative contraindication?
Absolute- event or substance could cause life threatening situation
Relative- caution should be used, acceptable if benefits outweigh risks
223
Bloods indicative of alcoholic liver disease?
AST levels elevated, normally above ALT level
| AST:ALT ratio above 2:1 in about 70% of cases
224
Main causative organisms of COPD exacerbations?
Moraxella catarrhalis, Hameophilus influenzae, S. pneumoniae
225
Class of drug of indapamide?
Thiazide like diuretic
226
How to calculate units in an alcoholic drink?
Units= volume (L) x %ABV
227
Concerning feature of a febrile seizure?
Focal seizure lasting over 15 minutes= complex febrile convulsion
228
UTI in men management?
7 days nitrofurantoin bd
or
7 days trimethroprim bd
229
Normal folic acid recommendation for pregnancy?
400 ug daily before pregnancy and throughout first 12 weeks
230
When are folic acid requirements different? How much to advise?
5 mg a day before and throughout first 12 weeks
If: on anti-epileptic drug, coeliac, diabetes, BMI over 30 or has neural tube defect risk
231
Score used to stratify upper GI bleeding patients who are low risk and candidates for outpatient management?
Glasgow-Blatchford bleeding score
232
What is the PERC score?
Used to rule out pulmonary embolism
233
What is the STOPP criteria?
Used to review medication regimes in elderly people
234
What is the waterlow score?
Estimates risk for development of a pressure sore
235
What is chvostek's sign?
Seen in hypocalcaemia
| Tapping of facial nerve on cheek causes twitching of face
236
What is Hoffman's sign?
UMN sign
| Involuntary flexion of index finger and adduction of thumb on flicking finger
237
What is Hoover's sign?
Patient supine, hand under patients heel, patient to press heels onto table
Examiner feels pressure on non-paretic limb
Patient raises non paretic limb against resistance, shouldn't feel pressure under paretic leg on table
Hoover's sign= pressure felt on paretic leg when non paretic leg raised and no pressure vice versa
238
Frontotemporal dementia features?
Disinhibition, personality change with memory relatively intact
239
Management of idiopathic intracranial hypertension?
Initially: acetazolamide or other diuretics
Other options: serial lumbar puncture, weight reduction
Surgery: optic nerve sheath fenestration, CSF diversion (lumboperitoneal or ventriculoperitoneal shunt)
240
Bone protection for those on long term steroids over 65?
Start alendronic acid or other bisphophonate, no need for DEXA scan
241
What drug to use to prevent vasospasm in cerebral vasculature after SAH?
Nimodipine for 21 days qds, start within 4 days of SAH
242
What is the bradford hill criteria used for?
9 principles used to establish epidemiologic evidence of a causal relationship
243
What are the bradford criteria?
Strength (effect size), consistency, specificity, temporality, dose-response relationship, plausibility, coherence, experiment, analogy
244
How will rhabdomyolysis present?
Myalgia, weakness, red-brown urine, elevated muscle enzymes (incl raised CK), might be asx
245
Bishop score low, how to induce labour?
Need to use vaginal prostaglandin E2 first line
246
Time cut off for acute stress reaction and PTSD?
PTSD can only be diagnosed after 4 weeks
247
Pregnant woman come into contact with chickenpox, never had it herself, what to do?
Give varicella-zoster immunoglobulin ASAP if under 20 weeks pregnant
248
Pregnant woman with chickenpox if presenting within 24 hours of rash onset, management?
If after 20 weeks, oral aciclovir
249
Normal OGTT result?
Less than 7.8 mmol/L
250
What sections don't apply in A&E?
5(2) and 5(4)
251
What is always going to be initial management with preterm labour?
Steroids
Then the emergency Cs
252
Status epilepticus management?
Lorazepam IV 4mg, then repeat dose after 10 minutes if no response
Then move onto IV phenytoin
253
Hirschprung's management?
Rectal washouts/bowel irrigation initially
| Definitive= anorectal pullthrough
254
How does extradural haematoma present?
Initial LOC then clinical improvement then sudden deterioration
255
Timecourse of subdural haematoma presentation?
Can have a latent period before symptoms appear
256
Labour management of obstetric cholestasis?
Induction of labour at 37-38 weeks (risk of stillbirth)
257
How to manage threadworm?
Mebendazole for household
258
What medication for acute dystonia?
IV procyclidine
259
Key causes of drug induced gynaecomastia?
```
Hormones (oestrogen, anabolic steroids)
Anti-androgens (finasteride)
Spironolactone
Antibiotics (metronidazole)
Antihypertensives (amlodipine, verapamil)
GI (omeprazole)
Psych drugs (diazepam, haloperidol, TCAs)
Statins
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