Prep 4 Flashcards
1
Q
ADHD diagnostic triad
A
inattention
hyperactivity
impulsivity
2
Q
MSE
A
appearance and behaviour speech emotion (mood and affect) perception thought (content, form) insight cognition (MMSE)
3
Q
cloazapine se
A
agranulocytosis
cardiomyopathy, weight gain
4
Q
management of GAD
A
education and active monitoring
low intensity psychological intervention (self- help, groups)
high intensity psychological intervention (CBT, applied relaxation) or drug treatment (SSRIs - sertraline)
5
Q
most common psychiatric problem after a CVA?
A
depression
6
Q
Management of ADHD?
A
methylphenidate (monitor growth, psychiatry every 6months) se abdo, nausea, dyspepsia
atomexitine
7
Q
three components of orientation
A
time
place
person
8
Q
What is wernickes encephalopathy and what causes it?
A
neuropsychiatric disorder due to thiamine (B1) deficiency
seen commonly in alcoholics
triad: ophthalmoplegia, ataxia, confusion
if untreated can develop into korsacoffs (amnesia and confabulation)
9
Q
step wise dementia
A
vascular
10
Q
What is a rumination
A
focused attention on ones symptoms of stress and the causes and consequences but not solutions
11
Q
excessive daytime sleepiness and sudden attacks of sleep
A
narcolepsy
12
Q
sleep disorder in depression
A
early wakening
13
Q
3 core symptoms of depression
A
anergia, anhedonia, low mood
14
Q
antideprassant in pregnancy
A
sertraline
15
Q
test for chlamydia
A
NAAT and PCR (endocervical swab or first pass urine)
16
Q
management of opiod overdose
A
naloxone
17
Q
coccaine overdose signs
A
dilated pupils
hyperstimulation
18
Q
heroin overdose signs
A
shallow breaths
pinpoint pupils
19
Q
man treated with antibiotics for presumed pneumonia, smoker, returns in 6 weeks still hoarse
A
refer to ENT immediately
20
Q
bullous pemphigoid
A
IgG linear at BM no acantholysis
21
Q
stabbed in neck and then shoulder pain
A
right axillary nerve
22
Q
Elbow replacement then tingling in ring finger, positive froments sign
A
cubital tunnel syndrome (ulnar nerve palsy - weakness of APL, loss of thumb adduction)
abnormal pinch FPL innervated by median nerve compensates and thumb IPJ flexes
23
Q
posterior hip dislocation
A
internal rotation
shortening
24
Q
treatment of a tibial fracture in middle aged
A
closed fractures with minimal discplacement or stable reduction (long leg cast - delay cast application for 3-5 days to allow swelling to go down)
unstable fractures - operative fixation
25
DDH screening tests
ortolani (abduct and push thigh anteriorly - trying to relocate)
barlow (adduction of hip and push posteriorly - trying to dislocate)
clicks normal clunks abnormal
26
AAA screening
abdo USS >5.5cm in males needs repair
27
back pain, small pupils, red eyes
ank spon
28
treatment for anterior uveitis
topical prednisolone
29
treatment for acute angle closed glaucoma
IV acetazolamide
30
Prevention of pre-eclampsia
aspirin
| hydralazine, labetalol, nifedipine
31
Treatment of eclampsia
mg sulphate
32
women with TAHBSO age 45 hot flushes and night sweats
oestorgen only hrt
33
39 year old woman with TAHBSO for endometriosis
sequential hrt
34
managing squints first step
correct refractive errors first
35
large for dates pregnancy missing GI tract
polyhydraminos is common in fetal anomoly
| duodenal or oesophageal atresia
36
post menopausal lady with menorrgagia and intermenstrual bleeding
urgent referral to gynae
| endometrial Ca, endometrial polyps, atrophy, endometrial hyperplasia, HRT
37
What is radiotherapy prescribed in?
gray
38
How are chemotherapy doses calcuated
patient's calculated surface area
39
If SVCO is caused by an intrinsic clot which treatment should not be used
stent
40
what kind of back pain is typical in spinal cord compression
radicular
41
initial management in a patient with hypercalcemia
iv fluids
42
what type of lung cancer is most likely to lead to hypercalcemia
squamous cell
43
what is breakthrough dose for 30mg bd morphine sulphate tablets
10mg oromorph
44
what virus causes a significant proportion of oropharyngeal cancers
EBV
45
what 3 screening programmes are there in the uk
breast, bowel, cervical
46
When can tamoxifen be used in breast cancer
pre-menopausal women
47
when does ovarian cancers normally present
late
48
side effects of chemo
alopecia, vomiting, pancytopenia, oedema
49
Patient is diagnosed with oesophageal cancer, who do you refer to
upper gi and oncology
50
managment of malignant hyper calcemia
hydration
| bisphosphonates
51
most likely of bilateral internuclear ophthalmoplegia in young
MS
| cant adduct affected eye and nystagmus in the other - damage to MLF tract that is heavily myelinated
52
features of dermatoyositis
symmetrical proximal muscle weakness and characteristic skin lesions (photosensitive rash, helitrope rash, gottrons paupules- roughened surfaces over extensor surfaces of fingers)
53
What are the 3 main inflammatory myopathies
polymyositis
dermatomositis
inclusion body myositis
54
What is addisons disease
primary adrenal insufficiency (low cortisol and aldosterone, most commonly AI destruction of adrenal cortex)
55
why does addisons cause hyperpigmentation
MSH and ACTH have same precursor (increased ACTH results in more of the precursor being produced thus MSH)
56
function of aldosterone
increases reaborption of Na and excretion of K at distal tubules and collecting duct (works to increase BP)
57
diagnosis of addisons
short synacthen test (plasma cortisol measured before and after ACTH administration 250mcg im)
58
features of addisonian crisis
hyperkalemia (more k retained at kidney)
hyponatremia (less Na reabsorption - lack of aldosterone)
hypoglycema (loss of glucocorticoid effect)
metabolic acidosis (H+ retention at kidneys)
59
acne treatment and contraceptive
dianette (contains cyproterone acetate - antiadrogen and acts as form of progesterone and contains eostrogen)
60
bilateral red eye in child
chlamydial conjunctivitis (a - c serological group)
61
what is a dermatofibroma
benign fibrous nodule that commonly arises on lower leg
| firm and tethered to skin surface move over underneath tissue
62
when can graduated compression be used on leg ulcers
ABPI >0.8 indicating venous cuase
63
ABPI 0.4
refer to vascular surgeon
64
histology in psoriasis
absent granular layer
| hyperproliferation of keratinocytes
65
What drugs interact macrolide abx (clarithromycin etc)
statins
theophylline
(potent inhibitors of P450 enzymes involved in metabolising these drugs, increased levels of statin and theophylline in the blood and se more likely)
66
What does the combination of ACEi, NSAID and diuretic increase the liklihood of
high risk of AKI
67
physiological change in elderly
increased heterogenity
68
benzodiazepines causing memory loss
idiosyncratic effect
69
first order drug kinetics
rate of administration = rate of elimination (elimination is proportional to drug concentration)
70
when are patches preferred to oral/iv morphine
CKD
71
side effect of calcium
gi upset
72
what drugs commonly cause tremor
```
caffeine
salbutamol
lithium
neuroleptics
cyclosporine
```
73
when is metformin CI
renal impairment
74
exudate vs transudate
transudate protein <25 (HF, cirrohosis, hypoproteinaemia)
| exudate protein >25 (malignancy, infection and inflammation)
75
Empyeme findings
pH <7.2
low glucose
raised LDH
76
walking up stairs and losing consciousness
vertebrobasilar insuffieciency
77
difference between alpha blockers (tamulosin, doxasosin) and 5-alpha reductast inhibitors (finasteride)
alpha blockers relax smooth muscle of prostate and bladder affect acheived in days and se postural hypotension
5-aloha reductase inhibitors reduce prostatic metabolism of testosterone take several months until effect se loos of libido and erectile dysfunction
78
tolteridone
antimuscarinic used in urge incontinence
79
bisphosphonate mechanism
increase apoptosis of osteoclasts
80
what combination is ueful in reducing fracture risk
bisphosphonate, calcium, vit d
81
mycobacterium tb features
acid fast bacilli
strict aerobe
stains ZN bright red
82
caseated granuloma
tb
83
ghon focus
tb
84
dka
metabolic acidosis
85
how can cushings cause infertility
pituitary adenoma with over secretion of ACTH
| other pituitary hormones affected reduces FSH & LH production
86
23 year old para 0+0 woman is currently at 20 weeks gestation. She is currently well. Her sister had severe early onset pre-eclampsia and delivered a growth-restricted infant at 28 weeks. Which test should be performed to further assess this patient’s risk of developing pre-eclampsia
urinalysis for proteinurea
BP
Maternal artery doppler (in pre-eclampsia there is a pathological increase in placental vascular resistance - absent end diastolic flow or reversed end diastolic flow)
87
GORD in pregnancy
antacids (maalox)
| alginates (gaviscon)
88
what should women at high risk of pre-eclampsia take
aspirin 75mg from week 12 until birth (previous htn, ckd, AI disorders, DM)
89
management and prophylaxis of seizures in pre-eclampsia
mg sulphate 4g IV
90
hrt in endometriosis
combined hrt (even if TAH BSO)
91
active 3rd stage of labour drug
syntocinon
92
definition of hypertension in pregnancy
>140/90 or DBP>110 or >30/15 from booking visit
| treat with labetalol, nifidepin or hydralazine
93
drugs in urge incontinance after bladder drills (at least 6 weeks)
oxybutinin (avoid in frail elderly)
| tolteridone (antimuscarincs relax the over active detrusor)
94
treatment of stress incontinence
pelvic floor excerises for at least 3 months then consider surgery
95
what can cause polyhydraminos
monchorionic twins
anomolys (GI atresias, anencephaly, downs and edwards) maternal diabetes
hydrops fetalis
96
management of persistent eclamptic seizure
diazepam 10mg iv
97
Post menopausal lady with menorrhagia and intermenstrual bleed
urgent gynaereferral
98
first line hormonal treatment of menorrhagia
IUS
| non hormonal tranexamic acid or mefanamic acid
99
contraception for pcos
COCP (increases ABG) or
| diannete (co cyprindiol) has antiadonergics effects
100
pcos management for fertility
clomifine (anti-oestorgen)
| +/- metformin
101
contraception if BMI >35
POP
102
what drug should be used for hyperthyroidism in pregnancy
propylthiouracil
103
PCOS criteria
>2 of:
clinical or biochemical raised androgens
oligo/amenorrhea
polycystic ovaries on USS
104
flagellae under microscope
trachomonas
105
G-ve diploccoi
gonorrhoae
106
painful ulcers on labia
HSV
107
40ish woman, still having periods, but mood swings and hot flushes, what HRT?
oestrogen and mirena
108
51 year old Woman with hot flushes, night sweats, 18 months since last period
continous combined
109
Younger woman, still having irregular periods
sequential HRT
110
what cancer does tamoxifen increase risk of
endometrial (is a oestrogen receptor antagonist at breast but not at endometrium)
111
How long is tamoxifen used for after removal of oestrogen sensitive breast ca
5 years
112
management of vault prolapse
sacrospinous fixation
113
best treatment for a urethrocele no other medical problems
pelvic floor exercises
114
tx endometrial polyps
myomectomy
115
what is term
38-42weeks
116
presentation
part presenting into pelvis
117
postion
baby facing OA OP
118
lie
foetal axis to maternal axis
119
inducing ovulation in pituitary adenomas
GnRH
| dopamine agonists
120
what does imperforate hymen increase risk of
endometriosis (retrograde menses)
121
tests to confirm menopause
FSH and LH levels
122
next investigation after increased endometrial thickness
endometrial biopsy
123
maagement of PID
IM ceftrioxone
metronidizole
doxycycline
124
deep dyspareunia fixed retroverted uterus
endometriosis
