random all topics Flashcards
(122 cards)
1
Q
HRT that most increases breast cancer risk
A
combined systemic oestrogen progestogen HRT - adding a progestogen increases chance of breast cancer
2
Q
first line SSRI ineffective for GAD, not sleeping
A
change to duloxetine
3
Q
which of these is safe in breastfeeding - tetracycline, ciprofloxacin, chloramphenicol, doxycycline, ceftriaxone
A
ceftriaxone
4
Q
tetracyclines in breast feeding
A
bind to calcium causing dental staining, enamel hypoplasia
5
Q
ciprofloxacin in breast feeding
A
fluoroquinolone that causes arthropathy
6
Q
chloramphenicol in breast feeding
A
grey baby syndrome
7
Q
trace glycosuria no other symptoms in pregnancy
A
reassure and safety net - common due to increased GFR and reduction in tubular reabsorption
8
Q
supraclavicular aortic stenosis
A
williams syndrome
9
Q
gingival hyperplasia causes
A
phenytoin, ciclosporin, CCB (nifedipine) and AML
10
Q
how to identify refractive erros
A
pin hole occluder
11
Q
initial management for TIA not suitable for DAPT with aspirin and clopidogrel
A
just clopidogrel
12
Q
aphasia stroke cause
A
Dominant hemisphere middle cerebral artery strokes
13
Q
expectant management of ectopic pregnancy
A
Expectant management of an ectopic pregnancy can only be performed for
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
NOT IF ABDO PAIN
14
Q
pelvic USS prior to gyn referral?
A
current UK guidelines do not require GPs to perform imaging before referring cases with clear features suggestive of secondary dysmenorrhoea; instead, timely referral is preferred so that appropriate investigations (which may include imaging) can be coordinated by specialists.
15
Q
contact lens inf
A
acanthamoeba infection
16
Q
Second degree perineal tear:
A
Injury to the perineal muscle but not including the anal sphincter
repair on ward by trained clinician
17
Q
weird miscarriage RF
A
Large cervical cone biopsy is a risk factor for 2nd-trimester miscarriage
18
Q
A 15-year-old male presents to his GP with the following skin complaint. He has recently had a sore throat, following which the rash started on his trunk.
droplets
A
Acute onset of tear-drop scaly papules on trunk and limbs → ?guttate psoriasis
19
Q
moderate asthma exacerbation /attack
A
Oral prednisolone and salbutamol via a spacer: one puff every 30-60 seconds to a maximum of 10 puffs is correct. Steroid therapy should be given to all children who have an asthma attack and this is the correct administration of salbutamol for a child of this age.
20
Q
subacute combined cord degeneration
A
Hyperreflexia, loss of proprioception, and loss of vibration sense
Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive → subacute combined degeneration of the spinal cord
21
Q
bells palsy
A
hyperacuses - not loss of sensation
22
Q
erythema nodosum mx
A
no active treatment, arrange routine follow-up.
23
Q
Dermatophyte nail infections - use
A
oral terbinafine
24
Q
triggers of autonomic dysreflexia
A
Faecal impaction / urinary retention are the most common triggers of autonomic dysreflexia
25
A 36-year-old with a long standing history of schizophrenia presents to the emergency department in status epilepticus. Once he is treated, he tells the doctor he has been having a lot of seizures recently.
Which of the following medications is most likely to be causing the seizures?
clozapine
26
how to suppress breastfeeding
Cabergoline is the medication of choice in suppressing lactation when breastfeeding cessation is indicated
27
A 24-year-old woman is reviewed in the endocrine clinic with a history of short stature, primary amenorrhoea, and mild hearing loss. She is on oestrogen replacement therapy and has no significant past medical history.
Examination reveals a high-arched palate, low hairline, and a broad chest with widely spaced nipples. Her BMI is 22 kg/m². She is otherwise well and lives independently.
What is the most serious long-term health risk in this patient?
aortic dilation
28
severe burns first step
intubation
29
vitreous haemorrhage vs retinal detachments
haemorrhage = floaters, detachment = curtain
30
HG fluids
Women who have been admitted with hyperemesis gravidarum are generally given IV normal saline with added potassium as hypokalaemia is common
not dextrose
31
A 54 year-old female presents with a loss of dexterity in both hands. She has been struggling to type at work and use her mobile phone. Her symptoms have been deteriorating gradually over the preceding months.
degenerative cervical myelopathy
32
A 70 year-old man has pain and weakness in both legs on walking. It settles with rest
lumbar canal stenosis
33
hard exudates in diabetic retinopathy
moderate to severe
34
dense shadow starting peripherally and progressing centrally, pt with myopia
retinal detachment
CRAO would have risk factors
35
Suspected cases of rubella in pregnancy should be
discussed with the local Health Protection Unit
36
quinine
ototoxic
37
Blunt ocular trauma with associated hyphema is a high-risk scenario of
raised intraocular pressure
38
pain vs heavy period
pain = mefenamic
heavy = tranexamic
39
31-year-old woman , one-day history of a unilateral painful eye. pain on eye movements.
recently treated for a urinary tract infection, joint pains
right eye is watery, and mild photophobia is present. Both pupils are equal and reactive to light. There is no reduced visual acuity.
scleritis
Anterior uveitis is incorrect. It is caused by the inflammation of the uvea which is made up of the iris and ciliary body. It causes a red, painful eye, and may also present with photophobia. However, it can cause a small, fixed pupil, as well as blurred vision. Therefore, scleritis is more likely in this scenario.
40
A 54-year-old man presents with a persistent tremor. On examination there is 6-8 Hz tremor of the arms which is worse when his arms are outstretched. His father suffered from a similar complaint. What is the most suitable first-line treatment?
propranolol
41
A 69-year-old man presents to the emergency department with severe headache and visual disturbance. He reports that he noticed sudden onset pain while watching television last night with the lights off. Painkillers have not helped and he has vomited twice since the pain began. He has no significant medical history and wears glasses for reading.
Which of the following medications should be given as part of the initial management?
AACG - IV acetazolamide
42
A cystic ovarian mass in a middle-aged woman is most likely a
serous cystadenoma - benign
43
hypertensive retinopahty grades
44
laser eye can cause p
loss of night vision
45
ectopic expectant vs medical vs surgical criteria
46
whooping cough school exclusion
2 days
47
seizure mx
leviteracetam for all
ethosuxamide for absence
lamotrigine for tonic-clonic
48
A 20-year-old man presents with recent episodes of severe, stabbing pain in the right eye. These episodes typically occur once a day and last around 30 minutes. His wife reports him pacing around and shouting with the pain. She also reports that his right eye appears red and that he has clear nasal discharge during the episodes.
Given the likely diagnosis, which one of the following should you advise the patient to avoid to help prevent further episodes?
cluster headache - avoid alcohol
49
Procyclidine vs tetrabenazine
P = acute dystonia T = tardive dyskinesia
50
Toby first presented 6 months ago when his mother was concerned about a birthmark on his face. Examination at the time noted that the birthmark was macular, red in colour and had a poorly defined border. On repeat examination today, the birthmark appears to have resolved.
salmon patch
51
This 17-year-old man has a history of asthma and eczema but is normally fit and well. Yesterday he developed a rash on face which extends down to his torso. He feels generally unwell with flu-like symptoms.
eczema herpeticum
52
erysipelas
Erysipelas is a less likely diagnosis in this case because it is a bacterial infection caused by Streptococcus pyogenes, which typically presents as a well-demarcated, raised, erythematous rash with fever. Although the patient has flu-like symptoms, the distribution of the rash and his history of eczema make eczema herpeticum more likely.
53
Placenta accreta increases the risk of what haemorrhage
postpartum
54
Mid-shaft humeral fractures are associated with what nerve injury.
radial - extend wrist
55
penicillin and rash
Toxic epidermal necrolysis is a rare but important side effect of which to be aware of penicillins
Staphylococcal scalded skin syndrome (SSSS) is clinically difficult to distinguish from toxic epidermal necrolysis, and both would present with a positive Nikolsky's sign. SSSS only affects the granular cell layer of the epidermis whereas TEN occurs between the epidermis and dermis. However, SSSS normally only affects infants, young children ( usually under 5 years ) and occasionally immunocompromised adults which makes this an unlikely diagnosis in this patient.
56
baby with glucose of 2
asymptomatic, blood glucose over 4 = breastfeed
if 2 then Initiate IV infusion of 10% dextrose
57
A 28-year-old man attends the dermatology clinic with a rash. On examination, you note an erythematous yellow scaly rash over his nasolabial fold, upper back and chest.
What is a common complication of this condition?
Otitis externa and blepharitis are common complications of seborrhoeic dermatitis
58
bells palsy when to refer
For a patient with a Bell's palsy, if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT
59
mastoiditis
IV abx then surgical drainage
60
A 68-year-old man presents with acute onset dizziness accompanied by nausea and unsteadiness. He has a history of atrial fibrillation. On examination, he exhibits difficulty fixating on the examiner's nose during the head impulse test, and a corrective saccade is observed.
What is the most likely diagnosis?
HINTS = vestibular neuronitis
not posterior stroke syndrome
Positive = Peripheral vertigo
61
brachial plexus pain unresponsive to paracetamol
Pregabalin is a first-line treatment for neuropathic pain according to the National Institute for Health and Care Excellence (NICE) guidelines in the UK.
62
Plucking of clothes is typically seen in
temporal lobe seizures
63
suicide RF
recent job loss
64
darker scars on fundoscopy
pan-retinal photocoagulation scars
65
corrective age to
40 weeks
66
Medical management of an incomplete miscarriage involves giving
vaginal misoprostol alone
67
hypospadias
avoid circumcision, correct surgically at 6m
68
Peripheral curtain over vision + spider webs + flashing lights in vision think
retinal detachment
69
A 64-year-old lady presents to the GP with urinary incontinence. On further questioning, she notes that the symptoms of incontinence are worst after she coughs or sneezes. She has had 4 children, all through vaginal delivery, the last of which was 30 years ago. These symptoms have been worsening for the last 6-weeks.
Given this woman's presentation, which of the following investigations should be ordered?
urinalysis
rule out UTI and DM
70
migraine prophylaxis young female
topiramate not for child bearing - give propranolol
71
nail bed of index finger
median nerve
72
pyoderma gangrenous tx
Oral steroids are the first-line treatment for pyoderma gangrenosum
73
Globus, hoarseness and no red flags → ?
laryngopharyngeal reflux
74
Juvenile myoclonic epilepsy is classically associated with seizures in the morning/following sleep deprivation
seizures in the morning/following sleep deprivation
75
Vision worse going down stairs? Think
4th nerve palsy
76
All TIA patients should have an
urgent carotid doppler unless they are not a candidate for carotid endarterectomy
77
By 6 months, a child can
hold objects with palmar grasp, and pass objects from one hand to another
78
TCA type of incontinence
overflow
79
Haemorrhage 5-10 days after tonsillectomy is
commonly associated with a wound infection and should therefore be treated with antibiotics
80
Headache linked to Valsalva manoeuvres =
raised ICP until proven otherwise so LP is contraindicated
give non contrast CT head
81
when is test of cure
6months
82
holmes adie
Holmes ADIe = DIlated pupil, females, absent leg reflexes
83
Examination and investigations are normal, however, you note that he is acting strangely. He is reluctant to answer questions and does not maintain eye contact. After developing trust with him, he discloses he has never been in a relationship and that he prefers to be on his own as he won't embarrass himself. He has no friends and doesn't speak to his family because they criticise everything he does.
Which form of personality disorder is he likely suffering from?
avoidant - fear of criticism and ridicule
84
orbital cellulitits
Key feature from the stem is the proptosis (bulging) of the eye which mains the infection has spread to behind the eye itself. That is what the USS is describing. This then supports a diagnosis of orbital cellulitis which gets IV antibiotics
33 Anonymous - 15 Jan 23
Also the involvement of the retro-orbital soft tissue points more towards orbital cellulitis as it means the infection has spread past the orbital septum. In pre-orbital cellulitis the infection does not cross the orbital septum.
85
A 67-year-old man presents to the emergency department with his wife due to confusion that has progressed over the last 4-5 days with fever and flu-like symptoms. Since admission, he has been persistently vomiting and has repeatedly attempted to leave the hospital against medical advice. His clinical state deteriorates further; his speech is now random and resembles 'word salad'. His current vital signs are listed below.
Heart rate 102bpm
Temperature 38.9ºC
Blood pressure 156/110mmHg
herpes simplex encephalitis
86
crawls
9 months
87
no head lag when pulled to sit
3 months
88
worst MND
Patients with progressive bulbar palsy typically have a median survival of approximately 2-3 years from symptom onset, w
89
Management of patients with cervical myelopathy should be by
neurosurgery
90
white vs black tongue
hairy leukoplakia - white, black hairy tongue - black
91
Rokitansky protuberance.
teratoma - dermoid cyst
92
beta blockers worsen
plaque psoriasis
93
PTSD medications
venlafaxine, then risperidone if severe
94
A 19-year-old woman presents with a two day history of central lower abdominal pain and one day history of vaginal bleeding. Her last period was 8 weeks ago. On examination her cervix is tender to touch
ectopic pregnancy
95
Laughter → fall/collapse ?
cataplexy
96
FH or weed more likely to cause schizophrenia
Fh
97
haemetemesis after burn
Curling's ulcers
98
The long history of diabetes mellitus in an elderly presentation along with unilateral blurry vision and halos surrounding light sources are strongly suggestive of a diagnosis of.
cataract
99
HG anti nausea
cyclizine
100
severe eczema unresponsive to acicylvir
Coxsackie virus can cause 'eczema coxsackium', which is a key differential for eczema herpeticum. It is usually a self-limiting infection that does not respond to treatment with acyclovir.
101
A 35-year-old woman presents to her GP complaining of intermittent double vision that comes on throughout the day. She finds that after resting her eyes her vision normalises.
She has been troubled by this for the last six months, and symptoms have been deteriorating. She has already seen her optician who was unable to find a cause. There have been no features of peripheral nerve or muscle problems.
Given the likely diagnosis, what medication is likely to be trialled first-line?
ocular mg - pyridostigmine
102
magnesium sulphate induced respiratory depression
calcium gluconate
103
ondansetron risk to baby
cleft lip and palate in first trimester
104
responds to name
9-12 months
105
Stereotypical PCOS results:
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low
106
how long seizure free to drive
12 months
107
insomnia
3 months, 3 nights a week
108
A 53-year-old male presents with difficulty speaking clearly and some swallowing difficulty. On examination of his cranial nerves, it is noted that he has an overactive gag reflex on both sides, tongue spasticity and the tongue seems to be wasted with fasciculations.
MND
109
Cat 1 C sec
3o mins
110
The thyrotoxicosis phase of postpartum thyroiditis is generally managed with what alone
propranolol
111
Hormonal contraception can be started when after using levonorgestrel (Levonelle) for emergency contraception
immediately
112
Brain abscess: IV
3rd-generation cephalosporin + metronidazole
113
Bow legs in a child < 3 is
a normal variant and usually resolves by the age of 4 years
114
what is 1st line for pregnancy induced hypertension
Labetalol is first-line for pregnancy-induced hypertension
115
pancoast = no sweating on
face
No sweating on the face and neck would be observed in a central cause of Horner's syndrome, such as a stroke, syringomyelia or multiple sclerosis.
116
degenerative cervical myelopathy / MS sign q
Hoffmans sign - flick middle finger q
117
right homonymous hemianopia with macula sparing. T
posterior cerebral artery infarct
118
is breast cancer a CI for POP
yes
119
Severe urticaria -
A short course of an oral corticosteroid may required in addition to a non-sedating antihistamine
120
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity
, medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)
121
Acute lymphoblastic leukaemia may present with haemorrhagic or thrombotic complications due to.
DIC
122
