Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

AKT Prep > Routine Problems 2 > Flashcards

Routine Problems 2 Flashcards

(102 cards)

Start Studying
1
Q

What is the difference between primary and secondary nocturnal enuresis?

A

Primary - never dry
SecondarWy - Dry for over 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What age is bed wetting considered to be normal?

A

Under 5 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name three common causes of bedwetting where there is also daytime symptoms?

A

Chronic constipation
UTI (if short history)
Anxiety (if specific situations)
Overactive bladder (can be masked by poor fluid intake)

Consider always family/ behavioral/ maltreatment issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How should bedwetting over the age of 5 be managed?

A

1) Advise and reassure process growing out of it
2) 2-week diary of the fluid intake, bedwetting, and toileting patterns
3) Advise on fluids intake, toileting (encourage 6-7 times daily and before bed) and reward charts (positive behaviours)
4) Trial enuresis alarm
5) Trial desmopressin
(If two courses of any combo 4/5 not worked then refer to secondary care)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A 48 year old taking the COCP comes to see you asking how long she is able to take it for. What age must it be stopped?

A

Stop at 50
(VTE + breast Ca risk) - some bone and heart protection

Over 40 efficacy of COCP decreases, risks increase - screen for these

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A 48y lady on the COCP comes to you, she still has reguarly bleeding with her pill but is wondering if she’s menopausal - how could you assess?

A

FSH generally not used after age 45
- However when on contraception - uncertainty justifies doing FSH
- Can do FSH whilst on progesterone contraception but NOT whilst on COCP - would need to switch to POP for at least 6 weeks before doing FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 48y lady on the COCP comes to you, she still has reguarly bleeding with her pill but is wondering if she’s menopausal - when does she need to take contraception until?

A

Take contraception until 55 (needs to stop COCP at 50 and go to alternative)

If menopausal (1/2yrs since last period/ FSH >30 depending on under or over 50yrs) then can stop.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A patient is starting the COCP, what are 3 common ostrogenic side effects?

A

Hair loss
Migraine
Mennorrhagia/ bleeding
Fluid retention (and fluid weight gain)

N+V/ breast tenderness/ diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A patient is starting the COCP, what are 3 common progesterone side effects?

A

Acne/ rash/ itch
Low mood
Dry vagina
Appetite increase (and weight gain)

N+V/ headache/ breast tenderness/ diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the difference between first and fourth generation contraceptive pills?

A

Oestrogen the same
Progesterones become more potent and longer half life as newer generations (and less androgenic)

So Yasmin (4th) is better than Microgynon (2nd) for breakthrough bleeding etc but carries higher VTE risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A patient who started Microgynon COCP 6 months is struggling with hair loss and migraine (no aura) headaches - which pill could you switch to?

A

If has ostrogenic side effects on COCP:

Prescribe alternative COCP which has less oestrogen and/or more progesterone (i.e. fermodette)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A patient who started Microgynon COCP 6 months is struggling with acne - which pill could you switch to?

A

If has progesterone side effects on COCP:

Prescribe alternative COCP which has less or newer progesterone and/or more oestrogen (i.e. Cilest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If a patient has no preference between POP and COCP, which would you tend to start them on?

A

COCP if no CI’s

Because cycle planning (progesterone gives unpredictable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are two options for managing breakthrough bleeding for a patient on the COCP?

A

Either:
- Increase oestrogen
OR
- Increase generation of progestrogen (i.e. across to Yasmin or similar, especially if oestrogen side effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which antibiotic is used as prophylaxis in sickle cell disease?

A

PenV
(Erythromycin if pen allergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What antibiotics should be avoided in G6PD deficiency? (2)

A

Quinolones (Ciprofloxacin)
Nitrofurantoin
Sulfonamides (Co-trimoxazole)

(Can precipitate hemolytic crisis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How would you describe the key points in a 28 day cycle to a woman?

A

D1-D5 (average) - Mensuration
D14 - Ovulation

Most fertile between 5 days before and 2 days after ovulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you calculate gestational age from LMP?

A

1st day of LMP (so first day of bleeding)

Conception likely around ovulation time so 2 weeks later but for simplicity measure weeks of pregnancy from LMP as difficult to calculate exact conception date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does hemophilia usually present? (Symptoms, gender)

A

X-linked recessive (so almost always male)

Presents: Haemarthrosis, muscle bleeds. Increased/ delayed bleeding with injury or post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the two types of haemophillia, what factors are affected and how is it inherited?

A

Haemophillia A (Factor VIII deficiency)

Haemophillia B (Factor IX deficiency)

Inherited X-linked recessive (almost always affects males)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the most common inherited coagulation disorder and how is it inherited?

A

Von Willebrand disease (1% general pop)

Autosomal dominant disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does Von WIllibrand disease usually present?

A

Mild to moderate:
Mucocutaneous bleeding (gums, nosebleed, menorrhagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are NICE 2ww criteria for bladder cancer?

A

Age 45 and over with:
- Unexplained visible haematuria (and no UTI)
- Persistent haematuria after successful UTI tx

Age 60 and over with non-visible haematuria AND either dysuria OR raised WCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

According to NICE, name 3 groups of patients who should be on Vitamin D supplimentation?

A
  • Pregnant/ breastfeeding
  • Adults >65
  • Not much sun exposure (religious covering)
  • Children 6m-5yrs on <500mls formula milk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
You have a patient with low folate levels. What should be checked and corrected before starting treatment to replace?
B12 Always correct first
26
A 60-year-old man, who worked underground in the coal industry for 30 years, has noticed a progressive deterioration in his hearing over several years. He has had a hearing test organised by his former trade union. He brings the audiometry printout to you for your advice. It shows a loss of 60 dB at a frequency of 4 kHz in both ears. What SINGLE MOST likely condition does this illustrate?
The loss at 4 kHz is characteristic of noise-induced deafness. As the deafness worsens, the loss can extend into the 8 kHz frequency. The loss is typically sensorineural.
27
Which virus is a risk factor for laryngeal cancer?
HPV (Human papilloma virus)
28
You see a 62-year-old man with shortness of breath. His wife has noticed that his feet tend to swell up during the day. These symptoms have gradually been worsening over the past 3 months. He is known to have chronic obstructive pulmonary disease (COPD). A recent blood test has shown a N-terminal-pro brain natriuretic peptide level of 1600pg/ml. What is the SINGLE MOST appropriate management plan to investigate for possible heart failure?
Echo within 6 weeks If the BNP is less than 400, heart failure is unlikely. If it is between 400-2000, an echocardiogram should be performed within 6 weeks with a cardiology review; if the level is higher than 2000, the referral and investigation should be done within 2 weeks.
29
Name 3 ways osteomalacia can commonly present?
- Lower back pain - Bone pain in the shoulder, ribs, pelvis, or legs; - Muscle pain and weakness (generally proximal muscles) - i.e. rising from a chair - Waddling gait - Impaired physical function.
30
What would LFT and bone profile bloods show in: a) Osteomalacia b) Pagets disease of bone
a) Osteomalacia is vit D deficiency May see raised ALP, low Ca b) Pagets disease is cause by increase bone turnover May see raised ALP and either normal or raised Ca
31
What is pagets disease of bone? - How does it commonly present?
Increased bone turnover (most common metabolic bone issue after osteoporosis) - Usually men over 50 Presents with bone pain/ deformity/ fractures - Usually isolated ALP rise
32
How does presbycusis usually present?
Progressive, bilateral sensorineural hearing loss - Very common after the age of 55 years. - High frequency perception most affected, making it difficult to understand speech.
33
What is complex regional pain syndrome (CRPS)
Chronic pain - precipitated by an injury Pain/ hyperesthesia not in single nerve territory and ongoing odema/ skin changes/ motor symptoms etc
34
What is best management of CRPS?
NSAIDS if bony or soft tissue trauma. If simple medication does not reduce the patient’s pain to a mild level after 3–4 weeks, consider using medication for neuropathic pain Opioids are not recommended.
35
You see a 62-year-old patient with suspected acute kidney injury. What is the SINGLE MOST important investigation in the management of acute kidney injury? How do you assess this from baseline?
Serum Creatinine (not egfr/ creatinine clearance) Baseline serum creatinine is assumed to be the lowest value over the previous 3 months
36
How does NICE define episodic headaches (vs. chronic)
Episodic headaches (tension, migraine, cluster) = frequency of less than 15 per month. Migraine or tension headaches are described as chronic if they occur on 15 or more days a month, for more than three months.
37
What are the classic presenting features of cluster headache?
Unilateral severe pain Localised in or around the eye Same sided symptoms of eye watering/ nasal congestion/ eyelid or facial swelling or flushing
38
Which HPV strains cause 90% of genital warts?
HPV 6 and 11
39
Which HPV strains cause 70% cervical cancer cases?
HPV 16 and 18
40
A sexually active 30-year-old woman presents with a frothy vaginal discharge, abnormal vaginal odour, dyspareunia, and mild vulval itching. Vaginal examination reveals a 'strawberry cervix'. A swab and smear test showed flagellated protozoa on microscopy. MLD?
Trichomonas vaginalis (up to 50% women have no symptoms)
41
An STI swab shows a flagellated protozoa in a patient who presented with discharge. What is MLD? Assuming no STI clinic available what treatment should be given?
Trichomonas vaginalis Ideally tx by STI clinic but should be given: Oral metronidazole 400-500mg BD for 5-7 days.
42
When considering the risk of sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) in people with asthma - name three features which increase risk?
Female sex Severe asthma Nasal congestion/ rhinorrhoea/ nasal polyps
43
According to BASH, how long after treatment should young patients under the age of 25 years be offered a repeat test for chlamydia infection?
Young people under the age of 25 years who test positive for chlamydia should be offered a repeat test around three months after treatment of the initial infection. (not a test of cure, re-test because high risk of reinfection and reinfection causes complications.
44
Name 3 symptoms of opioid induced bowel dysfunction (OIBD)
Constipation/ hard stools Dry mouth GORD, vomiting, bloating, abdominal pain Anorexia Delayed digestion
45
How does nephrotic syndrome usually present in children?
Nephrotic syndrome usually presents with early morning periorbital oedema and significant proteinuria. (Can have overlap with nephritic presentation, for example if some glomerulonephritis will also have blood)
46
What is the most common cause of glomerulonephritis in children?
Minimal change disease (Presents as nephrotic syndrome)
47
How does IgA nephropathy (bergers disease) usually present?
IgA nephropathy can be thought of when there is a recurrent history of painless and visible blood. - Often after URTI or GI infection Most common glomerular disease worldwide, common presentation in 20's and 30's
48
You see a 39-year-old lady who has moderate acne vulgaris that has not responded to topical treatment or antibiotics. She also suffers with polycystic ovarian syndrome. She comes in requesting contraception. What is the best option to prescribe?
Co-cyprindiol (Licenced for use in acne vulgaris which hasn’t responded to first-line treatment - it's estrogen + cyproterone an anti-androgen. It can also be used for women with troublesome polycystic ovarian syndrome and provides contraceptive cover).
49
Name 5 "B symptoms" of lymphoma?
Fever, night sweats, shortness of breath, pruritis and weight loss
50
A 43-year-old with a two-month history of dyspepsia attends for review following endoscopy. His endoscopy report confirms severe oesophagitis. What is the SINGLE MOST appropriate management option?
8 week trial of PPI (For GORD usually 4 weeks but if proven oesophagitis on endoscopy then 8 week trial initially) - If no response to PPI then for H2 receptor antagonist
51
What is the current referral guidelines for tonsilectomy with regard to infection frequency?
Offer tonsillectomy to children with - Seven or more documented severe sore throats in one year; - Five or more yearly in two successive years; - Three or more yearly in three successive years
52
After 2 years on sertraline your 43 year old patient wishes to come off sertraline 50mg OD. How should you advise she does this?
Reduce over 4 weeks Usually over a four-week period, - Drugs with a shorter half-life (such as paroxetine and venlafaxine) may need longer. This is not required with fluoxetine because of its long half-life.
53
Name 3 complications of coeliac disease?
Vitamin D deficiency Iron deficiency Osteoporosis Intenstinal lymphoma Functional hyposplenism Ulcerative jejunitis
54
A 5 year old boy has viral gastroenteritis, how long is the a) vomiting and b) diarrhoea likely to last?
a) 1-2, maximum 3 days b) 5-7 days, maximum 2 weeks
55
How is postnatal depression managed if: a) Mild b) Mod/ severe
a) Facilitated self help b) CBT/ antidepressants
56
A patient with low back pain starting under age 45 should be considered for referral to rheumatology for spondyloarthropathy if what additional features are present?
Needs to have 4 or more of: - Low back pain that started before the age of 35 - Waking during the second half of the night because of symptoms - Buttock pain - Improvement with movement - Improvement within 48 hours of taking NSAIDs - First-degree relative with spondyloarthritis - Current or past arthritis - Current or past enthesitis - Current or past psoriasis.
57
A 33 year old patient with low back pain which has now lasted 4 months also has waking in the early morning due to pain, and improvement once he starts moving. He is otherwise well. What's the next most appropriate management step?
Meets exactly 3 of the spondyloarthropathy criteria and so needs: HLA-B27 blood test (if 4 or more direct referral to rheum)
58
What blood test results are most commonly seen in refeeding syndrome? (name 3)
Carbs metabolised > rise in insulin > phosphate and K+ moved into cells = everything low Hypophosphatemia Hypomagnesaemia Hypokalaemia Thiamine deficiency Salt and water retention
59
What is the role of mindfullness in the management of depression?
NICE recommends mindfulness for relapse prevention in people who have had three or more episodes of depression.
60
What are the PHQ-9 depression cut offs?
<4= No depression 5-9 = Mild 10-14 = Moderate 15-19 = Mod/ severe 20-27 = Severe
61
What is Asthenozoospermia?
A sample where less than 50% of the sperm are moving
62
What is Teratozoospermia?
A semen analysis where less than 15% of sperm have normal morphology
63
What is first line treatment for genital/ rectal or pharyngeal chlamydia infections?
Doxycycline 100 mg twice-daily for seven days (No longer recommends single dose azithromycin)
64
What should be advised to pregnant women regarding nicotine patches as smoking cessation in pregnancy?
Nicotine is still toxic to fetus Intermittent methods (gums or lozenges) better than patches If patches used, take off overnight to reduce toxicity to fetus No evidence to suggest nicotine patches help quitting in pregnancy
65
Following a DEXA scan, what is measured by the T-score and z score?
T score - BMD compared with healthy 30 year old of same gender and ethnicity Z score - BMD compared with adult of same age, gender and ethnicity
66
On a DEXA scan what are the definitions of: a) Osteoporosis b) Osteopenia
a) Osteoporosis T score: -2.5 or less b) Osteopenia T score: -1 to -2.5
67
56y male with weight loss, fatigue, erectile dysfunction. Which two investigations should you perform if considering hemochromatosis?
Ferritin Transferin saturationsW
68
Which antibody test is most useful if considering a diagnosis of autoimmune hepatitis?
Anti-smooth muscle antibody
69
Which antibody test is most useful if considering a diagnosis of primary billiary cirrhosis?
Anti-mitochondrial antibodies
70
According to NICE what is the first line treatment for acute prostatitis?
Ofloxacin or ciprofloxacin for 14 days as first-line treatment.
71
A 62-year-old caucasian male presents with a history of back pain over this thoracic area for the last two weeks. It is particularly troublesome at night. He has no other symptoms except tiredness and no significant past medical history. A plain X-ray performed by a locum last week is normal apart from slight loss of bone density. You would like to rule out myeloma as a cause for his thoracic back pain. Which tests would be the SINGLE MOST useful to screen for this?
Immunoglobulins and urine free light chains Around 20% of cases of myeloma will have non diagnostic immunoglobulins but positive urine free light chains (Bence–Jones protein)
72
In what circumstances would you treat chickenpox in adults? What treatment and dose do you prescribe?
Consider prescribing aciclovir for an immunocompetent adult or those aged 14 years or above, with chickenpox who present within 24 hours of the rash Oral aciclovir 800mg five times per day
73
A patient with IBS has tried taking antispasmodic medication as well as loperamide for diarrhoea but these have been of no benefit. What is the second line option in management?
In IBS: Low-dose tricyclic antidepressants as second-line treatment where antispasmodics, laxatives or loperamide have not helped
74
When should you consider and how do you manage hoarding disorder?
Excessive retaining of items, regardless of value, in active house living areas, difficulty getting rid of items > Affects social functioning Management: - Safeguarding - CBT/ SSRI's used but limited evidence
75
What is the typical timeline of infantile haemangiomas?
- Not usually present at birth - Appears first few weeks - Usually rapid growth for first few months - Usually fully grown in 6 months - Starts to shrink age 1 - Usually fully resolved by age 4 70% will have some resiudual skin changes
76
What is the treatment for infantile haemangioma? When should it be started?
Start in rapid growth phase (first few weeks to months) - Treat with oral propanolol Use "infantile haemangioma referral score" (location causing complicatiion, size .4cm, face or eyes, midline lumbrosacral or >5 lesions)
77
At what age is puberty considered delayed and a red flag?
Boys: 14yrs Girls: 13yrs
78
When should children with concern about low height be referred (4)?
- Falling more >1 centile group - Below 0.4 centile = refer all - Below 2nd centile = refer is any other concerns - <3 centiles below mid-parental height
79
Name 3 red flags for a child with short stature?
Weight loss Change in bowel habit Vomiting/ headaches Dysmorphic features Absent puberty signs (13F, 14M) Safeguarding concerns
80
What treatment is given for varicella zoster prophylaxis?
Most people oral aciclovir (from Day 7 to Day 14 after exposure) - VZ immunoglobulin
81
What groups need varicella zoster prophylaxis to prevent shingles?
High risk (immunocomp, preganant, <4weeks) AND Significant exposure AND Subceptible (not had chicken pox before)
82
What blood test needs to be done to assess whether a patient is imune to Varizella Zoster if high risk for infection?
VZV IgG (Levels below cut off/ negative means give post exposure prophylaxis) - If delay will be more than 10 days treat anyway
83
What is the name of exercises patients should be advised to do for BPPV? (Self directed) How often should they be done?
Brandt daroff exercises 5 sets, three times daily for 2 weeks
84
What are the treatment options in PTSD? (name 3)
- Trauma-focused cognitive behavioural therapy (CBT) < Can also be done online for those who don't want to do F2F - EMDR - Medication: Venlafaxine or SSRI's in adults
85
A 38-year-old woman attends your morning surgery. Recent investigations for hoarseness of voice have confirmed the diagnosis of Reinke’s oedema. The patient, who is a smoker, asks you for specific advice as to how she can improve her symptoms and reduce the risk of future recurrence. What do you advise?
Stop precipitant (Smoking here, could also be GORD) Then also surgery +/- SALT
86
How do you classify learning disability according to IQ scores? (4)
IQ score of: Mild: 50–70 Moderate: 35–49 Severe: 20–34 Profound: <20
87
When does haemochromotosis usually present? How is it inherited?
Autosomal recessive Often asymptomatic until late stage Males usually develop syx age 40-60 Women usually after menopause
88
Name 5 common presenting features of haemochromotosis?
Lethargy/ weakness Impotence Loss of libido Generalised arthralgia New diabetes Bronzing of the skin Hepatomegaly Possible testicular atrophy
89
When does Wilsons disease usually present? How is it inherited?
Autosomal recessive Usually presents in 2nd and 3rd decades of life (teens + 20's) Often presents as liver disease in children and adolescents Often neuropyschiatric presentation in young adults
90
Name 3 presenting features of Wilsons disease?
Liver disease (hepatomegaly, deranged bloods) Pyschiatric (severe depression) Neurological - Tremour, ataxia, difficulty speaking etc Opthalmogical (Kayser-Fleischer ring)
91
What are come common features of Prader-Willi-Syndrome? (3)
Usually noticed from birth but can be diagnosed later on? - Excessive appetite and overwating - Restricted growth - Floppyness and hypotonia - Learning difficult - Lack of sexual development - Behavioural changes (aggression etc)
92
Name 3 key risk factors for NAFLD?
T2DM BMI > 25 Dyslipidemia Hypertension
93
What is the most validated way to assess who would benefit from self help/ physio and pyschological therapy for back pain?
STarT back tool (Nice recommened)
94
What are the referral criteria for sciatica/ nerve compression pain with no red flags?
Ongoing pain >12 weeks Impact on function
95
What are the analgesia options for non specific back pain?
NSAIDS No evidence for paracetamol alone Opiates (weak: codeine) can be used for acute but NOT chronic back pain
96
Name 3 early and 3 later signs for CES?
Early - Reduced sensation micturation/ saddle sensation Difficulty/ delay opening bowels or bladder Change in erections/ vagina sensation Late- Saddle anaesthesia, reduced anal tone Incontience (usually overflow) Weakness LMN signs
97
98
What is the main determinant of uric acid levels?
Genetic (Although lifestyle factors key)
99
How should raised uric acid without symptoms be managed?
Not at all Only treat if has symptoms of gout
100
What the the first line options for preventions of gout?
Both allopurinol and feboxistat are first line options
101
What clinical features are needed for diagnosis gout?
1st MTP - Rapid onset pain, redness, swelling (especially if starts overnight) - diagnose gout Any other joint - Consider gout with this but need to consider septic/ other arthritis (so may need to rule others out) If presence of gout tophi - mostly likely untreated gout
102
When is weight loss worrying in newborns?
If weight loss is more than 10% of birth weight or weight does not return to birth weight by 3 weeks of age

AKT Prep (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions