Stuff I have got wrong in the past Flashcards
1
Q
What two bacteria are most significant for those with CF and are the reasons they should not interact?
A
- Pseudomonas aeruginosa
- Burkholderia cepacia (contraindication to lung transplant in CF)
2
Q
When should infantile colic resolve by?
A
6 months
3
Q
What is the triad of features seen in shaken baby syndrome?
A
- Retinal haemorrhage
- Subdural haematoma
- Encephalopathy
4
Q
When can a child legally consent to sex and the doctor is not required to contact safeguarding?
A
13
5
Q
What medications can be used to close a PDA (3)?
A
- Indomethacin
- Ibruprofen
- Paracetamol
6
Q
What must be done before giving indomethacin to a neonate for PDA?
A
Echo to rule out duct dependant CHD
7
Q
PPROM definition?
A
(preterm premature rupture of the membranes) - rupture of membranes before 37 weeks and before labour
does not have to be a specific time period before labour
Prolonged = rupture more than 18 hours before labour
8
Q
What is prolonged rupture of membranes?
A
Amniotic sac ruptured more than 18 hours before labour
note prelabour rupture of membranes simply means before labour
9
Q
What are the sepsis six?
A
- Blood cultures
- Urine output
- Fluids
- Antibiotics
- Lactate
-
Oxygen
consider inotropic support e.g. epinephrine
10
Q
What is pituitary apoplexy and how does it present (3)?
A
Sudden enlargement of a pituitary tumour:
* Sudden onset headache
* Visual field defects
* Evidence of pituitary insufficiency (e.g. hypotension)
11
Q
What time period after going to hospital should deaths be reported to the coroner?
A
If death occurs within 24 hours
12
Q
What law allows treatment of a patient for emergency treatment?
A
Common law
this supersedes MCA/ MHA in an emergency
13
Q
What sort of memory loss does depression cause?
A
Global memory loss
14
Q
How should neuropathic pain be managed (3)?
A
- Try one of amitriptyline, gabapentin/ pregabalin, duloxetine
- Stop original drug, try another
15
Q
How should MS be diagnosed?
A
MRI WITH contrast
16
Q
When should bleeding whilst taking a progesterone only pill be investigated?
A
If it lasts beyond 3 months
17
Q
How is measles diagnosed (2)?
A
- If rash began within 3 days = PCR
- If rash began more than 3 days ago = serology
18
Q
How should a sickle cell crisis be managed (4)?
A
- Fluid
- Analgesia
- Oxygen
- Abx
19
Q
What are the different types of perineal tears (6)?
A
- 1 = superficial, no muscle involvement
- 2 = injury to perineal muscle, not sphincter
- 3a = <50% external anal sphincter
- 3b = >50% external anal sphincter
- 3c = internal anal sphincter
- 4 = rectal mucosa
20
Q
How should perineal tears be managed (3)?
A
- Nothing = 1st
- Suture on ward by midwife = 2nd
- Repair in theatre = 3/4th
21
Q
What medication can improve the success of ECV?
A
Terbutaline
22
Q
What nerve is often injured in a neck of fibular fracture?
A
Common fibular nerve
23
Q
What drug can be given for the active management of the third stage of labour?
A
Oxytocin
ergometrine sometimes used as an alternative
24
Q
When should urine cultures be sent in adults as opposed to relying on urine dipstick (4)?
A
- Over 65
- Visible/ non visible haematuria
- Men
- Pregnant women
25
What is jugular foramen syndrome?
Paralysis of CN 9, 10 and 11
26
What does a fluctuant breast mass suggest (2)?
* Cyst
* Abscess - refer to surgeons to drain
27
How should PID be managed with antibiotics (3)?
* Ceftriaxone
* Metronidazole
* Doxycycline
28
What are the signs/ symptoms of rickets (5)?
* Bowed legs (genuflects varum)
* Stunted growth
* Bone pain
* Frontal bossing
* Harrisons sulcus - indentation roughly along line of 6th rib (also seen in asthma)
29
What is Cushing's reflex (3)?
* Bradycardia
* Hypertension
* Irregular breathing
30
What is variance?
Standard deviation ^ 2
31
What is likelihood ratio for a positive test?
sensitivity/ (1 - specificity)
32
What is the likelihood ratio for a negative test?
(1 - sensitivity)/ specificity
33
Hazard ratio vs incidence rate ratio?
* Hazard ratio compares the risk over time periods
* Incidence rate ratio simply compares the incidence at different time points
34
Should patients with cystic fibrosis be allowed to interact with PPE?
No they should never be allowed to interact under NO circumstances
35
What is the hawthorne effect?
Change in behaviour due to the knowledge that it is being studied
36
What nerves are affected in vestibular schwannomas?
5, 7, 8
37
What medication is used for delirium tremens in those with liver failure?
Lorazepam
38
What is raised in the newborn blood spot test in children with cystic fibrosis?
Immunoreactive trypsinogen
39
How should pre-elampsia be managed by a GP?
Emergency secondary care assessment
40
What causes webers syndrome?
Occlusion in the branches of the posterior cerebral artery that supply the midbrain
41
How does webers syndrome (branches of posterior cerebral artery that supply the midbrain) present (2)?
* Ipsilateral CN 3 palsy
* Contralateral weakness of upper + lower extremities
42
What causes Wallenberg syndrome (lateral medullary syndrome)?
Posterior inferior cerebellar artery occlusion
43
What causes lateral pontine syndrome?
Anterior inferior cerebellar artery occlusion
44
How does Wallenbergs (PICA) present (4)?
* Ipsilateral facial pain + temp loss
* Contralateral limb pain + temp loss
* Ataxia
* Nystagmus
45
How does lateral pontine syndrome present (AICA) (3)?
* Same as Wallenbergs +++
* Ipsilateral facial droop
* Deafness
46
What neurological condition can cause fluctuating levels of consciousness?
Subdural haemorrhage
47
What is the presentation of a hydrocele?
Fluctuant mass in groin area
*fluctuant differentiates it from hernia*
48
What is the most common cause of painless massive GI bleed in 1-2 year olds?
Meckles diverticulum
49
What is the most common cause of mesenteric adenitis?
Yersinia enterocolitica
50
How is CJD definitively diagnosed?
Brain biopsy
51
What should indicate the need for antibiotics in women breastfeeding who have mastitis (3)?
* No improvement after 12-24 hours of expressing/ breastfeeding
* Nipple fissure
* Systemically unwell
52
How is whooping cough investigated (2)?
* Nasal swab + culture = first line
* Nasal swab + PCR = more sensitive
53
What medication is used to suppress breastfeeding?
Cabergoline (dopamine receptor agonist)
54
What is often the most significant sign of congestive heart failure in infants?
Hepatomegaly
55
What is a radial scar?
Benign breast condition causing scaring of the breast in a star shaped pattern (due to sclerosis of breast ducts)
56
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
57
What is confabulation?
Memory gaps are filled with false fabricated memories
58
How should abnormal vaginal bleeding be investigated in postmenopausal women (3)?
* TVUSS
* Hysteroscopy
* Biopsy
59
How should premenopausal women be investigated for abnormal vaginal bleeding (4)?
* TVUSS
* Chlamydia test
* Colposcopy
* Biopsy
60
What is cataplexy?
Sudden and transient loss of muscle tone caused by strong emotions e.g. **laughing**
61
How is spasticity due to MS treated (2)?
Baclofen or gabapentin
62
What is the bone marrow finding in those with ALL?
Blast cell predominance
*note ALL causes pancytopenia - even WCC can be low*
63
What are the combined test results for downs?
* Raised BhCG
* Increased NT
* Decreased PAPP-A
64
What are the quadruple test results for Downs?
* Raised BhCG
* Raised inhibit A
* Decreased AFP
* Decreased E3
65
How does a bartholins cyst present and what is the management?
Painless fluctuant lump on labia major
*manage with warm salt water baths*
66
What is usually the most significant risk factor for candidasis?
COCP
*also DM, recent Abx*
67
When is spinal stenosis pain/weakness usually worse?
Walking downhill
68
What type of biopsy should be used for most breast lumps?
Core needle biopsy
*fine is not used very frequently nowadays*
69
Which antipsychotic has the highest rate of prolactinaemia?
Risperidone
70
What tool is used to assess whether medications should be discontinued?
STOPP tool
71
Can aspirin be taken whilst breastfeeding?
NOOOOO
72
What are the ranges for a diabetes diagnosis (3)?
* FBG > 7.0
* HbA1C > 48 (or equal to)
* RPG > 11.1
73
How does gliclazide (sulfonylurea) cause hypoglycaemia?
Increases pancreatic beta cell insulin production + release independent of blood glucose level
74
What legislation allows patients who lack capacity to be made to do something/ not allowed to do what they want??
Deprivation of liberties safeguard
75
What are the 3 most common presentations of OCD (3)?
* Hand washing
* Fear of harm
* Perfectionism/ arranging things
76
How does lymphogranuloma vereneum present?
Small PAINLESS ulcer in genital area
*doxycyline = first line*
77
What is a differential for croup if symptoms do not improve with treatment?
Bacterial tracheitis
78
How is chorea in huntingtons treated?
Tetrabenazine
79
What is baclofen?
Muscle relaxant often used for MS and muscle spasms in palliative care
80
What bloods should be done before starting lithium (5)?
* FBC
* U&Es
* Ca2+
* eGFR
* TFTs
81
What are the percentages that fall within 1,2,3 standard deviations?
* 1 = 68.3
* 2 = 95.4
* 3 = 99.7
82
How long is the driving ban for a first unprovoked seizure?
6 months and must notify DVLA
83
What are the common causes of otitis media (7)?
* Bacterial = s. pneumoniae, h. influenziae, s. pyogenes
* Viral = RSV, rhinovirus, adenovirus, influenza virus
84
What are the first and second line Abx for otitis media (2)?
1. amoxicillin
2. clarythromycin
85
What other questions should be asked to a pregnant women presenting with pre-eclampsia (5)?
* Headache
* Oedema
* Reduced foetal movements/ SOB
* N+V
* Abdo/ epigastric pain
86
What are some side effects of levodopa and dopamine agonists (5)?
* Confusion
* Postural hypotension
* Dry mouth
* Psychosis
* Dyskinesia
87
What side effects are a higher risk in those taking dopamine agonists compared to dopamine agonists (and answer for the other way round as well)?
* Da agonists = psychosis, impulse control disorders,
* Levodopa = on-off phenomena, motor symptoms e.g. chorea
88
What are some examples of dopamine agonists (2)?
* Ropinirole
* Bromocriptine
89
What is an example of MAO-Bi?
Selegiline
90
What are some examples of COMT inhibitors?
Entacapone
91
What follow up should be arranged for a first seizure in a child?
Urgent (<2 weeks) referral to a paediatric neurologist
92
What advice should be given to children having seizures (3)?
* Don't have a bath or swim
* Take caution with heights
* Call ambulance after 5 mins of seizure
93
What are two tests recommended by NICE to investigate a patient who has had a fall (2)?
* Timed up and go test
* Turn 180 test
94
How should acute asthma be managed (5)?
1. Oxygen
2. Nebulised salbutamol
3. Nebulised ipatropium bromide
4. IV hydrocortisone/ oral prednisolone
5. IV MgSO4, aminophylline or salbutamol
95
What medication is typically used in end of life care for agitation?
Midazolam
96
What is important to monitor in those on venlafaxine?
BP - as it can cause hypertension
97
What is the most common cause of an incidentally found abdominal mass in a healthy child?
Wilms tumour (nephroblastoma)
*usually in younger children <5*
98
How is constipation managed in children?
1. Movicol disempaction regimen (+ Senna if not effective after 2 weeks)
2. Movicol maintenance regimen
99
How should all patients with antepartum haemorrhage be managed by a GP?
Urgent admission to hospital
100
How can an invasive ductal carcinoma be differentiated from an invasive lobular carcinoma (2)?
* Ductal (most common) = discrete lump
* Lobular = thickened area of breast
101
How can severe lithium toxicity be managed?
Haemodialysis
102
What sign is seen on USS in ectopic pregnancy and ovarian torsion?
* Torsion = whirlpool sign
* Ectopic = bagel sign
103
What are some side effects of atypical antipsychotics (4)?
* Hyperprolactinaemia
* Weight gain
* Dyslipidaemia
* Impared glucose tolerance
104
What is the difference between section 135 and 136?
* 135 = allows police to enter a persons home and take them to place of safety
* 136 = allows police to take someone in public place to place of safety
105
Give two examples of questionnaires used in the diagnosis of depression?
* PHQ-9
* HADS (hospital anxiety and depression scale)
106
What is the first, second and third line investigations for endometrial cancer?
1. TVUSS
2. Pipelle biopsy
3. Hysteroscopy
107
How are stage 1 and 2 endometrial cancer treated?
Total abdominal hysterectomy with bilateral salpingo-oophrectomy
(+/- radiotherapy if higher risk disease)
108
What are the criteria of the health belief model (4)?
* Believe they are susceptible to the condition
* Believe in serious consequences
* Believe taking action reduces susceptibility
* Believe benefits of action outweigh costs of acting/ not acting
109
What is the AED used for tonic clonic seizures?
* Male = valproate
* Female = lamotrigine or levetiracetam
110
What is the AED used for focal seizures (1st + second)?
1. Lamotrigine or levetiracetam
2. Carbemazepine
111
What is the AED used for absence seizures (1st + second)?
1. Ethosuximide
2. Male = valproate; female = lamotrigine or levetiracetam
112
What is the AED used for **m**yotonic seizures?
* Male = valproate
* Female = levetiraceta**m**
113
What is the AED used for **a**tonic seizures?
* Male = valproate
* Female = l**a**motrigine
114
How should meckels diverticulum be investigated?
Technetium scan
115
What is the equation for power?
1 - probability of a type 2 error
116
What is a type 1 error?
The null hypothesis is rejected when it is true
117
What is a type 2 error?
The null hypothesis is accepted when it is false
118
How could bells palsy affect taste?
Ipsilateral loss of tase in anterior 2/3rds of tongue
119
What antibiotics are used for a brain abscess?
Ceftriaxone + metronidazole
120
What type of cancer does PCOS increase the risk of?
Endometrial cancer
121
What is probably the strongest risk factor for completed suicide?
Previous suicide attempt
122
What is miosis vs mydriasis?
* Miosis = constricted pupil
* Mydriasis = dilated pupil
123
What is nocturnal enuresis?
Bedwetting in a 5 year old or older
124
What is the management of nocturnal enuresis (5)?
* Investigate underlying cause
* General advice
* Reward system
* Enuresis alarm
* Desmopressin (short term)
125
How should GBS be managed during pregnancy?
IV benzylpenicillin during labour + delivery
126
What medications can cause ototoxicity (hearing loss + vertigo) (2)?
* Loop diuretics (e.g. furosemide)
* Aminoglycoside (e.g. gentamicin)
127
Which vitamins are fat soluble and therefore deficient in CF?
DEAK
128
What is a contraindication for live vaccines e.g. MMR?
Immunosuppression e.g. ALL
129
How is epiglottits managed?
Urgent assessment by anaesthetist
(steroids/ adrenaline are not given)
130
How is TCA toxicity treated?
Sodium bicarbonate
131
What is cerebellitis?
Sudden onset of ataxia following a viral illness e.g. chickenpox
132
What is it known as when a child is stubborn and argumentative?
Oppositional defiant disorder
133
What should be given to children with nephrotic syndrome as prophylaxis?
Penicillin V
(prophylaxis against infection as children with oedema are susceptible)
134
What is the most common cause of meconium ileus?
CF (90% of cases)
135
What is the management for very elevated levels of unconjugated bilirubin?
Exchange transfusion
136
What is the treatment pathway for severe asthma attack (6)?
1. Oxygen
2. Salbutamol
3. Ipratropium bromide
4. Oral pred/ IV hydrocortisone
5. Escalate
5. IV salbutamol/ MgSO4/ aminophylline
6. Intubate/ CPAP
137
How is irregular bleeding when using depot/ implant managed (3)?
* Investigate cause (if beyond 3-6 months) e.g. STI screen, cervical pathology
* NSAIDs/ transexamic acid
* COCP
138
When should hormonal contraception be started after ulipristal and levonorgestrel (2)?
* Ulipristal = 5 days later
* Levonorgestrel = immediately
139
How should vaginal bleeding after a pregnancy test be managed (2)?
* Emergency assessment by EPAU = > 6 weeks gestation or Sx suggestive of ectopic
* Expectant management = bleeding alone in first 6 weeks
140
What must ALWAYS be done in those who have had a seizures?
Rule out **hypoglycaemia** and **hypoxia**
141
What is osgood-schlatters syndrome?
Swelling + tenderness over the tibial tuberosity
142
When is ECV offered for nulliparous women?
36 weeks
143
What are some poor prognostic factors for ALL (5)?
* <2 or >10
* WBC > 20
* Philadelphia chromosome
* Male
* Non-white
144
What is a galactocele?
Cystic like lump that develops in the breast shortly after breast feeding stops
145
What reflex can bulbar palsy cause the loss of?
Gag reflex
146
What is a big risk factor for infertility?
Older age > 35
147
What can recurrent temporal lobe seizures result in?
Damage to **hippocampus** causing difficulties with long term memory
148
What is the mechanism of ranitidine?
H2 receptor antagonist
149
What are the features of HSP (5)?
* Purpuric rash over legs + arms
* Abdominal pain
* Polyarthritis
* Haematuria
* Fever
150
What are the features of HUS (3)?
* AKI
* Thrombocytopenia
* Haemolytic anaemia
151
What murmur is heard with a VSD?
Pansystolic murmur heard loudest at lower left sternal border
152
What are the stages of delirium tremens (3)?
* 6-12h = tremor, sweating, anxiety
* 36h = peak incidence of seizures
* 48-72h = delirium tremens (coarse tremor, confusion, delirium, etc)
153
How does histrionic personality disorder present (3)?
* Dramatic
* Centre of attention
* Inappropriate sexual seductiveness
154
How is acetylcystine given for paracetamol overdose?
Infusion over 1 hour
155
What is the first line treatment for Alzheimers?
Donepezil
156
What is first line for induction of labour?
Vaginal prostaglandin E2 over misoprostol
157
What are some causes of foetal hydrops (6)?
* Severe anaemia
* Cardiac abnormalities
* Genetics (e.g. trisomes, turners)
* Infection
* Twin-twin transfusion (in recipient)
* Chorioangioma
158
What are the features of pre-eclampsia (5)?
* Hyperrefelxia
* Papilloedema
* Oedema
* Hypertension
* Abdo pain (RUQ)
159
Who is started on an ACE-i or ARB for hypertension (2)?
* Diabetics
* < 55 and not black
160
Who is started on CCB for hypertension (2)?
* > 55
* Black
*if they have diabetes they should be started on ACE, even if black*
161
What is a static vs dynamic risk factor?
* Static = can't change
* Dynamic = can change
162
What are the symptoms of wernickes encephalopathy (3)?
* Ataxia
* Opthalmoplegia
* Confusion/ disorientation
163
What are the features of Korsakoff syndrome (2)?
* Amnesia
* Confabulation (memory filled with made up things)
164
What is the most common cause of a convergent squint?
Hypermetropia (longsightedness)
165
How long is exclusion required for measles?
4 days
166
How should dyspepsia caused by clopidogrel be managed?
Lansoprazole
*omeprazole reduces function of clopidogrel*
167
Which antibodies can cross the placenta and are responsible for rhesus disease of the newborn?
IgG antibodies
168
What is otitis media with effusion?
Glue ear - not acute otitis media with a perforation
169
Who is the legal mother if there is a surrogate child?
The surrogate mother is (not the biological mother)
170
How is chickenpox in women > 20 weeks pregnant managed?
Oral aciclovir
171
What is a side effect of triptan use?
Tightness in throat and chest
172
What is selection bias?
The non random assignment of patients to a study
173
What is the first line treatment for von willebrands disease?
Desmopressin
174
How is reyes syndrome diagnosed?
Liver biopsy
175
What is the course of illness for roseola?
1. Fever
then...
2. Mac/pap rash
176
How should bipolar disorder be managed during pregnancy?
Switch to atypical antipsychotic
177
What is the most likely diagnosis if there is bilateral hip/ knee pain in an obese 13 year old girl?
SUFE
*learning point = SUFE can be bilateral*
178
What is a finding on lumbar puncture for those with GBS?
Raised protein
179
What aspects of voices would be suggestive of schizophrenia (4)?
* Own thoughts spoken aloud
* Auditory third person hallucinations
* Running commentary
* No commanding
180
Thinking clinically/ in an applied context what feature would suggest a life threatening rather than a severe asthma attack?
Unable to perform a peak flow measurement
181
What are some findings on CSF analysis of those with GBS (2)?
* Raised protein
* Normal WCC
182
What are some infectious triggers for GBS (3)?
* **C. jejuni**
* CMV
* EBV
183
What are some histological features of crowns disease (3)?
* Plasma cells in lamina propria
* Crypt abscess/ distortion
* Ulceration
184
How soon should Public Health England be notified of a notifiable disease?
Immediately
185
What is deontology?
The morality of an action should be determined by what is right or wrong under a series of rules and principles, rather than the consequences of that action
186
What is the most common complication of rubella?
Deafness
187
What is the most common genetic mutation seen in familial ALS?
SOD-1 mutation
188
What are the two types of autoimmune encephalitis?
* Anti NMDA receptor encephalitis
* Limbic encephalitis
189
What sort of prevention is preventing the recurrence of disease?
Typically considered secondary prevention
190
What is the difference between IgA nephropathy and post strep glomerulonephritis in terms of timing?
* IgA = days after infection
* Post strep = weeks after infection
191
What antibiotic should be tried next in the case of cefuroxime resistant UTI?
Meropenem
192
What medication is used to treat neonatal abstinence syndrome due to cocaine?
Phenobarbital
193
Which side is affected more commonly in CDH?
Left side
194
What are some indications for a head CT in children with a head injury (6)?
* Non-accidental injury
* Seizure
* GCS < 15 at 2 hours
* Suspected skull fracture
* Battle sign or panda eyes
* 3 episodes of vomiting
195
What are the chromosomes/ genetic abnormalities in prayer wili, Williams and angelmans?
* **P**rader wili = **p**aternal deletion on chromosome 15
* Angel**m**ans = **m**aternal deletion on chromosome 15
* William's = microsomal deletion on chromosome 7 (7 letters in William)
196
What are the names of the two types of mole and the most common genetic material?
* Complete = XX
* Partial = XXY (forms foetal tissue)
197
What are the categories of PPH via blood loss (3)?
* Minor = 500-1000
* Moderate = 1000-2000
* Severe = 2000+
*moderate + severe = major haemorrhage*
198
What are the categories of PPH in terms of timing?
* Primary = <24h
* Secondary = >24h
199
How should endometriomas be treated to increase fertility?
Laparoscopic ovarian cystectomy with excision of the cyst wall
200
What medication stops those breastfeeding from producing milk?
Cabergoline
