Stuff I have got wrong in the past part 2 Flashcards
1
Q
What are some reasons for taking high dose folic acid (3)?
A
- Taking AEDs
- BMI > 30
- FHx NTDs
2
Q
Out of thrombectomy and thrombolysis which treatment should definitely be offered if an MRI shows salvageable tissue?
A
Thrombectomy always offered, CONSIDER thrombolysis
3
Q
How should vaginal bleeding be managed in the first 6 weeks of pregnancy?
A
Send home for expectant management UNLESS abdo/ pelvic pain or cervical motion tenderness present … they then need emergency assessment
4
Q
How should vaginal bleeding after 6 weeks pregnancy be managed?
A
Refer to hospital for TVUSS
5
Q
How should VSDs be managed?
A
Most can be managed conservatively and monitored closely
6
Q
What are the criteria for having your tonsils removed due to tonsillitis (3)?
A
- 7 episodes in 1 year
- 5 episodes per year for 2 years
- 3 episodes per year for 3 years
7
Q
What criteria should be monitored for methylphenidate (4)?
A
- BP + pulse
- Psychiatric symptoms
- Appetite
- Weight + height
8
Q
When should the parameters be measured for people taking methylphenidate (3)?
A
- Initiation of treatment
- Dose adjustment
- Every 6 months
9
Q
What is classed as staggered overdose for paracetamol overdose?
A
First and last dose more than 1 hour apart
10
Q
What is opisthotonus?
A
Type of acute dystonia causing involuntary flexing of muscles in back
11
Q
What is the second line medication for OCD after SSRIs?
A
Clomipramine
not venlafaxine
12
Q
What is the first and second line pharmacological treatment for PTSD?
A
1st = SSRIs/ venlafaxine
2nd = antipsychotics
13
Q
When can venlafaxine be used first line (although sertraline is usually used first)?
A
- GAD
- Panic disorder
- PTSD
NOT used for OCD
14
Q
What migraine medication can cause serotonin syndrome?
A
Triptans
15
Q
What two signs indicate meningeal irritation and how do you elicit them?
A
- Brudzinskis - neck flexed –> involuntary flexion of hips + knees
- Kernigs - hips flexed, then knees straitened –> pain
16
Q
What are two special signs/ tests are seen in MS?
A
- Uhtoffs phenomena - worse after hot shower
- Lhermittes sign - neck flexion –> electric shock sensations down spine
17
Q
What is the most common cause of meningitis in adults?
A
S. pneumoniae
18
Q
What tool is used to assess the risk of developing pressure sores for patients?
A
Waterlow score
19
Q
What rash is pathological of secondary syphilis?
A
Condylomata lata - grey discs + rash on hands/ feet
20
Q
How should antiretroviral drugs for HIV be taken?
A
Same time every day
21
Q
How should patient be treated if they refuse a vulvovaginal and endocervical swab?
A
Order first catch urine, if they refuse this then empirically with Abx
22
Q
What is the difference between lymphadenopathy in lymphgranuloma vereneum and syphilis?
A
- Syphilis = non-painful
- Lymphgranuloma vereneum = painful
23
Q
What are the key explanations for health inequalities according to the black report (4)?
A
- Artefact
- Social selection
- Materialist/ structural
- Cultural/ behavioural
24
Q
How long should substance use disorder go on before a diagnosis?
A
12 months, or 1 month if use is continuous
25
What is in the censor score (5)?
* Age 3-15
* Exudate/ swollen tonsills
* Swollen LNs
* Temp > 38
* Cough absent
26
How should anaphylaxis be managed after giving two doses of IM adrenaline?
Fluid bolus + call for help
27
What is second line for diabetes management?
* **Sulfonylureas** (e.g. gliclazide)
* Heart disease/ CVD = **SGLT-2 inhibitors** (e.g. dapagliflozin)
28
How long should chronic fatigue syndrome last before a diagnosis?
3 months
29
What is a key side effect of colchicine use?
Diarrhoea
30
What is first line anticoagulant for AF and what is used in those with poor kidney function?
* 1st line = DOAC (e.g. apixaban)
* CKD = warfarin
31
What is the definition of postural hypotension in terms of BPs?
* Drop in 20 mmHg systolic
*or*
* Drop in 10 mmHg diastolic
* Within 3 minutes of standing
32
What two medications can treat postural hypotension?
1st = Midodrine
2nd = Fludrocortisone
33
What immunoglobulin is raised in hay fever/ asthma/ eczema?
IgE
34
How is cradle cap (seborrhoeic dermatitis) treated (3)?
1. Emollient + brushing
2. Topical anti fungal shampoo
3. Topical steroids
35
What is erythema infectiosum?
Slapped cheek
36
What is a sandal gap associated with?
Downs syndrome
37
What are the features of potters syndrome (4)?
* Low set ears
* Twisted body/ skeletal malformation
* Flattened nose
* Pulmonary hypoplasia (respiratory distress)
38
What are some criteria for assisted withdrawal (with chlordiazepoxide) for alcohol use disorder (2)?
* Audit > 20
* Drink more than 15 units per day
39
What is the most common cause of a painful third nerve palsy?
Posterior communicating artery aneurysm
40
If a woman is using lactational amenorrhoea as a form of contraception is it recommended for her to take the POP or not?
Yes POP is recommended even with lactational amenorrhoea
41
If a preterm woman is in labour and she is 4cm dilated what medications should she be given (2)?
* Betamethasone (mature lungs)
* Benzylpenicllin (indicated in preterm births)
42
How would GBS appear under the microscope?
Positive coccus
43
How should labour be managed after 3 pulls using an instrumental delivery?
Convert to LSCS
44
Can you take amiodarone whilst breastfeeding?
No, and not during pregnancy either
45
What is Galeazzis test?
Used to indicate whether leg length shortening is due to tibia or femur
46
What medication other than SSRIs can be helpful in treating those with anorexia nervosa?
Mirtazapine
47
What are some normal laboratory findings/ changes from normal in pregnancy (3)?
* Increased urinary protein
* Reduced serum creatinine
* Reduced serum urea
48
How long should symptoms of PTSD go on before a diagnosis can be made?
1 month
49
What is the second line medication for ADHD after methylphenidate?
Lisdexamfetamine
50
What heart defect is associated with Williams syndrome?
Supravalvular aortic stenosis
51
How is meningitis treated in those over and under 3 months?
* Over = ceftriaxone + dexamethasone
* Under = cefotaxime + amoxicillin
52
Is a meningococcal septicaemia rash raised?
No it is flat on skin
53
When does volvulus usually present?
Before 1 month
54
What are the signs/ symptoms of lithium toxicity (5)?
* Corse tremor
* Hyper-reflexia
* Acute confusion
* Polyuria
* Seizures
55
What are the 3 drugs used for alcohol dependance and what do they do?
* Disulfiram - unpleasant symptoms if alcohol consumed
* Acamprosate - reduces desire
* Naltrexone - reduces pleasure
56
What are the important blood tests to do in those taking lithium (4)?
* TFTs
* eGFR
* U&Es
* Lithium level
57
What is a lilliputian hallucination?
Seeing lots of small people
58
What is the most common type of hallucination in delirium tremens?
Tactile hallucinations
59
What is the most common type of hallucination in delirium?
Visual
60
Which nerves are affected in erbs palsy?
C5-6
61
When are cervical cerclage and vaginal progesterone used in preterm labour?
* Cerclage = when cervical length < 25mm AND previous preterm birth
* Vaginal progesterone = ONLY when cervical length < 25mm
62
When should serum progesterone be measured in those having trouble conceiving?
7 days before end of cycle
63
What are the criteria for prescribing antibiotics in mastitis (2)?
* Symptoms do not improve after 12-24 hours of breastfeeding
* Nipple fissure present
*fluclox first line*
64
What is a haematoclopos?
Accumulation of blood in the vagina usually due to imperforate hymen
65
What is the most common cause of hyperandrogegism in postmenopausal women?
Ovarian hyperthecosis - luteinised theca cell nests in ovaries
66
What are the 5 signs of heart failure on X-ray?
* **A**lveolar bat wing oedema
* Kerley **B** lines
* **C**ardiomegally
* **D**ilated upper lobe vessels
* Pleural **e**ffusion
67
What is the flow of CSF through to the subarachnoid space?
Lateral ventricles --> foramen on monro --> third ventricle --> cerebral aqueduct --> fourth ventricle --> foramina of luschka & magendie --> SAS
68
What autoantibodies are found in primary biliary cholangitis?
Anti mitochondrial antibodies
69
What two drugs are important in hyperthyroidism?
* Carbimazole - reduce thyroid levels
* Propanolol - symptomatic relief
70
What medication can be used to provide relief from stomach cramps of those with IBS?
Buscopan
71
How is DKA managed in the emergency setting?
* IV bolus 0.9% NaCl 10ml/kg given over 15 minutes
* Insulin at 0.1 units/kg/h
72
What causes molluscum contagiosum?
Poxvirus
73
What is conduct disorder?
Persistent behaviours that violate the right of others in people under 18
74
What is oppositional defiant disorder?
Angry, irritable mood and argumentative, but without the severe aggression seen in conduct disorder
75
What are some contraindications for donepezil (2)?
* Pelvic ulcers
* Bradycardia
76
What features suggest a worse prognosis for MS (3)?
* Male
* Older
* Motor signs at onset
77
How is a missed miscarriage managed medically?
1. Mifepristone
2. Misoprostol (48 hours later)
77
How is an incomplete miscarriage managed medically?
Misoprostol
77
How should a bishop score of more than 6 be managed?
Amniotomy AND IV oxytocin
78
How should a bishops score of 6 or less be managed?
Vaginal prostaglandin E2 OR oral misoprostol
79
What medication should be avoided in those with myasthenia gravis?
Beta blockers
80
When can antiepileptic medications be stopped and how long a period should they be stopped over?
Seizure free for **2 years**, stopped over a course of **2-3 months**
81
How is epiglottitis managed (2)?
1. Secure airway
2. IV antibiotics (cefuroxime)
82
What are the doses of adrenaline used for anaphylaxis depending on the age of the child (3)?
* Under 6 = 150 micrograms
* 6-12 = 300 micrograms
* Over 12 = 500 micrograms
83
What is the inheritance of Charcot Marie tooth?
Autosomal dominant
84
How should cervical ectropion be investigated if the GP is unsure of the diagnosis?
Urgent colposcopy
*smears are never used when there are symptoms*
85
What should the first step to investigated jaundice almost always be?
Conjugated and unconjugated bilirubin
86
In the acute management of delirium tremens what should be the first line management?
Oral lorazepam
87
What medications are risk factors for idiopathic intracranial hypertension (5)?
* Tetracyclines
* Steroids
* COCP
* Retinoids
* Lithium
88
What criteria is used to grade tumours in prostate cancer?
Gleason criteria
89
What is the first line for acute stress reaction?
Trauma focused CBT
90
When should labour be induced in women who have PROM?
After 24 hours, provided they are beyond 37 weeks gestation
91
According to ICD-11 what are the criteria for a diagnosis of mild depression?
2/3 key symptoms and 2/7 of the remaining for more than 2 weeks
92
What are some negative symptoms of schizophrenia (4)?
* **A**nhedonia
* **A**logia
* **A**volition
* Blunted **a**ffect
93
What sign may be seen on x-ray of those with bronchiolitis?
Hyperinflation
94
What criteria would prompt admission to hospital for bronchiolitis (5)?
* Apnoeas
* RR>70
* Sats < 92
* Grunting
* Central cyanosis
95
How can bronchiolitis be confirmed?
Nasopharyngeal aspirate + PCR
96
What is the period after a head injury before the patient deteriorates known as?
Lucid phase
97
How do penicillin Abx work?
Beta lactam antibiotics - inhibit cell wall synthesis
98
How do bacteria develop resistance to beta lactic antibiotics (penicillins)?
Beta lactamase production
99
What tool is recommended to assess for delirium by NICE, and what is included in it?
4AT - alertness, 4-AMT, attention, acute course?
100
What is the order of antiemetics for use in hyperemesis gravidarum (4)?
1. Antihistamines (cyclizine)
2. Chlorpromazine
3. Ondansetron/ metoclopramide
101
What are some features of atypical depression (3)?
* **Mood reactivity** - improves with positive events
* **Hyperphagia**
* **Leaden paralysis** - heavy feeling in limbs
102
What is a complication of urethritis?
Urethral strictures
103
What is the first line medication for severe Alzheimers?
Memantine
104
What is a side effect of memantine?
Constipation
105
What emerging blood test is most sensitive to bacterial sepsis?
Procalcitonin
106
What nuclei are within the midbrain?
* CN 3 = occulomotor
* CN 4 = trochlear
107
What nuclei are within the pons?
CN 5 - 8
108
What nuclei are within the medulla?
CN 9-12
109
Which cranial nerve decussates?
Trochlear
110
What are some examples of dopamine agonists (3)?
* Ropinirole
* Bromocriptine
* Apomorphine
111
What treatment is offered after a stroke if the patient has more than 70% stenosis of their carotid artery?
Carotid endarterectomy
112
What is the earliest a pregnant uterus can be palpated?
12 weeks
113
What blood tests are routinely offered to pregnant women (4)?
* FBC
* Group + save
* Rubella immunity
* HIV/ syphilis serology
114
What is increased nuchal translucency suggestive of other than downs, Edwards and pataus?
Other congenital defects e.g. CHD
115
What are the features of all miscarriages?
* Missed = no Sx, Os closed, foetus dead
* Threatened = Os closed, painless light bleeding
* Inevitable = Os open, heavy bleeding with clots + pain
* Incomplete = Os open, painful bleed
* Complete = empty uterus, painful bleed, os closed
116
What are some features of Alzheimers on an MRI (4)?
* Cerebral atrophy
* Hippocampal atrophy
* Ventricular enlargement
* Sulcal widening
117
What are some reversible causes of dementia (3)?
* Hypothyroidism
* NPH
* B12 deficiency
118
When is it recommended not to fly in twin and singleton pregnancies?
* Twin > 37 weeks
* Singleton > 32 weeks
119
Which symptoms are less common in drug induced parkinsons disease?
Rigidity and resting tremor
120
What tool is used to differentiate strokes from stroke mimics?
ROSIER
121
What is relative risk?
Risk of event happening: risk of not happening
122
How is myasthenia graves diagnosed?
Antibody screen
123
How should exposure to chickenpox during pregnancy be managed (2)?
* Measure VZV Igs if immunity unknown
* Give acyclovir day 7-14, or within 24 hours of rash, if more than 20 weeks
*I don't think VZV Ig are given any more*
124
What is the first line treatment for all eczema?
Emollients
125
Is any pain at all felt with a varicocele?
None at all
126
What are some side effects of topical corticosteroids (4)?
* Thinning of skin
* Striae
* Acne
* Telangiectasis
127
How does acamprosate, naltrexone and disulfiram work (3)?
* Disulfiram = increases levels of acetaldehydes
* Acamprosate = reduces cravings by enhancing GABA transmission
* Naltrexone = opioid antagonist to reduce pleasure
128
What are some causes of drug induced psychosis (5)?
* Anti-malaria drugs
* Steroids
* Da agonists
* Levodopa
* Recreational drugs
129
How do SSRIs affect benzodiazepines?
Increase plasma levels
130
What simple tests should be done on someone with hyperemesis gravidarum (4)?
* FBC
* U&E
* LFT
* Urinalysis
131
What is hypospadias?
Where the opening to the urethra is on the underside of the penis
132
What is in the hormonal patch for contraception?
Oestrogen AND progesterone
133
What are some common conditions/ things that should be screened for in pregnancy (8)?
* Bacteriuria
* HIV
* Syphilis
* Anaemia
* Hep B
* Congenital abnormalities/ triremes
* Pre-eclampsia risk factors
* Blood group
134
What is an important investigation to do in patients with menorrhagia but no suspicion of an underlying cause?
FBC
135
What antibiotic should be used to manage STIs if there are just general symptoms and no definitive diagnosis scan be made?
Azithromycin - it covers both gonorrhoea and chlamydia
136
How should all malignancies causing compression on nerves be managed initially?
High dose **dexamethasone**
137
What is the time course of symptoms of MS?
Develop over hours to days, resolve over weeks to months
138
What is a contraindication to joint aspiration (4)?
* Overlying infection
* Bacteraemia
* Inaccessible joint
* Prosthetic joint = relative - should be done in theatre by orthopaedic surgeon
139
What is second line to allopurinol for prophylaxis against gout?
Febuxostat
140
What is the first line management of symptomatic cholelithiasis?
Laparoscopic cholecystectomy
141
What is raised more in alcoholic liver disease - AST or ALT?
AST raised more!!!
142
What is first line management for the symptoms of BPH?
Tamsulosin
143
What is a common complication of prostatitis?
Urinary retention
144
What are some common causes of COPD exacerbations (3)?
* H. influenziae
* S. pneumoniae
* Moraxella catarrhalis
145
What is relative risk reduction?
Ratio of risk of experimental group : risk in control group
146
What visual field defect does a parietal lesion cause?
Contralateral inferior quadranopia
147
What visual field defect does a temporal lesion cause?
Contralateral superior quadranopia
148
What causes upper and lower bitemporal hemianopia?
* Lower = craniopharyngeoma
* Upper = pituitary tumour
149
What is Todds palsy?
Temporary weakness following a seizure
150
What airway should be used to manage a patient having a seizure?
Nasopharyngeal airway
151
Does hyperthyroidism cause menorrhagia or amenorrhoea?
Amenorrhoea
*hypothyroidism = menorrhagia*
152
What are the stages of clinical trials?
1 = test on healthy volunteers
2 = small number of those with disease (efficacy and adverse effects)
3 = large number with disease
4 = after regulatory approval
153
What is the most important management for acute delirium tremens and the most important for Wernicke-korsakoff syndrome?
* DT = oral lorazepam
* Wernicke - Korsakoff = IV thiamine
154
What is the most serious long term health risk for those with turners syndrome?
Aortic dissection/ dilatation
155
What are the layers of the abdomen cut through in a C-section?
Anterior rectus sheaf --> rectus abdominis muscle --> transversalis fascia --> extraperitoneal connective tissue --> peritoneum --> uterus
156
What should you do to the SSRI dose before starting ECT?
Reduce the dose to the minimum amount
157
What is the first line management for acute stress disorder?
Trauma focused CBT
158
What contraception methods can a trans man take?
All except COCP + patch as this interferes with testosterone
159
What physical health problem is a differential for baby blues?
Post partum thyroiditis
160
When do symptoms of postpartum psychosis usually begin?
First 2 weeks
161
What is cervical ectropion?
Growth of endocervical cells - **glandular columnar cells**, outside of the external os where **squamous cells** usually are
162
What features are suggestive of hypernatraemic dehydration (5)?
* Jittery movements
* Increased muscle tone
* Hyperreflexia
* Convulsions
* Drowsiness
163
What is the risk of developing schizophrenia if a monozygotic twin is affected?
50%
164
What neuropathic pain medication is contraindicated in open angle glaucoma?
Amitriptyline
165
How should antisocial personality disorder be managed?
Group based CBT
166
What is a breath holding spell/ reflex anoxic seizure?
A seizure following sudden pain/ strong emotion
167
How is a reflex anoxic seizure managed?
Reassurance
168
What is the most likely cause of a smooth palpable lump that grows very fast in a 40-60 year old woman?
Phyllodes tumour
169
Who should cases of child abuse be discussed with?
Senior or safeguarding lead
170
What does the DCML carry?
Proprioception and fine touch
171
What does the spinothalamic tract carry?
* Laterally = pain + temperature
* Anteriorly = crude touch
172
How long should MgSO4 continue for after giving birth?
24 hours after last seizure/ delivery
173
What time period does an appeal against a section 2 need to be made within?
14 days
174
What causes micrognathia and rocker-bottom feet?
Edwards syndrome
*patau = microcephaly + small eyes*
175
What is thought blocking?
When a patient suddenly stops talking or the thought process suddenly stops
176
What type of MS are disease modifying treatments used for?
Relapsing remitting
177
What is the first and second line investigation for asthma in children (5-15)?
1. Fractional exhaled nitric oxide (FeNO)
2. Bronchodilator reversibility with spirometry
178
How is constipation in adults treated (first and second line)?
1. Bulk forming laxatives (e.g. ispaghula)
2. Osmotic laxatives (e.g. macrogol - movicol)
179
How is CTG affected in Chorioamnionitis?
Foetal tachycardia
180
What is the difference between bulimia nervosa and anorexia nervosa (2)?
* Bulimia = binge eating and then purging
* Anorexia = significant restriction of food intake and intense fear of weight gain
181
What is seen on xray of those with respiratory distress of the newborn?
Ground glass appearance
182
Other than prematurity what are some risk factors for respiratory distress of the newborn (3)?
* Male
* Diabetic mother
* C-section
183
What are some examples of AIDs defining illnesses (7)?
* Pneumocystis pneumonia
* Oesophageal candidasis
* HIV encephalopathy (dementia)
* Toxoplasmosis
* Progressive multifocal leukoencephalopathy
* Kaposi sarcoma
* CMV retinitis
184
How is essential tremor often inherited?
Autosomal dominant
185
What does whooping cough look like under the microscope?
Gram negative coccobacillus
186
How should suspected bone malignancies be managed in children by the GP?
Urgent X-ray within 48 hours
187
When can hormonal contraception be taken after emergency contraception?
* Levonorgestrel = immediately after
* Ulipristal acetate = after 5 days
188
How soon should an ultrasound be done for babies born in breech?
Within 6 weeks for DDH
189
How does NAC work?
Glutathione metabolises NAPQI, NAC helps replenish the glutathione stores in the liver and break down the toxic metabolite NAPQI
190
What is a complex febrile seizure (3)?
* Lasts longer than 15 minutes
* Recurrence within 24 hours
* Focal seizure (rather than generalised)
191
When do febrile seizures typically occur?
6 months - 5 years
192
What medication is used in the management of IIH?
Acetazolamide
193
When should oxygen be offered to those with bronchiolitis?
If sats are below 90%
194
How is Guillain barre syndrome managed (2)?
1. IV Ig
2. Plasmapheresis
195
What are the MRI findings in huntingtons disease?
Atrophy of caudate nucleus and putamen
196
What is a long term side effect of levodopa (2)?
* Dyskinesia
* On-off phenomena
197
What organisms commonly cause PID (3)?
* **Chlamydia**
* Gonorrhoea
* Micoplasma genitalium
198
