Y3 Exam 1

Question 1

What is the ICD10 classification of mild depression?

What is the ICD10 classification of moderate ​depression?

What is the ICD10 classification of severe ​depression?

Answer 1

Mild depression, need 2 of the general criteria PLUS 1 additional sympotms

Moderate depression, need 2 of the general criteria PLUS 3 additional symptoms

Severe depression, need all 3 of the general criteria PLUS 5 additonal symptoms

General criteria for depression:

• Low mood for most of the day almost everyday for 2+ weeks
• Loss of interest or pleasure (anhedonia)
• Decreased energy (fatigue)

Additonal symptoms:

• Loss of confidence
• Feelings of guilt
• Suicidal ideation
• Decreased concentration
• Agitation/ psychomotor retardation
• Sleep disturbance
• Change in appetite

Question 2

List some symptoms of anorexia (7)

Answer 2

Lanugo hair

Cold intolerance

Blue hands / feet

Amenorrhoea

Dry skin

Hypotension

Weakness / fatigue

Question 3

List some features of nephrotic syndrome: (4)

List some features of nephritis syndrome: (3)

Answer 3

Nephrotic syndrome:
• proteinuria (+++)
• oedema
• hypoalbuminaemia
• hyperlipidaemia

Nephritic syndrome:
• haematuria
• hypertension
• proteinuira (+)

Question 4

What is the definition of epilepsy?

State the difference between generalised and partial (focal) seizures:

State whether the following types of epilepsy are generalised or partial:

a) tonic-clonic
b) simple partial
c) complex partial
d) absence seizures
e) myoclonic seizures
f) secondary generalised
g) tonic seizures
h) atonic seizures
i) clonic seizures

Answer 4

Epilepsy - More than 1 unprovoked seizure

Generalised seizures: electrical activity spreads across both hemispheres of brain
Partial (focal) seizures: electrical activity only involves one hemisphere/ lobe

• *a) tonic-clonic:** generalised seizure
• *b) simple partial:** partial seizure
• *c) complex partial:** partial seizure
• *d) absence seizures:** generalised seizure
• *e) myoclonic seizure:** generalised seizure
• *f) secondary generalised:** partial seizure
• *g) tonic seizure:** generalised seizure
• *h) atonic seizure:** generalised seizure
• *i) clonic seizure:** generalised seizure

Question 5

What are the 7 phases that anaethetists go through to manage a patient?
~ Note which ones are the 4 phases of anaesthesia

Answer 5

1) Pre-operative care/ planning
2) Preparation
* 3) Induction*
* 4) Maintenance*
* 5) Emergence (waking patient up)*
* 6) Recovery*
7) Post-operative care

Question 6

What are the 2 mechanisms underlying addiction?
~ State whether they underpin physical/ psychological dependence

Answer 6

• Tolerance - physical dependence
• Activation of the reward pathway - psychological dependence

Question 7

What screening tool is used to assess the likelihood of anorexia nervosa?

A score of what would suggest an eating disorder?

Answer 7

SCOFF questionairre

2+

Question 8

What is calculated alongside the ASA grade to risk stratify the patient before surgery?
~ a score of what makes them a high risk patient?

How is a patients exercise tolerance graded? (what unit is used?)
~ What score would the following exercise tolerances be given:
a) walking around the house
b) walk 100-200m on flat
c) strenuous exercise

Answer 8

Cardiac risk index - score 2+ = high risk patient!

METs

a) 2 METs
b) 4 METs
c) 9 METs

(Eg, diabetes, renal failure, ischaemic heart disease, congestive heart failure etc)

Question 9

What is a pleural effusion?

What is the difference between exudate & transudate?

List lung causes of an exudate (3) & transduate (1):

Answer 9

Pleural effusion = fluid in the pleural cavity

Exudate: fluid contains 3g+ of protein - caused by inflammation
• Lung cancer
• Pneumonia
• TB

Transudate: fluid contains less than 3g of protein - caused by fluid shifts
• Congestive heart failure

Question 10

There are 2 extremes of delirum. What are they called? List some symptoms seen in each: (3, 3)

Answer 10

Hyperactive delirium:

→ Aggression/ aggitation
→ Hallucinations
→ Restlessness

Hypoactive delirium:

→ Sleepiness/ fatigue
→ Withdrawn
→ Memory problems (temporary dementia)

Question 11

What type of hallucinations are common in lewy body dementia?

Answer 11

Visual hallucinations:

→ animals in the house

→ faces in the wallpaper

Question 12

What is the gold standard investigation for suspected vesico-uteric reflux in children?

What investigation is used to look for any kidney scarring/ function of the kidney?

What investigation is used to look at the structure (size & shape) of the kidney?

Answer 12

MCUG (micturicting urogram)

DMSA

US KUB

Question 13

What part of the GIT does coeliacs disease affect & what is the main histological finding seen?

List some clinical features seen in coeliac disease: (6)

What condition is closely associated with coeliac disease?

Answer 13

Small bowel (esp jejenum) - villous atrophy

• Failure to thrive (in children)
• Diarrhoea
• Weight loss
• Fatigue
• Dermatitis herpetiformis (itchy rash, usually on abdomen)
• Malabsorption

Type 1 diabetes (as well as other autoimmune conditions)

Question 14

What condition is indicated if a woman presents with recurrent miscarriages & a history of VTE events?

What is the treatment of this condition? (2)

Answer 14

Antiphospholipid syndrome

Aspirin & LMWH

Question 15

What is the prophylaxis management of haemophilia?

How is an acute episode of bleeding treated? (3)

Answer 15

Replacement of clotting factors via IV transfusions (VIII - A, IX - B)

1) Infusions of affected clotting factor (VIII or IX)
2) Desmopressin (DDAVP) - to stimulate VWF release
3) Tranexamic acid - reduces the rate of fibrinolysis so that clot remains for longer

Question 16

What drug class is used for the treatment of Alzheimers disease & Lewy Body dementia?

Give an example of a medication from this class.

Answer 16

Acetylcholinesterase inhibitors

Donepezil

Question 17

The Philadelphia chromosome is associated with what haematological condition?

The philadelphia chromosome (a mix of 2 chromosomes) results in what oncogenic gene?
~ What is the translocation of the gene?

Answer 17

Chronic myeloid leukaemia

BCR-ABL gene
~ t(9;22)

Question 18

Regarding sections from the MHA below, state a) how long they are valid for, b) who is able to use them, c) whether they include assessment/ treatment

Emergency detention certificate

Short-term detention certificate

Compulsary treatment order

Answer 18

Emergency detention certificate:
• Valid for 72h
• Fully registered doctor (FY2 onwards) + consent from a MHO (if available)
• ONLY detention

Short-term detention certificate:
• Valid for 28d
• Approved mental health doctor (psychiatrist!!) + MHO consent
• Detention & treatment

Compulsary treatment order:
• Valid for 6m - but can be renewed!
• MHO applies to Tribunal with 2 supporting medical reports from a AMP (psychiatrist) & GP (otherwise 2x AMPs)
• Detention & treatment

Question 19

Amyotrophic lateral sclerosis is a type of what disease?

List some features of this condition: (4)

What gene mutation is associated with this condition?

What is the treatment of this condition?

What type of penetrance does the disease have? - What does this mean for family members with the gene?

Answer 19

Motor neurone disease

ONLY motor symptoms!!!!!!
• Progressive muscle weakness (LMN)
• Muscle wasting (LMN)
• Hyper-reflexia (UMN)
• Spasticity (UMN)

SOD gene

NO TREATMENT

Incomplete penetrance:
~ People with the gene don’t always develop the disease so offspring may/ may not be affected
~ Environmental factors ‘switch’ the gene on - nobody knows how/ why

Question 20

What is Immune Thrombocytopenic Purpura (ITP)?

What blood abnormality does it result in?

What is the 1st line treatment for ITP?

If this doesn’t work, what do you add to the treatment?

Answer 20

Autoimmune attack of platelets (antibodies are made against platelets)

Results in thrombocytopenia (low platelet count)

1st line treatment: steroids

If steroids don’t work, add in IV IgG (immunoglobulins)

Question 21

Give 2 examples of:

a) obstructive lung diseases
b) restrictive lung diseases

Would you expect an FEV1:FVC ratio to be < or > 75% in each?

Answer 21

Obstructive lung diseases: FEV1:FVC < 75%
• COPD (permanent airway obstruction)
• Asthma (reversible airway obstruction)

Restrictive lung diseases: FEV1:FVC > 75%
• Pulmonary fibrosis (interstitial lung disease)
• Sarcoidosis

Question 22

What are the key clinical features in lewy body dementia? (3)

Answer 22

Fluctuating confusion throughout the day

Visual hallucinations

Parkinsonism symptoms (poor mobility, tremor)

Question 23

List some features of a pleural effusion: (3)

List 2 findings seen on a chest xray:
What other investigation would you do in a pleural effusion to determine the cause?

What is the treatment of a small effusion/ large effusion?

What is the name of an infected pleural effusion?

Answer 23

• SOB
• Reduced breath sounds
• Dullness to prescussion over the effusion

Xray findings:
• Blunting of the costophrenic angles
• Fluid in the lung fissures
Pleural fluid aspirate - to determine exudate VS transudate cause

• *Treatment:**
• Small effusion:* conservative management
• Large effusion:* chest drain

Infected pleural effusion = empyema

Question 24

What is the definition of psychosis?

What 2 clinical signs fall under pschosis?

Answer 24

The inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality (aka, lack of insight)

Hallucinations

Delusions

Question 25

List the positive & negative symptoms of schizophrenia: (3, 3) Having more of which type of symptoms indicates a better prognosis? How long do symptoms need to be present for an ICD-10 diagnosis?

Answer 25

Positive symptoms: - better prognosis! • Hallucinations • Delusions • Disordered thinking Negative symptoms: • Anhedonia • Lack of emotions (emotional blunting) • Apathy (lack of motivation) Schizophrenia = symptoms present for 1 month +

Question 26

Describe what nociceptive pain is: Describe what neuropathic pain is: Note whether they have a protective function or not.

Answer 26

Nociceptive pain = pain when there is tissue injury or illness (eg when you cut yourself) ~ has a protective function (the pain causes you to stop whatever is causing the pain) Neuropathic pain = pain caused by nervous system damage / abnormality ~ no protective function, often occurs long after there has been trauma!

Question 27

Regarding **fluids**, (**colloid &** **crystalloid's**): 1) give an example of each type commonly used in hospital 2) describe the size of the molecules they contain & the consequence of this on fluid compartments within the body 3) state a contraindiction in each type

Answer 27

* *1) Colloid**: fluid containing starch/ gelatin * *Crystalloid**: _plasmalyte_/ _hartmans_/ dextrose/ 0.9%NaCl * *2) Colloid:** large molecules → more fluid is retained in the blood vessels * *​Crystalloid:** small molecules → some fluid remains in blood vessels & some moves into the tissues/ cells * *3)** **Colloid:** the large molecules can cause kidney damage (so cannot be used in patients with renal failure) * *​Crystalloid:** 0.9%NaCl has a high Na conc so can cause **hypernatraemia**

Question 28

**Germline** **mutations:** • occur in what cells? • can mutations be passed on to offspring? **Somatic** **mutations** (non-germline): • occur in what cells? • can mutations be passed on to offspring?

Answer 28

**Germline**: • mutations occur in egg/ sperm • mutations *are* *passed* to offspring - offspring will have the mutation in every cell within their body! **Somatic:** • mutations occur in any cell of the body *except* egg/ sperm • mutations *are not* passed to offspring

Question 29

What is the treatment of mild-moderate Alzheimers disease? (Drug & drug class) ~ Name a common S/E of this. What is the treatment of severe Alzheimers disease/ if previous treatment has failed? What is the treatment of Vascular dementia? What is the treatment of Lewy-Body dementia? (Drug & drug class) ~ Name a common S/E of this. What is the treatment of Fronto-temporal dementia?

Answer 29

Anticholinesterase inhibitors: **donepezil** S/E = GI upset (nausea, vomiting, diarrhoea) ***Memantine*** Management of underlying vascular risk factors Anticholinesterase inhibitors: **donepezil** S/E = GI upset (nausea, vomiting, diarrhoea) No current treatment..

Question 30

Explain the difference in absorption of drugs between younger & geriatric patients: • amount of absorption • rate of absorption Name the exception (drug) to this!!!

Answer 30

* Amount of drug absorption is the SAME * **Rate** of drug absorption is SLOWER in geriatric patients compared with younger people → time of onset of drug action is delayed **LEVODOPA** is absorbed *quicker* in older people!!!

Question 31

List some features of Crohn's: (NESTS) +2

Answer 31

→ NO blood/ mucus (uncommon) → Entire GI tract → Skip lesions on endoscopy → Terminal ileum most affected & Transmural thickness of inflammation → Smoking = risk factor → Weight loss → Structures/ fistulas

Question 32

What is the mode of inheritance of **Myotonic dystrophy**? ~ What is the repeated gene? Explain what **anticipation** is: List some symptoms/ signs of Myotonic dystophy: (6)

Answer 32

**Autosomal dominant ~** CTG repeats **Anticipation**: Successive generations inherit more CTG repeats in the gene → earlier onset & increased severity of the disease • Distal muscle weakness/ stiffness (diaphragm/ face) **• Saggy face** (due to muscle weakness) • Bilateral ptosis **• Bilateral cataracts** **• Frontal balding** **• Difficulty letting go after shaking someones hand**

Question 33

What are the 1st rank symptoms of Schizophrenia? (ABCD)

Answer 33

A - Auditory Hallucinations B - Broadcasting of Thought C - Controlled Thought (delusions of control) D - Delusional Perception

Question 34

Having a H.pylori infection increases the risk of what condition? How is H.pylori infection treated & how long for? What is Barretts oesophagus & what causes it? Barretts oesophagus increases the risk of what? What is the a) prevention & b) treatment of Barretts oesophagus?

Answer 34

Stomach cancer (MALT) Triple therapy for 7 days: ~ PPI (eg omeprazole) ~ 2x antibiotics A premalignant change from squamous to columnar epithelium in the lower oesophagus - caused by persistent reflux (GORD) Adenocarcinoma Prevention: PPI's (eg omeprazole) Treatment: ablation of dysplastic cells

Question 35

What immunological mechanism is responsible for type 2 hypersensitivity reactions? Give 2 examples of conditions that this occurs in:

Answer 35

Auto-antibody mediated receptor activation Haemolytic disease of the newborn Transfusion reactions

Question 36

If a woman is \*Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood? Why does this happen? When should this be checked for during pregnancy? What can be given as prophylaxis for this? \*Rh = rhesus

Answer 36

The women will start developing anti-D antibodies after any sensitising event (commonly giving birth) If someone is rhesus negative, they don't have the D antigen on their RBC's so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens. Rh status of mother & baby is checked at the booking appointment (week 10) If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events (eg birth/ trauma)

Question 37

Name the condition described: "Episodes of binge eating with a sense of loss of control, followed by purging behaviour" - BMI less than 17.5

Answer 37

Anorexia nervosa: binge purge subtype

Question 38

A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs. What is the most likely diagnosis?

Answer 38

Schizophrenia

Question 39

Anti-CCP is specific for what condition?

Answer 39

Rheumatoid arthritis

Question 40

An extradural haemorrhage is commonly caused by a tear in which artery? A # in which part of the skull usually causes this tear?

Answer 40

Middle meningeal artery A # of the pterion - the pterion is weakest part of the skull & lies above the middle meningeal artery

Question 41

What are the 3 core symptoms of depression?

Answer 41

* Low mood (for more than half of the day, 2+ weeks) * Anhedonia * Low energy levels

Question 42

List some common symptoms of **asthma**: (3) List some common symptoms of **COPD**: (5) ~ state the biggest risk factor!!

Answer 42

**Asthma:** • Wheeze • Cough (worse at night) • SOB **COPD:** • Progressive SOB • Cough • Sputum production • Wheeze • Recurrent resp infections *Risk factor*: SMOKING

Question 43

Anti-CCP is specific for what condition?

Answer 43

Rheumatoid arthritis

Question 44

What are the 2 main joints affected in ankylosing spondylitis? What gene is associated with the condition? What is the main presenting symptom? ~ Describe this List 2 common xray findings seen in ankylosing spondylitis: What is the 1st line medical treatment? - what is used in acute flares?

Answer 44

* Sacroiliac joint * vertebrae **HLA B27** Lower back pain & stiffness ~ gradual onset (months) ~ worse at rest & in the morning/ night ~ improves with movement **Bamboo spine,** squaring of the vertebral bodies _1st line treatment:_ NSAIDs (no known drugs modify disease course!) • flares: steroids

Question 45

**Germline** **mutations:** • occur in what cells? • can mutations be passed on to offspring? **Somatic** **mutations** (non-germline): • occur in what cells? • can mutations be passed on to offspring?

Answer 45

**Germline**: • mutations occur in egg/ sperm • mutations *are* *passed* to offspring - offspring will have the mutation in every cell within their body! **Somatic:** • mutations occur in any cell of the body *except* egg/ sperm • mutations *are not* passed to offspring

Question 46

There are 2 types of immunity: innate & adaptive: 1) Which one is activated in a primary/ secondary infection? 2) Which one is rapid & non-specific/ slow onset & very specific? 3) Which one provides 'short'/ 'long' term immunity? 4) Which one involves phagocytes & the complement system? 5) Which one invovles antibodies and cellular immunity (provided by T cells)?

Answer 46

1) **Primary** infection = innate * *Secondary** infection = adaptive 2) **Rapid & non specific** = innate * *Slow & very specific** = adaptive 3) **Short term immunity** = innate * *Long term immunity** = adaptive 4) **Phagocytes & complement** = innate 5) **Antibody production & cellular immunity** = adaptive

Question 47

What is the mode of inheritance of Huntington's Disease? ~ What is the repeated gene? Explain what **anticipation** is: List some symptoms/ signs of huntingtons: (4) What type of penetrance does the disease have? - What does this mean for family members with the gene?

Answer 47

Autosomal **dominant** ~ CAG gene repeats **Anticipation:** Successive generations inherit more CAG repeats in the gene → earlier onset & increased severity of the disease * Chorea (involuntary, abnormal movements) * Dementia (poor memory/ cognitive function) * Personality change * Depression/ psychosis etc **Full penetrant** - all family members with the gene will develop the disease at some point

Question 48

What does SCID stand for? Which immune cells are affected in SCID? What are the 2 treatment options for SCID?

Answer 48

Severe combined immunodeficiency Development of B cells & T cells is affected producing dysfunctional B & T cells 1st line = stem cell transplant If not available: gene therapy

Question 49

Explain *urge incontinence*: • state the commonest cause What are the treatments of urge incontinence? • Non-pharmacolgical • Pharmacological

Answer 49

The sudden need to urinate without warning • overactive/ irritated bladder (detrusor muscle is over stimulated!) * *Non-pharmacolgical:** Bladder retraining * *Pharmacological:** Antimuscarinics\*\* (eg Oxybutinin) Antimuscarinics act to block activation of the detrusor muscle

Question 50

List some clinical features seen in haemophilia: (5)

Answer 50

Haemarthrosis (bleeding into the joints) Muscle haematoma CNS bleeding Prolonged bleeding after surgery/ trauma Menorrhagia

Question 51

List 3 screening tools used to identify an alcohol problem:

Answer 51

**CAGE** - score of 2+ indicates alcohol problem AUDIT FAST

Question 52

Explain the effects that the below changes in body composition in the elderly have on the drug effects: a) **increased** adipose tissue → volume of distribution → duration of action/ half life b) **reduced** body water → volume of distribution → serum concentration → duration of action c) **reduced** albumin → serum concentration → effect of drug

Answer 52

a) **Increased adipose tissue** → increased volume of distribution of **fat soluble drugs** → **fat soluble drugs** will have longer 1/2 life & duration of action! b) **Reduced body water** → lower volume of distribution of **water soluble drugs** → higher serum concentration → reduced duration of action c) **Reduced albumin** → reduced amount of drug will be bound to albumin (as there is less of it) → higher serum concentration of active drug → bigger (stronger) effect of drug produced

Question 53

Between which meningeal layers does a subarachnoid haemorrhage occur?

Answer 53

Between the arachnoid mater & pia mater

Question 54

What is the acute management of a manic episode? - give an example What is the chronic management of bipolar disorder?

Answer 54

Antipsychotic (eg, Olanzapine) Lithium (or sodium valproate) + antipsychotic (eg olanzapine) - if uncontrolled with lithium

Question 55

A patient with delirium does not have capacity. - T/F Capacity is decision specific. - T/F

Answer 55

**False**, some patients may still have capacity **True**, a patient may not have capacity for more complex decisions but may retain capacity for basic decisions

Question 56

What are 2 serious side effects of MAOI's? - How can these be avoided?

Answer 56

1) **Hypertensive crisis** (cheese reaction) ~ avoid **_tyramine_** rich foods as they cause huge increase in BP ~ eg, beer, wine, cheese 2) **Serotonin syndrome** ~ occurs when MAOI's are taken alongisde drugs that increase serotonin (eg SSRI's) ~ wait 2 weeks after stopping SSRI before starting MAOI

Question 57

What are the 2 main joints affected in ankylosing spondylitis? What gene is associated with the condition? What is the main presenting symptom? ~ Describe this List 2 common xray findings seen in ankylosing spondylitis: What is the 1st line medical treatment? - what is used in acute flares?

Answer 57

* Sacroiliac joint * vertebrae **HLA B27** Lower back pain & stiffness ~ gradual onset (months) ~ worse at rest & in the morning/ night ~ improves with movement **Bamboo spine,** squaring of the vertebral bodies _1st line treatment:_ NSAIDs (no known drugs modify disease course!) • flares: steroids

Question 58

What is the management of tension headaches?

Answer 58

Simple analgesia: NSAIDs / paracetemol

Question 59

An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support. What is the most likely diagnosis?

Answer 59

Delirium

Question 60

What type of dementia is most common in the under 65's age group?

Answer 60

Alcohol related brain damage (ARBD)

Question 61

The body compostion changes with age. In regards to the following, state what you would expect in older people, compared to young: a) **muscle mass** b) **adipose tissue (fat)** c) **% body water** d) **albumin** e) **permeability of the BBB**

Answer 61

a) **Reduced** muscle mass b) **Increased** adipose tissue c) **Reduced** body water % d) **Reduced** albumin e) **Increased** permeability of BBB

Question 62

What is the difference between **mania** and **hypomania**? For a diagnosis of either, how long do symptoms need to be present for?

Answer 62

**Mania**: Elated/ irritable mood PLUS: • psychotic features (halluctination/ delusions) • impacts on ADL **Hypomania**: Elated/ irritable mood PLUS: • NO psychotic features • NO impact on ADL Diagnosis requires symptoms for 1 week+

Question 63

Now-a-days most medications *aren't* stopped before surgery, even if patients are NBM...! List 3 medications that would **never** be stopped before a surgery: List 2 medications that **may** be stopped before a surgery:

Answer 63

**Never stop:** • Inhalers • Anti-anginals (GTN) • Anti-epileptics ***Sometimes* may stop:** • Diabetic meds • Anti-coagulants

Question 64

What is the ASA grading system used for in anaesthetics? Describe each ASA grade 1-6:

Answer 64

ASA used to identify how healthy the patient is in order to stratify the risk of surgery on the patient **ASA1:** Healthy patient, non-smoker **ASA2:** Mild systemic disturbance/ smoker/ obesity (eg, well controlled diabetes/ hypertension) **ASA3:** Severe systemic disturbance (eg, *poorly* controlled diabetes/ hypertension) **ASA4:** Life threatening disease (eg, recent MI/ sepsis) **ASA5:** Moribund patient (unlikely to survive the surgery) **ASA6:** Organ retrieval (patient is brain dead)

Question 65

What are the cancerous cells in **chronic lymphocytic leukaemia?** List some symptoms/ signs of CLL: (4) What autoimmune condition is associated with CLL? What cell would be seen on a blood film? What is the management of CLL? - is it curable?

Answer 65

Differentiated lymphoid cells (B & T lypmhocytes) * COMMONLY ASYMPTOMATIC !!!! * Non-tender lymphadenopathy * Hepatosplenomegaly * B symptoms **Warm** autoimmune haemolytic anaemia Smudge cells NOT CURABLE - if no symptoms, don't treat! (Otherwise chemotherapy)

Question 66

List some extrinsic causes of urinary incontinence: (5)

Answer 66

* Immobility issues - unable to get to toilet * Diuretics - increase volume of urine * Constipation * Confusion - may be unaware of needing toilet * Painkillers - can cause constipation

Question 67

A bacterial growth of what suggests a UTI?

Answer 67

**10⁵**

Question 68

In the RAT approach to pain management, what does R, A, T stand for? How would a patient describe **nociceptive** pain? How would a patient describe **neuropathic** pain?

Answer 68

* *R** - recognise pain * *A** - assess pain type/ severity * *T** - treat pain **Nociceptive pain:** • Sharp/ dull pain • Well localised (patient can point to location of pain) **Neuropathic pain:** • Burning/ shooting pain • Pins & needles • Numbnesss

Question 69

Describe what you might see in the following seizures: a) Tonic-clonic seizure b) Myoclonic seizure c) Absence seizure d) Atonic seizure

Answer 69

**Tonic-clonic seizure:** Muscles stiffen (go rigid = tonic) before generalised jerking of limbs (clonic) **Myoclonic seizure:** Sudden jerking of one limb - patient may be conscious! **Absence seizure:** Patient 'pauses' for a few seconds before restarting activity - patient often has no recollection **Atonic seizure:** Muscles suddenly loose all tone - patient falls over

Question 70

What is a common presentation of a cluster headache? (6)

Answer 70

Male with sudden onset, severe pain, behind one eye Associated with: ~ watery, bloodshot eye ~ lacrimation ~ ptosis ~ miosis ~ runny nose (rhinorrhea)

Question 71

What type of pain will the WHO pain ladder be successful at helping? What is the treatment for the other type of pain? (name 2 examples of drugs used)

Answer 71

Nociceptive pain = use WHO pain ladder Neuropathic pain - WHO pain ladder doesn't work ~ amitriptylline ~ gabapentin ~ duloxetine

Question 72

What type of headache is associated with autonomic symptoms? (Ptosis, miosis, lacrimation, nasal congestion)

Answer 72

Cluster headache

Question 73

What immunological mechanism is responsible for type 3 hypersensitivity reactions? Give an example of a disease that is caused by type 3 hypersensitivity.

Answer 73

Immune complex deposition SLE

Question 74

What are the 3 main criteria of PTSD according to ICD-10? - list some symptoms that fall under each one What is the management of sub-clinical PTSD? What is the management of moderate+ PTSD? ~ if this doesn't work, what medication can be used?

Answer 74

**1) Hyper-arousal** ~ persistent anxiety ~ poor concentration ~ emotional numbing **2) Flashbacks** ~ intense flashbacks at night/ during day **3) Avoidance** ~ activities that remind patient of trauma are avoided Subclinical: Watch & wait approach Moderate: Trauma focused CBT - SSRI's

Question 75

When should an ADR be reported to the yellow card scheme? (3)

Answer 75

* Any ADR seen in a **new** **drug** * Any ADR in **children** * Any **serious** **ADR**, even if the ADR is already known about (eg neutropenia/ agranulocytosis etc)

Question 76

What is the treatment of von Willebrand disease? List 2 contraindictations to the use of DDAVP:

Answer 76

There is no day-to-day treatment. Treatment is given after a bleed or in preparation for surgery 1) VWF concentrate IV 2) Desmopressin - stimulates the release of VWF 3) Tranexamic acid - inhibits fibrinolysis (clot breakdown) Contraindictations: young children, people with high cardiovascular risk

Question 77

What chromosome is associated with chronic myeloid leukaemia? - what are the consequences of this? What is the gene translocation? What is the 1st line management of CML?

Answer 77

**Philadelphia chromosome** ⇒ BCR-ABL gene (oncogene) **t (9;22)** Tyrosine kinase inhibitors (inhibit BCR-ABL!) ~ eg **Imatinib**

Question 78

What is often the first clinical feature seen in vascular dementia?

Answer 78

Aphasia (problems with communication) \* Memory is often spared until advanced disease

Question 79

TRUE/ FALSE: * Blood pressure normally goes up under anaesthesia. * End tidal CO2 measures how much CO2 the patient breathes in. * There are 5 pieces of monitoring that must be present before a GA is given. * Only some patients require airway management whilst under anaesthesia.

Answer 79

**False** - anaesthetics commonly make BP fall **False** - the amount of CO2 breathed out **True** - BP, SATs, ECG, end tidal CO2, airway pressure **False** - ***every*** patient will require some degree of airway management

Question 80

A bacterial growth of what suggests a UTI?

Answer 80

**10⁵**

Question 81

What is **Osteoarthritis** - what does it usually present with? ~ what makes it worse/ better? List the 4 commonest joints affected: List 2 common signs that are seen in the hands: What things are used in the management?

Answer 81

Mechanical wear & tear - presents with joint pain & stiffness ~ worse at night & upon activity, better with rest * Hips * Knee * DIPs (of hands) * MCP joint at base of thumb * Haberdens nodes (DIP joints) * Bouchards nodes (PIP joints) * Physiotherapy (mobilising joint) * Weight loss * Paracetemol & *topical* NSAIDs ⇒ oral NSAIDs * Intra-articular steroid injections

Question 82

What is the management of mild- moderate depression? What is the management of moderate- severe depression? What do you do next if the 1st medical managent of severe depression fails? ~ If this fails, then what? ~ What do you add in next? What is the management of severe treatment resistant depression? ~ If patient doesn't want this, what medical management is available?

Answer 82

**Mild-moderate:** • Group CBT **Moderate-severe:** • CBT PLUS SSRI (sertraline) Add in a 2nd SSRI ~ Swap one of the SSRI's for an SNRI ~ Use these along with lithium \*\* Review after 2 weeks ECT (electro convulsive therapy) ~ Monoamine oxidase inhibitors (MAOIs)

Question 83

What is a **tension pneumothorax?** ~ what is the cause? List some signs of a tension pneumothorax: (4) What is the **initial** management? What is the **definitive** management?

Answer 83

**Tension pneumothorax:** air enters the pleural space through a *one way valve* - during inspiration, air moves into pleural space, during expiration air cannot leave ~ Caused by trauma to the chest * SOB * Tracheal deviation *away* from side of pneumorthorax * Reduced air entry on affected side * Resonant to percussion on affected side * *Management:** * Initial*: insert a _large bore cannula_ into the 2^nd intercostal space in the midclavicular line * Definitive*: Chest drain

Question 84

Joint pain/ stiffness that is worse in the **morning** & improves with **exercise** indicates: a) mechanical cause b) inflammatory cause

Answer 84

**Inflammatory cause**

Question 85

Which electrolyte imbalance is seen in anorexia nervosa?

Answer 85

Hypokalaemia (low K)

Question 86

What cells are cancerous in **myeloproliferative disorders**? - where in the body are these cancerous cells found? (*before mets)* List some clinical signs/ symptoms of **chronic myeloid leukaemia** (a myeloproliferative disorder) (4) - what is the cancerous cell? What chromosome is associated with CML? - what are the consequences of this? What is the 1^st line management of CML?

Answer 86

Differentiated cells of myeloid origin ~ found in bone marrow • Anaemia (→ pancytopenia) • *Massive* splenomegaly • HIGH WCC • Gout ~ Cancerous cell = neutrophils **Philadelphia chromosome** ⇒ BCR-ABL gene (oncogene) Tyrosine kinase inhibitors (inhibit BCR-ABL!)

Question 87

What condition is indicated if a woman presents with **recurrent miscarriages** & a history of **VTE** events? What is the treatment of this condition? (2)

Answer 87

**Antiphospholipid syndrome** Aspirin & LMWH

Question 88

What are the 3 criteria needed for a diagnosis of learning difficulty? What are the 3 main causes of learning difficulty?

Answer 88

1) Intellectual impairment (IQ \< 70) 2) Social/ adaptive dysfunction (eg deficits in communication/ self-care, social skills etc) 3) Onset before 18y (whilst brain is still developing) 1) Head injury 2) Chromosomal abnormalities (eg Downs) 3) Congenital abnormalities (eg infection/ abnormal brain development)

Question 89

Explain what tolerance (in regards to addiction) means: Name the 2 types of tolerance & explain the physiological process behind each type: How can tolerance result in dependence?

Answer 89

Tolerance: Reduced responsiveness to a drug caused by the body adapting to previous physiological effects of the drug ~ body tries to maintain homeostasis Dispositional tolerance ~ less drug reaches the drug receptors Pharmacodynamic tolerance ~ drug has less action on the drug receptors Tolerance = body physiologically adapts each time drug is taken → stopping drug causes withdrawal symtpoms which are often unpleasant → drug is repeatedly taken to avoid withdrawal symptoms

Question 90

What is graft vs host disease? How can the risk of GVHD be minimised?

Answer 90

Rejection of a transplant caused by the **donor's** T cells attacking the **recipant's** antigens !! **Immunosuppression!** • steroids • cyclosporin/ rapamycin

Question 91

Anaphylaxis is what type of hypersensitivity reaction? This type of reaction is mediated by what?

Answer 91

Type 1 hypersensitivity reaction IgE mediated mast cell degranulation

Question 92

What cells are cancerous in **acute myeloid leukaemia**? - where in the body are these cancerous cells found? *(before mets)* List some clinical signs/ symptoms of AML: (4) What is the definitive investigation of AML? ~ List 2 things that would be seen on this What is the treatment of AML?

Answer 92

Undifferentiated, myeloid progenitor cells ~ found in the bone marrow * Pancytopenia * Gum hypertrophy * Hepatosplenomegaly * Petechiae & abnormal bleeding (caused by low platelets) **Bone marrow biopsy** • \> 20% blast cells • auer rods Chemotherapy +/- stem cell transplant

Question 93

What antibodies are present in coeliac disease? What type of Ig are these antibodies? When testing for these antibodies, what do you also need to test for to avoid a false negative result?

Answer 93

Anti-tissue transglutaminase (anti-TTG) & anti-endomysial (anti-EMA) IgA antibodies Total IgA levels - some people are IgA deficient so their total IgA will be low, even if they have coeliacs

Question 94

Where are *most* drugs excreted in the body? Explain the differences in drug excretion in older people & the effect this has on drug action:

Answer 94

Kidneys *Reduced kidney function* = **less excretion** of the drug → drug has a **longer** **action** in the body

Question 95

What are hypersensitivity reactions?

Answer 95

Exaggerated immune responses that cause damage to tissues/ blood

Question 96

Name the condition described: "Episodes of binge eating with a sense of loss of control, followed by purging behaviour" - normal BMI

Answer 96

Bulimia nervosa

Question 97

List some clincial features seen in someone with bulimia nervosa (6)

Answer 97

Swollen parotid glands Poor dentition (from the acid in the vomit) Mouth sores Eosophageal tears → haematemesis Heart burn Cuts on knuckles from induced vomiting (Russell's sign)

Question 98

List 4 risk factors for Hodkins lymphoma: What is the key presenting symptom? What is the diagnostic test/ investigation? ~ What is a key finding in this? What is the staging used in all lymphoma's? - describe the stages

Answer 98

→ Smoking → Epstein barr virus → HIV → Immunosuppression Lymphadenopathy - non-tender, alcohol causes pain in lymph nodes Lymph node biopsy ~ Reed sternberg cells **Ann Arbor Staging:** Stage 1: Only 1 lymph node group affected Stage 2: Several lymph nodes affected but on the same side of diaphragm Stage 3: Several lymph nodes affected but on different sides of diaphragm Stage 4: Organ invovlement (eg, lungs/ liver)

Question 99

Define what dementia is:

Answer 99

Dementia is a syndrome (a collection of different symptoms) associated with an progressive decline in brain functioning

Question 100

Name the condition described: "Episodes of binge eating with a sense of loss of control, followed by purging behaviour" - BMI less than 17.5

Answer 100

Anorexia nervosa: binge purge subtype

Question 101

What are the main features of myeloma? (CRAB)

Answer 101

→ Hyper**_C_**alcaemia → **_R_**enal failure → **_A_**naemia → **_B_**one disease

Question 102

What class of antidepressant's are lethal in overdose? Give an example of a drug in this class

Answer 102

TCA's - amitriptyline

Question 103

What 3 things are included in the *triad of anaesthesia?* (targets of drug action)

Answer 103

* Analgesia * Hypnosis * Relaxation (of muscles)

Question 104

What is the 1st line treatment of **generalised** **seizures**? What is the 1st line treatment of **partial (focal) seizures?** What is the treatment of **absence seizures**?

Answer 104

**Generalised seizures:** Sodium valproate (lamotrigine for females) **Partial seizures:** Lamotrigine **Absence seizures:** Ethosuximide

Question 105

What are the cancerous cells in myeloma & what do they produce? - explain what these are.. List some signs/ symptoms of myeloma: (4) Name the definitive investigation of myeloma: What would be seen on a bone marrow biopsy? - state what would qualify as myeloma

Answer 105

Plasma cells - produce paraproteins **Paraproteins =** identical immunoglobulins (usually IgG) produced by a (*cancerous)* clonal population of plasma cells * Hypercalcaemia * Renal failure * Anaemia * Lytic bone disease/ pain **Serum protein electrophoresis** Bone marrow biopsy: high plasma cells ~ plasma cells \>10% = myeloma ~ plasma cells \< 10% = MGUS

Question 106

**Lynch syndrome (HNPCC)** is caused by mutations in what? What mode of inheritance is seen in Lynch syndrome? What are the 3 commonest cancers associated with the condition?

Answer 106

**DNA mismatch repair genes** Autosomal **dominant** \*\* Colon cancer \*\* - commonest in distal colon • Endometrial • Ovarian

Question 107

Skin prick testing is used to test for what type of hypersensitivity reaction? Patch testing is used to test for what type of hypersensitivity reaction?

Answer 107

**Skin prick testing** = hypersensitivity I **Patch testing** = hypersensitivity IV

Question 108

List the distinguishing features that differentiate IgA nephropathy from post-streptococcal glomerulonephritis: (2)

Answer 108

**IgA Nephropathy:** ~ 1-2 days post URTI ~ Renal biopsy: IgA immune complex deposits in the glomerulus **Post-strep GN:** ~ 1-3 weeks post URTI (usually strep throat) ~ Renal biopsy: IgG immune complex deposits in the glomerulus

Question 109

Name the reversible neurological condition commonly seen in alcoholics: ~ What causes this condition? List the triad of presenting features seen in this condition: What is the treatment of it? If left untreated, what can it progress into?

Answer 109

**Wernicke's encephalopathy** ~ Thiamine (B1) deficiency 1) Ataxia (problems with coorindation, balance & speech) 2) Confusion 3) Opthalmoplegia/ nystagmus **Treatment**: IV thiamine (usually given as pabrinex) **Korsakoff's syndrome** (irreversible brain damage)

Question 110

Name the main neurones involved in the reward pathway & state which NT they release How is activation of the reward pathway involved in addiction?

Answer 110

VTA neurones → nucleus accumbens → pre-frontal cortex ~ release dopamine Release of dopamine creates feeling of pleasure → psychological cravings of this feeling then occur which result in dependence \*\* VTA = Ventral tegmental area

Question 111

How many days supply of controlled drugs are given at any time?

Answer 111

Up to 30 day supply

Question 112

What is found within the subarachnoid space?

Answer 112

CSF

Question 113

How long must diarrhoea persist for to be referred to as **chronic diarrhoea**?

Answer 113

More than 4 weeks

Question 114

List some patient factors that an anaesthetist would aim to optimise in their pre-operative assessment: (6)

Answer 114

* Diabetes control * Hypertension control * COPD * Epilepsy * Heart failure * *Lifestyle*: weight, exercise tolerance, smoking cessation

Question 115

What drug class is used for the treatment of Alzheimers disease & Lewy Body dementia? Give an example of a medication from this class.

Answer 115

Acetylcholinesterase inhibitors Donepezil

Question 116

Status epilepticus is pronounced after a generalised seizure has been ongoing for how long? What is the 1st line management of status epilepticus? ~ when should it be given? What is the 2nd line management of status epilepticus? What is the 3rd line management of status epilepticus?

Answer 116

5 minutes 1st line: Buccal midazolam or IV lorazepam ~ given at 5 minutes ~ repeat again at 10 minutes if still ongoing 2nd line: Sodium valproate 3rd line: Anaesthesia and intubation (propofol)

Question 117

What are 'neologisms'? - what condition might they be featured in?

Answer 117

**Neologisms** = made up words - indicates a thought disorder ~ common in Schizophrenia

Question 118

What other mental health disorders are associated with eating disorders? (3)

Answer 118

OCD, anxiety, perfectionism

Question 119

What cells does **HIV** destroy? What are the 3 ways that HIV can be **tested** for in someone? What 2 things are used to monitor a HIV infection? (below what num. would be abnormal/ end stage disease?)

Answer 119

**CD4 T helper cells** 1) **Antibody blood test** - may appear negative until *3 months post exposure* 2) PCR: **p24 antigen** - detects the HIV antigen in the blood 2) PCR: **HIV RNA** - detects the quantitiy of HIV in the blood (used to measure **viral load**) **Monitoring:** 1) **CD4 count** ~ below 500 cells/mm³ = abnormal (deficient) ~ below 200 cells/mm³ = end stage disease (AIDs) 2) **Viral load**

Question 120

**Tuberous Sclerosis** is a genetic condition in which **hamartomas** form throughout the body (benign tumours composed of multiple cell types). What is the mode of **inheritance**? What are the classic triad of features seen in Tuberous Sclerosis? List some skin lesions seen in this condition: (3)

Answer 120

**Autosomal dominant** * Epilepsy * Learning difficulties * Skin lesions * Ash leaf spots * Shagreen patches * Angiofibromas (looks like acne on nose, cheeks, chin)

Question 121

You are working in A&E and a patient is hypotensive. What do you do to increase the BP? How much of this would you give and over what time?

Answer 121

IV fluid resuscitation 500ml saline or plasmalyte bolus over 15 mins

Question 122

What are the common symptoms of a migraine? (5)

Answer 122

Unilateral, throbbing headache that's aggravated by movement Photophobia (light makes it worse) Phonophobia (loud noises make it worse) Nausea / vomiting +/- Aura

Question 123

If someone presents with a thunderclap headache, what is the most likely diagnosis?

Answer 123

Subarachnoid haemorrhage

Question 124

How long must diarrhoea persist for to be referred to as **chronic diarrhoea**?

Answer 124

More than 4 weeks

Question 125

What is the typical presentation of someone with an extradural haemorrhage? (symptoms)

Answer 125

Head trauma +/- unconsciousness followed by lucid period (as the blood is pooling) Progressive headache Nausea / vomiting Decreasing GCS

Question 126

How is Binge Eating Disorder different from Bulimia Nervosa? What is an effective treatment in Binge Eating Disorder?

Answer 126

In Binge Eating Disorder, patient's don't purge themselves after eating **Treatment BED:** CBT

Question 127

What genetic mode of inheritance is seen in haemophilia A & B? Which sex is haemophilia more common in?

Answer 127

X linked recessive inheritance! Males

Question 128

Which antibodies are tested for in SLE? (3) List some common symptoms seen in SLE: (6) What is the 1st line treatment of SLE? What is used to treat an SLE flare?

Answer 128

* Anti-nuclear antibodies (ANA) * Anti-double stranded DNA (anti-dsDNA) * Anti-smith * Fatigue * Weight loss * Photosensitive malar rash * Joint & muscle pain * Mouth ulcers * Hair loss * *Treatment:** NSAIDs & hydroxychloroquine * Flares:* steroids (commonly prednisolone)

Question 129

What is the mode of inheritance of **Myotonic dystrophy**? ~ What is the repeated gene? Explain what **anticipation** is: List some symptoms/ signs of Myotonic dystophy: (6)

Answer 129

**Autosomal dominant ~** CTG repeats **Anticipation**: Successive generations inherit more CTG repeats in the gene → earlier onset & increased severity of the disease • Distal muscle weakness/ stiffness (diaphragm/ face) **• Saggy face** (due to muscle weakness) • Bilateral ptosis **• Bilateral cataracts** **• Frontal balding** **• Difficulty letting go after shaking someones hand**

Question 130

**Amyotrophic lateral sclerosis** is a type of what disease? List some features of this condition: (4) What gene mutation is associated with this condition? What is the treatment of this condition? What type of **penetrance** does the disease have? - What does this mean for family members with the gene?

Answer 130

**Motor neurone disease** *ONLY motor symptoms!!!!!!* • Progressive muscle weakness (LMN) • Muscle wasting (LMN) • Hyper-reflexia (UMN) • Spasticity (UMN) **SOD** gene NO TREATMENT **Incomplete penetrance:** ~ People with the gene don't always develop the disease so offspring may/ may not be affected ~ Environmental factors 'switch' the gene on - nobody knows how/ why

Question 131

How is Binge Eating Disorder different from Bulimia Nervosa? What is an effective treatment in Binge Eating Disorder?

Answer 131

In Binge Eating Disorder, patient's don't purge themselves after eating **Treatment BED:** CBT

Question 132

When would **baby blues** typically present? When would **postnatal depression** typically present?

Answer 132

**Baby blues**: Within 2 weeks of delivery **Postnatal depression:** several weeks after delivery up to 1y

Question 133

What other mental health disorders are associated with eating disorders? (3)

Answer 133

OCD, anxiety, perfectionism

Question 134

What is the commonest blood cancer of children? What blood cell line does this cancer arise from? List some symptoms/ signs of this cancer: (4) What is the definitive investigation? What will be seen on this? What is the treatment of this cancer?

Answer 134

**Acute lymphoblastic leukaemia** Lymphoid progenitor cells (undifferentiated) * Child with a limp * Bone/ joint pain * Exertional SOB * Pancytopenia Bone marrow biopsy - *blast cells* Prolonged course of chemotherapy

Question 135

List some reasons to intubate a patient: (4)

Answer 135

* Protection from aspiration * Muscle relaxation is needed for the operation * Shared airway (the surgery invovles the airways areas) * Need for tight CO2 control

Question 136

List some characteristics seen in Borderline Personality Disorder: (5) What treatment options are available for personality disorders? (2)

Answer 136

* Impulsive behaviour * Inability to control emotions * Unstable relationships * Self harm * Feelings of paranoia/ anxiety **Treatment options:** • CBT • *Antipsychotics/ antidepressants/ mood stabilisers* - to treat underlying mental health condition!

Question 137

What is the difference between generalised anxiety disorder & phobic anxiety disorders? What is agoraphobia? What is the available treatment of GAD?

Answer 137

**GAD** - anxiety symptoms occur all the time & are not restricted to certain circumstances **Phobias** - anxiety symptoms only occur in particular circumstances **Agoraphobia**: A fear of crowded spaces 1) Counselling 2) SSRI's (sometimes TCA's)

Question 138

What are the key clinical features in lewy body dementia? (3)

Answer 138

Fluctuating confusion throughout the day Visual hallucinations Parkinsonism symptoms (poor mobility, tremor)

Question 139

Name the drug classes used in each of the 3 steps of the WHO pain ladder. Give an example of a drug in each class. Explain how to use the WHO pain ladder.

Answer 139

Step 1: NSAIDs & paracetemol ~ Aspirin, Ibuprofen, Diclofenac Step 2: Mild opioids (codeine/ tramadol) +/- NSAIDs/ paracetemol Step 3: Strong opiods (morphine/ fentanyl) +/- NSAIDs/ paracetemol Start with step 1, if pain not tolerated, add in mild opioid. If not tolerated, swap mild opioid fo strong one with NSAID/ paracetemol still

Question 140

What is an extradural haemorrhage?

Answer 140

A collection of blood between the skull and the dura mater

Question 141

Describe the meaning of **frailty**: List the 5 decompensated frailty syndromes:

Answer 141

Increased susceptibility to environmental stress that the body isn't able to physiologically deal with (eg catching a pneumonia/ falling) 1) Falls 2) Immobility 3) Delirium 4) Incontinence 5) Susceptibility to S/E of medications (eg, confusion with coediene, hypotensions with antidepressants)

Question 142

Explain *neuropathic bladder* (aka underactive bladder): • state the commonest cause • what type of incontinence can it result in? What is the **treatment** of a neuropathic bladder?

Answer 142

**Underactive bladder:** bladder no longer detects when it contains urine (detrusor muscle doesn't contract) • commonest cause = long term catheterisation • results in overflow incontinence **Treatment:** catheterisation!

Question 143

List some common side effects of antimuscarinics in the elderly: (5)

Answer 143

* dry mouth * constipation * confusion/ delirium * falls * urinary retention

Question 144

How long does a migraine attack usually last for?

Answer 144

4 - 72h

Question 145

Joint pain/ stiffness that is worse in the **morning** & improves with **exercise** indicates: a) mechanical cause b) inflammatory cause

Answer 145

**Inflammatory cause**

Question 146

What drug class is used as the 1st line treatment to manage an acute migraine attack? Give an example of a commonly used drug from this class.

Answer 146

Triptans Sumatriptan

Question 147

What is Neurofibromatosis Type 1 (**NF1**)? What mode of inheritance is seen in NF1? List some common symptoms/ signs of NF1: (5)

Answer 147

A genetic condition that causes cancers to grow along the nerves (often benign but can turn malignant) **Autosomal dominant** **•** Cafe au lait spots (coffee colour patches on the skin) - see below • Axilliary freckling • Neurofibromas (small nodular tumours on the skin) • Brown patches on the iris • Learning difficulties/ epilepsy

Question 148

List some common drugs that cause ADR's in the elderly: (8)

Answer 148

_**1) Anti-cholinergics 2) Sedatives (eg benzodiazepines)**_ * Opioids * Anti-psychotics * NSAIDs * Diuretics * Anti-hypertensives * Antibiotics

Question 149

What condition is associated with alcohol withdrawal? ~ How long after withdrawing alcohol does this usually present? List some clinical features associated with this condition: (5) What class of drugs are used to help prevent withdrawal symptoms? - Name the main drug used.

Answer 149

**Delirium tremens** ~ Presents 72h after stopping alcohol * ***Confusion*** * ***Hallucinations*** (visual & tactile (insects crawling under skin)) * Sweating * Hypertension * Seizures **Benzodiazepines** (eg Chlordiazepoxide)

Question 150

What would you expect to see in the blood results of a patient diagnosed with anorexia nervosa in regards to: 1. K levels 2. Cholesterol levels 3. Sex hormone levels (FSH, LH, Oestrogen, Testosterone) 4. GH levels 5. Cortisol levels

Answer 150

1. Hypokalaemia 2. Hypercholesterolaemia 3. Low sex hormones 4. Raised GH 5. Raised cortisol

Question 151

**TB** usually presents with chronic, slowly progressive symptoms. List some: (6) What is the management of **acute TB**? (*RIPE*) ~ state the common side effects

Answer 151

* Cough +/- haemoptysis * Fever/ night sweats * Weight loss * Fatigue * Erythema nodosum (nodules on shins) * Lymphaddenopathy **Management of acute TB:** **_R:_ Rifampicin (6 months)** S/E: red/ orange tears/ urine (secretions) **_I:_ Isoniazid (6 months)** S/E: peripheral neuropathy **_P:_ Pyrazinamide (2 months)** S/E: gout (causes high uric acid levels!) **_E:_ Ethambutol (2 months)** S/E: colour blindness

Question 152

Name the condition described: "Episodes of binge eating with a sense of loss of control, followed by purging behaviour" - normal BMI

Answer 152

Bulimia nervosa

Question 153

Medications that are associated with *dependence* which have the potential to be a*bused* are classed as what types of drug?

Answer 153

Controlled drugs

Question 154

Name the test used to differentiate between IBD & IBS: What criteria is used to assess severity of UC? Name the 1st line medication used to induce a) remission b) maintenance of Crohn's Name the 1st line medication used to induce a) remission b) maintenance of UC

Answer 154

Faecal calprotectin Truelove & Witts criteria Crohn's: Remission: Steroids (eg, prednisolone) Maintenance: Azathioprine (immunosuppressant drug) UC: Remission: Aminosalicylate (5ASA) - eg mesalazine Maintenance: Aminosalicylate (5ASA) - eg mesalazine

Question 155

What type of hallucinations are common in lewy body dementia?

Answer 155

Visual hallucinations: → animals in the house → faces in the wallpaper

Question 156

What is often the first clinical feature seen in vascular dementia?

Answer 156

Aphasia (problems with communication) \* Memory is often spared until advanced disease

Question 157

What is an autologous transplant? What is an allogeneic transplant? What is a syngeneic transplant? What is an xenogeneic transplant? What type of transplant has the highest risk of rejection?

Answer 157

**Autologous transplant:** tissue from the same person **Allogeneic transplant:** tissue from another member of the same species (eg, human - human) **Syngeneic transplant:** tissue from an identical twin **Xenogeneic transplant:** tissue from a different species Xeogeneic transplant has the biggest risk of rejection as it is tissue from another species

Question 158

What are the 2 commonest causes of a subarachnoid haemorrhage?

Answer 158

Ruptured aneurysm, commonly in the cirle of willis Severe head injury

Question 159

What is the management of Schizophrenia? - Name the drug class & 2 examples What are some common contraindictations of atypical antipsychotics? What can also be given if patient is aggitated in an acute episode of Schizophrenia? What medication is used in treatment resistant Schizophrenia? ~ Name an important S/E of this

Answer 159

Atypical antipsychotics - eg olanzapine/ risperidone\*\* Atypical's: • Weight gain & hyperlipidaemia/ hypercholesterolaemia (olanzapine) • Hyperprolactinaemia (risperidone) Aggitation: Benzodiazepam, eg lorazepam Clozapine - agranulocytosis (weekly blood tests needed) \*\* CBT may aslo be used

Question 160

What screening tool is used to assess the likelihood of anorexia nervosa? A score of what would suggest an eating disorder?

Answer 160

SCOFF questionairre 2+

Question 161

Describe the location & level of support provided in each level 1-3 of the organ system support:

Answer 161

**Level 1 care**: medical ward based care **Level 2 care**: HDU - offers *single* organ support (eg heart failure) **Level 3 care**: ICU - offers *multiple* organ support

Question 162

Describe a cluster headache. How long do they usually last for?

Answer 162

Sudden onset, unilateral pain behind one eye Typically last between 15 mins - 3 hours

Question 163

A 39 year old woman presents with a complaint that she is fearful that something bad may happen to her. This fear occurs where-ever she goes and she cannot describe what might happen. She also complains of pains in her chest, a tremor and sweating at times. What is the most likely diagnosis?

Answer 163

Generalised anxiety disorder

Question 164

What is the abnormality that results in **polycythaemia vera?** What mutation is associated with polycythaemia vera? List some clinical signs/ symptoms of this condition: (5) What is the management of this condition?

Answer 164

Proliferation of RBC's JAK2 mutation * Red face (plethora) * Vascular occlusion (DVT/ PE/ Stroke) * Splenomegaly * Headaches * Itchy, especially after hot bath **Management:** venesection (to prevent hyperviscosity of blood) & aspirin

Question 165

Which electrolyte abnormality can blood transfusions cause? Why does this happen?

Answer 165

**Hypocalcaemia** When blood is donated, it's mixed with sodium citrate to prevent it from coagulating. → The citrate in the blood can bind to the patient's circulating calcium resulting in a decreased amount of free calcium = symptoms of hypocalcaemia

Question 166

Someone with autism may have defecits in what 3 things? What does the management of autism involve? What congenital condition is autism commonly seen in?

Answer 166

1) Social interaction 2) Communiation 3) Behaviour **Management**: MDT team, no medications Down syndrome

Question 167

Regarding **pO2** & **pCO2**, what would be seen on a blood gas in: a) type 1 respiratory failure b) type 2 respiratory failure

Answer 167

**Type 1 resp failure:** low O2, normal CO2 **Type 2 resp failure:** low O2, high CO2 - respiraoty acidosis

Question 168

IV salbutamol can cause what **electrolyte** abnormality? - what monitoring is needed to identify this? Which of the following would be used in: a) **moderate** asthma attack b) **severe** asthma attack c) **life threatening** asthma attack * IV aminophylline * Nebulised salbutamol * IV magnesium sulphate * Nebulised ipratropium bromide * IV salbutamol * Intubation

Answer 168

Salbutamol causes K to move from serum into cells = **hypokalaemia ~**need to monitor serum K **Moderate asthma attack:** • Nebulised salbutamol • Nebulised ipratropium bromide **Severe asthma attack:** • IV aminophylline • IV salbutamol **Life threatening attack:** • IV magnesium sulphate • Intubation

Question 169

What are some common triggers of trigeminal neuralgia? (5)

Answer 169

Cold Wind Chewing Talking Touching face

Question 170

Where are *most* drugs metabolised in the body? Explain the differences in drug metabolism in older people: What effect does this have on serum conc. of drug? How does this affect the onset & effect of pro-drugs? (*drugs that are activated by the liver into their active form*)

Answer 170

**Liver** metabolises most drugs! **Drug metabolism** → liver works slower in older people SO metabolism of drugs is also slower → reduced 1^st pass metabolsim **Effect on drugs action:** Reduced 1^st pass metabolism = more drug in circulation that can have an affect (as it is being removed at a slower rate) **Pro-drugs** Less active form of the drug in circulation so ONSET = delayed, EFFECT = weaker (as there is less active drug)

Question 171

List some features of **nephrotic** syndrome: (4) List some features of **nephritis** syndrome: (3)

Answer 171

**Nephrotic syndrome:** • proteinuria (+++) • oedema • hypoalbuminaemia • hyperlipidaemia **Nephritic syndrome:** • haematuria • hypertension • proteinuira (+)

Question 172

What's the difference between hallucinations & delusions?

Answer 172

**Hallucinations** are seeing/ hearing things not related to an external stimulus ~ Can affect any of the 5 senses (touch, smell, taste, hearing, sight) **Delusions** are fixed, firm beliefs that are outwith the patients cultural beliefs ~ Patients will believe delusions are true, even if shown evidence against them

Question 173

What is the mode of inheritance of Huntington's Disease? ~ What is the repeated gene? Explain what **anticipation** is: List some symptoms/ signs of huntingtons: (4) What type of penetrance does the disease have? - What does this mean for family members with the gene?

Answer 173

Autosomal **dominant** ~ CAG gene repeats **Anticipation:** Successive generations inherit more CAG repeats in the gene → earlier onset & increased severity of the disease * Chorea (involuntary, abnormal movements) * Dementia (poor memory/ cognitive function) * Personality change * Depression/ psychosis etc **Full penetrant** - all family members with the gene will develop the disease at some point

Question 174

Regarding **pO2** & **pCO2**, what would be seen on a blood gas in: a) type 1 respiratory failure b) type 2 respiratory failure

Answer 174

**Type 1 resp failure:** low O2, normal CO2 **Type 2 resp failure:** low O2, high CO2 - respiraoty acidosis

Question 175

What is Neurofibromatosis Type 1 (**NF1**)? What mode of inheritance is seen in NF1? List some common symptoms/ signs of NF1: (5)

Answer 175

A genetic condition that causes cancers to grow along the nerves (often benign but can turn malignant) **Autosomal dominant** **•** Cafe au lait spots (coffee colour patches on the skin) - see below • Axilliary freckling • Neurofibromas (small nodular tumours on the skin) • Brown patches on the iris • Learning difficulties/ epilepsy

Question 176

If a patient presents with "the worst headache they've ever had", what diagnosis is this suggestive of?

Answer 176

Subarachnoid haemorrhage Commonly presents with a thunderclap headache

Question 177

What abnormality is seen in haemophilia A? What abnormality is seen in haemophilia B? What is the mode of inheritance of haemophilia? What tests would you do to diagnose haemophilia and what results would you expect in haemophilia? (3)

Answer 177

Haemophilia A: deficiency of clotting factor VIII Haemophilia B: deficiency of clotting factor IX X linked recessive 1) Clotting factor tests - to look at levels of factors VIII & IX (low VIII in haemophila A & low IX in haemophilia B) 2) Blood test APTT\*: prolonged 3) Blood test prothrombin: normal \* APTT = blood test that measures time taken for blood to clot

Question 178

What area of the brain is responsible for memory storage & is usually atrophied in Alzheimers? ~ What lobe(s) are affected in Alzheimers? What lobe(s) are affected in Frontotemporal dementia?

Answer 178

Hippocampus ~ Parietal lobe & temporal lobe Frontal lobe & temporal lobe

Question 179

**Lynch syndrome (HNPCC)** is caused by mutations in what? What mode of inheritance is seen in Lynch syndrome? What are the 3 commonest cancers associated with the condition?

Answer 179

**DNA mismatch repair genes** Autosomal **dominant** \*\* Colon cancer \*\* - commonest in distal colon • Endometrial • Ovarian

Question 180

What is lactate a marker of? Is a high or low lactate good?

Answer 180

Hypoperfusion (reduced O2 reaching the tissues) LOW lactate - the higher the lactate, the more tissues are without O2!

Question 181

What is the 1st line medication used to treat trigeminal neurlagia? This medication is also used in the treatment of what?

Answer 181

**Carbamazepine** Epilepsy!

Question 182

What is the function of haptoglobin?

Answer 182

It transports free haemoglobin in the bood → reticuloendothelial system to be recycled

Question 183

What is an unliscenced drug? What is an 'off label' drug?

Answer 183

**Unliscenced drug:** the drug is used in other countries but has not been approved in the UK (*or* it is being used in a different form to what it is liscened as, eg powdered tablet for children instead of the tablet) * *Off label drug:** the drug is liscenced by the MRHA but *not* for the treatment of the condition you are prescribing for * or* it is being used in a different age group to that listed on the liscence

Question 184

What is **sarcoidosis**? State the 'buzzword' features of sarcoidosis: (6) What results would be seen on: a) blood tests (3) b) chest xray

Answer 184

**Sarcoidosis:** a granulatomas inflammatory condition that *can* affect the whole body (commonest in *young, black females*) **Features:** • SOB • Dry cough • Erythmema nodosum (nodules on shins) • Mediastinal lymphadenopathy • Fatigue & weightloss **Bloods:** • Raised serum ACE (screening tool) • Hypercalcaemia • Raised CRP **Imaging:** • Chest xray: hilar lymphadenopathy

Question 185

An 8 year old boy is referred with behavioural problems to the child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others. What is the most likely diagnosis?

Answer 185

ADHD

Question 186

List the 3 main features of delirium:

Answer 186

**1) Fluctuating consciousness** ~ hypoactive ~ hyperactive ~ disrupted REM sleep **2) Change in cognition** ~ confusion ~ memory impairment **3) Acute onset**

Question 187

If a UTI is suspected in older, hospitalised patients, what test should be done to confirm the UTI? ~ Explain why this is done

Answer 187

Urine sample should be sent for **analysis** - DO NOT DO URINE DIP Most older people have asymptomatic bacteriurea which will indicate infection on a urine dip so need to send the sample for analysis!

Question 188

What is the gold standard investigation to confirm a diagnosis of **sarcoidosis** & what would this show? What other investigations would you do? (2) What is the treatment of sarcoidosis if: a) patient is asymptomatic b) patient has symptoms

Answer 188

**Biopsy of mediastinal lymph nodes**: non-caseating granulomas with epitheloid cells **Bloods** (raised serum ACE & CRP, hypercalcaemia) + **chest xray** **Treatment:** a) None - commonly self resolves b) 1^st line = **oral steroids** for 6-24m *PLUS* bisphosphonates (to protect their bones) ~ 2^nd line = methotrexate ~ 3^rd line = lung transplant

Question 189

List some symptoms of anorexia (7)

Answer 189

Lanugo hair Cold intolerance Blue hands / feet Amenorrhoea Dry skin Hypotension Weakness / fatigue

Question 190

Regarding sections from the MHA below, state **a)** how long they are valid for, **b)** who is able to use them, **c)** whether they include assessment/ treatment ## Footnote **Emergency detention certificate** **Short-term detention certificate** **Compulsary treatment order**

Answer 190

**Emergency detention certificate:** • Valid for 72h • *_Fully registered_* doctor (FY2 onwards) + consent from a MHO (if *available*) • ONLY detention **Short-term detention certificate:** • Valid for 28d • *_Approved mental health doctor_* (psychiatrist!!) + MHO consent • Detention & treatment **Compulsary treatment order:** • Valid for 6m - but can be renewed! • MHO applies to Tribunal *with* 2 supporting medical reports from a AMP (psychiatrist) & GP (otherwise 2x AMPs) • Detention & treatment

Question 191

What are the aims of **HIV** treatment? What does HIV treatment involve? ~ when is it started?

Answer 191

**Aims of treatment:** • normal CD4 count ​• undetectable viral load **HIV treatment: cART** *Treatment involves a combination of 3 of the below:* ​• Protease inhibitors ​• Integrase inhibitors ​• Nucleoside reverse transcriptase inhibitors (NRTIs) ​• NNRTIs ~ treatment is started as soon as infection is confirmed *regardless* of their CD4/ viral load count!

Question 192

What drug class are **extrapyramidal** side effects associated with? List some common ones: (4)

Answer 192

**_Typical_** **antipsychotics** ​• Akathisia (restlessness) ​• Parkinsonism features (bradykinesia, tremor, rigidity) ​• Dystonia (involuntary muscle twitching) ​• Tardive dyskinesia (involuntary facial movements)

Question 193

What is a subdural haematoma? Damage to which blood vessels cause a subdural haematoma?

Answer 193

A collection of blood between the dura mater and arachnoid mater Tear in the bridging veins between the cortex and dura mater

Question 194

What is the maximum score of a GCS? Explain each point in the GCS: (6 5 4, MOVE) ~ Eyes ~ Verbal response ~ Motor response

Answer 194

15/15 **Motor response:** 6 = Obeys commands 5 = Localised to pain 4 = Normal flexion 3 = Abnormal flexion 2 = Extends 1 = Nothing **Verbal response:** 5 = Orientated 4 = Confused conversation 3 = Inappropriate words 2 = Incomprehensible sounds 1 = Nothing **Eyes:** 4 = Spontaneously opens 3 = Opens to speech 2 = Opens to pain 1 = Nothing

Question 195

**Tuberous Sclerosis** is a genetic condition in which **hamartomas** form throughout the body (benign tumours composed of multiple cell types). What is the mode of **inheritance**? What are the classic triad of features seen in Tuberous Sclerosis? List some skin lesions seen in this condition: (3)

Answer 195

**Autosomal dominant** * Epilepsy * Learning difficulties * Skin lesions * Ash leaf spots * Shagreen patches * Angiofibromas (looks like acne on nose, cheeks, chin)

Question 196

Which electrolyte imbalance is seen in anorexia nervosa?

Answer 196

Hypokalaemia (low K)

Question 197

What is the first presenting symptom of: a) Alzheimers dementia b) Vascular dementia c) Lewy-body dementia d) Fronto-temporal dementia

Answer 197

a) Alzheimers: Loss of recent memory b) Vascular: Step wise decrease in ADL (language affected first) c) Lewy-body: Fluctuating confusion & visual hallucinations (+ parkinsonism symptoms) d) Fronto-temporal: Personality change

Question 198

Name the drug classes used in each of the 3 steps of the WHO pain ladder. Give an example of a drug in each class. Explain how to use the WHO pain ladder. Both weak & strong opioids have the potential to cause addiciton. **T/F?** When moving down the pain ladder, paracetemol should be stopped before NSAIDs. **T/F?**

Answer 198

Step 1: NSAIDs & paracetemol ~ Aspirin, Ibuprofen, Diclofenac Step 2: Mild opioids (codeine/ tramadol) +/- NSAIDs/ paracetemol Step 3: Strong opiods (morphine/ fentanyl) +/- NSAIDs/ paracetemol Start with step 1, if pain not tolerated, add in mild opioid. If not tolerated, swap mild opioid fo strong one with NSAID/ paracetemol still **TRUE** **FALSE** - stop NSAIDs first due to their side effects

Question 199

Define what dementia is:

Answer 199

Dementia is a syndrome (a collection of different symptoms) associated with an progressive decline in brain functioning

Question 200

Explain stress incontinence: What are the treatments of stress incontinence? • Non-pharmacolgical • Pharmacological • Surgical

Answer 200

Stress incontinence occurs when abdominal pressure is increased, eg coughing/ jumping * *Non-pharmacolgical:** physiotherapy (pelvic floor exercises) * *Pharmacological:** oestrogen pessary/ duloxetine (SSRI) * *Surgical**: Colposuspension

Question 201

What is delirium? What is a screening tool for delirium? What is the management of delirium? (5)

Answer 201

An acute confusional state 4AT Non-pharmacological management !!!!! ~ Stop/ treat any precipitating factors (eg medications, infection) ~ Mobilise patient asap ~ Make patient familiar with their surroundings ~ Normalise sleep-wake cycle ~ Discharge from hospital ASAP

Question 202

What is the textbook cause of an extradural haematoma?

Answer 202

Trauma to the head, eg car crash/baseball bat to the head

Question 203

What are the 6 components of sepsis 6? ~ state the order you would do these in (take 3, give 3)

Answer 203

1) Give O2 if sats are below 94% 2) Take blood cultures 3) Give IV antibiotics 4) Fluid challenge (give IV fluids) 5) Measure blood lactate 6) Measure urine output

Question 204

What are common signs of raised ICP? (4)

Answer 204

Headache that is worse in the morning & when bending over/coughing Headache that is relieved by lying down Papillodema Vomiting

Question 205

Cancers within the bone marrow can cause what result on a FBC? Why can this occur?

Answer 205

Pancytopenia Occurs when the cancerous occupy most of the space within the bone marrow - normal blood cells are unable to develop!

Question 206

What condition would the following indicate: A patient presents with a 2 day history of haemoptysis. Blood results show a raised urea & creatinine.

Answer 206

Goodpasture Syndrome (anti-glomerular basement membrane disease) ~ glomerulonephritis (AKI) ~ pulmonary haemorrhage (haemoptysis)

Question 207

Explain what **FEV1** & **FVC** are: **FEV1:FVC \< 75%** indicates what type of respiratory disease? **FEV1:FVC \> 75%** indicates what type of respiratory disease?

Answer 207

**FEV1:** *Forced expiratory volume in 1 second* ~ the amount of air exhaled in1s. ~ it measures how easily air flows **out** of the lungs **FVC:** *Forced vital capacity* ~ the total amount of air that someone can exhale after a full inhilation ~ it measures the lung capacity of the patient FEV1:FVC **\< 75% = obstructive lung disease** ~ FEV1 is reduced whereas FVC may be normal FEV1:FVC **\> 75%** = restrictive lung disease ~ both FEV1 & FVC are reduced so the ratio is normal/ high!

Question 208

Explain *urinary retention with overflow:* • state the commonest cause in males! What are the treatments of overflow incontinence? • Non-pharmacolgical • Pharmacological • Surgical

Answer 208

Stenosed urethra causing blockage of urinary flow • benign prostatic hyperplasia * *Nonpharmacolgical**-: suprapubic catheterisation (last resort) * *Pharmacological**: Alpha blockers *or* anti-androgens * *Surgical**: TURP (trans-urethral resection of prostate)

Question 209

What are the 5 standard things that the anaesthetic machine monitors?

Answer 209

* ECG * SATs * BP * End tidal CO2 * Airway pressure

Question 210

In a centrifuge, what 3 components will blood separate into? Name some cells that will be found in each component.

Answer 210

**_Plasma_** → Clotting factors → Albumin (& other proteins) → Antibodies **_Buffy coat_** → Platelets → WBC's (leucocytes) **_Red blood cells_**

Question 211

What are the 2 core features of OCD? What is the 1st line treatment of OCD? What is the 2nd line treatment? What is the last treatment option if the above 2 don't work?

Answer 211

1) Recurrent, obsessive thoughts 2) Compulsive acts (eg they can't stop themselves from doing something) 1st line: CBT 2nd line: SSRI's (fluoxetine) Psychosurgery

Question 212

What is a pneumothorax? What is the **1^st line** investigation? ~ If a pneumothorax is too small to be seen, what other investigation can be done? What is the management: a) no SOB/ \< 2cm b) SOB / \> 2cm c) unstable patients/ failure of **b)** twice

Answer 212

Air inside the pleural space separates the lung from the chest wall * *Investigations:** 1) **Erect** chest xray 2) CT thorax * *Management:** a) *no treatment* - should self resolve (advise follow up 2 - 4 weeks) b) *aspiration* of air → reassessment c) chest drain

Question 213

What would you expect to see in the blood results of a patient diagnosed with anorexia nervosa in regards to: 1. K levels 2. Cholesterol levels 3. Sex hormone levels (FSH, LH, Oestrogen, Testosterone) 4. GH levels 5. Cortisol levels

Answer 213

1. Hypokalaemia 2. Hypercholesterolaemia 3. Low sex hormones 4. Raised GH 5. Raised cortisol

Question 214

List some common presentations of von Willebrand disease: (5)

Answer 214

→ nose bleeds → menorrhagia → bleeding gums when brushing teeth → prolonged, heavy bleeding during surgery/ trauma → easy bruising

Question 215

What is the management of an acute cluster headache attack?

Answer 215

100% oxygen through a mask

Question 216

What is a type 4 hypersensitivity reaction? Give 2 examples of conditions that are caused by type 4 hypersensitivity reactions:

Answer 216

Delayed hypersensitivity reaction, mediated by T cells **Autoimmune conditions:** Rheumatoid arthritis Type 1 Diabetes

Question 217

List some features of UC: (CLOSEUP)

Answer 217

→ Continuous inflammation → Limited to colon & rectum → Only superficial mucosa affected → Smoking is protective → Excrete blood & mucus → Use aminosalicylates (1st line treatment) → Primary scleorising cholangitis

Question 218

What is the typical presentation of a subdural haematoma? (5)

Answer 218

Older person had a fall days-weeks ago Progressive headache Nausea / vomiting Confusion Reduced GCS

Question 219

What type of dementia is most common in the under 65's age group?

Answer 219

Alcohol related brain damage (ARBD)

Question 220

Refeeding syndrome can occur in people who havent eaten for how many days? What happens to K, phosphate & Mg²⁺ if food is reintroduced too fast to someone with anorexia? What are 3 common symptoms/ signs seen in refeeding syndrome?

Answer 220

**5+ days** Levels fall resulting in depletion of all 3 electrolytes! * Arrhythmia's * Confusion * Death

Question 221

What is the management of **all** personality disorders?

Answer 221

CBT

Question 222

Regarding the triad of anaesthetic medications, state what they are: From the anaesthetic drug classes below, state what part of the triad above they predominantly act upon: a) Opiates b) GA c) LA d) Muscle relaxants

Answer 222

**• Hypnosis • Analgesia • Relaxation** a) Opiates: **analgesia** b) GA: **hyponosis** c) LA: **analgesia** d) Muscle relaxants: **relaxation**