Year 6 General Flashcards
Pass Year 6 (118 cards)
1
Q
Spironolactone, goserelin, finasteride, and digoxin can all have what side effect in men?
A
Gynaecomastia
2
Q
What is the best differentiator in identifying seizures v syncope?
A
Recovery time
Seizures have a significantly longer post-ictal phase, particularly when syncopal patient lies flat
3
Q
Symptoms of dyskinesia, such as dystonia (abnormal postures/exaggerated movements), chorea (abnormal involuntary jerking), or athatosis (involuntary writhing/twisting), caused by dopaminergic drugs in PD can be managed by ______?
A
Memantine
4
Q
What common medications can prolong the QT interval?
A
- Antipsychotics, e.g. haloperidol, quetiapine, olanzapine, risperidone
- Amiodarone
- Amitriptyline
- Citalopram
- Ondansetron
- Clarithromycin and erythromycin
5
Q
What ECG changes can be seen in hyperkalaemia?
A
- Tall tented T waves (commonly first sign)
- P wave flattening with PR prolongation
- Bradycardia
- QRS widening with bizarre morphology
- Conduction blocks
When K+>9.0
- Sine wave appearance
- VF
- Asystole
6
Q
What are some of the benefits of SGLT-2i therapy?
A
Reduced blood glucose
Weight loss
Reduced blood volume, reducing hypertension and cardiac preload in heart failure
7
Q
What are the symptoms associated with symptomatic aortic stenosis?
A
- Breathlessness
- Dizziness
- Chest pain
- Sx of heart failure
- Loud murmur*
If severe:
- *Murmur can be paradoxically quiet
- Narrow pulse pressure
- Loss of peripheral pulses
- Syncope**
**Cardiologist concern due to increased risk of death
8
Q
How long does it take for the POP to become effective contraception?
A
2 days
(Immediately if taken between day 1-5 of the cycle after a period.)
9
Q
What is the most common cause of primary hyperparathyroidism?
A
Solitary adenoma (85%)
10
Q
What are the symptoms of haemochromatosis?
A
- Weakness and fatigue
- Arthropathy
- Skin hyperpigmentation
- Impotence in males, amenorrhoea
Associated diabetes
Abnormal LFTs, liver cirrhosis
11
Q
What respiratory conditions are NOT associated with finger clubbing?
A
COPD
Asthma
Small cell lung cancer
12
Q
What are common causes of hyperkalaemia?
A
Too much in - excess K+ supplements or K+ in diet, particularly in CKD, plasmalyte
Not enough out - AKI caused by medications such as ACE inhibitors or ARBs, dehydration, or interstitial nephritis - most commonly penicillins, NSAIDs and PPIs.
In the wrong place - acidosis
Also:
Rhabdomyolysis
Addisons disease
Beta-blockers
Spironolactone
13
Q
Patients with kidney injury and markedly elevated creatinine can have uraemia. What two conditions can this cause which are indicators for dialysis in this instance?
A
Pericarditis and encephalopathy.
Patients with a severe AKI and new confusion/drowsiness or pericardial rub should raise concerns for uraemia requiring dialysis.
14
Q
What is the interaction between amlodipine and clarithromycin?
A
Clarithromycin impairs the metabolism of amlodipine, increasing its concentration
15
Q
Why is ileocaecal resection a risk factor for gallstones?
A
Reduced bile salt reabsorption -> gallstone formation
16
Q
After a 10-week ‘watch and wait’ period following an ADHD diagnosis, if an assessment has been made by a paediatrician and symptoms are severe or failing to respond to patient education programmes, what is the first line treatment for children over 5 years? What are some of the side effects of this medication?
A
Methylphenidate (Ritalin)
This is a controlled drug.
Side effects:
- Stunted growth and poor weight gain (due to reduced appetite). Height and weight should be monitored every 6 months
- Headaches
- Abdominal pain, nausea, and dyspepsia
Can also cause palpitations. A baseline ECG is important, and methylphenidate can cause a slight increase in BP.
17
Q
What are the symptoms of optic neuritis?
A
- Unilateral reduced vision
- Central scotoma
- Pain on eye movement
- Reduced colour vision
- Relative afferent pupillary defect
18
Q
Why should beta-blockers and verapamil not be concurrently prescribed?
A
Risk of bradycardia, asystole, and severe hypotension
19
Q
What are some examples of acute phase reactants?
A
Increasing in inflammation:
- Ferritin
- CRP
Decreasing in inflammation:
- Albumin
- Transferrin
20
Q
Which contraceptives take 7 days to become effective (and therefore barrier protection should still be used in the meantime)?
A
- COCP
- Mirena IUS
- Depo-Provera injection
- Nexplanon implant
(IUD is effective immediately, and the POP is effective within 2 days)
21
Q
What should be done if a patient due for an endoscopy on a 2-week wait urgent referral is taking a PPI?
A
The PPI should be stopped 2 weeks prior to the endoscopy
22
Q
What are the first and second line treatments of candidiasis?
A
First line - oral fluconazole single dose
Second line - clotrimazole pessary
Topical pessary is the only treatment indicated in pregnancy
23
Q
What are the two non-shockable rhythms and how should they be managed?
A
- Asystole (NOthing)
- Pulseless electrical activity/PEA (NOrmal)
Initial treatment is 1ml of 1:1000 IV adrenaline
24
Q
What are the necessary steps to take when a patient with no history presents to clinic with a BP of over 140/90 and less than 180/120?
A
Repeat BP
If BP still raised after third measurement:
- Offer ABPM over 2 weeks and arrange appt
- Investigate for end organ damage (ECG, U&Es, fundoscopy, HbA1c, urine:albumin & haematuria)
- Assess CV risk (QRisk score, cholesterol)
25
What is the scoring for the motor component of GCS?
6 - Obeys commands
5 - Moves to localised pain
4 - Flexion withdrawal from pain
3 - Abnormal flexion to pain (decorticate)
2 - Abnormal extension to pain (decerebrate)
1 - None
26
A patient is due to have surgery in 3 months time. What is the correct advice regarding taking her COCP?
The COCP (and HRT) should be stopped 4 weeks prior to scheduled surgery
27
How should avascular necrosis of the femoral head be investigated?
MRI
28
What antibiotic is given first-line prophylactically to patient with ascites to prevent spontaneous bacterial peritonitis (SBP), and what is the biochemical result that indicates prophylaxis?
Ciprofloxacin PO
Ascites with protein <15g/l from tap
29
What are some side effects of anticholinergic medication?
Dizziness, drowsiness and confusion
Dry mouth
Decreased sweating, feeling hot
Blurred vision
Urinary retention
Tachycardia
Constipation
Note: there is also an increased risk of falls requiring hospitalisation and an association with dementia
30
What is the most useful diagnostic biochemical marker for alcoholic ketoacidosis?
Raised anion gap
This is due to the ketosis. pH can be normal due to vomiting causing a concurrent metabolic alkalosis.
31
What prophylactic medication should be started in patients with a new diagnosis of nephrotic syndrome?
Dalteparin/enoxaparin
This is important for VTE prophylaxis. However, LMWH is used rather than commonly used DOACs such as apixaban due to DOACs relying on serum proteins which will be reduced in patients with nephrotic syndrome, making them less effective
32
What are the four common topical steroids to know in order of potency?
Mild - hydrocortisone
Moderate - eumovate
Potent - betnovate
Ultrapotent - dermovate
33
What is the NICE CKS guidance for co-prescribing allopurinol with an ACE inhibitor?
Establish baseline white cell count and then monitor every 2 weeks for 3 months and periodically thereafter.
There is an increased risk of severe hypersensitivity reactions (such as SJS), particularly in the elderly and those with renal impairment.
34
T wave inversion and prominent U waves are associated with what electrolyte disturbance?
Hypokalaemia
35
Superior quadrantanopias are caused by a lesion in what lobe?
Temporal lobe
Superior quandrantanopias are caused by an inferior lesion, i.e. the temporal lobe, not the parietal lobe.
Many quandrantanopias, however, are actually caused by occipital lesions.
36
Acute liver failure, which has an onset over days or weeks, is characterised by what triad of symptoms?
Jaundice, encephalopathy, and coagulopathy
37
Pancreatitis is a recognised side effect of what diabetic medication?
GLP-1 mimetics (i.e. semaglutide)
38
What investigation is required urgently in a patient presenting with their right eye fixed inferiorly and laterally, with ptosis and a fixed dilated pupil unresponsive to light?
CT head
This patient has a third nerve palsy with a fixed dilated pupil indicating a surgical cause of the palsy; this is because there must be some kind of mass - for example a tumour or a bleed - pressing on the nerve to cause the dilation.
39
What medications can cause drug-induced Parkinsonism?
Haloperidol and other anti-psychotics including quetiapine and olanzapine
Antiemetics such as metoclopramide and chlorpromazine
Amiodarone
40
What is the drug of choice for cluster headache prophylaxis?
Verapamil
41
What are some classic symptoms of Parkinson’s disease?
Gradual onset of this classic triad:
Resting slow, asymmetrical tremor
Rigidity - resistance to passive movement, cogwheeling
Bradykinesia - slow movement including a mask like face, slow blinking, smaller handwriting, and shuffling gait
They can also have features including depression, anosmia, sleep disturbance, and GI issues
42
What is the mainstay treatment for acute pancreatitis?
Fluids and analgesia
Antibiotics are not routinely offered
43
What contributing factors should be considered when considering why a patient has had a fall?
From head to toe:
Cognitive impairment e.g. dementia
Parkinson’s disease
Vertigo
Leaning backwards when mobilising due to fear of falling
Poor eyesight
Alcohol intake
Postural hypotension
Improper walking aids
Incontinence causing hurrying
Age-related sarcopenia
Peripheral neuropathy
Improper footwear
Home factors such as layout, trip hazards, bathtubs, and stairs
44
What are UMN signs?
- Hypertonia
- Hyperreflexia
- Spastic paralysis
- Decreased power
- Extensor plantar response (Babinski sign)
- Clonus
- No fasciculations
45
What are the features of a Parkinsonian tremor?
Pill-rolling
4-6Hz (slow)
Asymmetrical
Worse on rest or distracted
Improves with intentional movement
No change with alcohol
These features help to distinguish a PD tremor from a benign essential tremor, which is symmetrical, faster, worse on intentional movement, and improves with alcohol.
46
Hypotension, bulging neck veins, and muffled heart sounds in a patient with suspected acute pericarditis are indicative of what?
Cardiac tamponade
These symptoms are known collectively as Beck's triad.
47
What immediate action is required if a neck surgery patient has post-operative stridor?
Remove sutures
This presentation is associated most likely with a post-operative bleed. The haematoma compresses the airway causing the stridor and the pressure should be relieved to prevent airway compromise. The patient will also need to return to theatre.
48
What is the age cutoff for when patients should aim for a BP of 150/90 (145/85 at home) in their hypertension management?
80 years old
49
What are the symptoms of vitamin B12 deficiency neuropathy?
B12 deficiency can cause **subacute combined degeneration of the spinal cord**. Symptoms include:
- Symmetrical, distal neuropathic pain or sensory loss
- UMN symptoms - weakness, hyperreflexia, hypertonia, spastic paralysis
- Ataxia with a positive Romberg sign
(These symptoms tend to present in lower limbs first)
50
What can cause acute liver failure?
- Most commonly paracetamol overdose in the UK.
- Also hepatitis A and B, autoimmune hepatitis, and acute fatty liver of pregnancy.
Internationally, viral infections such as hepatitis B and E are the most common causes.
51
If a patient is found on CXR to have an asymptomatic pneumothorax, what is the correct management?
Asymptomatic pneumothoraces can be treated conservatively.
If primary:
Discharge with outpatient review every 2-4 days
If secondary*:
Monitor as inpatient
*Patient with underlying precipitating lung disease, e.g. COPD, malignancy, ILD, TB
52
What medications can cause drug-induce cholestasis?
- COCP
- Abx e.g. co-amoxiclav, flucloxacillin, and erythromycin
- Chlorpromazine and prochlorperazine
- Sulfonylureas
53
Parkinson’s disease is a progressive condition caused by gradual decrease in dopamine in ______?
The basal ganglia
54
What level does serum albumin have to be in a patient to permit colorectal surgeons to proceed with an anastomosis as opposed to a stoma, and why?
Serum albumin >30
This is to reduce the risk of anastomotic leak (1 in 20) by promoting wound healing.
55
What are the symptoms and complications of long QT syndrome?
Often asymptomatic, but the most common symptom is syncope.
Long QT can cause torsades des pointes, VF, and is a cause of sudden cardiac death.
56
In a smoker with a pleural effusion, what is the value of the protein level you would expect if it was caused by malignancy? Would the glucose be low, normal, or high in this scenario?
Malignancy is associated with an exudative pleural effusion:
Protein >30g/l
Glucose: low
57
What are the two most accurate biomarkers for synthetic liver function?
Albumin and prothrombin time
A raised PT time and low albumin level indicate reduced protein production in the liver
58
ST elevation in leads II, III and aVF are indicative of an occlusion most likely in which coronary artery?
Right coronary artery (inferior MI)
59
Vitamin B12 is absorbed in the terminal ileum after having been combined with intrinsic factor in the stomach. What are some causes of B12 deficiency?
Pernicious anaemia (autoimmune intrinsic factor deficiency)
Coeliac disease
Diet (particularly vegan diets)
Crohn’s disease
Gastric or intestinal surgery
Medications such as PPIs and metformin
60
What is required to make a diagnosis of IBS?
1. Symptoms of abdominal discomfort related to the bowel dysfunction; the discomfort may be alleviated by defecation, and include urgency and incomplete emptying.
2. Assess for red flag symptoms - rectal bleeding, weight loss, and >55 years - indicating more sinister pathology requiring investigation
3. Faecal calprotectin and anti-TTG to rule out IBD or Coeliac disease
61
What is the most useful blood test to order to diagnose haemochromatosis?
Serum transferrin (elevated)
Serum ferritin will also likely be raised, but this is not diagnostic in itself as ferritin is an acute phase reactant, increasing in inflammation
62
What ECG changes are associated with pericarditis?
- Widespread saddle-shaped (concave) ST elevation in limb leads (I, II, III, aVL, aVF) with PR depression
- Reciprocal ST depression and PR elevation in aVR
- Sinus tachycardia common due to pain or effusion
63
Statins should be withheld if possible when patients are on what medications to decrease the risk of rhabdomyolysis?
- Antifungals (such as fluconazole, ketoconazole)
- Calcium channel blockers (such as verapamil, diltiazem, and amiodarone)
- Ciclosporin
- Clarithromycin and erythromycin (withholding statins to be considered if short course)
- Fusidic acid
- HIV protease inhibitors (such as atazanivir, lopinavir, and darunavir)
64
Why should plasmalyte be avoided in hyperkalaemic patients?
Plasmalyte contains K+
65
How is an AKI clinically diagnosed?
Either:
Increase in creatinine by >26 in the past 48 hours
Increase in creatinine by >1.5x baseline (determined clinically) within the past 7 days
Urine output <0.5ml/kg/hr for more than 6 hours
66
ST elevation in leads V1-V4 are indicative of an occlusion in which coronary artery?
Left anterior descending artery (anterior MI)
67
When is 500mcg IV atropine required in a bradycardic patient?
If they have:
- Signs of shock (hypotension, pallor, sweating, cold peripheries, confusion...)
- Syncope
- Heart failure
- MI
68
What respiratory conditions are associated with finger clubbing?
- ILD
- Bronchiectasis
- Non-small cell lung cancer (i.e. squamous cell cancer)
Finger clubbing can also be present in IBD, congestive heart failure, endocarditis, and liver cirrhosis
69
If a patient with Parkinsons disease has had a stroke and their swallow is unsafe, how should their medications be administered?
Rotigotine patch
70
When is a V/Q scan used instead of a CTPA when investigating a potential PE?
In renal impairment
71
What is a way to ascertain clinically whether a patient has coarse (secretory) or fine (fibrotic) crackles on chest auscultation?
Ask the patient to cough. If the crackles clear or change, the patient likely has secretory crackles associated with infection. Otherwise, the patient likely has the fine crackles associated with conditions such as pulmonary fibrosis.
72
What investigations are done to help diagnose myasthenia gravis?
ACh receptor antibodies
Muscle-specific tyrosine kinase antibodies
73
Crypt abscesses are seen in which type of IBD?
Ulcerative colitis
74
What is the target blood glucose for an inpatient?
6-11
There is an increased risk of hypos when hospitalised, so clinicians avoid low
75
How is long QT treated?
Stopping medications causing prolonged QT
Correct electrolyte disturbances
Beta blockers (not sotalol)
Pacemaker or implantable cardioverter defibrillator
76
What are some examples of anticholinergic medication?
Antimuscarinics, antipsychotics, antihistamines, antidepressants, antiemetics, and antidiarrhoeals:
Scoring high risk for anticholinergic burden (3 pts):
Solifenacin, oxybutynin, tolterodine, amitriptyline, chlorpromazine, promethazine
2pts:
Baclofen, cetirizine/loratadine, clozapine, olanzapine, loperamide, prochlorperazine
1pt:
Metoclopramide, mirtazapine, quetiapine, risperidone, paroxetine, tramadol, sertraline
Note: In frail patients with a high anticholinergic burden, domperidone can be used for nausea, and mirabegron for incontinence
77
What can cause long QT?
Congenital long QT (genetic FHx)
Acquired long QT
- Electrolyte imbalance (low Ca, Mg, K)
- Hypothermia
- Medications (antipsychotics, flecainide, amiodarone, amitriptyline, citalopram, venlafaxine, antihistamines, macrolides i.e. erythromycin and clarithromycin)
78
What are the two most common causes of hypercalcaemia?
- Primary hyperparathyroidism (most common) which directly drives osteoclast bone activity, reabsorption in the kidneys, and absorption in the gut
- Malignancy (such as PTHrP secretion and osteolytic activity)
Other causes include thiazide diuretics, vitamin D supplements, familial hypocalciuric hypercalcaemia, primary adrenal insufficiency, sarcoidosis, and TB
79
What are four absolute contraindications for the use of triptans, the first-line treatment for migraines?
- Cardiovascular disease (including ishcaemic heart disease, HTN, previous MI, arrythmias, and peripheral vascular disease)
- Cerebrovascular disease (including previous stroke, TIA, and haemorrhage)
- Severe hepatic impairment
- Taking MAOI medication (used in depression)
80
A patient presenting with a swollen, painful, and erythematous L knee has their synovial fluid aspirated. The aspirate contains no crystals and the culture is negative, but with a high white cell count. What is the patient likely to have had several weeks prior to this?
Gastroenteritis or an STI.
This scenario is consistent with reactive arthritis, an HLA-B27 positive condition, with joint inflammation seen a number of weeks after an infection, commonly dysenteric (shigella, salmonella, campylobacter) or chlamydia.
81
What are the two key contraindications for statin use?
- Hepatic impairment, including unexplained persistent markedly raised AST or ALT
- Pregnancy and breastfeeding, including women of childbearing potential who are not using contraception
Rhabdomyolysis and myalgia whilst using statins are also contraindications to stop.
82
What are 5 differentials for a chronic cough other than COPD?
- Post viral cough (inflammation)
- GORD
- Post nasal drip (chronic rhinitis)
- Asthma
- ACE inhibitors
83
What are two of the common side effects of SGLT-2 inhibitors, and what is the serious condition uncommonly associated with their use that patients need to be counselled about?
Common side effects:
UTIs
Dehydration
Serious condition:
Perineal necrotising fasciitis (Fournier's gangrene)
SGLT-2 inhibitors work by preventing the reabsorption of glucose in the kidneys, increasing glucose excretion and diuresis. This increased glucose excretion increases the risk of UTIs in patients.
84
What are some of the features of Addisons disease (primary adrenal insufficiency)?
General malaise and fatigue (also nausea, muscle cramps, and bowel changes)
Hyperkalaemia (due to reduced aldosterone)
Hypotension (due to reduced cortisol)
Hyperpigmentation
Salt cravings
Associated T1DM or hypothyroidism
85
Neonatal sepsis affects approximately 5 in 1000 live births. What are some of the key risk factors for this condition?
- Prematurity (85%)
- Low birth weight (80%)
- Prolonged rupture of the membranes
- Maternal GBS colonisation on prenatal screening, or previous baby with GBS infection
- Evidence of maternal chorioamnionitis
86
Due to inducing the P450 enzyme system, which medications and lifestyle habits can reduce the efficacy of the COCP, leading to increased risk of unplanned pregnancy?
Medications:
- Antiepileptics e.g. phenytoin, carbamazepine
- Rifampicin
Lifestyle:
- Chronic alcohol intake
- Smoking
87
How is alcoholic ketoacidosis treated?
IV thiamine and IV saline + dextrose
88
In an acute asthma attack, prednisolone should be administered by which route and for what duration?
Orally (40-50mg daily for 5 days or until recovery)
89
Apixaban is commonly prescribed as 5mg BD. Two of what three criterion have to be met in order to reduce this dose to 2.5mg BD?
Two of:
Weight under 60kg
Creatinine over 110
Age over 80 yrs
90
What test is used to diagnose Addison's disease?
Short synacthen test
If synacthen (an ACTH analogue) fails to induce cortisol production in the adrenal glands, then the low cortisol is caused by a primary problem with the glands themselves, not with the pituitary.
91
True or false:
Codeine is a predictably effective opiate that is less likely to cause delirium than oramorph or oxycodone.
False.
Codeine is metabolised by the liver into morphine differently by different people and therefore dosing does not have a reliable correlation with blood morphine concentration. Some patients, therefore, will experience little to no effect at the same dose that others will become delirious. As a result, it is best to start with low doses, particularly in the elderly.
92
What is the best investigation for small bowel overgrowth?
Hydrogen breath test
This involves drinking a glucose drink after fasting for 12 hours, having stopped smoking the week before and not been on antibiotics or probiotics for a month. A result is positive for SIBO if the result is greater than 20ppm within 90 minutes.
93
What are five indications for use of IV total parenteral nutrition (TPN)?
- Bypassing the gut in prolonged/chronic **bowel obstruction**
- Bowel rest in high-output gastrointestinal **fistulas**
- **Malabsorption in small bowel syndrome** post-surgery
- Where enteral feeding is not meeting **nutritional requirements**
- **Anastomotic breakdown**
94
Why is a swallow screen so important in a patient post-stroke?
To assess swallow risk and determine whether patient should be nil by mouth for their drug and dietary management, as well as to avoid risk of aspiration and malnutrition
95
What does a patient need to be counselled about when starting methotrexate therapy, what needs to be co-prescribed, and how does the patient get monitored?
Counselling
- Both men and women should use contraceptives and stop therapy 6 months prior to getting pregnant
- Long term therapy can cause penumonitis, ILD, mucositis, and liver fibrosis
Co-prescription
- Folate (reduced risk of myelosuppression)
Monitoring
- FBC, U&Es, LFTs monitored weekly until therapy stabilised, and then every 2-3 months
96
A creatinine increase by up to what percentage is acceptable when starting an ACE inhibitor for hypertension?
30%
97
What are the time cutoffs where thrombolysis, thrombectomy, and aspirin 300mg/PPI treatment are indicated an ischaemic stroke?
Thrombolysis (alteplase) - within 4.5hrs of onset
Thrombectomy - within 6 hours of onset
Otherwise aspirin 300mg/PPI
98
What are four cautions to be aware of when initiating treatment with quinolone antibiotics (ciprofloxacin)?
- Avoid in pregnancy & breastfeeding
- Avoid in G6PD deficiency
- Use in caution in epilepsy as it reduces seizure threshold
- Lengthens QT interval
99
Bilateral symptoms is a feature of what type of parkinsonism?
Drug-induced parkinsonism
(Most commonly antipsychotics, also metoclopramide and prochlorperazine)
100
What is given first line for secondary prevention after a patient has a stroke?
Clopidogrel
101
Memory problems, gait abnormalities, and urinary incontinence is the classic triad for what condition?
Normal pressure hydrocephalus
102
What antibiotics are prescribed for a child with scarlet fever, and when can they return to school?
Phenoxymethylpenicillin
24 hours after starting antibiotics
103
What is the risk of co-prescribing allopurinol and azathioprine and how should this be managed?
Myelosuppression
Patients should be counselled about spotting signs of myelosuppression (easy bruising and bleeding, fever); FBC should be monitored and azathioprine reduced to 1/4 dose. This is because allopurinol inhibits metabolism of azathioprine, prolonging its effect.
104
What feature on an ECG is absent in AF?
p waves
105
Osteoporosis, AF, anxiety, and gritty eyes with diplopia can all be complications and symptoms of what underlying condition?
Hyperthyroidism
Other symptoms include palpitations, goitre, sweating, unexplained weight loss, and menstrual changes
106
What is the BP cutoff to make a hypertension diagnosis both in clinic and with ambulatory blood pressure monitoring (ABPM)?
Clinic - 140/90
ABPM - 135/85
NICE CKS guidelines advise using clinical judgement in frail patients.
107
What is the scoring for the eye opening component of GCS?
4 - Spontaneous
3 - To speech
2 - To pain
1 - None
108
What medications are given pre-endoscopy in a patient with suspected oesophageal variceal haemorrhage?
Terlipressin and ceftriaxone
109
How is guttate psoriasis managed?
Conservatively with emollients only with reassurance that this will go away by itself
110
Why do doctors ask patients with a chest drain to cough when assessing them?
If their drain bubbles, it means the lung breach is still open and the lung will collapse again if the drain is removed.
111
What is the scoring for the verbal component of GCS?
5 - Oriented
4 - Confused
3 - Inappropriate words
2 - Sounds
1 - None
112
What is the appropriate prophylaxis for migraines in women of childbearing potential?
Propanolol
113
What is the immediate medical management in torsades de pointes?
IV magnesium
114
How does a posterior MI present on an ECG?
ST depression in anterior leads (V1-V3)
115
What are LMN signs?
- Hypotonia
- Hyporeflexia
- Flaccid paralysis
- Decreased power
- Fasciculations present
- Muscle wasting
116
ST elevation in leads I and aVL are indicative of an occlusion in which coronary artery?
Left circumflex artery (lateral MI)
117
What is Beck's triad, and what condition is it associated with?
- Hypotension
- Muffled heart sounds
- Bulging neck veins
118
When is an SGLT2 inhibitor indicated as appropriate in the management of CKD?
In patients with a urine albumin:creatinine ratio of >30, regardless of their diabetic status
