What drugs are used in Migraine Prophylaxis?
Propranolol is used as prophylaxis, as is atenolol. Amitriptyline has been shown to be effective in some patients and is useful in co-morbid depression. Pizotifen is used in migraines as prophylaxis. Diclofenac may be used as acute treatment, but not prophylaxis. Rizatriptan and other triptans are used only in acute attacks.
How do you differentiate between viral meningitis and encephalitis?
The crucial difference between viral meningitis and viral encephalitis is that impairment of brain function which should be completely absent in viral meningitis.
Does LMWH cross the placenta and are they safe in breastfeeding?
LMWHs do not cross the placenta and is not orally active so is safe in breastfeeding mothers
How do you reverse LMWH and unfractionated heparin
Although anticoagulation with unfractionated heparin can be reversed by protamine sulphate, there is no way of reversing LMWH.
What are the most common causes of osteolytic and osteoblastic bone metastases?
The most common causes of osteolytic bone metastases in an adult include lung, breast, thyroid, kidney and colon cancer. The most common causes of osteoblastic metastases in an adult include prostate (male) and breast (female).
HBV is chronic when present for how long?
Which wrist # is also known as a dinner fork deformity and where is the distal fragement displaced too?
Colle's # with dorsal displacement. As opposed to Smith's # which has a palmar displacement.
A FOOSH will most commonly cause what type of wrist #.
What will cause the other type of wrist #
Falling onto a flexed wrist
Childhood Vaccine Schedule?
2 months – DPT/polio/Hib + pneumococcal conjugate vaccine (PCV)
3 months – DPT/polio/Hib + MenC
4 months – DPT/polio/Hib + MenC + pneumococcal conjugate vaccine (PCV)
12 months – Hib/MenC
13 months – MMR + pneumococcal conjugate vaccine (PCV)
3-5 years (pre- school) – MMR II/ DTP / Polio
13-18 years (school leavers) – Diptheria/ Tetanus/ Polio (not Pertussis)
Barrett's Oesophagus is a risk factor for which type of cancer
Tell me about NNH and Maternal HSV
NNH is rare but when it occurs it has a high neonatal mortality rate and requires immediate treatment. The risk of NNH is highest if the mother acquires HSV for the first time during pregnancy, this is because she may not have had opportunity to develop maternal HSV antibodies that can cross the placenta and confer immunity to the baby before he or she is born. In the 1st and 2nd trimester, recurrences should be managed as they are in non-pregnant patients. Aciclovir is not licensed in pregnancy but there is substantial clinical experience supporting its safety. HSV outbreaks in the 3rd trimester are potentially more concerning, as there is a high risk of viral shedding during labour. Recurrences during the 3rd trimester should be managed as per non-pregnant patients and continuous aciclovir can be considered in the last 4 weeks of pregnancy to reduce the risk of clinical recurrence at term, subsequent risk of neonatal transmission and the need for caesarean section. However, if there is a high suspicion of primary HSV infection in the 3rd trimester then caesarean section should be considered to minimise the risk of neonatal transmission.These cases should be discussed with the obstetric/paediatric team.
Is there a hep A vaccine?
Hepatitis A vaccine can be given up to 14 days after exposure providing exposure was within the infectious period of the source case (i.e. during prodromal illness or first week of jaundice). Human normal immunoglobulin (HNIG) intra-muscularly (IM) can be considered for patients at higher risk of complications: concurrent hepatitis B or C, chronic liver disease or age over 50 years. It is most effective if given in the first few days after first contact, with an efficacy of 90%. It is unlikely to give any protection more than 2 weeks after first exposure but may reduce severity if given up to 28 days after exposure.
What is the Stamford Classification?
According to this classification, what is the difference between a Type A and B?
Classification of Aortic Dissections
Type A is ascending and more severe
Type B is descending and less severe
What is the Child-Pugh Score?
The Child-Pugh score is often used to assess the clinical state of patients with cirrhosis of the liver and to indicate the severity of the condition.
What are the radiographic changes associated with bronchiectasis?
Thickened bronchial walls
Ring shadows (thickened airways seen end-on)
Volume loss secondary to mucous plugging
Air-fluid levels may be visible within dilated bronchi
Causes off bronchiectasis?
Congenital/Hereditary: Cystic fibrosis, Ciliary dyskinesia, Marfan’s syndrome, alpha1-antitrypsin deficiency
Post infection: Pneumonia, measles, tuberculosis
Obstruction: Tumour, nodes, foreign body
Allergy: Allergic bronchopulmonary aspergillosis
Pulmonary fibrosis: Not usually visible on chest X ray but is seen on high resolution CT scanning with bronchiectasis in areas of fibrosis
Immunodeficiency states: eg AIDS – usually as a result of recurrent infection
Miscellaneous: Rheumatoid-arthritis-associated lung disease, Sarcoidosis, Bronchiolitis obliterans
what is the drug of choice for penicillin-allergic patients with uncomplicated community-acquired pneumonia?
Is Gentamicin good against aerobic or anaerobic bacteria?
Gentamicin is inactive against anaerobes (and Streptococcus pneumoniae).
How do you identify between Large and Small Bowel Obstruction?
Small bowels will have mucosal folds spanning the width of the bowel known as valvulae conniventes. Large Bowel will have mucosal folds that do not span the entire width of the bowel known as Haustra.
What do the antibodies ASMA and AMA stand for and what diseases are they found in?
Anti-smooth muscle antibodies and antimitochondrial antibodies are typical of autoimmune hepatitis and primary biliary cirrhosis respectively
What antibiotic is used to treat Giardia lamblia
What are the ECG changes associated with LV hypertrophy?
ECG changes showing LV hypertrophy include:
Prolonged QRS (broad)
Tall R wave (>5 squares)
Left axis deviation
Inverted T waves in V5/ V6 (if severe).
How do post-MI left ventricular aneurysms present?
ST elevation on ECG, pain and arrhythmias, although they may rupture with shock and rapid demise.
Do you know about Scleroderma
Yes or No
Treatment of Gout in pts. who have contraindications to NSAIDS.
Colchicine is an alternative to NSAIDS for acute attacks (can cause diarrhoea and vomiting). Allopurinol is used long-term to reduce serum urate but is not used acutely as it may precipitate gouty attacks.
What factors can precipitate a Gout attack?
Recent chest infection
Can you get post-exposure prophylaxis for HIV and Hep C?
Hep C no
Side effects of Tricyclic Antidepressants
Common side effects include:
Dry mouth, Sedation, Blurred vision, Constipation, Postural hypotension
Rare side effects include:
Urinary retention, Convulsions, Cardiac dysrhythmias, Weight gain, Precipitation of glaucoma, Hyponatremia, Hepatic impairment
How do you fill out centiles on a paeds growth chart
If the plotted point is within ¼ of the distance of the bandwidth to a centile (or ¼ of a bandwidth away from a centile) then we class the child as being on that centile
If a plotted point is more than ¼ bandwidth away
from a centile, we describe the child as being
between those two centiles
What drug must be avoided when a patient is on verapamil, and why?
Beta-blockers due to risk of bradycardia
What will happen to the K+ and Na+ levels in Addison's disease and why?
Hyperkalaemia and Hyponatraemia as aldosterone will be low. Aldosterone is responsible for Na+ reabsorption at the expense of K+ secretion. Without aldosterone, this cannot happen.
X-ray findings in Osteoarthritis?
L: loss of joint space
S: subchondral cysts
S: subchondral sclerosis
Which nerve causes foot drop?
Which nerve causes an inability of plantarflexion?
common peroneal nerve lesion will cause foot drop commonly following a fibular neck fracture
Tibial nerve lesion will prevent plantarflexion and inversion of the foot
Classify bacteria according to gram staining and shape?
Gram-positive cocci = staphylococci + streptococci (including enterococci)
Gram-negative cocci = Neisseria (meningitidis + gonorrhoeae) and Moraxella catarrhalis
Gram-positive rods (bacilli) = ABCD L
Bacillus anthracis (anthrax)
Diphtheria: Corynebacterium diphtheriae
Remaining organisms are Gram-negative rods, e.g.:
What constitutes a confusion screen?
Bloods: FBC U&E LFT TFT Ferritin B12 Ca2+ (bone screen) Glucose
X-ray: CxR Ct head
Reversible causes of dementia?
Brain: SDH, Normal pressure hydrocephalus
Metabolic: Hypothyroid, B12 deficiency, Hypercalcaemia
Name 4 dementia medications.
Donepezil, Galantamine, Memantine
What is the triad of Normal Pressure Hydrocephalus?
What is the treatment?
Gait Disturbance (Magnetic Gait)
Treatment: Ventriculoperitoneal Shunt:
What is pick's dementia also known as?
Sedative Medication for delirium?
Haloperidol 0.5mg IM
AMT Exam components?
Count back 20-1
Most important causes of falls?
Cardiogenic (HOCM, Arrhythmia, AS, MI, PE)
Neurogenic (Seizure, CVA, Hydrocephalus)
Vasogenic (Vasovagal, Carotid sinus, Micturation)
Postural Drop (Lying Standing BP)
Dexa Scan Cut Off scores?
-1 to -2.5 osteopenia
Oxford Bamford Classification?
ABCD2 Criteria for TIA
Investigation for MS
MRI brain + spinal cord
Optic Disc Cupping is associated with which disease
Acute open-angle glaucoma
1st Line treatment for Spasticity
Describe Brown Sequard Syndrome
What 3 conditions are Myaesthenia Gravis associated with
Thymoma or other thymus diseases.
Causes of Myopathies
Metabolic (Cushing's or Hyperthyroid)
Which organism is most associated with GBS?
Urinary Retention Treatment
Catheter followed by IV fluid and electrolyte check
TWOK when BO or more mobile
If TWOK fails then insert long term catheter and referral to TWOK clinic.
Red Flag questions for a headache
Meningitis: Neck, Fever, Vomiting, Photophobia
Raised ICP: Worse in the morning or straining, visual disturbance, vomiting
GCA: Jaw claudication and Scalp Tenderness
Positive and Negative Symptoms of Schizophrenia?
Which AED is safest in pregnancy?
Which AEDs can be used in breastfeeding?
All of them
4 Types of Tremor
Action / Postural (BEATS)
Intention (Cerebellar Pathology)
Dystonic (MS, Stroke)
Causes of Active (Postural) Tremor?
Benign essential tremor
Toxin: salbutamol, caffeine
Stress / Anxiety
Levodopa + Carbidopa
Benign Essential Tremor?
Worse on Action
Better with Etoh
Treat with propranolol
A Confined to the mucosa
B Confined to muscularis propria (full thickness = 2)
C Spread to lymph nodes (<4=1)
D Distant Mets
2 most important translocations in Blood Cancers
t(9:22) = Philadelphia
t(5:17) = APML
What staging is used in lymphoma?
How does it work?
What medication can be used prophylactically and for treatment for tumour lysis syndrome?
What cancer is associated with PTH related peptide
Squamous Cell Carcinoma
After IV fluids what else can you give for malignant hypercalcaemia
IV alendronate followed by IV furosemide
How long after DRE can PSA be checked
Which tumour is asscociated with Left varicocele?
Renal cell carcinoma or testicular cancer
Hormonal Treatment for breast ca.?
Pre Menompausal: Tamoxifen
Post Menopausal: Anastrazole
HER2 +ve: Transtuzumab
Convert Morphine to SC and Patch
(30mg PO morphine = 15mg SC morphine)
Patch lasts 3days
(30mg PO morphine = 12mcg/hr fentynal patch)
What minimum length of time should a patient be on pharmacological treatment for a 1st episode of mild to moderate depression?
How long should they be treated for if it reoccurs?
Min 6 months
Min 2 years
How many days before surgery do you stop the COCP?
4ml * % body surface area * weight (kg) = ml of Hartmann's to be given in first 24 hours. Half of which is to be given in first 8 hours.
Which medications reduce mortality in chronic heart failure?
A number of drugs have been shown to improve mortality in patients with chronic heart failure:
ACE inhibitors (SAVE, SOLVD, CONSENSUS)
hydralazine with nitrates (VHEFT-1)
Timeframe of Post Strep GM and IGA neph
PSGN develops 1-2 weeks after URTI. IgA nephropathy develops 1-2 days after URTI
Treatment for Trigeminal Neuralgia?
What medication would you co prescribe when you start an SSRI on a pt. already taking an NSAIDS
SSRI + NSAID = GI bleeding risk - give a PPI