BAMS

Question 1

Stroke

1. Define
2. 4 risk factors
3. 2 types
4. 3 signs/symptoms
5. 2 prevention methods
6. 3 management/treatment options
7. 3 complications

Answer 1

1. Acute focal neurological deficit due to cerebrovascular disease
2. HTN, smoking, TIA, hyperlipidaemia, increased alcohol
3. Haemorrhage, infarction
4. Face droop (unilateral), can’t raise and hold arms, speech slurred
5. Antiplatelets (aspirin), statins (reduce cholesterol), stop smoking
6. Ca-channel blocker, thrombolysis/remove clot, oxygen
7. Sensory/motor loss, dysphagia, dysphonia, cognitive impairment

Question 2

Epilepsy

1. Define
2. 2 main types of seizure (3 subtypes of each)
3. Describe 2 subtypes of seizures
4. Cause and management of acute febrile convulsion
5. 3 causes of seizures
6. 2 precipitators of seizures
7. Epilepsy treatment
8. Emergency seizure treatment
9. 3 components of a fit history
10. Definition of status epilepticus

Answer 2

1. Recurrent seizures associated with reduced GABA levels in the brain
2. Generalised - tonic clonic, absence, atonic, myoclonic
   Focal/partial - simple partial, complex partial, simple sensory
3. TC - prodromal aura, initial tonic, clonic (rapid spasms), post-ictal drowsiness. 2-4mins
   Absense - 5-15s. Loss of consciousness, no loss of postural reflexes. Individual unaware it has happened
4. Raised temperature (pyrexia). Cool down (Antipyretics, cold bath)
5. CNS disease (tumour, meningitis, encephalitis, stroke), trauma (head injury), idiopathic
6. Illness, fatigue, stress, infection
7. Anticonvulsants/anti-epileptics
8. Protect head (cushion), clear area around them, give O2 (OPA if possible). If >5mins, consider benzodiazepines (buccal midazolam), post-seizure reassurance and support
9. Last 3 fits, medications and compliance with medications, when fits most likely (morning, when tired, etc.)
10. A single epileptic seizure lasting more than five minutes or two/more within a five-minute period without the person returning to normal between them

Question 3

Neurology

1. Definition of MS
2. Main presentation of MS
3. Definition of MND

Answer 3

1. Progressive demyelination of axons (degeneration/loss of myelin sheath around axons) leading to reduced nerve conductivity
2. Intention tremor, muscle weakness, paraesthesia, visual disturbances/optic atrophy
3. Degeneration in spinal cord, affecting bulbar motor nuclei

Question 4

Osteoporosis

1. Define
2. 2 risk factors
3. 1 increased risk of
4. 2 preventions

Answer 4

1. Loss of matrix, secondary loss of mineral. Reduced bone mass/increased bone loss. Osteoclastogenesis > osteoblastogenesis
2. Age, sex, genes
3. Increased fracture risk (weaker bones), height loss
4. Increase peak bone mass, reduce bone loss, bisphosphonates

Question 5

Gout

1. Define
2. Cause
3. 2 symptoms
4. Treatment

Answer 5

1. Acute monoarthropathy affecting single joint (usually great toe)
2. Uric acid crystal deposition (increased uric acid levels in blood - due to diet, etc)
3. Pain, inflammation, swelling, red joint
4. NSAIDs, allopurinol for LT prevention

Question 6

Osteoarthritis

1. Define
2. 3 signs/symptoms
3. 2 radiographic signs
4. 2 treatments

Answer 6

1. Progressive, degenerative joint disease due to cartilage repair dysfunction
2. Pain, brief morning stiffness, joint swelling and deformity
3. Progressive loss of PIP and DIP joint space, osteophytes lipping at joint edge
4. NSAIDs, prosthesis, increase muscle bulk around joints, reduce pain

Question 7

Rheumatoid arthritis

1. Define
2. 2 types (and features)
3. 3 signs/symptoms
4. 2 treatments
5. 2 dental features

Answer 7

1. Autoimmune disease of synovium
2. Seropositive (RF present, affects peripheral joints) and seronegative (RF absent, affects central joints)
3. Thumb z-deformity, finger ulnar deviation at MCP joint, symmetrical synovitis of PIP, DIP and MCP joints, PIP joint hyperextension
4. Monoclonal antibodies, methotrexate (DMDs), NSAIDs, physio, OT
5. Atlanto-axial instability, Sjogren’s syndrome

Question 8

Seronegative arthritis

1. What are they associated with
2. 3 types
3. Features of each

Answer 8

1. HLA-B27
2. Ankylosing spondylitis - arthritis of spinal joints. Limited back moment, neck flexion and mouth opening, intermittent lower back pain
3. Reactive arthritis/Reiters disease - conjunctivitis, urethritis, arthritis
4. Enteropathic arthritis - chronic inflammatory arthritis associated with IBD

Question 9

Sjogren’s syndrome

1. Define
2. 3 signs/symptoms
3. 2 dental features

Answer 9

1. Autoimmune conditions affecting moisture-producing glands
2. Dry eyes, dry mouth, vaginal dryness, Raynaud’s phenomenon
3. Dry mouth, increased risk of (salivary) lymphoma, increased caries risk

Question 10

Acne vulgaris

1. 4 features
2. pathogen associated
3. 3 things that exacerbate
4. 2 treatments

Answer 10

1. Comedones, papules, pustules, nodules, inflammatory cysts
2. P. acnes
3. Greasy skin cleaners, some oral contraceptive pills, steroids, some anticonvulsants
4. Topical - gentle skin cleanser, antibacterial lotion (benzoyl peroxide), antibiotics
   Systemic - antibiotics (tetracyclines, retinoids)

Question 11

Eczema

1. Where affected
2. 2 triggers
3. 3 types
4. 2 treatments

Answer 11

1. Flexor surfaces of skin
2. Weather changes, stress, illness, menstruation
3. Atopic, contact, discoid, gravitational/venous, seborrhoeic
4. Topical steroids, cotton clothing, emollients, soap substitutes

Question 12

Psoriasis

1. Define
2. Where affected
3. 2 treatments

Answer 12

1. Dysregulated epidermal proliferation
2. Extensor surfaces of skin
3. Vitamin A derivatives, UV light

Question 13

Psychiatric disorders

1. 2 main psych disorders and define
2. Key psych law

Answer 13

1. Neurosis/non-psychotic disorders - contact with reality maintained
   Psychosis/psychotic disorders - contact with reality lost
2. Mental Health (Care and Treatment) (Scotland) Act 2003

Question 14

4 signs/symptoms of depression

Answer 14

Low mood, loss of self-esteem and confidence, reduced motivation and interest, lethargy and tiredness, sleep disturbance, early morning waking

Question 15

Antidepressants

1. 3 antidepressants
2. 3 features of 2

Answer 15

1. Tricyclics (TCAs), MAOIs, SSRIs
2. SSRIs - acute anxiety, GI upset, dry mouth, weight gain
   TCAs - dry mouth, weight gain, sedative

Question 16

Schizophrenia

1. Define
2. 4 symptoms
3. 2 treatments

Answer 16

1. Fundamental and characteristic distortions of thinking and perception. Relapsing and intermittent periods of acute psychosis, possibly due to a multifactorial abnormality in dopaminergic neurotransmission
2. Auditory hallucinations, delusions of thought control, delusions of thought, delusional perception
3. Antipsychotics (phenothiazines), ECT, psychological therapy

Question 17

Eating disorders

1. 2 types
2. 2 features of each

Answer 17

1. Anorexia nervosa, bulimia nervosa
2. Anorexia - dysmorphic. 2 types - restricting/binge and purge
3. Bulimia - normal weight. Binge eating and compensating behaviours (excessive exercising, vomiting, laxatives, fasting)