1
Q
Patient had knee surgery was not taking usual drug for anxiety disorder. Now she has coarse tremors, agitated, can’t sleep. What class of drugs is she not taking now?
A
Benzodiazepines
2
Q
A man with severe depression develops the belief that his body is rotting. What type of delusion is this?
A
Nihilstic delusions/cotard delusion
3
Q
- Loss of libido. DHx COCP Cetirizine Salbutamol inhaler. What is the cause of loss of libido?
A
Cetirizine
4
Q
What drugs can cause a loss of libido?
A
Cetirizine
5
Q
- Boy with conduct disorder is most likely to get what personality disorder when older?
A
Antisocial personality disorder
6
Q
10 days after having baby – feels teary and not sure why she is feeling like this about the baby?
A
Baby blues
7
Q
- Man presents with itching but no cause. In the past has presented with tingling, headache, and abdominal pain.
A
Somatisation disorder (functional symptoms)
8
Q
- Deficiency of what vitamin would cause visual disturbances, ataxia and confusion
A
Thiamine (B1 deficiency). Seen in alcoholics
9
Q
Test to do in woman who is scantily dressed, agitated, sweating, tachycardic
A
TFTs
10
Q
- Woman with learning difficulties in a care home with change in behaviour: change in feeding time and irritability because the carer that was looking after them has gone suddenly, what’s the diagnosis?
A
Challenging behaviour in reaction to the change
11
Q
- Woman with anorexia was admitted and she started eating. Then she gets muscle spasms, and abdominal pain. What’s the most important thing to check for?
A
Low phosphate? Low potassium? Refeeding syndrome
12
Q
- Drug to give for depression in a man who had a previous MI
A
Sertraline
13
Q
- Old age boxer rips out cannula, attacks staff what do you do?
A
Calm him with verbal de-escalation
14
Q
- Someone else kicking off and de-escalation has failed, what drugs?
A
Intramuscular Lorazepam
15
Q
- What does clozapine cause?
A
Neutropenia (agranulocytosis)
16
Q
- Man whose wife died a year ago, has 6 months of low mood, low energy, doesn’t like doing what he used to, getting forgetful, lacking concentration
A
Abnormal (prolonged) grief reaction
17
Q
- Man on haloperidol gets acute dystonia - treatment?
A
Procyclidine
18
Q
- Woman experienced trauma 6 months ago/has PTSD best management?
A
EMDR (CBT and SSRI weren’t options)
19
Q
- Man works as an IT engineer, doesn’t like sex, or people
A
Schizoid personality disorder
20
Q
What is schizotypal personality disorder?
A
Eccentric thoughts and beliefs
21
Q
Man worries about running kids over so has to check the road or every time
A
OCD
22
Q
Woman drops out of uni, goes back home lives with mother and accuses mother of poisoning her: Schizoid personality disorder, acute psychosis, prodromal schizophrenia/ at-risk mental state
A
Acute psychosis
23
Q
- Woman comes to A&E overdose after argument with boyfriend, previous history of overdosing - diagnosis?
A
EUPD
24
Q
- Woman blushes in public and becomes very nervous around people
A
Social phobia (repeat, though previous year question asked what was most associated with social phobia – answer was blushing)
25
Man has a fear of public speaking, worried about embarrassing himself, hasn’t seen his personal tutor, hasn’t left the house in a few? weeks, gets sick thinking about it. social phobia, agoraphobia, avoidant personality disorder
Social phobia
26
Woman has been spending more money, lots of energy, little sleep, going on for 6 weeks but not affecting her work (although feels more imaginative)
Hypomania
27
17. Old woman in care home, no PMH, no psych history, nurses complain she wakes up in night and sleeps in day- what do you do first?
Advise on sleep hygiene
28
18. A 25 year old students with asthma/diabetes, stressed about exams for 6 weeks and his exams are coming up in 2 weeks. What do you do? watch and wait, CBT, beta blocker, Benzodiazepines, Sertraline
???
29
Woman is anorexic (14.3 BMI) – discharge to GP, discharge to CAMHS, use the MHA and feed her, routine referral to eating disorder clinic, emergency CAMHS, urgent referral to A&E?
Urgent referral to A&E
30
20. The police want to detain someone under the MHA in public, which MHA section?
Section 136
31
The police want to detain someone under the MHA from a private residence, which MHA section?
Section 135
32
21. Woman on venlafaxine, starts developing symptoms of mania (BAD), what do you do first? Stop the Venlafaxine (other options: give lithium, refer to community mental health team)
Stop the Venlafaxine
33
22. 50 year old known alcoholic wanders in screaming he sees ants and tiny men running around?
Delirium tremens
34
23. Alcoholic wants to quit and wants something for reducing cravings
Acamprostate
35
Patient with Lewy body dementia, given a drug that makes him worse, what drug?
Haloperidol
36
Man on antipsychotic comes in with tremor – most likely drug
Haloperidol (any typical anti-psychotics)
37
26. A few questions on people with learning disabilities coming in with carers/families and their carers/families disagreeing with the doctor’s plan so what would you do first?
(ALWAYS assess capacity- everyone is assumed to have capacity until proven otherwise)
38
27. Kid is very disruptive in class/at home/has trouble organizing himself, what’s the diagnosis?
ADHD
39
28. Child has classic symptoms of ADHD, how do you manage?
Family therapy
40
Man writes letters to the PM, think he’s being spied on by the government for the past 10 years, shows no other symptoms
Delusional disorder
41
30. Man comes requesting for codeine for his back, concerned his painkiller use is spiralling, see some degeneration in his spine on imaging – what do you do?
Buprenorphine + addiction clinic referral
42
31. What would an alcoholic need to have to be classified as being dependent?
Giving up pleasurable activities to drink more alcohol (there are more criteria but this was the only one in the options)
43
32. Man has recurrent mental images of child pornography, finds them deeply distressing, seeking help
OCD
44
33. Man with history of paranoid schizophrenia, his Ix and tests are strongly suggestive of an MI, needs treatment. He has capacity and refuses treatment – what should you do?
Respect his wishes if it is a capacitous decision
45
34. Someone with dilated pupils, urinary retention, obs normal-ish - cause of overdose?
TCA/amitryptaline
46
35. Lithium – what do you monitor?
Serum Lithium levels every 3 months, U&Es, BMI, and TFTs every 6 months
47
36. Husband brings in wife who has bipolar, who’s taken 20 “white” tablets - has a tremor, hyperreflexia, and confusion. What tablet has she overdosed on?
Lithium
48
37. Patient on ward becomes aggressive, verbal de-escalation hasn’t worked. Treatment?
IM Lorazepam
49
38. 50y lady fell over gardening, comes in with paralysis of leg, no medical cause found?
Conversion disorder/dissociative disorder
50
39. Man who drinks a bottle of wine a day for the last 10 years, has tried to quit before but failed. Wants to cut down.
Initially motivational interviewing, then inpatient chlordiazepoxide when ready to fully quit
51
1. 16 y o having sex with a 12 year old, what is your next action?
Inform the police
52
2. Woman comes in with a pneumothorax and said her husband kicked her and has previously hurt their baby too. Baby is currently at home with him – what do you do?
Phone police, call social services, send her home??
Phone police, call social services?
53
Boy always playing video games from teenage years, not interested in other people threatening to kill himself?
Schizoid personality disorder
54
Person sees flower on wallpaper but perceives it as moving snakes
Illusion
55
Person sees things smaller?
Micropsia
56
3. Definition of feel insects under skin
Formication
57
Young Woman who has come into A&E multiple times with different presentations, nothing found for any of them
Somatisation disorder
58
3. Woman with abdominal pain, weight loss, lethargy and feeling low
Malignancy
59
Man who drinks and takes some drugs. Split up with girlfriend, cutting
EUPD
60
50 y woman with constant stomach pain, had many ix e.g. multiple laparoscopies with nothing found. Comes to A&E saying she needs another laparoscopy
Muchausen's
61
1. Addict patient presenting with dilated pupils and goosebump flesh
Opiate withdrawal
62
Neuroleptic Malignant Syndrome – recently started on antipsychotic what test would you do?
Creatinine kinase
63
Acute treatment for patient with manic episode
Olanzapine
64
What is moderate retardation defined as?
30-49
65
What is mild retardation defined as?
50-69
66
5. Woman with depressive episode in the past and was given antidepressants. Is now presenting to the GP wearing bright clothes, saying she is going to divorce her husband and move abroad – what is the diagnosis?
BPAD
67
Man on ward behaving aggressively, what do you do?
Verbal de-escalation
68
8. Woman with eating disorder, vomiting. Will she have a: metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis?
Metabolic alkalosis (hypokalaemia)
69
Vascular risk factors for vascular dementia – how do you treat?
Aspirin
70
Drug treatment for vascular dementia?
The standard drugs for Alzheimer’s and Lewy body dementia etc. are not used in vascular dementia – so the answer must be aspirin to limit further damage)
71
10. You are the GP and a 14-year-old Woman comes in and is Gillick competent, she is given COCP. A few days later her mum rings and says ‘she doesn’t like the new boyfriend’ and asks why her daughter has the pill and what happened in the consultation. What should you do?
a. Tell the mum everything
b. Tell her daughter requested the COCP to not get pregnant and you thought it was a sensible decision
c. Offer joint consultation with the mother and daughter
d. Say you can't discuss it with her, encourage them to talk about it at home
d) Say you can't discuss it with her, encourage them to talk about it at home
72
11. There was a chef who kept washing his hand, had loads of obsessions but he was hearing a voice, what did he have? OCD, psychotic episode... (repeat)
Psychotic episode (auditory hallucinations make it a psychotic episode)
73
13. Woman witnesses car crash and goes few hours later blind
Dissociative disorder
74
14. Mum with 20 units a day alcohol habit hides in room with 2 day newborn baby and think house is infested (maybe thinks insects crawling on wall?). What Dx? Puerperal psychosis. Alcohol withdrawal
Alcohol withdrawal?
75
15. Recurrent intrusive thoughts about child pornography but is distressed
OCD
76
7 year old with ADHD, 1st line treatment?
parent advice and support sessions, methylphenidate is not first line
77
18. Old man who enjoyed gardening in the past brought in by wife after he started neglected garden, she also describes some depressive symptoms?
Depression
78
19. Man prescribed citalopram, name one possible side effect he should be told about?
Sexual dysfunction
79
SSRIs are associated with which side effect?
Sexual dysfunction
80
20. Man who sticks his tongue out and grimaces involuntarily
Tardive dyskinesia (longterm typical antipsychotic use)
81
21. Treatment for torticollis
Procyclidine
82
22. Woman drops out of university, has no friends, finds it difficult to express her feelings?
Prodromal schizophrenia? Autism?
83
Man scared of public speaking. Doesn’t want to leave house
Social phobia
84
25. Disinhibition-Man being inappropriate at work... where is lesion?
Frontal lobe
85
29. Woman believes celebrity reciprocates her love and writes letters to him, then stalks him.
Clerembault delusion (erotomania)
86
31. Man has hallucinations and movement seems slower than usual
Lewy Body dementia
87
32. Woman has Caesarean section. 1 day after giving birth thinks she is at home when she is actually still in hospital. What is the diagnosis?
Acute confusional state
88
Man who is aggressive to staff requires rapid tranquilisation, which option is correct?: Oral haloperidol, IM haloperidol and promethiazine, oral lorazepam?
IM haloperidol and promethiazine IM lorazepam was not an option (but would be correct if it were)
89
34. Man with hyperreflexia and tremor, what drug has been overdosed?
Lithium
90
35. Section for a 38-year-old woman who is mentally ill and wants to kill herself in A&E? Section 5(2), DoLs, Section 2, Section 3?
Section 2
91
36. Which drug is most likely to cause neuroleptic malignant syndrome? Haloperidol, promethazine
Haloperidol
92
2. Treatment for postpartum depression?
Mild-moderate = Facilitated self help
Moderate-severe = CBT or SSRI/SNRI/TCA (medication used if preferred or if CBT fails)
93
A Woman has come in with recurrent abdominal pain associated with going to school. She is diagnosed with functional abdominal pain. What would your advice be with regards to her management?
a. She should return to school but come home when the pain starts
b. She should be homeschooled
c. She should change school
d. She should arrange for schoolwork to be delivered to her house until she gets better
e. She should return to school and remain there, even if the pain starts
e. She should return to school and remain there, even if the pain starts
94
26. Woman with dementia, which part of brain is likely to be affected early?
Hippocampus
95
Fregoli delusion?
Fregoli syndrome is the delusional belief that different people are in fact a single person who is in disguise.
96
Capgras delusion?
Capgras syndrome is the delusional belief that a friend, family member, etc., has been replaced by a twin impostor.
97
What is naltrexone used for?
Primarily used to manage alcohol use or opioid use disorder by reducing cravings and feelings of euphoria associated with substance use disorder.
Opioid-receptor antagonist.
98
How is severe mental retardation classfied?
20-34
99
How is profound mental retardation classified?
<20
100
What is a normal IQ score?
>70
101
How is mild mental retardation classified?
50-69
102
How is moderate mental retardation classified?
35-49
103
What is a low average IQ?
80-89
104
What is a borderline IQ?
70-79
105
What is an extremely low IQ?
<69
106
What is an average IQ?
90-109
107
What is a high average IQ?
110-119
108
Superior IQ?
120-129
109
Superior IQ?
120-129
110
Very superior IQ?
>130
111
Name the stages of grief?
Anger, denial, bargaining, depression, acceptance
112
Prolonged grief signs?
Patients show a preoccupation with the deceased and feel inner emptiness, no interest in life, and sleep poorly. There is a correlation between complicated grief and acute coronary syndrome (ACS). It has been estimated that 7-10% of those bereaved do not adapt to the loss and, in turn, develop complicated grief.[5]
113
What is Takosubo cardiomyopathy?
Broken heart syndrome
114
Treatment for abnormal grief reaction?
Complicated grief is best managed by complicated grief therapy.[3] Complicated grief therapy removes the impediment and promotes the adaptation to the loss. This therapy is more effective than citalopram and interpersonal therapy. [13][14] Patients experiencing complicated grief may require psychological treatment in the form of cognitive-behavioral therapy (CBT) and pharmacological bereavement-related depression.[15]. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships.
115
How long do symptoms last in prolonged grief reaction
6 months or more
116
Treatment for Stage 3/4 tears
Lactulose and a bulking agent (e.g. Fybogel) are recommended for 5-10 days
The woman should remain in hospital until she has had her first bowel motion
An oral broad-spectrum antibiotic should be prescribed for 5-7 days to reduce the risk of infection
Regular oral analgesia should also be provided
At 6-12 weeks, a full evaluation of the degree of symptoms should take place
Asymptomatic women should be told that the risk in future pregnancy is 6-8% and vaginal delivery is safely achievable
117
Which perineal tears are corrected in theatre?
Third or fourth degree tears require regional anaesthesia and are usually repaired in an operating theatre by an obstetrician
118
When should women be offered a c-section after perineal tear?
Women who experience significant pelvic floor symptoms following OASI should be offered an elective C-section in a future pregnancy
119
Contraindication to ventouse delivery?
Ventouse should NOT be used if < 34 weeks because of high risk of cephalhaematoma and intracranial haemorrhage
120
When are Non-rotational forceps used?
when the head is OA with no more than 45 degrees deviation to the left or right
Examples of non-rotational forceps
Neville Barnes
Simpson
If the head is positioned > 45 degrees from the vertical, rotation must be accomplished before tractions
Examples of rotational forceps: Kielland
121
Which type of operative delivery has higher risk of cephalohaematoma?
Ventouse delivery
122
What does cat 3 c section signify?
Requires early delivery
123
Treatment for neonates with syphillis congenital infection?
benzathine penicillin
124
Diagnostic test for toxoplasmosis infection in pregnancy?
Sabin Feldman Dye Test
125
Treatment for toxoplasmosis in pregnancy?
Spiramycin treatment can be used in pregnancy (3 week course of 2-3 g/day)
126
Neonatal management for Hep B?
The immunoglobulin should be given immediately after delivery
The vaccine is given at birth, 1 month and 6 months
127
Treatment for hepatitis C?
Interferon and ribavirin
128
Delivery options for HIV positive women?
Planned vaginal delivery is possible for women with a viral load < 50 copies/mL at 36 weeks gestation
C-section should also be recommended in women with hepatitis C coinfection
129
Women with a high viral load should receive what if they are undergoing a planned C-section or present with spontaneous rupture of membranes ?
IV azidothymidine (AZT)
130
Management of infants with HIV positive mother?
MANAGEMENT of Infants:
Cord should be clamped as soon as possible and the baby should be bathed immediately after birth
Women should be advised not to breastfeed (unless in low income country)
All infants should be given azidothymidine/zidovudine for 4-6 weeks after birth
Neonates test positive for HIV antibodies because of passive transfer from the mother. Therefore, a diagnosis of HIV in the neonate requires direct viral amplification by PCR (normally carries out at birth, 3 weeks, 6 weeks and 6 months)
131
How is neonatal HIV infection diagnosed?
Requires direct viral amplification by PCR at birth, 3 weeks, 6 weeks and 6 months
132
Congenital abnormalities associated with T1DM?
(particularly NTDs and cardiac anomalies)
133
Treatment for Type 1 diabetics in pregnancy?
IMPORTANT: all women with diabetes should be offered low-dose (75 mg) aspirin from 12 weeks gestation until delivery
134
How often should diabetes monitor blood glucose in pregnancy?
Blood glucose monitoring should be encouraged 7 times per day (before and 1 hour after meals)
Pre-meal target < 5.3 mmol/L
1-hour postprandial target < 7.8 mmol/L
135
Extra treatment in pregnant diabetics?
Serial growth scans are recommended to assess foetal growth and diagnose macrosomia and polyhydramnios
136
Glucose targets for women with GDM?
Principles are the same as diabetes mellitus
Encourage women to maintain blood glucose levels:
Pre-meal < 5.3 mmol/L
Postprandial (1 hour) < 7.8 mmol/L
137
Thyroid related physiological changes in normal pregnancy?
Plasma volume expansion
Increased thyroid binding globulin
Relative iodine deficiency
138
Treatment of thyroid storm in pregnancy?
Propylthiouracil
139
Treatment for pituitary adenoma?
80% of cases are treated with a dopamine agonist (bromocriptine or cabergoline)
140
Treatment of women with heart disease during pregnancy?
-An echocardiogram is usually performed at booking and at 28 weeks
-Anticoagulation is essential in patients with congenital heart disease who have pulmonary hypertension or artificial valves and those at risk of AF
WARNING: warfarin is teratogenic if used in the first trimester
-LMWH is used as an alternative (especially in 1st and 3rd trimester)
141
ergometrine should be avoided in which women?
Asthmatics
142
How should women on multiple epilepsy drugs be treated during pregnancy?
Women on multiple therapy should be switched to monotherapy before pregnancy
143
What should be given to pregnant sickle cell patients?
High-dose folate (5 mg) is recommended preconception
Low-dose aspirin (75 mg) daily from early pregnancy to delivery
144
Discuss Antiphospholipid Syndrome
Association of anticardiolipin antibodies and/or lupus anticoagulant with the typical clinical features of:
Arterial or venous thrombosis
Foetal loss after 10 weeks' gestation
3+ miscarriages at < 10 weeks gestation or delivery < 34 weeks due to FGR or pre-eclampsia
Furthermore, positive antibody titres must be present on 2 occasions, 3 months apart
Antiphospholipid syndrome may be primary or found in SLE
145
Anti-Ro antibodies can cause what to the fetus?
Congenital heart block
146
What should be monitored in pregnant SLE patients?
They should also be prescribed low-dose aspirin to start by 12 weeks gestation
Baseline renal studies including a 24-hour urine collection for protein should be performed
Blood pressure should be monitored (because of risk of pre-eclampsia)
Serial ultrasonography should be performed to assess foetal growth, umbilical artery Doppler and liquor volume
147
How is Pemphigoid Gestationis managed?
Topical and oral steroids
148
Risk factors for Prurigo of Pregnancy?
Previous atopy. Resolves after delivery
149
How is the severity of hypertension classified?
MILD = 140-149 systolic, 90-99 diastolic
MODERATE = 150-159 systolic, 100-109 diastolic
SEVERE = > 160 systolic, > 110 diastolic
150
Treatment of gestational hypertension should be conducted when?
Mild-to-moderate increases in blood pressure in this setting do NOT require treatment
151
Definition of pre-eclampsia
hypertension of at least 140/90 mm Hg recorded on at least 2 separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24-hr collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the 6th postpartum week
152
Risk factors for pre-eclampsia?
First baby, first baby with the current father, age>40, 10 year interval between pregnancies, previous pre-eclampsia, BMI>35, family history of pre-eclampsia, diastolic BP of 80 or more at booking, multiple pregnancy, proteinuria at booking, underlying medical conditions such as DM, lupus
153
What drug should be avoided in pre-eclampsia?
Ergometrine should be AVOIDED as it significantly increases blood pressure
154
Dose of magnesium sulphate?
Loading dose of 4 g should be given IV over 5 mins followed by an infusion of 1 g/hour for 24 hours
155
What is a fetal growth restriction?
failure of a foetus to achieve its genetic growth potential
This usually results in a baby that is small for gestational age (SGA) meaning that they are below the 10th centile for its gestation
IMPORTANT
Most SGA foetuses are constitutionally small
FGR suggests that there is a pathological process leading to restricted growth
156
Reduced foetal growth potential:
Aneuploidies
Single gene defects (e.g. Seckel's syndrome)
Structural abnormalities (e.g. renal agenesis)
Intrauterine infections (e.g. CMV, toxoplasmosis)
Reduced foetal growth support:
Maternal factors
Undernutrition (e.g. poverty)
Maternal hypoxia (e.g. living at altitude, cyanotic heart disease)
Drugs (e.g. alcohol, cigarettes, cocaine)
Smoking increases the amount of carboxyhaemoglobin in the maternal circulation thereby reducing the amount of oxygen available to the foetus
Placental factors :
Reduced uteroplacental perfusion (e.g. inadequate trophoblast invasion, sickle cell disease, multiple gestation)
Reduced fetoplacental perfusion (e.g. single umbilical artery, twin-to-twin transfusion syndrome)
157
Effect of chronic foetal hypoxia in FGR?
Foetal acidaemia (both respiratory and metabolic) which can lead to intrauterine death if prolonged
158
Best way to assess foetal growth?
The most precise way of assessing foetal growth is by ultrasound biometry
159
Risk factors for FGR?
Multiple pregnancies
History of FGR in previous pregnancy
Current heavy smokers
Current drug users
Women with underlying medical disorders
Hypertension
Diabetes
Cyanotic heart disease
Antiphospholipid syndrome
Pregnancies where symphysis-fundal height is less than expected
160
Who should take daily aspirin?
Women at HIGH RISK of pre-eclampsia should take 75 mg aspirin daily from 12 weeks until birth of the baby. High risk:
Hypertensive disease during a previous pregnancy
CKD
Autoimmune diseases (e.g. SLE or antiphospholipid syndrome)
Diabetes mellitus
Chronic hypertension
Advise women with pre-eclampsia that their risk of developing pre-eclampsia in a future pregnancy is 1 in 6
161
Risk of pre-eclampsia recurrence?
1 in 6
162
When would you recommend birth for women with severe HTN due to pre-eclampsia
Recommend birth for women who have pre-eclampsia with severe hypertension after 34 weeks when their blood pressure has been controlled and a course of corticosteroids has been completed
163
Recommend birth within 24-48 hours for women who have pre-eclampsia with mild or moderate hypertension at what gestation?
37 weeks
164
Special tests in pre-eclampsia
If conservative management planned, carry out:
Ultrasound foetal growth and amniotic fluid volume assessment
Umbilical artery Doppler velocimetry
165
When should corticosteroids not be used?
During HELLP syndrome
V Flashcards
flashcards
Decks in class (17)
# Cards
-
Monoclonal antibodies90
-
2021/2019 Path Exam PPQs190
-
2020 Paper Path155
-
Psych97
-
Path PPQs + Enzymes249
-
Specialities high yield qs117
-
Specialties PPQs109
-
O&G PPQs219
-
PACES300
-
Haematology PPQs137
-
Psych PPQs165
-
Med GEMS questions344
-
Calcium part 248
-
Med GEMS Questions Part 2308
-
MED GEMS HISTO146
-
Path260
-
O&G (19/06)194
