A: Finals: Things I Should Know

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Mike2556
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261423
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A: Finals: Things I Should Know
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2014-02-11 10:50:46
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  1. Outline 3 steps in the acute management of febrile seizure
  2. Give 3 points to tell the parents in prognosis of febrile seizure
    • Febrile seizure are different from epilepsy; slightly higher than general possibility but overall low
    • Short lasting seizures are not harmful to child
    • 1 in 3 will have another
  3. What should parents be told to do if another seizure occurs?
    • Protect from injury during seizure
    • Do not restrain/put in mouth
    • Seek help if >5 mins
  4. What should parents be told about managing a fever after convulsion?
    • Use of ibuprofen/paracetamol
    • Prevent dehydration
    • Seek help in prolonged symptoms/red flags
  5. Give 4 scenarios requiring immediate hospital assessment in febrile convulsions
    • Longer than 15 mins
    • Focal features before seizure
    • <18 months
    • Suspected serious cause
  6. How should a febrile seizure lasting >5 mins be managed acutely?
    • Rectal diazepam at 5 and 10 mins or
    • Buccal midazolam
    • 2.5, 5 and 10mg dose (1/12, year, 11 years)
    • Measure blood glucose
  7. Give 5 causes of cerebral palsy
    • Prematurity
    • Low birth weight
    • Hypoxia (myconium aspiration, asphyxia)
    • Instrument injury in delivery
    • Physical brain injury in childhood
  8. Give 4 contraindications to lumbar puncture
    • Coagulopathy
    • Skin infection at puncture site
    • Septicaemia
    • Mass effect in brain
  9. Give 3 complications of lumbar puncture
    • Post puncture headache
    • Infection/encephalitis
    • Cerebral hernia
  10. Give 5 parameters investigated in LP and their significance
    • CSF pressure: Hydrocephalus, SAH, cerebral oedema
    • Leucocytes: Granulocytes always abnormal,  low monocytes normal. Meningitis, bloody tap
    • Lactate: MS, malignancy, meningitis
    • LDH: Bacterial meningitis (not viral)
    • PCR: In suspected infection
  11. Give 5 stop-smoking therapies
    • NRT: Patches, gum, inhalers
    • Medication: Bupropion, vareniclin
    • Advice: GP or helplines
    • Therapy: Group/CBT
  12. What are bupropion or vareniclin?
    • Bupropion: Atypical antidepressant reducing craving and withdrawal symptoms
    • Varenicline: Nicotine receptor agonist, reducing craving and pleasurable effect of smoking
  13. What is the Care Programme approach? What does it provide?
    Mental health management in community

    • Provides:
    • - Assessment of care
    • - Management of crisis
    • - Social support
  14. What drugs affect the cytochrome system and what drugs are affected
    PCBRASS: Phenytoin, carbamazepine, barbiturates, rifampicin, steroids, alcoholOCCDEVICES: Omeprazol, cimetidine, chronic alcohol, erythromycin, isoniazid
  15. What is the significance of FEV1/FVC ratio
    • Low ratio: Reduced FEV1 due to airway narrowing
    • Normal ratio with low values: Restrictive disease
  16. Give 4 complications of warfarin therapy
    • Haemorrhage (common)
    • Birth defects (contraindicated in non-contraceptive women)
    • Drug interactions
    • Warfarin necrosis (initial hypercoagulability)
  17. Give 5 factors used to assess bleeding risk in warfarin therapy
    • Hypertension
    • Alcohol use
    • Stroke
    • Bleeding history
    • Liver disease
  18. How is a glucose tolerance test performed? What are the expected results?
    • Performed when patient healthy and not restricting carbohydrates
    • Zero time blood sample drawn
    • Measured glucose dose given
    • Blood drawn at intervals with 2 hours most important
    • Fasting glucose <6.1, 2hr <7.8
  19. What are the nerve roots for the commonly tested reflexes?
    • Biceps: C5
    • Bradialis: C6
    • Triceps: C7

    • Patellar: L4
    • Ankle: S1
  20. Give 3 types of diuretic and their MoA
    • Thiazide: DCT inhibition of Na/Cl pump resorption of Na/water
    • Loop: Ascending loop K/Na/Cl inhibition of Na/water
    • K+ sparer: Reduce K/NA pump in DCT and CT
  21. List and describe the hypersensitivities, giving examples
    • Type 1: IgE mediated (anaphylaxis)
    • Type 2: IgG mediated (Goodpasture's)
    • Type 3: Immune complex (SLE)
    • Type 4: T cell mediated (Hashimoto's)
  22. Describe the arterial circulation of the lower limb
  23. Give 3 mechanisms of signal transduction
    • G protein: Ligand binding causes structural change. Binds to adenyl cyclase. cAMP increases causing kinase activation. Kinase affects metabolism
    • TK: Receptor adds phosphate to protein to activate ti
  24. Give 3 mechanisms used to maintain acid/base balance
    • HCO3 buffering
    • Increased ventilation
    • Kidney HCO3 reabsorption and hydrogen excretion
  25. Give 3 investigations used in HIV infection
    • ELISA for glycoprotein
    • PCR
    • FBC
  26. How is gentamicin dose monitored?
    • On 3rd dose
    • Blood sample pre dose (trough) and 1 hr post dose (peak)
    • Change schedule if peak or trough outwith normal ranges
    • Repeat weekly

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