D Phil

(DK Satchithananda, A Macnab & AJF Page) · The following are true of atrial fibrillation: 1. An irregularly irregular pulse is pathognomonic of atrial fibrillation. 2. Co-ordinated atrial activity at around 300 beats per minute is usually apparent on the 12 lead ECG. 3. Ventricular rate is usually between 100-160 beats per minute in untreated AF. 4. Bradycardia usually implies the presence of an accessory pathway. 5. P-waves may be visible on the baseline of a 12-lead ECG. · The following are true of cardioversion for AF: 6. Following successful electrical cardioversion, more than 90% of patients remain in sinus rhythm at 1 year. 7. Anticoagulation prior to cardioversion is not mandatory if the duration of AF is less than 48 hours. 8. Biphasic energy defibrillation is associated with a higher success rate. 9. Sotalol is contraindicated for patients with ischaemic heart disease. 10. Flecainide is the pharmacological treatment of choice for patients with structurally normal hearts. (P Bhandari & P Patel) · The following are associated with a higher mortality following upper GI haemorrhage: 11. Older age. 12. Co-existent liver disease. 13. Reflux oesophagitis on endoscopy. 14. Systolic blood pressure >100mmHg on admission. 15. Pulse rate · Following the diagnosis of bleeding gastric ulcer: 16. Oral proton pump inhibitors reduce likelihood of rebleeding. 17. Intravenous ranitidine should be administered if peptic ulcer disease is identified on endoscopy. 18. Helicobacter pylori eradication may be beneficial. 19. Repeat endoscopy is not required. 20. Aspirin is less likely to cause recurrence if enteric-coated. (A J Lindahl, M E Hill & D Phil) · Which of the following are common clinical features of Myasthenia Gravis? 21. Unilateral foot drop. 22. Nasal regurgitation when swallowing liquids. 23. Fluctuating hemiparesis. 24. Headache. 25. Unilateral dilated unreactive pupil. · Which of the following statements about MG are true? 26. It is predominantly a disease of young women. 27. Removal of a thymoma may result in disease remission. 28. It is rare before puberty. 29. The elderly are less likely to respond to medication. 30. A negative anti-acetylcholine receptor antibody test does not rule out the diagnosis. · When treating MG: 31. It is generally safe to start steroid treatment as an outpatient. 32. Steroids should be introduced slowly. 33. Most myasthenics manage well on anticholinesterases and do not require immunosuppression. 34. Gastrointestinal side effects are common with anticholinerases. (J C Girling) · During pregnancy: 35. The ECG finding of an S wave in lead I, Q-wave in lead III and inverted T-wave in lead III usually implies pulmonary embolism. 36. PO2 is usually lower with the patient supine. 37. Increased risk of pulmonary embolism is confined to the 3rd trimester. 38. Low molecular weight heparin should be avoided. 39. D-dimer is usually positive. · Following a first fit during pregnancy: 40. The absence of proteinuria and normal blood pressure excludes the diagnosis of eclampsia. 41. Treatment with magnesium sulphate is recommended for eclampsia. 42. Cortical sinus thrombosis should be considered. 43. Sodium valproate is the drug of choice for non-eclamptic fits. 44. Amniotic fluid embolism should be considered. (D McNamara) · Neuroleptic Malignant Syndrome (N.M.S.) and Serotonin Syndrome (S.S.) have the following differences: 45. S.S. has a higher mortality. 46. N.M.S. has a quicker onset. 47. S.S. has a slower course. 48. S.S. has a higher recurrence rate following drug rechallenge. 49. Laboratory findings are more supportive diagnostically of N.M.S. · Strategies with proven efficacy include: 50. ECT for S.S. 51. Cyproheptadine for N.M.S. 52. Dantrolene for S.S. 53. Benzodiazepines for both. 54. Artificial ventilation for both. · Risk factors for N.M.S. include: 55. agitation. 56. rapid neuroleptisation. 57. previous ECT. 58. brain injury. 59. females.