# UKMLA & PLAB 1 Medicine II (NICE Guidelines): Neurology, Psychiatry (Mental Health Act), Infectious Diseases, Rheumatology & Haematology > High-yield UKMLA and PLAB 1 concepts across stroke thrombolysis, epilepsy, Mental Health Act 1983 sections, psychiatry prescribing, rheumatology DMARDs, infectious disease protocols, and haematology. - **Canonical URL:** https://flashcards.world/flashcards/sets/4334160e-928f-402c-aa82-7d19d18d3adf/ - **Markdown URL:** https://flashcards.world/flashcards/sets/4334160e-928f-402c-aa82-7d19d18d3adf.md - **Level:** intermediate - **Languages:** en → en - **Total Cards:** 32 ## Flashcards (32 Cards) | # | Front (Term / Prompt) | Back (Definition / Answer) | Example | Multiple-Choice Options | | :--- | :--- | :--- | :--- | :--- | | 1 | According to NICE NG100, what is the initial disease-modifying management of newly diagnosed active Rheumatoid Arthritis? | Offer first-line conventional DMARD monotherapy (oral Methotrexate, Leflunomide, or Sulfasalazine) within 3 months of symptom onset, alongside short-term bridging glucocorticoids (oral, IM, or intra-articular) AND folic acid 5 mg weekly (not on the same day as methotrexate). | | | | 2 | In Parkinson's disease (NICE NG71), when is Levodopa (co-careldopa/co-beneldopa) chosen first-line vs. a Dopamine Agonist or MAO-B inhibitor? | Levodopa is first-line if motor symptoms impact the patient's quality of life; if motor symptoms do NOT impact quality of life, offer a choice of dopamine agonist, levodopa, or MAO-B inhibitor (note: dopamine agonists carry impulse control disorder risks—pathological gambling, hypersexuality). | | | | 3 | In suspected Subarachnoid Haemorrhage (thunderclap headache), what is the diagnostic investigation if a non-contrast CT head performed >6 hours after symptom onset is normal? | Lumbar puncture performed at least 12 hours after headache onset looking for CSF xanthochromia (oxyhaemoglobin/bilirubin spectrophotometry); if CT is done within 6 hours of onset and reported normal by a neuroradiologist, LP is no longer routinely required per NICE. | | | | 4 | In Multiple Myeloma ('CRAB' features), what is the first-line imaging modality recommended by NICE to detect osteolytic bone lesions? | Whole-body MRI (or whole-body low-dose CT if MRI is unsuitable) rather than a plain skeletal survey. | | | | 5 | According to NICE NG217 for Epilepsy, what is the first-line monotherapy for Generalized Tonic-Clonic Seizures in men vs. women of childbearing potential? | Sodium Valproate is the most effective drug for generalized seizures but is strictly avoided in women/girls of childbearing potential (and now subject to strict MHRA restrictions in men <55) due to teratogenicity; Lamotrigine or Levetiracetam is used first-line instead. | | | | 6 | Under the Mental Health Act (MHA) 1983, compare Section 2 and Section 3 in terms of purpose, maximum duration, and professionals required. | Section 2: Admission for Assessment (up to 28 days, non-renewable); Section 3: Admission for Treatment (up to 6 months, renewable). Both require an AMHP (Approved Mental Health Professional) + 2 doctors (at least one Section 12 approved). | | | | 7 | When is Clozapine indicated in Schizophrenia per NICE guidelines, and what is its most critical haematological side effect? | Treatment-resistant schizophrenia after failure of at least two different antipsychotics (at least one atypical) each tried for 4–6 weeks; requires mandatory FBC monitoring for Agranulocytosis/neutropenia (plus myocarditis, constipation, hypersalivation, and weight gain). | | | | 8 | In Acute Ischaemic Stroke (NICE NG128), what is the time window for IV Alteplase/Tenecteplase thrombolysis after excluding haemorrhage on non-contrast CT head? | Within 4.5 hours of known symptom onset; mechanical thrombectomy can be offered up to 6 hours (or up to 24 hours if neuroimaging shows salvageable penumbra) for proximal anterior circulation occlusion. | | | | 9 | How do you clinically differentiate Serotonin Syndrome from Neuroleptic Malignant Syndrome (NMS)? | Serotonin Syndrome (SSRIs/MAOIs/tramadol): rapid onset (hours), neuromuscular excitation—hyperreflexia, inducible clonus, myoclonus, dilated pupils. NMS (dopamine antagonists/haloperidol): slower onset (days), 'lead-pipe' muscular rigidity, hyporeflexia/bradykinesia, fever, and markedly raised CK. | | | | 10 | In Giant Cell Arteritis (Temporal Arteritis), what is the immediate management if the patient has visual symptoms (amaurosis fugax/diplopia) vs. no visual symptoms? | Visual symptoms: Immediate high-dose IV Methylprednisolone (or oral Prednisolone 60 mg daily if IV delayed) and same-day ophthalmology assessment. No visual symptoms: Immediate oral Prednisolone 40–60 mg daily BEFORE temporal artery biopsy/ultrasound. | | | | 11 | In suspected Bacterial Meningitis in the community (GP setting) with a non-blanching petechial rash, what is the immediate antibiotic treatment before transfer to hospital? | Immediate IM or IV Benzylpenicillin (1.2 g in adults), provided it does not delay urgent ambulance transfer to hospital (where IV Ceftriaxone 2 g BD is first-line). | | | | 12 | Which opportunistic lung infection occurs in HIV patients with a CD4 count <200 cells/mm³, and what is its treatment and prophylaxis? | Pneumocystis jirovecii pneumonia (PCP/PJP), presenting with exertional desaturation, dry cough, and bilateral perihilar ground-glass infiltrates; treated and prevented with Co-trimoxazole (trimethoprim-sulfamethoxazole; add steroids if PaO2 <9.3 kPa). | | | | 13 | What is the first-line pharmacological class for Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) per NICE, and what must be co-prescribed if an SSRI is given to a patient on an NSAID? | SSRI (specifically Sertraline first-line for GAD and post-MI depression; Citalopram/Fluoxetine/Sertraline for MDD); co-prescribe a Proton Pump Inhibitor (PPI, e.g., lansoprazole) due to synergistic GI bleeding risk with NSAIDs/aspirin. | | | | 14 | Compare Section 5(2) and Section 5(4) of the Mental Health Act 1983. | Both apply ONLY to voluntary hospital inpatients (NOT in A&E): Section 5(2) is the Doctor's Holding Power (up to 72 hours); Section 5(4) is the Nurse's Holding Power (up to 6 hours until a doctor arrives). | | | | 15 | Which calcium channel blocker is given orally to patients with aneurysmal Subarachnoid Haemorrhage to prevent delayed cerebral ischaemia (vasospasm)? | Nimodipine 60 mg every 4 hours. | | | | 16 | What are the two core autoantibodies used to diagnose Rheumatoid Arthritis, and which is more specific? | Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (anti-CCP); anti-CCP has much higher specificity (~95–98%) and predicts erosive disease. | | | | 17 | What defines Neutropenic Sepsis in an oncology patient per NICE CG151, and what is the empirical first-line antibiotic within 1 hour? | Neutrophil count ≤0.5 × 10⁹/L plus temperature >38°C or clinical signs/symptoms of sepsis; administer immediate IV Piperacillin with Tazobactam (Tazocin) within 1 hour of presentation. | | | | 18 | In suspected Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) with a ' Likely' two-level Wells score (>1 for DVT, >4 for PE), what is the immediate next step if imaging cannot be performed within 4 hours? | Start interim therapeutic anticoagulation (e.g., Apixaban or Rivaroxaban) immediately, take a D-dimer, and arrange proximal leg vein ultrasound (within 24h) or CTPA. | | | | 19 | How do you distinguish Guillain-Barré Syndrome from Myasthenia Gravis clinically and on investigation? | Guillain-Barré: ascending symmetrical flaccid paralysis with AREFLEXIA after Campylobacter jejuni infection, CSF showing albuminocytological dissociation (raised protein, normal WCC), treated with IVIG/plasma exchange. Myasthenia Gravis: fatigable muscle weakness (ptosis, diplopia) with intact reflexes, anti-AChR antibodies, associated with thymoma. | | | | 20 | In a hot, swollen, painful single joint, what investigation is mandatory before starting antibiotics, and what microscopic findings distinguish Gout from Pseudogout? | Urgent synovial fluid aspiration for Gram stain, culture, and polarized light microscopy to exclude Septic Arthritis. Gout: needle-shaped monosodium urate crystals with negative birefringence. Pseudogout: rhomboid calcium pyrophosphate crystals with weak positive birefringence. | | | | 21 | What antibiotic is given as chemoprophylaxis to close household contacts of Meningococcal Meningitis? | A single oral dose of Ciprofloxacin (first-line per UKHSA/NICE; Rifampicin is an alternative). | | | | 22 | What is the standard 6-month UK RIPE regimen for drug-sensitive Tuberculosis, and what are the hallmark toxicities of each drug? | 2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol, followed by 4 months of Rifampicin + Isoniazid. Rifampicin: orange secretions, P450 induction, hepatitis; Isoniazid: peripheral neuropathy (prevent with Pyridoxine/Vitamin B6), hepatitis; Pyrazinamide: hyperuricaemia/gout, severe hepatitis; Ethambutol: optic neuritis (colour vision loss). | | | | 23 | When starting an SSRI in a patient aged under 30 (especially 18–25), when must their first follow-up review take place per NICE? | Within 1 week of initiation (compared to within 2 weeks for adults ≥30) due to increased early risk of suicidal ideation and self-harm. | | | | 24 | Which antiepileptic drug is first-line for Absence Seizures in children, and which drug can paradoxically worsen absence or myoclonic seizures? | Ethosuximide is first-line for absence seizures (Lamotrigine/Valproate if tonic-clonic seizures coexist); Carbamazepine (and phenytoin) exacerbates absence and myoclonic seizures. | | | | 25 | How do you manage an acute flare of Gout vs. urate-lowering prophylaxis per NICE NG219? | Acute flare: NSAID (with PPI), Colchicine, or short-course oral Corticosteroid (continue Allopurinol if already taking it, do NOT start it during an acute flare unless under cover). Prophylaxis: Start Allopurinol (first-line) or Febuxostat 2–4 weeks after the flare settles, targeting serum urate <300 µmol/L. | | | | 26 | What antiplatelet regimen is started once intracerebral haemorrhage is excluded in an Acute Ischaemic Stroke (non-cardioembolic) or TIA? | Aspirin 300 mg daily immediately for 2 weeks, followed by long-term Clopidogrel 75 mg daily (or dual antiplatelet therapy for 21 days in minor stroke/high-risk TIA per recent NICE updates). | | | | 27 | What is the step-by-step UK emergency drug ladder for Convulsive Status Epilepticus (seizure lasting ≥5 minutes)? | 1) Benzodiazepine (IV Lorazepam 4 mg or buccal Midazolam / PR Diazepam, repeatable once after 5–10 min); 2) Second-line IV antiepileptic (Levetiracetam, Phenytoin, or Sodium Valproate); 3) Rapid Sequence Induction (propofol/thiopental) and intubation within 30–45 minutes. | | | | 28 | What is the diagnostic triad of Thrombotic Thrombocytopenic Purpura (TTP) / pentad, and why is platelet transfusion contraindicated? | Microangiopathic haemolytic anaemia (schistocytes), severe thrombocytopenia, acute renal impairment, neurological symptoms, and fever (due to ADAMTS13 deficiency); platelet transfusion fuels microvascular thrombosis—treat urgently with Plasma Exchange. | | | | 29 | Compare Section 135 and Section 136 of the Mental Health Act 1983. | Section 135 allows police (with a magistrate's warrant and AMHP) to enter a private residence to remove a person to a place of safety (up to 24h); Section 136 allows police (without a warrant) to remove a person from a public place to a place of safety (up to 24h). | | | | 30 | When treating combined Vitamin B12 and Folate deficiency, why must Vitamin B12 (hydroxocobalamin) always be replaced BEFORE starting folic acid? | Giving folic acid alone when B12 is deficient can precipitate irreversible Subacute Combined Degeneration of the Spinal Cord (dorsal columns + lateral corticospinal tracts). | | | | 31 | After an Acute Ischaemic Stroke in a patient with Atrial Fibrillation, why is therapeutic anticoagulation delayed rather than started on Day 1? | To reduce the risk of haemorrhagic transformation; Aspirin 300 mg is given for the first 1–14 days (depending on infarct size) before switching to a DOAC. | | | | 32 | In Iron Deficiency Anaemia in a man of any age or a non-menstruating woman, what is the mandatory NICE referral action? | Urgent 2-week-wait suspected cancer referral for upper and lower GI investigations (OGD and colonoscopy/CT colonography) to exclude colorectal or gastric malignancy. | | | --- Study this deck interactively with FSRS-6 spaced repetition, audio review, and multiple-choice mode at [Flashcards World](https://flashcards.world/flashcards/sets/4334160e-928f-402c-aa82-7d19d18d3adf/).