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).

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).

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.

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.

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.

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).

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).

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.

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.

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.

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).

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).

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.

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).

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.

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.

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.

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.

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.

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.

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).

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).

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.

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.

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.

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).

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.

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.

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).

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).

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.

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.

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.

Level: intermediate
Languages: en → en
Cards: 32
Markdown: UKMLA & PLAB 1 Medicine II (NICE Guidelines): Neurology, Psychiatry (Mental Health Act), Infectious Diseases, Rheumatology & Haematology (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
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.