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3A/3B Deck Flashcards

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1
Q

Wet, Wacky, Wobbly?

A

Normal Pressure Hydrocephalus

  • Urinary incontinence
  • Dementia
  • Gait disturbance
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2
Q

Normal Pressure Hydrocephalus

A

Wet, Wacky, Wobbly:

  • Urinary incontinence
  • Dementia
  • Gait disturbance
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3
Q

Delirium Causes

A

PINCH ME
Pain

Infection / intoxication:
UTI, pneumonia, sepsis, meningitis, encephalitis, malaria

Nutrition
Vitamin deficiency - Thiamine, nicotinic acid, B12/Folate

Constipation

Hypoxia / hydration

Medication / drugs / substance abuse
Benzodiazepines, anticholinergics, anaesthetics, opiates, anticonvulsants, alcohol

Environmental

Others:
Surgical post op
Vascular -Stroke, HF, SAH, SDH, vasculitis, migraines
Metabolic - Hypoxia, electrolyte imbalance, renal/hepatic impairment, hypoglycaemia
Endocrine pathology -Hypo/hyperthyroid, Cushings, porphyria
Head trauma
Epilepsy

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4
Q

Osteoporosis risk factors

A 
SHATTERED
Steroids 
hyperthyroidism, hyperparathyroid, hypocalcaemia 
Alcohol / tobacco 
Thin 
Testosterone - low 
Early menopause - oestrogen deficiency 
Renal / liver disease
Erosive / IBD
Dietary intake - low Calcium / T1DM
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5
Q

Tonsilitis Tx

A

Symptomatic - paracetamol

Abx - Penicillin

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6
Q

Otitis Media Tx

A

Pain relief

Abx - amoxicillin

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7
Q

Sinusitis

A

98% viral - self limiting
Often secondary bacterial infection - (SAME ORGANISMS as OM)
Abx - amoxicillin

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8
Q

Croup Tx

A

Oral Dexamethasone +/- ABC+Oxygen +/- nebulised adrenaline

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9
Q

Acute epiglottitis Tx + organism

A

Haemophilus influenza tybe B

Intubation
Possible tracheostomy
Cefotaxime

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10
Q

Whooping Cough Tx + Organism

School leave?

A

Bordatella Pertussis
Azithromycin / clarithromycin / erythromycin

48hrs after Abx start - Abx do not alter course of disease - just infectivity

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11
Q

Pneumonia Tx

A

Amoxicillin
OR: clarithromycin, co-amoxiclav, azithromycin
Drainage of empyema - if unwell after period of improvement

Infants - GBS
Kids - Strep. Pneu / H.Influ / TB

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12
Q

ToF Features

A 
PROVE
Pulmonary stenosis 
RV Hypertrophy 
Overriding Aorta 
VSD
Ejection systolic murmur
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13
Q

Infective endocarditis Tx

A

BLIND - after 3 cultures - Benpen + gentamicin

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14
Q

Rheumatic Fever Tx + Organism

Diagnostic Criteria?

A 
Group A B-haemolytic Strep - PYOGENES
JONES criteria - 2major / 1major+2minor - (JONES PEACE)
Joints - large joint arthritis 
O - carditis 
N - nodules - painless + subcutaneous 
E - erythema marginatum 
S - syndenham's chorea

P - PR interval prolongation 
E - ESR v raised
A - arthralgia 
C - CRP raised 
E - elevated temp

Aspirin
Benpen - help strep throat
Prednisolone - for Syndenhams chorea (consider haloperidol)

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15
Q

Measles Organism + features

A

Paramyxovirus - RNA morbillivirus
4C’s - cough, coryza, conjunctivitis, Cranky
Koplik spots
RASH

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16
Q

Scarlet Fever Tx

A

Penicillin + azithromycin

Ibuprofen + paracetamol

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17
Q

Imetigo Tx

A

Fusidic acid + oral flucloxacillin

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18
Q

Complications of meningitis

A 
SHAPD
Sepsis 
Hydrocephalus / encephalitis
Abcess
Paralysis
Deafness - serineuonal hearing loss - MOST COMMON
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19
Q

Toxic shock syndrome Tx + Organisms

A

Toxin = producing s.aureus + group A strep

Clindamycin + ceftriaxone

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20
Q

Complications of preterm?

A

Heads - intraventricular haemorrhage, hypoxic ischaemic damage
Hearts - Patent ductus
and Lungs - respiratory distress syndrome
and Guts - NEC
and Retinitis drives me nuts!

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21
Q

TB Tx?

A 
RIPE
Rifampicin 
Isoniazide 
pyrazinomaide 
Ethambutol
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22
Q

5 stages of chemo

A 
Induction 
Consolidation 
Interim Maintenance 
Delayed intensification 
Maintenance
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23
Q

Histo finding of dermoid cyst?

A

Rokitansky’s protuberance

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24
Q

Signs of shock?

A 
I-SHOCKS
Increased RR
Sinus Tachycardia
hypotension 
Oliguria 
Cold 
Klammy 
Slow capillary refill
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25
SIRS criteria
``` 3 T's white with sugar: -Tachycardia Tachypnoea Temp (low or high) WBC low or high Sugar >7.7 - in absence of DM ```
26
Depression symptoms?
``` DEADSWAMP Depression Energy low Anhedonia Death thoughts ``` Sleep disturbance (insomnia / early morning waking) Worthlessness/Guilt Appetite / Weight change Mentation change - lack of concentration Psychomotor retardation / agitation
27
Who should you tell about a never event?
NRLS + StEIS
28
Key Wernicke's / Korsakoff features?
werNICkes Nystagmus Incoordination / ataxia Confusion - i.e. delirium KorSAKoffs - pSychosis - Anterograde amnesia + hallucinations (lilliputlin / formication) - (K)Confabulation
29
Cerebellar signs?
``` DANISH: Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred staccato speech Hypotonia ```
30
Vasculitis screen? 5 domains
[FUEL CAB] FBC - think EOSINOPHILS (churg-strauss) Urine ESR/CRP Liver - clotting CXR / CT pulmonary ANCA Biopsy
31
Post vasculitis screen - further Ix
[EM...III] EMG - neuropathy Myeloma screen Imaging - MRI, PET Infection - sepsis, HepB (in PAN) Imunology - RF/ACCP, ANCA, ANA, dsDNA
32
FRAX - mad formation
3-3-3-2 [estimate of 10 year fracture risk with low BMD) 3 person - Age, sex, BMI 3 fracture - previous?, parent hip fracture, low femoral neck BMD 3 put in - Alcohol, smoking, glucocorticoids 2 conditions - RA, secondary osteoporosis
33
How to tell #NOF on X-ray
Shenton's line broken
34
Secondary risk factors of osteoporosis?
SHATTERED Steroids + Cushings H - HyperTh, hyperPTh, Hypercalciuria A - Alcohol + tobacco T - thin (BMI<19) T - testosterone decreased - primary hypogonadism / anti-androgens E - Early menopause (<45) R - renal/liver function - chronic liver disease/ renal osteodystrophy in CKD E - erosive/inflam disease - RA, myeloma, mets D - diet - Ca/T1DM, malabsorption, malnutrition
35
Common sites for osteoprotic #
Sheffield Wednesday Protects Hillsborough Spine - crush Wrist - distal radius Pelvis Hip
36
What's covered in bony profile bloods?
``` Ca Vit D Phos PTH ALP ```
37
XR OA?
``` LOSS loss of joint space osteophytes subchondral/subarticular sclerosis subchondral cysts ```
38
XR RA?
``` LESS Loss of joint space Erosions Softening of bones (periarticular osteopenia) Soft tissue swelling ```
39
Common co-infection with polyarteritis nodosa?
Hep B
40
Pres of SLE?
Criteria + systemic: fatigue, fever, weight loss, lymphadenopathy 4/11 of DOPAMINE RASH: - Discoid rash - Oral ulcers - usually painless - photosensitive rash - skin rash from sunlight - Arthritis - deforming BUT non-erosive 2+ joints (similar deformities to RA) - Malar Rash - Immunological phenomena - dsDNA, anti-smith - Neuro symps - seizures/psychosis/autonomic disorder/headache - literally anything - ESR raised (*NOT CRP) + LOW COMPLEMENT - Renal disorder - proteinuria >0.5g/day or +++ (lupus nephritis) - ANA +ve - Serositis - pleuritis (pleural rub on ausc or pleural effusion) / pericarditis (ECG, pericardial rub) - Haematological - haemolytic anaemia (Coombs +ve), Neutropenia, thrombocytopenia, lymphopenia
41
Reiter's syndrome
Can't see (uveitis) Can't pee (urethritis) Can't climb a tree (arthritis)
42
Associations with ankylosing spondylitis?
The 6 A's: ``` Apical Lung Fibrosis Anterior uveitis Aortic regurg Achilles tendonitis Aortic incompetence - dissection/regurg Amyloidosis ```
43
Muscle blood tests/screen?
CK LDH Aldolase
44
Signs of compartment syndrome?
6 P's!!!
45
Kawasaki's age + symptoms? Major complication?
6months-5years CRASH and BURN (MyHEART as well ;) ) Conjunctivitis (bilateral + non-purulent) Rash - non-vesicular Adenopathy (cervical + unilateral) Strawberry tongue + inflammation of mouth + lips (cracked lips) Hands/feet - palmer erythema/swelling/desquamation (2-5days after onset) Fever > 5days (BURN) Comp - coronary artery aneurysm!! (do ECHO) --> deaths+signif. morbidity
46
Red Flags of Back pain?
TUNA FISH: Trauma Unexpected weight loss/loss of appetite Neuro symps - CAUDA EQUINA Age: >50 , <20 Fever/night sweats - osteomyelitis/cancer Immunosuppression/IVDU - osteomyelitis Steroid use - immunocomprimise/osteoporotic # History of cancer: Prostate, breast, lung, renal
47
Felty syndrome
``` SANTA: Splenomegaly Anaemia Neutropenia - low WCC Thrombocytopenia Arthritis - RA ``` (also leg ulcers + brown pigmentation of legs)
48
ECG of RBBB vs LBBB (v basically)
Broad QRS > 0.12ms MarroW - RBBB V1 - rSR' V6 - deep wide slurred S WilliaM - LBBB V1 - rS - deep S wave V6 - Broad R (may look like m) + absent Q waves
49
Digoxin drug interations? - i.e. induce toxicity
SAC those drugs, if you're gonna use them with digoxin you must be LOOPY S - spironalactone A - amiodarone C - CCB LOOPY - loop diuretics/thiazides - hypokalaemia - toxicity
50
X-ray signs of HF?
``` ABCDE: alveolar oedema Kerley B-lines cardiomegaly dilated pulmonary vessels effusion ```
51
Infective endocarditis: Most common symps? Signs
*Most common - fever, chills, weight loss, poor appetite FROM JANE: Fever>38 + tachycardia Roth spots - eyes, retinal haemorrhage with pale centre Osler's nodes - painful red blisters @ terminal phalanges + toes Murmur - tricuspid w/ s.aureus Janeway lesions - painless red maculae on thenar eminence Anaemia/arthritis: subacute - >3 joints (asymmetrical). acute: 1 joint septic Nail splinter haemorrhages Embolic phenomena - e.g. stroke
52
Given post-MI (not acute)
ABSeeD ACE-I BB Statin Dual antiplatelet - aspirin, clopidogrel
53
Complication of MI
``` DEPARTS + Fail Death, dresslers Electrical activity - arrhythmias - tachy/brady Pericarditis (acute), papillary muscle rupture Aneurysm --> persistent ST elevation Re-MI / rupture - tamponade Thrombus Shock - cardiogenic ``` Heart Failure - pulmonary oedema --> give B-BLOCKER! - bisoprolol
54
What is beck's triad?
Cardiac tamponade: - Decreased heart sounds - distended jugular veins - decreased arterial blood pressure
55
Triad in cardiac tamponade?
Beck's triad: - Decreased heart sounds - distended jugular veins - decreased arterial blood pressure
56
Key signs of sepsis? (score)
``` SOFA score (2+ is not good) HAT: Hypotension < 100 Altered mental state GCS<15 Tachypnoea >=22 ```
57
Normal CAP / HAP pneumonia organisms?
CAP: S.pneumoniae, H.Influenza (*esp in COPD) HAP: (Gram-ve bacilli) E.coli, klebsiella, pseudomonas aeruginosa, MRSA
58
Atypical CAP organisms?
Mycoplasm pneumonia - common in young adults Legionella pneumonia - air con! Chlamydia pneumoniae Chlamydia psitacci - bird fanciers
59
Mx of TB?
RIPE DOTS: Rifampicin 6M - liver tox, orange secretions Isoniazid 6M - liver tox, peripheral neuropathy Pyrazinamide 2M - liver tox, hepatitis Ethambutol 2M - visual disturbance, optic neuritis DOTS - directly observed therapy 3x/week Check LFTs before Check vision with Snellen
60
O/E of pulmonary fibrosis?
``` 4 D's: Digital clubbing Dry cough Dyspnoea Diffuse inspiratory crackles ```
61
Upper vs Lower lung fibrosis diseases/causes?
``` Upper - ESCHART (granulomatous disease) Extrinsic allergic alveolitis Sarcoidosis/silicosis Coal worker's pneumoconiosis Histiocytosis X Ankylosing spondylitis Radiotherapy TB ``` ``` Lower - RASCO (systemic disease) RA Asbestosis Systemic sclerosis/SLE Cryptogenic fibrosing alveolitis Other (drugs) - amiodarone, methotrexate, bleomycin ```
62
Causes of BHL (bilateral hilar lymphadenopathy)
``` TIMES TB Inorganic dust - Silicosis Malignancy - carcinoma, lymphoma, mediastinal EAA Sarcoidosis ```
63
Red flags for dyspepsia?
Weight loss, recurrent vomiting, dysphagia, chronic bleeding ALARMS: Anaemia, Loss of wt, Anorexia, Recent onset (if >55), Melaena, swallowing difficulty
64
H pylori mx?
PAM/PAC: PPI + amox + metron/clarith
65
Antibodies in CD / UC?
UC - pANCA | CD - ASCA
66
Types (+examples) of laxatives? 4 types!
Bulk forming - increase faecal mass, improve peristalsis - e.g. isphagula husk Stool softener - for impacted faeces - e.g. docusate Stimulant - increase motility - e.g. senna Osmotic - retain water in bowel - e.g. lactulose
67
Foods containing copper (i.e. to avoid in Wilson's)
Chocolate nuts mushrooms liver
68
Drugs affecting liver/hepatotoxic?
Paracetamol Alcohol Meds: Ciproflox, Methotrexate, Amox, flucolox, diclofenac
69
Signs of chronic liver disease?
``` FLAPSS Finger clubbing Leukonychia Asterixis (liver flap) Palmar erythema Shifting dullness Spider naevi/scratch marks (pruritis) ``` Bleeding (+ caput medusae)
70
Alcoholic Hepatitis triad?
Fever Mallory bodies Steatosis
71
Hepatitis B serology?
``` Surface antigen (HBsAg) – active infection E antigen (HBeAg) – marker of viral replication and implies high infectivity ``` ``` Core antibodies (HBcAb) – implies past or current infection - IgM (current), IgG (past infection) Surface antibody (HBsAb) – implies vaccination or past or current infection E antibody (HBeAb) = immune response ``` Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load
72
Causes of acute pancreatitis?
``` GET SMASHED Gallstones Ethanol (alcohol) Trauma Scorpions mumps AI Steroids Hyperlipidaemia/hypothermia/hypercalcaemia ERCP Drugs ```
73
Score for pacreatitis severity? (also good for remembering some Ix)
``` Glasgow score PANCREAS PaO2 < 8kPa (remember sepsis+pancreatitis = main cause of ARDS) Age > 55 Neutrophillia (WCC>15) Calcium <2mmol/L Renal, urea >16mmol/L Enzymes: -AST/ALT >200units -Albumin <32g/L -Sugar > 10mmol/L ```
74
Retroperitoneal structures?
``` SADPUCKER SVC Aorta/IVC Duodenum (2+3) Pancreas Ureters Colon Kidneys Esophagus Rectum ```
75
Who gets gallstones?
Fair, fat, female, fertile, forty, family history
76
Antibodies of PSC / PBC?
p-ANCA - PSC - primary sclerosing cholangitis AMA - PBC - primary billiary cirrhosis
77
Management of Hep B / Hep C
Pegylated interferon alpha Hep B - tenofovir (2nd line) Hep C - ribavarin w/ interferon
78
What causes activation of RAAS (i.e. release of renin) - where exactly??
Reduced perfusion to afferent arteriole --> juxtaglomerular apparatus
79
Nephrotoxic drugs?
``` CANT DAMAG Contrast Antibiotics (penicillin/ceph) NSAIDs Trimethoprim Diuretics ACE-I Metformin ARBs gentamicin!!!! ```
80
Indications for dialysis in severe AKI?
AEIOU (VOWELS) Acidosis (severe + unresponsive to treatment) Electrolyte imbalance (Hyperkalaemia + not responding to treatment) Intoxication (overdose of certain meds) Oedema (severe and unresponsive pulmonary oedema) Uraemia (seizures + reduced consciousness)
81
Why potential hyperglycaemia in peritoneal dialysis? | Other complications?
As dialysate = dextrose ``` Infection - peritonitis Blockage/infection/leak of catheter Fluid retention/weight gain Constipation Hernia ```
82
Nephritic vs Nephrotic BASICS?
Nephritic: - PROLIFERATIVE HTN --> glomerular inflam --> oliguria Haemturia - Dark urine - like coca-cola Main cause - IgA Berger's disease ``` Nephrotic: - NON_PROLIFERATIVE Main cause - FSG (focal segmental glomerular nephritis) [also main cause of glomerularnephrtitis in general] Triad: Hypoalbuminaemia Proteinuria Oedema (hyperlipidaemia) ```
83
Management of mod-severe Glomerulonephritis? (haematuria, proteinuria, low GFR) If nephrotic?
FAAP Furosemide, ACE-I/ARB, ABx, Pred nephrotic - immunosuppressant - cyclophosphamide
84
PKD characteristics?
Renal + extra-renal cysts Intracranial aneurysms (aortic root dilatation and aneurysms)
85
BPH symptoms? (urinary symptoms in general really)
Storage symptoms [FUN] Frequency, urgency, nocturia Voiding symptoms [HIIPP] hesitency, intermittent/incomplete emptying, poor flow /post-void dribbling
86
Very low risk prostate cancer scores (PSA + gleason + T-score)?
PSA<10 Gleason =< 6 T1/T2
87
Opioids in kidney disease? Why not morphine/codeine?
tramadol + oxycodone Morphine + codeine = accumulate in kidney disease
88
AKI - define
Rise in serum creatinine of 26+ µmol/L in 48 hours. =>50% rise in serum creatinine in last 7 days A drop in urine output to 0.5 ml/kg/hour for: - 6 hours in adults - 8 hours in children and young people
89
Acute COPD exacerbation?
``` SHONA Steroids - oral pred Heparin Oxygen (88-92%) Neb bronchodilators - SABA+SAMA (Salbutamol + Ipratropium) Abx ```
90
Foods that contain oxalate?
Chocolate Tea Nuts
91
Testicular swellings? 1. Separate and cystic? 2. Separate and solid? 3. Testicular and cystic? 4. Testicular and solid? 5. Can't get above?
Epidydimal cyst Epididymitis / varicocele Hydrocele Tumour/orchitis Inguinal hernia
92
Testie torsion pres? Mx? | Ddx?
TENDER, SWOLLEN, RED, HOT, HIGH, TRANSVERSE LIE Absent cremasteric reflex N+V Mx: orchidectomy + bilateral fixation Ddx: Testie appendix torsion (hydatid of morgagni) Epididymo-orchitis
93
Testicular Ca Ix?
BALUC (like bollock) B-hCG - AFP LDH USS CT abdo pelvis - LNs
94
Psychological therapies (for psych)?
Primary care: Counselling Psychoeducation (group/individual) CBT ``` Secondary care: Group therapy Family therapy Psychoanalytic psychotherapy Referral to CMHT ```
95
Examples for Bio-Psych-Social managment approach in psych?
Bio - DRUGS Psych - CBT, Psychoeducation, Counselling, Group therapy Social - Support (family/carer), Work/Education, Support with engagement/benefits
96
Clinical features of Dementia? (4 A's)
Aphasia Apraxia Agnosia Amnesia - anterograde (can't create new memories)
97
First rank schneiderlain symptoms (schiz)
PETER TAKES DINNER HOME Passivity phenoma Thought disorder Delusional perception Hallucinations - 3rd person auditory
98
Psychiatric assessment
Risk to self Risk to others Risk from others Risk of criminal damage to property
99
Suicide risk assessment? Mx for each score (4 sets)?
``` SAD PERSONS Sex (M>F) Age (peaks in young/old) Depression Previous attempts Ethanol - alcohol Rational thinking loss - e.g. schiz / severe depression Support network lost Organised? - note/ avoid detection/ planned or impulsive No significant other Sickness - e.g. physical disease ``` Scores: 0-2 = keep watch 3-4 = check frequently 5-6 = consider hospital - involuntary/voluntary 7-10 - definite hospital - involuntary/voluntary
100
Causes of polyhydramnias?
DITCH Diabetes - causes fetal polyuria = ^AM Idiopathic/infection (parvovirus/CMV) Twins - (+TTTS) Congen abnormalties (e.g. fetal duodenal atresia-swallow difficulty) Heart failure (due to VSD/Down's) - causes fetal polyuria (due to ^BNP)= ^AF
101
Risks of polyhydramnios? (6 Ps)
``` Placental abruption Pretty unusual lie Premature labour Prolapse cord Post partum haemorrhage Perinatal mortality ```
102
4 main indications for induction? (4 Ps)
Post dates Pre-labour rupture of membranes Pre-Eclampsia Plus Diabetes
103
Diabetes risks in pregnancy?
``` SMASH Shoulder dystocia Macrosomia Amniotic fluid excess - polyhydramnios Stillbirth Hypertension + neonatal hypoglycaemia ``` +Miscarriages + congenital malformations = if preceding diabetes
104
Gestational diabetes levels?
5, 6, 7, 8 Fasting >5.6 2hours post glucose >7.8
105
When to give Aspirin 75mg as prophylaxis for pre-eclampsia?
``` ECLAMPT Existing hypertension CKD Lupus Anti-phospholipid Maternal diabetes - pre-existing Previous hypertension in pregnancy Twins ``` (+nulliparity + obesity + Fam Hx)
106
Complications of pre-eclampsia? Fetal + Maternal
FIP (fetal) SHAME (maternal) Fetal growth restriction Intrauterine death Premature delivery ``` Stroke HELLP Abruption of placenta Multi-organ failure (+DIC +/- death) Eclampsia ```
107
Types of Small for gestational age - which is IUGR?
SWAN Starved small (IUGR) - pre-eclampsia, drug/alcohol abuse Wrong small - i.e. wrong dates Abnormal small - congentital/chromosomal things Normal small - genetic (growth velocity ok)
108
Complications of prematurity What reduces risk of these? Drug!
Heads, hearts, lungs, and guts (lungs and guts) x2 ..and Retinitis drives me nuts ``` Resp distress Interventricular haemorrhage necrotising enterocolitis (retinitis) congenital heart abnormalities - patent ductus! ``` Maternal steroids!!! - IM dexa
109
High risk factors for IUGR?
``` SHITS (common) CRAP (rare) Smoking Hypertension & pre-eclampsia IUGR previous Twins Previous stillbirth ``` Cocaine use Renal disease Antiphospholipid PAPPA levels low
110
Hyperkalaemia management?
C BIG K DRopS Calcium gluconate - cardioprotective - IV (up to 4 doses) Bicarbonates - sodium bicarb Insulin - IV Actrapid Glucose - IV - 250ml 10% glucose (15-30mins) Kayexalate - binds K+ in GI tract (Calcium resonium) Diuretics - if kidneys GOOD Renal Dialysis - if kidneys BAD (either HD / PD) Salbutamol - Nebs
111
Hyperkalaemia causes
Drugs: ACE-I/ARBs Diuretics - K+sparing - spironolactone, amilliride Beta-blockers Conditions: AKI Rhabdomyolysis (causes AKI aswell - myoglobin deposits in kidneys and forms casts) K+ predominantly intracellular CKD Addison's - K+ ^ in renal addison's (as driven by ACTH - which is high in renal, low in central)
112
Hyperkalaemia ECG
Tall tented T-waves Small/absent p waves Broad QRS
113
APTT measures what drug? | PT measures what drug?
APTT - heparin/LMWH | PT - warfarin - extrinsic pathway
114
Quick trick for hepatically excreted drugs? Why?
blood brain barrier drugs (i.e. neuro/nerve shit) - as need to be fat soluble to cross BBB
115
What renal patients does ACE-I not work?
if renovascular disease / hypovolaemia is the cause of AKI USED IF PROTEINURIA! Use as happy to accept small dip in GFR for benefits
116
Extra Mx for STI? (sex)
SEX Screen for other STIs Education - e.g. condom use Explain about partner education
117
PCOS criteria (i.e. signs and symptoms). Hint - where did Villa win the european cup??
ROTTERDAM ``` SHOP string of pearls hyperandrogenism - acne+hirsutism Oligomenorrhea - irregular + heavy Prolactin normal (also insulin resistance) ```
118
Risk factors for Ectopic? (kate middleton's sister)
``` PIPPA (1/3rd have no risk factors) Previous ectopic IUD - (if got pregnant with it in) Pelvic/tubal surgery PID Assisted reproduction ```
119
Common types of HPV + associations? (nursery rhyme)
1 and 2, do up my shoe (veruccas) 11 and 6, warts on pricks (genital warts) Please beware sweet little 16 Like number 18, she's an oncogene (Cervical cancer)
120
Causes of cerebellar signs?
PASTIES ``` P - Posterior fossa tumour A - Alcohol S - Multiple sclerosis T - Trauma I - Inherited (e.g. Friedreich's ataxia) E - Epilepsy treatments S - Stroke ```
121
What triggers a sickle cell crisis?
CHIDS: ``` Cold Hypoxia (extreme exercise) Infection Dehydration Stress ```
122
Common cytokines amongst seronegative arthropathies?
TNF + IL-17 (why they have linked features)
123
Nail changes psoriatic arthritis
Pitting | Oncholysis - nail separates from bed
124
COMMON EXAM QUESTIONS -'YOUNG PERSON GOING ABROAD'
``` REACTIVE ARTHRITIS (?i.e. because of STI?) - ITS CHLAYMDIA BRUV ``` or a GI infection - Campylobacter/salmonella/shigella
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Organs / Features of MM? Protein present in Urine? Blood film finding?
``` CRAB Calcium elevation Renal impariment Anaemia Bone disease - lytic / osteoporotic ``` Bence Jones Protein rouleaux formation - stacking of RBCs
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Philadelphia chromosome?
T(9:22)
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TTP = EMERGENCY. Pentad of symps?
Fuck Renal HTN ``` Fever Renal failure Haemolytic anaemia Thrombocytopenia Neuro change ```
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TTP absence of what? Gene mutation?
VWF cleaving protein [ADAMTS-13]
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Rituximab indications - EXAM QUESTION! it is an example of a biologic drug
RA, lymphoma, ANCA associated vasculitis, SLE
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Used in HyperThy instead of Carbimazole if pregnant????
Propylthiouracil
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Symptoms of hypercalcaemia? QT length? Muscles?
Bones, stones, abdominal moans, thrones, psychic overtones - Painful bones (osteitis fibrosa cystica) - thrones - polyuria - psychic - depression, psychosis, memory loss Short QT Muscle weakness/fatigue
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Hypercalcaemia long term complication - after penia+porosis
Osteitis fibrosa cystica - pepperpot skull + subperiostal resorption (phalanges)
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What stimulates prolactin release at ant. pit?
TRH - so think about primary hypothyroid in prolactinaemia causes
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Difference between acromegaly and gigantism?
Gigantism = before closure of epiphyseal plates! I.e. when young!
135
Layers of adrenals?
GFR - Salt, Sugar, Sex (the lower you go the sweeter it gets!) Zone glomerulosa - mineralocorticoids - aldosterone Zona fasiculata - glucocorticoid - cortisol Zona reticularis - androgens - DHEA
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Effects of cortisol?
RIDGE ``` Reproduction SUPPRESSION Immunity SUPPRESSION Digestion SUPPRESSION Growth SUPPRESSION Energy MOBILISATION ```
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Addison's features?
5 Ts ``` Tearful - depression, confusion, Thin - anorexia, weight loss, N+V Tanned - skin pigmentation Tired - fatigue + muscle weakness Tumbling - faintness due to hypotenison ```
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Bronchiolitis poem
In kids under 1, there's a common disease With cough, snotty nose, crackles and wheeze Always record the respiratory rate If it's severe, they'll desaturate
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ToF features? Embryology
``` PROVE Pulmonary stenosis...causing: RVH over-riding aorta VSD - R-->L shunt (due to pulmonary stenosis) Ejection systolic murmur ``` UNEQUAL PARTITIONING OF TRUNCUS ARTERIOSUS
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Down's syndrome face / head features? Others?
ROSEOLA (n.b. roseola not more common in down's) Round face Occipital flattening (&nasal flattening) Speckled iris (Brushfield spots) + Squint Epicanthic folds Open mouth + protruding tongue Low set ears Almond (oval) up-slanted eyes Others: Hand - single transverse palmar crease, short fingers, curved little finger Feet - sandal gap
141
AVPU score meaning?
Alert? responds to voice? responds to pain? Unresponsive?
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Status epilepticus management!
Oh My Lord Phone the Anaesthetist Oxygen (after ABC) Midazolam (buccal / rectal diazepam / IV lorazepam) Lorazepam IV (after 10mins) Phenytoin IV Rapid induction of anaethesia - risk of aspiration!!
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What prompts admission for bronchiolitis?
DRAMAS ``` Dehydration Resp rate >70 / marked increased WOB - recession/grunting Apnoeic episodes Milk/fluid intake <50% of normal Appearance - ill / exhausted Sats <92% ```
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Asthma Ix + signs of severe asthma?
5 PROPS ``` Peak flow - <50% best/predicted RR >30 O2 sats <92% Pulse >125/min Sentances - too breathless to talk ```
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Life threatening asthma?
33, 92 CHEST ``` PEF < 33% best/predicted Sats < 92% .... and any one of: - Cyanosis - Hypotension - Exhausation w/ poor resp effort - Silent chest - Tired / confused (i.e. reduced conscious level) ```
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What to give with methotrexate in Rheumatoid, why here and not in anti-cancer?
FOLIC ACID - as in rheumatoid = not using this function to treat. Using another methotrexate function
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Examples of anti-TNF What is rituximanb? What is tocilizumab? What effect does this have on what inflam marker? significance?
Infliximab Etanercept Golimumab Adalimumab Ritux = anti CD20 - anti-B cells Tocilizumab (anti IL-6) - this is a pre-cursor for CRP - so will have low CRP - issue if expecting high CRP - need to know if taking this drug - i.e. in septic arthritis will not see ^CRP
148
What is the epidermis made out of? | 4 layers pls
Keratinocytes (at different levels of maturation ``` BROWN SLUGS GRAB COCKS Stratum: - Basale - Spinosum - Granulosum - Corneum ```
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SEs of oral corticosteroids?
SHIP DOC ``` Syndrome (Cushing's) HTN Immunosuppresion Psychosis Diabetes Osteoporosis Cataracts ```
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What not to give in Acne (may give it in other skin conditions)
Oral/Systemic STEROIDS!! - Causes acne!!! - e.g. Cushing's ?topical ok?
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investigation for alopecia?
Positive hair pull test (>5)
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How does urticaria present?
WHEALS (think about nettle sting!!)
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Other than Topical retinoids + ABx / Oral retinoids, what can you give in mod/severe acne?
COCP - in females!!!
154
Path salivary gland swelling?
Infection, inflammation, obstruction, tumour
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Autonomic comps of tricyclics?
TURD MOUTH + constipation Tachycardia Urinary retention Dry mouth
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Endoderm, ectoderm, mesoderm - what do they form?
Endo - Liver, pancreas Ecto - brain, spinal cord, skin Meso - muscles, bones, heart + circulation
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Tonsilitis - bug. Scoring system? Mx?
``` Viral - coxsackie, EBV, HSV Strep Pyogenes - FeverPAIN - Fever >38 in last 24hours - Purulent tonsils - Absence of cough - Inflammed tonsils - New onset (<=3days) ``` 3 or 4 = 40-60% chance bacterial Mx: Antipyretics - NSAIDs/paracetamol Abx - penicillin V
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Quinsy also known as? What is it?
Peritonsilar abcess. Comp of tonsilitis - pus trapped between tonsil + pharyngeal wall
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Otitis media - comps?
common: OME, CSOM, perforation | MASTOIDITIS, facial nerve palsy, meningitis
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GCS score?
EVM | 456
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Cushings triad (in ^ICP)
Bradycardia, hypotension, apnoea
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4 stages of HIV?
Seroconversion / primary - short illness soon after infection (highest infectivity) - ABs detectable, antigens not! - BLOTCHY RED RASH Asymptomatic HIV infection - can last years - progressive CD4 depletion + lymphadenopathy Symptomatic HIV - Opportunistic infections + some cancers Late stage HIV +/- AIDS - Further opportunistic infections - AIDs related complex
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When to consider viral haemorhagic fever? NOTIFY PUBLIC HEALTH ENGLAND
unexplained pyrexia hypovolaemia, bleeding, ^vascular permeability, organ failure -essentially just lose everything - all clotting prolonged, leukocytopenia, thrombocytopaenia
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Sleeping sickness also known as?
Trypanosomiasis
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3 malaria species pls?
Plasmodium Falciparum P. Vivax P. Ovale
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Brain stem death signs?
``` No resp effort in reaction to turning off ventilator No response to pain REFLEXES: - No pupil light refex - No corneal reflex - No cough reflex - no response to supra-orbital pressure ```
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Zoledronic acid SEs?
Osteonecrosis of jaw Gastritis Oesophagitis
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Drug causes of reduced sodium?
``` Steroids PPI (change it to ranitidine) SSRI Carbamazepine Fluids Thiazide diuretics ```
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Complications of malaria?
``` CHARD Cerebral malaria Hypoglycaemia ARDS Renal impairment DIC ``` (pre-hepatic jaundice (haem anaemia) + hepatitis)
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Risk with chemo induced myelosuppression?
Neutropenic sepsis
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Meds that worsen hypercalcaemia?
Thiazide diuretics Lithium Calcium supplements
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What is tumour lysis syndrome? Most common Ca to get it in? Why do you get AKI?
Excessive cell lysis Metabolic + electrolyte imbalances = upon starting cytotoxic treatment --> ^Uric acid mainly Lymphoma AKI = due to uric acid nephropathy
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Lab findings tumour lysis syndrome?
Hyperuracaemia, hyperkalaemia, hyperphosphataemia - arrhythmia Hypo calcaemia - muscle cramps, tetany
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Management of tumour lysis syndrome?
``` allopurinol rasburicase Mx of hyperkalaemia Fluids consider dialysis ```
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Comps/symps of liver disease?
JEBA (JABBA THE HUT) Jaundice encephalopathy bleeding ascites
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Features of mania?
I DIG FAST ``` Insight lost Distractibility Impulsivity Grandiosity Flight of ideas Activty increase Sleep deficit Talkitiveness ```
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Charcot's triad? (For ascending cholangitis)
RUQ pain Fever Jaundice
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How to assess Abdo Xray?
Big Cuddly Spanish Giants Bones, Calcium, Soft Tissue, Gas
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Ages for Leukaemias?
ALL CeLL mates have CoMmon AMbitions (ages 45-75 = go up in 10s) ALL - < 5 + > 45years CLL - >55yrs CML - >65yrs AML - >75yrs
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4 strengths of topical steroid cream (getting stronger)
Harvey Elliot Beats Defenders Hydrocortisone Clobetasone butyrate (Eumovate) Betamethasone valerate (Betnovate) Clobetasol propionate (Dermovate)

Mnemonics / quick learn (7 decks)

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