AKT 4 Flashcards
(532 cards)
1
Q
What is the initial empirical therapy for meningitis in patients aged < 3 months?
A
IV cefotaxime + amoxicillin (or ampicillin)
This treatment covers common pathogens in young infants.
2
Q
What is the recommended initial empirical therapy for meningitis in patients aged 3 months to 59 years?
A
IV ceftriaxone
Ceftriaxone is effective against many pathogens causing meningitis in this age group.
3
Q
What is the initial empirical therapy for meningitis in patients aged ≥ 60 years?
A
IV ceftriaxone + amoxicillin (or ampicillin)
This combination targets a broader range of pathogens due to increased risk in older adults.
4
Q
What is the treatment for meningococcal meningitis?
A
IV benzylpenicillin or IV ceftriaxone
Both antibiotics are effective against Neisseria meningitidis.
5
Q
What is the recommended treatment for pneumococcal meningitis?
A
IV ceftriaxone
Ceftriaxone is a preferred agent for Streptococcus pneumoniae infections.
6
Q
What is the treatment for meningitis caused by Haemophilus influenzae?
A
IV ceftriaxone
This antibiotic effectively targets Haemophilus influenzae.
7
Q
What is the treatment for meningitis caused by Listeria?
A
IV amoxicillin (or ampicillin) + gentamicin
This combination is used to effectively treat Listeria monocytogenes infections.
8
Q
When do most neurologists start antiepileptics?
A
Following a second epileptic seizure
9
Q
What does NICE guidelines suggest regarding starting antiepileptics after the first seizure?
A
Start if any of the following are present:
* Neurological deficit
* Structural abnormality on brain imaging
* Unequivocal epileptic activity on EEG
* Patient or family considers risk of further seizure unacceptable
10
Q
What is the first-line drug treatment for males with generalised tonic-clonic seizures?
A
Sodium valproate
11
Q
What is the first-line drug treatment for females with generalised tonic-clonic seizures?
A
Lamotrigine or levetiracetam
12
Q
What is the first-line treatment for girls under 10 years with generalised tonic-clonic seizures?
A
Sodium valproate may be offered first-line
13
Q
What is the first-line treatment for focal seizures?
A
Lamotrigine or levetiracetam
14
Q
What are the second-line treatments for focal seizures?
A
Carbamazepine, oxcarbazepine or zonisamide
15
Q
What is the first-line treatment for absence seizures (Petit mal)?
A
Ethosuximide
16
Q
What is the second-line treatment for male patients with absence seizures?
A
Sodium valproate
17
Q
What is the second-line treatment for female patients with absence seizures?
A
Lamotrigine or levetiracetam
18
Q
What drug may exacerbate absence seizures?
A
Carbamazepine
19
Q
What is the first-line treatment for males with myoclonic seizures?
A
Sodium valproate
20
Q
What is the first-line treatment for females with myoclonic seizures?
A
Levetiracetam
21
Q
What is the first-line treatment for males with tonic or atonic seizures?
A
Sodium valproate
22
Q
What is the first-line treatment for females with tonic or atonic seizures?
A
Lamotrigine
23
Q
What substances may worsen seizure control in patients with epilepsy?
A
Alcohol, cocaine, amphetamines, ciprofloxacin, levofloxacin, aminophylline, theophylline, bupropion, methylphenidate, mefenamic acid
These substances can negatively impact seizure management.
24
Q
Which medications may provoke seizures during withdrawal?
A
Benzodiazepines, baclofen, hydroxyzine
Withdrawal from these medications can lead to increased seizure activity.
25
True or False: Alcohol can improve seizure control in patients with epilepsy.
False
## Footnote
Alcohol is known to worsen seizure control.
26
Fill in the blank: _______ is a medication that may worsen seizure control in patients with epilepsy.
Bupropion
## Footnote
Bupropion is listed among drugs that can worsen seizures.
27
Name one fluoroquinolone that may worsen seizure control.
Ciprofloxacin or levofloxacin
## Footnote
Both ciprofloxacin and levofloxacin are known to negatively affect seizure control.
28
What class of drugs does methylphenidate belong to?
Stimulants
## Footnote
Methylphenidate is commonly used in the treatment of ADHD.
29
What is Infantile spasms also known as?
West's syndrome
## Footnote
Characterized by brief spasms beginning in the first few months of life.
30
What are the key features of Infantile spasms?
* Flexion of head, trunk, limbs
* Extension of arms (Salaam attack)
* Last 1-2 seconds
* Repeat up to 50 times
* Progressive mental handicap
* EEG: hypsarrhythmia
## Footnote
These features indicate the severity and nature of the spasms.
31
What are potential causes of Infantile spasms?
* Serious neurological abnormality (e.g. tuberous sclerosis)
* Encephalitis
* Birth asphyxia
* Idiopathic
## Footnote
These conditions may lead to the development of Infantile spasms.
32
What are possible treatments for Infantile spasms?
* Vigabatrin
* Steroids
## Footnote
These treatments are used to manage the condition, but the prognosis remains poor.
33
What is the prognosis for Infantile spasms?
Poor prognosis
## Footnote
Indicates that many affected children may face severe long-term challenges.
34
Typical absence seizures are also known as what?
Petit mal seizures
## Footnote
These seizures typically occur in children.
35
What is the typical age of onset for typical absence seizures?
4-8 years
## Footnote
This is the age range when these seizures commonly begin.
36
What is the duration of typical absence seizures?
Few-30 seconds
## Footnote
These seizures have a very short duration.
37
What is the EEG finding for typical absence seizures?
3Hz generalized, symmetrical
## Footnote
This characteristic EEG pattern helps in diagnosis.
38
What is the prognosis for children with typical absence seizures?
90-95% become seizure free in adolescence
## Footnote
Indicates a favorable outcome for most children.
39
What is Lennox-Gastaut syndrome often an extension of?
Infantile spasms
## Footnote
This syndrome may evolve from earlier seizure types.
40
What is the typical age of onset for Lennox-Gastaut syndrome?
1-5 years
## Footnote
Early childhood is when this syndrome typically manifests.
41
What are the key features of Lennox-Gastaut syndrome?
* Atypical absences
* Falls
* Jerks
* 90% moderate-severe mental handicap
* EEG: slow spike
## Footnote
These features highlight the complexity of the syndrome.
42
What treatment may help in Lennox-Gastaut syndrome?
Ketogenic diet
## Footnote
This dietary approach can be beneficial for some patients.
43
What is the most common childhood epilepsy?
Benign rolandic epilepsy
## Footnote
This type of epilepsy is particularly prevalent in children.
44
What are the features of benign rolandic epilepsy?
* Paraesthesia (e.g. unilateral face)
* Usually on waking up
## Footnote
These symptoms are characteristic of this type of epilepsy.
45
What is juvenile myoclonic epilepsy also known as?
Janz syndrome
## Footnote
Named after the physician who first described it.
46
What is the typical age of onset for juvenile myoclonic epilepsy?
Teenage years
## Footnote
This condition typically begins during adolescence.
47
What are the features of juvenile myoclonic epilepsy?
* Infrequent generalized seizures
* Daytime absences
* Sudden, shock-like myoclonic seizure
## Footnote
These features are crucial for diagnosis and management.
48
What is the treatment response for juvenile myoclonic epilepsy?
Usually good response to sodium valproate
## Footnote
This medication is effective for many patients with this condition.
49
What are focal seizures previously termed?
Partial seizures
## Footnote
Focal seizures start in a specific area on one side of the brain.
50
What are the classifications of awareness in focal seizures?
* Focal aware (previously 'simple partial')
* Focal impaired awareness (previously 'complex partial')
* Awareness unknown
## Footnote
The level of awareness can vary in focal seizures.
51
What types of features can focal seizures have?
* Motor (e.g. Jacksonian march)
* Non-motor (e.g. déjà vu, jamais vu)
* Aura
## Footnote
Focal seizures can be classified based on their features.
52
What characterizes generalized seizures?
Engage networks on both sides of the brain at the onset
## Footnote
Consciousness is lost immediately during generalized seizures.
53
What is not needed in the classification of generalized seizures?
Level of awareness
## Footnote
All patients lose consciousness during generalized seizures.
54
What are the subdivisions of generalized seizures?
* Motor (e.g. tonic-clonic)
* Non-motor (e.g. absence)
## Footnote
Generalized seizures can be further classified into these categories.
55
What are the specific types of generalized seizures?
* Tonic-clonic (grand mal)
* Tonic
* Clonic
* Typical absence (petit mal)
* Atonic
## Footnote
These are specific examples of generalized seizures.
56
What does 'unknown onset' refer to in seizure classification?
When the origin of the seizure is unknown
## Footnote
This classification is reserved for seizures without a defined starting point.
57
What are focal to bilateral seizures previously termed?
Secondary generalized seizures
## Footnote
These seizures start on one side of the brain in a specific area before spreading to both lobes.
58
What is the referral guideline for lung cancer according to the 2015 NICE guidelines?
Refer people using a suspected cancer pathway referral for lung cancer if they have chest x-ray findings suggesting lung cancer or are aged 40 and over with unexplained haemoptysis.
59
What is the age threshold for urgent chest x-ray referral to assess lung cancer symptoms?
40 years and over.
60
What symptoms warrant an urgent chest x-ray in people aged 40 and over?
If they have 2 or more of the following unexplained symptoms or if they have ever smoked and have 1 or more of the following symptoms:
* cough
* fatigue
* shortness of breath
* chest pain
* weight loss
* appetite loss.
61
List the symptoms that indicate a need for urgent chest x-ray in smokers aged 40 and over.
At least 1 of the following unexplained symptoms:
* cough
* fatigue
* shortness of breath
* chest pain
* weight loss
* appetite loss.
62
What additional factors should be considered for urgent chest x-ray in people aged 40 and over?
Consider an urgent chest x-ray for:
* persistent or recurrent chest infection
* finger clubbing
* supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
* chest signs consistent with lung cancer
* thrombocytosis.
63
True or False: A person aged 40 and over with unexplained haemoptysis should be referred for lung cancer assessment.
True.
64
Fill in the blank: An urgent chest x-ray should be performed within _______ to assess for lung cancer.
2 weeks.
65
What does the acronym NICE stand for in the context of cancer referral guidelines?
National Institute for Health and Care Excellence.
66
What are the referral guidelines for suspected breast cancer published by NICE in 2015?
Refer people using a suspected cancer pathway referral for breast cancer if they are:
* aged 30 and over with an unexplained breast lump with or without pain
* aged 50 and over with nipple discharge, retraction, or other changes of concern
## Footnote
The guidelines emphasize the urgency based on age and symptoms.
67
What age and symptom criteria warrant an urgent referral for breast cancer?
People aged 30 and over with an unexplained breast lump or aged 50 and over with nipple changes.
## Footnote
Symptoms include discharge, retraction, or other concerning changes.
68
What additional criteria should be considered for a suspected cancer pathway referral?
Consider referral for:
* Skin changes that suggest breast cancer
* People aged 30 and over with an unexplained lump in the axilla
## Footnote
This allows for early detection of potential breast cancer.
69
What is the recommendation for non-urgent referral in individuals under 30?
Non-urgent referral for people under 30 with an unexplained breast lump with or without pain.
## Footnote
This reflects a lower risk profile in younger individuals.
70
True or False: All individuals with unexplained breast lumps should be referred urgently.
False
## Footnote
The urgency of referral depends on age and the presence of specific symptoms.
71
What is dyspepsia?
A condition characterized by discomfort or pain in the upper abdomen.
## Footnote
Dyspepsia can include symptoms like bloating, nausea, and indigestion.
72
According to the 2015 NICE guidelines, who needs urgent referral for an endoscopy?
Patients with:
* dysphagia
* upper abdominal mass consistent with stomach cancer
* aged >= 55 years with weight loss and any of:
* upper abdominal pain
* reflux
* dyspepsia
## Footnote
These guidelines aim to identify potential cases of cancer quickly.
73
What symptoms indicate non-urgent referral for endoscopy?
Patients with:
* haematemesis
* aged >= 55 years with:
* treatment-resistant dyspepsia
* upper abdominal pain with low haemoglobin levels
* raised platelet count with any of:
* nausea
* vomiting
* weight loss
* reflux
* dyspepsia
* upper abdominal pain
* nausea or vomiting with any of:
* weight loss
* reflux
* dyspepsia
* upper abdominal pain
## Footnote
Non-urgent cases still require evaluation but are not as time-sensitive.
74
What is the significance of weight loss in patients aged >= 55 years?
It is a critical factor in determining the need for urgent referral for endoscopy when combined with upper abdominal pain, reflux, or dyspepsia.
## Footnote
Weight loss can indicate serious underlying conditions, including cancer.
75
True or False: All patients with dyspepsia require urgent referral for endoscopy.
False
## Footnote
Only specific cases of dyspepsia, particularly in older patients with additional concerning symptoms, require urgent referral.
76
Fill in the blank: Patients with _______ and weight loss are considered for urgent endoscopy referral.
upper abdominal pain
## Footnote
This combination raises concerns for serious underlying conditions.
77
What is the recommended age to consider PSA testing in men?
Men older than 50 years of age who request a PSA test
## Footnote
PSA testing should also be considered in men with suspected prostate cancer.
78
What should be done if a patient's PSA level is above the threshold for their age?
Refer on the suspected cancer pathway referral for an appointment within 2 weeks
## Footnote
This applies to patients with possible symptoms of prostate cancer.
79
What is the PSA threshold for men aged 50-59?
> 3.5 ng/ml
## Footnote
This threshold indicates a higher likelihood of prostate cancer for this age group.
80
What are the PSA level thresholds for men aged 60-69?
> 4.5 ng/ml
## Footnote
Patients above this threshold should be referred if symptomatic.
81
What factors can raise PSA levels?
* Benign prostatic hyperplasia (BPH)
* Prostatitis and urinary tract infection (postpone test for 6 weeks after treatment)
* Ejaculation (ideally not in the previous 48 hours)
* Vigorous exercise (ideally not in the previous 48 hours)
* Urinary retention
* Instrumentation of the urinary tract
## Footnote
These factors can affect the accuracy of PSA testing.
82
True or False: Around 33% of men with a PSA of 4-10 ng/ml will be found to have prostate cancer.
True
## Footnote
This statistic highlights the poor specificity of PSA testing.
83
What percentage of men with a PSA of 10-20 ng/ml will likely have prostate cancer?
60%
## Footnote
This indicates an increased risk with higher PSA levels.
84
What percentage of men with prostate cancer have a normal PSA?
Around 15%
## Footnote
This underscores the limitations of PSA testing in diagnosing prostate cancer.
85
What should be used for men under 40 when considering PSA testing?
Clinical judgement
## Footnote
There is no specific threshold for this age group.
86
What is bladder cancer?
The second most common urological cancer.
87
What age group is most commonly affected by bladder cancer?
Males aged between 50 and 80 years.
88
What is the increased risk factor for bladder cancer in smokers?
2-5 fold increased risk.
89
What substance exposure increases the risk of bladder cancer?
Hydrocarbons such as 2-Naphthylamine.
90
What is a rare cause of chronic bladder inflammation that can lead to squamous cell carcinomas?
Schistosomiasis infection.
91
What are two examples of benign tumours of the bladder?
* Inverted urothelial papilloma
* Nephrogenic adenoma
92
What type of carcinoma accounts for over 90% of bladder malignancies?
Urothelial (transitional cell) carcinoma.
93
What percentage of bladder malignancies are squamous cell carcinomas?
1-7%.
94
What percentage of bladder malignancies are adenocarcinomas?
2%.
95
What is 'field change' in relation to urothelial carcinomas?
The effect that allows tumours to arise as multifocal lesions.
96
What is the growth pattern of up to 70% of transitional cell carcinomas?
Papillary growth pattern.
97
What is the prognosis for superficial urothelial tumours?
Better prognosis.
98
What is the risk of regional or distant lymph node metastasis for those with T3 disease or worse?
30% (or higher) risk.
99
What does T0 indicate in TNM staging?
No evidence of tumour.
100
What does Ta indicate in TNM staging?
Non invasive papillary carcinoma.
101
What does T1 indicate in TNM staging?
Tumour invades sub epithelial connective tissue.
102
What does T2a indicate in TNM staging?
Tumour invades superficial muscularis propria (inner half).
103
What does T2b indicate in TNM staging?
Tumour invades deep muscularis propria (outer half).
104
What does T3 indicate in TNM staging?
Tumour extends to perivesical fat.
105
What does T4 indicate in TNM staging?
Tumour invades prostatic stroma, seminal vesicles, uterus, vagina.
106
What does T4a indicate in TNM staging?
Invasion of uterus, prostate or bowel.
107
What does T4b indicate in TNM staging?
Invasion of pelvic sidewall or abdominal wall.
108
What does N0 indicate in TNM staging?
No nodal disease.
109
What does N1 indicate in TNM staging?
Single regional lymph node metastasis in the true pelvis.
110
What does N2 indicate in TNM staging?
Multiple regional lymph node metastasis in the true pelvis.
111
What does N3 indicate in TNM staging?
Lymph node metastasis to the common iliac lymph nodes.
112
What does M0 indicate in TNM staging?
No distant metastasis.
113
What does M1 indicate in TNM staging?
Distant disease.
114
When should men be referred for a suspected prostate cancer pathway?
If their prostate feels malignant on digital rectal examination
## Footnote
Referral should be for an appointment within 2 weeks.
115
What tests should be considered to assess for prostate cancer?
Prostate-specific antigen (PSA) test and digital rectal examination
## Footnote
These tests are recommended for men with specific symptoms.
116
What symptoms warrant consideration of a PSA test and digital rectal examination?
* Any lower urinary tract symptoms (nocturia, urinary frequency, hesitancy, urgency, retention)
* Erectile dysfunction
* Visible haematuria
## Footnote
These symptoms may indicate the need for further investigation.
117
What PSA levels indicate a need for referral for prostate cancer?
If PSA levels are above the age-specific reference range
## Footnote
This is a critical factor for referral.
118
What is a suspected cancer pathway referral for penile cancer?
An appointment within 2 weeks for suspected penile cancer.
119
What conditions warrant a referral for suspected penile cancer?
Either a penile mass or ulcerated lesion with excluded sexually transmitted infection, or a persistent penile lesion post-STI treatment.
120
What should be excluded as a cause for a penile mass before referral?
A sexually transmitted infection.
121
What symptoms may indicate a need for referral for penile cancer?
Unexplained or persistent symptoms affecting the foreskin or glans.
122
What is the time frame for a suspected cancer pathway referral for penile cancer?
Within 2 weeks.
123
Fill in the blank: A persistent penile lesion after treatment for a sexually transmitted infection may require a _______.
[suspected cancer pathway referral]
124
What is the age threshold for referral using a suspected cancer pathway for bladder cancer?
45 years and over
## Footnote
This age threshold is crucial for identifying individuals at risk for bladder cancer.
125
What is a key symptom for referral for bladder cancer in individuals aged 45 years and over?
Unexplained visible haematuria without urinary tract infection
## Footnote
Visible haematuria is a significant indicator of potential bladder cancer.
126
What condition must be present for individuals aged 60 years and over to be referred for bladder cancer?
Unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
## Footnote
These symptoms warrant urgent investigation for bladder cancer.
127
What is the recommendation for non-urgent referral for bladder cancer in people aged 60 years and over?
Recurrent or persistent unexplained urinary tract infection
## Footnote
This indicates a need for further evaluation for bladder cancer.
128
What is the age threshold for referral using a suspected cancer pathway for renal cancer?
45 years and over
## Footnote
Similar to bladder cancer, this age threshold is critical for renal cancer referrals.
129
What is a key symptom for referral for renal cancer in individuals aged 45 years and over?
Unexplained visible haematuria without urinary tract infection
## Footnote
This symptom is a significant red flag for renal cancer.
130
What additional condition must be met for referral for renal cancer if visible haematuria is present?
Visible haematuria that persists or recurs after successful treatment of urinary tract infection
## Footnote
This persistence indicates the need for further investigation.
131
Fill in the blank: Referral for bladder cancer should be made if a patient has unexplained visible haematuria without _______.
urinary tract infection
## Footnote
This condition is a key indicator for bladder cancer.
132
True or False: Individuals aged 60 years and over with unexplained non-visible haematuria should be referred for renal cancer.
False
## Footnote
The referral criteria for renal cancer focus on visible haematuria.
133
What is the primary development pathway for most colorectal cancers?
Most cancers develop from adenomatous polyps.
134
By what percentage has screening for colorectal cancer been shown to reduce mortality?
16%
135
What type of screening does the NHS offer to older adults for colorectal cancer?
Home-based, Faecal Immunochemical Test (FIT) screening.
136
What age group is targeted by the NHS national screening programme FIT in England?
Men and women aged 60 to 74 years.
137
What is the age range for colorectal cancer screening in Scotland?
50 to 74 years.
138
What can patients aged over 74 years do regarding colorectal cancer screening?
They may request screening.
139
How are eligible patients notified about the Faecal Immunochemical Test (FIT)?
They are sent FIT tests through the post.
140
What does the Faecal Immunochemical Test (FIT) specifically detect?
Human haemoglobin (Hb).
141
What is the main advantage of FIT over conventional faecal occult blood (FOB) tests?
It only detects human haemoglobin, not animal haemoglobin from diet.
142
How many faecal samples are needed for the FIT compared to conventional FOB tests?
Only one sample is needed for FIT, compared to 2-3 for conventional FOB tests.
143
What information is provided to the patient regarding the numerical value generated by FIT?
It is not reported to the patient or GP.
144
What happens to patients with abnormal FIT results?
They are offered a colonoscopy.
145
At colonoscopy, what percentage of patients typically have a normal exam?
5 out of 10 patients.
146
What percentage of patients at colonoscopy may be found to have polyps?
4 out of 10 patients.
147
What is the potential risk associated with the polyps found during colonoscopy?
They may have premalignant potential.
148
What percentage of patients at colonoscopy will be found to have cancer?
1 out of 10 patients.
149
150
When should I refer a person with suspected colorectal cancer?
Refer if they have:
* An abdominal mass
* A change in bowel habit
* Iron-deficiency anaemia
* Aged 60 years and over with anaemia (even without iron deficiency)
* Aged 40 years and over with unexplained weight loss and abdominal pain
* Aged under 50 years with rectal bleeding and unexplained abdominal pain or weight loss
* Aged 50 years and over with unexplained rectal bleeding, abdominal pain, or weight loss
## Footnote
These criteria help guide timely referrals for suspected cases.
151
What quantitative testing should be offered to guide referral for suspected colorectal cancer?
Offer quantitative faecal immunochemical testing (FIT) using HM-JACKarc or OC-Sensor
## Footnote
FIT is used to detect hidden blood in the stool, which can indicate colorectal cancer.
152
What should be considered if people need help returning their faecal sample?
Consider if people need additional help, information, or support
## Footnote
Ensuring that individuals can return their samples is crucial for accurate testing.
153
Should FIT be offered even if a person has had a negative result from the NHS bowel screening programme?
Yes, offer FIT even if the person has previously had a negative FIT result
## Footnote
This ensures that potential cases are not overlooked.
154
What FIT result indicates a referral for colorectal cancer using a suspected cancer pathway?
A FIT result of at least 10 micrograms of haemoglobin per gram of faeces
## Footnote
This threshold helps identify individuals at higher risk of colorectal cancer.
155
What should be done if a person has not returned a faecal sample or has a FIT result below 10 micrograms?
Ensure safety netting processes are in place
## Footnote
This is important to monitor symptoms and ensure timely intervention.
156
What action should be taken if there is a strong clinical concern of cancer due to ongoing unexplained symptoms?
Do not delay referral to an appropriate secondary care pathway
## Footnote
Timeliness is crucial in managing potential cancer cases.
157
What is a sign that might indicate an CONSIDERATION of urgent referral is necessary?
Evidence of rectal mass
## Footnote
A rectal mass is a significant clinical finding that requires prompt action.
158
159
What is the most common cause of cancer in the UK?
Breast
## Footnote
Other common causes include lung, colorectal, prostate, bladder, non-Hodgkin's lymphoma, melanoma, stomach, oesophagus, and pancreas.
160
What is the leading cause of death from cancer in the UK?
Lung
## Footnote
Other leading causes include colorectal, breast, prostate, pancreas, oesophagus, stomach, bladder, non-Hodgkin's lymphoma, and ovarian.
161
Fill in the blank: The most common cause of cancer in women in the UK is _______.
BREAST
162
Which cancer has the highest incidence in men in the UK?
PROSTATE
## Footnote
Other common cancers in men include lung and bowel.
163
List the common causes of cancer in the UK.
* Breast
* Lung
* Colorectal
* Prostate
* Bladder
* Non-Hodgkin's lymphoma
* Melanoma
* Stomach
* Oesophagus
* Pancreas
164
List the most common causes of death from cancer in the UK.
* Lung
* Colorectal
* Breast
* Prostate
* Pancreas
* Oesophagus
* Stomach
* Bladder
* Non-Hodgkin's lymphoma
* Ovarian
165
Fill in the blank: The second most common cause of cancer in the UK is _______.
Lung
166
What is the third most common cause of cancer in the UK?
Colorectal
167
What is the fourth most common cause of cancer in the UK?
Prostate
168
Fill in the blank: The fifth most common cause of cancer in the UK is _______.
Bladder
169
What type of cancer is the most common in women after breast cancer?
Lung
## Footnote
Bowel cancer also has significant incidence among women.
170
What is a common site of cancer incidence in women aside from breast and lung?
Uterus
171
ORDER of cancer incidence in women
Incidence of cancer in women:
1.BREAST
2.lung
3.Bowel
4.OTTHER SITES
5. UTERUS
172
Order of cancer incidence in men
Incidence of cancer in men:
1. PROSTATE
2.lung
3.Bowel
173
174
What are the two main categories of treatment for ulcerative colitis?
Inducing and maintaining remission
175
What is the classification of ulcerative colitis severity?
Mild, moderate, severe
176
Define mild ulcerative colitis.
< 4 stools/day, only a small amount of blood
177
Define moderate ulcerative colitis.
4-6 stools/day, varying amounts of blood, no systemic upset
178
Define severe ulcerative colitis.
>6 bloody stools/day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
179
What is the first-line treatment for mild-to-moderate proctitis?
Topical (rectal) aminosalicylate
180
If remission is not achieved within 4 weeks for proctitis, what should be added?
Oral aminosalicylate
181
What should be done if remission is still not achieved after adding oral aminosalicylate for proctitis?
Add topical or oral corticosteroid
182
What is the first-line treatment for proctosigmoiditis and left-sided ulcerative colitis?
Topical (rectal) aminosalicylate
183
After 4 weeks of treatment for proctosigmoiditis and left-sided ulcerative colitis, if remission is not achieved, what options are available?
* High-dose oral aminosalicylate
* Switch to high-dose oral aminosalicylate and topical corticosteroid
184
What is the treatment approach for extensive disease in ulcerative colitis?
Topical (rectal) aminosalicylate and a high-dose oral aminosalicylate
185
What is the treatment protocol for severe colitis?
Should be treated in hospital with IV steroids first-line
186
What should be considered if there is no improvement after 72 hours of treating severe colitis?
* Add IV ciclosporin to IV corticosteroids
* Consider surgery
187
What is the maintenance treatment following a mild-to-moderate ulcerative colitis flare for proctitis and proctosigmoiditis?
* Topical (rectal) aminosalicylate alone
* Oral aminosalicylate plus topical (rectal) aminosalicylate
* Oral aminosalicylate by itself
188
What maintenance treatment is recommended for left-sided and extensive ulcerative colitis?
Low maintenance dose of an oral aminosalicylate
189
What is the recommended treatment following a severe relapse or >=2 exacerbations in the past year?
Oral azathioprine or oral mercaptopurine
190
Is methotrexate recommended for the management of ulcerative colitis?
No, it is not recommended
191
What evidence exists regarding probiotics in ulcerative colitis management?
Probiotics may prevent relapse in patients with mild to moderate disease
192
What is the surgical option when ulcerative colitis is unresponsive to optimal medical therapy?
Consider surgery
193
What does subtotal colectomy involve?
Removal of part of the colon, usually with a temporary loop ileostomy
194
What is the preferred surgical approach for ulcerative colitis?
Restorative proctocolectomy (IPAA)
195
What does complete panproctocolectomy entail?
Removal of the entire colon and rectum, resulting in a permanent ileostomy
196
What is Crohn's disease?
A form of inflammatory bowel disease that commonly affects the terminal ileum and colon but may occur anywhere from the mouth to anus.
197
When did NICE publish guidelines on the management of Crohn's disease?
In 2012.
198
What lifestyle change should patients with Crohn's disease be strongly advised to make?
Stop smoking.
199
What medications are generally used to induce remission in Crohn's disease?
Glucocorticoids (oral, topical, or intravenous).
200
What is an alternative medication to glucocorticoids for inducing remission in some patients?
Budesonide.
201
What dietary approach may be used to induce remission in Crohn's disease?
Enteral feeding with an elemental diet.
202
What second-line drugs are used after glucocorticoids to induce remission?
5-ASA drugs (e.g., mesalazine).
203
Which medications may be used as an add-on to induce remission but not as monotherapy?
Azathioprine or mercaptopurine.
204
What is the role of infliximab in Crohn's disease?
Useful in refractory disease and fistulating Crohn's.
205
What is the first-line medication to maintain remission in Crohn's disease?
Azathioprine or mercaptopurine.
206
What should be assessed before starting azathioprine or mercaptopurine?
TPMT activity.
207
What is the second-line medication used to maintain remission?
Methotrexate.
208
What percentage of patients with Crohn's disease will eventually require surgery?
Around 80%.
209
What surgical procedure is indicated for stricturing terminal ileal disease?
Ileocaecal resection.
210
What is a perianal fistula?
An inflammatory tract or connection between the anal canal and the perianal skin.
211
What is the investigation of choice for suspected perianal fistulae?
MRI.
212
What is the typical treatment for symptomatic perianal fistulae?
Oral metronidazole.
213
What may be effective in closing and maintaining closure of perianal fistulas?
Anti-TNF agents such as infliximab.
214
What is a draining seton used for?
Complex fistulae.
215
What is required for a perianal abscess?
Incision and drainage combined with antibiotic therapy.
216
What are the standard incidence ratios for small bowel cancer and colorectal cancer in Crohn's disease?
Small bowel cancer = 40; colorectal cancer = 2.
217
What additional health risk is associated with Crohn's disease?
Osteoporosis.
218
What is Von Willebrand's disease?
The most common inherited bleeding disorder
219
How is Von Willebrand's disease primarily inherited?
In an autosomal dominant fashion
220
What are common symptoms of Von Willebrand's disease?
* Epistaxis
* Menorrhagia
221
What symptoms are rare in Von Willebrand's disease?
* Haemoarthroses
* Muscle haematomas
222
What is the role of von Willebrand factor?
* Promotes platelet adhesion to damaged endothelium
* Carrier molecule for factor VIII
223
What is the size of von Willebrand factor multimers?
Up to 1,000,000 Da
224
What are the types of Von Willebrand's disease?
* Type 1: partial reduction in vWF
* Type 2: abnormal form of vWF
* Type 3: total lack of vWF
225
Which type of Von Willebrand's disease is the most common?
Type 1
226
What is a characteristic finding in the investigation of Von Willebrand's disease?
Prolonged bleeding time
227
What might be a prolonged test in Von Willebrand's disease?
APTT may be prolonged
228
What happens to factor VIII levels in Von Willebrand's disease?
They may be moderately reduced
229
What is a specific test finding in Von Willebrand's disease?
Defective platelet aggregation with ristocetin
230
What is a treatment option for mild bleeding in Von Willebrand's disease?
Tranexamic acid
231
What is desmopressin (DDAVP) used for in Von Willebrand's disease?
Raises levels of vWF by inducing release from Weibel-Palade bodies
232
What is another treatment option for Von Willebrand's disease?
Factor VIII concentrate
233
What is thrombophilia?
A condition that increases the risk of thrombosis.
234
What is the most common inherited cause of thrombophilia?
Factor V Leiden (activated protein C resistance).
235
What is the second most common inherited cause of thrombophilia?
Prothrombin gene mutation.
236
What are the deficiencies of naturally occurring anticoagulants associated with thrombophilia?
* Antithrombin III deficiency
* Protein C deficiency
* Protein S deficiency
237
Which deficiency has the highest relative risk of venous thromboembolism (VTE)?
Antithrombin III deficiency.
238
What is an acquired cause of thrombophilia?
Antiphospholipid syndrome.
239
What drug is associated with an increased risk of thrombophilia?
The combined oral contraceptive pill.
240
Fill in the blank: The most common cause of thrombophilia is _______.
factor V Leiden (activated protein C resistance).
241
True or False: Protein S deficiency is one of the deficiencies of naturally occurring anticoagulants.
True.
242
List three inherited causes of thrombophilia.
* Factor V Leiden (activated protein C resistance)
* Prothrombin gene mutation
* Deficiencies of naturally occurring anticoagulants
243
What is thrombocytosis?
An abnormally high platelet count, usually > 400 * 10^9/l.
244
What are the causes of reactive thrombocytosis?
* Severe infection
* Surgery
* Iron deficiency anaemia
245
Name two malignancies associated with thrombocytosis.
* Chronic myeloid leukaemia
* Polycythaemia rubra vera
246
What is essential thrombocytosis?
A myeloproliferative disorder characterized by megakaryocyte proliferation and overproduction of platelets.
247
What is the platelet count indicative of essential thrombocytosis?
> 600 * 10^9/l
248
What are two complications associated with essential thrombocytosis?
* Thrombosis (venous or arterial)
* Haemorrhage
249
What is a characteristic symptom of essential thrombocytosis?
A burning sensation in the hands
250
What mutation is found in around 50% of patients with essential thrombocytosis?
JAK2 mutation
251
What medication is widely used to manage essential thrombocytosis?
Hydroxyurea (hydroxycarbamide)
252
Which treatment may be used for younger patients with essential thrombocytosis?
Interferon-α
253
True or False: Low-dose aspirin may be used in essential thrombocytosis to reduce thrombotic risk.
True
254
Fill in the blank: Thrombocytosis can occur as a result of _______.
hyposplenism
255
What age range should be considered for suspected haematological malignancy management?
0-24 years
256
What is the urgency for a full blood count if features of leukaemia are present?
Very urgent, within 48 hours
257
Name a symptom that should prompt a full blood count in young people suspected of leukaemia.
Pallor
258
What symptom indicates a need for immediate investigation in young people for leukaemia related to energy levels?
Persistent fatigue
259
What unexplained symptom could suggest leukaemia in a young person?
Unexplained fever
260
What type of persistent infections should raise suspicion for leukaemia in young individuals?
Unexplained persistent infections
261
What physical finding, characterized by swelling of lymph nodes, should prompt a full blood count?
Generalised lymphadenopathy
262
What symptom related to bone health may indicate leukaemia in young people?
Persistent or unexplained bone pain
263
What unexplained symptom involving skin discoloration may suggest leukaemia?
Unexplained bruising
264
What type of abnormality involving bleeding could indicate leukaemia in young individuals?
Unexplained bleeding
265
What is immune thrombocytopenia (ITP)?
An immune-mediated reduction in the platelet count
## Footnote
Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.
266
How does ITP commonly present in children?
Usually has an acute thrombocytopenia that may follow infection or vaccination.
267
How does ITP commonly present in adults?
Tends to have a more chronic condition.
268
What demographic is more commonly affected by ITP?
Older females.
269
How may ITP be detected in adults?
Incidentally following routine blood tests.
270
What are common symptoms of ITP in adults?
* Petechiae
* Purpura
* Bleeding (e.g. epistaxis)
271
Is catastrophic bleeding (e.g. intracranial) a common presentation of ITP?
No, it is not a common presentation.
272
What is the typical finding in a full blood count for ITP?
Isolated thrombocytopenia.
273
What investigations are used for ITP?
* Full blood count
* Blood film
274
Is a bone marrow examination routinely used in the investigation of ITP?
No, it is no longer used routinely.
275
What is the sensitivity of antiplatelet antibody testing in ITP?
Poor sensitivity.
276
What is the first-line treatment for ITP?
Oral prednisolone.
277
What is the role of pooled normal human immunoglobulin (IVIG) in ITP management?
Raises the platelet count quicker than steroids; may be used if active bleeding or an urgent invasive procedure is required.
278
Is splenectomy commonly used in the management of ITP?
No, it is now less commonly used.
279
What is Evan's syndrome?
ITP in association with autoimmune haemolytic anaemia (AIHA).
280
What is Haemophilia?
An X-linked recessive disorder of coagulation
281
What percentage of patients with Haemophilia have no family history of the condition?
Up to 30%
282
What causes Haemophilia A?
A deficiency of factor VIII
283
What is Haemophilia B also known as?
Christmas disease
284
What causes Haemophilia B?
A lack of factor IX
285
List three features of Haemophilia.
* haemoarthroses
* haematomas
* prolonged bleeding after surgery or trauma
286
What blood test result is prolonged in Haemophilia?
APTT
287
What are the normal blood test results in Haemophilia?
* bleeding time
* thrombin time
* prothrombin time
288
What percentage of patients with Haemophilia A develop antibodies to factor VIII treatment?
Up to 10-15%
289
What are the inducers of the P450 system?
Inducers include:
* phenytoin
* carbamazepine
* phenobarbitone
* rifampicin
* St John's Wort
* chronic alcohol intake
* griseofulvin
* smoking
## Footnote
Smoking affects CYP1A2, which is why smokers require more aminophylline.
290
What mnemonic can help remember the inducers of the P450 system?
PCBRASS + griseofulvin
291
Name two antiepileptic drugs that are inducers of the P450 system.
phenytoin and carbamazepine
292
Which barbiturate is an inducer of the P450 system?
phenobarbitone
293
What is the effect of chronic alcohol intake on the P450 system?
It induces the P450 system.
294
What are the inhibitors of the P450 system?
Inhibitors include:
* ciprofloxacin
* erythromycin
* isoniazid
* cimetidine
* omeprazole
* amiodarone
* allopurinol
* ketoconazole
* fluconazole
* fluoxetine
* sertraline
* ritonavir
* sodium valproate
* acute alcohol intake
* quinupristin
## Footnote
These inhibitors reduce the effect of the desired drug.
295
True or False: Rifampicin is an inhibitor of the P450 system.
False
296
Which two antibiotics are known inhibitors of the P450 system?
ciprofloxacin and erythromycin
297
Fill in the blank: _______ is an imidazole that inhibits the P450 system.
ketoconazole
298
What is the effect of acute alcohol intake on the P450 system?
It inhibits the P450 system.
299
Name one SSRI that inhibits the P450 system.
fluoxetine or sertraline
300
What is the chemical name for Vitamin A?
Retinoids
301
What is the deficiency state associated with Vitamin A?
Night-blindness (nyctalopia)
302
What is the chemical name for Vitamin B1?
Thiamine
303
What are the deficiency states associated with Vitamin B1?
* Beriberi
* Polyneuropathy
* Wernicke-Korsakoff syndrome
* Heart failure
304
What is the chemical name for Vitamin B3?
Niacin
305
What are the deficiency states associated with Vitamin B3?
* Pellagra
* Dermatitis
* Diarrhoea
* Dementia
306
What is the chemical name for Vitamin B6?
Pyridoxine
307
What are the deficiency states associated with Vitamin B6?
* Anaemia
* Irritability
* Seizures
308
What is the chemical name for Vitamin B7?
Biotin
309
What are the deficiency states associated with Vitamin B7?
* Dermatitis
* Seborrhoea
310
What is the chemical name for Vitamin B9?
Folic acid
311
What are the deficiency states associated with Vitamin B9?
* Megaloblastic anaemia
* Neural tube defects during pregnancy
312
What is the chemical name for Vitamin B12?
Cyanocobalamin
313
What are the deficiency states associated with Vitamin B12?
* Megaloblastic anaemia
* Peripheral neuropathy
314
What is the chemical name for Vitamin C?
Ascorbic acid
315
What are the deficiency states associated with Vitamin C?
* Scurvy
* Gingivitis
* Bleeding
316
What is the chemical name for Vitamin D?
Ergocalciferol, cholecalciferol
317
What are the deficiency states associated with Vitamin D?
* Rickets
* Osteomalacia
318
What is the chemical name for Vitamin E?
Tocopherol
319
What are the deficiency states associated with Vitamin E?
* Mild haemolytic anaemia in newborn infants
* Ataxia
* Peripheral neuropathy
320
What is the chemical name for Vitamin K?
Naphthoquinone
321
What are the deficiency states associated with Vitamin K?
* Haemorrhagic disease of the newborn
* Bleeding diathesis
322
What protozoa is primarily responsible for the majority of malaria cases?
Plasmodium falciparum
## Footnote
Around 75% of malaria cases are caused by this protozoa.
323
What percentage of patients who develop malaria did not take prophylaxis?
The majority
## Footnote
This indicates a significant gap in preventative measures.
324
What happens to UK citizens from malaria endemic areas regarding immunity?
They quickly lose their innate immunity.
325
What should be consulted prior to prescribing malaria prophylaxis?
Up-to-date charts with recommended regimes for malarial zones.
326
What is the time to begin Atovaquone + proguanil (Malarone) before travel?
1 - 2 days.
327
What are the side effects of Atovaquone + proguanil (Malarone)?
GI upset.
328
How long after travel should Atovaquone + proguanil (Malarone) be continued?
7 days.
329
How often is Chloroquine taken for malaria prophylaxis?
Weekly.
330
What side effects are associated with Chloroquine?
Headache, contraindicated in epilepsy.
331
What is the time to begin Chloroquine before travel?
1 week.
332
How long after travel should Chloroquine be continued?
4 weeks.
333
What are the side effects of Doxycycline?
Photosensitivity, Oesophagitis.
334
What is the time to begin Doxycycline before travel?
1 - 2 days.
335
How long after travel should Doxycycline be continued?
4 weeks.
336
What is the time to begin Mefloquine (Lariam) before travel?
2 - 3 weeks.
337
What are the side effects of Mefloquine (Lariam)?
Dizziness, Neuropsychiatric disturbance, contraindicated in epilepsy.
338
How often is Mefloquine taken for malaria prophylaxis?
Weekly.
339
What is the time to begin Proguanil (Paludrine) before travel?
1 week.
340
How long after travel should Proguanil (Paludrine) be continued?
4 weeks.
341
What should pregnant women be advised regarding travel to malaria endemic regions?
To avoid travelling.
342
What is a challenge in diagnosing malaria in pregnant women?
Parasites may not be detectable in the blood film due to placental sequestration.
343
What is advised for folate supplementation in pregnant women taking Proguanil?
5mg od.
344
What is the recommendation for children travelling to malaria endemic regions?
They should take malarial prophylaxis.
345
What percentage of DEET has been shown to repel mosquitoes effectively?
20-50%.
346
What is the licensing age for Doxycycline in the UK for children?
Over 12 years.
347
True or False: Doxycycline is contraindicated for pregnant women.
True.
348
What are the major congenital infections encountered in examinations?
Rubella, toxoplasmosis, cytomegalovirus
349
Which congenital infection is the most common in the UK?
Cytomegalovirus
350
Is maternal infection of cytomegalovirus usually symptomatic or asymptomatic?
Asymptomatic
351
What are the characteristic features of rubella?
* Sensorineural deafness
* Congenital cataracts
* Congenital heart disease (e.g. patent ductus arteriosus)
* Glaucoma
352
What are additional features of rubella?
* Growth retardation
* Hepatosplenomegaly
* Purpuric skin lesions
* 'Salt and pepper' chorioretinitis
* Microphthalmia
* Cerebral palsy
353
What are the characteristic features of toxoplasmosis?
* Cerebral calcification
* Chorioretinitis
* Hydrocephalus
* Low birth weight
354
What are other features of toxoplasmosis?
* Anaemia
* Hepatosplenomegaly
* Cerebral palsy
355
What are the characteristic features of cytomegalovirus?
* Purpuric skin lesions
* Sensorineural deafness
* Microcephaly
356
What are other features of cytomegalovirus?
* Visual impairment
* Learning disability
* Encephalitis/seizures
* Pneumonitis
* Hepatosplenomegaly
* Anaemia
* Jaundice
* Cerebral palsy
357
Fill in the blank: The characteristic feature of rubella that involves heart defect is _______.
Congenital heart disease (e.g. patent ductus arteriosus)
358
True or False: Hydrocephalus is a characteristic feature of toxoplasmosis.
True
359
Fill in the blank: One of the other features of cytomegalovirus is _______.
Visual impairment
360
What immunisation is recommended at birth if there are risk factors?
BCG vaccine
## Footnote
The BCG vaccine is given if there is a family history of tuberculosis in the past 6 months.
361
What does the '6-in-1 vaccine' protect against?
Diphtheria, tetanus, whooping cough, polio, Hib, and hepatitis B
## Footnote
This vaccine is administered at 2, 3, and 4 months.
362
At what age is the oral rotavirus vaccine administered?
2 months and 3 months
## Footnote
It is part of the immunisation schedule for infants.
363
What vaccine is given at 3 months alongside the '6-in-1 vaccine'?
PCV
## Footnote
PCV stands for pneumococcal conjugate vaccine.
364
At what age is the Hib/Men C vaccine given?
12-13 months
## Footnote
This is part of a combination immunisation schedule.
365
What vaccinations are included in the 12-13 months immunisation schedule?
* Hib/Men C
* MMR
* PCV
* Men B
## Footnote
MMR stands for measles, mumps, and rubella vaccine.
366
What is the recommended immunisation for children aged 2-8 years?
Flu vaccine (annual)
## Footnote
This vaccine is a seasonal immunisation.
367
What is administered at ages 3-4 years?
* '4-in-1 pre-school booster' (diphtheria, tetanus, whooping cough, polio)
* MMR
## Footnote
The 4-in-1 booster is essential for preschool children.
368
What vaccination is given at 12-13 years?
HPV vaccination
## Footnote
HPV vaccination is important for preventing human papillomavirus infections.
369
What is included in the '3-in-1 teenage booster' at ages 13-18 years?
* Tetanus
* Diphtheria
* Polio
## Footnote
This booster is crucial for adolescents.
370
True or False: The Men ACWY vaccine is given to children at 2 months.
False
## Footnote
Men ACWY vaccine is administered between 13-18 years.
371
What is the role of the 'Proper Officer' at the Local Health Protection Team?
To notify the Health Protection Agency on a weekly basis.
372
Which notable exception is not included in the list of notifiable diseases in the UK?
HIV
373
Name one of the diseases removed from the notifiable diseases list in April 2010.
Dysentery
374
What type of disease is Acute poliomyelitis?
Notifiable disease
375
List three notifiable diseases in the UK.
* Acute encephalitis
* Anthrax
* Malaria
376
True or False: COVID-19 is a notifiable disease in the UK.
True
377
Fill in the blank: _____ is a notifiable disease caused by a virus and characterized by high fever and respiratory symptoms.
COVID-19
378
What disease is caused by the bacterium Yersinia pestis?
Plague
379
What is Haemolytic uraemic syndrome (HUS)?
A notifiable disease
380
List four examples of viral notifiable diseases.
* COVID-19
* Measles
* Rubella
* SARS
381
What disease is characterized by a severe respiratory syndrome and is notifiable?
Severe Acute Respiratory Syndrome (SARS)
382
Fill in the blank: _____ is a notifiable disease that can be transmitted through food and is often caused by bacteria.
Food poisoning
383
Which disease is known for causing outbreaks in children and is notifiable?
Mumps
384
True or False: Tuberculosis is not a notifiable disease in the UK.
False
385
Which disease is associated with the bacterium Brucella?
Brucellosis
386
Name a notifiable disease caused by a virus that leads to hemorrhagic fever.
Viral haemorrhagic fever (VHF)
387
List all diseases that were removed from the notifiable diseases list in April 2010.
* Dysentery
* Ophthalmia neonatorum
* Leptospirosis
* Relapsing fever
388
Fill in the blank: _____ is a notifiable disease that can be transmitted through contaminated water and is caused by Vibrio cholerae.
Cholera
389
List the 4 diseases removed from the Notifiable disease list
Dysentery
Ophthalmia neonatorum
Leptospirosis
Relapsing fever
390
List the 32 notifiable diseases
Therefore, the current notifiable diseases are:
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires Disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
391
5 notifiable diseases starting with A
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
392
2 notifiable diseases starting with B and 2 starting with C
Botulism
Brucellosis
Cholera
COVID-19
393
Notifiable diseases starting with D, E , F , H
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
394
2 notifiable diseases starting with I and L
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires Disease
Leprosy
395
4 Notifiable diseases starting with M
Malaria
Measles
Meningococcal septicaemia
Mumps
396
Notifiable disease starting with P
Plague
397
2 notifiable diseases starting with R
Rabies
Rubella
398
3 notifiable diseases starting with S
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
399
3 notifiable diseases starting with T
Tetanus
Tuberculosis
Typhus
400
Notifiable disease starting with V, W, Y
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
401
402
What type of vaccine is offered to children traditionally given the flu vaccine?
Intranasal vaccine unless inappropriate
## Footnote
Inappropriate situations include immunosuppression.
403
How many doses of the influenza vaccine are needed for children aged 2-9 years who have not received it before?
2 doses
404
What is the effectiveness of the intranasal vaccine compared to the injectable vaccine?
More effective
405
Name one contraindication for the intranasal flu vaccine.
Immunocompromised
## Footnote
Other contraindications include: aged < 2 years, current febrile illness, blocked nose, current wheeze, egg allergy, pregnancy/breastfeeding, taking aspirin.
406
List two side effects of the intranasal flu vaccine.
* Blocked nose/rhinorrhoea
* Headache
* Anorexia
407
What is the composition of the current trivalent influenza vaccine?
Two subtypes of influenza A and one subtype of influenza B
408
Who does the Department of Health recommend should receive annual influenza vaccination?
All people older than 65 years and those older than 6 months with specific conditions
## Footnote
Conditions include chronic respiratory (including asthmatics on inhaled ICS), heart including (hypertension if associated with cardiac complications), kidney, liver, biliary atresia, neurological diseases, diabetes, immunosuppression, asplenia, pregnancy, and high BMI (=/>40)
409
What is a recommended vaccination strategy for health and social care staff?
Annual influenza vaccination
410
What type of vaccine is the influenza vaccine classified as?
Inactivated vaccine
411
What is the storage requirement for the influenza vaccine?
Stored between +2 and +8ºC and shielded from light
412
What is the effectiveness of the influenza vaccine in adults?
Around 75% effective
413
How long does it take for antibody levels to reach protective levels after immunisation?
10-14 days
414
True or False: The inactivated influenza vaccine can cause influenza.
False
415
Fill in the blank: The intranasal flu vaccine is contraindicated for children who are _______.
Immunocompromised
416
What are the two types of pneumococcal vaccines currently in use?
Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPV)
## Footnote
The PCV is primarily for children, while the PPV is for adults and certain high-risk groups.
417
At what ages is the pneumococcal conjugate vaccine (PCV) given to children?
At 3 and 12-13 months
## Footnote
This is part of routine immunisations for children.
418
Who is offered the pneumococcal polysaccharide vaccine (PPV)?
All adults over 65 years, patients with chronic conditions, and those who have had a splenectomy
## Footnote
Chronic conditions include respiratory, heart, kidney, and liver diseases.
419
List the groups who should be vaccinated against pneumococcal disease.
* Asplenia or splenic dysfunction
* Chronic respiratory disease (COPD, bronchiectasis, cystic fibrosis, interstitial lung disease)
* Chronic heart disease (ischaemic heart disease, heart failure, congenital heart disease) ischaemic heart disease if requiring medication or follow-up, heart failure, congenital heart disease. Controlled hypertension is not an indication for vaccination
* Chronic kidney disease
* Chronic liver disease (including cirrhosis and chronic hepatitis)
* Diabetes mellitus (if requiring medication)
* Immunosuppression (due to disease or treatment)
* Cochlear implants
* Patients with cerebrospinal fluid leaks
## Footnote
Asthma is included only if it requires significant immunosuppression.
420
How often do adults with asplenia, splenic dysfunction, or chronic kidney disease need a booster dose of the PPV?
Every 5 years
## Footnote
Most adults only require one dose of the vaccine.
421
True or False: Controlled hypertension is an indication for pneumococcal vaccination.
False
## Footnote
Only significant chronic heart conditions are indications for vaccination.
422
Fill in the blank: The PCV is given to children as part of their routine immunisations at _______.
3 and 12-13 months
423
What is primary hyperparathyroidism caused by?
Excess secretion of PTH resulting in hypercalcaemia
## Footnote
It is the most common cause of hypercalcaemia in outpatients.
424
What percentage of primary hyperparathyroidism cases are caused by a parathyroid adenoma?
85%
## Footnote
Primary hyperparathyroidism is often diagnosed following an incidental finding of an elevated serum calcium concentration.
425
Fill in the blank: The causes of primary hyperparathyroidism are _____, hyperplasia, multiple adenoma, and carcinoma.
solitary adenoma
426
What are the percentages of causes for primary hyperparathyroidism?
* 85%: solitary adenoma
* 10%: hyperplasia
* 4%: multiple adenoma
* 1%: carcinoma
## Footnote
These figures highlight the commonality of solitary adenomas.
427
What percentage of patients with primary hyperparathyroidism are asymptomatic?
Around 80%
## Footnote
They are often diagnosed on routine blood tests.
428
What mnemonic can be used to remember the symptomatic features of primary hyperparathyroidism?
'bones, stones, abdominal groans and psychic moans'
## Footnote
This includes polydipsia, polyuria, depression, anorexia, nausea, constipation, peptic ulceration, pancreatitis, bone pain/fracture, renal stones, and hypertension.
429
List the symptomatic features of primary hyperparathyroidism.
* polydipsia
* polyuria
* depression
* anorexia
* nausea
* constipation
* peptic ulceration
* pancreatitis
* bone pain/fracture
* renal stones
* hypertension
430
What conditions are associated with primary hyperparathyroidism?
* hypertension
* multiple endocrine neoplasia: MEN I and II
431
What findings might be seen on blood tests for primary hyperparathyroidism?
Raised calcium, low phosphate
## Footnote
PTH may be raised or normal despite raised calcium.
432
What imaging technique is used in the investigations of primary hyperparathyroidism?
Technetium-MIBI subtraction scan
## Footnote
X-ray findings may include pepperpot skull and osteitis fibrosa cystica.
433
What is the definitive management for primary hyperparathyroidism?
Total parathyroidectomy
## Footnote
Conservative management may be offered under specific conditions.
434
Under what conditions might conservative management be offered for primary hyperparathyroidism?
If the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage.
435
What medication may be used for patients not suitable for surgery?
Cinacalcet
## Footnote
Cinacalcet is a calcimimetic.
436
How does a calcimimetic like cinacalcet work?
It mimics the action of calcium on tissues by allosteric activation of the calcium-sensing receptor.
437
What are the two main conditions that account for 90% of cases of hypercalcaemia?
1. Primary hyperparathyroidism
2. Malignancy
438
What is the commonest cause of hypercalcaemia in non-hospitalised patients?
Primary hyperparathyroidism
439
What is the commonest cause of hypercalcaemia in hospitalised patients?
Malignancy
440
What processes may cause malignancy-related hypercalcaemia?
* PTHrP from the tumour (e.g. squamous cell lung cancer)
* Bone metastases
* Myeloma due to increased osteoclastic bone resorption
441
Why is measuring parathyroid hormone levels important in patients with hypercalcaemia?
It is the key investigation for determining the cause of hypercalcaemia
442
Name two other causes of hypercalcaemia.
* Sarcoidosis
* Vitamin D intoxication
443
What granulomatous diseases can lead to hypercalcaemia?
* Tuberculosis
* Histoplasmosis
444
What condition is associated with hypercalcaemia due to increased growth hormone?
Acromegaly
445
What is Milk-alkali syndrome?
A cause of hypercalcaemia related to calcium-containing antacids
446
Which drug class is known to cause hypercalcaemia?
Thiazides
447
What condition can lead to hypercalcaemia due to prolonged immobilisation?
Paget's disease of the bone
448
True or False: Dehydration can cause hypercalcaemia.
True
449
Fill in the blank: _______ is a condition that may lead to hypercalcaemia and is characterized by adrenal insufficiency.
Addison's disease
450
What is hypoparathyroidism?
A condition characterized by decreased secretion of parathyroid hormone (PTH)
## Footnote
Hypoparathyroidism can be primary or secondary to other conditions such as thyroid surgery.
451
What is primary hypoparathyroidism?
A decrease in PTH secretion, often secondary to thyroid surgery
## Footnote
It results in low calcium and high phosphate levels.
452
What are the main symptoms of hypoparathyroidism?
Symptoms include:
* Tetany: muscle twitching, cramping, and spasm
* Perioral paraesthesia
* Trousseau's sign
* Chvostek's sign
* Chronic symptoms: depression, cataracts
* ECG: prolonged QT interval
## Footnote
Symptoms are primarily due to hypocalcaemia.
453
What is Trousseau's sign?
Carpal spasm induced by occluding the brachial artery with a blood pressure cuff
## Footnote
This occurs when the pressure is maintained above systolic.
454
What is Chvostek's sign?
Twitching of facial muscles upon tapping over the parotid gland
## Footnote
It indicates neuromuscular excitability due to low calcium.
455
What is pseudohypoparathyroidism?
A condition where target cells are insensitive to PTH due to a G protein abnormality
## Footnote
It is associated with low IQ, short stature, and shortened 4th and 5th metacarpals.
456
What are the biochemical findings in pseudohypoparathyroidism?
Low calcium, high phosphate, high PTH
## Footnote
Diagnosis involves measuring urinary cAMP and phosphate levels after PTH infusion.
457
What happens to cAMP and phosphate levels in hypoparathyroidism after PTH infusion?
Both cAMP and phosphate levels increase
## Footnote
This is in contrast to pseudohypoparathyroidism where only cAMP may rise.
458
What distinguishes pseudohypoparathyroidism type I from type II?
Type I shows no increase in cAMP or phosphate; Type II shows an increase in cAMP only
## Footnote
This difference is crucial for diagnosis.
459
What is pseudopseudohypoparathyroidism?
A condition with a similar phenotype to pseudohypoparathyroidism but normal biochemistry
## Footnote
It reflects the phenotypic features without the biochemical abnormalities.
460
What is the treatment for primary hypoparathyroidism?
Treated with alfacalcidol
## Footnote
Alfacalcidol is a form of vitamin D that helps increase calcium absorption.
461
What does a Box-and-whisker plot represent?
Graphical representation of the sample minimum, lower quartile, median, upper quartile and sample maximum
## Footnote
Box-and-whisker plots are useful for visualizing the distribution of data and identifying outliers.
462
What is the purpose of a Funnel plot?
Used to demonstrate the existence of publication bias in meta-analyses
## Footnote
Funnel plots help visualize the relationship between study size and effect size.
463
What type of data does a Histogram display?
A graphical display of continuous data where the values have been categorised into a number of categories
## Footnote
Histograms are useful for showing the frequency distribution of a dataset.
464
What is typically shown in a Forest plot?
Graphical representation of the strength of evidence of the constituent trials
## Footnote
Forest plots summarize the results of multiple studies in a meta-analysis.
465
What does a Scatter plot represent?
Graphical representation using Cartesian coordinates to display values for two variables for a set of data
## Footnote
Scatter plots are useful for identifying relationships or correlations between two variables.
466
What does a Kaplan-Meier survival plot show?
A plot of the Kaplan-Meier estimate of the survival function showing decreasing survival with time
## Footnote
Kaplan-Meier plots are commonly used in clinical research to estimate survival rates.
467
What does the null hypothesis (H0) state?
Two treatments are equally effective
## Footnote
It is negatively phrased.
468
What is the purpose of a significance test?
To assess how likely the null hypothesis is to be correct using sample data.
469
What is the alternative hypothesis (H1)?
There is a difference between the two treatments.
470
What does the p value represent?
The probability of obtaining a result by chance at least as extreme as the observed result, assuming the null hypothesis is true.
471
What is a type I error?
The null hypothesis is rejected when it is true, leading to a false positive.
472
What determines the chance of making a type I error?
The preset significance level (alpha)
## Footnote
Increasing the number of end-points raises the chance of a type I error.
473
What is a type II error?
The null hypothesis is accepted when it is false, leading to a false negative.
474
What is the probability of making a type II error called?
Beta.
475
What factors determine the probability of a type II error?
Sample size and alpha.
476
What is the power of a study?
The probability of correctly rejecting the null hypothesis when it is false.
477
How is power calculated?
Power = 1 - the probability of a type II error.
478
How can the power of a study be increased?
By increasing the sample size.
479
What does bias describe in a trial?
A situation where one outcome is systematically favoured
## Footnote
Variations in definitions and classifications of bias exist.
480
What is selection bias?
Error in assigning individuals to groups leading to differences influencing the outcome
## Footnote
Subtypes include sampling bias, volunteer bias, and non-responder bias.
481
What is sampling bias?
Subjects are not representative of the population
## Footnote
Often due to volunteer bias.
482
What is volunteer bias?
A situation where individuals at risk may be more or less likely to participate in a study
## Footnote
Example: A study on Chlamydia prevalence in students.
483
What is non-responder bias?
Occurs when individuals who do not respond to a survey may differ significantly from those who do
## Footnote
Example: Poorer diets among non-responders in dietary surveys.
484
What is loss to follow up bias?
Bias occurring when participants drop out of a study, potentially affecting the outcome
## Footnote
This can lead to skewed results.
485
What is prevalence/incidence bias (Neyman bias)?
Occurs when a study omits missed cases due to early fatalities or silent cases
## Footnote
Affects calculations and outcomes.
486
What is admission bias (Berkson's bias)?
When cases and controls in a hospital study are systematically different
## Footnote
Due to the combination of exposure to risk and disease occurrence.
487
What is the healthy worker effect?
Bias where employed individuals are generally healthier than the general population
## Footnote
Affects studies comparing health outcomes.
488
What is recall bias?
Difference in accuracy of recollections retrieved by study participants
## Footnote
Particularly problematic in case-control studies.
489
What is publication bias?
Failure to publish results from valid studies, often due to negative or uninteresting results
## Footnote
Important in meta-analyses.
490
What is work-up bias (verification bias)?
Issue in studies comparing new diagnostic tests with gold standards
## Footnote
Clinicians may avoid ordering gold standard tests unless new tests are positive.
491
What is expectation bias (Pygmalion effect)?
Bias occurring in non-blinded trials where observers may favour expected outcomes
## Footnote
Influences measurement and reporting.
492
What is the Hawthorne effect?
Change in behavior of a group due to awareness of being studied
## Footnote
Can affect the validity of study results.
493
What is late-look bias?
Gathering information at an inappropriate time, such as studying a fatal disease long after cases have died
## Footnote
Affects the accuracy of study findings.
494
What is procedure bias?
Occurs when subjects in different groups receive different treatments
## Footnote
Can lead to confounding results.
495
What is lead-time bias?
Occurs when a new test diagnoses a disease earlier without affecting the outcome
## Footnote
Can misrepresent the effectiveness of screening methods.
496
What is the primary cause of increased intraocular pressure (IOP) in acute angle-closure glaucoma (AACG)?
Impairment of aqueous outflow
## Footnote
This condition is characterized by a sudden increase in IOP due to blockage in the drainage of aqueous humor.
497
List three factors that predispose individuals to acute angle-closure glaucoma (AACG).
* Hypermetropia (long-sightedness)
* Pupillary dilatation
* Lens growth associated with age
## Footnote
These factors contribute to the anatomical changes that may lead to AACG.
498
What type of pain is commonly associated with acute angle-closure glaucoma?
Severe pain
## Footnote
Pain may be localized to the eye or present as a headache.
499
What is a symptom that worsens with mydriasis in AACG?
Decreased visual acuity
## Footnote
Symptoms can be exacerbated by conditions such as watching TV in a dark room.
500
What are the ocular signs of acute angle-closure glaucoma?
* Hard, red eye
* Halos around lights
* Semi-dilated non-reacting pupil
* Corneal oedema leading to dull or hazy cornea
## Footnote
These signs result from increased IOP and related complications.
501
True or False: Systemic upset such as nausea and vomiting can occur in acute angle-closure glaucoma.
True
## Footnote
Patients may also experience abdominal pain as part of the systemic upset.
502
What is anterior uveitis also referred to as?
iritis
503
What does anterior uveitis describe?
inflammation of the anterior portion of the uvea - iris and ciliary body
504
Which genetic marker is associated with anterior uveitis?
HLA-B27
505
What is a common feature of anterior uveitis related to onset?
acute onset
506
What symptom of anterior uveitis may increase with use?
ocular discomfort & pain
507
What is the pupil's condition in anterior uveitis?
small +/- irregular due to sphincter muscle contraction
508
What type of vision issue is associated with anterior uveitis?
blurred vision
509
What is ciliary flush in the context of anterior uveitis?
a ring of red spreading outwards
510
What does hypopyon describe?
pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
511
What happens to visual acuity in anterior uveitis?
initially normal → impaired
512
Name a condition associated with anterior uveitis.
ankylosing spondylitis
513
Name another condition associated with anterior uveitis.
reactive arthritis
514
List two inflammatory bowel diseases associated with anterior uveitis.
* ulcerative colitis
* Crohn's disease
515
What is another condition linked to anterior uveitis?
Behcet's disease
516
What systemic condition may present as bilateral disease in anterior uveitis?
sarcoidosis
517
What is the recommended management for anterior uveitis?
urgent review by ophthalmology
518
What class of medication is used to relieve pain and photophobia in anterior uveitis?
cycloplegics
519
Fill in the blank: An example of a cycloplegic used in anterior uveitis is _______.
Atropine
520
What type of eye drops are used in the management of anterior uveitis?
steroid eye drops
521
What does scleritis describe?
Full-thickness inflammation of the sclera
## Footnote
Scleritis typically has a non-infective cause.
522
What are the common symptoms of scleritis?
Red eye, pain, watering, photophobia, gradual decrease in vision
## Footnote
Pain is classically more severe than in episcleritis.
523
Which condition is the most commonly associated with scleritis?
Rheumatoid arthritis
## Footnote
Other associated conditions include systemic lupus erythematosus, sarcoidosis, and granulomatosis with polyangiitis.
524
What is a key feature that distinguishes scleritis from episcleritis?
Scleritis is classically painful
## Footnote
Episcleritis typically has less severe pain.
525
What is the first-line treatment for scleritis?
Oral NSAIDs
## Footnote
These are typically used for initial management.
526
What may be used for more severe presentations of scleritis?
Oral glucocorticoids
## Footnote
These are considered when NSAIDs are insufficient.
527
What is the management approach for resistant cases of scleritis?
Immunosuppressive drugs
## Footnote
These may also be used to treat any underlying associated diseases.
528
What is a common characteristic of the eye when affected by scleritis?
Redness
## Footnote
This is one of the primary features observed.
529
Fill in the blank: Scleritis typically causes a _______ eye.
red
## Footnote
This characteristic is essential for diagnosis.
530
True or False: Scleritis can be caused by infectious agents.
False
## Footnote
Scleritis generally has a non-infective cause.
531
What is a common ocular symptom associated with scleritis besides pain?
Photophobia
## Footnote
This sensitivity to light is often reported by patients.
532
What is the importance of same-day assessment by an ophthalmologist in scleritis?
To ensure timely diagnosis and management
## Footnote
Prompt assessment is crucial due to potential complications.
