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clinical Flashcards

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1
Q

Thromboembolic disease in pregnancy symptoms

A

Unilateral leg swelling, pain, SOB, chest pain, tachycardia, pleural rub, cough

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2
Q

Thromboembolic disease in pregnancy investigations

A

ECG
leg dopplers
CXR/VQ scan
CTPA

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3
Q

Thromboembolic disease in pregnancy treatment

A

Low molecular weight heparin

TED stockings
hydration and mobility

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4
Q

maternal sepsis investigations

A

Blood cultures

LVS, MSSU, wound swabs

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5
Q

maternal sepsis treatment

A

Prompt IV antibiotics

IV fluids

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6
Q

Down syndrome investigations

A 
Beta hCG
pregnancy associated plasma protein (PAPPA-A)
Nuchal translucency
amniocentesis
non-invasive prenatal testing
CVS
US
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7
Q

Leiomyomata symptoms

A

Asymptomatic, dysmenorrhoea, menorrhagia, pressure, pelvic pain, infertility, pelvic distortion

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8
Q

Leiomyomata treatment

A

Hormonal GnRH analogues,
myomectomy, hysterectomy, uterine artery embolization
small then COCP, POP, mirena
fertility preservation

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9
Q

endometriosis symptoms

A

Pelvic pain
multi-system involvement, painful menstrual cramps, lower back pain, abnormal bleeding, diarrhoea, nausea, painful bowel movements, post/ pre coital pain

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10
Q

endometriosis investigations

A

Pelvic examination
US
diagnostic laparoscopy

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11
Q

endometriosis treatment

A

IVF with salpingectomy by laparoscopy

analgesia
COCP, POP, mirena IUS, depot provera, GnRH analogues, surgical ablation hysterectomy, endometria excision, pelvic clearance

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12
Q

congenital rubella syndrome signs

A

Eye abnormalities
congenital heart disease
sensorineural deafness

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13
Q

breast cancer symptoms and signs

A 
Mass
asymmetry 
malignant
irregular, ill-defined, dense
benign
smooth, lobulated
change in areola appearance
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14
Q

breast cancer investigations

A 
Mammography
US 
‘triple assessment’ 
FNA cytology 
core biopsy 
MRI
sentinel node sampling 
lymphoscintigraphy

FBC, U+E’s, LFT, calcium, PO2

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15
Q

breast cancer treatment

A

Tamoxifen
aromatase inhibitors
arimidex, Letrozole
mastectomy

chemotherapy
taxane, anthracycline
HER2 tx
Trastuzumab (Herceptin)

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16
Q

ovarian cancer symptoms and signs

A

Indigestion, poor appetite, altered bowel habit, pain, bloating, discomfort, weight gain, pelvic mass

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17
Q

ovarian cancer investigations

A

US abdo/pelvis
CT, CA125
laparotomy

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18
Q

ovarian cancer treatment

A 
Surgery 
laparotomy 
chemotherapy
platinum and taxane 
high risk women then prophylactic oophorectomy
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19
Q

vulvovaginal candidiasis symptoms

A 
Asymptomatic
itch
discharge
thick cottage cheese 
fissuring 
erythema with satellite lesions
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20
Q

vulvovaginal candidiasis investigations

A

Gram stained preparation

culture (sabouraud’s medium)

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21
Q

vulvovaginal candidiasis treatment

A

Clotrimazole
fluconazole
avoid irritants

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22
Q

bacterial vaginosis symptoms

A

Asymptomatic, watery grey fishy discharge, worse after period/sex, sore/itch from dampness

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23
Q

bacterial vaginosis investigation

A

History and examination findings

gram stained smear

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24
Q

bacterial vaginosis treatment

A

Metronidazole

clindamycin

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25
molar pregnancy investigation
High BhCG | US
26
complication of molar pregnancy
May become a choriocarcinoma
27
symptoms of missed miscarriage
No symptoms, or could have been bleeding
28
treatment for molar pregnancy
Cure my methotrexate if BhCG stays high
29
septic miscarriage symptoms
Open cervix, vaginal bleeding (may have to be bleeding)
30
missed miscarriage treatment
Conservative medical (prostaglandins): misoprostol surgical
31
septic miscarriage treatment
Antibiotics and evacuate uterus
32
ectopic pregnancy symptoms
Amenorrhoea vaginal bleeding abdomen pain GI/urinary symptoms
33
ectopic pregnancy investigations
Scan serum BHCG serum Progesterone levels
34
ectopic pregnancy treatment
Medical – methotrexate | surgical – laparoscopically
35
antepartum haemorrhage treatment
Balloon tamponade oxytocin, ergometrine, carbaprost, tranexamic acid ligation of uterine artery or iliac vessels, hysterectomy
36
placenta praevia symptoms
Painless bleeding malpresentation of fetus soft non tender uterus
37
placenta praevia investigations
US | no vaginal examination!
38
placenta praevia treatment
C section, watch for post-partum haemorrhage
39
placental abruption symptoms
Pain, vaginal bleeding, increased uterine activity
40
placental abruption treatment
Vaginal delivery, or C section
41
pregnancy hypertension treatment
``` Lower dietary sodium labetolol nifedipine methyldopa monitor fetal growth ```
42
pre-eclampsia symptoms
``` headache blurring vision epigastric pain below ribs vomiting hand and leg swelling clonus, papilloedema, epigastric tenderness, reducing urine output, convulsion ```
43
pre-eclampsia sign
hypertension and Significant proteinuria >20 weeks raised liver enzymes, urea, creatinine, urate, bilirubin. Low platelets, haemoglobin, haemolsysis
44
investigations for pre-eclampsia
24-hour urine protein collection FBC, LFT, renal function tests, coagulation tests, foetal investigations, CTG
45
treatment for pre-eclampsia
Only cure is delivery, anti-hypertensives (labetolol, methyldopa, nifedipine) steroids for foetal lung maturity if gestation <36 weeks
46
complications for pre-eclampsia
``` Seizures haemorrhage, stroke HELLP DIC renal failure pulmonary oedema cardiac failure foetal distress, prematurity perinatal mortality ```
47
future prophylaxis for pre-eclampsia
low dose aspiring from 12 weeks
48
pre-eclampsia seizures treatment
seizures MG sulphate bolus IV infusion IV labetolol, hydralazine
49
diabetic pregnancy treatment
``` Induce labour about 38-40 weeks elective C section maintain blood sugar In labour with insulin and dextrose CTG monitoring early baby feeding ```
50
diabetic pregnancy risks
``` Neonatal hypoglycaemia increased risk of respiratory distress miscarriage foetal macrosomia perinatal mortality infection pre-eclampsia ```
51
gestational diabetes investigations
Screening for HbA1C, OGTT post delivery yearly check on HbA1C
52
urinary incontinence symptoms
Irritation urgency, increased frequency, nocturia, dysuria, haematuria incontinence straining to void, interrupted flow, recurrent UTI vaginal lumps, constipation, IBS, prolapse symptoms
53
urinary incontinence investigations
``` QoL fluid intake urinary diary urine dipstick abdo/neuro/gynae assessment urinalysis post voiding residual volume assessment urodynamics ```
54
urinary incontinence treatment
``` Stop smoking lose weight eat healthily stop drinking alcohol and caffeine physiotherapy pelvic floor muscle training Yentreve (duexetine) culposuspension mid urethral sling ```
55
overactive bladder syndrome symptoms
Urgency, incontinence, frequency, nocturia
56
overactive bladder syndrome treatment
Normalise fluid intake reduce caffeine, stop smoking, weight loss bladder training programme with continence nurse antimuscarinics tri-cyclic antidepressants botox neuromodulation
57
infertility investigations male
FSH, LH, testosterone, PRL, CF screen, karyotype
58
infertility investigations female
Weight, height, BMI, fait and hair distribution, galactorrhoea, abdo/pelvic exam ferryman Gallwey score, semen analysis, rubella immunity, chlamydia, TSH, mid luteal progesterone, US, tubal patency test, laparoscopy
59
group 1 ovulation disorder for infertility treatment
pulsatile administration of gonadotrophin releasing hormone +/- LH
60
PCOS ovulation induction treatment
induction clomifene, gonadotrophins, weight loss gain
61
tubal factors for infertility treatment
salpingectomy with IVF treatment | urology, donor insemination, reversal of vasectomy
62
heavy menstrual bleeding treatment
``` Hysterectomy tranexamic acid mefenamic acid hormonal contraception combined contraceptive pill ``` endometrial ablation
63
causes of heavy menstrual bleeding
``` Polyps endometriosis adenomyosis PID PCOS uterine fibroids coagulation disorders hypothyroidism anticoagulation treatments intrauterine devices ```
64
adenomyosis symptoms
Heavy menstrual bleed, significant dysmenorrhea
65
treatment for adenomyosis
Partially responds to hormones, definitive treatment is hysterectomy
66
endometrial polyps symptoms
heavy bleeding
67
endometrial polyps investigations
US, hysteroscopy
68
treatment for endometrial polyps
polypectomy
69
PCOS symptoms
Infertility, weight gain, depression, acne, hair thinning, facial hair, irregular period, nausea, body hair, high B.P.
70
PCOS investigations
``` US metabolic factors FSH, LH oligo-anovulation hyperandrogenism ```
71
PCOS treatment
``` Lifestyle adjustment BMI reduction COCP POP mirena clomiphene metformin antiandrogens (spironolactone ```
72
labial adhesions treatment
Oestrogen therapy | surgery rarely required
73
menorrhagia treatment
``` POP Deop provera mirena IUS tranexamic acid mefenamic acid ```
74
potential differentials for menorrhagia
Exclude von Willebrand disease and immune thrombocytopenic prupura
75
primary amenorrhea investigation
FSH, LH, PRL, TSH, testosterone, oestrogen, US, pregnancy test
76
primary amenorrhea treatment
Gradual build up of oestrogen, add progesterone
77
intraduct papilloma sign
nipple discharge
78
fat necrosis symptoms
Lipid filled cysts, fibrosis, calcifications, egg sell on mammography
79
phyllodes tumour signs and symptoms
Fleshy tumour, leaf like pattern, cysts on cut surface, circumscribed
80
metastatic spread of phyllodes tumour
haematogenous
81
breast carcinoma symptoms
Hard lump, fixed mass tethering to skin, Peau d’orange,
82
prognostic markers for carcinoma symptoms
HER – 2, ER/ PR predictors
83
breast paget's disease symptoms
Pain, itching, scaling, redness, ulceration, crusting, serous or bloody discharge
84
pelvic organ prolapse vaginal symptoms
``` Vaginal bulge protrusion pressure heaviness difficulty inserting tampons ```
85
pelvic organ prolapse urinary symptoms
urinary incontinence weak stream, incomplete emptying manual reduction of prolapse, urgency
86
pelvic organ prolapse bowel symptoms
bowel | incontinence, incomplete emptying, urgency, digital evacuation, splinting to aid defecation
87
investigations for pelvic organ prolapse
``` Baden -walker – halfway grading POPQ score QoL USS/MRI urodynamics IVU ```
88
treatment for pelvic organ prolapse
silicone pessaries | surgery
89
preventative treatment for pelvic organ prolapse
Prevention avoid constipation, small family size, improved antenatal and intrapartum care, management of chronic chest pathology pelvic floor training electrical stimulation, biofeedback, vaginal cones
90
menopause symtpoms
``` Hot flushes vaginal dryness low libido muscle and joint aches osteoporosis mood changes ```
91
investigations for menopause
DEXA scan | FRAX score risk
92
menopause treatment
``` Calcium and Vit D HRT bisphosphonates denosumab teriparatide HRT local oestrogen selective oestrogen receptor modulators SSRI/SNRI antidepressants venlafaxine or clonidine natural methods phytoestrogen ```
93
secondary amenorrhea sign
No periods for the past 6 months
94
investigations for secondary amenorrhea
BMI, androgenic signs abdominal and bimanual vaginal examination urine pregnancy test FSH, oestrogen, thyroid function, prolactin, testosterone, US
95
endometrial cancer symptoms
Post- menopausal bleeding, irregular cycle
96
endometrial cancer investigations
Transvaginal US for endometrial thickness, pelvic and speculum examination biopsy if >4mm MRI
97
endometrial cancer treatment
Early stage surgical hysterectomy, peritoneal washing and salpingectomy chemotherapy is high risk advanced RT palliation progesterone
98
endometrial cancer differentials
Polyps, other cancers, atrophic vaginitis
99
chlamydia male symptoms
Slight watery discharge, dysuria
100
chlamydia female symptoms
vaginal discharge, dysuria, intermenstrual/post-coital bleeding
101
chlamydia investigations
First void urine in men. Self-ta
102
Gonorrhoea male symptoms
asymptomatic, Thick, profuse yellow discharge, dysuria. Rectal and pharyngeal infection often asymptomatic
103
Gonorrhoea female symptoms
asymptomatic, vaginal discharge, dysuria or intermenstrual/post-coital bleeding
104
Gonorrhoea investigations
Nucleic acid amplification test gram stained smear culture cure test 2 weeks test of reinfection 3 months
105
Gonorrhoea treatment
Ceftriaxone 1g im
106
chlamydia treatment
Doxycycline 100mg bd 1 week Azithromycin 1g po once if pregnant
107
herpes symptoms
80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration. Tender inguinal lymphadenopathy. Flu-like symptoms. Dysuria, Neuralgic pain in back, pelvis and legs,
108
herpes investigations
Clinical impression. Swab from lesion tested using PCR
109
herpes treatment
Aciclovir and lidocaine
110
trichomoniasis male symptoms
asymptomatic
111
trichomoniasis female symptoms
Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.
112
trichomoniasis investigation
PCR on a vaginal swab. NB not validated on urine yet so no test for men. Point of Care - Microscopy of wet preparation of vaginal discharge
113
trichomoniasis treatment
Metronidazole 400mg po bd for 5 days or 2g single dose.
114
anogenital warts symptoms
Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.
115
anogenital warts investigation
Appearance. Biopsy if unusual
116
anogenital warts treatment
Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments. Others – cryotherapy Bulky warts – diathermy, scissor removal.
117
syphilis primary symptoms
local ulcer
118
syphilis secondary symptoms
Secondary Rash, mucosal ulceration, neuro symptoms, patchy alopecia, other symptoms
119
syphilis tertiary symptoms
Neurological, cardiovascular or gummatous – skin lesions, (all v rare
120
syphilis investigations
Clinical signs Serology for TP IgGEIA, TPPA and RPR PCR on sample from an ulcer
121
syphilis treatment
Doxycycline or benzathine penicillin
122
Unilateral leg swelling, pain, SOB, chest pain, tachycardia, pleural rub, cough
DVT
123
Asymptomatic, dysmenorrhoea, menorrhagia, pressure, pelvic pain, infertility, pelvic distortion
Leiomyoma
124
Pelvic pain multi-system involvement, painful menstrual cramps, lower back pain, abnormal bleeding, diarrhoea, nausea, painful bowel movements, post/ pre coital pain
endometriosis
125
``` breast Mass asymmetry malignant irregular, ill-defined, dense benign smooth, lobulated change in areola appearance ```
breast cancer
126
Indigestion, poor appetite, altered bowel habit, pain, bloating, discomfort, weight gain, pelvic mass HNPCC/Lynch type 2 BRAC1 BRAC2
ovarian cancer
127
``` Asymptomatic itch discharge thick cottage cheese fissuring erythema with satellite lesions ```
vulvovaginal candidiasis
128
Painless bleeding malpresentation of fetus soft non tender uterus Multiparous women multiple pregnancies prior C section
placenta praevia
129
Multiple pregnancies, smoking, increased age, parity, cocaine, previous abruption, polyhydramnios, pre-eclampsia Pain, vaginal bleeding, increased uterine activity
placental abruption
130
``` Significant proteinuria >20 weeks headache blurring vision epigastric pain below ribs vomiting hand and leg swelling clonus, papilloedema, epigastric tenderness, reducing urine output, convulsion raised liver enzymes, urea, creatinine, urate, bilirubin. Low platelets, haemoglobin, haemolsysis ```
pre-eclampsia
131
Infertility, weight gain, depression, acne, hair thinning, facial hair, irregular period, nausea, body hair, high B.P.
PCOS
132
Distorted elongated ducts, well circumscribed, freely mobile, non-painful mass
Fibroadenoma
133
Lipid filled cysts, fibrosis, calcifications, egg sell on mammography
fat necrosis of the breast
134
nipple discharge
intraduct papillma
135
breast Fleshy tumour, leaf like pattern, cysts on cut surface, circumscribed
Phyllodes tumour
136
breast Pain, itching, scaling, redness, ulceration, crusting, serous or bloody discharge
Paget's disease
137
``` Hot flushes vaginal dryness low libido muscle and joint aches osteoporosis mood changes ```
menopause
138
Post- menopausal bleeding, irregular cycle
endometrial cancer
139
M – asymptomatic, Thick, profuse yellow discharge, dysuria. Rectal and pharyngeal infection often asymptomatic F – asymptomatic, vaginal discharge, dysuria or intermenstrual/post-coital bleeding
Gonorrhoea
140
M - Slight watery discharge, dysuria f- vaginal discharge, dysuria, intermenstrual/post-coital bleeding B – conjunctivitis
chlamydia
141
80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration. Tender inguinal lymphadenopathy. Flu-like symptoms. Dysuria, Neuralgic pain in back, pelvis and legs
herpes
142
M – asymptomatic | F - Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.
trichomoniasis
143
Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.
anogenital warts
144
Primary Local ulcer (chancre) Secondary Rash, mucosal ulceration, neuro symptoms, patchy alopecia, other symptoms. Tertiary Neurological, cardiovascular or gummatous – skin lesions, (all v rare
syphilis

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