Conditions List Flashcards

Question

Transient Synovitis

Answer 1

Epi: 3% children have an episode. 5-6y PkAg. 3-12y. Aet: Mostly unknown. Link to viral URTI ~2w before. May be 1st sign of JIA/Chronic inflammation. Hx/Sx: Limitation but freedom within limitaiton; --Abduct, --InternalRot. +LogRollSign (Guarding on InternalRot). ±Limp +Pain. Ix: FBC, ESR, Temp (3/4 Kocher's for SA) +XR ±USS. Mx: Ibuprofen + Paracetamol + Rest (Self-limiting). Make sure they are referred if <3y (SA), >9y -InternRot (SUFE), or other red flags.

Answer 2

Epi: 10.8/100,000 white people. Varies massively between ethnicities (0.45/100,000 black people). Ages 4-8yo. Aet: Idiopathic Avascular Necrosis of Femoral Head. RF: Low socioeconomic status +Passive smoke ±Hyper-coagulable state. 10% bilateral. Hx/Sx: Limp + Pain + Limited ROM (Adduction, Flexion, Abdu+Exten due to impingement). Ix: Bilateral Hip XR: AP + Frog. ±CRP/FBC/ESR. Mx: <5y: good prog: Analgesia +Containment (FemHead-Acetab) + Checkup. 5-12y: ±Surgical containment ±Salvage (Dig into acetab). >12y: poor prog: Salvage ±Hip replacement once mature.

Answer 3

Epi: 5/100,000 /year in UK. ++Males, Age 10-15y, obese. Bilateral in 20%. Aet: Growth + weight ±hormones + stress > Sheer force on joint. Hx/Sx: EXTERNALLY rotated leg + Weight++ ±Trandelenburg's gait. Ix: AP + Frog bilateral XR hip. Mx: Urgent surgical repair ±Prophylactic fixation of contralateral hip.

Answer 4

Epi: Prev: 1/11,000 of <16yo. ++in F, <6yo. Aet: ??? - A bit genetic, and considered auto-immune. Systemic, Polyart (>4), Pauci/Oligoart (≤4), JuvRheumArt, JuvAnkyl, JuvPsoriatic. Hx/Sx: Joint pain, joint swelling, >6w of sx, ?Fever. ±Morning stiffness ±Limp ±Rash ±Uveitis ±Nodules ±Salmon-pink rash. Ix: FBC + ESR + CRP + ANA + RheumF. ±ACCP ±USS ±MRI. Mx: All: ±NSAIDs ±IFa-inhibs. >5 joints: Methotrex ±IA steroids ±Oral steroids. <5 joints; IA steroids ±Methotrex.

Answer 5

Epi: 1/3000. 5-10% of diabetics. 10-14y most common age. Aet: Autoimmune attack on pancreatic islets b-cells. HLA-DR/DQ. Coeliac also HLA-DQ. Hx/Sx: Recent weight loss. Fatigue. Polyuria+dipsia. ±DKA. ±Abdo pain. Ix: +Urine dip +Random/2h/Fasting Glucose +HbA1C ±C-Peptide (Distinguishing T1 from others). Mx: Basal insulin (Long-Acting: Glargine/Detemir) + Pre-Meal: (Short: "LAG": Lispo/Aspart/Glul) ±Metformin. Preggo: Insulin ±Metformin +75mg Aspirin.

Answer 6

Epi: 1/4000 person-years. Ages 2-10. Aet: Normally post-viral in children. IgA released and damages vessels. Hx/Sx: Prev URTI. Non-blanching petechia on legs and bum. ±Arthralgia ±Abdo pain ±Haem/Proteinuria (Microscopic). Ix: BP + Morning-Urinalysis + Cr/Urea levels (eGFR) ±IgA ±Coag studies ±USS abdo ±USS testicles (?Swelling). Mx: Only in presence of nephritis: Mild Steroids ±Azathioprine. Severe: Cyclophosphamide ±Steroids etc.

Answer 7

Epi: 1/20,000 children per year Aet: Typically idiopathic. Hodgkin's, leukaemia, and Hep B/C can both cause it. Hx/Sx: Facial + general oedema. >1y & <8y. No heamaturia. Normal BP. ±Recent viral illness. Ix: Urinalysis. 24h Ur-protein. GFR, USS Serum --albumin/++lipids, LFTs, compliment. ±Biopsy ("Minimal Change"). Mx: Steroid every other day x 6w ±Low-salt diet ±Albumin ±Furosemide. Ster resist: Cyclophosphamide/Tacrolimus.

Answer 8

Epi: 1/33,000. 75% in <6y. Aet: Genetic (20% twins) + Radiation + Infection + T21 + Klinefelters + t(9,22) BCR/ABL. B + T cell proliferation. Hx/Sx: Lymphad ±^^Hep/Splen ±Pallor ±Ecchymosis (bruising) ±Fever ±Fatigue ±Unilateral ^^Testicles ±Bone pain. Ix: FBC + Smear + U&Es + LFTs + Coags + Marrow + Cytogenetics ±LP ±CT-head. Mx: Induce: Pred + Cycloph + Vincr + Doxorub. + CNS prophlyaxis: Methotrex. -CNS: Methotrex -t(9,22)? > Tyrosine Kinase Inhib. -Consolidation: Above + Stem-cell trans.

Answer 9

Epi: 7/100 VLBW infants on NICU. Aet: Breastmilk + Steroids protective. Hx/Sx: Mother: Drug use/HIV/Choranioamnitis. Child: 3w of life: Vague symptoms ±Abdo distension ±feeding difficulty. Ix: Baseline bloods (May show ++CRP/WCC). Lying abdo XR: Dilated loops, gas in wall, gas in liver, bowel wall thickening. Mx: Nill/Mouth. NG tube decompression. IV fluid + 3xAbx (Amox, Gent, Metro) + Analgesia (?Morphine). ±Antifungals with abx.

Answer 10

Epi: Clinically evident: 1/6000 live births (Many many more are asymptomatic). 75% in <1yo. Aet: 6w ges:Herniation > 10w: Return with 90 + 180 degrees = 270 total. Arrest may occur at any point. Hx/Sx: Bilious vomiting + Abdo pain ±Normal examination ±^^HR ±vvBP ±^^BP. Ix: Upper GI contrast series ±CT abdo (When no vomiting seen) ±WCC (Long-term Volvulus) ±ABG in severe cases. Mx: Ladd's Procedure. Either emergency if sign of ischaemia, urgent if just obstruction. +Cefo as an abx.

Answer 11

Epi: 1/10,000. T21 associated. Aet: Presents a few hours after birth. FGF pathways? Mostly unknown. T21 more commonly presents with it. Hx/Sx: Bilious/Non-Bilious vomit. Ix: ±USS for antenatal detection. Postnatal: Abdo XR + NG-inflation: Double-bubble sign diagnostic. Mx: NG tube fluid removal +IV fluids +Duodenoduodenostomy.

Answer 12

Epi: 1/5000 births. T21 Associated. Aet: 10q deletion common. 50% inherited RET and ~20% sporadic. Aganglionic submucosal plexus. Hx/Sx: Vomiting + Explosive Leaky/Fowl stools +Abdo distension --Meconium (/delay >24-48h) ±Fever ±FTF. Can present over a month after birth. Ix: GSfDx: Rectal Biop. Plan XR Abdo: Air-fluid level seen + dilation of colon. Contrast Enema (Dilated prox + contracted distal). Mx: Typical: Bowel irrigation + Surgery in 1stW of life. Sometimes: 2-3m of life. Short segment: Laxatives. Total Colonic: Illiostomy + Surgery.

Answer 13

Epi: 1/333 births. 3-6w old. Aet: Not sure, less common in East-Asia. Hx/Sx: ++Male, Non-bilious vomit, projectile vomit, 3-6w old ±Upper abdo mass. Ix: Palpation can > dx "Olive". USS. ±ABG (--Cl, ++pH, --K+) Mx: Fluids + Pyloromyotomy.

Answer 14

Epi: Common: 75% of <1500g neonates. Aet: Failure for umbilical ring to close. Hx/Sx: Clear bulge. Mostly asymptomatic. Present from birth. Easily reducible. ±Sx of Small bowel obstruction. Ix: Clinical Diagnosis. Mx: Bowel in hernia (Incarcerated) > Milk + reduction > Surgery next day. Non-reducible: Emergency Surgery. Large/Symptomatic: Outpatient surgery @2-3y. Small/Asymptomatic: Observe until 4/5y then ?Surgery if needed.

Answer 15

Epi: 1/1500. PkAg: 5-7m. Aet: Lead point (Most common: Payer's patch) leading to auto-peristalsis/telescoping. Hx/Sx: Colicky pain ±Vomit (bilious/non-bili) ±Lethargy in waves ±Redcurrant-Jelly stool (late sign). ±Sausage-mass in abdo. Ix: USS: Doughnut/Bullseye sign. Suspected obstruction/perf: XR. Only do enema if there is no perforation (Risk of Barium peritonitis). Mx: 1st: Air enema. ±Saline/USS enema (Less experience but good results). ±Fluid Resus. Surgery if perforation/Shock or other CI to enema.

Answer 16

Epi: 2-8% infants. 0.5% in excl breast-fed. Aet: Mostly IgE, some non-IgE. Hx/Sx: Dermatitis, resp signs, Ix: 2-4w Elimination diet > Challenge w/CMP; No: Egg, milk, peanuts, or soy ±fish ±wheat. Mx: BrFee-mothers to avoid it in their diet. Excl Breast-feeding ideal. ±ExtenHydrolyFormula ±Amino-Acid-Formula. Severe: Assess whether IgE (?Atopy) > Allergy pathway.

Answer 17

Epi: 0.3-3% prev. Probably higher, but asymptomatic. <2y = 50% of cases. Aet: Failure for vitelline duct to close > Fistula/Div. 40-60% have Gastro (+some pancreatic) tissue releasing acid > Damage. Hx/Sx: Often found incidentally. Bright-red Bleeding + Constipation ±pain ±vomit. Ix: GSfDx: Tech-99m-Scan (Gastric mucosa). +FBC +USS to begin with. ±CT-Abdo. Mx: Sx: Surgical removal of div + opposing bowel. No Sx: Surgical-Incidental: Remove. Imaging-Incidental: Leave alone.

Answer 18

Epi: 1/400 per year in 10-17y. 2/10,000 <4y. Aet: Obstruction of appendix: Faecolith (poo stone), stool, ^^Lymphoid, idiopathic. Hx/Sx: Pain (Gen>Local RIF), Anorexia, N/V ±tense abdomen ±mass ±reduced bowel sounds ±pyrexia. Ix: FBC + CRP + USS (1st for children/pregnant) +Contrast CT abdo. ±bHCG ±Urinalysis. Mx: Uncomplicated: Surgery in 24h. Complicated: Emergency appendectomy. +Fluid +Analgesia ±Abx if perforation.

Answer 19

Epi: 3% of paediatric consultations. ~20% prevalence in US. Aet: --Fibre, --Fluid, ++Hard stools, ±Motility delay. Vicious-Cycle: Slower transit through colon > ++water-absorption > harder stool. Hx/Sx: RF + painful poo ± <3 poo/week ±Faecal incont ±Faecaloma +Otherwise healthy ±Anal fissure. Ix: Clinical dx sufficient normally. ±USS ±XR ±Bloods (If complicated / other dx concerns). Mx: Diet change ± Osmotic Lax (Movicol [pEG] / Lactulose). No impaction: ±Stim Lax (Senna). Impaction: Enema. Severe + Chronic: ±Appendicostomy continuous flush.

Answer 20

Epi: 3m - 3y. Almost all children show evidence of having been infected. Aet: RSV infection of multiple smaller airways Hx/Sx: Wheeze +Cough ±^^Resp Effort ±Poor feeding ±Low-fever ±Rhinitis ±Crackles. Ix: Pulse ox ±Nose-swab (Enz-Link-Immunosorbent-Assay (ELISA) ±CXR. Mx: ±Fluids ±O2 ±Ribavirin in SEVERE cases. Palivizumab prophylaxis in high-risk patients.

Answer 21

Epi: Common. Figures can't be found. Aet: Background smoke, Prematurity. Rhinovirus, RSV, Coronavirus, Parainfluenza, Adenovirus. Is a blend of bronchiolitis and asthma/MultTriggWheeze. Hx/Sx: Multiple episodes (> 4/ year). Well between episodes. Coryza. Presents to hospital if >6 puffs Sal every 4h. Ix: Dx clinical; Consider XR if sx asymmetrical or atypical. Mx: 2-4x Salbutamol/Spacer every 4h ±Maintenance 3m-TRIAL with ICS then Montelukast ±Oral steroids ONLY if signs of atopy or previous severe (Req O2) wheeze.

Answer 22

Epi: 8.5% of Children in USA. Aet: Pretty much the same as "Multi-Trigger-Wheeze" in <5s. IgE mediated. Up to 75% genetic. Hx/Sx: Wheeze w/Triggers. ±Atopy. ^^Work of Breathing ±Night Cough +Reversible ±Intermittent Sx ±Diurnal. Ix: Spiro (FEV/FVC < 0.9). Reversible (>12% increase in FEV1). ±CXR ±Peak-Flow ±DDx Ix. ±Growth Monitoring (steroids). Mx: 0-5y: -1: SABA -2: >3x/week: +Mod-ICS trial x8w. -3: Stop Mod-ICS -4: Did sx go away then come back? Yes: Start long-term Low-ICS. No: Consider other dx. -5: Add LTRA. -6: Stop LTRA and refer. >6y: SABA > Low-ICS > LTR > Med-ICS+SABA OR Low-ICS+LABA. ACUTE: SABA x10 puffs (/30-60s) and switch to O2Nebs when possible + 3-5d PO Steroids. Worsening: "Oh Shit I Hate Asthma Mx".

Answer 23

Epi: 15% all LRTI in kids. 6m-3y peak. Aet: Parainfluenza. Inflammation of upper+lower airway. Previously: Diphtheria (Now vaccinated). Hx/Sx: Barking cough ±Stridor ±Resp Effort. ±Sx worse at night. ±Late-autumn. Ix: Clinical dx. Rarely would you XR neck, if complicated: Steeple Sign. Mx: Single Dose Oral Steroids ±O2 ±Fluids. Severe: Nebulised adrenaline. Life-Threat: Intubation. Try best not to scare the child.

Answer 24

Epi: <1/100,000 incidence. Aet: G(-), Pertussis bacteria. Usually Vaccinated against (8,12,16w+3-5y). Highly contagious in unvaccinated. 4-21 incubation. Irritation of cilia. Hx/Sx: 2-3d Flu-Like sx. Bouts of coughing followed by inspiratory whoop ±Post-cough vomit ±Apnoea ±Unvaccinated. Ix: Nasopharynx swab +Culture +NAAT. +FBC (++WBC) ±CXR. Mx: Macrolides (Clarythromycin) +Monitor for PyloricStenosis in <1m. >1m: Macrolides or Co-Trimoxazole if CI. >21 since cough begins; No abx.

Answer 25

Epi: <1/100,000 /year. Decreased due to vaccination. Aet: Usually due to Haem-Influ-B. Other pathogens (Strep Pneu. Staph. A) and trauma can precipitate. Hx/Sx: Sore Throat +Stridor +Dysphagia +Fever +Toxic-appearance ±Tri-podding ±Drooling ±Non-vaccinated. Ix: Laryngoscopy IN THEATRE ±Lateral-Neck Radiograph: Thumb sign. ±FBC ±Cultures. Mx: Secure airway +Abx ±O2 ±Oral steroids every 6-12h.

Answer 26

Epi: PkAg: 6-15m Aet: 4d-1w infection. SrepPneumo. Can have chronic issues with Eustachian tube (T21/Cleft-Lip etc). >6w: Chronic? Hx/Sx: Pain ±Coryza ±fever ±malaise +Inflamed TympMem ±Conductive Hearing loss. Mastoiditis: Swelling behind ear. Ix: Swabs ± Tympanometry: Minimal movement (Flat curve). Mx: Seriously/Systemically unwell / <2y: Abx (5-7d Amox or Claryth). Otherwise: Safety-netting ±Delayed abx. ?Mastoiditis: Hospital +IVAbx. ±Gromit if chronic.

Answer 27

Epi: Lifetime incidence of 10%. Aet: PseudomonasAer (20-60%) +S.Aureus (10-70%). Abnormal pH, moisture, heat can cause it- Making it ++In swimmers. Hx/Sx: Acute ear pain +Ear-canal swelling/redness/tenderness. Malignant: granulation tissue seen. ±Ottorhoea ±Itching. Ix: PneumaticTests/Tympanometry (Normal if OtEx, abnormal w/OtMed) ±Culture ±ESR ±CT (?Temporal bone) Mx: Ear drops (Abx or Afx). +PainMx. Necrotising: IVAbx +Debridement.

Answer 28

Epi: Bacterial ~1/50-1/35. PkAg: 5-15y. Aet: Bacterial: StrepPyogen (GAS). More commonly viral: Rhino/Adeno ±EBV. Hx/Sx: Pain on swallowing ±Exudate(+1) ±Fever >38(+1). ±Headache ±Erythema/Swelling ±Anterior lymph-node swelling(+1) and NO COUGH(+1) =bacterial. Ix: Clinical Dx (Centor Criteria) ±Throat cultures ±WBC (?EBV). Mx: Analgesia. Bacterial: 10d Phenoxymethylpenicillin ±1 dose steroid. Recurrent bacterial: Tonsillectomy.

Answer 29

Epi: 1/2500 babies. Aet: Bochdalek (90% - posterior) / Morgagni (Anterior). Mostly polygenetic, but still idiopathic. Hx/Sx: Difficulty breathing ±Cyanosis ±Tachycardia ±Abnormal Chest development. Commonly associated with CHD. Ix: 60% Diagnosed antenatally (Anomaly USS scan). +Echo (Ante/Post) ±MRI (Ante) ±CXR (Post) ±ABG. Mx: AnteDx: Get to specialist hospital. Early ventilation +NG-tube +analgesia +arterial access. Stop Pulm hypertension then surgical repair.

Answer 30

Epi: 24% of female cancers. 40% of these are metastatic. 1/5000/year for In-Situ. Lifetime risk: 12%! PkAg 74y. Aet: Often oestrogen-related. In situ (85/100 of these Lobular, 15/100 ductal) or metastatic. Hx/Sx: RF: FHx, HeredDiffuseGastricCancer, Klienfelter's, Nulliparity/^^MenopauseAge. DISCHARGE ±Lump ±NippleEczema ±Ulceration ±Pau d'Orang. Met: ±BonePain --Weight ±SOB. Ix: 3x: Palpation +Mammography (?Calcifications)/USS(?Cystic/Solid) +Core-Bio: ?Necrosis ?Grade.±Hormone-tests ±Genetic-tests. Screening: 1y (45-54y). 2y (>54y). Mx: Ductal: LowRisk: Excision ±Further. HighRisk: Mastectomy ±AxLymph-Staging ±Radiotherapy ±EndoTherapy (Tamox/Aromat). Lobular: LowRisk: EndoTherapy. HighiRisk: Bilateral breast removal. Metastatic: EndoTherapy. HER2+: Pertuzumab. Triple-Negative: Chemo.

Answer 31

Epi: 3-11% of women with mastitis (So 0.03%-1.1% of lactating women). 50% Infants with neonatal mastitis will develop a breast abscess. Aet: ±Infective. Staph. Aureus most common. ±Poly-microbial. Lactational mastitis when breast-feeding. Hx/Sx: ±Fever ±Reduced milk. ±Warmth ±Tenderness ±Firmness ±Fluctuant Mass. Ix: GSfDx: Needle Bio w/USS: Purulent fluid. USS: Check underlying abscess. Discharge cytology. Refractory/Recurring: Biopsy. Mx: Multiple needle aspiration +Milk-Removal (?Pump) + Pain-relief +Flucloxacillin (or Clinda) x10-14d.

Answer 32

Epi: 1-10% prev in lactating-women. Aet: Staph. Aureus most common. ±Poly-microbial. Lactational mastitis when breast-feeding. Hx/Sx: ±Fever ±Reduced milk. ±Warmth ±Tenderness ±Firmness ±Mass (Abscess = Fluctuant) Ix: GSfDx: Needle Bio w/USS: Purulent fluid. USS: Check underlying abscess. Discharge cytology. Refractory/Recurring: Biopsy. Mx: Milk-Removal (?Pump) + Pain-relief. >24h / too painful after this: Flucloxacillin (or Clinda) x10-14d ±Topical Anti-fungal + Above.

Answer 33

Epi: 5-9% non-lactating women Aet: Ageing, smoking, nipple inversion; All leading to breast duct obstruction. Hx/Sx: Green/Dirty-White discharge. ±Thickening/Lump ±Redness +Tenderness ±Inverted nipple. Ix: Examination ±USS ±Mammogram. Mx: May self-resolve. ±Abx (10-14d) ±Analgesia ±Surgery if not resolving.

Answer 34

Epi: ~1/10-20,000 women die /year. Aet: HPV 16/18 - 70% of cases - Infection usually resolved in 2y. E6/P53 + E7/Rb. Early sex, Multiple Partners, HIV, cigarettes, COCP. --SocialEcoStat. Hx/Sx: Abnormal Vag Bleeding ±Post-coital bleeding. ±Backpain ±Mass ±MaligSigns. Ix: GsFDx: Biop. ±Other imaging in atypical / staging. Screen: HPV(+)> Pap: ASCUS (AtypSquamCellUndetSig) (+)> Colposcopy. Pap(-)> 1y > HPV(+)> 1y >HPV(+)> Colposc. HPV(-)> 3y(<50) / 5y(>50). HIV = Every year. Mx: Staged (I)A-(IV)B. FertilityPrez: Cold-Cone biopsy / LETZ ±LymphNodes for (I)A1, (I)A2, (I)B1. FamFinished: Radical Hysterectomy >(I)A2 ±Lymphs ±ChemoRadio (Cisplatin).

Answer 35

Epi: 17-50% of women at some point. Aet: Oestrogen > Cells from cervical canal are outside the opening. COCP / Pregnancy / Hormone change. Hx/Sx: ±Non-purulent discharge ±Inter-menstrual bleeding ±Post-coital bleeding. Ix: Clinical dx, picked up on specula or colposcopy. Mx: Leave alone or if severe: ?Discontinue COCP ?Cryotherapy ?Ablation. Postpartum: Observe after 3m.

Answer 36

Epi: 1/10,000 women per year. PkAg: 63. Aet: BRCA1/2. HNPCC. Spreads through peritoneal cavity >Liver/Omentum/Others. Hx/Sx: Mass ±Ascites ±GI sx ±UrinaryFreq/Urg ±Pain. (Meig's: Pleural effusion/Ascites/Benign). Ix: GSfDx: Biop +TransVag Pelvic USS +CA-125 ±PET/MRI/CT. Mx: Surgical Removal + Debulking (from other organs, also stages the disease). +Platinum-Chemo in stage 2+ or not-for-surgery.

Answer 37

Epi: 7% of women at some point. A lot self-resolve without symptoms. Aet: Follicular, Corpus Luteum, or Lutein cysts. or Physiological, Infectious, BenignNeo, MaligNeo. Hx/Sx: Pelvic pain ±early satiety ±bloating ±adnexal mass. ±Tamoxifen ±1st-Trim? ±^^LH/FSH? Ix: TV-USS: Large ovary, may be cystic, solid, or mixed. ±CA-125 ±Pregnancy-test ±MRI/CT. "Risk of Malignancy Index /250) Mx: Acute/HaemoUnstable: Laparotomy + Fluid resus ±Doxy+Cefoxitan. <10cm and stable: USS in 3m, conservative ±COCP. >5cm in PreMen: 6m USS. >1cm in PostMen: 6m USS. Malignancy suspect (All cases in post-menopausal): Laparotomy + Onc review.

Answer 38

Epi: ++Women of reproductive age. 56% have an ovarian mass. Aet: Large ovaries (Cysts, pregnant (1/2000), OHSS (1/33) ±Long FallopianTube. More common on right (Rat = 3:2). Hx/Sx:Pain(Acute/Chron/Intermittent) ±Radiation(Back,Groin,Flank). ±N/V/D ±Tender ±Mass ±Strenuous movement ±Fever. Ix: Pregnancy Test (?Ectopic), Urine (?Renal), FBC (++WCC in torsion, --Hb: ?RuptEctop) CRP (++In torsion) TV-USS: ±Mass ±Whirpool sign. Mx: Surgery: 1: Detorsion OR salpingo-oophorectomy if unviable ±2: Removal of cyst/tumour.

Answer 39

Epi: 6-13% of women of reproductive age. 90% of hyperandrogegism in women. Aet: ?Hypothalamus issue ?Primary ovarian > ++LH. Insulin > +Androgen? > Insulin resistance? Hx/Sx: Irregular Mens ±Infertility ±Hirsutism ±FHx. Sx typically start at puberty (Unless COCP) ±Acne ±Obesity ±HTN. Ix: Ser-17HydroxyProg: R/O AdulOnset-21-Hydrox-Def (NCAH) +Ser-Prolactin: R/O hyperprolactinaemia +OGTT +Fasting lipids +TFTs ±Testosterone ±USS-Pelvis (After period): Polycystic; however not specific. Mx: Weight-loss, metformin, COCP (FamFinished). Letrozole/clomifene ±FSH/LH/GNRH therapy (WantKids).

Answer 40

Epi: 0.5-5% of women on fertility Tx. Aet: More common with gonadotrophin therapy, rarely seen with Clomifene. ++VEGF > ++Vascular permeability & ++Cytokines. Hx/Sx: Mild: Abdo pain/bloating. Moderate: Mild N/V. Severe: Clinical ascites +Oliguria ++Haematocritt --Protein. Critical: VTE + ARDS + Anuria. Ix: USS cysts/ascites +U&Es +Protein. Mx: Hydration ±Paracentesis +Anti-emetics +Analgesia ±Electrolyte correction. +Delay pregnancy. AVOID NSAIDS / Teratogens.

Answer 41

Epi: 1/100 females before age 40. 1/250 before age 35. Aet: Def: ++Gonadotrophins (--Oestrogen) and sx of menopause before age 40. Idiopathic, bilat-Oophorectomy, mumps, chemo, radiotherapy. Hx/Sx: ±FHx +Menstrual irregularities ±Hot flushes ±Poor sleep ±Vaginal Dryness ±Infertility. Ix: BhCG test +Ser-FSH/LH/E2ol +TFTs +Ser-Prolactin +TVUSS (Ovarian dysgenesis?). +Others for rarer disease (Turner's/FragX). Mx: 1. Cyclic combined HRT for 1 year or if there are any "breakthrough bleeds" then 2. Continuous combined HRT. ±Testost (Libido + Bone-health) ±Donor oocyte (When on cyclic).

Answer 42

Epi: 1/4000 women. PkAg 63y. Aet: Chronic oestrogen, unopposed > Endometrial Hyperplasia. (Obesity, PCOS, Tamoxifen, exogenous are all sources of this). Hx/Sx: Uterine mass ±Abnormal PV bleed (inc post-menopausal) ±Pain ±Weight-loss ±Metastatic Signs/sx. Ix: GSfDx: Biop ±Hysteroscopy (Adenocarc). TVUSS +FBC (bleed) +PapSmear + ±MRI/PET/CT Mx: Standard: Surgery (Uterus, Ovaries, ±Nodes dependent on stage) ±Radiotherapy (Stage IB+) (External Radio or Vaginal Brachytherapy). Preserve fertility/Frail (rare): Progesterone (Megestrol) + Aggressive Monitoring ±Careful surgery in young.

Answer 43

Epi: 16-30% women have had an episode. PkAg: 20-24y. Aet: 30% due to Chlamyd (G-Rod). Also NeisGonorr(G-Coc), Mycoplas, GardnerVag, H-Influ, StepAgal. Begins in cervix and ascends. +Iatrogenic (Dilat+Currit). Hx/Sx: RF: ++UPSI. +VagTenderness +CervicalMotionTenderness ±Fever ±LowerAbdoPain ±Discharge. ±RUQ pain (Fitz-Hugh-Curtis Synd). Ix: WCC (++) +NeutrophilSmear (Good PPV) +GeneticProbe/Culture for Neiss/Chlamyd +Nucleic-Acid-Amp for Mycoplasma. ±TVUSS/MRI. Mx: Ceftriaxone x1d (Neiss Gonorr) +Doxy x14d (Chlamyd) +Metro x14d (Others). SexPartner Prophylax. Manage potential infertility. PROBABLY don't remove IUD.

Answer 44

Epi: ~1/10 women of reproductive age. PkAge: 18-29y. Aet: Retrograde Menstruation (Endomet > Peritoneum) + --CellMediatedImmunity + Vascular/Lymphatic dissemination ±Mullerian abnormalities (poor outflow). Hx/Sx: RF: +FHx. Dysmenorrhaea (±2d before "Secondary Dys") ±ChronPelvPain ±Subfertility ±FrozenPevlis (Retrovert) ±Dysuria/FlankPain/Haematuria. Ix: GSfDx: Laparoscopy + Biop. TVUSS: endometroma / UteroSacLig Nodularity. ±RectalUSS ±MRI. Mx: 1. NSAIDs (E.g, Mefanamic Acid)/Analgesia. FamFinished: 2.COCP / Mirena / OtherProgesterone. 3. GNRH antag 4. Hysterectomy. WantKids: Controlled Ovarian HyperStim (Clomifene/Letrozole) ±IVF.

Answer 45

Epi: 1/4 women. PkAg: 35-50. Aet: Endometrial Tissue in the myometrium. Breakdown of junction between endo + myometrium: C-Sec, Pregnancy, SurgicalTermination. Hx/Sx: Dysmenorrhea, Menorrhagia, Large uterus, ChronPelvPain, Dyspareunia. Ix: GSfDx: SurgicalBiop (Often not done). 1st: TVUSS/MRI. Mx: NSAIDS + Hysterectomy or GnRH agonists / Mirena / Progesterone. Tranexamic acid if not wanting the above.

Answer 46

Epi: 1/4 women >30y. ++In Black women. Aet: A single mutated myometrial cell > Single fibroid. Multiple are all de novo (It is benign/in-situ). Oestrogen + Progesterone involved. Hx/Sx: Asymptomatic ±HeavyMenBleed ±FirmPelvicMass ±PelvPain ±Dysmenorrhea ±Bloating ±Constip ±Infertility ±Dyspareunia. Red degeneration occurs in 1/2Trim (Temp, Pain, N/V). Ix: TVUSS and AbdoUSS + EndoBiop (Look for carcinoma, instead of leiomyoma). ±Hysteroscopy ±MRI. Mx: GnRH agonist ± Anti-Progesterone (Mifepristone) or Mirena. ±NSAIDs ±TranexamicAcid. FamFinished: UterineArteryEmbolisation / Hysterectomy.

Answer 47

Epi: ~40% post-menopausal women. Aet: ++Age, Multiparity (Vag delivery), Obesity, Spina Bifida - Weakness in PF-Muscles/Ligaments. Hx/Sx: "Dragging"/"Coming Down" ±Dyspareunia ±Bleeding ±Urine Incontinence/Frequency/Urgency. Ix: Clinical Dx. Mx: LifeMod: --Smoking, --Weight. Cons: Kegels / Pessaries. Surg: Hysterectomy / Uterine-suspension surgery (Mesh from Sacrum>Uterus).

Answer 48

Epi: 100% of women. PkAg: 51y. Aet: --Ovarian production of Oes/Prog/Testosterone. --Fertility. Hx/Sx: Amenorrhoea +Irregular MenCycle +HotFlush +NightSweats +MoodChange +Vaginal Dryness/Itching. ±Issues with Sleep/Memory. ±HeavyBleeding. Ix: hCG-Test ±FSH (++ >30). (Only women <45y) ±E2ol (Extra testing not always needed beyond hCG). Mx: Contraception for 12m if >50, 24m if <50. --Weight, ++Exercise. Continuous E2 + 14d on/off progest (Sequential). ±SSRI ±Gabapentin.

Answer 49

Epi: 6% of 15-44y women have difficulty after 1y of trying. Aet: Issues with: 30% sperm. 25% ovulation, 15% tubal. 10% uterine. 20% idiopathic. Hx/Sx: >35y fecundity. ±Hirsuitism ±Hx pelvic surgery ±IrregMenst ±dyspareunia. Ix: Semen analysis, chlamydia screen, BMI (PCOS/AnOv), SerLH/FSH on d2-5 (?PCOS). SerProg on cycle-7d (Confirm Ovulation). TFTs, Prolactin, Rubella immunity ±TVUSS. Mx: 400mcg folate acid. --Weight / Alcohol / Smoking + Sex every 2-3d. ±IVF ±Menotrophin/Lutropin (--Pit/Hypothal) ±Metformin (PCOS) ±Clomifene/Letrozole (if pit/hypothal are fine). ±Surrogacy (Damaged uterus).

Answer 50

Epi: ~75% of women will have 1 infection in their life. Aet: Albicans. Pregnancy / DM / Broad-Abx / Steroids / Hormone pills. Hx/Sx: Thick, odourless, white discharge. Itching ±Discomfort ±Fissures ±Redness ±Dysparaunia ±Dysuria ±Excoriation. Ix: pH with swab; <4.5. GSfDx: Charcoal swab + microscopy. Mx: Antifungal: 1x Clotrimazole cream or 1x Clotrimazole pessary or 1x Fluconazole tablet. Recurrent (>4/y): 6m regime oral/vaginal antifungals. ++Alternate Contraception.

Answer 51

Epi: 30% 14-49y women in US. Aet: Anaerobic bacteria. Loss of lactobacilli (Thereby ++pH >4.5). Can ++Risk of STIs. Gardnerella Vaginalis, Mycoplasma Hominis. Hx/Sx: Fishy-smelling grey/white discharge. ±Hx of douching/Soap-washing. NOT TYPICALLY ITCHY. ±Complications in pregnancy (PPROM, LBW, Chorioamnionitis). Ix: High-vaginal charcoal swab OR Low swab (Clue Cells). pH paper (>4.5). ±Other infections. Mx: Normally no treatment needed. ±Metronidazole (anaerobic bacterial) + Avoid alcohol (Disulfiram-like-R) via oral/vaginal gel. ±Clindamycin.

Answer 52

Epi: 3% general US population affected. Aet: Protozoa (4 flagella front, 1 one back). Lives in urethra/Vagina. ++Risk of HIV + other infections. Hx/Sx: 70% asymptomatic. ±Purulent/Yellow-green+Frothy ±Fish-smell ±Itching ±Balanitis (men). STRAWBERRY CERVIX. Ix: GSfDx: Charcoal Swab from post fornix + Microscopy ±pH strip (>4.5). UrethralSwab / First-catch urine in men. Mx: Metronidazole oral x1 +Tx sexual partners.

Answer 53

Epi: In USA: 1/200/y Chlamyd. 1/500/y Gonorr. PkAg 15-24y. Aet: 58% transmission M->F after one single UPSI (23% F->M) for Gonorr. Chlamyd Incubation: 7-21d (Gonorr: 3-4d). Hx/Sx: ±Asymptomatic (++Chlamyd) ±PurrDischarge (Gonorr) / Yellow Discharge (Chlamyd). Epididymitis in Gonorr. ±Dysuria ±Pelvic pain ±Can't pee/see/climb a tree (++In Chlamyd). Ix: GSfDx: NAAT Swab (1st-Urine/Urethral/Vaginal) ±Oropharyngeal Swab. HIV+Syphilis bloods. Charcoal swab/1st-urine for MCS. ±TVUSS/MRI for PID. Mx: Gonorr: Ceftriaxone IM x1 (Gent IM+ Azithromycin PO if allergic). Chlamyd: Doxy PO BDx7 (Erythromycin in preg/breast-feeding).

Answer 54

Epi: 1/10,000/y primary + secondary. Aet: Trep Pallidum. Can spread oro-genitally (So condoms may not prevent). 30-60% risk after UPSI. 10% of untreated get tertiary. Hx/Sx: Prim: One painless ulcer (Chancre). Secon: Widespread vasculitis (MacPapRash) which resolves. Tertiary: Neuro/Gummatous/Cardio: Tabes Dorsalis (Ataxia, incontinence, --Proprio/vibration) +AorticRegurg. Ix: GSfDx: Microscopy from lesion x3 (Often imposible). ±LP/Echo/CXR/HIV/FBC. 1: Trep-Test: Enzyme-ImmunoAssay (EIA) or TPPA/TPHA: Remains (+) for life. 2: Non-Trep-Test: Ser-Reagin (RPR) OR VDRL: Only (+) in active infection; Low sensitivity, though. Mx: Empirical IM BenPen x1 (Or Doxy PO BDx14). NeuroSyph: BenPen IM 1/week x1-3 (Or Doxy PO BDx28). ±Steroids.

Answer 55

Epi: 1/10,000/y new infections. 57.6% heterosexual. 10% MSM. 22% IVDU. Aet: HIV1 (More progressive). HIV2 (Less progressive, more in West Africa). CD4+ T/Macrophages. 0.1%/contact Hetero transmission. ->Immunodeficiency. Hx/Sx: Fever/Night Sweats, --Weight ±Rash ±Oral Ulcers ±Diarrhoea ±Kaposi's Sarc ±Multi-dermal-Shingles ±CMV ±Lymphomas. Ix: After window period of 12w: ±ELISA (EnzLinkedImmunoSorbAssay). ±RapidTest ±WesternBlot (Protein) ±CD4-Count (<200 = AIDS. >500 = Asymptomatic). Ser-ViralLoad. ±hCG (Before antiretrovirals). +HepC +Tuberculin ±CXR (PCP) ±LFTS ±IgG Toxoplasmosis/HepA. Mx: ART: DoluTEGravir (InTEGrase Inhib) + Abacavir (Rev-Transcriptase Inhib [Goes BACk]) + Lamivudine (Rev-Transcriptase Inhib). +Prophylaxis of other infections (Vaccines).

Answer 56

Epi: 1/100 pregnancies. 1 death / 200,000 pregnancies. Aet: 6-8w after LMP. RF: PriorEctopic, TubalSurgery, STIs, IVF, IUD, Smoking. Hx/Sx: AbdoPain +Amenorrhea +VaginalBleed +AdnexalMass +Blood in VagVault. ±HaemodynInstability ±ShoulderPain ±NeedPoo. Ix: hCG (Normally x2 in 48h) +TVUSS +AbdoUSS (Locate). ±Serial Ser-hCGs (Normal pregnancy = Large increase). Mx: hCG <1500 (Ideally <1000) & FALLING & <35mm: Expectant. Failed Expectant & hCG <5000 & <35mm : Methotrexate. Ruptured/HeartBeat/Other: ±FluidResus +Surgery ±Metho ±Anti-D-Prophylaxis.

Answer 57

Epi: 1/1000 pregnancies. Aet: 46 XX/XY / 69 XXX/XXY. 2 copies of paternal DNA with 0/1 copies of maternal. Previous mole: 1-2% risk in future. Hx/Sx: ^^Uterus for GestAge +MissedPeriod +1stTrimester +VagBleed ±Severe N/V ±Pre-Eclamptic ±Thyrotoxicotic. Ix: Ser-hCG (Normal = x2/48h) +FBC +PT/PTT +LFTs/U&Es +ABO-Rh (?Haemorrhage) +USS (Snowstorm) +TFTs (?Thyrotox) +CXR (?Metastatic). Mx: CervDilat +Oxytocin +Suction +LargeCannula (±Blood ±Abx) +STRICT Contraception x12m. Thyrotox: b-Blocker. Pre-Ecl: Labetolol/Nifedipine + MgSO4. ViableTwin: Expectant +CloseMonitoring (Unless choriocarcinoma).

Answer 58

Epi: Up to 30% of pregnancies. Aet: 80% 1stTrimester. Majority: Embryonic Disease (Cr diseases). MaternalFactor: ++2ndTrimester, due to damage, infection, immunology (Anti-PhosLip), fibroids, etc. Hx/Sx: Moderate-Severe bleeding = 18x risk than pts without these. ±Suprapubic/Back pain ±Post-coital bleed ±Trauma. Ix: TVUSS ±Serial Ser-hCG: >50% fall in 48h = Failing. >50% rise = ?Ongoing. hCG test (+) upto 21d after miscarriage. ±FBC ±LupusAnticoag (AntiPhosLip) ±VagSwab ±ParentKaryotype. Mx: All: Paractemol ±Anti-D-Prophy if >12w. Threatened: Preservation attempt = Progesterone until 16w. Inevitable: Seen in Cervix/Vag: Manual ±Misoprostol. >15mm: Suction +Abx ±Oxytoc.

Answer 59

Epi: 1/200 pregnancies. Aet: Dead foetus >24w since LMP. Idiopathic / Pre-Eclampsia / PlacAbruption / ObstetCholeo / Rubella/Parvo/Listeria / MultPreg. Hx/Sx: ±Pain, +Reduced foetal movements, +VagBleed. RF: Smoking, Alcohol, sleeping on back. Ix: USS (?Heartbeat). +Investigate RFs. Mx Anti-D-Prophylaxis + Counsel + DopamineAgonist (Suppress lactation) +Mifepristone/Misoprostol (Stimulate Labour),

Answer 60

Epi: 1 abortion /50 women /year recorded in the UK. Aet: <24w legal if will cause woman or immediate family mental/physical health issues. >24w if substantial risk of baby abnormalities / Threat to mother's life/Physical health. Hx: Can cause: Bleeding / pain / infection. Abortion can fail. Can damage uterus/cervix. Mx: <10w: Telephone + Home kits. Rh-: >10w&medical OR Surgical: Anti-D. Medical: Misoprostol (Anti-Prost) & Mifepristone (Anti-Proget - Not used in UK) *Less preferred* at later gestations. Surgical: Dilation (Osmotic, Miso/Mife) + Suction (<14w) OR Forceps (14-24w).

Answer 61

Epi: 1/300 deliveries. Aet: Previous accreta / C-sec / surgery. ++Multigravida ++Maternal age. Acc: Superficial Myo, Inc: Deep Myo, Per: Perimetrium. Hx/Sx: ±Antepartum Haemorrhage ±Significant PPH and difficulty delivering placenta at birth. Generally asymptomatic otherwise. Ix: Antenatal dx w/ USS. ±MRI for extent of invasion. Mx: Plan deliv for 35-36+6w +Steroids x7d before if <34w. Found incidentally in C-sec: Close + Delay delivery so services can be put in place. During C-Sec: Hysterectomy / Preserving Surgery.

Answer 62

Epi: 1/200 pregnancies. Aet: Scarring, ++Age, ++Pregnancies, ++Tobacco. Placenta 100% covering cervical os. Haemorrhage at birth +Death x2 if untreated. Low-lying = <20mm from os. Hx/Sx: Asymptomatic to 36w, >36w: ±Painless bleeding ±Low BP. Ix: 18-22w Anomaly scan (+)THEN 32w (+)THEN 36w USS . ABO-Typing. FBC. Mx: Steroids if <34w. Plan C-sec at 36-37w. ±Anti-D. Bleeding ±Instability: Resus + Stabilise ±C-Sec if persistent. Preterm: Prevent labour w/Tocolytics. Term + Stable OR Pre-term + Labour: C-Sec.

Answer 63

Epi: 0.3-1% of births. Aet: Direct/Indirect Trauma ±Cocaine (Vasospasm). Can be concealed / apparent. Hx/Sx: ±Bleeding +Pain +Tenderness +Woody Uterus +High-Freq-Low-Amp contractions. Ix: Foetal Monitoring +Hb/Hct +CoagStudies ±USS. Mx: Monitor + Stabilise: Keep Hb >100 ±Tranexamic Acid ±Anti-D ±Post-delivery Oxytocin (Tonic). <34w Reassuring: Vag delivery @37-38w + Steroids. >34w Reassuring: Vag delivery (Membrane Sweep +Oxytocin). Non-Reassuring: C-Sec.

Answer 64

Epi: 30% all preterm deliveries. Aet: <37w rupture of amniotic sac. Hx/Sx: ++Water breaking. Ix: Speculum: Pooling of amniotic fluid in vagina. Monitor CRP/FoetalHR/WCC for chorioamneonitis. Mx: ≤10d (or until labour) Erythromycin. <34w: Steroids + Monitor ((±Tocolytics)). <32w: Above + MgSO4 (Foetal Brain). >34w: Deliver (Try to get to 37w).

Answer 65

Epi: 2-8% of pregnancies worldwide. Aet: Placental spiral arteries maladaptation > Systemic HTN > vascular dysregulation of liver/brain. Assoc with DM, GTD, and MultPreg. RF: Hx/Sx: >20w gestation. Prev Normotensive & BP >140 / 90. Headache ± Visual disturbances ±UpperAbdoPain ±FGR ±Oedema ±Breathlessness ±Oliguria ±Clonus/++Reflex. Ix: Urinalysis (?Protein) +Foetal USS +UmbilicalArteryDoppler (?No End-Diastolic Flow)- Repeat 2x/w. +CTG +FBC (Platelets) +LFTs +Ser-Cr (RFT) ±Coag Screen. Mx: Aspirin Prophylaxis from 12w gest: 1 mjr RF or 2 mnr RFs. Hospital > Stabilise > >37w = Deliver. <34w = Don't deliver ±Steroids @34-36 (Patient-based). Deliver if no improvement with other interventions. HTN: 1. Labetolol, 2. Nifedipine, 3. Methyldopa, 4. Hydralazine (Severe) - Switch this to Enalapril/Nifedipine after birth. + MgSO4 (<32w for Baby +Seizure prevention).

Answer 66

Epi: 10-20% women with severe pre-eclampsia develop HELLP. Aet: HELLP: Haemolysis, Elevated Liver Enzymes, Low Platelets. Hx/Sx: HELLP: N/V, RUQ-Pain, Lethargy. Eclampsia: Seizures Ix: Ensure it is an eclamptic seizure and not epileptic, via hx + lab results seen in Pre-Eclampsia. Mx: Seizures: MgSO4 to prevent AND treat- Continue for 48h after last seizure/delivery. too much MgSO4: Give CaGluconate. HELLP: Deliver baby.

Answer 67

Epi: 2-12% of pregnancies. Aet: Unknown about precisely why. Belief it is related to insulin resistance in later pregnancy. SVR remains low, Cardiac output goes up. Hx/Sx: >20w gest. Previously normotensive. Absence of pre-eclampsia symptoms. Normally asymptomatic. RF: Nulligravid, obesity, T1DM. Ix: BP >140/90. Urinalysis. Baselines: FBC, LFTs, U&E/Cr, Uric acid, and Foetal size (USS). Mx: Lifestyle mod. ±Antihypertensives: Labetolol, Nifedipine, Methyldopa, and (>160/110): Hydralazine. Induction of labour if not controlled by 37w.

Answer 68

Epi: 16.7% of pregnancies. Aet: HPL + TNFa lead to ++Insulin Resistance, mostly in 3rdTrim. Hx/Sx: Polyuria, Polydipsia. RF: Previous, FHx DM, Previous macrosomia, ++BMI, Non-White, Old, PCOS. Ix: OGTT @24-28w. (>5.6 fast, >7.8 2h). HbA1c (Assess whether they had T2DM). Mx: Fasting <7mmol/L: 2w trial lifestyle then Metformin. 6-6.9mmol/L & ++Hydramnios / Macrosom: OR >7mmol/L alone: Insulin ±Metformin +Monitoring +Exercise/Weight-loss +USS foetal monitoring (?Size). Already diabetic before preggo: 5mg Folate.

Answer 69

Epi: 1-2% of pregnancies. Aet: Most frequent in 3rd trimester; believed to be due to circulating reproductive hormones. FamHx/PrevCholestasis/HepC/Stones = RFs. Hx/Sx: Itching + Excoriations without rash ±Mild jaundice. Ix: Ser-Bile Acid + LFTs. ±Coag profile (Vit-K worry) ±USS ±FBC. Repeat some of these. Mx: Labour induction at 37-38w. ±VitK. ±Antihistamines (for SLEEP, not itching). ±Emolients ±Ursodeoxycholic acid (Ser-Bile-Acid >40) ±Delivery at 35w (Severe: Ser-Bile-Acid >100).

Answer 70

1. Assoc with GestDiabetes. Shoulder Dystoica; Anterior shoulder on pubic synthesis. Mx: McRobert's manoeuvre ±Wood-Screw (stuck shoulder down+distal, other up+proximal) ± Epis ±Symphysiotomy. Complications: BrachPlx ±Erb'sPals +FoetalDeath. 2. "Small for gest age" = <10th cent. SevereSGA = <3rd. May be "Constitutionally small" which DOES NOT indicate IUGR. Caused: Infec / Anaemia / Malnutrition / Smoking / Alcohol / Pre-Ecl. Can cause stillbirth / NeoHypoglyc / NeoHypotherm. 3. 33% <28w THEN 6% 37-40w. Frank (HipFlex, Knee Exten. 70%) OR Complete (HipFlex, Knee Flex). Mx: Tocolytics, ECV (When membranes intact). Failure = C-Sec / Breech Birth(++Complications: Mortality, Cord prolapse). 4. 50% when PROM. CTG abnormal + Mass vaginally. RF: Abnormal lie. Mx: Minimal handling, wet, moist; Knee-Chest:All fours or LeftLatPos + Fill bladder. Tocolytics (Terbutaline) + Ideally Emerg-C-sec. 5. Umbilical vessels go onto membrane before foetus. RuptureOfMembranes > Bleeding. Risk: Low-lying Placenta. Mx: Steroids <34w. Elective C-Sec 34-36w if found. Bleed = Cat-1-C-Section. 6. 1/50,000 deliveries. No clear cause. ++MaternalAge +Induction. High Mortality. ++HR/RR ±Seizures ±MI. Mx: ABCDE- Nothing specific- Get help!

Answer 71

Epi: Primary: 5-7% of deliveries. Aet: Primary = >500ml (Vag) / >1000ml (C-Sec) blood-loss in <24h after delivery of baby+placenta. Secondary = >24h-12w. "Tone, Trauma, Tissue, Thrombin". Hx/Sx: Bleeding. RF: LongLabour / Prev / Pre-Ecl / Macrosomia / ++Age / Praevia/Accreta. Ix: Clinical Dx. Clotting screen +FBC +Group/Save. Mx: ABCDE, O2, WarmIV-Fluids ±FreFrozPlaz (If clotting abnormal). Uterus: Rub, empty bladder. Medical: Oxytocin ±Prostaglandin ±Ergometrine (++SmoothMuscle) ±Tranexamate. Surgical: BalloonTamp > B-Lynch-Suture (Wrap around and tighten) > ArteryLigation > Hysterectomy.

Answer 72

Epi: Rare. More common in women giving birth at home. Aet: PPH = Avasc necrosis of pituitary gland. Hx/Sx: --Lactation, Amenorrhoea, Adrenal insufficiency/crisis, --Thyroid (All from Anterior Pituitary). Ix: TFTs, Ser-prolactin, Ser-FSH/LH, Oestrogen. Ser Cortisol/ACTH. ±MRI pit. Mx: Specialist endocrinologist; Lifelong hormone replacement.

Answer 73

1. Hyperemesis Gravidarum >5% WL +ElectImbalance +Dehydration Mx: Ginger > 1. Metoclopromide (D2 Ant) > 2, Odansetron (5-HT Ant) (+Risk Cleft-Palate) ±PPI ±Steroids ±IVFluid. 2. VZV Infection 1st check Abs if unsure <20w: Anti-VZV-IVIG >20w: <24h since rash: 7d Aciclovir. 3. Hypothyroid in pregnancy -50% more thyroxine needed -Thyroxine safe to take. -Measure TSH every 4. Post-Partum Thyroiditis -6-12m TSH tests for ++Risk women (T1DM, LevoThyrox Therapy, FHx), PP-Depression, --Lactation, or Hypo/Hyper-sx. Can go up-normal, down-normal, up-down-normal, or down forever. +Rule out Grave's (TSH-R). 5. Anaemia <110 1st trim, <105 2nd trim, <100 PP: Give iron supplement.

Answer 74

1. Hypoglycaemia 2. Poor-Feeding: >10% Weight-loss in 1w since birth = Midwife-lead clinic. 3. Undescended Testes: -Bilateral: Urgent Paeds Referral (?CAH). -Unilateral: Re-Examine at 6-8w, Re-Examine 4-5m. Still there: Refer to surgery.

Answer 75

Epi: ++In Crohn's and Diverticulitis. Aet: EnteroCutaneous (To Skin), EnteroEntero (To other bowel), EnteroVaginal, EnteroVesicular (To bladder) Hx/Sx: ±Fowl smelling vaginal discharge ±Gas Ix: ±Barium Contrast ±MRI ±USS. Mx: Will self-resolve if there is no obstruction. Prevent skin-damage (stoma bag) ±Abx ±Surgery (Especially in RectoVaginals).

Answer 76

Epi: 40-60% of women. Aet: Stress: (Weakness Pelv-Floor +Weight): Laugh/Cough/Exercise. Urge: (More Neurological- ++Detrusor). Or mixed. Overflow: ++Post-void-Pressure. Ves-VagFistula: Constant dribbling. Hx/Sx: Leakage 1. with ++Abdo Pressure or 2. Followed by rapid urgency +Frequency points to UrgeIncont. Bladder Diary (Night+Freq = Urge?). Caffeine / Alcohol / Medicine / BMI. Ix: Urine dip (?UTI) +BladderDiary +Urodynamics (Pressure + Cough/Running water) +ResidualBladderVolume. Mx: Stress; --Caffeine --Weight ++Kegels ±Duloxetine ±Surgery (Retro-Pubic Suspension). Urge: Bladder Retraining ±Oxybutynin ±Botox injections. Mixed: A bit of both of the above.

Answer 77

Epi: 1/10 Women. Peaks 3m after birth. Aet: Baby blues (Most women, Peaks 1w PP), PPPsychosis (1/1000; Peaks 3-4w PP. Less psychotic, more a mix of manic/psychotic ±depressive features - 25-50% chance of recurrence). Hx/Sx: Low mood +Anhedonia +Low energy. Ix: Edinburgh Postnatal Depression Scale (10Qs, Score /30). Mx: Mild: followup. Moderate: SSRI (Sertraline or Parox for breastfeeding) DON'T USE St.JOHNS-W. Severe: ±Specialist input ±Mother/Baby unit. PPPsych: Mother+Baby unit (25-50% chance reoccurrence).

Answer 78

Epi: PMS: 3-8% of women. PMDD: 1.5% of women (w/ Strict dx criteria). Aet: Luteal Phase (Last 14d cycle). Believed to be due to a drop in Oes/Prog; similar mechanism to post-natal depression. Hx/Sx: --Mood ±Anxiety ±Mood-Swings ±Bloating ±Headaches/Fatigue ±Breast-Pain ±Low Libido. Ix: Symptom diary x2 Cycles. ±TFTs ±FBC (?Anaemia) ±FSH ±Depression Screen. Mx: LifeStyle: Exercise, --weight, Relaxation + High-Carb Diet. ±CBT ±NSAIDs ±COCP. Moderate / Severe: COCP +Low-Dose-SSRI +Above.

Answer 79

Epi: 1-3% in UK, USA, Canada. PkAg 20-30y. Aet: Depressive and Bipolar disorder associated with season of year. Common in bipolar II disorder. ?Melatonin rhythm? Hx/Sx: >2y period of season-effected mood. Autumn/Winter depression + Spring/Summer remission. ±Spring/Summer mania/hypomania. Ix: Clinical + Hx (As above) sufficient. ±Metabolic panel (Mostly TFTs). Mx: Similar to depression. Psychological +2-WEEK FOLLOWUP. ±SSRIs. DO NOT GIVE SLEEPING TABLETS. Bipolar sx: Valproate / Lithium.

Answer 80

Epi: 10.8% lifetime prevalence. F:M = 2:1. Aet: Leading cause of disability and premature death in 18-44y. ±Genetic ±Gut-Flora. ++Stressful life events. ±Dysreg of Hypo-Pitu Axis ±Abnormal Neurotransmitters. RFs: Propanolol, Post-Natal, Steroids, Dementia, OCPs. Hx/Sx: DEAD-SWAMP; DeprMood, EnergyLoss, Anhedonia, DeathThoughts, Sleep--, Worthless, Appetite--, Memory--, Psychomotor agitation. Ix: PHQ-9 / HAD score / ICD10 = Clinical: >2-3/5 CoreSx= mild. 4/5Sx+FunctImpair = Mod. Severe = ??ReallyBad??. +Metabolic panel + FBC/TFTs ±B12/Folate/Cortisol. Mx: 1. PsychoTherapy ±Antidepressant (<18y: Fluox. >18y: Sertraline); Treat for 9-12m after remission achieved or RELAPSE. Switch drugs with care. CLASSIC Antidepressant Withdrawal: "BRAIN-ZAPS (±Akin to orgasm??)" ±Hyper-Arousal ±Anxiety ±Dysphoria. Tx Resistant or Emergency: ECT. Severe: Psychologist +Above ±Antipsychotic (Psychotic depression) ±Lithium (?Mood) ±ECT.

Answer 81

Epi: 1/10,000 /year. M>F. Aet: High / Med / Low Risk. Link to self-harm. Hx/Sx: High Risk: Avoid-discovery, Left a Note, Final acts (Finances), Violence. SAD PERSONS: Sex(M), Age(<19/>45), Depres, PrevAttempt, EtOH, --Rational, --SocialSupp, Organised, NoSpouse, Sickness. Ix: Clinical: Try to stratify risk and enquire what happened. Toxicology? Protective factors? Mx: Ensure you're safe. Assess pt safety. Document identifiable features of patient. Remove self-harm objects. Document bruises/marks. Mx underlying illness. Form safety plan.

Answer 82

1. 2w of doses enough. Metab --pH, arrhythmia (Long QT), seizures, coma. +AnticholinergicTox: Mydriasis etc. Mx: ECG +ABG. Hypervent, bicarb (++pH and QRS), fluids ±Benzos/Propofol with seizures. 2. 50% of poisonings. ++NAPQI to LivFail. N/V, RUQpain, LivFailSigns. --Consciousness. Ix: Ser-Paracetemol, LFTs, INR, Glucose, ABG (?Lac--pH?), FBC. Mx: Activated charcoal <1h. Staggered dose or levels >line of 100@4h to 15@15h: Give Acetylcysteine (++Glutathione). pH <7.3 after 24h: Liver transplant. 3. Impaired mental state +Drowsiness +Slurred Speech +Ataxia --Resp ±Coma --TendonReflex. Ix: O2%, ABG, FBC, U&Es, LFTs, ECG (+QT? Block?). CK (LongLie?) ±Ser-Paracetemol. Mx: ±Charcoal (<1h), ±Flumenazil (Benz Antag- ++Side-effects) +Support/ABCDE. 4. Pinpoint pupils, --Resp. Ix: Can be dx'd by giving naloxone: RAPID response. +ECG. Mx: Naloxone ±CPR ±Ventilation ±Bowel-Irrigation.

Answer 83

Epi: 1% Lifetime risk. PkAg 19-25. Aet: Mania/Hypomania + Depression. A bit genetic +Some structural abnormality in frontal cortex on MRI. T1: >1 Manic episode. (>7d, FuncImpair/Psy) T2: >1 Hypomanic and >1 Depressive episode. (No Psy Sx, function intact). Cyclothymia: Sub-threshold of T2. Hx/Sx: --Need for sleep ±Talkative ±Distractible +No underlying Cause ±FlightIdeas +Not due to anti-depressants. Ix: PHQ9 +MDQ (MoodDisorder) +TFTs (++Thyroid mimics) +FBCs +VitD +Toxicology ±Lipids (Baseline) +Glucose (Assoc w/ T2DM) ±MRI-Brain. Mx: Agitated: Benzodiaz or Olanzapine (Rapid) -PO or, failing, IM. 1: Lithium / Valpro. 2: Switch or Combine 1sts. ±Benzos ±ECT and STOP antidepressants.

Answer 84

Epi: 30% get sx <25y, 30% >35y, Epidemiology uncertain due to dx criteria. Aet: Often clumped with either schizophrenia or bipolar disorder. Further sub-classified as manic-type (More common in younger) or depressive-type (older). Hx/Sx: (+)Sx: Hallucinations +Delusions +Thought Disorder +Bizarre behaviour. (-)Sx: Anhedonia, Social Isolation, --Affect. +Major depressive & manic episodes. ++FamHx. Ix: Drug Screen +STI Screen (HIV/Syph) +FBC +TFT (Mimics). Mx: Acute: Start/Review antipsychotics. ±Tranquillisation (Benzo PO/IM) ±ECT Long-Term: Lithium / Valproate and anti-depressants if depressive sx.

Answer 85

Epi: 1/150 affected. Onset <25 in M / <35 in F. Aet: Heavily genetic. ?More common if born in Winter? Triggers: Loss + Trauma. ±Brain atrophy ±Large ventricles --Amygdala? ?Neurotransmitter imbalance. Hx/Sx: DSM5 Criteria: ≥6m decline + ≥1m of ≥2 of: Delusions, Halluc, disordered speech, catatonia, or (-)Sx; ≥1 (+)Sx must be present. No relation to substance misuse. ICD10: ≥1m of ≥1 of 1st Rank: 3rdPAudHallu +ThoughtDisorder +DelPercep +Passivity. Ix: Lipid profile (Baseline) ECG (For medication) ±bHCG (Pregnant?). Mx: Benzodiazepines (PO/IM if quickly needed). Specialist +CBT +Antipsychotic (Aripip 1st). Monitor: Weight, AbdoCircum, BP 1w,12w,1y,2y; Lipid/>HbA1C/Fasting 12w,1y,2y; ±ECG/Prolactin if needed. Switch to other antipsychotics then Cloz after 2 others. Most (but not Cloz) can be given as 1-monthly depot.

Answer 86

1. NMS -Few days onset. Rigidity +Temp +Autonomic. ++CK/WBCs/K. Tx: Dantrolene (Relax), Dopamine, Discontinue AntiPsychs. 2. Parkinsonism 3. Acute Dystonia -E.g., Torticolis & Oculogyric Crisis. Tx w/ Procyclidine (Anticholinergic). 4. Akathisia 5. Tardive Dyskinesia -May be irreversible. 40% -Tx: Tetrabenazine (Depletes Dopamine).

Answer 87

Epi: 1-4% of children. Aet: Genetic / Trauma / Paediatric AutImmune Neuropsycic disorder. Assoc with depression (30%), Schizop, Tourrettes, and AnorexiaNerv. Hx/Sx: Obsessions (Unwanted, intrusive thoughts). Compulsions (Self-reinforcing actions that offer mild relief). Pt has INSIGHT into irrationality. NOT delusional. +Sensory phenomena. Ix: Non-structured Clinical Interview is often sufficient. DSM-V criteria if needed; "SCID" Mx: Mild: CBT (Ideally Exposure-Response Prevention [ERP]) > Fluox (>7y) > Both > Specialist.

Answer 88

Epi: Lifetime Prev of 8%. Aet: Genetic + Trauma + Stressors. "Excessive worry about multiple things". Hx/Sx: ++Worry for ≥6m. Not matching other disorder (PTSD/Panic/SocialPhobia). Not due to drugs. ±Sleep issues ±Fatigue ±Irritability ±PoorConcentration. Ix: Clinical Dx: GAD-7 (5=Mild, 10=Mod, 15=Sev). ±TFTs ±Drug-Screen ±PulmonaryFTs (++RR?) ±ECG (Palpitations?). Mx: Mindfulness ±Sleep-Hygeine Edu ±Exercise. 1. CBT ±Sert (or SNRI). 2. ±Benzodiazepine or Pregabalin or Quetiapine or Tri-Cyc. NO DRUGS IN KIDS.

Answer 89

Epi: 2-3% adolescents and adults. Aet: Now different from agoraphobia (Being surrounded by lots of people + Panic). Genetic, environment, and "temperamental" (Inhibition of self) factors contribute. Hx/Sx: Unexpected Onset +Avoidance of situations / sensations (exercise). ++HR in anticipation of exposure. ±Palpitations ±Derealisation ±Muscle-Shaking ±Faint. Ix: GAD-7: Clinical Dx; 5/10/15 Mild/Mod/Sev. ±ECG (Chest Pain) ±Glucose (--?) ±TFT ±Toxicology. Mx: Reassurance + Benzos for acute attack. Disorder: CBT + SSRI/SNRI (Sert 1st). ±Combined Drug Therapy: SSRI + SNRI / Tri-Cyc / NaSSA (Mirtazapine),

Answer 90

Epi: 6.8% lifetime prevalence in USA. Aet: Experience +1. IntrusiveThoughts +2. Avoidance +3. --Mood +4. ++Arousal / Reactivity. Acute-Stress Disorder for >4w, Hx/Sx: 1. Exposure to threat/actual trauma to you or others. >1m of sx. As above: ±HyperVigilance(4) ±Feeling Detached(3) ±Avoiding people(2) ±Flashbacks(1). ±Depression ±Anxiety ±Substance Misuse. Ix: Clinical: DSM-5-PTSD-Checklist +Others. Mx: 1. Trauma-Focused CBT or EMDR (Eye-Movement Desensitisation & Reprocessing). 2. SSRI (+if CBT Contraindicated -Ongoing trauma). 3. SNRI or SSRI + Quetiapine. +Above.

Answer 91

Epi: 6-33% of people who have experienced trauma. 33% of mass-shooting experiencers. Aet: >3d of Sx. Same as PTSD but with Sx <4w. Hx/Sx: DISSOCIATIVE (which partly differentiates it from PTSD). +IntrusiveThoughts +NegativeMood +SleepDisturbance +HyperVigilance. Ix: Clinical dx. Mx: Trauma-Focused CBT can prevent progression to PTSD. Reassure +Lie down. ±Benzodiazepines for sleeping. Delay any exposure therapy, as patient may show severe stress reaction. NO GOOD EVIDENCE THAT SSRIs HELP.

Answer 92

Treatment for all: CBT ±ExposureTherapy ±Tensing (Muscles to ++TPR) ±Benzos. 1. 1.7% of adults. Fear of busy places, where there is no ease of escape. ±PanicAttack ±Fainting. 2. 2-7% of adults. Fear of (-)evaluations from people. ++Conscious, Inaccurate Self-Defeating thoughts. Tx: SSRIs helpful +above. 3. "Melissophobia" - Fear of bees. "Lepidopterophobia" - Fear of Moths/Butterflies. Tx: Medications used less; otherwise, as above. 4. "White-Coat" is a very minor form of this. Rarely treated; Anaesthesia is often used as the "treatment" to allow procedures to go ahead. 5. MRI machines = big issue. Related to amygdala function. B-Blockers or Anaesthesia can be used along with the above.

Answer 93

Epi: 0.3% prevalence. 9:1 F:M diagnosed; it is believed the actual ratio is 7:3. Aet: Environmental, Social, +Genetic. Weight-loss leading to abnormal function of EVERY organ system: Osteoporosis = long-term effect. Hx/Sx: --EnergyIntake +FearOfWeightGain +DisturbanceOfBodyImage. Restricting OR Binge/Purging subtypes. ±Laxatives ±Diuretics ±Diet-Pills ±Amenorrhoea. BMI: >17,16,15,">" = Mild,Mod,Sev,Ext. Ix: Low body-weight for height. FBC (NormCyt Anaemia) +Ser-Chem (Met++pH --K/--Na/--Pho/--Ca?) +TFTs +LFTs +Urinalysis ±ECG ±E2 (?Amenorrhea) Mx: Structured eating plan +CBT (++Family Therapy in <18s) ±Potassium ±HospitalAdmission ±Parenteral/Enteral Feed ±Olanzapine+ECG (--Dysphoria and ++Weight)

Answer 94

Epi: 2.6% lifetime prevalence in women by age 20. Aet: Binging + Purging + "(+)"Feedback. Body-dissatisfaction ±Perfectionism ±SexualAbuse ±Depression. Purging = Vomit / Laxatives / Diuretics. Hx/Sx: ±DentalErosion +Above ±Low-SelfEsteem ±ParotidHyper ±ScarringOnHandDorsum (Vomit-Induction) ±Arrhythmia. Ix: Clinical: 1 episode Binge+Purge / week for >3m. ≤3,7,13,"≤" weekly = Mild,Mod,Sev,Extr. Ser: Electr + Cr + Mg. +BhCG +FBC +LFTs +Urine. Mx: CBT + MealSupport ±SSRI/SNRIs (Children: Fluox). With Suicidality / DM / Physical Sx: Refer to specialist or A&E.

Answer 95

Epi: 30% of elderly patients in hospital. Aet: RFs: >65y, Dementia, Significant injury, Polypharmacy (++AntiCholinergics). Caused by: Infection, Urine/Bowel Retention, Electrolyte Imbalance. Many causes. Hx/Sx: Inattention, ~~State of Consciousness, Disorganised Thinking. ±MoodChange ±Hallucinations ±DisturbedSleepCycle. Ix: Ensure the changes have occurred acutely and are not related to dementia: CAM, MMSE, AMTs. ±Urine ±CXR ±ECG ±U&Es ±Drug-Levels ±LFTs ±Blood-Cultures ±OtherXRs. Check hydration. Mx: Treat underlying cause, Modify Environment ±Haloperidol/Olanzapine. In PD: Don't give antipsychotics; perhaps slowly reduce Parkinson's meds.

Answer 96

Epi: 20% of admissions to hospital have "potentially-harmful" alcohol consumption. Aet: Abrupt withdrawal of alcohol; Either "Cold-Turkey" attempts or >1d of hospital admission. DelTrem Peaks at 48-72h (2-3d) after stopping. Occurs due to --GABA-Receptors (Which are used to being stimulated by EtOH) which leads to low GABA action, --Inhibition. Hx/Sx: 6-12h: Sweating, ++HR, Anxiety. 36h = ±Seizures 48-72h = Coarse Tremor, Confusion, Delusions, Aud/Visual Halluc, Fever, +Above. Ix: AUDIT (AlcUseDisorderIdentifTest). Calculate units/week. +CollateralHx +AssessNutrition +U&Es +LFTs/Coag/Glucose +FBC +VBG. Mx: Benzo (Chlordiazepoxide / Diaz preferred) +Pabrinex (B-Vits [Thiamine]) +Sort Electrolytes (Dehydration AND Anorexia common in ChronAlcUse) ±Airway Mx. Psychotic: Halop/Olanz ±Ket/Propofol (Tranquil) ±Barbiturate.

Answer 97

Epi: 7-10% Prev in Western Countries. M:F = 2:1. Aet: Genetic (~50%)/Environmental/Social. Causes long-term down-reg of GABA-Rs, and up-reg of NMDA-Rs. Positive reinforcement through opioid/dopamin/serotonergic receptors. Hx/Sx: ±Alcohol withdrawal (Tremor, ++HR, Delirium, Seizures etc). ±Wernicke's (--Memory --Balance) ±LF-Sx (Ascites, RUQ-Pain etc). +Tolerance. --Nutrition --Hydration. Ix: AUDIT / CAGE diagnostic interview. ±Blood-Alcohol ±LFTs ±FBC (Hb/MCV). Mx: "*CH*oose *T*o stop *D*rinking *A*lcohol": CHlordiazepoxide +Thiamine initially then, to prevent relapse, Disulfiram +Acamprosate. +PsychoSocialTherapy: "AA" good.

Answer 98

Epi: 0.8-2% total prevalence on autopsy. Aet: --Thiamine. Higher prev in Chronic Alcoholism (12.5%), AIDS (10%), and Bone-Marrow-Transplant (6%) pts. +Other causes of malnutrition (E.g., Bypass surgery). 18d of storage in body. Def = KrebCyc Dysfunction. Hx/Sx: MentalSlowing, Apathy, FrankConfusion ±Gaze-Palsy/Nystagmus ±VI CN Palsy ±Gait Dysfunction ±Delirium/Coma. Korsakoff's = ++MemoryLoss ++Confabulation. Ix: Trial of Thiamine (B1) +FBC +Glucose +U&E/Cr +Ser-Ammonia (Mimics) +Ser-EtOH/B1 and Mg. ±LP (Exclu Meningitis) Mx: Thiamine + Mg++ + Folate +Multivitamins +Fluids.

Answer 99

Epi: 1.2% Prev in 15-64y. Rise in synthetic-opioid-related deaths. Aet: 25% opioid-related deaths involved Benzos too. Kappa-Opioid receptors in CNS = Dysphoria. ±IV-Use. Hx/Sx: --Ability to socialise (Work / School / Home). ±Use in hazardous environment (E.g., Heavy vehicle) +Blunting of euphoria (Tolerance) +Miosis (/Mydriasis in withdrawal) ±Needle-Marks --RR ±Coma ±Constipation (Diarr on withdrawal) ±N/V. Ix: Urine/Saliva Levels +FBC +U&Es/Cr +LFTs +HepB/C-Ser +HIV-Screen +bHCG (?Preg) +Cultures (?InfEndo). Mx: Induction: Buprenorphine/Methadone +Naloxone. ±NSAIDS/Parac (Pain) ±Odansetron (N/V) ±Bismuth (Diarr) ±Chlordiazepoxide (Benzo for Insomnia). ±Needle exchange.

Answer 100

Epi: Data is terrible. Aet: Overdose, SNRIs/SSRIs + MAO-Is, Opioids, some TCAs (Imipramine), St.JohnsWart. Hx/Sx: SerotonergicAgent(1) ±SpontaneousClonus(2) ±InducedClonus(3) ±Agitation/Sweating(4) ±OccularClonus(5) ±Tremor(6) ±HyperReflexia(7) ±Hypertonia(8) ±Pyrexia(9). Ix: Clinical Dx: Criteria: 1&2 OR 3&4 OR 5&4 OR 6&7 OR 8&9&(5/3) = Serotonin Toxicity. ±CK (?NMS) ±ECG (+QT) ±LP (CNS cause?). Mx: ABCDE + Relevant. ±Activated Charcoal (<2h Ingestion). ±Cyproheptadine (Lots of low doses if fluoxetine, or one high dose if others) ±Consider stopping long-term serotonergic meds. Rhabdo: Paralyse muscle + Cool.

Answer 101

Epi: Incidence data limited. 8-9% Mortality. Aet: Indistinguishable from a syndrome that occurs in Parkinson's when dopamine agonists are suddenly stopped: Sudden hypostimulation of CNS. Speculation of genetic link. Hx/Sx: Hx of Antipsychotic use. ++Thermia ++Rigidity ++Bp/HR. +Confusion +Delirium. Ix: Ser-CK +U&Es (AKI/K+) +FBC (?WCC++) +ABG (Met--pH) +Glucose +LFTs (?Fail) +Repeated ECGs. Remember: KKK from "NMS Kidney Disease". Mx: DDD: +Dantrolene +Dopamine (Start/Continue agonists) +Discontinue Antipsychotics. ±Benzos ±ECT. Eventually: Restart Antipsychotics.

Answer 102

"Suspicious": Mx: ±Low-Dose Antipsychotics ±Antidepressants. ALL PDs: 11% Prevalence. Aet: Early psychological trauma +Genetics +TobaccoInPregnancy. Hx: Enduring problems in 2/4: Cogn/Percep / AffectRegulation / InterpersonalFunc / ImpulseControl. ++Risk of self-harm. Mx: Psychotherapy. 1. Paranoid +Suspects infidelity from partner +Suspects hidden intention from people's actions +Reluctance to confide ±Conspiracy. 2. Schizotypal ++Odd thinking ±SocialAnxiety ±Ideas of Reference ±OddSpeech ±Eccentric. 3. Schizoid +Lack of desire to socialise -Feels this is of no benefit. +May seem cold +Few interests.

Answer 103

"Emotional" ALL PDs: 11% Prevalence. Aet: Early psychological trauma +Genetics +TobaccoInPregnancy. Hx: Enduring problems in 2/4: Cogn/Percep / AffectRegulation / InterpersonalFunc / ImpulseControl. ++Risk of self-harm. Mx: Psychotherapy. 1. Emotionally Unstable Personality Disorder +Episodes of intense Anger ±Impulsive ±Self-Destructive (self-harm) ±Difficulty Maintaining Relationships. Mx: ±Lithium/Valproate. 2. Histrionic Personality Disorder +Wanting to be the centre of attention ±Performing to maintain this. +"Impressionistic Speech" ±InappropriateSexualSeductivness. 3. Narcissistic Personality Disorder ++Grandiose sense of importance ±Fantasies of unlimited beauty+power+success. ±ChronicEnvy ±LackOfEmpathy. 4. Antisocial Personality Disorder --Social Norms regarding law. +Lying +Conning +LackOfRemorse +Impulsive.

Answer 104

"Anxious" ALL PDs: 11% Prevalence. Aet: Early psychological trauma +Genetics +TobaccoInPregnancy. Hx: Enduring problems in 2/4: Cogn/Percep / AffectRegulation / InterpersonalFunc / ImpulseControl. ++Risk of self-harm. Mx: Psychotherapy. 1. Avoidant Personality Disorder +SevereAnxiety about rejection ±Needs to be certain they'll be liked +Self-Inferiority. Mx: ±Antidepressants. 2. Dependent Personality Disorder ±Difficulty making everyday decisions without others ±Lack of initiative +Fear of being alone. 3. Obsessive Compulsive Personality Disorder +Occupied with rules/lists/order. Demonstrates perfectionism which slows the completing of tasks. +Ethics +Stingy

Answer 105

Epi: 5.5% of people >60y. Aet: 60-70% of dementias. 5% ADi. RFs: T21 +White +FHx +SatFats +Smoking. b-Amyloid plaques (Tau) +NeurofibrilaryTangles. Moderate Alcohol consumption may be protective. Hx/Sx: MemoryLoss ±Disorientation ±NominalDysphasia (Naming objects) ±GettingLost ±Apathy ±PersonalityChange. Ix: MMSE FBC (?--Hb) +MetPanel (?--Ca --Na) +TSH +Drugs +CT/MRI (Atrophy, ++Ventricles) Mx: Support ±Cholinesterase-Inhibitors (Rivastigmine / Donepezil) ±NMDA-Antagonists (Memantine). ±Manage Insomnia (Trazodone) +Depression (Sert) +Psychosis (Risperidone)

Answer 106

Epi: 1.4% of people >60y. Aet: 17% of all dementias Several diseases lead to it; Ischaemia ±Haemorrhage ±Leukoaraiosis. RFs: HTN +Choleterol +DM. Hx/Sx: Stroke Hx. ±Apathy ±Difficulty Solving Problems ±Slow Information Processing ±Sustained-Glabellar/FrontalReflexes +Disinhibition. Ix: FBC (?Anaemia) ±ESR ±B12/Folate ±TFTs ±MRI/CT ±ECG (?AF). Mx: Aspirin ±Clopidogrel +LifestyleMod. CarotidSten >70 = Endarterectomy. ±BP-meds ±Statins ±GlycaemicControl (DM) ±AntiCoag (EmbolicDisease) ±SSRIs (Depression/Agitation).

Answer 107

Epi: 3rd Most Common Dementia. 15 / 100,000 45-64y. Affects younger (~45y). Aet: 30% have strong FHx ±Traumatic Brain Injury. ±Tau Protein (50% cases). Subclassified as Pick's (Classical FTD), Coticobasal degeneration, & ProgSupranuclearPalsy. Sometimes includes Parkinsonism. Hx/Sx: Key feature is a change in Personality / Behaviour / Taste / Movements / Language. +Must show deterioration/ Ix: GSfDx: Post-Mortem Biop. MMSE / MOCA +MRI(/CT) (?Frontal Atrophy) +FBC +CRP +TFTs +U&Es +LFTs +B12/Folate +Syphilis/HIV. Mx: Irritability: Benzos or Risperidone. Compulsions: SSRIs. Poor Sleep: Mirtazapine. Distractibility: Amantadine (NMDA Antag, like Memantine). Mania etc: Valproate / Topiramate.

Answer 108

Epi: 10-15% of dementias. Aet: a-Synuclein (Lewy Bodies) (Involved in synaptic vesicles). 40% of Alzheimer's patients also have Lewy Bodies. Difference between PD: 1y of cognitive sx BEFORE motor sx. Hx/Sx: Fluctuations ±VisualHallucinations ±ParkinsonianFeatures (85%) ±REM disturbance. ±AntipsychoticSensitivity ±Depression ±Anxiety ±OrthoStatHypotension ±Hyposmia ±Delusions. Ix: TSH ±B12 ±MRI/CT (Often shows something). ±FBC ±Drug-Screen Mx: Support +Rivastigmine/Donepezil (AcChoEst-I) / Memantine (NMDA-Ant) ±Risperidone (w/Psychosis - BE CAREFUL) ±Carbidopa/Levodopa (Motor sx).

Answer 109

Epi: 1/333 person-years 80-99y. PkAg: 65. Aet: Some genetic: Sporadic and AD. Death of dopaminergic neurones in SubsNig. +LewyBodies (a-Synuclein). Juvenile (<19y) + Young-Onset (21-40y) PD occurs rarely. Hx/Sx: STARTS UNILATERAL. Bradykinesia (+Shuffle-Gait), Rigidity, "Pill-Rolling" Tremor, PostInstability ±Masked-Facies ±Micrographia ±Depression ±Dementia. Ix: Trial dopamine (Upto 1200mg Levodopa). ±MRI ±Genetic ±24h-Urine-Copper (?Wilson's) ±OlfactoryTests. Mx: Drugs started as late as tolerated. Carba/Levodopa (together). if not: Dopamine agonist (Ropinirole) If not: MAO-Bs (Selegiline). Tremor: Propanolol or Deep-Brain-Stimulation.

Answer 110

Epi: 4/100,000 /year. PkAg: 70-80y. Aet: Unknown. Theories: ±MalAbsorption of CSF. ±Toxic-Metabolites in CSF ±Compression of venous vasculature. NO structural abnormalities. Hx/Sx: "Wet, Wacky, Wobbly". Urinary Incontinence/Frequency, Cognitive fluctuations, Ataxic Gait (Cautious, unstable, falls). Symmetrical signs. Ix: Levodopa Challenge (?PD or NPH). Non-Contrast CT/MRI head (Normal or mild/mod leukomalacia +Ventricular enlargement). ±LP (Pressure 7-25cm water ±Sx relief). Mx: Surgery (Shunt) or, if not suitable: Repeated CSF taps.

Answer 111

Epi: 1/18,000 in UK. Can affect young. Aet: >40xCAG nucleotide repeats = certain to get disease. Penetrance is affected by number of repeats. Autosomal Dominant, less likely to inherit it from mother (Sperm = Unstable). Hx/Sx: ++FamHx. Impaired work/school performance. ±Impulsivity ±Irritability ±Chorea ±CoordinationLoss ±Depression ±Compulsions. Ix: Clinical Dx. GSfDx: CAG repeat testing; Will condemn patient, and is often deferred. <28 = normal. ±MRI (?Atrophy of caudate) Mx: Counselling. Depression: SSRIs then ECT if resistant. Chorea: Tetrabenzine / Risperidone. Mood instability: Valproate / Carbamazepine. Eye movements +Incoordination +Speech cannot be treated.

Answer 112

Epi: 17% of strokes. Aet: Primary (Idiopathic / AntiCoag) or Secondary (Malformation / Disease e.g. Cancer or Berry Aneurism). Burst artery > Growth ±Sheering more arteries ±Expanding for several hours. ±Mass-effect. Hx/Sx: Unilateral weakness/Sensory-Loss ±Dysphasia/Dysarthria ±HomogHemiAnOp ±Headache (Insidious or Thunderclap in SubArach). Ix: Non-Contrast CT. Glucose + U&Es (Mimics) +LFTs/FBC/Coag +ECG (?AF). Mx: Neurosurgical referral ±RAPID BP reduction (If >150sys). Warfarin: Reverse Vit K. Dabigatran: Reverse with Idarucizumab Xa-Inhib (Apixa): Prothrombin Complex. +Pneumatic Leg Compression Driving: 1m off.

Answer 113

Epi: 1/650 strokes/year. 1/1900 deaths/year. Aet: 10% external atherosclerotic. 25% cardioembolic. 4 Classes of infarct: Total Anter, Partial Anter, Poster, Lacunar. RF: Smoking, obesity, ++Lipids/Cholesterol, ++Age. Hx/Sx: 1: Unilateral --Motor and/or --Sensation. 2: HomogHemAnOp. 3: Higher-Cog-Dysfunction (?Dysphasia). TotalAnter = 3/3. PartialAnter = 2/3. Lacunar = 1 OR PureSensory OR Ataxic Hemiparesis. Post: 2 OR Weber's (--Motor) OR Lateral-Medullary (--Sensory) OR Cerebellar (DANISH), OR Basilar (Locked-In). Ix: Non-Contrast CT Head + Non-Contrast CTangio + Contrast CTangio. ±CT-Perfusion if potential Thrombectomy after 6h. Glucose, U&Es, Troponin/ECG, FBC + PTT (?Platelets). Mx: Exclude Haemorr: Aspirin 300mg. <4.5h: Alteplase then <6h + CTA shows Proximal: Thrombectomy. IF <24h & CT-Perfusion shows SALVAGEABLE brain +Proximal: Alteplase + Thrombectomy. After 2d: Statin. After 2w: Clopidogrel 75mg, not Aspirin. Driving: 1m off.

Answer 114

Epi: 1/500 /year. Aet: Cardioembolic (30%). Small-vessel occlusion (15%). Symptoms lasting <24h (Most resolve entirely in <1h). Hx/Sx: (See Ischaemic Stroke). Total Anterior (3/3), Partial Anterior (2/3), Lacunar, Posterior, Webber's Synd, Lat-Medullary Synd, Basilar. Ix: Consider MRI (TIA Clinic Discretion). +CarotidDoppler +Glucose +FBC +Platelets +INR +Lipids +U&E +ECG. ±CT (Only if Haemorrhage suspected). Mx Aspirin (300mg) / Clopidogrel (Long term- 75mg). +Statin. ±Anticoag for AF (CHADS2VASC). Driving: 1m off. Multiple: 3m off + inform DVLA.

Answer 115

Epi: 1/800-2000 annually. 50-60% of intercranial haematomas. Aet: Mostly trauma- SHEER force or other. Rarely due to rupture of aneurism. ++Age, ++Anti-Coagulation Hx/Sx: ±Headache ±Trauma ±N/V ±AbnormalPupils, --GCS ±Seizures. Ix: Non-Contrast CT (Banana/Crescent). Mx: Correct any coagulopathy. <10mm Size, <5mm Mid-Shift, no neuro signs, GCS >9: CT in 2-3w +1w Phenytoin/Keppra ±HypERtonicSaline (To lower ICP), All else: ICP+EEG monitoring +Surgery

Answer 116

Epi: 2% of head injuries. 5-15% of fatal head injuries. Aet: Usually a rupture of the Middle Meningeal artery. Between bone and dura mata. Limited by the suture lines of the skull. Hx/Sx: Loses > Regains > Loses consciousness (Lucid Interval). Ix: CT head: Biconcave (Lense/Lemon). Mx: Craniotomy + Evacuation. Driving: 1y off after craniotomy.

Answer 117

Epi: 10% suffer chronic in the UK. Aet: Acute (<12w) / Chronic. Endpoint of many diseases. RF: Smoking, CF or Primary Ciliary Dyskinesia, mid-septal deviations. S.Aureus (50%), Gram(-)Rod (20%), HFlu (4%), GAS (4%). Hx/Sx: FacialPain ±NasalObstruction ±NasalDischarge/Drip ±Headache ±Purulence ±Fatigue ±Cough ±Fever. Ix: Anterior Rhinoscopy +NasalEndoscopy (ENT, no anaesthesia- ?Polyps/Obstruction) ±Cultures ±Sinus-MRI (?Air-Fluid levels) Mx: SalineSinusIrrigation +NasalSteroids ±Abx ±Decongestant (Phenylephrine). Ongoing: Oral Steroids / Surgery.

Answer 118

Epi: Chronic: 2-3% prevalence. Aet: Psychological Stress ±Minimal tightening of pericranial muscles. Major nociceptor is within the pericranial muscles. Hx/Sx: Non-throbbing, bilateral head pain. "Tight band around head". ±Muscle tenderness ±Depression/Anxiety ±Medication-Overuse Headache (Transforms episodic headache to chronic). Ix: Clinical dx. CT sinuses / MRI brain (If progressing / Refractory). Mx: Paracetamol / Ibuprofen / Aspirin. >7-9 days/m: TCA / other antidepressant +Relaxation-training ±a2-Agonist (Tizanidine).

Answer 119

Epi: 1/90,000 incidence. Aet: Unknown; ++In obese women of childbearing age. Hx/Sx: Risk factors +Some visual-field loss (Sometimes unnoticed -Due to papilloedema) ±Headache ±Tinnitus (with pulse) ±Photophobia Ix: VIsualFields (Perimetry) +Dilated Fundoscopy +MRI (Transverse sinus stenosis) +L3/L4 LP (20-25cm H20). Mx: --Weight --VitA --Sodium --Steroids. ±Acetazolamide (CarbonAnhydInhibitor) ±Furosemide / Topiramate. Persistent: TCAs.

Answer 120

Epi: 15% of the population (20% of women). Aet: ++Genetics. Hyperexcitability to many stimuli. Neuronal inflammation > ++Blood supply > ++Sensitisation. Hx/Sx: RF: F +Menstruation +Stress +Obesity. Long headache +Nausea --Function +Photophobia. Headache worse on activity. ±Phonophobia ±Aura (Zig-zags, flashing, numbness/tingling. dysphasia). Ix: Clinical. ±ESR (?GCA) ±LP (?Xantho) ±MRI (Normal in migraine) ± Mx: Acute: Metoclopromide (N/V) +Sumatriptan SC ±O2 ±Hydration ±IV Paracetamol ±Steroid. Ongoing: Propanolol OR Topiramate (Terato) then TCAs. Menses: Contraception (Not COCP if aura) ±Mg.

Answer 121

Epi: 1/20,000 incidence. Aet: Mostly due to demyelination after compression of CN V by vasculature. Compression is usually bilateral, but sx are not. 20x more common in MS. Hx/Sx: Facial pain: >1 devision of CN-V +Intense/Sharp/Sudden/Superficial +Triggers +ASx between episodes +No neurological deficit ±Hx of trauma. Ix: Clinical dx. May need oral XR or MRI if oral or other cause suspected. Mx: Carbamazepine then Baclofen. Unresponsive: MicrovascDecompression > Fails: AblativeSurgery > Fails: Neurostimulation (Frontal lobe).

Answer 122

Epi: 1/3000-8000 >50y. PkAg: 80y Aet: Associated with PolymyalgiaRheum. ++F +Genetics. Granulomatous inflammation >Intimal expansion +LumenCompression. Hx/Sx: Headache +ScalpPain/Tender +Aching/Stiffness (All-over) ±Claudication (Jaw, tongue, shoulders) ±VisionLoss ±OpticDiscSwelling/Pallor. Ix: Take blood then treat immediately: CRP/ESR +FBC +USS +Biop (If USS(-), be aware of skip lesions) +LFTs +U&Es/Cr. +Opthalmology review. Mx: Oral Prednisolone 60mg Immediately. Longterm: Pred PO OD ±Bisphosphonates ±CaVitD ±PPI ±Aspirin 75mg OD.

Answer 123

Epi: 1/500 prevalence. Aet: Hx head trauma / Alcohol / Smoking. Associated with sleep apnoea +Genes. Key: CN-V distribution +Ipsilateral Cranial Autonomous Sx +Daily/Annual pattern of attacks. Hx/Sx: +++Pain +One-sided +N/V +Lacrimation/Rhinorrhoea ±PartialHorner's. Average 4 attacks/day lasting 1/4-3h. Ix: MRI w/wo/contrast (Normal in cluster) +ESR (?GCA) +PituitaryFunc (Normal usually), Mx: Triptan (CI in cardiovasc disease: Lidocaine instead here) + O2 (100%, >12L, >15m). Chronic: Verapamil > Fail: Lithium / Topirimate / Gabapentin > Fail: Valproate > Fail: Occipital Nerve Stim / Deep Brain Stim.

Answer 124

Epi: 1/300. M:F = 1:3. PkAg: 20-40. Can occur in young children. Aet: Inflammatory +Degenerative disease of white matter in CNS. RelapsingRemit (90% initially), PrimProg (10%), SecProg (65% of Rel/Remit). Hx/Sx: Optic Neuritis (Pain w/Movement, VisualLoss, Redness) +PeculiarSensations (Hot water, shooting down spine). ±Bowel/Bladder sx ±MSK ±Incoordination. Ix: MRI brain/spine +Contrast (Lesions diff/ Time+Space). +FBC +B12/B9 +TFTs ±CSF (OliigoClonBands in 80%). Mx: Ongoing: IFb. Pain: Gabapent / Pregab. Tremor: Propanolol. Physio. ACUTE: MethylPred ODx3 ±Plasma Exchange.

Answer 125

Epi: 1/50,000 incidence. Sometimes occurs in outbreaks (1976 Swine Flu). Aet: Autoimmune attack on Schwann cells. 2/3 of patients have had an infection within 6w. Usually viral (CMV, EBV, HepE) sometimes Bacterial (Campylo). Hx/Sx: Parasthesia, normally before Muscle weakness, both extending proximally to be worse at 2-4w. ±Leg pain ±RespIssues ±SlurredSpeech ±ReducedReflexes. Ix: Nerve conduction +LP (++Protein) +Spirom (Aggressive monitoring- Every 6h) +LFTs (++) ±Serology (Virus+Bact+HIV) +CXR (?Resp). Mx: IVIG (Can cause anaphylaxis if --IgA) OR PlasmaExchange (If --IgA. x2-5). +PainMx +VTEProph

Answer 126

Epi: 1/2500 people (Most common inherited neuro disorder). Can show at any age. Aet: Some AD, Some AR, Some XLR inheritance. Mechanism different depending on gene. Primarily issues with Schwann cells or myelin > demyelination. Hx/Sx: Walking difficulties ±High-Arch feet +FamHx ±SteppageGait --Reflexes --Vibration/Pinprick --Strength: Starts distally. +"Inverted-Wine-Bottle Legs". Ix: Nerve-conduction. ±GeneticTests (Commonly CMT1A- ADi). Mx: No cure: PT +OT +Orthopaedic Surgery +Bracing +Prevention of osteoarthritis.

Answer 127

Aet: Motor: GBS, CMT, LeadTox, Diphtheria, Porphyria. Sensory: DM, Uraemia, Leprosy, Alcohol (B1/B12), B12. Vincristine, Phenytoin, other drugs. Hx/Sx: Slow progression in many of the above. Mononeuropathies, nerve routes, or systemic demyelination (which gives more glove/stocking). Ix: B12/Folate. Can be clinical (Hx deficiency, FHx, medication, infection) - Therefore FBC/HbA1C/Drug-Levels/Cultures/TFTs. Mx: Remove stimuli, replace deficiency, treat infection, manage chronic disease.

Answer 128

Epi: 1/100,000 incidence. F:M = 2:1. Aet: 80-90% have Abs against post-synaptic nicotinic ACh receptor. Also: Muscle-specific-Tyrosine Kinase (MuSK)(3-7%). ±Thymus involvement (Thymoma in 10%). Strong genetic link. Hx/Sx: Fatiguability. Ptosis +Diplopia +Dysphagia +Dysarthria +ProximalLimbWeakness ±SOB (if severe enough = Myasthenic Crisis). Ix: Ser-AChR Abs and Ser-MuSK Abs. ?Crisis: Serial Spirometry. ±ElecMyoGram ±CT-Chest (Thymoma). Mx: Crisis: Intubation +Ventilation ±Steroid +IVIG OR, with --IgA, Plasma Exchange. Maintenance: Pyridostigmine (AChE-I) ±Steroids ±Rituximab ±Azathioprine ±Thymectomy.

Answer 129

Epi: 1/250,000 prevalence. Aet: Depletion of pre-synaptic calcium channels. Associated with Small-Cell Lung Cancer. Non-Cancer LEMS is associated with other auto-immune conditions. Hx/Sx: Proximal then distal limb weakness. Dry mouth "metal taste". ±WaddlingGait. Later: Ptosis/Diplopia and others. Weakness improves w/ some exercise (Weakens w/Sustained). Ix: ElecMyoGram (Post-Exercise Boost of conduction) +RepetNerveStim (DropInAmplitude) +Anti-Ca-Channel Abs +CT-Chest (?Cancer in >50-60%) +AChR-Abs (Found in 13%). Mx: Resp Crisis: Intubation +Ventilation. +IVIG OR, in --IgA, PlasmaExchange. Maintenance: Tx underlying cause +Amifampridine (--K efflux and longer action potentials) +Pyridostigmine (Some small improvements).

Answer 130

Epi: 0.1-2% prevalence in the UK. Aet: Dx after >4m of disabling fatigue unexplained by other causes 50% of the time. Past psychological Hx not shown to be a RF. Overlap with Post-Covid-Syndrome and other post-viral syndromes. Hx/Sx: Post-exercise exhaustion. Short-term memory/cognitive impairment. Unrefreshing sleep, orthostatic Intolerance +Diffuse pain. Ix: DePaul Syndrome Questionnaire. FBC, ESR/CRP, TSH, ANA, RF, HIV (Exclude differentials). ±HbA1c ±TTGA/Endomyseal for coeliac, Mx: ±CBT ±Mindfulness +"Energy Envelope" ±SSRI/Benzos for sleep or depression.

Answer 131

Epi: 1/25,000 incidence: ALS (50%). Aet: AmyoLatSc: UMN (More in arms) +UMN (More in legs), Cr21/SOD1 implicated. PrimLatSc: UMN. PBP: Cranials: Worst prognosis. ProgMuscAtro: Isolated LMN. Hx/Sx: Weakness. UMN: Hyperreflexia, rigidity, spasticity, LMN: Foot drop, dyspnoea, spasms/fasciculations, atrophy. NO sensory signs (Sometimes pain with cramping, though), NO cerebellar signs, external ocular signs, or changes in abdomen reflexes. Ix: Clinical. ±NervCondStudies (Normal) ±EMG (Evidence of denervation) ±MRI (Exclude myelopathy, especially in PBP). Mx: Rituzole (Na-Blocker- +3m of life) +BPAP (+7m of life) +PEG-Tube. 50% die in 3y. ±Carbocisteine (Mucolytic) ±Baclofen/Botox (Muscle relaxants).

Answer 132

Epi: Aet: CSF within spinal cord. Similar to Syringobulbia (CSF in medulla). Caused by: Chiari Malformation (Around cerebellum), Trauma, tumours, or idiopathic. Hx/Sx: Loss of mostly temperature sensation, bilaterally, on neck, shoulders, and arms. +LowerLimb UMN signs (Spastic, Weak, UpPlanters). Ix: Spine MRI w/Contrast. Brain MRI (Exclude Chiari). Mx: Treat cause of syrinx ±Shunt to drain CSF from syrinx.

Answer 133

Epi: Wild-Type: eradicated. Still some very rare vaccine-associated types. Aet: Faeco-oral spread. Spreads to CNS and lymph-nodes. Hx/Sx: Unvaccinated (<36m), resident or travel to endemic area. --TendonReflex --Tone/Function +Atrophy of. ±Fever ±Malaise. Ix: CSF/stool/Pharynx culture +Abs +CSF (+Lymphocytes) +MRI-Spine (AntHornCell Abnormalities). Mx: Notify PHE +SupportiveCare +Ventilation (Bulbar Poliomyelitis) +PT.

Answer 134

Epi: 1/500,000 incidence. PkAg 10-19y + 30-39y (Bimodal). Aet: Lesions, often 1-2 vertebrae in length, asymmetrical in PartialTM, longer and symmetrical in ExtensiveTM. MS, post-vaccine, post-viral, SLE, Sjogren's, Sarcoidosis, Para-Neoplastic. Aquaporin channels implicated leading to demyelination. Hx/Sx: ±Bowel/Bladder Dysfunction (Differs from Gullian-Barre). Can present with Brown-Sequad. UMN signs below lesion ±LMN signs at lesion. ±SensoryLoss+Level. ±SOB (High lesion) +ElectricalSensation (L'Hermitte's). Ix: MRI Brain+Spine (+Gadolinium -Rule out compression/MS). Ser-AqPor4-Abs. LP (OligoClonal +Lymph= MS, Neuts ?= TM). +CSF Cultures/PCR/VDRL (EBV / CMV / Lyme / Syphilis / HSV). Mx: 1. IV steroids for 3-5d. 2. Plasma Exchange. ±DVT-Proph ±RespSupport ±Catheterisation. AqPor4(+): Azathioprine. MS: Treat MS.

Answer 135

Epi: 80% of women and 95% of men >65y = degenerative changes. Aet: Thickening of surrounding bone > CaudaEquina and/or Radiculopathy Hx/Sx: Slow onset, back pain. Leg pain ±LowerNumbness when walking. Absence of NeuroSigns. ±Pain radiating down leg (Radiculopathy) ±Bowl/Bladder Dys. Ix: Plain XR (Degeneration +Spondylolisthesis) +T2-MRI (Guides treatment) ±CT ±EMG. Mx: Significant: Surgical decompression. Otherwise: MxPain; NSAIDs ±Steroids ±SteroidEpidural.

Answer 136

Epi: 1/20ish. Aet: ±CervicalRib ±Trauma ±Tennis ±Painters / Swimmers / Desk-Work. Neurological (Most common) ±Venous ±Arterial (Rare). E.g., CompleteSholAbduc = 180 degree bend in AxilArtery. Hx/Sx: Pain (All-types), Fatiguability (art/venous), Parasthesia (Neuro), Numbness (Art), Raynauds (Neuro/Art), Weakness (Neuro), Ix: C-Spine XR (?Rib, Frac, Other) ±CXR ±NerveConduct (Median: ?Carpel Tunnel or TOS) ±Angiogram (?Arterial TOS) ±USS (?Venous). Mx: Objective signs of compression (True TOS): Surgical correction +PT. Otherwise: PT (Core/posture) ±NSAIDs ±Surgery (If else is ineffective +Lower conduction velocity). ±Thrombolysis (If seen) ±Anticoag (art/ven).

Answer 137

Epi: ~7% of Cancer patients, ~1/25,000 Spinal Cord Injuries / year. Aet: Car accidents, falls, GunSW, Sports, motorbike accidents, KnifeW. OlderPts; Osteoporosis, Cancer, Steroids. DiscHerniation, Discitis, TB (Pott's), EpiduralAbscess. Hx/Sx: Hx Trauma, malignancy, disc disease (C5/6, L4/5, L5/S1). ?Acute (Trauma/SlipDisc). ±Hypotension/--HR (NeurogenicShock) +UMNSigns ±Bladder/BowelDys ±CaudaEquina (SaddleAna, LegWeak, UrinReten) ±BrownSequad (Ipsi Motor/Vib, Contra Pain/Temp) ±TotalTransection. Ix: MRI-Spine (Any Aet) +XR-Spine (SpinSten/SlipDisc) +CT (Surgical Planning) / CTMyelography (+Dye). Mx: Surgery in all: Immobilising+Decompressive (Trauma). Laminectomy in <48h (CaudaEquina). Removal (Abscess[+Abx]/Cancer) ±Steroids (Be careful, CI in lots of aetiologies- Used in cancer) ±BP-maintenance (NeuroShock).

Answer 138

Epi: 3.7% Prevalence. Aet: ++Weight +RepetitiveMovement +Genetics +Others = ++Pressure on median-nerve = Ischaemia (Symptoms) +Demyelination (Asymptomatic). Hx/Sx: Intermittent Numbness +Weakness +Clumsiness. Worse at night. MedianNerveDistribution (Sparing ThenEminence- Superficial Branch). Ix: EMG (Slowing conduction ±LowAmp) ±USS (?GangliCyst) ±MRI (Same as for USS). Mx: 1. Wrist Splint ±Steroid Injection (Maximum 2x per year). 2. Relieving surgery.

Answer 139

Epi: 0.9% Prevalence. ++In Older. Aet: Autosomal Dominant. Unknown Aetiology or gene. Issue with ?Cerebellum / Thalamus / Brainstem. Cerebellar strokes seem to cure pt of essential tremor. Hx/Sx: Bilateral upper-limb tremor; Makes tasks of upper limb difficult +no other signs/sx. +Better with alcohol / Benzos / Gabapentin. ±Tremor of head, voice, and limbs. ±RestingTremor. Ix: Clinical Dx. MRI only useful for ruling out other diseases (But no signs = no concern). Mx: No dysfunction or embarrassment: No intervention. Otherwise: Propanolol or Primidone (>Barbiturate). 2. DeepBrainStim (Good outcome, risky). 3. Unilateral UltraSound Thalamotomy. 4. Gamma-Knife Thalamotomy (Older, Surgery CI).

Answer 140

Epi: >50% of seizures. Epilepsy = 1/2000 person-years incidence. Aet: ±Idiopathic ±Trauma (+Skull fracture with >0.5h unconsciousness) ±CNS-Infection ±Tumour ±Stroke ±Dementias ±FHx ±Malformation ±PerinatalHypoxia. Hx/Sx: One side of body or one body part. ±Pre-Seizure: Deja/Jamais ±Fear etc. ±Automatisms (E.g., Smacking lips- ?FIAS) ±PoorAwareness (FIAS) +Aphasia +Post-Ictal Period. Ix: CT-Head (First episode) +MRI +Ser-Glucose +FBC (+WCC ?= Encephalitis) +U&Es ±Toxicology +EEG (50% Sensitivity, Perform within 72h ideally). Mx: Acute Community: Rect/Buc Diaz. Hospital: IV Diaz +Phenytoin/Valpro. Ongoing: 1&2: Mono: Lamotrigine / Keppra (Leve) then switch. 3&4: Mono: Carbamaz / Oxycarbaz / Zonisamide then switch. 5: Combine 2 drugs of different / agonistic mechanisms. COCP: AVOID Carbamaz, Phenyt, Primidone, Phenobarbital. Driving: 1st = 6m off. Established / Multiple unprovoked = 12m. No lorries for 5y. Withdrawal off drugs: 6m after last dose.

Answer 141

Epi: Epilepsy: 1/2000 person-years incidence. GTonClon = 25%. Aet: Provoked (--Glucose, Eclampsia)/ Unprovoked (Epilepsy). Primary generalised tend to be genetic. Secondary (to focal) are more lesion-associated. Hx/Sx: ±NeurologicalDeficit before/after seizure. ±TemporaryHemiPlegia ±MeningSigns ±PreLimSx (Fear, Deja/Jamais). Ix: EEG (--Sensitivity) +Glucose +FBC (?Encephalitis) +U&Es +CT Mx: Ongoing: 1. Valproate, or F: Lamotrigine / Keppra (Levetiracetam). 2. Try other from above or: Topirimate, Carbamaz, Phenytoin. 3. Duel therapy from above. Acute: Buc/Rect Midaz/Diaz, IV Loraz, IV Phenytoin, then anaesthetics. Driving: 1st = 6m off. Established / Multiple unprovoked = 12m. No lorries for 5y. Withdrawal off drugs: 6m after last dose.

Answer 142

Epi: 1/20,000 incidence. Aet: Anti-Epileptic withdrawal / hypoxia / stroke / alcohol-withdrawal. Prolongued = ++Glutamate = Damage to Limbic System. Hx/Sx: Prolonged tonic-clonic seizures w/ altered level of consciousness (Convulsive SE). Non-Convulsive SE (NeuroDeficits etc) may follow. Ix: EMERGENCY: Glucose, ABG, urea, Cr, LFTs, U&Es, FBC (WCC), CRP, Coag. ++AntiConvulsant Drug Level (?Withdrawal due to PoorCompliance). Mx: 1. Rule out non-epilepsy (NEA) and give Oxygen if needed. 2. Give Bucal/Rectal Midaz/Diaz. OR 3. Give IV Lorazepam. Maximum of 2x of 2 and/or 3 are given. 4. Phenytoin / Valproate / Levetiracetam (Keppra). 5. Get anaesthetist for GA or Phenobarbital. "Oh My Lord, Call the Anaesthetist".

Answer 143

Epi: 0.8% of emergency department visits. Aet: Cardiac (Dysarrhythmia, Tamponade etc), Reflex (Vasovagal, CarotidSinus, Situational), Orthostatic (Dyautonomia, Hypotension), Neuro (SAH, ?Migraine), Metabolic (--Glucose, --O2, --Co2), Psych (Anxiety, Convers). Hx/Sx: DM Hx (?--Glucose), FHx sudden death (?Cardio), Posture+Prodrome+Provoking. +Before/after (?Neurological) +Other signs +LengthOfTime. Ix: Clinical offers a lot. +ECG +L/S-BP (>20 drop=POTS) +NeuroExam +FBC (?Anaemia) + Mx: Reverse any cause (Glucose), manage any long-term diseases better and encourage compliance.

Answer 144

Epi: ~1/5000 incidence. 5-20% of epilepsy outpatients. Aet: Chronic stress or conflict ±Taboos against emotional expression ±Emotional Processing deficit. Subconscious and thought to be related to dissociation. Hx/Sx: FamilyMember w/Epilepsy. Thrusting, ++F, Don't occur when alone, +Crying +Falling down +LACK of severe tongue-biting, no rise in prolactin (as in epilepsy). Slightly longer duration that average seizures. Ix: Lab-Tests + EEG (Both normal). Mx: Explain +Manage consultation empathetically. Discontinue Epilepsy Meds. ±CBT ±SSRI (w/ Depression/Anxiety) ±Hypnosis ±Aripiprazole (If SSRIs fail). Acute: Calm, get people to leave the room, no treatment.

Answer 145

Epi: CAP: 1/1000 person-years. Aet: Community (CAP)- S.Pneum, H.Flu, S.Aur, S.Pyo. 22% Atypical (E.g., Mycoplasma). +Hospital (HAP) (>48h admission) +Ventilator (VAP) (>48h intubation). Hx/Sx: Cough ++Sputum +SOB ±Confusion ±Fever ±Night-Sweats ±PleuriticChestPain ±AsculationFindings (Crackles, dullness, wheeze). Ix: CURB65: Confusion +Urea >7 +RR >30 +BP <90/60 +Age >65y. +CXR +O2% +ABG +FBC (WCC > 15 = bacterial) +CRP (>100) +LFTs (?Legionella) ±Cultures ±Sputum ±CT/USS (?Effusion). Mx: CURB65: 1/2 = 5d PO Ammox / Claryth / Eryth (Preggo). 3/4/5 = Co-Amox PO / Claryth PO / BenPen IV.

Answer 146

Aet: Older age +Osteoperosis +Polypharmacy (Opioids +Specific Anti-ACh Burden: TCAs, Furosemide, AntiHistamines, AntiEmetics, AntiACh) +Sarcopenia --ADLs. +Strokes +Barthel Index (Strokes) +Waterlow (Pressure sores) +ORBIT (AF-Bleeding) +AMT (CogImpair = <8/10). +Clinical Frailty Score (/9): 1= Fit. 9= Terminally ill. 7= Dependent. 5= Need help with hard ADLs. Hx/Sx: Weakness, tiredness, weight-loss, dementia/confusion, --ADLs, falls, fractures. Ix: L/S BP ±ECG (?AF) ±AMT ±CT-Head ±DEXA (<-2.5) ±FBC (?Hb) ±U&Es (++Ca?) ±Cr/Ur/eGFR (?CKD) ±CXR (?Pneumo) ±UrineDip (Delirium). Mx: DePrescribing (ACB), Fludrocortisone (Orthostatic --BP), Bisphosphonates+VitD+Ca. ±AntiCoag (?ORBIT). ±PT/OT.

Answer 147

Epi: 50% F & 20% M Fractures >50y. Aet: Low bone mass, abnormal bone architecture, low bone mineral density, & a low peak-bone mass in earlier life. --Oestrogen, --VitD, --Ca. +RANK-L issue. Hx/Sx: Back pain ±Kyphosis (VertFrac) ±Hx secondary amenorrhoea, smoking, steroids, --VitD, --Ca, ++Immobile, FamHx. Ix: DEXA (May not be needed in women >75y w/Signs of LowBMD) (<-2.5 = Osteoporosis. <-1.0 = Osteopenia). +FRAX (10y frac-risk) +XR +PTH/Ca/Phos/ALP/VitD (Normal). Mx: Bisphosphonates +Ca +VItD ±TestosteroneReplacement ±Teriparatide (PTH-Segment). Above CI: Denosumab (MonoClAb).

Answer 148

Epi: 1/3333 prevalence. Aet: 80% Post-surgical, Autoimmune, 22q11.2d, ++/--Mg. --Calcium ++Phos. Low PTH OR High-PTH +PTH-Resistance (?Receptor issue -Pseudohypopara). Hx/Sx: ±SurgicalHx, Poor Diet, Alcoholism. Face-tap = Spazm. ±Convulsions. Ix: Ca (Low), Albumin (Corrected Ca), Mg (--/++Mg?), VitD (Deficient), PTH (?Pseudo), ECG (?Long QT). Mx: Acute: CaGluc. ±Mg (In --Mg) +Correct any alkalosis (++Albumin binding). Ongoing: VitD +Ca ±PTH. HyperCalciUria: Thiazide +Low salt diet.

Answer 149

Epi: 1/500 F, 1/2000 M >40y. Aet: Adenomas (80%) / MEN1/MEN2 (AD) / Lithium > ++PTH > +BoneResorp +VitD +KidneyReabsorp > ++Ca/--Phos Hx/Sx: ±Osteoporosis (++Resorp) Moans (Depression), Groans (Myalgia), Thrones (++Urine/Const), Stones (CalcOxalate). Ix: Ca (++), Phos (Low/Normal), PTH (++), VitD (If low, this could elevate the PTH levels), DEXA (Osteoporosis). ±CT/MRI neck for Mx planning. Mx: Surgery ±VitD ±Bisphosphonates ±Cinacalcet (Calcium Mimetic- Think "Syn"acalcet -Suppresses PTH).

Answer 150

Epi: CKD prevalence = 6.7% - 80% at risk of --VItD and ++PTH. Aet: CKD (Starts around GFR=45 / Stage 3a) / VitD-Deff. PsudohypoPTH is also, technically, a secondary hyperPTH, as fewer receptors = ++PTH. Hx/Sx: Bone pain (--Ca > ++PTH > Bone Resorption), Rickets / Osteomalacia, Face-Tap-Spaz Sign ±Hx CKD. Ix: iPTH (++), Ca (--), Cr/Urea (eGFR), Phos (++ = CKD as cause, -- = ?VitD / Other). High Ca+Phos = Calciphylaxis risk. VitD (-- = Cause), Mg (Cause PTH resistance or --release), USS Neck. Mx: +VitD: Sun exposure ±Supplement. ±Ca Supplement. CKD: Less phosphorous consumption. Persistant ++PTH: Cinacalcet ("Syn"acalcet - Mimetic) / Surgery.

Answer 151

Epi: 1/20,000 prevalence. Central DI More common. Aet: Anything damaging pituitary (Tumour, haemorrhage, Phenytoin) = Central. Nephrogenic: Lithium. Both: Genetic. Hx/Sx: Polyuria/Nocturia +Polydipsia. FHx / PsychHx / AutoImmuneHx / Brain-SurgeryHx. Ix: Water-Deprivation + synADH (Low UrinOsmol unchanged w/Deprivation then ++w/synADH =Neurogenic. then remains unchanged =Nephrogenic. Increasing from start =PrimPolydipsia). +UrineDip/Glucose (DM) +K (-- in Nephrogenic) +Na (++) Mx: Neurogenic: ADH + Fluids PO/IV. Nephrogenic: ++Fluid intake, low sodium, Thiazide.

Answer 152

Epi: 6-20% of psych patients. Aet: Strongly associated with schizophrenia "Feels better" +Anorexia Nervosa (?Reduce hunger) +Smoking (Nicotine stimulates ADH release) +Alcohol-abuse. 3-6% develop --Na. Hx/Sx: Water-seeking +Drinking, Agitation prior to water-loading. ±Polyuria ±Headache ±N/V. Ix: Ser-Osmolality (<280) +Ur-Osmolality (<100) +Ser-Na (<135) +Ur-Na (<20). 24-Urine-V. Urea (?Renal Failure) +Urinalysis (?UTI) Water-Deprivation test (++Urine osmolality). Mx: Severe --Na: 3% NaCl (Hypertonic). Chronic: Fluid restriction ±Furosemide (Add salt specifically to get it to suck water into urine) ±AtypicalAntiPsychotic (Schizophrenia).

Answer 153

Epi: 8.3% prevalence. Aet: ++Insulin resistance (And lower relative insulin) Due to: ++BMI ++Age. Hx/Sx: Polydipsia +Polyuria. ±Candidiasis ±Cellulitis ±Fatigue ±BlurredVision ±Weight-loss ±AcanthosisNigricans (InsulinResist). Ix: FastingGluc/>8h (>7) +RandomGluc/2h-75g (>11.1) +HbA1c >48 (Measure every 6m) ±FastingLipids ±UrineKetones ±C-Peptide (?T1) Mx: Lifestyle if 42-48HbG 1: Metformin Max 2000mg/d. Aim for 48, Not in eGFR <30, PO. ±SGL2 (-Flozin) ++w/ HF. CI w/--eGFR, Risk of DKA (As not Insulin-related), PO 2: >58HbG: Dual therapy w/ aim of 53: ±DPP4 (-Gliptin), PO ±Thiazolid (-Glitazone), PO ±Sulfonylurea (Gliclazide), PO 3: >58HbG: Triple therapy w/ aim of 53:(Or Double wo/ Metformin) 4. Insulin SC &/Or GLP-Mimetic (-Tide), BMI >35, SC. 5. ±Bariatric Surgery.

Answer 154

Epi: 30% cases of hyponatraemia in cancer patients. Aet: Small-Cell, Pancreas, Prostate Cancer. Also: Antidepressants, Carbamazepine, Amiodarone, Chemo. +Other pulmonary issues. Hx/Sx: NO hypovoolaemia & NO hypervolaemia (So, Normovolaemic), --Na, N/V. NO signs of Addison's/Hypothyroid. ±Seizures, coma. Ix: Na (Low: <135) +Ser-Osmol (Low: <275) +Ser-Urea (Low) +Ur-Osmol (High: >100) +Ur-Na (High: >30). ±Sodium-Infusion Trial (Ser-Na will NOT improve in SIADH). Mx: Acute: 3% NaCl. Treat underlying cause +FluidRestrict ±Furosemide (Add and flush sodium w/ water). Chronic: ADH-RecepAntag: Conivaptan.

Answer 155

Epi: 0.2-5.3% prevalence. F>M. Aet: IodineDef (Global), Hashimotos (Europe), Iatrogenic (RadioIodine, Lithium). Primary = Damage to thyroid gland. Hx/Sx: Constipation +Weight gain + Lethargy +WeightGain +Bradycardia ±Cold-sensitivity. Ix: TSH (>10) +Free-T4 (Normal = ?Subclinical) ±TPO (?Hashimoto's) ±FBC (Mild normocytic anaemia?) ±FastingGlucose (?Tiredness). Mx: Levothyroxine. Low dose with CVD or sub-clinical. Titrate up until TSH normalises.

Answer 156

Epi: 1/3000 person-years incidence. F:M = 8:1. Aet: HLA-DR3/DR5. Anti-TPO Abs. ±Lymphocytic invasion of thyroid. ±Initial hyPERthyroid phase. Leading to chronic HyPOthyroidism. Hx/Sx: Painless ±Goitre. Cold Intolerance, weight gain +Fatigue +Constipation +Hypertension +Bradycardia. Ix: TSH (+), T4 (-). Mx: Levothyroxine. Low dose in CVD- Titrate up until TSH levels are normalised.

Answer 157

Epi: 1/20,000 incidence. Aet: ?Viral (Seasonal variation) on top of a genetically predisposed person. Returns to normal function in >90% pts. 4-6w ++Thyroid, 2-6m --Thyroid. Hx/Sx: Pain, tender thyroid. +Fever ±Palpitations ±RecentVirus ±Tremor ±Heat-Intolerance. Ix: ESR/CRP (++) +TSH (- at start, variable later) +T3/T4 (++) +I-123 Scan (Very low uptake in all phases, better in recovery) +TPO (Normal/Elevated). Mx: Hyperthyroid: ±Iodine (Prevent T4 conversion to T3). Symptoms: Propanolol / Verapamil. Pain: NSAIDS, Paracetemol, Codeine, or finally, prednisolone. Hypothyroid (TSH >10): Levothyroxine.

Answer 158

Epi: 1/60,000 incidence in Iodine-Sufficient populations. ++Older. Aet: Iodine deficiency = main risk factor. Therefore, this is the most common cause of hyperthyroidism in developing countries. Hx/Sx: Lumpy, irregular goitre. RF: Prior Iodine deficiency, Neck radiotherapy, or increasing age. +Tremor +Heat-Intolerance +Tachycardia +Weight-loss. Ix: TSH (Needs to be low). T3/T4 (++), I-123 Scan (Multiple Hot+Cold areas). TPO/TSH ((-), but not specific). Mx: 1. I-131 therapy (If not preggo). ±Carbimazole ±Propylthyrouracil. 2. Thyroid surgery (Risks of recurrent laryngeal damage or hypocalcaemia). Pregnancy: Propylthyrouracil - Ideally not in 1st trimester.

Answer 159

Epi: 1/3333. Larger proportion of hyperthyroidism in developed countries. Aet: TSH-R-Abs (But also present with elevated TPO Abs, as it is a spectrum of disease). TSH receptors found in retro-orbital and dermal tissue. Hx/Sx: Heat intolerance, ++HR, --Weight, Palpitations, PreTibial Myxoedema, Tremor, Goitre (Diffuse), Proptosis. ±CardiacFlowMurmur. Ix: TSH (--), TSH-R-Abs (++), T3/T4 (++ Unless subclinical). ±I-123/Tc-99 scan (Diffuse uptake). Mx: Symptoms: Propanolol. Antithyroid Drugs (Carbimazole / Propylthyrouracil). OR Thyroid Surgery OR Radioactive Iodine +Steroids. Thyroid Storm (CHF, Shock, N/V): High dose Carbimazole +Propanolol +Iodine +Steroids.

Answer 160

Epi: 50-60% lifetime incidence in F. Aet: E.Coli = 70-90%. Proteus, Klebsiella. GBS. ±Decrease in urine flow > Ascending infection. Hx/Sx: ±Dysuria ±Nocturia ±Urge Frequency ±Cloudy Urine. ±Fever ±Flank-Pain ±Haematuria (Ix if absence of other features) ±Incontinence. Ix: Dipstick +Mic/Cult/Sens ±USS kidneys. Mx: Complex: 7 Days. Simple: 3 Days. Complex = Catheter, Male, Pregnant. 1. Trimethoprim (Not in 1st Trim) / Nitrofurantoin (Not in 3rd Trim or eGFR <45). Pregnant: Cefalexin or Cefuroxime.

Answer 161

Epi: 0.5-2% in pregnant women. Aet: E.Coli (60-80%), Proteus (5%). Ascending (Cystitis first) or seeding from blood. Asymptomatic pyelo occurs in 30% of women with cystitis. Hx/Sx: Flank Pain +Fever ±Myalgia +CostovVertebralAngle Tenderness +N/V Ix: Urinalysis (Protein, Leuks, MicroHaem) +M/C/S +BoodCultures +U&Es +Cr (Kidney Function). ±USS/CTKUB (?Stones). Mx: Complicated = Preg/Male/Catheter. 7-10d of Cefalexin / Co-Amox 14d Trimethoprim (Not in 1st Trim). ±Analgesia Complicated: IV Co-Amox / Cefuroxime

Answer 162

Epi: Seen in 10-20% of hospital emergencies. Aet: Pre (--Perfusion), IntaRenal (E.g., HaemolyticUraemicSynd), Post-Renal (E.g., Stones). 45% = Acute tubular necrosis- which is caused by sepsis in 19% of ICU patients. Hx/Sx: RF: >65, CKD/CHD/LF/DM Hx, Myeloproliferative disease, Prev AKI ±DAMN drugs ±LowBP ±ReducedUrine ±Lower UT Sx ±Haematuria ±N/V ±Oedema ±Fever/Rash. Ix: Stages 1-3: Cr (Rise by 50/100/200%) +6/12/(24)h Urine (<0.5(0.3)ml/kg/h). +U&Es (eGFR) +K/ECG (++K) +FBC/CRP +Bicarb (Risk of acidosis) +Urinalysis +FluidChallange (Response = Pre-Renal) ±CXR/BloodCultures. Mx: Fluid Resus (500ml NaCl bolus over 15m) - 250ml if HF, Hartmann's if NOT ++K. +More boluses up to 2L. +Stop Nephrotoxics (DAMN) +Treat Underlying Cause. ±Noradrenaline ±Vasopressin ±CalciumGluconate / Insulin / Dextrose (++K) ±Bicarb (Met Acidosis).

Answer 163

Epi: 9-13% prevalence. Aet: 1: DM: 1/3 patients will develop CKD. 2: HTN. 3: PKD/Nephritic syndromes etc. Stages 1-3b-5 (eGFR >90,60,45,30,15). Hx/Sx: Fatigue ±Oedema ±N/±V ±Pruritus ±RestlessLeg (Uraemia) ±EnlargedProstate ±Orthopnoea ±Seizures. +RF (>65y, DM, HTN). Ix: U&Es +Cr +Glucose +eGFR (Cr, <60. Uses CYSTATIN-C in people w/ high muscle-mass) +Urinalysis (Protein / Blood?) +USS-Kidney ±Biopsy. Mx: 1: ACE/ARBs for BP ±SGLT2 (w/wo DM) +Statin. Complications: ±EPO/Iron (Anaemia) ±Lower Phosphate/VitD (++Parathyroid) ±Bicarb (Acidosis) ±Glycaemic Control. 2: Verapamil / Diltiazem. 3: Stage-V: Transplant or Dialysis: Peritoneal: Continuous at night. Haemo: 3x4h/7d.

Answer 164

Epi: 1/7 prevalence. 31% of men in England. Aet: Stage 1&2 BP >140/90 (ABPM >135/85) & >160/100. Reflex+Increasing TPR to match CO. ++Na intake. +Renin & Na retention. +InsulinResistance. Hx/Sx: ±Asymptomatic ±Retinopathy ±Headache ±ChestPain ±Dyspnoea. Ix: ECG +eGFR +TSH +Hb +Lipids ±Renin/Aldosterone (?Conn's) ±24h-Catecholamines (?Phaeo) Mx: 1. Lifestyle + Black/>55y: CCB / Thiaz-Like-Diur DM/<55y: ACE-I/ARB (-Pril / -Sartan) 2. + ACE-I/ARB/Thiaz-Like or CCB. 3. All 3 of above options. 4. K>4.5: +a/b-Blocker. K<4.5: +Spiro. 5. Specialist.

Answer 165

Epi: 1-2% prevalence. Aet: CoronaryArteryDisease +HTN +Valvular Disease +Myocarditis +Other causes. Preserved/Reduced EjFrac (StrokeVolume <40% predicted). Also stages I-V (Mild-Discomfort@Rest). Hx/Sx: Dyspnoea (++Orthoptic) ±NightCough +Neck-Vein distension ±S3 Gallop +CardioMegaly ±Hepatomegaly ±Rales ±AnkleOedema. Ix: TTEcho (SysHF: Dilation --EjFrac. DiasHF: Hypertrophy ±Preserved EjFrac) +ECG (?QT++) +CXR (CardioMeg, KerlyB, AlveoOdema. DilatedUpperVessels, Effusion) +BNP (++) +FBC (?Anaemia) +U&E (--Na) +LFTs (?Congestion) +Other tests for cause. Mx: Furosemide +ACE/ARB +b-Block ±SGLT2 (Start one drug at a time). ±Statin ±Aspirin/Clopidogrel +Vaccines ±Amiodarone/Digoxin. (AF).

Answer 166

Epi: 0.5-1% prevalence. Aet: Many: A/V dilation/hypertrophy ±Sick-Sinus ±Tumours ±Thyroid ±Alcohol/Caffeine ±Infections. Paroxysmal = >1 x >30s self-resolves in 7d. Persistent = >7d (Corrected by Cardioversion). Permanent: Persistent +Failed Cardioversion. Hx/Sx: Palpitations +Tachycardia +Irregular Pusle ±Stroke ±SOB ±ChestPain ±Murmur (Normally Mitral Stenosis ±RheumaticFever). Ix: ECG (No Ps, irregularly irregular) +TFTs +Echo (Ideally trans-oesophageal to exclude thrombus BEFORE cardioversion) +U&Es. Perform ORBIT and CHA2DS2VaSc. Mx: Acute, HaemUnstable: DC Cardioversion. Paroxysmal / Persistant: Exclude Clots and/OR Start DOAC 3w before +Continue DOACs 4w after. ±Amiodarone 4w before DC +12m after. Medical: Amiodarone (Struc Defect) or Flecainide (No Struc Defect). Long-term: Apixaban (Reverse: Andexanet) / Dabigatran (Reverse: Idarucizumab) +Atenolol / Diltiazem / Digoxin (--Rate). Treatment resistant: Ablation (Needs to have detectable pathology).

Answer 167

Epi: 15-20% Children. 1-3% Adults. Aet: Genetic: Mostly Filaggrin gene. ++Environment: ++Cities, ++Lower SE-Status. Irritants +Infections +Allergens lead to breakdown of barrier. Hx/Sx: Pruritus +DrySkin (Xeroxes) +TypicalSite (Flexor surfaces in teens/adults. May be on chin/scalp/forehead in children). +Scaling +Vesicles +Papules +Excoriations. Ix: Clinical Diagnosis. ±IgE-test (+Food allergy test after initial mx). ±Patch-allergen testing. Mx: 1. Barrier-Cream +Emollients. ±Intermittent topical Hydrocortisone. ?Infection (?Impetigo): Abx (Topical or oral). 2. Systemic steroids / cyclosporin / Tacrolimus.

Answer 168

Epi: Prevalence variable. Aet: Genetics (60-90%). External insult to susceptible individuals: Trauma, infection, lithium, b-Blockers. Guttate = 2nd to Strep-Throat or HIV. Hyperproliferative disease. Hx/Sx: Scaly, red, circumscribed lesions. NailPitting +FHx ±JointSwelling ±Patches on extensors. Ix: Clinical Dx. In doubt: Skin biopsy. Mx: 1. Topical Hydrocortisone and/or Calcipotriol (VitD). Moderate/Severe: Phototherapy +Methotrex / Ciclosporin ±Oral retinoid (Acitretin).

Answer 169

Epi: 1/10,000 Aet: 30-50% have psoriasis in 1st-degree relative. 15% have same disease in 1st degree relative. HLA-B27. CD8+ T-Cells. Hx/Sx: "SPINEACHE". FamHx +JointPain +Stiffness +PeripheralArthritis +Dactylitis +Scalp / Nail Problems. Ix: XR hand+feet. RF (Can rule out RA in some) +ESR/CRP (Should be normal) +ACCP (Should be negative in most) +UricAcid (Normal/++) +Lipids (Risk of metabolic synd). Mx. NSAIDs ±Physio ±Steroid-Injections (Up to 3x annually). Progressive: DMARDs (Metho / Ciclo) ±TNF-a-I (Entanercept / Infliximab)

Answer 170

Epi: 0.24-0.56% prevalence. Aet: HLA-DR4 genetic factor. ±Infection in susceptible individuals? Inflamed synovium > ++Angiogenesis +T/B cells +TNF/IL1/IL6. Hx/Sx: ±Age 50-55y. >6w active, symmetrical arthritis ±Female ±Joint pain / swelling / stiffness. +MorningStiffness >30m ±Nodules ±Scleritis ±Swan-Neck ±UlnarDeviation. Leads to Felty (+Splenomeg --WBCs) ±Interstitial Lung Disease ± Ix: RF (Non-specific) +ACCP (Specific) +Radiographs (LESS - LossOfJointSpace +Erosions +Soft-Tissue +SoftBones). Mx: 1. NSAIDs +Methotrexate / Sulfasalazine ±PO OD steroids / IM steroids every 1-4w as "Bridging" therapy. Severe: ±TNFa-I (Infliximab / Entanercept).

Answer 171

Epi: 1/500 prevalence. M > F. Aet: HLA-B27. 97% inheritable. Inflammation > Erosion > Repair. Hx/Sx: Inflammatory back pain (Worse in morning) +Uveitis +Enthesitis +FamilyHx ±Fatigue ±Dyspnoea ±Kyphosis ±Psoriasis (10% - THESE ARE NOT Psoriatic Spondylotic patients). Ix: Pelvic XR (Sacroiliitis) ±MRI (Bone-Marrow Oedema) ±B27 (Not diagnostic). Mx: Acute: 1. Naproxen +Paracetamol. 2. Hydrocortisone injections. W/ Peripheral Joints: Methotrex / Sulfasalazine. Long-Term: TNFa-I: Infliximab / Entanercept +NSAIDs +Physio.

Answer 172

Epi: 1/5000 person-years incidence. Aet: 43.9% heritable. Many gene loci. +DRUGS: Terbinafine, Sulfasalazine, Isoniazid, Phenytoin, Carbamazepine. High affinity of antibodies to dsDNA. Hx/Sx: Butterfly, photosensitive Rash (30-40%). Additive Criteria: Constitutional: FEVER. Haemo: --Leukos, --Thrombocytes, Autoimmune haemolysis. Neuro: Delirium, psychosis, seizure. Mucal: Alopecia, oral ulcers, cutaneous lesions. Serosal: Pericardial/Pleural Effusion. MSK: Joint involvement. Renal: ?Proteinuria. Ix: ANA (Must be present) +FBC (Lymphopenia) +APT (?Long) +U&Es (+Urea/Cr) +ESR (++) +ANA/dsDNA (+) +CXR (?Effusion) +ECG (?Chest Pain). Mx: Hydroxychloroquine ±NSAIDs. Steroids: Useful to do pulses of IV steroids reduce SideEffects x3d. ±Methotrexate / Azathioprine ±Rituximab. Clotting issues: Anti-platelet or Anticoag. Haematological issues: TPO-Agonist or Splenectomy.

Answer 173

Epi: 1-5.6% have antibodies. Aet: W/wo any autoimmune conditions underlying- But most commonly SLE associated (25% of SLE pts) and RA (6%). Abs bind to various blood-phospholipids and can cause thromboses. Hx/Sx: Hx or dx of vascular thrombosis ±Hx of lost pregnancy or pregnancy morbidity. ±SLE ±PetichialRash ±GumBleeds ±Arthralgia ±Murmur (vegetations). Ix: Serum Lupus-Anticoag +Anti-CardioLipin +anti-b2-glycoprotein +ANA +dsDNA +FBC (--Platelets?) +Cr/Urea (Nephopathy?). Mx: Acute/Diagnosed: LMW (Preferred in pregnancy- Endoxaparin) or Unfractionated (Deltaparin) Heparin Then: switch to Warfarin. Pregnancies: LMWH +75mg/d Aspirin upto 6-8w postnatally.

Answer 174

Epi: 1/1700 incidence. PkAg >60y. Aet: Acute onset. Link to infections, link to HLAs. IL6 +Link to GCA +Fewer B cells and ++T cells. Hx/Sx: Shoulder +Hip stiffness +Pain +Rapid response to steroids. Acute ±Fever ±Weight-Loss ±Anorexia ±Malaise. ±GCA. Ix: ESR/CRP +FBC ±TSH (Normal) ±ACCP/RF (Normal) ±CK/EMG (Normal). Mx: Pred 12-25mg for 3-4w until ESR/CRP stabilise. Taper dose. +Ca/VitD/Bisphosphonates ±NSAIDs. 2. Methotrex as a steroid-sparing mx (Check lungs with XR to exclude interstitial lung disease before) +Folate. 3. Tocilizumab (IL6-Antag).

Answer 175

Epi: 1/4000 prevalence. Aet: ANA +Genes assoc. 3 patterns: Limiting Cutaneous (Distal Limbs +CREST - AC-abs). Diffuse Cutaneous (Trunk+Proximal limbs, lung involvement - scl-70). Scleroderma (No internals, just skin). Hx/Sx: ±Raynauds ±DigitalPits/Ulcers ±SkinThickening ±ReducedHandFunc ±Dysphagia/Heartburn ±Telangiectasia ±Calcinosis ±Dyspnoea ±Fatigue ±DryCough. Ix: Anti RNA/scl/NA +FBC (?MicroAnaemia- Bleeding) +Urea/Cr (?RenalFailure) +ESR/CRP (+ = Poor prognosis) ±ECG/Echo ±CXR (?Interstitial Lung disease) ±BariumSwallow (--Peristalsis?) Mx: Renal: ACE ±CCBs etc (--BP) CardiacTamp: Pericardial window surgery +Prednisolone. Raynaud's: CCB ±Aspirin +Lifestyle. Progression to ulcers: PDE5-Inhibitors +EndothelinInhibitor +Analgesia. Gastric: Erythromycin then Octerotide. Myopathy: Steroids then Methotrex (sparing- CHECK LUNGS). Lungs: Steroids + O2 ±Lung Transplant.

Answer 176

Epi: 0.5-5% prevalence. PkAg 30-50y. Aet: CNS: Pain/Sensory amplification. One of multiple chronic-pain conditions (IBS, headache, etc.). Some stressors may incite it (Rheumatic disease, Lyme, EBV). Hx/Sx: Chronic pain (>3m) +Diffuse tenderness on examination. ±Fatigue unresolved by rest ±SleepDisturbance ±Headache ±Stiffness. Ix: Clinical Dx: 9 pairs of tender points; 11/18 makes Dx likely. All the following = normal: TFT/ESR/FBC//VitD and RF/ACCP/ANA (Not recommended due to high false(+)) Mx: Explanation ±AerobicExercise ±CBT ±Drugs: Amitryptaline, Pregabalin, Duloxetine.

Answer 177

Epi: Aet: Hx/Sx: Ix: Mx:

Answer 178

Epi: Aet: Hx/Sx: Ix:

Answer 179

Epi: Aet: Hx/Sx: Ix: Mx:

Conditions List Flashcards

Gives a brief overview (Epidemiology, Aetiology/Pathophysiology, Symptoms/History, Investigations/Screening, and Management) of, hopefully, every condition that we might come across.