Flash Flashcards
(118 cards)
1
Q
What are the key modifiable risk factors for Atrial Fibrillation represented by the acronym CATHODE?
A
- C- Cholesterol
- A- Alcohol
- T- Tobacco
- H- Hypertension / hyperthyroidism
- O- Obesity or overweight
- D- Diabetes
- E- Exercise
2
Q
What are some other risk factors for Atrial Fibrillation?
A
- Coronary heart disease
- L diastolic dysfunction
- Valvular heart disease
- Heart failure
3
Q
What are the key modifiable risk factors for Coronary Heart Disease represented by the acronym …?
A
- T- Tobacco
- O- Obesity or overweight
- P- Physical inactivity
- C- Cholesterol
- H- Hypertension
- D- Diabetes
4
Q
What are the non-modifiable risk factors for Coronary Heart Disease represented by the acronym AGE?
A
- A - Age (increases with age)
- G- Genetics (FH of CHD)
- E- Ethnicity (South Asian / Afro-Caribbean have higher risk)
5
Q
What are the WHO criteria for diagnosing Diabetes?
*Random glucose
* Fasting glucose
* HbA1c
* OGTT (2 hrs)
A
- Random glucose 11.1+ mmol/L
- Fasting glucose 7.0+ mmol/L
- HbA1c 48+ mmol/mol
- OGTT (2 hrs) 11.1+ mmol/L
6
Q
What are the classical diabetic symptoms to consider when diagnosing Diabetes?
A
- Polyuria
- Polydipsia
- Nocturia
- Weight loss
7
Q
When should gestational diabetes screening be performed?
A
- Screen only patients at high risk
- Test of choice: OGTT
- Usually done at 24-28 weeks
8
Q
What is the threshold for clinic blood pressure to be considered normotensive?
A
Clinic BP <140/90
9
Q
What should be done if the first blood pressure reading is 140/90 or higher?
A
Repeat reading
10
Q
Which medications should be considered for hypertension management?
A
- A = ACE inhibitor / ARB if ACE not suitable
- C= Calcium channel blocker
- D = Thiazide like diuretic
11
Q
What is the first-line drug for non-specific low back pain?
A
NSAID e.g. ibuprofen / naproxen
12
Q
What are the red flag signs/symptoms for follow-up in non-specific low back pain?
A
- Advise to report any red flag signs / symptoms
13
Q
What are the signs of Cauda Equina Syndrome?
A
- New onset low back pain / sciatica
- Bilateral neurological deficit in legs
- New onset urinary retention / incontinence
- New onset faecal incontinence
- Saddle anaesthesia or paraesthesia
- Unexpected laxity of anal sphincter
14
Q
What is the statutory duty concerning notifiable diseases?
A
Notify ‘proper officer’ of suspected cases of certain diseases / organisms
15
Q
Which vaccinations serve as clues for notifiable diseases?
A
- Acute meningitis / encephalitis (MenB / MenC)
- Diphtheria, tetanus, pertussis, polio (DTaP/IPV)
- Measles, mumps, rubella (MMR)
- Tuberculosis (BCG)
16
Q
Which patients should not routinely receive live attenuated vaccines?
A
- Clinically immunosuppressed patients
17
Q
What is the FeverPAIN score used for?
A
Aid decision making for antibiotics in sore throat
18
Q
What are the risk factors for pre-eclampsia?
A
- Age 40+
- BMI 35 kg/m? or more at first visit
- Multiple pregnancy
- First pregnancy
- Pregnancy interval >10 years
- FH of pre-eclampsia
- Hypertension in past pregnancy
- Chronic kidney disease
- Thrombophilia
- SLE / Antiphospholipid syndrome
- Diabetes
19
Q
What are the features of stable anginal pain?
A
- Constricting discomfort in the front of chest, neck, shoulders, jaw or arms
- Precipitated by physical exertion
- Relieved by rest or GTN within 5 mins
20
Q
What should be done if a patient has typical or atypical anginal pain?
A
Offer diagnostic testing with coronary angiography
21
Q
What are key features of Parkinson’s disease?
A
- Bradykinesia
- Hypokinesia
- Reduced facial expression / blinking
- Difficulty with fine movement
- Slow, shuffling, festinating gait
22
Q
What is the first-line treatment for mild acne?
A
- Benzoyl peroxide
- Topical retinoid +/- benzoyl peroxide
- Topical antibiotic + benzoyl peroxide
- Azelaic acid 20%
23
Q
What is recommended for acute migraine management in adults?
A
- Oral triptan + NSAID
- Oral triptan + paracetamol
24
Q
What are the symptoms of Vitamin D deficiency?
A
- Bone pain / discomfort in lower back, pelvis, and lower extremities
- Impaired physical function
- Muscle aches and weakness
25
What is the treatment for Vitamin D deficiency based on serum levels?
* Level <25 mol/L= deficiency - treat
* Level 25-50 mol/L= insufficiency - treat if:
* Has fragility fracture / osteoporosis / high fracture risk
* On treatment with antiresorptive drug
* Has symptoms suggestive of deficiency
26
Who should undergo osteoporosis risk assessment?
* All women aged 65+
* All men aged 75+
* Women aged 50-64 with:
* A previous osteoporotic fragility fracture
* Current or frequent recent oral steroid use
* History of falls
27
What BMI indicates underweight status?
BMI < 18.5 kg/m2
## Footnote
Indicates potential health risks and may require further assessment.
28
List two secondary causes of osteoporosis.
* Current or frequent use of oral steroids
* Untreated premature menopause
29
What age group is at risk for fragility fractures if they have a previous fracture?
People younger than 50
30
What is a common medication that can increase fracture risk?
Selective serotonin reuptake inhibitors
31
What is the first-line medication for trigeminal neuralgia?
Carbamazepine
32
What should you NOT do when prescribing for neuropathic pain?
Do NOT prescribe more than 1 drug at the same time
33
What are the red flags for diagnosing IBS?
* Signs or symptoms of cancer
* Markers for inflammatory bowel disease
34
What is the classic triad of symptoms for Reactive arthritis?
* Conjunctivitis
* Urethritis
* Arthritis (seronegative)
35
What is the Jarisch-Herxheimer reaction?
A reaction that can occur with antibiotic treatment, causing worsening of fever, chills, muscle pains, and headache.
36
What metrics are needed to calculate eGFR?
* Creatinine
* Age
* Sex
* Ethnicity
37
What is Bell’s Palsy characterized by?
Unilateral, idiopathic, acute facial nerve paralysis
38
Who should be admitted for Whooping cough management?
* 6 months old or younger and acutely unwell
* Significant breathing problems
* Significant complications (e.g., seizures, pneumonia)
39
What are the typical features of impetigo?
Golden coloured, crusting lesions
40
What is the first-line medication for lipid therapy in primary prevention?
Atorvastatin 20mg
41
What does the CHA2DS2-VASc score assess?
Stroke risk in patients with atrial fibrillation (AF)
42
What are the criteria for assessing bleeding risk in patients with AF?
* Haemoglobin <130 g/L (males)
* Haemoglobin <120 g/L (females)
* Personal history of bleeding
* Age > 74 years
* eGFR < 60 mL/min/1.73m2
43
What is the management for chronic plaque psoriasis?
* Topical emollients
* Topical potent steroid + Vitamin D preparation
44
What should you do if a patient presents with sudden onset hirsutism?
Refer urgently to rule out androgen-secreting tumors
45
List two autosomal dominant genetic conditions.
* Marfan syndrome
* Huntington's disease
46
What is a common feature of Turner syndrome?
45X0 (missing X chromosome)
47
What spirometry result indicates obstructive lung disease?
FEV1/FVC ratio < 70%
48
What are the typical symptoms of frozen shoulder?
* Shoulder pain
* Stiffness on elevation and external rotation
49
What is the first step in infertility investigations for females?
Regular unprotected sex for 1 year, test earlier if less likely to conceive
50
What is the procedure for male infertility semen analysis?
Collect after 2-7 days of sexual abstinence; sample should be at lab within 1 hour
51
What is prolactin?
52
What is the first step in investigating male infertility?
Arrange semen analysis
53
What is the recommended sexual abstinence period before semen analysis?
2-7 days
54
How quickly should a semen sample be at the lab after production?
Within 1 hour
55
If the first semen analysis result is normal, what should be done next?
No need to repeat
56
What should be done if the first test for semen analysis is abnormal?
Repeat after 3 months for confirmation
57
When should a repeat test be conducted sooner than 3 months?
If azoospermia or severe oligospermia detected
58
What are the WHO reference values for semen volume?
1.5 ml+
59
What is the minimum sperm concentration according to WHO reference values?
15 million+ per ml
60
What is the minimum total motility percentage required in semen analysis?
40%+ motile or 32%+ with progressive motility
61
What groups are recommended for influenza vaccination?
* Age 65+
* 6 months+ in clinical risk groups
* Chronic respiratory disease
* Chronic heart disease
* Chronic kidney disease
* Chronic liver disease
* Chronic neurological disease
* Diabetes mellitus
* Immunosuppression
* Asplenia or splenic dysfunction
* Pregnant women
* Morbid obesity (BMI 40+)
* Healthcare workers / carers
62
What is the first-line treatment for anaphylaxis?
IM Adrenaline 1:1000
63
What is the adult dosage of IM Adrenaline for anaphylaxis?
500 micrograms (0.5 mL)
64
What additional drugs may be used in anaphylaxis management?
* Chlorphenamine
* Hydrocortisone
* Salbutamol
65
What factors are associated with neglect/maltreatment?
* Previous social services involvement
* Parental mental health problems
* History of domestic abuse
* Poor housing/frequent moves
* Parental substance misuse
* Parental criminal convictions
* Parental learning difficulty
* Age <1 year
* Low birth weight / SCBU admission
* Known disability
66
What are some obesity-related health problems?
* Type 2 diabetes
* Coronary heart disease
* Hypertension and stroke
* Asthma
* Depression / psychological distress
* Metabolic syndrome
* Dyslipidaemia
* Cancer
* Gastro-oesophageal reflux disease
* Gallbladder disease
* Reproductive problems
* Osteoarthritis and back pain
* Obstructive sleep apnoea
* Breathlessness
67
What does the acronym STAIRS refer to in alcohol withdrawal symptoms?
* Sweating
* Tremor
* Anxiety
* Insomnia
* Rapid heart rate
* Seizures
* Hallucinations
* Disorientation
68
What does the acronym SAFESAL represent in hypertension risk factors?
* S - Sex
* A - Age
* F - Family history
* E - Ethnicity
* S - Social deprivation
* A - Anxiety / stress
* L - Lifestyle
69
What are the features of generalized seizures?
* Tonic
* Clonic
* Tonic-clonic
* Absence
* Myoclonic
* Atonic
70
What are some differential diagnoses for seizures?
* Syncope
* Cardiac arrhythmias
* Panic attacks with hyperventilation
* Non-epileptic attack disorders
* Night terrors
* Breath-holding attack
71
What should be done for seizure management if it lasts less than 5 minutes?
* Protect them from injury
* Cushion head
* Move harmful objects away
* Do not restrain or put anything in the mouth
* Check airway and put in recovery position after seizure stops
72
What should be done for seizure management if it lasts more than 5 minutes?
* Follow usual seizure protocol AND treat with buccal midazolam or rectal diazepam
* Call ambulance for urgent admission if seizures do not respond promptly
73
What are the criteria to suspect Polycystic Ovary Syndrome (PCOS)?
* Infrequent or no ovulation
* Hyperandrogenism
* Irregular cycles in women over 18
* Indirect evidence of insulin resistance
74
What tests are used to diagnose PCOS?
* Total testosterone
* Sex hormone-binding globulin
* Free androgen index
* LH and FSH
* Prolactin
* Thyroid-stimulating hormone
* Pelvic ultrasonography
75
What factors indicate higher risk pregnancies?
* Multiple pregnancy
* Aged <18 or >40
* BMI >35 kg/m2 or <18 kg/m2
* Recurrent miscarriage or preterm birth
* Family history of genetic disorder
76
What assessments are conducted during an uncomplicated pregnancy in the 1st trimester?
* Height, weight and BMI
* Blood pressure and proteinuria
* Offer scans: dating & anomaly
* Offer fetal screening for Down Syndrome
* Blood typing
* Maternal screening for anemia
77
What are the typical features of a febrile seizure?
* Child aged 6 months - 5 years
* Last no longer than 3 - 6 minutes
* Generalised tonic-clonic type
* Complete recovery of consciousness within 1 hour
78
What is the management for a child with suspected febrile seizure?
* Urgently admit any child with suspected meningitis
* Immediate hospital assessment if 1st seizure or diagnostic uncertainty
79
What are the equivalent doses of opioids to morphine 10mg PO?
* Codeine: 100mg
* Dihydrocodeine: 100mg
* Tramadol: 100mg
* Oxycodone: 6.6mg
* Morphine: 5mg IM, SC, IV
* Diamorphine: 3mg IM, SC
80
What is the equivalent dose of codeine to morphine 10mg PO?
100mg PO
## Footnote
This is part of a list of opioids and their approximate equivalences.
81
What is the equivalent dose of oxycodone to morphine 10mg PO?
6.6mg PO
## Footnote
This is part of a list of opioids and their approximate equivalences.
82
What are the two main types of analgesia according to the WHO ladder?
1. Non-opioid analgesic
2. Opioid analgesics
## Footnote
The WHO ladder includes three steps for pain management.
83
What is the first step in the WHO pain management ladder?
Non-opioid analgesics such as paracetamol or NSAIDs
## Footnote
This step is for mild pain management.
84
What characterizes Achilles tendinopathy?
Intermittent pain in the back of the leg or heel, stiffness in the tendon
## Footnote
Symptoms are often worse in the morning and aggravated by activity.
85
What is the typical morning cortisol level that indicates adrenal insufficiency?
<100 nanomol/L
## Footnote
This level suggests a high likelihood of adrenal insufficiency.
86
What is the primary treatment for Addison's Disease?
Glucocorticoid replacement, usually hydrocortisone
## Footnote
Other options include prednisolone and dexamethasone.
87
What are the main types of allergic rhinitis?
* Seasonal
* Perennial
* Occupational
## Footnote
Seasonal allergic rhinitis is commonly known as hay fever.
88
What is the primary treatment for primary amenorrhea?
Refer if there is parental/patient concern or if abnormality is suspected
## Footnote
Most referrals are to a gynecologist.
89
What are common symptoms of iron deficiency anemia?
* Dyspnoea
* Fatigue
* Alopecia
* Cognitive dysfunction
* Restless leg
* Vertigo
## Footnote
Symptoms can vary based on the speed of onset.
90
What is the calculation for Body Mass Index (BMI)?
Weight / height squared
## Footnote
Units are kg/m².
91
What is angioedema?
Swelling of deep dermis, subcutaneous, or submucosal tissue
## Footnote
Often affects the face, genitalia, hands, and feet.
92
What is the first-line treatment for mild to moderate pain in children under 16?
Paracetamol or ibuprofen alone
## Footnote
If no response, adherence should be checked.
93
What is the definition of primary amenorrhea?
Failure to establish menstruation by 16 years of age with normal secondary sexual characteristics
## Footnote
Or by 14 years without secondary characteristics.
94
What are the 4As associated with Ankylosing Spondylitis?
* Anterior uveitis
* Apical fibrosis
* Aortic regurgitation
* Achilles tendonitis
## Footnote
These conditions may be present alongside Ankylosing Spondylitis.
95
What is the common treatment for iron deficiency anemia?
Iron salt supplements
## Footnote
Common options include ferrous fumarate, ferrous sulfate, and ferrous gluconate.
96
What is the management strategy for angina with poor control?
* Ensure maximum licensed dose is taken
* Switch to or add CCB
* Consider adding a nitrate or other medications
* Refer to cardiologist if on dual therapy
## Footnote
Adjustments may be needed based on patient response.
97
True or False: Imaging is routinely recommended for diagnosing Achilles tendinopathy.
False
## Footnote
Achilles tendinopathy is primarily a clinical diagnosis.
98
What is the typical morning cortisol level that warrants referral to an endocrinologist for further investigations?
100 - 500 nanomol/L
## Footnote
Urgency of referral depends on severity of symptoms.
99
What is the medical term for inflammation of the uvea?
Uveitis
## Footnote
Uveitis can refer to anterior, intermediate, posterior, or panuveitis, depending on the affected area.
100
What is apical fibrosis?
A condition characterized by the thickening of lung tissue at the apex of the lungs
## Footnote
Apical fibrosis may be associated with various pulmonary diseases.
101
What is aortic regurgitation?
A condition where the aortic valve does not close properly, allowing blood to flow back into the heart
## Footnote
It can lead to heart failure if not managed properly.
102
Define Achilles tendonitis.
Inflammation of the Achilles tendon, often due to overuse or injury
## Footnote
Common in athletes and can lead to pain and stiffness in the heel.
103
What tests confirm inflammation in Ankylosing Spondylitis?
ESR, CRP, and FBC
## Footnote
These tests help assess the level of inflammation present in the body.
104
What imaging method can detect early changes in sacroiliac joints for Ankylosing Spondylitis?
MRI
## Footnote
MRI is more sensitive than X-rays for early detection.
105
What is the maximum daily dose of Topiramate for migraine prophylaxis?
200mg daily
## Footnote
The effective starting dose is usually 25mg at night, increasing weekly.
106
What is the typical initial dose of Propranolol for migraine prophylaxis?
80mg daily
## Footnote
This can be adjusted based on the patient's response and tolerance.
107
Define medication overuse headache.
Headache occurring on 15+ days a month due to overuse of acute headache medications
## Footnote
Overuse is defined as using specific medications more than 10 or 15 days per month, depending on the type.
108
What is the typical presentation of cluster headache?
Unilateral peri-orbital pain associated with ipsilateral cranial autonomic symptoms
## Footnote
Symptoms may include conjunctival injection and lacrimation.
109
What is a common risk factor for atrial fibrillation (AF)?
Irregular pulse
## Footnote
Other symptoms may include breathlessness, palpitations, and reduced exercise tolerance.
110
What is the first-line treatment for new-onset atrial fibrillation with a pulse rate over 150?
Urgent admission for cardioversion
## Footnote
This is critical if the patient is hemodynamically unstable.
111
What are aphthous ulcers?
Small, round or ovoid oral ulcers with circumscribed margins
## Footnote
They often recur and are not associated with systemic diseases.
112
What is the classic symptom of appendicitis?
Abdominal pain that migrates to the right iliac fossa
## Footnote
Other symptoms include anorexia, nausea, and vomiting.
113
What are the atypical presentations of appendicitis in older adults?
Minimal pain and absence of fever
## Footnote
Confusion or shock may also be present in older adults.
114
What is Attention Deficit Hyperactivity Disorder (ADHD)?
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning
## Footnote
Symptoms must occur in two or more settings and persist for at least six months.
115
List some risk factors for autism in children.
* Born before 35 weeks gestation
* Birth defects associated with CNS malformation
* Sibling with ASD
* Parent with schizophrenia-like psychosis
* Mother who received sodium valproate in pregnancy
## Footnote
These factors increase the likelihood of developing autism spectrum disorder.
116
What are the characteristics of Baker's cyst?
A popliteal cyst that can be primary (idiopathic) or secondary (associated with disease)
## Footnote
Primary cysts are usually found in children, while secondary cysts are more common in adults.
117
What is the management for severe recurrent aphthous ulcers?
* Topical corticosteroid
* Topical anaesthetic
* Short course of systemic prednisolone
* Vitamin B12 supplement
## Footnote
Avoiding trigger factors is also recommended.
118
What are the red flags associated with Baker's cyst?
* Sudden increase in size
* Acute symptoms with dissection/rupture
* Sudden 'pop' with pain
## Footnote
These symptoms may indicate a serious alternative cause.
