General Flashcards
(102 cards)
1
Q
What hormone therapies is breast cancer a contraindication for?
A
progesterone only contraception.
HRT
2
Q
What can you use to assess someones alcohol dependance?
A
CAGE
Have you ever thought that you should cut down?
Do you get annoyed at people commenting on your drinking?
do you ever feel guilty about your drinking?
Eye opener - do you ever drink first thing in the morning?
3
Q
Blood results in liver disease?
A
Raised ALT/AST
Raised gamma GT
ALP raised in late disease
Raised bilirubin in cirrhosis
Low albumin due to reduced function of liver.
Elevated PTT due to reduced liver function
Raised MCV on FBC suggests alcoholism
4
Q
Signs of vernickes encephalopathy?
A
Confusion
Ataxia
Oculomotor dysfunction
5
Q
Differentials for generalised abdominal pain?
A
Peritonitis
Ruptured AAA
Bowel obstruction
Ischaemic colitis
6
Q
Differentials for generalised abdominal pain?
A
Peritonitis
Ruptured AAA
Bowel obstruction
Ischaemic colitis
7
Q
Differentials for RUQ pain?
A
Biliary colic
Acute cholecystitis
Acute cholangitis
8
Q
What is charcots triad and which condition is it associated with?
A
Acute cholangitis
RUQ pain
Fever
Jaundice
9
Q
What should you think about in a septic patient with known liver disease (ascites)
A
SBP
10
Q
What are the 3 main causes of bowel obstruction?
A
Adhesions (peritonitis, surgery, infection)
Hernias
Malignancy
11
Q
Management of bowel obstruction
A
Drip & Suck
- NBM
- IV fluids
- NG tube with free drainage
12
Q
What should be considered with AF and abdo pain?
A
Mesenteric ischaemia
Clot in SMA - diagnosed by contrast CT
13
Q
What makes you think gallstones?
A
Fat
Female
Forty
Fair
Worsened by fatty foods.
14
Q
Imaging for gallstones?
A
Abdo USS
ERCP if needed (biliary)
15
Q
What is Murphys sign and what does it suggest?
A
Palpation of right subcostal area whilst asking patient to take deep inspiration
Gallbladder lowers during inspiration and hits off hand causing pain in cholecystitis
16
Q
Causes of microcytic anaemia?
A
Thalassemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia
17
Q
Causes of macrocytic anaemia?
A
B12 and folate deficiency
Normoblastic =
alcohol
liver disease
hypothyroid
azathioprine
18
Q
Causes of normocytic anaemia?
A
Acute blood loss
anaemia of chronic disease
aplastic anaemia
haemolytic anaemia
hypothyroid
19
Q
What are specific symptoms of iron deficiency?
A
Pica - cravings for specific foods
Hair loss
20
Q
Investigations of iron deficiency anaemia?
A
Bloods - FBC (haem & MCV)
B12, folate, ferritin
Blood film
Urgent OGD/colonoscopy
21
Q
Management of iron deficiency anaemia?
A
Premeopausal or pregnant woman - iron trial for 2-4weeks
Men and postmenopausal woman need GI causes of bleeding excluded
Check TTG for coeliac
22
Q
What must you check if folate is low?
A
B12
23
Q
Should b12 or folate be replaced first and why?
A
B12
risk of subacute combined degeneration of the cord
24
Q
What is guillian barre?
What triggers it?
Concerns?
Management?
A
Symmetrical ascending peripheral nerve neuropathy
Usually triggered by infection (campylobacter/CMV/EBV)
Worried about ascending to diaphragm - respiratory weakness, Increases risk of VTE.
IVIG, plasma exchange, VTE prophylaxis
25
Red flags for headaches?
New onset >55 years old
Known/prev malignancy
Early morning
Exacerbated by valsalva
disturbing sleep
26
Investigations and management of migraine?
If no red flags.
Headache diary to identify potential triggers.
pain relief - paracetsamol/ibuprofen
Triptan to take at onset.
Propanolol/topiramate/amitriptyline for prophylaxis
27
What long term drugs are expected after an ischaemic stroke?
Aspirin first 14 days then clopidogrel
atorvastatin/rosuvastatin
anticoagulant - DOAC/warfarin
28
What classification system is used for strokes?
Bamford
29
Scoring tools for stroke?
ROSIER
FAST
30
Scoring tools for stroke?
ROSIER
FAST
31
What common drugs should be stopped when pregnant?
Statin
ACEi/ARB
32
What changes to normal antenatal care occur if diabetic?
Oral meds changed to insulin.
HbA1c checked at booking.
scan at 20 weeks for fatal anomaly.
induction @ 37-38 weeks.
Blood testing every 2-4 hours in the newborn
Discharged after 24 hours if suitable blood glucose.
33
Cervical cancer info and risk factors
Associated with HPV
- unprotected sex
- numerous partners
Women of childbearing age
COCP >5 years
34
Cervical cancer presentation?
Intermenstrual/post coital/post menopausal bleeding
Vaginal discharge
Pelvic pain/dyspareunia
35
Investigation/management of cervical cancer?
Speculum (ulceration, inflammation, bleeding)
Urgent colposcopy under cancer referra
36
how frequently should a smear be performed?
every 3 years (25-49)
every 5 years (50-64)
37
What prompts colposcopy after smear results?
1. Inadequate sample (repeat) but if continued inadequate sample then colposcopy.
2. HPV +ve result with abnormal cytology
38
Management of simple ovarian cysts?
surgery to anyone symptomatic
Asymptomatic:
<5cm leave alone
5-7cm repeat scan in 12 months
=>7cm surgery due to risk of torsion
39
When should ca125 be checked?
complex cyst (premenopausal)
any cysts in post menopausal women
unexplained bloating, satiety
40
Management of fibroids
<3cm & no cavity distortion
1. mirena
2. TXA/NSAIDs, COCP/POP
3. endometrial ablation/hysterectomy
>3cm
1. TXA, mefanamic acid
2. mirena
3. uterine artery embolisation
GnRH analogues given to reduce size before surgery
41
Risk factors for endometrial cancer?
Obesity
T2DM
Nulliparity, early menarche, late menopause
Tamoxifen
PCOS
HNPCC
42
Protective factors for endometrial cancer?
COCP
Smoking
43
Presentation of endometrial cancer?
Post menopausal bleeding
altered intermenstrual bleeding
rare - pain & discharge
=>55 y/o refer via urgent cancer pathway
44
Investigations for endometrial cancer?
Management?
TVUS
(normal endometrial thickness <4mm)
hysteroscopy & endometrial biopsy
Total hysterectomy + bilateral sapling-oophrectomy + post op radio if high risk
progestogen therapy if frail/unsuitable for surgery
45
Investigations for ectopic pregnancy?
TVUS (haemoperitoneum/free fluid)
hCG measured 48 hours apart
- increased >60% suggests intrauterine pregnancy but TVUS required 7-14 days later to locate pregnancy
- Decrease >50% pregnancy unlikely to continue
- decrease <50 or increase <60% = review @ EPAC within 24 hours
46
Management options for ectopic?
Expectant
- stable tubal ectopic, no heartbeat
Medical (methotrexate)
- no sig pain, enraptured and <35mm, serum hug < 5000
- side effects include PV bleeding, abdominal pain/cramping, N&V
Surgical (salpingectomy)
- Pain
- >35mm
- ectopic with visible heartbeat
- serum hcg >5000
- antiD required if rhesus neg
47
Management of chlamydia?
Doxy 100mg bd for 7 days
abstain from sex
contact tracing
48
Gonorrrhoea management?
1g IM ceftriaxone
test of cure
49
Symptoms of endometriosis
cyclical pain
Dyspareunia
Bleeding (heavy menstruation)
Non cyclical pain from adhesions
infertility
50
Management of endometriosis?
analgesia
COCP, POP, depo, mirena - stop ovulation and reduce endometrial thickening
GnRH agonist (goserelin)
Surgery
51
Treatment of syphilis?
IM Benzylpenicillin
Contact tracing
52
Presentation of molar pregnancy ?
Severe hyperemesis
Hypertension
++ hCG
Variation in bleeding
- grape like tissue
- dark brown/red
Thyrotoxicosis
abdominal pain/swelling
53
Diagnosis of molar pregnancy?
USS
- bubble
- snowstorm
Serum hCG
54
Management of molar pregnancy?
Surgical evacuation with histology performed on tissues.
urine & serum hCG 4 weeks post evacuation
- contraception must be used whilst undergoing follow up
55
Management options for miscarriage?
Expectant
vaginal misoprostol
- bleeding should occur within 24 hours
- neg pregnancy test after 3 weeks
- pain relief and antiemetic
surgical
- MVA
- EVA
56
Indications and contraindications for COCP?
Indications
- menorrhagia/endo
- reduces risk of ovarian, endometrial and colorectal cancer
- works immediately if day1-5 of cycle (otherwise 7 days)
- can help acne
Contraindications
- Migraine with aura
- VTE history
- <6 weeks post partum
- >35 and smoking >15/day
- hypertension
- AF
- Age =>50
Cons
- human error
- increased cervical and breastr cancer risk
- hormonal side effects
- irregular bleeding
Cautions
age => 40
obesity
57
How does transdermal patch work?
oestrogen and progesterone
pros and cons similar to COCP
changed every 7 days, 7 day patch free period allows a bleed.
if falls of less than 48 hours then no need for emergency contraception
58
Pros and cons of levonorgestrel IUS ?
Pros
- Safe when breast-feeding
- fertility returns to normal after immediate cessation
- dont need to remember to take a pill
- fewer side effects as hormones act locally on endometrium not systemically
- generally 5 years (3 for some types - jaydess)
- mirena useful for menorrhagia approx 50% amenorrheoic
Cons
- Needs to be inserted within first 7 days of cycle
- 7 days to become effective
- small risk that device will move
- increased risk of ectopic
59
Pros and cons of Copper IUD
Pros
- fitted at any point in cycle
- reliable immediately after insertion
- can be fitted immediately after childbirth or 4 weeks later
- effective up to 10 years
-suitable for emergency contraception
Cons
- pain
- perforation of uterine wall
- variable bleeding especially in first 3- months
- risk of ectopic/PID
60
Emergency contraceptive options?
1. Copper IUD
- most effective
- <= 5 days UPSI
- can be left in as LARC
- if not acting as LARC it must be kept in until next MP
2. Levonorgestrel
- <72 hours after UPSI
- Can immediately start hormonal contraception
3. Ullipristal (EllaOne)
- <120 hours post UPSI
- can reduce effectiveness of hormonal contraception (start 5 days later or use barrier methods)
- use with caution in asthma
- cannot breastfeed until 7 days after
61
Indications for digital examination (vagina)?
Coil insertion
Bleeding
62
Symptoms to screen for preeclampsia?
Headaches
Visual disturbance
Swelling of hands, feet, face
Vomiting
63
Investigations for pre-eclampsia ?
BP
Urinalysis - proteinuria
protein/albumin:creatinine ration
Bloods - FBC U&E, LFT, coag, crossmatch & resus if unstable?
Examination
- Reflexes (brisk)
- if clonus present then CCU/HDU
-listent ot chest for pulmonary oedema
64
Management of hypertension/pre-eclampsis?
1. Labetalol
2. Nifedipine (1st line in asthma)
3. Methyldopa
If mild/mod pre-eclampsia = delivery within 48 hours
Severe pre-eclampsia = IV mgSulph and immediate delivery
65
Approach to a presentation of hyperemesis?
Differentials
- Hyperemesis gravidarum
- Molar pregnancy
- pre-eclampsia
Focused history
investigations
- BP, urinalysis, ophthalmoscopy
- examine - check reflexes listen to chest
- ECG & bloods to assess electrolytes
management - likely admission for rehydration and investigation
- tolerating oral fluids/meds
- managing foods?
- worried about pre-eclampsia or HG
- oral anti-emetics not helping (suggests HG)
66
Drug treatment for hyperemesis?
1. cyclizine/prochlorperazine
2. metoclopramide/ondansetron
67
Symptoms of ovarian cancer?
BEAT
Bloating
Early satiety
Abdo pain
Tell GP
68
Investigations for diagnosis of ovarian CA?
Ca125 >35
Pelvic USS (mass)
Calculate RMI
>200 refer to gynae under cancer pway
69
Which gynaecological malignancy has worst prognosis?
Ovarian
- 5 year survival 42%
- 1 year survival 71%
70
What are you going to ask for any paediatric history taking stations?
PC
HPC
- neck stiffness
- N&V
- rashes/bruising
- fever
71
What are reassuring aspects of febrile convulsions?
Occur only once
short duration
generalised seizure involving whole body
these simple seizures are generally response to fever from viral infection and often do not warrant any further investigation
Tell parents:
febrile convulsions do not affect developmental delay
They are relatively common
The increased risk of epilepsy following febrile convulsions is very small (2%) compared with 0.5-1% if no febrile convulsions
Discuss importance of recovery position and phoning an ambulance if the parent wants to know how to manage the seizures
72
What is a differential for AF?
Ventricular ectopic
73
What investigations would you do for new AF presentation?
ECG
Look for cause - bloods,cultures, TFTs
If ECG normal but paroxysmal AF suspected then 24 hour ambulatory monitor
echo if valvular disease suspected/heart failure or cardioversion
74
When is delayed cardio version performed for AF management?
Presenting >48 hours after onset but stable.
3 weeks of anticoagulation before cardioversion
75
When is immediate cardioversion indicated for AF and what options are there?
Presentation <48 hours or unstable
Electrical cardioversion
Pharmacological - flecanide or amiodarone
76
When is amiodarone preferred for pharmacological cardioversion in AF?
when should flecanide be avoided?
Structural heart disease
Atrial flutter
77
Rate control in AF
One of:
b-blocker (bisoprolo, atenolol)
Ca channel blocker (verapamil/diltiazem)
- avoided in heart failure
Digoxin
78
When is rhythm control indicated for AF?
reversible cause
new onset <48 hours
no response to rate control
heart failure due to the AF
rhythm control is cardioversion or long term therapy with:
1. b-blocker
2. Droneradone (after successful cardioversion)
3. Amiodarone (HF/LV dysfunction)
79
Other than rate/rhythm control what other medication is required for AF?
Anticoagulation
1. DOAC
2. Warfarin if doac unsuitable
80
What scoring tools are used in AF?
CHADsVASC
ORBIT
81
Management of NSTEMI
Beta blocker
Aspirin
Ticagrelor/clopidogrel
Morphine
Anticoagulant (fondaparinux)
Nitrate (GTN)
82
What are complications of an MI?
Death
Rupture of papillary musvles
Oedema
Arrhythmia/aneurysm
Dressslers
83
Management of STEMI?
PCI within 2 hours
Thrombolysis is 2 hour window passed but still within 12
medical - aspirin & ticagrelor
84
Medications for secondary management post MI?
Aspirin
Antiplatelet (clopidogrel)
Atorvastatin
ACEi
Atenolol
aldosterone antagonist (eplerenone) if reduced LVEF
85
Management of pericarditis?
ECG
Bloods
- FBC, U&E, LFTs
- Troponin
- CRP
-TFTs
Blood cultures
Treatment = NSAID (& Abx if bacterial)
86
investigation for suspected stable angina?
CT coronary angiogram
87
Medical management of stable angina?
GTN for acute attack
B-blocker (5mg bisoprolol) or
CCB (5mg amlodopine)
88
Management of unstable angina?
300mg aspirin
Fondaparinux
Calculate grace score
if high risk then immediate angio and consideration for PCI
low risk (clopidogrel & aspirin)
89
How would you investigate and manage a new hypertension diagnosis?
Investigations
BP - home readings/ambulatory
ECG
Bloods - HbA1c, U&E, cholesterol
ophthalmoscopy - signs of hypertensive retinopathy
?urine dip for protein
calculate risk if greater than 10% give statin
meds
annual review
90
Important symptoms to screen for HF?
Orthopnoea
PND
SOB
Oedema
91
Management of HF?
ACEi (10mg ramipril)
B-blocker (10mg bisoprolol)
40mg Furosemide (helps with symptoms)
Spiron (aldosterone antagonist) if reduced LVEF or not controlled by A&B
92
Investigations for HF
NT-pro BNP
Echo & ECG
93
How does acute LVF differ from HF?
Blood cannot move into aorta from LV so get backlog from LV to lungs causing:
Acute breathlessness (worse on lying)
May have S3 and basal crackles (pulmonary oedema)
Cardiomegaly
T1 rest failure
Management:
Stop IV fluids
Sit up
Oxygen
Diuretics (40mg IV furosemide)
Inotropes in HDU
94
What scoring system is used to decide if PE likely?
Wells
95
How should a patient be managed with a Wells score suggestive of PE?
CTPA
96
How should a patient be managed if a Wells score suggests PE is unlikely but clinically you still suspect?
D-dimer
Consider CTPA
97
What will an ABG show for an acute PE?
Resp alkalosis
98
Management of PE
- Regular
- Massive
How long does treatment continue?
Anticoagulation - apixaban/rivaroxiban/LMWH
(LMWH in pregnancy or malignancy)
Thrombolysis
3months if obvious reversible cause
6 months if no clear cause/recurrent/malignancy
99
UMN signs
Hypertonicity
Hyperreflexia
Spastic gain
Extensor plantar reflex
100
LMN signs
Muscle wasting
Weakness
Fasciculations
Absent or reduced reflexes
101
When should motor neurone disease be considered?
Motor symptoms
absence of sensory. symptoms
102
Acute MS flare
steroids - methylpred IV
