GG Flashcards
(239 cards)
1
Q
Rate control and Rhythm control Rx in AF
A
Rate: metoprolol - diltiazem/verapamil - digoxin
Rhythm: flecanide - sotalol - amiodarone
2
Q
AF: anti-coag/anti-plt, and which Rx?
A
Anti-coag (anti-plt arterial blood); warfarin or NOACs (not in valvular AF)
3
Q
Rx you’re concerned with in renal failure
A
- Abx: vancomyin, gentamicin
- NOACs
4
Q
Signs indicating retroperitoneal bleeding and DDx of it
A
- DDx: AAA and pancreatitis
- Grey-Turner’s (flank bruising)
- Cullen’s (peri-umbilical bruising)
5
Q
how to calculate ECG axis
A
Quadrant approach: ○ If I and aVF positive = normal ○ I negative aVF positive = RAD ○ I positive aVF negative ->: ○ II +ve = normal II -ve = true LAD
6
Q
Typical march of appendicitis Sx
A
- prodromal bowel upset
- abdo pain -> worsens
- anorexia, N/V
- mod fever
- signs of peritonitis
- normal T/WCC early on is normal!
7
Q
what is agoraphobia
A
Fear of places and situations that might cause panic, helplessness or embarrassment.
8
Q
Most specific cancer markers for following Ca:
- HCC
- ovarian
- bowel
- testicular/germ cell
A
- HCC: alpha feto-protein
- ovarian: CA-125
- bowel: CEA
- testicular/germ cell: hCG
9
Q
Female puberty development
A
Female:
- breast bud enlargement
- growth spurt
- axillary hair
- pubic hair
- menstruation
10
Q
Male puberty development
A
Male:
- Scrotal and testicular growth
- Deepening of voice
- Pubic hair
- Penile enlargement
- Growth spurt
- Facial + axillary hair
11
Q
Erb’s palsy - signs and nerve roots affected
A
- Asymmetric moro
- Arm: adducted, shoulder internal rotation, elbow extension and pronation, flexed wrist
12
Q
side effects of steroids
A
C – Cataracts U – Ulcers S – Striae, Skin thinning H – Hypertension, Hirsutism I – Immunosuppression, Infections N – Necrosis of femoral heads G – Glucose elevation O – Osteoporosis, Obesity I – Impaired wound healing D – Depression/mood changes
13
Q
right lung lobar changes on CXR - which lobe?
A
middle = R heart border obscured, lower = costophrenic angle obscured
14
Q
Rx pneumonia
A
CAP - typical/atypical:
- Amoxycillin (oral) / OR doxycycline (oral)
- Benpen (IV) / AND doxy (oral)
- Ceftriazone (IV) /AND azithromycin (IV) - legionella
HAP:
- Low risk MDR (e.g. just admitted) = ABCDDA
High risk MDR (i.e. long hospital stay) = tazocin
15
Q
COPD exacerbation
A
ASOSS:
- Abx: amoxy/doxy 5 days
- salbutamol
- O2
- steroids: pred/hydrocort
- support - ventilatory
16
Q
ddx high troponin
A
- MI
- PE
- HF
- pericarditis
- strenuous exercise
17
Q
transudate vs exudate
A
Transudate
- = fluid pushed through capillary due to high capillary pressure
- Low protein, low LDH, low cell count
- Usually bilateral
- RHF (inc venous pressure)
- Liver failure (inc venous pressure, dec oncotic pressure, hypoalbuminaemia)
- Nephrotic syndrome (dec oncotic pressure)
Exudate
- = fluid leaking through capillaries due to inflammation
- High protein, high LDH, high cell count
- Usually unilateral
- Pneumonia
- Malignancy
- TB
18
Q
diuretics - K sparing and non-sparing
A
K sparing:
- spironolactone + amiloride (CD)
K non-sparing:
- loop diuretic e.g. frusemide
- thiazides e.g. hydrochlorothiazide (DCT)
- mannitol - osmotic agent
- CA inhibitor e.g. acetazolamide (PT)
19
Q
Symptoms/signs of pre-eclampsia
A
- headaches
- high BP
- RUQ pain
- peripheral oedema
- proteinuria
20
Q
early vs late schizophrenia
A
late schizophrenia:
- less negative symptoms/disorganisation
- high rates florid delusions/hallucinations
21
Q
Sx/signs of pulmonary atelectasis
A
- tachy
- mild fever
- mucoid sputum
- <24h post-op
22
Q
pre-menopausal irregular ovulatory cycles: most likely dx?
A
Cystic glandular hyperplasia (CGH) - predominance of oestrogen, no progesterone
- atypical hyperplasia/endometrial polyp less likely
23
Q
partial facial nerve palsy pathognomonic of…
A
infiltrative malignant parotid tumour (NB: benign parotid tumours displace, not paralyse, the facial nerve)
24
Q
Addison’s: signs/symptoms and Ix findings
A
- vomiting -> hypotension
- hyperpigmentation
- weight loss, fatigue
- hair loss, hypoglycaemia
- hyponatraemia
- high ACTH and CRH
25
ear test: Rinne and Webber findings, and conductive vs sensorineural
Rinne = middle ear function (not cochlear):
- Rinne +ve: AC > BC = normal
- Rinner -ve: BC > AC = defective middle ear (mostly conductive issues)
Weber:
- conductive: sound louder in worse ear - the conductive issue blocks ambient sound and the sound is conducted through bone instead
- sensorineural: sound louder in better ear
- Conductive: BC>AC, lateralisation to worse ear
- SN: AC>BC, lateralisation to better ear
26
aniline + work in dye industry -> ??
bladder + urinary tract Ca
27
cocaine intox vs heroin withdrawal - differentiating factor
fever in cocaine intox
28
highest populations at risk of Fe deficiency
In order:
1. weaned toddlers
2. adolescents
3. women of child-bearing years
29
what is the triple test negative we look for when Ix a benign breast lump?
1. -ve clinical findings
2. -ve imaging (US for young, mamm for old)
3. cytology/histology -ve (FNAC/percutaneous core biopsy)
30
what is cyclothymic disorder
2 years minimum of numerous hypomanic and depressive episodes, but not bipolar
31
myopia vs hypermetropia
1) myopia = short-sighted = eyeball long so image comes up short -> concave to spread out light rays
2) hypermetropia = long-sighted = eyeball short so image comes up long -> convex to focus light rays
32
what lens for astigmatism
cylindrical
33
conn syndrome v renal artery stenosis
1) conn syndrome = primary hyperaldosteronism
- AngII independent: kidneys secrete aldosterone -> Na/H2O retention -> inc. BF + HTN -> reduced renin
2) renal artery stenosis = secondary hyperaldosteronism
- AngII dependent: reduced renal BF -> high renin -> HTN
34
CT appearance of:
- hemangioma
- hydatid cyst
- liver cyst
- liver mets
- hemangioma: dense in arterial, less dense in portal venous phase
- hydatid cyst: well-defined lining, septate/locular due to daughter cysts
- liver cyst: low density, homogenous
- liver mets: hypovascular cf surrounding parenchyma
35
stye vs chalazion
stye/hordeolum:
- infection of eyelid gland - on eyelid margin
- red, acutely tender
chalazion:
- infection of blocked mebomian gland -> subsides to small fibrosis, hard nodule - non-tender
36
digitalis leads to...
... AV block/dissociation (slows down conduction through AV junction)
37
classic hx of reflux nephropathy
- childhood recurrent UTIs, enuresis, fevers
| - hypertension
38
Ix of choice for reflux nephropathy or renal stones
- now US for reflux nephropathy, non-contrast helical CT for renal stones
- previously IVP (but, contrast!)
39
nerve root supply of:
1. quads
2. knee jerk reflex
3. bladder
4. ankle jerk
1. quads: L2,3, (mainly) 4
2. knee jerk reflex: L4
3. bladder: lower sacral
4. ankle jerk: S1
40
foot drop:
1. weakness of which muscles
2. which nerve root
3. type of gait
1. tib anterior + ankle and toe extensors
2. L5 (through common peroneal)
3. high-stepping gait with slapping down
41
unilateral nasal discharge...
= foreign body
42
scc vs bcc
scc: keratotic crusty ulcerous lesion, more invasive and quicker growing, precursor lesion (Bowens in situ)
bcc: pearly nodule, telangiectasia, umbilicated centre, more indolent, more common (2/3) and locally invasive
43
free subdiaphragmatic gas on XR
perforated peptic ulcer
44
risks of tamoxifen therapy
1. endometrial polyp formation (more likely)
2. subendometrial oedema
3. endometrial Ca (less likely)
(NB: not endometrial atrophy)
45
red currant jelly stool =
intussusception
46
pregnant lady with CIN3 on pap smear. what do you do?
colposcopy; only if lesion extends up canal would you need cone biopsy or LLETZ biopsy
47
sleep disturbances and associated dx:
- difficulty falling asleep
- middle insomnia
- difficulty falling asleep: anxiety/stimulants
| - middle insomnia: depression
48
giardia story
- diarrhoea, cramps, bloating, nausea, fatigue, weight loss
- loose, pale greasy stool
- contaminated food/water
- illness ~7 days after infection
49
vesiculo-colic fistula from which disease?
diverticulitis
50
glioblastoma multiforme: fast or slow growing
fast - faster than months!
51
mullerian agenesis
= no formation of endometrial tissue
52
symptoms of H.pylori peptic ulcer
- dyspepsia
- haematemesis
- weight loss
- dysphagia
- anaemia Sx
53
MS symptoms and signs, UMN/LMN
- visual: optic neuritis, diplopia
- UMN weakness
- paraesthesia
- autonomic dysfunction
- cerebellar
- fatigue, dysarthria
- <60yo onset, more women
54
MND symptoms and signs, UMN/LMN
- progressive LMN AND UMN, asymmetrical weakness
| - bulbar involvement
55
alcoholic peripheral neuropathy
- mixed motor and sensory symmetrical peripheral neuropathy
| - other alcohol signs
56
SLE vs ITP
SLE has splenomegaly, not ITP
57
SLE findings
A RASH POIN MD:
- arthritis
- renal disease
- ANA =+ve
- serositis
- haem disorder
- photosensitivity
- oral ulcers
- immunological - anti-dsDNA, anti-phospholipid
- neurological
- malar rash
- discoid rash
+ Raynauds, alopecia, spelnomegaly
58
elevated JVP + cardiomegaly =
mitral regurgitation
59
JVP loss of a waves =
AF
60
what is an endometrial thickness assessment performed for?
- which pts should have D&C, esp younger post-menopausal (>4mm)
61
most consistent finding of obstructed labour needing C/S?
brow presentation in nulliparous woman
62
what would have greatest effect on reducing perinatal mortality in the developed world?
reducing premature births 20-26 weeks
63
side effects of opioids
- constipation
- drowsiness
- resp depression
- hypotension
- nausea
64
no foetal movements 24h after normal CTG - what to do?
induction of labour (immediate C/S not req unless cervix not fully dilated)
65
normal clinical picture of infective mononucleosis
- malaise, fever
- pharyngitis
- maculopapular rash
- lymphadenopathy
- splenomegaly
- lymphocytosis on film
66
bilirubin patterns:
1) high unconjugated: conjugated
2) high conjugated + transaminases
3) conjugated + urine bilirubin, no urobilinogen
1) high unconjugated: conjugated = haemolytic jaundice
2) high conjugated + transaminases = hepatocellular
3) conjugated + urine bilirubin, no urobilinogen = post-hepatic obstructive jaundice
67
orbital vs periorbital cellulitis
orbital: proptosis, eye paralysis, URGENT CT needed
periorbital: full eye movement, eyelid swelling
68
urinary injuries in setting of pelvic trauma: Ix of choice, and what Ix not to do
ascending urethrogram, don't catheterise - may cause more trauma
69
onset of NICU gut issues:
| duodenal atresia v hirschprung's v mec plug syndrome v volvulus v small bowel obstruction v intuss
1. duodenal atresia/volvulus/sbo: first few hours
2. intuss - more hours
3. mec plug - 2-3 days
4. hischprung's - usually 4-5 days
70
obstetric cholestasis vs acute fatty liver in pregnancy
obstetric: milder LFT derangement, no severe vomiting
71
GCA (temporal arteritis) clinical picture, diagnostic test, how to treat
- temporal headache
- jaw claudication
- irreversible monocular vision loss
- scalp tenderness
- MSK + systemic e.g. weight loss
- 50yo female
- girdle pain = PMR
- temporal artery biopsy
- steroids (pred) + aspirin
72
chance of recurrence of psychosis postpartum?
15-20%
73
Horner syndrome
damage to sympathetic trunk, triad of 1) miosis 2) partial ptosis 3) loss of hemifacial sweating
74
how soon after acute gout attacks do we introduce allopurinol?
after 4 weeks
75
RFs for ischaemic stroke: rank them - HTN, smoking, obesity, T2DM, hyperchol
1. HTN
2. T2DM
3. obesity
4. smoking
5. hyperchol - u shaped
76
shingles: what Rx and when?
first 24-48h after rash = famcyclovir - oral or IV
| rash 10 days or more = amitryptiline for post-herpatic neuralgia
77
```
levonorgestrel - which is true:
A) vaginal spotting in 1st 3 days
B) menstruation within 7 days
C) N/V in 50% women
D) virilisation of fetus
E) fails in 2-3%
```
E) fails in 2-3%
78
alcoholic hallucinosis vs delirium tremens
sensorium remains clear despite auditory hallucinations in alcoholic hallucinosis
79
which more common - duodenal or gastric ulcers
duodenal ulcers
80
transient episodes of monocular blindness = what medical term, and indicates what pathology?
=amaurosis fugax, carotid artery plaque causing ophthalmic artery platelet embolisation
81
typical picture of oesophageal rupture (boerhaave)
- forceful vomiting, pt tries to hold it in - sudden onset chest pain after
- subsequent shock, hypotension, cyanosis
82
what is testamentary capacity?
capacity to make a valid will
83
nipple discharge:
- yellow/green + worm-like
- single duct bloody, no ass. lump
- yellow/green + worm-like: mammary duct ectasia
| - single duct bloody, no ass. lump: benign duct papilloma
84
DCIS (intraductal carcinoma in-situ) usually presents as...
... focal/generalised microcalcification seen on mammography
85
pneumothorax mx options
1. <15% = obs, supplemental o2,
2. >15% = needle aspiration is Mx of choice (previously intercostal tube insertion + underwater seal drainage), thoracotomy
86
branchial cyst findings
- fluctuant
- anterior chain
- partially covered by sternocleidomastoid
- painless
87
normal location of branchial cyst v salivary gland tumour v neck lymphoma
- branchial cyst = anterior chain, partially covered by sternomastoid
- salivary gland = higher in neck, closer to mandibular angle
- neck lymphoma = deep cervical chain
88
reversing agent for warfarin and heparin
warfarin = vit K, heparin = protamine
89
pt needs urgent surgery but on warfarin with INR 2.5, what do you do?
give FFP (has coag factors), vit K takes too long to work
90
breech presentation: c/s or vaginal, induction/spontaneous?
c/s optimal but woman can choose vaginal if aware of risks, spontaneous as induction has risk of cord prolapse
91
why can hypertrophic pyloric stenosis vomitus present with coffee ground appearance?
due to tearing of gastric mucosa + associated bleeding, but not bile stained
92
L4, L5, S1 radioculopathy signs
L4 impaired: knee jerk, quads, inner lower leg sensation
L5...: no reflex impaired, foot drop + toe ext -> high stepping gait, outer lower leg sensation
S1...: ankle jerk + plantar reflex, ankle PF, sole
93
risk of arm abduction during surgery
nerve injury - ulnar nerve at elbow or lower trunk of brachial plexus
94
pathognomonic joint feature of acute rheumatic fever
migratory polyarthritis
95
definitive mx of acute cholangitis v cholecystitis v choledocolithiasis v cholelithiasis v biliary colic
- biliary colic = analgesia, elective lap chole
- acute cholangitis: abx, ERCP + lap chole
- acute cholecystitis = abx + lap chole
- choledocolithiasis/lithiasis = ERCP/MRCP
96
common risk of central venous catheter insertion
pneumothorax
97
duration of acute gout flare treatment with NSAIDs
3-5 days
98
abdo mass in young child ddx
- Wilms tumour (most common): haematuria, HTN, hemi-hypertrophy ass from Beckwith-Wiedermann
- faecal loading 2' constipation
- PCKD/hydronephrosis
- neuroblastoma
99
pain/limp in child ddx and classic picture
- transient synovitis: post-viral, <4yo
- perthes (osteochondritis of femoral head): 4-8 yrs
- slipped capital femoral epiphyses: tubby adolescent
- septic arthritis: intense pain, can't WB
- osteogenic sarcoma: chronic pain + swelling
100
CVB vs amniocentesis risk of miscarriage
CVS = 1:100, amniocentesis = 1:200
101
types of paediatric congenital cardia lesions
1. cyanotic right-left: ToF, TGV
2. left right: VSD, ASD, PDA
3. obstructive: AS, PS, aortic coarctation
102
asd vs vsd murmur in kids
```
ASD = soft mid-systolic, LUSE
VSD = systolic, LSE, radiates to left axilla and back
```
103
myasthenia gravis
- muscle fatiguability (prox -> distal) esp. ocular, facial
104
acute red eye NTBM and their findings
1) iritis: light sensitivity, non-reactive pupil
2) ACA glaucoma: halos, corneal and scleral injection, corneal oedema, hard globe, inc. IOP, non-reactive pupil
2) scleritis: pain +++
3) microbial keratitis: contact lens wear, compromised corneal surface
105
signs of third nerve palsy
- ptosis
- eye paralysis -> down and out eye
- loss of direct + consensual reflexes
106
diff types of ulcers: neuropathic / venous / arterial
neuropathic: metatarsal heads bc highest pressure; deep, painless.
arterial: toes + dorsum of foot, v painful
venous: over malleoli, ass. haemosiderin staining
107
binocular vs monocular vertical diplopia
binocular = EOM involvement, monocular = refractive error
108
isolated fourth CN lesion most likely due to? describe the fourth CN lesion findings.
DM; superior oblique affected (rotates eye down and in) - pt tilts to remove diplopia
109
difference between bell's palsy and stroke, and why?
bells = peripheral lesion -> no forehead sparing; stroke = central lesion -> innervation from other side of brain -> forehead sparing
110
dissociated vs complete sensory loss in all modalities: where is the lesion in the brain?
dissociated = pons or below, bc DCML and anterolateral fibres cross there
111
spotaneous rupture of EPL =
rheumatoid arthritis
112
posterior dislocation of hip findings
hip flexion + IR, shortened leg
113
femoral neck fracture at particular risk of...?
non-union (not avascular necrosis): bc of orientation of the # line, so internal fixation can cut soft bone and -> displacement of fracture
114
typical picture dermatomyositis vs inclusion body myositis
dermatomyositis:
1. progressive muscle weakness + raised CK
2. maculopapular skin rash
3. erythematous, scaly eruptions on back of hands
inclusion body - predom distal muscle weakness
115
typical picture of muscular cramping vs ischaemic rest pain
Muscular cramping:
- intense, acute pain at night often in calves
- middle aged pt
- have to get up to relieve
Ischaemic rest pain:
- intense pain, burning/throbbing in feet/toes
- have to hang foot off bed
116
mx of ischaemic rest pain vs intermittent claudication
- claudication - just stop smoking and more exercise
| - rest pain - arteriogram
117
mx options for SVT
- face in cold water
- carotid massage (caution), valsalva
- adenosine/verapamil IV
118
which valvular lesion most likely to cause issues in pregnancy and why?
mitral stenosis - pregnancy induced inc. BV + CO -> pul HTN and oedema with MS -> inc risk of AF and tachy
119
```
what structure is at risk in the following conditions:
A) posterior knee dislocation
B) elbow dislocation
C) pos hip dislocation
D) anterior shoulder
```
A) posterior knee: popliteal artery (***highest vascular risk***)
B) elbow dislocation (brachial artery)
C) pos hip dislocation (sciatic nerve)
D) anterior shoulder (axillary nerve)
120
Anastomotic leak following oesophagectomy:
1. when
2. clinical picture
3. how often
4. how to confirm?
1. when: D7-10 post-surg
2. clinical picture: sudden onset AF, pleural effusion, sepsis
3. how often: 5% cases
4. how to confirm: oral contrast study
121
buttock pain relieved by rest: DDx
- spinal canal stenosis
| - large vessel atherosclerotic occlusion
122
best initial tx for flail chest is?
controlled PPV (restores chest expansion on inspiration), intubation, and ICC - prevents tensio pneumothx while on PPV
123
causes of haematemesis
oesophagus: varices (10-30%), oesophagitis, Ca, mallory weiss (10%, repeated wretching against closed glottis causing tear)
stomach: gastric ulcer (20%), Ca, erosive gastritis
duodenum: ulcer (25%)
124
indicators of disease severity in liver disease
Child pugh score:
1) INR
2) albumin
3) bilirubin
4) confusion
5) ascites
125
perforated peptic ulcer v pancreatitis presentation
- perf ulcer: sudden onset, pain worse with pressure/movement
- pancreatitis: gradual onset, radiates to back, often move to try and relieve
126
causes of dysphagia and differentiating factors
oropharyngeal = hard to initiate swallow:
- neuro
- muscular e.g. MG, polio
- structural
oesophageal = gets stuck:
A) solids only = mechanical
- progressive -> Ca, peptic stricture: dysphagia improves as stricture worsens
- variable -> oesophagitis
B) solids + liquids = neuromuscular disorder
- intermittent -> spasms
- progressive: achalasia, paraoesophageal hernia
127
Crohn's vs coeliac disease: risk of which GI Ca?
- coeliac: primary jejunal lymphoma
| - Crohn's: ileal adenocarcinoma
128
regurg in pharyngeal pouch vs achalasia
pouch = regurg after eating, achalasia = noctural regurg
129
abdo colic + vomiting + constipation + abdo distention =
abdo obstruction
130
diverticulitis range of presentation and complications
- asymptomatic, incidental finding
- LLQ pain, constipation/diarrhoea, N/V, low grade fever
- painless rectal bleeding
- complications: abscess, fistula, obstruction, peritonitis
131
what is most likely to cause deep wound dehiscence post abdo op?
- paralytic ileus
132
adult vs childhood intussusception- most likely cause
- child: enlarged peyer's patches
| - adult: metastatic deposits (commonly melanoma)
133
peptic ulcer: PPI vs triple therapy - when?
PPI for normal ulcer, triple therapy (PPI, Abx - clarithro + amoxy) for H.pylori
134
explain mechanism of gallstone ileus + typical AXR picture
stone -> necrosis of gallbladder + duodenal wall -> fistula -> obstruction -> free air in RUQ on AXR
135
why pale poo and dark pee in obstructive jaundice?
- bilirubin gets redirected to blood stream and doesn't go through rest of GIT -> poo has nothing in it = pale -> pee only gets bilirubin = dark
136
fat necrosis of breast: usually follows what, physical signs
- usually after trauma
| - signs: firm stellate lump/parenchymal distortion/skin puckering/dimpling - DDx ca
137
mammary duct ectasia: other name, and typical mammography appearance
= plasma cell mastitis; spilt milk appearance
138
recurrent thyrotoxicosis and b/d partial thyroidectomy mx and what not to do
- carbimazole -> radioactive iodine
| - no surgery: likely scarred - more risk than benefit if there's no indicator for surgery
139
ITP: what and Mx options
- sensitied IgG against plts (secondary e.g. SLE) or idiopathic
- steroids then IgG if not working -> splenectomy
140
Egyptian + UTI + haematuria =
urinary schistosomiasis
141
what pathology is often associated with epididymo-orchitis?
prostatomegaly + UTI -> secondary infection of epididymis via vas def
142
chronic urinary retention - common aetiologies
obstructive/neuropathic/psychogenic
143
cauda equina = LMN or UMN
LMN
144
gold standard mx of prostate vs testicular ca
radical prostatectomy + orchidectomy
145
worst prognosis draining nodes of testicular ca and why
cervical - drains into systemic venous circulation
146
FNA in testicular Ca - what's the use?
NONE - it's contra-indicated bc could spread neoplasm
147
prostate Ca mx options - local vs locally advanced
- local = radical prostatectomy, locally advanced = external beam radiotherapy
148
classic hyperkalaemia ECG findings
peaked T waves, wide QRS
149
how to deal with hyperkalaemia in ED
1. membrane stabiliser - calcium gluconate - works on toxic effects
2. shift K into cell e.g. glucose + insulin, salbutamol
3) K excretion e.g. NaHCO3, frusemide
150
causes of hyponatraemia
```
#Isotonic: hyperprotein/lipidaemia
#Hypertonic: hyperglycaemia/mannitol
#Hypotonic
1. hypovolaemic: A) extrarenal salt loss (diarrhoea/sweat/vomit) B) diuretics
2. euvolaemic: SIADH /hypothyroid/post-op/adrenocorticotropin deficiency
3. hypervolaemic = dilutional e.g. heart/renal/liver
```
151
small vs squamous cell carcinoma hormone secretions
- small cell = ACTH, SIADH
| - squamous = PTHrP
152
hyperglycaemia hyponaetraemia is also known as?
pseudohyponatraemia
153
Q fever: how to Dx?
serum Ab testing; rickettsia doesn't grow in standard media
154
non-immused pt with tetanus prone wound, what does tetanus prophylaxis involve?
- tetanus human Ig
| - + active immunisation: 3 x ADT vaccines
155
lung mets - where is the primary most likely to be from?
renal cell carcinoma
156
renal tx patients are long-term most at risk of dying of...?
malignancy
157
classic presentation wound dehiscence
copius haemoserous discharge from wound site
158
HSP clinical picture
- most common 2-8yo, takes weeks to develop and resolve - renal cx months later
- arthralgia + joint swelling
- normothrombocytopaenia purpura over bottom and legs - gravity dependent
- colicky abdo pain + malaena
- nephritis, oedema
159
rash due to measles vs viral infection (kids)
measles rash isn't urticarial, viral one is
160
clubbing in paediatric cardiac disease: which conditions?
right-left shunt i.e.cyanotic e.g. ToF or TGA
161
acute OM with intact eardrum vs chronic otitis media/externa: how to treat
AOM:
>12mo -> analgesia 24-48h -> if not resolving + amoxy
<12mo -> analgesia+amoxy 5 days
COM/E: + topical cipro
162
autoimmune thyroiditis in kids: common presentation
- often only swelling + tenderness in neck
| - some have classic hypothryoid symptoms
163
main screening Ix for secondary nocturnal enuresis
urine microscopy and culture
164
non-specific vulvovaginitis in children: cause
low oestrogen -> thin epithelium -> (normal vaginal flora cultured)
165
vaccination in pre-term infants - when?
at 2 months chronological age (not based on weight) according to normal schedule
166
what are salaam spasms?
infantile spasms associated with:
- clusters of seizure activity
- falling off of developmental skills
- T21
167
XR appearance of:
- Perthes'
- Slipped femoral epiphyses
- DDH
- Perthes': irregular fragmentation of head, enlocated, children
- Slipped femoral epiphyses: normal femoral head, displaced
- DDH: small femoral head, shallow hip joint angle, dislocated femoral head, younger children
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mouth ulcers in kids DDx
- herpes: + fever, lymphadenopathy
| - enterovirus: vesicular/maculopapular rash on hands/feet/butt/trunk i.e. HFMD
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petechial/purpural vs blanching rash DDx in children
Petechial + purpural = non-blanching:
- meningitis
- HSP
- ITP
- leukaemia
- viral e.g. enterococcus or bacterial (strep. pneumoniae)
Blanching:
- roseola, kawasaki, scarlet fever, viral exanthem
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signs of significant cardiac murmur in children?
- thrills
- diastolic murmur
- loud >4/6
- failure to thrive
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persistent cyanosis at birth DDx
- asphyxia e.g. meconium aspiration
- CDH
- HMD
- cyanotic heart disease: ABG is diagnostic (not ECG/CXR)
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group A strep vs strep aureus/pyogenes Abx of choice
phenoxymethylpenicillin = GAS, strep = fluclox
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howell jolly bodies =
asplenia
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absence seizure vs infantile spasms vs breath-holding attack
- absence seizure: fluttering of eyelids, subtle
- infantile spasms: not that subtle, 1st year of life, associated dev delay/regression
- breath-holding: ass w collapse/cyanosis
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short duration fever + grunting + tachypnoea + cough + child =
sepsis, likely pneumonia
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major problem with petrol ingestion =
aspiration pneumonia
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bronch vs asthma vs croup
```
asthma = expiratory wheeze
bronch = exp wheeze, fine inspiratory crackles
croup = inspiratory stridor
```
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what is acanthosis nigricans
dark rash in axilla and around neck; indicative of DM
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seatbelt injuries cause what trauma?
abdo trauma
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fluid type and volume in kids: maintenance vs resusc
- resusc = 10-20ml/kg normal saline
| - maintenance: 4/2/1 (4ml per 1st 10kg, 2ml per next 10kg, 1ml for every kg after); and 2/3 of this if unwell
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stress fracture: typical position and how to Dx
- shaft/neck of 2nd metatarsal
| - nuclear bone scan with increased intensity at site
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baby dead at 39 weeks. what do you do?
amniotomy, treat shock via blood transfusion, treat any resulting coagulopathy
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obstructed vs inefficient/incoordinate labour
obstructed: fetal head moulding, caput formation, cervical oedema, fetal tachy ++ and progressive, usually >2cm head palpable above pelvic brim
incoordinate: no moudling +/- caput, no oedema, fetal tachy +, <1cm
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GBS +ve pregnancy, what to do?
parenteral penicillin 6hourly while in labour
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foetal distress in OP position during labour is most likely due to?
incoordinate uterine action
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grand multiparous woman with PPH =
uterine rupture
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most common cause of thrombocytopaenia in pregnancy, and numbers we worry about
incidental thrombocytopaenia of pregnancy, only worry if <50
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common causes of post-partum pyrexia
- UTI
- wound infection
- breast engorgement
- endometritis (less common)
- DVT (least common)
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most common adverse effect of syntocinon
fetal distress
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most likely cause of dyspareunia post-partum breastfeeding + amenorrhoeic
atrophic vaginal epithelium
191
what is the appropriate monitoring for a low lying pregnancy (18-20 weeks) with no bleeding?
US at 32-34 weeks
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causes of uterus smaller than expected size
- reduced foetal growth
- inadequate liquor
- incorrect dates
- PROM
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most appropriate way to recognise foetus with spina bifida
US of foetal spine at 16-18 weeks
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CTG vs intermittent auscultation in low risk pregnancy, which is better?
neither.
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long-term Mx for premature ejaculation
clomipramine
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what is a delusional perception?
sudden, urgent attribution of abnormal, irrational significance to an ordinary event
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delusion vs illusion vs hallucination vs overvalued idea
- delusion = fixed, firm belief
- illusion = misperception with stimulus
- hallucination = perception without stimulus
- overvalued idea = comprehensible pursued beyond bounds of reason
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what is passivity?
person believes someone/thing else is controlling their thoughts/actions etc.
199
what does registration in the MMSE test?
anterograde working memory (i.e. ability to remember those three objects)
200
schizoid vs schizotypal personality disorder
schizoid (Julian assange): lifetime of withdrawal, recluse, restricted affect, successful work, no FHx schiz
schizotypial: v eccentric, FHx schiz, rarely successful work, actually want to be part of society
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Diogenes syndrome
person who is dirty/lives in squalor/hoarder
202
what is the point prevalence of schizophrenia in the population?
1%
203
ECT is advantageous for what kinds of psych illness?
- major depression + psychotic features/psychomotor retardation/previous suicidal ideation
204
normal grief picture
- tearfulness
- auditory or visual hallucinations e.g. hearing deceased's voice
- disturbances in sleep
- anxiety and chest pain
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most appropriate initial medication for breastfeeding mother with a) psychotic Sx b) bipolar
a) olanzapine b) sodium valproate (not lithium!)
206
what is important in the workup for ADHD?
- talk to both parents
- behavioural rating scales
- visual and hearing assessments
- psychometric assessment
207
anti-depressant of choice in adolescents
fluoxetine - not mirtaz (not approved for use)
208
atypical anti-psychotics olanzapine and clozapine associated with what AEs
- abnormal lipid profile
- inc weight
- T2DM
209
classic restless legs syndrome picture
- tingling/burning
- involves thighs
- sleep disturbance
- have to wake up and walk to relieve
- FHx
210
Diazepam better IM or IV
never give diazepam IM - absorption too erratic, can cause tissue necrosis
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serotonin syndrome vs NMS
SS: due to SSRI, acute onset, agitation, tremor, hyperreflexia
NMS: due to DA-blockade e.g. haloperidol, ANS instability, CK rise, delirium, peaks in 3 days
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traveller's diarrhoea + bloody stool + long incubation time =
entamobea histolytica
213
where do testicular and rectal tumours drain
to para-aortic nodes
214
appropriate chemoprophylaxis for malaria
doxy 2 days before arrival and 2 weeks after/chloroquine 1 week prior and 4 weeks post
215
incubation period for falciparum malaria
2 weeks
216
diphtheria toxoid vs immunoglobulin - when to give?
toxoid for active protection, ig when passive protection needed
217
example of significant prognostic factor for reduced mortality in younger vs elderly populations
- younger: marital status
| - older: presence of living children
218
Rx contraindicated in pregnancy
- ACEI
- NSAID
- diuretics
- beta-blockers
- lithium
- warfarin
219
post-menopausal bleeding + adnexal mass NTBM
bleeding = endometrial carcinoma, adnexal mass = ovarian carcinoma
220
rhythm method of contraception: cycles between 26-29 days. What is the correct abstinence period, and why?
day 6-17 of cycle.
A) ovulation occurs 14 days before period, luteal phase is 14 days regardless of follicular phase (D12-15)
B) sperm can survive 6 days - so cease 6 days prior (D6)
C) ovulated egg can be fertilised 2 days post - so D17
221
beta-hcg can be measured using what in early pregnancy?
LH
222
most common organisms for PID
chlamydia and gono
223
cyst mid-menstrual cycle =
follicular cyst
224
PCOS fertility tx 1st line
metformin
225
FSH and E2 findings in the menopause
high FSH, low E2
226
most likely primary site of ovarian ca in aus
colon
227
GP screening: CRC
- low risk: FOBT every 2y from 50
- mod risk (1 relative <55 or 2 relatives): FOBT every 2y 40-49, colonoscopy every 5y from 50
- high risk: FOBT every 2y from 35-44, colonoscopy every 5y from 45
228
GP screening: breast Ca
- low risk: mamm every 2y form 50
- mod risk (1 relative <50): annual mammogram from 40
- high risk: mamm/MRI/US
or 5-10 yrs prior to when dx was made in relative
229
DDx vertigo
Migraine (Y) = migrainous vertigo
Migraine (N):
- Hearing loss (Y)
- Episodic vertigo Y -> Meniere's (UNILAT fullness in ear, tinnitus, SN deafness, low-pitched rumbling)
- Episodic vertigo N -> Labyrinthitis
- Hearing loss (N)
- Episodic vertigo Y -> BPPV
- Episodic vertigo N -> vestibular neuronitis
230
DDx otologic tinnitus
1) Meniere's: excess endolymph, usually unilat tinnitus
2) acoustic neuroma: continuous usually unilat tinnitus from slow destruction of vestibular nerve, so slow that vertigo is minimal
3) otosclerosis: bilateral tinnitus, hearing loss, hyperacusis, pregnancy, FHx, femalel
4) presbycusis: progressive, old person, bila tinnitus, hearing loss
5) labyrinthitis
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Causes of conductive vs SN hearing loss
Conductive = outer/middle ear = OM/OE, trauma, cholesteatoma, TM perf, usually otosclerosis (but can be both)
SN = inner ear = infection/Rx/AI/presbycusis/meniere's/acoustic neuroma
232
sigmoid volvulus presentation and AXR findings
- acute colicky pain
- absolute constipation
- inverted U gas rising from pelvis/coffee bean sign
233
bowel obstruction AXR
- dilated loops of bowel with air fluid levels, with no distal bowel gas
234
GBS
- symmetrical ascending paralysis
| - distal starting paraesthesia
235
roseola vs parvovirus vs measles vs kawasaki vs HFMD
roseola/6th: infants, sudden high fever -> febrile convulsions -> blanching rash after fever
parvo/5th: a bit older, fever + coryza, macular blanching rash on trunk + slapped check after fever, waxes and wanes
measles: prodrome (high fever + 3 C's - cough, coryza, conjunctivitis, Koplic spots), cephalocaudal macpap rash
kawasaki: <5yo, CRASH (conjuncitivitis, polymorphous rash, adenopathy unilat, strawberry tongue, hand erythema -> desquamation) and burn 5 days
HMFD: mouth ulcers, vesicular lesions, high fever
236
meningitis bacterial organisms
<2 mo = GEL: GBS, E.Coli, listeria
| >2mo = NHS: neisseria meningitidis, HiB, strep pneumoniae
237
earliest signs of chronic venous insufficiency
- hyperpigmentation
| - dilated tortuous veins
238
anal fissure vs fistula vs colinic polyps vs 1st deg haemorrhoids
fissure = painful defecation + bleeding
distula = pain no bleeding
colonic polyps = bleeding no pain
1st deg haemorrhoids = bleeding no pain
239
pulmonary HTN signs
right sided S4
loud P2
right ventricular heave
- prominent v waves in JVP
- TR
- pulsatile liver
