GP Flashcards

Question

What will an examination of the vagina show in AV?

Answer 1

Pale mucosa Thin skin Reduced skin folds Erythema and inflammation Dryness Sparse pubic hair

Answer 2

- Systemic HRT - Breast cancer - Angina - Venous thromboembolism Can also cause endometrial hyperplasia and cancer

Answer 3

- It refers to an overgrowth of bacteria in the vagina specifically **anaerobic bacteria** - It is not **Sexually transmitted**

Answer 4

Loss of lactobacilli which produce lactic acid and keep the vaginal pH low

Answer 5

Gardnerella vaginalis (most common) Mycoplasma hominis Prevotella species

Answer 6

- Multiple sexual partners - Excessive vaginal cleaning - Recent antibiotics - Smoking - Copper coil

Answer 7

Fishy-smelling watery grey or white vaginal discharge. Half of women with BV are asymptomatic.

Answer 8

- Test vaginal pH anything above 4.5 is bad - charcoal vaginal swab can be taken for microscopy. This can be a high vaginal swab taken during a speculum examination or a self-taken low vaginal swab.

Answer 9

Clue cells

Answer 10

Metronidazole Or clindamycin but is less effective

Answer 11

It increases risk of **STI** - Also can cause problems in pregnancy Miscarriage Preterm delivery Premature rupture of membranes Chorioamnionitis Low birth weight Postpartum endometritis

Answer 12

An idiopathic conditions which causes unilateral lower motor neuron facial nerve palsy

Answer 13

Prednisolone 50mg for 10 days 60mg for 5 days followed by a 5-day reducing regime of 10mg a day They will also require lubricating eye drops to prevent it from drying out

Answer 14

Lactational abscess (associated with breastfeeding) Non-lactational abscess (unrelated to breastfeeding)

Answer 15

Inflammation of breast tissue often related to breastfeeding but can be caused by an infection

Answer 16

- Smoking - Damage to the nipple - Underlying breast disease affecting the drainage of the breast

Answer 17

Staphylococcus aureus (the most common) Streptococcal species Enterococcal species Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)

Answer 18

- Nipple changes - Purulent nipple discharge (pus from the nipple) - Localised pain - Tenderness - Warmth - Erythema (redness) - Hardening of the skin or breast tissue Swelling

Answer 19

- Swollen fluctuant (can move around on palpation) tender lump within the breast

Answer 20

- Analgesia - Antibiotics - need to be broad spectrum - Treatment for underlying cause

Answer 21

Co-amoxiclav Erythromycin/clarithromycin (macrolides) plus metronidazole (to cover anaerobes)

Answer 22

Managed conservatively, with continued breastfeeding, expressing milk and breast massage. Heat packs, warm showers and simple analgesia can help symptoms. Antibiotics (flucloxacillin or erythromycin/clarithromycin where there is penicillin allergy) are required where infection is suspected or symptoms do not improve

Answer 23

Commonly referred to as thrush. It refers to a yeast infection most commonly **candida albicans**

Answer 24

- Increased oestrogen: pregnancy - Poorly controlled diabetes - Immunosuppression - Broad spectrum antibiotics

Answer 25

- Thick, white discharge that does not typically smell - Vulva and vaginal itching, irritation or discomfort

Answer 26

Erythema Fissures Oedema Pain during sex (dyspareunia) Dysuria Excoriation

Answer 27

- Testing vaginal pH often it is below 4.5 in thrush but will be higher with vaginosis - Charcoal swab is gold standard

Answer 28

- A single dose of intravaginal clotrimazole cream - A single clotrimazole pessary - A single dose of fluconazole

Answer 29

- Inflammation of the conjunctiva which is the tissue that covers the inside of the eyelids and the sclera

Answer 30

- Bacterial - Allergic - Viral

Answer 31

- Red, bloodshot eye - Itchy or gritty sensation - Discharge It does not cause pain, photophobia or reduced visual activity

Answer 32

- Bacterial often presents with a purulent discharge and worse in the morning also it is highly contagious - Viral conjunctivitis is common and usually presents with a clear discharge. It is often associated with other symptoms of a viral infection, such as a dry cough, sore throat and blocked nose

Answer 33

Acute angle-closure glaucoma Anterior uveitis Scleritis Corneal abrasions or ulceration Keratitis Foreign body Traumatic or chemical injury These tend to be more serious and require urgent intervention

Answer 34

- It usually resolves in 1-2 weeks with no need for treatment - Chloramphenicol or fusidic acid eye drops are options for bacterial conjunctivitis if necessary. - Neonates under one month with conjunctivitis need urgent ophthalmology assessment. Neonatal conjunctivitis may be caused by gonococcal infection

Answer 35

It causes swelling of the conjunctival sac and eyelid with itching and a watery discharge. Antihistamines (oral or topical) can help symptoms.

Answer 36

- An acute infective respiratory disease affecting young children - It typically affects children aged 6months to 2 years

Answer 37

It causes oedema in the larynx

Answer 38

Parainfluenza

Answer 39

Influenza Adenovirus Respiratory Syncytial Virus (RSV)

Answer 40

It used to be caused by diphtheria. It leads to epiglottitis and has a high mortality.

Answer 41

- Increased work of breathing - “Barking” cough, occurring in clusters of coughing episodes - Hoarse voice - Stridor - Low grade fever

Answer 42

Mainly can be conservative but **dexamethasone** is effective if needed

Answer 43

Oral dexamethasone Oxygen Nebulised budesonide Nebulised adrenalin Intubation and ventilation

Answer 44

A superficial bacterial skin infection usually caused by S.aureus

Answer 45

A golden crust

Answer 46

S.pyogenes

Answer 47

- Bullous - Non-bullous

Answer 48

occurs around the nose or mouth. The exudate from the lesions dries to form a “golden crust”. They are often unsightly but do not usually cause systemic symptom

Answer 49

- Topical fusidic acid can be used to treat localised non-bullous impetigo - antiseptic cream (hydrogen peroxide 1% cream) first line rather than antibiotics for localised non-bullous impetigo.

Answer 50

- Always caused by S.aureus - They produce epidermolysis toxins that break down proteins that hold skin cells together

Answer 51

Neonates and children under 2

Answer 52

Can cause severe infection called staphylococcus scalded skin syndrome - Treat with flucloxacillin

Answer 53

Cellulitis if the infection gets deeper in the skin Sepsis Scarring Post streptococcal glomerulonephritis Staphylococcus scalded skin syndrome Scarlet fever

Answer 54

- A condition caused by infection with the EBV. - Commonly known as the kissing disease or Mono

Answer 55

- It is found in the saliva of infected individuals and is spread by kissing, or sharing cups and toothbrushes

Answer 56

- When symptoms present

Answer 57

- Fever - Sore throat - Fatigue - Lymphadenopathy - Tonsillar enlargement - Splenomegaly (can cause splenic rupture)

Answer 58

- A intensely itchy maculopapular rash will appear

Answer 59

Heterophile antibodies - Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result. - Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep.

Answer 60

- Is usually self-limiting and lasts 2-3 weeks but can cause fatigue for several months

Answer 61

- Avoid alcohol as EBV impacts the livers ability to process it - Avoid contact sports due to risk of splenic rupture

Answer 62

Splenic rupture Glomerulonephritis Haemolytic anaemia Thrombocytopenia Chronic fatigue EBV infection is associated with certain cancers, notable Burkitt’s lymphoma.

Answer 63

B burgdorferi

Answer 64

- Tick bite with rash called **erythema migrans** - Fever - Headache - Myalgias - Stiff neck - Facial palsy

Answer 65

**Doxycycline**, unless there is just a rash that can't be distinguished from cellulitis then use **amoxicillin**

Answer 66

- Acute neurological complications - Cardiac complications such as AV block and myocarditis

Answer 67

- A retrospective diagnosis made after a woman has had no periods for 12 months - It is defined as a permanent end to menstruation - Menopause is the point at which menstruation stops

Answer 68

- Perimenopause refers to the time around the menopause, where the woman may be experiencing vasomotor symptoms and irregular periods. - Postmenopausal describes the period from 12 months after the final menstrual period onwards. - Premature menopause is menopause before the age of 40 years. It is the result of premature ovarian insufficiency.

Answer 69

- It is caused by a lack of ovarian follicular function, resulting in changes in the sex hormones associated with the menstrual cycle - Oestrogen and progesterone levels are low - LH and FSH levels are high in response to an absence of negative feedback from oestrogen

Answer 70

- In the ovaries the process of primordial follicles maturing is into primary and secondary follicles is always occurring - At the start of the menstrual cycle FSH stimulates the further development of secondary follicles - As the follicles grow the **granulosa cells** that surround them secrete increasing amounts of oestrogen

Answer 71

- The menopause begins with a decline in the development of ovarian follicles - Without the growth and development of the follicles there is reduced production of oestrogen - This results in increasing levels of LH and FSH as oestrogen has a negative feedback on these hormones in the pituitary gland

Answer 72

- Falling follicular development means ovulation does not occur (anovulation) - Without oestrogen the endometrium does not develop leading to a lack of menstruation (Amenorrhoea) - The low levels of oestrogen lead to the perimenopausal symptoms

Answer 73

- Hot flushes - Emotional lability or low mood - Premenstrual syndrome - Irregular periods - Joint pains - Heavier or lighter periods - Vaginal dryness and atrophy - Reduced libido

Answer 74

- CVD - Osteoporosis - Pelvic organ collapse - Urinary incontinence

Answer 75

- Symptoms without blood test - Use FSH blood test in women under 40 or aged 40-45 with menopausal symptoms

Answer 76

- Two years after the last menstrual period in women under 50 - One year after the last menstrual period in women over 50

Answer 77

Hormone replacement therapy (HRT) Tibolone, a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea) Clonidine, which act as agonists of alpha-adrenergic and imidazoline receptors Testosterone can be used to treat reduced libido (usually as a gel or cream) Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT) Vaginal moisturisers, such as Sylk, Replens and YES

Answer 78

When there is a decrease in haemoglobin.

Answer 79

Reduction in cell mass Increased plasma volume

Answer 80

80-100 femtolitres

Answer 81

Microcytic- low MCV indicating small sized RBC Normocytic- normal MCV indicating normal sized RBC Macrocytic- high MCV indicating large sized RBC

Answer 82

T- Thalassaemia A- Anaemia of chronic disease I- Iron deficiency L- Lead poisoning S- Sideroblastic anaemia TAILS

Answer 83

A- anaemia of chronic disease A- Acute blood loss A- Aplastic H- haemolytic H- Hypothyroidism 3 As and 2 Hs

Answer 84

Megaloblastic Normoblastic

Answer 85

Problem in DNA synthesis caused by vitamin deficiency Folate B12

Answer 86

Alcohol Hypothyroidism Liver disease Drugs such as azathioprine

Answer 87

Pale skin Conjunctivital pallor Tachycardia Raised respiratory rate

Answer 88

Most common cause in the world

Answer 89

Vegetarian diet H. pylori infection Pregnancy and breastfeeding IBS Coeliac PPI's Increased iron loss through bleeding (this is the principal cause if Fe deficiency)

Answer 90

Iron is needed for the formation of haemoglobin and when there is a lack of iron not enough haemoglobin is made to make normal sized RBC's. Therefore smaller RBC's are produced by the bone marrow which can't carry enough oxygen to meet the bodies demand hence hypoxia

Answer 91

Duodenum and jejunum

Answer 92

Women lose about 2mg daily when menstruating where as men will only on average lose 1mg a day

Answer 93

Pregnancy results in net loss of 580mg of iron, due to expansion of RBC mass and growth of the foetus and placenta. Most occurs in the third trimester

Answer 94

It traps Fe itself in the stomach preventing it from reaching the duodenum

Answer 95

Iron requires acid from the stomach to stay in it's soluble form fe2+ where as without acid it becomes insoluble Fe3+. Therefore PPI's as they reduce amount of stomach acid can lead to Fe deficiency

Answer 96

As iron is required for enzymes in the mitochondria, and as hair and nails are fast growing they are most affected by this deficit

Answer 97

- Conjunctivital pallor - Koilonychia (spoon shaped nails) - Angular stomatitis (redness around mouth) - Glossitis

Answer 98

- Fatigue -Dyspnoea on exertion - Dizziness - Headache - Nausea - bowel disturbance - Hair loss

Answer 99

FBC- would have low Hb, low MCV - Iron studies would measure the: serum iron, serum ferritin and total iron binding capacity If ferritin in the blood is low it is highly suggestive of iron deficiency. If ferritin is high then this is difficult to interpret and is likely to be related to inflammation rather than iron overload. A patient with a normal ferritin can still have iron deficiency anaemia, particularly if they have reasons to have a raised ferritin such as infection. transferrin levels increase in iron deficiency and decrease in iron overload.

Answer 100

- Treat underlying cause - Oral iron supplements ferrous sulphate/fumarate - Iron infusion e.g., cosmofer - Blood transfusion in severe cases

Answer 101

- Cognitive impairment - Impaired muscular performance - Preterm delivery - High output heart failure

Answer 102

- New born screening with heel prick happens at day 5 - **FBC:** normocytic anaemia with reticulocytotic - **Blood film:** sickled RBCs, target cells, Howell-Jolly bodies (RBC nuclear remnants seen later in the disease due to hyposplenism) - **Hb electrophoresis and solubility: diagnostic** investigation, demonstrating ****increased HbS (2 alpha chains and 2 abnormal beta chains) and reduced/absent HbA (α2 β2)

Answer 103

A stem cell disorder. It is characterised by anaemia, leukopenia and thrombocytopenia

Answer 104

- Idiopathic - radiation and toxins - Drugs - Infections HIV

Answer 105

Anaemia caused by B12 deficiency it is a macrocytic megaloblastic anaemia

Answer 106

- Inadequate intake (vegans and vegetarians as it is found in animal products) - Inadequate secretion of intrinsic factor - Malabsorption (crohn's, patients who have had a gastric bypass) - Inadequate release of B12 from food (alcohol abuse and gastritis) - Can also be caused by pernicious anaemia which is where there is autoimmune destruction of the gastric epithelium

Answer 107

- Pallor - Signs of neurological defect

Answer 108

- SOB - Palpitations - Headaches - Fatigue - Glossitis - CNS involvement - **Personality change** - **Depression** - **Memory loss** - **Visual disturbances** - **Numbness, weakness and paraesthesia affecting the lower extremities** - **Ataxia** - **Loss of vibration sense or proprioception** - **Autonomic dysfunction (e.g. bladder/bowel dysfunction)**

Answer 109

folate= a few months B12= A few years

Answer 110

- Inadequate intake - Malabsorption - Increased requirement (malignancy and pregnancy) - Increased loss (chronic liver disease) - Alcohol abuse

Answer 111

- **Fatigue** - **Dyspnoea** - **Palpitations** - **Headache** - **Glossitis** - **Features of pancytopenia** e.g. excessive bleeding and bruising due to thrombocytopenia, recurrent infections due to leukopenia - **Symptoms of underlying cause** e.g. - Coeliac disease: diarrhoea, bloating, dyspepsia and abdominal discomfort.

Answer 112

- A chronic disease due to chronic inflammation process from underlying infection, malignancy or systemic disease - Normally normocytic but can be microcytic

Answer 113

- Decreased lifespan as a result direct cellular destruction via toxins from cancers, viruses and bacteria - Decreased production of RBC- inflammation inhibits iron metabolism and cytokines inhibit erythropoietin production in the kidney

Answer 114

- Treatment of underlying cause - EPO injections - Parenteral iron - Transfusions

Answer 115

is a macro re-entrant atrial tachycardia with atrial rates usually above 250 bpm up to 320 bpm.

Answer 116

Results from either structural or conduction abnormalities. Structural= atrial dilation, incisional scars and fibrosis of the atrium. Can also occur as a result of taking drugs for atrial fibrillation

Answer 117

Presence of the risk factors and worsening heart failure or pulmonary symptoms. Leads to a atrial HR of 300. 2:1 (most common)= 150 heart rate in ventricles

Answer 118

Sawtooth P waves with fast heart rate

Answer 119

Palpitations and fatigue, racing pulse

Answer 120

If haemodynamically unstable then cardiovert either electrically or chemically Use beta-blockers and CCB's if not. Treat underlying cause

Answer 121

Acute stroke, myocardial ischaemia, then lots of medication related.

Answer 122

Atrial fibrillation (AF) is a common tachycardia. It can be caused by many other underlying illness, especially in the acutely unwell patient (such as sepsis, pneumonia, hyperthyroidism or other illness). It may be reversible by treating the underlying cause. Is also very common idiopathic

Answer 123

Paroxysmal: episodes last >30 seconds but <7 days and are self-terminating but recurrent * Persistent: episodes last less than or more than seven days but require electrical or chemical cardioversion * Permanent: episodes fail to terminate with cardioversion OR a terminated episode that relapses within 24 hours OR long-standing AF (usually >1 year) in which cardioversion has not been indicated or attempted

Answer 124

Irregularly irregular pulse Palpitations Chest pain Dyspnoea Dizziness / syncope (particularly in paroxysmal) ECG

Answer 125

No p wave Fluttering baseline

Answer 126

Two principles for treating AF: Rate or rhythm control Anticoagulation to prevent stroke

Answer 127

Beta blocker bisoprolol , CCB amlodipine

Answer 128

Rhythm control can be achieved by either electrical or chemical cardioversion Chemical cardioversion= Flecainide Amiodarone

Answer 129

Left atrial ablation

Answer 130

Use CHAD-VASc score to determine anti-coagulant. Used to be more warfarin now DOAC more commonly used e.g., apixaban/rivaroxaban

Answer 131

Acute stroke (most common) due to blood pooling and coagulating in the atrium MI Congestive heart failure Amiodarone related pulmonary toxicity/thyroid dysfunction Hypotension

Answer 132

Ventricular tachycardia Ventricular fibrillation

Answer 133

Asystole- when there is no electrical activity Pulseless electrical activity

Answer 134

A sinus tachycardia Focal atrial tachycardia Atrioventricular re-entry tachycardia AV nodal re-entry tachycardia

Answer 135

A group of cells in the atria act as the pacemaker going quicker than the SAN node often seen in patients with chronic lung disease. Normal P wave

Answer 136

Atrioventricular re-entry tachycardia- when there is an accessory pathway ANTEGRADE (atria to ventricles) which is shown as pre-excitation on the resting ECG (the mythical DELTA wave) Wolf-Parkinson-White syndrome RETROGRADE (ventricle to atria) which is not seen on a resting ECG

Answer 137

This is where re-entry circuits form within the AV node, or anatomically adjacent similar tissue. Most common type and more common in women. Can be caused by drugs and lifestyle. Usually sudden onset and can cause shortness of breath.

Answer 138

Cardiovert them either chemically or electrically

Answer 139

use vagal manoeuvres if that doesn't work then can use adenosine which interrupts the AV node

Answer 140

Narrow unless present with bundle branch block

Answer 141

Ventricular tachycardia, Ventricular fibrillation Torsades de pointes

Answer 142

Usually observed in the setting of ischaemic heart disease. IHD and CAD are the most common. Things such as Chagas disease can also cause. Other forms of structural heart disease, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and anomalous coronary arteries are also associated with ventricular arrhythmias.

Answer 143

Areas previously scarred are the substrate for re-entry causing rapid ventricular depolarisation

Answer 144

Hypotension and syncope. Along with racing pulse and dyspnoea

Answer 145

Treatment if they are haemodynamically unstable with a pulse- do a cardioversion and look for underlying cause try and solve. Consider using antiarrhythmic medication amiodarone If stable then use adenosine/amiodarone then cardiovert if not successful

Answer 146

Looks like normal ventricular tachycardia on an ECG however there is an appearance that the QRS complex is twisting around the baseline. The height of the QRS complexes progressively get smaller, then larger then smaller and so on. It occurs in patients with a prolonged QT interval.

Answer 147

A prolonged QT interval means that there is a longer peroid before ventriuclar repolarisation

Answer 148

Long QT syndrome (inherited) Medications (antipsychotics, flecainide, sotalol, amiodarone, macrolide antibiotics) Electrolyte disturbances- hypokalaemia, hypomagnesaemia, hypocalcaemia)

Answer 149

Correct the disturbance Magnesium sulphate cardioversion if the problem does not resolve

Answer 150

- A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyperreactivity

Answer 151

- History of atopy (allergies) - Viral URTI - Occupational exposure

Answer 152

- Episodic - Diurnal variability- worse at night and in the morning - Dry cough with wheeze and shortness of breath - Bilateral widespread “polyphonic” wheeze heard by a healthcare professional - Family history of other ectopic disease such as eczema and hayfever

Answer 153

- **Fractional exhaled nitric oxide** a value of >40 ppb is positive - **Spirometry** will show a FVC/FEV1 ratio of less than 70% but will improve by **12% and increase by >200ml** when using a bronchodilator

Answer 154

- PEFR: measured multiple times a day over a 2-4 week period. Variability of >20% throughout the day is diagnostic - Airway hyperreactivity testing: a histamine or methacholine direct bronchial challenge

Answer 155

They work quickly but the effect only lasts for an hour or 2. Nor Adrenalin acts on smooth muscle of airways to cause relaxation. Reliver or rescue medication **salbutamol**

Answer 156

Same as short acting but last for longer **salmeterol**

Answer 157

They block **acetylcholine receptors** =stimulated by the parasympathetic nervous system which cause bronchoconstriction. **tiotropium** is an example

Answer 158

They reduce inflammation and reactivity of the airways. They are used for maintenance and prevention. **Beclomethasone**

Answer 159

Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction and mucus secretion. **Montelukast**

Answer 160

1. SABA as required for wheezy episodes 2. Regular low dose ICS inhaler 3. Add LABA e.g. salmeterol 4. Consider LTRA e.g. Montelukast or oral beta 2 agonist, oral theophylline or an inhaled LAMA (i.e. tiotropium). 5. Titrate up ICS 6. Add oral steroids at lowest possible dose

Answer 161

1. SABA as required or wheezy episodes 2. Regular lose dose ICS inhaler 3. Add LTRA e.g. Montelukast 4. Add LABA 5. Consider MART 6. Increase steroid dose

Answer 162

- Allergy exposure - Viral infection - Smoking exposure - Pollution - Exercise

Answer 163

- PEFR - ABG: patients will initially have respiratory alkalosis. Abnormal or high PCO2 is concerning as it implies the patient is tiring

Answer 164

- PEFR 50-75% of predicted

Answer 165

- PEFR 33-50% - Resp rate >25 - Heart rate above 110 - unable to complete sentences

Answer 166

- PEFR <33% - Sats <92% - Becoming tired - No wheeze. This occurs when the airways are so tight that there is no air entry at all. This is ominously described as a “silent chest”. - Haemodynamic instability (i.e. shock)

Answer 167

- Nebulised salbutamol - Nebulised ipratropium bromide - Steroids oral continue for 5 days after

Answer 168

- Oxygen is required to maintain stats - **Aminophylline** infusion - Consider IV salbutamol

Answer 169

- IV magnesium sulphate - Admission to ICU - Intubation in worst cases

Answer 170

Increase in the size of the prostate without malignancy. This causes bladder outlet obstruction and lower urinary tract symptoms.

Answer 171

- Increasing age - Family history - Ethnicity more common in black people - Diabetes - Obesity due to increasing circulation of oestrogen

Answer 172

- Basal and luminal cells rely on stimulation from androgens for survival. Such as testosterone (produced by testicles) and dihydrotestosterone (produced by prostate). DHT is produced by 5α-reductase which converts testosterone into the more potent dihydrotestosterone. - As age increases levels of testosterone drop but levels of DHT increase as there is an increase in 5a-reductase activity - This will form hyperplastic nodules to form

Answer 173

- Digital rectal exam will find smooth, enlarged and non-tender prostate - Lower abdominal tenderness and palpable bladder: Indicates acute urinary retention Perform bladder scan Requires urgent catheterisation

Answer 174

- Voiding: weak stream and incomplete emptying - Storage: urgency and incontinence - Oliguria: if complete obstruction - Lower abdominal pain and inability to urinate Indicates acute urinary retention

Answer 175

- Prostate-specific antigen (PSA): predicts prostate volume, may suggest cancer if significantly raised but BPH can also raise it - International Prostate Symptom Score (I-PSS): a 7-symptom questionnaire with an additional bother score to predict progression and outcome

Answer 176

- α-1 antagonists: Tamsulosin it is considered first-line. It inhibits the action of noradrenaline and relaxes the smooth muscle. Can cause **Postural hypotension, dizziness, dry mouth and depression** - 5-α reductase inhibitors e.g. finasteride. This will work to reduce the prostate size but can take up to 6 months to work. Can cause: **reduced libido, erectile dysfunction, adn gynaecomastia**

Answer 177

Prostate<30g - **Transurethral incision of the prostate (TUIP):** one or two cuts in the small grooves of the bladder neck to open the urinary channel and allow urine to pass through more easily. Prostate 30-80g **Transurethral resection of the prostate (TURP)**: accessing the prostate through the urethra and “shaving” off prostate tissue from inside using diathermy (heat) Prostate >80g **Transurethral electrovaporisation of the prostate (TUVP)**: prostate tissue is removed using a laser **Open prostatectomy** via abdominal or perineal incision

Answer 178

life-threatening triad of fluid overload, dilutional hyponatraemia and neurotoxicity due to systemic absorption of irrigation fluids during TURP procedure

Answer 179

- Hypertension (second most common) - Diabetes (most common)

Answer 180

- Hypertension - Fluid overload - Uraemic sallow: yellow or pale brown colour of skin - Uraemic frost: urea crystals can deposit in the skin - Pallor - Evidence of underlying cause

Answer 181

- Pruritis - Loss of appetite - Nausea - Oedema - Muscle cramps

Answer 182

- **Estimated GFR**: can be checked using U&E blood test. **Two tests required 3 months apart** - **Proteinuria**: can be checked using a **urine albumin:creatinine ratio**. A result of greater than 3mg/mmol is significant - **Haematuria**: can be checked using a **urine dipstick** - **Renal ultrasound**

Answer 183

G score and A score

Answer 184

G score is based of eGFR G1: eGFR>90 G2: eGFR: 60-89 G3a: eGFR: 45-59 G3b: eGFR: 30-44 G4: eGFR: 15-29 G5: eGFR<15 known as end-stage renal failure

Answer 185

Based off the albumin:creatinine ratio: A1: <3 A2: 3-30 A3: >30

Answer 186

A1 combined with G1 or G2

Answer 187

Slowing the progression of the disease Optimise diabetic control Optimise hypertensive control Treat glomerulonephritis Reducing the risk of complications Exercise, maintain a healthy weight and stop smoking Special dietary advice about phosphate, sodium, potassium and water intake Offer atorvastatin 20mg for primary prevention of cardiovascular disease

Answer 188

- Renal bone disease - Anaemia - Cardiovascular- hypertension, hypercholesterolemia , heart failure due to fluid overload and anaemia

Answer 189

Describes progressive and irreversible obstructive airway disease. It is a combination of emphysema and chronic bronchitis

Answer 190

- Tobacco smoking (biggest risk factor) - Air pollution - A1AD - Occupational exposure such as dust, coal, cotton, cement and grain

Answer 191

Emphysema and bronchitis

Answer 192

- Barrel shaped chest due to air trapping and hyperinflation - Downward displacement of liver due to hyperexpansion of the lungs

Answer 193

Inflammation of the bronchial tubes of the lungs. It is said to be chronic when it causes a **productive cough for at least 3 months every year for 2 or more years**

Answer 194

- Tachypnoea - Barrel chest - Cyanosis - Quiet breath sounds and wheeze

Answer 195

- Dyspnoea - Productive cough - Wheeze - Chest tightness - Weight loss

Answer 196

- Drowsy - Asterixis (flapping tremor of hands) - Confusion

Answer 197

The usual drive for respiration is CO2 however body becomes desensitised to high CO2. - Hypoxaemia becomes the new drive for respiration.

Answer 198

5 point scale for assessing impact of breathlessness. Grade 1 – Breathless on strenuous exercise Grade 2 – Breathless on walking up hill Grade 3 – Breathless that slows walking on the flat Grade 4 – Stop to catch their breath after walking 100 meters on the flat Grade 5 – Unable to leave the house due to breathlessness

Answer 199

- Clinical presentation plus **spirometry**

Answer 200

**FEV1/FVC ratio less than 0.7** Important to note that it does not show a dramatic response to **reversibility testing** with salbutamol (beta-2 agonist). If it does then consider asthma as a differential

Answer 201

GOLD classification Stage 1: FEV1 >80% of predicted Stage 2: FEV1 50-79% of predicted Stage 3: FEV1 30-49% of predicted Stage 4: FEV1 <30% of predicted

Answer 202

STOP SMOKING - Annual flu vaccine and the pneumococcal vaccine (this is a one off vaccine)

Answer 203

- **SABA**: short-acting beta-agonist (e.g. **salbutamol**) - **SAMA**: short-acting muscarinic antagonist (**ipratropium**) - **LABA**: long-acting beta-agonist (e.g. **salmeterol**) - **LAMA**: long-acting muscarinic antagonist (e.g. **tiotropium**)

Answer 204

- Usually triggered by viral or bacterial infection - Can be heart failure, pulmonary embolism or medications

Answer 205

- Too much oxygen in someone that is prone to retaining CO2 can depress their respiratory drive. - **Venturi masks** are designed to deliver specific percentage concentrations of oxygen - If retaining CO2 aim for oxygen saturations of 88-92% titrated by Venturi mask - If not retaining CO2 and their bicarbonate is normal (meaning they do not normally retain CO2) then give oxygen to aim for oxygen saturations > 94%

Answer 206

Type 1 diabetes mellitus is a metabolic disorder characterised by hyperglycaemia due to absolute insulin deficiency.

Answer 207

Due to insulin deficiency glucose can’t be utilised from muscle and adipose. Stimulates secretion of glucagon (adrenaline, cortisol, and growth hormone) So increased Lipolysis, = weight loss More glucose in urine - Polyuria and Polydipsia

Answer 208

- Hyperglycaemia (above 11.1). - Polyuria (passing urine frequently). - Polydipsia (drinking water frequently) - Tiredness

Answer 209

young age, weight loss, blurred vision, nausea, and vomiting, Abdo pain,

Answer 210

- Random plasma glucose (above 11) - Fasting plasma glucose (above 7)

Answer 211

Glycohemoglobin test (HbA1c) Reflects the degree of hyperglycaemia over the preceding 3 months greater than 6.5% (48 mmol/mol) indicates diabetes

Answer 212

o Basal-bolus insulin (insulin glargine s/c) o Pre-meal insulin correction dose o Amylin analogue (pramlintide) 2nd line: fixed insulin dose

Answer 213

Measure HbA1c levels every 3 months in children and every 3-6 months in adults Make sure level is under 6.5% (48 mmol/mol) Also monitor BP and kidney function

Answer 214

- Microvascular: retinopathy, peripheral or autonomic neuropathy - Cardiovascular disease, diabetic kidney disease. - Potential for depression and eating disorder# - Foot amputations - Blindness

Answer 215

Ageing high BMI gestational diabetes non-white ancestry polycystic ovary syndrome hypertension

Answer 216

Hyperglycaemia with presence of risk factors E.g., Overweight, certain ethnic groups, age

Answer 217

Polydipsia Polyuria candidal infections, skin infection, UTIs, fatigue, blurred vison uncommon symptoms

Answer 218

Fasting glucose, 2-hour post load glucose (75g orally) random plasma glucose

Answer 219

Coronary artery disease is a major cause of death in diabetics Peripheral ischaemia causes poor healing, ulcers and “diabetic foot” Stroke Hypertension

Answer 220

Peripheral neuropathy- nerves in the body's extremities, such as the hands, feet and arms, are damaged Retinopathy- damage to vessels in the eye Kidney disease, particularly glomerulosclerosis

Answer 221

When HBA1c rises above 58mmol/mol despite maximum dose of metformin

Answer 222

- Metformin which increases the rate of gluconeogenesis in the liver??????? tom i think this is the exact opposite of what it does - Increases cell sensitivity to insulin - Helps with weight issues - reduces CVS risk in diabetes

Answer 223

- **Sulfonylureas (gliclazide)** they promote insulin secretion but only work in people with functional B-cells. Risk of hypoglycaemia and weight gain. Increased risk of CVD when used as a monotherapy - **Dipeptidyl peptidase-4 inhibitor (DPP-4i) (incretins)**: they are hormones produced in the GI tract which increase Increase insulin secretions, Inhibit glucagon production, Slow absorption by the GI tract - **SGLT-2 inhibitors “-gliflozin”, such as empagliflozin, canagliflozin and dapagliflozin**- it inhibits glucose reabsorption from the the urine into the blood

Answer 224

A blood pressure above 140/90

Answer 225

- Obesity - Sleep apnoea - Alcohol intake - Sodium intake - Stress - Insulin intake

Answer 226

- All renal disease - Endocrine diseases e.g., Cushing's, Conn's acromegaly - Congenital disease - Neurological diseases e.g., brainstem lesions and raised intercranial pressure - Pregnancy- pre-eclampsia - Drugs - Oral contraceptives

Answer 227

Benign- is the stable elevation of BP over many years (is still dangerous) Malignant- is the acute and severe elevation of BP. If undiagnosed then it can lead to death within 2 years

Answer 228

>140 systolic or >90 diastolic

Answer 229

>160 systolic or >100 diastolic

Answer 230

>180 systolic or >110 diastolic

Answer 231

Clinical BP of 140/90 and ABPM or HBPM of above 135/90

Answer 232

- Bloods- HbA1c look for diabetes, creatinine and urea to asses renal function - ECG/echo to look for ventricular hypertrophy

Answer 233

ACE inhibitor (Ramipril and enalapril)

Answer 234

Calcium channel blocker (amlodipine) or thiazide diuretic if not CCB not tolerated

Answer 235

Cardiovascular- Atherosclerosis, aortic aneurysm , cardiac failure, AF, stroke Renal- renal failure Eye effects- visual disturbances Systemic hypertensive heart disease- changes that were initially adaptive to cope with the hypertension, lead to cardiac dilatation, congestive heart failure, and even sudden death

Answer 236

- Family history - Female gender 3 times more common - Obesity - Triggers

Answer 237

**CH**- Chocolate **OC**- Oral contraceptive **OL**- alcohOL **A**- anxiety **T**- travel **E**- exercise CHOCOLATE Other triggers can be red wine, bright lights and menstruation

Answer 238

- Migraine without aura - Migraine with aura - Silent migraine (just the aura without the headache) - Hemiplegic migraine

Answer 239

Last between 4-72 hours: - Pounding or throbbing in nature - Usually unilateral (can be bilateral more common in children) - Photophobia - Phonophobia (loud noises) - Aura - Nausea and vomiting

Answer 240

They can mimic a stroke. Need to rule out if patient has symptoms: - typical migraine - Sudden onset - Hemiplegia - Ataxia - Change in consciousness

Answer 241

- **Prodromal stage** subtle symptoms such as yawning, fatigue or mood changes - **Aura** - **headache** - **Resolution** the headache can fade away and be relieved by vomiting or sleeping - **Postdromal stage**

Answer 242

At least two headaches filling criteria shown in picture

Answer 243

At least five headaches filling criteria shown in picture

Answer 244

- Analgesia (avoid opioids) - Oral triptan ( 500mg sumatriptan) as the headache starts - Antiemetics metoclopramide

Answer 245

They **5HT (serotonin) receptor agonists** and they cause: - smooth muscle contraction in arteries - Peripheral pain receptors to inhibit activation of pain receptors - Reduce neuronal activity in the central nervous system

Answer 246

- Propranolol - Topiramate (don't use in pregnancy as it is teratogenic and can cause cleft lip) - Amitriptyline

Answer 247

- **Acupuncture**: if both propranolol and topiramate are ineffective or unsuitable - **Riboflavin (vitamin B2)**: **may be effective in some people, but avoid in pregnancy

Answer 248

The combined pill it increases the risk of a stroke

Answer 249

Osteoporosis is a condition where there is a reduction in the density of the bones. Osteopenia refers to a less severe reduction in bone density than osteoporosis. Reduced bone density makes bone less strong and more prone to fractures.

Answer 250

- Primary disease - Malignancy - Endocrine dysfunction - COPD - IBD - CLD - CKD

Answer 251

**S**- Steroid use **H**- Hyperthyroidism, hyperparathyroidism **A**- Alcohol and tobacco use **T**- Thin **T**- Testosterone decrease **E**- early menopause- oestrogen is protective **R**- renal or liver failure **E**- Erosive/inflammatory bone disease **D**- dietary e.g., reduced Ca2+, malabsorption, diabetes

Answer 252

- Osteoclasts are responsible for the breakdown of bone and osteoblasts are responsible for the formation. As we age osteoclast activity is increased however this is not matched by osteoblast activity - The **peak mass we reach as young adults is key** a higher peak bone mass can be protective

Answer 253

- Oestrogen deficiency leads to an increased rate of bone loss. It is key yo the activity of bone cell receptors found on osteoblasts, osteocytes, and osteoclasts. - It is thought that osteoclasts survive longer in the absence of oestrogen and there is an arrest of osteoblastic synthetic architecture

Answer 254

It gives a prediction of the risk of a **fragility fracture** over the next **10 years** It involves the inputting of information such as age, BMI, co-morbidities, smoking, family history and if done you can enter a **bone mineral score from a DEXA scan**

Answer 255

More than -1: Normal -1 to -2.5: Osteopenia Less than -2.5: Osteoporosis Less than -2.5 plus a fracture: Severe Osteoporosis

Answer 256

Low risk- reassure Medium risk- offer DEXA scan and recalculate the risk with the results High risk: offer treatment

Answer 257

**Bisphosphonates**- they interfere with osteoclast activity reducing their activity. eg: **Alendronate** 70mg once weekly **Riseronate** 35mg once weekly **Zoledronic acid** 5 mg once yearly (intravenous)

Answer 258

- Activty and exercise - Weight control - Reduce alcohol/stop smoking NICE recommend calcium supplementation with vitamin D in patients at risk of fragility fractures with an inadequate intake of calcium. An example of this would be Calcichew-D3, which contains 1000mg of calcium and 800 units of vitamin D (colecalciferol). Patients with an adequate calcium intake but lacking sun exposure should have vitamin D supplementation.

Answer 259

- Reflux and oesophageal erosions. - Osteonecrosis of the jaw and external auditory canal **They are taken on an empty stomach and person should sit upright for 30 minutes before taking**

Answer 260

Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease

Answer 261

The presence of diverticula (out-pouching) in an asymptomatic patient

Answer 262

Diverticulitis refers to inflammation and infection of diverticula.

Answer 263

- Increasing age - Low fibre diets - Obesity - NSAIDs - Smoking

Answer 264

- When faecal matter becomes lodged in the diverticula or more often due to the erosion of the diverticular wall from high luminal pressure - This can cause inflammation and the rupture of vessels leading to bleeding

Answer 265

- Bowel habits changed - Bloating a flatulence - Left lower quadrant pain - Nausea and vomiting

Answer 266

- Oral co-amoxiclav (at least 5 days) - Analgesia (avoiding NSAIDs and opiates, if possible) - Only taking clear liquids (avoiding solid food) until symptoms improve (usually 2-3 days) - Follow-up within 2 days to review symptoms

Answer 267

A type of crystal arthritis which is associated with chronically high levels of uric acid. Urate crystals are deposited in the joint causing it to become hot swollen and painful

Answer 268

- Increased cell turnover - Cytotoxic drugs e.g., chemotherapy - Purine rich diet, seafood and alcohol - Obesity - Severe psoriasis

Answer 269

- CKD - Diuretics e.g., thiazide and loop - Pyrazinamide - Lead toxicity - High fructose intake They are the more common cause they account for 90%

Answer 270

- Elderly - Men - Post-menopausal women - Alcohol - Diabetes - IHD - High diet intake of purines

Answer 271

- **Gout tophi** are deposits of uric acid - Ears - Base of big toe - Wrists - Base of thumb

Answer 272

- Red, tender, hot and swollen joints - Joint stiffness - Rapid onset of severe pain

Answer 273

Can be made on just clinical presentation but excluding **septic arthritis** is key - **Joint aspiration** will show no bacterial growth, needle shaped crystals, **Negatively birefringent of polarised light**, Monosodium urate crystals - Measure serum urate levels 4-6 weeks after attack as they can be low at time of attack

Answer 274

- NSAIDs first line - Colchicine second line- severe diarrhoea is a side effect - Steroids as third line

Answer 275

Lifestyle management and a **Xanthine oxidase inhibitor** - First-line **Allopurinol** - Second-line **Febuxostat**

Answer 276

Is a form of inflammatory arthritis caused by the deposition of **calcium pyrophosphate crystals** in the synovium

Answer 277

- Hyperparathyroidism - Hemochromatosis - Hypomagnesaemia - Hypophosphatemia - Wilson's disease - Acromegaly

Answer 278

A neurodegenerative disorder characterised by the loss of dopaminergic neurons within the substantia nigra pars compacta (SNPC) of the basal ganglia.

Answer 279

- Bradykinesia - Tremor - Rigidity PD symptoms usually start unilaterally and then become bilateral later in the disease course.

Answer 280

- Handwriting gets smaller - Only take small steps (**shuffling gait**) - Difficulty initiating movement - Difficulty turning around when standing - Reduced facial movements and expressions

Answer 281

- A unilateral **resting** tremor. Described as pill rolling tremor looks like they are rolling pill between thumb and finger - The tremor is worse at resting and when they are distracted like using the other hand Frequency of 4-6 times a second

Answer 282

- PD= asymmetrical BET= symmetrical - PD= frequency= 4-6 BET= 5-8 - PD= worse at rest BET= better at rest - PD= improves with intentional movement BET= worse - PD= no change with alcohol BET= better with alcohol

Answer 283

PD is a clinical diagnosis and should be suspected in a patient with **bradykinesia** and at least one of the following: - Tremor - Rigidity - Postural instability

Answer 284

Motor symptoms not affecting quality of life: A choice of one of the following: **Dopamine agonist** (non-ergot derived) - Pramipexole, ropinirole **Monoamine oxidase B inhibitor** (MOA-B) - Selegiline, rasagiline - Stop breakdown of circulating dopamine Motor symptoms affecting the quality of life: - Synthetic dopamine **levodopa** given with a drug that stops it being broken down. These are **peripheral decarboxylase inhibitors**. Carbidopa and benserazide. Co-benyldopa (levodopa and benserazide) Co-careldopa (levodopa and carbidopa)

Answer 285

- Incontinence - Dementia - Early falls - Symmetry Can be a sign of normal pressure hydrocephalus

Answer 286

- Being tall - Obesity and high fat diet - Use of steroids - Cadmium exposure found in cigarettes, batteries and those in welding industry - BRCA1 and BRCA"

Answer 287

-Spreads to the bines of the vertebrae and pelvis resulting in hip and in back pain

Answer 288

- Asymmetrical, hard and nodular prostate with the loss of the median sulcus - Urinary retention

Answer 289

- Frequency - Dribbling - Haematuria or haematospermia - Dysuria - Bone pain (suggests metastatic disease)

Answer 290

Involves the implanting of radioactive seeds into the the prostate delivering continuous targeted radiotherapy. The radiation can cause inflammation in nearby organs, such as the bladder (cystitis) or rectum (proctitis). Other side effects include erectile dysfunction, incontinence and increased risk of bladder or rectal cancer.

Answer 291

- it aims to reduce the levels of testosterone that can stimulate the tumour to grow Drugs include **androgen-receptor blockers**-bicalutamide **GnRH agonists**- such as goserelin (Zoladex) or leuprorelin (Prostap) **Bilateral orchidectomy**- removal of the testicles

Answer 292

- Sexual intercourse - Catheter - Diabetes - Pregnancy - Renal stones

Answer 293

- Fever - Loin/back pain - Nausea/vomiting - Renal angle tenderness

Answer 294

A lower UTI that involves the bladder

Answer 295

The urethra is much shorter in women so it makes it easier for bacteria to reach the bladder and kidneys

Answer 296

- Dysuria - Frequency - Urgency - Nocturia - changes in appearance - Suprapubic discomfort

Answer 297

- **Mid-stream urine microscopy, culture and sensitivity (MC&S)**: - The most specific and sensitive test; bacteria, WBCs, +/- RBCs expected

Answer 298

Treatment may be delayed if symptoms are mild - First line would be 3 days of **nitrofurantoin avoided in patients with CKD** or **trimethoprim** - Second line Antibiotic course for 3 days -**pivmacillinam or fosfomycin single-dose sachet**

Answer 299

- **First line:** Antibiotic course for 7 days - nitrofurantoin avoid in third trimester. Trimethoprim is avoided in first trimester as it increases the risk of neural tube defects - **Second line:** Antibiotic course for 7 days - amoxicillin or cefalexin

Answer 300

- **Pre-term delivery** - **Low-birthweight**

Answer 301

Urethral inflammation due to infectious or non-infectious causes. It is primarily a sexually acquired disease!

Answer 302

- Trauma - Irritation - Urinary calculi (in english we call these kidney stones why use silly words)

Answer 303

- Urethral discharge - Urethral irritation/itching - Dysuria - Penile discomfort - Skin lesions

Answer 304

- Nucleic acid amplification test - Microscopy of gram-stained smears of genital secretions - Culture of urethral discharge - Urine dipstick to rule out UTI

Answer 305

- Tender, hot swollen prostate (on digital rectal exam) - Palpable bladder - Tachycardia - Pyrexia

Answer 306

- Dysuria - Frequency and retention - Straining - Back pain - Fever - Perineal, rectal or pelvic pain

Answer 307

- Digital rectal exam - Urine dipstick - MSU, semen and blood culture

Answer 308

First line- Oral ciprofloxacin or ofloxacin Second line- Oral levofloxacin or co-trimoxazole

Answer 309

Inflammation of the epididymis (epididymitis) and inflammation of the testicle (orchitis)

Answer 310

- Tenderness and palpable swelling - **Prehn's sign positive**: pain is relieved with lifting the testicle, negative in testicular torsion - **Cremasteric reflex preserved**- unlike testicular torsion

Answer 311

- **Unilateral tender, red, and swollen testicle** - Pain develops over a few days - **Lower urinary tract symptoms e.g. dysuria** - **Urethral discharge: may and or may not be present**

Answer 312

- Fluoroquinolone e.g., ofloxacin or ciprofloxacin

Answer 313

- Musculoskeletal: reactive arthritis - Infective: disseminated infection secondary to gonorrhoea

Answer 314

- Being tall - Obesity and high fat diet - Use of steroids - Cadmium exposure found in cigarettes, batteries and those in welding industry - BRCA1 and BRCA"

Answer 315

-Spreads to the bines of the vertebrae and pelvis resulting in hip and in back pain

Answer 316

- Asymmetrical, hard and nodular prostate with the loss of the median sulcus - Urinary retention

Answer 317

- Frequency - Dribbling - Haematuria or haematospermia - Dysuria - Bone pain (suggests metastatic disease)

Answer 318

Involves the implanting of radioactive seeds into the the prostate delivering continuous targeted radiotherapy. The radiation can cause inflammation in nearby organs, such as the bladder (cystitis) or rectum (proctitis). Other side effects include erectile dysfunction, incontinence and increased risk of bladder or rectal cancer.

Answer 319

- it aims to reduce the levels of testosterone that can stimulate the tumour to grow Drugs include **androgen-receptor blockers**-bicalutamide **GnRH agonists**- such as goserelin (Zoladex) or leuprorelin (Prostap) **Bilateral orchidectomy**- removal of the testicles

Answer 320

- A common cause of recurrent episode of vertigo triggered by head movements - A common trigger is turning over in bed and symptoms last for around 60 seconds. - It does not cause hearing loss or tinnitus

Answer 321

- Calcium carbonate crystals called **otoconia** become displaced in the semi-circular canals and the disrupt the flow of the endolymph

Answer 322

Dix-Hallpike Manoeuvre

Answer 323

Epley Manoeuvre

Answer 324

fever, cough, runny nose, conjunctivitis, marked malaise, Koplik spots, Maculopapular rash- it typically starts on the face It is a notifiable disease

Answer 325

Pneumonia Diarrhoea Dehydration Encephalitis Meningitis Hearing loss Vision loss Death occur in 30% of patients

Answer 326

- 1 year - 3 years and 4 months

Answer 327

mini mental state examination (MMSE)/ Montreal cognitive assessment scale (MoCA

Answer 328

- Inflammation of the skin in the external ear canal. - Often called swimmers ear as swimming can lead to inflammation in the ear# - Wax is protective and earbuds and earplugs are predisposing

Answer 329

Bacterial infection Fungal infection (e.g., aspergillus or candida) if gets worse with antibiotics Eczema Seborrhoeic dermatitis Contact dermatitis

Answer 330

Pseudomonas aeruginosa Staphylococcus aureus

Answer 331

Ear pain Discharge Itchiness Conductive hearing loss (if the ear becomes blocked) Examination can show: Erythema and swelling in the ear canal Tenderness of the ear canal Pus or discharge in the ear canal Lymphadenopathy (swollen lymph nodes) in the neck or around the ear

Answer 332

acetic acid 2%

Answer 333

Topical antibiotic and steroid. Exclude perforated tympanic membrane before prescribing aminoglycoside **Severe might require oral antibiotics**

Answer 334

The infection spreads to the bones surrounding the ear canal and skull. It progresses to osteomyelitis of the temporal bone of the skull. Diabetes Immunosuppressant medications (e.g., chemotherapy) HIV

Answer 335

- Infection of the middle ear which is the space that sits between the tympanic membrane and the inner ear - This is where the nerves are found

Answer 336

- Bacteria enter from the back of the thorat through the eustachian tube - A Viral URTI often precedes otitis media

Answer 337

Strep pneumoniae

Answer 338

- **Ear pain** - Reduced hearing - Feeling unwell - Signs of URTI

Answer 339

- Otoscope tympanic membrane will look bulging red and perforation will show discharge and hole in tympanic membrane

Answer 340

Most otitis media cases will resolve without antibiotics within around three days, sometimes up to a week. Antibiotics make little difference to symptoms or complications. Amoxicillin for 5-7 days first-line Clarithromycin (in pencillin allergy) Erythromycin (in pregnant women allergic to penicillin)

Answer 341

- Is the inflammation and infection of the organs of the pelvis, caused by infection spreading through the cervix - It is a significant cause of tubular infertility and chronic pelvic pain

Answer 342

- Endometritis is inflammation of the endometrium - Salpingitis is inflammation of the fallopian tubes - Oophoritis is inflammation of the ovaries - Parametritis is inflammation of the parametrium, which is the connective tissue around the uterus - Peritonitis is inflammation of the peritoneal membrane

Answer 343

Tends to be caused by STIs Neisseria gonorrhoeae tends to produce more severe PID Chlamydia trachomatis Mycoplasma genitalium

Answer 344

- Multiple sexual partners - Previous PID - Intrauterine device - Younger age

Answer 345

- Pelvic or lower abdominal pain - Abnormal vaginal discharge - Pain during sex - Fever - Dysuria

Answer 346

- Pelvic tenderness -Cervical motion tenderness (cervical excitation) - Inflamed cervix (cervicitis) - Purulent discharge

Answer 347

- A single dose of **intramuscular ceftriaxone** for gonorrhoea - Doxycycline for chlamydia -Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis) Ceftriaxone and doxycycline will cover many other bacteria, including H. influenzae and E. coli.

Answer 348

- Sepsis - Abscess - Infertility - Chronic pelvic pain - Ectopic pregnancy

Answer 349

- Caused by inflammation and infection of the liver, leading to adhesions between liver and the peritoneum - It results in right upper quadrant pain

Answer 350

The typical presentation of acute sinusitis is someone with a recent viral upper respiratory tract infection presenting with: Nasal congestion Nasal discharge Facial pain or headache Facial pressure Facial swelling over the affected areas Loss of smell

Answer 351

ICE recommend for patients with symptoms that are not improving after 10 days, the options of: - High dose steroid nasal spray for 14 days (e.g., mometasone 200 mcg twice daily) - A delayed antibiotic prescription, used if worsening or not improving within 7 days (phenoxymethylpenicillin first-line)

Answer 352

PAD includes a range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.

Answer 353

Atherosclerosis Can also be acute due to a thrombus

Answer 354

Smoking Alcohol High BMI Age Gender

Answer 355

Stage 1: asymptomatic Stage 2: Mild claudication/severe Stage 3: Ischaemia rest pain Stage 4: Ulceration or gangrene

Answer 356

- Weak pulse - Cold distal limbs - Postural colour change (Bureger's test)

Answer 357

- Cyanosis - Dependant redor - Muscle wasting - Hair loss - Ulcers - Poor wound healing - Gangrene

Answer 358

Used to determine extent of PAD. Measures the difference between systolic blood pressure of arm to ankle. Done using a Doppler probe

Answer 359

0.9-1.3 is normal 0.6-0.9 indicates mild 0.3-0.6 indicates moderate to severe <0.3 indicates critical ischaemia

Answer 360

Spinal stenosis Arthritis Venous claudication

Answer 361

Annual visits recommended for those with claudication ABI taken and Duplex ultrasound

Answer 362

The first part involves the patient lying on their back (supine). Lift the patient’s legs to an angle of 45 degrees at the hip. Hold them there for 1-2 minutes, looking for pallor. Pallor indicates the arterial supply is not adequate to overcome gravity, suggesting peripheral arterial disease. Buerger’s angle refers to the angle at which the leg is pale due to inadequate blood supply. For example, a Buerger’s angle of 30 degrees means that the legs go pale when lifted to 30 degrees. The second part involves sitting the patient up with their legs hanging over the side of the bed. Blood will flow back into the legs assisted by gravity. In a healthy patient, the legs will remain a normal pink colour. In a patient with peripheral arterial disease, they will go: Blue initially, as the ischaemic tissue deoxygenates the blood Dark red after a short time, due to vasodilation in response to the waste products of anaerobic respiration

Answer 363

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck. There is a strong association with giant cell arteritis, and the two conditions often occur together.

Answer 364

Diagnosis is based on clinical presentation, response to steroids and excluding differentials.

Answer 365

15mg prednisolone daily initially Treatment with steroids typically lasts 1-2 years. NICE suggest the following reducing regime of prednisolone: 15mg until the symptoms are fully controlled, then 12.5mg for 3 weeks, then 10mg for 4-6 weeks, then Reducing by 1mg every 4-8 weeks

Answer 366

Patches of psoriasis are dry, flaky, scaly, faintly erythematous skin lesions that appear in raised and rough plaques, commonly over the extensor surfaces of the elbows and knees and on the scalp. These skin changes are caused by the rapid generation of new skin cells, resulting in an abnormal buildup and thickening of the skin in those areas.

Answer 367

**Plaque psoriasis**: features the thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp **Guttate psoriasis**: is the second most common form of psoriasis and commonly occurs in children. It presents with many small raised papules across the trunk and limbs. **Pustular psoriasis**: is a rare severe form of psoriasis where pustules form under areas of erythematous skin. **Erythrodermic psoriasis**: is a rare severe form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin.

Answer 368

Topical steroids Topical vitamin D analogues (calcipotriol) Topical dithranol Topical calcineurin inhibitors (tacrolimus) are usually only used in adults Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis

Answer 369

- Inflammation of the tonsil most commonly caused by a viral infection - Most common cause of bacterial is strep pyogenes (strep A)

Answer 370

- Used to estimate the probability that the tonsillitis is due to a bacterial infection Fever over 38 Tonsillar exudates Absence of cough Tender cervical lymph nodes A score of 3 or more indicates a 40-60% likelihood it is bacterial

Answer 371

A score of 2 – 3 gives a 34 – 40% probability, and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis: Fever during previous 24 hours P – Purulence (pus on tonsils) A – Attended within 3 days of the onset of symptoms I – Inflamed tonsils (severely inflamed) N – No cough or coryza

Answer 372

- Safety net advice for viral and say come back in 3 days if not better - Penicillin V for a 10- day course is typically first-line - Clarithromycin if penicillin allergy

Answer 373

A type of parasite spread through sexual intercourse

Answer 374

-Vaginal discharge (frothy green which may have a fishy smell - Itching - Dysuria - Balanitis - Painful sex 50% of cases are asymptomatic

Answer 375

Strawberry cervix” (also called colpitis macularis). A strawberry cervix is caused by inflammation (cervicitis) relating to the trichomonas infection Also vaginal pH would be high like bacterial vaginosis

Answer 376

Metronidazole

Answer 377

urge incontinence stress incontinence.

Answer 378

Overactivity of the detrusor muscle

Answer 379

Weakness of the pelvic floor and sphincter muscles

Answer 380

- A bladder diary - Urodynamic tests

Answer 381

- Avoid dirutetics - Weight loss - Pelvic floor exercises - **Duloxetine**

Answer 382

- Anticholinergic medication, for example, **oxybutynin**, tolterodine and **solifenacin** They have side effects which include dry mouth dry eyes, postural hypotension and can lead to cognitive decline

Answer 383

Mirabegron but is a beta-3 agonist so raises BP

Answer 384

Urticaria are also known as hives. They are small itchy lumps that appear on the skin. They may be associated with a patchy erythematous rash. This can be localised to a specific area or widespread. They may be associated with angioedema and flushing of the skin.

Answer 385

Fexofenadine cream

Answer 386

Varicella zoster

Answer 387

Bacterial superinfection Dehydration Conjunctival lesions Pneumonia Encephalitis (presenting as ataxia)

Answer 388

Adrenaline (IM*) 1:1000 (repeat after 5 minutes if no better) 500 micrograms (0.5 mL) (give 300 micrograms IM [0.3 mL] in a child who is small or prepubertal) 300 micrograms (0.3 mL) 150 micrograms (0.15 mL) 100-150 micrograms (0.1 to 0.15 mL) can also give steroids and anti-histamines

Answer 389

- Dehydration - Missed meals - Extended standing in warm environment - Vasovagal response to stiumli

Answer 390

- Hypoglycaemia - Anaemia - Hypovolaemia e.g. due to haemorrhage, GI bleeding, ruptured aortic aneurysm - Infection - Anaphylaxis - Arrhythmias - Valvular heart disease - Hypertrophic obstructive cardiomyopathy - Pulmonary embolism: causing hypoxia

Answer 391

- Caused by problems with the autonomic nervous system regulating blood flow to the brain - When the vagus nerve receives strong stimulus it causes an increase in parasympathetic activation which causes vasodilation and reduction in BP and blood flow to brain leading to the loss of consciousness

Answer 392

This occurs when mild external pressure on the carotid bodies in the neck is enough to induce this reflex response (vagal stimulation). Mild pressure could be due to shaving, neck turning, tight collar etc

Answer 393

- A drop of blood pressure of more than 20mmHg or a reflex tachycardia of more than 20 beats. When a person goes from lying down to standing - It occurs when there’s a delay in constriction of the lower body veins, which is needed to maintain an adequate blood pressure when changing position to standing. As a result, blood pools in the veins of the legs for longer and less is returned to the heart, leading to a reduced cardiac output.

Answer 394

Clinical Hx and examination Ix to rule out pathological causes: Bloods - infection FBC - anaemia ECG- arrythmia Glucose - Hypoglycaemia B-hCG - ectopic pregnancy

Answer 395

- First disease: measles - Second disease: scarlet fever - Third disease: Rubella - Fourth disease: Dukes' disease - Fifth disease: Parvovirus b19- slapped cheek syndrome - Sixth disease: Roseola infantum- can lead to febrile convulsions

Answer 396

can lead to congenital rubella syndrome, which is a triad of deafness, blindness and congenital heart disease.

Answer 397

URTI caused by **Bordetella pertussis**

Answer 398

Mainly children 90% are under 5

Answer 399

- Dry unproductive cough - Low grade fever - Conjunctivitis - Coryzal symptoms

Answer 400

- Coughing fits: typically consist of a short expiratory burst followed by an inspiratory gasp, causing the ‘whoop’ sound - Post-tussive vomiting

Answer 401

Whoop sound caused by sharp inhalation of breath after coughing bout

Answer 402

Nasopharyngeal swab/aspirate: culture/PCR Anti-pertussis toxin IgG

Answer 403

Notify PHE - Antibiotics marcolids **clarithromycin or azithromycin** - Stay off school as highly contagious

Answer 404

- Pneumonia - Encephalopathy - Otitis media - Injuries from coughing e.g., pneumothorax and seizures