Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 3a > GP > Flashcards

GP Flashcards

1
Q

Positive impacts of ADHD diagnosis?

A
  • Signpost to appropriate services
  • Identify the reason for the behaviour
  • Be given treatment to manage symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Negative impacts of ADHD diagnosis?

A
  • Stigma

- Labelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Factors to take in when planning ADHD treatment?

A
  • Previous history of epilepsy or mental health conditions
  • Existing heart condition
  • Weight, Height, BP, HR
  • Other medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Minimum age children can be prescribed medication for ADHD?

A

5 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of questions that can confirm a diagnosis of ADHD?

A
  • Duration of symptoms
  • How are the symptoms affecting their lives
  • Examples of inattention, hyperactivity or impulsivity
  • School report or observation of behaviour from others
  • Other mental health or neurological conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the shared care protocol?

A

When a patient is under the care of both secondary and primary care. In ADHD, the diagnosis and medication is the responsibility of the secondary care team and the primary care team to monitor the patient, looking for side effects an seeing how effective the medication is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the GP’s role in supporting people with hidden disabilities?

A
  • Empower them to take ownership of their own health
  • Make sure the patient understands their condition so they can explain
  • Signpost to relevant services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 Main signs of ADHD

A

Inattention
Hyperactivity
Impulsivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ddx of ADHD?

A 
Anxiety
Depression
Bipolar
BPD
Substance abuse 
Epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should the GP monitor for a patient with ADHD?

A

Weight
Height
BP
HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

1st line management of ADHD in children

A

Methylphenidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1st line management of ADHD in Adults

A

CBT or Lisdexamfetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3rd line management of ADHD in adults

A

Dexamfetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a maintenance dose?

A

Balancing between drug administration and drug elimination. Dose administered to maintain therapeutic concentrations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 CI of ADHD medication?

A

<5 years old
Pregnant
Breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Max units of alcohol per week?

A

14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 complications of alcoholism?

A

Accidents
Korsakoff
Psychiatric illness
Substance abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

2 questionnaires that can be used to assess the severity of alcoholism?

A

AUDIT - Alcohol use disorders identification test

SADQ - Severity of alcohol dependence questionnaire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 signs of severe alcoholism?

A

Seizure
Ataxia
Confusion
Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long can withdrawal symptoms begin?

A

4 to 6 hours or up to 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What medication can be given to people who have completed the detoxification programme?

A

Acamprosate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

FRAME guidance for structured brief advice?

A 
Feedback 
Responsibility 
Advice 
Menu 
Empathy 
Self-efficacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

3 causes of B12 deficiency?

A

Pernicious anaemia
GI: Gastrectomy or Zollinger-Ellison syndrome
Intestinal: Crohns, Coeliac, Fish tapeworm
Vegan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

3 causes of folate deficiency?

A

Decreased inatke
Increased usage e.g. pregnancy
Liver disease
Malabsorption disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
3 Symptoms of macrocytic anaemia?
``` Insidious headache Weakness Confusion Decreased appetite Palpitations ```
26
3 signs of Macrocytic anaemia?
``` Glossitis Angular stomatitis Confusion Weakness Brown nail beds Neuropathy ```
27
Describe the blood film of a patient with macrocytic anaemia?
Oval macrocytes with hypersegmented neutrophils
28
3 Ddx of macrocytic anaemia?
Severe hypothyroidism Myelodysplasia Liver disease Alcohol abuse
29
4 complications of macrocytic anaemia?
Neuropathy Neurological symptoms Heart failure Neural tube defects
30
Management of B12 deficiency?
Hydroxocobalamin or Cyanocobalamin
31
2 medications associated with B12 deficiency?
Colchicine, Metformin
32
2 medications associated with folate deficiency?
Nitrofurantoin, Trimethoprim, Methotrexate, Sulfasalazine
33
Symptoms of asthma?
Cough (at night or after exercise) Wheeze Chest pain SOB
34
What can be used to confirm a patient has an eosinophilic airway?
Fractional exhaled nitric oxide
35
Asthma red flags in adults?
``` Systemic features Crepitus Clubbing Blood eosinophilia Can't finish sentences ```
36
Ddx of asthma?
COPD, PE, GORD, HF, TB, Pneumonia, Brochiectasis, CF
37
1st line management of asthma?
ICS + SABA
38
3 SE of salbutamol?
Fine tremor of hands, Hypokalaemia, Palpitations, Headache, Anxiety, Arrhythmia
39
3 SE of ICS?
Sore throat, Horase voice, Oral thrush, cough
40
MOA of SAMA and give an example?
The short-acting muscarinic antagonist of acetylcholine causes smooth muscle relaxation. inhibit parasympathetic activity
41
MOA of LTRA and give an example?
Leukotriene receptor antagonist of Leukotriene D4 causes bronchodilation and decreased inflammation
42
MOA of theophylline?
Phosphodiesterase type 3 + 4 inhibitors cause bronchodilation and inhibit adenosine-induced bronchoconstriction
43
Royal college of physicians 3 asthma questions?
Is your asthma disrupting your sleep? Are your usual asthma symptoms occurring during the day? Is your asthma interfering with your usual activities?
44
Management of acute asthma exacerbation?
O2 to be between 92 and 96% Nebulised Salbutamol then Ipratropium x4 ICS or prednisolone
45
Features of life-threatening asthma?
PEFR <33% PO2 <92% Altered consciousness, Confusion, Silent chest
46
Features of moderate asthma exacerbation?
PEFR >50% Able to speak fine Normal PO2
47
Features of acute severe asthma exacerbation?
PEFR 33 - 50% PO2 min 92% RR 25,30,40 (12+, 12-5, 5-2) HR (110,125, 140)
48
What is atrial fibrillation?
Supraventricular arrhythmia characterised by irregularly irregular pulse
49
Which major blood vessel is the foci located that can cause atrial fibrillation?
Pulmonary vein
50
3 symptoms of atrial fibrillation?
``` Palpitations Breathlessness Chest discomfort Dizziness Syncope Decreased exercise tolerance ```
51
3 causes of atrial fibrillation? - 1 cardiac, non-cardiac and diet/lifestyle
Rheumatic valvular disease
52
3 cardiac causes of AF?
Rheumatic valvular disease Heart failure Sick sinus syndrome
53
1 complication of AF?
Thromboembolism
54
3 investigations conducted when investigating AF?
TTE ECG Bloods
55
3 features of an ECG that confirms a diagnosis of AF?
Missing P waves Irregularly irregular Rhythm strip Ventricular tachyarrhythmia 160 - 180
56
What scoring system is used to determine if a patient is at risk of thromboembolism if they have non-rheumatic atrial fibrillation?
CHA2D-VaSc >2
57
3 Ddx of AF?
Sinus tachycardia AVNRT/ AVRT Atrial flutter
58
1st line treatment if a patient has had symptoms for <48 hours and is hemodynamically unstable?
DC cardioversion
59
What is autism?
A spectrum of neurodevelopemental condition characterized by difficulties in social interaction and communication
60
Clinical features of autism?
``` Difficulties communicating Restrictive and fixed interests Repetitive behaviours Lack of interest in conversation Inflexible adherence to daily routines ```
61
Ddx of autism?
``` Anxiety ADHD Bipolar OCD Developmental regression Child abuse ```
62
Risk factors of autism?
``` Genetics/ Affected relative Parents with schizophrenia Down's syndrome Muscular dystrophy Birth defects associated with the nervous system Encephalopathy ```
63
Complications of autism?
``` Unemployment Challenging behaviour Strained relationships Poor attainment in school At the risk of mental health problems ```
64
What is Aspergers?
A form of ASD with normal or above-average intellect with no learning difficulties. Just some difficulties understanding language and speech
65
What is meningitis?
Inflammation of the leptomeningies (pia and arachnoid)
66
3 causative organisms of bacterial meningitis?
Neisseria Meningitidis Strep pneumonia Haemophilus influenza B
67
Describe the rash seen in suspected bacterial meningitis?
Non-blanching purpuric rash distributed on soles, palms, eyelids, abdomen or roof of the mouth
68
3 specific symptoms of bacterial meningitis?
Rash Neck stiffness Photophobia
69
How is bacterial meningitis transmitted?
Aerosol Droplets Direct contact
70
Describe Kernig's sign?
Patient laid on their back Hip flexed and leg flexed at the knee +ve = Patient is unable to extend the leg at the knee
71
Describe Brudzinski sign?
Forced flexion of the neck causes the the thigh and the knee to flex
72
Management of bacterial meningitis in primary care?
999 | Benzylpenicillin
73
6 categories of fever <5?
``` Behaviour Respiration Hydration and circulation Temp Skin Disease-specific symptoms ```
74
Complications of meningitis?
``` Cerebral infarctions Hearing loss Seizures Amputations Cognitive/ Motor/ Visual impairment Hydrocephalus ```
75
Important questions to ask a patient with breastfeeding problems?
Infant history - feeding behaviour, weight, sleep, crying Maternal PMH Current medication History of breastfeeding and what happens usually
76
Management of thrush for breastfeeding mother and baby?
Fusidic cream + Flucanozole | Miconazole for 10 to 14 days
77
How long does it take for medication to start treating the symptoms of thrush in breastfeeding mothers and their babies?
2 - 3 days
78
How would you differentiate between mastitis and thrush?
Mastitis - Unilateral wedge shape redness + slight fever Thrush - crack nipples and bilateral pain + baby has a white coating on their tongue or around their mouth
79
Key features of blocked ducts?
Bilateral breast pain relieved by breastfeeding and white spots on the nipple
80
Causes of decreased milk production?
Maternal depression or anxiety Infrequent feeding Prolactin deficiency
81
Management of ductal infection?
Flucloxacillin or Erythromycin or Clarithromycin
82
Management of mastitis?
Continue breastfeeding Reassurance Heat packs/ Cool packs Pain relief
83
Medication that can be used for mothers struggling to breastfeed due to Raynaud's syndrome?
Nitroprusside
84
Signs of candida infection in babies?
White coating on the tongue, roof of mouth or lips Unsettled baby Breastfeeding pain lasts >1 hour after feeding
85
4 causes of breastfeeding problems?
Breast pain Nipple pain Underproduction of milk OVer production of milk
86
What indicates a galactocele is present?
Smooth painless mass that when pressed expressed milky discharge Patient also has white spots on the nipple
87
How many months should a child be breastfed?
6 months
88
What are the benefits of breastfeeding?
Less likely to be obese or have eczema | Increased immunity
89
What 2 HPV strains are most associated with cervical cancer?
16 + 18
90
How long can the spontaneous resolution of HPV take?
1 to 2 years
91
How is HPV transmitted?
Sexual intercourse
92
Complications of CIN?
``` Pain Renal failure Leg lymphoedema Bleeding Malodour from necrotic tissue or fistulae Urinary or faecal incontinence ```
93
How would the cervix appear in a patient with suspected cervical cancer?
Inflamed and bleed easily | Mucoid/ purulent vaginal discharge
94
Ddx of CIN?
``` Cervical ectropion Endometriosis Endometrial cancer STI Hormonal contraception ```
95
Stage 1 CIN?
CIN remains confined in the cervix
96
Stage 2 CIN?
CIN extends past cervix to upper 2/3 of the vagina but not invaded pelvic wall
97
Stage 3 CIN?
CIN has extended to lower 1/3 of the vagina and invaded pelvic wall
98
Stage 4 CIN?
CIN has metastasized or invaded the rectum or bladder
99
Management of confirmed cervical cancer?
Colposcopy - Excision and biopsy Lymphadenectomy Chemo + radio Chemo and palliative
100
3 preventative measures of HPV infection?
HPV vaccination NHS cervical cancer screening Safe sex practice
101
Risk factors of HPV infection?
``` Increased sexual partners Age at first sexual intercourse Immunocompromised Co-existing STI Family history High parity Smoking ```
102
Symptoms of CIN?
``` Pelvic pain Intermentrual/ Post-menopausal/ Post-coital bleeding Blood stained discharge Leg lymphoedema Purulent dischatge Incontinence ```
103
3 criteria for CKD?
ACR>3 eGFR<60 Urine sediment abnormalities
104
3 examples of nephrotoxic drugs?
ACEi NSAIDs Diuretics
105
Causes of CKD?
``` Hypertension Diabetes Glomerulonephropathies Nephrotoxic drugs Obstructive uropathy Multisystem disease CVD Obesity and metabolic syndrome ```
106
Complications of CKD?
``` AKI Hypertension Renal anaemia Renal bone disease Metabolic acidosis Malnutrition Peripheral oedema Peripheral neuropathy ```
107
Signs of CKD?
``` Uraemic frost Uraemic odor Pallor Dehydration Tachy Cachexia ```
108
Symptoms of CKD?
``` Disturbed urine output Sleep disturbances Lethargy Itch Breathlessness Bone pain Abdo cramps ```
109
Investigations used to confirm CKD?
``` ACR eGFR Urinalysis Serum and urine electrolytes Renal ultrasound ```
110
A patient with hypertension with an ACR>3 should be given what antihypertensive medication?
Lisinopril or Losartan
111
What is accelerated CKD?
eGFR change >25%/15 over 12 months
112
4 factors to be measured when assessing a patient's nutritional status?
BMI, BP, HbA1c, Lipid profile
113
What causes peripheral paresthesia in pregnancy?
Fluid retention compresses the peripheral nerves
114
Management of pelvic girdle pain in pregnancy?
``` Osteo manipulative therapy Exercises Belts Crutches Pain resolves 6 months post-delivery ```
115
Talking to a patient on the phone, how would you be able to determine they don’t have a chest infection and no treatment is needed?
``` Normal dyspnoea, cough and wheeze Sputum is clear and regular in volume No chest pain Able to finish the sentence Able to move around ```
116
Talking to a patient on the phone, how would you be able to determine they have an infective exacerbation of COPD and how will you treat them over the phone?
Purulent sputum Increased volume of sputum Increased breathlessness Description of fever Safety net the patient if emergency kit doesn't work
117
Talking to a patient on the phone with diagnosed COPD, what factors would make you call 999?
``` Unable to finish a sentence Loss of consciousness Increased dyspnoea Increased depth of cough Increased sputum production Emergency kit not relieving symptoms Altered consciousness ```
118
1st line treatment of COPD?
SABA - Salbutamol
119
2nd line treatment of COPD if the patient also has a history of asthma?
ICS (Butclometasone) or LABA (Formoterol)
120
2nd line treatment of COPD if the patient's main complaint is breathlessness?
LAMA (Tiotropium) or LABA (Formoterol)
121
Side effects of prolonged use of steroids?
``` Easy bruising Osteoporosis Skin Thinning Immunocompromised Oral thrush Sore throat Adrenal insufficiency Diabetes ```
122
Ddx of acute exacerbation of COPD?
``` PE Pneumonia Pneumothorax Chronic congestive heart failure Asthma Bronchiectasis Rib fracture Pleural effusion ```
123
2 methods of classifying COPD?
FEV1 and MYC dyspnoea scale
124
What is included in the triple therapy of COPD and provide an example of each?
LABA + LAMA + ICS | Formoterol + Tiotropium + Betclometasone
125
What is in the emergency kit of a COPD patient?
SABA Prednisolone Abx - Amoxicillin
126
Non-pharmacological management of COPD?
Smoking cessation Respiratory exercises Dietary changes
127
Acceptable O2 sats for a patient with COPD?
88 - 92%
128
Duration of acute cough?
<3 weeks
129
Duration of subacute cough?
3 to 8 weeks
130
Duration of chronic cough?
>8 weeks
131
Ddx of acute cough?
Coronavirus Asthma Viral URTI Bronchitis
132
Ddx of subacute cough?
Post-infection e.g. Bortadella Pertussus or Mycoplasma pneumonia
133
Ddx of chronic cough?
``` COPD Eosinophilic bronchitis ACEi GORD Hypersensitivity syndrome Smoking ```
134
Risk factors for dementia
``` Down's syndrome Alcohol abuse Strokes + TIA Mental illness Genetics (amyloid proteins) Increasing age Parkinsons Huntington's Cardiovascular disease ```
135
3 examples of improving communication for people with intellectual disabilities
Videos Allowing extra time Images Not using complicated medical terms and explain in simple terms
136
3 examples of community support available for people with intellectual disabilities
Support worker Local charity support groups Friends and family
137
How does dementia present in people with down's syndrome compared to people with normal intellect?
Instead of loss of memory, they experience personality change e.g. not enjoying the things they used to, agitated, not wanting to talk
138
Example of a questionnaire used to diagnose dementia in people with down's syndrome
Dementia screening questionnaire for individuals with intellectual disabilities
139
5 key principles of the MCA?
``` Assume capacity Maximise decision-making capacity Freedom to make seemingly unwise decisions Best interest Least restrictive option ```
140
Definition of dementia?
Clinical syndrome of deteriorating mental function that affects 2 or more areas of life with no other identifiable cause
141
How can cognition be assessed?
GPCOG
142
Examples of cognitive impairment found in patients with dementia?
Memory loss Dysphasia Lack of co-ordination Difficulty making decisions
143
Symptoms specific to vascular dementia?
Visual impairment Problems with gait attention Personality change
144
Symptoms specific to lewy body dementia?
Parkinsonian features syncope Falls Memory loss occurs later
145
How can cognition be assessed?
GPCOG | 6 item cognitive impairment test
146
Ddx of dementia?
``` Delirium Depression Anxiety Bipolar Hypothyroidism Substance abuse UTI Mild cognitive impairment DKA ```
147
Causes of delirium?
``` UTI Constipation Infection Hypoxia Benzodiazepines Electrolyte imbalance ```
148
2 medications used for dementia and their MOA?
Acetylcholinesterase inhibitors e.g. Rivastigmine Memantine - Inhibit glutamate receptors to alleviate the behavioural symptoms of dementia such as aggression and hallucinations
149
7 categories found in the MMSE?
``` Orientation Registration (repeat 3 objects) Attention Calculation (-7 from 100 and continue) Recall Language Copy ```
150
What is included in a confusion screen?
``` Vitals CT Blood Urine CXR ```
151
Difference between delirium and dementia?
Onset | Fluctuations
152
Management of delirium?
Treat underlying cause Supportive reorientaiton + aids Haloperidol or Loarzepam
153
Complications of dementia?
Disability + dependence Institutionalization Financial hardship
154
The difference in symptoms between Alzheimer's and Lewy body dementia
A - Memory loss is usually the initial symptoms whereas LB -memory loss occurs later in disease progression, mostly parkinsonian features
155
What is DoLS?
When you restrict a patient's right to make their own decisions and live without supervision Decisions are made for them by others, with the patients best interests in mind
156
What is a lasting power of attorney?
An individual appointed by the patient to make decisions for them. Required documentation
157
What is a court of protection?
When a patient doesn't have a LPA and the court makes decisions about the patient's finances and welfare
158
What is an advanced decision?
Living will Detailed plans made by a patient with regards to their care, while they still have capacity. It can include DNACPR, Hospitalization, Nutrition, Hospital admission
159
Medications that can cause dementia-like symptoms?
``` Benzodiazepines Analgesics Antidepressants Antipsychotics Antiepileptics Anticholinergics ```
160
Symptoms specific to frontotemporal dementia?
Insidious change in personality + behaviour | Memory and perception remain intact
161
What is delirium?
Sudden confusion/ disturbance in mental abilities resulting in confused thinking and reduced awareness
162
What is depression?
Persistent low mood +/- pleasure in most activities causing significant impairment to the patient's life >5/9 symptoms over the past 2 weeks
163
What are the symptoms of depression?
``` Decreased appetite Low mood Sleep disturbances Agitation Fatigue Cognitive symptoms Withdrawal Self-harm ```
164
Risk factors of depression?
``` Male Certain professions Experience of abuse Grief Substance abuse Deprivation Involved in justice system Genetics ```
165
How to assess the risk of suicide?
THOUGHTS PLANS PROTECTIVE FACTORS RISK FACTORS
166
4 questionnaires that can be used to assess the severity of depression?
Patient health questionnaire 9 Hospital Depression and anxiety scale Beck's Depression Inventory Depression thermometer
167
What is dysthymia?
Persistent sub threshold depression (<5/9) for >2 years
168
Prevalence of depression in the UK?
4.4 - 4.5% of the population
169
Complications of depression?
Increased perceived pain Unemployment Difficulty maintaining relationships Increased risk of other mental illnesses
170
Ddx of depression?
``` Anxiety Bipolar Grief MND Dementia Parkinsons BPD Hypothyroidism ```
171
Prognosis of depression?
Episodes last 3 to 6 months with treatment
172
1st line anti-depressant for a patient who also takes anti-epileptics?
Sertraline
173
A patient takes anticoagulant medication, what is the recommended antidepressant?
Mirtazapine
174
What is Reboxetine used for?
NRI used for acute severe depression
175
What is moclobemide used for?
MAOI used for depression and social anxiety | 2nd line for patient's on anti epileptics after sertraline
176
What factors should be considered when prescribing antidepressants?
``` Patient preference Toxicity Side effects PMH Drug history ```
177
2 most toxic SSRI?
Citalopram and Escitalopram
178
What group of antidepressants has the greatest likelihood of toxicity? A. SSRI B. Mitarzapine C. TCA
TCA
179
Which SNRI is associated with arrhythmia?
Venlafaxine
180
3 useful organisations that can help people with depression?
MIND Depression UK Samaritans
181
How long can a patient be confined under the MHA 3?
6 months (with family consent)
182
When prescribing sertraline to the elderly, what other medication should be prescribed?
PPI for gastroprotection
183
Common side effects of SSRI?
``` Dry mouth Nausea Abdo pain Constipation Tremor Suicidal ideation Palpitations Anxiety Insomnia ```
184
What 5 things should be monitored when prescribing antidepressants?
``` Hyponatremia Suicidal thought suicide attempts BP Cardiac disorders ```
185
How often should a patient started on antidepressants be reviewed?
2 to 4 weeks for the next 3 months
186
What antidepressant is contraindicated in <18 year olds?
Mitarzapine
187
A patient takes sodium valproate, what 2 options of antidepressants can be prescribed to them?
Sertraline | Moclobemide
188
What are examples of antimuscurinic effects that can be caused by TCA?
``` Dry mouth Sweating Blurred vision Difficulty urinating Sexual dysfunction Dry skin Tachy ```
189
What is serotonin syndrome?
When a patient takes too many antidepressants resulting in an accumulation of serotonin which can be fatal Headache, nausea, fever, hypertension, tachy, confusion = coma and convulsions
190
Withdrawal effects of abruptly stopping antidepressants?
``` Decreased appetite Disturbed sleep Low mood Agitation Nausea Fatigue ```
191
Example of an antidepressant that can be stopped abruptly?
Fluoxetine at 20mg
192
What antidepressant should be avoided when breastfeeding?
Doxepin
193
2 antidepressants that can be used during breastfeeding in severe cases?
Sertraline | Paroxetine
194
1st line treatment of confirmed DVT?
Apixaban or Rivaroxaban
195
Symptoms of DVT?
Unilateral calf welling Red Warm Tender
196
Risk factors of DVT?
``` Immobile Long haul flights OCP Obesity Recent surgery/ Trauma Pregnancy HRT ```
197
2 main risk factors that need to be screened for when unprovoked DVT confirmed?
Antiphospholipid syndrome | Thrombophilia
198
What is unprovoked DVT?
DVT that occurs in the absence of risk factors
199
What is D-dimer?
Fibrin degradation product It Shows clots are being broken down in the body. Associated with DVT or PE
200
Complications of DVT?
PE | Anticoag bleeding or induced thrombocytopenia
201
CI of DOACs?
Recent history of active bleeding Bacterial endocarditis Heparin induced thrombocytopenia High risk of uncontrolled bleeding
202
How long are patients with confirmed DVT given medication for?
3 months
203
Baseline tests used for patients on anticoagulation?
``` FBC Renal function - U+E, eGFR LFT PT APTT ``` within 24 hours of starting treatment
204
2nd line treatment of confirmed DVT?
LMWH | Dabigatran or Edoxaban
205
3rd line treatment of DVT?
LMWH | Vitamin K antagonist
206
2 situations that would require an urgent referral if DVT suspected?
Pregnant | 6 weeks post-partum
207
What percentage of people develop PE from DVT?
1/3
208
What is a DVT?
Formation of a thrombus in deep veins of legs/ pelvis that can partially or completely obstruct blood flow back to the heart
209
MOA of Dabigatran?
Direct thrombin inhibitor
210
Prolonged risk factors of DVT?
``` History of DVT Cancer >60 Overweight Male Heart failure Thrombophilia Inflammatory disease Varicose veins Smoking ```
211
Ddx of DVT?
``` Thrombophlebitis Cellulitis Trauma Post-thrombotic syndrome Vascultits Ruptured baker's cyst ```
212
Other atopic disease associated with eczema?
Hayfever + Asthma
213
3 complications of eczema?
Impetigo - staphy aureus Herpes simplex - eczema herpeticum Psychosoicla problems - anxiety, depression, poor self image
214
The difference in rash distribution of eczema between infants and children
Infants - scalp, face, extensor surface of limbs Children - localised in flexures of limbs
215
Signs of chronic eczema?
Skin has become thick, discoloured, lichenified due to repeated scratching
216
Signs of infected eczema?
Weeping Crusted Malaise Fever
217
Ddx of eczema?
Impetigo Psoriasis Contact dermatitis Cows milk allergy
218
MOA of Calcineurin inhibitors?
Immunosupressive effects by inhibiting production of IL2 and it's receptors meaning decreased T-cell activation Tarcolimus or Pimecrolimus or Cyclosporine
219
Eczema patient experiencing redness and inflammation?
Emollient
220
Eczema patient experiencing dryness?
Ointment
221
Eczema patient experiencing itch?
Lauromacrogols - anaesthetic and antipruritic effects
222
What is endometriosis?
When endometrial tissue grows outside of the uterus and symptoms are associated with menstruation + hormones
223
5 causes of endometriosis?
- Retrograde menstruation - Lymphatic + Circulatory dissemination - Genetic disposition - Metaplasia - Environmental factors e.g. red meat, early menarche, late menopause, delayed childbearing, late first intercourse
224
Prevalence of endometriosis?
1 in 10 women of reproductive age | Most common gynae issue
225
Complication of endometriosis?
``` Endometriomas (ovarian cysts of blood) Infertility Adhesion Bowel obstructions Chronic pain ```
226
Symptoms of endometriosis?
``` Dysuria Dysmenorrhoea Dyschezia Dyspareunia Chronic pelvic pain ```
227
Gold standard diagnosis of endometriosis?
Laparascopy
228
Ddx of endometriosis?
PID Ovarian cysts Ovarian cancer Ectopic pregnancy Interstitial cystitis Recurrent UTI Fibroids Primary dysmenorrhoea Uterine myoma IBD IBS Appendicitis Coeliac Congenital abnormalities of reproductive tract
229
Management of endometriosis?
3 month paracetamol +/- NSAIDS Contraception Screen for complications Ultrasound + Laparoscopy
230
A patient has deep endometriosis that involved the bowel, bladder and ureter. What medication can be given?
GnRH agonist
231
Surgical management of endometriosis?
Laparoscopic excision | Hysterectomy
232
What is generalised anxiety disorder?
Disproportionate widespread worry that can manifest into physical symptoms such as restlessness, palpitations and sweating
233
How does drinking affect anxiety?
Temporarily relieves anxiety symptoms but once effects wears off, the symptoms come back + hungover. Reliance then can turn into an addiction
234
Main symptoms of anxiety?
``` Sweating Overwhelming worry Palpitations Expressing fears Muscle tense ```
235
How can you differentiate between anxiety and depression?
Depression - low mood, lack of interest, slow movement, fatigue, suicidal ideation Anxiety - Palpitations, worry about events or situations, muscle tense, sweating
236
Diagnostic tool used for generalised anxiety disorder?
Generalised Anxiety Disorder 7
237
1st line pharmacological treatment of GAD?
SSRI - Sertraline, Paroxetine, Escitalopram
238
Ddx of anxiety?
``` Depression Substance abuse OCD Bipolar Dementia Hyperthyroidism Phaechromocytoma ```
239
Risk factors of GAD?
``` Childhood abuse Trauma Female Substance abuse Co-morbidities ```
240
DSM5 criteria of GAD?
Symptoms for 6 months + 3 months restlessness, muscle tension + sleep disturbances
241
ICD10 criteria of GAD?
Generalised and persistent symptoms of anxiety in any environment including restlessness, muscle tension, sweating and expression of fears
242
3 types of anxiety disorder?
OCD Panic disorder PTSD
243
Main risk of giving a pregnant woman SSRI or SNRI during pregnancy?
Persistent pulmonary hypertension of newborn | Withdrawal effects
244
What are the symptoms of GORD?
Burning central retrosternal chest pain Nausea Vomiting Cough
245
Risk factors of GORD?
``` Alcohol Smoking Obesity Pregnancy Spicy food Hiatus hernia Stress ```
246
Complications of GORD?
``` Barret's oesophagus Haemorrhage Ulcers Strictures Positions Oesophageal cancer ```
247
Lifestyle advice that can be given to manage GORD?
``` Cut back smoking and drinking Eat 2 to 3 hours before sleeping Eating more frequent smaller portions Manage anxiety and stress Sleep on elevated pillow ```
248
2nd line management of GORD if omeprazole is ineffective?
H2RA x2 for 1 month | Ranitidine 2 weeks
249
Surgical procedure used to manage severe GORD?
Laporascopic fundoplication
250
What is Barrett's oesophagus?
When the epilethium of the oesophagus changes from squamous to columnar due to repeated exposure to gastric contents
251
Ddx of GORD?
``` Angina Achalasia Gastritis Cancer Oesophageal motility disorders ```
252
What 2 things are people on long term PPI at risk of?
Osteoporosis | Hypomagnesia
253
PPI can increase the potency of which 4 medications?
Digoxin Warfarin Phenytoin Methotrexate
254
PPIs can decrease the potency of which 2 medications?
Clopidogrel | Azole Antifungals
255
Red flag upper GI symptoms?
Haematemesis Malaena Dysphagia Weight loss
256
Common side effects of PPI?
``` Dizziness Headache Diarrhoea Constipation Abdo pain ```
257
How long should a patient stop taking PPIs before having an endoscopy?
2 weeks
258
Management of recurrent endoscopic-ve reflux disease?
H2RA for 4 weeks
259
Who are PPI and H2RA CI in and why?
People about to have endoscopies because they can mask the symptoms of GI malignancy
260
3 examples of specialist tests that can be used to investigate the oesophagus?
Oesophageal manometry Ambulatory 24 hours oesophageal pH testing Barium Swallow
261
At what age does GOR usually begin in infants?
8 weeks
262
What is the difference between GORD + regurgitation?
GORD >1 year with symptoms of reflux disease Regurgitation <1 year old and not pathological
263
Red flags of reflux disease in infants?
``` Projectile vomiting Bile in vomit Excessive crying Crying while feeding Chronic cough Gagging ```
264
1st line management of reflux disease in infants?
Gaviscon for 1 to 2 weeks
265
2nd line management of reflux disease in infants?
4 week omeprazole suspension
266
Complications of reflux disease in infants?
``` Aspirational pneumonia Barrett's oesophagus Oesophagitis Ulcers Dental erosions Acute otitis media ```
267
Risk factors of reflux disease in infants?
Congenital atresia Congenital hiatus hernia Premature Parents with reflux disease
268
Ddx of reflux disease in infants?
Raised ICP UTI Sandifer syndrome Cow's milk allergy
269
What is Sandifer syndrome?
Torticollis with neck extension and rotation found in infants with GORD or hiatus hernia
270
What is gout?
Disorder of purine metabolism caused by raised uric acid levels in blood resulting in uric acid crystals depositing in joints and other tissue
271
3 stages of gout attacks?
Long period of asymptomatic hyperuricaemia Acute attack of gouty arthritis Chronic tophaceous gout where nodules start affecting joints
272
Risk factors of gout?
``` Thiazide diuretics Myeloproliferative disorders Increased age Renal disease Obesity Alcohol Red meat ```
273
Complications of gout?
``` Tophi Urinary stones CKD Hypertension Osteoarthritis Obesity Diabetes Progressive joint damage ```
274
Prognosis of gout?
Self-limiting can resolve within 1 to 2 weeks
275
Symptoms of Gout?
Swollen 1st metatarsophalangeal joint but can also affect midfoot, ankle, knee, fingers , wrist and elbow Rapid onset swelling, redness, warmth and tenderness
276
Microscopy difference between gout and pseudogout?
Gout - Crystal shaped negatively birefringent monosodium urate Pseudogout - Rhomboid shaped positively birefringent calcium pyrophosphate dihydrate
277
Diagnosis of gout?
Microscopy of synovial fluid Serum uric acid X-ray Assess potential CVD or renal disease risk
278
Ddx of gout?
``` Septic arthritis Cellulitis Pseudogout Oesteoarthritis Reactivate arthritis Haemochromatosis Trauma ```
279
1st line management of gout?
NSAIDs + Colchicine
280
2nd line management of gout?
Joint aspiration and intra articular corticosteroids
281
What should be checked 4 to 6 weeks after a diagnosis of gout?
Serum uric acid HbA1c Renal function Lipid profile
282
1st line prevention medication of gout?
Allopurinol
283
2nd line prevention medication of gout?
Febuxostat
284
MOA of colchicine?
Inhibits neutrophil activation and adhesion
285
MOA of allopurinol?
Purine analogue which acts as a xanthine oxidase inhibitor that prevents the conversion of xanthine to uric acid
286
SE of allopurinol?
Precipitate acute attacks of gout Rash Vertigo Ataxia
287
MOA of febuxostat?
Non-competitive inhibitor of xanthine oxidase
288
MOA of NSAIDs?
COX1 + COX2 inhibitor to decrease prostaglandins that mediate platelet aggregation and inflammation
289
What are haemorrhoids?
Abnormally vascular mucosal cushions present in the canal. Anal cushions help maintain anal continence
290
Difference between internal and external haemorrhoids?
External - richly innervated pain fibres + itch Internal - painless but become painful when strangulated
291
Risk factors of haemorrhoids?
``` Straining Heavy lifting Pregnancy Chronic cough Exercising Low fibre diet ```
292
Complications of haemorrhoids?
Perianal thrombosis Incarceration of prolapse haemorrhoidal tissue = pain Skin tags Ischaemia, thrombosis or gangrene of haemorrhoid Anal stenosis Anaemia from continuous bleeding
293
Symptoms of haemorrhoids?
``` Bright red blood on toilet paper, bowl or outside stool - not mixed in Anal itch or irritation Feeling incomplete bowel evacuation Soiling Pain ```
294
Diagnosis of haemorrhoids?
Observation Digital rectal exam Proctoscopy FBC
295
Ddx of haemorrhoids?
``` Diverticulitis IBD Anal/ Colorectal cancer anal fissure Pruritus ani Rectal prolapse STI ```
296
1st line management of haemorrhoids?
``` Fibre + balanced diet Adequate fluid intake Good hygiene Paracetamol Topical haemorrhoid preparation e.g. Anusol ```
297
What is heart failure?
Inability of the heart to pump blood to the body - reduced cardiac output that doesn't meet the demands of the body
298
3 main causes of heart failure?
Arrhythmia Abnormal loading Diseased myocardium
299
Epidemiology of heart failure?
1 - 2% of the population and 10% of over 70s
300
Symptoms of heart failure?
Breathlessness Fatigue Ankle swelling
301
Signs of heart failure?
``` Paroxysmal nocturnal dyspnoea Orthopnoea Syncope Oedema Raised JVP Cardiomegaly Tachypnoea ```
302
ABCDE CXR showing heart failure?
``` Alveolar oedema Kerley B lines Cardiomegaly Dilated upper vessels Pleural effusion ```
303
Investigations used to confirm Heart failure?
``` Pro-BNP ECG Echo Full bloods CXR Urine ```
304
Factors that can decrease BNP?
``` Obesity Afro-Caribbean Diuretics ACEi ARB BB Spironolactone ```
305
Factors that can increase BNP?
``` Diabetes >70 LVH Hypoxaemia eGFR<60 Liver Cirrhosis Sepsis COPD ```
306
Prognosis of heart failure?
50% die within 5 years
307
Management of HF in a patient with a reduced EF
ACEi BB Spironolactone
308
Why are ACEi used to manage heart failure?
Decrease preload | Help repair cardiac muscle
309
CI of ACEi?
Renal artery stenosis Aortic stenosis Hyperkalaemia Severe renal impairment
310
Most people with heart failure usually die of what?
Ventricular tachycardia
311
Risk factors of heart failure?
``` Obesity Smoking Diabetes Hypertension Cardiovascular event before 65 High BMI ```
312
What 2 medications decrease mortality in heart failure?
BB | CCB
313
2 drugs that can be used to manage impotence in men who are on heart failure medication?
Sildenafil | ARB
314
Which calcium channel blockers are CI in heart failure?
Verapamil or Diltiazem
315
Min ejection fraction that can be classed as heart failure with preserved ejection fraction?
45%
316
What is accelerated hypertension?
Severe increase in BP >180/120 or higher with signs of end-organ damage
317
What is masked hypertension?
Clinical BP normal but home BP higher
318
AMBP classed as stage 1 hypertension?
135/85
319
Factors that can result in referral to secondary care?
``` Very young >80 Pregnant suspected phaeochromocytoma Accelerated hypertension ```
320
Examples of secondary causes of hypertension?
``` Diabetes OSA Pre-eclampsia Coarctation of aorta Cushing's Hyperthyroidism Acromegaly Renal disease Phaeochromocytoma ```
321
65, T2DM, Male, new diagnosis of hypertension. What is the 1st line treatment?
ACEi
322
Examples of end-organ damage of hypertension?
Stroke Renal failure MI Hypertensive retinopathy
323
3 scenarios where standing and sitting BP would have to be measured?
Postural hypotension >80 years old T2DM
324
Qrisk3 score required to start statins?
>10%
325
If the patient has K+ <4.5mmol/l what additional medication can be added to control hypertension?
Spironolactone
326
If the patient has K+ >4.5mmol/l what additional medication can be added to control hypertension?
Alpha-blockers/ Beta-blockers
327
Potential side effects of ACEi?
First dose hypotension Cough Urticaria
328
What 2 medications are most likely to cause impotence in men?
Diuretics | BB
329
What medication can be used to treat impotence in men who take antihypertensive medication?
Sildenafil or ARB
330
Common side effects of statins?
Myalgia Headache Nausea
331
Atrial fibrillation and hypertension management?
BB or Diltizem for rate control
332
What kind of virus is HIV?
Lentivirous with a long incubation period | Attacks CD4 T lymphocytes
333
What is a window period?
Time between getting infected and antibodies appearing
334
2 things that should be monitored in a patient with suspected HIV?
CD4 count | Viral load
335
CD4 count classed as AIDS?
<200 per microlitre
336
3 phases of HIV?
Seroconversion illness - 10 days to 6 weeks of flu like illness Asymptomatic phase - last up to 10 years AIDS - opportunistic infection, Malignancies, CD4 <200
337
Risk factors of HIV?
``` MSM Frequent sexual partners Sex worker IV drug users Needlestick injury High ```
338
When to suspect HIV?
``` Prolonged recurrent infections Conditions related to immunosuppression Lymphadenopathy Pyrexia Weight loss Risk factors ```
339
The causative organism of pneumonia in patients with HIV?
Pneumocystitis Jirovecii
340
Constitutional symptoms of HIV?
``` Flu-like symptoms Fever Weight Loss Sweats Lymphadenopathy ```
341
4 neurological conditions associated with HIV?
Cryptococcal Meningitis Cerebral Toxoplasmosis Cerebral Lymphoma CMV Retinitis
342
4 malignancies associated with HIV?
Lymphoma Kaposi Sarcoma Cancer of skin or oropharynx Cervical cancer
343
Management of newly diagnosed HIV?
Referral within HIV clinic within 48 hours Safer sex Support groups
344
1st line management of HIV?
Triple therapy NRTI Tenofovir Disoproxil Emtricitabine
345
5 groups of antiviral therapy that can be prescribed to a HIV patient?
- Nucleotide Reverse Transcriptase Inhibitors - Non-nucleotide reverse transcriptase inhibitors - Protease inhibitors - Integrase inhibitors - Entry inhibitors
346
What is PrEP?
Pre-exposure prophylaxis | - Drug to take before and after for HIV-ve people
347
What is PEP?
Post-exposure prophylaxis - HIV-ve has sex with HIV+ve within 24 hours Follow up 8 to 12 weeks
348
Thyroid function testing for hypothyroidism measures T4 rather than T3. Patients may attend and ask for testing of T3 based on internet searches. What evidence is available to explain why T4 is measured, and why T3 may not be a suitable biochemical marker for hypothyroidism?
T3 is more potent than T4 but more T4 is released by the thyroid which gives a better indication of thyroid function T3 mostly made peripherally and can be affected by liver or renal disease
349
What are the risks of overtreatment with levothyroxine and what changes could be present in patients?
Hyperthyroidism - Tremor, palpitations, diarrhoea, fatigue, hypertension
350
3 causes of hypothyroidism?
Drug Iodine deficiency Infiltration Post-partum thyroiditis Autoimmune - Hashimoto's
351
3 Ddx for hypothyroidism?
Anaemia Coeliac T1DM
352
How often should TFT be conducted for patients on levothyroxine?
Every 3 months
353
3 medications associated with hypothyroidism?
Amiodarone Carbimazole Lithium
354
2 complications of hypothyroidism?
Dyslipidaemia | Increased fatigue affecting the quality of life
355
What diabetic medication has been associated with secondary hypothyroidism?
Metformin
356
Implications of hypothyroidism on pregnancy?
Pre-eclampsia Low birth weight Still born
357
How does myxoedema madness present?
Hypothermia Bradycardia Seizure Coma
358
The incubation period of measles?
10 days
359
Timeline of measles from first contact to recovery
10 day incubation period 2 - 4 days fever, malaise, conjunctiva, runny nose 3 -5 days after prodromal then rash appears
360
4 complications of measles?
Panencephalitis Pneumonia or Pneumonitis Otitis media Seizure/ Convulsions
361
Which group of patients have the greatest risk of panencephalitis after getting measles?
Unvaccinated patients
362
High-risk groups of measles?
Pregnant Immunocompromised Unvaccinated adolescence Infants
363
Signs of measles?
``` Fever Other prodromal signs - Bilateral conjunctiva, runny nose, malaise, unsettled Koplik spots Erythematous Maculopapular rash Bark like cough ```
364
Symptoms of measles?
``` Fever Unsettled baby Rash Bark like cough Runny nose Conjunctiva of both eyes Not sleeping Poor feeding ```
365
When do Koplik spots appear?
3 to 5 days of prodromal symptoms starting
366
Describe the rash seen in measles and its distribution?
Erythematous Maculopapular rash that becomes confluent Not-itchy Starts at the head/ neck working down then torso with hands and wrists last
367
Who needs to be notified of measles cases?
Health protection team | Recent contacts of the affected patient
368
Ddx of measles?
``` Early Meningococcal disease Meningitis Parvovirus (slap cheek - no koplik) Strep infection (maculopapular rash, sore throat, strawberry tongue) Rubella - maculopapular rash but not confluent and starts behind the ears then face Herpes encephalitis UTI Kawasaki disease (5 days fever) ```
369
How can you differentiate between meningococcal disease and measles?
Distribution and features Measles - Erythematous Maculopapular rash that becomes confluent, starts at the head/ neck then down to the torso and lasts affects hands/ wrists Meningococcal disease - Non-blanching purpuric rash on soles, palms, eyelids, abdo and roof of the mouth + other signs of meningitis
370
Describe the management of measles to a mother of a child with measles?
Self-limiting Self-isolate Fluids, Paracetamol or ibuprofen to settle the child Safety net
371
Management of a patient who has been in contact with possible measles?
Notify the health protection team Check vaccination history Vaccinate within 3 days of contact + 1 month later if not already done
372
When is measles most infectious?
4 days before rash to 5 days after rash
373
What observations should be done for a child with fever in primary care?
``` Temp BP HR RR CRT ```
374
What is the fever pain score used for?
Criteriod if antibiotic should be given to patients >3 years old who present with sore throat. Aims to use a targeted antibiotics approach and improve patient symptoms 0 -1 - not antibiotics 2 -3 delayed antibiotics 4 -5 immediate antibiotics ``` Fever Purulence Attend within 3 days severely Inflamed tonsils No cough or coryza ```
375
What is the traffic light system used for?
Assess the risk of a child <5 years old + fever if they are low, medium or high risk and need to be admitted to secondary care. It looks at skin, behaviour, resp, hydration + circulation, disease-specific symptoms
376
Traffic light: skin colour difference between amber and red risk?
Amber - Pale | Red - Mottled, Blue
377
Traffic light: activity difference between amber and red risk?
Amber - Wakes on prolonged stimulation, No smile, No response to social cues, Decreased activity Red - unresponsive, no smile, no activity, high pitched continuous cough
378
Traffic light: Resp signs showing amber risk?
``` RR>50 for <1 year old RR>40 for >1 year olds Nasal flare O2 sats <95 Crackles on the chest ```
379
Traffic light: Resp signs showing high risk?
RR>60 Intercostal breathing Head bobbing Grunting
380
Traffic light: Heart rate showing tachycardia in 11-month-old?
>160
381
Traffic light: Heart rate showing tachycardia in 1-year-old?
>150
382
Traffic light: Heart rate showing tachycardia in 2 to 5-year-olds?
>140
383
Traffic light: Circulation change that shows high risk?
Reduced skin turgor
384
Traffic light: babies aged 3 to 6 months with temp of >39 degrees, what risk category?
Amber
385
Traffic light: Babies <3 months with temp of >38 degrees, what risk category?
Red
386
Traffic light: normal CRT?
<2 seconds
387
Antibiotics used for 2-month-old with fever if admitted to hospital?
3rd gen cephalosporin - Ceftriaxone
388
What O2 sats would require a child to be given oxygen?
<92%
389
Traffic light: Amber signs for circulation and hydration?
CRT>3 seconds Dry mucous membranes Poor feeding Reduced urine output
390
What is insomnia?
Difficulty getting to sleep, Maintaining sleep, Waking up early or non-restorative sleep resulting in impaired daytime functioning
391
Complications of insomnia?
``` Cognitive difficulties e.g. impaired memory, attention, concentration Decreased quality of life Psychiatric complications Increased risk fo CVD + T2DM Increased risk of mortality ```
392
Diagnosis of insomnia?
History - triggers, behaviour, sleep patterns, impact on life 2 week sleep diary
393
Ddx of insomnia?
OSA Parasomnia - unpleasant experiences or behaviors associated with sleep Restless leg syndrome Narcolepsy Circadian rhythm disorders e.g jet leg or shift work
394
Short term management of insomnia?
``` Sleep clinic + hygiene Address concerns/ stressors 3 - 7 days non-benzodiazepine CBT z drug or prolonged-release melatonin ```
395
Management of chronic insomnia?
``` Alert DVLA Sleep clinic CBT 1 week hypnotic Modified release melatonin ```
396
Examples of Z-drugs + MOA?
Zopiclone or Zolpidem Sedatives that work by binding to GABA-A receptors and slow down activity of the brain
397
3 categories of LUTS?
Storage - Urgency, frequency, incontinence, feeling the need to urinate again just after passing urine Voiding - Hesitancy, weak stream, dribble, splitting, spraying, terminal dribble Post-micturition - Dribble, sensation of incomplete emptying
398
Conditions associated with LUTS?
``` BPH Prostate/ bladder/ rectal cancer Bladder outlet obstruction Overactive bladder Antimuscuruics Diabetics autonomic neuropathy Stree incontince Neurological conditions LUTI, STI, prostitis ```
399
Risk factors of LUTS?
``` Diabetes Increase serum dihydrotestosterone Obesity Increase size of prostate Bladder decompensation ```
400
Diagnosis process of a patient with LUTS?
- History - Examination: Abdo (bladder), External genitalia, - Digital rectal exam, Perineum and lower limbs for motor and sensory function - International prostate symptom score - Urine, eGFR, PSA
401
What is PSA?
Prostate-specific antigen is a glycoprotein produced by both normal and cancerous prostate cells into prostatic fluid to allow spermatozoa to move more freely
402
Factors that can increase PSA?
``` Prostate enlargement Prostate manipulation Exercise Cancer DRE Ejaculation ```
403
Factors that can decrease PSA?
``` 5ARI Aspirin Statins Thiazide Obesity ```
404
The scoring system used to assess the severity of LUTS and impact on quality of life?
International prostate symptom score >8
405
1st line management of voiding problems?
Alpha blocker - Tamsulosin, Alfuzosin, Doxazosin, Terazosin
406
2nd line management of voiding problems?
5-alpha reductase inhibitor - Finasteride or Dutasteride
407
1st line + 2nd line medication for voiding problems has been ineffective. What other medication can be used?
Antimuscarinic - Oxybutynin, Tolterodine, Darifenacin
408
What is Mirabegron?
Used for an overactive bladder when antimuscrinics are not effective Beta3 agonist that help the bladder relax
409
Management of acute on chronic urinary retention?
Alfuzosin for 24 hours before catheter then remove the catheter and see if they can void freely
410
Management of post micturition dribble?
Milk urethra after urinating (if not caused by obstruction) - press fingers behind the scrotum and gently massage bulbar urethra in forwards and upwards motion Urine containment products
411
Signs of lung cancer?
``` Haemoptysis SOB Chest pain Weight loss Bone pain Fatigue Loss of appetite Chest infection ```
412
Prognosis of lung cancer?
<10% survive 5 years after diagnosis
413
Risk factors of lung cancer?
``` Smoking Asbestos exposure Occupational exposure COPD Lung fibrosis ```
414
Diagnosis of lung cancer?
History CXR + CT Biopsy
415
What is a Pancoast tumour?
Tumour found in the apex of the lung that can invade the sympathetic nervous system e.g. horner's syndrome and damage brachial plexus
416
Examples of paraneoplastic effects of small cell lung cancers?
SIADH Hypercalcaemia Ectopic ACTH Lambert-eaten myasthenic syndrome
417
Where do lung mets travel to?
Bone Brain Liver Adrenals
418
Management of lung cancer?
- Biopsy and stage - Chemo or radio - Lobectomy or pneumonectomy - Smoking cessation - Palliative care
419
What is menopause?
When menstruation stops due to loss of ovarian follicular activity. 12 months of amenorrhoea
420
Causes of premature menopause?
Bilateral oophorectomy | Premature ovarian insufficiency
421
Physiology of menopause?
- Ovarian follicles begin to fail - Oestrogen + Inhibin decrease so reduce -ve feedback effect of FSH + LH - Decreased oestrogen causes hot flushes and night sweats (vasomotor symptoms) - Decreased Estradiol so endometrium not stimulated enough an period stops
422
Risk factors of early menopause?
``` Early menarche Nulliparity or Low parity Smoking Being underweight Premature ovarian insufficiency ```
423
Complications of menopause?
``` Osteoporosis + rib fracture CVD Stroke GU symptoms T2DM ```
424
Symptoms of menopause?
Change in menstrual pattern Vasomotor symptoms (hot flush and night sweat) Mood changes Cognitive impairment Vulvovaginal irritation, dryness, dysuria, dyspareunia, low libido Sleep disturbance
425
Diagnosis of menopause?
Amenorrhoea for 12 months FSH <45 + symptoms, x2 samples 4 - 6 weeks apart Osteoporosis risk BP + BMI
426
Ddx of menopause?
Secondary amenorrhoea Irregular bleed - fibroids, polyps, hyperplasia Hot flush - Hyperthyroidism, carcinoid, alcohol, anxiety, TB Vaginal atrophy
427
SE of HRT?
``` Fluid retention Bloating Breast tenderness/ enlargement Nausea Headache Cramps Dyspepsia Unschedules vaginal bleeding ```
428
CI of HRT?
``` Breast cancer history Oestrogen dependant cancer Undiagnosed vaginal bleeding Endometrial hyperplasia Thromboembolic disease Thrombophilic disorder ```
429
Management of vasomotor symptoms of menopause?
Oral or transdermal Estradiol +/- progesterone
430
What are migraines?
Primary headaches not associated with an underlying condition. Usually unilateral and described as throbbing or pulsating
431
Associated symptoms of migraines?
``` Photophobia Phonophobia Nausea Vomiting +/- Aura ```
432
Causes of migraines?
``` Cheese OCP Caffeine Alcohol Anxiety Travel Exercise Obesity Sleep disorders Stress Anxiety and Depression ```
433
Complications of migraines?
``` Medication overuse headaches Progress into chronic headaches Status migrainosus - attack lasting >72 hours Seizure Increased risk of stroke ```
434
Examples of atypical aura?
``` Motor weakness Double vision Poor balance Visual symtoms only affecting 1 eye Decreased level of consciousness ```
435
Prodromal symptoms of migraines?
``` Fatigue Poor concentration Neck stiffness Yawning 1-2 days before ```
436
Postdromal symptoms of migraines?
Fatigue Change in mood Lasting 48 hours
437
Full headache assessment?
SOCRATES Dx Examination: vitals, fundoscopy, cranial + peripheral nerves, extracranial structures
438
Ddx of migraines?
Trigeminal neuralgia Tension headache Cranial or cervical vascular disorders (GCA or haemorrhage) Substance withdrawal
439
Management of migraines?
Avoid triggers Headache diary Good sleep hygiene Paracetamol or Ibuprofen
440
2nd line migraine management?
Triptan (sumatriptan) at the start of the headache
441
3rd line migraine management?
Triptan + Paracetamol/ NSAID
442
1st line migraine prophylaxis?
Propanolol or Topiramate (inhibit glutamate pathway and increase GABA by blocking calcium and sodium channels) or Riboflavin
443
What medication is given alongside Triptans?
Antiemetics e.g. Prochlorperizine or Metoclopramide
444
How does the incidence of migraines change before and after puberty?
Before puberty - equal between males and females After puberty - More females than males
445
CI of triptans?
``` Cardiovascular disease Arrhythmia Hypertension Cerebrovascular disorders Severe hepatic impairment on MAOI ```
446
Migraine medication CI in < 18-year-olds and pregnant women?
Topiramate
447
What are the 4 variations of motor neurone disease?
- Amyotrophic lateral sclerosis - Progressive bulbar palsy - Progressive muscular atrophy - Primary lateral sclerosis
448
Order of progression of MND symptoms?
Limb onsent - Bulbar onset - Resp onset
449
Medication used to treat fasciculations of MND?
Riluzole - inhibits glutamate release and inhibit ach receptors
450
Symptoms of MND?
Weakness of distal limbs Bulbar onset - difficulty swallowing, talking, chewing Difficulty holding objects Fasciuclations Gait disorder Difficulty rising from chair Bladder, bowel and oculomotor function affected in later stages
451
4 medications used in palliative care and their uses?
Opioids Hyoscine butylbromide Diazepam Anti-depressants
452
3 factors that make up the el escorial criteria to diagnose MND
Evidence of LMN + UMN Progressive spread of symptoms or signs within a region or other regions Absence of other causes of LMN +/- UMN
453
What is advanced planning and what does it involve?
Documents that states the wishes of the patient while they still have the capacity to make decisions. It can include DNACPR, hospital admissions, place of death, feeding, medication that prolongs life
454
What do most people with MND die of?
Resp failure | Pneumonia
455
How would ALS differ in presentation to progressive bulbar palsy?
ALS - fasciculations, stiff muscles, muscle wasting (limb onset - Bulbar onset - Resp onset) PBP - lesions of UMN of 9,10,12 so only difficulty swallowing, talking or chewing
456
Difference between progressive muscular atrophy and primary lateral sclerosis?
PMA - only affects small muscles of hands and feet PLS - involved UMN of legs (bladder, bowel and extraocular muscles are spared)
457
Ddx of MND?
``` Gulllain-Barre Diabetic amyotrophy Myasthenia gravis Diabetic neuropathy Spinal cord tumours Polymyositis or Dermatomyositis ```
458
Diagnosing MND?
Electrophysiological studies + nerve conduction studies CT/ MRI Bloods Muscle biopsy
459
What do electrophysiological studies show when a patient has MND?
Fibrillation + Fasciculations - High amplitude and duration
460
Pathophysiology of MND?
Lesions involving UMN + LMN of the anterior horn cells of the spinal cord Sporadic MND associated with mutation of superoxide dismutase-1 gene
461
What is polymyalgia rheumatica?
Chronic systemic inflammatory disease characterised by aching and morning stiffness in the neck, shoulder and pelvic girdle in people aged 50+
462
Causes of polymyalgia rheumatica?
Genetic and environmental | Synovitis of proximal large joints, tenosynovitis and bursitis
463
Complications of polymyalgia rheumatica?
GCA | Long term corticosteroid use
464
Symptoms of polymyalgia rheumatica?
>50 + 2 week history Bilateral shoulder pain (tender) radiates to elbow Pelvic girdle pain Hip pain radiating to the knee Neck pain Morning stiffness other: Low-grade fever, fatigue, weight loss, depression
465
Ddx of polymyalgia rheumatica?
Inflammatory: RA, SLE, Spondyloarthropathy, Poly or dermato Thyroid disease Degenerative disorder: Osteo, Spondylosis, Adhesive encapsulates Osteomalacia Fibromyalgia Chronic fatigue syndrome Osteomalacia
466
Management of polymyalgia rheumatica?
1 to 2-year course of oral prednisolone | PMR support groups e.g. versus arthritis
467
What is rheumatoid arthritis?
Chronic systemic inflammatory disease. Inflammatory symmetrical arthritis of the small joints of hands and feet
468
Extra-articular manifestations of rheumatoid arthritis?
``` Vasculitis Keratoconjunctivitis Parenchymal lung disease Rheumatoid nodules Oesophagitis Pericarditis Peripheral Neuropathy Anaemia Glomerulopathies ```
469
Symptoms of rheumatoid arthritis?
Symmetrical synovitis of small joints of hands and feet Pain worse at rest, better by movement Early morning stiffness lasting >1 hour Rheumatoid nodules found on extensor surfaces
470
Ddx of rheumatoid arthritis?
``` Osteoarthritis Connective tissue disorders e.g. SLE Fibromyalgia Polymyalgia rheumatica Psoriatic arthritis Reactive arthritis Septic arthritis Seronegative spondyloarthritis ```
471
Bloods required to confirm a diagnosis of rheumatoid arthritis?
Anti-cyclic Cirtrullinated peptide | Rheumatoid factor
472
classic hand signs of rheumatoid arthritis?
``` Swan neck deformity Boutonniere Z shaped thumbs Ulnar deviation MCP subluxation ```
473
Management of suspected rheumatoid arthritis?
referral within 3 weeks | NSAIDs + PPI
474
Management 1st line management of confirmed rheumatoid arthritis?
Methotrexate
475
What is T1DM?
Autoimmune destruction of the beta cells of the islet of langerhans resulting in no/ decreased insulin production and chronic hyperglycaemia
476
When are most people diagnosed with T1DM?
During childhood between 10 and 14
477
Counterregulatory hormones of insulin?
Cortisol Glucagon Catecholamines GH
478
Blood glucose measurement that confirms hypoglycaemia?
<3.5mmol/L
479
What other autoimmune conditions are associated with T1DM?
Autoimmune thyroid disease Pernicious Anaemia Addison's disease
480
What is DKA?
Diabetic ketoacidosis | Hyperglycaemia + Metabolic acidosis + Ketonaemia
481
Signs of DKA?
``` Polyuria, polydispsia D+V Visual disturbances Lethargy Acidotic breathing (Kussmaul respiration) Dehydration signs Sunken eyes ```
482
Signs of hypoglycaemia?
``` Confused with being drunk Hunger Irritability Sweating Palpitations Tremor Weakness Lethargy Confusion Irrational behaviour ```
483
What is DAFNE?
Dose Adjustment For Normal Eating | - Self-education programme for T1DM to live normal lives, manage risk and understand their condition
484
Examples of rapid-acting insulin?
Humalog or Novorapid | 15 min onset lasting 2 to 5 hours
485
Examples of short-acting insulin?
Actrapid or Humulin S | 30 to 60 min onset lasting 8 hours
486
Examples of intermediate-acting insulin?
Isophane, Humulin I, Insuman Basal, Insulatard | 1 to 2-hour onset lasting 11 to 24 hours
487
Examples of long-acting insulin?
Insulin Glargine, Insulin detemir, Insulin Degludec | Last 24 hours with steady-state achieves after 2 to 4 days
488
What is the multiple daily injections of basal-bolus insulin?
Short/ rapid acting before a meal + intermediate/ long for basal requirement
489
What is the biphasic regimen for insulin?
1,2,3 insulin injections of short/rapid mixed with an intermediate action
490
How does an insulin pump work?
Regular continuous basal-bolus by SC cannula or needle
491
What is DESMOND?
Diabetes Education for Self-Management for Ongoing and Newly Diagnosed
492
What is T2DM?
Metabolic disorder characterised by persistent hyperglycaemia due to peripheral insulin resistance or decreased insulin production
493
Risk factors of T2DM?
``` Obesity Dyslipidaemia Asian or Afro-Caribbean PCOS History of gestational diabetes Metabolic syndrome Endocrine disorders ```
494
1st line management of T2DM?
Metformin
495
Order of T2DM medication?
``` Biguanide - metformin DPP4 inhibitors - Sitagliptin Thiazolidinediones - Pioglitazone Sulfonylureas - Gliclizide SGLT2 Inhibitors - Canagliflozin ```
496
Symptoms of TB?
``` Fever Malaise Night sweats Fatigue Loss of appetite Breathlessness Haemoptysis ```
497
How long after exposure can symptoms of TB develop?
3 weeks
498
3 examples of extrapulmonary manifestations of TB?
``` Renal TB TB meningitis Lupus vulgaris Hepatitis Addisons disease ```
499
What is a ghon complex?
Caseous granuloma found in the mid/lower lobes that has spread to nearby lymph nodes which have also become caseated
500
What is a ranke complex?
When ghon complex undergoes fibrosis and calcification
501
Risk factors of TB?
``` Migrating to another country immunocompromised Elderly <5 Close contact Recent travel ```
502
How is TB transmitted?
Respiratory droplets and contaminated food
503
2 methods of screening for TB?
Tuberculin test | Interferon-gamma release assay
504
Stain used to confirm the presence of TB and what colour does it go?
Ziehl-Neelsen | Bright red rods
505
Ddx of TB?
``` Pneumonia Lung cancer COPD Asthma Occupational lung disease ```
506
What investigations can be done to differentiate between TB, Pneumonia and Lung cancer?
``` Tuberculin test Interferon-gamma release assay CXR Sputum culture Blood culture Tumour markers in blood History ```
507
What would be positive on a urine dipstix of a patient that has suspected renal TB?
Sterile pyuria
508
Management of TB?
``` 4 months RIPE, 2 months RI Rifampicin Isoniazid (Pyridoxine) Pyrazinamide Ethambutol ```
509
What medication has to be given alongside isoniazid and why?
Pyridoxine - isoniazid can decrease B6 leading to peripheral neuropathy
510
How is reactivated TB able to spread to other parts of the lungs or even systemic circulation?
When a patient gets older or becomes immunocompromised, it can spread to the upper lobes of the lung where there is greater concentrations of oxygen and replicate Cavities form to the bronchioles and systemic circulation
511
Suspected TB patient, what factors would be important in the initial consultation?
``` Recent travel Contact with people Occupation Smoking Living situation Immunocompromised Duration of symptoms ```
512
What are some difficulties immigrants face when accessing healthcare?
``` Language barrier No contact details No fixed address Not knowing where to access help Transport ```
513
Groups of people who are not ordinary residents who can still have access to free secondary care?
``` Asylum seekers Victims of human trafficking Prisoners Children under local protection Detained immigrants ```
514
What type of hypersensitivity is TB?
Type 4 - granuloma formation
515
What can be causing a rise in TB infection?
Increasing HIV+ve patients People not complete the whole 6 months of medication Increasing migrants from TB high countries Increasing homeless
516
Uncomplicated UTI?
Caused by typical pathogens in people with normal urinary tract and kidney function with no predisposing co-morbidities
517
Complicated UTI?
Increased likelihood of complications such as persistent infection, treatment failure and recurrent infection Catheter Structural abnormalities of UT Virulent organism Comorbidities e.g Diabetes or Immunosuporessed
518
Recurrent UTI?
2+ UTI within 6 months or 3+ in 1 year
519
Relapse UTI?
Infection due to the same organism
520
Cause of UTI?
Bacteria of the GI tract e.g. retrograde, blood or instrumentation
521
Risk factors of UTI?
``` Sexual intercourse Childhood UTI history Urinary incontinence Catheter Urological instrumentation DM or immunosuppressed ```
522
Complications of UTI?
Ascending infections e.g. pyelonephritis, renal or perirenal abscesses, renal failure, Urosepsis
523
Symptoms of UTI?
``` Frequency Urgency Dysuria Odor Change in urine consistency + colour Nocturia Delirium in elderly ```
524
Ddx of UTI?
Pyelonephritis STI Reactive arthritis Urolithiasis
525
1st line management of UTI?
Nitrofurantoin or Trimethoprim
526
2nd line management of UTI?
Nitrofurantoin or Pivmecillinam or Fosfomycin
527
Management of UTI if haematuria present?
Restates urine sample after antibiotic and if it persists then refer to specialist
528
Non-pharmacological management of UTI?
Avoid douching or occlusive underwear Wipe front to back after defecation Poet-coital urination Increased hydration
529
Pregnant + UTI management?
Nitrofurantoin or Amoxicillin or Cefalexin
530
1st line treatment of catheter-associated UTI?
Nitrofurantoin / Trimethoprim | Amoxicillin
531
2nd line treatment of Catheter-associated UTI?
Pivemcillinam
532
Vaginal discharge caused by bacterial vaginosis?
``` pH>4.5 Fishy smelling Thin Grey/ white No itch or soreness ```
533
Vaginal discharge caused by vaginal candidiasis?
``` pH<4.5 White Odourless Cottage cheese Vulval itch + soreness ```
534
Vaginal discharge caused by Trichomoniasis?
``` pH>4.5 Fishy smelling Yellow/ green Frothy Itching Soreness Dysuria ```
535
Examination of a patient with abnormal vaginal discharge?
- Palpate abdomen - Inspect vulva - lesion, tender, mass, discharge - Speculum examination - pH sample from the lateral wall of the vagina - High vaginal swab (Amies transport medium with charcoal) - Pregnancy test - Urine dipstix
536
Strawberry cervix?
Trichomoniasis
537
What is cryptorchidism?
Incomplete descent of 1 or both testes from the abdomen to the scrotum through the inguinal canal
538
True cryptorchidism?
Testes lie along the normal path of descent in the abdomen or inguinal region but not made it to the scrotum
539
Ectopic testis?
Testes lie outside the normal path of descent, outside of the scrotum e.g. femoral region, perineum, penile shaft, opposite hemiscrotum
540
Ascending testes?
Previously made it to the scrotum but moved to a higher position over time Persistent processus vaginalis which prevents the elongation of testicular vessels and vas deference
541
Absent or atrophic testis?
Missing testis, seen at birth then disappear Atrophy can be due to lack of testicular blood supply
542
Causes of cryptorchidism?
Disruption in hormonal control of testicular descent during fetal development Disorder of sexual development e.g. congenital hypogonadism, lack of androgen, congenital adrenal hypoplasia
543
Risk factors of cryptorchidism?
``` Family history Preterm Low birth weight Endocrine disorders Disorders of sexual development Maternal smoking ```
544
Complications of undescended testes?
Impaired fertility (scrotum is cooler than lower abdomen) Testicular cancer Testicular torsion Inguinal hernia
545
Screening for undescended testes?
within 72 hours of birth and 6-8 weeks after Re-examine at 4-5 months
546
Management of palpable undescended testes?
Orchidopexy - Freeing the testes and implanting them into the scrotum
547
Management of non-palpable undescended testes?
Inguinal exploration and diagnostic laparoscopy
548
What are the 2 phases of testicular descent?
Transabdominal phase - testicular hormone Inguinal scrotal phase - androgens
549
Prehn's sign indicates what?
Pain and tenderness of testes relieved by elevation
550
Testicular cause of scrotal pain/ swelling?
Testcicular torsion (torsion of spermatic cord) Torsion of testicular or epididymal appendage Testicular cancer Squamous cell carcinoma of the scrotum Indirect inguinal hernia Epididymo-orchitis
551
Extra-testicular causes of scrotal swelling?
``` Haematocele Varicocele Hydrocele Epididymal cyst Indirect inguinal hernia Idiopathic scrotal oedema in children Squamous cell carcinoma of the scrotum ```
552
Haematocele?
Sudden or chronic onset Painful and tender Doesn't illuminate as well as hydrocele Usually occur with trauma but can occur with cancer
553
Epididymal cyst/ Spermatocele?
Chronic onset Painless, non-tender, smooth, soft, round nodule of epididymis No transillumination
554
Varicocele?
Dilation of internal spermatic veins + pampiniform plexus of spermatic cord Painless, non-tender but dull discomfort Bag of worms There when standing then disappears when lying down
555
Hydrocele?
Ovoid swelling enveloping the testis or located above testis along spermatic cord Transilluminates Common in neonates
556
Indirect inguinal hernia?
Painless unless strangulated or incarcerated Dull/ dragging discomfort in scrotum Enlarge with valsalva manoeuvres and disappear when laying down Can't get above swelling or palpate spermatic cord
557
Squamous cell carcinoma of the scrotum?
Chronic onset Painless Raised papule/ plaque on scrotal wall that is purulent Inguinal lymphadenopathy
558
What cause of scrotal swelling appears clear on transillumination?
Hydrocele
559
Testicular torsion?
``` Neonatal or around puberty History of undescended testis Sudden onset Severe unilateral pain + Nausea/ vomiting Absent cremesteric reflex ```
560
Torsion of appendix testis or appendix epididymis?
Embryological remnants that become tort during adolescence Pain on head of testis or epididymis not associated with nausea or vomiting Nodule grows to generalised scrotal oedema Cremesteric reflex normal
561
Epididymo-orchitis?
Gradual onset over days Prehn sign +ve Swelling Urethral discharge and vomiting/ nausea
562
Blue dot sign?
Infarcted appendage of testis or epididymis
563
Management of testicular torsion?
Urgent admission to urology or paediatric surgery
564
What age do hydroceles normally resolve by?
2 years old
565
complication of testicular torsion?
Segmental ischaemia of testis
566
What can be measured in blood to confirm testicular cancer?
Alpha feto-protein | Human Chorionic gonadotropin levels
567
Causes of contraception failure rates?
User failure - not used properly | Method failure - Even when the method was used, pregnancy still occurred
568
Things to consider when discussing contraceptive choices?
``` Age Patient preference Co-morbidities Other medication taken BMI History of cancers Pregnancy Protection against STI ```
569
MOA of COCP?
Combined synthetic oestrogen and progesterone - Suppress synthesis and secretion of FSH + LH needed for ovarian follicles and ovulation - Thicken cervical mucus - Inhibit blastocyst implantation in the endometrium
570
Potential side effects of COCP?
``` VTE risk BTB Mood swings MI Stroke Breast cancer ```
571
Benefits of COCP?
``` Effective Reversible Relief of menstrual problems Can protect against PID Reduced incidence of breast, ovarian and endometrial cancer ```
572
Examples of progesterone-only contraceptive pill?
Levonorgestrel or Desogestrel | Levonelle - emergency contraception
573
MOA of POCP?
Inhibit ovulation Delay ovum transport Thick cervical mucus Endometrium becomes unstable for implantation
574
3 types of progesterone-only injectable contraceptives and how long they last?
Depo - 12 weeks Sayana - 13 weeks Noristerat - 8 weeks
575
What form of contraception is not easily reversible?
Progesterone-only injectable contraceptive
576
What is the progesterone-only subdermal implant?
Etonogestrel (Nexplanon) | Long-acting reversible contraceptive combined in a rod that is slowly released into systemic circulation
577
MOA of IUD-Cu?
T shaped device that is inserted into the uterus - Prevents fertilisation due to copper effect on ova or sperm - Cu affects cervical mucus so reduced sperm penetration - Induces endometrial inflammation giving anti-implantation effect
578
Types of Levonogestrel-releasing IUD?
Mirena - 5 years | Jaydess - 3 years
579
CI of COCP?
``` >35 and smokes >15 a day Migraine with aura BP >160/100 Cardiovascular disease Thromboembolic conditions Breast cancer BMI >35 Immobile Diabetes Gall bladder disease ```
580
What is the age of consent?
16
581
What is the difference between Gillick competence and Fraser guidelines?
Gillick - <16 can make any medical decisions without the consent of the parents Fraser guidelines - <16 makes medical decisions with regards to contraception and contraceptive advice without parental consent
582
Male symptoms of chlamydia?
Urethral discharge Dysuria Urethral discomfort Reactive arthritis
583
Female symptoms of chlamydia?
Cervix/ Urethral/ vaginal discharge Post-coital or intermenstrual bleeding Dyspareunia Pelvic pain
584
What can NAAT be used to confirm the presence of?
Chlamydia or Gonorrhoea
585
1st line management of chlamydia?
Doxycycline
586
Complications of chlamydia?
``` PID Epididymo-orchitis Adult conjunctivitis Reactive arthritis Neonatal infections Low birth weight ```
587
1st line management of Gonorrhoea?
Refer to GUM + Ceftriaxone
588
Male symptoms of Gonorrhoea?
Purulent urethral discharge Rectal discharge/ Pain/ Tenesmus/ Bleeding Pharyngeal infection
589
Female symptoms of Gonorrhoea?
``` Vaginal discharge Lower abdo pain Dysuria Dyspareunia Endocervical bleeding Abdo tender Mucopurulent discharge ```
590
What organism causes Chlamydia?
Chlamydia Trachomatis
591
What organism causes Gonorrhoea?
Neisseria Gonorrhoea
592
Complications of Gonorrhoea?
``` PID Miscarriage Congenital infections Epididymo-orchitis Prostitis Urethral stricture Infertility ```
593
How does syphilis enter the blood?
Through skin abrasions or intact mucous membranes then into the blood. Inoculation period of 3 months
594
What organism causes syphilis?
Treponema Pallidum
595
1st line management of syphilis?
Benzathine Penicillin or Azithromycin
596
Difference between primary and secondary syphilis?
Primary - Localised painless papule that becomes an ulcer Secondary - Generalised headache, malaise, fever, polymorphic non-itchy rash of palms, soles, face
597
3 main systems affected tertiary syphilis?
Cardiovascular - Aortic root dilation, regurg, aneurysm Gummatous - inflammatory fibrous nodules which are locally destructive Neuro - Dementia
598
What organism causes Trichomoniasis?
Trichomoniasis Vaginalis
599
Symptoms of Trichomoniasis?
``` Fishy green/ yellow frothy discharge Strawberry cervix Purulent urethral discharge Dysuria Frequency ```
600
Investigations used to confirm Trichomoniasis?
``` Abdo exam High vag swab pH + speculum Urethral swab First void urine ```
601
What STI can be detected using blood tests?
Syphilis + HIV
602
Management of Trichomoniasis?
Refer to GUM | Metronidazole
603
Complications of Tichomoniasis?
``` Perinatal complications Postpartum sepsis Low birth weight PID Increased risk of cervical cancer Infertility Prostatitis ```

Phase 3a (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions