MEMORISE Flashcards
(295 cards)
1
Q
In anorexia nervosa what are part of the blood tests?
A
Most things are low C and G are raised
gh, glucose, salivary glands, coritsol, cholestrol and carotinaemia
2
Q
Lithium side effects
A
nephrotxicity
hypothyroidism
hyperparathyrodisim
leucocytosisi
3
Q
All tb patients musty have what test?
A
HIV test
4
Q
Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?
A
osteomalacia
5
Q
Third nerve palsy features and causes
A
down and out
ptosisi and dialated pupil (surgical)
Mydriasis
painful= PCA
Vasculitits
DM
Cavernous isnus thrombosis
Webers
6
Q
chadvasc 0 and ready to discharge what must be done before this
A
transthoracic echo
7
Q
what drugs should be stopped because the worsen renal function in AKI
A
- NSAIDs (except if aspirin at cardiac dose e.g. 75mg od)
- Aminoglycosides
- ACE inhibitors
- Angiotensin II receptor antagonists
- Diuretics
8
Q
what drugs should be stopped because they increase risk of toxicity in aki
A
Metformin
* Lithium
* Digoxin
9
Q
TB drug management and 2 sx of each
A
RIPE 6622
Rifampicine- orange red tears, hepatitis
Isonazine- peripheral neuropathy have to give pyridoxine (b6), agranulocytosis
Pyrazinamide- gout and arthlagoa
Ethambutol- optic neuritis check VA before treasting
10
Q
Jaundice in babies
causes in
24 hours
2-14 days
after 14 days
A
first 24 hours always pathological RAH g
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
2-14 physiological- It is more commonly seen in breastfed babies
prolonged - uncojugated= BA
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
cmv
11
Q
asthma attack management
A
Oh, shit, I, Hate, My, Asthma
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol
12
Q
normal CTG
A
Baseline fetal heart rate (FHR) is between 110-160 bpm * Variability of FHR is between 5-25 bpm * Decelerations are absent or early * Accelerations x2 within 20 minutes.
13
Q
in Pneumonia what ABX managment is there
A
low severity- amoxicillin 5 day
Moderate severity- amoxicillin + erythromycin - 7-10
Severe co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia
14
Q
by using irridated transfusion products what is prevented
A
graft vs host disease
14
Q
by using irridated transfusion products what is prevented
A
graft vs host disease
15
Q
What antibody is found in limited cutaneous systemic sclerosis
WHat antibody in diffuse cutaneous systemic sclerosis
A
ACA
Anti scl 70
16
Q
what drugs cause urinary retention
A
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
17
Q
how is hydrocortisone split in patients with addisons
A
2 doses majority in mornuing
ie 20 at 8 am
10 at 5pm
18
Q
platelet level transfusions
A
no bleeding= 10x10^9
Active bleeding- haemesis, epistaxis- 30x10^9
critical bleeding eg cns- 100x10^9
18
Q
platelet level transfusions
A
no bleeding= 10x10^9
Active bleeding- haemesis, epistaxis- 30x10^9
critical bleeding eg cns- 100x10^9
19
Q
ATN vs prerenal causes
A
pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea
ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge
19
Q
ATN vs prerenal causes
A
pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea
ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge
19
Q
ATN vs prerenal causes
A
pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea
ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge
19
Q
ATN vs prerenal causes
A
pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea
ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge
20
ATN vs prerenal causes
pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea
ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge
20
ATN vs prerenal causes
pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea
ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge
21
ways to measure synthetic liver function
albumin and prothrombin time
prothrombin time faster result
22
how many day course abx in women
non pregnant nitro/trimeth 3 days
pregannt 7 days nitro
catheter 7 days
23
when must a person have a ct scan immediately
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
24
when must a person have a ct scan within 8 hours
age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes' retrograde amnesia of events immediately before the head injury
25
drugs avoided in breast feeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
26
significant pain and a tender lump
examination reveals a purplish, oedematous, tender subcutaneous perianal mass
thrombosed haemorroid
tool softeners, ice packs and analgesia. Symptoms usually settle within 10 days
27
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
dengue fever
27
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
dengue fever
28
webers syndrome
(branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
29
Lateral medullary aka wallenberg
Posterior inferior cerebellar artery
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
30
bradycardia management if doesnt respond to initial management
atropine, up to maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response
31
true love and witts criteria for severe UC
more than 6 bowel movements a day containing blood and systemic upset
fever
tachycardia
abdominal tenderness, distension or reduced bowel sounds
anaemia
hypoalbuminaemia
32
gynaecomastia caused by spironolactone switch to which drug
eplerenone
33
patients not suitable for parathyroidectomy what should they be started on?
patients not suitable for surgery may be treated with cinacalcet, a calcimimetic
a calcimimetic 'mimics' the action of calcium on tissues by allosteric activation of the calcium-sensing receptor
34
haemochromatosis main complication
hcc
35
low T3/T4 and normal TSH with acute illness
sick euthyroid syndrome
36
Metabolic ketoacidosis with normal or low glucose
alcoholic ketoacidosis
37
iX for PAD
hand held arterial doppler/duplex us--> ABPI
38
pneumonia and recent bout of flu
staph aureus
39
primary pneumothorax management
If the patient is NOT short of breath AND the pneumothorax is <2 cm on a chest x-ray conservative management is sufficient. The patient can be discharged and reviewed in the outpatient department in 2-4 weeks.
If the patient IS short of breath OR the pneumothorax is >2 cm the pneumothorax should be aspirated with a 16-18G cannula under local anaesthetic. If this is successful the patient can be discharged. If this fails an intercostal drain is necessary (and the patient must be admitted).
40
primary pneumothorax management
If the patient is NOT short of breath AND the pneumothorax is <2 cm on a chest x-ray conservative management is sufficient. The patient can be discharged and reviewed in the outpatient department in 2-4 weeks.
If the patient IS short of breath OR the pneumothorax is >2 cm the pneumothorax should be aspirated with a 16-18G cannula under local anaesthetic. If this is successful the patient can be discharged. If this fails an intercostal drain is necessary (and the patient must be admitted).
41
secondary pneumothorax management
If the patient is NOT short of breath AND the pneumothorax is <1 cm on the chest x-ray they do not require further invasive intervention but should be admitted for observation for 24 hours and administered oxygen as required.
If the patient is NOT short of breath and the pneumothorax is 1-2 cm on the chest x-ray aspiration is required. If this is successful the patient can be admitted for 24 hours of observation. If this is unsuccessful and intercostal drain is necessary.
If the patient IS short of breath OR the pneumothorax is >2 cm on the chest x-ray an intercostal drain is necessary (and the patient should be admitted).
42
anyone who has engaged in anal sex prescribe?
post exposure prohylaxis
43
What is autoimmune hepatitis
ANA and anti smooth muscle antibodies attacking the liver
usual live symptoms
Raised ALT and bilirubin with normal/mildly raised ALP.
Management
steroids, other immunosuppressants e.g. azathioprine
liver transplantation
44
management of non insulin dependent diabetes in surgery
Hold all oral diabetic medication on the morning of the procedure.
If the patient is on insulin then switch to sliding scale infusion (restart when they can eat).
Restart all oral medication the morning after surgery.
45
Peri-operative Management of Insulin Dependent Diabetics
Peri-operative management principles of insulin use are:
Put the patient as early on the theatre list as possible minimising the amount of time the patient is nil by mouth.
If on long acting insulin this should be continued but reduced by 20%.
Stop any other insulin and begin sliding scale insulin infusion from when the patient is placed nil by mouth.
Continue infusion until patient is able to eat post-operatively.
Switch to normal insulin regimen around their first meal.
46
does chadvasc metter in valvular pathology?
no always anticoagulate
47
patients on warfarin going a emergency surgery?
Patients on warfarin undergoing emergency surgery - give four-factor prothrombin complex concentrate
but if surgery in 8 hours
If surgery can wait for 6-8 hours - give 5 mg vitamin K IV
48
blood tests in dic
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes due to microangiopathic haemolytic anaemia
49
causes of large bowel obstruction
tumour
diverticular disease
volvulus
50
generalised tonic clonic seizures treatment
sodium valporate first
lamotrigine second/carbemazapine
51
absence seizures treatment
ethosuxamide then sodium valporate
52
myoclonic seizures
codium valporate first
lamotrigine= second line
53
focal seizures
carbemazapine/lamotrigine
54
abx safe in pregnancy
1st trimester trimethoprim
last trimester= nitrofurnatoin
55
posterior mi ecg changes
Changes in V1-3
Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2
Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)
56
first line investigation for heart failure and what to do after
Nt Pro BNP
if levels are 'high' arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are 'raised' arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks
57
osteoporosis mx
bisphosphonates
BNF states them to be contraindicated if the eGFR is less than 35 mL/minute/1.73m
58
drugs to avoid in chronic renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
Drugs likely to accumulate in chronic kidney disease - need dose adjustment
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
59
complications of type 1 neurofibromatosis
complications of nf2
optic glioma
bilateral vestibular schwannomas
60
under 90 af do we prescribe rate control
no but prescribe anticoagulation
61
ebv amoxicillin reaction known as
morbillifoprm eruption
62
peripheral neuropathy in crohns which medication
metronidazole
63
how do we work out absolute risk reduction
subtract the 2 numbers
64
how do we work out relative risk reducion
x/y
x= new control
65
in tachycardias if asthma and cant take adenosine what do we give
diltiazem
66
increased APTT, normal PT, and normal bleeding time?
haemophillia
67
Increased APTT, normal pt increased bleeding time
von willebrands disease
68
Increased APTT, PT, normal bleeding time
vitamin k deficiency
69
Serology of hep b
HBsAg= carrier status, present after 6 months= chronic infection
HBeAg= Marker of an infection
ANti-hbs= previous vaccination
anti hbc- past infection
if anti hbc is present and hbs, theyve got immunity from carrying it
Patients with acute infection have raised IgM to HBcAg, while this is negative in chronic infection (igG)
70
cor pulmonale effects which valve
failure of the right ventricle due to respiratory cause
71
what is creutzfeldt jakob disease
symptoms
a group of neuro-degenerative diseases caused by prions (mis-shaped proteins).
rapidly progressive dementia, psychiatric impairment, and myoclonus.
Diagnosis is by tissue biopsy. Tonsil/olfactory mucosal biopsy is less invasive and safer than brain biopsy. Supportive investigations include EEG (showing periodic sharp-wave complexes), MRI (showing basal ganglia hyperintensity), and lumbar puncture (showing abnormal proteins e.g. 14-3-3 protein).
mri to differentiate between sporadfic and variant
no cure
72
in a patient weith ppi whats the preferred method of induction
rsi
73
which artery may lead to bheart block
RCA
74
migraines in pregnancy
paracetamol 1g first
Nsaids safe in first and second trimester
75
symptoms of brown sequard syndrome
Ipsilateral spastic paresis
Ipsilateral loss of proprioception and vibration sensation
Contralateral loss of pain and temperature
76
subdural when is it acute vs when is it chronic
acute= under 72 hours
hypodense= chronic
77
neuro epileptic syndrome
antipsychotic medication/parkinsons
pyrexia, muscle rigidity, autonomic liability slower onset treated wiith iv fluids and dantrolene decreased reflex normal pupils
serotonin syndrome
maoi, ecstasy faster onset increase in reflexes, dialated pupils
treat with cyproheptadine and chlorpromazine
78
brain metastases which nerve usually affeced
abducens 6th nerve as thinnest
79
POST MI complciations
cardiac arrest
cardiogenic shock
chronic heartfailure
Tachyarrythmias
bradyarrythmias
Left ventricular anneurysm
Left ventricular wall rupture
VSD
acute mitral regurgitation
cardiac arrest= VF treat with defibrillator
Vtac- broad complex tachycardia
Bradyarrythmias- after inferior MI= av block
pericarditis= within 48 hours
dresslers syndrome- 2-6 weeks after
LV anneurysm= persistent st elevation
Left ventricular free wall rupture- featuures of cardiac tamponade- raised jvp, pulsus paradoxus and diminished heart sounds) need pericardiocentogeneisis
VS- pan systolic murmur
Mitral regurgitaton
80
name dopamine agonists
bromocriptine, ropinirole, cabergoline, apomorphine
Impulse control and pulmonary fibrosis
81
indications for rrt
acidosis
electrolyte abnormalities- hyperkalameia
Infection
O- pulmonary oedema
Uraemia- hepatic encephalopathy/ pericardiitis
82
do we treat asymptomatic bacteria in catheterised patients
no
83
what should be monitored in henoch schonlein purpura
blood press and urinalysis
84
how do we differentiate between syphilis and genital herpes
Genital herpes is mostly associated with painful ulceration, while syphilis presents mostly with painless ulceration
84
how do we differentiate between syphilis and genital herpes
Genital herpes is mostly associated with painful ulceration, while syphilis presents mostly with painless ulceration
85
severity of copd
mild= above 80%
moderate= 50-79%
Severe=30-49%
Very severe= less than 30%
86
clozapine side effects
agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
87
hyperkalaemia causes and ecg features
acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison's disease
rhabdomyolysis
massive blood transfusion
tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
88
resection needed for caecal, ascending or proximal transverse colon
right hemicolectomy
89
resection needed for distal transverse, descending colon
left hemicolectomy
90
resection needed for sigmoid colon
high anterior resection
91
in emergency situations/ after hartmans what anastamosis required
end colestomy
92
aortic regurgitation features
Early diastolic murmur
collapsing pulse
wide pulse pressure
quincke's sign - nailbed pulsation
de musst sign- head bobbing
93
aortic stenosis featuires
ejection systolic murmur radiates to
carotids
chest pain syncope
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure
94
mitral stenosis
caused by rheumatic fever
dysponea
haemoptysisi
mid-late diastolic murmur (best heard in expiration)
loud S1, opening snap
low volume pulse
malar flush
atrial fibrillation
95
mr
The murmur heard on auscultation of the chest is typically a pansystolic murmur described as “blowing”. It is heard best at the apex and radiating into the axilla. S1 may be quiet as a result of incomplete closure of the valve. Severe MR may cause a widely split S2
96
toxic multinodular goitre
autonomously functioning thyroid nodules resulting in hyperthyroidism.
Nuclear scintigraphy reveals patchy uptake.
The treatment of choice is radioiodine therapy.
97
low likelyhood of dvt
2 points or more- us if negative then ddimer
if 1 point- ddimer
if us not available interim anticoagulation
if the scan is negative but the D-dimer is positive:
stop interim therapeutic anticoagulation
offer a repeat proximal leg vein ultrasound scan 6 to 8 days later
98
ssri interactions
Interactions
NSAIDs: NICE guidelines advise 'do not normally offer SSRIs', but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin: see above
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
99
most common ovarian cyst
choc cyst
follicular cyst.
corpus luteum cyst - more lilkely to bleed
dermoid cyst- contains hair teeth skin
seous cysteadenoma- benigbn epithelial tumur
mucous cystadenoma- ruptures= pseudomyxoma peritonei
100
oseteomalacia
low vit d, low calcium, phosphate raised ALP
101
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
retinal vein occlusion
102
upper zone fibrosis
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
103
lower zone fibrosis
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
104
drug induced urinary retention
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
105
person with addisons keeps vomiting how should we manage
im hydrocortisone
106
lithium can cause what on blood tests
benign leucocystosis
107
causes of avascular necrosis of the hip
IX of choice
long-term steroid use
chemotherapy
alcohol excess
trauma
MRI is the investigation of choice. It is more sensitive than radionuclide bone scannin
108
men and voiding issues
if its predominately vodiing issues
conservative measures include: pelvic floor muscle training, bladder training,
if the prostate is enlarged and the patient is 'considered at high risk of progression' then a 5-alpha reductase inhibitor should be offered
if the patient has an enlarged prostate and 'moderate' or 'severe' symptoms offer both an alpha-blocker and 5-alpha reductase inhibitor
if overactive bladder
anticholinergics
oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)
108
men and voiding issues
if its predominately vodiing issues
conservative measures include: pelvic floor muscle training, bladder training,
if the prostate is enlarged and the patient is 'considered at high risk of progression' then a 5-alpha reductase inhibitor should be offered
if the patient has an enlarged prostate and 'moderate' or 'severe' symptoms offer both an alpha-blocker and 5-alpha reductase inhibitor
if overactive bladder
anticholinergics
oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)
109
prohylactic treatment for cdiff
Bezlotoxumab is a monoclonal antibody which targets Clostridium difficile toxin B
110
water dep test
111
Positive non-treponemal test + positive treponemal test
consistent with active syphilis infection
112
Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)
113
Negative non-treponemal test + positive treponemal test :
consistent with successfully treated syphilis
114
what is uhtoffs phenomenon
worsening of vision following rise in body temperature
115
lhermittes syndrome
paraesthesiae in limbs on neck flexion
116
lhermittes syndrome
paraesthesiae in limbs on neck flexion
117
p450 inductor on warfarin
increases metabolism of warfarin so DECREASES INR
Inducers
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John's Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
Inhibitors
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
118
t wave inversion in v1-v3
Arrhythmogenic right ventricular cardiomyopathy
sotalol
and implantable cardiac defib
119
Preceding influenza pneumonia
S aureus
120
head rapidly accelerated and decelerated injury
1. Multiple haemorrhages
2. Diffuse axonal damage in the white matter
121
reversible causes of dementia screening
FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate
122
when should ebta blockers be stopped in a person with heart failure
beta-blockers should only be stopped if the patient has heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock
123
haemodynamically stable ectopic management
Surgical - laparoscopic salpingectomy
OPEN ONLY DONE IF UNSTABLE
Surgical - open salpingectomy
124
WHEN SHOULD WE DO SALPINGOTOMY
Salpingectomy is first-line for women with no other risk factors for infertility
Salpingotomy should be considered for women with risk factors for infertility such as contralateral tube damage
125
if diagnosis of acute cholecystitis uncertain after US
technetium-labelled HIDA scan may be done
126
open fracture first line
administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film.
127
iscahemic collitis mainly affects the
splenic flexure
128
dry age related macular degen management
beta carotene. vitamin A,C,E and zinc
129
most common fracture in foot
most common fracture as a result of stress frcatures
The proximal 5th metatarsal is the most commonly fractured metatarsal
The most common site of metatarsal stress fractures is the 2nd metatarsal shaft
130
contact lense wearers have 2 main infections
pseudomanas aeruginosa
and certain cases acanthamoebic keratitits
131
organic causes of ED
Gradual onset of symptoms
Lack of tumescence
Normal libido
132
organic causes of ED
Gradual onset of symptoms
Lack of tumescence
Normal libido
133
athletes foot treatment
topical imidazole, undecenoate, or terbinafine first-line
134
pityriasis vesicolour management
topical antifungal. NICE Clinical Knowledge Summaries advise ketoconazole shampoo as this is more cost effective for large areas
and oral itraconazole
135
most aggressive malignant melanoma
nodular
136
in temporal arteritis what eye nerve is affected
anterior ischaemic optic neuropathy- swollen pale disc and blurred margins
Ischaemia to anterior optic nerve
137
Diverticulitis symptoms + vaginal passage of faeces or flatus
colovaginal fistula
138
Diverticulitis symptoms + pneumaturia or faecaluria → ?colovesical fistula
colovesical fistula
139
weight loss in t2dm
SGLT-2 inhibitors
140
early shock
Late shock
early shock- Normal bp, tachycarsia, tachypnoea, pale skin, reduced urine output
Late shock- bradycardia, hypotension, acidotic, blue absent urine
141
cherry haemangiomas
benign spots due to proliferation of capillaries
142
Otalgia, fever, protruding ear and post-auricular tenderness
mastoiditis
143
when should we give abx in acute bronchitis
are systemically very unwell
have pre-existing co-morbidities
have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
NICE Clinical Knowledge Summaries/BNF currently recommend doxycycline first-line
doxycycline cannot be used in children or pregnant women
alternatives include amoxicillin
144
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast's, cervical rib
absent = post-ganglionic lesion: carotid artery
LEARN
145
mycoplasma features
IX
managemnt
haemolytic anaemia, thrombocytopenia
erythema multiforme, erythema nodosum
Mycoplasma serology
doxycycline or a macrolide (e.g. erythromycin/clarithromycin)
146
dermatomyositis antibody
ANA
147
complication of pelvic inflammatory disease in which the liver capsule becomes inflamed causing right upper quadrant pain. This leads to scar tissue formation and peri-hepatic adhesions. It usually occurs in women who have either chlamydia or gonorrhoea.
fitz hugh curtis syndrome
148
shoudl aspirin be stopped in aki
not if cardio protective
149
ace inhibitor significantly worsens renal function suspect
renal artery stenosis
150
ace inhibitor significantly worsens renal function suspect
renal artery stenosis
151
how are primary and secondary aldosteronism differentiated
Primary and secondary aldosteronism can be differentiated by looking at the renin levels. If renin is high then a secondary cause is more likely, i.e renal artery stenosis.
152
ckd vs aki
bilateral shrunken kidneys and hypocalcaemia
153
best investigation for hydronephrosis
us
154
severe hepatitis in a women
hepatitis e
155
tender goitre and hyperthyrodism
non tender
dequiverains thyroiditis
non tender= graves
156
pneumoperitoneum occurs in which condition
bowel perforation
157
rose spots on trunk after holiday
typhoid
158
rose spots on trunk after holiday
typhoid
159
upper gi bleed land mark
The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the ligament of Treitz
160
which drugs reduce mortality in heart failure
ACE-inhibitors
Beta-blockers
Angiotensin receptor blockers
Aldosterone antagonists
Hydralazine and nitrates
161
chicken pox ezposure before 20 weeks and after 20 weeks
before 20 wereks check antibodies and give vzig
after 20 weeks vzig or antivirals 7-14 days after exposure
162
scalp psoriasis management
NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks
if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid
163
management of infectious mononucleosis
rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture
164
serotonin syndrome caused by
monoamine oxidase inhibitors
SSRIs
St John's Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
ecstasy
amphetamines
165
how do we monitor haemchromatosis
ferritin and transferrin sat
low tibc
165
how do we monitor haemchromatosis
ferritin and transferrin sat
low tibc
166
order of management in hyperkalaemia
Stabilisation of the cardiac membrane
IV calcium gluconate
does NOT lower serum potassium levels
Short-term shift in potassium from extracellular (ECF) to intracellular fluid (ICF)
compartment
combined insulin/dextrose infusion
nebulised salbutamol
Removal of potassium from the body
calcium resonium (orally or enema)
enemas are more effective than oral as potassium is secreted by the rectum
loop diuretics
dialysis
haemofiltration/haemodialysis should be considered for patients with AKI with persistent hyperkalaemia
167
metclopromide should be avoided in
bowel obstruction
168
causes of drug induced lupus
Most common causes
procainamide
hydralazine
Less common causes
isoniazid
minocycline
phenytoin
169
when do we give abx in copd
They recommend giving oral antibiotics 'if sputum is purulent or there are clinical signs of pneumonia'
the BNF recommends one of the following oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.
170
non communicating hydrocephalus
headache
syringomyelia
Arnold-Chiari malformation
171
Management of mania/hypomania in patients taking antidepressants
stopping the antidepressant and start antipsychotic therapy
172
pkd associated with which valve abnormality
mitral valve prolapse
173
lower than expected levels of hba1c caused by
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
174
higher than expected levels of hba1c
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
175
diabetic neuropathy
sensory loss in a 'glove and stocking' distribution, with the lower legs affected first
176
hypomagnasemia treatment
<0.4 mmol/L or tetany, arrhythmias, or seizures
intravenous magnesium replacement is commonly given.
an example regime would be 40 mmol of magnesium sulphate over 24 hours
>0.4 mmol/l
oral magnesium salts (10-20 mmol orally per day in divided doses)
diarrhoea can occur with oral magnesium salts
177
high risk baby
passmed Feverish illness in children
178
hashimotos thyroiditis associated with which cancer
Hashimoto's thyroiditis is associated with thyroid lymphoma
179
all patients with mi should be given
dual antiplatelet therapy (aspirin plus a second antiplatelet agent-
ACE inhibitor
beta-blocker
statin
180
non fasted patients emergency setting do not use
laryngeal mask as not safe against aspiration
181
in heart failure which medication should we be careful with?
cyclizine as can reduce cardiac output
181
in heart failure which medication should we be careful with?
cyclizine as can reduce cardiac output
182
urinary incontinence
Urge incontinence
detrusor overactivity, urge to urinate followed by uncontrollable bladder emptying
bladder retraining
oxybutynin--> old= mirabegron
183
stres incontinence
laughing/coughing
Pelvic muscle training and duloxetine
184
functional incontinence
comorbid physical conditions impair the patient’s ability to get to a bathroom in time
causes include dementia, sedating medication and injury/illness resulting in decreased ambulation
185
abx for whooping cough
clarithromycin, azithromycin or erythromycin
186
ruptured AAA vs aortic dissection
ruptured aaa- hypotension
aortic dissection= raised bp
187
keloid scars
sternum, shoulder, neck, face, extensor surface of limbs, trunk
steroids and excision
188
causes of rapidly progressive glomerulonephritis
Goodpasture's syndrome
Wegener's granulomatosis
others: SLE, microscopic polyarteritis
formation of epithelial crescents on glomeruli
189
SAH- electrolyte abnormalityu
SIADH - hyponatraemia
190
blood product transfusion reactions
Non haemolytic febrile reaction
Minor allergic reaction
anaphylaxis
Acute haemolytic reaction
Tranfusion associated circulatory overload
TALI
Non haemolytic febrile reaction- fever chills- give paracetamol, slow and stop transfusion
Minor allergic reaction- pruritus and urticaria, temporary slow and stop transfusion and give antihistamines
anyphylaxis occurs when IgA deficiency and anti-IgA antibodies- stop supportive and IM adrenaline
acute haemolytic reaction- occurs due to human error- fever abdominal pain hypotension, stop transfusion and check identity send for cooms test
TACO- pulmonary oedema and hypertension- slow/stop transfusion give IV loop diuretic
TRALI- lung issue and hypotension= stop transfusion and give oxygen
190
blood product transfusion reactions
Non haemolytic febrile reaction
Minor allergic reaction
anaphylaxis
Acute haemolytic reaction
Tranfusion associated circulatory overload
TALI
Non haemolytic febrile reaction- fever chills- give paracetamol, slow and stop transfusion
Minor allergic reaction- pruritus and urticaria, temporary slow and stop transfusion and give antihistamines
anyphylaxis occurs when IgA deficiency and anti-IgA antibodies- stop supportive and IM adrenaline
acute haemolytic reaction- occurs due to human error- fever abdominal pain hypotension, stop transfusion and check identity send for cooms test
TACO- pulmonary oedema and hypertension- slow/stop transfusion give IV loop diuretic
TRALI- lung issue and hypotension= stop transfusion and give oxygen
191
heart failure not responding to ace i beta blocker aldosterone antagonist
next step IF
-Widended QRS complex
-Hr above 75 LVEF below 35%
widended qrs= Cardiac resynchronisation therapy
HR above 75- ivabradine
192
nitrous oxide should be used in caution in?
pneumothorax
193
classification of cerebral palsy `spastic-
increased tone from UMN
Dyskinetic- damage to basal ganglia and substantia nigra
Ataxic- cerebellum
194
renal tubular acidosis
all of them have hypercloraemic metabolic acidosis normal anion gap
type 1- inability to secrete h+ ions in distal tubule, leads to hypokalaemia
Type 2- decreased hco3- reabsorption inpct= hypokalamaeia
Type 4= reduced production in aldosterone= hyperkalaemia
195
in anayphylaxis after 2 doses opf IM adrenaline whaty dow e give
expert help should be sought for consideration of an IV adrenaline infusion
196
discharge during anaphylaxis
fast-track discharge (after 2 hours of symptom resolution):
good response to a single dose of adrenaline
complete resolution of symptoms
has been given an adrenaline auto-injector and trained how to use it
adequate supervision following discharge
minimum 6 hours after symptom resolution
2 doses of IM adrenaline needed, or
previous biphasic reaction
minimum 12 hours after symptom resolution
severe reaction requiring > 2 doses of IM adrenaline
patient has severe asthma
possibility of an ongoing reaction (e.g. slow-release medication)
patient presents late at night
patient in areas where access to emergency access care may be difficult
observation for at 12 hours following symptom resolution
197
discharge during anaphylaxis
fast-track discharge (after 2 hours of symptom resolution):
good response to a single dose of adrenaline
complete resolution of symptoms
has been given an adrenaline auto-injector and trained how to use it
adequate supervision following discharge
minimum 6 hours after symptom resolution
2 doses of IM adrenaline needed, or
previous biphasic reaction
minimum 12 hours after symptom resolution
severe reaction requiring > 2 doses of IM adrenaline
patient has severe asthma
possibility of an ongoing reaction (e.g. slow-release medication)
patient presents late at night
patient in areas where access to emergency access care may be difficult
observation for at 12 hours following symptom resolution
198
causes of erythema nodosum
infection
streptococci
tuberculosis
brucellosis
systemic disease
sarcoidosis
inflammatory bowel disease
Behcet's
malignancy/lymphoma
drugs
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy
199
how does digoxin work
inhibits Na+ k+ ATPase pump
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
Percipitated by anything hypo
200
globus hoarseness and no red flags
Globus, hoarseness and no red flags → ?laryngopharyngeal reflux
201
HOCM managment
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*
Drugs to avoid
nitrates
ACE-inhibitors
inotropes
202
in renal artery stenosis how do we manageme bp
ccb
203
reinfection with syphilis if
Reinfection with syphilis should be suspected if the RPR rises by 4-fold or more
204
what is maddreys discriminant function
calculated by a formula based on the prothrombin time and serum bilirubin for alcoholic liver disease
205
when is warfarin stopped before surgery
5 days before
206
syphilis abxc treatment problem
the Jarisch-Herxheimer reaction is sometimes seen following treatment
just give paracetamol
207
patients who are allergic to aspirin may also be allergic to
sulfazaline
207
patients who are allergic to aspirin may also be allergic to
sulfazaline
208
iniital investigations in incontinence
bladder diaries should be completed for a minimum of 3 days
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles ('Kegel' exercises)
urine dipstick and culture
urodynamic studies
209
what is the msot specific and sensitive lab finding in cirrhosis, in those who have liver disease
Thrombocytopenia (platelet count <150,000 mm^3) is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease
210
hep b post exposure
accelerated course of hep b vaccine and hep b immune globulin
211
hep b post exposure
accelerated course of hep b vaccine and hep b immune globulin
212
PSA levels may be raised by therefore should wait how long before testing
benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract
213
before starting bisphosphonates important to correct
hypocalcaemia and vit d deficiency
214
antiphospholipid syndrome treatment
if no previous thromboses- low dose aspirin
if previous then give warfarin
215
ankle ottawa rules
to know when to giev xray
bony tenderness at lateral malleolar zone
bony tenderness at medial malleolar zone
inability to walk four weight bearing steps
216
supraspinatus tendonitis and subacromial impingement painfula rc features
Rotator cuff injury
Painful arc of abduction between 60 and 120 degrees
Tenderness over anterior acromion
217
signs of sepsis and lower limb neurology
possible epidural abscess
218
metabolic acidosis with normal anion gap
Normal anion gap between 10-18
gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison's disease
219
metabolic acidosis with raised anion gap
actate:
shock
sepsis
hypoxia
ketones:
diabetic ketoacidosis
alcohol
urate: renal failure
acid poisoning: salicylates, methanol
220
how should bisphosphonates be taken
Oral bisphosphonates should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
221
in billiary colic what happens to the lfts
in biliary colic there is no fever and LFTs/inflammatory markers are normal
222
what is ludwigs angina
progressive cellulitis that invades the floor of the mouth
life threatening emergency
airway management and IV ABX
223
what is ludwigs angina
progressive cellulitis that invades the floor of the mouth
life threatening emergency
airway management and IV ABX
224
incisions
Midline incision
Commonest approach to the abdomen
Structures divided: linea alba, transversalis fascia, extraperitoneal fat, peritoneum (avoid falciform ligament above the umbilicus)
Bladder can be accessed via an extraperitoneal approach through the space of Retzius
Paramedian incision
Parallel to the midline (about 3-4cm)
Structures divided/retracted: anterior rectus sheath, rectus (retracted), posterior rectus sheath, transversalis fascia, extraperitoneal fat, peritoneum
Incision is closed in layers
Battle
Similar location to paramedian but rectus displaced medially (and thus denervated)
Now seldom used
Kocher's Incision under right subcostal margin e.g. Cholecystectomy (open)
Lanz Incision in right iliac fossa e.g. Appendicectomy
Gridiron Oblique incision centered over McBurneys point- usually appendicectomy (less cosmetically acceptable than Lanz
Gable Rooftop incision
Pfannenstiel's Transverse supra pubic, primarily used to access pelvic organs
McEvedy's Groin incision e.g. Emergency repair strangulated femoral hernia
Rutherford Morrison Extraperitoneal approach to left or right lower quadrants. Gives excellent access to iliac vessels and is the approach of choice for first time renal transplantation.
225
how are asymptomatic patients monitored in mitral stenosis
monitored with regular echocardiograms
226
what should be stopped in cdiff infections
opioids
227
obesity with abnormal lfts
non alcoholic fatty liver disease
228
Psoriatic arthiritis worrying complication
cardiovascular disease
229
management of lichen scleoriss
clobetasol propionate - a steroid
230
most common central line infection
staphylococcus epidermis
231
pathological fractures in bones prevented by
bisphosphonates if eGFR below 30 then denosumab
232
osteroporosis in a man make sure to check
serum testosterone
232
osteroporosis in a man make sure to check
serum testosterone
233
urinary incontinence first line treatments
Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training
233
urinary incontinence first line treatments
Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training
234
klebsiella pneumonia can cause what lung pathology
pleural empyema
235
bronchiecstasis most common organisms
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
236
copd sympotms in a young patient think?
a1at
237
Recurrent chest infections + subfertility
think cf if negative then
think primary ciliary dyskinesia syndrome (Kartagener's syndrome)
238
facial rash and lymphadenopaty
sarcoidosis
239
high risk of post op vomiting give what?
propofol
240
metronidazole and alcohol=
disulifram reaction
241
mnd how do we feed
peg tube
242
boerhaave syndrome IX and management
ct
Treatment is with thoracotomy and lavage
243
red flag for lower back pain
age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
thoracic pain
244
bowel perforation first line iX
ax double wall sign
245
contraindications to stroke thromolysis
active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension
246
inhaler technique
1. Remove cap and shake
2. Breathe out gently
3. Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply
4. Hold breath for 10 seconds, or as long as is comfortable
5. For a second dose wait for approximately 30 seconds before repeating steps 1-4.
Only use the device for the number of doses on the label, then start a new inhaler.
247
in haemorrhage shock, BP does not fall until abou
30% blood loss
248
managment of type 2 diabetes
249
what does a p450 inducer do to cocp
reduces effectiveness
250
for a bone fracture what do we do first
frax then dexa
251
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
dengue fever
252
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
dengue fever
253
Management of mania/hypomania in patients taking antidepressants
consider stopping the antidepressant and start antipsychotic therapy
254
chronic lithium toxicity leads to
hypothyroidism and high calcium and leucocytosis
255
type 1 bipolar is associated with
mania
type 2= hypomania
256
type 1 bipolar is associated with
mania
type 2= hypomania
257
how do we tell if parvovirus or acute sequestration
acute sequestration and haemolysis have a high reticulocyte count
258
threshold blood trasnfusions
70 in no acs
80 if acs
259
cryoprecipitate constitutes of?
factor 8, fibrinogen, vwf, factor 13
260
positive coombs test
autoimmune haemolytic anaemia
261
cll assocated with
warm autoimmune haemolytic anaemia and transformation to high grade lymphoma
262
large vessel vasculitis
temporal arteritis and takaysus arteritis
263
medium vessel vasculitis
polyarteritis nodosa and kawasaki disease
264
small vessel vasculitis
ANCA-associated vasculitides
granulomatosis with polyangiitis (Wegener's granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis
immune complex small-vessel vasculitis
Henoch-Schonlein purpura
Goodpasture's syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)
265
what is eosinophillic granulamatosis with polyangitis churg strauss syndrome
PANCA mediated small vessel vasculitis
asthma
eosinophillia
sinusitis
266
Granulomatosis with polyangiitis (Wegener's granulomatosis)
CANCA
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulon
steroids and cyclophosphamide
267
what is buergers disease
thromboangilitis obliterans
leg ischaemia and rayndaud phenomenon associated with smoking
268
what is anti glomerular basemenet membrane disease
good pastures
pulmonary haemorrhage and rapidly progressive glomerulonephritis
renal biopsy: linear IgG deposits along the basement membrane
plasma exchnage steroids and cyclophosphamide
269
metformin MOA SX
biguanide
reduces hepatic gluconeogenesis and increases insulin sensitivity
Nausea and vomiting
GI discomfort
Acute kidney injury
Lactic acidosis
270
sulfonylureas
gliclazide and glibenclamide
Bind to and close ATP-K+ channel on Beta cells causing depolarisation and insulin release
weight gain and hypoglycaemia
271
Thiazolidinediones
pioglitazone
reduces insulin resistance
Weight gain
Fluid retention
Hepatotoxicity
Bladder cancer
272
dpp4 inhibitors
linagliptin, sitagliptin
Prevent degradation of incretins and therefore promote insulin secretion
pancreatitis
273
sglt-2 inhibitors
dapagliflozin, empagliflozin
Inhibit sodium-glucose co-transporter 2 in the proximal tubule causing urinary glucose excretion
utis
best for cardio risk
274
GLP-1 mimetics
liraglutide
Incretin mimetic which stimulates insulin secretion
Causes weight loss
Reduced appetite
Nausea and vomiting
Pancreatitis
275
uc management
Inducing remission:
first line if mild/moderate= topical asa if that doesn't work then go for oral
if that doesnt work oral corticosteroid
If there is extensive disease then topical and oral asa
Severe - admit iv corticosteroids and iv ciclosporin
Maintenance of remission- Topical ASA or oral asa if severe
Oral azathiprine or mercaptopurine
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either oral azathioprine or oral mercaptopurine to maintain remission
276
before starting azathioprine or mercaptopurine what should we do?
assess TPMT activity
277
inducing remission in crohns
glucocorticoids
if moderate azathiprine/mercaptopurine
maintaining remission
1st line: Azathioprine or mercaptopurine
278
inguinal hernia repairs
mesh repair is associated with the lowest recurrence rate
unilateral inguinal hernias are generally repaired with an open approach
WITHIN 2 WEEKS
279
safest method of contraception in breast cancer
copper coil
280
Ferritin is low in iron deficiency anaemia but high or normal in anaemia of chronic disease
