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MRSA Flashcards

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1
Q

which drugs is

  • small s/e risk of breast ca
  • have have sexual dysfun within 1yr (less than1%)
A

Finsateride/Dutasteride

- 5 alpha rectase inhib for BPH

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2
Q

Example of atypical and typical antipsychotics

A

Atypical = Clozapine (agranulo, prolact), Olanzipine (dyslip + obesity). rispiderdone

Typical = haloperidol, chlopromazine (good sedaiv if agitated)
- EP S/Es, hyperprolac

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3
Q

tx of mild/mod C.Diff

A

metro 400mg TDS 10-14days

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4
Q

1st lines

  • GTC
  • absence
A
  • SV, alternative is lamotrigene

- ethosuximide

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5
Q

35 - 40 BMI

A

Obesity 2

> 40 = 3 (morbid)
- could get surgery

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6
Q

post partum complications for SGA babdies

Rx to get it

A 
hypoglycaemia 
nec enteri 
polycytheamia - chronic intraurtine hypoxia 
thrombocytopenia - BM/hepatic comprise 
hypocalcamia

maternal substance abuse, con infection (rubella), >40 years

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7
Q 
verbal fluency 
estimation
response inhibition (copy tapping)
clock drawing 
abstract thinking
A

frontal lobe function - executive thinking

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8
Q

what is MOE + treatment

A

temporal bone oestisis, caused by pseudo.ergo

–> IV Abx (ciprflox)

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9
Q

14yr old - asthma not controlled

- currentlly on SBA + low dose ICS + LTRA

A

stop LTRA, used LABA in combo with low dose ICS

still not working - change to MART regime

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10
Q

ix of tinea capitits

A

woods lamp –> bright green fluoscrence of hairs, tx oral antifundal

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11
Q

Painful arc is a sign of ?

A

Rotator cuff issue - supraspinatous

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12
Q

copd test to differenitae between bacterial and non-bacterial exacerbation

A

procalcitonin - CRP, ESR< WBC will go up in both

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13
Q

example of 20g short acting carbs

A

3 tablets, 5 jelly beans, small carton of juice

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14
Q

example of low GI foods

A

fruit, veg, peanuts

white rice etc high

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15
Q

rosacea

- tx

A

topical metero or azelaic acid or ivermeticn cream
brimonidine (mirvaso) topicl gel good for flushing
2nd line = oral tetracycline or eryhtomycin (for 3mo)

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16
Q

where are heinz seen

where are burr seen

tear drop cells (dacrocyte)

A

splenomeg, g6pd def, suplhonamides

burr - uraemia

myelofibrosis

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17
Q

paeds ALS - Ratio and shock

A

5 breaths, 15:2, 4j/kg

vs adults 30:2, mon 360j shock
150-360 biphasic

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18
Q

Tx line for CML

A

Young for for BMTx

Or imatimb

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19
Q

viterous haem
vs post viterous haemorrhage
vs ret detach

A

Posterior vitreous detachment

  • Flashes of light (photopsia) - in the peripheral field of vision
  • Floaters, often on the temporal side of the central vision

Retinal detachment
= Dense shadow that starts peripherally progresses towards the central vision
- A veil or curtain over the field of vision or FLOATERS
- Straight lines appear curved
Central visual loss

Vitreous haemorrhage
- uusually painless

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20
Q

cold aggulatans

increase titre of complement

A

found in mycoplasma –> haemollytic anaemia

psuttascosis

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21
Q

bladder cancer

  • most common type WORLD WIDE
  • some risk factors
A

Transitional cell carcinoma = developed countries. Smoking, Exposure to aniline dyes, Rubber manufacture, Cyclophosphamide
Squamous cell carcinoma = most in world: Schistosomiasis, Smoking

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22
Q

pain in knee walking up and down the stairs

tennage girl

A

chondromalacia patella

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23
Q

toxoplasmpos effects on baby - CHICM

A

chonoreintis
HYDROCEPHalus
INtracranial CALICficaion
MICROcephaly

vs CMV = periventri calc, sens HL, microceph

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24
Q

coeliac disease

  • antibodies
  • how long on glut
  • important to check for
A

IgA tTGA IgA EMA
6 weeks BD – or it needs to be a biopsy
IgA def

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25
UKMEC 4
Examples of UKMEC 4 conditions include more than 35 years old and smoking more than 15 cigarettes/day migraine with aura history of thromboembolic disease or thrombogenic mutation history of stroke or ischaemic heart disease breast feeding < 6 weeks post-partum uncontrolled hypertension current breast cancer major surgery with prolonged immobilisation
26
step wise decline in function 1st line for alzethimers
more likley vascular dementia the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) - momentine is 2nd line
27
tx of thrush in paeds
miconazole gel 7 days | then nystain 7 days
28
``` DVLA - time off in CV disorders - annual review 1 wee 4 weeks 6mo/lifelong ```
annual review = AAA >6 1 week = angio, pacemaker, ablation (2days) 4 weeks = CABG, ACS, H transplant (6) 6monghs/life = ICD insertion, AAA >6.5
29
casues of hyperprolaectaemia - women : period problems and galatoorhoea - men : ED and low libido
``` pit tumours preg excessive exercise hypothryoid chronic renal failure cushings drugs: risperidone, metocholpramide, domperidone, TCA ```
30
ulcerated, crusty lesion - can be there for a few years . rarely mets on leg = marjolins ulcer suncream prevents recuurence
squamous cell carcinoma - on eye, more likely is a basal cell carcinoma
31
which tropical illness will give you all over body pain
dengue
32
Most common cause of hypogond
Klinefeleters (47 XXY) | Nondisjuctioj meiosis
33
best tx for personality disorders
psychotherapy
34
step wise tx of psoarsis
emollients --> betamethasone - salicyclic acid can by used if ++scaling - coal tar - vit d analogues e.g.. calcipotriol UV light Ciclosporin, methorexate
35
Common Abx okay to give in Pen Anaphylaxis
amikacin, cipro, clari, clindamycin, co-trimazole, doxy, erthrmycin, gent, metro, rifampicin, vanc, nitro, trimeth
36
contraception - within 72hrs - wtihin 120 - iwthin 5 days (or on d 5 to 14 ov)
Levongrestrol Uliprsitol Copper IUD
37
adren dose for 11yr old boy
0.3ml of 1/1000 solution IM 0. 15 is <6 0. 5 if >12
38
DDx of Beckers to Duchenes
- beckers cramping, able to walk | - duchenns delayed motor mile stones, big old calfs
39
bacterial conjunctivitis | - when to treat?
after 3 days | chlorprmphencial for 5 days
40
low Ca | high PO4, ALP, PTH
CKD
41
Contras for live vaccines
Pret, symptomatic HIV, radiation Other - prev anaphalyxis - intercurrent illness
42
Gardnerella leads to whats on thr mivcropsy what does tric vaginalis have
baci vag clue cells motile trophozoites
43
what type of eye drops to help elivate pain
mydriatics (dilate) rest the pupil - cyclopentolate | - precents posterio syntheaia in anterior uveitits
44
change of an ulcer - painful, slough
?marjolins | - malignancy
45
progressive dysphagia from solids to liquids and PAIN on swallowing
hypopharyngeal ca | v sunexplainined hoarsness = squamous larngeal ca
46
pressure sore that you can see fat
grade 3 | 2 - 4 = warm moist enviroment
47
bullous pemphigoid vs pemphigus
BP - blisters, elderly, not involving mucosa - tx steroids PV - blisters involving mucosa, jews - tx steroids - not itchy
48
Dyspepsia assessment + treat
Trial OTC antacids Eradication treatment Hyplori
49
S/Es : Hair loss, nose bleeds, sore lips, dry mouth, lipids and eyes tetrogenic
oral retinoids
50
?thyroid nodule but assymetatic | - most useful IX
fine needle aspira hot - adeneno cold - malignant non-sec adeno
51
Parkinsons treat - on l dopa * symptoms not controlled * dyskinesia due to therapy
* add in a dopamine agaonist (bromocriptine, cabergoline) to use a long side rx - pulmonary fib *offer MAO-B (selegiline) or COMT (entacapone)
52
what causes rheumatic fever
group a strpetococcus
53
Most common cause bone primary - most common site Name the childhood one
Osteosarcoma - metaphyes of long bones Ewing’s only in children (peristeal gives onion appearance)
54
Schwartz sign
Otosclerosis
55
What doesn’t reduce relapse RATE in MS
IVMP reduces duration and severity but not rate or long term disability
56
choice in SSRI in 1st depressive epiosdes - but if has triptan - when would you give PPI
an SSRI (e.g citalopram) - would giver mirtazapine - older adults also on NSAIDs or aspirin
57
Treatment algorithm for those tolerant for metformin and Hba1c is >6,5% - i.e second line options
Metformin up to 1g BD 2nd line Pioglitazone (thiazolidinediones) - Issues: weight gain, avoid in Bladder Ca , HF, Xrisk and macular oedema Sulphonurea: gliclazide, glipizide - issues: weight gain, high hypo risk, avoid in renal failure DDP4 inhibitors: Gliptins - weight neutral, low hypo risk - GI upset with panc SGLT2: canagliflozin
58
referral to genetic services
1st degree relative <45 two close relatives <60 3 or more with similar cancers <60 a hx of a predisoping conditions e.g FAP
59
H.pylori erd tx
PPI amox clarith or met for 7 days if persists - use Abx not used initally alternate includes levoflaxcin
60
measures to red rx of hiv in preg/deliv (1%) observing baby - how many tests
meds, ideally c -section atfer 39 weeks can do vaginal if load <50 don;t breast feed HIV DNA PCR at 48hrs. 6 weeks and 12weels then anitbody test at 18months
61
tx for hyperemesis gravidarum
1st line = promethazine, cyclizine or prochloperazine 2nd line = metoclopramide or ondasterom hosp - dehydrated, hypotenisve, urinary ketone
62
post coital bleeding
if persistence = urgent gynae ref
63
orbital cellulitis - features that make likely
painful eye movements loss of colour vision proptosis
64
full dilation ?
10cm
65
COPD FEV 35%
severe | 50-79% mod, <80% mild
66
Ix if suspect Lyme?
just start doxy only do ELISA if you aint got a rash
67
causes of clubbing
``` lung ca fibrosing alveolitits bronchiectasis, empyema lung abscess CF mesothelioma Cyanotic CHD IE!! cirrhosis IBD coeliac dissease thyroid acropathy ```
68
Ovarian torsion vs cyst
torsion shrap onset that doesnt resolve cyst will then self-resolve
69
low thyroid levels, goitre (which is a bit tender)
hashimotos - Antithyroid peroxidase antibodies positive | de quervians - POST VIRAL, tender (high then low)
70
When and what is in the combined screening
11 + 13 weeks - nuchal transluency - bHCG + PAPP-A - maternal age`
71
criterica for PCOS tx for hirsuitism
clinical hyperandrogeism or test raised oligomenorrhoea US showing polystic - test up, oest up, LH up, FSH normal weight loss, hiar removal then topical eflornithine or fianette
72
What part of ear does otosclerosis affect | Type of hearing loss
Stapes | Conductive
73
when should aspirin be given in preg
>40, bmi >35 | fhx preeclamp
74
Side effects of viagra (sildenfail) 4 When to avoid
Headaches Facial flushing Dyspepsia Blue green vision Avoid - recent stroke or MI, low BP, nitrates or nicorandil
75
poor prognosis factors for schizo
``` Factors associated with poor prognosis strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant ```
76
``` PAIN meds: morphine PO to SC to oxycodone to diamorphine (SC/IM) to tramadol to fentyl patch ```
``` divide 2 times by 2/3 divide 3 times 10 half 24 dose and then go for patch lower ```
77
HAS BLED
``` Hypertension Abnormal renal and liver function Stroke Bleeding Labile INR Elderly Drugs or alcohol ```
78
Digoxin toxicity
Measure levels within 8-12hrs of dose Cl - unwell, confused, green/yellow vision, arrhythmias, gynaecomastia Causes - hypokalaemia, age, RENAL failure, MI Drugs - amidoarone, verapamil, diltiazem, spiro, thiazides, loop Tx - digibind
79
low PO4 | high Ca, ALP, PTH
prim hyperPTH
80
anaemia of chronic disease
low Hb and rest within normal limits
81
viral warts on vagina causes by ___ - tx is Cervical cancer called by ____
HPV 6, 11 - imiquimod HPV 16, 18
82
amnesia types
anterograde is inability to make new memories after the event retrograde is loss of memories before event
83
timeframe of chest pain to be seen on same day
12 to 72hrs | if longer within 2weeks and consider starting aspirin, statin and GTN
84
ECG changes in hypocalacemia
prolonged QT + ST seg
85
heterophile antibodies in serum indicate
mono
86
Ix of SAH
non-contrast within 6hrs | - if negative LP
87
``` section 2 section 3 section 4 section 5(2) section 135 ```
28 days --> by pyschiatrist, for tx 6months 72hrs assessment order - GP, bring in to hosp preventing a patient leaving for 72hrs police remove someone from house if concerns
88
``` Achondroplasia Gilberts Huntingtons Neurofirbeom Protein C def osteogen imperfecta ```
AD
89
IVDU with patchy consolifation | - orgainsim?
likely staph aeurus
90
NES vs serotonin syndrome
NEW: haloperidol hyperthermia, fluctuating consiousness, muscle ridigity, tachy, sweating, redcue reflex Tx = stop drug, given bromocriptine (can last 5days) SS - SSRIs, MAOIs, ectasy fatser onsent, increase relfex, clonus Tx = IV fluids, benzos, cyprohepatine/chloropromazine in severe
91
drug causes of HTN Endocrine causes
EtOH, COCP, ciclosporin, prednisolone. venlaflaxine and celecoxib conns, cushings, phaeochromovytome
92
Chronic pancreatitis vs ca
Streathorroea Jaundice
93
Perthes disease | - what is the classic examintion findinig
ABDuction and INTERNAL rotation is limited | - 4-8yrsm ANN
94
leser-trelat sign
lots of seb. kerotsisis | ?internal maliganacy
95
Tx for Diabetes insidious
Cranial - desmopressin Nephrology- bendrofluothiazide (Demeclocycline is SIADH)
96
safe choice of antiepl for preg (if seziure>2yrs, look at stopping) drug choice in hyperthry
carabamezamine lamotrigene proplochouricl PTU
97
Sciatica stepwise tx
Rest, paracetamol and NSAIDs | Physio if remains at 6weeks
98
what does colummnar epith indicate | due to which type of ca
metasplasia --> barrtets (pre-maliganant) | adenocar (more common that squa which is upper 2/3rd)
99
keratoacanthoma features
erupting volcano | dome shape - slowing grow
100
Priapism prostatitis
uro emergency - take blood from it and given iv phenylephrine ciprofloxacin 500mg BD for 14 days
101
30 - 35 BMI
Obesity 1
102
leflunomide is an immunodul drug for RA | - 3 S/Es
HTN, GI upset, hepatitis
103
Dx - renal failure, haemoptysis and nose bleeds
GPA (Wegners) is more likley than goofpastures - c-anca positive - nephritic syndrome
104
bone pain, bossing of skul | high ALP
pagets
105
strabismus - esotropia - hypertropia
eye turns inwards | eye turns upwards (but would turn turn downwards in uncover test)
106
Bladder Ca Tx - non invasive - invasive - spread m/non operable
Intravesicl BCG and TURBT Radial cystectony + formation of ileal conduit Chemotherapy (also if recurrence)
107
squints - what would an eye going out in a conver uncover test mean if only seen in cross cover
Convergent squint (esotropia) eeophoria
108
sentinel node biopsy is done when positive node on US | when is clearance performed
if there is clinically palpable lymph nodes
109
migraine tx
NSADs, paracetamol or triptan - try dual ergotamine = avoid in pill, PVD, IHD + preg preventive = propranolol, amitrtirpylline, topiramtae (pill interferevce), pizotifien
110
What is chlormbucil used in
NHL or CLL as less aggressive - Rituximab is alternative for b cell lymphm (also in ITP)
111
two options for postponing peroids
Norethisterone - start 3 days before period Medfroxyprogresterone acetate - if >35 or rx for VTE, smoker, overweight
112
what nerve supplies diaphragm
phrenic nerve! | - from C3=5 +> ?significant SC injury
113
ER+ breast Ca --> what are you going to give
``` Tamoxifen = oesteogen antagonis/agonist Anastrozole = aramotase inh --> OP ```
114
auer rods rouleaux formation smear cells
AML high esr --> infections, maliganacy CLL
115
UKMEC catergories for breastfeeding women
1 for everything apart from | COCP - is 4 within first 6 weeks, then 2 till 6months
116
Drugs to induced abortions
Mifepristone then misoprostol 7 days later (PG anaologues)
117
empirical Abx for treatment of ?PID
ofloxacin + metro for 14days
118
who is at risk of pseudomaonas? - treatment - bacteria in kids
CF + bronchiectasis patients azithro neb or clipro oral with neb colomycin - staph is more in childhood cf => flucox - burkia is tramsmissiable
119
what level causes hearing loss at long periods of time
90 decibles
120
Conditions with koebner phenomenon
[spriasis, lichen planus, viral warts, molluscum
121
What is Galeazzi sign
Unequal knees on examination | Used after 3 months for DDH
122
changes seen in proliferative retinopathy
cotton wool spots cluster haemorrhages rubeosis iridis - neovascularisation
123
What are high rx women offered (from combined test)
CVS if 11 to 14 Aminocentesis after 15weeks - riskier for misscarriage in 1st
124
Features of lichen planus
shiny flat topped plaques at FLEXORS itchy, koebner phenom wicken striae = fine white lines on plaques and in oral cavity tx = itch relifey or steroids
125
gastritits that improves with eating | commonest cause
duodenal | h.pylori
126
Churg straus- 3 features
Sinusitis Asthma had/GI pain/renal issues P anca
127
extended breech flexed breech fetal heart lying in the flank
buttocks first mix of but and feet first transverse lie
128
stress ECG
for those with KNOWN CAD disease to quanitify risk CI for an exercise ECG - recent MI, AS, HF, pul oedema, unstable angina
129
``` painful vision loss acruate scotoma (lower half) haloes, N/V + headache semi-dilated pupil disc cupping ``` Dx, Rx + treatment
Acute angle closure glaucoma (>20) LANTANOPROST (PG analogue) Timolol or bromide drops to reduce aqueus formation carbonic anhydrase inhibitor — e.g. acetazolamide 500mg IV started Rx - myopia, HTN, DM, TCAs
130
g positive coccus, black disgusting foot, unwell pt | - ?
nec fas - group A strep! | ddx: gas gangrene (c.perfing) --> crepitius + g rod
131
all over body pain, weakness in shoulder/legs, maybe some tingling calcium is around 2 and ALP is raised
osteomalcia second to vit d def pagets - ca would be normal, again pain
132
What happens at 28 week appointment
OGTT is at risk of GD (would start aspirin if so) 1st anti D proph if rhesus negative Vaccinations - whooping cough etc
133
CES vs SC compression
CES is BELOW level of L2 | a lesion T10 to L1 would have loss of reflexes
134
when fasting glucose is more than 7, but OGTT is between 7.8 and 11.1
IGT IFG is fasting between 6 and 7
135
B12 C D E
Cyanocobalamin= Megaloblastic anaemia, peripheral neuropathy Ascorbic acid Scurvy, gingivitis, bleeding Ergocalciferol, cholecalciferol Rickets, osteomalacia Tocopherol, tocotrienol Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
136
Asthma pt not controoled on SBA, ICS, TRA and LABA | - whats the max dose of steroids
can go to 100mcg
137
Felty syndrome
RA Neutropenia Splenomegaly —> low Plt and Hb from hypersplenism Need a splenectomy Can give rituximab and leflunomide
138
when should patients with TIA be referred to hosp
score >4 (also start 300mg asp) 2 or more within 1 week has symptoms on warfarin <3 = see within a week rem long term clopi
139
most DIAGNOSTIC test for Acromegaly
OGTT + GH measure Insulin like factor = screening
140
post bilateral adrenelctomy - hyperpig + bitmpo hom heminopeia
nelson syndrome
141
chlamydia - tx for sti - test - ulcer on penis: other symptoms
doxy 7 days (consider stat azithroymycin in young man who might not take it all) NAAT + 2weeks after exposure Lymphogranuloma venereum - chalmaydia trachomatis (same as STI) - also with painful lymph nodes + erythema nodosum
142
what is sialolithiases
submandiular gland stone - radio-opaque
143
scalp psoarsisi tx plan can get itchy plaques under boobs (
topical steroids | oral steorid + vit d analogue
144
gential herpes = painful ulcers + blisters | causes by ____
HSV 2 (1 is cold sores)
145
leading cause of blindness in the world
trachoma | - can lead to trichalisis (in ward growth of lases)
146
OCD medication options
Sertraline max dose (or fluxo) | then clomipramine
147
paraphimosis
unretractable foreskin - push back with pain relief
148
Where would you find q fever
cattle farm! likely with GI upset and flu like symptoms | Tx - classical atypical with erythro (marcolade)
149
chicken pox in preg - now with signs
acyclovir, too late for Ig eye defects, hypoplasia, microcephaly
150
Treatment of mets breast ca
Chemo - to prolong life (if too far gone)
151
tx for liver mets
``` usually inoperable (unless single from CRC), tx with pallative rxt doesnt work ```
152
1st line for symptomatic ventricular extra systole
beta blocker
153
Trastuzimab is what?
hercpertin, Her 2. Rx of HF
154
actinis keratosis tx for a few lesions tx for lots of lesions (>4)
- cryotherapy - topical 5-fluroacil cream (mild cases can try topical dicolfenac) pre-malig => safe sun + remove
155
acute severe asthma exacerbation
RR >25 Tachycardic struggling to complete sentences PEFR 33-50
156
IQ of moderate LD
35 - 49 - greater is mild (>69 is normal) - profound is <20
157
``` Transudate causes (prot <25) - disruption of hydrostatic and oncotic pressures across pleural membrane ```
HF, liver cirrhosis, renal failure, hypothryoid | low albymin and meig (ovarian tumour) and malabortopns
158
What is the most common cancer in men
Prostate - Afro Caribbean is a major risk and age
159
focal seizures | or partial seizures
carbamazepine or lamotrigine | - then keppra, oxcarbaezmine of epilem
160
What can be treated with steroids, regaine, fintserdie (BPH)
alopecia
161
what conditions require higher dose of folic acid in preg (5mg vs 400mcg) Up till 12weekd
``` anti-epileptics BMI >30 DIabetes Sickle or Thalassaemia - take till term FHx or personal hx of NTD ```
162
when are brachial cysts commonly seen
3rd decade | slowly grow
163
indications for dialysis
hyperkalaemia >7 met acidosis pulmonary oedema ureaemia
164
lupus Abs - most prevalent - most specific - in between the both - DRUG induced (procaniamide, HYDRALAZINE, isonisizid, phenytonin)
- ANA - smith - dsDNA - anti-histone
165
addinsons crisis
just IV hydro --> flucort when stable
166
T2DM aims - BP - HbA1c - fasting glucose
140/80 7.5% (58mmol) - 6.5% if diet controlled or single drug 4 - 7
167
paronychia tx (staph aureus)
fluclox or clair with I+D | preg/bfeeding + pen aller - erythroymucin
168
Raised PTH, but low Ca And then high phosp Also short fingers
Pseudo hyper parathyroid sun Pseudo pseudo is with normal Biochem
169
antibitocis causes of cholestatsis
NITROFURONIN, co-amox + fluxoc
170
lower GI Ix - pilles - UC - Crohns - Coelic
- proctoscopy | - flex sig
171
Complications of haemochromo - 2 reversible - 4 not
Skin discolouration, cardiomyopathy Liver cirrhosis, DM, hypogonatriphic hypogondaism, arthropathy
172
MGravis - treatment options x5
Ab against Ach receptors at NMJ - Thymectomy - Pyridostigmine cholinesterase inhibitor (stops enzyme breaking down ACh) - aziothioprine - steroids - plasma exchange
173
Chronic granulomatous disease causes by klebsiella
Rhinoscleroma | Enlarging nose - tx tetracycline
174
slow growing pulastile lump which can move side to side in neck
carotid body tumour | - an aneursym would may have features of CV insuff
175
apnoea during ENT surgery likley cause
displaced tracheal tube
176
what can myelofibrosis porgress to ?
AML
177
INR: 5-8 with no bleeding | - if minor bleeding
- with-hold 1-2doses and reduce next dose | - give 1-3mg vit k and restart once inr <5
178
high BP, low K, high Na | low renin + raised aldo
``` Conns = primary hyperaldo due to adrenal adenoma tx = sprio ```
179
pallative - boney pain
NSAIDDs better | radiotherapy only used to shrink a tumour causing pain
180
tx of discoid lupus | how would diff from discoid ecezema
topical steroids or fluconidide cream | discoid ecezema wouldnt affect face - mostly extremitiites, also hyperpig (no hypopig like lupus)
181
RA with picture pulmonary fibrosis
Caplans syndrome | - May cavitate and resemble TB
182
lots of sweatinf after parotid surgery
freys syndrome
183
causes ataxia
``` cerbellar lesion - stroke, lesion infection - varicella malignancy/paraoneoplastic proptiception sensory loss - b12 def, b1/wernickes peripheral neuropathy medications - baributates ``` inheritence - frereichs
184
finklestein test
de quervains tenosynovitis
185
what hypersensivity would ABO/MG/haemoylsis/goodpastures be in
``` type 2 (antibody) 3 is RA/SLE (immune) 4 is delayed contacted dermattis ```
186
Extrapyramidal side effects - most common in (x3) - symtpoms
prochlorperazone, heloperidol and depot injections | - PD symtoms, dystonia, dyskinesia, akasthasia, tardic dyskindesia
187
awareness vs incomplete paralysis in surgery
awareness - finger twitching + increase BP --> give midaz post op incomplete paralysis - tachycardia and more general muscle spasms
188
1st rank schizo drug of choice
1. delusional perception = deluge of false belief that can't be corrected by logic 2. auditory hallucinations 3. thought disorder 4. passivity/delusion of control 5. somatic hallucinations risperidone - i/m injection every 2weeks or chlorpramizine
189
nicotine withdrawl drugs tx when to r/v
can be up to 3 weeks weight gain, irrtibaility r/v 2 weeks NRT - 16hr or 24hrs vareniciline - start BEFORE quite day, partial recptor agonsit => reduces affects bupropion
190
COPD patient is on a SABA or a LABA - next stage is asthma features - if no asthma features
LABA with ICS LABA with LAMA final stage is all 3 - esp if recent hospital admission
191
STEMI treatment
is presenting within 12hrs (+PCI can be given in 120mins) -->prasugrel or tig with aspirin - Glycoprotein IIb/IIIa Inhibitors (tibfrian) if PCI not possible = fibro with reteplase/alteplase/streptokinase (and with heparin in fusion)
192
LTOT conditions
``` hypoxia <7.3 (or <8 with polycthaemia/pulHTN) COPD, ILD, Crhonic HF, Pul HTN severe chronic asthma CF bronchiectasis Pulmonary vacular diease pumonary maliganacy ```
193
ovarian ca - risks - tx - pallative tx
anything increasing oestogen BRCA1 or the BRCA2 gene, early menarche, late menopause, nulliparity surgery and chemo pallative is radiothepat
194
Swollen pale turbinate Mobile mass
Allergic rhinosinustis Nasal polyp
195
rx for placenta praevia
maternal age, soking, prev praevia increase pariety, prev c -section cl - painless bleeding after 20th week
196
tumours for WLE | - RxT offered
solitary lesion peripheral small in a large bood DCIS <4cm
197
<6mon old has an atypical uti <3 - admit to paeds
US during acute DMSA within 6 weeks (if it was typical - then just US within 6weeks)
198
two types of bipolar
1 - manic episodes with major depressive, manic presenting often needs hospitalisaion 2 - hypomania with severe depression
199
When is the repeat anomonly scan When is second rhesus
32 weeks | 34
200
bipolar tx options
litium --> thyroid disorders, cognitive impairment | carbamazepine if unresponsive
201
LFTs: whats most raised in cholestaisis - acute liver damage (viral, hepatits)
- ALP | - ALT
202
BMI 25 - 30
Overweight
203
polcytgemia vera tx
asymp = venesection + aspirin symp = immunosupression, then last resort is splenoecomy
204
pretibial myoxemedam + thyroid acropathy are features of
graves
205
seborrhoeic dermatitis - red scaly rash around scalp, nasolabial folds, cheeks
daktacort (fungal with steroid)
206
4th CN lesion (trochelar)
innverates SO | - vertical diplopia, worse on looking down or AWAY from lesion side
207
Tx for ADHD
Pyshcoloscoail | Methylphendiate (ritalin), second line dexamfetamine
208
Sickle cell, CF, Tay sachs, McArdlers, Wilsons, PKU all examples of
AR
209
rheum disease associated with hep B and high BP
polyarteris nodusa | medium cell vasculitis
210
Oesophageal cancer | - signs to refer
Ref - Wright loss + dysphagia Or - weight loss + >55, with upper abdo pain, reflux or dyspepsia Endoscopy if dyspepsia + >55 and Anaemia, Loss of weight, anorexia, recent onset, melanoma, swallowing diff Squamous most common (adeno is lower down) Ex - etoh, smoking, GORD, achalasia (solids + liquids with cough), Plummer-vinson, fatty diet, vit A C def
211
best thing for OCD tx
exposure and response prevention | drug - fluoxetine
212
Dupuytrens risk factors
``` Manual labour Trauma Phenytoin Peyronie’s disease Myxoedema Norther Europeon FHx Smoking and alcohol Diabetes and epilepsy Lipids ``` Injecting enzyme therapy sometimes tried (Xiapex) or surgery
213
causes of polydraminos
- anecphaly - oedophageal or duodenal atresia - anaenia - spina bidifia - maternal diabeets - multiple preg
214
diff between cushing syndrome and disease
``` syndrome = excess steroids (usually pre etc) - acth will be low disease = overproduction by pituitary adenoma (acth high, with bilateral adrenal hyperplasia) ``` disease is suppressed by hig dose dex meth
215
drugs that can flare psoariasis
BB, hydroxychloroquine, lithium, NSAIDs + alcohol
216
indications for statins | Dose for primary prev
``` T1DM >40 or diabetes >10yrs or CVRx CKD Qrisk >10% Atrovstatin 20 Increases to 80 is for secondary prev (has stroke) ```
217
what drug is interferon used in | liver
hep c
218
IBS - conspitation is an issue - diarrhoea - abdo cramping - all measure tried and till pain
- Movicol (avoid lactose) - codeine or loperamide - pepp oil and mebvereine - TCAs, amitrpylline
219
aplastic anaemia causes
Carbamazepine, phenytoin | quinine, chloramphenicol
220
features of a innocent murmur
change in intensity venous hum can have 'machinary' quality - chanegs with neck posture systloic - likley ejection - pansystolic is more likley to be abnormal
221
things that alter PSA levels
ejaculation or exercise wtihin 48hrs UTI prostated biopsy 6 weeks ago current tx with finasteride
222
changes seen in background retinopathy
micro anuerysma and haemoorhages | NO MACULA involvement
223
Multiple system atrophy
orthostatic hypotension incontinet of urine dry mouth and skin
224
Most common hormonal producing pituitary tumours
Eosinophilia GH adenoma - adults Basiophillic ACTH Prolactin Adenoma - children
225
describe boutinerres deformity
button hole deform PIP felx with DIP hyperestension rupture of central slip of extensor
226
tx of hyperprolactaeimae
cabergoline | bromocriptine
227
feautres of SCLC vs NSCLC | tx
SCC - SIADH, ACTH smokers, central , Lamberton-eton (MG-like picture) - tx Chemo + radiation v good NSCC - Sqaumous = HPOA, PTHr - adeno (non-smok), gynaecomas - large cell (bchcg) - surgery better
228
Swallowing worse after few bites | Bit of a chronic cough
Pharyngeal pouch | - elderly
229
NF - inhertiance, how many cafe au lait sports | tumours
AD, >6 is characteriayic pupberty - neurofibroma children - optic glioma (brain tumour from astrocyst) --> casues squint and vision problems
230
unstable angina
load aspitin LMWH (dalt/fond) work out grace score -->PCI /angio within 72hrs if high
231
Ann arbour staging 3?
nodes at eith side of diaphram
232
first line contracep in young with no risk factors
cocp
233
meds used in GAD
1st line Antidepressant = SSRI => Paroxetine, sertaline, fluxo in younger if s/es --> Vanlafaxine or Duloxetine (SNRII Propanolol and diazepam used but technically not an antidepressant
234
notifiable diseases
``` anyone with vaccine scarlet fever TB malaria invasive strep ``` NO: HIV, opthal neonatrium, lepto
235
Causes for each Eosinophilia Neutrophils Lymphocytes Lymphopenia
E - Gold, penicillin, parasites, allergy N - bacteria, L viral L - aids, steroids, malignancy, liver disease, renal, sarcoidosis
236
3rd line option for diabetic control (still >6.5%)
GLP-1 mimetic - dulaglutide, exenatide - issues: slows gastric emptying (weight loss!), its injectional, cholecystitis and pancreatitis rx Acarbose - fltulence + diarrhoea s/e
237
indications for RRT
``` CKD 4 malnutrion ureamia enceph hyperkaelaemic not responsive to tx pleuritits and pericarditis ```
238
tx of prostatitis Ix too
cipro 500mg BD for 14days - ofloxacin alterative Is - multiparameteic MRI
239
What is v jaundice, frontal bossing and haemolytic anaemia likely to be
Beta thalassemia - major/cooley’s Alpha more Asian/African 3 genes - moderate anaemia (2 mild) 4 genes - barts hydros
240
ims at 2 months same at 3 but whatinstead of ____ 4 - same as 2 without
'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B) Oral rotavirus vaccine Men B PCV at 3 no rota at 4
241
When is ECV
After 36
242
HF when the cardiac output can increase with exertion peripheral oedema, raised jvp and ascites
low output heart failure right-sideded
243
most common for on newborn intensital obstruction | 1/10000
hirschsprung
244
What dizziness lasts for few hours
Menieres Few mins BBPV or central vertigo Days more Labyrinthitis
245
<5yr with asthma - 8 week trial of mod dose ICS - continues to be poor depsite low ICS
if improvement - stop - if retur, after 4 weeks, re-start low odse as maintenance - if return <4, repeat the 8 week trial add in LTRA
246
tx for renal osteodystrophy
low ca and high phsopha | tx = ca + vit d (alfacalcidol)
247
risk for gout - 3main drugs alternative for allopurinol
``` Thiazide, ACEi, BB, ciclosporin hyperuricaemia FHx obesity diet - red meet ``` febuxostat
248
AF anticoag rules
if CHA2DS2 VSc is >2 | - most won't have antiplatet prescribed along side NOAC (unless v high risk)
249
screening test for cognitive function | score for ?dementia
MMSE - <10 = severe (max score 30) | <24 ?dementia
250
Sulfasalazine: inhibits output of TNF + cytokines 3 s/es infliximab s/e
S/Es: hepatotoxic, Steven Johnson Syndrome, reduced sperm count - CCF
251
PANCREAS | GET SMASHED
``` PaO2 <8kPa Age <55y, Neutrophils>15, Calcium <2 Urea >16 Enzymes - ldh ast Albumin <30 Sugars >10 >3 = needing icy ``` GallstonesEthanol, Trauma , Steroids, Mumps + other infections, Autoimmune Scorpion, Hyperlipidaemia/hypercalacaeima/hypothermia, ERCP, Drugs – thiazides, azathioprine, metoclop, diabetic drugs, valporate
252
Systolic murmur vs Diastolic
Sys = AS, MR/TR (pans), MVP (late sys) ``` Dias = AR(early), MS(mid), TS (early + large a waves) PR = graha steel due to pul HTN = early dais ```
253
tx to induce rem for UC
1st 5ASA (mesalazine --> pred --> azathioprine maintaining is sulf/5asas
254
hypertensive eye disease
``` AV nipping flame haemorrhages hard educates cotton wool (retinal infracts macular oedema ```
255
rules for switchign SSRIs | rule for trying
cross titrate over 4-6 week except fluxoteine - need 4-7day wash out period (i.e can just stop) x2 diff SSRI or mirtaz then switch to SNRI (e.g venalfaxine) or tca
256
1st line Abx for UTI in preg
NITRO, can give amox or cefalaxine
257
treatment of radiation pneumonitits
prednisolone
258
positive anti-HBs, rest negative
immunization
259
what is most freq type of testicular ca markers
most germ-cell tumours. - Seminomas Senior (>35) maybe bHCG - non-seminomas: teratoma Teen (25) and embryonal, yolk sac, AFP LDH Non-germ cell tumours include Leydig cell tumours and sarcomas.
260
thrush | >16
pessary and topical for 7days - can be oral in not preg - no pessarys for <16
261
graunula casts in urine micrcopsy
CKD hyaline can be normal
262
where are target cells seen
IDA, liver disease, thalassaemia post splen
263
tx of graves opthalopathy
high dose steroids | compression if threatened vision
264
pyleo vs uti
flank pain | would given co-amox or trimeth for 7-14days
265
painless ulcer, lymph nodes up and now a maculopapular rash
syphillis (t2)
266
tx for acute iritis
steroid drops + cyclopentolate or atropine
267
what type of bacteria is gonorrhoea | Tx
G negative diplococcus IM ceftriaxone - can given azithromycin with IM cef in young man
268
autoimmune hepatitis antbodies in T1 | what about T2
anti-smooth muscle ANA - ? if pt has goitre (autoimmune link) T2 - antibodies to liver and kidney
269
what is lights criteria | but what singificance is ph?
(pro >0.5, LDH >6, pleural ldh >2/3) ?empyema and ph <7.2 --> CT
270
when is glucose levels self-monitored
on insulin hypoglycaemic epiosdes meds with hypo risk pregs
271
chloramphenical vs chlorpheniramine
antibiotic | antihistamine (sedating), non-sedating - loratadine or sertraline
272
Alports - inheritance - issues
X, AR or AD SHL + CKD eye provlems
273
when mastectomy is done | - RXT if t3.4 or lots of positive nodes
multifocal, central | DCIS >4cm
274
stepwise tx for endometerosis
1 - paracetamol, nsaids 2 - COCP, POP, Implant or mirena 3 - ablation 4 - hysterectomy
275
tx pf lewy body dementia | what makes it worse
rivastigmene | l-dopa
276
OA: Bouchard vs herbens
bouch proximal, herbens distal
277
proximal muscle weakness in a diabeteic vs glove/stocking distrubtion loss and painful lower limbs (tx)
amyotrophy 'proximal neuropathy' sensory polyneuropathy --> TCAs, gabapentin
278
TB drug S/Es lenght of TX - inclu miliary/mengitits or pericarditis
Active = all RIPE for 2 months, then R + I for 4 months Active TB meningitis/ military TB or pericarditis = 10months of R + I plus oral pred Rifampicin = cytochrome P450 induced, hepatic metabolism - Rash, hepatitis, yellow/orange discolouration of bodily fluids, flu-like symp Ioniazid = hepatic metabolism - Rash, hepatitis, peripheral neuropathy, agranulocytosis - Co-prescribed with Pyridoxine (Vit B6) to prevent neurological S/Es Pyrazinamide = hepatic metabolism - Rash, hepatitis, arthralgia & gout (hyperuricemia) Ethambutol = renal metabolism - Optic neuritis => monitor acuity during therapy
279
Mutation in chromosome 7 | neonatal presentation
``` Transmembrane conductor regulator gene = CF df508 = commonest mutation meconium ileus haemorrhagic disease of newborn constipation failure to thrive ```
280
TLS bloods - whats low
Calcium
281
diagnostic imaging for RAS
digital subtraction angiograpghy most common causes Fibromuscular dysplasia or athersclerosis
282
how long have to use condoms if starting POP after day 5
48hrs (COCP is 7days)
283
When is dating scan
10-13 weeks
284
tx of bells palsy
50mg pred for 10day (within 72hrs)
285
which virus is related to laryngeal papillomatosis tx for wa
HPV
286
Gest DM associations
polyhydro, macrosomia, hypogly, hyperbilirubineam, pre-eclpasia
287
BPH tx
Alpha-1 antagonists e.g. tamsulosin, alfuzosin, tarazosin - decrease smooth muscle tone (prostate and bladder) - adverse effects: dizziness, postural hypotension, dry mouth, depression 5 alpha-reductase inhibitors e.g. finasteride (simil s/e risk to thalaiodmide) - block the conversion of testosterone to DHT - slow disease progression. (reduced prostate size) -adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
288
defitinvitve tx for stress incontinence urge
mesh cling/surgery options - duloxetine is alternative - solficaicin Bladder retraining Oxybytynin (old mirabegron), botux or sacral nerve stimulation
289
scleritis vs episcleritits
episcler = blanches, mild pain/none, often self-limiting scler - painful+, needs steroids + nsaids + opthal r/v
290
statins upper limit in lfts - checked at 3 and then 12mo expected affect on HDL chol
x3 should also be stopped in preg (and 3mo prior) >40% reduction (if not, increase dose)
291
Bariatric surgery indications
>40 BMI 35-40 but with a comorb that would benefit from weight loss T2DM
292
White marks on tongue you can't scrap off
leukoplakia --> need ot biospy as pre-maligant
293
anastmotic leak in the peri-operative period
gastrogaffin enema | - CT is some time after surgery
294
ERCP use as IX
for CHRONIC pancreatits problems, not acute | also GB/Bile duct
295
Step wise pain management for SCD
Simple paracet and NSAID If more than 2 morphine, need PCA
296
Where a J waves seen
hypercalaemia brugada syndrome hypothermia
297
slow growing red scaly plaque | squamous cell carcinom ain situ
bowens disease | Tx cryotherapy or topical 5-flurouracil cream
298
post-natal depression drug choices
SSRI (flux the safests), oestorgens contravesial TCAs avoid benzos
299
DVLA - time off in neuro disorders
1 month : syncope explainined, stroke/tia recovered 3 month - multiple TIAs 6months: syncope unexplained, first seziure in normal brain , withdrawl of antiseziure meds, post pit brain surgery 1 yr : Knonw epilesy + further seziure, two or more syncopes and craiotomy
300
LFTS for alcoholic LD | for hepatitis
increase AST | increase more ALT (acute Liver)
301
Tx of quinsy
I&D, or Aspiration IV Abx BG if tonsillitis - then do a tonsillectomy
302
Mycosis Fungoides - dry itch plaques | ?
Cutaneous form of T-Cell lymphoma
303
absences
SV or ethosuximbe | - defs avoid carbamazepine
304
bp measurements for pre-eclamp
rised >30/20 reading is >160/90 140/90 (HTN normall) but with protein or signs of IUGR
305
dermatomyositisis antibodies
anti-jo, anti-MI
306
dacryocystitis vs dacryoadenitis
Lac sac,medial swelling Lac gland, lateral swelling
307
antibodies in APL syndrome coag signs
anti-cariolipin anti-b2-glycoprotein lupus anticoagulant prolonged APTT (intrisinic)
308
Dose for Citalorpram sertraline mirtazepine fluxoteine
10mg anxiety, 20mg depression up to 40mg sert - if recent mi, 50mg max 200mg mirtazepine - 30mg up to 45/45 fluxo = 20 up to 40
309
lymphoma work up - 3 things
Ann Arbor Staging = from both HL + NHL, via CxR, CT/PET + biopsy I = single region, one lymph node to IV = disseminated involvement (liver, BM)
310
ix of haemoatospermia
``` PSA test (if>40) mid-stream urine microscopy + culture ```
311
Phaeochromcytomas link to 3 malignancies
Von Hippel Landu MEN NF
312
what vitamin is Naphthoquinone
Vit K --> Haemorrhagic disease of the newborn, bleeding diathesis
313
drugs causing renal stones
acetzaolamide, allopurinol. laxatives, asorbic acid
314
pain after exercise, with swelling and locking
osteochondritis dissecans
315
- empty stomach - >200mls of water + whole table - stay upright for 30mins - dental check
bisphosphonates
316
what Ix for erectile dysfunction
Testesterone, BP, BM, Lipidis, exam (?peynoids) | - if LUTS add in PSA
317
renal cancer most common type | assoications
clear cell | asso: TS, VHL syndrome, smoking
318
diagnosis of amylodosis AL + AA
congo red stain red/green poisitive birefrigmeent 10% of myeloma will develop AL Tx: Oral Melphalan + prednisolone AA will not affect heart, more chronic inflam disease
319
as and when tx for allergic rhinitis
IN aselastime spray | - if not for nasal = certirizine/loratadine
320
cutaenous lava migrans pediculscapularis
hookworm (cats/dogs) --> topical bezdazole head lice --> malathion, permethin
321
tx of typid fever | fever, malasia, hepatspleno, rose spots, bradyacaria
salmoneall virsus | CIPROFLOXACIN of azthromycin
322
what drugs are avoided in g6pd def (3) Ix
diuretics - indapamide fava beans ciprofloxacin Ix: non-immune haemolytic crisis (neg direct coombs) +heinz bodies
323
low Ca, PO4 | high ALP, PTH
osetomalacia - bone pain - proximal myopathy - looser zones (pseudo#)
324
respiatroy test for upper airway function test for lung function in IPF
spirometery lung diffusion
325
causes of gynaecomastia
Kidney or liver failure Endocrine disturbances - hyperthyroid Malignancy Drugs - spiral, finasteride, cimetidine, digoxin, Gostelin, anaebolic steroids
326
whats needed for diagnosis of ank spond
radiological sacroillitis
327
Gentamicin, cipro, quinine, aspirin and furosemide (IV) all cause what
Tinnitus
328
Painless ulcer in the most
Think SCC before aptholous (which would be painful)
329
rx for prostate ca
fhx black brca1/2 increasing age
330
COCP | - UKMEC 3
more than 35 years old and smoking less than 15 cigarettes/day BMI > 35 kg/m^2* family history of thromboembolic disease in first degree relatives < 45 years controlled hypertension immobility e.g. wheel chair use carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2) current gallbladder disease
331
ddx between hydrocele and epididymal cyst
cyst can be seperated - excisoin | both translum
332
tx for viral conjunctivitis | - small follicles seen in eyelid
self-limiting | sterile water cleaning
333
Travellers diarrhoea
E Coli
334
choices of antidepressant - co-exisiting chronic pain - post MI - acute depressive episodes in bipolar
- Amitriplyine - Seraline - citalopram
335
Treatment for GTC seziures
SV (obvs not if pregs) | then lamotrigine or carbamaezpine
336
pt with active ca develops clot - tx?
just lmw hep for 6months
337
current acute Hep B infection
anti-IgM HBc
338
allergic conjunctivits
conjunc erythema, chemosis (swelling), itch seasonal = summer/spring perennial = dust mites first-line: topical or systemic antihistamines second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
339
13-18 years
'3-in-1 teenage booster' (tetanus, diphtheria and polio) | Men ACWY
340
13-18 years
'3-in-1 teenage booster' (tetanus, diphtheria and polio) | Men ACWY
341
Associations with acanthosis nigricians
Obesity Diabetes Stomach Ca - also oesophageal, lymphoma and pancreatic
342
what is cholrprozamine used in | s/e
schizo | - shaky, abnormal body movements
343
what does minocycline cause | anx for acene
``` drug induced lupus! others: Isoniazid. Hydralazine. Procainamide. Tumor-necrosis factor (TNF) alpha inhibitors (such as etanercept, infliximab and adalimumab) Quinidine. ```
344
Smith vs colles Monteggia vs Galeazzi
Smith - distal radius is tilted anteriorly Colles - posteriorly Mon - #ulna and dislocation of radial head Gal - #radial shaft and disclosure of inferior radio-ulnar joint
345
simple ecezema on chin
1% hydrocortisone | if signs of infection - dakacort or another with abx
346
``` Pulsus paradoxous Slow rising/plataeu Collapsing Pulsus alternans Bsferiens '2 peaks' Jerky ```
``` severe asthma or cardiac tamponade aortic stenosis aortic regurg or PDA severe LVF mixed aortic valve disease HOCM ```
347
INR >8 and no bleeding | - if bleeding
give vit k oral and restart once inr <5 - give 1-3mg vit k and restart once inr <5 major bleed = IV vit k with prothrombin complex
348
febrile seziures - incidence of further piosdes | peak ages
1 in 3 | 12 to 18months
349
Epididymo-orchitis tx | - if likely chalr/gon
ceftriaxone 500mg IM single dose, plus doxycycline 100mg by mouth BD for 10-14 days
350
Dodgy nose
Evucate haematoma | Then manipulate under GA within 1 weeks
351
Bladder Cancer referral criteria
non-visible haematuria, - direct in >60, or if still present <60 WBC or dsyuria in absent of UTI
352
Diff between microscopic polyangitis and wegnes? | And antibodie
``` P anca (wegner c-anaca) Eosinophilia ```
353
H pylori
Test with breath or stool Can re check after eradication (stool will remain positive) Abc
354
when is islet transplant indicated
multiple hypo epiosdes, icnluding impaired response
355
good pastures has which antibodies
anti-gbd | can progress to rpgn
356
Mx of tension headache
simple analegesia prev: 10weeks acupunture - low dose amitripyline (off label)
357
12-13 months ims
Hib/Men C MMR PCV Men B
358
time frame a nasal trauma nose can be manipulated
2 weeks ->after it needs rhinoplasty
359
what is pulm oedema 6hr after lots of transfusion
transfusion related acute lung injury 1degree temp increase is just febrile reaction -->slow the rate
360
when is quadruple
15 to 20 weeks (2nd tr) | - AFP, uncog estradiol and inhibin A, along with bHCG
361
Necorsis looking ulcer
attempt debridement/maggot --> amuptation
362
CI to POP
active liver disease | breast ca within 5yrs
363
which herina passes THROUGH the internal ring of the inguinal canal - 80%
Indirect - neonates (direct older people, weight lifting) open surgical repair for most (mesh) laprscopic if bilaterlal
364
CHOP for NHL with s/es ?Hodgkins - ABVD
Cyclophosphamide (cysitis/hair loss/bm supp) Hydroxyurbic (doxrubacin/Adriamycin) - cardiomyopathy Vincristin - perip neuropathy Prednisone Adriamycin (doxrubacin), Bleomycin (pulmonary fibrosis), Vinblastine, Darcarbazin)
365
Induction of labour | IV and one oral
``` IV oxytonin Oral misoprostol (or vaginally) ```
366
whats needed prior to anti-tnf | when x2 dmardshave failed
cxr, hep screen, hiv
367
what can hamartoma of the post hypothalamus causes
precocious puberty in a girl <2
368
tx to induce remission for crohns
1. glucosteroids, budesonide if ileocaeacl then its meslaazine %ASA perianal = metrondiazole maintaining woud be azathioprine or metotrexate
369
Myolconics
SV - then clonaezpam or lamotrigine - avoid carbamazepine
370
features of SCC skin
bleeds, slow growings, asymmetrical, can met | can occur after transplant
371
what is the 1 st line tx for aortic valve replacementin children
balloon valvuplasty (also those not fit for valve placement or TAVI in adults)
372
tx of acute sinusitis
avoid abx, paracetamol | >10days - nasal steroid, nasal decongest, lavage
373
test for ACL | - pop, swelling, difficult weight bearing
lachman's test
374
what can focal dystonia be treated with | e.g. writers cramp
betablocker or botulin injections
375
Diagnostic criteria for IBS
Abdo pain, bloating, change in bowel habit Or abdo pain with Altered stool passage (straining) Abdo distension Worsening from eating Mucous stools
376
myopia vs hypermyopia
myo = short sighted, CONCAVE lense - risk of detahcmenet, glucoma and cataract hyper = long sighted, CONVEX
377
in an UMN facial palsy - where must the lesion be
above pons - i.e. stroke
378
duodeneal vs gastric ulcer
DU - more common, 2-3hrs after meal or at night, easised with snack - more common - 90% hpylroi GU - worse with eating, 60% hpyori, will need biopsy
379
Ix of haemorrhoids
PROCTOSCOPY
380
Low Ka, Low Chloride and met alkalosis | ?
Bartters syndrome - inherited (AR) like furosemide Vs conns where BP is rasied
381
tired all the time bloods
FBE, CRP/ESR, LFTs, UEC, TFT, HBA1c, IgA tissue transglut only vit d if muscle ache/body pain - course is 400 IU all yeat
382
``` A = keratomalacia B1 - th B3 - ni the 4Ds B6 - B7 0 bio B9 - fol ```
Retinoids Night-blindness (nyctalopia) Thiamine Beriberi polyneuropathy, Wernicke-Korsakoff syndrome heart failure Niacin Pellagra dermatitis, diarrhoea, dementia B6 Pyridoxine Anaemia, irritability, seizures B7 Biotin Dermatitis, seborrhoea B9 Folic acid Megaloblastic anaemia, deficiency during pregnancy - neural tube defects
383
positive anti-HBs and HBsAg
prev infection of hep b and carrier | antigen neg would not be arrier
384
smooth annular plaque which is red-pink in colour | asso DM
granuloma annular | = delayed sensitivity reaction
385
causes of exudate effusion (pro >35)
maligancy, infection, sepsis and inflammation
386
features of BCC
most common, pearly and slow growing | non-urgent referral
387
Most common type of thyroid cancer is ___ | Most common in elderly is ___
Papillary | Anaplastic type
388
tx of Polycythenia
venesection | low dose aspirin
389
whic Ig is: first in infection most prevalent
IgM first and biggets | IgG everywhere and crosses placenra
390
anorexia nervosa bloods diagnosis wieght
``` everything low apart from - GH - glucose - cholesterol carotin cortisol ``` below 15% of normal (17.5)
391
slow growing painless lump in superfifcal lobe of parotid gland
pleomorphic adenoma ddx warthins tumour
392
TIA - if suspected to have occured within last week - if >1week ago - if more than one episode
refer to stroke specailist and start 300mg Asp - in already on, just continue - assessment within 1 week - urgent referral today
393
eyes stye vs chalazion if eye lases are lost
stye 'ouch' tender lump, eyelash chaz - clogged firm gland worried its a cancer
394
ischaemic/arterial ulcer vs venous
aterial rx factors, punched out edges, LATERAL side/pressure points, reduced pulses - tx hydrocolloid dress (moist) MEDIAL aspect, v painful
395
diffuse systemic sclerosis vs limited systemic sclerosis (CREST) - calcinosis, raynuads, oesophageldysmotility, sclerodactly, telangiectasia
anti-scl-70 anti-centromere
396
where is folate and b12 absorderd
duodenum and prox jejnum | termal ileum
397
travellers diarrhoea - watery - blood - prolonged and non-bloodr
- e.coli most common - campylobacter (flu sym) or shigella - giardiasis 3 different samples for stool cultutre dont routinely offer abx
398
hyperemisis rx factors
``` multiple preg mola preg hx of eating disorders primiparous (non-smoking)` ```
399
Hearing test in newborns 6-9months? Speech/performance testing till 2.5, what after
Otoacustic emission Then brain stem response if abnormal Distraction Pure tone once >3yrs
400
stoma care for conspitation and diarrhoea
constipation --> osmotic laxative like mag sulp diarrhoea --> loperamide + codeine
401
what is thomas test used in
achilles tendon rupture - squeeze calf
402
return from peru, flu like symptoms | slow pulse and elevated fever (fagets)
yellow fever
403
causes of bm failure
Aquired = radiation, drugs, chloramphenicol, EBV, hep B, CMV, preg, Graft-verus-host disease b12 and folat def Inherited + malignancy
404
prostate advances tx | - 2 diff options, types and some s/es
Flutamide = anti-androgen tablet, can cause gynaemoastia Gosreline is a LHRH analague injection - also cause gyanemaotasia but can casue tumour flare Bone pain - give bisphosphates
405
ddx of propotsis
unilateral = orbital myositis Bilat + slower = thyroid eye disease red = orbital cell
406
ecezema v v itch
?scabies incontigo
407
Wilms tumour vs Neuroblastoma
Wilms: - asso WAGR syndrome (aniridia) + Beckwith-weidrman - doesn’t cross midline - microscopic haematuria, may have HTN ``` Neuroblastoma - asso ospoclonus myoclonus, blueberry muffin skin, anaemia - can cross midline - urine catechilamines - HTN, fever From neural crest of adrenal medulla 75% retroperitoneum ```
408
1 point about each thyroid cancer - anaplastic - medullary - papillary
old people, v. ill = pallative hypocalacomia -- calcintonin, men 2 related most common, young gals
409
Rubella congenital features - T, J, H, C | When is highest risk
Thrombocytopenia, jaundice, hepatosplenomegaly, cerebral calcification (=> cerebral palsy) 1st trimester
410
tx for SEVERE legionella
erthyromycin/clarith + rifampicin
411
screening - glasgow vs ransons - waterlow - SCOFF
pancreatitis GS + alocholol panc pressure sores eating disorders
412
2 screening tests for CVD
qrisk and framingham
413
PAD - what pressure is claudification - tx options acute limb ischaemi tx options - thombosis (hours) - embolus (sudden)
- <0.9 - aspirin/clop - angioplasty thrombolysis iafter dx from angio embolectomy, and then warfarin
414
recommeded weekly units beer vs wine single spirit and then bottle of wine
14 2, 1 1, 10
415
ca risks in coeliac
lymphoma | SB carcinoma NOT colon ca
416
10 year absolute risk of osteoporotic fractures what age of people without the risk factures
qfratcure FRAX (with or without BM) 65 women 75 men
417
right sided infarct
left hom hemiphonia | left sided weakness
418
diff in blood for subclinical and clinical hypothy
``` subclinical = TSH is HIGH to keep T4 in normal range clinical = T4 is low , with raised tsh ```
419
WHO PAIN LADDER 1 - 2 - 3 -
paracetamol with an NSAID then add weak opiod eg codeine 60mg QDS then add strong opiod - morphine - if still, ?change route e.g fentyl patch (total dose in 24hr /2)
420
Cushing syndrome vs disease
Syndrome is ectopic ACTH secretion - often predict => NOT able to be suppressed Disease is pit adenoma -> high dose suppresses

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