MSRA Flashcards

Question

how does fragile X present?

Answer 1

Learning difficulties Macrocephaly Long face Large ears Macro-orchidism

Answer 2

Webbed neck Pectus excavatum Short stature Pulmonary stenosis

Answer 3

Micrognathia Posterior displacement of the tongue (may result in upper airway obstruction) Cleft palate

Answer 4

Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis

Answer 5

ToF - most common , at 1-2 months transposition of great arteries - at 1-2 days tricuspid atresia

Answer 6

* a. understand the information relevant to the decision * b. retain that information * c. use or weigh that information as part of the process of making the decision * d. communicate the decision made by talking, sign language or other means also need o have an impairment/disturbance to mind - permanent or temporary

Answer 7

* instant: IUD * 2 days: POP * 7 days: COC, injection, implant, IUS

Answer 8

- Vision: o Strabismus o Cataracts o Recurrent blethritis o Glaucoma - Hearing – otits media

Answer 9

acute otitis media - bulging otitis media + effusion - retracted

Answer 10

chondromalacia patellae - Anterior knee pain walking up and down stairs and rising from prolonged sitting - Most common in teenage girls

Answer 11

labyrnthitis: Recent viral infection Sudden onset Nausea and vomiting Hearing may be affected vestibular neuritis: Recent viral infection Recurrent vertigo attacks lasting hours or days No hearing loss

Answer 12

Associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears

Answer 13

gentamicin

Answer 14

- Phase 1 – hyperthryroid, raised ESR, tender goitre - Phase 2 – euthyroid - Phase 3 – hypothyroid

Answer 15

high ESR hyperthryoid tender goitre recent illness reduced iodine uptake

Answer 16

as the 'involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract'

Answer 17

look for possible underlying causes/triggers (constipation, diabetes mellitus, UTI ) advice: fluid intake, toileting patterns, reward systems enuresis alarm - 1st line desmopressin - for sleepovers/ one off

Answer 18

mild - microaneurysm moderate - above + blot haemorrhages, hard exudates, cotton wool spots , venous beeding severe - blot haemorrhages/ microaneurysm in 4 quadrants OR venous beeding in 2 quadrants

Answer 19

neovascularisations fibrous tissue forming anterior to retinal disc

Answer 20

glycaemic control yearly review maculopathy - intravitreal VEGF inhibitors (if there's a change in visual acuity) non proliferative - if severe laser photocoagulaton proliferative - laser photocoagulation + VEGF inhibitors if severe vitreous haemorrhage - vitreoretinal surgery

Answer 21

keratitis - red eye, photophobia, gritty sensation anterior uveitis - acute red eye, associated with inflammatory disorders acute closed angle glaucoma - red painful eye, headache, N&V, halos in vision, fixed mid dilated pupil , corneal haze, hard eyeball blethritis - gritty sticky eyes, esp in morning

Answer 22

contact lens wearers

Answer 23

topical quinolones cyclophenolate for pain releif

Answer 24

clopidogrel , statin (atorvastatin 80mg) exercise training

Answer 25

spherocytosis

Answer 26

auto dominant

Answer 27

jaundice and gall stones splenomegaly and splenic rupture aplastic crisis precipitated by parvovirus

Answer 28

EMA binding test but those with symptoms + high Mean corpuscular haemoglobin concentration [MCHC], increase in reticulocytes and spherocytes - do not need testing

Answer 29

X linked recessive males african and mediterrean

Answer 30

BPH can take up to 6 months

Answer 31

black >white>asian

Answer 32

International Prostate Symptom Score (IPSS) from 0 to 35, the higher the worse

Answer 33

watchful wait alpha 1a antagonist - tamsulosin, alfuzosin 5 alpha reductase - finasteride surgery - transurethral resection of prostate

Answer 34

decrease smooth muscle tone of prostate and bladder

Answer 35

stop conversion of testosterone to DHT

Answer 36

erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia

Answer 37

propanolol or topimarate - but not usefule for women of child bearing age (teratogenic)

Answer 38

alcohol, noctunal sleep more common in men and smokers

Answer 39

co-amoxiclav pen allergy - doxy and metro dont suture / close a puncture wound unless cosmesis at risk

Answer 40

Pasteurella multocida

Answer 41

manual labour phenytoin treatment alcoholic liver disease diabetes mellitus trauma to the hand

Answer 42

rign and little

Answer 43

mild: < 4 stools/day, only a small amount of blood moderate: 4-6 stools/day, varying amounts of blood, no systemic upset severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Answer 44

proctitis: rectal aminosalicyclate (mesalazine). if not induced after 4 weeks, can add oral mesalazine. If still not after 4 weeks, add oral steroid proctosigmoiditis: topical (rectal) aminosalicylate if remission is not achieved within 4 weeks, add a high-dose oral aminosalicylate OR switch to a high-dose oral aminosalicylate and a topical corticosteroid if remission still not achieved stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid extensive disease: topical (rectal) aminosalicylate and a high-dose oral aminosalicylate if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid severe collitis - IV hydrocortisone and admission. can add IV ciclosporin after 72 hours

Answer 45

proctitis/ sigmoiditis - topical aminosalicyclates/oral or both left sided colitis/ extensive - oral aminosalicyclate Following a severe relapse or >=2 exacerbations in the past year oral azathioprine or oral mercaptopurine NOT METHOTREXATE

Answer 46

parainfluenza

Answer 47

community acquired pneumonia most common cause of bronchiectasis exacerbations acute epiglottis

Answer 48

Flu-like symptoms classically precede a dry cough. Complications include haemolytic anaemia and erythema multiforme

Answer 49

Classically spread by air-conditioning systems, causes dry cough. Lymphopenia, deranged liver function tests and hyponatraemia may be seen

Answer 50

exertional dyspnoea few chest signs HIV patients

Answer 51

degeneration of retinal photoreceptors results in drusen that can be seen on fundoscopy

Answer 52

females smoking Fhx

Answer 53

dry macular degeneration - 90% of cases - also known as atrophic - characterised by drusen - yellow round spots in Bruch's membrane wet macular degeneration - 10% of cases - also know as exudative or neovascular macular degeneration - characterised by choroidal neovascularisation leakage of serous fluid and blood can subsequently result in a rapid loss of vision carries worst prognosis

Answer 54

worse vision particularly of nearby objects and ability to adapt at night can get flashing lights/ glare around objects distortion of line perception may be noted on Amsler grid testing Fundoscopy reveals the presence of drusen, yellow areas of pigment deposition in the macular area, which may become confluent in late disease to form a macular scar. in wet ARMD well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage

Answer 55

VEGF laser photocoagulation

Answer 56

3 months of isoniazid (with pyridoxine) and rifampicin, or 6 months of isoniazid (with pyridoxine)

Answer 57

doesn't smile at 10 weeks cannot sit unsupported at 12 months cannot walk at 18 months

Answer 58

this is abnormal to have left/right handedness before 12 months could mean cerebral palsy

Answer 59

double hydrocortisone keep fludrocortisone the same

Answer 60

erythema migrans - bulls eye appearance at the centre. red non itchy

Answer 61

CVS: heart block, myocarditis neurological: cranial nerve palsies, meningitis polyarthritis

Answer 62

IM benzylpenicillin - pre hosp <3months : IV cefotaxine and amoxicillin / ampicillin >3months to 50: IV ceftriaxone - at hosp >50 - ceftriaxone and ampicillin/amox

Answer 63

meningococcal - IV benzylpenicillin or cefotaxime (or ceftriaxone) Pneuomococcal meningitis OR haemophilus influenzae - IV cefotaxime (or ceftriaxone) Meningitis caused by Listeria Intravenous amoxicillin (or ampicillin) + gentamicin

Answer 64

IV dexamethasone unless... septic shock, meningococal septicaemia, immunocompromised, meningitis following surgery

Answer 65

oral ciprofloxacin or rifampicin those who have had contact within 7 days of onset of confirmed bacterial meningitis

Answer 66

COCP Topical eflornithine spironolactone, finasteride, flutamide

Answer 67

depression

Answer 68

REM sleep disorder

Answer 69

motor symptoms rapid onset and bilater tremor and rigidity are less common

Answer 70

A pharyngeal pouch (also known as Zenker's diverticulum) is a posteromedial diverticulum through Killian's dehiscence. Killian's dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles more common in older pts and men

Answer 71

urea breath test

Answer 72

after 2 weeks of no PPI and 4 weeks of no Abx

Answer 73

deoxygenation infection acidosis dehydration

Answer 74

increases worsening anaemia because red cells are trapped in lung/spleen

Answer 75

vaso-occlusion within the pulmonary microvasculature → infarction in the lung parenchyma dyspnoea, chest pain, pulmonary infiltrates on chest x-ray, low pO2

Answer 76

pain relief, oxygen antibiotics transfusion can help

Answer 77

reduced (bone marrow supression)

Answer 78

fever, RUQ pain, jaundice

Answer 79

under 13 - would automatically be rape 13-16 - assess capacity

Answer 80

levonelle - levonogestrel - up to 72hrs, can be used more than once in a cycle ellaone = urlipristal - up to 120hours, can be used multiple times, dont take with levonelle

Answer 81

need to use barrier contraception after as it distrubs efficacy of COCP not to be used in severe asthma delay breastfeeding for 1 week after using the drug

Answer 82

selective progesterone receptor modulator

Answer 83

copper IUD up to 120 hours most effective option

Answer 84

C peptide (high in type 2) auto antibodies - in type 1

Answer 85

anti GAD islet cell insulin autoantibodies

Answer 86

fasting glucose >7 oral glucose >11.1 HbAC1 >6.5 (48) fasting 6-7 and oral 7.8-11.1 = im[paired glucose tolerance

Answer 87

lateral - extensor, supination, tennis elbow medial - flexion, pronation, golf

Answer 88

similar to lateral epicondylitis pain 5-6cm distal to lateral epicondyle sensory changes around 1st webspace

Answer 89

itching irritation followed by ulceration inguinal lymphadenopathy around 65 yrs

Answer 90

HPV, Vulval neoplasma insitu , lichen sclerosus

Answer 91

Clinical features are notoriously vague abdominal distension and bloating abdominal and pelvic pain urinary symptoms e.g. Urgency early satiety diarrhoea

Answer 92

epithelial - serous

Answer 93

endometriosis cysts menstrations

Answer 94

35 abdo USS

Answer 95

chloroquine for malaria taken once/week side effects - headache contraindicated in epilepsy

Answer 96

photosensitivity oesophagitis 1 to 2 days before. 4 weeks post

Answer 97

GI upset 1 to 2 days before travel 7 days post travel

Answer 98

dizziness, neuropsychiatric issues taken once a week contraindicated in epilepsy

Answer 99

chloroquine progaunil can be taken with 5mg folate supplements

Answer 100

stop warfarin IV vit K IV prothrombin complex

Answer 101

minor bleeding - stop warfarin, IV vit K 1-3mg, restart warfarin when INR <5 no bleeding - stop warfarin, oral vit K, restart when <5

Answer 102

minor bleed - stop warfarin, IV vit K 1-3mg, resrt when <5 no bleeding - withhold warfarin 1-2 doses

Answer 103

NRT, varenicline or bupropion should normally be prescribed as part of a commitment to stop smoking on or before a particular date (target stop date) Normally, this will be after 2 weeks of NRT therapy, and 3-4 weeks for varenicline and bupropion, never give in combination

Answer 104

N&V, headache, flu like

Answer 105

nicotine receptor partial agonist nausea, headache, insomnia, weird dreams increased suicidal behavior contraindicated in pregnancy and breast feeding

Answer 106

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist risk of seizures contraindicated in epilepsy, breastfeeding and preg eating disorders - relative contraindication

Answer 107

topical antibiotic or a combined topical antibiotic with a steroid

Answer 108

3 shocks, then CPR (for shockable rhythms)

Answer 109

non-shockable - asystole, PEA shockable - pulseless VT and VF

Answer 110

hypoxia, hypovolaemia, hyperkalaemia, hypothermia toxins, tamponade, thrombus, tension pneumothorax

Answer 111

adrenaline 1mg asap for non-shockable adrenaline 1mg after 3rd shock and then every 3-5mins only shockable rhythms.. amiodarone 300mg after 3rd shock further 150mg can be given after 5th shock

Answer 112

myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase. Liver impairment

Answer 113

Advanced age, female sex, low body mass index and presence of multisystem disease such as diabetes mellitus. Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)

Answer 114

LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

Answer 115

Macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course pregnancy

Answer 116

inhibitor of cytochrome system increases statins

Answer 117

Q risk score >10% anyone with T1DM for >10 yrs or are >40yrs or have neuropathy (type 2 are asessed with q risk like eveyrone else)

Answer 118

stop taking 2 weeks before endoscopy

Answer 119

All patients who've got dysphagia All patients who've got an upper abdominal mass consistent with stomach cancer Patients aged >= 55 years who've got weight loss, AND any of the following: upper abdominal pain reflux dyspepsia

Answer 120

baseline bradycardia - HR <100, could be due to maternal B blockers, increased fetal vagal tone baseline tachy >160 - hypoxia, premiturity, chorioamniotis, maternal pyrexia loss of baseline variablity <5beats/min - prematurity, hypoxia Early deceleration - Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction Usually an innocuous feature and indicates head compression Late deceleration Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction Indicates fetal distress e.g. asphyxia or placental insufficiency Variable decelerations Independent of contractions May indicate cord compression

Answer 121

4-6 months once fetal Hb replaced

Answer 122

sickle cell

Answer 123

weakness of foot dorsiflexion, eversion, extensor hallucis longus sensory loss over the dorsum of the foot and the lower lateral part of the leg wasting of the anterior tibial and peroneal muscles

Answer 124

injury to neck of fibula diabetes

Answer 125

antihistamines e.g. cyclizine/ promethazine

Answer 126

high bHCG associated with multiple pregnancies trophoblastic disease hyperthyroidism nulliparity obesity

Answer 127

8 to 12 weeks but can be up to 20 weeks

Answer 128

N&V, 5% weight loss, dehydration, electrolyte imblance

Answer 129

Those that dont want contraception: - mefanamic acid 500mg TDS or transexamic acid 1g TDS - start on first day of period requires contraception - mirena IUD is 1st line - COCP

Answer 130

mobile breast lump under 30yrs non tender

Answer 131

middle aged women, lumpy breasts, may be tender symptoms may worsen prior to menstration

Answer 132

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate) osteonecrosis of the jaw increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate acute phase response: fever, myalgia and arthralgia may occur following administration hypocalcaemia: due to reduced calcium efflux from bone

Answer 133

Twith plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking table

Answer 134

calcium/ vit D

Answer 135

Idarucizumab

Answer 136

all factor Xa inhibitors except dabagatran which is a direct thrombin inhibitor

Answer 137

lack of clinical improvement following sequential use of at least two antipsychotics for 6-8 weeks, with at least one of these antipsychotics being from the atypical class.

Answer 138

weight gain excessive salivation agranulocytosis neutropenia myocarditis arrhythmias

Answer 139

propanolol

Answer 140

ABCDE terlipressin - vasoactive prophylactic IV Abx - quinolones e.g. ciprofloxacin then endoscopy after the above endoscopy and band ligation Sengstaken-Blakemore tube if uncontrolled haemorrhage Transjugular Intrahepatic Portosystemic Shunt (TIPSS) if above measures fail

Answer 141

connects the hepatic vein to the portal vein risk of hepatic encephalopahy

Answer 142

For those who have medium - large varices

Answer 143

MS diabetes sphylis

Answer 144

Unilateral decrease in visual acuity over hours or days poor discrimination of colours, 'red desaturation' pain worse on eye movement relative afferent pupillary defect central scotoma

Answer 145

high dose steroids

Answer 146

benign responds to accomodation but poorly to light and dilates slowly after often women associated with absent knee/ankle reflexes

Answer 147

take pill asap even if it means taking 2 pills in one day no additional contraception needed

Answer 148

take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. if pills are missed in week 1: emergency contraception if unprotected sex in the pill-free interval or in week 1 if pills are missed in week 2: no need for emergency contraception if pills are missed in week: omitting the pill free interval

Answer 149

premature babies initially: feeding intolerance, abdominal distension and bloody stools can quickly progress to abdominal discolouration, perforation and peritonitis.

Answer 150

dilated bowel loops (often asymmetrical in distribution) bowel wall oedema pneumatosis intestinalis (intramural gas) portal venous gas pneumoperitoneum resulting from perforation air both inside and outside of the bowel wall (Rigler sign) air outlining the falciform ligament (football sign)

Answer 151

on examination -sausage-shaped mass in the right hypochondrium and emptiness in the right lower quadrant (Dance's sign) where not present in this patient

Answer 152

doxycycline 7 days - 1st line 2nd line - azithromycin 1g stat OR 500mg BD 2 days pregnancy - azithromycin/ erythromycin dont wait results if exposure has been confirmed

Answer 153

men with urethral symptoms - all partners in last 4 weeks prior to onset of symtoms for women and assymptomatic men - all partners in last 6 monhts

Answer 154

sample, treat and then results

Answer 155

pregnant women - tested 6 weeks post azithromycin non pregnant women/ men - not tested.

Answer 156

BCG MMR oral polio yellow fever oral typhoid

Answer 157

Toxoid (inactivated toxin) tetanus diphtheria pertussis

Answer 158

vaccine attached to immunogenic part to enhance immunity pneumococcus (conjugate) haemophilus (conjugate) meningococcus (conjugate)

Answer 159

blepharitis: inflammation of the eyelid margins typically leading to a red eye stye: infection of the glands of the eyelids chalazion (Meibomian cyst)

Answer 160

entropion: in-turning of the eyelids ectropion: out-turning of the eyelids

Answer 161

Hot compresses and analgesia. CKS only recommend topical antibiotics if there is an associated conjunctivitis

Answer 162

Atopic eruption of pregnancy - most common, eczematous, itchy red rash. no specific treatment is needed Polymorphic eruption of pregnancy - pruritic condition associated with last trimester, often first appear in abdominal striae managed with steroids - topical or oral Pemphigoid gestationis - pruritic blistering lesions often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy oral corticosteroids are usually required

Answer 163

Hx of gastroenteritis initially - leg or back pain (65% of people) proggressive symmetrical weakness of limbs - ascending few sensory signs absent/weak reflexes can get cranial nerve/ autonomic nerve involvement

Answer 164

LP - rise in protein, normal WCC nerve conduction study - decreased motor nerve conduction velocity (due to demyelination) prolonged distal motor latency increased F wave latency

Answer 165

SABA SABA +ICS SABA + ICS + LTRA (montelukast) SABA + ICS + LABA (cont LTRA if working) The above but with ICS and LABA as a MART increase the ICS to medium lose increase ICS to high dose / add thiophylline

Answer 166

often Fhx Onset before 65 Insidious onset Relatively preserved memory and visuospatial skills Personality change and social conduct problems

Answer 167

Frontotemporal dementia (Pick's disease) - most common Progressive non fluent aphasia (chronic progressive aphasia, CPA) Semantic dementia

Answer 168

personality change and impaired social conduct. Other common features include hyperorality, disinhibition, increased appetite, and perseveration behaviours.

Answer 169

Focal gyral atrophy with a knife-blade appearance is characteristic of Pick's disease. Macroscopic: Atrophy of the frontal and temporal lobes Microscopic: Pick bodies - spherical aggregations of tau protein (silver-staining) Gliosis Neurofibrillary tangles Senile plaques

Answer 170

Ach receptor inhibitors memantine

Answer 171

non fluent speech. They make short utterances that are agrammatic. Comprehension is relatively preserved.

Answer 172

fluent progressive aphasia. The speech is fluent but empty and conveys little meaning. Unlike in Alzheimer's memory is better for recent rather than remote events.

Answer 173

Compromised immunity < 20 years and a history of malignancy a history of malignancy known to metastasis to the brain vomiting without other obvious cause worsening headache with fever 'thunderclap' new-onset neurological deficit new-onset cognitive dysfunction change in personality impaired level of consciousness recent head trauma headache triggered by cough, valsalva, sneeze or exercise orthostatic headache (chnages with posture) symptoms suggestive of giant cell arteritis or acute narrow-angle glaucoma a substantial change in the characteristics of their headache

Answer 174

acts by activation of the AMP-activated protein kinase (AMPK) increases insulin sensitivity decreases hepatic gluconeogenesis may also reduce gastrointestinal absorption of carbohydrates

Answer 175

gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20% reduced vitamin B12 absorption - rarely a clinical problem lactic acidosis with severe liver disease or renal failure

Answer 176

eGFR <30 or creatinine <150 lactic acidosis if taken when there is tissue hypoxia (e.g. MI, sepsis, AKI, dhydration) iodine containing contrast alcohol missuse - relative contraindication

Answer 177

Sweet's syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia

Answer 178

Necrobiosis lipoidica - shiny, painless areas of yellow/red/brown skin typically on the shin. often associated with surrounding telangiectasia Infection - candidiasis, staphylococcal Neuropathic ulcers Vitiligo Lipoatrophy Granuloma annulare - papular lesions that are often slightly hyperpigmented and depressed centrally

Answer 179

pain and tenderness localised to the medial epicondyle pain is aggravated by wrist flexion and pronation symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

Answer 180

compression of ulnar nerve initially intermittent tingling in the 4th and 5th finger may be worse when the elbow is resting on a firm surface or flexed for extended periods later numbness in the 4th and 5th finger with associated weakness

Answer 181

ACEi and B blockers - first line - start one at a time (bisoprolol, carvedilol) (not good for HF with preserved ejection fraction). second line - aldosterone antagonist - monitor K Third-line treatment should be initiated by a specialist. Options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy furosemide - symptomatic control - no effect on mortality influenza vaccine yearly one off pneumococcal (unless CKD, asplenic then every 5 yrs)

Answer 182

sinus rhythm > 75/min and a left ventricular fraction < 35%

Answer 183

left ventricular fraction < 35% considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs should be initiated following ACEi or ARB wash-out period

Answer 184

digoxin has also not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties it is strongly indicated if there is coexistent atrial fibrillation

Answer 185

this may be particularly indicated in Afro-Caribbean patients cardiac resynchronisation therapy indications include a widened QRS (e.g. left bundle branch block) complex on ECG

Answer 186

widened QRS (e.g. LBBB)

Answer 187

NSAIDs / colchicine oral steroids if above is contraindicated if already taking allopurinol - continue this

Answer 188

to anyone after 1st acute attack of gout allopurinol - initial dose 100 OD and then titrate every few weeks until urate <300 colchicine / NSAIDs used to cover whilst starting

Answer 189

Xanthine oxidase inhibitors

Answer 190

extensor surface itchy rash associated with coeliacs blistering IgA deposits

Answer 191

dapsone gluten free diet

Answer 192

beckers - milder duchennes dystrophin gene - X linked recessive

Answer 193

Progressive proximal muscle weakness from 5 years calf pseudohypertrophy Gower's sign: child uses arms to stand up from a squatted position 30% of patients have intellectual impairment

Answer 194

at 10 years

Answer 195

yes at 16 and 20 weeks for semen analysis to check its worked.

Answer 196

gram + rod

Answer 197

clindamycin

Answer 198

C diff toxin in stool

Answer 199

First episode of C. difficile infection first-line therapy is oral vancomycin for 10 days second-line therapy: oral fidaxomicin third-line therapy: oral vancomycin +/- IV metronidazole recurrent episodes within 12 weeks of symptom resolution: oral fidaxomicin after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin life threatening - IV metro + oral vanc

Answer 200

quinolone use (e.g. ciprofloxacin) is associated with tendon disorders hypercholesterolaemia (predisposes to tendon xanthomata)

Answer 201

simmonds test - calf squeeze and no movement

Answer 202

follows viral infection recurrent vertigo horizontal nystagmus no hearing loss/ tinnitus N&V may be present

Answer 203

oral prochlorperazine

Answer 204

subdural haemorrhage can present several weeks later

Answer 205

LFTs and TFTs every 6 months

Answer 206

thyroid dysfunction: both hypothyroidism and hyper-thyroidism corneal deposits pulmonary fibrosis/pneumonitis liver fibrosis/hepatitis peripheral neuropathy, myopathy photosensitivity 'slate-grey' appearance thrombophlebitis and injection site reactions bradycardia lengths QT interval

Answer 207

increased digoxin reduced metabolism of warfarin therefore high INR

Answer 208

smoking cessation annual flu, one off pneumoccacal pulmonary rehab if MRC grade is 3 or above SABA or SAMA as 1st line second step depends on if asthma features: - check for any prev asthma/ atopy/ high eosinophil/ variation in FEV1/ peak flow - if no add LABA and LAMA (stop SAMA, cont SABA) - if yes add LABA + ICS (can add LAMA too if still symptomatic)

Answer 209

azithromycin is used for some patients - do not smoke - ECG to exclude QT prolongation - LFTS

Answer 210

smoking cessation LTOT lung reduction surgery

Answer 211

frequent exacerbations e.g. 3 in 1 yr

Answer 212

for depression 0-4 no depression 5-9 mild 10-14 moderate 14-19 mod/severe >19 severe

Answer 213

S1-2 ankle L3-4 - knee C5-6 - elbow tricep - C7-8

Answer 214

cervical ectropian

Answer 215

Bilateral causes viruses: mumps sarcoidosis Sjogren's syndrome lymphoma alcoholic liver disease Unilateral causes tumour: pleomorphic adenomas stones infection

Answer 216

IM depo antipsychotic injections

Answer 217

weight gain clozapine is associated with agranulocytosis (see below) hyperprolactinaemia

Answer 218

increased stroke and VTE

Answer 219

onlanzapine

Answer 220

if others have been tried - two or more for atleast 6-8 weks each

Answer 221

agranulocytosis reduced seizure threshold constipation myocarditis - baseline ECG before hypersalivation

Answer 222

if patient starts/ stops smoking

Answer 223

ECG bloods - inc TFTs, UEs, FBC holter monitor

Answer 224

supravalvular aortic stenosis upturned nose long philtrum (gap between nose and lip) wide mouth, full lips, small chip puffy eyes very friendly

Answer 225

williams coarctation turners

Answer 226

spironolactone unilateral - surgery

Answer 227

HTN hypoK - muscle weakness alkalosis

Answer 228

bilateral idiopathic adrenal hyperplasia

Answer 229

aldosterone : renin ratio - shows high aldosterone, low renin then high resolution CT abdo and adrenal vein sampling

Answer 230

oral glucose tolerance test as soon as possible after booking otherwise oral glucose tolerance test at 24-28 weeks

Answer 231

BMI >30 previous macroscomic baby >4.5kg prev. gestational diabetes 1st degree relative with diabetes family origin of high prevalence

Answer 232

fasting glucose >/= 5.6 2 hour glucose >/= 7.8

Answer 233

attend joint diabetes/antenatal clinic within 1 week education - food and BMs if fasting glucose <7mM - trial of diet and exercise offered. if targets not met within 1-2 weeks - metformin. if still not med - insulin (short acting only) if >7mM at booking - start insulin. if 6-6.9 but evidence of macrosomia, hydramnios - insulin

Answer 234

attend joint diabetes/antenatal clinic within 1 week education - food and BMs if fasting glucose <7mM - trial of diet and exercise offered. if targets not met within 1-2 weeks - metformin. if still not med - insulin (short acting only) if >7mM at booking - start insulin. if 6-6.9 but evidence of macrosomia, hydramnios - insulin

Answer 235

stop meds except metformin start insulin folic acid 5mg/day from pre-conception to 12 weeks anomoly scan at 20 weeks

Answer 236

carbamazepine / lamotrigine stop valproate phenytoin - associated with cleft lip start 5mg of folic acid / day if taking phenytoin then give vitamin K in last month of preg

Answer 237

antiepileptics are safe

Answer 238

C - congestive heart failure H - HTN A - Age >75 (2), age >65 (1) D - diabetes S - stroke/TIA/VTE - 2 points V - vascular disease - IHD/PVD S - Sex (female) anticoagulation if 2 or more if 1 in males consider anticoag

Answer 239

watchful waiting may be used for mild symptoms lasting less than 4 weeks trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

Answer 240

Age 25 years: first invitation. Age 25-49 years: screening every 3 years. Age 50-64 years: screening every 5 years.

Answer 241

looks for high risk HPV if positive tests cytology

Answer 242

vaginal discharge: offensive, yellow/green, frothy vulvovaginitis strawberry cervix pH > 4.5 in men is usually asymptomatic but may cause urethritis

Answer 243

oral metro 5-7 days

Answer 244

primary: painless ulcer, local non tender lymphodenopathy latency secondary (6 -10 weeks later) - rash on trunk/palms/soles, fevers, buccal ulcers, condylomata lata (painless warty lesions on penis) tertiary: gummas (granulomatous lesions of the skin and bones) ascending aortic aneurysms general paralysis of the insane tabes dorsalis Argyll-Robertson pupil

Answer 245

blunted upper incisor teeth (Hutchinson's teeth), 'mulberry' molars rhagades (linear scars at the angle of the mouth) keratitis saber shins saddle nose deafness

Answer 246

mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis

Answer 247

FBC, UEs, LFTs repeat weekly until stablised then 2-3 months

Answer 248

folic acid take >24hours after methotrexate

Answer 249

activated charcoal if <1hr NAC liver transplantation

Answer 250

urinary alkalinisation haemodialysis

Answer 251

flumazentil however risk of seizures with this so only if severe

Answer 252

IV bicarb avoid class 1a / flecainide as these prolong QT

Answer 253

saline if mild/mod haemoldialysis if severe

Answer 254

atropine for brady glucagon if resistent

Answer 255

fomepizole or ethanol haemodialysis

Answer 256

antibodies to fragments of digocin

Answer 257

desferrioxamine

Answer 258

dimercaprol calcium edetate

Answer 259

hydroxocobalamin

Answer 260

a.ka. intrahepatic cholestasis seen in 3rd trimester pruritis often palms and soles no rash raised bilirubin

Answer 261

ursodeoxycholic acid for symptom relief weekly LFTs induce at 37 weeks

Answer 262

still birth prematurity passage of meconium post partum haemorrhage

Answer 263

abdominal pain nausea & vomiting headache jaundice hypoglycaemia severe disease may result in pre-eclampsia 3rd trimester or immediately after delivery high ALT

Answer 264

renal artery stenosis

Answer 265

predominately atherosclerosis in young women - fibromuscular dysplasia

Answer 266

dry cough - due to increase bradykinin hyperkalaemia angiooedma - even after 1 yr of starting hypotension

Answer 267

U&Es before treatment and after increasing dose if creatinine >30% of baseline or K >5.5 , may need to stop

Answer 268

quinolone - e.g. ciprofloxacin or oflaxacin or trimethroprim

Answer 269

wihin 5 days of admission: co-amoxiclav or cefuroxime More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

Answer 270

flucloxacillin OR clarithromycin/doxy/erythromycin if pen allergy if near eyes/nose - co-amox (or clarithro + metro if pen allergy)

Answer 271

IM ceftriaxone

Answer 272

Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

Answer 273

benzylpen or doxy or erythromycin

Answer 274

oral /topical metronidazole

Answer 275

aged 30 or over and have unexplained breast lump aged 50 and over with any of the following in one nipple only - retraction, discharged, other change of concern

Answer 276

usually found on new born exam barlows and ortolani test positve unequal skin folds/ leg length

Answer 277

usually 2-10yrs of age usually associated with viral infection sudden onset hip pain and limping gets better

Answer 278

avascular necrosis of femoral head - occurs in 4-8yrs olds more common in boys. can be bilateral

Answer 279

hip pain - over few weeks limp stiffness

Answer 280

typically ages 1--15 overweight often boys knee or distal thigh pain loss of internal rotation of leg in flexion

Answer 281

pancreatic

Answer 282

HCC (liver), teratoma

Answer 283

melanoma, schwanomas

Answer 284

Small cell lung gastric neuroblastoma

Answer 285

hirsuitism - caused by excess androgens hypertrichosis - excess hair growth in areas that would normally not have hair

Answer 286

porphyria cutanea tarda anorexia nervosa drugs: minoxidil, ciclosporin, diazoxide

Answer 287

topical eflornithine (contraindicated in preg/breast feeding)

Answer 288

CXR - look for TB (risk of reactivation)

Answer 289

DMARD monotherapy + short course of bridging steroids monitor CRP and disease actiivty (DAS28)

Answer 290

inadequate response to atleast 2 DMARDs

Answer 291

osteosarcoma - adolescents - long bones. xray shows codman triangle and sunburst pattern. ewings sarcoma - children/adolescent. pelvis and long bones. severe pain. xray shows onion skin appearance

Answer 292

ACEi inotropes nitrates

Answer 293

amiodarone B blockers Cardioverter defib Dual chamber pacemaker Endocarditis prophylaxis - no longer ABCDE

Answer 294

dendritic corneal ulcer red painful eye photophobia epiphora visual acuity reduced

Answer 295

MI, HTN, aortic stenosis, cardiac myopathy

Answer 296

4 weeks before

Answer 297

combined oral contraceptive pill hormone replacement therapy: more for those on O+P raloxifene and tamoxifen antipsychotics esp olanzapine

Answer 298

a scoring mechanism to assess the 6 month mortality of those with MIs. Includes age, ECG, troponin and renal function, killip class (i.e. HF), HR and BP, cardiac arrest at presentation

Answer 299

MONA morphine 10mg oral oxygen if low sats GTN spray - only used in ongoing chest pain. aspirin 300mg anything over 6% is high mortality

Answer 300

symptoms >20mins ECG changes >20 mins 2 contiguous leads of - more than 2.5 small squares of ST elevation in V2-3 in men <40yrs or >2 small squares in over 40yrs - >1.5 small squares in women - 1 small square ST elevation in other leads - new LBBB

Answer 301

1. aspirin 300mg 2. is PCI possible within 120 mins if yes --> give prasugrel , unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor (radial access) if femoral access instead bivalirudin + bailout GPI if no - fibrinolysis with antithrombin (fondaparinux/ unfractionated heparin). after give ticagrelor

Answer 302

12 hours of symptoms onset if PCI cant be offered within 120mins do ecg 90mins after and if no resolution of ST elevation , then transfer for PCI

Answer 303

should be offered if the presentation is within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given

Answer 304

immediately - if unstable within 72 hours - if GRACE >3% further ischaemic event after admission

Answer 305

aspirin + further antiplatelet ticagrelor if not high risk bleed clopidogrel if high risk bleed

Answer 306

type A - ascending - majority of cases type B - descending

Answer 307

BP in all 4 limbs - difference of >20mmHg between left and right arm (right arm is higher). dimished femoral pulses - more so on the right CXR - widened mediastinum D dimer - raised a lot CT angio TOE - more suitable for unstable patients who cant go for scan

Answer 308

type a - surgical - maintain BP at 100-120mmHg whilst waiting type B - IV labetalol to prevent progression, conservative management - bed rest

Answer 309

Complications of backward tear aortic incompetence/regurgitation MI: inferior pattern is often seen due to right coronary involvement Complications of a forward tear unequal arm pulses and BP stroke renal failure

Answer 310

compression dressing need to do ABPI before to check no arterial disease

Answer 311

normal ABPI = 0.9 to 1.2 below 0.9 or 1.3 and above can indicate arterial disease

Answer 312

stroke/ TIA symptoms in territory of carotid artery that has 70% or more stenosis

Answer 313

Once haemorrhage has been excluded: - aspirin 300mg asap - BP should not be lowered in acute phase unless complications such as hypertensive encephalopathy - thrombolysis within 4.5 hours - thrombectomy if AF - anticoagulation started 14 days later if cholesterol >3.5, statins started 48hours after (risk of haemorrgage)

Answer 314

- Previous intracranial haemorrhage - Seizure at onset of stroke - Intracranial neoplasm - Suspected subarachnoid haemorrhage - Stroke or traumatic brain injury in preceding 3 months - Lumbar puncture in preceding 7 days - Gastrointestinal haemorrhage in preceding 3 weeks - Active bleeding - Pregnancy - Oesophageal varices - Uncontrolled hypertension >200/120mmHg

Answer 315

- Concurrent anticoagulation (INR >1.7) - Haemorrhagic diathesis - Active diabetic haemorrhagic retinopathy - Suspected intracardiac thrombus - Major surgery / trauma in the preceding 2 weeks

Answer 316

confirmed PAC stroke - offer thrombectomy asap (if within 6 hours of symptom onset) and with IV thrombolysis (if within 4.5 hours. confrimed PAC stroke with potential salvagable brain tissue - offer thrombectomy if within 6 and 24 hours (inc wake up strokes) confirmed proximal posterior stroke + salvagable brain tissue - thrombectomy if within 24hours (+ thombolysis if wihtin 4.5 hrs)

Answer 317

confirmed PAC stroke - offer thrombectomy asap (if within 6 hours of symptom onset) and with IV thrombolysis (if within 4.5 hours. confrimed PAC stroke with potential salvagable brain tissue - offer thrombectomy if within 6 and 24 hours (inc wake up strokes) confirmed proximal posterior stroke + salvagable brain tissue - thrombectomy if within 24hours (+ thombolysis if wihtin 4.5 hrs)

Answer 318

clopidogrel if contraindicated - asprin + dipyridamole carotid artery endartectomy

Answer 319

itchy papular rash on palms, soles, flexor surfaces, genitalia polygonal in shape white lines pattern (typically white lace pattern on buccal mucosa)

Answer 320

topical steroids benzydamine mouthwash

Answer 321

semen analysis serum progesterone 7 days prior to expected next period (should be >30 to indicate ovulation)

Answer 322

ceftriaxone 500mg IM plus doxycycline 100mg BD 10-14days

Answer 323

OA: LOSS loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis RA: LESS loss of joint space, erosions, soft tissue swelling, soft bones (osteopenia - juxta-articular osteoporosis)

Answer 324

for those at high risk e.g. liver cirrhosis secondary to hep B/C or haemochromatosis OR men with cirrhosis secondary to alcohol screening with USS +/- alpha fetoprotein

Answer 325

worldwide - hep B europe - hep C

Answer 326

dermatophyte infetion: oral terbinafine toe nails - treat 3 months - 6months finger nails - 6 weeks to 3 months candida infection - topical antifungals. but if severe oral itraconazole 12 weeks

Answer 327

oral metronidazole

Answer 328

gardnerella vaginalis

Answer 329

Amsel's criteria for diagnosis of BV - 3 of the following 4 points should be present thin, white homogenous discharge clue cells on microscopy: stippled vaginal epithelial cells vaginal pH > 4.5 positive whiff test (addition of potassium hydroxide results in fishy odour)

Answer 330

overgrowth of gardnerella means less lactic acid producing bacteria.

Answer 331

metro 5-7 days (in preg too)

Answer 332

anyone >65 with chronic cough, productive, exertional breathlessness FEV/FEV1 CXR blood test - check for polycythaemia BMI

Answer 333

all should have FEV/FEV1 <0.7 mild - FEV1 <0.8% predicted moderate - 50-79% predicted severe - 30-49% very severe - <30%

Answer 334

restrictive

Answer 335

fluoxetine

Answer 336

sertraline

Answer 337

Gastrointestinal symptoms are the most common side-effect there is an increased risk of gastrointestinal bleeding in patients taking SSRIs. anxiety and agitation after starting a SSRI hyponatraemia

Answer 338

2 weeks after starting if <30 - 1 week as higher risk of suicide

Answer 339

only 6 months after symptoms resolved stop slowly over 4 week period (not needed with fluoexetine)

Answer 340

increased mood change restlessness difficulty sleeping unsteadiness sweating gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting paraesthesia

Answer 341

paroextine

Answer 342

BNF says to weigh up benefits and risk when deciding whether to use in pregnancy. - Use during the first trimester gives a small increased risk of congenital heart defects - Use during the third trimester can result in persistent pulmonary hypertension of the newborn - Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Answer 343

miosis (small pupil) ptosis enophthalmos* (sunken eye) anhidrosis (loss of sweating one side)

Answer 344

heterochromia (difference in iris colour) i

Answer 345

central lesion - anhydrosis of the arms, trunk, face e.g.stroke, Syringomyelia, Multiple sclerosis, Tumour, Encephalitis pre ganglionic lesion - anhydrosis of face Pancoast's tumour, Thyroidectomy, Trauma, Cervical rib post ganaglionic lesion - no anhydrosis Carotid artery dissection, Carotid aneurysm, Cavernous sinus thrombosis, Cluster headache

Answer 346

separate from the body of the testicle found posterior to the testicle

Answer 347

if they do not regress spontaneously in 1-2 yrs

Answer 348

associated with infertility

Answer 349

teratogenicity dry skin, eyes and lips/mouth- most common side-effect low mood depression and other psychiatric problems raised triglycerides hair thinning nose bleeds (caused by dryness of the nasal mucosa) intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason photosensitivity

Answer 350

positive Dix-Hallpike manoeuvre, indicated by: patient experiences vertigo rotatory nystagmus

Answer 351

epley manoeuvre - treats 80% Brandt-Daroff exercises

Answer 352

hydrops fetalis parvovirus B19 in pregnant women can cross the placenta in pregnant women this causes severe anaemia due to viral suppression of fetal erythropoiesis → heart failure secondary to severe anaemia → the accumulation of fluid in fetal serous cavities (e.g. ascites, pleural and pericardial effusions) treated with intrauterine blood transfusions

Answer 353

Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female)

Answer 354

fungal mass in preformed cavities associated with TB , sarcoidosis, bronchiectasis, and ankylosing spondylitis, lung cancer, CF. all of these diseases create cavities

Answer 355

cavitating lung mass on CXR . A crescent sign may be present high titres Aspergillus precipitins cough and sometimes haemoptysis

Answer 356

refer any secondary dysmenorrhea (period pains that start later) to gynae

Answer 357

history of glucocorticoid use rheumatoid arthritis alcohol excess history of parental hip fracture low body mass index current smoking others sedentary lifestyle premature menopause chronic kidney disease

Answer 358

streptococcal infection 2-4 weeks before

Answer 359

acute cholecystitis - infection of common bile duct ascending cholangitisi - infection of common hepatic duct Right upper quadrant (RUQ) pain, fever and raised inflammatory markers suggests acute cholecystitis or ascending cholangitis. The abnormal liver function tests (LFTs) suggest ascending cholangitis rather than cholecystitis (according to Charcot's triad of RUQ pain, fever and jaundice for cholangitis).

Answer 360

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 positive antiphospholipid antibodies (e.g. in SLE)

Answer 361

Onset is usually at 20-40 years - features include: conductive deafness tinnitus normal tympanic membrane* positive family history - auto dominant

Answer 362

tamoxifen menstrual disturbance: vaginal bleeding, amenorrhoea hot flushes venous thromboembolism endometrial cancer anastrazole osteoporosis NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer hot flushes arthralgia, myalgia insomnia

Answer 363

aromatase inhibitor - for breast cancer in post menopausal women

Answer 364

club foot, describes an inverted (inward turning) and plantar flexed foot diagnosed at newborn exam

Answer 365

males spina bifida cerebral palsy Edward's syndrome (trisomy 18) oligohydramnios arthrogryposis - congenital contractures 50% are bilateral

Answer 366

conservative methods such as the Ponseti method - manual manipulation Achilles tenotomy is required in around 85% of cases but this can usually be done under local anaesthetic

Answer 367

IV procyclidine

Answer 368

Pain (affecting the neck, upper or lower limbs) Loss of motor function (loss of digital dexterity, arm or leg weakness/stiffness leading to impaired gait and imbalance) Loss of sensory function causing numbness Loss of autonomic function Hoffman's sign

Answer 369

MRI cervical spine

Answer 370

Urgently referred for assessment by specialist spinal services due to the importance of early treatment. any existing spinal cord damage can be permanent. Early treatment (within 6 months of diagnosis)

Answer 371

Chest pain: benzodiazepines + glyceryl trinitrate. If myocardial infarction develops then primary percutaneous coronary intervention hypertension: benzodiazepines + sodium nitroprusside

Answer 372

Cardiovascular effects include: coronary artery spasm → myocardial ischaemia/infarction both tachycardia and bradycardia may occur hypertension QRS widening and QT prolongation aortic dissection Neurological effects seizures, mydriasis., hypertonia, hyperreflexia Psychiatric effects agitation. psychosis. hallucinations metabolic acidosis , rhabdomyolysis, hyperthermia

Answer 373

chadsvasc warfarin even after dc cardioversion cont life long

Answer 374

synchronised to the R wave to prevent delivery of a shock during the vulnerable period of cardiac repolarisation when ventricular fibrillation can be induced

Answer 375

<48hr of AF - heparinised before DC >48hr of AF - 3 weeks of anticoag prior - or transoesophageal echo to cjeck for thrombus continue anticoag after for those who have chadsvas>1 but atleast 4 weeks of anticoag

Answer 376

DC electrical pharmacological - amiodarone / flecainde (amiodarone is chosen if structural heart disease)

Answer 377

inhibitor 5a reductase - metabolises testosterone to DHT

Answer 378

male patern baldness BPH

Answer 379

impotence decrease libido ejaculation disorders gynaecomastia and breast tenderness

Answer 380

C Confusion (abbreviated mental test score <= 8/10) U urea > 7 mmol/L R Respiration rate >= 30/min B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg 65 Aged >= 65 years

Answer 381

based on curb65 0-1 - at home, amoxicillin 2 - hospital for oral Abx 3 - IV Abx moderate and high-severity community acquired pneumonia dual antibiotic therapy is recommended with amoxicillin and a macrolide. a 7-10 day course is recommended a repeat chest X-ray at 6 weeks after clinical resolution

Answer 382

ventricular septal defect (VSD) right ventricular hypertrophy right ventricular outflow tract obstruction, pulmonary stenosis overriding aorta

Answer 383

1-2 months

Answer 384

severity of the right ventricular outflow tract obstruction

Answer 385

cyanosis episodic hypercyanotic 'tet' spells - tachypnoea and severe cyanosis that may occasionally result in loss of consciousness they typically occur when an infant is upset, is in pain or has a fever ejection systolic murmur due to pulmonary stenosis

Answer 386

a right-sided aortic arch is seen in 25% of patients chest x-ray shows a 'boot-shaped' heart, ECG shows right ventricular hypertrophy

Answer 387

black >asian>white

Answer 388

watchful waiting alpha-1 antagonists e.g. tamsulosin, alfuzosin decrease smooth muscle tone of the prostate and bladder considered first-line: NICE recommend if moderate-to-severe voiding symptoms (IPSS ≥ 8) 5 alpha-reductase inhibitors e.g. finasteride indicated if the patient has a significantly enlarged prostate and is considered to be at high risk of progression. combinations can be used. if there is a mixture of storage symptoms and voiding symptoms that persist after treatment with an alpha-blocker alone, then an antimuscarinic (anticholinergic) drug such as tolterodine or darifenacin may be tried surgery transurethral resection of prostate (TURP)

Answer 389

dizziness, postural hypotension, dry mouth, depression

Answer 390

unlike alpha-1 antagonists causes a reduction in prostate volume and hence may slow disease progression. This however takes time and symptoms may not improve for 6 months

Answer 391

International Prostate Symptom Score (IPSS) tool for classifying the severity of lower urinary tract symptoms (LUTS) and assessing the impact of LUTS on quality of life Score 20–35: severely symptomatic Score 8–19: moderately symptomatic Score 0–7: mildly symptomatic

Answer 392

dipstick urine U&Es: particularly if chronic retention is suspected PSA: should be done if there are any obstructive symptoms, of if the patient is worried about prostate cancer urinary frequency-volume chart - should be done for at least 3 days

Answer 393

vertigo, hearing loss, tinnitus and an absent corneal reflex.

Answer 394

MRI of the cerebellopontine angle

Answer 395

phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs

Answer 396

due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which codes a cAMP-regulated chloride channel

Answer 397

3 months at a time reduce steroids by 25-50%

Answer 398

metaclopramide

Answer 399

extrapyramidal effects: oculogyric crisis. This is particularly a problem in children and young adults hyperprolactinaemia tardive dyskinesia parkinsonism

Answer 400

concurrent use of nitrites hypotension previous stroke/ MI

Answer 401

visual disturbances- blue discolouration non-arteritic anterior ischaemic neuropathy nasal congestion flushing gastrointestinal side-effects headache priapism

Answer 402

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge.

Answer 403

communicating hydrocele - opening of processus vaginalis - present in new born those that present in adults : epididymo-orchitis testicular torsion testicular tumours

Answer 404

in new born - watch and wait, usually resolve in few months. repaiered if still present after 1-2 yrs in adults if testicle cant be examined - urgent USS

Answer 405

No breastfeeding vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended a zidovudine infusion should be started four hours before beginning the caesarean section zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.

Answer 406

anterior - kisselbach plexus

Answer 407

5-15% 30-40% chnace of adenoma

Answer 408

every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland. Patients aged over 74 years may request screening FIT test - uses Ab to detect human hb

Answer 409

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

Answer 410

loss of peripheral vision

Answer 411

Phenylephrine 10% eye drops can be used to distinguish between episcleritis and scleritis. It blanches the redness in episcleritis but doesn't in scleritis scleritis causes photophobia and reduced acuity (episcleritis doesnt)

Answer 412

red eye classically not painful (in comparison to scleritis), but mild pain/irritation is common watering and mild photophobia may be present 50% bilateral

Answer 413

chloroquine doxyxyline malarone (Atovaquone + proguanil) Mefloquine (Lariam)

Answer 414

GI upset started 1-2 days beofre , stopped 7 days fater

Answer 415

headache, contraindicated in epilepsy started 1 week before, stopped 4 weeks later only taken once / week

Answer 416

photosensitivity/ oesophagiits take 1 - 2 days before and stop 4 weeks later only for those >12 yrs

Answer 417

dizziness, neuropsych contraindicated in epielpsy taken once a week take 2-3 weeks before and stop 4 weeks after

Answer 418

advised not too as the parasite can be sequestratedd in placenta and undetectable if cant be avoided - chloroquine prophylaxis is best doxy contrindicated proguanil - need a folate supplement

Answer 419

Lying or exaggerating for financial gain is malingering, for example someone who fakes whiplash after a road traffic accident for an insurance payment

Answer 420

also known as Munchausen's syndrome the intentional production of physical or psychological symptoms

Answer 421

Legionella include flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia bibasal pneumonia deranged LFTs

Answer 422

erythromycin/ clarithromycin

Answer 423

PPARg agonists (intranuclear receptor) - reduce insulin resistance

Answer 424

pioglitazone

Answer 425

weight gain liver impairment: monitor LFTs fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin recent studies have indicated an increased risk of fractures bladder cancer: pioglitazone

Answer 426

Methadone or buprenorphine compliance is monitored using urinalysis detoxification should normally last up to 4 weeks in an inpatient/residential setting and up to 12 weeks in the community

Answer 427

'inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast-feeding

Answer 428

in <35yrs - after regular intercourse for 12 months >35yrs - after regular intercourse for 6 months Regular sexual intercourse is defined as intercourse every 2-3 days.

Answer 429

MEN: previous surgery on genitalia, Varicocele, Previous STI, Significant systemic illness, Abnormal genital examination FEMALE Abnormal genital examination Amenorrhoea Previous STI Previous pelvic surgery

Answer 430

semen analysis serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21. < 16 nmol/l Repeat, if consistently low refer to specialist 16 - 30 nmol/l Repeat > 30 nmol/l Indicates ovulation

Answer 431

benign lesion papulue with keratin filled crater often spontaneously regresses after 3 months

Answer 432

urgent derm referral and excision to rule out Squamous cell carcinoma

Answer 433

statin, B blocker, ACEi, aspirin, clopidogrel/ prasugral/ticagrelor medeterean diet advice light exercise sex after 1 month post acute coronary syndrome (medically managed): add ticagrelor to aspirin, stop ticagrelor after 12 months post percutaneous coronary intervention: add prasugrel or ticagrelor to aspirin, stop the second antiplatelet after 12 months Patients who have had an acute MI and who have symptoms and/or signs of heart failure and left ventricular systolic dysfunction - start aldosterone antagonist (e.g. eplerenone) within 3-14 days of the MI, preferably after ACE inhibitor therapy

Answer 434

dermatitis herpetiformis (a vesicular, pruritic skin eruption) and autoimmune disorders (type 1 diabetes mellitus and autoimmune hepatitis

Answer 435

HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).

Answer 436

anaemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease) hyposplenism osteoporosis, osteomalacia lactose intolerance enteropathy-associated T-cell lymphoma of small intestine subfertility, unfavourable pregnancy outcomes rare: oesophageal cancer, other malignancies

Answer 437

Duodenal biopsy from a patient with coeliac disease. Complete atrophy of the villi with flat mucosa and marked crypt hyperplasia. Intraepithelial lymphocytosis. Dense mixed inflammatory infiltrate in the lamina propria.

Answer 438

Indapamide chlortalidone

Answer 439

ambulatory/ home reading consistently... >135/85mmHg: treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater >150/95 mmHg - regardles of age

Answer 440

<55yrs OR diabetic = ACEi/ ARB >55yr OR black = Calcium channel blocker second step - add on ACEi/ CaB/ thiazide likediuretic step 3 - add on final one missing of above step 4: confirm elevated clinic BP with ABPM or HBPM assess for postural hypotension. discuss adherence. check pottasium - if <4.5 can add spironolactone. if >4.5 add alpha/ b blcoker

Answer 441

<80yrs home - 135/85 surgery - 140/90 >80 home - 145/85 surgery - 150/90

Answer 442

hypotension hyponatraemia hypokalaemia, hypomagnesaemia hypochloraemic alkalosis ototoxicity hypocalcaemia renal impairment (from dehydration + direct toxic effect) hyperglycaemia (less common than with thiazides) gout

Answer 443

Smoking Increased alcohol consumption Trauma Diabetes mellitus Long-term corticosteroids Radiation exposure Myotonic dystrophy Metabolic disorders: hypocalcaemia

Answer 444

reduced vision - esp night Faded colour vision: making it more difficult to distinguish different colours Glare: lights appear brighter than usual Halos around lights Defect in the red reflex

Answer 445

Posterior capsule opacification: thickening of the lens capsule Retinal detachment Posterior capsule rupture Endophthalmitis: inflammation of aqueous and/or vitreous humour

Answer 446

after 4-6 weeks of conservative treatment failing

Answer 447

Sensory loss over anterior thigh Weak quadriceps Reduced knee reflex Positive femoral stretch test

Answer 448

Sensory loss anterior aspect of knee Weak quadriceps Reduced knee reflex Positive femoral stretch test

Answer 449

Sensory loss dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stret

Answer 450

Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test

Answer 451

falls prior to ovulation due to oestrogen rising in luteal phase due to progesterone

Answer 452

Following menstruation the mucus is thick Just prior to ovulation the mucus becomes clear, acellular, low viscosity. It also becomes 'stretchy' in luteal phase - thick mucus

Answer 453

>15mg steoids for >3 months or equivalent e.g. newly diagnosed polymyalgia rheumatica

Answer 454

>15mg steroids for >3 months or equivalent e.g. newly diagnosed polymyalgia rheumatica

Answer 455

1. >65yrs 2. previous fragility fracture 3. <65ys and T score of <-1.5

Answer 456

>0 - reassure 0 to -1.5 rearragnge DEXA in 1-3 yrs <-1.5 bone protection first line alendronate + calcium + vit D

Answer 457

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

Answer 458

pelvic floor muscle training- at least 8 contractions performed 3 times per day for a minimum of 3 months surgical procedures: e.g. retropubic mid-urethral tape procedures duloxetine may be offered to women if they decline surgical procedures

Answer 459

a combined noradrenaline and serotonin reuptake inhibitor mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced

Answer 460

bladder retraining (lasts for a minimum of 6 weeks) bladder stabilising drugs: antimuscarinics are first-line NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation) Immediate release oxybutynin should, however, be avoided in 'frail older women' mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients

Answer 461

women aged 25 to 49 every 3 years smear for HPV if negative - repeat in 3 years as normal if positive , samples are sent for cytology - normal cytology - repeat smear in 1 year - if still abnromal in 12 months - repeat again in 12 months. - if abnormal on 2nd repeat - then colposcopy - abnormal - refer for colposcopy inadequate sample - repeat in 3 months. 2 consecutive inadequate samples - colposcopy

Answer 462

borderline changes in squamous or endocervical cells. low-grade dyskaryosis. high-grade dyskaryosis (moderate). high-grade dyskaryosis (severe). invasive squamous cell carcinoma. glandular neoplasia

Answer 463

Large loop excision of transformation zone (LLETZ)

Answer 464

a) Child pugh b) HAD or GAD (HAD for hospitals) c) AUDIT, CAGE or FAST*

Answer 465

bishop - assess abiluty to induce labour APGAR - assess health of a newborn immediately

Answer 466

acute pancreatitis

Answer 467

mitral tricuspid in IVDU

Answer 468

S.viridans = streptococcus mitis and Streptococcus sanguinis - usually following dental work S.auresu - IVDU S epidermidis - indwelling lines/ prosthetic valve surgery streptococus bovis and particularly S.gallolyticus is most linked with colorectal cancer

Answer 469

janeway lesions (erythematous macular or nodular lesions caused by septic emboli) - usually on palms osler nodes (painful erythematous lesions caused by immune complex deposition) - usually on fingers

Answer 470

Penicillamine - Proteinuria and Exacerbation of myasthenia gravis Etanercept - Demyelination, Reactivation of tuberculosis Gold - proteinuria hydroxychloroquine- retinopathy, corneal deposits

Answer 471

leflunomide: liver impairment, ILD, HTN methotrexate:Myelosuppression, Liver cirrhosis, Pneumonitis Sulfasalazine: Rashes, Oligospermia, Heinz body anaemia, Interstitial lung disease

Answer 472

IgE mediated: pruritus, erythema, urticaria, angioedema Gastrointestinal system: nausea, colicky abdominal pain, vomiting, diarrhoea nasal itching,sneezing, rhinorrhoea or congestion (with or without conjunctivitis). cough, chest tightness, wheezing or shortness of breath Symptoms of anaphylaxis Non IgE pruritus, erythema, atopic eczema gastro-oesophageal reflux disease loose or frequent stools blood and/or mucus in stools abdominal pain infantile colic food refusal or aversion constipation perianal redness pallor and tiredness faltering growth plus one or more gastrointestinal

Answer 473

eliminate the suspected allergen for 2-6 weeks, then reintroduce. use food ladder e.g. egg ladder - start with egg baked in biscuits and evntually scrambled eggs would be high up

Answer 474

- for patients with heart failure and wide QRS Indicated in patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms.

Answer 475

improves symptoms but not hospitalisation

Answer 476

achieved by biventricular pacing leads to improved symptoms and reduced hospitalisation in NYHA class III patients

Answer 477

An Implantable cardiac defibrillator (ICD) is indicated in patients with previous sustained ventricular tachycardia, ejection fraction <35% and symptoms no worse than class III of of the New York Heart Association functional classification.

Answer 478

Digoxin reduces hospitalisation but not mortality in heart failure

Answer 479

All pregnant women should take a daily supplement containing 10micrograms of vitamin D

Answer 480

Risk factors male sex siblings with glue ear higher incidence in Winter and Spring bottle feeding day care attendance parental smoking

Answer 481

rommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months adenoidectomy

Answer 482

Caput succedaneum is a swelling due to pressure of the presenting part on the cervix. It is present from birth with poor margins and crosses suture lines. It typically resolves in 1-2days and does not usually require treatment. due to ventouse or prolonged delivery. Cephalohaematoma is caused by ruptured blood vessels e.g. forceps causing a subperiosteal swelling limited by the suture lines. takes months to resolve. develops 1-2 hours post birth Subgaleal haematoma is swelling between the periosteum and the epicranial aponeurosis. This typically presents as a swelling 12-72hours post delivery and is associated with ventouse assisted deliveries.

Answer 483

prolactin - increases galactorrhoea dopamine inhibits it (e.g. dopamine agonist bromocriptine)

Answer 484

men: impotence, loss of libido, galactorrhoea women: amenorrhoea, galactorrhoea

Answer 485

prolactinoma pregnancy oestrogens physiological: stress, exercise, sleep acromegaly: 1/3 of patients polycystic ovarian syndrome primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release) drugs

Answer 486

metoclopramide, domperidone phenothiazines haloperidol very rare: SSRIs, opioids

Answer 487

incision along tension line

Answer 488

Early keloids may be treated with intra-lesional steroids e.g. triamcinolone

Answer 489

small bowel: surgery / adhesions followed by hernias large bowel : malaignancy

Answer 490

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

Answer 491

causes vasoconstriction in the skin and kidneys causing a narrow pulse pressure

Answer 492

self-limiting condition. Spontaneous resolution usually occurs within 18 months Explain that lesions are contagious, and it is sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings) Encourage people not to scratch the lesions. Exclusion from school, gym, or swimming is not necessary Cryotherapy may be used in older children or adults

Answer 493

For people who are HIV-positive with extensive lesions urgent referral to a HIV specialist For people with eyelid-margin or ocular lesions and associated red eye urgent referral to an ophthalmologist Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections

Answer 494

usually 50-70yrs more common in men SoB bibaseal fine end inspiratory crackles dry cough clubbing

Answer 495

Spirometry: restrictive picture (FEV1 normal/decreased, FVC decreased, FEV1/FVC increased) impaired gas exchange: reduced transfer factor (TLCO) imaging: bilateral interstitial shadowing - 'ground-glass' - later progressing to 'honeycombing') may be seen on a chest x-ray high-resolution CT scanning is the investigation of choice and required to make a diagnosis of IPF ANA positive in 30%, rheumatoid factor positive in 10%

Answer 496

5 doses - 2 months, 3 months, 4 months, 3-5yr, 13-18yrs

Answer 497

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago if tetanus prone wound: reinforcing dose of vaccine high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin If vaccination history is incomplete or unknown reinforcing dose of vaccine, regardless of the wound severity for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

Answer 498

knee - adults hip - kids

Answer 499

aspirate knee first flucloxacillin or clindamycin if penicillin allergic wash out

Answer 500

protazoa, STI features: vaginal discharge: offensive, yellow/green, frothy vulvovaginitis, strawberry cervix, pH > 4.5, urethritis in men

Answer 501

oral metronidazole for 5-7 days

Answer 502

Maternal mortality includes any death in pregnancy and labour as well as up to six weeks post partum

Answer 503

interferes with DNA synthesis by inhibiting dihydrofolate reductase

Answer 504

myelosuppression transient rise in creatinine: trimethoprim competitively inhibits the tubular secretion of creatinin

Answer 505

high risk - IV allopurinol or IV rasburicase immediately prior to and during the first days of chemotherapy. lower risk - should be given oral allopurinol during chemotherapy cycles in an attempt to avoid the condition

Answer 506

Rasburicase is a recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin. Allantoin is much more water-soluble than uric acid and is, therefore, more easily excreted by the kidneys.

Answer 507

reduces effect of rasburicase

Answer 508

high PO4 high K low Ca high urate

Answer 509

Examples of suitable antimuscarinic drugs include oxybutynin, tolterodine and darifenacin.

Answer 510

urine dip, PSA, DRE, IPSS pelvic floor muscle training, bladder training, prudent fluid intake and containment products if 'moderate' or 'severe' symptoms offer an alpha-blocker 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 there are mixed symptoms of voiding and storage not responding to an alpha blocker then a antimuscarinic (anticholinergic) drug may be added

Answer 511

vasodilator diuretic and natriuretic suppresses both sympathetic tone and the renin-angiotensin-aldosterone system

Answer 512

Factors which reduce BNP levels include treatment with ACE inhibitors, angiotensin-2 receptor blockers and diuretics.

Answer 513

use of left ventricular dysfunction such as myocardial ischaemia or valvular disease may raise levels. Raised levels may also be seen due to reduced excretion in patients with chronic kidney disease.

Answer 514

all women should take 400mcg of folic acid until the 12th week of pregnancy women at higher risk of conceiving a child with a NTD should take 5mg of folic acid instead e.g. either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait. the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).

Answer 515

2-5 days after

Answer 516

known renal impairment (especially diabetic nephropathy) age > 70 years dehydration cardiac failure the use of nephrotoxic drugs such as NSAIDs

Answer 517

Symtpoms of stroke lasting less than 25 hours (but typically less than 1 he) a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

Answer 518

give aspirin 300 mg immediately, unless - bleeding disorcder/ DOAC - already on low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist - Aspirin is contraindicated Specialist review withing 7 days however if more than 1 TIA within 1 week then within 24 hours Advise the person not to drive until they have been seen by a specialist. after seing specialist - clopidogrel first line

Answer 519

urgent CT head to exclude haemorrhage

Answer 520

HbA1c 6.5 or more - metformin - can titrate up and manage with life style up to 7.5% if >7.5% - add 2nd drug - sulphonylyrea/ DDP4/glitazone if still high add 3rd drug or start insulin can also add GLP1 if 3rd drug doesnt work and BMI is >35 or insulin has occupational issues if CVD risk/CVD// HF - add SGLT2 to metformin - does not depend on HbA1c. metformin should be titrated up and established before starting SGLT2

Answer 521

lifestyle alone - 6.5% metformin - 6.5% other mrfd - 7%

Answer 522

only continue if there is a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months

Answer 523

lifestyle alone - 6.5% metformin - 6.5% other drugs - 7%

Answer 524

benign lesions in older people - looks bit like a mole can get multiple of them large variation in colour from flesh to light-brown to black have a 'stuck-on' appearance keratotic plugs may be seen on the surface clue to differntiating from mole is it develops in later life

Answer 525

1. adequate first aid for 20 minutes (squeeze both nasal ala firmly and sit forward. Ice in the mouth can help) 2. topical adrenaline/local anaesthetic 3. topical tranexamic acid 4. nasal packing (e.g. with Rapid Rhino. Initially insert into the affected nostril. If unsuccessful, a pack in the other nostril may help. Posterior bleeds can be packed with a posterior pack, or with a Foley catheter). 5. surgical intervention (sphenopalatine artery ligation).

Answer 526

kisselbach

Answer 527

women who are post-menopausal women. It presents with vaginal dryness, dyspareunia and occasional spotting. Treatment is with vaginal lubricants and moisturisers topical oestrogen

Answer 528

vitamin A - retinoids - night time blindness B1 - thiamine - beriberi (polyneuropathy, wernickes, HF) B3 - niacin - pellagra - dermatitis, dementia and diarrhoea B6 - pyridoxine - anaemia, irritability, seizures

Answer 529

B7 - biotin - dermatitis B9 - folic acid - anaemia, neural tube B12 - cyanocobalamin - anaemia, neuroathy C - scurvy

Answer 530

D - rickets/ osteomalacia E - haemolytic anaemia of new born, ataxia, peripheral neuropathy K - haemorrhoagic disease of new born, coagulopathy

Answer 531

polyhydramnios - due to polyuria preterm - associated with polyhydramnios macrosomia hypoglycaemia RSD- surfactant delay polycythamia still birth hypoMg/Ca shoulder dystocia

Answer 532

a) cross links DNA. haemorrhagic cyctitis, transistional cell carcinoma, myelosupression b) degrades DNA. lung fibrosis c)stabilisies DNA topoisomerase II complex, cardiomyopathy

Answer 533

methotrexate - folate analgoe. myelosupression, liver, lung fibrosis, mucositis 5 flurouracil - pyridimine analogue - myelosupression, mucositis, dermatitis 6-mercaptopurine Purine analogue. Myelosuppression Cytarabine pyridimine antagonist. myelosupression

Answer 534

Vincristine Inhibits formation of microtubules Peripheral neuropathy (reversible) , paralytic ileus Docetaxel Prevents microtubule depolymerisation & disassembly Neutropaenia

Answer 535

Cisplatin cross-linking in DNA Ototoxicity, peripheral neuropathy, hypomagnesaemia

Answer 536

age related sensorineural hearing loss auditometry shows bilateral high freq hearing loss

Answer 537

Fhx (auto dom0 20-40yrs conductive hearing loss tinnitus

Answer 538

recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom a sensation of aural fullness other features include nystagmus and a positive Romberg test episodes last minutes to hours

Answer 539

Sjogren's syndrome (seen in up to 80% of patients) rheumatoid arthritis systemic sclerosis thyroid disease

Answer 540

IgM anti mitochondrial

Answer 541

females often asymptomatic - raised ALP jaundice

Answer 542

first-line: ursodeoxycholic acid slows disease progression and improves symptoms pruritus: cholestyramine fat-soluble vitamin supplementation liver transplantation e.g. if bilirubin > 100 (PBC is a major indication)

Answer 543

all patients - aspirin and a statin sublingual glyceryl trinitrate PRN beta-blocker or a calcium channel blocker first-line - increase to max tolerated dose and if still symptomatic can use combo if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used if used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine)

Answer 544

Total iron-binding capacity (TIBC) + transferrin levels are typically raised in iron-deficiency anaemia low ferritin low transferrin saturation low serum iron

Answer 545

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics conjunctival injection bright red, cracked lips strawberry tongue cervical lymphadenopathy red palms of the hands and the soles of the feet which later peel

Answer 546

high dose aspriin immunoglobulins echo - look for aneuryms

Answer 547

congenital hypothyroidism cystic fibrosis sickle cell disease phenylketonuria medium chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU)

Answer 548

Relative causes dehydration stress: Gaisbock syndrome Primary polycythaemia rubra vera Secondary causes COPD altitude obstructive sleep apnoea excessive erythropoietin: cerebellar haemangioma, hypernephroma, hepatoma, uterine fibroids*

Answer 549

The classic symptom of this condition is intense itching which usually occurs after exposure to hot water or hot and humid weather tinnitius DVT flushing headaches

Answer 550

arthritis: polyarticular, symmetric Uveitis (mainly UC) Pyoderma gangrenosum Clubbing Primary sclerosing cholangitis (mainly UC)

Answer 551

Arthritis: pauciarticular, asymmetric Erythema nodosum Episcleritis Osteoporosis

Answer 552

chadsvasc for bleeding - has bleed/ ORBIT

Answer 553

MR dipyrimidole

Answer 554

The Centor criteria are: score 1 point for each (maximum score of 4) presence of tonsillar exudate tender anterior cervical lymphadenopathy or lymphadenitis history of fever absence of cough

Answer 555

either phenoxymethylpenicillin or clarithromycin (if the patient is penicillin-allergic) should be given. Either a 7 or 10 day course should be given

Answer 556

typically affects nose, cheeks and forehead flushing is often first symptom telangiectasia later develops into persistent erythema with papules and pustules rhinophyma ocular involvement: blepharitis sunlight may exacerbate symptoms/

Answer 557

mild - topical metronidazole severe/resistant: oral tetracycline

Answer 558

Invasive ductal carcinoma (no special type)

Answer 559

Paget's disease of the nipple is an eczematoid change of the nipple associated with an underlying breast malignancy

Answer 560

cocaine blocks the uptake of dopamine, noradrenaline and serotonin

Answer 561

severe gingivitis / mutuliple genital vesivcles lymphadenopathy fever

Answer 562

gingivostomatitis: oral aciclovir, chlorhexidine mouthwash cold sores: topical aciclovir genital herpes: oral aciclovir.

Answer 563

if primary attack occurs during pregnancy after 28 weeks - C section recurrent herpes whilst pregnant - supressive therapy

Answer 564

DOAC - apixaban/rivaroxaban provoked - 3 months unprovoked -6 months cancer patients - 6 month if neither apixaban or rivaroxaban are suitable then either LMWH followed by dabigatran or edoxaban OR LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin) if renal impairment is severe (e.g. < 15/min) then LMWH, unfractionated heparin or LMWH followed by a VKA if the patient has antiphospholipid syndrome then LMWH followed by a VKA should be used

Answer 565

Trichomonas vaginalis

Answer 566

Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen

Answer 567

bull's eye retinopathy - may result in severe and permanent visual loss baseline opthalmology exam recommended

Answer 568

short synacthen plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM. Adrenal autoantibodies such as anti-21-hydroxylase may also be demonstrated.

Answer 569

hyperkalaemia hyponatraemia hypoglycaemia metabolic acidosis

Answer 570

> 500 nmol/l makes Addison's very unlikely < 100 nmol/l is definitely abnormal 100-500 nmol/l should prompt a ACTH stimulation test to be performed

Answer 571

Auditory hallucinations of a specific type: two or more voices discussing the patient in the third person thought echo voices commenting on the patient's behaviour Thought disorders: thought insertion, withdrawal or broadcasting Passivity phenomena: bodily sensations being controlled by external influence actions/impulses/feelings - experiences which are imposed on the individual or influenced by others Delusional perceptions e.g. 'The traffic light is green therefore I am the King'.

Answer 572

nirtofurantoin first line (avoid near term) 2nd line axocillin/cefalexin 7 days urine culutre

Answer 573

7 days nitro/trimethroprim

Answer 574

if haematuria / >65yrs

Answer 575

assymptomatic - no treatment symtpomatic - 7 days , change catheter

Answer 576

retinoblastoma urgent opthal referral

Answer 577

only if brca positive

Answer 578

positive BHCG transvaginal USS - shows mass not in uterus

Answer 579

expectant - <35mm, no heart beat, assymptomatic, no rupture, hcg <1000, medical - as above but symptoms as long as no significant pain. hcg <1500 surgical - >35mm, pain, heart beat, ruputred, hcg >5000

Answer 580

salpingectomy or 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

Answer 581

methotrexate

Answer 582

ilieostomy - spouted (more irratating), liquid content, right sided colostomy- not spouted, solid content, left side

Answer 583

A loop ileostomy can be used to defunction the colon to protect an anastomosis

Answer 584

ankle oedema, flushing, headache

Answer 585

citalopram

Answer 586

The Mental Health Act overrides the Mental Capacity Act and enables people with capacity to be given treatment against their will

Answer 587

symptoms are usually bilateral grittiness and discomfort, particularly around the eyelid margins eyes may be sticky in the morning eyelid margins may be red. styes and chalazions a secondary conjunctivitis may occur more common in patients with roscea

Answer 588

softening of the lid margin using hot compresses twice a day 'lid hygiene' - mechanical removal of the debris from lid margins artificial tears for those with dry eys

Answer 589

first-line: offer combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol

Answer 590

SpO2 <92% PEF <33% best or predicted Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis

Answer 591

all women aged >= 65 years and all men aged >= 75 years should be assessed. using FRAX tool reassess if chnage in risk factor

Answer 592

exercise NSAIDs anti TNF

Answer 593

pregnancy <16yrs old thyroid eye disease - can worsen

Answer 594

fall onto outstretched hand dinner fork deformity - dorsal diplacement radial fracture

Answer 595

fall onto outstretched hand dinner fork deformity - dorsal diplacement radial fracture

Answer 596

refverse of colles - falling onto back of hand . volar displacement

Answer 597

Risk of fracture associated with fall onto outstretched hand (tubercle, waist, or proximal 1/3) The main physical signs are swelling and tenderness in the anatomical snuff box, and pain on wrist movements and on longitudinal compression of the thumb.

Answer 598

bennets - fracture of thumb montagegi - fracture of ulnar and dislocation of proximal radio-ulnar joint galeazzi - radius fracture and distal radio-ulnar joint bartons- radius fracture + radiocarapal dislocation

Answer 599

if the motor symptoms are affecting the patient's quality of life: levodopa if the motor symptoms are not affecting the patient's quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor

Answer 600

excessive sleepiness, hallucinations and impulse control disorders dopamine agonists e.g. ropinerole have highest risk of hallucinations and impulse control disorders

Answer 601

sleepiness - medafenil orthostatic - midodrine

Answer 602

levo dopa with decarboxylase inhibitor - prevents peripheral conversion to dopamine - fewer side effects

Answer 603

dry mouth anorexia palpitations postural hypotension psychosis on off dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)

Answer 604

bromocriptine, ropinirole, cabergoline, apomorphine

Answer 605

ergot-derived dopamine receptor agonists (bromocriptine, cabergoline) have been associated with pulmonary, retroperitoneal and cardiac fibrosis. echocardiogram, ESR, creatinine and chest x-ray should be obtained prior to treatment and patients should be closely monitored

Answer 606

MOA - B inhibitor - for parkinosn

Answer 607

COMT inhibtiros - parkinsons

Answer 608

weight loss > 10% in last 6 months fever > 38ºC night sweats

Answer 609

nodular sclerosing good prog

Answer 610

lymphocyte deplete

Answer 611

alcohol induced pain - hodgkins

Answer 612

Reed sternberg

Answer 613

Whipple's resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas.

Answer 614

suggests pancreatic cancer double duct' sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

Answer 615

salmonella typhi/parathyhi (cause of enteric fever)

Answer 616

nitially systemic upset relative bradycardia abdominal pain, distension constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

Answer 617

salmonella

Answer 618

mild: open and closed comedones with or without sparse inflammatory lesions moderate acne: widespread non-inflammatory lesions and numerous papules and pustules severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring

Answer 619

single topical therapy (topical retinoids, benzoyl peroxide) topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid) oral antibiotics: tetracyclines: lymecycline, oxytetracycline, doxycycline cocp oral isotretinoin can use topical retinoid and oral Abx together oral antibiotics 3 months max

Answer 620

retinoids - oral and topical tetracyclines (use erythromycin instead)

Answer 621

D2 receptor antagonist - prokinetic

Answer 622

extrapyramidal effects acute dystonia e.g. oculogyric crisis this is particularly a problem in children and young adults diarrhoea hyperprolactinaemia tardive dyskinesia parkinsonism

Answer 623

metoclopramide (may be useful in paralytic ileus)

Answer 624

no periods for 12 months

Answer 625

Contraindications: Current or past breast cancer Any oestrogen-sensitive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia

Answer 626

uterus - need O+P no uterus - O along (oral or transdermal) risk to VTE - use transdermal patch

Answer 627

Vasomotor symptoms fluoxetine, citalopram or venlafaxine Vaginal dryness vaginal lubricant or moisturiser Psychological symptoms self-help groups, cognitive behaviour therapy or antidepressants Urogenital symptoms if suffering from urogenital atrophy vaginal oestrogen can be prescribed.

Answer 628

onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years.

Answer 629

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)

Answer 630

MEN type II, neurofibromatosis and von Hippel-Lindau syndrome

Answer 631

24 hour urinary catecholamine

Answer 632

alpha-blocker (e.g. phenoxybenzamine), given before a beta-blocker (e.g. propranolol)

Answer 633

obesity female sex pregnancy drugs* combined oral contraceptive pill steroids tetracyclines vitamin A lithium

Answer 634

weight loss diuretics e.g. acetazolamide topiramate

Answer 635

carbemazepine

Answer 636

U waves small or absent T waves prolonged PR interval ST depression

Answer 637

hypokalaemia

Answer 638

antiphospholipid syndrome

Answer 639

primary thromboprophylaxis - low-dose aspirin secondary thromboprophylaxis initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3 recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4 arterial thrombosis should be treated with lifelong warfarin with target INR 2-3

Answer 640

blurring of vision again years after cataract surgery can occur due to posterior capsule opacification

Answer 641

he peak incidence is at around 2-5 years of age and boys are affected slightly more commonly than girls

Answer 642

age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-Caucasian male sex

Answer 643

small cell lung cancer

Answer 644

stroke subarachnoid haemorrhage subdural haemorrhage meningitis/encephalitis/abscess tuberculosis pneumonia Drugs positive end-expiratory pressure (PEEP) porphyrias small cell lung cancer

Answer 645

fluid restriction demeclocycline: reduces the responsiveness of the collecting tubule cells to ADH ADH (vasopressin) receptor antagonists

Answer 646

Campylobacter enteritis Clarithromycin Salmonella (non-typhoid) Ciprofloxacin Shigellosis Ciprofloxacin

Answer 647

quinolone or trimethroprim

Answer 648

Impetigo Topical hydrogen peroxide, oral flucloxacillin or erythromycin if widespread Cellulitis Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic) Cellulitis (near the eyes or nose) Co-amoxiclav

Answer 649

flucloxacilin

Answer 650

<2cm in aggregate -Lithotripsy <2cm in pregnant females - Ureteroscopy Complex renal calculi and staghorn calculi Percutaneous nephrolithotomy Ureteric calculi less than 5mm Manage expectantly ureteric obstruction + infection - surgical emergency e.g. nephrostomy tube placement, insertion of ureteric catheters and ureteric stent placement.

Answer 651

can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more

Answer 652

angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel

Answer 653

pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers

Answer 654

aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA

Answer 655

croup : 6m - 3y brocnchiolitis - 1-9m

Answer 656

single dose oral prednisolone

Answer 657

parkinsons

Answer 658

amiodarone cytotoxic agents: busulphan, bleomycin anti-rheumatoid drugs: methotrexate, sulfasalazine nitrofurantoin ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Answer 659

tenosynovitis migratory polyarthritis dermatitis

Answer 660

implantable contraceptive every 3 years

Answer 661

certain antiepileptic and rifampicin

Answer 662

low electrolytes (inc Ca) gout ototoxic

Answer 663

acts by activation of the AMP-activated protein kinase (AMPK) increases insulin sensitivity decreases hepatic gluconeogenesis may also reduce gastrointestinal absorption of carbohydrates

Answer 664

recent myocardial infarction, sepsis, acute kidney injury and severe dehydration risk of lactic acidosis

Answer 665

metformin should be discontinued on the day of the procedure and for 48 hours thereafter

Answer 666

HSV temporal and inferior frontal lobes IV aciclovir

Answer 667

dopamine antagonists

Answer 668

Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm.

Answer 669

patients >= 40 years with unexplained weight loss AND abdominal pain patients >= 50 years with unexplained rectal bleeding patients >= 60 years with iron deficiency anaemia OR change in bowel habit tests show occult blood in their faeces (see below)

Answer 670

o2 ipratropium/ salbutamol nebs prednisolone - 5 days if no response - IV MgSO4, then IV aminophyline then intubation

Answer 671

been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours inhaler technique checked and recorded PEF >75% of best or predicted

Answer 672

symmetrical, erythematous, tender, nodules which heal without scarring

Answer 673

shiny, painless areas of yellow/red skin typically on the shin of diabetics often associated with telangiectasia

Answer 674

calcium pyrophosphate weak postive rhomboid

Answer 675

haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly, Wilson's disease

Answer 676

knee, shouldr, wrist chondrocalcinosis

Answer 677

both auto dom ADPKD1 - more common, renal failure earlier ADPKD2 - less common

Answer 678

uss if <30yrs and 2 cysts in 1 or 2 kidneys if <60 and 2 cysts in both kidney if >60 and 4 cysts in both kidneys

Answer 679

tolvaptan - vassopressin receptor 2 antagonist

Answer 680

intranasal antihisatimines intranasal steroids oral steroids

Answer 681

low IQ gradual onset strong family history social withdrawal

Answer 682

group A strept (pyogenes)

Answer 683

fever strawberry tongue sore throat rash - torso, sandpaper texture, flushed appearance

Answer 684

pen V 10days can return to school 24hours after starting Abx notifiable disease

Answer 685

otitis media: the most common complication rheumatic fever: typically occurs 20 days after infection acute glomerulonephritis: typically occurs 10 days after infection

Answer 686

Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses

Answer 687

high dose aciclovir high dose steroids eye protection

Answer 688

Abx - 4 weeks ago PPI - 2 weeks ago

Answer 689

bradycardia hypertension wide pulse pressure

Answer 690

CPP= Mean arterial pressure - Intra cranial pressure

Answer 691

HBsAg normally implies acute disease (present for 1-6 months) if HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective) anti HBs - previous vaccine or infection (immunity) antiHBc - previous infection HbeAg - marker of infectivity

Answer 692

HBsAg normally implies acute disease (present for 1-6 months) if HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective) anti HBs - previous vaccine or infection (immunity) antiHBc - previous infection HbeAg - marker of infectivity

Answer 693

at risk patients / incidental finding of increased echogenicity on USS - Enhnaced liver fibrosis test

Answer 694

Alcoholic liver disease is typically associated with an AST:ALT ratio >2 i

Answer 695

azathioprine, mesalazine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

Answer 696

Retinal haemorrhages, subdural haematoma and encephalopathy

Answer 697

Riluzole prevents stimulation of glutamate receptors used mainly in amyotrophic lateral sclerosis prolongs life by about 3 months Respiratory care non-invasive ventilation (usually BIPAP) is used at night studies have shown a survival benefit of around 7 months Nutrition percutaneous gastrostomy tube (PEG) is the preferred way to support nutrition and has been associated with prolonged survival

Answer 698

ASAP , doesnt matter what CD4 count is

Answer 699

Duodenal ulcers: more common than gastric ulcers, epigastric pain relieved by eating Gastric ulcers: epigastric pain worsened by eating

Answer 700

MUST, FAST, CAGE

Answer 701

4 questions max score 16 3 or more = hazardous drinking

Answer 702

10 questions. max score 40

Answer 703

Usually midline, between the isthmus of the thyroid and the hyoid bone Moves upwards with protrusion of the tongue May be painful if infected

Answer 704

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side

Answer 705

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx

Answer 706

start with levothyroxine 50 and titrate depending on TSH (check every 8-12 weeks until stable dose) in elderly (>50)/ IHD start at 25 insterad

Answer 707

increased by 25-50mic

Answer 708

hyperthyroidism: due to over treatment reduced bone mineral density worsening of angina atrial fibrillation

Answer 709

calcium carbonate, iron take 4 hours apart

Answer 710

when painful, same as other forms of neuropathy rst-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin if the first-line drug treatment does not work try one of the other 3 drugs - monotherapy tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)

Answer 711

chronic diarrhoea, gastropparesis, GORD

Answer 712

bloating, erratic BMs metoclopramide

Answer 713

inhibit ovulation

Answer 714

hyponatraemia, hypomagnasaemia osteoporosis → increased risk of fractures microscopic colitis increased risk of C. difficile infections

Answer 715

within first 48hours dresslers - within 2-6 weeks following - leuritic pain, fever, effusion, biconcave ST elevation

Answer 716

no pain ST elevation tiredness / signs of HF need to be anticoagulated

Answer 717

teratogenic neural tube defects P450 inhibitor gastrointestinal: nausea increased appetite and weight gain alopecia: regrowth may be curly ataxia tremor hepatotoxicity pancreatitis thrombocytopaenia hyponatraemia

Answer 718

8-12 hours post last dose

Answer 719

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia

Answer 720

hypoK renal failure myocardial ischaemia hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis hypoalbuminaemia hypothermia hypothyroidism drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

Answer 721

<2cm and no SoB discharge if this fails, aspitate >2cm/ sob- chest drain

Answer 722

if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted. 1-2cm - aspiration If aspiration fails - a chest drain should be inserted. if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

Answer 723

never dive dont smoke can fly after 2 weeks if succesful drainage and no residual air/ can fly after 1 week if CXR check

Answer 724

cortisol / GH

Answer 725

bradycardia, hypotension

Answer 726

minimla change steroids

Answer 727

MRI whole spine - look for skip lesions

Answer 728

narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill duration of murmur left ventricular hypertrophy or failure

Answer 729

if asymptomatic then observe if symptomatic then valve replacement if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery

Answer 730

progesterone implant

Answer 731

tricyclic antidepressants e.g. amitriptyline anticholinergics e.g. antipsychotics, antihistamines opioids NSAIDs disopyramide

Answer 732

IUD - instant POP - 2 days everything else inc mirina - 7 days

Answer 733

sudden loss in muscle tone brought on by emotion e.g. laughter causing syncope linked strongly to narcolepsy

Answer 734

impaired fasting glucose (IFG) - due to hepatic insulin resistance impaired glucose tolerance (IGT) - due to muscle insulin resistance IGT more likley to develop IHD

Answer 735

rifampicin - flu like, orange secretions, liver enzyme inducer isoniazid - peripheral neuropathy (treat with pyridoxine),hepatitis, agranulocytosis, liver enzyme inhibitor pyrazinamide - gout, arthralgia/myalgia, hepatitis ethanbutol - optic neuritis

Answer 736

older patients chronic constipation Chagas disease neurological conditions e.g. Parkinson's disease, Duchenne muscular dystrophy psychiatric conditions e.g. schizophrenia

Answer 737

sgmoid more common sigmoid presents as large bowel obstruction caecal presents as small bowel obstruction

Answer 738

internal style

Answer 739

seborrhoeic dermatitis

Answer 740

Iliotibial band syndrome pain lateral side of knee

Answer 741

family history i.e. a parent with scizophrenia

Answer 742

hair loss following stressful period e.g. surgery

Answer 743

facotr V leiden

Answer 744

antithrombin 3

Answer 745

fall in BP, raised JVP, muffled heart sounds

Answer 746

electrical alternans

Answer 747

glucose > 11 mmol/l or known diabetes mellitus pH < 7.3 bicarbonate < 15 mmol/l ketones > 3 mmol/l or urine ketones ++ on dipstick

Answer 748

fluids 0.1units/kg/hr insulin fixed when glucose <15 give 5% dextrose too cont long acting inulin give pottasium if K+ <5.5

Answer 749

pH >7.3 and blood ketones < 0.6 mmol/L and bicarbonate > 15.0mmol/L

Answer 750

headache jaw claudication anterior ischemic optic neuropathy polymyalgia rheumatica

Answer 751

follicular common in menstrual women physiological cyst

Answer 752

dermoid cyst benign - germ cell torsion is more common

Answer 753

dermoid cyst benign - germ cell torsion is more common

Answer 754

germ cell - dermoid epithelial - serous or mucinous

Answer 755

serous carcinoma

Answer 756

symmetric polyarthritis - most common type asymmetrical oligoarthritis: typically affects hands and feet sacroiliitis DIP joint disease (10%) arthritis mutilans

Answer 757

type 1 - IgE/ mast cells - anaphylaxis, atopy type 2 - IgG/M bind antigen on cell surface e.g. autoimmune haemolytic anaemia, ITP, pernicious anaemia tyope 3 - free antigen and antibody form complexes - SLE, post strept glomeulonephritis type 4 - T cell - TB , scabies, allergic contact dermatitis, MS type 5 - Ab to cell surface receptor - graves

Answer 758

Thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage causes fever and tachy managed by slowing and giving paracetamol

Answer 759

plasma protieuns uritcaria temporarily slop , antihistaines

Answer 760

those with anti IgA ab

Answer 761

ABO incompatible fever, abdo pain, hypotension A to E , check identity, send blood back

Answer 762

TRALI - Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood. presents as hypoxia, infiltrates, fever, hypotension TACO - overload, HYPERTENSION

Answer 763

valsalva/ carotid massage adenosine 6mg, 12mg, 18mg adenosine is contraindicated in asthmatics, use verapamil instead

Answer 764

immediately

Answer 765

anterior resection for anything more than 5cm from anal verge below this is an abdomino perineal resection

Answer 766

anterior resection for anything more than 5cm from anal verge below this is an abdomino perineal resection

Answer 767

rheumatological problems: arthralgia, arthritis eye problems: Sjogren's syndrome cirrhosis hepatocellular cancer cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal) porphyria cutanea tarda (PCT) membranoproliferative glomerulonephritis

Answer 768

6 months ribivirin is teratogenic

Answer 769

port wine stains - no strawberry naevus - develop in first month, grow up to 9 months and then spontaneuously go

Answer 770

tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole

Answer 771

14 -21 days doxycycline Jarisch-Herxheimer reaction-worsening of symptoms

Answer 772

perianal itching, particularly at night girls may have vulval symptoms mebendazole is used first-line for children > 6 months old and household members. A single dose is given unless infestation persists

Answer 773

14 units/week best to spread out over 3 or more days

Answer 774

fetal macrosomia ( high maternal body mass index diabetes mellitus prolonged labour

Answer 775

mcroberts manouevre episiotomy

Answer 776

seminomas: seminomas: hCG may be elevated in around 20% non-seminomas: AFP and/or beta-hCG are elevated in 80-85% LDH

Answer 777

laproscopy

Answer 778

acute onset ocular discomfort & pain (may increase with use) pupil may be small +/- irregular due to sphincter muscle contraction photophobia (often intense) blurred vision red eye lacrimation ciliary flush: a ring of red spreading outwards hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level

Answer 779

urgent opthal review

MSRA Flashcards

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