msra Flashcards

Question

What are the management steps for asthma treatment?

Answer 1

1) SABA 2) SABA + Low Dose ICS 3) SABA + Low Dose ICS + Leukotriene receptor Antagonist (LTRA) e.g. Montelukast 4) SABA + Low Dose ICS + LABA +/- LTRA 5) SABA +/- LTRA + MART (Maintenance + Reliever) + ICS 6) SABA +/- LTRA + Moderate dose ICS MART 7) SABA +/- LTRA + High dose ICS +/- Theophylline (musc rec antagonist)

Answer 2

Cellulitis of the mouth/neck due to a blocked salivary duct. Typically red, swollen under mandible. Urgent referral to ENT + antibiotics.

Answer 3

E.g. Budesonide Low: <400mg Moderate: 400 - 800mg High: >800mg

Answer 4

Benign neoplasm of salivary gland Tends to be softer and fluctuant

Answer 5

Topical antibiotic drops + steroid drops Avoid aminoglycosides e.g. gentamicin if rupture of ear drum If treatment fails then ENT referral

Answer 6

ACE inhibitors Beta Blockers ARBs Aldosterone antagonist e.g. spironolactone

Answer 7

1st: ACEi + Beta blocker (start one at a time). - BB e.g. Bisoprolol, Carvediolol, Nebivolol. 2nd: Aldosterone antagonist e.g. spironolactone or eplerenone +/- SGLT-2 Inhibitor e.g. dapagliflocin or empagliflocin. 3rd: Sacubatril Valsartan, Hydralazine. Remember to give annual influenza and pneumococcal vaccines.

Answer 8

Visual loss (hours/days) - Central scotoma (key feature!) Periocular pain (worse on eye movement) Dyschromatopsia (change in colour perception e.g. red desaturation. Look for Relative Afferent Pupillary Defect (RAPD) aka Marcus Gunn Pupil - lack of constriction in affected and non-affected pupil when light is swung to affected eye.

Answer 9

Multiple Sclerosis Diabetes Syphylis Bloods/Sexual health screen MRI: if >3 white matter lesions then 50% get MS in 5 years!

Answer 10

High dose steroids. IV methylprednisolone 30mg/kg for 3-5 days. Expect resolution in 4-6 weeks.

Answer 11

Short Synacthen Test: Measures serum cortisol levels after ACTH stimulation is administered (Synacthen).

Answer 12

Hypotension Hyperpigmentation Vitiligo Hyponatraemia Hyperkalaemia Treat with IV hydrocortisone

Answer 13

Ischaemic Optic Neuropathy

Answer 14

HTN Diabetes Floaters/Flashes Loss of vision 'curtain fall' / peripheral Painless

Answer 15

Distortion of vision e.g. straight lines appearing curved Blurring Central loss of vision Drusen (yellow spots) on the retina (in Dry Macular Degeneration) Dry MD is more common and less severe than Wet MD. In wet MD blood vessels are leaky and vision loss is more severe. MD is the most common cause of blindness

Answer 16

AKA Giant Cell Arteritis Rapid onset, headache, jaw claudication, blurred/loss of vision, tenderness around temporal nerve. Oral Prednisolone 40-60mg/day with temporal artery biopsy within a week.

Answer 17

Saline IV 0.9% pre and post administration of contrast (1ml/kg/hr 12hrs pre and post) Contrast nephrotoxicity = 25% increase in creatinine within 3 days of contrast

Answer 18

Cryptosporidium

Answer 19

Central Retinal Artery Occlusion

Answer 20

Dix Hallpike

Answer 21

1) Benzodiazepines (chlordiazepoxide) 2) Disulfiram (inhibits acetaldehyde dehydrogenase enzyme) 3) Acamprosate NMDA receptor antagonist

Answer 22

IUD Instant POP 2 days COCP, Implant, IUS 7 days.

Answer 23

Dexamethasone as it reduces the risk of neurological sequelae e.g. deafness

Answer 24

Live attenuated vaccines e.g. BCG Yellow Fever Oral polio Intranasal influenza Varicella MMR

Answer 25

Relative: - BMI >35 - FHx VTE in 1st deg <45yrs - Immobility e.g. wheelchair - BRCA1/2 - Controlled HTN - > 35 and smokes <15 /day Absolute: - >35 and smokes > 15/day - Migraine with aura - CVA hx - Breast feeding <6 weeks - Uncontrolled HTN - Major surgery - SLE - Active breast ca

Answer 26

Herpes 1/2 IV Aciclovir

Answer 27

Pregnancy Test Transvaginal US

Answer 28

Aspergilloma A fungal mass in a lung cavity commonly secondary to TB, lung cancer or cystic fibrosis.

Answer 29

Increases Gs and Cs increase. Everything else decreases Growth hormone Glucose Salivary Glands Cortisol Cholesterol Carotinaemia

Answer 30

Varicocoele Dilatations of the pampiniform plexus. Most common on left side (80% of cases). "Bag of worms". US Doppler and conservative management in most cases.

Answer 31

Clotrimazole pressary 500mg Oral antifungals are contraindicated

Answer 32

Oral fluconazole 150mg single dose. If pregnant then clotrimazole pessary 500mg.

Answer 33

Diabetes Pregnancy Steroids Antibiotics

Answer 34

Lower. Faster turnover of RBC which means reduced glycation time.

Answer 35

DEXA Aromatase inhibitors e.g. anastrazole may cause osteoporosis by reducing peripheral oestrogen activity.

Answer 36

Loss of motor or sensory function caused by stress

Answer 37

Somatisation affects multiple physical systems, whereas conversion is typically one complaint with no explanation.

Answer 38

Malingering is to falsely claim to have a condition or complaint for gain. Munchausen's is to deliberately induce a symptom to adopt a sick role.

Answer 39

Admit Tocolytics (delay labour) - Atosiban (oxytocin antagonist) - Magnesium Sulfate - Ca blockers e.g. nifedipine - Betamimetics e.g. Terbutaline - Prostaglandin inhibitors e.g. ketoralac. - Nitroglycerine Steroids (matures foetus' lungs in case pregnancy cannot be avoided) as premature.

Answer 40

Strengthens contractions

Answer 41

Detrusor muscle Muscarinic antagonist e.g. oxybutynin, solifenacin, tolteradine. Investigate with bladder diary for >3 days, vaginal examination to exclude prolapse, urine dip and culture, urodynamic studies.

Answer 42

Blurred vision (cant see) Urinary retention (cant pee) Dry mouth (cant spit) Constipation (cant shit)

Answer 43

- Neonates (<3months) - Cefotaxime + Amoxicillin - 3months - 50 years Cefotaxime/Ceftriaxone - >50 years Cefotaxime/Ceftriaxone + Amoxicillin - Community meningococcal Benzylpenicillin - Hospital meningococcal Cefotaxime/Ceftriaxone - Listeria Amoxicillin - Pneumococcal Cefotaxime/Ceftriaxone - Haemophilus influenzae Cefotaxime/Ceftriaxone - Prophylaxis Ciprofloxacin / Rifampicin (close contact within 7 days e.g. in same house hold).

Answer 44

Yes. Prophylactic Benzylpenicillin

Answer 45

100% O2 Triptan Subcutaneous Verapamil and tapered prednisolone can be effective prophylaxis.

Answer 46

ELISA for antibodies to Borrelia burdoferi Repeat this 4-6 weeks after

Answer 47

If erythema migrans is present (clinical diagnosis) or systemically unwell following a tick bite. Skin lesions e.g. bull's eye lesion usually show 1-4 weeks post bite. Treat with Doxycycline unless contraindicated e.g. pregnancy, then use Amoxicillin. If patient is asymptomatic, you dont treat tick bites.

Answer 48

Tachycardia, and fever following commencement of antibiotics for certain infections e.g. syphilis or lyme's disease.

Answer 49

If SABA doesn't work, then <5yrs you trial 8 weeks of MODERATE ICS. In 5yrs and over you treat with LOW dose ICS.

Answer 50

Oral Candidiasis Lichen Planus Dx of exclusion is Leukoplakia - premalignant condition. 1% will transform into malignancy. Therefore this requires monitoring.

Answer 51

FBC LFT U&E

Answer 52

Lithium levels (weekly until stable then 3 monthly, then 6 monthly) TFT U&E

Answer 53

Corticosteroids

Answer 54

Erbs palsy = inward rotation of arm, with extended elbow 'waiters tip'. Upper brachial plexus injury (C5, C6). Klumpke's palsy = flexed IP joints and extended MCPJs. Often caused by hyperextension of arm e.g. holding onto a rail when falling. Lower brachial plexus injury (C8, T1)

Answer 55

Erb-Duchenne Palsy Upper brachial plexus injury (C5, C6)

Answer 56

Radial nerve

Answer 57

Axillary nerve

Answer 58

Musculocutaneous Elbow flexion (C5-7) Axillary Shoulder abduction (C5, C6) Radial Wrist extension (C5-8) Median LOAF muscles of hand (C6, C8, T1) Ulnar Intrinsic muscles of hand (C8, T1) Long Thoracic Serratus anterior

Answer 59

Lateral two umbricals Opponens Pollis Abductor policis brevis Flexor policis brevis Median nerve

Answer 60

Radial nerve

Answer 61

Non-alcoholic Fatty Liver Disease (NAFLD) Obesity with deranged LFTs suggests NAFLD. 17 units of alcohol is not significantly high

Answer 62

HBsAg (surface antigen) positive suggests infection. First marker to appear. Appears as early as 1 week. Anti HB positive suggests previous vaccination.

Answer 63

Long term oxygen therapy

Answer 64

Duloxetine Inhibits reuptake of serotonin and noradrenaline which increases their pain suppression

Answer 65

1st line SABA or SAMA 2nd line add LABA + LAMA if non asthmatic features If asthmatic features add LABA + ICS. Theophylline, Mucolytics, Azithromicin, and PDE-4 inhibitors (reduce exacerbations) can also be added. Annual flu vaccination One off pneumococcal vaccination

Answer 66

Typically flucloxacillin is first line. If penicillin allergy then Clarithromycin, Erythromycin, Doxycycline are good alternatives.

Answer 67

Squamous Cell Carcinoma

Answer 68

Inferolateral to pubic tubercle = femoral hernia. Incarcerated is non-reducible but patient is well Strangulated is when the blood supply is compromised and the patient is sick with it.

Answer 69

Direct goes directly through the posterior wall and out the superficial ring of the inguinal canal. INdirect goes IN the deep ring and through the superficial ring of the inguinal canal. 2/3rds of inguinal hernias are indirect.

Answer 70

Gastrointestinal disturbance

Answer 71

Intrapartum Benzylpenicillin Clindamycin is an alternative.

Answer 72

Myelosuppression Liver / Lung fibrosis

Answer 73

Permanent cessation of menstruation for 12+ months. Symptoms last 2-5 years. HRT - Combination therapy if still has a uterus (unopposed oestrogen increases risk of endometrial cancer). If no uterus then oestrogen only therapy is fine.

Answer 74

SSRI e.g. fluoxetine Weight loss, regular exercise and reduced stress are also advised.

Answer 75

13C Urea Breath Test CLO test if symptomatic and doing a gastroscopy

Answer 76

Coronary Heart Disease VTE risk Stroke Breast ca Ovarian ca

Answer 77

Current/Prev breast ca Oestrogen sensitive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia

Answer 78

Autoimmune vs thyroid gland Treat with Levothyroxine Monitor TSH levels to ensure they are in normal range. This determines when the levothyroxine is at appropriate levels.

Answer 79

Hormone Replacement Therapy / COCP until 51 (age of menopause). Combined hormone therapy if has uterus as unopposed oestrogen increases risk of endometrial cancer. Look for raised gonadotrophins e.g. FSH and low oestrogen on bloods. Bloods should be checked again 4-6 weeks apart. If occus <40 years then the ovarian failure is "premature". This occurs in 1% of women, and is mostly idiopathic.

Answer 80

Bladder retraining for 6 weeks (aim is to increase time between voids). Kegel exercises Anti-muscarinics e.g. Oxybutynin, or Tolterodine If elderly and concerned about ant-muscarinic side effects then Mirabegron (Beta-3 agonist).

Answer 81

False. No prophylaxis is given

Answer 82

It is lower in the first stages of menstruation and rises following ovulation (due to rising progesterone levels).

Answer 83

Mentruation 1-4 Follicular phae (proliferation) 5-13 Ovulation 14 Luteal (secretory phase) 15-28

Answer 84

LH spike (FHS rises modestly)

Answer 85

Oestrogen (oestradiol) rises gradually up to ovulation which triggers the leutenising hormone spike and then oestrogen levels decrease. Following ovulation progesterone is released by the corpus luteum (this causes increased body temperature and makes cervical mucus thick and tacky.

Answer 86

Osteochondritis dissecans - Loose bone fragment in knee due to poor blood supply. Moves around under cartilage causing joint to lock, swell and be painful. Common in young active people. Mostly heals with rest. JIA: Typically affects multiple joints, with morning stiffness which improves and systemic signs e.g. rash. Osgood Schlatter: Inflammation at tibial tuberosity where patellar tendon attaches. No pain at rest. Sporty teenagers. Osteosarcoma: Severe bone pain typically at night time. Associated with B symptoms/Red flags. Chondromalacia patellae: 'Grinding/clicking' in the knee with quadriceps weakness. No locking or swelling.

Answer 87

False. They tend to have larger heads.

Answer 88

Occipito-frontal head circumference <2nd percentile. Congenital infection Patau Fetal alcohol syndrome Family inheritance Craniosynostosis (early fusion of bones of skull)

Answer 89

Switch to modified release Metformin first before considering second line treatments.

Answer 90

Risk of Hypoglycemia and Weight gain

Answer 91

AMP-activated protein kinase (AMPK) activation Increases insulin sensitivity Decreases liver gluconeogenesis Decreases GI absoption of carbohydrates

Answer 92

EGFR <45 - Reduce EGFR <30 - Stop NB: GI side effects are common with metformin which is why you titrate the dose up. Lactic acidosis is a less common side effect.

Answer 93

False. Lifestyle change is the first line treatment in most cases.

Answer 94

False. It is associated with macrosomia (large for gestational age). Indeed, previous macrosomia is a risk factor for gestational diabetes.

Answer 95

True. Afro-Caribbean and South asian are at higher risk.

Answer 96

Oral Glucose Tolerance Test (OGTT) Fasted: > 5.6 2hr glucose: > 7.8

Answer 97

Drusen = Dry (aka atrophic) Drusen are yellow retinal deposits in Bruch's membrane.

Answer 98

Macular degeneration fluctuating, gradually deteriorating vision, with poor dark adaptation. Can also present with Charles Bonnet hallucinations and photopsia (flickering lights).

Answer 99

Herpes Simplex Keratitis Topical Aciclovir Drops Refer to ophthalmology urgently

Answer 100

Increases risk of: Breast and Cervical cancer Decreases risk of: Ovarian and Endometrial cancer

Answer 101

A test for organic vs in-organic paresis. If a patient claims right leg paresis. Perform a straight leg raise on the left leg with your hand under the heel of the right leg. If you feel pressure then it suggest the muscles of the right leg are operative and counterbalancing. This suggests a non-organic cause e.g. conversion.

Answer 102

When flexion of the neck induces flexion of the hips. This is suggestive of meningitis, encephalitis or Subarachnoid Haemorrhage .

Answer 103

A test for Parkinsons. Tap the glabellar region (between eye brows). Healthy individuals will blink for the first few times. If they are unable to resist blinking after this then it is suggestive of PD.

Answer 104

UML test Over 2yrs. Plantar stimulation should cause plantarflexion and curling of toes. If it causes dorsiflexion and extension of toes [Positive Babinski] it is suggestive of UML e.g. stroke. In <2yr old Babinski is normally +Ve.

Answer 105

Test for disc herniation and radiculopathy. If radiating leg pain can be induced by a straight leg raise then this suggests disc herniation as the cause.

Answer 106

Actinic keratosis AKA solar keratosis Florouacil cream +-/ hydrocortisone cream for inflammation. Topical imiquimod Curettage / Cautery

Answer 107

Nitrofurantoin (avoid at term) 7 days Trimethoprim is contraindicated due to teratogenicity / neural tube defects.

Answer 108

Pregnancy Male Haematuria >65 years old

Answer 109

Women 3 days Men 7 days

Answer 110

Cefalexin 7-10 days PO If unable to tolerate e.g. vomiting or severe illness then IV Cefuroxime Co-amoxiclav is only advised if you have culture results.

Answer 111

False. Don't treat it if they are asymptomatic.

Answer 112

TSH Low T4 / T4 Raised TSH receptor Autoantibodies +Ve

Answer 113

Subacute thyroiditis commonly caused by certain infections. Lasts for several weeks. Triphasic - Presents with temporarily rasied thyroid levels then low levels then they normalise.

Answer 114

Painless, Palpable gall bladder with jaundice. Unlikely to be gall stones. Likely to be pancreatic or biliary tree cancer.

Answer 115

Normal = < 5.6 Pre-diabetic = 5.6 - 6.9 Diabetic = > 7

Answer 116

Removal of pancreas and duodenum. Mostly often due to pancreatic cancer. 80% of which affect the head of the pancreas.

Answer 117

Intestinal Tissue Biopsy Following a positive Anti Tissue Transglutaminase (Anti TTG) and IgA serology.

Answer 118

Dermatitis Herpetiformis - caused by IgA deposition in the dermis. Extensor surfaces e.g. knees, elbows. Vesicular, itchy. Skin biopsy Gluten free diet Dapsone

Answer 119

Seborrhoeic Dermatitis Caused by a fungus (Malassezia furfur) Treated with Head and Shoulders or Neutrogena shampoos [1st line]. Second line is topical ketoconazole Risk factors associated HIV and Parkinsons.

Answer 120

Coxsackie A16 Sore throat, fever, vesicular rash on palms and soles.

Answer 121

Parvovirus B19

Answer 122

Group A Haemolytic Strep Strawberry tongue and rash Penicillin 10 days.

Answer 123

Measles Koplik spots are a key feature

Answer 124

Macular --> Paupular --> Vesicles Incubation is around 2 weeks.

Answer 125

Thickening of the palmar aponeurosis. Causes moderate flexion of the medial digits. No sensory or motor component. Consider surgical management if hand cannot be extended fully e.g. placed flat on a table.

Answer 126

Renal colic Non-contrast CT KUB within 14hrs. Diclofenac 75mg IM Stone <5mm expectant will pass in 4 weeks Stone >5mm Lithotripsy If pregnant then Ureteroscopy If staghorn calculi or complex renal calculi then Percutaneous Nephrolithotomy.

Answer 127

<3/60 while wearing prescribed glasses.

Answer 128

FEV1/FVC ratio <0.70 FEV1 >80 = Mild (Stage 1) FEV1 50 - 79 = Moderate (Stage 2) FEV1 30 - 49 = Severe (Stage 3) FEV1 <30 = Very Severe (Stage 4)

Answer 129

False. It i restrictive. Expect FEV1/FVC >0.7 But FEV1 and FVC to be <0.80 of predicted

Answer 130

Obstructive: - COPD - Bronchiectasis - Emphysema - Asthma Restrictive - Pulmonary Fibrosis - Pulmonary Oedema - Pneumoconiosis

Answer 131

400mcg Salbutamol with a repeat 15minutes later. If 12% improvement in FEV1 or FVC.

Answer 132

Global ST and PR changes across ECG Saddle ST elevation PR depression (most specific sign) Troponin should be normal in pericarditis and raised in Myocarditits. Treatment for pericarditis is NSAID + Colchicine.

Answer 133

Coxsackie Radiotherapy Trauma SLE TB MI (Dressler Syndrome)

Answer 134

Pericarditis 1-3 days post MI

Answer 135

True NB: They are more common in men and smokers.

Answer 136

True. Risk of Reye's syndrome. Other contraindications: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides lithium, benzodiazepines Clozapine carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone

Answer 137

True. Cataracts Glaucoma Blepharitis Strabismus Otitis media Glue ear (otitis media + effusion)

Answer 138

Tropical disease. Genital ulcer with ragged border. Caused by Haemophilus ducreyi. Treated with azithromycin, ceftriaxone, ciprofloxacin etc.

Answer 139

Trichomonas vaginalis, a sexually-transmitted disease classically causing offensive vaginal discharge, dysuria and vulval itching. Speculum examination may reveal a 'strawberry cervix' caused by multiple punctate haemorrhages of the cervix. Treatment is metronidazole 5-7 days.

Answer 140

Patau (Trisomy 13)

Answer 141

Pierre Robin Syndrome

Answer 142

Edward's Syndrome (Trisomy 18)

Answer 143

Noonan Syndrome

Answer 144

William's Syndrome

Answer 145

Ejection systolic murmur Due to bicuspid aortic valve Female with missing second sex chromosome.

Answer 146

Cri du chat (Chromosome 5p deletion)

Answer 147

True. In the first trimester. However, SSRIs are still used in pregnancy with caution.

Answer 148

Lens dislocation

Answer 149

Levonorgestrel is better (must be taken within 3 days (72hrs) EllaOne can exacerbate asthma. Must be taken within 5 days (120hrs). The IUD can also be used. Must be given within 5 days or 5 days after the likely ovulation date.

Answer 150

Stop LTRA and trial LABA e.g. salmeterol. If that doesnt work, swap the (ICS+LABA) for MART (maintenenace and reliever e.g. Fostair, or Symbicort). If that doesnt work then switch the MART to moderate steroid MART and then high dose steroid MART.

Answer 151

Trial LTRA

Answer 152

Coronary Artery Aneurysm Echocardiogram

Answer 153

Conscious and alert then oral glucogel. Unconscious or not able to tolerate oral medication. Then IM glucagon or IV 20% Glucose.

Answer 154

Vasculitis presenting with: 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 Treatment is high dose aspirin (one of the few indications for use of aspirin in children <16) IV immunoglobulin. It is importantto do an echocardiogram to rule out coronary artery aneurysm!

Answer 155

Vagal maneuvers IV bolus Adenosine 6mg then 12mg then 18mg. SVT characterised by sudden onset narrow complex tachycardia.

Answer 156

Varicella Zoster Oral antiviral e.g. oral famciclovir within 72hrs of start. Remain infective until crusted over. Typically in 5 days.

Answer 157

Perthes disease Common 4-8 years old Avascular necrosis of the femoral head, resulting in widening of the joint space and flattening of the femoral head on X-Ray. It is 5x more common in boys.

Answer 158

Transient Synovitis The most common hip problem in children. Common ages 2-10. Typically presents after a viral infection.

Answer 159

Slipped Upper Femoral Epiphysis

Answer 160

Juvenile Idiopathic Arthritis Typically multiple joints affected. Must be <16 years old JIA is associated with anterior uveitis

Answer 161

Aspirin 300mg Clopidogrel Statin (if Cholesterol >3.5) Thrombolysis if within 4.5hrs and not contraindicated.

Answer 162

Osteoarthritis Bouchard's affect proximal IPJs Heberden's affect distal IPJs

Answer 163

4.5 hrs from onset give Alteplase or Tenecteplase Pregnancy Active bleeding LP in last 7 days Prev ICH Seizure at onset of stroke Intracranial Neoplasm Uncontrolled HTN >200 Oesophageal varices Stroke in prev 3 months Traumatic brain injury in prev 3 months

Answer 164

<1yr 300 mg Benzylpenicillin IM 1-10 600 mg Benzylpenicillin IM >10 yrs 1.2 g Benzylpenicillin IM

Answer 165

False. Morning stiffness which improves is typical of rheumatoid arthritis.

Answer 166

DOAC (Apixaban or Rivaroxaban) for 3 months if provoked. 3-6 months if provoked by cancer. 6 months if unprovoked. Then reassessed as to whether to continue for life.

Answer 167

If restraint is required for more than 10 minutes and the patient is a risk to themselves or others.

Answer 168

If their BMI is >35 kg/m2

Answer 169

Pioglitazone DPP-4 Inhibitor SGLT-2 Inhibitor You start with metformin + lifestyle. At this point the target is Hba1c of <48 mmol/mol (<6.5%) Only add a second drug e.g. gliclazide (sulfonylurea) if Hba1c rises above 58 (7.5%). Then the target is 53mmol/mol (7.0%) as there is an increased risk of rebound hypoglycemia. Hba1c should be reviewed every 3-6 months until stable then every 6 months.

Answer 170

SGLT-2 inhibitor e.g. Dapagliflozin. These are the best choice if the patient has a raised risk of CVD or existing CVD history. QRisk >10% would indicate this.

Answer 171

True. To reduce risk of GI distubance.

Answer 172

Artovastatin 20mg ON

Answer 173

Thrombolysis within 4.5hrs if CT rules out haemorrhagic stroke. If low risk ABCD 3 or less. Aspirin 300mg OD 14days Atorvastatin 40mg OD on-going Clopidogrel 75mg OD to replace aspirin after 14 days and given life-long. If high risk ABCS 4-7. Immediate Clopidogrel 600mg + Aspirin 300mg. Dual Antiplatelet Therapy (DAPT) of Clopidogrel 75mg and Aspirin 75mg OD for 21 days. Then Clopidogrel only 75mg OD on-going. Atorvastatin 40mg OD on-going. ACEi +/- Thiazide diuretic to lower blood pressureto < 130/80

Answer 174

ACEi ARB if Black/Afrocaribbean Target: 140/90 (<80yrs) 150/90 (>80yrs)

Answer 175

Ampicillin or penicillin G and gentamicin. Listerosis is 20x more common in pregnancy

Answer 176

Bloods test for listeria IgM NB Listeria is Gram +ve

Answer 177

Ascending cholangitis typically triad of RUQ pain, Jaundice and Fever (Charcot's Triad) Gallstone ileus typically presents with abdominal distension as it is an obstruction. Pancreatic cancer presents as a painless jaundice typically. Acute pancreatitis presents as severe epigastric pain with vomiting. Biliary Colic presents as on/off RUQ pain related to eating. Acute Cholecystitis is similar to biliary colic but is more persistent and often radiates to shoulder.

Answer 178

Cephalohaematoma is a bleed/swelling on a baby's head secondary to labour/extraction with forceps. Typically on the parietal bone. Unlike the others, it does not cross suture lines. It can take months to resolve.

Answer 179

Squamous Cell Carcinoma Immunosuppression and sun exposure.

Answer 180

False. HypOkalaemic, metabolic acidosis.

Answer 181

Low-Dose Dexamethasone Suppression test. In patients with Cushing's their Cortisol spike in the morning is not suppressed by Dexamethasone.

Answer 182

Colposcopy referral Any woman with an abnormal cytology and +ve HPV should be referred. If the smear was inconclusive then a repeat should be offered in 3 months. If the smear was +ve but cytology is normal then repeat screen in 12 months.

Answer 183

Gram-negative diplococcus Neisseria gonorrhoeae. Nucleic Acid Amplification Test (NAAT) or by Culture (swab/MSU) IM Ceftriaxone (due to increased resistance) PO Cefixime or Azithromicin if needle-phobic.

Answer 184

Anti-Ro Artificial tears Pilocapine (may increase saliva)

Answer 185

Cervical Intraepithelial Neoplasia CIN1 - <1/3 thickness of epithelium CIN2 - 1/3 to 2/3rd thickness CIN3 - >2/3rd thickness Large LoopExcision of Transformational Zone (LLETZ) is the standard treatment. TOC review 6 months after.

Answer 186

ANA (Antinuclear Antibody) Test

Answer 187

Test in Sjogren's (lymphocytic infiltration of exocrine glands) Dry mouth Dry eyes Arthralgia Vaginal dryness Filter paper to conjunctiva to assess tear production

Answer 188

Elevated ACE Elevated Calcium Low WCC SOB and persistently dry cough Bilateral hilar lymphadenopathy is most common XR finding.

Answer 189

6 months before turn 25 25 - 49 every 3 years 50 - 64 every 5 years 65+ only if recently abnormal test

Answer 190

Endometrial cancer

Answer 191

Lacunar: Pure sensory, Pure motor or mixed sensory/motor only. Posterior Circulation: LOC, Cerebellar/Brain stem signs, isolated Hononymous Hemianopia. Total Anterior: Unilateral weakness of face, arm, legs, Homonymous Hemianopia, higher cerebral signs. Partial Anterior: 2 of the above for Total. NB: Higher cortical signs e.g. aphasia, agnosia, neglect, apraxia, or hemianopsia

Answer 192

Loss of the same hemifield of vision in each eye.

Answer 193

Accommodation reflex present e.g. constricts on near vision. Pupil reflec to light not present i.e. no change with light exposure. Most common in Diabetes Classically found in Neurosyphylis!

Answer 194

7th cranial nerve Prednisolone 4 months NB: 15% have residual weakness if not treated. If no improvement after 3 weeks of treatment then refer to ENT Cause unknown. ? Herpes simplex

Answer 195

Amsel's criteria: Thin, white discharge Clue cells on microscopy: stippled Vaginal epithelial cells pH > 4.5 Positive whiff test (addition of potassium hydroxide results in fishy odour) PO Metronidazole

Answer 196

Modified Release Dipyridamole

Answer 197

Bacterial Vaginosis

Answer 198

Trichomonas vaginalis Oral metronidazole

Answer 199

IM ceftriaxone 1g single dose

Answer 200

Polymorphic eruption of pregnancy. No treatment is needed.

Answer 201

Vaginal candidiasis Oral Fluconazole

Answer 202

True. Occurs in ~40%

Answer 203

Refer to hospital. Sounds like Eczema herpeticum which is potentially life threatening and requires IV aciclovir. This is an HSV 1 or 2 infection which can take hold in patients with eczema.

Answer 204

Viral encephalitis 95% of encephalitis is caused by Herpes Simplex Virus IV aciclovir

Answer 205

Bradykinesia Rigidity (Lead pipe rigidity or Cogwheel rigidity) Resting Tremor (pill-rolling; 3-5 Hz)

Answer 206

Levodopa Diagnosed clinically. However, if unclear then SPECT can be done. Lewy Bodies (made of alpha synuclein)

Answer 207

A rare skin ulceration on the lower legs associated with Ulcerative Colitis. Oral steroids is first line or other immune suppression.

Answer 208

Lichen planus is a purpuric, polygonal rash on flexor surfaces, genitals and oral mucosa. Liceh sclerosis affects older women and men and involves white patches on the vulva or penis.

Answer 209

Lichen Planus Planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae (white lines) over surface. Oral involvement common Koebner's phenomenon is a rash caused by skin injury. Oral steroids

Answer 210

True. Sarcoptes scabiei Trail burrows often inbetween webbed spaces of hands. Permethrin cream

Answer 211

Pityriasis rosea

Answer 212

Anti HBs = immunity HBsAg = active infection 'HBs what a breeze, HBSag what a drag!'

Answer 213

True Back pain Red Flags : <20 or >50 Previous malignancy Systemically unwell Trauma Night pain

Answer 214

Spinal stenosis Needs an MRI

Answer 215

COCP / Oestrogen inhibit oulation Progesterone thickens cervical mucus

Answer 216

Non-contrast CT KUB

Answer 217

Tonsillar exudate No cough Fever Tender anterior lymph nodes Indicate likelihood of Strep throat

Answer 218

Acute <1wk: - Stool softener e.g. lactulose - Topical numbing agent Chronic >1wk: Topical GTN If no improvement in 8 weeks refer to secondary care

Answer 219

True. (Bordatella pertussis) Inspiratory whoop Coughing fits +/- cyanosis Post-tussis vomits PO Azithromycin

Answer 220

Daily Folic acid 400mcg VitD 10 mcg

Answer 221

Common peroneal nerve

Answer 222

Primary Sclerosing Cholangitis

Answer 223

UC: Bloody Diarrhoea Ileocecal - Anus LLQ pain Tenesmus Assoc. Primary Sclerosing Cholangitis Crypt abscesses Decreased Goblet cells Crohn's: Non bloody diarrhoea Mouth - Anus RLQ mass Assoc. Gallstones Cobblestone appearance Skip lesions Full thickness mucosa - serosa

Answer 224

True Iron Deficiency Anaemia B12/Folate deficiency Also do the same. The following decrease RBC life span and decrease Hba1c: - Sickle-cell anaemia - GP6D deficiency - Hereditary spherocytosis - Haemodialysis

Answer 225

Velvety dark patches typically under the arms and neck. Associated with diabetes, cushing's but can also suggest internal malignancy especially gastric cancer.

Answer 226

Carbimazole 40mg which is reduced gradually over time Propranolol canalso begiven for symptom control e.g. anxiety The major concern with Carbimazole is agranulocytosis.

Answer 227

True. Both use the same metabolic pathway in the liver.

Answer 228

CAP: Amoxicillin (/Doxycycline) Atypical: Clarithromycin HAP: <5d of admission Co-amox >5d of admission Pip/Taz

Answer 229

Disseminated Intravascular Coagulopathy (DIC) A procoagulation state secondary to acute stress on the body e.g. severe illness. Schistocytes are formed due to the microangiopathic haemolytic anaemia. Treatment is fix the cause e.g. antibiotics for infection. Clotting factor/platelet replacement.

Answer 230

GDH antigen stool test If antigen +ve and toxin +ve then confirms c diff. If antigen +ve but toxin -ve then c diff is unlikely to be the cause First case = Oral Vancomycin 125mg QDS for mild moderate and severe cases 10 days. Repeat case then Fidaxomycin

Answer 231

Cephalosporins

Answer 232

Dental abscess Amoxicillin Gingervitis Metronidazole

Answer 233

Flucloxacillin Animal bites: co-amoxiclav Cellulitis near eyes/nose: Coamoxiclav

Answer 234

Phenoxymethylpenicillin (erythromycin if allergic)

Answer 235

Metronidazole

Answer 236

Gonorrhoea IM ceftriaxone Chlamydia Doxycycline or Azithromycin

Answer 237

Ofloxacin + metronidazole

Answer 238

Quinolone or Trimethoprim

Answer 239

Normally benzathine benzylpenicillin But as penicillin allergic, doxycycline or erythromycin.

Answer 240

False. It is non-itchy.

Answer 241

Retinitis pigmentosa Typically presents with night blindness first then tunneling of vision. Glaucoma can present with tunnel vision but is not associated with night blindness.

Answer 242

Tue. Erythema multiforme is a hypersensitivity reaction associated with infection and some drugs. It causes a pruritic rash over the body + palms. Starts on the back of the hands typically and then spreads to the body.

Answer 243

Aortic Stenosis

Answer 244

Staphylococcus aureus Very short incubation Severe vomits Resolves in 1-2 days No diarrhoea typically

Answer 245

Guillaine Barre Syndrome NB: Campylobacter presents typically with a flu-like prodrome and can mimic appendicitis

Answer 246

Bacillus cerrus (associated with rice; 1-6 hrs) Staph aureus (30mins - 6hrs) Severe vomiting.

Answer 247

Within 12 hrs of onset if PCI cannot be done within 120 minutes.

Answer 248

Morphine GTN Oxygen if <94% Aspirin 300mg Dual antiplatelet with Clopidogrel if on anticoagulant or prasugrel if not. PCI within 2 hours (120mins) Fibrinolysis e.g. alteplase if PCI not possible in 2hrs and within 12hrs of start. Fondaparinux if no bleeding risk

Answer 249

6 month mortality following ACS <3% Low risk >3% High risk

Answer 250

Calcium Channel Blockers or Thiazide diuretics

Answer 251

>135BP ABPM / >140clinical <80 years old >150 systolic in any age 1st line ACEi/ARB if <55 and not Afrocaribbean If >55 or Afrocaribbean then CCB or Thiazide diuretic

Answer 252

Post partum hypopituitarism Amenorrhoea Hypothyroidism Milk production issues

Answer 253

Stage 1 - 140 - 160 Stage 2 - 160 - 180 Crisis 180+

Answer 254

Baclofen (+/- gabapentin) Dantrolene can be used for MS spasticity if Baclofen fails. Dantrolene is hepatotoxic so it is avoided as a first line. Gabapentin is great for oscillopsia in MS

Answer 255

Osteomalacia You may also see transverse bands called Looser's bands on XR

Answer 256

Community Treatment Order Under mentalhealth act, gives the power to treat in community or recall to hospital for up to 72 hours for treatment if the patient is not complying with medication.

Answer 257

Confusion Urea >7mmol/L Resp Rate >30/min BP <90 systolic >65 years old 1-2 moderate risk,consider hospital 3-4 high risk; hospital assessment

Answer 258

First line: (start one at a time) ACEi (1st; regardless of age) Beta Blocker Nebivolol, carvediolol, bisoprolol Second line: Spironolactone or eplerenone. SGLT-2 inhibitors e.g. empagliflozin Third line: Sacubatril valsartan Digoxin Hydralazine

Answer 259

True. Local procedure: none required. Moderate procedure: 50mg hydrocortisone before induction and 25mg every 8h for 24h Major surgery: 100mg hydrocortisone before induction and 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached.

Answer 260

Selective mineral corticoid receptor antagonist which has less hormonal effects (gynecomastia, mastodynia etc) than spironolactone.

Answer 261

Non-thyroidal illness. Unwell patients, or elderly patients may present with low/normal TSH, or low T4, T3. This typically recovers on its own. Repeat tests in 6 weeks are advised. No treatment is given typically.

Answer 262

True. There can be no male to male transmission.

Answer 263

True. Prolonged PR intervals can be normal.

Answer 264

Lateral cutaneous nerve

Answer 265

Sarcoidosis

Answer 266

Colchicine + NSAID cover e.g. diclofenac. Commence allopurinol (urate lowering medication) after the first attack. Don't start it for 14 days / 2 weeks or until pain has settled as it can precipitate another attack! The patient then continues on allopurinol.

Answer 267

Aortic stenosis 'SAD' Syncope Angina Dyspnoea on exertion

Answer 268

Normally conservative but ivermectin can be applied to pustules if bothersome. No known cause of acne rosacea. Typically affects nose and cheeks.

Answer 269

Aortic Regurgitation Sharp upstroke with slow collapsing downstroke

Answer 270

Sudden loss of muscular tone in response to high emotion e.g. laughing or stress. Ranges from buckling knees to full collapse. 2/3rd of narcoleptics have cataplexy.

Answer 271

True. Don't need a DEXA scan for this. If they are under 75 then a DEXA scan is needed.

Answer 272

True. Increases risk of breast and ovarian cancer.

Answer 273

Immunocompromised, neonates, pregnant women exposed to chickenpox who have no immunity. Serology checks should be done to check for immunity. VZIG should be given within 10 days. Close contact is direct contact or +15mins contact time.

Answer 274

Procyclidine

Answer 275

Benzodizepines or cyproheptadine

Answer 276

Keratitis Typically presents with grittiness, red, watery eye and photophobia. Typically bacterial infection with staph aureus, but can be viral e.g. herpes simplex If contact lens wearer then refer to eye specialist

Answer 277

Primary = no underlying pelvic pathology. Just pain associated with periods. Typically due to excessive endometrial prostaglandins. NSAID (1st line) / COCP (2nd line) Secondary: Underlying pelvic pathology e.g. endometriosis, adenomyosis, PID, Fibroids, IUD.

Answer 278

Invasion of endometrial tissue into the myometrium. Can be a cause of secondary dysmenorrhoea.

Answer 279

Refer to spinal surgical team + MRI ? Degenerative Cervical Myelopathy (DCM)

Answer 280

Lumbar Epidural Abscess More common in diabetes. Presents as a septic patient with lower limb neurological issues. Inflammation of the spinal cord causes cada equina presentation. This can also be a complication of discitis (infection of vertebral discs).

Answer 281

Irregular menstrual cycle <45yrs Raised FSH/LH Low oestradiol

Answer 282

Tetralogy of Fallot Overriding aorta Pulmonary stenosis Right ventricular hypertrophy VSD Causes right to left shunt, cyanosis and tet spells (suddenly turn blue or faint). Transposition of the great arteries is another cyanotic congenital heart disease

Answer 283

NSAID or cardiac catheterisation

Answer 284

12 & 13 year old girls and boys (year 8)

Answer 285

Induce remission: Glucocorticoids e.g. budesonide. Mesalazine (second line) Maintain remission: 1st: Azathioprine or mercaptopurine 2nd: Methotrexate 80% of Crohn's patients will have surgical resection of bowel. They are at increased risk of bowel cancer.

Answer 286

Rate control with bisoprolol Anticoagulation with apixaban for at least 3 weeks before cardioversion

Answer 287

High resolution CT

Answer 288

Respiratory or cardiovascular impairment despite two doses of adrenaline IM. At this point switch to IV adrenaline infusion.

Answer 289

<6months 100mcg 6m - 6 yrs 150mcg 6-12yrs 300mcg >12 500mcg Every 5 minutes. Anterolateral middlethird of thigh (remember to change sites)

Answer 290

Motor Neuron Disease or ALS Eye movements are typically spared in MND

Answer 291

Ankylosing spondylitis

Answer 292

Spironolactone Primary hyperaldosteronism due to hyperplasia is managed with spironolactone. If due to adrenal cancerthen adrenaletomy would be the best option.

Answer 293

Carbamazepine

Answer 294

Anion gap Sepsis the anion gap will be increased (anything over 14) due to increased acid In diarrhoea the anion gap is normal as there is no increased acid but rather loss of base (bicarbonate in diarrhoea).

Answer 295

8-14 (Na + K) - (bicarbonate + chloride)

Answer 296

Low risk = GRACE <3% High risk = GRACE>3% Low risk: Aspirin, Ticagrelor, Fondaparinux (clopidogrel if high bleeding risk) High risk: Coronary angiography within 72hrs + above medications. PCI is for STEMI

Answer 297

Beck's triad: hypotension raised JVP muffled heart sounds You might also see pulsus paradoxus - a drop in BP on inspiration of >10mm/hg and low amplitude QRS on ECG. Pericardiocentesis.

Answer 298

After 21 days IUD can be inserted within 48hrs of birth or after 4 weeks. COCP is contraindicated for 6 weeks w breast feeding.

Answer 299

Livedo reticularis

Answer 300

Posterior vitreous detachment

Answer 301

Boys testicular growth ~12yrs Girls breast growth ~12yrs

Answer 302

AKA benign migratory glossitis. Squiggly, white, raised lines over the tongue. Unknown cause. Asymptomatic. No need to treat.

Answer 303

High dose glucocorticoids To prevent ocular complications NB: GCA affects medium/large vessels

Answer 304

True. Oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx. Fluctuant, doesnt move with swallowing. Does not transilluminate.

Answer 305

Thyroglossal cyst Treatment is surgical removal

Answer 306

Azithromycin

Answer 307

Tacrolimus Sun block Topical corticosteroids Phototherapy

Answer 308

Port wine stain doesn't resolve

Answer 309

Atropine IV

Answer 310

HIV Cystomegalovirus causes chorioretinitis which is an infection associated with HIV

Answer 311

Metronidazole 400mg BD 5 days Clue cells and fishy smell (Whiff test) are key signs

Answer 312

External Cephalic Version Women at 36 weeks or more in breech (feet first) should be referred for this procedure to convert from breech to cephalic presentation (head first). Has a success rate of ~60% NB: While 25% at 28 weeks are in breech position, only 3% are near term

Answer 313

Any death in pregnancy, labour, or up to 6 weeks post partum

Answer 314

1/6th the daily dose

Answer 315

Recurrent episodes of vertigo, fluctuating sensorineural hearing loss, and a sensation of fullness or pressure in the affected ear

Answer 316

False. Whole spine MRI is needed to look for skip lesions.

Answer 317

True. They are advised to refrain from driving until their symptoms have resolved.

Answer 318

Prochlorperazine aka Stematil

Answer 319

Loss of >500ml within 24hrs of delivery. Most commonly caused by uterine atony. Mechanical: Palpation of the uterine fundus and bladder catheterisation may help to stimulate uterine contractions. Medical: IV oxytocin Carboprost IM Ergometrine IV/IM Tranexamic acid Surgery may be required if the above doesnot work NB: Secondary Postpartum Haemorrhage is from 24hrs to 6 weeks. Most commonly caused by uterine infection.

Answer 320

Tone (uterine atony): the vast majority of cases Trauma (e.g. perineal tear) Tissue (retained placenta) Thrombin (e.g. clotting/bleeding disorder)

Answer 321

GnRH agonists e.g. leupromide

Answer 322

DepoProvera (progesterone injection) NB: Medroxyprogesterone acetate 150mg, given every 12 weeks.

Answer 323

They need compression dressings They therefore need an Ankle Brachial Pressure Index to ensure sufficient circulation AKBI is 0.9 - 1.2 in healthy people

Answer 324

True Chronic kidney disease affects vitamin D metabolism which in turn affects calcium levels

Answer 325

If <48hrs then they should be admitted, heparinised and converted. If >48hrs then they needto be on anticoagulation for 3 weeks before they can be converted. A transoesophageal echo to look for left atrial appendage in the heart is also advised.

Answer 326

Amiodarone

Answer 327

400mcg OD until 12th week unless high risk (obeses, on antiepileptic drugs, history of NTD e.g. partner, self, family) of neural tube defect in which case it is 5mg OD until the 12th week.

Answer 328

5 breaths even beforechecking fora pulse Respiratory arrest is most common in children whereas cardiac arrest is more common in adults

Answer 329

True Normally staph aureus is most common but not in homozygous SCD

Answer 330

6 weeks of flucloxacillin Clindamycin if allergic to penicilllin

Answer 331

Fluoroquinolones Ciprofloxacin, levofloxacin Clindamycin and azithromycin also can cause tendonitis

Answer 332

500mcg up to a max of 3mg. If this is not succuessful then transcutaneous pacing is required. until more permanent treatment can be put in place e.g. permanent pacemaker.

Answer 333

Pre Renal: Sepsis, dehydration, HF Renal: Acute Tubular Necrosis (most common) - look for raised urinary sodium, Glomerulonephritis. Post Renal: Obstruction. Look for hydronephrosis on US.

Answer 334

Post streptococcal Glomerulonephritis is associated with Strep pyogenes. Antibiotics such as penicillin can be given.

Answer 335

Adults 30:2 Children 15:2

Answer 336

Acute Tubular Necrosis Caused by ischaemia to kidney e.g. stroke or MI

Answer 337

Livedo reticularis Caused by obstruction of capillaries. Most often this is idiopathic.

Answer 338

Coeliacs Causes villous atrophy in the bowel which causes malabsorption and failure to thrive. Anti TTG screen Jejunal biopsy showing subtotal villous atrophy

Answer 339

True Tetralogy of Fallot and Tricuspid atresia are two other examples

Answer 340

15mg OD prednisolone for 1 week then review. PMR most common in >60s presents with bilateral shoulder pain, stiffness and raised ESR. It responds very well to steroids and is associated with temporal arteritis (unknown why).

Answer 341

Codeine dose /10 give morphine dose. Tramadol is the same conversion

Answer 342

Divide morphine dose by 1.5 or 2 (Oxycodone is 1.5 - 2 x stronger)

Answer 343

Divide by 2

Answer 344

2x stronger

Answer 345

Polymorphic eruption of pregnancy is themost common skin complaint in pregnancy and presents as an itchy rash over the abdomen and abdominal striae. Pemphigoid gestationis is a similar presentation however it involves blistering lesions. Oral corticosteroids are usually required.

Answer 346

Choreathoid movements, tongue protrusion, grimacing, rapid blinking. Tetrabenazine

Answer 347

Typical: Haloperidol, chlorperazine, prochlorperazine. Extra-pyramidal side effects: - Akathisia - Parkinsonism - Acute dystonia - Tardive dyskinesia Atypical: Clozapine, Olanzapine. - Agranulocytosis (low neutrophil count) - Prolactinaemia - Weight gain - QT prolongation

Answer 348

Otitis media + effusion Typically a grommet can be inserted which allowsair to pass through the ear drum much like a eustachian tube

Answer 349

Campylobacter jejuni Progressive, ascending, symmetrical lower limb weakness is the typical sign Immune mediated demyelination of the PNS

Answer 350

Coxsackie virus

Answer 351

A variant of GBS wherethe eyes areaffectedfirst e.g ophthalmoplegia, areflexia and ataxia. Usually presents with descending paralysis (not ascending as in GBS) AntiQB1g antibodies are present in 90% of cases.

Answer 352

Depends if asthmatic featuresr notIf no asthmaticfeatures i.e. notlikely to respondto steroids then LABA + LAMA If asthmatic features: Any previous, secure diagnosis of asthma or of atopy Higher blood eosinophil count Substantial variation in FEV1 over time (at least 400 ml) Substantial diurnal variation in peak expiratory flow (at least 20%) Then LABA + ICS

Answer 353

Salbutamol SABA Salmeterol LABA Tiotropium LAMA Ipratropium SAMA

Answer 354

Stroke risk in AF Score 0 no treatment 1 in males consider anticoag 1 in femalesno treatment 2+ treat with anticoagulant (Score 1 for being female) Rivaroxaban 20mg OD NB: Age >75 counts for 2 points

Answer 355

Atrioventricular septal defect

Answer 356

Upslanting palpebral fissures, Epicanthic folds, Brushfield spots in iris Protruding tongue Small low-set ears Round/flat face Flat occiput Single palmar crease Pronounced 'sandal gap' between big and first toe Hypotonia Congenital heart defects (40-50%) Duodenal atresia Hirschsprung's disease

Answer 357

Narrowingof the duodenum in neonates --> bilious vomits. No bowel movements after the firstfew meconium movements. Requires surgical correction.

Answer 358

Corneal light reflection test Refer to ophthalmology Eye patches may help Strabismus (cross eyed) can progress to amblyopia (lazy eye) where the brain deprioritises one eye in favour of the other.

Answer 359

Associated with temporal arteritis ESR should be raised Needs prednisolone 15mg OD

Answer 360

Injection POP Impant Condom (male/female) IUS/IUD (within 48hrs) NB: IUS/IUD mustbeafter4 weeks if not within 48hrs. 3 weeks (if not breast feeding): COCP Patch / Ring 6 weeks (if breast feeding)

Answer 361

Irregular / Heavy periods

Answer 362

One a day for 21 days then 7 days break during which time you have a bleed.

Answer 363

False. There is no evidence of this. DepoProvera is the only contraceptive linked to weight gain.

Answer 364

If you take it day 1-5 of the cycle i.e. while on your period then you are protected straight away. If after this then you are not protected for 7 days.

Answer 365

True. If you continue to vomit then you must use another safer form of contraception e.g. condoms until you have taken the pill for 7 days without vomiting.

Answer 366

True. You must use another form of contraception until you have stabilised on COCP without diarrhoae for 7 days.

Answer 367

Migraine (especially with aura) 35+ and smoker Obese Pregnant VTE (+ in family <45yo) Breast ca

Answer 368

Take another (even if it means taking 2 in one day) and continue as normal

Answer 369

Depends on the week. Week one of pack - Emergency contraception may be needed if you have had sex - Condoms 7 days and continue - Take the last pill you missed (even if means 2 in one day) Week 2 or 3: - No emergency contraception needed. - Condoms 7 days. - Take the last pill missed. NB: 7 missed pills you have to start again. Emergency contraception may be required. Contact health professionals.

Answer 370

True Especially if uncontrolled by analgesia, if >50 years old, or <20 years old

Answer 371

Retinal haemorrhages Subdural haematoma Encephalopathy

Answer 372

Urge = Bladder retraining (6 weeks). If fails then antimuscarinics e.g. oxybutynin or tolterodine. Stress = Pelvic floor training 8 contractions TDS for 3 months. If fails then retropubic midurethral tape. Duloxetine if refuse surgery.

Answer 373

They are mobile and slip away when you grab them. They typically occur in 16-24yo women. Aberration of development. Benign.

Answer 374

Fat necrosis

Answer 375

Breast abscess

Answer 376

Epididymal cyst A non-tender, lump at the posterior testicle which feels separate fromthe testicle itself.

Answer 377

Germ cell tumours (>90%)

Answer 378

Collection of fluid in the tunica vaginalis - layer iof tissue surroundingthe testicle. Treated surgically

Answer 379

4-6 weeks of NSAID/Analgesia and physio. 90% of cases settle in 3 months. If no improvement then refer to secondary care.

Answer 380

Idiopathic juvenile arthritis Characterised by high spiking fevers, an evanescent salmon-pink rash, and arthritis.

Answer 381

SGLT-2 inhibitor monotherapy e.g. dapagliflozin. If raised CVD risk and cannot take metformin this is the choice If raised CVD risk and can tolerate metformin then take both. Start metformin first then add SGLT-2 inhibitor

Answer 382

Alpha 1 antagonist e.g. tamsulosin or alfuzocin. Decreases the smooth muscle tone of the prostate and bladder A 5 alpha reductase inhibitor would be second line e.g. finasteride

Answer 383

IUS IUD DepoProvera The only ones safe to use with enzyme inducing drugs such as carbamazepine

Answer 384

True. Should measure Bilirubin levels immediately. Possible causes of pathological jaundice: - Rhesus haemolytic disease - ABO haemolytic disease - hereditary spherocytosis - glucose-6-phosphodehydrogenase 2-14 days is common (40%) - Physiological jaundice. 14 days + = Prolonged jaundice Phototherapy is the first line treatment

Answer 385

False. You lose the peripheral vision first

Answer 386

Bitemporal hemianopia + upper quadrant defect Optic chiasm lesion + inferior compression (lower quadrant = superior compression)

Answer 387

Glucose challenge - measure growth hormone following glucose. IGF-1 levels will also be testedasthey will be raised in acromegaly.

Answer 388

Left (contralateral) homonymous hemianopia

Answer 389

Superior = Inferior radiation Temporal lobe (Meyer's loop) lesion. Defect is contralateral Inferior = Superior radiation Parietal lobe. Defect is contralateral PITS Parietal Inferior Temporal Superior

Answer 390

Occipital cortex lesion

Answer 391

Macular degeneration

Answer 392

Reduces risk of pulmoanry hypertension

Answer 393

Rough, red papules over the extensor surfaces associated with dermatomyositis. Often over the knuckles. Dermatomyositis involves symmetrical proximal muscle weakness and papular rash over extensor surfaces. May be associated with malignancy or idiopathic.

Answer 394

100 ml/kg/day for the first 10kg of weight 50 ml/kg/day for the next 10kg of weight 20 ml/kg/day for weight over 20kg

Answer 395

0.5ml/kg/hr If less than this, consider bolus IV 0.9% saline over 15 minutes.

Answer 396

10 ml/kg over 20 minutes

Answer 397

If unstable arrythmia e.g. shock, syncope, MI, heart failure then 3x shocks DC cardioversion + amiodarone loading + 24hr infusion. If stable, then depends if regular and on QRS. Regular Narrow Complex = Adenosine. Irregular then maybe A Flutter (consider beta blocker) Regular Broad Complex = Amiodarone (loading dose followed by 24hr infusion) aslikely VT. If irregular then consider rate control as ? AF NB: Amiodarone is a broader word than Adenosine

Answer 398

True. It is a DA antagonist and can make parkinson's worse! Domperidone targets DA receptios but doesnt cross the BBB!

Answer 399

True They compete for the same binding sites on Na/K ATPase pump and therefore if K is low, moire digoxin binds increasing its toxic effect. Digibind is the treatment for digoxin toxicity

Answer 400

A longer-acting dihydropyridine calcium channel blocker e.g. amlodipine should be added. If this cannot be tolerated then a long-acting nitrate e.g. ivabradine or nicorandil should be employed. If medical management fails then referral for revascularisation e.g. PCI is the next step

Answer 401

Scleritis is a red and PAINFUl eye Episcleritis is not painful just red

Answer 402

Prodrome of feeling unwell for a few days then bloody diarrhoea and abdominal pain. Campylobacter is the most common gastroenteritis in the UK

Answer 403

Vancomycin: 125 mg orally four times a day for 10 days Second line: Fidaxomicin: 200 mg orally twice a day for 10 days if Vancomycin is ineffective.

Answer 404

True <33% Life threatening 33-50% Severe 50-75% Moderate

Answer 405

[Peak flow <33% predicted = life threatening O2 15L Non-rebreather mask SABA: Salbutamol high dose neb SAMA: Ipratropiumbromide IV Magnesium Sulfate Oral prednisolone (continue for 5 days after) Consider IV aminophylline If fails to respond then ICU for possible ECMO - Extracorporeal membrane oxygenation.

Answer 406

Infectious Mononucleosis (Epstein Barr Virus / Glandular fever) caused by Herpes 4. Amoxicillin + EBV causes a macular papular rash in 99% of people!

Answer 407

Heterophil antibody test (Monospot test)

Answer 408

True. To prevent recurrence.

Answer 409

Macrolides if within 21 days of infection e.g. Azithromycin. If pregnant then erythromycin.

Answer 410

Occulomotor 3rd nerve palsy

Answer 411

Gliclazide (sulfonylurea) would bea good choice. Alternative second lines: - DPP-4 inhibitor - Pioglitazone SGLT-2 inhibitor e.g.empagliflozin if CVD risk.

Answer 412

-2.5 or less -1 to -2.5 = Osteopenia 0 to -1 = Normal

Answer 413

False. 0 to -1 = Normal -1 to -2.5 = Osteopenia Less than -2.5 = Osteoporosis

Answer 414

70mg once weekly

Answer 415

Methotrexate + DMARD + Corticosteroids. Folate should also be supplemented

Answer 416

Risk of neonatal haemolysis Best alternative is cefalexin or amoxicillin

Answer 417

Skin patch test

Answer 418

False. It is not safe

Answer 419

High blood pressure in pregnancy. New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following: Proteinuria Other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction Asirin 75-150mg daily from 12 weeks until delivery. Oral labetalol is the first line for treating acutely

Answer 420

BIPAP If this fails then ITU

Answer 421

When all lesions have crusted over

Answer 422

4 days after onset of rash Rubella is 5 days

Answer 423

5 days from onset of swollen glands.

Answer 424

48hrs with no symptoms

Answer 425

Oral vancomycin + IV Metronidazole

Answer 426

Identifying Septic Arthritis fever >38.5 degrees C non-weight bearing raised ESR raised WCC If a child presents with a hot joint (particularly after an infection) then transient synovitis is most likely.

Answer 427

True. Amiodarone, methotrexate,nitrofurantoin can also be causes.

Answer 428

Haemophilus influenzae

Answer 429

1st Hydrogen peroxide 1% cream 2nd Topical antibiotic e.g. fusidic acid If extensive then oral flucloxacillin

Answer 430

Headache, flushing, peripheral oedema.

Answer 431

A life threatening skin reaction to a drug where the epidermis detatches and the patient is systemically unwell. Typical causes: phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs Treatment: IV Ig and often ITU

Answer 432

Analgesia, O2 and IV fluids

Answer 433

Sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Answer 434

Oestreogen pessary Labial adhesions are usually caused by low oestrogen and typically occur in girls 3months to 3 years.

Answer 435

True CABG would be 4 weeks off driving

Answer 436

Lateral eicondylitis

Answer 437

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Answer 438

Syndrome after a DVT. Painful, heavy calves Pruritus Swelling Varicose veins Venous ulceration

Answer 439

5 Days EllaOne (ullipristal) 3 Days Levonelle 5 days Copper Coil or within 5 days of expected start of ovulation (typically day 14 of 28 day regular cycle is start of ovulation).

Answer 440

PVD - numbness and claudication (pain in thigh, calf, buttock) typically occurs in older patients. Buerger's is a medium vessel vasculitis which presents similarly but in young smokers most often.

Answer 441

True. It is to prevent seizure.

Answer 442

Can't give labetolol Nifedipine is the choice. Hydralazine is another option.

Answer 443

True Other reversible causes: Depression, B1 and B12 deficiency, sleep deprivation, ICH, brain tumour.

Answer 444

<1hr of ingestion

Answer 445

Urinary alkalisation with IV bicarbonate Haemodialysis if severe!

Answer 446

Flumazenil Only used in extreme cases as Flumazenil carries the high risk of seizures! Most benzo overdoses are managed with supportive care only.

Answer 447

IV bicarbonate to reduce the risk of seizures and arrhythmias

Answer 448

Atropine if bradycardic Glucagon if severe

Answer 449

Fomepizol (1st line) - inhibits alcohol dehydrogenase Haemodialysis in extreme cases Alcohol used to be used to out compete ethylene glycol for alcohol dehydrogenase. Methanol poisoning is the same management

Answer 450

100% oxygen Hyperbaric oxygen

Answer 451

Hydroxocobalamin

Answer 452

Desmoferoxamine

Answer 453

Dimercaprol

Answer 454

IV saline haemodialysis if severe

Answer 455

12-15 months

Answer 456

Autoimmune vs intrinsic factor / parietal cells aka oxyntic cells at the gastric body/fundus which impairs B12 absorption.

Answer 457

Stage 1: Cr 1.5-1.9 x baseline, (~26.5umol increase), <0.5ml/kg/hr urine output for >6hrs. Stage 2: Cr 2-2.9 x baseline, <0.5ml/kg/hr urine output for >12hrs Stage 3: Cr 3+ x baseline, <0.3ml/kg/hr urine output for >24hrs.

Answer 458

Strong corticosteroid e.g. betamethasone + topical Vit D e.g. calcipotriol.

Answer 459

Keratoacanthoma. Benign skin lesion. Urgent referral to dermatology as cannot exclude malignancy e.g. squamous cell carcinoma.

Answer 460

De Quervain's subacute thyroiditis. TENDER goitre + thyrotoxicosis = De Quervains which is inflammation of the thyroid gland comonly due to recent viral infection. Tenderness is key. Thyroid issues or thyroid cancer would be painless!!

Answer 461

Papillary NB: Thyroid cancer is not associated with derranged thyroid levels.

Answer 462

When 2 other antipsychotics have failed

Answer 463

Primary 20mg ON Secondary 80mg ON Primary if QRisk >10% Secondary if Ischaemic heart disease, peripheral vascular disease or CVD.

Answer 464

Stop 4 weeks prior as may increase risk of clotting

Answer 465

De Quervains TSH is raised. Sick euthyroid TSH is normal (T3/4 is low). AKa non-thyroidal illness

Answer 466

Pain. Cahancroid ulcers are painful (caused by Haemophilus ducreyi - tropicalillness). Syphylis ulcers are non-tender.

Answer 467

Overflow urinary incontinence i.e. leaking. Anticholinergic effect.

Answer 468

Ciprofloxacin 500mg BD (Quinolone)

Answer 469

Guttate psoriasis Tear drop papules is the giveaway. Typically inducedby strep infection 'Gutta' is latin for tear drop Resolves in about 6 weeks

Answer 470

Baseline, 3 months and 12 monhts.

Answer 471

Observe for 6-12 weeks as usually self limiting. No antibiotics needed in most cases. Refer for hearing test if problem persists.

Answer 472

IV Magnesium sulfate

Answer 473

MRI pelvis

Answer 474

Advise her to avoid contact with infective persons. MMR vaccine can be offered post natally.

Answer 475

ITP typically presents with petechiae, purpura, epistaxis, thrombocytopenia and often follows a respiratory infection. Autoimmune vs platelets Treatmentis oral steroids first line

Answer 476

False. It can affect tooth and bone development

Answer 477

True Acoustic neuroma aka vestibular schwanoma

Answer 478

Press them. Spider naevi (Liver impairment, pregnancy) fill from the centre, telangiectasia from the edge

Answer 479

CCB e.g. amlodipine or thiazide diuretic indapamide. Spironolactone or beta blocker after this if both CCB + Diuretic fails.

Answer 480

Congenital diaphragmatic hernia presents with scaphoid abdomen, due to herniation of the abdominal contents into the cleft

Answer 481

Paroxetine

Answer 482

Enuresis alarm Wakes the child up when it detects urine is passing i.e. moisture High success rate

Answer 483

<18.5 Underweight 18.5 - 24.9 Normal 25 - 29.9 Overweight 30 - 34.9 Obese I 35 - 39.9 Obese II 40+ Morbidly obese

Answer 484

Breast development in puberty

Answer 485

If no thelarche (breast development) by 13 or no menarche by 15

Answer 486

True Girls 45XO or 45X

Answer 487

Oral vancomycin + IV metronidazole

Answer 488

Hypokalaemia Hypernatremia HTN Aldosterone antagonist e.g. spironolactone

Answer 489

Aspergilloma NB: Often will have past history of TB

Answer 490

Symptomatic

Answer 491

Yes and no, only BRCA associated breast cancer is a contraindication <45yrs VTE in first degree relative is however a contraindication

Answer 492

Symptoms lasting more than 4 days or not improving Systemically unwell but not requiring admission Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease Younger than 2 years with bilateral otitis media Otitis media with perforation and/or discharge in the canal

Answer 493

High dose oral dexamethasone

Answer 494

Topical GTN Relaxes the anal sphincter

Answer 495

Anti histone antibodies

Answer 496

Propranolol or Topiramate (not in pregnancy/women of child bearing age)

Answer 497

Transient idiopathic osteoporosis

Answer 498

Pubic symphysis dysfunction

Answer 499

Meralgia paraesthetica

Answer 500

Pain can be ilicited by palpation if its Greater trochangteric pain whereas it cannot if its osteoarthritis.

Answer 501

True Club foot aka Talipes equinovarus is normally picked up at the first baby check. Ponseti method is favoured which is non-surgical gradual correction of foot position with braces.

Answer 502

Within 72 hours of being born

Answer 503

12 week (10-14 wk) - US 'Dating scan' - check how far along in pregnancy, development and whether Down's, Edward's, Patau, sceening is needed. If after 14 weeks then a Quadruple test is done to look for Down's. 20 week (18 - 21 wk scan): A more detailed US checking development and for other conditions such as Patau's.

Answer 504

Retinal/ophthalmic artery

Answer 505

Chorionic Villous Sampling 11-14 weeks. Higher risk of miscarriage 1 in 200. Amniocentesis 15-20 weeks. Slightly lower risk of miscarriage but roughtly 1 in 200 still.

Answer 506

Within 1 week

Answer 507

IM lorazepam In antipsychotic naieve patients with unknown cardiovascular background, Lorazepam is the safest choice. IM Haloperidol is second line but less safe.

Answer 508

A large downwards V1 QRS suggests LBBB. Anterolateral / Septal MI is the most likely cause

Answer 509

0% X-linked conditions cannot be passed male to male. He can only have carrier female children. Males will not be affected.

Answer 510

Yes If FHX of breast cancer AND ovarian in1st or 2nd degree relative

Answer 511

50 -70 yo Every 3 years mammography

Answer 512

Assessment of sepsis risk. If 2 ormore of the following then assume sepsis qSOFA score Respiratory rate > 22/min Altered mentation Systolic blood pressure < 100

Answer 513

Meconium ileus: presents in the first 24-48 hours of life with abdominal distension and bilious vomiting, more common in cystic fibrosis. NB Dueodenal atresia would be present within a few hours ofbirth and would show on antenatal scans Pyloric stenosis would present 2-12 weeks and would be projectile vomiting.

Answer 514

US Abdo Ladd's procedure 3-7 days after birth Sick patient Volvulus

Answer 515

Posseting - posseting is the act of bringing up small quantities of milk without any pain or discomfort.

Answer 516

Usually 2nd week of life Associated with prematurity Dilated bowel loops on AXR High risk perforation

Answer 517

Previously infected with Hep B virus HBsAg (surface antigen) and cAg (core antigen) are negative suggestingno active infection. Anti-HBs (surface) and Anti-HBc (core) antibodies are present suggesting previous infection which has resolved. If the patient was immunised then AntiHBs would be positive but Anti-HGc would be negative.

Answer 518

First degree: Prolonged PR interval >0.2 seconds. No treatment if asymptomatic. Second degree: Mobitz 1 (Wenkebach): progressively longer PR until QRS dropped. Transcutanous pacing symptomatic until pacemaker can be provided. Mobitz 2: Prolonged PR (fixed) with a dropped QRS atintervals. (2:1 block is 2 P waves then 1 QRS) Third degree: No association between P waves and QRS waves.

Answer 519

Type 1: mixed anaerobe and aerobe bacteria. Most common. Type 2: Strep pyogenes Fournier's gangrene (perineum) is the mostcommon site. Appears like cellulitis. Treatment is surgical debridement andbroad spectrum antibiotics e.g. Tazocin + Vancomycin NB: Mortality ~20%

Answer 520

Ethmoidal sinus (due to thin medial wall of orbit) following a cold

Answer 521

Orbital celluliitis there is: Proptosis Pain on eye movement Reduced visual acuity This is not the case in preseptal

Answer 522

Hashimoto's (autoimmune thyroiditis) Iodine deficiency is the most common cause in the developing world

Answer 523

True Nitrofurantoin (1st line) but avoided near term Amox or cefalexin 2nd line

Answer 524

Analgesia: NSAID / Paracetamol COCP or progeserone GnRH analogues (pseudomenopause) NB: Medical treatment does not hel with infertility Surgical laparoscopic excision or ablation can improve chances of conception

Answer 525

Laparoscopy NB: US is of little value

Answer 526

It induces ovulation and may help counteract subfertility in endometriosis. Clomifene is typically used for anovulatory oroligo-ovulatory infertility

Answer 527

Fasting > 7 (Key diagnostic!) Random > 11 Hba1c > 6.5 (48) Prediabetic: Fasting 5.5 - 6.9 2hrs Post Prandial: 7.8 - 11% Hba1c: Normal <42 (6%) Pre 42 - 47 (6 - 6.4%) Diabeteic 48+ (6.5%)

Answer 528

CA19-9 - Pancreatic CEA - Colon CA 153 - Breast cancer CA 125 - Ovarian cancer Alpha Feto Protein - Hepatocellular

msra Flashcards

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