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1
Q

What are the filling pressures like in heart failure

A

Normal or high

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2
Q

What symptoms does left heart failure lead to

A

Lung symptoms: pulmonary oedema, orthopnoea, paroxysmal nocturnal dysponea, fatigue

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3
Q

What symptoms does right heart failure lead to

A

Body symptoms: pedal oedema, raised JVP, ascites, hepatomegaly

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4
Q

Definitive treatment of heart failure

A

TAVI

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5
Q

Acute management of heart failure

A

High flow oxygen, IV GTN, IV furosemide, IV morphine

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6
Q

Who gets pneumococcal and influenza vaccines

A

COPD and HF

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7
Q

2nd line treatment for heart failure

A

Spironolactone

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8
Q

3rd line treatment for heart failure

A

Candesartan and hydralazine

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9
Q

Causes of dilated cardiomyopathy

A

Alcoholic or idiopathic

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10
Q

Treatment of hypertrophic cardiomyopathy

A

Amiodarone

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11
Q

Symptoms of cardiomyopathy

A

Dyspnoea, fatigue, pulmonary oedema and emboli

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12
Q

First line treatment of pericarditis

A

Cardiocentesis

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13
Q

Second line treatment of pericarditis

A

Ibuprofen, Omeprazole, Colchicine, Exercise restriction

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14
Q

Triad of signs of pericarditis

A

Low BP, Raised JVP, Muffled HS

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15
Q

Treatment of aortic aneurysm

A

Asprin, Ace Inhibitor, Beta blocker, Statin

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16
Q

Treatment of aortic dissection

A

ABCDE, labetalol and morphine before surgery

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17
Q

Treatment post aortic repair

A

HTN below 120, BB and ACEI

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18
Q

Lead V1-V4 artery and area

A

LAD, Anterior/ Septal

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19
Q

Leads 2,3,AVF artery and area

A

RCA, inferior

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20
Q

Leads V5,6 and 1, artery and area

A

Circumflex and lateral

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21
Q

Stage 2 hypertension values

A

160/100 or 150/95 at home

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22
Q

Angina ongoing treatment

A

GTN, Aspirin, BB, Statin

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23
Q

Advice about taking GTN

A

Expect pounding headache and light head

Take, 5 mins, take, 5 mins, take phone ambulance

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24
Q

Signs of VSD and AVSD

A

Systolic murmur and thrill

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25
Cardinal sign of coarctation
Right arm hypertension
26
Cyanotic structural heart disease without shunts
Coarctation, congenital AS
27
Acyanotic structural heart disease without shunts
Pulmonary stenosis, tricuspid regurg
28
Treatment of structural heart disease
Surgery, IE prophylaxis
29
Regular broad complex tachycardia
VT | Give amiodarone
30
Regular narrow complex tachycardia
SVT Vagal Manouveres Adenosine
31
Wolf parkinson white ECG
Delta waves (slope on the Q)
32
Sustained ventricular tachycardia
VT/ ectopic lasting more than 30s
33
Non sustained ventricular tachycardia
VT/ ectopic lasting less than 30s
34
Digoxin antidote
Digoxin Immune Fab
35
AV node reentrant tachycardia
Often young people, most common SVT
36
Describe sarcoid features
Non caseating granulomas Bilateral lymphadenopathy, fibrosis, fever,arthralgia Young black woman
37
Diagnosis of sarcoid
Bronchoscopy and biopsy
38
Features of IPF
Clubbing, fibrosis
39
Diagnosis of IPF
High resolution chest CT
40
Treatment of IPF
IV prednisolone
41
Antifibrinolytic for IPF
Perfenidone
42
Active TB 1st investigation
CXR
43
Active TB diagnostic investigation
Sputum for NAAT
44
What do you give to treat isoniazid neuropathy
Pyridoxine
45
How long do you treat CNS TB for
12 months
46
Potts Disease
Spinal TB
47
Pulmonary Hypertension clinical findings
Loud Second Pulmonary HS
48
Treatment of H Influenza pneumonia
Amoxicillin
49
Treatment of S Aureus pneumonia
Flucloxacillin
50
Treatment of pulmonary hypertension
Diuretics, Calcium Channel Blockers, ?LTOT
51
Treatment of pseudomonas
Ciprofloxacin
52
Diagnosis of bronchiectasis
High resolution CT Chest
53
Treatment of bronchiectasis
Firstly: Exercise and Diet. Then chest Physio, nebulised saline and salbutamol
54
Exudative pleural effusion
High protein, Infection, Cancer, PE, Connective tissue disorders
55
Transudative pleural effusion
Low protein, cardiac, renal, liver failure, Meigs, hypoalbuminaemia, hypothyroid
56
Treatment of pleural effusion
Thoracocentesis then furosemide
57
Treatment of a secondary pneumothorax less than 1cm in size
Oxygen and observe
58
Treatment of a secondary pneumothorax in a patient over 50
Chest drain
59
Wegeners features
Nasal, lung and glomerulonephritis
60
Other name of wegeners
Granulomatosis with Polyangitis
61
Treatment of GPA/ Wegeners
IV prednisolone Methotrexate Folic acid
62
How do you diagnose goodpastures
Renal biopsy= cresenteric glomerulonephritis
63
Treatment of goodpastures
1- IV pred | Definitive- plasmaphoresis
64
Where can mesothelioma involve
Pleura, perineum, pericardium and testes
65
Describe pleuritic fluid in mesothelioma
Bloody and straw coloured
66
PE Wells score over 4
Skip D Dimer, go straight to CTPA
67
How long on a DOAC for a provoked PE (not cancer)
3 months
68
When and how do you use fibrinolysis in PE
Alteplase when they are haemodynamically unstable
69
How do you treat a meconium ileus
Constrast enema and lactulose
70
What is a gene modulator for CF
Ivacafter
71
What does the FBC of a COPD patient show
Secondary polycythaemia
72
How do you treat an infective exacerbation of COPD
Amoxicillin and Prednisolone
73
What virus can cause a COPD exacerbation
Rhinovirus
74
Which virus commonly causes tonsilitis
Adenovirus
75
Name 2 nasal decongestants used for sinusitis
Pseudoephidrine, oxymetalozine
76
Treatment of croup
Adrenaline nebulised, dexamethasone, oxygen, fluids
77
Treatment of epiglottitis
Intubation and IV fluids
78
Score used for common cold
CENTOR/McIsaac
79
What is needed for diagnosis of pneumonia
Chest XR
80
Pneumonia treatment in penicillin allergic patient
Cefuroxime
81
Post influenzae pneumonia cause
staph aureus
82
Gram negative hospital acquired pneumonia
E Coli
83
ITP, Encephalopathy, Pneumonia, Diagnose on serology
Mycoplasma Pneumonia
84
Hypernatraemia and Pneumonia
Legionella, diagnose with urinary antigen
85
Treatment of atypical pneumonia
Erythromycin
86
Features of adenocarcinoma
Non smokers, gynaecomastia, HPOA
87
What warrants a 2WW for lung cancer
40 + and haemoptysis CXR suspicious of cancer 40 + and 2 symptoms suspicious of cancer
88
Asthma questions to ask in hisotry
Last 3 months - nocturnal waking - daily symptoms - affecting ADLs
89
COPD questions to ask in history
Home Oxygen? How Many Exacerbations? How Many Rescue Packs? How Many Admissions?
90
Diagnostic for cholecystitis when query sepsis
CT
91
What are 2 things that bile stones can be made of
90% cholesterol, 10% calcium bilirubinate
92
What type of cancer is oesophagea
Adenocarcinoma
93
Where does oesophageal cancer metastasise to
Lung and liver
94
Describe two distinct features of gastric cancer
``` Epigastric pain that doesn't radiate Tingling feet (from b12 deficiency) ```
95
Treatment of gastric cancer
Chemo and surgical resection
96
What type of cancer is pancreatic cancer
Ductal adenoma
97
Investigation for pancreatic cancer
CT and tumour markers
98
Where is the pain for pancreatic cancer
Epigastric/ RUQ/ LUQ but radiates to the back
99
What type of cancer is colorectal cancer
Adenocarcinoma
100
Bowel cancer screening
FIT/FOB testing for 60-74 year olds, once every 2 years
101
Diagnostic investigation for colorectal cancer
Colonoscopy
102
What imaging is used for staging colon cancer
CT
103
What imaging is used for staging rectal cancer
MRI
104
Treatment fo severe colon cancer
Radiotherapy
105
Treatment of mild rectal cancer
Transanal excision
106
First line treatment of an acute crohns flare
IV hydrocortisone
107
Second line treatment of acute crohns flare
Azathioprine
108
Third line treatment of acute crohns fare
Infliximab
109
Complications of crohns
Fistulae, abscesses, colon cancer
110
Extra GI features of crohns
Arthropathy, erythema nodosum, pyoderma gangrenosm. Uveitis and episcleritis
111
Treatment of a symptomatic hernia
Laparoscopic mesh repair
112
Chronic diarrhoea and malabsoprtion diagnosis and management
Giardiasis and metronidazole
113
What causes Guillain Barre Syndrome
Campylobacter
114
Whats the likely causative organism when the diarrhoea is bloody with abdominal pain
Shigella
115
Vomitting and diarrhoea within 6 hours of ingesting dodgy food
S Aureus
116
Which two bloods can rule out appendicitis
FBC and CRP
117
How do you treat appendicitis if theyre not for surgery
Antibiotics
118
Distinctive blood result of diverticulitis
Polymorphonuclear lymphocytosis
119
Treatment of diverticulitis
Increase fibre in diet, analgesia and antibiotics
120
Where is the pain in pancreatitis
LUQ
121
Invesigation for acute pancreatitis
Serum lipase
122
Investigation for chronic pancreatitis
Abdominal ultrasound
123
Symptoms of hereditary haemochromatosis
Bronze skin, hepatomegaly, diabetes, likely post menopausal if female
124
Diagnostic investigation for hereditary haemochromatosis
HFE gene testing
125
Treatment of hereditary haemochromatosis
Desferrioxamine
126
Diagnostic investigation for wilsons disease
24 hour urinary copper excretion
127
Treatment of wilsons disease
Zinc
128
Alpha 1 antitrypsin deficiency first linvestigation
Spirometry and LFTs
129
Alpa 1 antitrpysin deficiency diagnostic investigation
Plasma alpha 1 antitrpysin level
130
First treatment in Alpha 1 antitrpysin deficiency
Smoking cessation
131
Investigation for ascites
Ultrasound
132
Investigation for spontaneous bacterial peritonitis
Ascitic fluid- absolute neutrophil count
133
Symptoms of volvolus
Abdo pain and bilious vomiting
134
Investigation for volvolus
Upper GI contrast CT
135
Treatment of volvolus
Ladd procedure
136
Hep A first line investigation
Anti HAV antibody
137
Hep A diagnostic investigation
HAV RNA
138
First line treatment of Hep B
Interferon alpha
139
Long term treatment of Hep B
Tenofovir
140
Hep C first line investigation
Anti HCV antibody
141
Hep C diagnostic investigation
HCV RNA
142
Hep D first line investigation
Anti HDV antibody
143
Which of the Hepatitises are RNA
ACE
144
Hep E first line investigation
Anti HEV antibody
145
Hep E diagnostic investigation
HEV RNA
146
What should be calculated for alcoholic cirrhosis
Discriminant function (bilirubin and PTT)
147
Treatment of ascites
Spironolactone
148
Treatment of portal hypertension
Propanolol
149
Treatment to prevent hepatic encephalopathy
Lactulose
150
What causes UC flares
NSAIDs and stress
151
UC on biopsy
No granulomas or inflammation beyond submucosa, reduced goblet cells, crypt abscesses
152
What is mild UC flare
Less than 4 stools a day
153
Second line treatment of Acute Severe UC flare
IV Ciclosporin
154
Third line treatment of Acute Severe UC flare
Infliximab trial
155
PBC and PSC treatment
Ursodeoxycholic acid
156
PSC diagnosis
ERCP
157
New painless obstructive jaundice
Pancreatic cancer
158
Well person, new jaundice after new drug/ antibiotic
Acute drug induced liver injury
159
Bloods for coeliac
IgA TTG and serum IgA levels
160
Associated symptoms of coeliac
``` Dermatitis Herpetiformis Osteomalacia Enteropathy associated T cell lymphoma of small bowel Hyposplenism Anaemia ```
161
What does dermatitis herpetiformis look like
Cluster of itchy bumps, eczema like
162
Anaemia of B12, Folate and IDA after travel
Tropical sprue
163
Investigation for haemorrhoids
Anoscopic examination
164
First line treatment for haemorrhoids
Diet and lifestyle change
165
Second line treatment for haemorrhoids
Topical hydrocortisone
166
Third line treatment for haemorrhoids
Band ligation
167
Investigation for anal fistulae
MRI and ultrasound
168
Treatment of anal fistulae
Fistulotomy and drainage
169
Anal fissure symptoms
Tearing sensation, blood, defecation pain
170
Anal fissure treatment
Lifestyle, topical GTN
171
GORD treatment
8 week PPI and lifestyle measures
172
What do you give if nocturnal symptoms with GORD
Rantidine
173
When do you do an OGD in GORD
``` Over 55 Weight Loss More than 4 weeks OR Relapsing ```
174
What treatment does mallory weiss tear need
Resolves spontaneously
175
Diagnosis of mallory weiss tear
OGD
176
Plummer vinson syndrome
Glossitis, IDA and dysphagia
177
Boerhaave syndrome
Retrosternal chest pain, vomiting, surgical emphysema
178
Eradication of H Pylori
Amoxicillin (or metronidazole) + clarithromycin + omeprazole for 7 days
179
Treatment of varices
Blood, terlipressin, prophylactic ceftriaxone
180
Investigation of varices
OGD, NILS
181
Symptoms of scleroderma
CREST and fibrosis and renal
182
limited systemic sclerosis antibody
Anti centromere antibody
183
Diffuse systemic sclerosis antibody
Anti Scl 70/ antitopoisomerase
184
First line treatment of IBS
Lifestyle and FODMAP
185
2nd line treatment of IBS
Constipation: lactulose Diarrhoea: loperamide
186
Requirements for IBS diagnosis
1 day a week for past 3 months with 2 of - altered stool frequency - altered stool form - pain associated with defecation
187
Treatment for unstable patient with SBO Sx or AXR suggestive of SBO
CAT 1 laparatomy
188
Investigation for stable patient with SBO Sx or AXR suggestive fo SBO
CT with contrast
189
Features for surgery in small bowel obstruction
Bowel ischaemia Closed loop obstruction Obstructive lesion
190
Tympanic abdomen
Large bowel obstruction
191
Investigation for large bowel obstruction
AXR
192
Charcot Marie Tooth
Motor inherited neuropathy. Frequently sprained ankles. Foot abnormalities
193
Posterior spinal cord neuropathy
Romberg positive, sensory
194
Lateral spinal cord neuropahty
UMN signs (motor) and spastic
195
Describe alcohol neuropathy and treatment
Sensory then motor. Treatment is pabrinex
196
Important thing to do after giving prednisolone in GCA
Opthalmology review
197
Severe stabbing pain in one side of face
Trigeminal neuralgia
198
Treatment of parkinsons
Levodopa (dopaminergic) and Carbidopa (decarboxylase inhibitor)
199
Incontinence, dementia and ataxia
Symptoms of normal pressure hydrocephalus
200
Investigation for normal pressure hydrocephalus
MRI and CSF flow studies
201
Treatment of normal pressure hydrocephalus
Ventriculoperitoneal shunt
202
Diagnosis of huntingtons
CAG repeat testing (more than 40)
203
Treatment of huntingtons
Symptomatic- SSRI or haloperidol
204
DMARD in MS
Interferon beta
205
Acute treatment in MS
Methylprednisolone
206
Symptoms of MS
Foot drop, UMN, optic neuritis, Lhermittes electric shock down spine
207
Investigations for Myasthenia Gravis
Serum anticholinesterase receptor antibodies | Muscle Specific Tyrosine kinase antibodies
208
What imaging might you do in Myasthenia Gravis
CT chest looking for thymoma
209
Treatment for MND
Riluzole and supportive care
210
Investigations for meningitis
LP, blood cultures, bloods inc lactate
211
Who gets amoxicillin added on for meningitis
Over 50 or under 3 months
212
What do you treat meninigitis with
Cefuroxime (+amox) and IV dexamethasone
213
Treatment of fungal meningitis
Amphotericin B
214
Treatment of viral meningitis
Aciclovir (as likely HSV)
215
Treatment of CMV
Ganciclovir
216
Investigation of encephalitis
MRI
217
How long does a TIA last
Up to 24 hours
218
Investigation of TIA
ECG and bloods (FBC, clotting, U and E, glucose)
219
Whats the treatment of TIA
300mg aspirin | Long term clopidogrel and statin
220
16-30 year old with spinal cord compression
Trauma
221
30-50 year old with spinal cord compression
Disc disease
222
40 plus year old with spinal cord disease
Malignancy
223
Acute onset spinal symptoms
Trauma or disc herniation
224
Chronic onset spinal symptoms
Osteoporosis, osteomyelitis or malignancy
225
Treatment of spinal cord compression
Immobilisation and decompressive laminectomy
226
Treatment of spinal malignancy
Corticosteroids, surgery and radiotherapy
227
What tissue do most pancreatic cancers come from
Exocrine
228
Imaging for abscess
Ultrasound
229
Hayfever treatment
Daily oral antihistamine, daily nasal steroid
230
Who gets an erythematous rash with amoxicillin
Allergic, CLL and infectious mononucleosis
231
Most common brain tumour
Astrocytoma
232
Investigation for astrocytoma
MRI and surgical biopsy
233
Progression of astrocytoma
Pilocytic, diffuse, anaplastic, glioblastoma multiforme
234
Visible bony growth, brain tumour
Meningioma
235
Child, vomiting relieves headache
Medulloblastoma
236
Medulloblastoma imaging
CT and MRI
237
Treatment of medulloblastoma
Resection
238
Mild head injury GCS
13-15
239
Moderate head injury GCS
9-12
240
Severe head injury GCS
<9
241
Vision change caused by parietal lobe problem
Inferior vision
242
Vision change caused by temporal lobe problem
Superior vision
243
Vision change caused by pitiutary tumour
superior quadrant defect
244
Vision change caused by craniopharyngoma
Inferior quadrant defect
245
Treatment of brain bleeds
Phenytoin | Removal of anticoagulation
246
Treatment of subarrachnoid haemorrhage
ABCDE and nimodipine
247
2nd line epilepsy medication
Lamotrigine
248
How long does an epileptic need to be seizure free before they can drive
1 year
249
How long do you have to be seizure free after 1 seizure if not epileptic
6 months
250
3 things for Total anterior circulation stroke
Honomymous hemianopia, motor, cognition
251
1st line treatment of stroke
Alteplase within 4.5 hours
252
Contraindication for alteplase for stroke
Bleeding anywhere or neuro disease
253
Alternative to alteplase for stroke
Thrombectomy in 6 hours
254
Long term medications after stroke
Clopidogrel and statin
255
AF and stroke, anticoagulant choice
DOAC not clopidogrel
256
Imaging for stroke
Carotid artery doppler and CT head
257
Which artery causes locked in syndrome
Basilar artery
258
Acronym for features of migraine
POUNDing
259
Prophylaxis of Tension headache
Amitryptilline and acupuncture
260
Treatment of acute tension headache
NSAID and paracetamol
261
Treatment of acute migraine
Sumatriptan and ibuprofen
262
Prophylaxis of migraine
Propanolol
263
Symptoms of cluster headache
autonomic and one sided
264
How many counts as chronic tension headache
15 a month
265
Symptoms of migraine
Pounding, pulsatile, 4-72 hours, unilateral N and V, disabling
266
When do you operate on varicocele
More than 2cm, 20% volume or symptoms
267
Hydrocele description
Fluid collection which varies in size (operate if 2-21yrs old or infected)
268
What would you see on Ultrasound of a torsion testes
Whirlpool sign
269
Investigations for ED
Sexual health inventory for men Glucose Lipids
270
2 line treatment of ED
Intracavernous alprostadil suppository
271
3rd line treatment of ED
intraurethral alprostadil suppository
272
Investigation for renal colic
Non contrast KUB CT
273
Treatment of nephrolithiasis acutely
PR diclofenac and ondansetron
274
Treatment of urice acid renal stones
Allopurinol
275
Treatment of calcium renal stones
Indapamide
276
Treatment of oxalate renal stones
Calcium carbonate
277
Treatment of all renal stones
Pottasium citrate
278
BHcG is a tumour marker for which
Choriocarcinoma or seminoma
279
AFP is a tumour marker for which
Non seminoma
280
LDH is a tumour marker for which
Tumour burden
281
Investigation for testicular cancer
Ultrasound and tumour markers
282
Investigation for prostatic cancer
PR and PSA then TRUS (Transrectal US guided needle biopsy)
283
Treatment for prostate cancer when more than 10 years to live
Brachytherapy
284
Treatment for prostate cancer when high risk
Prostatectomy
285
Treatment for prostate cancer when metastatic
Androgen deprivation with lueprolin
286
third line treatment for BPH
Sildenafil
287
Non bothersome BPH treatment
Watchful waiting and behaviour management
288
What does BPH surgery choice depend on
TUIP, TURP or prostatectomy dependent on prostate volume
289
Nephrotic child treatment
MCD so give pred
290
Young adult nephrotic treatment
FSGN so ACE
291
Older person nephrotic treatment
IgA so ACE
292
Criteria for PCKD in under 30s
2 cysts
293
Criteria for PCKD in 30-60 year olds
2 cysts in each kidney
294
Criteria for PCKD in 60+ year olds
4 cysts in each kidney
295
Other considerations in PCKD
ECG and CT head as aneurysm and murmur risk
296
Pyelonephritis first investigations
MC and S of urine, blood culture and bloods (renal US)
297
Treatment of chlamydia
Azithromycin
298
Treatment for Gonorrhoea
Ceftriaxone and azithromycin
299
Causative organisms of prostatitis
E Coli
300
Treatment of prostatitis
Ciprofloxacin
301
Cystitis commonly caused by
E Coli
302
Cystitis treatment first line
3 days trimethoprim
303
Treatment of complicated cystitis
Ciprofloxacin
304
ECG changes in hypercalcaemia
Reduced QT interval Osborn J waves Arrythmias
305
Causes of hypocalcaemia
Parathyroidectomy Vitamin D Bisphosphonates
306
Hypocalcaemia ECG
Long QT | Arrythmias
307
Treatment of hypocalcaemia
IV calcium gluconate (then AdcalD3)
308
Name a vitamin D supplement
Colecalciferol
309
Diagnostic investigation of diabetes insipidus
Water deprivation test (wont concentrate urine)
310
Treatment of central diabetes insipidus
Desmopressin
311
Treatment of diabetes insipidus
Fluid intake
312
Treatment of SIADH
Fluid restriction
313
1st line investigation for conns
Serum aldosterone: renin ratio
314
Diagnostic investigation for conns
Fludrocortisone suppresion test
315
Treatment of Conns
Adrenalectomy or spironolactone
316
Acute treatment of addisons
IV hydrocortisone
317
Long term treatment of addisons
Hydrocortisone and fludrocortisone for life
318
Biochemistry in primary hyperparathyroidism
PTH high, calcium high, urine calcium low
319
Causes of primary hyperparathyroidism
Low calcium, parathyroidectomy, bisphophonates
320
Treatment of secondary hyperparathyroidism
Ergocalciferol
321
Signs of pseudohypoparathyroidism
Short 4th and 5th metacarpals, round face and short
322
Causes of hypoparathyroidism
Gland failure
323
Long term removal of pottasium from blood
Calcium resonium
324
Progress of ECG changes in hyperkalaemia
Peaked T waves, prolonged PR, flat P, wide QRS, sine wave, v fib, asystole
325
Upper limit of how much pottasium to give an hour
20mmol
326
ECG changes in hypokalaemia
ST depression, loss of T waves, long PR
327
Long acting insulin example
Insulin glargine
328
Education courses for diabetes
DAFNE- T1DM | DESMOND- T2DM
329
How long do you give 1L of fluid over in DKA
2,2,4,4,6
330
When do you escalate management of T2DM
When HbA1C still over 58
331
Treatment of increased sugar after meals in T2DM
Acarbose
332
MODY
Maturity onset diabetes of the young
333
Investigation for MODY
C peptide present
334
Treatment of MODY
Sulfonylurea
335
LADA
Latent autoimmune diabetes in adults
336
Treatment of LADA
Metformin, soon progresses to insulin
337
Diagnostic test for acromegaly
Oral glucose tolerance test
338
Treatment of acromegaly
Transphenoidal surgery | Ocreotide
339
Low ACTH in cushings syndrome suggests
Adrenal adenoma
340
Treatment of cushings disease
Pituitary MRI | Transphenoidal surgery
341
Renal cancer causes
Increased EPO and subsequent polycythaemia
342
Ovarian cancer causes
Hypoglycaemia
343
Medullary thyroid cancer causes
Increased calcitonin and subsequent hypocalcaemia
344
SCLC causes
SIADH Lambert eaton Cushings
345
Carcinoid tumours causes
serotonin syndrome
346
Squamous cancers cause
PTHrP relase and hypercalcaemia
347
Treatment of toxic multinodular goitre or toxic thyroid adenoma
Radioactive iodine
348
Investigation for thyrotoxicosis
Radioactive iodine uptake
349
Hypothyroid investigation
MRI incase pituitary adenoma
350
Tetracyclines example and side effect
Mirtazepine, weight gain
351
TCA side effects
Sedation, anticholingeric, cardiac arrythmias
352
SNRIs examples
Duloxetine, velafaxine
353
Examples of typical antipsychotics
Haloperidol | Chlorpromazine
354
Examples of atypical antipsychotics
Olanzapine, risperidone
355
Symptoms of anxiety (3 of which must be present most of the time)
Muscle tension, sleep disturbance, fatigue, restlessness, irritability, poor concentration
356
Methylphenidate side effect
Appetite suppression | Psychosis
357
Atoxemetine side effect
Liver dysfunction | Suicidality
358
Mild depression
2 core and 2 others
359
Moderate depression
2 core and 3 other
360
Severe depression
3 core and 4 others
361
Step wise medical management of depression
SSRI TCA SSRI and TCA
362
Define deliberate self harm
Self poisoning or injury, irrespective of apparent purpose of teh act
363
Tuberous sclerosis
Cognitive delary Angiofibromas on cheeks Ash leaf spots on spine
364
6 components of addiction
``` Tolerance Withdrawal Impaired control Continued use despite adverse consequences Compulsion to take Neglecting other activities ```
365
Section 2 of mental health act
Assess 28 days
366
Section 3 of mental health act
Treatment 6 months
367
Section 5.2 of mental health act
Doctors holding power, 72 hours
368
Conditions of mental capacity act
Assume they have capacity Maximise their ability to make decisions Unwise decisions doesnt mean you lack capacity Anything done must be in best interests Anything done must be least restrictive option
369
PD, isolated and restricted expression
Schizoid
370
PD, delusions and hates social interaction
Schizotypal
371
PD, social inhibition and extreme sensitivity
Avoidant
372
Cluster A personality disorder
Odd- paranoid, schizoid, schizotypal
373
Cluster B personality disorder
Dramatic- antisocial, borderline, narcissistic
374
Cluster C personality disorder
Anxious- avoidant, dependent, anankastic
375
Tool for autism diagnosis
CAST- childhood autism screening tool
376
Treatment of autism
Applied behaviour analysis ASD preschool programme Psychoeducation
377
Something to remember in the treatment of ADHD
Treat coexisting anxiety and depression first
378
Requirements for gender dysphoria diagnosis
Desire to live as other gender and seeking body transformation for 2 years Taken steps regarding presentation to resemble other sex
379
Requirements for gender dysphoria treatment
Observe changed sex role officially for 1 year
380
Hormonal treatment for male to female
Estradiol valerate and goserelin
381
Hormonal treatmetn for female to male
Testosterone
382
schneiderian first rank symptoms
3rd person auditory hallucinations Made acts/ feelings Thought disorder Delusional perception
383
Simple schizophrenia
Just negative symptoms
384
Hebephrenic schizophrenia
Thought disorder and flat affect
385
Catatonic schizophrenia
Immobile or agitated behaviour
386
Residual schizophrenia
Chronic negative symptoms
387
Bipolar definition
Two occasions where the patients moody and activity levels are significantly disturbed
388
Treatment of an eating disorder
Structural eating plan with electrolyte and vitamin supplementation. SSRI
389
Describe refeeding syndrome
If fed too quickly get low phosphate, pottassium and magnesium as glucose and insulin are increased meaning electrolytes are driven into cells
390
Differences between bulimia and anorexia
Bulimia= BMI over 18.5, parotid hypertrophy, slightly older
391
Treatment of syphilis
IM benzathine penicillin
392
Describe primary syphilis
Painless ulcer, local non tender lyphadenopathy
393
Features of tertiary syphylis
Tabes dorsalis, ascending aortic aneurysms, neurosyphilis
394
Name two female sexual disorders
Female sexual arousal disorder= less thoughts feeling sand responses Female orgasmic disorder= absent, infrequent, reduced or delayed orgasm
395
Types of sexual therapy
CBT Systemic Integrative
396
Treatment of peyronies
Watchful wait and traction
397
Treatment of chlamydia
Doxycycline 7 days
398
Treatment of gonorrhoea
IM ceftriaxone 1g
399
Genital warts
Small fleshy protrubrences, HPV. Topical podophyllum or cryotherapy
400
Gential herpes
Painful ulcers. HSV2. Aciclovir, saline bathing and analgesia (c-section)
401
Chancroid
Painful ulcers and unilateral painful lymphadenopathy. Haemophilus ducreyi. Azithromycin
402
Lymphogranuloma venereum
Painless pustule. Painful lymphadenopathy. Proctocolitis. Chlamydia trachomatis. Doxycycline
403
Trichomonas Vaginalis
Offensive green frothy discharge, strawberry cervix. Microscopy of wet mount. Metronidazole
404
Bacterial vaginosis
Fishy. Garderella Vaginalis. Metronidazole
405
Thrush
Cottage cheese. Candida albicans. Fluconazole
406
First line treatment of OA
Topical diclofenac
407
Second line treatment of OA
Paracetamol
408
X Ray signs of RA
Loss of joint space periarticular Erosions Soft tissue swelling Soft bones (osteopenia)
409
1st line treatment for RA
Methotrexate and NSAIDs | pred for flares
410
2nd line treatement for RA
Etanercept
411
Treatment of RA in pregnancy
Pred
412
Treatment of spondyloarthritis
NSAIDs and physio
413
Treatment of GCA when there are eye signs
IV methylpred
414
1st line treatment of psoariatic arthritis
NSAIDs
415
2nd line treatment of psoariatic arthritis
Methotrexate
416
Investigations for psoariatic arthritis
Bloods and XR
417
Presentation of JIA
Knee pain in child, more than 6 weeks
418
Imaging of JIA
US
419
1st line treatment of JIA
NSAIDs and MDT
420
2nd line treatment of JIA
Methotrexate
421
Investigations for reactive arthritis
Fluid analysis and microscopy | NAAT and stool cultures
422
Treatment of acute reactive arthritis
First NSAIDs Second pred
423
Treatment of chronic reactive arthritis
Sulfasalazine
424
What are you doing to the fluid in septic arthritis
MC and S Polarising microscopy WCC
425
Treatment of septic arthritis
Abx | Refer to surgeons
426
Second line treatment of osteoporosis
Denosumab
427
FRAX
Osteoporosis, BMD, FHx, PMHs, corticosteroids, obesty Smoking, alcohol, RA (not OA)
428
Pagets on XR
Lytic lesions
429
Diagnosis of pagets
Bone biopsy
430
Diagnosis of osteomalacia
Iliac crest biopsy
431
Treatment of osteomalacia
Adcal D3
432
Treatment of vitamin D deficiency
Colecalciferol for 8 weeks
433
First line treatment of gout flare
Naproxen
434
Second line treatment of gout flare
Prednisolone
435
Third line treatment of gout flare
Colchicine
436
Pseudogout findings on XR
Chondrocalcinosis
437
1st line treatment of pseudogout
Intraarticular dexamethasone
438
Treatment of disc disease
Ibuprofen and physio
439
How would herniated disc present
Dermatomal symptoms
440
Which disease is better when lying down
Spinal stenosis
441
Degenerative disc/ compression fracture imaging
First XR then MRI
442
Undisplaced fracture treatment
Splint
443
Closed displaced fracture treatment
Open reduction, internal fixation
444
Treatment of osteomyelitis
IV Flucloxacillin
445
Treatment of femoral closed stable and undisplaced fracture
Intramedullary nailing
446
Humerus fracture, closed, stable and undisplaced
Elevate and ice
447
First line treatment of fibromyalgia
amitryptilline
448
Imaging of PMR
US
449
Treatment of polymyalgia rheumatica
Prednisolone
450
SS = Crest BUT ALSO
Renal, fibrosis and carpal tunnel
451
Treatment of raynauds
Iloprost or sildenafil
452
Antibodies in antiphospholipid
Lupus anticoagulant Anti cardiolipin Anti beta 2 glycoprotein 1
453
Treatment of antiphospholipid syndrome
Dalteparin acutely | Warfarin long term
454
Antibodies in poly/dermatomyositis
Anti Jo | Anti Mi2
455
Treatment of poly/dermatomyositis
Prednisolone
456
1st line treatment of lupus
Hydroxycholoroquine and suncream
457
Name some social interventions
Statutory benefits, care package, supported housing, cultural advocacy, psychoeducation, employment support, arts based and exercise based groups, safeguarding, educational support package, social integration package
458
Rapid tranquilisation in psych
Firstly oral/ deescalation then | IM Lorazepam/ haloperidol + promethazine (to avoid SE)
459
Which drugs can cause NMS
Metoclopramide, antipsychotics
460
Treatment of serotonin syndrome and NMS
Stop meds
461
Investigations for NMS and serotonin syndrome
Creatinine kinase and WCC
462
Common SE of lithium
Nausea, dry mouth, fine tremor, metallic taste, thisty
463
Signs of lithium toxicity
Polyuria, worse tremor, drowsy, confused
464
Investigation of lithium toxicity
Lithium level
465
Lithium toxicity treatmetn
Supportive care
466
What to tell a patient when theyre starting on lithium
Regular blood tests, avoid dehydration, dont suddenly change your salt intake, take care with NSAIDs, Diuretics, SSRIs, epilepsy, antibiotics
467
Drug reaction which happens straight after administration of antipsychotics
Acute dystonic reaction
468
Treatment of acute dystonic reaction
Medical emergency- procyclidine IM
469
Symptoms of acute dystonic reaction
Mouth held open, dysarthria, oculogyric crisis, neck spasm
470
Treatment of extrapyramidal SE from antipsychotics
IM Procyclidine
471
Side effects of clozapine
Neutropenia | Toxic megacolon
472
Country where hepatitis B is endemic
Pakistan
473
Specific name of drug used to treat hep C
Ledipasvir
474
Diagnosis of malaria
3 thick and thin films 24 hours apart
475
Treatment of malaria if no complications
Chloroquine
476
Complications of malaria
Acidotic Renal impairment Seizures DIC
477
Treatment of complication. malaria
IV artesunate
478
Prophylaxis of malaria
Chloroquine and doxycycline
479
Ongoing monitoring of malaria
12 hourly blood films for parasitaemia, FBC and clotting
480
Peripheral stigmata of IE and where they are found
Janeaway lesions on palms Oslers nodes on finger pulps Roth spots on fundoscopy Splinter haemorrhages in nail beds
481
Criteria for IE
Duke criteria
482
Investigation of IE
3 blood cultures 30 minutes apart
483
Which organism would cause an IE from UTI
Enterococcus
484
Complications of infective endocarditis
Heart failure Pericarditis Arrythmias Renal failure
485
Treatment of strep IE
6 weeks IV ben pen
486
Treatment of staph IE
6 weeks IV fluclox
487
Treatment of MRSA IE
6 weeks vancomycin
488
Name of drug used for prep and pep
Truvada
489
Antibiotic given as prophylaxis in AIDS
Cotrimoxazole
490
Antibiotic given to treat PCP
Cotrimoxazole
491
Whatre you looking for on TB sputum culture
Acid fast bacilli
492
Bloody diarrhoea without feer
E coli
493
Most common cause of gastroenteritis and comes from meat
Campulobacter
494
What do you want to do to the stool in infective diarrhoea
Microscopy, culture and sensitivities C Difficile toxin testing Microscopy for ova, cysts and parasites
495
Treatmetn of travellers diarrhoea
Rehydration Loperamide Azithromycin
496
Treatment of meningitis is over 65 or immunocompromised
Add in amoxicillin to cover for listeria
497
Order of investigations/ treatments in meningitis
1. Blood culture 2. LP 3. IV Abx
498
What do you give to household contacts of meningitis
Rifampicin or ciprofloxacin
499
How do you test for Mycoplasma or Chlamydia pneumonia
Sputum
500
Which antibiotic for cover of atypical pneumonias
Clarithromycin
501
Pen Allergic pneumonia treatment
PO doxycycline | IV teicoplanin
502
When does it class as hospital acquired pneumonia
Been in hospital more than 48 hours
503
Cellulitis but well treatment
PO flucox (clinda if pen allergic)
504
Treatment of strep cellulitis if unwell
IV ben pen
505
Treatment of MRSA cellulitis if unwell
IV teicoplanin
506
Treatment of necrotising fasciitis
Early aggressive debridement and IV Abx
507
Age defined as elderly
85 - 80+ frail - 75+ parkinsons
508
Malnutrition requirements
BMI under 18.5 BMI under 20 and 5 percent weight loss in 6m 10 percent weight loss in 6m
509
Considerations in MUST
BMI Weight loss Acute disease effect i.e. NBM
510
What to do if low risk MUST
Repeat weekly
511
What to do if medium risk MUST
Observe diet for 3 days
512
What to do if high risk MUST
Refer to dietician
513
Investigations to do after a fall
``` Lying and standing BP ECG Bloods inc glucose Urinalysis CT head ```
514
Does gylcaemic control have to get tighter with age
No can get looser, as less time for complications to occur
515
What drug does trimethoprim interact with
Methotrexate
516
What drug does clarithromycin interact with
Warfarin
517
Treatment of Dementia
Rivastigmine and Donepezil
518
Treatment of BPSD
Haloperidol | Risperidone
519
What changes are happening in alzheimers
Atrophy and beta amyloid plaques
520
Alzheimers history
Progressive, recent events forgotten first, word finding difficulties
521
What medication would you use in gestational diabetes once diet and exercise failed
Insulin
522
Diagnosis of post natal depression
Edinburgh post natal depression score
523
1st line treatment of post natal depression
Self help and CBT
524
First line treatment of dysfunctional uterine bleeding when not requiring fertility
Endometrial ablation
525
BP in pregnancy which requires medication
Labetalol at 160/110
526
Treatment of hyperemesis gravidarum without fluid depletion
Pyridoxine, supportive care
527
Treatment of hyperemesis gravidarum with fluid depletion
IVI | Metaclopramide
528
Hypothalamic cause of amenorrhoea
Low GNRH, anorexia, psych
529
Pituitary cause of amenorrhoea
High prolactin, endocrine or sheehans
530
What is sheehans syndrome
Pituitary necrosis after large obstetric bleed
531
Ovarian causes of amenorrhoea
PCOS, turners
532
Adrenal causes of amenorrhoea
Congenital adrenal hyperplasia
533
Investigation of CAH
17 hydroxyprogesterone
534
Tract causes of amenorrhoea
Vaginal septum, Ashermanns syndrome
535
What is ashermanns syndrome
Adhesions after surgical miscarriage
536
1st line treatment of amenorrhoea
COCP
537
1st line treatment of amenorrhoea if desires fertility
Clomifene
538
3 symptoms of PID
Uterine tenderness Cervical motion tenderness Adnexal tenderness
539
Treatment of PID
Ceftriaxone and doxycycline
540
Symptoms of lichen sclerosis
Itchy external genitalia (non hairy areas)
541
Treatment of lichen sclerosis
Clobetasone topical, avoid perfumes
542
Does thrush smell
No, just looks like cottage cheese
543
1st line treatment of thrush
Clotrimazole topical
544
2nd line treatment of thrush
Oral fluconazole
545
Diagnosis of prolapse
Clinical
546
Treatment of prolapse
1st supportive and pelvic floor exercises | 2nd surgery
547
Ovarian torsion symptoms
Severe pain and palpable adnexal mass
548
Investigation of ovarian torsion
TVUS and doppler flow
549
Treatment of ovarian torsion
Surgery- detorsion or salpingoophrectomy
550
investigation of uterine fibroids
TVUS then endometrial biopsy
551
Treatment of uterine fibroids
Mifepristone (antihormonal)
552
Surgery for fibroids
Myomectomy
553
Investigation of ovarian cysts
TVUS, if ?Ca then CA125 and CT
554
Investigation of male infertility
Sperm studies
555
Treatment of male infertility
Treat cause and assisted reproduction
556
Female infertility treatment
1. diet and exercise 2. clomifene and counselling 3. ovarian drilling
557
Placenta praevia investigations
TVUS, repeat at 32 and 36. Delivery at 36
558
Placental abruption and more than 37 weeks pregnant
Induction
559
Pulsations over the os
Vasa praevia
560
Severe abdo pain between contractions
Uterine rupture, c section
561
Endometrial cancer 1st line investigation
TVUS
562
Diagnostic investigation for endometrial ancer
Endometrial biopsy and hysteroscopy
563
1st line investigation for ovarian cancer
TVUS
564
1st line investigation for cervical cancer
Speculum examination
565
Diagnostic investigation for cervical cancer
Colposcopy and biopsy
566
Steps of surgery in cervical cancer
Cone biopsy Trachelectomy Hysterectomy
567
Diagnosis of ovarian cancer
Histopathology after surgery
568
Treatment of threatened or complete miscarriage
Paracetamol and counselling
569
Treatment of inevitable, incomplete or missed miscarriage
Evacuation | Misoprostol
570
Investigation of miscarriage
TVUS | Serum BHcG
571
Grapelike discharge from vagina, increased uterine size and increased blood pressure
Hydratiform mole/ molar pregnancy
572
Treatment of hydratiform mole
Dilation and cutellage
573
Endometriosis treatment if family desired
Clomifene and IVF
574
Treatment of PCOS
1. Weight loss 2. Metformin 3. COCP 4. Clomifene 5. anti androgens- spironolactone, finasteride
575
First line treatment of menorrhagia
IUS, levonorgestrol
576
2nd line treatment of menorrhagia
Tranexamic acid if wants kids | COCOP if doesnt
577
Third line treatment of menorrhagia
Depot progestogen
578
First line treatment of dysmenorrhoea
NSAID, waterbottle, stop smoking
579
Second line treatment of dysmenorrhoea
COCP
580
What counts as premature labour
24-37 weeks
581
When to induce delivery in premature labour
Over 34 weeks
582
1st line treatment of prolonged labour
Vaginal prostaglandins
583
2nd line treatment of prolonged labour
Amniotomy and syntocin
584
Causes of primary PPH
Tone (uterine atony) Tissue (retained placenta) Trauma (instrumental, episiotomy) Thrombin (vascular, coagulopathies)
585
What counts as secondary PPH
More than 24 hours | Less than 12 weeks
586
Treatment of secodnary PPH
IV Abx and misoprostol
587
Where does MM metastasise to
Liver Lung Lymph
588
What is acral MM
On palms and soles
589
What is lentigo maligna
Large premalignant lesion on face
590
Treatment of MM <1mm thick
excision with 0.5cm margin
591
Treatment of MM >1mm thick
excision with sentinel lymph node biopsy
592
Diagnosis of skin cancers
Biopsy
593
Treatment of BCC
Mohs excision, radiotherapy if untreatable
594
Treatment of SCC
Surgical excision, radiotherapy if untreatable
595
Causes of pigmentation under nail
MM or trauma
596
Diagnsois of fungal infections
Skin scrapings/ nail clippings
597
Preciptants of fungal infections
Immunosuppressants, moisture
598
Treatment of fungal infections
1st- topical terbinafine | 2nd- oral fluconazole
599
Molluscum contagiosum
Small firm papules with umbilication Areas of body contact, genitals in adults Adults= curettage and cry Children= conservative
600
What causes itch
``` Renal (urea) Cholestatic (bile salts) Haem (PCV, basophils and mast cells) Endocrine Malignant (carcinoid) ```
601
Scabies
Linera burrows in webspaces
602
Treatment of scabies
Topical permethin and antihistamines, treat whole family
603
Primary prevention of premalignant and malignant skin lesions
Sun cream Avoid sun Avoid tanning Cover areas
604
Treatment of actinic keratosis
Cryotherapy, fluoracil and emolients
605
Treatment of seborrheic keratosis
Cryotherapy and topical beclometasone
606
Treatment of Bowens disease
Fluoracil and cryotherapy
607
Treatment of keratoacanthoma
Excision biopsy +- radiotherapy
608
Compound naevus
Dome shaped papule
609
Dermal naevi
Flat patch
610
Junctional naevi
Flat patch with sticky up bit
611
Dysplastic naevi
ABCDE features
612
First line treatment of acne
Topical retinoid- tretinoin
613
Second line treatments of acne
Topical benzoyl peroxide, topical clindamycin, COCP
614
Treatment of allopecia
Dermovate, cosmetic camouflage, patient support
615
Investigation for allopecia
Positive hair pull test
616
1st line treatment of psoarisis
Dermovate and calcitriol
617
Ranking of steroids
``` Hydrocortisone Eumovate Betnovate Dermovate Oral ```
618
What happens if you use steroids near eyes
Cataracts | Glaucoma
619
Eczema + widespread blistering rash
Eczema herpeticum | Aciclovir
620
1st line treatment of eczema
Topical hydrocortisone and emolient
621
2nd line treatment. of eczema
Eumovate and cetirizine
622
3rd line treatment of eczema
Betnovate and chlorphenamine
623
4th line treatment of eczema
Dermovate and tacrolimus
624
Erythema multiforme
Target lesions | Herpes and mycoplasma pneumonia
625
Cutaneous T cell lymphoma
Atrophy, telangectasia, pigmentation | Sezory cells on biopsy
626
Pityriasis rosea
Herald patch | Thumb sign
627
Pityriasis vesicolor
patches of discoloured skin Not itchy harmless
628
Macule
Flat area of altered colour- less than 1.5cm
629
Patch
Flat area of altered colour- more than 1.5cm
630
Papule
Solid rasied palpable lesion less than 0.5cm
631
Nodule
Solid raised palpable lesion more than 0.5cm
632
Vesicle
Raised clear fluid filled lesion less than 0.5cm
633
Bulla
Raised clear fluid filled lesion more than 0.5cm
634
Pustule
Pus containing lesion less than 0.5cm
635
Abscess
Localised accumulation of pus
636
Wheal
Oedematous papule or plaque caused by dermal oedema
637
Causes of conductive hearing loss
otitis externa Obstruction Cholesteatoma
638
Causes of sensory neural hearing loss
Presbycusis Post bacterial meningitis Acoustic neuroma
639
Alport syndrome
Hearing loss and renal
640
Positive sign of dix hallpike if its BPV
Rotary nystagmus
641
Maintenance exercises for BPPV
Brandt daroff
642
Treatment of menieres disease
1- low salt diet and acetazolamide | 2. Promethazine
643
How to prevent menieres disease
Beta histine
644
What else do you have to consider in management. of menieres
Have to inform DVLA
645
Vestibular neuronitis symptoms
URTI and then vertigo
646
Vestibular neuronitis treatment
Prochlorperazine
647
Viral labrynthitis symptoms
URTI, vertigo, hearing loss and tinnitus
648
Treatment of viral labrynthitis
Chrochlorperazine
649
Referral of unilateral nasal polyps
2ww
650
Referral of bilateral nasal polyps
Routine NET referal
651
Treatment of nasal polyps
Flexible endoscopic sinus surgery and polypectomy
652
Infectious mononucleosis causative organism
EBV
653
Infectious mononucleosis symptoms
sheet of pus on tonsils
654
Treatment of infectious mononucleosis
Conservative | No contact sports for 8 weeks
655
What shouldnt you give in infectious mononucleosis and what will happen
Maculopapular rash if give amoxicillin
656
First investigation for cholesteatoma
Audiogram and otoscopy
657
What will otoscopy find in cholesteatoma
Attic crust
658
Diagnostic for cholesteatoma
CT scan of petrous temporal bones
659
Symptoms of acoustic neuroma
Unilateral sensorineural hearing loss, dizziness and numbness
660
Investigation for acoustic neuroma
Gadolinium enhanced MRI
661
What could bilateral acoustic neuroma suggest
Neurofibromatosis type 2
662
Treatment of TMJ dysfunction
Joint rest
663
Treatment of bells palsy
Pred and eye protection
664
Treatment of Ramsay Hunt
Aciclovir and pred
665
Sinusitis less than 10 days
Viral
666
Sinusitis more than 10 days
Bacterial (S. pneumoniae, H influenzae)
667
1st line investigation for sinusitis
Nasal speculum examination
668
Diagnostic investigation for sinusitis
Nasal endoscopy
669
Treatment of sinusitis
Co amoxiclav if bacterial Nasal saline irrigation Intranasal budesonide
670
What causes mumps
RNA paramyxovirus
671
Investigation for mumps
Salivary Mumps IgM
672
Gingitivits
Gum disease
673
Sialadenitis
Staph Aureus Gland swelling Airway support and coamoxiclav
674
DeGeorge syndrome
mastoiditis and pneumonia
675
Otoscopy and tympanometry to distinguish ear infections
Normal in otitis externa
676
1st line treatment of mastoiditis
1. IV antibiotics | 2. mastoidectomy and grommets
677
Complications of mastoiditis
Abscess, 6th or 7th nerve palsy
678
Cause of acute otitis media
``` Normally viral (RSV or parainfluenza) Bacterial: S.pneumoniae, H.influenza, Moraxella ```
679
Treatment of acute otitis media
Regular analgesia | Back up prescription of amoxicillin
680
Treatment of acute otitis media if no improvement in 2 weeks
Myringometry and drainage
681
What does ear granulation tissue suggest
Otitis externa malignant
682
symptoms of otitis externa
Tragal tenderness, otalgia, ear canal inflammation
683
Treatment of bacterial otitis externa
Topical ciprofloxacin
684
Treatment of fungal otitis externa
Topical acetic acid
685
Treatment of malignant otitis externa
Oral and topical clindamycin
686
Bacteria that cause otitis externa
Pseudomonas and S Aureus
687
Advice to someone with otitis externa
Avoid swimming
688
Describe OM with effusion
Glue ear, more than 3 months, conductive hearing loss, not infection. Bulging grey tympanic membrane
689
Treatment of OM with effusion
Conservative, hearing aids, grommets
690
Cerebral perfusion pressure calculation
MAP - intracranial pressure
691
Which med is used when someone has been on opioids and needs a step down
Dihydrocodiene
692
Why do you give adrenaline with lidocaine
Causes vasoconstriction so acts for longer locally
693
Stepwise SE of anaesthetic
``` Numb tongue Lightheaded Visual/auditory disturbance Muscle twitching Unconscious Seizures ```
694
4 components of anaesthesia
Lack of consciousness Analgesia Amnesia Muscle relaxant
695
Bloods for a DVT
``` FBC U and E LFT Clotting ?D dimer ```
696
Symptoms of fat embolus
``` Petechial rash Drowsiness Oliguria PE symptoms Fleck like shadows on CXR ```
697
Treatment of fat emboli
High flow oxygen and stabilise fracture
698
Treatment of severe vomiting in acute abdomen
NG
699
Things that are in both a DVT and a PE Wells score
Cancer, immobilisation, previous DVT/PE, alternative diagnosis less/more likely
700
Things just in a DVT Wells score
Entire leg swollen Swelling more than 3cm Unilateral pitting oedema Superficial oedema
701
Things just in a PE Wells score
DVT Sx Tachycardia Haemoptysis
702
Antidote to benzodiazepines
Flumazenil
703
GCS Motor 1
None
704
GCS Motor 2
Extension
705
GCS Motor 3
Flexion
706
GCS Motor 4
Withdraws
707
GCS Motor 5
Localised
708
GCS Motor 6
Follows commands
709
Treatmetn of bradycardia
ABCDE ECG 500mcg Atropine (then repeat or adrenaline)
710
Treatment of unstable tachycardia
Shock x3 then amiodarone
711
Symptoms of second degree burns
Blistering
712
Treatment of sunburn/ scald
Showers and cold presses Analgesia Adequate oral intake Apply emolients
713
Causes of post op fever
``` Wind- respiratory Water- uti Walk- dvt/pe Wound- infection Wonder- drugs? ```
714
When to increase flow when giving oxygen
Not at target sats or RR over 30
715
How much water do you need to give a day
30ml/kg
716
How much K, Na, Cl do you need to give a day
1ml/kg
717
What can you see on mallampati 4
Hard palate
718
What can you see on mallampati 3
Soft palate and uvula base
719
What can you see on mallampati 2
Soft palate, uvula, fauces
720
What can you see on mallampati 1
Soft palate, uvula, fauces, pharyngeal pillars
721
How do you manage COCP around surgery
Stop 4 weeks before, bridging POP, start 2 weeks after
722
Which drugs do you keep going through operations
Beta blockers and steroids
723
What would you give in massive blood loss
Warm NaCl 4 units warm O- tranexamic acid
724
What would you give to treat low Hb
Red cells
725
What would you give to treat high APTT and high PT
Fresh frozen plasma
726
How would you treat low platelets
Platelets
727
What would you give to treat low fibrinogen
Cryoprecipitate
728
What do you do if someone is unable to maintain their airway despite airway adjuncts in an emergency setting
Rapid sequence induction
729
How do you treat open pneumothorax
Simple adhesive dressing
730
What imaging in trauma if the patient is unstable
CXR
731
What imaging in trauma if the patient is stable
CT
732
What imaging in trauma if its a child
CXR or US
733
How do you treat pelvic fracture after high energy trauma
Pelvic binder
734
What should you give if someone has been involved in major trauma
Tranexamic acid
735
What should you give if someone on warfarin has undergone trauma
Prothrombin complex
736
Investigations for acute heart failure
CXR, ECG, BNP, Troponin
737
Dose of salbutamol given in acute asthma
5mg
738
Dose of prednisolone given in acute asthma
30mg
739
4 symptoms of horners syndrome
Miosis Ptosis Enopthalmos Anhydrosis
740
What causes Horners syndrome
Loss of sympathetic nerve supply to the eye
741
What does papilloedema look like
Swollen optic disc on fundoscopy
742
Bilateral grittiness and discomfort around eye margins
Blepharitis, hot compresses twice dialy
743
Outer eye lid gland infection- tender
Stye, hot compresses and analgesia
744
Inner eye lid gland infection- non tender
Chalazion, hot compresses and eye hygeine
745
Name an antiVEGF
Afibercept
746
Investigation for diabetic retinopathy
Fundus photographs
747
Progression of findings in Diabetic retinopathy
``` Microaneurysms Blot haemorrhages In every quadrant Hard exudates Cotton wool spots Neovascularisation ```
748
Acute closed angle glaucoma
Sight threatening | IV azetazolamide
749
Symptoms of acute closed angle glaucoma
Sudden pain Halos around lights Nausea and vomitting Headache
750
Diagnosis of acute closed angle glaucoma
Gonioscopy
751
Open angle glaucoma
Optic disc cupping on fundoscopy
752
Open angle glaucoma symptoms
Peripheral vision loss and patches of missing vision
753
Treatment of open angle glaucoma
Latanoprost (prostaglandin antagonist) | Timolol
754
What does severe pain, reduced acuity, semidilated pupil and hazy cornea suggest
Glaucoma
755
Small fixed pupil, ciliary flush, photphobia, HLAB27, hypopyon
Anterior uveitis, prednisolone eye drops
756
Severe pain especially on movements and tenderness of eye, Rheumatoid
Scleritis, prednisolone eye drops
757
Purulent discharge from the eye
Conjunctivitis, chloramphenicol eye drops
758
What is keratitis and who gets it
Inflammation of the cornea, people who wear contact lenses
759
investgation for keratitis
Corneal scraping
760
Dendritic pattern keratitis
Herpes, aciclovir
761
Eye signs after trauma/ coughing
Subconjunctival haemorrhage
762
Eye signs post eye surgery
Endopthalmos
763
Faded colour vision, glare, halos around lights
Cataracts
764
Investigation of cataracts
Silt lamp examination of anterior chamber
765
1st investigation of age related macular degeneration
Amsler grid
766
Age related macular degeneration on fundoscopy
Drusen, neovascularisation
767
Diagnostic of ARMD
Optical coherence tomography
768
Treamtnet of ARMD
Observe, anti VEGF
769
Investigation for CRVO and CRAO
Fluorescin angiogram
770
Treamtent of CRVO and CRAO
Supportive
771
Dense shadow starts peripherally and progresses to centre, straight lines appear curved, central vision loss
Retinal detachment
772
Define health
A state of complete physical, mental and social wellbeing, not merely the absence of disease
773
What are the three domains of public health
Health protection Health improvement Improving services
774
Define health protection
Measures to control infectious disease risk and environmental hazards e.g. notifiable diseases, contact tracing for STI
775
Define health improvement
Social interventions aimed at preventing disease, promoting health and reducing inequality e.g. 5 a day campaign, screening
776
Define improving services
Organisation and delivery of safe, high quality service e.g. auditing and implementing reccomendations
777
Categories of determinants of health
Genetic Lifestyle Environmental Health care
778
Genetic determinants of health
Age Gender Ethnicity
779
Lifestyle determinants of health
Smoking status Wealth Employment
780
Environmental determinants of health
Housing Socioeconomic status Access to education
781
Health care determinants. ofhealth
Economic factors Access Quality
782
What is the inverse care law
The availability of medical or social care tends to vary inversely with the need of the population served
783
Define equality
Equal shares
784
Define equity
What is fair and just
785
Define horizontal equity
Equal treatment for equal need
786
Define vertical equity
Unequal treatment for unequal need
787
Describe a health needs assessment
Needs assessment, planning, implementation, evaluation Review health issues affecting a population which leads to agreed priorities and resource allocation which will improve health and reduce inequalities
788
3 types of health needs assessments
Epidemiological Comparative Corporate
789
Epidemiological health needs assment
Looks at current service and population served and suggests improvements
790
Comparative health needs assessment
Compares services received by one population with another
791
Corporate health needs assessment
Considers the views of key stake holders
792
Define need
The ability to benefit from an intervention
793
Define supply
What is provided
794
Define demand
What people ask for
795
Define felt need
Individual perceptions of deviations from normal health
796
Define expressed need
Seeking help to overcome variation in normal health
797
Define normative need
Professional defines intervention for expressed need
798
Define comparative need
Comparison between severity, interventions and cost
799
Describe maslows heirachy of need
``` Physiological Safety Love Esteem Self actualisation ```
800
What are three approaches to resource allocation
Egalitarian Maximising Libertarian
801
Describe a egalitarian approach
Provide all care that is necessary and required to everyone
802
Describe a maximising approach
Based solely on consequence
803
Describe a libertarian approach
Each individual is responsible for own health
804
6 things. tolook for when assessing the quality of a service
Access, Appropriate, Acceptible | Equity, efficient, effective
805
Define health behaviour
Behaviour aimed at preventing disease
806
Define illness behaviour
Behaviour aimed at seeking remedy
807
What are the steps of the transtheoretical model
PC PAM | Precontemplation, contemplation, planning, action, maintenance (relapse)
808
What are steps of the theory of planned behaviours
Attitudes, subjective norms and percieved behaviour control affect intention which affects behaviour
809
What does intention to behaviour depend on
P PAIR | Prepatory action, percieved control, anticipated regret, implementation intentions, relevance to self
810
What is the health belief model
``` Percieved susceptibility Percieved severity Health motivation Percieved benefits Percieved barriers All affect likelihood of action ```
811
What are absolute rights
Never acceptable Article 3- right to protection Article 4- prohibition of slavery Article 7- protection from retrospective criminal penalties
812
What is diversity
Appreciating the differences between people and treating peoples values, beliefs, cultures and lifestyles with respect
813
Kahneman and Tversky
Intuitive- understand instantly without conscious reasoning | Analytical- measured and calculated
814
Define screening
Identifying apparently well individuals who have (or are at risk of having) a particular disease
815
Screening criteria categories
Wilson and junger | Disease, test outcome
816
Wilson and junger screening criteria- disease
Important Natural history known Early treatment better than late
817
Wilson and junger screening criteria- test
Acceptable to the population Facilities available Simple, safe, precise
818
Wilson and junger screening criteria- outcomes
Ongoing feasbility Treatment available Cost benefit analysis
819
Randomised control trial advantages
Infer causality, less bias
820
RCT diasadvantages
time consuming, expensive, not always ethical
821
Describe cohort study
Longitudinal prospective, records exposures and conditions in a population as they develop
822
Describe case control
Retrospective observational, comparing experiences of those with and without the disease
823
Cross sectional study
Snapshot of those with and without the disease looking at associations at a particular time
824
Factors to assess causality
``` Biological plausibility Temporal relationship Dose response Strength of association Specificity Consistency Coherence with existing themes Reversibility ```
825
Define confounders
Risk factors other than those being studied which influence the outcome
826
Define bias
Systematic error that results in a deviation from the true effect of an exposure on an outcome
827
Give three types of bias
Selection Information (measurement, observer, recall, reporting) Publication
828
4 questions for medical negligence
1) Was there a duty of care 2) Was there a breach in that duty 3) Was the patient harmed 4) Was the harm due to the breach in care
829
Bolam rule
Would a reasonable doctor do the same
830
Bolitho rule
Would that be reasonable
831
Types of error
``` Fixation and loss of perspective Communcation breakdown Poor team working Playing the odds Bravado Ignorance Mis triage Lack of skill System error Sloth ```
832
Swiss cheese error model
Shows how several latent failures of failed or absent defenses lead to active failure
833
The three bucket model
Error involves interaction between Self Context Task
834
Never events
Serious, largely preventable patient safety incidents that should not occur if available, preventative measures have been implemented. - wrong route chemo - wrong site surgery - escape of a mental health patient
835
Consequences of never events
Financial penalty CQC visit Reputation loss
836
Define domestic abuse
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those who are 16 and over who are/have been intimate partners or family members irrespective of gender or sexuality
837
Types of domestic abuse
``` Psychological Physical Sexual Financial Emotional ```
838
Which tool is used to assess risk in domestic abuse
DASH tool
839
What is an IDVA
Independent advocate to help domestic abuse victim access help
840
What. isa domestic homicide review
Review after someone dies from domestic abuse
841
wHAT. ISA marac
MultiAgency Risk Assessment Conference- MDT meeting about domestic abuse
842
Risk factors to think about in breast cancer
``` Early menarche Late menopause Children Breast feeding HRT ```
843
Most common type of breast cancer
Invasive ductal carcinoma
844
Breast cancer screening
50-70 every 3 years
845
Treatment for oestrogen or progesterone receptor positive breast cancers
Tamoxifen
846
Whats another name for herceptin
Tastuzumab
847
Mammogram shows calcification
Ductal carcinoma in situ
848
Mammogram shows irregular spiculated mass
Breast ancer
849
Where does breast cancer metastasise to
LLB: liver lung brain
850
What drug would you give to a post menopausal woman with breast ancer
Anastrozole, letrozole= aromatase inhibitors
851
What is stage 4 breast cancer and what should you give
Metastatic, bisphophonates
852
Lump behind nipple and clear/ blood stained discharge
Duct papilloma
853
Menopause age, areola lump, milky thick nipple discharge
Duct ectasia
854
Pagets disease
Nipple eczema, indicates underlying breast cancer
855
Treatment of non cyclical mastalgia
NSAID, check for cardiac/MSK pain
856
Treatment of cyclical mastalgia
Proper bra | Short term tamoxifen
857
Mastitis and breast feeding
Peripheral breast. | Flucloxacillin and keep breast feeding
858
Mastitis and not breast feeding
Central breast | Flucloxacillin and metronidazole
859
G6PD on peripheral blood film
Blister and bite cells, Heinz bodies
860
Treatment of G6PD
Folic acid Avoid fava beans Blood transfusion
861
Symptoms of hereditary spherocytosis
Pallor Jaundice Splenomegaly
862
Treatment of hereditary spherocytosis
Splenectomy Vaccinations Blood transfusions
863
Describe patients with ITP
Low platelets Not ill Bleeding Purpura
864
How do you treat ITP
Prednisolone and IVIG
865
Whats the difference between ITP and TTP and DIC
ITP doesnt have schistocytes and theyre not ill
866
Treatment of TTP
Plasma exchange
867
Signs of TTP
Schistocytes on blood film but other clotting fine or raised
868
Signs of DIC
Schistocytes on blood film and abnormal clotting, thrombin excess
869
Investigations for acute leukaemias
1. Peripheral blood film | Gold= bone marrow biopsy
870
Investigations for chronic leukaemias
1. Peripheral blood film | Gold= flow cytometry
871
Symptoms of leukaemia
SOB Fatigue Splenomegaly Lymphadenopathy
872
Age groups for leukaemias acronyms
``` ALL CeLLmates have CoMmon AMbitions under 5, over 45 over 55 over 65 over 75 ```
873
ALL
Most common in children. | Downs syndrome
874
CLL
Most common in adults | Warm haemolytic anaemia, Richters transformation into lymphoma, smudge and smear cells
875
AML
Auer rods and blasts | Can come from myeloproliferative disorder
876
CML
Philadelphia chromosome
877
Painless lymphadenopathy and mediastinal mass
Hodgkins lymphoma
878
Diagnosis of lymphoma
Excisional lymph node biopsy
879
Treatment of hodgkins
ABVD
880
Scan for lymphoma staging
CT PET
881
Symptoms. of non hodgkins lymphoma
Lymphadenopathy, splenomegaly, B symptoms (night sweats, weight loss, fever, amalaise)
882
Treatment of non hodgkins lymphoma
RCHOP
883
Treatment of hyeprcalcaemia
Saline | IV Pamidronate
884
ECG in hypercalcaemia
Short QT
885
When to suspect myeloma
Over 60 and bone/ back pain
886
Myeloma diagnostic investigation
Serum/ urine electrophoresis for light chains/ bence jones protein
887
Treatment of myeloma
Stem cell transplant or Thalidomide | Dexamethasone
888
Consequences of myeloma
``` Calcium Renal Anaemia Bone pain Bleeding infection ```
889
Fibroadenosis
Multiple breast lumps and pain prior to menstruation or menopause
890
Symptoms of PCV
Red cheeks Headaches Raised haematocrit and haemoglobin
891
Treatment of PCV
1. Hydroxycarbamide | 2. Phlebotomy
892
Treatment of DVT if pregnant
LMWH
893
DIC treatment
Fresh frozen plasma
894
What are the clotting studies results in haemophilia
Increase APTT but normal bleeding time
895
What are the findings in antiphospholipid investigations
Lupus anticoagulant antibodies | Increased APTT
896
Treatment of von willebrands disease
Mild: tranexamic acid | More severe: desmopressin
897
Treatment of B12 anaemia
Hydroxocabalamin
898
Hypersegmented polymorphonuclear and megalocytes
B12 and folate
899
Treamtent of raised ICP
IV mannitol and prednisolone
900
Signs of raised ICP
High BP Low pulse Low resp rate
901
Symptoms of SVC obstruction
Oedema of the face and upper extremities
902
Investigations. of SVC obstruction
1. CXR | 2. CT
903
Imaging of SBO
CT
904
Imaging of LBO
AXR
905
Investigation of seizures
Video telemetry and EEG
906
Which anticonvulsant if elderly
Lamotrigine
907
Side effects of chemotherapy
``` Mucosal irritation Myelosuppresion Infertility Mouth ulcers Alopecia ```
908
ECOG 0
Fully active
909
ECOG 1
Light work
910
ECOG 2
Ambulatory
911
ECOG 3
Limited self care
912
ECOG 4
Disabled
913
ECOG 5
Dead
914
Duodenal atresia investigation and finding
Abdominal XR= double bubble
915
Treatment of GORD in child
Upright positioning Feed thickeners Fundoplication
916
Small bowel biopsy findings in Coeliac
Villous atrophy Crypt Hyperplasia Increased intraepithelial lymphocytes
917
Fanconi
Thirsty and weeing lots Damage to PCT Electrolyte losses
918
Scan to look for renal scarring
DMSA
919
Rate of chest compressions in child
100-120
920
Fluid used for replacement in children
0.9% saline + 5% dextrose + 10mmol KCl
921
Amount of fluid to give to rehydrate child stat
10ml/kg
922
Perthes
4-8 year old | AVN of femoral head
923
Slipped upper femoral epiphysis
10-15 years old | Displacement of femoral head posterio-inferiorly
924
Developemntal dysplasia of hip
Neonate girl
925
Treatment of intermittent/ exercise induced asthma
Salbutamol
926
How do you assess severity of asthma in an under 5
Same as over 5 just without peak flow

FINALS (8 decks)

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