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OSCE questions Flashcards

1
Q

What colour would you expect ascitic fluid to be? and if there was infection what colour would you expect?

A

Clear/ Straw coloured for ascites

Cloudy for SBP

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2
Q

What does the WWC have to be over for diagnosis of SBP?

A

> 250 Microliters

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3
Q

What must the SAAG be in order for an exudate to be diagnosed?

A

<11g/L or 1.1g/dL

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4
Q

Name some causes of Transudate for ascites:

A

Cirrhosis
Bud chari syndrome
Extreme malnutrition
Alcohol hepatitis

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5
Q

Name some causes of exudate for ascites:

A

Malignancy
Infection
Inflammatory
pancreatitis

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6
Q

What biochemical results would you expect to see in bacterial meningitis?

A

High neutrophil count >100 cells per microliter
High protein >50mg/dL
Low glucose <40% serum

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7
Q

What biochemical results would you expect to see in viral meningitis and what pathogens are commonly attributed to the condition?

A

High Lymphocyte count >50-1000 cells
High protein >50mg/dL
Normal glucose

Enterovirus 
HSV2 
VZV
HIV 
Mumps
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8
Q

What is the biochemical finding seen in the CSF following a subarachnoid bleed, and how long till it shows?

A

Xanthochromia

12 hours

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9
Q

What is your immediate management of a subarachnoid bleed?

A

Fluid resuscitation
Ted X stockings
Nimodipine
Analgesia

Neurosurgical:

  • clipping
  • coils
  • stenting
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10
Q

What are the radiological findings of O/A and RA

A

O/A:

  • reduced joint space
  • Subchondral sclerosis
  • Osteophytes
  • subchondral cyst

RA:

  • reduced joint space
  • Joint erosion
  • osteoporosis
  • soft tissue swelling
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11
Q

Surgical intervention for acute critical limb ischemia:

A

angioplasty/ stenting
surgical by- pass
- femoral popliteal bypass
- aorto- iliac bypass

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12
Q

What is the long term management of someone with limb ischemia?

A

Aspirin
Anti-hypertensives - avoiding Beta blockers
Statins
Fibrates

Lifestyle changes:

  • smoking
  • diabetes control
  • activity levels
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13
Q

What are the treatment options for RA?

A

First line:
NSAIDs

Bridging:
- steroids

2nd Line:
DMARDs

Biological agents:

  • Infliximab
  • Tocilizumab
  • Rituximab
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14
Q

what are the antibodies screened for in MG?

A

ACh receptor auto-antibodies
muscle specific kinase receptor antibodies
low density lipoprotein receptor related antibodies

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15
Q

What is the treatment of MG?

A

Pyridostigmine
Immunosuppressive
rituximab
thyectomy

if there is a MG crisis:

  • ventilation
  • immunoglobulins
  • Plasma exchange - filtration
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16
Q

What is the biggest risk factor for a stroke?

A

Hypertension

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17
Q

What is the immediate treatment following a stroke?

A

Admission to stroke unit.
- Alteplase - within 4.5 hours of stroke
+
Aspirin

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18
Q

what is the subsequent treatment of stroke?

A

2 weeks aspirin 300mg

then switch to:
Clopidogrel 
\+ 
Simvastatin 
\+ 
anti HTN 
\+ 
Life style changes 
- stop smoking 
\+ 
Physiotherapy
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19
Q

What are the different types of stroke a person can have?

A

TACS:
- contra - lateral hemiparesis

  • contra-lateral homonymous hemianopia
  • Higher cerebral dysfunction

PACS:
- 2/3 or higher dysfunction

PCS:

  • Cranial nerve palsy
  • Pupil disorders
  • Cerebellar dysfunction
  • isolated homonymous hemianopia

Lacunar:

  • pure sensory
  • pure motor
  • ataxia hemiparesis
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20
Q

What are the main types of MS:

A

Relapsing remitting
Secondary progressive
Primary Progressive

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21
Q

Name Some symptoms of MS:

A 
Weakness 
Optic neuritis
Scanning speech 
clumsiness 
Painful shocks  
bowel/ bladder dysfunction 
depression 
fatigue

Uhthoff’s phenomenon
- worse after hot shower

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22
Q

Diagnostic criteria for MS and investigations:

A

> 2 attacks of demyelination disseminated by time and space

MRI - t2 weighted

LP - Oligoclonal IgG bands

Visual Evoked Responses

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23
Q

Treatment of MS:

A

Relapse:
- Methylprednisolone
+
- PPI

1st line:

  • Interferon beta
  • glatiramer acetate

2nd line:

  • Fingolimod
  • natalizumab
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24
Q

What is the pathological feature behind migraines?

A

Trigeminovascular system

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25
Management of migraines:
Avoid triggers High dose Aspirin Triptans Anti-emetics Prophylaxis - propranolol - amitriptyline
26
Name some causes of cushing's syndrome:
Cushing's disease - adenoma in the pituitary gland Adrenal adenoma Iatrogenic Paraneoplastic effect - small cell
27
What are the diagnostic tests for cushing's?
1. late night cortisol salivary sample. 2. Dexamethasone suppression test: first low dose of 1mg - no effect if cushing syndrome this then leads onto the second dose which is: High dose of 8mg. - if cushing's disease it will suppress CRH and ACTH reducing cortisol - if adenoma will reduce ACTH but not cortisol - if paraneoplastic neither will be reduced.
28
What is the treatment of cushing's syndrome?
Removal of tumour: - transsphenoidal approach - removal of adrenal - cancer removal Ketoconazole can also be used
29
What diagnostic tests can be done to diagnosis Pheochromocytoma? and how is it treated?
24 hour adrenaline measurement plasma free metadrenalines Urinary analysis of: - adrenaline - Metaadrenaline - Metanoradrenaline Treatment: Alpha blockers Beta blockers Removal of tumour - adrenalectomy
30
What is the treatment of hyperthyroidism?
1st line: Carbimazole - prevents thyroperoxidase Block and replace or titrate 2nd line: Propylthiouracil - blocks 5' iodinase beta blockers - propranolol - non cardioselective Thyroid storm: - beta blockers - antiarrhythmic drugs - fluid resuscitation
31
What treatments are available for acromegaly?
Transsphenoidal removal of tumour Dopamine agonists - bromocriptine somatostatin agonists - octreotide
32
What investigations should be done into adrenal insufficiency?
Diagnostic: - Short synacthen test Blood osmolality - hyponatremia Hyperkalemia
33
What is the treatment of adrenal insufficiency?
Hydrocortisone - start when even suspected. Fludrocortisone Emergency ID tag Steroid card Addisonian Crisis: - IV hydrocortisone - IV fluids - Glucose - Electrolyte management
34
What are the two major causes of hyperaldosteronism, and how can they be biochemically differentiated? and what is the management?
Primary: - adenoma Secondary: - renal artery stenosis Primary: - low renin, high aldosteronism Secondary: - High renin, high aldosteronism Management: - Spironolactone - Eplerenone Surgery - removal of tumour - angioplasty of tumour
35
List some sign of peritonitis:
Guarding Absent bowel sounds Pyrexial Extreme tenderness
36
Name some causes of abdominal distention:
Ascites Constipation Fat Pregnancy
37
Name some causes of hepatomegaly:
``` Alcoholic liver disease Fatty liver disease Right sided heart failure Hepatocellular carcinoma Lymphoma Leukemia ```
38
Name some causes of splenomegaly:
Haematological disorders: - leukemia - Myeloproliferative disorders - haemolytic anaemias Infections: - mononucleosis - TB Portal Hypertension
39
Name some causes that will cause a drastic rise in the ALT and AST:
Hep A Hep E Toxins Ischemia
40
List some symptoms of aortic stenosis, and what pulse would you expect to feel?
Breathlessness Syncope/ presyncope angina dizziness Narrow Pulse pressure Low volume slow rising
41
List some causes of finger clubbing:
``` Carcinoma of the bronchus Interstitial lung disease fibrosing alveolitis cyanotic congenital heart infective endocarditis IBD - ulcerative colitis idiopathic familial Liver cirrhosis ```
42
Name the dermatomal patterns of the upper limb at distal ends:
``` C4 - top shoulder C5 - regimental area C6 - tip of thumb C7 - middle finger C8 - little finger T1 - inside of forearm ```
43
What stain can be used for haemochromatosis of the liver?
Prussian blue
44
How is Hep B managed?
Interferon alpha Nucleotide analogues Fibroscan Lifestyle advice - stop smoking - stop drinking
45
What is a useful biochemical marker for assessing if someone has had an upper G.I bleed?
Urea | - rising rapidly
46
What scoring system can be used to establish whether someone has had an upper G.I bleed? and what does it include? and what scoring system is used once endoscopy has been done to determine likely hood of survival and rebleed?
Glasgow Blatchford Score: - Hb - rise in urea - drop in blood pressure - HR - melena - Syncope Rockall score
47
What investigations would you want to do when considering DKA?
``` Plasma glucose ABG Plasma Ketones Urinalysis - ketones - glucose U&Es ```
48
What is your initial treatment of DKA?
``` Fluids Insulin Glucose K+ Bicarb treat underlying infection ```
49
Orthopedically if someone presents with a shorten externally rotated limb, what is the pathology?
Broken Hip
50
Following an infection, how long does Gullia Barre syndrome take to present, what investigations can be done and what is the medical management?
~4 weeks post infection Diagnosis is Brighton's criteria - bilateral flaccid weakness - loss of reflexes - LP studies EMG studies LP - raised protein Treatment: - IV immunoglobulins - Plasma exchange - Supportive care - ventilation
51
What are the symptoms of coeliac disease? and what antibodies tested for in coeliac disease?
``` Diarrhea failure to thrive Fatigue Weight loss Mouth Ulcer Anaemia Dermatitis Herpetiformis ``` tTG Endomysial Antibodies Anti - Deamidated gliadin peptide antibodies - endoscopy biopsy Treatment: - Gluten free diet
52
What symptoms would you expect to see with leukaemia and what investigations would you carry out?
``` Fatigue Fever Anaemia Night sweats Bruising - petechiae Purpuric Rash Abnormal bleeding - epistaxis, bleeding gums Gum hypertrophy recurrent infections Abdominal pain - hepatosplenomegaly Lymphadenopathy Headaches - if CNS involvement ``` ``` FBC Blood film LDH Bone marrow aspirate LP - if CNS involvement ```
53
What is the defective gene in CML and how is it treated?
BCR ABL - 9:22 chromosome. Imatinib
54
What tests could you order in suspected inflammatory arthritis?
Rh factor Anti CCP HLA B27 testing ESR levels
55
What are the symptoms of Multiple Myeloma?
Bone Pain Hypercalcemia symptoms - mood, stomach pain, Kidney Stones Renal dysfunction - bence jones protein Anamia Infections
56
What investigations should be ordered in suspected myeloma? and how is the diagnosis made?
Urine electrophoresis - bence jones proteins Serum free light chain assay Serum Immunoglobulins Serum electrophoresis Bone marrow biopsy
57
What is the treatment for Hodgkin's lymphoma?
Doxorubicin Bleomycin Vinblastine Dacarbazine (ABVD)
58
What is the diagnostic criteria for nephrotic syndrome? and what investigations would you want to order?
>3.5g protein loss <30g of albumin serum oedema Pro-coagulable hyperlipidaemia Investigations: - urine analysis - protein- creatinine ratio - U&Es - FBC - Serology - Imaging
59
What nephritic syndrome occurs weeks after the infection?
Post strep glomerulonephritis
60
Common Drug interaction to be aware off:
Metformin and Cimetindine Warfarin and Aspirin ACE inh and Metaformin ACE and K+ sparing diuretics Gentamicin and Loop diuretics Statins and Macrolides Thiazides and PPIs
61
What abnormality is being looked for in cervical screening? What is used to analyse the smear and what is the next step if there is an abnormality seen?
Dyskaryosis - koilocytes Colposcopy - with 5% acetic acid
62
What is the margins for melanoma removal?
``` <1mm= 1cm margin >1mm = 2cm margin ```
63
Name a specific chemotherapy agent used for melanomas:
Vemurafenib
64
What investigations would one want to do for suspected endocarditis? and what Antibiotic regimen for infective endocarditis:
Echocardigram 3 sets of blood cultures CRP and FBC Native valve: - flucloxacillin - gentamicin - amoxicillin * 4 weeks Prosthetic: - vancomycin - gentamicin * 5 weeks Viridans: - Benzylpenicillin - Gentamicin
65
What is your long term management following an M.I?
``` Beta Blockers Aspirin Statins ACE inhib Ticagrelor +/- Eplerenone (diabetics and Heart failure) ``` Lifestyle changes - smoking
66
Management of NSTEMI?
Aspirin Heparin Clopidogrel
67
Investigations and treatment of meningitis:
CT if signs of: - raised ICP - neurological deficits - Papilloedema - seizure * over 60 Lumbar Puncture. Blood cultures Throat swaps S.Pneumonia - Ceftriaxone - 10-14 days - dexamethasone - 4 days N. Meningitidis: - ceftriaxone - 7 days - dexamethasone - 4 days ``` Listeria monocytogenes - Ceftriaxone - 21 days + Amoxicillin - 21 days + Dexamethasone ``` Ciprofloxacin to family and friends `
68
Management of heart failure:
``` Beta blockers + ACE inhib + Mineralocorticoid + Sacubitril and Valsartan + ICD or Ivabradine + Digoxin ```
69
What is an important investigation into heart failure?
Presence of natriuretic peptides
70
List some features of severe and life threatening asthma:
``` Severe: PEF - 33-50% tachy >110 Tachy >25 inability to complete sentences ``` ``` Life threatening: PEF <33% Stats 92% silent chest reduced GCS Normal PaCO2 arrhythmia ```
71
Management of asthma attack:
Oxygen - >94% Nebulised: salbutamol and Ipratropium Steroids - prednisolone +/- antibiotics IV magnesium + Senior help ICU + IV salbutamol
72
What investigations would be done into a women presenting with postmenopausal bleeding?
FBC - establish anaemia Trans-vaginal ultrasound Biopsy of endometrium *postmenopausal bleeding is endometrial cancer until proven otherwise.
73
What is needed when checking a prescription:
``` Name, DOB of patient and address. Black Ink Capital letters Drug, dose and instructions No short hand for micrograms, units or nano-litres Minimum dosing interval Signature of doctor GMC No. Address of practice ``` Check for: - unnecessary decimals (3mg vs 3.0mg)
74
List some AIDS defining illnesses:
``` Kaposi Sarcoma Pneumocystis Jiroveci Pneumonia Burkitt's lymphoma TB Candidiasis of esophagus ```
75
How is AIDS monitored? | and how is AIDs treated?
CD4 levels Viral Load HAART - high active antiretroviral treatment Prophylaxis cotrimoxazole - PCP Frequent Cervical smears
76
What investigations are carried out for TB?
Culture stains with Ziehl Neelsen staining Mantoux test / PDD test
77
What can be put into place when an adult is seen to lack capacity?
``` Adults with Incapacity Act 2000 - benefit of the adult - minimum intervention - present past wishes Consultation with adult ```
78
What can be used to address the use of contraceptives in children under the age of 16?
Fraser guidelines
79
What are the DVLA restrictions around certain diseases:
Diabetes: car: inform Lorry: banned until checked Seizure: car: 6 months Lorry: 5 years Stroke: Car: 1 month Lorry: 1 year M.I Car: 1 week Lorry: 6 weeks Hypoglycaemic: >1 episode in 12 months. Must notify DVLA
80
How long does endoscopy take and what are the complications?
~10mins. Allow 2 hours mins. Day procedure - go home after 30mins Complications: - sedation - bleeding - sore throat - damage to crown or teeth - aspirate pneumonia - perforation
81
What are the typical pathogens associated with CAP Pneumonia?
S. Pneumonia H. Influenza Moraxella Catarrhalis Atypicals: Legionella Pneumophila Mycoplasma Pneumonia Chlamydia Psittaci
82
What are HAP pathogens?
S. Aureus E. Coli Pseudomonas
83
Outline CURB65 and name the antibiotics given:
``` Confusion Urea >7 Respiratory >30 Blood pressure <90 65 years old ``` CURB <2 = PO amoxicillin CURB >3 = IV Clarithromycin + IV co-amoxiclav
84
Outline your management of exacerbation of COPD:
``` Cultures Chest x-ray ABG FBC CRP ``` Treatment: - oxygen - 88-92% - Nebulised salbutamol - Antibiotics - amoxicillin (+IV + clarithromycin) - Low dose steroids
85
What would your typical investigations be for COPD in a non- exacerbation setting?
Spirometry - reversibility - 15% change/ <400ml of change - FEV1/ FVC ratio <0.7 Chest x-ray Sputum FBC - polycythemia?
86
What investigations would you do when asthma is suspected?
PEAK Flow Histamine Provocation test - >20% drop Scratch test
87
What factors may exacerbate Myasthenia gravis?
Gentamicin, opiates, Beta blockers
88
What laboratory investigations would you want to do in someone presenting with abdominal pain?
**consider Pregnancy test FBC CRP Amylase
89
In diarrhea what investigations would you like to complete?
Stool cultures faecal calprotectin C. Diff toxins consider sigmoidoscopy
90
List four organisms that cause bloody diarrhea:
E. Coli 0157 Campylobacter Shigella Salmonella
91
Name some causes of diarrhea that won't cause bloody stool:
Cholera Enterotoxigenic E. Coli Viral infection - norovirus Enterotoxins of Staph aureus
92
In a patient with non-mechanical causes of back pain, what investigations would you want to consider?
Imaging - MRI Calcium levels ALP Anti - CCP and Rh factor
93
Name an aromatase inhibitor:
Letrozole
94
Name a Oestrogen receptor blocker used in breast cancer and what may it cause?
Tamoxifen endometrial hyperplasia - increasing risk of endometrial cancer
95
How would you manage a patient with an STI?
``` Accurate diagnosis Treat disease and prevent complications Bring back to test for cure Advise to contract partners Screen for other STIs Education on safe sex ```
96
What is the investigation for gonorrhea and what is the treatment?
Nucleic acid amplification test - NAAT - throat and genitals - mid flow sample - swap (females) Ceftriaxone + Azithromycin - to cover for chlamydia as well
97
What is the organism that causes syphilis, name some complications of it and what is the treatment?
Treponema Pallidum CNS Cardiovascular VIsual Dark Field Microscopy for diagnosis Treatment: - Penicillin injection
98
What is the most common type of renal cancer? and where is a common spread of this too? and how does it present?
Renal Cell carcinoma Cannon ball metastasis to the lungs ``` Haematuria - frank Hydrocele flank pain palpable mass fever ```
99
Most common cause of bladder cancer? and name a surgical management of it:
Transitional transurethral resection of bladder tumour (TURBT)
100
What are the investigations into prostate cancer? | What are the management options for prostate cancer?
Rectal Examination PSA levels Transrectal ultrasound guided biopsy ``` Watch and weight Radiotherapy - directly to the prostate LHRH antagonist Anti - androgens orchiectomy ```
101
What antibodies are involved in Hashimoto's disease? | and what are the causes of hypothyroidism?
Anti - thyroperoxidase Anti - perioxidase antibodies ``` Autoimmune Thyroiditis Severe Iodine deficiency thyroidectomy Drug induced - amiodarone ```
102
List some common side effects of Anti TB drugs:
Rifapamcin - red tears Isoniazide - hepatitis Pyramide - Hepatits ethambutol - Optic neuritis
103
Name some gait types:
Antalgic gait - painful gait Apraxic gait - unable to lift legs Ataxic gait - uncoordinated, wide base Spastic gait - restricted knee movement Myopathic - waddling, belly leaning out
104
What is it called when you can see free gas either side of the bowel, allowing both walls of the bowel to be seen?
Riglers sign
105
What is thumb printing on the bowel suggestive off?
Inflammation - oedema.
106
How does a caecal and sigmoidal volvulus present radiographically?
Caecal - Embryo sign Sigmoidal - Coffee bean
107
What investigation do you want to carry out in the evidence of an Upper G.I bleed? and what is your management?
``` FBC - anaemia U & Es - urea for upper G.I bleed Cross Match / Group and Save ABG - lactate LFTs Erect chest x-ray ``` ``` ABCDE approach - fluid resuscitation - Blood transfusion <7 urea - Oxygen - Assess risk (Glasgow Blatchford) - endoscopy - banding, clipping, adrenaline, haemostatic powders + Terlipressin + Tazocin ``` **stop NSAIDS & Anticoagulants
108
What is the definition of AKI? what is your initial investigations and what is your management?
Decline of renal excretory function over hours to days recognised by an increase in creatinine and urea. Stage 1: 1.5 - 2 x base line Stage 2: 2 - 3 x base line Stage 3: >3 x base line Investigations: - urinalysis - blood, nitrites, protein: creatinine ratio - ultrasound of kidneys - U&Es - ECG - tall T waves and wide QRS complex - Immunocomplex screen Management: * stop ACE and NSAIDs - IV fluids - Removal of obstruction - treatment of infection - Manage hyperkalemia: Calcium gluconate, Salbutamol, IV Insulin, calcium resonate *consider Renal replacement therapy
109
What investigation would you carry out for a suspected UTI/ Pyelonephritis and what is your management?
Urinalysis - nitrates, blood, glucose, wwc Urine cultures - midstream - send in specific container FBC - white cells CRP U & Es Management: * don't treat unless symptomatic - nitrofurantoin/ trimethoprim - men and non- pregnant women - removal of catheter - ciprofloxacin - upper UTI in men and non - pregnant women - gentamicin - signs of sepsis *pregnant women and children always treated even if asymptomatic
110
What is indications for renal replacement therapy?
Refractory Hyperkalemia >6.5 Refractory Pulmonary oedema Refractory acidosis encephalopathy - uraemia
111
What test is done to establish diagnosis of Diabetes insipidus? and what is your treatment?
water deprivation test - 8 hours. followed by synthetic ADH - urine measure for osmolality Desmopressin
112
Management of CKD:
``` Control blood pressure - ACE inhibitors recommended Darbepoetin - synthetic EPO Phosphate binders Vit D supplements Bisphosphonates Renal replacement ```
113
In a patient with suspected rhabdomyolysis, what is your investigations and management?
Creatine Kinase U&Es - AKI ECG - Hyperkalemia urinalysis management: IV fluids Mannitol
114
What are the types of dialysis present?
``` Haemodialysis Continuous ambulatory peritoneal dialysis Automated Dialysis - weight gain - bacterial peritonitis - abdominal sclerosis ```
115
What is Q - SOFA: Define Septic Shock:
<15 GCS >22 breaths <100mmHg 2/3 for positive Persistent low blood pressure (MAP <65) with a lactate >18mg/dL despite adequate vasopressors
116
When is pyelonephritis actually diagnosed?
Fever + Bacteriuria or Loin Pain + Bacteriuria
117
What antibodies are associated with hyperthyroidism Grave's disease? and what can be some triggers for it?
TSH receptor antibodies Anti - perioxidase antibodies pregnancy amiodarone HLA DR3 - type 1 DM, celiac disease, Autoimmune hep
118
In parkinson's disease what investigations do you want to order and what is the treatment options?
DAT- SPECT MRI Scan Bloods - copper, thyroid (rule out) MRI - rule out vascular Treatment: - L-Dopa - dopamine agonists - pramipexole/ bromicide - MAO - Inhibitors - Decarboxylase inhibitor Deep brain stimulation
119
What is the investigations into a sinister looking mole? and what is the most common mutation?
Dermoscopy Biopsy - ideally removal of the entire mole in doing so. Sentinel node biopsy BRAF
120
How would you differentiate between Acute Cholecystitis and Ascending cholangitis? How do you diagnosis this?
Acute cholecystitis: - RUQ pain - Fever - Leukocytosis Investigation: - LFTs - US of gallbladder ``` NIL by mouth Fluids Analgesia +/- Antibiotics Elective cholecystectomy ``` Ascending Cholangitis: - RUQ pain - Fever - Jaundice - Rigors Investigations: - FBC - infection - LFTs - MRCP - ERCP Management: - Sepsis 6 management - ERCP to clear the CBD
121
What are your investigations when someone presents with suspected gallstones, cholecystitis or cholangitis?
LFTs Ultrasound MRCP ERCP - indicated if obstruction in the common bile duct
122
What are your investigations and management of acute pancreatitis?
``` Amylase (3x normal is diagnostic) CT Scan Ultrasound of Gallbladder for stones MRCP ERCP - when able ``` Modified Glasgow Score - predicting severity. >3 suggests ICU intervention ``` Management: - IV fluid - Analgesics - Anti - emetics - Urinary output - measure organ dysfunction - organ Support +/- Antibiotics ``` 48 hours start eating Further Management: - ERCP - Cholecystectomy - Alcohol removal
123
What investigations do you want to do in suspected appendicitis?
Pregnancy test Ultrasound FBC - WWC CT Scan
124
What is your investigation and management of SJS and TEN?
Investigations: - Skin biopsy - U & Es - assess hypovolemia - ABG - mucosal involvement - Blood cultures - assess for infection Management: Remove causing agent/ Drug IV fluids - measure fluid output Ophthalmology examination Admit to ITU for burns Protective dressings/ Bedding Prophylactic antibiotics IV immunoglobulins
125
What is your management of psoriasis?
Patient advice - not infectious etc ``` 1st Line: Emolients Vitamin D analogue Tar Corticosteroids ``` 2nd Line: Narrow Band UVB Retinoid cream Methotrexate Severe: Ciclosporin PUVA Ustekinumab
126
List some drugs that cause postural hypotension:
``` Ca2+ blockers ACE inhibitor Nitrates (sildenafil) Alpha -1 blockers Tricyclics Antipsychotics Beta blockers ```
127
What sign can be conducted to assess for SJS and TEN?
Nikolsky's sign - exfoliation of the epidermis on gentle rubbing
128
Medication that can cause a fall:
Diabetic medication - hypoglycemia Postural hypotension medication Benzodiazepines - lowered GCS
129
What investigations would be useful to do when a patient has had a fall?
``` Standing/ sitting blood pressure ECG - arrhythmias Echo - valvular disease Blood glucose CT head - neuro ```
130
What further investigations would you want to do into someone presenting with hypertension?
``` ECG Lipid profile Renin: Aldosteronism U & Es Uroanalisis - end organ damage ```
131
What investigations would you want to do in hypothyroidism?
Thyroid function tests Anti peroxidase/ thyroglobulin antibodies Glucose levels - associated type 1 DM
132
Investigations into hyperthyroidism?
TFTs Auto antibodies Ultrasound ECG
133
What investigations would you want to carry out on someone with anaemia?
``` FBC Blood film TIBC Ferritin levels MVC Reticulocyte count ECG ```
134
How do you manage AF?
Rate control - 1st Line: atenolol, verapamil 2nd Line: Digoxin **HF only atenolol and Digoxin Rhythm control - Flecainide Amiodarone *Amiodarone only for HF Anti-coagulation - >48 hrs consider 6 weeks course of anti - coagulation
135
What scoring system is used to assess whether someone needs to be anti-coagulated?
CHAD2DS2VASc score
136
How does LVH appear on ECG?
S in V1 + R in V6 = >35mm / 7 large squares R in aVL = >11mm
137
If FBC and Blood film have been done for anaemia, what other investigations would you want to consider?
B12 Folate Ferritin levels U & Es
138
What additional assessments can be done into depression? and what is your management?
MMS Thyroid levels FBC **always assess risk Management: - SSRIs - Citalopram, fluoxetine - Counseling - CBT * review 2 weeks
139
What investigations would you want to order in someone with palpitations?
``` ECG TFTs CXR U & Es - for electrolyte imbalances Troponins - if chest pain ```
140
What are some risk factors for melanoma?
``` Previous skin cancer Sun burn Previous lived abroad Immunosuppression >5 atypical Naevi Family history Parkinson's disease ```
141
What is the strongest predictor of the outcome of melanoma?
Breslow's thickness
142
What further investigations should be offered following a skin examination?
Dermoscopy Skin biopsy - diagnostic excision of lesion for melanomas Skin Scrapings

Phase 3 (50 decks)

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