PassMed 5 Flashcards
(481 cards)
1
Q
inheritance of otosclerosis
A
autosomal dominant. Leads to a bilateral conductive hearing loss
2
Q
Mx of chronic sinusitis
A
> 12 weeks
- intranasal corticosteroids
nasal irrigation with saline solution
3
Q
most common cause of meningitis in neonates
A
Gr B strep
4
Q
most common causes of meningitis aged 3 months - 60 years
A
Neisseria meningitidis
Streptococcus pneumoniae
5
Q
> 60, meningitis tends to be caused by
A
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes - GIVE AMOXICILLIN COVER IN OVER 60
6
Q
IS meningitis
A
listeria
7
Q
when should metformin be stopped
A
after an MI - risk of lactic acidosis
8
Q
T scores
A
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis
9
Q
Primary vs secondary aldosteronismq
A
- look at renin levels
- high renin -> secondary cause like RAS
10
Q
? is a risk factor for acute pericarditis
A
sle
11
Q
HPV vaccination
A
All boys aged 12-13 (school year 8) are now offered the HPV vaccine as well as girls
12
Q
If women take HRT for premature menopause it should be continued
A
until 50
13
Q
Children presenting with ?should be referred to ENT
A
glue ear with a background of Down’s syndrome or cleft palate
14
Q
Guillain-Barre syndrome is classically triggered by
A
Camplobater
15
Q
displaced hip #
A
- frail: hemiarthroplasty
- total hip replacement: able to walk independently, no cog impairment, medically fir
16
Q
Medical abortions are undertaken using
A
Oral mifepristone and vaginal misoprostol
17
Q
symptoms of hypomania in PC
A
-Routine referral to CMHT
18
Q
Symps of mania in PC
A
if there are features of mania or severe depression then an urgent referral to the CMHT should be made
19
Q
Indications for corticosteroid treatment for sarcoidosis are:
A
parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement
20
Q
PMB Ix
A
- 1) TVS
2) pipelle biopsy
3) Hysteroscopy with directed sampling (dilation and curettage) can be used to detect lesions or when pipelle has been inconclusive.
21
Q
Mx of uncomplicated descending aorta dissection
A
medical -IV labetalol
22
Q
Mx of ascending aorta dissection
A
hypertension control with intravenous (IV) labetalol and surgical repair, which is usually thoracic endovascular aortic repair.
23
Q
A 2% strength liquid medicine means that
A
- 2g are dissolved in 100ml
24
Q
Proliferative retinopathy is more common in
A
t1dm
25
if oral iron is not working in CKD
start IV (Iron has to be corrected b4 starting EPO)
26
HHT
- genetic condition that leads to abn blood vessel formation in the skin
- autosomal dominant
27
classifying NVP
The Pregnancy-Unique Quantification of Emesis (PUQE) score can be used to classify the severity of nausea and vomiting in pregnancy
28
Recurrent sticky eye in neonates
Congenital tear (lacrimal) duct obstruction is a cause of recurrent watery or sticky eye in neonates and usually, self-resolves by 1 year of age
29
Bone pain, tenderness and proximal myopathy (→ waddling gait) →
osteomalacia
30
Mx of orbital cellulitis
- proptosis, ophthalmoplegia, fever and eyelid swelling and redness.
- admit to hospital (risk of CVT and intercranial spread) + IV ab
31
the ulnar paradox
- proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions
- Ulnar injury at wrist : marked claw
Ulnar injury at elbow : less claw but get worse before getting better
32
Absolute contra-indications for the combined oral contraceptive pill (category 4) include:
Migraine with aura
Breastfeeding <6 weeks post-partum
Age 35 or over smoking 15 or more cigarettes/day
Systolic 160mmHg or diastolic 95mmHg
Vascular disease
History of VTE
Current VTE (on anticoagulants)
Major surgery with prolonged immobilisation
Known thrombogenic mutations
Current and history of ischaemic heart disease
Stroke (including TIA)
Complicated valvular and congenital heart disease
Current breast cancer
Nephropathy/retinopathy/neuropathy
Other vascular disease
Severe (decompensated) cirrhosis
Hepatocellular adenoma
Hepatoma
Raynaud's disease with lupus anticoagulant
Positive antiphospholipid antibodies
33
normal pressure hydrocephalus neuroimaging findings:
ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement
34
GP #
35
All patients with chronic kidney disease should be started on
A STATIN
36
how are vaso-occlusive crises diagnosed in sickle cell
clinically
37
aplastic vs sequestration crises
38
sig RF for placental praevia
IVF
39
Acute respiratory distress syndrome is a recognised complication of
acute panc
40
Normal/raised total gas transfer with raised transfer coefficient:
asthma
41
what rash spares nasolabial fold
SLE spares
42
Aspergilloma
- may arise in a lung cavity that developed secondary to previous tuberculosis
- crescent sign on chest x-ray is a characteristic finding of aspergilloma
43
? is the major criteria determining the use of cryoprecipitate in bleeding
low fibrinogen
44
wilsons disease blood findings
ALT raised
urinary copper raised
serum caeruloplasmin reduced (normally carries copper)
45
mx of camb
Campylobacter infection is often self-limiting but if severe then treatment with clarithromycin may be indicated
46
oculomotor plasy
ptosis
'down and out' eye
dilated, fixed pupil
47
Trochlear nerve palsy
Palsy results in defective downward gaze → vertical diplopia
48
trigeminal nerve lesion
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side
49
Adducens nerve lesion
Palsy results in defective abduction → horizontal diplopia
50
facial nerve lesion
flaccid paralysis of upper + lower face
loss of corneal reflex (efferent)
loss of taste
hyperacusis
51
Vestibulocochlear nerve lesion
Hearing loss
Vertigo, nystagmus
52
Glossopharyngeal palsy
Lesions may result in;
hypersensitive carotid sinus reflex
loss of gag reflex (afferent)
53
vagus nerve lesion
uvula deviates away from site of lesion
loss of gag reflex (efferent)
54
accessory nerve - CN11 lesion
weakness turning head to contralateral side
55
hypoglossal nerve lesion
Tongue deviates towards side of lesion
56
RAPD
- RAPD is a defect in the direct response to light.
- It is due to damage in optic nerve or severe retinal disease
- often caused by optic neuritis or severe glaucoma
57
Acute intestinal obstruction with dilated bowel loops is a
CI to lap surgery
58
causes of torsades
- hypothermia
- hypomg, hypocal, hypokalaemia
59
Inflammatory arthritis involving DIP swelling and dactylitis points to
psoriatric arthritis
60
Methotrexate: must be stopped ? before conception in both men and women
at least 6 months
61
first line for CML
imatinib - TKI
62
Cotard syndrome is characterised by a person believing they are
DEAD or non existent
63
caphras=
rational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostorq
64
charles bonnet =
l visual disorder where patients with significant vision loss have vivid, often recurrent visual hallucination - pts almost always have insight
65
Codeine to morphine
/ by 10. (E.g. if 60mg 4x a day = 240mg -> 24mg)
66
Massive PE + hypotension -
thrombolyse
67
HHS
- comes on over many days (unlike DKA = hrs)
- dehydrated, polyuria, polydipsia
- lethargy and N and V
- confused, focal neuro
- hyperviscosity
68
diagnostic criteria for HHS
hypovolaemia
marked hyperglycaemia (>30 mmol/L)
significantly raised serum osmolarity (> 320 mosmol/kg)
can be calculated by: 2 * Na+ + glucose + urea
no significant hyperketonaemia (<3 mmol/L)
no significant acidosis (bicarbonate > 15 mmol/l or pH > 7.3 - acidosis can occur due to lactic acidosis or renal impairment)
69
mX OF hhs
- 1) FLUIDS - IV sodium chloride
- 2) insulin - should not be given unless blood glucose stops falling while giving IV fluids
+ VTE prophylaxis due to hyperviscosity
70
raised APTT and normal PY
APS
71
Whirpool sign on US
Ovarian torsiobn
72
Ludwigs angina
- cellulitis at the floor of the mouth
- usually IVDU/ IS, poor denition
- can lead to lymphadenopathy, oedema, and airway compromise
- does not cause splenomeg like EBV
73
Oral ulcers + genital ulcers + anterior uveitis =
bechets
74
referral for PD
urgently to neuro
75
MODY
- HNF1A mutation
- Sulfonylureas (e.g. gliclazide) are the optimal treatment in HNF1A-MODY.
76
HINTS - central vs peripheral vertigo
- peripheral e.g. VN - eyes move and make corrective saccades
- central: post circ stroke: head impulse -
77
Mx of dyspepsia with no red flags
- PPI 1 month/ H pylori for 2 weeks
- switch to the other
78
Pappenheimer bodie
can be seen on blood film following splenectomy
79
Sickle cell patients should receive the pneumococcal polysaccharide vaccine
every 5 yrs
80
Which one of the following pathologies does a positive straight leg raise suggest?
Sciatic nerve pain
81
False labour
- Occurs in the last 4 weeks of pregnancy
Presentation: contractions felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent.
82
most SPECIFIC AB FOR LUPUS
Anti-ds DNA
83
Best rule out ab for lupus (high sensitivity)
ANA
84
Most common inherited bleeding disorder
VWD
85
Brown sequard syndrome
- lateral hemisection of SC
- causes same sided weakness and proprioception/vibration loss and
-loss of pain/temperature on the opposite side to the hemisection.
- CONtemplate the PAIN of the HEAT
Pain and temperature are contralateral
86
Approximately 80-90% of abdominal aortic aneurysms (AAAs) occur in the
INFRARENAL AORTA
87
most common cause of sudden onset SN HL
idiopathic
88
perforated tympanic membrane ->
conductive hearing loss
89
open f# or GCS < 8
urgent neurosurgery review before CT
90
head injury + bruising over mastoid
posiive battles sign -> CT within 1 hr
91
head injury and unable to rotate C spine
CT c-spine an CT c-spine
92
DIC typical blood picture:
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
93
fluid replacement for kids
94
preventing gangrene in diabetes and PAD
Education abt foot care + appt at diabetic foot clinic
95
In acute asthma, the BTS guidelines only recommend ABGs for patients with
O2 below 92%
96
intensely itchy, symmetrical vesicular rash on the knees and back of arms is highly suggestive of
DH - linked to anti-TTG ab
97
If a patient has actually attempted suicide, there are a number of factors associated with an increased risk of completed suicide at a future date:
efforts to avoid discovery
planning
leaving a written note
final acts such as sorting out finances
violent method
98
Chest x-ray in transient tachypnoea of the newborn may show
hyperinflation of lungs and fluid in HF
99
Preterm infants with haemodynamically significant patent ductus arteriosus 1 week after birth
give ibuprofen/indomethacin to promote duct closure
100
Children with new-onset purpura
referred immediately for investigations to exclude ALL and meningococcal disease
101
CXR finding in AS
apical fibrosis
102
Tearing chest pain, a diastolic murmur (suggesting aortic regurgitation) and a widened mediastinum on chest x-ray in a man over 50 suggest
ascending AD
103
iX FOR AD
- 1: CT angio: chest abdo pelvis
- if haem instability: transthoracic echo
104
If a semen sample is abnormal,
repeat test after 3 months
105
double sickening
- initial period of recovery -> worsening symptoms
- suggests bactetrial sinusitis: also fever and purulent discharge on rhinoscopy
106
A disulfiram-like reaction can occur if ? and alcohol are taken together
metronidazole
107
surgery of choice for distal colon cancers
- loop colostomy
- used to defunction and decompress the distal colon in obstructing cancers
108
Which one of the following types of Hodgkin's lymphoma carries the worst prognosis?
lymphocyte depleted
109
best prognosis NHL
lymphocyte predom
110
Boggy swelling of nasal septum ->
nasal septum haematoma -> urgent ENT ref
111
Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel → ?
giardiasi
112
Giardiasis ->
- lactose intolerance
- Tx with metronidazole
113
klinefelters
- 47XXY
- tall stature, low-volume testes, sparse pubic hair, and gynecomastia
- high LH and low test
114
CLL can lead to
- Autoimmune haem anaemia
- positive coombs test
115
Nausea and vomiting in pregnancy: admission should be considered
- Ketonuria
- 5% pre-preg weight loss
116
where are varices more common
left side
117
Smoking and CC
2x greater risk
118
RF for CC
- HPV - 16,18,33
- smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
119
COCP increases risk of
Breast and Cerv - ones we screen for
120
Anterior uveitis
presents with acutely painful red eye, photophobia, small pupil, reduced visual acuity. It is often associated with pus in the anterior chamber (a hypopyon)
121
Mx of vitiligo
- sunblock for affected areas of skin
- camouflage make-up
- topical corticosteroids may reverse the changes if applied early
- there may also be a role for topical tacrolimus and phototherapy,
122
vitigo vs PV
- vitigo: symmetrical, normal texture skin more around mouth hands and face
- PV: asymmetrical, flaky/ scaly skin, more on the chest, tummy, back and upper arms.
123
asthma: normal vs raised CO2
- CO2 should be low due to hyperventilation
- normal: life threatening
- high: near fatal
124
most likely area to be affected by ischaemic colitis
splenic flexure - watershed area
125
Alport syndrome
- microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
retinitis pigmentosa
126
renal biopsy finding in alports
splitting of lamina densa seen on electron microscopy
127
inheritance of alports
- x linked dominant
- ue to a defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM)
- more severe in males > females
128
Cervical cancer screening: if sample is hrHPV +ve + cytologically abnormal →
colp
129
colour vision is affeted in
Colour vision ('red desaturation') is affected in optic neuritis
130
features of toxic shock syndrome
- tampon use
- fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
131
Mx of toxic shock
- removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics
132
toxic shock toxin
staphylococcal exotoxins, the TSST-1 superantigen toxin.
133
A history of Mycoplasma pneumonia followed by anaemia and jaundice with hepatosplenomegaly points towards the diagnosis of
Cold haem anaemia - do a DAT
134
If thrombolytic drugs are given during ALS then
prolonged CPR time of 60-90 mins should be cons
135
what is affected in brocasI
INFERIOR FRONTAL GYRUS
136
SEVERE UC
should be treated in hospital
IV steroids are usually given first-line
IV ciclosporin may be used if steroids are contraindicated
if after 72 hours there has been no improvement, consider adding IV ciclosporin to IV corticosteroids or consider surgery
137
CREST syndrome ab
- anti-centromere
138
Etanercept =
Anti-TNF
139
Dermatitis in acral, peri-orificial and perianal distribution → ?
- Zinc def
- hypogonadotropic hypogonadism
- cognitive impairment, alopecia and hepatosplenomegaly
- alcoholism is a RF
140
When can a baby be delivered for pre-ec
After 34 weeks it can be cons
141
what can be done during labour for pre-ec to reduce BP
epidural anasthesia
142
rough red papules over knuckles
gottrons papules - dermatomysoitis
143
COPD: asthmatic/ steroid responsive features
- Any previous, secure diagnosis of asthma or of atopy (this applies to the patient above).
A higher blood eosinophil count.
Substantial variation in FEV1 over time (at least 400 ml).
Substantial diurnal variation in peak expiratory flow (at least 20%).
144
T1DM mx
- basal bolus insulin
- add metformin if BMI > 25
145
Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l
- trial diet and exercise for 1-2 weeks
- then add metformin
- then insulin
146
Correction of chronic hypernatraemia too fast predisposes to
cerebral oedema
147
tx of hyponatreamia can ause
Central pontine myelinolysis
148
GHB toxicity
- CNS depressant - coma, respiratory depression, mild bradycardia, and vomiting.
- key feature of short recovery time - usually within 6 hrs
- pts often recover spont and self-exubate
149
Pre-existing vs gestational vs pre-ec
- Prex: BEFORE 20 WEEKS
- gestational: after 20 weeks but no proteinuria or oedema
- pre-ec: after 20 weeks but proteinuria, oedema
150
IPF ix of choice
high res CT
151
Swollen red calf and target shaped rash
LYME DISEAS E(ERTHYTHEMA MIGRICANS -> ORAL DOXY)
152
graves disease scintigraphy
diffuse uptake
153
subacute thyroidisitis scintigraphy
inflammation damages thyroid tissue leading to leakage of pre-formed thyroid hormone (causing hyperthyroidism), before leading to hypothyroidism. Nuclear scintigraphy would show very low uptake, and the thyroid gland would appear faded rather than dark.
154
thyroid cancer scintigraphy
non-functioning cold areas = small pale regions
155
toxic mutlinodular goitre
patchy uptake i.e. there would be multiple blotches of darker parts dispersed throughout the thyroid gland.
156
gliptin MAO
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
157
CLL -> suddently unwell ->
CLL can transform to high-grade lymphoma (Richter's transformation) making patients suddenly unwell
158
glandular fever increases risk of
splenic rupture (thats why they need to avoid contact sports for 4 weeks)
159
mx of oculogyric crisis
- IV am: procyclidine or benztropine
160
Sudden onset lower abdominal pain in a woman following vigorous exercise → ?
- ovarian torsion. Do pelvis US 1- whirpool sign
- Laparascopy is Tx
161
Local anesthetic toxicity can be treated with
IV 20% lipid emulsion
162
what can differentiate between AKI and CKD
Small kidneys on ultrasound usually helps to differentiate CKD from AKI (exceptions include ADPKD and early stages of diabetic nephropathy)
163
? blood products are required in patients following bone marrow and stem cell transplants
- irriadiated
- prevents graft vs host diseasse
164
Hypertrophic obstructive cardiomyopathy - is associated with
WPW - short PR and long QR with upsloping delta wave
165
An older child with missed DDH may present with
trendelenburg and leg length discrepency
166
mesothelioma CXR
Large peripheral mass
167
Tb tx
- Rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months
- continuation phase with rifampicin and isoniazid: 4 months
168
A 75-year-old man presents with a swelling in his right scrotum. On examination a large, non-tender swelling is found in the scrotum. You cannot palpate above the swelling during the examination.
inguinal hernia
169
A 44-year-old man notices a pea-sized lump on his right testicle. On examination a discrete soft mass can be felt posterior to the right testicle.
epididymal cyst
170
Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness -
ant inferior CA
171
Chancroid is caused by
Haemophilus ducreyi
172
Chancroid =
- sexually-acquired genital ulcers in the tropics
-> painful uinilateral inguinal lymphadenopathy
- multiple ulcers with ragged edges and a grandular base
173
LGV
- Caused by chlamydia trachomatis
- singular painless ulcer
- spont resolves
174
Tx for fulminant UC unresponsive to medical Tx
Sub total colectomy
175
UC unresp to medical Tx who want to avoid a perm stoma
Panproctocolectomy and ileoanal pouch
176
Men who have sex with men should be offered immunisation
- against hep A
- note: hep C vaccination does not exist
177
Key features of hypocalcaemia
- perioral paraesthesia, cramps, tetany and convulsions
178
eponymous signs of hypocal
- Chvostek's sign, where the facial muscle twitches upon tapping of the facial nerve,
- Trousseau's sign, where there is carpopedal spasm in an arm when a blood pressure cuff is inflated.
179
6 in 1 vaccination
- DPT
- polio
- haem influenzae type b
- hep B
Parents Will Immunise Toddlers Bc Death
180
COCP: If 2 pills are missed in week 1,
- EC
- take extra pill today
- use extra contraception for 7 days
181
which analgesia can cause SS when prescribed with SSRI
Tramadol
182
? is the most likely diagnosis in an uncircumcised man, who has developed a tight white ring around the tip of the foreskin and phimosis
lichen sclrosis
183
ACE and ARB b4 surgery
stop 24 hrs before - association with severe hypotension after induction of anaesthesia
184
malrotation sx
- bilious vomiying
- firm swollen abdomen
- not passing stool - can lead to strangulation
185
? is the most accurate way to asses the burns area
lund and browder
186
Woman who has diabetes becomes pregnant ->
startt aspirin from 12 weeks until birth - high RF for pre-ec
187
pre-ec RF
188
Most common cause of isolated thrombocytopenia
itp
189
Gingival hyperplasia
phenytoin, ciclosporin, calcium channel blockers and AML
190
Mx of hypernatremia -> AKI
0.9% isotonic saline
191
prerenal disease - urine sodium
< 20
192
Impetigo Mx
1) topical hydrogen peroxide
2) topical fusidic acid
193
what is protective for osteoporosis
obesity
194
when is haemodialysis required in AKI
- hyperkalaemia
- pulm oedema
- acidosis or uraemia (e.g. pericarditis, encephalopathy).
195
rhinophyma
comp of rosecea.
196
Allergic bronchopulmonary aspergillosis
- bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)
- eosinophilia!!
197
Mx of Allergic bronchopulmonary aspergillosis
oral glucocorticoids
198
biscupid aortic valve murmur
ejection systolic murmur in the aortic region (right sternal border at the 2nd intercostal space), - crescendo-decrescendo murmur
199
Returning traveller with fever/flu-like symptoms, anaemia/jaundice/renal impairment → ?
p falciparum malaria
200
pts with VSD are at high risk of
endocarditis
201
what is required in suspected spinal epidural abscess
full spine MRI to search for skip lesions
202
which type of osteomyelitis occurs in sickle cell
salmonella enteriditis
203
SVT mx
1) vagal maouvres
1) adenosine - avoid i asthma
2) verapamil
204
Clinical findings in anylosing spondylitis include
reduced chest expansion, reduced lateral flexion and reduced forward flexion (Schober's test)
205
alcohol related liver disease
- raised ferritin but normal transferrin saturation
- raised gGGT
206
? is the definitive treatment for acute angle-closure glaucoma
Laser peripheral iridotomy
207
For babies who are born to mothers who are hepatitis B surface antigen positive, or are known to be high risk of hepatitis B, should receive
- hep B vaccine and 0.5ml HBIG within 12 hrs if birth
- further vaccine at 1-2 months
- further vaccine at 6 m
208
Fluctuating confusion/consciousness? -
subdural bleed
209
In Raynaud's phenomenon with extremity ischaemia think
- Buerger's disease
- a.k.a thromboangitis obliterans
210
Status epilepticus: rule out
hypoxaemia and hypogly
211
most common cause of PMB
- Vaginal atrophy
212
What is osmotic demyelination syndrome
- occurs after rapid correction of hyponatreamia
- speech disturbances, swallowing dysfunction, limb paralysis, movement disorders, and behavioural and psychiatric disturbances.
213
how can adenosine be given
- large vein e.g. 16G cannula in right antecubital vein
- use large bore cannula
- do not give orally - v short HL
214
Diabetes meliitus diagnosis
fasting > 7.0, random > 11.1 - if asymptomatic need two readings
215
Intracranial haemorrhage on warfarin →
give IV vitamin K 5mg + prothrombin complex concentrate
216
? s the likely causative medication with new onset achilles tendon disorders; tendinitis and tendon rupture is a key side effect of which to be aware
CIPROFLOXACIN - fluoroquinolones
217
classical feature of AS on xr
Syndesmophytes (ossification of outer fibres of annulus fibrosus)
218
? is a scale that measures disability or dependence in activities of daily living in stroke patients
barthel index - can they take a barth at home
219
how to formally assess frailty
PRISMA-7
220
frax =
alculates a patient's 10-year risk of developing an osteoporosis-related fracture.
221
what is diagnostic of malnutrition
Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition
222
hep E is commonly transferred with
shellfish and pork
223
Glaucoma can result from
- normal IOP - normal tension glaucoma
- increased up to disc ratio
224
Pompholyx eczema may be precipitated by
humidity (e.g. sweating) and high temperatures
225
seizure after DKA tx
cerebral oedema - higher risk in younger pts
226
where does ovarian cancer spread first
para-aortic LN
227
Triptans should be avoided in patients taking
An SSRI
228
spinal cord ompression
- progressive back pain that is not relieved when lying down and worse when straining
- reduced power and sensation
- URGENTLY DO A WHOLE SPINE MRI AND GIVE HIGH DOSE ORAL DEX
229
Most common cardiac manifestation of lupud
pericarditis
230
cyst lined by sq epithelium and hair follicles
dermoid cyst
231
50 & stopping contraception
< 50: stop after 2 yrs amenorrhoea
> 50 - stop after 1 yr no periods
232
severe manifestations of enteri fever
intestinal perforation and neuro comp
233
hx of rash to peniciillin and meningitis
A history of rash with penicillin is not a contraindication to using benzylpenicillin or ceftriaxone in meningococcal sepsis. For penicillin anaphylaxis NICE recommends urgent transfer to hospital and IV chloramphenicol
234
the first-line test for HIV screening of asymptomatic individuals or patients with signs and symptoms of chronic infection
Combined HIV antibody/antigen tests
235
inheritance of huntingtons
autosomal dom
236
most common cause of dysphagia and odynphagia with HIV
oesophageal candidiasis
237
Serotonin syndrome can be caused by overdose of
Ectasy or amphetamines
238
Trichomonas vaginalis - treat with
TMV - metronidazole
239
CP
- Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
240
MEASLES
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots ('grain of salt') on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
241
mumps
Fever, malaise, muscular pain
Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral
242
rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
243
erythema infectiosum
Also known as fifth disease or 'slapped-cheek syndrome'
Caused by parvovirus B19
Lethargy, fever, headache
'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
244
SF
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
'Strawberry' tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
245
hfm
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet & bum
246
Goitre moves
up on swallowing
247
Thyroglossal cyst
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
248
Cystic hygroma
- transilluminates
- usually before age of 2
- ypically found in the neck, classically on the left side
249
Brachial cyst
- develops between the sternocleidomastoid muscle and the pharynx
- Develop due to failure of obliteration of the second branchial cleft in embryonic development
- Usually present in early adulthood
250
Scleritis can lead to
perforation of the globe especially in necrotising scleriris
251
collapsing pulse
AORTIC REGURG
252
slow rising pulse
aortic stenosis
253
anaemia, eosinophilia and the rash ->
Hookworm especially if returning from travel to endemic areas e.g. indian subcont
254
Consider? in young female patients who develop AKI after the initiation of an ACE inhibitor
- fibromuscular dysplasia - 'string of beads' appearance.
- older: atherosclerosis of RA
255
Haemolysis of the transfused cells occurs causing the combination
- Shock, haemoglobinaemia, loin pain
- coombs test to confirm
256
which type of HSN is SLE
3
257
sepsis ABG
Raised anion gap met acidosis from lactic acid acting as a strong acid
258
? is the primary dose-limiting side effect of cisplatin
- nephrotoxicity. Also causes hypoMg
259
The first-line management of cisplatin nephrotoxicity involves
IV fluids an mg supplementation
260
. Useful for managing tremor in drug-induced parkinsonism
procyclidine
261
PD drug which has beenassociated with pulmonary fibrosis
carbergoline
262
Often has a reduced effectiveness with time
levodopa
263
Painless, transient monocular blindness together with the description of a 'black curtain coming down' is characteristic of
amaurosis fugax
264
painful erythematous swelling on the posterior aspect of the elbow without preceding trauma.
olecranon bursitits
265
Tx of raynaurds
- Keep hands warm & stop smoking
- 1) nifedipine
266
what worsens raynaurds
bb - cold peripheries
267
how is anterior uveitits tx
steroid + cycloplegic (mydriatic) drops
268
small, erythematous papule on her left cheek that then became scaly and well-defined, with central atrophy and adherent scaling. + photosensitivity
discoid lupus
269
A 40-year-old man develops pneumonia following an episode of influenza
staph aureus
270
Avoidance of using hypotonic (0.45%) in paediatric patients - risk of
hyponatreamic encepalopathy
271
ADPKD is associated with which clinical finding
hepatomegaly (due to hepatic cysts)
272
what is not indicated in severe TCA toxicity
dialysis - does not do anything
273
hat monitoring equipment is most important to assess apatient's intubation?
Capnography - used to detect accidental oesophageal intubation
274
cause of galactorrhoea
chlorpromazine
275
A1AT def vs COPD emphysema
Emphysema is most prominent in the lower lobes in A1AT deficiency and the upper lobes in COPD
276
? found in the CSF of patients with MS
oligoclonal bands
277
platelet transfusion threshold
- 30x10'9 = bleeding
- 10 x10'9 if not bleeding
278
Diabetic ketoacidosis: the IV insulin infusion should be started at
0.1 unit/kg/hr
279
Yellow card scheme reporting
- all suspected adverse drug reactions for new medicines (identified by the black triangle symbol) should be reported
- all suspected adverse drug reactions occurring in children, even if a medicine
has been used off-label
- all serious suspected adverse drug reactions e.g. anaphylaxis but not rashes
280
Where do ewings sarcomas occur
- diaphysis of the pelvis and long bones
- onion skin appearance on XR
281
Sometimes referred to as chocolate cysts due to the external appearance
endemetriotic
282
most common ovarian cancer
Serous carcinoma
283
An ultrasound done on a 23-year-old female for recurrent urinary tract infections incidentally shows a 3 cm 'simple cyst' on the left ovary. She is asymptomatic
follicular cyst
284
Contralateral homonymous hemianopia with macular sparing and visual agnosia -
posterior cerebral artery
285
Relative afferent pupillary defect indicates
an optic nerve lesion or severe retinal disease
286
what is closed and open angle glaucoma assoc w
Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle glaucoma is associated with myopia
287
best prognosis thyroid ca
papillary (eventhough it spreads to cervical LN early)
288
What is the drug of choice for reversing respiratory depression caused by magnesium sulphate?
ca gluconate
289
imaging in MS
MRI with contrast
290
EBV: associated malignancies:
- Burkitt's lymphoma
Hodgkin's lymphoma
nasopharyngeal carcinoma
291
how do thiazides affect ca
hypercalcaemia
292
Hb cut offs pregnancy
293
Pseudo-Cushing's
mimics Cushing's
often due to alcohol excess or severe depression
causes false positive dexamethasone suppression test or 24 hr urinary free cortisol
insulin stress test may be used to differentiate
294
A 22-year-old man presents with symptoms of lethargy and bilateral facial nerve palsy. On examination he has bilateral parotid gland enlargement.
sarcoid
295
A 21-year-old man presents with a unilateral facial nerve palsy after being hit in the head. On examination he has a right sided facial nerve palsy and a watery discharge from his nose.
petrous temporal f# - Nasal discharge of clear fluid and recent head injury makes a basal skull fracture the most likely underlying diagnosis.
296
Which of the following is most associated with the development of ovarian cancer?
Early menarche
297
what is the reasoning behind ovarian cancer RF
risk is greater if ovulation is not suppressed. In this way, early menarche and late menopause, both of which would increase ovulation, are risk factors for ovarian cancer.
298
Intermittent limb claudication, absent or weak peripheral pulses in a young woman, → ?
- Takayasu's arteritis
- associated with aortic regurg
299
Typhoid fever -
- samlonella
- initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
300
comps of typhoid
osteomyelitis (especially in sickle cell disease where Salmonella is one of the most common pathogens)
GI bleed/perforation
meningitis
cholecystitis
301
causes of duputrens ontracture
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
302
APGAR score
303
caecum cancer tx
Right hemicolectomy
304
Any patient who presents with new-onset flashes or floaters
should be referred urgently for assessment by an ophthalmologist within 24 hours
305
What to test b4 starting TB tx
visual acuity - isoniazid
306
stopping driving after TIA
1 MONTH
307
Mx of orbital cellulitis
IV cefotaxime
308
? is the bacteria that contributes to the development of acne
propionibacterium acnes
309
Patients with an uncertain tetanus vaccination history should be given
a booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old
310
first degree perineal tear
do not req suturing
311
mx of addisons
IV hydrocorrtisone
312
mx of herpes infection in pregnancy
oral aciclover - same as non preg
313
tx of galactorrhoea
bromocriptine
314
Campylobacter infection is characterised by
a prodrome, abdominal pain and bloody diarrhoea
315
Nephrotic syndrome is associated with a hypercoagulable state due to
loss of antithrombin III by kidneys
316
TNM tx
radioiodine therapy.
317
reaction seen w NAC
N-Acetylcysteine commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release)
318
Consider ?with polyangiitis when a patient presents with ENT, respiratory and kidney involvement
- granulomatosis
- . cANCA is the antibody most commonly found in patients with GPA.
319
Medullary thyroid cancer is associated with
RET oncogene
320
A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with
Clostridium botulinum
321
The maximum rate of IV potassium infusion that can be conducted without monitoring is
10mmol/ hr
322
features of retinoblastoma
- absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems
323
Tx of retinoblastoma
enucleation is not the only option
depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation
324
Management of myasthenic crisis -
intravenous immunoglobulin, plasmapheresis
325
what should be done pre-op for RA pts
anteroposterior and lateral cervical spine radiographs - checking for atlantioaxial subluxulation
326
When should LMWH be started after sugery
6-12 hrs post-op
327
Malignant hypertension usually involve
Malignant hypertension usually involves severe hypertension and bilateral retinal hemorrhages and exudates
328
Reflex anoxic seizures have
fast recovery time unlike epilepsy
329
Erratic blood glucose control, bloating and vomiting think
gastroiparases
330
giardia vs shigella
- giardia: good - no blood
- shigella: shit i'm bleeding
331
This medication may have to be stopped in AKI as increased risk of toxicity (but doesn't usually worsen AKI itself) -
lithium
332
buprion MAO
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.
333
You receive a call from the Biochemistry Lab. A blood sample you have taken from a patient is reported to have a potassium level of 6.4mmol/L. What is your first step?
all patients with a serum K+ of 6.0 or more to undergo an urgent ECG.
334
Hypomg, hypocal, hypokal ->
PPI
335
tca OD ecg
sinus tachycardia with a widened QRS and prolonged QT interval classically seen in TCA toxicity
336
cANCA vs pANCA
cANCA = granulomatosis with polyangiitis; pANCA = eosinophilic granulomatosis with polyangiitis + others
337
CIN cervical screening
6 months - as a test of cure
338
HPV types that would require referral if +
- high risk - 16,18,33
- if low risk such as 6 and 11 are positive, return to normal recall
339
colles f#
Dorsally Displaced Distal radius → Dinner fork Deformity
340
bimalleolar ankle #
Potts
341
bennets #
Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal
342
urien sodium > 40
ATN
343
Disproportionate microcytic anaemia - think
beta thalassemia trait
344
mx of wound dehiscence
- immediately call for senior helo
- sterile swab soaked with 0.9% saline
345
Immediate ref to neurosurgery Ix
- if patients have significant abnormalities on imaging or other features such as persisting coma, unexplained confusion, deterioration of a patient's Glasgow coma scale, seizures without recovery, progressive focal neurological signs, cerebrospinal fluid leaks, or definite or suspected penetrating injury/fracture.
346
All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against
Pneumocystis jiroveci pneumonia - start co-trimazole now
347
first line Ix for PMR
ESR and CRP
348
What shpuld be given to all women with PROM
10 days erythromycin should be given to all women with PPROM
349
? can cause malignant hyperthermia
SUXAMETHONIUM
350
FUNDOSCOPY FINDING of papilloedema
Papilloedema is associated with blurring of optic disc margin on fundoscopy
351
Barlow
attempted dislocation of a newborns femoral head
I've been remembering it as B comes before O....
So you do Barlow then Ortalani
You have to dislocate first, then relocate...
So Barlow first then Ortalani
352
ortlani
Attempts to relocate a dislocated femoral head
353
UTI in men - all men should have
Culture b4 starting ab
354
A 67-year-old man with a history of Parkinson's disease presents due to the development of an itchy, red rash on his neck, behind his ears and around the nasolabial folds. He had a similar flare up last winter but did not seek medical attention. What is the most likely diagnosis?
seb derm - assoc w PD
355
Metformin dosing in Ramadan
1/3 b4 sunrise, 2/3 after sunset
356
weight neutral AD drug
DDP4 inhibitors
357
anti-diabetics causing WG
- sulfonylurea
- pioglitazone
- insulin
358
? a potential complication of panretinal photocoagulation
decrease in night vision
359
Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, 'semi-dilated' pupil
uveitis: small, fixed oval pupil, ciliary flush
360
rf for 2nd T miscarriage
large cervical cone biopsy
361
The first line investigations for patients with a suspected diagnosis of vestibular schwannoma
audiogram + galodlinium enhanced MRI scan
362
? is the most common cause of death in patients with hypertrophic obstructive cardiomyopathy
vent arrhythmia
363
raised ? are characteristic of autoimmune hepatitis
Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels are characteristic of autoimmune hepatitis
364
viral meningitis
- RAISED LYMPHOCYTES
- mIldly elevated protein (0.7 g/L), and a relatively normal CSF glucose level compared to serum glucos
- cloudy CSF
365
Bac mening
- NEUTROPHIL PREDOMINANCE
- high protein
- reduced CSF glucose
- The white cell count in bacterial meningitis is usually much higher, often >1000/mm³.
366
mx of SVT - adenosine dosing
apid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
367
A 50-year-old man complains of central, pleuritic chest pain 24 hours after being admitted with an anterior myocardial infarction. The pain is eased when he sits upright
pericarditis
368
Broad complex tachycardia following a myocardial infarction is almost always due to
VT
369
Initial fluid resus
500ml 0.9% saline over 15 min (avoid harmanns in AKI due to added K)
370
Resp acidosis + metabolic compensation in COPD
acute on chroni resp acidosis - metabolic compensation takes time to occur
371
pretibial myxoedema is only seen with
Graves - not seen with hyperthyroidism from other causes
372
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with
Oral fidaxomicin
373
causes of LOng QT
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
acute myocardial infarction
myocarditis
hypothermia
374
squaring of thumbs ->
osteoarthritis
375
which muscles are usually spared in MND
ocular muscles
376
What is the most common reason that a revision operation would need to be performed in a patient who has had a THR?
aseptic loosening of the implant
377
anterior groin pain + steroids ->
avascular necrosis
378
? should be considered for the prevention of calcium stones
Potassium citrate
379
first line in impacted ear wax
1 week olive oil drops
380
severe C diff
Hypotension
Partial or complete ileus
Toxic megacolon, or CT evidence of severe disease
381
NSAIDs should be avoided with
Warfarin - risk of life threatening bleeding in the elderly
382
The most common ECG change in PE is
Sinus tachy
383
mx of anaphylactoid reaction to NAC
Stop transfusion, give nebulised salbutamol, re-commence IV infusion at a slower rate
384
? describes patients with ischaemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia
unstable angina
385
how does lithium cause hypercalcaemia
by causing hyperparathyroidism
386
oral morphine -> subcutaneous morphine
divide by 2
387
what is assoc w a retinal detachment
myopia
388
stippled vaginal epithelial cells ->
clue cells seen in BV
389
Delirium in PD
IM lorazapam. DO NOT GIVE HALOPERIDOL
390
Remembering SH classification
1 i = physis
2 i's = physis, metaphysis
3 i's = physis, epiphysis
4 i's = physis, metaphysis and epiphysis
5 = crush
391
which pregnant women should be immediately referred to EPAU
Women who have a positive pregnancy test and either abdominal, pelvic or cervical motion tenderness should be immediately referred for assessment
392
Hypothermia, hyporeflexia, bradycardia and seizures, think
Myxoedema coma
393
? is at risk in a shaft fracture of the humerus
radial nerve
394
initial fluid bolus in kids
Start IV fluid resuscitation in children or young people with a bolus of 10 ml/kg over less than 10 minutes
395
Bisphosphonates are associated with an increased risk of
atypical stress #
396
otosclerosis
- conductive hearing loss, tinnitus and positive family history
- Schwartz sign - redness of the promontory of the cochlea
397
mx of atheles foot
- topical imidazole or undecenaoate
- oral tebinafine alt
398
fluids given in hyperemesis
IV normal saline with added K+
399
intercurrent illness and metformin
Metformin increases the risk of lactic acidosis - suspend during intercurrent illness eg. diarrhoea and vomiting
400
when would microbio stool Ix be done in a chil
- 1) You suspect septicaemia
2) there is blood and/or mucus in the stool or
3) the child is immunocompromised
401
delirium on background of BPH
Abdominal distension and suprapubic tenderness on a background of prostatic hyperplasia indicate acute urinary retention
402
Can be used to evaluate the anxiety level of a patient
HAD
403
Trastuzumab targets
HER2
404
When assessing blood transfusion reaction, ?is an ominous sign that suggests a serious reaction necessitating the stopping of the transfusion
hypotension
405
hypertension + hypokal
primary hyperaldosteronisn
406
shockable rhythms
ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT)
407
Non shockable rhythms
asystole/pulseless-electrical activity (asystole/PEA)
408
ALS - chest compressions
the ratio of chest compressions to ventilation is 30:2
chest compressions are now continued while a defibrillator is charged
409
defibrillation
a single shock for VF/pulseless VT followed by 2 minutes of CPR
if the cardiac arrested is witnessed in a monitored patient (e.g. in a coronary care unit) then the 2015 guidelines recommend 'up to three quick successive (stacked) shocks',
410
ALS: drug delivery
iV access should be attempted and is first-line
if IV access cannot be achieved then drugs should be given via the intraosseous route (IO)
411
adrenaline
adrenaline 1 mg as soon as possible for non-shockable rhythms
412
during a VF/VT cardiac arrest, adrenaline
- during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
- repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
413
what should be given after 3 shocks for VF/ pulseless VT
amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
414
Amiodarone - if not available for ALS use
lidocaione
415
what should be added in ALS for suspected PE
- THROMBOLYTIC DRUGS
- if given, CPR should be continued for an extended period of 60-90 minutes
416
reversible causes of cardiac arrest
417
most likely SSRI to lead to QT prolongation and Torsades de pointesC
Citralopram
418
hyponatremia, hyperkalemia and hypoglycemia ->
Addisons
419
hypokalemia and hypernatremia ->
cushings
420
PS murmur
ejection systolic louder on inspiration
421
Refer adults to a respiratory specialist when
asthma is not controlled despite treatment with moderate-dose MART, and trials of an LTRA and a LAMA
422
having a pneumothorax means u can ever
deep sea dive again
423
Palliative prescribing - renal impairment
oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
424
angina - what should be avoided if known HF
verapamil
425
Ankylosing spondylitis features - the 'A's
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
426
this medication may have to be stopped in AKI as increased risk of toxicity (but doesn't usually worsen AKI itself) -
metformin
427
cotton wool spots
In diabetic retinopathy, cotton wool spots represent areas of retinal infarction
428
mx of PS
Ramstedt pyloromyotomy
429
Chronic insomnia is diagnosed after
3 months
430
Complete heart block following a MI? -
RCA lesion - AV node
431
what is useful for testing for ARDMD
Amsler grid testing (to check for distortion of line perception)
432
Definitive Tx of WPW
accessory pathway ablation
433
? is a good first line anti-emetic for intracranial causes of nausea and vomiting
cyclizine - interCranial
434
before starting phenytoin for status, get
cardiac monitoring - pro arrhythmogenic
435
oncholysis -
painless detachment of the nail from the nail bed) - psoriasis
436
fluid - K requirements
1mmol/kg/day
437
requirements for maintenance fluids
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis
438
bowel prep for colonoscopy
laxatives the day b4 the exam & dont eat for 24 hrs before
439
what can impact HBA1C
440
MS - relapse Mx
methypred
441
Reduicng MS relapse
- natalizumab
- ocrelizumab
- beta-interferon
442
MS - fatigue
amantadine
443
Spasticity in MS
baclofen and gabapentin are first-line. Other options include diazepam, dantrolene and tizanidine
physiotherapy is important
444
bLADDER DYSFUNCTION MS
an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients
if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency
445
ms -Oscillopsia (visual fields appear to oscillate)
Gabapentin 1st
446
Sick euthyroid syndrome =
low T3/T4 and normal TSH with acute illness
447
Yeast on LP + india pink stain
cryptococcal
448
? is an appropriate technique to treat cervical intraepithelial neoplasia
LLETZ
449
All post-tonsillectomy haemorrhages should be
Immediately referred to ENT
450
13-18 years immunisations:
DT + IPV + Men ACWY
451
RASH SEEN WITH APS
levido reticularis - purplish, lace-patterned discolouration of the skin
452
mid humeral fracture damages
radial nerve -> wrist drop
453
First line treatment in diabetic neuropathy is with
amitriptyline, duloxetine, gabapentin or pregabalin
454
If an unborn has exomphalos then
caesarean section is indicated to reduce the risk of sac rupture
455
NG feeding
- Usually administered via fine bore naso gastric feeding tube
- Complications relate to aspiration of feed or misplaced tube
- May be safe to use in patients with impaired swallow
456
when is NG feeding often CI
basilar skull #
457
Naso jejunal feeding
Avoids problems of feed pooling in stomach (and risk of aspiration)
Insertion of feeding tube more technically complicated (easiest if done intra operatively)
458
which type of feeding is safe to use following oesophagectomy
naso-jejenal
459
Feeding jejunostomy
- Surgically sited feeding tube
May be used for long term feeding
- Low risk of aspiration and thus safe for long term feeding following upper GI surgery
460
Risks of feeding jejunostomy
tube displacement and peritubal leakage immediately following insertion, which carries a risk of peritonitis
461
Percutaneous endoscopic gastrostomy
- Combined endoscopic and percutaneous tube insertion
- May not be technically possible in those patients who cannot undergo successful endoscopy
- Risks include aspiration and leakage at the insertion site
462
The definitive option in those patients in whom enteral feeding is contra indicated
TPN
463
administration of TPN
Should be administered via a central vein as it is strongly phlebitic
464
TPN - long term use assoc w
fatty liver and deranged LFTs
465
Drusen =
dry aged related MD
466
Cardiac catheterisation results - jump in oxygen saturation from right atrium to right ventricle
vsd
467
all housebound pts should be started on
Vit D
468
O2 targets COPD
- 94-98%
- Unless CO2 retainer on ABG -> 88-92%
469
most common cause pf ambiguous genitalia in neonates
cah
470
medical Mx ectopic
methotrex
471
? SSRIs of choice in breastfeeding women
sertraline or parx
472
Refer adults to a respiratory specialist when asthma is not controlled despite treatment with
moderate-dose MART, and trials of an LTRA and a LAMA
473
Intensely itchy bumps on the arms, torso or legs: consider
bed bug infestation
474
Levine scale for grading murmurs
Grade 1 - Very faint murmur, frequently overlooked
Grade 2 - Slight murmur
Grade 3 - Moderate murmur without palpable thrill
Grade 4 - Loud murmur with palpable thrill
Grade 5 - Very loud murmur with extremely palpable thrill. Can be heard with stethoscope edge
Grade 6 - Extremely loud murmur - can be heard without stethoscope touching the chest wall
475
good vein for TPN
subclavian line
476
intracapsular NOF fracture mx
internal fixation
477
apple core sign
O cancer
478
If a woman vomits within 3 hours of taking levonorgestrel or ulipristal acetate ->
take another dose
479
ed, scaly patches that grow on sun-exposed sites in older patients should raise suspicion of
bowens
480
AK vs bowens
- Actinic keratosis: Usually skin coloured (may be reddish, pinkish), typically smaller, scaly rough patches or plaques.
- Bowens disease: uniformly red, larger, more well demarcated, may itch, bleed or crust, prominent vessels on dermascopy.
481
