PassMed Flashcards
(230 cards)
1
Q
Likely diagnosis?
‘Pop’ in ankle, sudden onset significant pain in calf / ankle + inability to continue sport or walk. Positive Simmond’s sign,
A
Achilles tendon rupture
2
Q
Likely diagnosis?
Pain on forced plantar flexion when jumping or kicking. Common in gymnasts and ballet dancers.
A
Posterior ankle impingement
3
Q
Likely diagnosis?
Athletes involved in sprinting and jumping. Pain in foot.
A
Navicular bone fracture - stress #
4
Q
Likely diagnosis?
Repeated ankle sprains causing friction and inflammation of tendon
A
Peroneal tendon dislocation
5
Q
Likely diagnosis?
Foot injury common in soldiers and hikers; long periods of standing or walking.
A
Stress metatarsal fracture - march #
6
Q
Statins inhibit which enzyme in hepatic cholesterol synthesis?
A
HMG-CoA reductase
7
Q
Risk factors for myopathy with statins?
A
- Advanced age
- Female
- Low BMI
- Multisystem disease - DM
8
Q
Myopathy is more common in:
1 - Lipophilic statins (simvastatin, atorvastatin)
2 - Hydrophilic statins
A
- Lipophilic
9
Q
When starting statins, LFTs should be checked at ______ months and ________ months. Stop statins if transaminase concentrations rise to _____ times the upper limit.
A
- 3 months
- 12 months
- Three
10
Q
Statins should be stopped with what Abx?
A
Macrolides (e.g. erythromycin)
11
Q
Assessment tool for starting statins?
A
QRISK2
12
Q
NICE - Primary prevention (20mg) with statins should be given to:
- ?
- ?
- ?
A
- 10 year CVR >/ 10%
- T1DM
- CKD if eGFR <60
13
Q
NICE - Secondary prevention (80mg) with statins should be given to?
A
Cardiovascular disease
14
Q
NICE - Dose of primary prevention statin should be increased if non-HDL has not reduced by _____ %
A
> / 40%
15
Q
Who should receive a statin?
- All people with established ________.
- Anyone with 10-year CV risk _______ (QRISK2).
- T1DM patients who were diagnosed _______ or aged _______ or have _________.
A
- CVD - stroke, TIA, IHD, PAD
- > / 10%
- More than 10 years ago / over 40 / established nephropathy.
16
Q
Likely diagnosis?
25F + 8 weeks gestation presents to GP with circular and outwardly expanding painless rash on right arm (looks like a target). Rash started 2 weeks after coming back from hiking trip in the USA.
A
Lyme disease
17
Q
Rx for Lyme Disease?
A
Doxycycline (early disease)
Ceftriaxone (disseminated disease)
18
Q
Rx for Lyme Disease in pregnancy?
A
Amoxicillin
19
Q
What is erythema migrans?
A
‘Bulls-eye’ rash seen in Lyme Disease.
20
Q
What investigation to order for suspected Lyme Disease?
A
First line:
- Enzyme-linked immunosorbent assay (ELISA) - antibodies to Borrelia burgdorferi
- If negative but disease still suspected; repeat 4-6 weeks after first test
Second line:
- In people with symptoms for 12 weeks +
- Immunoblot test
21
Q
What is Jarisch-Herxheimer reaction?
A
Seen after initiating therapy for Lyme Disease - fever, rash, tachycardia. Occurs after first dose of Abx. (Also seen in syphilis).
22
Q
Symptoms of Lyme Disease?
A
- Erythema Migrans rash (80%)
- Systemic: fever, arthralgia
- CV: heart block, myocarditis
- Neuro: facial nerve palsy, meningitis
23
Q
- vWD is what type of genetic trait?
- What does vWF do?
- Ix for vWD?
- Rx for vWD?
A
- Autosomal dominant (type 1)
- Promote normal platelet function (adhesion to endothelium) + stabilising F8 (acts as carrier molecule)
- Coag - APTT prolonged, vWD assay (x3 blues)
- Desmopressin (DDAVP)
Note: Type 3 is the worst and is autosomal recessive.
24
Q
First line Rx for generalised seizures? This works by ________ activity.
A
Sodium Valproate
Increasing GABA activity.
25
Examples of ARB?
(Angiotensin reception blocker)
How do these work?
Losartan, Candesartan - all the -TANs.
Blocks AT1 receptors which angiotensin II would usually act on - found in heart, blood vessels and kidneys.
Reduces action of angiotensin II - causes vasodilation of blood vessels and stops retention of salt + water - lowering BP.
26
Examples of CCB?
How do these work?
Amlodipine, Felodipine, Verapamil, Diltiazem
Reduce amount of calcium entering heart and blood vessels, thus reduces muscular contraction and allowing the relaxed muscles to receive more oxygenated blood - lowering BP and treat angina.
27
Examples of thiazide-like diuretic?
How do these work?
Indapamide
Works in the kidneys on the proximal part of distal tubule - increases sodium excretion and urine volume - long term reduces peripheral resistance.
28
Stage 4 of HTN Rx - if potassium >4.5 then treat with _______ or _______. If <4.5 then treat with __________.
1. Alpha-blocker (Doxazocin) or Beta-blocker.
| 2. Spironalactone.
29
How do alpha-blockers work?
Blocks alpha-1-adrenoreceptors found on vascular smooth muscle, preventing norepinephrine acting here which would cause vasoconstriction - allowing better blood flow + lowering blood pressure.
30
First trimester of pregnancy is up to ________ weeks gestation. Second trimester is from ___ weeks to _________. Third trimester is from ___ weeks to end of pregnancy.
- 12+6 weeks
- 26+6 weeks
- 27 weeks
31
Likely diagnosis?
Scaly lesions under eyebrows, around nose + top of chest. Hx of dandruff.
How would you Rx?
- Seborrhoeic dermatitis
| - Topical Ketoconazole
32
Proliferation of Malassezia furfur causes what skin condition?
Associated with what health conditions?
Seborrhoeic dermatitis
HIV + Parkinson's
33
Pregnant women with UTI. ___1____ should be avoided in first trimester; ____2____ is first line. However, this should be avoided near term because it can cause ____3_____. Second line is ___4____ or ____4____.
Asymptomatic UTI should also be treated to reduce risk of progression to _____5______.
Total of __ days Rx.
1. Trimethoprim
2. Nitrofurantoin
3. Haemolytic disease of the newborn
4. Amoxicillin or Cefalexin
5. Acute pyelonephritis
Total: 7 days Rx
34
Catheterised patients with asymptomatic bacteria should or should not be Rx with Abx?
Should NOT
If symptomatic Rx with Abx for 3 days
35
Acute pyelonephritis should be treated with Abx for ________ days.
BNF recommends broad-spectrum ___________ for pregnant women or ____________ otherwise.
10-14 days
Cephalosporin - cefuroxime, ceftriaxone. (Safe in pregnancy).
Quinolone - ciprofloxacin, levofloxacin. (Avoid in pregnancy).
36
How long should SSRI be continued before thinking about stopping?
6 months - reduces risk of relapse.
37
What class of drugs may be associated with increased risk of VTE and stroke in elderly?
Atypical antipsychotics
38
Treatment with Clozapine for schizophrenia should only be commenced if there is not clinical improvement following use of at least ___ anti-psychotics for _________. One of these must be an atypical class.
Serious side effects of Clozapine include:
1. 2
2. 6-8 weeks
3.
- Bloods: agranulocytosis (causing neutropenia)
- CV: myocarditis, arrhythmia
- Other: hypersalivation + weight gain
- Reduce seizure threshold
39
Which SSRI is recommended post MI?
If also on anti-platelet therapy what advice should be given?
Sertraline
Risk of dyspepsia / GI bleed - consider starting PPI.
40
In anorexia nervosa are the levels high or low?
1. Potassium
2. Cortisol
3. Growth hormone
4. Sex hormones
5. Cholesterol
1. Low
2. High
3. High
4. Low
5. High
Remember most things low except G's and C's which are high - growth hormone, glucose, salivary glands AND cortisol, cholesterol and carotinaemia.
41
Examples of atypical antipsychotics?
Clozapine, Olanzapine, Risperidone, Quetiapine, Amisulpride, Aripiprazole
42
Main side effects of atypical antipsychotics?
- Weight gain
- Agranulocytosis (clozapine)
- Hyperprolactinaemia
43
Which atypical antipsychotic is high risk for dyslipidemia?
Olanzapine
44
Patient needs to be commenced on atypical antipsychotic but has a high BMI. Which one should be avoided.
Olanzapine
45
Which atypical antipsychotic should be used in patients with high prolactin?
Aripiprazole
46
Psych condition:
Patient convinced partner is cheating.
Othello syndrome
47
Psych condition:
Patient believes that a celebrity is in love with them. (Clare from the Bachelor)
De Clerambault Syndrome
48
Psych condition:
Patient believes that bugs are under their skin.
Delusional parasitosis or Ekbom syndrome
49
Psych condition:
Patient believes family member has been replaced by an imposter.
Capgras delusion
50
What SSRI is associated with hyponatraemia?
Sertraline
51
If patient is needing Rx for depression but is on warfarin, what medication is best?
Avoid SSRIs - antiplatelet effect increases risk of bleeding.
Mirtazapine should be used.
52
Monitoring when starting SSRI:
Patients should be reviewed after __ weeks or __ week if under 30 or suicidal.
SSRIs should be reduced over _______. The one that does not require this is _________.
2 weeks
1 week if under 30 or with suicidal ideation
Reduce over 4 weeks unless on Fluoxetine - doesn't require.
53
Panic disorder is Rx with what?
SSRIs
54
You are reviewing a 24-year-old PhD student who presents with feeling on edge all of the time. He feels that nothing specific makes him feel worse. He cannot relax and as a result is not sleeping too well, but his appetite is good. He tells you that his mood is okay. You have reviewed him for several weeks with the same symptoms and despite referral to self-help sessions he has made no improvement
- Likely diagnosis?
- What Rx?
GAD
SSRIs
55
Patient usually takes POP (not Desogestrel) at 08:00 but has remembered at 12:30 that she has yet to take it - what advice would you give?
3 hour window
Take the missed pill ASAP and continue taking the pills as normal.
Use a condom until pill taking has been re-established for 48 hours.
56
Cerazette usually taken at 08:00 is taken at 13:00 - what should be done?
Nothing. 12 hour window for Desogestrel.
If longer than 12 hours then would have to use condoms until pill taking has been re-established for 48 hours.
57
Women at high risk of developing pre-eclampsia should take ___________ from _________ until delivery.
75mg aspirin
12 weeks
58
High risk groups for pre-eclampsia?
1. Previous pre-eclampsia or pregnancy induced HTN
2. CKD
3. Autoimmune disorder - SLE or antiphospholipid
4. Diabetics
59
What blood pressure is regarded as HTN in pregnancy?
From what week gestation is this regarded as pregnancy induced?
140/90 mmHg
20 weeks
60
What is pre-eclampsia?
Pregnancy induced HTN (BP of >140/90) + proteinuria (>0.3g / 24 hrs)
61
Most common cause of cyanotic congenital heart disease? What age does it typically present?
1. VSD
2. AVSD
3. Tetralogy of Fallot
4. Patent ductus arteriosus
Tetralogy of Fallot
Presents at 1-2 months
62
What conditions cause cyanotic congenital heart disease?
Tetralogy of Fallot
Transposition of the great arteries
63
Transposition of the great arteries causes what in the newborn and what age does it present?
Cyanosis
Within the first 24 hours of life
64
What are the features of Tetralogy of Fallot?
(PROV)
1. Pulmonary stenosis
2. Right ventricular hypertrophy
3. Overriding aorta
4. Ventricular septal defect
65
What are the features of Ovarian Hyperstimulation Syndrome?
Mild - abdo pain
Moderate - N+V, ascites
Severe - clinical ascites, oliguria
Critical - thromboembolism, ARDS, anuria, tense ascites
66
Ovarian Hyperstimulation Syndrome is caused by the presence of multiple ___________ within the ovaries, resulting in high levels of ___________ and _________ and vasoactive substances - e.g. ____________.
This causes _________________ and therefore loss of fluid from the intravascular compartment.
Multiple luteinized cysts
Progesterone and Oestrogen
Vascular Endothelial Growth Factor (VEGF)
Increased membrane permeability
67
Likely diagnosis?
55F presents with pain in bilateral shoulders and hips for 3 weeks, worse in the morning and increased fatigue. Bloods - ESR >40.
Rx for condition?
Polymyalgia rheumatica (PMR)
Steroids
Note: PMR usually in patients 60+, not associated with weakness just stiffness and lethargy. Can also have depression, fever and night sweats.
68
Rx of SLE?
Hydroxychloroquine
69
Rx for RA and psoriasis?
Sulfasalazine (DMARD)
Disease Modifying Anti-Rheumatic Drug
70
Patients with HF should be offered the ______ vaccine annually.
Influenza vaccine
(Pneumococcal vaccine as a once off - unless spleen issues or CKD then every 5 years).
71
First line Rx for HF?
ACE-inhibitor + Beta-blocker
(Bisoprolol, Carvedilol and Nebivolol tend to be used).
72
Second line Rx for HF?
Aldosterone antagonist - potassium sparing
E.g. Spironolactone and Eplerenone.
73
Drug mostly associated with this side-effect:
Cataracts
Prednisolone
- Cushingoid
- Osteoporosis
- Impaired GT
- HTN
- Cataracts
74
Drug mostly associated with this side-effect:
Interstitial lung disease
Sulfasalazine (DMARD)
- Rash
- Oligospermia
- Heinz body anaemia
- Interstital lung disease
75
Drug mostly associated with this side-effect:
Corneal opacities
Hydroxychloroquine
- Retinopathy
- Corneal deposits
76
Drug mostly associated with this side-effect:
Bronchospasm in asthmatics
NSAIDs
- Peptic ulcer / dyspepsia
- Bronchospasm in asthmatics
77
Drug mostly associated with this side-effect:
Pneumonitis
Methotrexate
- Myelosuppression
- Liver cirrhosis
- Pneumonitis
78
Drug mostly associated with this side-effect:
Exacerbation of Myasthenia Gravis
Penicillamine
- Used to Rx Wilson's disease
- Fun fact about MG = associated with thymoma
79
Drug mostly associated with this side-effect:
Reactivation of TB
Infliximab or Adalimumab
80
If patient has B12 and folate deficiency, _______ must be Rx first to prevent subacute combined degeneration of spinal cord.
B12
| - give Cobalamin injections
81
Vitamin B12 is used for RBC development and maintain CNS.
It is mostly absorbed after binding to __________ and is actively absorbed in __________.
B12 deficiency is the most common cause of ____________.
Intrinsic factor
Terminal ileum
Pernicious anaemia - macrocytic anaemia, sore tongue / mouth, mood disturbances (think psych)
82
Replacing folate before B12 can cause what?
Subacute combined degeneration of spinal cord.
83
Rx of pernicious anaemia with no neuro involvement?
1mg Hydroxocobalamin (IM)
- 3 times / week for 2 weeks
- Then once every 3 months.
84
First line Rx to induce remission in severe UC?
IV steroids
If no improvement in 72 hours - can consider adding ciclosporin
85
Second line Rx to induce remission in severe UC?
IV ciclosporin
86
Ulcerative colitis severity is dependant on number of stool and blood in stool:
Mild = ? stools / day
Moderate =
Severe =
Mild = <4 stools
Moderate = 4-6 stools
Severe = >6 stools + systemically unwell
87
Rx for mild to moderate flare of UC?
E.g. proctitis, left-sided UC
Rectal aminosalicylate with oral also given in extensive disease - Mesalazine
88
Anti-D should be given to Rhesus negative women at _____ and ______ weeks.
28 + 34 weeks
89
Elderly patient with non-healing skin ulcer on shin + not improved with Flucloxacillin. What Ix should be ordered?
Ankle-brachial pressure index - ABPI
- ?arterial insufficiency
- if abnormal then refer to vascular
- biopsy to exclude malignancy to be considered
Note: Infection is not a common cause of non-healing leg ULCERS
90
Normal range of ABPI?
0.9 - 1.2
91
ABPI above 1.3 indicates arterial disease secondary to ______________ - seen in DM.
Arterial calcification
92
Mx of venous ulcers?
Compression bandaging
93
Fist-line of Rx for obese women with PCOS trying to conceive?
Weight-loss
94
_________ can be given to obese women with PCOS trying to conceive to increase ovulation
Metformin
95
General management for PCOS?
1. Weight loss
2. Combined oral contraceptive pill - regulate periods and induce bleed (if trying to conceive). Can also help with hirsutism.
96
Likely diagnosis?
Bilateral + painful neck swellings post infection.
Reactive lymphadenopathy
97
Likely diagnosis?
Rubbery + painless neck swelling. Associated with night sweats and splenomegaly.
Lymphoma
Burkitt's - associated with EBV
98
Likely diagnosis?
Neck swelling that moves up when swallowing. Hypo or Hyper-thyroid features also present.
Thyroid swelling
99
Likely diagnosis?
Neck swelling that moves up when sticking out tongue. Common in young patients (< 20 years). Can be painful if infected.
Thyroglossal cyst
100
Likely diagnosis?
Neck swelling classically on the left-side. Mostly evident around birth, 90% present before the age of 2.
Cystic hygroma - lymphangioma.
101
Likely diagnosis?
Mobile cystic mass, develops between sternocleidomastoid and pharynx. Present in early adulthood.
Branchial cyst
- Failure of obliteration of second branchial cleft in embryonic development
102
Likely diagnosis?
Common in adult females. Can cause pain / tingling / weakness in the shoulder when raising arm.
Cervical rib - causing thoracic outlet syndrome
103
All anti-malarial tablets need to be taken for 4 weeks post return from travel, apart from _________.
Malarone (Atorvaquone + Proguanil)
104
Which anti-malarial drugs are contraindicated in epilepsy?
The QUINEs - Chloroquine, Mefloquine
105
Which anti-malarial drug should be avoided in depression?
Mefloquine
106
Which anti-malarial drug is contraindicated in pregnancy?
Doxycycline
107
Which anti-malarial drug should be given with folate if taken in pregnancy?
Proguanil and Malarone (Atovaguone + Proguanil)
108
Primary amenorrhoea is?
No periods by age 16 years
109
Secondary amenorrhoea is?
Stopping of normal periods for 6 months +
110
Causes if primary amenorrhoea?
- Turner's syndrome
- Congenital adrenal hyperplasia
- Congenital malformation of the genital tract
111
Causes of secondary amenorrhoea?
- PCOS
- hypothalamic amenorrhoea (stress, excessive exercise)
- Hyperprolactinaemia
- Premature ovarian failure,
Other:
- Sheehan's syndrome
- Asherman's syndrome
Note: Sheehan's syndrome = postpartum pituitary gland necrosis caused by PPH
Asherman's syndrome = adhesions in the uterus (interuterine)
112
Hutchinson's sign?
Rash on the tip or side of nose - seen in Herpes zoster opthalmicus. Indicates potential ocular involvement
113
Likely diagnosis?
67M presents with painful blistering rash around right eye - examination shows vesicular rash covering right trigeminal nerve dermatome.
Herpes zoster opthalmatica
114
Likely diagnosis?
39F returns from Spain and notices two large circular plaques on scalp - resulting in hair loss at the site. On going joint pain and stiffness.
Discoid lupus
115
Allopurinol should be given to patients with gout when?
| ULT = urate-lowering therapy
After acute symptoms of gout have gone.
Although if attacks are super frequent then you can consider allopurinol even if inflammation hasn't fully settled.
116
Acute management of gout?
1. NSAIDs (or Colchicine if contraindicated however this has a slower mechanism of action).
2. Oral steroids if both contraindicated - Prednisolone 15mg, OD for 3 days (seen in renal)
117
If patient is on Allopurinol during an acute flair of gout, it should be __________.
Continued
118
ULT is particularly recommended if patients have > __ gout flares in 12 months, if there is _______ present and in _______ disease
- 2
- Tophi
- Renal disease
119
What drugs can precipitate gout?
Thiazides
120
Erythema multiforme is a _________ reaction commonly triggered by _________.
Hypersensitivity reaction
Infection
121
Likely diagnosis?
Patient with hx of viral illness 5 days ago has blisters on mouth and is now haemodynamically unstable with target lesions on back of hands and feet before spreading to chest.
Erythema multiforme MAJOR
- mucosal involvement
Otherwise minor
122
Likely diagnosis?
Red, itchy, painful lesion usually appearing on fingers or hands. Caused by paropox virus spread from sheep and goats.
Orf
123
First-line RX for hypercalcaemia?
IV fluids
124
________ seizures (previously known as partial seizures) start in a specific area on ______ side of the brain.
Level of awareness can vary:
1. ______ aware
2. _______ impaired
3. Awareness unknown
- Focal
| - One
125
Generalised seizures involve ______ sides of the brain and involve loss of consciousness.
Two subdivisions:
1. _____ (tonic-clonic)
2. _______ (absence)
- Both
- Motor
- Non-motor
126
Acromegaly is caused by __________ secondary to a ___________ in 95%.
- Excess growth hormone
| - Pituitary tumour
127
Features of pituitary tumour?
Hypopituitarism
Headaches
Bitemporal hemianopia
128
Features of acromegaly?
- Spade hands, large feet, large tongue, coarse facial appearance
- Sweat gland hypertrophy = excessive sweating + oily sin
- Galactorrhea
129
Complications of acromegaly?
HTN
Cardiomyopathy
DM
Colorectal ca
Associated with MEN-1
130
Childhood syndrome caused by:
Trisomy 13
Patau
131
Childhood syndrome caused by:
Trisomy 18
Edward's
132
Childhood syndrome:
Small head, small eyes, cleft lip, polydactyly, scalp lesions
Patau (Trisomy 13)
133
Childhood syndrome:
Small lower-jaw, low-set ears, rocker bottom feet, overlapping fingers
Edward's (Trisomy 18)
134
Childhood syndrome:
LD, big head, long face, long ears, big ball
Fragile X
135
Childhood syndrome:
Webbed neck, sunken in chest (excavatum), short, congenital heart defect - which one?
Noonan's syndrome
Pulmonary stenosis
136
What is micrognathia?
Small lower jaw
137
Childhood syndrome:
Micrognathia, upper airway obstruction, cleft palate
Pierre-Robin syndrome
138
Childhood syndrome:
Obesity (constant hunger), floppy baby, low sex hormones
Prader-Willi
139
Childhood syndrome:
Short, overly chatty, LD, congenital heart disease - which one?
William's syndrome
Supravalvular aoritc stenosis
140
Childhood syndrome caused by:
Chromosome 5p deletion
Cri du chat
141
Childhood syndrome:
Characteristic cry (sounds like a kitten) - larynx + neuro problems, feeding problems, LD, small head and small lower jaw
Cri du chat
142
Childhood syndrome:
Micrognathia, upper airway obstruction, cleft palate, family hx of same
Treacher-Collins
143
Causes of oligohydramnios?
```
PROM
Renal agenesis
IUGR
Post-term gestation
Pre-eclampsia
```
144
AFI at 32-36 weeks is considered low at what ml?
< 500 ml
145
Oral morphine conversion to subcut?
Divide by 2
146
Oral morphine conversion to subcut diamorphine?
Divide by 3
147
Oral codeine conversion to oral morphine?
Divide by 10
148
Rx for otitis media?
Amoxicillin for 5 days
If allergy = macrolide (erythromycin or clarithromycin)
149
Rx for lichen planus?
Topical clobetasone butyrate
150
Likely diagnosis?
Abnormal flexion of finger, finger becomes 'stuck', common in rheumatoid arthritis
Trigger finger
151
Patient on quadruple therapy for TB c/o vision deteriorating and becoming less vivid. What medication is the likely cause of this?
Ethambutol - s/e include optic neuropathy and colour blindness
152
What is given alongside Ethambutol in the Rx of TB to prevent its side effects?
Pyridoxine (vitamin B6)
153
Quadruple therapy for TB?
Rifampacin
Isoniazid
Pyrazinamide
Ethambutol
154
What is the mechanism of action of Bupropion - help stop smoking?
1. SSRI
2. Norepinephrine and dopamine reuptake inhibitor + nicotinic antagonist
3. Dopamine agonist
4. Nicotinic receptor partial agnosit
2
155
When should Bupropion be started?
1-2 weeks before patient's target date to stop smoking
156
What smoking cessation aid can be given in pregnancy / breast feeding?
1. Varenicline
2. Bupropion
Both contraindicated
157
First line Rx for ankylosing spondylitis?
Exercise and NSAIDs
158
Pregnant women <20 weeks + not immune to varicella zoster virus should be offered _________ asap if exposed.
This is effective up to ____ days after contact.
Varicella-zoster IG (VZIG)
10 days
159
Mx of chickenpox in pregnant woman - 19 week gestation?
Oral Aciclovir should be CONSIDERED WITH CAUTION
160
Mx of chickenpox in pregnant woman - 32 weeks gestation
Oral Aciclovir
161
Swinging light test - right pupil constricts + left pupil constricts less than normal (looks dilated)
This is an example of what condition?
Optic neuritis
162
Optic neuritis causes _______ in the region of eye which is aggravated by _________.
What examination should be performed?
Dull ache
Movement
Swinging-light test
163
Rx for chlamydia in pregnant women?
Azithromycin 1g stat
164
Test of cure should be performed _________ after infection in pregnant women.
6 weeks
165
Perihepatitis post chlamydia?
Fitz-High-Curtis syndrome
166
Incubation period of chlamydia?
7-21 days
167
Characteristic of chlamydia seen on pap smear?
Red inclusion bodies
168
Mx of chlamydia?
7 day doxycycline
Stat azithromycin - pregnancy
169
Common side effect of sulfonylureas?
Hypoglycaemia
| Weight gain
170
Risk factor of DDH?
1. Male sex
2. Maternal DM
3. Polyhydramnios
4. Oligohydramnios
Oligohydramnios
171
UKMEC 4 means?
Unacceptable health risk and should not be prescribed
172
Absolute contraindications for COCP?
- Migraine with aura
- Over 35 years and smoking
- Hx stroke, IHD, VTE
- HTN
- Breast feeding < 6 weeks post-partum
- Current breat ca
173
Is having a first degree relative with hx of DVT a complete contraindication for COCP?
No - UKMEC 3
HOWEVER risks outweigh the benefits
174
Likely diagnosis?
28M c/o dry cough for 10 days, abdominal pain, widespread target lesions.
CAP
Mycoplasma pneumoniae
175
Length of LMWH for provoked DVT?
3 months
176
Length of LMWH for unprovoked DVT?
6 months
177
CHANGE IN 2020:
First-line Rx for DVT - to be given if suspected + continued if confirmed?
DOAC
Apixaban or Rivaroxaban
178
CHANGE IN 2020:
First-line Rx for DVT if eGFR < 15?
LMWH
179
Weakness in external rotation is classically impaired in _________
Adhesive capsulitis
180
Shoulder problems:
Popping or grinding of shoulder + positive scarf test
Acromioclavicular degeneration
181
Shoulder problems:
Pain when reaching up to top shelves in kitchen. Shoulder abduction worse between 90-120 degrees. Popping / grinding.
Subacromial impingement
182
Shoulder problems:
Avid gardener / fall onto arm. Weakness in shoulder and pain. Muscle wasting.
Rotator cuff tear
183
Unilateral ENT symptoms, unilateral polyps or blood-stained discharge should be ___________?
Urgently referred to ENT
- Increased suspicion of cancer.
184
GORD in infants typically develops before what age?
8 weeks
185
Next step of management for infants with GORD not responding to Gaviscon?
H2RA or PPI
e.g. Ranitidine
186
First-line Rx for stroke?
Clopidogrel
187
What is phimosis?
Foreskin cannot be retracted
188
What is paraphimosis?
Foreskin becomes stuck behind the tip of the penis + cannot be unretracted
189
What is balanitis?
Head of penis is swollen
190
Chronic + progressive disease. Can lead to phimosis and urethral stenosis if left untreated. White, crinkly platches on foreskin
Lichen sclerosis of male genitalia - Balanitis xerotica obliterans
191
Menopause is a clinical diagnosis. No periods for?
12 months
192
How long do menopausal symptoms last for?
7 years +
193
Mx of menopause:
Unsuitable for use within 12 months of last menstrual period as may cause irregular bleeding?
Tibolone
| Replaces sex hormones - oestrogen + progesterone, but also some androgen effects
194
Mx of menopause:
Used for hot flushes?
Clonidine
195
When are pregnant women advised to get the whooping cough vaccine?
Between 16-32 weeks
196
Whooping cough immunisation in infants is when?
2, 3, 4 months and then booster at 3-5 years old.
197
Sx of pertussis?
Acute cough for 14 days
- paroxysmal
- inspiratory whoop
- vomiting post cough
- apnoea in infants
198
Mx of whooping cough?
Admit if child is < 6 months
Clarithromycin or azithromycin
Household contacts given prophylaxis
199
Kawasaki symptoms?
```
High grade fever
Conjunctiva
Red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles of feet
```
200
Rx of Kawasaki?
High dose aspirin
| IV Ig
201
Ix in Kawasaki?
ECHO - coronary artery aneurysms
202
Rx of salicylate OD
Urinary alkalinization with IV bicarb
| Haemodialysis
203
Rx of tricyclic antidepressant OD
IV bicarbonate
204
Rx of digoxin OD
Digoxin-specific antibody
205
Rx of breast cancer in pre-menopause
Tamoxifen
- 5 years max
206
Rx of breast ca in post-menopause
Anastrazole
207
Tamoxifen side effects?
Increased risk:
- Endometrial cancer
- VTE
- Menopause symptoms
208
X-ray: Flattened and fragmented femoral head and widened joint space of hip
What condition is this describing?
Avascular necrosis of femoral head
Perthes' disease
209
What age does Perthes' disease typically present?
4-8 years
210
What medication could make clopidogrel less effective?
Omeprazole
| Can use lansoprazole
211
Harmful drugs in pregnancy?
Tetracyclines (doxy)
Aminoglycosides (gentamicin)
Sulphonamides and trimethprim
Quinolones
```
ACI-i
Statins
Warfarin
Sulfonylureas
Retinoids
```
212
Likely diagnosis?
An adult with erythematous target lesions on the hands which later spread to the torso following herpes simplex infection
Erythema multiforme
213
Likely diagnosis?
A man with poorly controlled coeliac disease develops itchy vesicles on his elbow and bottom
Dermatitis herpetiformis
214
Likely diagnosis?
Young adult with an abdominal herald patch, followed by erythematous, oval, scaly patches in a 'fir-tree' distribution
Pityriasis rosea
215
Likely diagnosis?
An elderly woman develops itchy, tense blisters around the flexures. No mucosal involvement
Bullous pemphigoid
216
Likely diagnosis?
A man presents with an itchy, purple, papular rash on the palms and flexor surfaces of arms. The lesions are polygonal + covered in 'white lace'
Lichen planus
217
Likely diagnosis?
A young adult notices hypopigmented patches on the trunk after getting a tan. Mildly pruritic with some scale.
Pityriasis versicolor
218
Likely diagnosis?
Dementia, diarrhoea, dermatitis
Niacin deficiency
219
Rx for mild acne rosacea
Topical metronidazole
220
Likely diagnosis?
Young child with history of atopic eczema develops eruption of painful vesicles and pustules. Systemically unwell with fever
Eczema herpeticum
221
Likely diagnosis?
A man presents with raised, red, spherical lesion on his neck. Initially a red spot that rapidly grew over 4 weeks
Pyogenic granuloma
- 'Eruptive haemangioma'
- Benign skin lesion
- Linked to: trauma, pregnancy, more common in women
222
AKA 'eruptive haemangioma'?
Pyogenic granuloma
223
Likely diagnosis?
Itchy, red skin lesions, lymphadenopathy, hepatosplenomegaly
Mycosis fungoides
| T-cell lymphoma
224
Psoriasis made worse by which drugs?
```
Propanolol (B-Blockers)
Lithium
ACE-i
Anti-Malarials
NSAIDs
Alcohol
```
225
Likely diagnosis?
An elderly woman presents with an itchy lesion on her vulva. Started of red and now turned white plaque
Lichen sclerosis
226
Rx for seborrhoeic dermatitis?
Topical ketoconazole
227
Likely diagnosis?
Epistaxis, spider naevi, arteriovenous malformations
Hereditary Haemorrhagic telangiectasia
228
Likely diagnosis?
Middle-aged woman develops painful, erythematous, nodular lesions over both shins
Erythema nodosum
229
Likely diagnosis?
Grave's disease, orange peel shin lesions
Pretibial myxoedema
230
Likely diagnosis?
Diabetes, waxy yellow shin lesions
Necrobiosis lipodica diabeticorum
