PASSMED ALL Flashcards
Bedwetting under age of 5 treatment
Reassurance
It’s normal
First line for over age 5 bedwetting
Enuresis monitor
Bedwetting over age 5, if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family
Desmopressin (to be assessed regularly)
Important side effect of sulfonylureas ? (e.g. gliclazide)
Hypoglycaemia
19 year old male, nipple discharge, gynaecomastia and poor vision
Prolactinoma
Poor vision = prolactinoma compressing the optic chiasm
A 14 year-old boy develops visible haematuria following an upper respiratory tract infection
IgA nephropathy
60 year old male
1. Haematuria
2. Loin pain
3. Abdominal mass
Renal cell carcinoma
(could have varicocele as a testicular vein could be occluded)
21-year-old female
Dysuria for the past week, despite just completing a three day course of trimethoprim.
Urine dipstick = positive for blood + and leucocytes
A MSSU shows no organism.
Chlamydia
Sore throat, pyrexia and lymphadenopathy - 3 weeks, young adult
Glandular fever a.k.a. infectious mononucleosis
2-4 weeks, flu-like illness followed by the patient feeling nauseous, + arthralgia, then can cause hepatosplenomegaly and jaundice
Viral hepatitis A
Spread by seafood - faecal-oral route
Chronic ear infections and offensive discharge + vertigo for the past 48 hours
Cholesteatoma
Large cholesteatoma can invade the inner ear resulting in sensorineural hearing loss and vertigo
Elderly, presents with pneumonia. Why do thyroid tests show low T4 + normal TSH ?
Sick euthyroid
Normal, no need to treat thyroid symptoms
Before starting azithromycin, what tests must be done ?
ECG + baseline LFTs
Acutely painful red eye, photophobia, small pupil, reduced visual acuity, pus in the anterior chamber (a hypopyon)
Anterior uveitis
Associated with HLA-B27 related conditions
HLA-B27 related conditions
ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen
Management of anterior uveitis
urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
steroid eye drops
Investigation for bladder cancer
Flexible cystoscopy
Rheumatoid + painful red eye
Scleritis
usually atoimmune cause e.g. RA, lupus, sarcoidosis, GPA
Hand clumsiness, difficulty word-finding, with new symptoms of acute photophobia
Examination shows double vision and papilloedema (blurring of the optic disc margin)
Potential space-occupying lesion (tumour)
requires urgent CT head
Raised intracranial pressure - what investigation is contraindicated and why?
Lumbar puncture
due to risk of cerebral herniation
What medication causes lower zone lung fibrosis?
Amiodarone
Dysphagia - barium swallow shows ‘bird’s beak’ appearance of the lower oesophagus
Achalasia
LOS constricted, oesophagus above dilated
in more detail:
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus
Papilloedema - unilateral or bilateral ?
Almost always a bilateral finding
due to raised ICP
Newly-started medication
Widespread rash with large, flaccid, blisters over her arms and trunk and an erythematous macular rash
Severe mucosal involvement
Steven-Johnson syndrome
Hospital admission required for supportive management,
opthalmology admission required to rule out ocular involvement
