Pastest Learnings Flashcards
(298 cards)
1
Q
Autosomal dominant, chromosome 4, triple repeat
A
Huntingtons
2
Q
Decreased crown pubis/crown heel ratio. Infertility, gynacomastia, learning disability. Normal lifespan
A
Klinefelter
3
Q
47 XXY or 48XXXY
A
Klinefelters
4
Q
Digoxin toxicity features on ECG
A
- premature ventricular beats
- bradycardia
Reverse tick sign
5
Q
First and second line tx for heart failure?
A
1st: Beta blockers and ACEIs
2nd: aldosterone antagonists eg spiro
6
Q
Side effects of which drug?
Acne, gum hypertrophy, paraesthesia, peripheral neuropathy
A
Phenytoin
7
Q
Side effects of which anti epileptic drug?
HypoNa, thrombocytopaenia, haemolytic anaemia, dry mouth, fatigue
A
Carbamazepine
8
Q
Lead poisoning symptoms in children?
A
GI symptoms and raised ICP (papillodema)
9
Q
Iron toxicity symptoms in children?
A
Vomiting, GI bleeding, drowsiness, CVD compromise
10
Q
Autosomal dominant condition leading to 80% increase in risk of bowel cancer
A
Lynch syndrome : increases risk of bowel, endometrial, stomach, ovarian, prostate, Urinary cancers
11
Q
Von Hippel Lindau
A
Multiple cysts in brain, eyes, spinal cord, adrenals, kidneys, pancreas. Increases risk of kidney and pancreatic Ca
12
Q
Psoriasis tx?
A
- Betnovate + vitamin D OD
- Vitamin D BD
- Steroid BD or coal tar
13
Q
Common cause and presentation of interstitial nephritis
A
NSAIDs, arthralgia, eosinophilia
14
Q
Anti-dsDNA, anti-Ro, ANA
A
SLE
15
Q
SLE Presenting features
A
- vasculitic lesions
- mouth ulcers
- butterfly rash
- small joint arthralgia
- ophthalmological involvement
- Neuro involvement
16
Q
Cranial nerve palsy, neck pain, headache, ptosis, miosis
A
Carotid artery dissection
17
Q
Role of proximal and distal convoluted tubule?
A
Proximal: Sodium and glucose re absorption
Distal: urine concentration
18
Q
Mechanism of action of acarbose
A
Inhibits alpha-glucosidase
19
Q
Mechanism of action of metformin
A
decrease hepatic gluconeogenesis
Increase insulin sensitivity
May reduce GI carb absorption
20
Q
COPD spirometry
A
FEV1<80%, FEV1:FVC <0.7 or 70%
21
Q
Contraindications to sildenafil
A
ISMN - potent vasodilatory effects, hypoT
22
Q
AFP, CEA, LDH cancer markers
A
Alpha fetoprotein - hepatocellular carcinoma
CEA-colon cancer
LDH - testicular cancer
23
Q
Anti cholinergic symptoms
A
Mydriasis, reduced secretions, dry skin, fever, altered mental state
24
Q
Drugs that exacerbate psoriasis
A
Lithium and beta blockers
25
Congenital adrenal hyperplasia at birth?
Large penis and pigmented (++testosterone), hyperK and hypoNa (low aldosterone), hypoglycaemia and hypotension (low cortisol). 21 hydroxylase deficiency
26
HOCM presentation?
Syncope after exercise, systolic murmur, worsens with valsalva, better with squatting. Jerky pulse
27
Ace inhibitor cough caused by?
Bradykinin breakdown
28
Infection predisposes to guttate psoriasis
Streptococcus infection
29
Ichthyosis
Dry scaly skin on abdomen, fingertips, fish scale appearance
30
Psoriasis on hands and soles of feet
Pustular psoriasis
31
Hepatitis B recent immunisation?
HBsAg antigen - HBS antibodies produced
32
Acute or recent infection of Hep B antibodies?
IgM anti-hepatitis B core (HbC)
33
Less common side effects of nicorandil
Mouth ulcers and stomatitis
34
Most common bugs in IECOPD
Moraxella, haemophilus, strep pneumoniae
35
Pulmonary HTN features
Raised JVP, SOB, left parasternal heave, peripheral oedema, pansystolic murmur (tricuspid regurgitation)
36
Cluster headaches treatment
Nasal sumitriptan or short burst oxygen therapy. Verapamil prophylactic.
37
Meningitis treatment in primary care
IM Ben pen
38
Most common cause glomerulonephriits
IgA nephropathy (Bergers), lung and kidney involvement
39
Cast nephropathy
Myeloma
40
Most common form of nephrotic syndrome in children?
Minimal change disease
41
thin basement membranes on renal biopsy, which disease
Alport syndrome : ears, kidney, eyes
42
Amiodarone monitoring blood tests? How often
LFTs and TFTs 6 monthly
43
Body burn percentages
Head and neck - 9%
Each upper limb - 9%
Lower limbs - 18%
Trunk - 36%
44
EBV causes what and predisposes to?
Infectious mono. Lymphoma.
45
Poor prognosis in breast cancer?
Young age, progesterone/estrogen negative,
46
IVDU, Recent resp infection, cavitating pneumonia
Staphylococcus
47
Immuno compromised individual, which pneumonia
Pneumocystis jiroveci
48
Alcohol and elderly pneumonia
Klebsiella
49
Low grade fever, rigors, hypotension and tachycardia with psoriasis
Erythrodermic psoriasis - emergency
50
Presentation of waldenstroms macroglobinaemia
IgM paraprotein causes hyperviscosity symptoms and amyloidosis. Infiltration of bone marrow and organs.
Retinal haemorrhages, lethargy, headache, blurred vision
51
Amyloidosis link to which IBD? Presents how?
Crohns - hepatomegaly, oedema
52
Marjolins ulcer
Underlying malignancy, slow healing, shallow ulcer
53
Lung tumour causing weight gain, HTN, hirsutism
Bronchial carcinoid
54
Haemophilia A : inheritance, clotting abnormality and deficiency
```
X linked recessive
Prolonged APTT
Factor VIII (8) deficiency
```
55
Cobblestone lesions
Crohns
56
Varenicline side effects
Abnormal dreams, menorrhagia
57
Seminona vs teratoma
Seminona: 30-40, older (sergeants)
Teratoma: 20-30, younger (troops)
58
Screening for TB in at risk groups?
Mantoux test
59
MCA stroke presentation
Contra lateral hemiparesis, face and arm worse affected
60
ACA lesions?
Contralateral hemiparesis, leg and shoulder worse than arms and face
61
Behçet’s disease
More common in Turkey, Japan and Iran. Ulcers in mouth and genitalia
62
Mode of inheritance of duchenne muscular dystrophy
X linked recessive
63
Mode of inheritance vitamin d resistant rickets
X linked dominant
64
Which organism and which patients get malignant otitis externa
T2DM . Pseudomonas.
65
Erythema nodosum and proctitis
UC
66
Turner syndrome cardiac abnormality
Coarctation of aorta
67
Down syndrome CV defect
AVSD
68
Cyanosed child with ESM at left sterna edge
Tetralogy of fallot
69
Eye: Fluroscein staining shows a dendritic ulcer
Herpes simplex keratitis
70
Turner syndrome
45 XO: lymphodema, small chin, low hairline, webbed neck, short stature
71
Trisomy 18
Edwards syndrome: rocker bottom feet
72
22q11 disease and features
Di George ; cleft palate, Absent thymus, aortic arch abnormality, T cell dysfunction
73
Adverse effects of ACEIs in pregnancy
Renal function and skull abnormalities
74
Adverse effects of streptomycin in pregnancy
Audio and vestibular damage
75
Adverse effects of NSAIDS in pregnancy
Premature labour and closure of PDA
76
cyp450 INDUCERS
Carbamazepine, barbiturates, rifampicin and phenytoin, smoking and chronic alcohol
77
cyp450 inhibitors
STICK FACES COM
```
Sodium valproate
Trimethoprim
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol
Chloramphenicol
Erythromycin
```
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice
78
Abx for C. Diff?
1. 10 days Vancomycin
2. Fidaxomicin
If life threatening, add IV metronidazole
79
Argyll Robertson pupils - causes and presentation
Syphillus and diabetes, small and minimally reactive
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
80
Acne vulgaris pregnancy
Oral erythromycin
81
tick causing pneumonia
Q fever - coxiella. Also presents with hepatosplenpmegaly
82
Brucellosis presentation
Middle Eastern disease, unpasteurised milk: fever, pneumonia, hepatosplenomegaly, epididymoorchitis
83
MEN1
3 p; pituitary, parathyroid, pancreas
84
MEN2
Parathyroid, phaeo, medullary thyroid
85
MEN3
Phaeo, medullary thyroid, Marfanoid
86
FOOSH, fat pad sign on X-RAY, elbow injury
Radial head #
87
Glomerulonephritis: Ig ? Precipitant
IgA nephropathy, precipitated by URTI, young males
88
Chest, eye and renal involvement, c-ANCA +be
Granulomatosis with polyangitis
89
Adult stills disease
Rheumatic disease: pink rash, arthritis, recurrent fever
90
Proximal muscle weakness, tenderness, raised CK
Polymyositis
91
Headache, fever, agitation, hydrophobia
Rabies
92
Presentation and diagnosis of typhus
Fever, meningism, rash. Dx with serology
93
Emergency contraception pill options
Ulipristal acetate: up to 5 days post intercourse
| Levonelle: 72 hours post intercourse, but efficacy drops
94
Referral pathway following abnormal smear?
Mild dyskaryosis AND HPV +ve: colposcopy and biopsy within 6wks
Moderate/high dyskaryosis : colposcopy 2wks
95
Crusting of both eyelids, worse in the morning, normal acuity and pupils
Blepharitis
96
Test for suspected acromegaly
1. First line: IGF-1
| 2. 2nd line: OGTT
97
P-ANCA IBD?
UC
98
discrepancy between kidney size and worsening HTN
Renal artery stenosis
99
How might Burkitts lymphoma present?
Child with Ascites, abdo pain, hepatosplenomegaly, B symptoms,
100
How does internuclear opthalmoplegia present? Where is the lesion?
Rapid saccades, lesion in the medial longitudinal fasciculus (which connects 3rd and 6th nerve nuclei)
101
Risk factors for sudden infant death syndrome
Male sex, winter months, young maternal age
102
Management of unstable VT
Synchronised cardio version up to 3x
103
Telogenum effluviam presentation
acute onset hair shedding in response to variety of stressed eg anorexia, childbirth, chronic illness, etc
104
Hair loss with tapered hairs and exclamation mark hairs, fine white hair in areas of regrowth
Alopecia
105
Most common diarrhoea
Campylobacter
106
Treatment for prolonged and unwell gastroenteritis
Ciprofloxacin
107
GBS risks
Previous GBS, PROM, Pre term labour
108
UTI drugs in pregnancy and breastfeeding
Nitro - fine until term then you can't
Trimethoprim - never
Cefalexin at term
After birth: trimethoprim safe in breast feeding
109
Tests for DDH, imaging, treatment
At 6 weeks, USS if:
Barlow - dislocates
Ortolani - relocates
If >4 months: X ray
Tx: Pavlik harness
110
VSD murmur and ECG findings
ECG: biventricular hypertrophy
| Pansystolic murmur over lower left sternal edge
111
Immunoflurescence findings in pemphigus vulgaris vs bullolus pemphigoid? Antibody findings?
PV: Intraepidermal circular deposits. Anti desmosome Abs
BP: Linear IgG and C3 deposits. Anti hemidesmosome Abs
112
Name of manoeuvre for tx of BPPV
Epsley manoeuvre
113
Presentation of acute glaucoma
Red, painful eye, fixed and dilated pupil with hazy cornea
114
Acute glaucoma treatment
Acetazolamide, topical beta blocker
115
Optic neuritis pupil effects?
Loss of direct pupillary reflex, preservation of consensual reflex. Due to optic nerve damage
116
Medical treatment options for acromegaly
Somatostatin analogues and pegvisomant (GH antagonist)
117
How might a basilar artery infarction present?
Quadriplegia, locked in syndrome
118
Law around children and sexual intercourse
Under 13, no one considered competent to consent. Always statutory rape. Gillick competence is irrelevant. Involving parents difficult as you do not know how responsible they may be or involvement in child’s life
119
Treatment for stage 4 renal cancer
Immunomodulatory drugs
120
Abx for orbital cellulitis
1. Co-amoxiclav
| 2. Clindamycin with metronidazole if penicillin allergy
121
Becker’s vs Duchenne Muscular dystrophy and mode of inheritance
Becker’s - later childhood, slower progression
DMD- early childhood, rapid progression
Both X linked recessive
122
Mechanism of action of aspirin
Inhibits thromboxane A2
123
MOA of clopidogrel
Activates antithrombin III, which inactivates factor Xa. This prevents prothrombin from being converted into thrombin
124
Presentation of dry AMD on retina
Drusen spots (yellow small spots)
125
Myotonic dystrophy presentation and mode of inheritance
Myotonia, wasting and weakness of affected muscles, mainly face and upper limbs . Slowly progressive, associated with cataracts, hypogonadism, frontal balding. Slow relaxing, eg difficulty letting go of grip.
Autosomal dominant
126
Which malaria subtype can lie dormant and how?
Plasmodium vivax ; hypnozites in the liver
127
Tumour markers:
Ca 19-9
Ca 125
Ca 15-3
Ca 19-9 ; pancreatic
Ca 125 ; ovarian
Ca 15-3 ; breast
128
Common side effects of levetiracetam
Weight changes, anorexia, GI symptoms, anxiety
129
Presentation of benign rolandic epilepsy
Children; often during sleep or before waking, parasthesia of lips, slurred speech
130
Gonococcal arthritis
Rash on palms and soles of feet with a fever and arthritis
131
Pseudo vs gout under microscope
Gout: negatively bifringent crystals
Psuedogout: positively bifringent
132
Tumours likely to metastasise to bone
```
Thyroid
Breast
Lung
Kidney
Prostate
```
133
Presentation and usual precipitatant of toxic epidermal necrolysis
Affects 30-100% of body area, skin sloughs off easily (Nikolsky sign).
Drug induced often NSAIDs, methotrexate, steroids
134
When to perform lithotripsy in renal stones?
Uncomplicated, normal renal anatomy, <1.5cm
135
Presentation of viral conjunctivitis
Viral: Serous discharge, Recent URTI, Preauricular lymph nodes
136
Treatment for wet vs dry AMD
Dry: antioxidants
Wet: anti VEGF agents
137
Shadow on the red reflex or absent red reflex
Cataracts
138
Cause of Argyll-Robertson pupils
Diabetes, syphillus
139
Causes of papilloedema
```
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
```
140
Pupils in uveitis vs acute glaucoma
Uveitis: small, fixed oval pupil
| Acute glaucoma: dilated pupil
141
Causes of chorioretinits and necessary tests?
Must do HIV test.
```
Causes
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
```
142
How do episcleritis/scleritis present, and how to distinguish between them?
Both present with red, tearing eye.
| Vessels blanch in episcleritis when phenylephrine drops are applied and is not painful, whereas scleritis IS painful
143
Presentation of optic neuritis
Pain, visual loss, loss of colour perception
RAPD and central scotoma
144
Presentation of chorioretinitis
Pizza pie appearance ; red and white retinal spots
145
Tunnel vision and night blindness?
Retinitis pigmentosa
146
Marfanoid and sudden loss of vision
Lens disclocation upwards
147
Ocular manifestations of RA
```
keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis
```
148
Keith Wagner classification of hypertensive retinopathy
Grade 1: tortuous vessels, arteriolar narrowing, silver wiring
Grade 2: AV nipping
Grade 3: cotton wool exudates, flame/blot haemorrhages
Grade 4: papilloedema
149
Conjunctivitis tx in pregnant women
Topical fusidic acid
150
definitive treatment for acute angle-closure glaucoma
Laser peripheral iridotomy
151
Reversal of dabigatran
Idarucizumab
152
First line treatment of CML
Imatinib
153
CML presentation
Massive splenomegaly
Raised WCC
Anaemia
154
Presentation of immune thrombocytopenic purpura
Petichiae, purpura, bleeding (epistaxis)
155
First line management for ITP
oral prednisolone
156
Disseminated intravascular coagulation blood test picture
- Low platelets (as consumed)
- Low fibrinogen (fibrinolysis activated)
- High PT/APTT (prolonged bleeding times)
- High DD (fibrinogen degradation product)
157
Causes of DIC
sepsis
Trauma
Malignancy
Obstetric complications
158
Antidote for heparin
Protamine sulfate
159
Adrenaline dosing from children to adults
Of 1:1000
0-6: 150mcg
6-12: 300mcg
12 - adult: 500mcg
160
Opioids in CKD patients
Alfentanil, buprenorphine and fentanyl
161
Side effects of cyclophosphamide
Haemorrhagic cystitis
162
Side effects methotrexate
Liver fibrosis, myelosuppression, lung fibrosis
163
Side effects Vincristine
Peripheral neuropathy
164
Oral codeine to morphine conversion
Oral codeine to morphine (divide by 10). Therefore, oral codeine 10mg = oral morphine 1mg.
Breakthrough dose 1/6th.
165
Side effect doxorubicin
Cardiomyopathy
166
Machine like murmur radiating to the back
PDA
167
Presentation of RCC
Flank pain, haematuria, abdo mass. Hypercalcaemia and varicocele sometimes
168
Disorder affecting nails associated with lymphoedema or pleural effusion
Yellow nail syndrome
169
CHADSVAS
CHA2 DS2 VAS
```
CXR
HTN
Age >75(2)
DM
Stroke/TIA
Vasc disease
Age 65-74
Sex female
```
170
```
STEMI leads
Inferior
Anterolateral
Anteroseptal
Anterior
Posterior
```
```
Inferior : II, III, avf
Anterolateral: I, avl, v4-6
Anteroseptal: v2-4
Anterior: v2-6
Posterior: v1-v3, recip
```
171
Lymphocytosis and neutropenia with recurrent tonsillitis
EBV
172
STEMI management re PCI
PCI within 120 mins, or primary fibrinolysis within 12 hours if PCI can’t happen within that timeframe
Unfractionated heparin as part of PCI.
173
Drug management of HTN
<55 or t2DM: A, A+C OR A+D
>55 or black: C, C+A OR C+D
Both then A+C+D
ACEIs have reduced efficacy in black people, so go for ARB instead
If treatment resistant and require a 4th drug, spiro if potassium <4.5, otherwise alpha/beta blocker
174
When would you give 3 back to back shocks?
Patient already on cardiac monitor and goes into VT/VF
175
Angina management
Beta blocker OR Rate limiting calcium channel blocker (eg diltiazem)
Do not coprescribe, consider asthma patients
176
Post MI medications
Beta blocker, ACEI, statin, aspirin, clopidogrel
177
What drug for AF and heart failure together?
Digoxin
178
When to stop ramipril re kidney function
Creatinine rise >30%
EGFR fall >25%
Swap to an ARB
179
Which artery corresponds to which MI location
Inferior - right coronary
Anteroseptal/lateral - LAD
Lateral - left circumflex
180
Hypokalaemia on ECG
Long QT and U waves
181
Tx of bradyarrythmias
If shocked - atropine IV
| If stable - transcutaneous pacing
182
Components of GRACE score
Age, troponin, renal function, blood pressure
183
Persistent ST elevation following recent MI, no chest pain
Left ventricular aneurysm
184
What drug to avoid in HOCM
ACEIs
185
Statin dosing for first time
Atorvastatin
20mg primary prevention
80mg secondary
186
Tx for VT
If stable - Amiodarone
| If not - synchronised cardioversion
187
COCP and cancer
Protects against ovarian and endometrial
Increased risk of breast and cervical
188
Post partum emergency contraception
Only 21 days post birth
| EllaOne and Levonelle both okay as both are progesterone based
189
COCP UKMEC 4 Re smoking and breastfeeding
Age > 35 and >15 cigarettes per day
Breastfeeding <6 weeks PP is UKMEC4
190
POP vs desogestrel MOA
POP ; thickens cervical mucus
| Desogestrel; inhibits ovulation
191
GDM management
BM <7: diet and exercise, if no improvement after 2 weeks, metformin
>7: insulin
192
Folic acid high risk dose and criteria
Anti epileptics, coeliac, diabetes, thalassaemia,BMI >30
5mg pre conception until w12
193
When does Downs screening happen in pregnancy
11-13+6 weeks (includes nuchal scan)
194
When does auto antibody and anaemia screening happen in pregnancy
28 weeks
195
congenital rubella triad
Sensorineural deafness, cataracts, pulmonary artery stenosis
196
HPV strains assoc with cervical cancer
16 , 18
197
Risk factors for ovarian cancers
Many ovulations, ie early menarche, late menopause, nuliparity
198
Mx of bleeding in early pregnancy
<6 weeks, expectant for threatened miscarriage if painless
>6 weeks, refer to EPAU
199
Flexural and facial psoriasis tx
Steroids
200
Keloid tx
Intralesional triamcinolone
201
Normal ABPI values
0.9-1
| Less than 0.9 suggests arterial insufficiency
202
Otitis externa, blepharitis and eczema like rash
Seborrhaeic dermatitis
203
Rosacea tx
mild/moderate: topical metronidazole
| severe/resistant: oral tetracycline
204
direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
Dermatitis herpetiformis
205
Seborrhaeic dermatitis features and treatment
peri-orbital and nasolabial scaly rash associated dandruff
| Topical ketoconazole
206
Lichen planus features
4 P’s
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over surface. Oral involvement common
207
Impetigo treatment and presentation
Golden crust lesion on lips
1st line: hydrogen peroxide
2nd line: topical fusidic acid
Flucloxacillin if severe
208
Causes of erythema multiforme,
Infections: herpes , Streptococcus, mycoplasma pneumoniae
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
disease:
SLE
sarcoidosis
malignancy
209
Onychomycosis treatment
Oral terbinafine
210
Lichen planus treatment
Topical steroids
211
Tx for capillary hemangioma
Propanolol
212
Medication to prescribe following SAH
Nimodopine to prevent vasospasm
213
Head injury, lucid interval
extradural (epidural) haematoma
214
Vasectomy failure rate and semen analysis follow up
1 in 2000
| Semen analysis at 16 and 20 weeks
215
Breast cancer referral pathway on 2WW
aged 30 and over and have an unexplained breast lump with or without PAIN or
aged 50 and over with any of the following symptoms in ONE nipple only: discharge, retraction or other changes of concern
216
CT head within 8 hours criteria
age 65 years or older
any history of bleeding or clotting disorders
dangerous mechanism of injury
more than 30 minutes' retrograde amnesia of events immediately before the head injury
217
1st line investigation for high PSA in suspected prostate cancer
Multiparametric MRI
218
Prostate cancer risk factors
increasing age
obesity
Afro-Caribbean ethnicity
family history: around 5-10% of cases have a strong family history
219
Tx for epididimoorchitis and unknown organism
IM ceftriaxone one off dose, 10 days doxycycline
220
Screening for abdominal aneurysms
One off USS at 65
221
Test of exocrine function in chronic pancreatitis
Faecal elastase
222
First and second line tx for BPH
Alpha 1 antagonists eg tamsulosin
5 alpha-reductase inhibitors e.g. finasteride (may take 6 months)
223
Anaesthetic with anti emetic properties
Propofol
224
Contraindication to donepizil
Bradycardia/sick sinus syndrome
225
Features of ankylosing spondylitis
6 As
```
Achilles tendonitis
Amyloidosis
AV node block
Aortic regurgitation
Anterior uveitis
Apical fibrosis
```
226
management of patients following a fragility fracture
>75y; bisphosphonates
| <75: DEXA first
227
Severe side effect of hydroxychloroquine
Retinopathy
228
When to avoid prescribing sulfasalazine
Aspirin allergy
| G6PD deficiency
229
Drugs that cause drug induced lupus
procainamide
| hydralazine
230
Triad of reactive arthritis and triggers
Uveitis
Arthritis
Urethritis
However not always the case. Usually precipitated by GI infection or urogenital infection
231
Likely organism to cause osteomyelitis in sickle cell disease
Non typhi salmonella
232
Tinnitus, conductive hearing loss, family hx
Otosclerosis
233
Otitis external treatment
Mild: acetic acid
Severe (discharge, deafness) : abx and steroid
234
Drugs that cause tinnitus
```
Aspirin
NSAIDS
Aminoglycosides (Gentamicin)
Furosemide
Quinine
```
235
Antibiotics treatment for otitis external in diabetics
Ciprofloxacin
236
Centor criteria
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
237
Causes of gum hypertrophy
phenytoin, ciclosporin, calcium channel blockers and AML
| PACC
238
Otitis externa in diabetics - antibiotic choice
Ciprofloxacin - cover for pseudomonas
239
Treatment of glue ear
None, allow to resolve for 6-12 weeks, UNLESS
Symptoms are significantly affecting hearing, development or education
Immediate referral in children with Downs syndrome or cleft palate
240
Smudge cells / smear cells on blood film
ALL
241
Haemophilia A is a deficiency in what factor ?
VIII - 8
242
Drugs causes colour changes to vision
Sildenafil - blue tint
| Digoxin - green/yellow tint
243
Antidote to tricyclics in overdose
IV bicarbonate
244
Adverse effects of quinolones
(Eg ciprofloxacin)
Tendon damage
Reduced seizure threshold in epilepsy
Prolonged QT interval
245
Drugs to avoid in heart failure
“They Never Give Verapamil”
Thiazolididiniones (eg pioglitazone)
NSAIDs (except low dose aspirin)
Verapamil
Glucocorticoids
246
Amiodarone monitoring
TFTs and LFTs 6 monthly
247
Sodium valproate and pioglitazone monitoring
LFTs only
248
Diclofenac contraindications
Any CVD
249
Adrenaline doses in anaphylaxis and cardiac arrest
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
| cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
250
Preciptating factors of digoxin toxicity
HypoK
Renal failure
Some drugs,eg amiodarone, diltiazem, thiazides
251
What abx to stop with statins
Macrolides eg erythromycin
252
Minimum SSRI term and tapering
6 months
4 weeks of dose reduction
253
Cotard syndrome
Belief that they are dead or rotting
254
De Clerembault syndrome
Belief that someone of higher stature is in love with them
255
Ekbom syndrome
Delusional parasitosis
256
Othello syndrome
Delusional infidelity belief
257
NSAIDs and SSRI risk
Bleeding, always co prescribe PPI
258
Atypical anti psychotics
QORCAA
```
Quetiapine
Olanzapine
Risperidone
Clozapine
Aripiprazole
Amisulpride
```
259
SSRI discontinuation symptoms
Sweating
GI symptoms
Paraesthesia
260
MOA of benzodiazepines
Enhance the effect of GABA
261
Anti psychotic risks in elderly
Stroke / VTE
262
Typical antipsychotics
Haloperidol
| Chlorpromazine
263
SSRI post myocardial infarction
Sertraline
264
Drugs to avoid in breastfeeding
```
AC LAMBS
Lithium
Benzos
Aspirin
Amiodarone
Carbimazole
Methotrexate
Sulphonylureas
```
265
First line treatment for primary dysmenorrhea
NSAIDs such as mefanemic acid
266
Hyperemesis gravidarum diagnostic criteria
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
267
Investigating infertility
> 12 months regular sex and <35
If >35, >6 months regular sex
268
When is expectant management of ectopic pregnancy indicated
Asymptomatic
No foetal heartbeat
bHCG<1000
269
Need for contraception after menopause
>50, no periods for 12 months
| <50, no periods for 24 months
270
Gestation week for:
- early scan to confirm dates
- Anaemia and auto-antibody screens
- Anti D given
- Anomaly scan
1. 10-12 (and this is often done with Down’s screening, 11wks)
2. 8 and 28
3. 28 and 34
4. 18 weeks
271
How long does Nexplanon provide protection for
12 months
272
Premature ovarian failure age
<40
273
Diagnostic thresholds for GDM
fasting glucose is >5.6 mmol/L
| 2-hour glucose is >7.8 mmol/L
274
Ménière’s disease treatment
Acute attacks: prochorperazine
| Prophylaxis: beta histine
275
Diabetes diagnosis criteria
Fasting > 7
Random > 11
Hba1c >48
If asymptomatic need 2 readings
276
Conditions causing lower than expected hba1c
Sickle cell
G6PD
Hereditary spherocytosis
277
Diabetic drugs causing fourniers gangrene
SGLT2 inhibitors
278
When to commence third line therapy or insulin in T2DM
Hba1c above 7.5
279
Impaired fasting glucose and impaired glucose tolerance definition
IFG: 6.1 to 7
IGT: 7.8 to 11.1
280
MOA and example of SLGT2 inhibitors
Dapaglifozin
| Prevent glucose reabsorption in kidneys
281
MOA and example of thiazolididiones
Pioglitazone reduces peripheral insulin resistance
282
Sulphonylurea MOA and example
Gliclazide increases insulin production
283
Gliptin MOA
reduce insulin resistance
284
Pioglitazone contraindications
Heart failure
| Bladder cancer
285
Drug causes of raised prolactin
Think of p’s
MetocloPramide
DomPeridone
Phenothiazines
HaloPeridol
286
features of RA vs OA
```
OA - LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
```
```
RA - LESS
Loss of joint space
Erosions
Soft bones (osteoporosis/osteopenia)
Soft tissue swelling
```
287
Dual antiplatelet therapy for people with acute STEMI having primary PCI
If not on anticoagulant: aspirin for life and prasugrel/ticagrelor
If already on anticoagulant/stable CAD: aspirin for life and clopidogrel
288
How to calculate osmolarity
2Na + urea + glucose
289
Calculate ion gap
Na - [HCO + CL]
290
Systematic scleroderma antibodies
Anti scl 70
291
Limited cutaneous systemic sclerosis antibodies
CREST
Anti centromere
Anti nuclear
292
Physiological changes of pregnancy
Hb and BP fall
| Everything else rises
293
Mammogram screening programme
Every 3 years 50-70
294
NSTEMI tx
1. Aspirin 300mg, if NOT FOR IMMEDIATE PCI, fondaparinux
2. Assess GRACE score
3. If <3%, ticagrelor
4. If >3% PCI & prasugrel OR ticagrelor
295
STEMI tx
1. Aspirin 300mg
2. PCI within 120 mins, give prasugrel
3. if not, thrombolyse with anti thrombin, followed by ticagrelor
296
Stroke Mx
If <4.5 hours, thrombolysis and thrombectomy
If <6 hours, thrombolysis
297
Asthma ladder <5y
1. SABA
2. SABA + 8wk trial of MODERATE dose ICS
3. SABA + low dose ICS + LTRA
4. Stop LTRA refer to specialist
298
Asthma ladder 5-16y
1. SABA
2. SABA + low dose ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA
5. SABA + low dose MART
6. SABA + high dose MART
