Postits Flashcards
(313 cards)
1
Q
Colonic angiodysplasia is…
What does it cause?
Who gets it?
A
Vascular malformation
Causes PR bleeding
Often in elderly
Usually asymptomatic
2
Q
Prerequisites for good bone healing (3)
A
Patient condition (nutrients, age, comorbidities) Minimal fracture gap Minimal movement in the break
3
Q
Wolffs law regarding bone
A
Bone will adapt to forces applied to it (remodel)
4
Q
How long until a fracture fully heals?
A
6 months typically
Dependent on other factors may take less time or more time
5
Q
Which bones tend to heal faster?
A
Generally upper limbs heal faster
6
Q
Fracture management
A
ABCDE
Reduce = bring the bone back together in an acceptable alignment Rest = hold the fracture in that position to prevent distortion of movement Rehabilitate = get function back and avoid stiffness
7
Q
What are the 4 Rs of fracture?
A
Resuscitate
Reduce
Rest
Rehabilitate
8
Q
What’s the big risk of immobility?
A
VTE
Need VTE prophylaxis!
9
Q
Conservative fracture management
A
Conservative (for minor fractures)
- Rest, ice, elevation
- Plaster cast/fibreglass or splint
- Traction (weights to keep them in a particular position)
10
Q
Surgical fracture management
A
Intramedullary nail
ORIF
External fixation = mono/biplanar, multiplanar
Arthroplasty = hemiarthroplasty, or total
11
Q
Bronchopneumonia shows what on X-ray?
A
WIDESPREAD consolidation
12
Q
Peripheral consolidation on X-ray =>
A
COVID
13
Q
Line along femur that should cross femoral epiphysis =
A
Klein’s line
Relevant in SUFE
14
Q
Line that should be smooth in pelvis, regarding hip fracture
A
Shenton’s line
15
Q
X-ray view for SUFE
A
Frogs legs view
16
Q
Features of Perthe’s disease on X-ray
A
Avascular necrosis of the femoral head
Flattening of the femoral head
Widening or reduction in joint space
Appearance of fragmentation
17
Q
Difference between golfer’s elbow and tennis elbow
A
Golfer’s elbow is inside elbow pain (medial)
Tennis elbow is outside (lateral)
18
Q
Management of tennis and golfers elbow
A
Rest
Ice
Brace
Reduce activity
19
Q
Symptoms of tennis and golfers elbow
A
Stabbing, burning pain
20
Q
Structure for presentation
A
HERID History Examination Recommended tests Investigations Differential diagnoses
21
Q
DDx of abdominal pain, think in categories
A
Viscera = appendicitis, renal colic, pyelonephritis, testicular torsion
Vascular = mesenteric ischaemia, AAA
Gynae = ectopic, ovarian cyst, saplingitis, PID
Other causes = DKA, referred pain from pneumonia
22
Q
Neonatal cause of abdominal pain and red current stool, very upset
A
Intussception
23
Q
Presentation of obstruction
A
Colicky pain
Not passed any stool or flatus
Pain may become constant
24
Q
Presentation of inflammatory abdominal pain
A
More constant pain than an obstruction
More likely going to pick it up elsewhere
25
How do you screen for IBD?
Faecal calprotectin
Sign of inflammation in the bowel
If it isn’t present, can pretty much rule out IBD
26
Signs of peritonism
Rigid abdomen
| Lying very still
27
Where does foregut pain refer to?
Epigastric/upper abdomen
28
Where does midgut pain refer to?
Umbilicus/central abdomen
29
Where might the pain from salpingitis present?
LIF, RIF
30
Supra pubic/ LIF pain in elderly most likely
Diverticulitis
31
Sign of appendicitis on urine dip
Raised leukocytes
32
Normal lactate level
Less than 1
33
Immediate manage of bowel perforation
```
Escalate to senior
NBM
Sepsis 6
Analgesia
Theatre
```
34
What can increase risk of bowel obstruction?
Previous surgery -> adhesions
35
Immediate management of volvulus
```
Escalate
NBM
Drip and suck
Consider sliding scale
CT abdomen
```
36
PEARL in ABCDE is?
Pupils even and responsive to light
37
Haustra of small bowel are called
Valvulae conniventes
38
What separates intracellular and extra cellular fluid components?
Cell membrane
39
Examples of crystalloid fluid
Sodium chloride
Hartmanns
Dextrose
40
Signs of fluid overload
Raised JVP
| Oedema (peripheral or pulmonary)
41
Signs of dehydration
Dry mucous membranes
Reduced skin turgor
Urine output
Tachycardia
42
Loss of fluid can be due to
```
Vomiting
Urine
Diuretics
Stoma
Bleeding
3rd spacing
```
43
How much potassium can you prescribe /hr
10mmol
44
How much glucose / hr?
50-100g / 24hr
45
Jobes test is also known as the .... test
Empty can test
46
Which muscle does the Jobes test assess?
Supra-spinatous
47
If Jobe's test is positive, what does this indicate?
Shoulder impingement
48
Erythasma is...
Rash under the armpits and in the groin
49
Lichun planus is...
Superficial infection
See Wickham's striae
Purple
50
Pityriasis versicolour is caused by...
Fungus
51
Pempholyx is...
Rash in the family of eczema
Tiny pustules along fingers and on feet
Resolves after a few weeks
52
Hidradenitis suppurativa is...
Issue with sebaceous glands
| Results in chronic, recurring abscesses in armpit
53
Follicular pyoderma is...
Staph infection
| Small yellow pustules
54
Bullous pemphigoid is
AI condition involving deep skin
| Get tense blisters
55
What does insulin do to ketone production?
Switches it off!
56
If osteopaenia in CKD, which drug might you give?
Alfacalcidol
Active vit D
Cant activate with shit kidneys so can't give cholecalferol
57
Patients reliant on steroids, what should you do with their dose when admitted with infection?
Double the dose
58
Hyperkalaemia management
```
C BIG K DROP
Calcium gluconate
Beta agonist
Insulin
Glucose
Dialysis/diuretics
```
59
Signs of aortic dissection
Widened mediastinum on x-ray
Severe, tearing pain
Low BP
Cold and clammy
60
Causes of radio-radial delay
Coarctation of the aorta
| Cervical rib interrupting blood flow
61
What do we use to screen for colorectal cancer?
FIT test
| Faecal immuno testing
62
Risk factors of colorectal cancer
```
Diet
Neoplasticism polyps
Alcohol
Smoking
Genetic predisposition = FAP
```
63
Presentation of colorectal cancer
Left sided => bleeding and altered bowel habit and mass
Right sided => weight loss, anaemia (iron deficiency microcytic), abdominal pain
Complications = haemorrhage, fistula, perforation
64
Bowel cancer markers
CEA (used to monitor after operation)
65
Where do colorectal cancers often spread to?
The liver
| Make sure to do a CT abdo pelvis
66
Dukes stage A
Tumour confined to the bowel but not extending beyond it
67
Dukes D is ...
Invasion of the bowel wall
68
Dukes C is...
Lymph node involvement
69
When do you do a right hemicolectomy?
Caecal tumours
Ascending tumours
You then attach the small intestine to the remaining colon
70
Left hemicolectomy procedure
Remove bit of bowel and then connect colon to colon
| Anastomoses isn’t very good
71
What is Hartmanns procedure?
Removal of some colon with the formation of a stoma and end anorectal stump that can be joined up later
72
Indications for drain insertion
To eliminate dead space
Stop build up of fluid, pus, blood, bile, serous exudate
Seen decision making in gynae surgery, try to avoid by making sure there is no internal bleeding
73
Types of drains
Open
Closed
Active
Passive
74
Passive drainage post op most likely uses which drain?
Robinsons drain
75
Drain for drainage of bile, sits in the hepatobiliary tree
Pigtail drain
76
Assessment of drain involves...
Drain site, any ooze or erythema
Fluid output, what’s coming out of it
Any blockages
Assess infection risk and when it needs to be removed
77
Symptoms of anterior uveitis
```
Blurred vision
Small pupil
Red eye
Lacrimation
Photophobia
Eye pain
```
Remember HLA-B27
78
Management of hepatic encephalopathy
```
Oral lactulose (helps reduce ammonia load by affecting gut absorption)
Rifiximin is another choice if refractory to lactulose
```
79
Signs of hepatic encephalopathy
```
Confusion
Coma
Disruption of sleep cycle
Liver flap
Altered GCS
```
80
RUQ pain radiating to shoulder tip
Cholecystitis
Subphrenic collection
Perforated duodenal ulcer
81
RUQ -> back
Biliary colic/cholecystitis
82
Central -> back pain
Pancreatitis/aorta
83
Any woman of childbearing age is having an X before proven otherwise?
Ectopic
84
3 categories of jaundice
Pre hepatic
Hepatic
Post hepatic
85
Which drug do you give alongside aspirin in NSTEMI?
Ticagrelor
86
First line treatment for Dresser's syndrome
Aspirin
87
Symptoms of poly myalgia rheumatica
Stiffness in morning around shoulders
88
Treatment of polymyalgia rheumatica
Prednisolone
89
CO poisoning causes a rise in what?
Carboxyhaemoglobin
90
Unprovoked DVT, what do you need to do after acute management?
CT to check for malignancy
91
Scaling skin over wounds =>
Psoriasis
92
What improves cranial diabetes insipidus?
Desmopressin
93
Symptoms of prolactinoma
Irregular period
Galactorrhoea
Decreased libido
94
First-line medical management of prolactinoma
Cabergoline
95
Which tube protects from aspiration?
Tracheal tube
96
Causes of hepatomegaly
Heart failure
Haemochromatosis
Liver abscess
Hepatocellular carcinoma
97
Hepatomegaly, what levels do you want to check?
LFTs
| Ferritin
98
Hepatomegaly and raised ferritin =>
Haemochromatosis
99
What type of headache can spinal anaesthetic cause?
Low-pressure headache
100
How long do you need to fast for before surgery?
6hr solids
| 2hr fluids
101
The antibody in rheumatoid arthritis
Anti-CCP
102
Cocaine-induced ACS =>
Coronary artery spasm
103
Drug to give in coronary artery spasm? Think ruptured berry aneurysm
Nifedipine
104
Malaria blood test
Thick and thin blood films
105
Symptoms of malaria
Confusion
Drowsiness
High fever
106
Cause of malaria
Plasmodium falciparum
107
4 Hs of hepatomegaly
Heart failure
Hepatic abscess
Hepatocellular carcinoma
Haemochromatosis
108
What is the treatment for severe hydronephrosis (say, due to a stone)
Nephrostomy
109
What does a nephrostomy do?
Drains the fluid from the kidney
110
What do you give in severe, sinus bradycardia?
Atropine
| It poisons the vagus nerve, reducing parasympathetic activity and raising heart rate
111
Way to remember that atropine speeds up heart rate
Atro is agro
| It poisons the vagus nerve
112
Treatment for acute gout
Naproxen = NSAID
113
Conductive hearing loss, Rinne test will show what
Louder on the pinna, because lost ability to conduct sound through air
114
Most likely, spreading cellulitis
Strep pyogenes
| Can spread because it breaks down the cell matrix using streptokinase
115
Symptoms of superficial thrombophlebitis
Swollen, hard cord in the distribution of the long saphenous vein
116
How do you check if a superficial thrombophlebitis is a DVT?
USS
117
What drug can you give for superficial thrombophlebitis?
Naproxen
118
How long does it take for a superficial thrombophlebitis to settle?
6 weeks
119
Diabetic undergoing surgery, what do you do before?
Stop sulphonyureas and gliciazide
| Make them 1st on the list to minimise fasting times (in case there are delays!)
120
Which part of the leg does the common fibular nerve innervate?
Anterior leg
121
Damage to the common peroneal nerve results in what sign?
Foot drop
122
Twitching in the arm for approx 2 mins then weak after => what type of seizure?
Partial seizure
123
Which lymph nodes do the abdominal organs drain to?
Para-aortic lymph nodes
124
Treatment of symptomatic cholecystitis
Laparoscopic cholecystectomy
125
The drug you can give in obstetric cholestasis (the main Sx of which is itching)
Ursodeoxycholic acid
126
Signs of cerebellar stroke
Prominent headache
Ataxia (because balance centre)
N+V (because balance centre!)
127
ABPI >0.5
| Venous ulcer Mx
Compression stockings
128
Localise to pain = what GCS scoring
5/6
129
Symptoms of acute, closed angle glaucoma
Hazy cornea
Blurred vision
Halos around lights
Sudden, red painful eye
130
Red-eye, small pupil, painful =>
Anterior uveitis
131
Recurrent candida can be seen in which endocrine condition?
Diabetes mellitus (because pissing out sugar)
132
Time cut off for alteplase in ischaemic stroke
<4.5hr
133
DIC platelet level on FBC
LOW
134
Which drug can you give to reduce tumour size?
Dexamethasone
135
How can you reverse warfarin?
Vitamin K IV and prothrombin complex concentrate
136
Features of nephrotic syndrome
Ankle oedema
| Low albumin
137
Ix for nephrotic syndrome
Renal biopsy
138
Which vasopressor can be given peripherally
Metraminol
139
Complications of chest drain
Insertion related = damage to nearby structures, pneumothorax, subcutaneous emphysema
Infection
Placement, e.g. it’s got kinked
140
When do you do hemiarthroplasty?
Poor baseline
| May be demented or unable to walk
141
When might you use an intramedulary nail?
Good baseline, young, Garden 1/2
142
When might you do a total hip replacement?
Good functional baseline
Young
Displaced fracture, can’t fix it with a nail
143
Example of an inotrope
Digoxin
| Dopamine
144
Examples of vasopressors
Metraminol
| Adrenaline
145
2 medications for a medical abortion
Mifepristine (clinic) + Misoprostal (home)
146
Which oesophageal condition can cause dysphagia and can be visualised and removed via endoscope
Oesophageal candidiasis
147
Mx of anterior uveitis
Topical steroids
148
Cyst that moves with the tongue
Thyroglossal cyst
149
What does the Lachmann test test for
Pull the knee forwads, see if there is an ACL injury
150
Features to classify and present a fracture
```
Which bone
Which part
Type of fracture
Simple/open
Displacement (relative to PROXIMAL fragment)
Rotation
Shortening
Bone quality
```
151
Questions to ask if you are thinking of hepatitis
Sexual history
Abdominal Sx
Cirrhosis
152
Typical pabrinex prescription
2 pairs
| 3x daily
153
Markers for acute pancreatitis
Amylase
| Lipase!
154
Pancreatic cancer, red lines on legs, what's the condition?
Migratory thrombophlebitis
155
What does cholestyramine do?
Bings to bile acids
| Reduces itching
156
What can overdose of aspirin cause?
Reyes syndrome
157
Why do you do an echocardiogram in Kawasaki?
Coronary artery aneursym
158
Features of Scarlet fever
Group A strep
Sandpaper rash
Fever
159
Kawasaki disease Mx
High dose aspirin
| IV Ig
160
Cut off for abortion (not due to risk to mother)
24 weeks
161
Mx of acute flare in UC
IV hydrocortisone
162
Long standing rash
Lymphadenopathy
Peeling hands and feet
Kawasaki
163
Additional questions to ask in abortion Hx
```
Contraception
Normal Hx aswell
Sexual Hx
Ectopic stuff
SH
```
164
Mx of acute- severe asthma
Nebulised salbutamol
Ipratropium bromide
Oral prednisolone
(IV if refractory)
165
When might you use amiodarone?
Anti-arrhythmic drug
166
How does eclampsia cause seizures?
You are leaky everywhere
The abdominal pain is fluid causing the liver capsule to stretch
Cerebral oedema causes the seizures
167
What neurological assessment should you do in eclampsia?
Clonus
Looking for UMN signs
Reflexes
168
Drug for pre-eclampsia
Labetalol
169
Blood pressure cut off for pre-eclampsia
140
170
Urinary tests for pre-eclampsia
Protein
| PCR 30< (confirms pre-eclampsia)
171
Mx of large pneumothorax or secondary
Chest drain
172
Which types of jaundice cause itching?
Hepatic and post hepatic
173
In a woman, what test should you always consider doing?
Pregnancy test
174
When should you not use a nasopharyngeal tube?
Basal skull fracture
175
Features of Colles fracture
FOOSH
Osteoporosis RF
Dorsal displacement of the distal radius
176
Important things to check with arm fractures
Neurovascular involvement
177
Which bone is the radius?
Thumb side forearm bone
178
Mneumonic for suicide risk
```
HIRMS
Hope
Intention
Risk
MSE
Support network
```
179
Whats an important place to ask about regarding paediatrics?
How school is going
180
Causes of epigastric pain in categories
```
Gastric = ulcer, gastritis
Pancreas = pancreatitis
Intestinal = appendicitis, obstruction, colitis
Biliary = gallstones, cholecystitis, ascending cholangitis
```
181
Drug to treat oesophageal candidiasis
Nystatin
182
Risk factors of breast cancer
```
2 first degree relatives or 1 young close relative with breast cancer or if they had bilateral cancer or a male affected in the family
Ovarian cancer
Jewish ancestry
Increased age
BRCA mutation
```
183
Things that decrease breast cancer risk
Pregnancy
Breastfeeding
Use of oral contraceptives
184
Chance of detecting a cancer with screening and follow up tests
1%
185
Which radiograph do you use for younger people for screening for breast cancer?
USS
186
Popcorn calcification is a feature of which breast mass?
Calcified fibroadenoma
187
Micro calcifications in the ducts on breast mammogram =>
Breast carcinoma
188
Causes of high stoma output
New stoma
Short bowel syndrome
Sepsis
Prokinetics
189
Risk factors of AAA surgery (categorise)
Immediate = blood loss, anaesthetic issues
Intermediate = sepsis
Long term = DVT
190
Which diagnosis do you always have to remember when reporting flank pain?
AAA!
191
What is shock?
Inability to perfuse body’s tissues
192
Hypovolaemic shock, which 4 compartments do you need to check for loss of blood?
Chest
Abdo
Long bones
On the floor
193
Type of scan you can do quickly to determine if there is free fluid/bleeding?
FAST scan
194
Signs of hypovolaemic shock
```
Hypotension
Tachycardia
Pallor
Weak thready pulse
Pallor
Reduced urine output
```
195
What medications can you give to improve hypovolaemic shock?
Fluids
| Vasopressors (but can cause peripheral tissue ischaemia because pushing all the fluid centrally)
196
Average age of menopause
51
197
Drug for breast cancer, oestrogen sensitive in post-menopausal women
Anastrozole
198
FNA or core needle biopsy for histology sample?
Core needle biopsy
199
Fast growing, smooth lump in breast in elderly
Phyllodes tumour
200
Painful breast in lactating woman, no mass just tenderness. Fever.
Peuperal mastitis
| Local inflammation due to ascending infection through crack in nipple
201
HER2 positive drug treatment for breast cancer
Trastuzumab (herceptin)
202
Pulmonary oedema, tense swelling in legs, breathless, having chemotherapy for breast cancer, what’s the likely drug culprit?
Herceptin
| Cardiotoxic
203
Triad of acute liver failure
New onset jaundice
Coagulopathy (INR >1.5)
Encephalopathy
204
Causes of vitamin B12 deficiency
Pernicious anaemia
Zollinger Ellison syndrome
Terminal ileum resection
Chronic severe gastritis
205
Long term management of pernicious anaemia
Cobalamin
206
What is Whipple’s disease?
Rare, systemic disease caused by tropheryma whipplei
Diarrhoea
Abdo pain
Joint pain
Diagnosed with bowel biopsy -> presence of acid-schifff macrophages
207
Treatment of hepatic encephalopathy
Oral lactulose
| Reduced ammonia production
208
Painful ascites and unwell implies
Spontaneous bacterial peritonitis
209
Treatment of cholera
Effective rehydration
| Potentially doxycycline
210
Long term UC management (distal rectal disease)
Mesalazine suppository
211
Triad of nephrotic syndrome, with values
Hypoalbuminaemia (<30g)
Proteinuria (3.5g25hr)
Oedema
212
Mx of child with nephrotic syndrome
Refer to renal
| Prednisolone treatment
213
What is the only acceptable form of contraception in women with active breast cancer?
IUD
214
Woman doing lots of planks at the gym, now got a painful lump on her elbow, not tender to touch
Olecranon bursitis
215
Mx of olecranon bursitis
Ice
Rest
Anti-inflammatories
216
At what time in the cycle does ovulation occur
Halfway
| Say day 14 of 28
217
Symptoms of coeliac disease
```
Loose smelly stools
Bloating
Abdo pain
Hx/FH of autoimmune disease
Failure to thrive
```
218
Gene linked with coeliac disease
HLA DQ2
219
Complications of coeliac disease
Osteoporosis
| MALT
220
Why shouldn't you use an IUD in active chlamydia infection?
Can result in an ascending infection (PID)
221
Drug treatment for benign prostatic hyperplasia
Tamsulosin
222
Antibiotic for cellulitis in penicillin allergic
Cephalosporin e.g. clindamycin
223
48 years old, last period 12 months ago, contraception advice
IUD for 1 year
| Need 2 years of no periods if under 50yo
224
Hx of breast cancer, which contraceptive to prescribe
IUD
225
Someone has forgotten to take their POP for 4 hours, what do you advise?
Take the pill, continue as normal, condoms for 2 days
226
Patient on methotrexate, encountered patient with chickenpox 2 days ago, what do you do?
Give VZIG
227
Key differences between GPA, Churg-strauss and Goodpastures disease
GPA: URT involvement (epistaxis)
Churg-Strauss: More of an asthma picture with sinusitis
Good pastures: More respiratory (pulmonary haemorrhage + haematuria)
228
Causes of proximal myopathy
```
PEACH PODS
Polymyositis
Endocrine
Alcohol
Carcinoma
HIV
```
Osteomalacia
Drugs (statins)
Steroids and sarcoidosis
229
Features of polymyositis
Proximal muscle weakness with no pain or stiffness or skin involvement
230
Which marker is raised in polymyositis
CK
231
Dermatomyositis and polymyositis turn your muscles to CLAA mneumonic for blood tests to order stands for...
CK
Lactate dehydrogenase
ALT
AST
232
Best NSAID to use in GI bleed (should be avoiding, but in case they really need it)
Celocoxib
These are COX-2 inhibitors
DONT use in IHD
233
Which medication, used in rheumatoid arthritis alongside methotrexate can cause loss of colour vision
Hydroxychlorquine
| Stop it immediately at the first signs of damage
234
Mx of temporal arteritis
1mg/kg oral prednisolone for 4 weeks then slowly taper off for 6 months
235
Why do you taper steroids very slowly in temporal arteritis?
High risk of recurrence
236
What type of vaccine is contraindicated in methotrexate Mx?
Live vaccines
| e.g. yellow fever
237
Features of chronic fatigue syndrome
Persistent disabling fatigue
May have on and off flu symptoms
Tired all the time, lots of naps
May have muscle aches (difficult to determine between this and fibromyalgia often)
238
Pyoderma gangrenosum is associated with...
IBD (usually UC)
239
Complications of septic arthritis
Immediate: Sepsis, loss of limb, osteomyelitis
| Long term: Arthritis, removal of replacement joint
240
Triad of Felty's syndrome
Rheumatoid arthritis
Enlarged spleen
Neutropaenia (can lead to infection!)
241
SANTA features of Felty's syndrome
```
Splenomegaly
Arthritis
Neutropaenia
Thrombocytopaenia
Anaemia
```
242
Scoring system for hypermobility
Beighton
243
X-ray features of psoriatic arthritis
Loss of joint space
Pencil in cup deformity
Bone erosions
Arthritis mutilans
244
Mx of psoriatic arthritis
Treatment is conservative at first with local steroid injections and NSAIDs, but most require regular immunosuppression with methotrexate, and increasingly novel biologics
245
Pain in ankle
Recent chemotherapy
Chronic kidney disease
DDx?
GOUT
Septic arthritis
Trauma
Pseudogout
246
What is an obturator hernia?
Abdominal contents herniate through the obturator canal (the hole in the pelvis)
On PR may feel a mass in the upper lateral region
Symptoms of bowel obstruction
Parasthesia down the medial thigh because the obturator nerve is impacted
247
Most common site of occlusion in mesenteric ischaemia
Superior mesenteric artery
248
Acute rectal bleeding, with no pain DDx
```
Meckel's
Ischaemic colitis (due to tissue necrosis)
```
249
Alcohol is a risk factor to developing which type of oesophageal cancer?
SCC?
250
What is malignant hyperthermia?
Hyperthermia triggered by anaesthetics
Often caused by an autosomal dominant mutation in ryanodine receptor 1
Patient may have a very rigid abdomen
251
How much of the bodies surface area does each leg count for?
18%
252
Complications of venous ulcers
Immobility
Osteomyelitis
Infection and sepsis
253
Mx of venous ulcers
```
Lifestyle advice
Keep ulcer clean
Encourage mobility
Weight reduction
Leg elevation at rest
Emollient treatment of the leg
```
Compression bandaging - aimed at improving venous return from the leg
Patients must have an ABPI to exclude co-commitment arterial disease as bandaging will worsen arterial supply to the leg.
Surgery – not usually necessary
Debridement
Skin grafting
254
Flatulence related to fatty meals
Indigestion
Abdominal pain
Long-standing
Chronic cholecystitis
255
How long do you give nitrofurantoin for in pregnancy?
7 days
256
Management of intussception
Rectal air insufflation or contrast enema (only to be performed if child is stable)
Operative reduction indicated if:
Failure of non-operative management
Peritonitis or perforation is present
Haemodynamically unstable
257
Painless scrotal lump, can still palpate testis, transilluminates
Epididymal cyst
258
Fluid requirement in cardiac disease
25ml/kg/day
259
Drug treatment of delirium
Low dose haloperidol
260
Myasthenic crisis, what do you want to measure?
FVC with spirometry
261
What might the PR interval being prolonged indicate in infective endocarditis?
It's a poor prognostic marker
Indicates greater mortality
This is because it's associated with an aortic root abscess
262
What is Waterhouse-Freidrichson syndrome?
Waterhouse-Friderichsen's syndrome is caused by a severe bacterial infection which results in disseminated intravascular coagulation and subsequent adrenal haemorrhage and failure.
263
Investigations for bladder cancer
Urine dip
Flexible cytoscopy
Histological sampling
CT urogram
264
Features of pseudobulbar palsy
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UMN signs
Dysphagia
Difficulty with speech
Small stuff tongue
Exaggerated gag reflex
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265
Features of bulbar palsy
LMN signs
Absent gag reflex
Floppy tongue because hypotonia
266
Features of femoral nerve damage
Loss of sensation to front of thigh and medial leg
| Absent knee jerk
267
Operation for a Achalasia
Heller myotomy
268
Whenever the patient doesn’t eat for a while they get dizzy and agitated. Gained a lot of weight recently. Ix and Dx
C peptide levels
| Insulinoma
269
What is a myxoedema coma?
Extremely low levels of thyroxine
| Low BP low HR and temperature
270
Jaundiced gentleman with distended abdomen and prominent abdominal veins. Most likely cause =
Alcoholic liver disease
271
Rx for hypospadias
Surgical correction
272
Features of a Monteggia fracture
Ulna fracture
| Radial displacement
273
Features of Galazzi fracture
Radial fracture
| Ulna displacement
274
Features of bowel obstruction
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Abdominal pain
Vomiting
Not passing stool
Tinkly bowel sounds
Distended abdomen
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275
What is proctalgia fugax?
Stabbing anal pain
276
Features of a pantaloon hernia
2 parts
| Straddles the inferior epigastric artery
277
If unconscious what type of breathing tube is needed?
Endotracheal tube
The others are for partially conscious/impaired consciousness.
If unconscious they will not be able to maintain their airway!
Get an endotracheal tube down
278
What Ix for a psoas abscess?
Abdominal MRI
279
Ix for ectopic
B-Hcg
| TVUSS
280
Sx of ectopic
Amennorhoea
Abdominal pain
Spotting
Shoulder tip pain
281
Sudden onset knee pain and swelling
Pt complains of the knee ‘locking’
Dx & Mx
Osteochondritis dissecans
A fragment of bone is stuck in the knee, ouch
Need key hole surgery to remove it
282
What is the pathophysiology of Osgood Schlatter disease?
Repeated rubbing of the patella tendon across the knee growth plate
That’s why you see it in young athletes!
283
What is chondromalacia patellae?
Chronic overuse of knee leads to damage and inflammation to the underside of the patella (the cartilage)
It becomes rough and painful to move across the cartilage
In short, damage to the cartilage underneath the patella
284
Which 3 components to breast lump triple assessment
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Examination
Scan (USS in young women, mammography for older)
FNA/core biopsy
Core biopsy for histology
FNA for cytology
```
285
What is Cushing’s disease?
ACTH secreting tumour in the pituitary
286
Pt up who had Cushing’s syndrome had their adrenals removed, but now they have darkening skin and high BP
Dx?
Nelsons syndrome
The original cause for their Cushing’s was an ACTH secreting tumour
Now that the negative feedback is gone, it has grown loads and is making loads of ACTH hence the tanning (like Addison's disease)
287
Symptoms of Conn’s syndrome
```
Excessive thirst.
Fatigue.
Frequent urination.
Headache.
Muscle cramps.
Visual disturbances.
Weakness or tingling
```
All caused by excess aldosterone
288
Surgical procedure for rectal tumours
Abdominoperineal resection
289
Mx of colorectal cancer
```
MDT
Staging
Radiotherapy
Chemotherapy
Surgery and potential stoma
```
290
Features of an incarcerated hernia
Painless and persistent
291
Features of a strangulated hernia
Twisted around blood supply
Painful
May have signs of bowel obstruction
292
Fleshy, rubbery lesions, often on torso
| When you touch them they tingle
Neurofibromas
293
Which type of neurofibromatosis is more related to cutaneous issues?
1
| Treeman is number 1!
294
Which movements are performed by each of the arm nerves
```
Radial = extend at wrist
Median = scout sign
Ulna = abduct fingers
```
295
Which nerve does a humeral fracture often damage?
Radial nerve
296
What is the difference between a radial nerve injury and a posterior interosseous nerve injury?
Both cause wrist drop
No sensation loss in posterior interosseous injury
Still have sensation on back of thumb and scaphoid. Wouldn’t in radial injury.
297
What is a pleomorphic adenoma?
Hard lump on jaw angle
Painless
NO FACIAL NERVE INVOLVEMENT
298
What is the pathology and presentation of an acoustic neuroma?
Benign tumour of the Schwann cells of the vestibular cochlear nerve
May have facial nerve involvement
Sensorineural hearing loss and facial tingling
299
Which type of hearing loss do you get in otosclerosis?
Conductive hearing loss
| Because the stapes (middle ear) is fixed
300
Features of splenic injury
Elevated left diaphragm
LUQP
Guarding
301
Which bacteria are encapsulated?
Meningococcus
| Pneumococcus
302
Symptoms of salivary gland calculus
Swelling and pain on eating
303
Management of SUFE
Surgery with screw, potentially the other side as well
304
Features of incisional hernia
Late complication of abdominal surgery
| Usually managed conservatively if stable
305
What Ix should you consider for ulcers?
USS Doppler
Need a skilled operator but can determine if there is a deep vein issue that may benefit from surgery (can often really benefit)
306
What is erysipelas?
Superficial streptococcal infection
307
Mx of erysipelas
IV antibiotics to avoid cellulitis and sepsis
308
What is paronychia?
Infection of the nail
309
Mx of paronychia
Antiseptic cream
| If gets big, need to cut and drain it (seen in A&E)
310
What should you do for a Dupytrens that is interrupting function?
Operate
311
Causes of Dupytrens contracture
Liver disease
Anti epileptics
Peyronie disease
312
How long do upper limb fractures take to heal?
6-8weeks
313
Factors that affect healing
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Body habitus
Blood supply
Drugs
Diabetes
Steroid use
```
