Revision Flashcards
(559 cards)
1
Q
when should you never prescribe the combined oral contraceptive pill
A
FHx of thrombophilia
2
Q
when should you never prescribe doxycycline
A
if patient< 12
3
Q
what condition should you consider before prescribing furosemide
A
gout
4
Q
what condition should you consider before prescribing an NSAID
A
hypertension
5
Q
what should you consider before considering prochlorperazine
A
if patient pregnant
6
Q
when should you not prescribe naproxen
A
if patient on warfarin- increased risk of GI bleeding
7
Q
when in pregnancy is trimethoprim contraindicated
A
first trimester- folate antagonist
8
Q
what antibiotic is first line for UTI in pregnancy
A
nitrofuratoin
9
Q
give examples drugs you should monitor (4)
A
ACEi (BP, renal function, electrolytes)
warfarin
DMARDs
chemotherapy
10
Q
how long is exclusive breastfeeding recommended for
A
first 6 months
11
Q
what supplements should babies get
A
vit d from birth (not if on formula)
vit A,C and D from 6 months
12
Q
what BMI decile would mean a child is overweight
A
> 91st
98th obese
99.6th clinically obese
13
Q
what is the treatment for a baby with a suspected cows milk intolerance
A
2-4week lactose exclusion with extensively hydrolysed infant formula followed by a reintroduction of cows milk (if symptoms return then confirms diagnosis)
14
Q
what condition is dermatitis herpetiformis associated with
A
coeliac disease
15
Q
what percentage weight loss is recommended for BMIs of 25-35
A
5-10%
>35 15-20%
16
Q
what does an insulin ratio mean
A
insulin to carb
e.g. 1:10 will need 1 unit for 10g of CHO
17
Q
should T1DM patients carb count alcohol
A
no as increased risk of hypo following consumption of alcohol
18
Q
does high fibre reduce CVD risk
A
yes
19
Q
how does fibre reduce colon cancer risk
A
fibre fermentation creates short chain fatty acids which have anti-proliferative effect
20
Q
what GI condition can exclusive enteral nutrition induce remission
A
crohns disease in paediatric patient
21
Q
what is parenteral nutrition
A
the provision of all nutrients, fluids and electrolytes directly into a central or peripheral vein (indicated for an inadequate or unsafe oral and/or enteral nutritional intake or a no functional inaccessible or perforated GI tract.
22
Q
what are the red flags for spinal pain
A
thoracic pain fever and unexpected weight loss bladder of bowel dysfunction ill health/ presence of other medical illness progressive neurological deficit disturbed gait, saddle anaesthesia age of onset <20 or >55
23
Q
what are the yellow flags of pain
A
psychosocial factors shown to be indicative of long term chronicity and disability (predictors of response to treatment)
- negative attitude that back pain is harmful or potentially severely disabling
- fear avoidance behaviour and reduced activity levels
- expectation that passive treatment will be beneficial rather than active treatment
- tendency to depression, low morale, and social withdrawal
- social or financial problems
- compensation issues
24
Q
what are the reds flags for cauda equina
A
bilateral sciatica
severe/ progressive neurological deficit of the legs (major weakness)
difficulty initiating micturition or impaired sensation of urinary flow- may lead to irreversible retention with overflow incontinence
loss of sensation of rectal fullness- may lead to reversible faecal incontinence
perianal, perineal or genital sensory loss (saddle anaesthesia/ paraesthesia)
laxity of anal sphincter
25
what are the red flags for a spinal fracture
sudden onset severe central spinal pain which is relieved by lying down
Hx of trauma/ strenuous lifting in people with osteoporosis/ corticosteroid users
structural deformity
point tenderness
26
what are the red flags for cancer associated spinal pain
>55y/o
gradual onset of symptoms
severe unremitting paint hat remains when supine, aching night pain that prevents/ disturbs sleep and aggravated by straining
thoracic pain
localised tenderness
no symptomatic improvement after four-six weeks of conservative low back pain therapy
unexplained weight loss
PHx of cancer (esp breast, lung, prostate, GI, renal, thryoid)
27
what are the red flags for infection associated back pain
```
fever
TB
recent UTI
diabetes
Hv of IVDU
HIV infection
immunosuppressants
```
28
what are the trigger words for neuropathic pain
```
shooting
numb
stabbing
electric feel pain
tingling
burning
traditional pain killers don't help emotional impact
```
29
what is anticholinergic syndrome
when antocholinergic drugs (e.g. amitriptyline) blocks M3 muscarinic receptors (parasympathic nervous system) causing anorexia, blurry vision, constipation/ confusion, dry mouth, sedation/ stasis of urine, drowsiness and QT prolongation
30
what dosing technique should you use with anticholinergic drugs
start low go slow and be aware of side effects
| dont use post MI or in the manic stage of BPAD
31
when is creatine most effective in showing kidney function
when patient underweight or elderly
32
what BP medication can cause a cough
ACEi (e.g. lisinopril- increases bradykinin levels)
33
name a side effect of amlodipine
ankle swelling
34
what is edoxaban
anti-coagulant: inhibits factor 10a
| prescribed based on patient weight
35
what is a coagulopathy
tendency to bleed due to inability to coagulate blood
36
doacs vs warfarin go
doacs cause less major bleeds, dont need monitoring and have faster onset
but cant be reversed unlike warfarin (vit K) and cant be given to patients with mechanical heart valves
37
name the doacs
dabigatran
apixaban
edoxaban
rivoroxaban
38
what is leucopenia
reduction in leukocytes (WBC)
39
what happens when steroids are stopped too quickly
adrenal insufficiency/ crisis
40
how is gentamicin given
IV only
41
how could you clinically differentiate intracranial heamorrhages
subdural- subclinical, slow deterioration
extradural- lucid period, quick deterioration
subarachnoid- thunderclap headache
42
treatment pathway asthma
SABA as required
consider low dose ICS to diagnose- if helps symptoms prescribe as regular
if >3 times a week use of SABA or disturbing sleep add in LABA to ICS and SABA
increase ICS or add LTRA
43
when should you do peak flow
3-4x a day to look for diurnal variation, low value usually in morning, cough at night
44
can you give SAMA and LAMA at the same time
no
45
how many puff of salbutamol should you take in suspected asthma attack
10
46
what does PRHrP released by Sqclc cause
hypercalcaemia with normal PTH
47
what can pancoast tumour cause
SVC syndrome, horners, vocal cord palsy (recurrent larhyngeal nerve)
48
how long should you give DOACs in DVTS
provoked- 3 months
unprovoked 6 months
more than 2 unprovoked lifelong
if renal impairement give LMWH
49
what scoring system for DVT and PE
wells score (>2 DVT >4 PE)
50
Tx for PE
calculate wells score (if <4 do d dimer, if +ve immediate CTPA)
if >4 admit for CTPA with interim DOAC if needed
if unstable unfractionated heparin and thrombolysis (alteplase/ streptokinase)
if stable CTPA and DOAC
continue anticoagulation for at least 3 months (DOAC)
51
what are the features of horners
anhidrosis
ptosis
miosis
52
what is in the paediatric sepsis 6
give high flow oxygen
obtain IV or IO access for: blood cultures, blood glucose (treat if low), blood lactate/ gas
give IV/IO abx
if shocked
fluid resus
consider early inotropic support
involve seniors early
53
how should you start child CPR
5 rescue breaths then 15 to 2
54
what drugs do you stop in AKIs
nephrotoxics- ACEi, ARBs, NSAIDs, aminoglycosides (gent, -micins)
drugs that increase comps: duiretics, metformin, anti-hypertensives
55
what are the indications for anticoagulants
venous thrombosis, AF, prophylaxis
56
what factors is def the haemophilias
a- 8
| b- 9
57
what does APPT measure and what raises it
```
intrinsic system (8+9)
raised in heparin, haemophilias, DIC and liver dissease
```
58
what does PT measure and what raises it
extrinsic (2,7)
measured as INR (0.9-1.2)
raised by warfarin, vit k def, liver disease and DIC
59
what is the anticoagulation after DVT or PE
offer apixaban or rivaroxaban for at least 3 months
if provoking factor no longer presence can stop after 3
if active cancer 6 months
if unprovoked or risk factors remain then calculate has bled score (stop anticoag if >4) and chadvasc score if risk of stroke to decide on lifelong anticoagulation
60
what drugs should be stopped before surgery
acei, arbs
nsaids,
warfarin 5 days before (INR<1.5)
DOACS- 24hrs if low risk, 48hrs if high bleeding- dont stop if op no bleeding risk)
all diabetic meds (except long acting insulin)
contraceptive pill and HRT if major op
61
what antiemetics are best post op
5HT3 receptor antagonists (odansetron)
dexamethasone, prochlorperazine
Cyclizine for opioid nausea
62
what antiemetic is best for chemo
ondansetron
| dexamethasone
63
what antiemetics for motion sickness
cyclizine
hyoscine hydobromide
promethazine (sedating)
64
what are mild opioids
codeine
| dihydrocodeine
65
what are strong opioids
morphine
| oxycodone
66
what score for DVT
wells (calculate before doing dimer)
if 2 or more DVT likely do USS then d dimer if that is negative. if cant to USS in 4 hours do d dimer then intermin coagulation.
if d dimer +ve scan negative stop any interim coag and repeat USS in a week
if wells score 1 or less DVT unlikely do a d dimer, if thats +ve do USS
67
what score for PE
wells
>4 PE likely do CTPA, if CI offer anticoagulation
if 4 or less do d dimer, if positive do CTPA
68
what anticoagulation for DVT and PE
apixaban or rivaroxaban
| if APS or renal impairment LMWH
69
what is acute cholecystitis
impaction of stone in neck of gallbladder
| continuous RUQ/ epigastric pain, fever, vomiting, murphys sign positive
70
what causes biliary colic, how is it different to acute cholecystitis
cause by stone in cystic duct or common bile duct
| doesnt have inflammatory component to cholecystitis (local peritonism, fever, increased WCC)
71
what are the features of chronic cholecystitis
chronic inflammation + colic
flatulent dyspepsia, nausea, distension, fat intolerance
treatment- cholecystectomy
72
what is ascending cholangitis
infection of bile duct
73
what are the features of ascending cholangitis
RUQ, fever and jaundice
rigors
tx- piperacillin, tazobactm
74
when is ERCP used
common bile duct clearance- stone in CBD
75
when should you consider antibiotics in sinusitis
when symptoms lasting for >10 days or symptoms of bacterial infection (purulent discharge, severe pain, fever) or systemically unwell
76
what is the centor criteria
```
tonsilitis: 3 or more bacterial
fever
anterior cervincal tender nodes
no cough
tonsilar exudates
```
77
what are the urgent referalls for red eye
acute closed angle glaucoma
anterior uvetitis
scleritis
acute iritis
78
what causes of red eye also cause decreased visual acuity
acute glaucoma
| anterior uveitis
79
what cause of red eye causes painful eye movements
scleritis
80
what is the pupil like in anterior uveitis
small, may have synechiae which distort pupil via adhesions
81
how do you diagnose ant uveitis
slit lamp- leukocytes in anterior chamber
82
what is the uvea
iris, cillary body, choroid
83
what is the eye like in acute angle closure glaucoma
hard, fixed dilated pupil, hazy cornea
84
what is the treatment for acute angle closed glaucoma
urgent referal, avoid darkness (dilates pupil more)
beta blocker (timolol) - decreases aqeous production
pilocarpine- constricts pupil, opens angle
IV acetazolamide- decreases aqueous production
analgesia, antiemetic
once IOP controlled peripheral iridectomy
85
treatment for herpes simplex corneal ulcer
aciclovir (NOT steroids as this causes full thickness involvement)
86
treatment for GCA
40mg
if visual involvement 60mg pred
tapered over a year,
87
what is the treatment for optic neuritis
high dose methylpred for 72 hours then pred for 11 days
88
white retina W/ cherry red spot=?
central retinal artery occlusion
89
tx for crao
occular massage, surgical removal of aqueous, treat RF
90
signs of CRVO
dot and flame haemorrhages
cotton wool spots
macular oedema
swelling of optic disc
91
treatment for open angle glaucoma
prostaglandins, pilocapine, sympathetmetics, trabeculoplasty: latanoprost increase outflow
beta blockers, alpha adrenergics (-nidine), carbonic anhydrase (azetazolamide)- decrease aqueous production
92
normal IOP
<21
93
what biochemical signs does pagets have
isolated rise of ALP
94
treatment for psoriasis
potent steroid + vit d once daily 4 weeks
vit d twice daily 8-12 weeks
potent steroid + vit d 2x daily/ coal tar
v potent
dithranol, phototherapy (PUVA), systemic tx (methotrexate, ciclosporin, acritrenin (oral retinoid), biologics)
(if face, flexures or genitals use mild-mod steroid)
95
list steroids mild to mod
hydrocortisone
betnovate
dermovate
96
acne treatment
mild: topical retinoid (adapalene, tretinoin) or BP or clindamycin
mod: combo of 2 of above, oral abx (doxy, tetra, erythrcycline) with topical BP
severe: isotretoin
97
treatment for rosacea
avoid sun and alcohol, soap substitutes
mild- topical metronidazole or azelaic acid
mod to severe: oral tetra- doxycycline, isotretinoin
lasers
98
what laxative for hard stools
osmotic- lactulose, laxido
| softeners- docusate
99
what laxatives for stimulant issue
senna
100
what can be used to reduce ammonia is hepatic encephaopathy
lactulose
101
how do you take bisphosphonates
on empty stomach, sit up for thirty minutes
102
convert 40mg of oxycodone to morphine
80mg morphine
| oxycodone is 2 times as potent as morphine, need to divide the daily dose of morphine by 2 to get oxycodone dose
103
daily dose of 120mg morphine, how much is breakthrough dose
20mg
| breakthrough dose is 1/6th daily dose
104
what type of infusion is a syringe driver
subcut
105
500mg of morphine oral, covert this to subcut morphine
250mg
| divide oral doses by 2 to get subcut doses
106
what electrolyte abnormality do PPIs cause
hyponatraemia
107
what should you prescribe is someone who is diabetic with proteinuria
ACEi
108
anticholinergic side effects
constipation, dry mouth, dry eyes, blurred vision, urinary retention, tachycardia, cog impairment, falls
109
examples of anticholinergic drugs
oxybutin, ipatopium, tolteridine, amitriptyline
110
what electrolyte imbalance can thiazides cause
hyponatraemia
111
what electrolyte imbalance can SSRIs cause
hyponatraemia
112
what drugs for acute confusion
haloperidol
| if alcohol withdrawal benzos long acting: chlordiazepoxide
113
how long is an emergency detention and who can authorise it
72 hrs
fy2 and above
does not authorise tx, no right of appeal
114
how long is a short term detention, what does it allow and who can do it
28 days
assessment and treatment
approved mental practitioner and MHO
right of appeal
115
how long is a compulsory treatment order, what does it allow and who can authorise it
6 months
one medical practitioner, one MHO then report from 2 independent doctors (2x AMP or AMP + GP) who make care plan
mandatory tribunal
reviewed at 6 months, right to appeal
116
what does bronchial breathing suggest
consolidation or fibrosis
117
what electrolyte abnormalities happen in refeeding syndrome
hypophosphataemia (rhabdomyolysis, leucocyte dysfunction, respiratory failure, cardiac failure, hypotension, arrhythmias, seizures, coma, and sudden death)
hypomagnesium and hypopotassium
118
what order should you replace calcium and phosphate
| and magnesium and potassium
replace calcium before phosphate (or will cause hypocalcaemia)
replace magnesium before potassium as potassium needs calcium to go up
119
what is HHS
hyperosmolar hyperglycaemic state
happens in type 2
presents with polydipsia, polyuria, dry, shock, acute cos impairment
hyperglycaemia, hyper serum osmolality, volume depletion
NO KETOACIDOSIS
120
treatment for HHS
IV fluids with potassium replacement
insulin
thromboprophylaxis
121
treatment for alzheimers
anticholinesterase inhibitors: donepezil, rivastigamine, galantamine
memantine (NMDA antagonist) in late stage
antipsychotics
122
what medications for incontinence should you avoid in eldery
tolterodine and oxybutin
| use mirabegron
123
management for parkinsons
avoid levodopa as long as possible
DA ropinirole and pramipexole
antichoingerics in young, MAO-B inhibitors (-giline)
levodopa- given as co-beneldopa or co-careldopa to prevent nause and vomiting
124
what are the signs of spinal cord compression
pain: in spine, worse on straining, radicular (band like burning e.g. around rib cage, precedes weakness)
weakness: bi or unilateral
altered sensation: proprioception, light tough
urinary problems: retention
bowel problems: constipation
125
Ix for Spinal cord compression
urgent MRI of spine
126
Treatment for spinal cord compression
16mg IV dexamethaxone, followed by 8mg po bd (to reduce vasogenic oedema)
radiotherapy mainstay of tx
surgery if appropriate
chemo
127
if you suspect spinal cord compression what should you do
arrange urgent MRI and start dexamethasone 8mg bd
128
radicular pain= ?
cord compression
129
symptoms of superior vena cava obstruction
```
swelling of face, neck, one or both arms
distended veins
SOB
HA
lethargy
late- injected conjunctiva, sedation
```
130
Ix for SVC obstruction
cxr- is there a mass/ foreign body
venogram- is there a clot
CT chest
131
treatment for SVC obstruction
clot- thrombolysis with alteplase, anticoagulation (LMWH, warfarin)
extrinsic compression- steroids, chemo, radio, stent
132
what side of lung tumour causes SVC obstruction
right
133
what can cause hypercalcaemia in cancer pt
humoural (PTHrP)
bone destruction
tumour production of vit D (lymphomas)
134
symptoms of hypercalcaemia
```
nausea, anorexia
thirsty
polydipsia, polyuria
constipated
confused
poor concentration, drowsy
```
135
Ix for hypercalcaemia
U+Es to look for dehydration
phosphate (low in hyperparathryoidism)
if no known malignancy myeloma screen
136
ts for hypercalcaemia
rehydrate first - several L of saline
| bisphosphonates (pamidronate after rehydrated)
137
symptoms + signs of cardiac tamponade
SOB
fatigue, palpitations, pericarditis (chest pain improved by sitting forward), symptoms of advanced cancer
JVP distention, pulsus paradoxus (fall in pressure during inspiration), soft heart sounds/ pericardial rub, tachycardia with low BP
138
IX for tamponade
CXR
ECG
echo (rim of pericardial fluid)
cytology of fluid
139
tx for tamponade
pericadiocentesis
| pericardial window
140
does perciardial tamponade cause systolic or diastolic heart failure
diastolic
141
what is neutropenic sepsis
sepsis in a patient with a neutrophil count less than 0.5 or <1 in cancer patients or who have had chemo in the last 21 days
142
tx for neutropenic sepsis
antibiotics within 1 hr of admission
| give immediately before septic screen/ blood tests
143
what is CO2 like in a PE
low (blowing it off with tachypnoea)
144
Ix for Pe
```
CTPA
ABGs
O2 sats
ECG
bloods
```
145
tx for PE in malignancy
LWMH for 6 months
| consider rivaroaban if recurrent DVTs/PE
146
what is 8/500 co-codamol
8mg codeine with 500 mg paracetamol
147
100mg of codeine = ? morphine
10
| morphine is 10 times as strong as codeine
148
what is the pain ladder
mild- paracetamol
mod- co-codamol 30/500, dihydrocodeine, tramadol
severe- morphine, diamorphine, oxycodone, hydromorphine, methadone
adjuvants: NSAIDs, TCAs, anticonvulsants. steroids, anxiolytics, muscle relaxants, antimuscarinics
149
what should you prescribe with opioid
anti-emetic and laxative
150
what drugs can be used as muscle relaxants
diazepam, baclofen
151
what drugs can be used as antimuscarinics (for colicky pain)
hyoscine butylbromide
152
how do you convert oral tramadol dose to oral morphine dose
divide tramadol dose by 10
153
how do you convert oral morphine to SC diamorphine
divide by 3
154
what are the anticipatory care medications
Opioid for pain and/or breathlessness: morphine 2mg SC
anxiolytic or sedative for anxiety, agitation or breathlessness: midazolam 2mg sc
anti-secretory medications for resp secretions: hyoscine butylbromide 20mg sc
anti-emetic for n+v: levomepromazine 2.5-5mg sc
155
what are the dexa results meaning
t scores
1- -1 normal
-1 to -2.5 osteopenia
-2.5 or less osteoporosis
156
talk me through the bone protection guidelines girly xx
calculate Qfracture/frax score (10 year risk of fragility fracture) for all high risk (>65 women, >75 men, RFs)
if score 10% or more do DEXA
if -1 to -2.5 modify risk factors
if less than -2,5 bone protection (once weeklr bisphosphonate)
consider bone protection in those taking steroids
offer HRT to young post menopausal women
157
rank these from least to most potent:
| methyl pred, betamethason, hyrocortisone, cortisone, prednisolone, dexamethasone
cortisone, hydrocortisone, methyl pred, pred, dex
158
what drug first line for delirium
haloperidol
| benzos if have PD
159
what can be used to treat acute pulmonary oedema
high flow oxygen
IV furosemide
IV diamorphine (vasodiltor, reduces CO)
digoxin
160
what is a modified release preparation
12 hourly tablets
161
who should adenosine not be given to
asthmatics
162
what are the signs of brugada syndrome on ECG
st change - coved/ saddle
163
which brain bleed has a period of lucidity
```
extradural
lemon shaped (lens shaped), MMA, associated with skull fractures, young men, LOC following lucidity after injury
```
164
who gets subdural haematomas
old people on blood thinners, slow decline in cognition
165
what is laryngomalacia
congenital cause of stridor in infants
| resolves usually by 12-24 months
166
what are the features of epiglottitis
dsypnoea, dysphagia, drooling, dysphonia (muffled voice)
stridor is a late sign
tripod position
distinguished from retropharyngeal abscess by xray
167
what is seen on cray in croup
steeple sign of subglottis
168
what is quinsy
peritonsilar abscess
169
what occurs sooner physiological or breast feeding jaundice
physiological- after 24 hours
breast feeding- usually in 2-3 weeks, can be in first
in sufficient intake- first week not getting enough calories
170
what are the alarm symptoms of dyspepsia
```
anaemia
loss of wight
anorexia
recent progression
malaena/ haematemesis
swallowing difficulties (dysphagia)
(think malignancy)
```
171
how does phenytoin affect COCP
induces liver enzymes, reduces efficacy of CoCP
172
what are the features of osteomalacia
bony pain
vit d and calcium def (calcium can be normal)
high PTH
173
what is the most important step in HHS
IV fluids first
| insulin when rehydrated
174
what contraception for dysmenorrhoea
COCP
175
what causes CNIII palsies
intracranial anuerisms, diabetes and extradural haematomas
176
difference between somatosism and conversion disorder
Conversion disorder is characterised by voluntary motor or sensory function deficits that suggest neurological or medical conditions but are rather associated with clinical findings that are not compatible with such conditions. Somatic symptom disorder is characterised by one or more somatic symptoms that are distressing or result in significant disruption of daily life.
177
tender mass in RIF- UC or crohns
crohns
178
how do you tell the difference between an indirect and a direct inguinal hernia
indirect goes down towards scrotum
direct above pubic tubercle
indirect can be controlled by pressure at the internal ring (halfway between pubic tubercle and ASIS)
179
what type of incontinence does oxybutin help with
OAB
180
what type of incontinence does duloxetine help with
stress
181
treatment for STEMI
300 mg aspirin - continue indefinitely unless CI
presenting in 12 hours: reperfusion therapy (PCI or fibrinolysis)
-PCI available in 120 mins: prasugrel if not on AC, clopidogrel if on anti coagulant, if >75 and high bleeding risk offer tricagrelor or clopidogrel instead of prasugrel
- PCI not available in 120 mins: fibrinolysis= alteplase, streptokinase, antithrombin (fondaparinux) at same time, ECG 60-90 mins after fibrinolysis, give tricagrelor (or clopidorgrel if high bleeding risk)
medical management:
-tricagrelor or clopidogrel if high bleeding risk
182
treatment for NSTEMI/ unstable angina
300mg aspirin and continue indefinitely
antithrombin (fondaparinux) unless high bleeding risk or immediate angiography
calculate grace score (6 month mortality), ECG, troponin I/ T
intermediate or high risk (>3%): if unstable offer immediate angiography +/- PCI, if stable offer in 72 hours
give prasugrel with aspirin (or clopidogrel if on AC), give unfractionated heparin if getting PCI
low risk: <3%
(young people may still benefit from PCI)
tricagrelor (or clopigrel if high bleeding risk)
183
what drugs used for secondary prevention following an MI
```
ACEi (arb if intolerant) indefinitely
dual antiplatelet (aspirin + another e.g. clopidogrel) for 12 months
beta blockers 12 months/ indefinitely if LVEF reduced
statin (atorvastatin 80mg)
```
if LVEF reduced start aldosterone antagonist 3-14 days after MI
184
what lifestyle changes for secondary prevention following an MI
exercise, stress, Mediterranean diet, alcohol, smoking
cant drive with unstable angina
stop driving for a week after PCI
185
when should a statin be started for primary prevention
in those with a QRISK2 score >10%, CKD, T1DM, >85 who smoke/ HPTN, severe obesity
(atorvastatin 20mg)
186
management of AF
if unstable DC cardioversion (+ amiodarone if unsuccessful)
heparin for anticoagulation in the acute setting
treat underlying cause: HPTN, valvular disease, HF, IHD, infection, cancer, alcohol, hyperthyroid, electrolytes
if <48 hrs: rate (BB, RL CCB (verapamil/ diltiazem), digoxin if sedentary)/ rhythm (cardioversion, flecainide, amiodarone)
if >48 hours: rate control, need to be anticoagulated for 3 weeks before rhythm control
assess CHA2DS2VASc score (stroke risk) and ORBIT bleeding risk
anticoagulation if CV score 2 or more, 1 if man: apixaban, dabigatran, rivaroxaban (if DOAC CI warfarin) (do not offer anticoagulation to those <65 with 0 (men) or 1 (women) CHV score)
rate control: beta blocker or diltiazem/ verapamil or digoxin if sedentary
(do not offer amiodarone long term)
rhythm control if rate control unsuccessful: flecainide, amiodarone, electrical cardioversion, ablation
amiodarone not flecainide if ischaemic or structural HD
187
what can you not prescribe verapamil and ditiazem with
alpha blockers, ACEis, arbs, antipyschotics, amiodarone, beta blockers, digoxin, NSAIDS LOADS
188
how is heart failure diagnosed
HX, exam, ECG, NT-proBNP, if high echo (>2000 in 2 weeks, 400-2000 in 6 weeks)
189
management for chronic HF
```
diuretics- mineralocorticoid receptor antagonist (spironolactone)
if reduced ejection fraction:
-ACEi (or ARB) (if intolerant to both hydralazine and nitrate)
-BB
if still symptoms:
-sacubitril if EF <35%
or
-ivabridine sinus rhythm EF<35%
or
-hydralazine and nitrate
or
-digoxin
```
190
treatment for stable angina
GTN (2nd dose after 5 mins, ambulance 5 mins after 2nd dose)
BB/ CCB (combo of two if not helped- must be -dipine ones (dihydropyridine))
if not helping: long acting nitrate (isosorbide), ivabradine, nicorandil
if still not helping referral for revascularisation surgery (CBG)
consider aspirin 75 mg
consider ACEi
Statin
191
what should you do for people with BPs in clinic between 140/90- 179/119
ABPM
if 135/85-149/94 : lifestyle advice + tx if >80 or CVD/ organ damage/ high CVD risk (>10%)
150/95 lifestyle + tx
192
what should you so for people with BP in clinic of 180/120
refer same day if papilloedema/ life threatening symptoms or suspected pheochromocytoma
anti hypertensives immediately
193
what are the BP targets
<80 140/90 clinic 135/95 ABPM
| >/= 80 150/90 clinic 145/95 ABPM
194
what is the tx pathway for HPTN
hypertension with type two diabetes or <55: ACEi/ ARB -> A + CCB or thiazide (indapamide) -> A + C + T
>55 or black african or african-caribean : CCB + C + A/T -> C + A + T
resistant: spironolactone if potassium <4.5
alpha (sin) or beta blocker if >4.5
195
what bugs usually cause infective endocarditis
commonest- staph aureus: amox + gent / fluclox if sepsis
prosthetic valve/ abnormal valves/ IVDU- staph epidermidis: vancomycin and gent
dental- viridans ( beta lactam (penicillin, cephalosporins) +/- gent, vancomycin
196
what is S1
closure of mitral and tricuspid valves
| start of systole, pulse felt at same time
197
what is S2
closure of aortic and pulmonary valves
| start of diastole
198
what causes a split S2
inspiration, pulmonary stenosis
199
what grade of murmer has a thrill
4-6
200
Murmur: ejection systolic, crescendo decrescendo, radiates to carotids, loudest on expiration when patient sitting forward, slow rising pulse
AS
| most common cause calcification, bicuspid valve, rheumatic heart disease
201
Murmur: pansystolic, radiating to axilla, loudest on expiration lying on left side
MR
| Ax- IE, MI, rheumatic HD
202
murmur: early diastolic, crescendo decrescendo, left sternal border 3/4th ICS
AR
| bicuspid valve, RHD, IE, aortic dissection
203
collapsing pulse
AR
204
murmur: mid diastolic, rumbling, opening click, low volume pulse, heard loudest over...
MS
congenital
... apex
205
mid systolic click, late systolic murmur
mitral prolapse
206
pan systolic murmur over left 4th ICS
tricuspid regurg
207
what sided murmurs are loudest on inspiration
right- tricupsid regurg, pulmonary stenosis
208
soft diastolic murmur, loudest at 3/4th ICS at left sternal edge, loudest on inspiration
TS
209
ejection systolic, loudest on inspiration, a waves
pulmonary stenosis
210
does smoking make UC or crohns worse
crohns
211
treatment for crohns
inducing remission:
- monotherapy if 1 epsiode in 12 months: steroid/ budesonide (sulfsalazine or mesalazine (5-ASA) - less effective)
- add azathioprine if 2 or more episodes (or methotrexate if CI)
-infliximab/ adalimumab if severe
maintenance:
-azathioprine/ metacaptopurine monptherapy
-methotrexate
212
treatment of UC
```
inducing remission:
mild mod (max 6 stools a day, no pyrexia, pulse <90, no anaemia, ESR<30)- topical (proctitis/ proctosiggmoiditis/ left sided UC)/ oral aminosysalicylate (5-ASA/ sulfasalazine) (or both)
-steroid short term
-biologics
severe acute:
-Iv steroids/ ciclosporin/ surgery (if no improvement at 72 hours or worsening symptoms: stools >8x/day, pyrexia, tachycardia, colonic dilatation, abnormal bloods)
maintaining remission:
-topical/ oral aminosalicylate (5-ASA)
-azathioprine
```
213
where does UC affect
distal to ileocecal valve (end of large intestine)
| left sided UC common
214
who should you test for H pylori
uncontrolled dyspepsia with no alarm symptoms (no response to lifestyle changes, antacids, one month course of PPI)
patients at high risk, previous ulcer/bleed, unexplained IDA after endoscopy exclude malignancy
215
what tests for h pylori
urea 13c breath test
stool helicobacter antigen test
(not within 2 weeks of ppi and 4 weeks of abx)
216
treatment for H pylori
triple therapy: PPI and 2 abx (consider previous ones tried)
1st line: amoxicillin + clarithromycin/ metronidazole (depending on previous use) for 7 days
if that doesn't work try the other one for another 7 days
if penicillin allergic
- PPI + clarithromycin + metronidazole
217
tx for dyspepsia
weight loss, eating (alcohol, coffee, chocolate, fatty foods), smoking
- PPI for 4 weeks, h pylori test if this doesnt help
- endoscopy if alarm symptoms/ GI bleed
- offer H2RA if still inadequate response (-tidines)
218
what drugs can cause dyspepsia
calcium antagonists, nitrates, theophyllines, bisphosphonates, cortitosteroids, NSAIDs
219
what are the alarm symptoms
nice 2 weeks:
dysphagia
>55+ weight loss with: upper abdo pain/reflux/ dyspepsia
```
anaemia
loss of weight
anorexia
recent progression
malaena/haematemesis
swallowing difficulties
```
220
what laxatives for diverticulosis
bulk forming (high fibre diet, lots of water)
221
when should you suspect diverticular disease
(diverticulosis asymptomatic)
DD- intermittent abdo pain in left lower quadrant with constipation, diarrhoea and occasional large rectal bleeds
-pain triggered by eating and relieved by passage of stool/ flatus
222
what are the symptoms of acute diverticulitis
constant abdo pain, severe and localising to left lower quadrant with:
fever
or
sudden change in bowel habit and significant rectal bleeding/ mucus
or
Tender LLQ, Hx of DD
complicated if:
- mass palpable- abscess
- adbo rigidity and guarding- perforation
- signs of sepsis
- signs of fistula
- signs of obstruction
223
Ix for acute complicated diverticulitis
if inflam markers raised contrast CT within 24 hours
224
tx for acute diverticulitis
systemically well- paractamol
unwell/ cormorbid- abx (co-amoxiclav/ cefalexin + met)
complicated- IV abx (same as above)
surgery if continuing symptoms
225
what antibiotics cause C diff
clindamycin, cephalosporins, co-amoxiclav, ciprofloxacin
| Cephalosporins: ceph or cefts
226
what are the severities if c diff infection
mild- normal WCC, <3 loose stools
mod- wcc <15, 3-5 stools/ day
severe- wcc >15, increased serum creatinine, temp >38.5, evidence of severe colitis
life threatening- hypotension, partial/ complete ileus, toxic megacolon
227
tx for c diff
mid/ mod/ severe- oral vanc for 10 days (2nd line fidaxomicin)
if that ineffective- oral vanc IV met 10 days
further episodes (<12 weeks fidaxomicin, >12 weejs oral vanc, both 10 days)
life threatening: vanc + IV met 10 days
228
what scan for renal stones
non contrast CT
229
what abdo stuff do you use USS for
gall bladder and biliary tree
renal tract
appendicitis
chronic pancreatitis
230
duodenal biopsy endoscopy or colonscopy
endoscopy
231
imaging for pancreatitis
ct
232
what bug:
incubation 1-6 hours
starchy food (rice)
baciluus cereus
233
what bug: 1-6 hours
rood temp food
milk/ meat/ fish/ cream
staph aureus
234
what bug: bloody diarrhoea
| beef, raw milk, petting zoos
ecoli 0157 (causes HUS)
notify health protection unit
stool toxin
235
what bug: 2-5 days, most common cause, raw poultry, GBS
campylobacter
236
what bug: poultry, meat, raw eggs, 12-48 hours
salmonella
237
travellers diarrhoea
e coli
238
what bug: kids, mild watery, not bloody
rotavirus
239
what bug: winter vomiting big, explosive D+V, cruise ships
noravirus
240
treatment for hepatic encephalopathy
lactulose
| if persistent symptoms add rifaximin
241
what prophylatic antibiotic in acute variceal bleed
ceftriaxone IV
242
what prophylatic treatment to prevent bleeds in oesophageal varcies
small- diagnostic and annual andoscopy
| medium to large- beta blocker +/- band ligation
243
what is wernickes encephalopathy
reversible thiamine def that causes: confusion, ataxia and opthalmoplegia
tx with thiamine and magnesium replacement
244
what is korsakoffs
irreversible hypothalamic damage and cerebral atrophy due to thiamine deficiency
confabulation due to retrograde amnesia, unable to make new memories, lack of insight and apathy
245
tx for withdrawal
chlordiazepoxide
acamprosate after acute withdrawal to reduce cravings
disulfram for chronic dependence
246
what are the CAGE questions
ever tried to/ felt like you should cut down
angry at criticism
guilt over drinking
eye opener
247
what does HBsAg mean
surface antigen
first thing to arise after infection
converted to anti-HBs and HBsAg cleared in resolved infections
presence for >6 months = chronic infection
248
HBeAG
positive and chronic
| shows high viral replication and infectiousness
249
Anti-HBe
inactive, carrier disease
| immunity from previous infection
250
anti-HBc
current or previous infection
| persists for life
251
anti-HBc IgM
infection in last 6 months
252
anti-HBc IgG
chronic or past infection
253
anti-Hbs
previous vaccination or cleared infection
254
HBV DNA
viral replication
| increased risk of cirrhosis and hepatocellular cancer
255
HBV DNA
viral replication
| increased risk of cirrhosis and hepatocellular cancer
256
what is positive in previous hep B vaccination
anti-HBs only
257
when is HbsAg -ve
vaccination
| cleared infection
258
when is HbeAg -ve
vaccination
cleared infection (anti-HBe +ve)
chronic infection inactive carrier (anti-HBe +ve)
259
treatment for PBC
ursodeoxycholic acid
| colestyramine for itch
260
treatment for PSC
transplant
| colestyramine for itch
261
hypertension + hypokalaemia=?
primary hyperaldosteronism
- 2/3rds due to aldosterone producing adenoma (conns syndrome), surgery
- 1/3rd due to bilateral adrenal hyperplasia, treated with spironolactone
262
commonest cause of pneumoniae
strep pneumoniae
263
describe what happens in barretts
intestinal metaplasia
| squamous to columnar with goblet and paneth cells
264
is bicarb an acid or a base
base
265
what does a high base excess mean
alkalotic
266
what is the rate of insulin infusion for DKA
0.1 units /kg/hr
267
what does SSRI + statin risk
GI bleed- give PPI
268
when can you insert a copper IUD after birth
within 48 hours or after 28 days
269
a bishops score of 5 or less indicates what
labour is unlikely to start without induction
270
how should you alter medication in addisonian patients with intercurrent illness
double hydrocortisone, same fludrocortisone
271
how do you tell small from large bowel
small has valvulae conniventes that go whole way across bowel
large bowel has haustra
272
what are the size limits for the bowels
small 3cm
colon 6cm
caecum 9cm
273
where is the ceacum
start of large bowel,
| RIF
274
what does a small bowel obstruction look like
coiled spring
central
can see valvulae conniventes
275
what does a large bowel obstruction look like
haustra
276
what does a sigmoid vovulus look like
coffee bean in left lower quadrant
ahaustral
as distal bowel ascending, transverse and descending bowel may be dilated
277
what does a caecal volvulus look like
right lower quadrant
haustra
distal colon collapsed
looks like a fetus
278
what is riglers sign
can see both sides of bowel
| means theres air in abdomen
279
what are the features of IBD on a-xray
thumbprinting: thickening of haustra
lead pipe colon: loss of normal haustral marking secondary to chornic colitis
toxic megacolon: dilatation of colon
280
is a subcapital hip # intra or extra capsular
intra
281
what surgery should you stop the COCP/HRT 28 days prior to
any lasting over 30 mins
emergency surgery
(dont need to do it for e.g. tooth extractions or varicose vein surgery)
282
what causes osteomalacia
vit D def
283
what biochem is seen in osteomalacia
low vit D, low calcium, low phosphate
| high ALk phos and PTH
284
what is the empirical tx for gonorrhoea
IM ceftriaxone
285
what does gonorrhoea look like on gram stain
gram -ve diplococci
286
what is the anticoagulation in a DVT
LMWH for 5 days then DOAC
| if active cancer then DOAC
287
what causes a cavitating pneumonia in the upper lobes, seen in diabetics and alcoholics
klebsiella
288
what is pseudomonas aeruginosa like
commin in bronchiectasis and CF patients
| causes ground glass on CT
289
symptoms of mycoplasma pneumoniae
flu like, HA, arthalgia, dry cough
290
what is legionella pneumonia like
flu like symptoms, dry cough, fever, myalgia, hepatitis, diarrhoea and vomiting
bi basal consolidation
291
who gets staph areus pneumonia
IVDU, young, elderly, comorbid
| people after the flu
292
blood stained nipple discharge= ?
duct papilloma (malignant potential so gets removed)
293
what will duct ectasia have
green brown discharge
abscess
smoking
294
how long should people eat gluten for before testing TTG
6 weeks
295
what is the management for acute upper urinary tract obstruction
nephrostomy
296
best test for liver function
PT
297
pain when exposed to cold
vasoclusive crises in sickle cell
298
what does FFP contain and help with
blood proteins and CFs
| when low INR/ PT
299
what does CLL transformin to
non hodgkins lymphoma (richters transformation)
300
what med should you stop beofre coronary angioplasty
metformin
| lactic acidosis
301
can you attempt external cephalic version after membranes have ruptured
no
302
Tx for suspected PE
admit immediately if unstable or pregnant/ post partum. everyone else calculate wells score and admit if >4
CTPA, DOAC for interim
if <4 do d dimer, DOAC if cant be done in 4 hours
if positive do CTPA, if -ve stop DOAC
(LMWH if renal impairment or pregnant)
303
tx for confirmed PE
DOAC
LMWH if CI ot APS
3 months if provoked, 6 months if unprovoked or cancer
if patient unstable thrombolysis (alteplase)
304
difference between schizoid and schizotypal PD
schizotypal had ideas of refence, odd beliefs and behaviours
305
when should patients with a mild diverticulitis flare be admitted
if symptoms dont improve in 72 hours
306
what iron study results in Haemochromatosis
high transferrin sats
raised transferrin
low TIBC
307
difference between acute and critical limb ischaemia
acute: pale, pulseless, pain, paralysis, paraesthesia, perishingly cold
critical: pain at rest for >2 weeks aften at night not helped by analgesia
308
what prophylaxis following spontaneous bacterial peritonitis
ciprofloxacin
309
what antiemetic for intracranial tumours
dexamethasone
310
do you need to x-ray an ng tube with apsiriate <5.5
no
311
treatment for thrush
oral fluconazole
clotrimazole pessart
topical imidazole if vulval symptoms
312
when is mastectomy preferred to WLE
mutlifocal tumour
large, central tumour
DCIS >4cm
313
treatment after breast surgery
radiotherapy for all WLE and mastectomy for T3-4 tumours
if hormone receptor positive:
-tamoxifen for pre and perimenopausal (blocks oestrogen receptors in breast)
-aromatase inhibitors for post menopausal (anastrozole) (prevent peripheral conversion of oestrogen)
HER2 +ve: trastuzumab
314
how do the glaucoma drugs work: B blockers
reduce aqueous secretion
315
how do the glaucoma drugs work: prostglandins
increase aqueous outflow through uveoscleral route
316
how do the glaucoma drugs work: sympathomimetics (brimonidine)
reduce secretion and increase outflow
317
how do the glaucoma drugs work: miotics (pilocarpine)
opening aqeous drainage in trabecular meshwork
318
how do the glaucoma drugs work: laser cycloablation
destroys secreting bit of ciliary body
319
what treatment should be offered first in open angle glaucoma
prostaglandin analogue (latanoprost)
(2nd line beta blocker, CAinhibitors, symps)
more advanced laser
320
how do the glaucoma drugs work: carbonic anhydrase (dorzolamide)
reduce aqueous
321
treatment for acute angle closure glaucoma
```
pilocarpine drops
acetazolamide IV
beta blockers
steroids
analgesia and anti-emetic
surgery: iridotomy
```
322
first line antiplatelet following a stroke
clopidogrel
323
can acute pancreatitis cause hyper or hypocalcemia
hypo
324
tx for thredworm
oral mebendazole
325
what Das 28 score to qualify for biologics
>5.1
326
what should you give instead of morphine in patients with renal impairment
oxycodone
327
what should be the first test in reduced fetal movements
doppler
328
do no need to stop ARBs in ACEis
yes
329
what is used as prophylaxis for meningitis
ciprofloxacin
330
test for Achilles rupture
USS
331
tx for chronic vestibular neuronitis
vestibular rehab
| prochlorperazine for symptom control in acute setting
332
what is the main risk factor for cholangiocarcinoma
PSC
333
vision worse going down stairs
trochlear nerve palsy
334
do patients >75 with fragility # need a dexa
no start bisphosphonates
335
when do you give amiodarone in CPR
when its a shockable rhythm after 3rd shock and then after every 2nd shock
336
what weeks if you miss 2 pills should you consider emergency contraception
pill free week
| week 1
337
what happens if you miss 1 pill
take asap, even if its 2 in one day
338
what happens if you miss 2 pills in week 2
no need for emergency contraception
339
what happens if you miss 2 pills in week 3
finish current pack, start next pack right with no pill free interval
340
what general advice for missing 2 pills
use condoms until pills taken for 7 days in a row
341
chlamydia psittaci pneumonia
birds, dry cough
342
pneumocystitis pneumonia
immunosuppressed
343
common HAP bugs
staph aureus, pseudomonas, klebsiella
344
when should you consider an antibiotic in an acute exacerbation of COPD
signs of infection, change in volume or colour of sputum
| give amoxicillin/ doxy
345
COPD treatment pathway
SABA/SAMA
if no response stop SAMA, add LABA + LAMA
if asthmatic features (asthma, atopy, high eosinophils, diurnal peak flow variation, variation in FEV1) then LABA + ICS
LAMA+ LABA + ICS (+SABA)
346
paediatric asthma pathway
SABA
ICS
LTRA
LABA
347
what does a protein content of 45 in a pleural effusion mean
exudative, effusions >30 exudate, <30 transudate
348
what causes transudative effusions
congestive HF
liver cirrhosis
severe hypoalbuminemia
nephrotic syndrome
349
what causes exudative effusions
```
malignancy
infection, if purulent empyema
trauma - can be bloody, food particles oesophageal rupture
pulmonary infarction
pulmonary embolism
```
350
what are the normal BM levels
4 -> 7 (fasting) 11.1 (random)
| HbA1C <42 (6%)
351
what blood sugars should diabetics aim for
4-7 before meals
5-9 2 hrs after
4-7 bed time
HbA1C <48 (6.5%), if on hypoglycaemic drugs <53 (7%)
if goes above 58 (7.5%) lifestyle advice and add another drug aim for 53
352
what is a pre diabetic HBA1C
42-47
353
when can you diagnose T2DM
HBa1C of 48 or more
random of 11 or more, fasting of 7 or more
if symptomatic can diagnose off one result, if not repeat test
dont use HBA1c on children, pregnant women, acutely unwell...
354
what are the gliptins
DPP-4 inhibitors
355
what weight effect does piaglitazone have
gain
356
what are the gliflozins
SGLT2 inhibitors
357
what effect do GLTT2 inhibs have on weight
loss
358
what are: glimepiride, glipizide, tolbutamide
| what weight effect do they have
sulfonylureas (also glicalzide) #gain
359
what is renin like in primary and secondary hyperaldosteronism
primary low, adrenals making too much aldosterone
| secondary high, BP in kidneys low so body making more renin
360
what causes hyperaldosteronism
primary: conns syndrome (adrenal adenoma) , bilateral adrenal hyperplasia
secondary: renal artery stenosis
361
screening tool for hyperalsosteronism
renin: angiotensin ratio
| low renin primary, high renin secondary
362
treatment for hyperadlosteronism
primary: spironolactone, removal of adenoma, angioplasty for stenosis
363
tx for acromegaly
transphenoidal surgery
somatostatin analogues: ocreotide
pegvisomant (GH antagonist) if resistant
364
what causes SIADH
too much ADH (vasopressin):
| SCLC, too much from post pit: infection, post op, menigitis, medications (thiazides, carbamazepine)
365
features and tx for SIADH
hyponatraemia, high urine osmolarity, high urine sodium
| correct sodium slowly to prevent central pontine myelinolysis
366
features of diabetes insipidus
lack of response to ADH- nephrogenic (lithium) or cranial (tumours, injury, infections)
polydipsia, polyuria, hypERnatraemia
367
Ix for diabetes insipidus
water deprivation test: (desmopressin stimulation test)
avoid fluids for 8 hours and measure urine osmolality
give desmopressin and 8 hours later measure urine osmolality again:
-cranial will concentrate after desmopressin
-nephrogenic will not concentrate
368
management for DI
demopressin
369
tx for hyperprolactinaemia
if <10mm bromocriptide
| if >10mm bromocriptide then surgery
370
treatment for pheochromocytoma
```
alpha blockade (phenoxybenzamine) then beta blockade
then surgery
```
371
what scan for suspected pancreatic cancer
CT
372
what test for stomach cancer
upper GI endoscopy
373
what scan for gall bladder and liver cancer
USS
374
what age do unexaplined breast lumps get referred on suspected cancer pathway
30
375
what test if CA125 if higher than expected
USS
376
What are the minor and major criteria for suspected melanoma referall
major : change in size, irregular shape or colour
| minor: diameter 7mm or more, inflammation, oozing, change in sensation
377
how urgent do SCC and BCCs need to be referred
```
BCC routine
SCC Urgent (2 weeks)
```
378
when is ulceration in mouth worrying
if there for >3 weeks
379
how quick should you refer children with new neuro signs
very urgent- MRI in 48 hours
380
how urgent is a suspected adult and child leukaemia referal
very - under 48 hours
381
referal for lymphadenopathy and spenlomegaly, fever, nightweats, SOB, pruitus or weight loss (lymphoma) in adults and children
adults 2 weeks, children 48 hours
382
referral for bone and soft tissue sarcomas adults and children
adults 2 weeks
| children 48 hours
383
referal for child wilms tumour (haematuria, abdo mass)
48 hours
384
what is CK in rhabdomyolysis
>10,000
385
how to tell primary from tertiary hyperparathyroidism
tertiary may have abnormal renal function- seen in chronic renal failure
PTH can be high or inappropriately normal in primary, always high in tertiary
386
perineal ulcer, tender lymphadenopathy and proctitis
lymphogranuloma venereum
387
is the lymphadenopathy tender in herpes
yes
388
features of pernicious anaemia
AI atrophic gastritis
anti gastric parietal cell antibodies
B12 def- macrocytic anaemia
389
does coeliac cause a micro or macro cytic anaemia
micro
390
how to tell the difference between IgA and post infectious GN
IgA- haematuria few days after URTI
| PI- 2 weeks after infection
391
are duodenal ulcer better or worse after eating
relieved by eating
392
treatment for prolonged QRSs followinf tricyclic OD
sodium bicarb
393
amiodarione can cause pulmonary fibrosis, what would the diagnostic test be
CT chest
394
when should LP be done to diagnose SAH
at least 12 hours after symptom onset to look for xanthochromia
395
treatment for SLE
NSAIDs- joint stiffness and pain (naproxen), avoid in hypertension
hydroxychloroquine: constitutional and cutaneous symptoms
IV methylpred for immediate relief, oral steroids for a short a time as possible
if not responding: methotrexate, azathioprine, mycophenolate, biologic agents
396
signs of rheumatoid arthritis on x ray
reduced joint space
articular erosions
periarticular osteopenia
soft tissue swelling
397
tx for RA
dmard within 3 months: methotrexate, lefunomide, sulfasalazine
bridging steroids
398
features of PMR
elderly, myalgia of hip and shoulder girdle with morning stiffness
15% have GCA
raised CRP and PV/ESR
responds to 15 mg steroids tapered over 18 months
399
treatment for GCA
40mg pred, 60mg if visual involvement
400
features of polymyositis
symmetrical proximal muscle weakness
dysphagia may occur
anti Jo-1, SRP, ANA and RNP
ILD commoner in those with Jo-1
inflam markers raised, CK 10x normal
EMG
pred 40mg with immunosuppressants: methotrexate/azathioprine
401
features of dermatomyosis
those of PM but with gottrons paules, V shaped rash, heliotrope rasg
management and Ix as for PM
402
what are the ANCA positive vasculitis
microscopic polyagnitis
granulomatosis with polyangiitis
eosinophilic granulomatosis with polyangitis
403
what are the large vessel vasculitis
```
giant cell (temporal)
takayasu arteritis
```
symps- low grade fever, weight loss, arthralgia and fatigue
ESR, PV and CRP raised
Tx steroids, steroid sparing agents (methotrexate, azapthioprine)
404
features of granulomatosis with polyangitis
nose bleeds, deafness, recurrent sinusitis, nasal crusting (collapse of nose), haemoptysis, cavitating lesions on x ray
cANCA
405
features of eosinophllic granulomatosis with polyangitis
late onset asthma, rhinitis and raised peripheral blood eosinophil count
406
features of eosinophllic granulomatosis with polyangitis
late onset asthma, rhinitis and raised peripheral blood eosinophil count
407
microscopic polyangitis causes what
GN
408
tx for anca vasculitis
Iv steroids and cyclophosphamide
409
what mediated HSP
IgA
410
features of HSP
URTI
few weeks later purpuric rash over bottocks and legs, abdo pain, vomiting and joint pain
self limiting
411
what are the nephritic GN
IgA (12-72 hours post infection, IgA deposits on mesangium, proteinuria)
post step (2-3 weeks post infection, oedema)
HSP (purpuric rash, abdo/ joint pain , IgA)
Anti-GBM (renal disease and pulmonary haemorrhage)
rapidly progressing (lots of causes, failure in weeks/days)
412
treatment for nephritic syndrome
IgA- ACEi/ARB to reduce proteinuria, steroids if this doesnt help
HSP- steroids
PS-abx
Anti-GBM- plasma exchange, steroids and cyclophosphamide
rapidly progressing- steroids and cyclophosphamide
413
what is nephrotic syndrome
proteinuria (>3g/24hrs)
hypoaluminaemia
oedema
414
what can cause nephrotic syndrome
GN
| pre-eclampsia, lupus, DM, myeloma, amyloid
414
what can cause nephrotic syndrome
GN
| pre-eclampsia, lupus, DM, myeloma, amyloid
415
Tx for nephrotic syndrome
fluid and salt restriction, furosemide
treat cause
ACEi/ARB to reduce proteinuria
Abx, thromboprophylaxis
416
what are the nephrotic GN
minimal change (idiopathic, NSAIDs, lithium, HL; light microscopy normal, electron podocyte effacement, pred)
focal segmental glomerulosclerosis- ACE/ARB, steroids in primary disease
membranous- (malignancy, infection, AI, drugs - gold, spikes of silver stain, thickened basement membrane)
membranoproliferative- immune complex of C3, electron dense deposits on membrane, ACEi/ARB
417
what are the pre renal causes of AKI
```
hypoperfusion:
decreased plasma volume
decreased CO
vasodilation
renal vasoconstriction (NSAIDs, ACEi, hepatorenal syndrome- concurrent liver cirrhosis/ failure)
```
418
what are the renal causes of AKI
```
glomerular
interstitial (drugs, infection, infiltration- sarcoid)
```
419
what are the post renal causes of AKI
stone, malignancy, stricture, clot, extrinsic compression
420
treatment for AKI
```
fluid resus
monitor fluid balance, K+
assess for proteinuria
USS in 24 hours
check liver function
check platelets - if low check film for haemolysis (TTP, HUS)
treat cause
```
421
stages of CKD
```
GFR:
1= >90 and evidence of kidney damage
2=60-89 and evidence of kidney damage
3a= 45-59
3b= 30-44
4= 15-29
5=<15 failure
```
422
management for CKD
refer when stage 4-5/ declining gf/ genetic cause/ proteinuria despite tx/ poor BP control
ACE/ARB for BP and proteinuria
glycaemic control
salt restriction <2g
treat: anaemia, renal bone dystrophy (high phosphate low vit D) (phospahte binders, diet low in phosphate, vit D supplements), iron for restless legs, antiplatelets, statins
RRT
423
tx for gout
acute: NSAID, colchine, steroids if CI
lifestyle (low urate- alcohol, red meat)
prophylaxis: allopurinol/ febuxostat
424
VTE prophylaxis for patients with renal impairment
LWMH or unfractionated heparin
425
VTE prophylaxis in palliative care
LMWH
426
what do you do for people with a negative USS but positive D dimer for DVT
stop interim anticoagulation and repeat USS 6-8 days later
427
can you drive after stroke/ TIA
1 month after TIA, 3 months if multiple
| stroke 1 month, notify DVLA if residual neuro deficit
428
what is the secondary prevention following a stroke
```
antiplatelet (not if paroxysmal AF) :
aspirin in first two weeks then clopidogrel 75mg (if CI 75mg with modified release dipyridamole 200mg). Dual therapy aspirin + clopidogrel if high risk of TIA for 90 days
statin: 80mg atorvastatin
HPTN control
anticoagulation: (for all inc AF) DOAC
```
429
what are the iron studies like in IDA
decreased ferritin, increased total iron binding capacity
430
what should you consider in microcytic anaemia that is not responding to iron
sideroblastic- will have high iron and sideroblasts
431
what are howell jolly bodies seen in
hyposplenism (sickle cell, IBD, amyloid)
432
what is rouleaux seen in
chronic inflammation, myeloma
433
what are schistocytes seen in
intravascular haemolysis (DIC, HUS, TTP)
434
what are spherocytes seen in
sherocytosis, autoimmune haemolytic anaemia
435
what must you always check before giving folate
B12 levels as replacing folate without B12 may precipitate subacute combined degeneration of spinal cord
436
what biochem markers in haemolytic anaemia
increased unconjugated bilirubin and urobilinogen
| increased LDH
437
how to tell intravascular from extravascular haemolysis
splenomegaly in extravascular
| free plasma haemoglobin in intra
438
what are the causes of haemolytic anaemia
```
acquired:
coombs test +ve
-drug induced
-AIHA (extravascular haemolysis, warm IgG steroids, cold IgM keep warm
coombs -ve:
-autoimmune hepatitis
-hep b/c
-post infection, drugs
microagiopathic haemolytic anaemia: mechanical damage, intra, Ax: DIC, HUS, TTP, pre-eclampsia, mechanical valve,
infection
```
hereditary:
- G6PD def, x linked,
- sherocytosis
439
abx seen in autoimmune hepatitis
ASMA, ANA, LKM1
440
tx for AI hepatitis
steroids
azathioprine for sparing
transplant if needed
441
what is the inheritance of sickle cells
AR
442
prevent for sickle cell crises
hydroxycarbamide
443
what is the inheritance of beta thalassaemias
recessive
heterozygous- carrier, minor or trait
intermediate- moderate anaemia, homo/hetero
major- hetero, lifelong transplant, hair on end bones, bossing, extramedullary haemotpoesis
444
is VwF def a coagulopathy or bleeding disorder
bleeding- VWF aggregates platelets
445
what inheritance are the haemophilias
x linked recessive
446
when do you give platelets and FFP
platelets when <20
| FFP to replace clotting factors: DIC, warfarin OD hen vit k would be too slow e.g. liver disease TTP
447
what is seen in TRALI
white out
448
what does LMWH target
factor Xa
449
what does warfarin target
vit K
450
what malignancy:
uncontrolled immature blast proliferation, children
anaemia, infections, bleeding (marrow failure)
tx: fluids, allopurinol (TLS), transfusion, IV abx, chemo, marrow transplant
Acute lympoblastic leukaemia
451
what blood malig:
| auer rods
AML
452
what blood malig:
| 40-60, philadelphia chromosome, imantinib
CML
453
which blood malig:
| rubbery nodes, often asymptomatic, progresive accumulation of functionally incompetant B cells
CLL
454
what blood malignancy:
| reed sternberg cells, young adults and elderly, alcohol induced node pain, ann arbour staging
HL
455
what blood malignancy:
| b cells, includes MALT
NHL
456
what myeloproliferative:
| JAK2, itchy after hot bath, venesection
PCV
457
treatment for thrombocythaemia
aspirin
458
which myeloproliferative disorder :
| teardrop RBCs, marrow fibrosis, massive hepatosplenomegaly
myelofibrosis
459
which blood malignancy:
IgG, paraprotein on urine/ electrophoresis, osteolytic bone lesions, hypercalcaemia, marrow failure, renal impairment (light chain deposition), roulaeux
myeloma
460
what tests for myleoma
serum and urine electrophoresis
461
Tx for myeloma
analgesia, bisphosphonate, chemo, transfusions
462
which jaundice:
| normal urine and normal stools
pre-hepatic cause
| unconjugated bili is not water soluble
463
which jaundice:
| dark urine + normal stools
hepatic cause
| conjugated bili, able to get into bowel
464
which jaundice:
| dark urine + pale stools
post hepatic obstructive
| conjugated bili, unable to get into bowel
465
abx for animal bite
co-amoxiclav
466
most common side effect with POP
irregular bledding
467
what should all patients with peripheral arterial disease be taking
antiplatelet (clopid) and a statin
468
abx for neutropenic sepsis
piperacillin with tazobactam
469
what test for post H pylori eradications therapy
urea breath test
470
what is a comp of fluid resus in DKA
cerebral oedema- monitor kids and YA especially for it
471
dose blockage of the cystic duct cause jaundice
no, neither dose blockage of the gall bladder
472
why is mastoiditis an emergency
risk of meningitis, cranial nerve palsies, osteomyelitis, hearing loss, osteomyelitis, carotid artery spasm
473
what drug for babies in womb to help prevent resp distress
dexamethasone
474
normal nuchal translucency
<3.5mm at 11-14 weeks
475
when is a postural drop in BP significant
20 or more systolic/ below 90/ >10 with symptoms
476
what is anastrozole
aromatase inhibitor
477
what is a normal FEV1
>80%
478
what is the breast cancer screening programme
mammography every 3 years for women aged 50-70
479
what abx for GBS prophylaxis
benzylpenicillin
480
can you take statins in pregnancy
no
481
what drugs are bad in G6PD def
sulpha drugs (sulphasalazine, sulphonylureas)
482
what eGFR is metformin CI
<30
483
what Tx for fasting glucose >7 in pregnancy
insulin
| if <7 lifestyle changes for 2 weeks then metformin if still high
484
what does irradiating blood prevent
transfusion associate graft versus host disease
485
what form of ventilation in acute COPD exacerbation
BiPAP
486
when can hypertonic saline be given
acute severe hyponatraemia <120
487
first line investigation for prostate cancer (after PR and PSA)
MRI
| then TRUS biopsy
488
tx for trichomonas vaginalis
oral metroniazole
489
how long should you be faste for before surgery
6 hours
490
what are the biochem markers of myleoma
calcium up, phosphate normal/up, ALP normal
491
biochem markers of bone mets
calcium, phosphate and alp all up
492
phosphate in primary hyperparathyroidism
down
493
potassium up or down in cushings and addisions
cushings down
| addisons up
494
normal UO
1500, 200 in stool, 800 insensible
495
can you use 5% dextrose for resus
no
496
how to calculate the anion gap
(Na+ + K+) - (Cl- + HCO-)
497
what do you need to be careful of when treating hyponatraemia
replacing too quickly can cause central pontine demyelination
498
treatment for K>6.5 or >6 with ECG changes (tall tented T waves, increased RR, widened QRS, sine wave)
10ml of 10% calcium chloride (or 30ml 10% of calcium gluconate) IV over 5-10 mins (cardioprotective)
IV insulin (10u in 25g glucose- 50ml of 50%) over 30-60 mins (re-uptakes K)
salbutamol neb
renal replacement
499
how to differentiate thyroid cancers
most common, young patients= papillary
middle aged, haem spread= follicular
MEN, calcitonin= medullary
500
causes of hypocalcaemia with raised phosphate
CKD
| hypoparathyroidism
501
causes of hypocalcaemia with normal/ low phosphate
vit D def (helps absorb phosphate and calcium from gut)
osteomalacia (raised ALP)
acute pancreatitis
502
tx for hypercalcaemia
rehydrate
| bisphosphonates
503
how much of ions and sugar and water do you need a day
1mmol/kg/day of sodium potassium and chloride
50-100g/kg/day glucose
25-30ml/kg/day water
504
what ion can be raised by thiazides
hypercalcaemia
505
what nerve does froments test test
ulnar
506
tx for prolactinoma and acromegaly
prolactinoma- dopamine agonists (bromocriptide, cabergoline) for both macro >10mm and micro (surgery rarely needed)
acromegaly- transhenoidal surgery, somatostatin analogues (ocreotide), GH antagonist (pegvisomant)
(A= SS and surgery ASS)
507
first line tx for superficial thrombophlebitis
NSAIDs
508
what is used to reverse warfarin in emergency
prothrombin complex concentrate
509
what is the desirable INR for invasive procedures
<1.5
510
how should warfarin be managed before and after surgery
(low risk patients) withhold 5 days before, day before check INR and give vit K if >1.5
restart usual dose on day of procedure
511
stop for surgery? loop diuretics
yes (omit morning of)
512
stop for surgery? K sparing diuretics
yes (omit morning of)
513
stop for surgery? beta blockers
no
514
stop for surgery? acei and arbs
yes (omit morning of)
515
stop for surgery? CCbs
no
516
stop for surgery? DOACs
yes stop 48 hours before
517
stop for surgery? clopidogrel
stop 7 days before
518
stop for surgery? inhaled steroids
no
519
stop for surgery? first gen antipsychotic
no
520
stop for surgery? 2nd gen antipsuchotic
yes stop 12 hours before
521
stop for surgery? bisphosphonates
omit on day
522
stop for surgery? NSAIDs
stop 24 hours before, 72 if naproxen
523
how do you change insulin for surgery
for multiple daily doses continue the daily long acting basal insulin subcut (glargine, determir, degludec)
for major surgery five VR IV insulin (actrapid)
aim for first on list, omit all medication and insulin expect long acting on morning of if AM, restart as usual with meal post op (if once daily regime or breakfast routine give half dose at lunch)
if PM 50% reduction in insulin dose at breakfast, omit oral meds at breakfast, fast after breakfast and omit lunchtime meds
VRII if major surgery
524
how do you change oral diabetic meds for surgery
if poorly controlled or major surgery treat as insulin controlled diabetes (long acting + VRII)
give all usual day before except SUs
if AM omit all morning meds, take any missed drugs with lunch
if PM give morning doses, omit lunch time doses and give any missed doses with late lunch
if not eating/ drinking after op start VRII 2 hours before op and restart oral hypoglycaemics when eating
525
what are the antihistamine anti-emetics
cyclizine, promethazine
526
what anti-emetic for gastrointestinal or biliary disease
metoclopramide (prokinetic- stimulates gastric emptying, can cause tardive dyskinesia)
527
what can domiperdone be used for
antiemetic for dopaminergic drugs (PD)
528
what anti emetic for menieres
prochlorperazine
| cyclizine
529
what anti-emetic for migraines
metoclopramide or prochlorperazine
530
what is the orbit score
```
>/= 75 1 point
reduced Hb 2 points
bleeding history 2 points
eGFR <60 1 point
on antiplatelet 1 point
```
0-2 low risk
3 medium risk
4-7 high risk
531
what is the chadvasc score
```
CHF 1
HPTN 1
age >/= 75 2
Age 65-74 1
DM 1
stroke/tia/VTE 2
vascular disease 1
female 1
```
532
can apixaban be used in CKD
yes
533
what is the feverpain criteria
```
fever
purulence
attends rapidly (within 3 days)
inflamed tonsils
no cough or corzya
```
score 0-1 do not offer an antibiotic, seek help if dont improve within a week
2-3 no antibiotic/ back up prescription (not needed immediately, use if no improvement in 3-5 days/ worsening (likely streptococcal)
4-5 immediate abx/ back up prescription
abx= phenoxymethylpenicillin
534
what is the centor criteria
tonsilar exduate
tender anterior cervical lymphadenopathy
fever
absence of cough
0-2 no abx
3-4 immediate/ back up abx
abx phenoxymethylpencillin
535
which is the most common cause of malaria
plasmodium falciparum - more likely if cerebral involvement
| causes fever, cough, HA, malaise, diarrhoea,
536
ix and tx for malaria
ix- giemsa stained thick and thin blood smears, rapid diagnostic test
tx: chloroquine or hydroxychloroquine
537
difference between gram -ve and positive
-ve pink, has thin peptidoglycan cell wall
| +ve purple, thick peptidoglycan wall
538
is staph areus coagulase negative or positive
positive
539
how to beta lactam antibiotics work
inhibit cell wall synthesis
540
what antibiotics contain a beta lactam ring
(all cause penicillin allergy!)
penicillins
cephalosporins (ceph and cef)
clavulanic acid
541
findings in LP in bacterial meningitis
cloudy, turbid
high pressure
>100 WBC (leukocytes)
glucose low, protein high
542
findings in viral meningitis LP
clear, normal/ elevated pressure
WBC elevated, primarily lymphocytes
glucose normal (low in HSV), protein high
543
findings in fungal meningitis (LP)
clear/ cloudy
elevated pressure
WB elevated, glucose low
protein elevated
544
findings in tb meningitis LP
opaque, fibrin web
elevated pressure
WBC high, glucose low, protein high
545
specificity
the ability of a test to correctly identify those withOUT the disease
546
sensitivity
the ability of a test to correctly identify patients WITH a disease
547
prevalence
the percentage of people in a population who have the condition of interest
548
incidence
number of new cases over a period of time
549
randomised control trial
gold standard of clinical trial, treatment vs placebo
550
case control study
two groups identified on a differing characteristic (disease/condition) then explores retrospectively as to the cause of that characteristic
551
cohort study
cohort of people followed to determine rate of disease/ risk factors prospective- people divided into two groups based on exposure to RF an then followed for several years to determine incidence
retrospective when cohort selected from the past and data is collected in past or present of how many people in that group were exposed to risk factor/ develop disease
552
cross sectional study
data collected at specific time and point, don't interfere, looking at incidence or prevalence of disease
553
what is the bowel screening programme
people aged between 60 and 74 to return a faecal immunochemical test (FIT) kit every 2 years to detect the presence of blood in the stool.
554
localising features of a temporal seizure
HEAD
hallucinations (auditory, gustatory, olfactory)
Epigastric rising/ emotional
Automatism (lip smacking, grapping, plucking)
Deja vu/ dysphagia post ictal
555
localising features of the frontal lobe
head/leg movements, posturing, post-ictal weakness, jacksonian march
(motor)
556
parietal localising features
(sensory) paraesthesia
557
occipital localising features
(visual) floaters/ flashes
558
what are the first rank symptoms of schizophrenia
auditory hallucinations (thoughts spoken aloud, third person, commentary)
though withdrawal/ insertion/ interruption
thought broadcasting
somatic hallucinations
delusional perceptions
passivity phenomena
