Revision Topics Flashcards
(174 cards)
1
Q
Age of premature menopause
A
< 40
2
Q
Who should be offered a DEXA scan to screen for osteoporosis
A
All post-menopausal women > 65
3
Q
Conservative management of menopause
A
Vaginal estrogen creams
Reduce risk of osteoporosis by smoking cessation and vitamin D
4
Q
What are the 2 main health problems caused by menopause
A
Osteoporosis
Cardiovascular disease
5
Q
Indications for HRT
A
Menopausal symptoms
Premature menopause until age 51, even if asymptomatic
Women < 60 at risk of osteoporotic fracture who aren’t suitable for other treatments
6
Q
Risks of HRT
A
Endometrial cancer if unopposed
Breast cancer
Thrombotic disease - DVT, PE, stroke, CHD
7
Q
Main contraindications to HRT
A
If still have uterus can't have unopposed Undiagnosed vaginal bleeding Breast/endometrial cancer Untreated endometrial hyperplasia VTE Untreated HTN MI, angina, coronary artery disease
8
Q
What medications can be used for hot flushes associated with menopause that aren’t HRT
A
SSRIs - Paroxetine
Clonidine
Gabapentin
9
Q
Actions of parathyroid hormone in response to low Ca
A
Increased osteoclast activity
Increased renal Ca reabsorption and PO4 excretion
Increased vitamin D levels
10
Q
Overall effect of PTH on serum Ca and PO4
A
Increases serum Ca
Decreases serum PO4
11
Q
Causes of primary hyperparathyroidism
A
Solitary adenoma
Parathyroid gland hyperplasia
Parathyroid gland cancer
12
Q
Chronic renal failure commonly causes which type of hyperparathyroidism
A
Tertiary hyperparathyroidism
13
Q
A paraneoplastic syndrome commonly from SCLC that causes high Ca
A
Parathyroid hormone related protein
14
Q
Symptoms of high parathyroid hormone
A
Pruritus Bone pain/fractures/osteopenia High BP Ca deposits in skin Sx of high calcium - weak, tired, low mood, polyuria, polydipsia, renal stones
15
Q
Medication used to lower PTH levels
A
Cinacalcet
16
Q
Angiotensinogen comes from which organ
A
Liver
17
Q
Angiotensin converting enzyme comes from which organ
A
Lung
18
Q
Symptoms of hypocalcaemia
A
Cramps Perioral numbness Muscle spasm Chvostek sign Confusion Seizures
19
Q
Actions of angiotensin II
A
Vasoconstriction
Aldosterone release from the adrenal cortex (Na retention)
20
Q
Typical presentation of erythema multiforme
A
Target lesions
Initially back of hands/feet then spread to torso
Upper limbs > lower limbs
Mild pruritus
21
Q
Main precipitating factor for erythema multiforme
A
Herpes simplex virus
22
Q
At what percentage of body surface area affected does Stevens-Johnson syndrome become Toxic Epidermal Necrosis
A
When > 30% of the skin is affected
23
Q
What is the name of the sign when mild lateral pressure separates the epidermis
A
Nikolsky’s sign
24
Q
Percentage body area needed to be affected in erythroderma
A
90+ %
25
Classical presentation of squamous cell carcinoma
Painless, non-healing, bleeding ulcer
Everted edges
Floor of ulcer resembles granulation tissue and bleeds easily
26
Is SCC or BCC more common
BCC
27
Risk factors for squamous cell carcinoma
```
Sun
Skin type
Radiation
Chronic immunosuppression
Actinic keratosis
Bowen's disease
Chemical carcinogens
```
28
What is a Marjolin's ulcer
An aggressive form of SCC that typically develops from areas of chronically damaged skin such as ulcers (e.g., pressure ulcers, osteomyelitis) and scars (e.g., burn scars)
29
What is Bowen's disease
Squamous cell carcinoma in situ
30
What infection is Bowen's disease associated with
HPV 16 and 18
31
Keratin pearls are a histological finding of which skin disease
Squamous cell carcinoma
32
What is Keratoacanthoma and how do they characteristically look
A benign skin tumour
Common in the elderly
Rapid growth on sun exposed areas
Round erythematous nodule with a central crater
33
What is Moh's microsurgery used for
Skin cancers - removes them later by layer so best method for ensuring its all removed whilst also ensuring uninvolved skin is spared
34
What is the most common type of skin cacner
BCC
35
Risk factors for basal cell carcinoma
```
Sun exposure
Skin type
Gorlin syndrome
Arsenic exposure
Radiation
Chronic immunosuppression
```
36
What is Gorlin syndrome
A genetic condition that puts you at risk for multiple BCCs and other tumours
37
Topical chemotherapy for some skin cancers
Imiquimod
| 5-FU
38
Risk factors for melanoma
```
UV
Skin type
Numerous nevi
Immunosuppression
Xeroderma pigmentosum
```
39
Clinical features of melanoma
Pruritic, bleeding
Asymmetry
Irregular border with indistinct margins
Colour change of various pigmentation within the same lesion
Diameter >6mm
Evolving in regards to size, shape or colour
40
Types of melanoma
```
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Amelanotic
Uveal
```
41
What is the most common type of melanoma
Superficial spreading
42
Describe lentigo maligna
A type of melanoma common in the elderly on sun exposed areas
Large and irregularly shaped patch with irregular pigmentation and slow horizontal growth
43
Describe Acral lentiginous
A type of melanoma common in dark skinned ethnicities
Irregularly shaped brown/black nodule that may ulcerated
Affects the palms/soles/nailbed/mucous membranes
44
Biopsy of choice in suspected skin cancers
Full thickness excisional biopsy with safety margins
45
What system is used to stage melanomas based on thickness/depth
Breslow scale
46
2 pre-cancerous skin lesions that can develop into SCC
Actinic keratosis
| Leukoplakia
47
Describe a typical actinic keratosis
Sun exposed area
| Small lesion with rough surface, sandpaper like texture. Grow and become erythematous and scaly
48
Treatment options for actinic keratosis
```
Cryotherapy
Topical Imiquimod or 5-FU
Phototherapy
Curettage
Excision
SUN SCREEN
```
49
Difference between hypertrophic and keloid scars
Hypertrophic don't grow beyond the boundaries of the original lesion whereas keloid scars do
50
Typical appearance of seborrheic keratosis
```
Darkly pigmented plaques or papules
Sharply demarctaed
Soft, greasy, wax like texture
Stuck on appearance
May be itchy/bleed/increase in number over time
```
51
Slowly growing skin coloured/brown nodule mainly on lower legs, sometimes related to bites/skin trauma
Pinching the lesion produces a central dimple (Fitzpatrick's sign)
Dermatofibroma
52
What are the 3 main types of nevus
Junctional
Compound
Intradermal
53
Describe a junctional nevus
Flat, well demarcated brownish macule
| Growing at the dermal-epidermal junction
54
Describe a compound nevus
Elevated lesion
| Arising from a junctional nevus
55
Describe an intradermal nevus
Elevated lesion that may be hard/fibrotic and grow hair
56
Causes of acanthosis nigricans
```
T2DM
PCOS
Cushing's
Steroids
Oral contraceptives
```
57
What is a solar lentigo
Benign skin lesion
| Flat brown macules or patches induced by sun exposure - usually on the cheeks and backs of hands
58
Delirium tremens typically occurs how many days after alcohol cessation
3 days
59
Typical triad of symptoms in Wernicke's encephalopathy
Mental status change/confusion
Gait ataxia
Occulomotor dysfunction/nystagmus
60
Which vitamin is Thiamine
B1
61
What is the main feature of Korsakoff syndrome
Loss of short term memory and confabulation as a result
62
Symptoms of polymyalgia rheumatica
Morning stiffness of proximal limb muscles
Lerthargy, depression, anorexia, low grade fever
Symptoms of GCA
63
What is polyarteritis nodosa
A medium vessel vasculitis
64
Who gets polyarteritis nodosa
Middle aged men with Hep B infection
65
Typical angiography description of polyarteritis nodosa
'Beading' appearance - numerous microaneurysms
66
What is the life-threatening complication of Kawasaki disease and how do you check for it
Coronary artery aneurysm
| Echocardiogram
67
6 Key features of Kawasaki disease
```
High grade fever for >5 days
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles of feet which later peel
```
68
Management of Kawasaki disease
High dose Aspirin
IV immunoglobulins
Echocardiogram
69
What is Scarlet fever
A reaction to toxins produced by group A strep (usually strep pyogenes)
70
Organism that can result in scarlet fever
Group A Streptococci - usually Strep Pyogenes
71
Typical features of Scarlet fever
Fever 1-2 days
Malaise, headache, nausea, vomiting
Sore throat/strep throat
Strawberry tongue
Fine punctate erythematous rash that spares the palms and soles, rough sandpaper texture, later desquamation around fingers/toes
Flushed appearance with circumoral pallor
72
Treatment for Scarlet fever
Oral Penicillin V for 10 days
73
What is the most common complication of scarlet fever
Otitis media
74
Rheumatic fever usually occurs how long after what infection
2-6 weeks after Streptococcus Pyogenes infection
75
Major criteria for Rheumatic fever
```
Erythema marginatum (ring shaped)
Sydenham's chorea
Polyarthritis
Pancarditis
Subcutaneous nodules
```
76
Minor criteria for Rheumatic fever
Raised CRP/ESR
Pyrexia
Arthralgia
Prolonged PR interval
77
Causes of osteomalacia
Vitamin D deficiency
Renal failure
Anticonvulsants
Liver cirrhosis
78
Pagets disease - are Ca, PO4, ALP high, normal or low
Normal Ca and PO4
| Raised ALP in isolation
79
Treatment for Pagets disease
Bisphosphonates
80
First line treatment for dysfunctional uterine bleeding
Progesterone only contraception (usually coil)
81
Treatment options for dysfunctional uterine bleeding/menorrhagia
Progesterone only contraception (coil) or combined contraception
NSAIDs - Mefanamic acid
Antifibrinolytics - Tranexamic acid
D+C if want future children
GnRH analogues if want future children
Endometrial ablation/resection/hysterectomy if they don't want more children
82
3 main types of fibroids
Intramural
Subserosal
Submucosal
83
Which medications can shrink fibroids
```
GnRH analogues (injection)
Ulipristal acetate
```
84
Surgical treatment of fibroids in someone who wants future children
Myomectomy
| Hysteroscopic resection
85
A differential for menorrhagia caused by endometrium growing into the myometrium
Adenomyosis
86
Treatment for myasthenia gravis
Pyridostigmine (cholinesterase inhibitor)
87
In myasthenia gravis, what are antibodies directed against
ACh receptors
88
Myasthenia gravis can be associated with a benign tumour of ?
Thymus gland (Thymoma)
89
Features of myasthenia gravis
Sx worsen with muscle use and improve with rest
Eye muscle weakness - ptosis, diplopia, blurred vision
Bulbar muscles - slurred speech, chewing/swallowing difficulties
Proximal limb weakness
Respiratory muscle weakness
90
Diagnosis of myasthenia gravis
EMG
ACh receptor antibody screen
Tensilon/Edrophonium test
91
In Lambert Eaton syndrome what are antibodies directed against
Voltage gated Ca channels
92
Management of myasthenic crisis
Plasmapheresis
IV immunoglobulin
Airway management
93
Monoclonal proteins found in Multiple Myeloma
IgG > IgA > Bence Jones
94
Abnormal production of monoclonal IgM suggests which plasma cell dyscrasia
Waldenstrom's macroglobulinaemia
95
Multiple myeloma a) best initial test b) confirmatory test
a) serum protein electrophoresis
| b) bone marrow biopsy
96
Diagnosis of organ damage in multiple myeloma
Hypercalcaemia
Renal insufficiency
Anaemia
Bone lesions on MRI
97
Diagnostic criteria for multiple myeloma
10+ % of clonal bone marrow plasma cells in biopsy plus at least one of;
- Organ damage - Ca, Renal, Anaemia, Bone lesions
- 60+ % clonal plasma cells in bone marrow
- Serum free light chain ration 100+
- > 1 focal lesion on MRI
98
Rouleaux formation on blood smear indicates which disease
Multiple Myeloma
99
Treatment of multiple myeloma
Chemotherapy
Stem cell transplant
Immunotherapy
Bisphosphonates, blood transfusion, EPO
100
What is the most common plasma cell dyscrasia
MGUS (monoclonal gammopathy of undetermined significance)
101
What is MGUS
Monoclonal gammopathy of undetermined significance
Monoclonal immunoglobulins in serum WITHOUT CLINICAL SYMPTOMS
< 10% plasma cells in marrow
No evidence of organ damage
Watch and wait as usually precedes multiple myeloma
102
Organism that cause croup
Parainfluenza virus
103
Organism that causes bronchiolitis
RSV
104
Organism that causes epiglottitis
HiB
105
Organism that causes whooping cough
Bordetella pertussis
106
Organisms that cause bacterial tracheitis
Staph aureus
| Group A beta-haemolytic strep
107
Treatment of croup
Stat steroids
108
Management of whooping cough
Antibiotics
| Admit if < 6 months old
109
Management of epiglottitis
Call anaesthetics and ENT
| IV Cefotaxime
110
Management of bacterial tracheitis
Emergency airway management
| Cefotaxime and Flucloxacillin
111
Stepwise management of chronic asthma in children
```
SABA
+ Steroid
If < 5 + Motelukast
If > 5 + LABA
Refer, add PO prednisolone if >5
```
112
Children below what age should really be using a spacer with their inhaler
< 8 years old
113
Treatment of severe asthma in a child
1. Sit up, high flow 100% oxygen
2. Salbutamol 5mg nebulised in 4ml saline with Ipratropium bromide 0.25mg
3. Hydrocortisone 100mg IV or Prednisolone soluble tablets (1-2mg/kg max 40)
4. Consider one IV magnesium sulphate dose 40mg/kg over 2omins
5. Aminophylline 5mg/kg IV over 20mins then IV infusion. Give with ondansetron to prevent vomiting
6. Nebulisers continuously until improving then reduce frequency. Give Ipratropium 8hrly if needed
7. Consider starting CPAP in the ED. If refractory or exhausted take to ITU
114
Primary biliary cholangitis features
```
Raised ALP
Fatigue
Pruritus
Pressure point hyperpigmentation
Xanthelasma, Xanthomata
Clubbing, hepatosplenomegaly
May progress to liver failure
```
115
Diseases associated with primary biliary cholangitis
Sjogrens
RA
Systemic sclerosis
Thyroid disease
116
Primary biliary cholangitis significantly increases the risk of which cancer
Hepatocellular cancer (20 X)
117
Antibodies associated with primary biliary cholangitis
Anti-mitochondrial antibodies - M2 subtype are highly specific
Smooth muscle antibodies
118
Management of primary biliary cholangitis
Cholestyramine for pruritus
Ursodeoxycholic acid
Fat soluble vitamin supplementation
Liver transplant
119
Diseases associated with primary sclerosing cholangitis
Ulcerative colitis
Crohn's
HIV
120
Features of primary sclerosing cholangitis
Cholestasis --> jaundice and pruritus
RUQ pain
Fatigue
121
Standard diagnostic investigation for primary sclerosing cholangitis and the characteristic finding
ERCP or MRCP
| 'Beaded' appearance of biliary strictures
122
Management of primary sclerosing cholangitis
Cholestyramine for pruritus
Ursodeoxycholic acid
Liver transplant
123
What features would make you consider encephalitis rather than meningitis
Altered mental status
Seizures
Focal neurological findings (weakness, visual disturbance, aphasia, cerebellar finding, behaviour change)
124
What type of organism usually causes encephalitis
Virus
| HSV, Japanese encephalitis
125
```
Vertigo:
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing loss
```
Viral labyrinthitis
126
Vertigo:
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss
Vestibular neuritis
127
Vertigo:
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds
BPPV (benign paroxysmal positional vertigo)
128
```
Vertigo:
Vertigo
Hearing loss
Tinnitus
Sensation of pressure/fullness
```
Meniere's disease
129
Vertigo:
Elderly patient
Dizziness on neck extension
Vertebrobasilar ischaemia
130
```
Vertigo:
Hearing loss
Vertigo
Tinnitus
Absent corneal reflex
Signs of neurofibromatosis type 2
```
Acoustic neuroma
131
How can you explain what PSA is to a patient
A protein made by the prostate gland
132
Who is eligible for PSA testing if asymptomatic and ask for it
Men age 50+
133
Things to avoid in the lead up to a PSA test
Don't ejaculate 48hrs before
Don't exercise 48hrs before
Also can't have it if you have a UTI or have had a prostate biopsy in the past 6 weeks
134
What are the 4 H's and 4T's for reversible causes of cardiac arrest
1. Hypoxia
2. Hypovolaemia
3. Hyperkalaemia/Hypokalaemia/Hypoglycaemia/Hypocalcaemia/Acidaemia
4. Hypothermia
1. Thrombosis – coronary or pulmonary
2. Tension pneumothorax
3. Tamponade
4. Toxins
135
What are the 'shockable' rhythms of cardiac arrest
Ventricular fibrillation
| Ventricular tachycardia
136
What are the 'non-shockable' rhythms of cardiac arrest
Asystole
| Pulseless electrical activity (other than TV)
137
Management of shockable rhythms
Compressions (30:2) and five first shock straight away
Shock every 2 minutes (every 5 cycles of CPR)
With the third shock give 1mg IV Adrenaline and IV Amiodarone
Give Adrenaline after every other shock
Consider Amiodarone again after 5th shock
138
Management of non-shockable rhythms
Chest compressions 30:2
Give 1mg IV Adrenaline straight away
Give further Adrenaline every 5 cycles of CPR
139
What 2 substances can cause pupil dilation in overdose
Benzodiazepines
| Tricyclic antidepressants
140
ECG changes in tricyclic antidepressant overdose
Sinus tachycardia
Broad QRS
Long QT interval
141
Reversal of warfarin
Vitamin K
| Prothrombin complex
142
Reversal of heparin
Protamine sulphate
143
What do you give if someone has taken too many beta blockers and is bradycardic
Atropine
144
Typical features of measles
```
Erythematous maculopapular rash
Palms and soles spared
Desquamation days later
Prodromal illness - cough, coryza, conjunctivitis
Koplik spots
Fever, malaise, lymphadenopathy
```
145
Typical features of scarlet fever
```
Erythematous maculopapular rash
Fine, rough, feels like sandpaper
Linear petechiae in groin/joint folds
Desquamation weeks later
Sudden onset high fever
Red flushed face with perioral pallor
Strawberry tongue
Recent strep throat infection/tonsillopharyngitis
```
146
Typical features of rubella
Pink maculopapular rash
Only lasts 3 days
Mild systemic disease
Red petechiae on soft palate
147
Typical features of slapped cheek
```
Maculopapular confluent rash that eventually becomes lace-like
Initially red, flushed cheeks
Mild systemic disease
Arthritis
Pruritus worse in sunlight
```
148
Presentation of HSP
```
Usually 3 days after a cough
Purpuric rash on legs, buttocks
Abdo pain
Nephritis + haematuria
High BP
```
149
Presentation of HUS
Usually 5-10 days after bloody diarrhoea in children
Low platelets
Microangiopathic haemolytic anaemia
Decreased renal function
150
5 key features of TTP
```
Microangiopathic haemolytic anaemia
Low platelets
AKI
Neuro sx
Fever
```
151
Secondary causes of ITP
```
Lymphoma
Leukaemia
SLE
HIV
HCV
```
152
Key features of Kawasaki disease
Fever >5 days
Bilateral conjunctival injection
Change in mucous membranes/strawberry tongue
Change in extremities - erythema and then desquamation of hands
Polymorphous rash
Cervical lymphadenopathy
153
Hungtington disease inheritance pattern
Autosomal dominant
154
Typical features of Huntington disease
Age 30-50
Initially - chorea, oculomotor disorders, hyper-reflexia, autonomic dysfunction
Later - hypokinetic, akinetic, dysarthria, dysphagia, dementia, depression, aggression
155
Neck lumps:
Midline, painless, firm
Elevates on swallowing and tongue protrusion
Thyroglossal duct cyst
156
Neck lumps:
Lateral to midline, anterior to sternocleidomastoid
Painless, firm
Doesn't move on swallowing
Branchial cleft cyst
157
Neck lumps:
Posterior triangle
Transilluminates
Soft, compressible, painless
Cystic hygroma
158
Antiplatelet medication
Aspirin
Clopidogrel
Ticagrelor
159
Bilateral conjunctival injection
Change in mucous membranes/strawberry tongue
Change in extremities - erythema and then desquamation of hands
Polymorphous rash
Cervical lymphadenopathy
Kawasaki disease
160
```
Microangiopathic haemolytic anaemia
Low platelets
AKI
Neuro sx
Fever
```
TTP
161
Usually 5-10 days after bloody diarrhoea in children
Low platelets
Microangiopathic haemolytic anaemia
Decreased renal function
HUS
162
```
Usually 3 days after a cough
Purpuric rash on legs, buttocks
Abdo pain
Nephritis + haematuria
High BP
```
HSP
163
```
Maculopapular confluent rash that eventually becomes lace-like
Initially red, flushed cheeks
Mild systemic disease
Arthritis
Pruritus worse in sunlight
```
Slapped cheek/Parvovirus
164
Pink maculopapular rash
Only lasts 3 days
Mild systemic disease
Red petechiae on soft palate
Rubella
165
```
Erythematous maculopapular rash
Fine, rough, feels like sandpaper
Linear petechiae in groin/joint folds
Desquamation weeks later
Sudden onset high fever
Red flushed face with perioral pallor
Strawberry tongue
Recent strep throat infection/tonsillopharyngitis
```
Scarlet Fever
166
```
Erythematous maculopapular rash
Palms and soles spared
Desquamation days later
Prodromal illness - cough, coryza, conjunctivitis
Koplik spots
Fever, malaise, lymphadenopathy
```
Measles
167
Well score for:
a) DVT likely
b) PE likely
a) 2+
| b) >4
168
Difference in calf circumference of ?cm indicates DVT
> 3cm
169
CTPA findings that are pathognomonic for PE
Wedge shaped infarction with pleural effusion
170
Medication to treat hyperprolactinaemia
Cabergoline or Bromocriptine (dopamine agonist)
171
What is the common cause of aplastic crisis in sickle cell disease
Parvovirus B19
172
Dactylitis is a finding of which blood disease
Sickle cell
173
Medication for sickle cell that can reduce number of crises
Hydroxyurea
174
Skull XR finding in myeloma
'Raindrop' appearance
