sca stuff Flashcards
1
Q
cubital tunnel syndrome - what nerve and fingers affected
A
ulnar nerve compression
numbness of 4th and 5th finger
2
Q
carpal tunnel syndrome - what nerve and fingers affected
A
median nerve compression
numbness of 1st, 2nd, 3rd, half of 4th finger
3
Q
gastric ulcers are affected by eating how
A
worsened by eating
4
Q
duodenal ulcers are affected by eating how
A
relieved by eating
5
Q
what type of treatment options for vasomotor symptoms in menopause
A
HRT
Clonidene
SSRIs
6
Q
what type of treatment options for mood changes in menopause
A
HRT
Self help
CBT
7
Q
what type of treatment for libido in menopause
A
off license testosterone
8
Q
what type of HRT if LMP <12 months ago
A
sequential HRT
8
Q
what type of HRT if LMP >12 months ago
A
continuous HRT
8
Q
treatment for reflux in formula fed baby
A
- reduce volume of feeds if over-feeding
- formula thickening trial for 2 weeks
- gaviscon trial for 2 weeks
- PPI trial for 4 weeks
8
Q
treatment for reflux in breast fed baby
A
- gaviscon trial for 2 weeks
- PPI trial for 4 weeks
9
Q
Down’s screening in pregnancy - what steps are done
A
- Combined testing at 11-13 weeks: Nuchal transparency and bloods for hormones
- Quadruple testing at 15-20 weeks: more bloods
If high risk, offer more screening e.g. non-invasive prenatal testing (NIPT) blood test OR diagnostic testing (amniocentesis or chorionic villous sampling)
10
Q
what week is cut off for hypertension induced pregnancy vs pre-existing
A
<20 weeks - pre-existing
>20 weeks - pregnancy induced
11
Q
what is 1st and 2nd line for HTN in pregnancy
A
Labetalol
Nifedipine
12
Q
what vitamins are we taking in pregnancy
A
- folic acid up until 12 weeks
- vitamin D throughout pregnancy
- iron if Hb <11
13
Q
chickenpox in pregnancy, if starting aciclovir it sould be given if they present within how many hours of the rash, and if >20 weeks
A
within 24 hours of the rash and if >20 weeks, give acyclovir
14
Q
when is triple AAA screening done for men - this is a one-off ultrasound
A
65 years old
15
Q
what result of triple AAA aneurysm is normal and not investigated further
A
<3.5cm
16
Q
what size triple AAA is referred:
(a) repeat scan in 12 months
(b) repeat in 3 months
(c) refer urgently to vascular in 2 weeks
A
(a) 3.5-4.5
(b) 4.5-5.5
(c) >5.5cm
17
Q
when is bowel cancer screening
A
aged 60-75
every 2 years
18
Q
when is breast cancer screening
A
aged 50-70
every 3 years
19
Q
when is cervical cancer screening
A
aged 25-50 every 3 years
50-65 every 5 years
20
Q
recent viral URTI
tinnitus
hearing loss
vertigo
A
acute labyrinthitis
21
Q
recent viral URTI
tinnitus
vertigo
nystagmus
NO hearing loss
A
vestibular neuronitis
22
tinnitus
hearing loss
vertigo
nystagmus
sensation of fullness
episodes recurrent
Meniere's disease
23
CABG - how many weeks off driving
4 weeks
24
PCI post-MI - how many weeks off driving
1 week
25
Post-MI - no PCI done, how many weeks off driving
4 weeks
26
When to inform the DVLA about triple AAA
>6.0 - notify DVLA
>6.5 - STOP driving
27
How is premature ovarian insuffiency diagnosed
Raised FSH on two blood tests taken 6 weeks apart
<40 years old
28
Nitrofurantoin is contraindicated in eGFR what...
eGFR <45
29
Precocious puberty is early puberty in what ages in females and males
<8 years old in girls
<9 years old in boys
30
when to refer undescended testes
- bilateral
- unilateral
Bilateral - at birth
Unilateral - after 3 months
31
Rash
Pink maculopapular initially on face
Then spreads to whole body
Usually fades by day 3-5
Lymphadenopathy - subocciptal and post-auricular
Rubella
Exclusion - 5 days from onset of rash
32
Prodome: irritability, conjunctivitis and fever
KOPLIK spots in mouth
Rash - starts behind ears then to whole body
Measles
Exclusion - 4 days from onset of rash
33
Fever, malaise, muscular pain
Parotitis - earache, pain on eating
Initially unilateral then becomes bilateral in 70%
Mumps
Exclusion - 5 days from onset of swollen glands
34
Fevers, headache
Slapped cheek rash spreading to arms and extensor surfaces
Erythema infectiosum
(also called fifth disease)
No school exclusion
35
Fever for 24-48hrs
Sore throat
Strawberry tongue
Rash - sandpaper pinpoint
Scarlet fever (group A strep)
Exclusion - 24 hours after starting antibiotics
36
Subclinical hypothyroidism (high TSH but normal T3/T4) - what is the next step if the patient is:
under 65 and symptomatic
Repeat in 3 months
Treat if still abnormal bloods
37
Subclinical hypothyroidism (high TSH but normal T3/T4) - what is the next step if the TSH >10?
Repeat test in 3 months
If TSH still >10, then start levothyroxine
38
Subclinical hypothyroidism (high TSH but normal T3/T4) - what is the next step if the TSH is between 5.5-10 and patient is:
under 65 and symptomatic
Repeat test in 3 months
If still abnormal then start levothyroxine
39
Subclinical hypothyroidism (high TSH but normal T3/T4) - what is the next step if the TSH is between 5.5-10 and patient is:
over 80 years old
Watch and wait
40
Subclinical hypothyroidism (high TSH but normal T3/T4) - what is the next step if the TSH is between 5.5-10 and patient is:
<80 years old and asymptomatic
Repeat in 6 months
If still abnormal can treat
41
When to treat otitis media with antibiotics
- <2 years old and bilateral
- Symptoms for >4 days
- Otorrhoea (discharge)
42
When to admit otitis media
- Under 3 months
- 3 to 6 months with fever
- Systemically unwell
43
Ovarian cancer risk is increased by many ovulations. Endometrial cancer risk is increased by excess oestrogen. What increases this risk?
- nulliparity
- early menarche
- late menopause
- unopposed oestrogen
44
What is triad is seen in ascending cholangitis
Fever
RUQ pain
Jaundice
45
DVLA Meniere's disease
Need to inform DVLA
Stop driving
46
Mouth ulcers for how long need referral to ENT 2ww
>3 weeks
47
Ear wax treatment options
Ear drops - olive oil, sodium bicarb
Ear syringing - do not do if grommets in situ or perforated TM
48
Conductive deafness
Tinnitus
Flamingo tinge of tympanic membrane
Autosomal dominant in family
Otosclerosis
49
Decreased visual acuity
Patient sees HALOES
Semi-dilated pupil
Hazy cornea
Peripheral vision loss
Acute glaucoma
50
Symptoms worsen watching TV in a dark room
Glaucoma!
51
Reduction in vision
Difficulties in dark adaptation with an overall deterioration in vision at night
Glare
Visual hallucinations
Distortion of straight lines
Central vision loss
Age related macular degeneration
52
What red eye syndrome is typically associated with underlying autoimmune disorders e.g. rheumatoid arthritis
Scleritis
note that episcleritis is not painful
53
Blurred vision
Photophobia
Red eye, watery
Ciliary flush - ring of red that spreads outwards
Anterior uveitis
Common in ankylosing spondylitis
54
blurred optic disc margin
venous engorgement
papilloedema
55
Veil/curtain over visual field
Straight lines appear curved
Central vision loss
Flashes/floaters
Retinal detachment
56
20mg atorvastatin is given as primary prevention for what patients
Qrisk >10%
Most Type 1 DM
eGFR <60
57
80mg atorvastatin is given as secondary prevention for which patients
IHD
previous stroke
peripheral arterial disease
58
Starting statins, when to do LFTs bloods
Baseline
3 months
12 months
59
non-visible haematuria, when to refer to 2ww
over 60 years old with dysuria or raised WCC on bloods
60
How to diagnose CKD? What do you need on bloods?
eGFR <60 on 2 occasions separated by at least 90 days
61
what are acceptable changes in eGFR and Cr after starting an ACEi
eGFR decrease of up to 25%
Cr rise of up to 30%
62
adrenaline doses for
6 months - 6 years
6 years - 12 years
>12 years
6 months - 6 years = 150mcg
6 years - 12 years = 300mcg
>12 years = 500mcg
63
FEV1/FVC = normal or increased
restrictive lung disease
64
FEV1/FVC = decreased
obstructive lung disease
65
CRB65 what does it stand for
Confusion
RR >30
BP <90/60
65 years
66
What does it mean with CRB scores of:
0
1-2
3-4
0 = treat at home
1-2 = consider hospital assessment
3-4 = urgent admission
67
how to diagnose asthma in adults
1. FeNO or eosinophils
2. spirometry if not confirmed above
68
What FeNO in adults denotes a diagnosis of asthma
over 50
69
how to diagnose asthma in children aged 5 to 16
1. FeNO
2. If FeNO is not raised, then spirometry
70
What FeNO in children denotes a diagnosis of asthma
over 35
71
what BMI is classed as obese
over 30
72
when is surgical bariatric surgery indicated in BMI
>40
or >35 with comorbidities
73
Twisting injury to the knee can affect which part
Meniscus
(locking, popping, giving way)
74
Anterior blows to the knee can result in what region damage
Posterior cruciate ligament
75
Sideways blows to the knee can damage which part of the knee
Medial or lateral collateral ligaments
76
Swelling in the knee injury can suggest what
fracture or tendon/ligament rupture
77
McMurrays test +ve indicates what
meniscus injury/tear
78
When does meniscus tear need urgent referral to ortho vs routine physio
Locking = urgent referral
No locking = refer to physio
79
non-urgent referral for urology indications
>60 with recurrent or persistent UTI
<40 with non-visible haematuria, normal renal function, no proteinuria, normal BP
80
impaired fasting glucose
fasting glucose between 6.1-7.0
81
impaired glucose tolerance
OGTT between 7.8-11.1
82
what are the fasting glucose, OGTT readings and HbA1c for diabetes diagnosis
fasting glucose >7.0
OGTT >11.1
HbA1c >48
83
what is the hba1c target for patient with any drug that can cause hypoglycaemia e.g. sulfonylurea
53
84
when to add on a second medication if patient is only on metformin for diabetes
hba1c is above 58
85
what is the hba1c target for patient with lifestyle treatment or metformin only
48
(add on a second drug if over 58)
86
What hormones are low or raised in Addison's disease (primary adrenal insufficiency)
LOW cortisol
LOW aldosterone
87
Hyponatraemia
Hyperkalaemia
Hypotension
What endocrine disorder is this
Addison's disease
(low aldosterone and low cortisol)
88
What investigation is used for addison's disease
Short syncACTHen test
Tries to stimulate cortisol production which is low
89
2ww criteria for upper GI
- all patients with dysphagia
- all patients with upper abdo mass
- anyone over 55 years with weight loss AND:
-- upper abdo pain
-- dyspepsia
-- reflux
90
Routine criteria for routine upper GI referral
- haematemesis
- anyone over 55 years with:
-- treatment resistant dyspepsia
-- upper abdo pain and low Hb
-- raised plts count - with wt loss, N+V, reflux, upper abdo pain
91
what is regime of b12 injections for low b12
3x week for 2 weeks
Then 3 monthly
92
in patients with non-alcoholic fatty liver disease, what do NICE recommend as next test
enhanced liver fibrosis (ELF) blood test
to check for advanced fibrosis
93
management of non alcoholic fatty liver disease
LOSE WEIGHT
Monitoring
Check for fibrosis using enhanced liver fibrosis (ELF) blood test
Refer if advanced fibrosis
94
malnutrition definition
- BMI <18.5
- >10% wt loss in last 3-6 months
- BMI <20 and wt loss >5% in last 3-6 months
95
treatment for haemachromatosis (excess iron)
venesection
desferroxamine
96
treatment for Wilson's disease (excess copper)
penicillamine
97
AST:ALT ratio in alcohol hepatitis is usually...
2:1
98
all male patients drinking >50 units and female >35 units per week should be referred for what
enhanced liver fibrosis (ELF) blood test or fibroscan even if LFTs are normal
99
if erythema migrans rash is present in Lyme Disease what is the treatment
doxycyline for 21 days
no need for any extra tests
100
what is first line test for lyme disease
ELISA antibodies
101
If ELISA test for Lyme disease is negative and still suspected, what test should be done next?
- If symptoms <4 weeks, repeat ELISA 4-6 weeks later
- If symptoms >12 weeks, do immunoblot test
102
If ELISA test for Lyme disease is positive and still suspected, what test should be done next?
Immunoblot test
103
what are the 7 live attenuated vaccines
1. BCG
2. Oral rotavirus
3. Oral polio
4. Oral typhoid
5. Intranasal influenza
6. Yellow fever
7. MMR
104
what vaccines are offered to high risk groups/men who have sex with other men
Hep A
Hep B
HPV
105
treatment for gonorrhoea if refuses IM ceftriaxone
oral cefixime + oral azithromycin
106
post exposure prophylaxis for Hepatitis A
give immunoglobin + hep A vaccine
107
post exposure prophylaxis for Hepatitis B
- if patient is a responder (>100) to Hep B vaccine, give a booster
- if non-responder, give Hep B immunoglobulin + hep B vaccine
- if in process of being vaccinated - give accelerated course
108
post exposure prophylaxis for Hepatitis C
monthly PCR
if seroconversion, then start antivirals
109
post exposure prophylaxis for HIV
- antiretrovirals for 4 weeks within 72 hours
- test at 4 weeks and 12 weeks post exposure
110
who to send a urine culture off for
- over 65 years old with UTI
- any age with haematuria
- pregnant women
- all men
- catheter patients
- kids
111
when do you admit hypercalcaemia
over 3.0 (moderate)
or if symptomatic
112
symptoms of hypercalcaemia
Bones - bone pain, #
Stones - renal stones
Groans - abdo pain, constipation
Moans - psych memory loss, fatigue
113
what to do for suspected vit D deficiency
- bloods - bone profile, calcium, PTH
- xrays if any bone deformities
- treat with vit D supplements (high dose for 8-12 weeks then step down to maintenance)
114
what blood pressure meds can cause hypercalcaemia
thiazide diuretics
115
mild hypercalcaemia (2.6-2.99) - what bloods shall we check
Bone profile
PTH
Myeloma screen
116
when is genetics referral indicated in breast cancer where there is a family history of...
can also do breast clinic referral too
Breast cancer in 1st or 2nd degree relative AND one of:
- age of diagnosis <40 years
- bilateral cancer
- male breast cancer
- jewish ancestry
- ovarian cancer
- sarcoma in <45 years
- glioma or adrenal cancers
- paternal family history of breast cancer (at least 2 members on paternal side)
117
doses of benzylpenicillin for meningitis
300mg - <1 years
600mg - 1-10 years
1200mg - >10 years
118
rosacea treatment for:
(a) redness/flushing
(b) mild-moderate pustules
(c) moderate-severe pustules
(a) topical brimonidine gel
(b) topical ivermectin gel or topical metronidazole
(c) topical ivermectin + oral doxycycline
119
psoriasis treatment for:
(a) body
(b) scalp
(c) face, flexures, genitals
(a) 8 weeks potent steroid + vit D analogue
(b) 4 weeks mild steroid cream -> switch to shampoo after
(c) 2 weeks of mild steroid cream
120
what psoriasis treatment should be avoided in pregnancy
vitamin D analogue
121
topical treatment options for mild-moderate acne - for 12 weeks
- BPO + adapalene
- BPO + clindamycin
- tretinoin + clindamycin
122
treatment for moderate to severe acne - for 12 weeks
- BPO + adapalene
- tretinoin + clindamycin
- BPO + adapalene + oral lymecycline or doxycyline
- COCP in women
- oral retinoid - refer to derm
123
Shingles is a live attenuated vaccine - what age group is it offered to
70-79 years
124
investigations for developmental dysplasia of the hip
USS <4 months
x-ray >4.5 months
125
<3 months old
Excess crying, pulling up of legs
Worse in the evening
Infantile colic
126
6-18 months old
Excess crying
Draws knees up, turns pale
Vomiting
Cramping abdo pain
Bloodstained stool
Intussusception
+ sausage shaped mass
127
when to water restrict with desmopressin
sips of water 1 hour before and up to 8 hours after
128
risk of down's syndome in:
30 year old
35 year old
40 year old
1 in 800 - 30 years
1 in 270 - 35 years
1 in 100 - 40 years
129
severe asthma attacks in children have what HR and RR numbers in ages:
(a) 2-5
(b) >5 years
(c) adults
(a) HR >140, RR >40
(b) HR >125, RR >30 - also PEF 33-50%
(c) HR >110, RR >25
130
what is the level of SaO2 and PEF in a life-threatening asthma attack in children aged more than 5 and adults?
SaO2 <92%
PEF <33%
131
what is the level of PEF in a moderate asthma attack in children aged more than 5 and adults?
PEF 33%-50%
can't complete sentences
132
what investigations should be done in children <6 months when there is:
(a) first UTI or atypical or recurrent infections
USS within 6 weeks
133
what investigation should be done in children >6 months with atypical or recurrent UTIs and when should it be done
USS within 6 weeks
or static radioisotope scan (DMSA) to look for renal scars, 4-6 months after initial infection
134
delayed puberty definitions
14 in boys with no testes growth
13 in girls with no breast growth, or 15 with breast growth but no periods
135
what is the management of babies with weak or absent femoral pulses at 6-8 week check
discuss immediately with paediatrics
136
migraines treatment in adults + children
adults:
- NSAIDs + triptans
- prophylaxis = propranolol, topiramate
children:
- NSAIDs
- intranasal triptans in over 12s
137
peak incidence age of croup
6 months to 3 years
138
croup when it is moderate or severe needs admission to hospital. what features are present in this?
- STRIDOR - this is not present at rest in mild croup
- chest wall recessions
- in distress or agitation in severe croup
- tachycardia
139
treatment for croup regardless of severity
single dose of oral dexamethasone (0.15mg/kg)
140
Teenage girls
Anterior knee pain on walking up and down stairs
Responds to physio
Chondromalacia patellae
Softening of cartilage of patella
141
Sporty teenages
Pain, tenderness and swelling of tibial tubercle
Osgood-schlatter disease
a.k.a tibial apophysitis
142
Pain after exercise
Swelling and locking intermittent
Osteochondritis dissecans
143
Knee may give way
Medial knee pain due to lateral subluxation of patella
Patellar subluxation
144
Chronic anterior knee pain worse after running
Athletic teenage boys
Tender below patella
Patella tendonitis
145
conjunctivitis bilaterally in baby <1 months age should have what management
immediate same-day opthal review
146
what test is useful if jaundice >14 days in a baby and wondering if biliary atresia
conjugated and unconjugated bilirubin
high conjugated levels in biliary atresia
147
levonorgestrel - take within 72hrs of UPSI
what is the vomiting rule
if vomiting within 3 hours, repeat dose
148
levonorgestrel - take within 72hrs of UPSI
what is the weight rule
if BMI >26 or weight >70kg then double dose
149
ullipristral - take witin 120hrs of UPSI
what is contraception (oral) rule with this
start COCP/patch/ring 5 days after this
barrier methods should be used until then
150
ullipristral - take witin 120hrs of UPSI
what is breastfeeding rule for this
breastfeeding should be delayed for 1 week after taking ellaone
151
when can an IUD (copper coil) be used after UPSI
up to 5 days after UPSI
or up to 5 days after expected ovulation date (i.e. until day 19 for a regular 28 day cycle)
152
tension headache treatment
acute: aspirin, paracetamol, NSAID
prophylaxis: low dose amitryptiline
or acupuncture
153
cluster headache treatment
acute: 100% high flow oxygen, subcutaneous triptans
prophylaxis: verapamil
154
how long until contraceptives are effective?
- IUD
- POP
- IUS mirena
- COCP
- implant
- injection
- IUD - immediately
- POP - 2 days
- Mirena IUS, COCP, implant, injection - 7 days!
155
how long does the IUS mirena coil last for
up to 8 years
(for HRT up to 5 years)
156
how long does the IUD copper coil last for
up to 10 years
157
how long does the progesterone implant last for
3 years
158
Infertility bloods serum progesterone is done. What do you do when serum progesterone is low (<16)
Repeat serum progesterone
If still <16, refer to specialist
159
when to refer to fertility clinic, ages and timeframes for trying for baby
<35 years - trying for 12 months
>35 years - trying for 6 months
160
Infertility bloods - serum progesterone. Result is:
(a) <16
(b) 16-30
(c) >30
(a) Repeat - if still <16 refer
(b) Repeat
(c) Normal ovulation
161
lifestyle counselling points for fertility
1. folic acid
2. BMI 20-25
3. regular intercourse 2-3 times per week
4. no smoking or drinking
162
hyperemesis gravidarum first line medications
cyclizine
promethazine
prochlorperazine
163
when to admit patient for hyperemesis gravidarum
- unable to keep liquids or oral antiemetics down
- vomiting with ketonuria and weight loss >5%
164
which contraceptive reduces bone density and increases risk of osteoporosis
progesterone injection
165
Who is screened for gestational diabetes and with what tests?
1. Women who have had it before - OGTT is done ASAP after booking and at 24-28 weeks if first one is normal
2. Women with any risk factors - offered OGTT at 24-28 weeks
166
Diagnostic thresholds for gestational diabetes
Fasting glucose >5.6
2-hour glucose >7.8
167
When is insulin started for gestational diabetes (diagnosed with fasting glucose >5.6 or 2-hour glucose >7.8)
Fasting glucose >7.0
otherwise lifestyle for 2 weeks + then metformin
168
when to repeat pregnancy test after medical termination of pregnancy
2 weeks afterwards
169
treatment for stress incontinence
- pelvic floor muscle training
- duloxetine
BLADDER DIARY!
170
treatment for urge incontinence
- bladder retraining
- oxybutynin
- or mirabegron in old ladies
BLADDER DIARY!
171
what is good alternative to oxybutynin or other medications in urge incontinence in old ladies
Mirabegron
172
angina - all patients should receive what
ASPIRIN 75mg
STATIN
B-blocker +/- CCB
GTN spray to abort attacks
173
what is tibolone
synthetic compound of both oestrogen and progesterone actions, type of HRT
174
4 contraindications to HRT
- current or past breast cancer
- any oestrogen sensitive cancer
- undiagnosed vaginal bleeding
- untreated endometrial hyperplasia
175
what cancers does HRT increase the risk of
breast cancer
ovarian cancer
176
if women are not breastfeeding, when do they require contraception from after giving birth
after day 21
177
what contraceptions can be used immediately after birth
IUD/IUS - up to 48hrs after
POP - immediately
Progesterone implant - immediately
Progesterone injection - immediately
178
when can you start COCP after birth
- if breastfeeding, after 6 weeks
- if not breastfeeding, after 21 days
179
lactational amenorrhoea method of contraception is 98% effective if the woman is what 3 criteria...
1. fully breastfeeding
2. no periods
3. <6 months post-partum
180
all patients with myocardial infarction should be offered what 4 classes of medication
dual antiplatelet therapy
ACE inhibitor
b-blockers
statin
181
when can you have sex after an MI
4 weeks afterwards
182
Platelet count what to do if between:
(a) 100-150 asymptomatic
(b) 50-100 asymptomatic
(c) 50-100 with symptoms e.g. bleeding
(d) <50 without red flags
(e) <20 or active bleeding
(a) repeat in 4-6 weeks
(b) repeat in 1-2 weeks
(c) urgent referral
(d) urgent referral
(e) immediate hospital
183
What symptoms to ask about with thrombocytopenia (low platelets)
Any active bleeding
Bruising
Fatigue
184
High BP, high HR
Diarrhoea
Sweating
Headache
Restlessness
Muscle ridigity/spasms
Started new meds recently...
SEROTONIN SYNDROME
185
Stage 1 hypertension
Stage 2 hypertension
Stage 3 severe hypertension
Stage 1 = 140/90 or 135/85
Stage 2 = 160/100 or 150/95
Stage 3 = >180 or >120
186
what patient groups are started on ACE inhibitors for high blood pressure in HTN guidelines
>55 years old or T2DM
187
what patient groups are started on amlodipine for high blood pressure in HTN guidelines
>55 years old
No T2DM
Or Black ethnicity
188
if patient on warfarin and INR >5.0 what to do
(a) INR 5.0-8.0 no bleed
(b) INR >5.0 bleeding
(c) INR >8.0
(a) withold 2-3 doses then recheck
(b) and (c) - send to hospital
189
angina 3 criteria for typical angina
2 = atypical angina
1 = non-anginal chest pain
1. chest pain (or in neck, shoulders, arms etc)
2. worse on exertion
3. relieved by rest or GTN spray
190
When to refer patients for chest pain:
(a) current or in last 12 hours
(b) 12-72 hours ago
(c) >72 hours ago
(a) straight to A&E
(b) same day hospital admission
(c) >72 hours ago - can do ECG + troponin then decide
191
what do you give to someone who you suspect ACS in
GTN spray
aspirin 300mg
oxygen if needed
192
Patients should have BNP test for heart failure. What do you do if BNP is:
(a) >2000
(b) 400-2000
(c) <400
(a) very raised, TTE + cardio review in 2 weeks
(b) high, TTE + cardio review in 6 weeks
(c) nothing normal
193
What medication is given for chronic heart failure
1. ACE inhibitor
2. B-blocker
3. Aldosterone antagonist
+/- SGLT-2 inhibitors
4. Next is started by specialists: ivabradine etc
194
What vaccinations do patients with chronic heart failure have
Annual influenza
One off pnuemococcal
195
What do you do if Well's score is 2 or more?
USS within 4 hours
Or if unable, then d-dimer, start anticoagulation, USS within 24 hours
196
Conservative treatment for varicose veins
- leg elevation
- weight loss
- regular exercise
- graduated compression stockings - check ABPI first!
197
When do varicose veins need referral (5 reasons)
1. SIGNIFICANT lower limb symptoms e.g. pain, discomfort or swelling
2. previous bleeding from varicose veins
3. skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)
4. Superficial thrombophlebitis
5. An active or healed venous leg ulcer
198
Management of asthma inhalers in adults steps
1. Low dose MART - PRN use
2. Low dose MART - regular use
3. Moderate dose MART
4. If high FeNO or eosinophils - refer to specialist
5. If normal FeNO and eosinophils - add on LTRA (montelukast) or LAMA
199
Management of COPD inhalers steps
1. SABA (better) or SAMA PRN
2. If steroid responsive - add ICS + LABA
3. If not steroid responsive - add LABA + LAMA
-> Switch all SAMAs to SABA
4. ICS + LABA + LAMA (+SABA PRN)
200
Weber's test, in the middle of the head tuning stick, what ear does the sound move towards for:
(a) conductive loss
(b) sensorineural loss
(a) the same affected ear
(b) the opposite ear
e.g. if left ear hears it, then there is right sensorineural loss or left conductive loss
201
Rinne result
What is normal
Air conduction > bone conduction
therefore when it is bone conduction > air conduction - there is conductive loss in that ear.
202
management of mild-moderate asthma attack
SABA via spacer
1 puff every 30-60s up to a max of 10 puffs
If not controlled, repeat and refer to hospital
203
Steroid dose for asthma vs COPD
Asthma - 40mg
(n.b. kids is 1-2mg/kg OD)
COPD - 30m
204
What lifestyle changes, vaccines are recommended for being with COPD in management
Stop smoking
One off pneumococcal
Annual influenza
Pulmonary rehab if MRC stage 3 or more (can't walk more than 100m without stopping)
Emergency Abx + steroids at home
205
When COPD patients have done pulmonary rehab and maxxed out all their inhalers (ICS + LABA + LAMA + SABA), what 5 things can be considered next?
1. carbocisteine for sputum
- or referral for:
2. oral theophylline
3. oral antibiotics - azithromycin prophylaxis
4. PDE-5 inhibitors
5. LTOT/ lung surgery
206
Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following three criteria:
Secondary polycthaemia
Peripheral oedema
Pulmonary HTN
207
How long can you not drive with first unprovoked seizure vs multiple seizures (epilepsy)
Group 1: 6 months (unprovoked first), 12 months (multiple epilepsy)
Group 2: 5 years (unprovoked first), 10 years (multiple)
208
How long can you not drive for provoked seizure
Group 1: 6 months
Group 2: 5 years
209
Stroke/TIA - how long can they not drive
Stop driving until TIA appointment
usually can restart 1 month if clinically recovered
need to tell DVLA
210
Angina - driving rules
Can drive if asymptomatic
No driving if symptoms at rest
211
Obstructive sleep apnoea - driving rules
No driving, need to tell DVLA
212
what is the target BP for patients with chronic kidney disease and ACR >70?
please note it is normal (140/90) for CKD with normal ACR <70
<130/80
213
when to refer to nephrology for CKD patients
- ACR >70
- ACR >30 and 2 episodes of haematuria with no UTI
- eGFR drop of 25% in 12 months
- eGFR drop of 15 in 12 months
214
what is the blood pressure target in T1DM patients
<135/85
