Tricky ones Flashcards
1
Q
Measles
- Symptoms
- Rash timing
- Rash spread
- Pathognomonic sign
- Natural history
- Requirements
A
Measles
- Symptoms
1. Fever, coryza, conjunctivitis
2. 10-12 days after exposure - Rash timing
1. 3-5 days after fever - Rash spread
1. Face (behind ears)
2. Spreads to body (red, macular) - Pathognomonic sign
1. Koplik spots (bucal mucosa)
2. 2 Days after fever - Natural history
1. Self-resolve 7-10 days
2. 30% complications - Pneumonia
- D&D
- CNS involvement
- Hearing/vision loss
- Requirements
1. 4 days isolation
2. Notifiable disease
2
Q
Scarlet fever
- Mx
- Requirements
A
Scarlet fever
- Mx
1. Pen V 10 days - Requirements
1. Off school until 24 hrs ABx
2. Notifiable disease
3
Q
Rubella
- Incubation
- Symptoms
- Rash
- Mx
- Requirements
- Complications
A
Rubella
- Incubation
1. 2 weeks after exposure - Symptoms
1. Rash
2. Mild fever
3. Joint pain
4. Sore throat
5. Lymphadenopathy (post-auricular, post cervical) - Rash
1. Mild red macular rash
2. Starts on face and spreads
3. Classically 3 day rash - Mx
1. Self-limitting - Requirements
1. Off school 5 days after rash appears
2. Notifiable
3. Avoid pregnant women - Complications
1. Thrombocytopenia
2. Encephalitis
3. Congenital rubella syndrome - Deaf
- Blind
- Heart disease
4
Q
Slapped cheek disease
- Cause
- Symptoms
- Rash
- Mx
- Requirements
- Immunocompromise complications
A
Slapped cheek disease
- Cause
1. Parvovirus B19 - Symptoms
1. Mild fever
2. Coryza
3. Muscle aches/lethargy - Rash
1. 2-5 days after symptoms
2. Bright red diffuse on cheeks
3. Reticular torso/limb rash later - Mx
1. 1-2 week self-limitting
2. Return to school once rash appears - Immunocompromised/preg/haem
1. Serology to confirm
2. FBC and retics (aplastic anaemia)
3. CNS
4. Fetal death
5
Q
Roseola (6th)
- Cause
- Symptoms
- Rash
- Mx
- Complications
A
Roseola (6th)
- Cause
0. HHV-6 or HHV-7 - Symptoms
1. 1-2 weeks incubation
2. High fever (40º), 3-5 days+sudden
3. Coryza symptoms - Rash
1. 1-2 day rash after symptoms
2. Mild rash across limbs, trunk, face - Mx
1. 1 week self-resolve
2. Not off school - Complications
1. Febrile convulsions
6
Q
Urticaria
- Acute causes
- Chronic causes
- Management
A
Urticaria
- Acute causes
1. Allergy - food, medication, animal
2. Contact - chemical, latex, stinging nettle
3. Medications
4. Viral infections
5. Insect bites
6. Dermatographism (skin rubbing) - Chronic causes
1. Sunlight
2. Temperature change
3. Exercise
4. Strong emotions
5. Pressure (dermatographism)
6. Autoimmune (eg. SLE) - Management
1. Fexofenadine
2. Steroids in flare
3. Montelukast (specialist)
4. Ciclosporin (specialist)
7
Q
Hand, foot, and mouth
- Cause
- Symptoms
- Rash
- Mx
- Requirements
- Complications
A
Hand, foot, and mouth
- Cause
1. Coxsackie A virus
2. 3-5 day incubation - Symptoms
1. URTI
2. 1-2 day small mouth ulcers
3. Then blistering red body spots - Mostly hands, feet, mouth (tongue)
- Mx
1. Supportive
2. 7-10 day self-resolving - Requirements
1. Highly contagious
2. Avoid transmission (hands, towels, bedding) - Complications
1. Dehydration
2. Bacterial superinfection
3. Encephalitis
8
Q
Molluscum contagiosum
- Symptoms
- Rash
- Mx
- Requirements
- Complications
A
Molluscum contagiosum
- Symptoms
1. Small fleshy papules - Central dimple
2. Crops of lesions - Mx
1. Self-resolving
2. 18 months
3. Avoid picking - Requirements
1. Avoid sharing towels
2. Avoid close contact - Complications
1. Bacterial superinfection - Fusidic acid, fluclox
2. Immunocompromised/eyelids/anogenital - Topical KOH, Benzoyl P, imiquimod, tretinoin
- Surgical/cryotherapy
9
Q
Pityriasis rosea
- Cause
- Presentation
- Mx
-
A
Pityriasis rosea
- Cause
0. Possible HHV6, HHV7 - Presentation
1. Herald patch (faint, pink, scaly, oval, 2cm+)
2. Widespread pink, scaly, oval lesions <2cm. (X-mas tree formation)
3. Itch, low fever, headache/lethargy - Mx
1. Self-resolving 3 months
2. Discolouration resolves
3. Symptomatic eg. emollients, topical steroid, sedating antihistamines at night
10
Q
Nappy rash
- Triggers
- Appearance
- Candida checks
- Mx
- Complications
A
Nappy rash
- Cause
0. Delayed changes
1. Irritant cleaning
2. Poor nappies
3. Diarrhoea
4. ABx use
5. Pre-term birth - Appearance
1. Red, inflamed skin
2. Exposure surfaces to nappy
3. Skin creases healthy (unlike candida)
4. Erosions and ulceration if long - Candida check
1. Skin folds
2. Larger red macules
3. Well-demarcated scaly border
4. Circular outward pattern
5. Satellite lesions
6. Oral thrush - Mx
1. Highly absorbent nappies (disposable gel matrix)
2. Prompt canges
3 Gentle products
4. Drying
5. Reduced nappy time
- Anti-fungals/antibiotics
- Clotrimazole, miconazole, fusidic acid, oral fluclox
- Complications
1. Candida/cellulitis
2. Jacquets erosive diaper dermatitis
3. Perianal pseudoverrucous papules and nodules
11
Q
SSSS in children
- Cause
- Appearance
- Mx
A
SSSS in children
- Cause
0. Staphylococcus toxins/enzymes - Appearance
0. <5 yo
1. Patches of erythema
2. Bullae (burn-like)
3. Nikolsky sign positive - Mx
1. Admission - IV ABx
- Fluid balance
12
Q
A
13
Q
BPH
- BNF Management (classes and names)
A
BPH
- BNF Management
- Alpha blocker
- Doxazosin
- Tamsulosin - 5 alpha reductase inhibitors
- Finasteride - PDE5 Inhibitor
- Tadalafil
- Helpful in ED - Anticholinergic
- Oxybutinin - Combination
(Includes Sympathomimetic
- Mirabegron)
14
Q
Rheum Antibodies
- RA
- CREST
- Phospholipid
- Sjogren
- Dermatomyositis
A
Rheum Antibodies
- RA
- CCP - CREST
- Centromere - Phospholipid
- Cardiolipin - Sjogren
- Anti-Ro - Dermatomyositis
- Anti Jo-1
15
Q
Menopausal symptoms
- Non-hormonal options
A
Menopausal symptoms
- Non-hormonal options
- Lifestyle (diet, ex, smok/alch, caff/stress)
- CBT
- SSRI (fluoxetine)
- SNRI (venlafaxine)
- Clonidine (alpha-adren)
- Gabapentin
16
Q
HRT
- Main indications
A
HRT
- Main indications
- Premature ovarian insufficiency
- even asymptomatic - Osteoporosis risk under 60
- Vasomotor symptoms
- Joint pain, poor sleep, low mood, libido
17
Q
HRT
-Risks
A
HRT
-Risks
- Breast cancer
- Endometrial cancer
- VTE (2-3x bg risk)
- Stroke/coronary artery disease
- Long-term use in older women - Ovarian cancer (inconclusive/minimal)
18
Q
HRT
- Contraindications
A
HRT
- Contraindications
- Pregnancy
- AUB
- Endometrial hyperplasia/cancer
- Breast ca
- HTN uncontrolled
- VTE
- Angina/MI
- Liver disease
19
Q
HRT Decisions
- Four steps
A
HRT Decisions
- Four steps
- Cancer/VTE risk
- Local/systemic sx
- Uterus?
- Peri/post-menopausal?
- Cyclical vs continuous
20
Q
HRT: Continuous vs Cyclical
- Over/Under 50s
- Last period
- Length of course
A
Continuous HRT
- Last period
1. 24 months in under 50s
2. 12 months in over 50s - Switch after cyclical
0. Switch during withdrawal bleed
- 24 months in under 50s
- 12 months in overs 50s
21
Q
HRT
- Progestogen classes and effects
A
HRT
- Progestogen classes and effects
C19 eg. norethisterone, levonorgestrel, desorgestrel
- Derived from testosterone
- Good in low libido
C21 eg. progesterone, dydrogesterone
- Good in low mood/acne
22
Q
Example HRT
- E-only pills
- E-only patch
- Cyclical tablet
- Cyclical patches
- Mixed medium cyclical
- Continuous tablets
- Continuous patches
- Continuous mixed
A
Example HRT
- E-only pills: Elleste Solo, Premarin
- E-only patch: Evorel, Estradot
- Cyclical tablet: Elleste-Duet, Clinorette
- Cyclical patches: Evorel Sequi
- Mixed medium cyclical: Mirena + Elleste Solo/Premarin/Evorel/Estradot
- Continuous tablets: Elleste Duet Conti,
- Continuous patches: Evorel-Conti
- Continuous mixed: Mirena +Elleste Solo/Premarin/Evorel/Estradot
23
Q
HRT
- Followup
A
HRT
- Followup
- 3 mo check up
- 3-6 mo for effect
- Problem bleeding -> specialist
- Appropriate contraception
- Stop 4 weeks before surgery
- Consider other causes for continued symptoms
