Y4 zero to finals mix Flashcards
(500 cards)
1
Q
Gram positive cocci
A
Staphylococcus StreptococcusEnterococcus
2
Q
Gram positive rods
A
Corny mike’s list of basic cars
CorneybacteriaMycobacteriaListeria BacillusNocardia
3
Q
Gram positive anaerobes
A
CLAPClostridiumLactobaccilus Actinomyces Propionibacterium
4
Q
Abx inhibit cell wall synthesis
A
With beta-lactam ring (penicillin, carbapenem, cephalosporin)Without beta-lactam ring(Vancomycin, teicoplanin)
5
Q
Abx inhibiting folic acid metabolism
A
Sulfamethoxazole and Trimethoprim block formation of folic acid Co-trimoxazole is a combination of the two
6
Q
Abx inhibit protein synthesis (target ribosome)
A
Macrolides (erythromycin, clarithromycin, azithromycin)ClindamycinTetracyclinesChloramphenicol
7
Q
Unusual chest infection organisms
A
Moraxella catarrhalis (in immunicompromised with chronic Lung disease) Pseudomonas auerginosa (CF) Staphylococcus aureus (CF)
8
Q
Most common UTI bacteria
A
E. coli| Gram -ve, anaerobic, rod shaped
9
Q
Chest infection 1st line
A
Amoxicillin
10
Q
UTI 1st line
A
Trimethoprim| Nitrofurantoin
11
Q
UTI in pregnancy
A
7d abx 1st Nitrofurantoin (do not give in 3rd trimester - haemolytic anaemia)2nd amoxicillintrimethoprim (do not give in 1st or anti-epileptics as has ANTI FOLATE effect)
12
Q
Cellulitis and golden crust?
A
Staph aureus infection
13
Q
Cellulitis tx 1st line
A
Flucloxacillin
14
Q
Centor criteria
A
<3 not bacterial tonsilitisFever >38*CTonsillar exudatesAbsence of coughTender lymph nodes
15
Q
Bacterial tobsilitis 1st line
A
Penicilin V /phenoxymethylpenicillin 10days
16
Q
Otitis media 1st line
A
Amoxicilin| But (erythronycin, clarithromycin if penicillin Allergy)
17
Q
Sinusitis management
A
Pencilin V/ phenoxymethylpenicillin 5daysNo improvement after 10 days: 2 weeks of high dose steroid nasal sprayNo improvement after 10 days + likely bacterial cause: Abx
18
Q
Septic arthritis tx
A
1st flucloxacillin + rifampicin| 2nd vancomycin + rifampicin (joint replacement or penicillin allergy)
19
Q
Influenza treatment
A
Oral oseltamivir 75mg 2x day for 5 days Or Inhaled zanamivir 10mg 2x day for 5 days(Treatment must start within 48h of symptoms) Same drugs but 1x day for 10 days in PEP
20
Q
Gram negative diplococcus
A
Gonorrhoea| Neisseria meningitidis
21
Q
Bacterial meningitis in adults
A
Neisseria meningitidis, strep pneumoniaeNeonates: group B strep
22
Q
Lumbar puncture in babies
A
<1 month with fever 1-3 month fever and unwell <1 year unexplained fever and serious ilness
23
Q
Kernig’s test
A
Pt on back, flexing hip and straightening knee - meninges stretch and -> resistance or pain
24
Q
Brudzinski’s test
A
Pt flat on the back, chin to chest -> if meningitis then pt flexes hips
25
Community meningitis 1st line
Benzylpeniclinin IM/IV stat300mg <1y600mg 1-9y1200mg >10y
26
Meningitis hospital tx
<3m cefotaxime + amoxicillin>3m ceftriaxone+ Dexamethasone to prevent hearing loss and neuro damage 4x/4 days
27
Lumbar puncture results
Bacterial - cloudyViral / normal - clear Bacteria release proteins and use up glucose Viruses don’t use glucose and release little protein Neutrophils released for bacteria and lymphocytes released for virusesHigh WBC for both
28
TB staining
Ziehl Neelsen stain turns bacteria bright red and background blueTB grows acid-fast bacilli (rod shaped)
29
BCG vaccine
Intradermal infection of life attenuated TB- works against complicated TB- not as effective for pulmonary TB
30
Mantoux test
Injecting tuberculin into intradermal space| Check after 72h, >5mm is positive (previous vaccination, latent, or active TB)
31
Interferon gamma release assays
Confirms latent TB disease
32
Pts at risk of TB reactivation (w latent TB) tx
Isoniazid and rifampicin 3m| Isoniazid 6m
33
Acute TB tx
Rifampicin 6mIsoniazid 6mPyrazinamide 2mEthambutol 2m
34
Isoniazid side effects and tx
Peripheral neuropathy| - Pyridoxine (B6)
35
Rifampicin se
Red discolourstion of urnie and tears| Induces p450 so reduces effect of contraceptive pill
36
Pyrazinamide se
Hyperuricaemia (high uric acid and gout)
37
Ethambutol se
Colour blindness and reduced visual acuity
38
PCP in hiv
Co-trimoxazole prophylaxis in CD4 <200
39
PEP
<72h| Truvada (emtricitabine/ tenofovir) and Raltegravir 28days
40
Uncomplicated malaria treatment
MalaroneQuinine sulphateDoxycycline
41
IV tx for complicated malaria
Artesunate and quinine dihydrochloride
42
Antimalarials
Malarone (2d/during/1week)Mefloquine (2w/during/4week) - psychotic episodes and seizuresDoxycycline (2w/during/4week) - Abx so thrush, diarrhoea
43
OA risk factors
```Obesity AgeTraumaFemaleFamily history```
44
OA X-ray
Loss of joint spaceOsteophytesSubarticular sclerosisSubchondral cysts
45
OA symptoms
Pain and stiffness worsened by activity
46
OA signs
Haberdens nodes DIPBouchards nodes PIPSquaring of the thumb
47
OA management
Weight loss, physioParacetamol + topical NSAIDAdd oral NSAID + PPIAdd codeine / morphine
48
RA genetics
HLA DR4 - RF positive pt| HLA DR1 - often present in RA
49
Antibodies in RA
RF| anti CCP
50
RA presentation
```Symmetrical polyarthritis MCP and PIP jointsAtlantoaxial subluxationPain, swelling, stiffnessPain worse after rest, improves with activity```
51
Signs in the hands RA
```Boggy feelingZ shaped thumbSwan beck deformityBoutonnières deformity (flexor digitorum superficialis works)Ulnar deviation```
52
Felty’s syndrome
RA, neutropenia, splenomegaly
53
DAS 28
Disease activity score Swollen jointsTender jointsESR/CRP result
54
RA DMARDs
1st mono: methotrexate, leflunomide, sulfasalazine, hydroxychloroquine2nd: 2 drugs3rd: methotrexate + biological therapy (TNF inhibitor - adalimumab, infliximab, etanercept)4rd: methotrexate + rituximab
55
Methotrexate SEs
Pulmonary fibrosis
56
Leflunomide se
Hypertension and peripheral neuropathy
57
Sulfasalazine se
Male infertility (reduced sperm count)
58
Hydroxychloroquine se
Nightmares and reduced visual acuity
59
Anti TNF se
Reactivation of TB and hep B
60
Rituximab
Night sweats and thrombocytopenia
61
Psoriatic arthritis signs
```Nail pittingPsoriasis plaques on skinOnycholysis- nail separates from nail bedDactylitis ConjunctivitisPencil in cup appearance```
62
Chlamydia vs| Gonorrhoea ->
Chlamydia -> Reactive arthritis| Gonorrhoea -> gonococcal septic arthritis
63
Reactive arthritis
Conjunctivitis, arthritis, balanitis
64
Seronegative spondyliarthropathy
HLA B27 geneAnkylosing spondylitisReactive arthritisPsoriatic arthritis
65
AS features
Sacroiliac and vertebral pain and stiffnessVertebral fracturesPain worse at night Morning stiffness, gets better throughout the dayStiffness worse with rest and better with movement
66
AS associations
```AnaemiaAnterior uveitis Aortitis Heart block Pulmonary fibrosis```
67
X ray changes in AS
```Bamboo spine Squaring of vertebral bodiesSubchondral sclerosisFusion of joints Syndesmophytes```
68
AS treatment
Nsaids 2-4weeks then change if no improvementSteroidsAnti TNF (etanercept)Monoclonal antibody against TNF (infliximab, adalimumab)
69
SLE signs
Photosensitive malar rash| Worse with sunlight
70
SLE investigations
C3 and C4 decreased in active diseaseCRP and ESR raised in active inflammationIncreased PCR in lupus nephritis
71
SLE antibodies
ANA| anti ds DNA (increased with disease activity)
72
Anti Smith
specific to SLE
73
Sensitivity
How many/% ill people had positive result
74
Specificity
What % of healthy people had negative result
75
Anti centromere
Limited cutaneous systemic sclerosis
76
Anti Ro and Anti La
Sjorgen’s syndrome
77
Anti Scl 70
Systemic sclerosis
78
Anti Jo 1
Polymyositis
79
SLE treatment
NSAIDsSteroids (prednisolone) Hydroxychloroquine (mild SLE 1st line)Biological therapies: rituximab, belimumab
80
Systemic sclerosis
Hardening of the skin| Fibrotic connective tissue disease
81
Limited cutaneous systemic sclerosis antibodies
Anti Scl 70| Anti centromere
82
Limited cutaneous systemic sclerosis features
```CalcinosisRaynuaurd phenomenonEsophageal dysmotilitySclerodactylyTelangectasia```
83
Diffuse cutaneous systemic sclerosis antibodies
Anti Scl 70
84
Diffuse cutaneous systemic sclerosis symptoms
CREST+ CV problems+ lung problems + kidney problems
85
Polymyalgia rheumatica
```2 weeks ofBilateral shoulder pain, pelvic girdle painWorse with movementWakes up from sleepAt least 45min stiffness in the morning```
86
Polymyalgia rheumatica tx
```15mg prednisolone /dayUntil symptoms settle (3-4 weeks)Then 12.5mg for 3 weeks10mg for 4-6 weeksReduce by 1mg every 4-8 weeks```
87
Giant cell arteritis risk
Vision loss
88
Temporal artery biopsy findings in giant cell arteritis
Multinucleated giant cells| Also investigations: raised ESR, CRP, hypoechoic halo on duplex ultrasound
89
Giant cell arteritis tx
40-60mg prednisolone/day| also 75mg aspirin daily
90
Polymyositis and /dermatomyositis+ diagnosis+tx
Chronic muscle inflammation /+ skin involvementRaised CKCorticosteroids
91
DermatoMyositis signs
Gottron lesions (knuckle hardening)Photosensitive rash on the back and neckCalcium deposits in subcut tissue
92
Polymyositis antibodies
Anti Jo 1
93
Dermatomyositis antibodies
Anti Mi 2| ANA
94
Antiphospholipid syndrome antibodies
Lupus anticoagulantAnticardioliptin antibodiesAnti beta 2 glycoprotein I antibodies
95
Libmann-Sacks endocarditis
Non bacterial endocarditis with vegetations on mitral valve, SLE and antiphospholipid association
96
Livedo reticularis
Purple lace like rash with mottled appearance to the skin
97
Sjorgen’s Syndrome
Autoimmune condition affecting exocrine glands| -dry mucous membranes, dry mouth, eyes, vagina
98
Secondary Sjorgen’s
When condition is related to SLE or rheumatoid arthritis
99
Sjorgen’s antibodies
Anti Ro| Anti La
100
Schirmer test
Tears should travel 15mm in healthy adult| 10mm is significant
101
Sjorgen’s syndrome tx
Artificial saliva, tearsVaginal lubricantsHydroxychloroquine stops disease progression
102
Vasculitis markers
ESR and CRP raised| Anti neutrophil cytoplasmic antibody ANCA
103
pANCA
peri Nuclear anti-neutrophil cytoplasmicAnti-PR3Microscopic polyangitis, churg-Strauss
104
cANCA
Wegener’s granulomatosis
105
Vasculitis treatment
Steroids,| Immunosuppressants (cyclophosphamide, methrotrexate, azathioprine)
106
Henoch Schonlein Purpura
```IgA Vasculitis Purpuric rash in lower limbs and buttocks- purpura- joint pain- abdominal pain- renal involvement```
107
Wegener’s polyangitis
Respiratory track and kidney involvement EpistaxisHearing loss and sinusitisSaddle shaped nose due to perforated septum
108
Kawasaki disease (medium vessel Vasculitis)
```CRASH AND BURNConjunctivitisRashAdenopathy /LymphadenopathyStrawberry tongueHands and feet skin peeling ```Fever >5d
109
Kawasaki disease complication
Coronary artery aneurysm
110
Behcet disease gene
HLA B51 (prognostic of severe disease)
111
Behcet disease features
Oral and genital ulcers + skin inflammation, uveitis, muscle stiffness, GI ulceration, veins - Budd chiari syndrome, DVT, pulmonary artery aneurysm)
112
Pathergy test
For Behcet disease Tests for skin hypersensitivity Skin subcut abrasion, reviewed 24-48h later, >5mm weal is positive
113
Behçet’s disease tx
Colchicine for inflammationImmunosuppressant azathioprineTopical (bethamethasone) and systemic (prednisolone) steroids
114
Gout aspirate features
No bacteriaNeedle shaped crystalsNegative birefringent Monosodium urate
115
Gout X ray
Sclerotic boarders with overhanging edges| Punched out erosions
116
Gouty throphi
Subcut deposits of uric acid
117
Gout mx
Acute: NSAID, colchicine, steroid
118
Colchicine se
Diarrhoea -given in pts who can’t use NSAID
119
Gout prophylaxis
Allopurinol, reduces uric acid levels
120
Pseudogout
Calcium pyrophosphate crystals / chondrocalcinosis
121
Pseudogout joint aspirate
No bacteria Calcium pyrophospahte crystalsRhomboid shapedPositive birefringent
122
Pseudogout on X ray
Chondrocalcinosis
123
Pseudogout tx
NSAID, colchicine, steroids| +- joint washout
124
Risk factors for osteoporosis
```Old ageFemaleLow BMILow activity/ mobilityAlcohol and smokingRheumatoid arthritisLong term corticosteroid usePost menopause (oestrogen is protective)```
125
FRAX tool
Prediction of fragility fracture in 10years| Age, BMI, smoking, alcohol, co-morbidities, family history
126
Osteoporosis tx
Bisphosphonates (upright, empty stomach, 30 min before eating)- alendronate 75mg/week- risedronate 35mg/week- zolendronic acid 5mg/ year IV
127
Osteomalacia
Defect in bone mineralisation due to insufficient vit D| If in children before growth plate close - rickets
128
Osteomalacia pathology
Low vit Dcauses low Ca and PO42* hyperparathyroidismReabsorption of Ca from bones (causing soft bones)
129
Investigation for vit D
<25 - vit D deficiency 25-50 insufficient >75 optimal
130
Osteomalacia tx
Vit D 50. 000 1x weekly (6w)20. 000 2x weekly (7w)4. 000 daily (10w)Maintenance 800 daily
131
Paget’s disease
Excessive bone turnover (formation and reabsorption due to increased osteoblast and osteoclast activity)Forms high density sclerotic and low density lytic patches.
132
Paget’s disease biochemistry
Raised ALPNormal Ca Normal PO4
133
Paget’s X ray
Cotton wool skull| V shaped defect in long bones
134
Paget’s disease treatment
Bisphosphonates + vit D and Ca supplementation on bisphosphonates NSAIDs for pain
135
ABCD2 score
```48h risk of stroke post TIAAge >60 (1)BP >140/90 (1)Clinical features - dysphasia (1), +weakness (2)Durstion >60min (2), 10-60min (1)Diabetes (1)```
136
Stroke management
Aspirin 300mg/ day for 2 weeks| Thrombolysis with alteplase within 4.5h (after CT)
137
TIA mx
Aspirin 300mg + secondsry prevention:Clopidogrel 75mg 1x or dypiridamole 200mg 2xAtorvastatin 80mg
138
Crescendo TIA follow up
Within 24h specialist assessment| ABCD2 >3 24h assessment, otherwise 1 week assessment
139
GCS
Eyes: none, Pain, speech, spontVerbal: None, sounds, words, confused, orientalnedMotor: none, Extends, abnormal flexion, flexion, localises Pain, obeys commands
140
Subdural haemorrhage location
Bridging veins| Between dura and arachnoid
141
Subdural haemorrhage on CT
crescent shape| Crosses cranial sutures
142
Subdural haemorrhage risk factors
Elderly and alcoholic
143
Extradural haemorrhage location
Middle menigeal artery Temporal/parietal regionAssoc w fx of temporal bone
144
Extradural haemorrhage CT
Biconvex| Does not cross cranial sutures
145
Extradural haemorrhage hx
Young ptOngoing headache Period of improvement and rapid decline in consciousness
146
Subarachnoid haemorrhage location
Pia matter and arachnoid membrane
147
Subarachnoid haemorrhage vessel
Cerebral aneurysm rupture
148
Subarachnoid haemorrhage hx
```Occipital headache (strenous activity)Thunderclap headacheNeck stiffnessPhotophobiaHit on the back of head```
149
Subarachnoid headache associations
```Cocaine useSickle cell anaemiaAlcoholSmokingHTN```
150
Ix in subarachnoid haemorrhage
CT hyperattenuation| CSF red cell count and xantochromia
151
Subarachnoid haemorrhage mx
Coiling or clipping of the aneurysm Nimodipine for vasospasmLumbar puncture and shunt to treat hydrocephalus
152
CN VI palsy in MS
Internuclear ophthalmoplegia| Conjugate lateral gaze disorder
153
MS lumbar puncture
Oligoclonal bands
154
Optic neuritis features
Central scotomaPainReduced colour visionRAPD
155
MS relapse treatment
Methylprednisolone 500mg PO 1x for 5 days| Or 1g IV daily 3-5d
156
Lower motor neurone disease
Muscle wastingReduced toneFasciculationsReduced reflexes
157
Upper motor neurone disease
Increased toneBrisk reflexesUpgoing plantars
158
Management of motor neurone disease
Riluzole
159
Parkinson’s triad
Resting tremorRigidityBradykinesia
160
Parkinson’s features
```Ansomnia Shuffling gait Hypomimia Asymmetrical tremor 4-6hzWorse at restImproves with movementNo change with alcohol```
161
Levodopa
Synthetic dopamine
162
Peripheral decarboxylase inhibitors
Benserazide| Carbidopa
163
Too high dopamine se
Dskinesia (excessive motor activity)
164
Dystonia
Abnormal postures and exaggerated movements
165
Chorea
Abnormal involuntary movements (jerking and random)
166
Athetosis
Involuntary twisting in hands feet fingers
167
COMT inhibitor
Inhibits levodopa metabolism in body and brain| Slows levodopa breakdown
168
Dopamine agonists
SE pulmonary fibrosisBromocryptinePergolideCarbergoline
169
MAO B Inhibitors
Block enzyme breaking down dopamine neurotransmitterSelegiline Rasagiline
170
Benign essential tremor tx
Propanolol (non selective beta blocker)| Primidone (anti epileptic)
171
Tonic clinic seizure
```Prolonged post ictalLoss of consciousness ConfusedDrowsyIncontinence```
172
Focal seizures characteristics
Hearing speech memoryDeja vu Autopilot (strange things, don’t remember)Hallucinations
173
Focal seizure location
Temporal
174
Infantile spasms
West syndrome full body spasmsTx prednisolone and vigabatrin
175
Seizure treatment
(Everything but focal)Sodium valproate Lamotrigine/carbamazepineFocal Lamotrigine/carbamazepineSodium valproate/levetiracetam
176
Absence Seizure tx
Sodium valproate or Ethosuximide
177
Carbamazepine se
```AgranulocytosisP450 inducer (eg cocp)```
178
Phenytoin se
Folate and vit D deficiency Osteomalacia Megaloblastic anaemia
179
Status epileptic is mx in community
Buccal midazolam| Rectal diazepam
180
Status epilepticus mx in hospital
```O2Check blood glucose IV accessIV lorazepam 4mg (repeat after 10min)IV phenobarbital or phenytoin```
181
Trigeminal neuralgia tx
Carbamazepine
182
Neuropathic pain tx
```(1 at a time, if doesn’t work switch, try all 4)AmitryptylineDuloxetineGabapentinPregabalin```
183
Bell’s palsy tx
Prednisolone (start within 72h)50mg for 10days60mg for 5 days and 5days reducing regime (10a day)
184
Ramsay Hunt Syndrome
Herpes zoster virus| 72h prednisolone, acyclovir
185
Bilateral acoustic neuromas association
Neurofibromatosis type 2
186
Acoustic neuroma symptoms
Hearing lossTinnitus Balance problems
187
Bromocriptine
Block prolactin secreting tumours
188
Somatostatin analogue (ocreotide)
Block growth hormone secreting tumours
189
Huntingtons genetics
```ADOn chromosome 4Trinuckeotide repeat disorder mutation in HTT geneAnticipation```
190
What is anticipation
Successive generation have more repeats of the gene- earlier onset age- increased severity of disease
191
Drugs to manage huntingtons symptoms
Antipsychotic (olanzapine)Benzodiazepines (diazepam)Dopamine depleting (tetrabenazine)
192
Myasthenia gravis antibodies
Acetylcholine receptor antibodies 85%Muscle specific kinase antibodies 10% (make up the receptor)LRP4 abs (5%)
193
Edrophonium test
IV 10mg of endrophonium chloride / neostigmineStops breakdown of acetylcholine and relieves weaknessAtropine 0.6mg IV to reverse
194
Myasthenia gravis treatment
Acetylcholinedterase inhibitors (neostigmine, pyridostigmine)Or monoclonal:Rituximab, eculizumab
195
Myasthenic crisis tx
IVIG| Plasma exchange
196
Lambert Eaton associations
Small cell lung cancerProximal muscles affectedDiplopia, ptosis, dysphagia
197
Lambert Eaton treatment
Amifampridine - allows more Ach to be released in junction synapses
198
Charcot Marie tooth genetics
AD
199
Charcot Marie tooth characteristics
```High foot arch/ pes cavusInverted champagne bottle legsLoss of ankle dorsiflexionWeak handsReduced muscle tone Peripheral neuropathy```
200
Gillian barre triggers
#NAME?
201
Gullain barre ix
CSF raised protein| Nerve conduction reduced
202
NF1 genetics
AD| chromosome 17
203
NF1 diagnostic criteria
```Cafe au lait (6 spots >15mm)Relative with NF1Axillary/inguinal frecklesBony dysplasia, bowing of bonesIris hamartomasNeurofibromatomasGlioma of optic nerve```
204
NF2
Chromosome 22 AD —> leads to development of Schwannomas and acoustic neuromas
205
NF 2 associations
Bilateral acoustic neuromas
206
Tuberous sclerosis genetics
TSC1 gene chromosome 9 - hamartinTSC2 gene chromosome 16 - tuberinHamartin and tuberin control cell growth
207
Skin signs of tuberous sclerosis
```Ash leaf spotsShagreen patches AngiofibromasCafe au laitPoliosis+ epilepsy and developmental delay```
208
Migraine acute and long term management
Acute: paracetamol, sumatriptan 50mg, nsaid, metoclopramide for vomitingLong: propanolol, topiramate (teratogenic, cleft lip and palate), amitriptyline
209
Migraine around menstruation tx
NSAIDs Or FrovatriptanZolmitriptan
210
Cluster headache acute and long term mx
Acute: high flow O2, sumatriptan 6mg subcut| Long term: veramapil, lithium, prednisolone
211
Glaucoma
Optic nerve damage due to rise in intraocular pressure
212
IOP
10-21mmHg| Start treatment in >24mmHg
213
Risk factor for glaucoma
Black ethnicAgeMyopia/ near sight
214
Glaucoma tx
LatanoprostTimolol DorzolamideBrimonidine
215
Latanoprost
Prostaglandin analogue eye dropsIncrease uveoscleral outflowEyelash growthEyelid and iris pigmentation
216
Timolol
B blocker| Reduce aqueous humour production
217
Dorzolamide
carbonic anhydrase inhibitor| Reduce aqueous humour production
218
Brimonidine
Sympathomimetic| Reduce aqueous fluid production and increase uveoscleral flow
219
Medications precipitating close/acute angle glaucoma
Noradrenalin OxybutyninSolifenacinAmitryptyline
220
Close angle glaucoma immediate management
Lie on the backPilocarpine eye drop (pupil contatriction)Acetazolamide PO 500mg (carbonic anhydrase, reduces aqueous humour production)
221
Close angle glaucoma 2* care
```PilocarpineAcetazolamide Hyperosmotics (mannitol, glycerol)Timolol DorzolamideBrimonidine```
222
Age Related Macular Degeneration presentation
```Reduced visual acuity Wavy appearance of straight linesWorsening of central vision -drusen -scotoma-amsler grid```
223
Dry AMD tx
LifestyleStop smokingControl BP
224
Wet AMD
anti VEGF injected into vitreous chamber (ranibizumab, bevacizumab, pegaptanib)
225
Diabetic retinopathy pathophysiology
Blot haemorrhage Hard exudatesCotton wool spots
226
Micro aneurysm
Small bulges in blood vessels due to weakness
227
Venous beading
Walls of vessels no longer straight, string of beads or sausages
228
Cotton wool spots
Nerve fibre damage - white fluffy patches
229
Retinopathy management
Laser photocoagulation| Anti VEGF ranibizumab, bevacizumab
230
Silver wiring/ copper wiring
Walls of arterioles are thickened and sclerosed
231
Av Nicking
Arterioles compress veins when they cross over
232
Cataract
Lens of the eye becomes cloudy and opaque
233
Cataracts presentation
Worsening visionChange in colour vision (colours more brown/yellow)Starburts around lights Loss of red reflex
234
Dilated pupil
Horner adieRaised icp 3rd nerve palsy Anticholinergics
235
Constricted pupil
Horner syndromeArgyll Robertson pupilOpiateNicotine
236
3rd CN palsy (oculomotor)
PtosisDilated pupilDown and out
237
Horner syndrome
PtosisMiosis Anhidrosis + enophthalmos/ sunken eye
238
Anhidrosis - pre ganglionic
#NAME?
239
Anhidrosis central
```- Face arm trunkSyringomyeliaStrokeMSSwelling (tumour)```
240
Post ganglionic Anhidrosis
No AnhidrosisCarotid aneurysmCarotid artery dissectionCavernous sinus thrombosis
241
Holmes Aldie pupil
dilated pupil, slow to react to light, slow dilatation
242
Holmes aldie syndrome
Holmes aldie pupil| Ankle and knee reflexes absent
243
Test for Horner syndrome
Cocaine (stops noradrenaline reuptake) - normal dilates, affected no reaction Adrenaline eye drop - will dilate affected pupil but no reaction in normal
244
Hordeolum externum
stye| Gland of zeis/ moll infection at base of eyelashes
245
Hordeolum internum
Meibomian glands infection, pointing inwards towards the eyeball
246
Chalazion
Mebomian gland blockage and swellingHot compress and analgesiaChloramphenicol if acutely inflamed
247
Trichiasis
Inward growth of eyelashes
248
Preorbital cellulitis
Infection of eyelid and skin in front of the ortbital septum
249
Orbital cellulitis
Infection around the eyeball involving tissues behind the orbital septum- pain on movememt- proptosis- reduced vision- abnormal pupil reactions
250
Episcleritis vs scleritis
Episcleritis painless| Scleritis painful
251
Conjunctivitis mx
Cool water eye cleaning| Chloramphenicol and fusidic acid drops
252
Neonatal conjunctivitis
Gonococcal infection
253
Anterior uveitis genetics
HLA B27Ankylosing spondylitisIBDreactive arthritis
254
Anterior uveitis mx
Steroid (oral topical Iv)Immunosuppressants (dmard and TNF inhibitor) Cycloplegic-mydriatic - dilate pupil to reduce pain (cyclopentolate, atropine)
255
Corneal abrasion in contact lenses
Pseudomonas infection
256
Corneal abrasion complication
Herpes keratitis (antiviral treatment)
257
Corneal abrasion /herpes keratitis diagnosis
Fluorescein stain - ulcer /abrasion
258
Keratitis
Inflammation of the cornea
259
Bacterial keratitis causes
Pseudomonas or staphylococcus
260
Viral keratitis
Herpes simplex keratitis
261
Herpes keratitis fluorescein
Dendritic corneal ulcer
262
Herpes keratitis tx
Acyclovir (topical or oral)| Ganciclovir eye gel
263
Sensorineural hearing loss caused by drugs
```Loop diuretics (furosemide)Aminoglucoside antibiotics (gentamicin)Chemotherapy drugs (cisplatin)```
264
Causes of prebyscusis
```(Sensorineural hearing loss)Loss of hair cells in cochleaLoss of neurons in cochleaReduced endolymphAtrophy of stria```
265
Sensorineural hearing loss tx
Cochlear implants
266
Sudden sensorineural hearing loss
Over 72h| Loss of 30 decibels in 3 consecutive frequencies
267
Sudden sensorineural hearing loss tx
Steroids (oral, intratympanic)
268
Eustachian tube dysfunction mx
Valsava manouvre (blow closed nose)Decongestant nasal spraySurgery (grommet, ballon dilatation)
269
Otosclerosis
Remodelling of small bones of middle ear - bone hardeningAD patternOnset <40yoConductive hearing loss
270
Hearing loss at low frequencies
Otosclerosis
271
Conductive hearing loss mx in otosclerosis
Hearing aids| Surgery - stapedectomy or stapedotomy
272
Bacterial cause of otitis media
Step pneumoniaeOther: Hem influenzaMoraxella catarrhalisStaphylococcus aureus
273
Otitis media tx
Amoxicillin 5-7dClarithromycin (in penicillin allergic)Erythromycin (in pregnant and allergic to penicillin)
274
Otitis externa bacterial causes
Pseudomonas auerginosa| Staph aureus
275
Otitis externa hearing loss
Conductive
276
Pseudomonas auerginosa
Gram -ve aerobic rod shaped bacteria Colonises in lungs in CFTx with aminoglycosides (gentamicin), quinolones (ciprofloxacin)
277
Otitis externa tx
```Mild: acetic acid 2%Moderate: topical abx + steroid - neomycin, dexamethasone, acetic acid-neomycin and bethamethasone- gentamicin and hydrocortisone- ciprofloxacin and dexamethasoneSevere: oral abx flucloxacillin or clarithromycin```
278
Ototoxic drugs
Aminoglycosides (gentamicin and neomycin) Toxic if get past tympanic membraneMust exclude perforated tympanic membrane
279
Fungal otitis externa tx
Clotrimazole ear drops
280
Malignant otitis externa findings
Granulation tissue
281
Malignant otitis externa tx
AdmissionImaging IV abx
282
Methods of removing ear wax
Ear drops (olive oil, sodium bicarbonate 5%)Ear irrigation Microsuction
283
Primary tinnitus
Occurs with sensorineural hearing loss
284
BPPV
Calcium carbonate crystals displaced into aemicircular canals
285
Labirynthitis vs vestibular neuronitis
Labirynthitis causes hearing loss
286
Posterior circulation infarction symptoms
VertigoAtaxia DiplopiaCN or limb symptoms
287
Cerebellar examination
```DysdiadochokinesiaAtaxic gaitNystagmus Intention tremor SpeechHeel to shin```
288
Head impulse test
Shaking head left or right Asking pt to keep looking at doctors noseIf saccades, PERIPHERAL vertigo
289
Nystagmus test
Quick look right to left (repeat)Unilateral horizontal: PERIPHERAL causeBilateral vertical: CENTRAL cause
290
Central vertigo treatment
Referral, CT MRI
291
Peripheral vertigo tx
Prochlorperazine| Antihistamine
292
Meniere disease Tx
Betahistine
293
Vestibular migraine tx
Triptans| Propanolol/ topiramate/ amitryptyline long term
294
BPPV symptoms
Vertigo attacks 20-60 secasymptomatic in betweenOver several weeksNo tinnitus or hearing loss
295
Vestibular neuronitis
Vestibular nerve inflammation
296
Inner ear parts
Semicircular canalsVestibuleCochlea
297
Semicircular canals role
Detect head rotation
298
Otolith organs role
Detect gravity and linear acceleration
299
Labirynthitis LOSS of hearing| Neuronitis NO loss of hearing
Tinnitus and hearing loss - Labirynthitis or Menieres disease Nausea and balance - vestibular neuronitis
300
Vestibular neuritis and Labirynthitis treatment
Prochlorperazine| Antihistamines (cyclizine, promethazine)
301
Meningitis complication
Hearing loss
302
Meniere disease triad
```Hearing lossVertigoTinnitus- unilateral- symptoms 20min-couple hours- low frequency sensorineural hearing loss```
303
Cholesteatoma
Squamous epithelial cells abnormal collection in middle ear
304
Choelsteatoma presentstion
Foul discharge| Unilateral conductive hearing loss
305
Nosebleed management
Nasal packing (tampons or inflatable packs)Nasal cautery with silver nitrateThen 4x day for 10 days - naseptin nasal cream (chlorhexidine, neomycin)
306
Naseptin components and contraindication
Chlorhexidine and neomycin| Cd: peanut or soya allergy
307
Acute sinusitis
If symptoms not impoving after 10dHigh dose nasal spray 14d (momethasone 200mcg 2x daily)Delayed abx prescription if not improved after 7d (phenoxymethylpenicilline)
308
Nasal polyps unilateral
Concern for malignancy, specialist referral
309
Samter’S triad
Nasal polyps, asthma, aspirin intolerance/allergy
310
Nasal polyps apperance
Pale grey/yellow growth on mucosal wall
311
Apnoea assessment
Epworth sleepiness scale
312
Tonsilits bacterial cause and tx
Group A step (streptococcus pyogenes) - penicillin V / phenoxymethylpenicillin```Or strep pneumoniaOther causes: Haemophilius ibfluenza Moraxella catarhhalis Staphylococcus aureus```
313
Centor criteria - probability of bacterial tonsilitis
```3 or more (40-60%) Fever 38*CTonsilar exudatesAbsence of coughLymphadenopathy```
314
FeverPAIN score
4-5 score (62-65%) - Fever in previous 24h - Pus on tonsilitis - Attend within 3 days of symptoms - Inflamed tobsils (severely inflamed) - No cough or coryza
315
When to prescirbe abx?
Centor >= 3| FeverPAIN >= 4
316
Tonsilitis tx
Penicillin V 10 day Course Or Clarithromycin for penicillin allergy
317
Peritonsillar abscess cause
Strep pyogenes (group A Strep) Staph aureusHaemophilius influenzae
318
Quinsy treatment
Co amoxiclav| Incision and drainage
319
Tonsilectomy indications
7 tonsilitis in 1y5 tonsilitis in 2y3 tonsilitis in 3y
320
Post tonsilectomy bleeding management
Hydrogen peroxide gargleAdrenalin soaked swabRe - surgery
321
Thyroid lump
Moves with swallowing
322
Thyroglossal cyst
Movement when sticking tongue out
323
Bronchial cyst
Transluminates with light| Anterior triangle
324
EBV and abx
Maculopapular rash in response to amoxicilin and cefalosporin
325
Hodgkin lymphoma node biopsy
Reed Sternberg cell
326
Thyroglossal cyst
MobileNon tenderSoftFluctuant
327
Lipoma
MobileSoftPainlessNo skin change
328
Branchial cyst
```RoundSoftCystic swellingTransluminate with lightAnterior to SCM```
329
Glossitis causes
Iron deficiencyB12, folate deficiencyCoeliac disease
330
Oral candidiasis treatment
Miconazole gelNystatin suspensionFluconazole tablets
331
Leuko and erythroplakia
Leuko - white patchesErythro - red lesionsPrecancerous changes, increasing risk of squamous cell carcinoma
332
Aphthous ulcers treatment
Topical:Choline salicylateBenzydamineLidocaineTopical corticosteroids - severe:Hydrocortisone buccal tabletsBethamethasone soluble tabletsBeclomethasone inhaler spray
333
VTE prophylaxis in hip/knee
LMWH 28d post hip, 14d post knee replacement| Or aspirin, rivaroxaban, stockings
334
Prostethic joint infection organizm
Staphylococcus aureus
335
Children fracture types
Salter Harris ONLY in childrenGreenstickBuckle fracture
336
Cancers that metastasise to the bone
```PoRTaBLeProstateRenalThyroidBreastLung```
337
FRAX tool
Measures pt’s risk of fragility fracture over 10 years
338
Tx for preventing fragility fractures
Calcium and vit D| Bisphosphonates (alendronic Acid) - alternstive with monoclonal ab Denosumab-
339
Bisphosphonates side effects
Osteonecrosis of jaw or external auditory canalReflux and oesophageal erosionAtypical fractures
340
Non displaced intra capsular fx tx
Internal fixation
341
Displaced intra capsular fx tx
Hemiarthroplasty - elderly, co morbidities, mobility issues| Total hip replacement - young, walk independently
342
Extra capsular fx
Intertrochanteric fx| Subtrochanteric fx
343
Intertrochanteric fx tx
Dynamic hip screw
344
Subtrochanteric fx tx
Intramedullary nail
345
Hip fx presentation
Shortened, abducted, externally rotated leg
346
Disruption of Shenton line
NOF fx
347
Acute limb ischaemia
PULSELESS limb
348
Acute compartment syndrome
```Pain - disproportionate, worsened by passive movememt ParaesthesiaPaleHigh pressureParalysis```
349
Osteomyelitis
Inflammation of bone and bone marrow due to bacterial infection
350
Most common cause of osteomyelitis
Staph aureus
351
Acute osteomyelitis treatment
6 weeks of flucloxacillin with rifampicin/fusidic acid added for first 2 weeksClindamycin if penicillin allergy Vancomycin or teicoplanin if MRSA
352
Most common bone cancer
Osteosarcoma
353
Kaposi sarcoma cause
HHV 8
354
Most common sarcoma metastasis
Lungs
355
Sciatic nerve roots
L4 - S3Exits pelvis through greater sciatic foramenThen divided into tibial and common peroneal nerve
356
Thomas test
Flexibility of hip flexors (eg iliopsoas muscle group)
357
Long term back ache tx
Duloxetine| Amitryptyline
358
Cauda equina
Compression of cauda equina nerve roots L3-S5
359
Cervical cancer Red flag
IMB| PCB
360
Primary amenorrhoea
Not starting period by 13yo when no other pubertal development Not starting period by 15yo when there are other signs of puberty
361
Normal puberty dates/events
Girls 8-14 with Breast buds then pubic hair| Boys 9-15
362
Hypogonadotrophic hypogonadism
LH and FSH deficiency so no stimulation for ovaries to produce sex hormones
363
Causes of hypogonadotrophic hypogonadism
```HypopituitarismCFDelay in growth and developmentGrowth hormone deficiencyHypothyroidismCushing HyperprolactinemiaKallman syndrome```
364
Kallman syndrome
Hypogonadotrophic hypogonadism| Ansomnia
365
Hypergonadotrophic hypogonadism
Gonads fail to respond to gonadotropins (LH FSH)
366
Hypergonadotrophic hypogonadism
Previous gonads damage (torsion, cancer, mumps)Congenital absence of ovariesTurner syndrome XO
367
Congenital adrenal hyperplasia symptoms
```FEMALE with:TallFacial hairPrimary ammenorhoeaDeep voiceEarly puberty```
368
Androgen insensitivity syndrome
MalesMale sexual characteristics do not developResults in female phenotype, female external genitalia, absent uterus/vagina/fallopian tubes/ovaries
369
GH deficiency screening
ILGF low = low GH
370
Hypogonadotrophic hypogonadism tx
(Eg hypopituitarism or Kallman syndrome) Treat with pulsatile GnRH (induce menstruation and ovulation)Replacement sex hormones (cocp - induce menstruation)
371
Secondary amenorrhoea
No menstruation >3m if previous regular periods| No menstruation 6-12m if previous irregular
372
Pituitary causes of secondary amenorrhoea
```Pituitary tumour (prolactinoma)Pituitary failure (Sheehan syndrome)```
373
Drugs to reduce prolactin production
Bromocriptine| Cabergoline
374
Dopamine agonists (cabergoline bromocriptine)
Treat hyperprolactinemjaParkinson’sAcromegaly
375
Primary ovarian failure bloods
High FSH
376
PCOS bloods
High LH| High LH:FSH ratio
377
Raised testosterone conditions
PCOSAndrogen insensitivity syndrome Congenital adrenal hyperplasia
378
Reducing osteoporosis risk in pts with amenorrhoea
Vit D and Calcium| Hormone replacement therapy
379
PMS
Symptoms during luteal phase| These are progesterone induced
380
PMS mx
Healthy lifestyleCOCP (drospirenone)SSRI CBT
381
Physical symptoms of PMS tx
Brest swellingWater retention Bloating - spironolactone
382
Cyclical breast pain tx
Danazole, tamoxifen
383
Menorrhagia
Heavy menstrual bleeding (>80ml)
384
Menorrhagia mx (no contraception)
Tranexamic acid - if no pain (antifibrynolytic reduced bleed)Mefenamic acid - pain (NSAID reduce bleed and pain)
385
Menirrhagia mx contraception
Mirena coil IUSCOCPCyclical oral progestogens (norethistone 5mg 3x daily days 5-26)
386
Fibroid
Benign tumour of uterus smooth muscle They grow in response to oestrogen
387
Fibroid types
IntramuralSubmucosalSubserosalPedunculated
388
Fibroids <3cm mx
IUS mirenaNSAID/ tranexamic acidCOCPCyclical legal progestogens
389
Surgical options for fibroids <3cm
Endometrial ablationResection during hysteroscopyHysterectomy
390
Fibroids >3cm mx
```Referral to GynaeNSAID/ tranexamic acidMirena coil IUSCOCPcyclical progestagen```Uterine artery embolisationMyomectomyHysterectomy
391
How to reduce fibroid size?
GnRH agonist before surgery Goserelin (Zoladex)Leuprorelin (Prostap)Induce ovulation-like state
392
Uterine artery embolisation
Blockage of arterial supply to fibroids causes them to shrink
393
Malignant change of fibroid
Leiomyosarcoma
394
Red degeneration
Ischaemia and necrosis if fibroid due to disrupted blood supply (occurs in larger fibroids >5cm)Fibroid enlarges quickly in 2nd and 3rd trimester and outgrows it’s blood supply so it dies
395
Red degeneration hx
```Severe abdominal painLow grade fever Tachycardia Vomiting +history of fibroidsTx: test fluid analgesia```
396
Endometriosis
Ectopic endometrial tissue outside the uterus
397
Endometrioma
Lump of endometrial tissue outside uterus - in ovaries these are called chocolate cysts - within the myometrium: adenomyosis
398
Risk factors for adenomyosis
Multiparous| Later reproductive years
399
Adenomyosis symptoms
DysmenorrheaMenorhhoagiaDyspareunia
400
Gold standard ix for endometriosis and adenomyosis
Endometriosis - laparoscopy| Adenomyosis - hysterectomy with histological examination
401
Adenomyosis tx
Same as endometriosis and heavy menstrual bleeding
402
Premature menopause
Before age of 40Result of premature ovarian insufficiency - lack of ovarian follicular function - Low oestrogen and progesterone - LH and FSH High
403
Lack of oestrogen risks
```Osteoporosis Pelvic organ prolapseUrinary incontinenceCVDStroke```
404
Symptoms of lack of oestrogen
```Hot flashesLow moodPMSirregular and heavy/light periodLow libidoJoint painsVaginal dryness```
405
When can menopause be diagnosed?
12 months with no periods in women >45yo
406
When to do FSH blood tests?
<40 yo with suspected menopause| 40-45yo with symptoms or change in menstruation
407
Contraception and menopause
For 2 years after LMP of <50yo| For 1 year after LMP >50yo
408
Depo - Provera (progesterone depot injection) SE
Weight gainReduced bone density / osteoporosisUNSUITABLE in >45yo
409
Progesterone with low risk of DVT
Norethisterone| Levonorgestrel
410
Primenopausal symptoms management
HRTTibolone (steroid hormone, continuous combined HRT)Clonidine (agonist of alpha-adrenergic and imidazoline receptors)Testosterone for low libidoVaginal oestrogen or moisturiser
411
Premature ovarian insufficiency
Menopause <40yo| Hypergonadotrophic hypogonadism
412
Diagnosis of premature ovarian insufficiency
FSH raised >25/30 on 2 samples with 4 weeks apart
413
HRT under 50yo
Does not increase risk of breast cancer| Increased risk of VTE, but this is reduced by transdermal patch
414
Why progesterone must be added to contraception?
Must be given to women with uterus as it prevents endometrial hyperplasia secondary to unopposed oestrogen
415
Continuous or cyclical HRT
if still have periods must go on cyclical HRT with cyclical progesterone and regular breakthrough bleedsIf no periods for >12months go on continuous combined HRT
416
Non hormonal menopause tx
```Lifestyle changesCBT SSRI Clonidine (agonist of alpha adrenergic) Venlafaxine (SNRI) Gabapentin```
417
Clonidine
Lowers BP and HRAlpha 2 adrenergic receptor agonistsUsed to prevent vasomotor symptoms SE dry mouth, headaches, dizziness, fatigue
418
Alternative remedies for menopause
```Black cohosh - cause liver damageDong quai - causes bleeding disordersRed clover - oestrogenic side effectsPrimrose oil - clotting disorders and seizuresGinseng- mood and sleep benefit```
419
HRT risks (worse in older women and longer use)
Breast cancerVTEStrokeCoronary artery disease
420
HRT risks that do not apply
To women <50yoNo risk of endometrial cancer if no uterusNo risk of breast cancer and CVD if oestrogen-only HRT
421
Choosing HRT formulation
1) local or systemic symptoms (topical or systemic tx)2) uterus - combined HRT, no uterus - continuous oestrogen only HRT3) perimenopausal - cyclical HRT, postmenopausal- continuous HRT
422
Cyclical progesterone use
10-14 days per month
423
Continuous progesterone HRT
When no period in 24months <50yo or 12 months >50yo
424
Progestogens definition
Chemicals that target progesterone receptors
425
Progesterone
Hormone naturally produced in the body
426
Progestin
Synthetic progesterone
427
Progestogen classes
C19 peogestogen derived from testosterone (norethisterone, levonorgestrel, desogestrel) - help with reduced libidoC21 progestogen derived from progesterone (dydrogesterone, medroxyprogesterone) - help with mood and acne
428
Best way of delivering oestrogen in HRT?
Patches, reduced VTE risk
429
Best way of providing progesterone in HRT?
Intrauterine deviceAdded benefit of contraception and treating heavy periodNo progestogenic side effects or risk of breast cancer or CVD
430
Tibolone
Synthetic steroid Oestrogen and progesterone receptorsContinuous combined HRTHelp with reduced libido
431
HRT and surgery
Stop 4 weeks before major surgery| HRT and oestrogen contraceptive
432
Oestrogen SE
BloatingBreast swelling HeadacheLeg cramps
433
Progesterone se
```Mood swings BloatingFluid retentionAcneWeight gain```
434
Rotterdam criteria for PCOS
Anovulation Hyperandrogenism (hirsuitisn or acne)PCOS
435
Drugs causing hirsuitism
```PhenytoinCyclosporinCorticosteroidsTestosteroneAnabolic steroids```
436
Pelvic ultrasound in PCOS
String of pearls - 12 or more follicles in the ovary| Ovary >10cm3
437
Impaired fasting glucose
6.1-6.9
438
Impaired glucose tolerance (at OGGT 2h)
7.8-11.1
439
Diabetes OGTY 2h
>11.1
440
Drugs to induce fertility/ovulation
Clomifene| Metformin/letrozole
441
Hirsuitism mx
COCP Co-Cyprindol (treats hirsuitism and acne)| Topical eflornithine
442
Acne mx
```Topical adapalene (retinoid)Topical abs (Clindamycin with benzoyl peroxide)Tetracycline Abx oral```
443
Reducing risk of ovarian cancer (factors)
Late menarcheEarly menopausePregnancy COCP
444
Risk of malignancy index (whether ovarian mass is malignant)
Menopausal statusUSCA125
445
Ovarian cyst Simple 5-7cm
Routine gynaecology referral and annual screen
446
Meig syndrome
Women (older) with pleural effusion and ovarian massOvarian fibromyalgiaPleural effusionAscites
447
When is ovarian torsion more likely to occur?
Pregnancy| Benign tumour
448
Ovarian torsion imaging
Whirlpool sign
449
Asherman syndrome
Adhesions formed in the uterus due to damage- post dilatation and curettage- uterine surgery- endometritis
450
Asherman syndrome presentation
Secondary amenorrhoeaLight periodsDysmenorrhoea
451
Gold standard ix for Asherman syndrome
Hysteroscopy and dissection of adhesions
452
Cervical ectropion
Columnar epithelium of endocervix extends to the ectocervix
453
Ectroption presentstion
Due to high oestrogen / COCPincreased vaginal dischargeVaginal bleedingDyspareunia(Boarder between columnar epithelium and squamous epithelium)
454
Ectropion tx
Cauterisation with silver nitrate| Cold coagulation during colposcopy
455
Rectocele
Defect in posterior vaginal wall, rectum prolapses into the vagina
456
Cystocele
Defect in anterior vaginal wall, bladder prolapses backwards into the vagina If urethra prolapses as well: cystourethrocele
457
Uterine prolapse grades POP-Q
Grade 0: normal 1: lowest part >1cm above introitus2: lowest part within 1cm of introitus3: lowest part >1cm below introitus4: full descent with eversion of vagina
458
most common cervical cancer
squamous cell carcinoma| Adenocarcinoma
459
hpv cancer strains
type 16, 18| HPV inhibits tumour supressor genes
460
risk factors for cervical cancer
```smokingHIVCOCPincreased number of pregnanciesearly sexual activitynot using condoms increased number of sexual partners```
461
CIN - grading for level of dysplasia
diagnosed at colposcopyCIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer,CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, ]CIN III: severe dysplasia, progress to cancer
462
cervical screening programme
Every three years aged 25 – 49| Every five years aged 50 – 64
463
exceptions from screening programme
- HIV are screened annually- >65 may request a smear if they have not had one since aged 50- previous CIN - immunocompromised- Pregnant women due a routine smear should wait until 12 weeks post-partum
464
IUD device and smear result
Actinomyces-like organisms are often discovered in women with an intrauterine device (coil)
465
inadequate sample
repeat the smear after at least three months
466
HPV negative
continue routine screening
467
HPV positive with normal cytology –
repeat the HPV test after 12 months
468
HPV positive with abnormal cytology –
refer for colposcopy
469
acetic acid in colposcopy
appear white / acetowhite - CIN and cervical cancer
470
Schiller’s iodine test
healthy cells brown, abrnoaml areas do not stain
471
cervical cancer staging
Stage 1: Confined to the cervixStage 2: Invades the uterus or upper 2/3 of the vaginaStage 3: Invades the pelvic wall or lower 1/3 of the vaginaStage 4: Invades the bladder, rectum or beyond the pelvis
472
cervical cancer management
1A: LLETZ or cone biopsyStage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapyStage 2B – 4A: Chemotherapy and radiotherapyStage 4B: surgery, radiotherapy, chemotherapy and palliative care
473
Pelvic exenteration
removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum.(for cervical cancer)
474
HPV vaccine
Gardasil strains 6, 11- genital wartsstrains 16, 18- cervical cancer
475
most common endometrial cancer and risk factors
Adenocarcinoma (oestrogent dependent cancer)- obesity- diabetes
476
endometrial hyperplsia treatment
IUS| continuous oral progestogen (medroxyprogesterone or levonorgestrel)
477
Risk facotrs for endometrial cancer
```(unopposed estrogen)Increased ageEarlier onset of menstruationLate menopauseOestrogen only hormone replacement No pregnanciesObesityPolycystic ovarian syndromeTamoxifen```
478
tamoxifen
Tamoxifen has an anti-oestrogenic effect on breast tissue, but an oestrogenic effect on the endometrium
479
protective factors for endometrial cancer
Combined contraceptive pillMirena coilIncreased pregnanciesCigarette smoking
480
tx for endometrial cancer
radical hysterectomyradio/chemoprogesterone to slow progression of cancer
481
most common ovarian cancer
Epithelial cell tumours (serous tumour most common)
482
germ cell tumours blood results
alpha fetoprotein and hCG raised
483
krukenberg tumour
metastatis from GI to ovary,| signet ring on histology
484
risk factors for ovarian cancer
```BRCA 1 2obesitysmokingincreased number of ovulationrecurrent use of clomifeneearly periodslate menopauseno pregnancies```
485
protective facotrs for ovarian cancer
COCPbreastfeedingpregnancy
486
ovarian mass on obturator nerve
reffered hip or groin pain
487
ovarian cancer symptromes
ascitespelvic massabdominal mass
488
Ix for ovarian cancer
CA125 (>35IU/ml is significant)| pelvic ultrasound
489
risk of malignancy index
menopausal statusUS findigsCA125
490
germ cell tumour markers
raised:alfa fetoproteinhCG
491
ovarnian cancer staging
Stage 1: Confined to the ovaryStage 2: Spread past the ovary but inside the pelvisStage 3: Spread past the pelvis but inside the abdomenStage 4: Spread outside the abdomen (distant metastasis)
492
vulval cancer most common
squamous cell carcinoma
493
risk factors for vulval cancer
>75yoimmunosurpressionHPVlichen sclerosus
494
frequent location of vulval cancer
labia majora| ulceration, bleeding, irregular mass
495
Mx in vulval cancer
wide local excisiongroin lymph node dissectionchemoradio
496
BV bacteria
```anaerobic bacteria due to loss of lactobacilli- Gardnerella vaginalis (most common)- Mycoplasma hominis- Prevotella species```
497
BV 4
clue cells on microscopypH >4.5fishy smellgrey-white discharge
498
mx of BV
Metronidazole PO - DO NOT DRINK alcohol, causes N&V, flushing, shock, angiodemaClindamycin
499
Candidiasis
candida albicansthick white dischargevulval and vaginal itching, irritation, discomfort+- erythrema, dyspareunia, dysuria
500
Risk factors for candidasis
oestrogen increase (pregnancy)poorly controlled diabetesimmunosuppressionborad-spectrrum abx
