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Yr3 Sam > Yr 3 Conditions > Flashcards

Yr 3 Conditions Flashcards

1
Q

Characteristics of a BCC?

A

Pearly, rolled edged
May uclerate in middle and bleed
Usually skin coloured or pink
Slow growing

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2
Q

Characteristics of SCC?

A

Grow quickly, weeks or months
Ulcerating tender and sore
On the face, lips, ears, hands, forearms and lower legs

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3
Q

Treatments of BCC and SCC?

A

Both can be surgical, although BCC can benefit from creams such as 5 FU or imiquimod

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4
Q

Erysipelas features and treatment?

A

Red rash, quite superficial often raised, caused by streptococcus.
Usually penicillins used - erythro or clarithro is allergic
Vancomycin if MRSA

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5
Q

Features of lichen planus?

A

papules, raised and firm, can be polygonal in shape itchy and shiny.
Crossed by fine white lines

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6
Q

Treatment lichen planus?

A

Potent topical steroid, calcineurin inhibitors and topical retinoids usually

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7
Q

Bran like scale on discoloured areas of skin? Treatments?

A

Pityriasis versicolour - azole creams and shampoos

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8
Q

Bimatoprost and latanoprost useful how?

A

Glaucoma as prostaglandin inhibitors

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9
Q

Timolol used for what?

A

B-blocker for glaucoma

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10
Q

Flashes of light and increase in floaters most likely to be?

A

PVD

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11
Q

PVD can lead to what?

A

Retinal detachment

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12
Q

Reflux common in which sex?

A

Men

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13
Q

Notorious drugs to stick to throat causing inflammation?

A

Tetracyclines and NSAIDS (also beware of bisphosphonates)

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14
Q

Is reflux a risk factor for Oesophageal CA?

A

Yes :(

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15
Q

Symptoms of GORD?

A

Retrosternal burning, can feel like rising up pain on swallowing, or water brash

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16
Q

Resp symptoms due to GORD?

A

Chronic cough, seen in up to 10%

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17
Q

Investigating GORD?

A

Endoscopy ideally but fbc to rule out anaemia often no investigations are needed

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18
Q

Treatment for GORD?

A

Full dose PPI 1 month

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19
Q

H.pylori associated with which ulcers most?

A

95% duodenal

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20
Q

Symptoms of Peptic ulcer?

A

Epigastric pain, 1-3 hrs after food, often relieved by food and can wake at night. Burping, distention. Heartburn can occur but not always.

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21
Q

Treatment of peptic ulcer ?

A

h.pylori triple therapy 2 abx and ppi/H2

smoking cessation!

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22
Q

Investigating ulcer?

A

FBC- possible anaemia, H.pylori serology or breath/stool test. Endoscopy not usually unless first time and above 55 years, or red flag symptoms!

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23
Q

H.pylori drugs?

A

1g amoxicillin, plus clarithromycin or metronidazole twice a day! Plus PPI full dose

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24
Q

Symptoms of acute GI bleed?

A

Hypotension, Tachycardia, malaena/blood pr, haematemesis, profuse bleeding from varices.
Rockall risk calcuated!

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25
Q

Treatment acute GI bleed?

A

High flow oxygen, large bore cannulae, iv fluids, catheter, basically as per RRAPID if compromised by bleeding give blood cells and or correct clotting.

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26
Q

Symptoms of crohns?

A

Diarrhoea, abdo pain, weight loss, fever malaise anorexia with acute active disease. Erythema nodosum( non gi signs of crohns)

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27
Q

Appearance of crohns on colonoscopy?

A

Cobblestone but with skip lesions, full mural thickness

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28
Q

Crohns treatment ?

A

Lots of options surgery not normal at first but likely in lifetime… AZA, Sulfasalaxine, methotrexate, and then tnf modifies such as infliximab/Humira

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29
Q

UC symptoms?

A

Relapsing remitting, only affects anus-beginning of colon, particularly the left side.
Gradual onset diarrhoea, which has blood and mucous in it . systemic symptoms and crampy abdo pain

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30
Q

UC treatment?

A 
Proctitis- Prednisone suppositories
or mesalazine
IV fluid maintenance if systemically unwell 
Hydrocortisone 
rectal steroids too

Surgery can be used in about 20% this is curative usually

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31
Q

IBS definition?

A

GI problems, but no organic cause found.

Not usually associated with weight loss, onset is a long time coming! Defecation often relieves pain.

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32
Q

Infectious gastroenteritis symptoms?

A

Fever, generally unwell, diarrhoea which is often bloody can make infection more likely.

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33
Q

Acute Pancreatitis symptoms?

A

Most commonly presents as severe upper abdominal pain of sudden onset with vomiting.
Pain is focused in the left upper quadrant of the epigastrium and penetrates to the back.

Pain tends to decrease steadily over 72 hours.

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34
Q

Pancreatitis in men more or women?

A

Equal

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35
Q

Which biochemical marker specific for pancreatitis and x what normal range?

A

amylase 3-4times normal virtually diagnostic

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36
Q

Most common causes of pancreatitis?

A

Alcohol, gall bladder disease.

ERCP can cause it through trauma

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37
Q

Cullen’s sign and Grey turner’s sign are what?

A

Bruising in umbilicus and flanks respectively (sever cases of pancreatitis)

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38
Q

Treatment for acute pancreatitis?

A

Pain relief with pethidine or buprenorphine ± intravenous (IV) benzodiazepines.
Nil by mouth
Only ABX for specific infection
NG tube (only for vomiting)

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39
Q

Chronic Pancreatitis symptoms and presentation?

A 
Abdominal pain, epigastric moving to back
Nausea vomiting and decreased appetite
Weight loss due to malabsorption
Possible onset of diabetes 
Steatorrhea
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40
Q

What does imaging often show in chronic pancreatitis?

A

Calcified parts of pancreas

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41
Q

Management of Chronic pancreatitis?

A

Depends on individual case, usually adress malbsorption and pain.
Diet modification, alcohol cessation
ERCP can help by dilating ducts

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42
Q

Prognosis of chronic pancreatitis?

A

1/3 die in 10 years so not great!

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43
Q

Gallstones symptoms?

A

Usually asymptomatic

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44
Q

Gallstones common with what disorder?

A

Diabetes, twice as common

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45
Q

What are gallstones usually made of ?

A

Cholesterol

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46
Q

Acute cholecystitis symptoms?

A

Continuous epigastric or RUQ pain, vomiting, fever, local peritonism, or a GB mass

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47
Q

Acute cholecystitis vs Biliary colic?

A

Colic often simialr pain and some vomiting, but not inflammatory componenets such as mass, fever or peritonism.

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48
Q

Features of acute hepatitis?

A

Non specific prodromal
headache, arthralgia, nausea and anorexia
Jaundice (after 2 weeks) Pale stools, dark urine
(usually 3-6 weeks lasting)

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49
Q

Complications of acute hepatitis?

A

Liver failure
aplastic anaemia
chronic liver problems B and C

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50
Q

Hep C symptoms?

A

Usually none until liver failure

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51
Q

Drug induce hepatitis investigations?

A

Can present with features of allergy such as eosinophilia

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52
Q

What is Rovsings sign?

A

Pressing on LIF causes pain in RIF

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53
Q

Appendicitis general symptoms?

A

Fever, unwell, umbilical then RIF pain
Lack of appetite
Peritonism (guarding and rebound)

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54
Q

Most common cause of a small bowel obstruction?

A

Adhesions from previous surgery

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55
Q

Most common cause of a large bowel obstruction?

A

Cancers

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56
Q

Faecal vomiting present in which obstruction types?

A

Low (large bowel)

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57
Q

Greater distention in small or large bowel obstruction?

A

Large

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58
Q

What is absolute constipation?

A

No bowel movements or flatus at all

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59
Q

Femoral hernia likely to strangulate?

A

Yes

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60
Q

Direct inguinal hernia?

A

Through abdo wall reduce easily

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61
Q

Indirect inguinal hernia?

A

Through rings and into scrotum strangulate more often

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62
Q

Which is most likely an emergency repair inguinal or femoral herniae?

A

Femoral 2/3 are emergency repairs

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63
Q

on coughing which herniae type reappears after reduction?

A

Inguinal

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64
Q

Pagets disease of the breast affects which part?

A

Nipple long term “eczema”

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65
Q

Most common breast lump?

A

Fibroadenoma (20-24years of age)

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66
Q

Feature of fibro-adenoma?

A

Firm non-tender and highly mobile

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67
Q

Fat necrosis of the breast, causes and risks?

A

Obesity, old and following trauma

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68
Q

Features of breast cysts?

A

Cysts are most common between the ages of 35 and 50. They are palpable as discrete lumps and may be recurrent. Not easily distinguished on examination.

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69
Q

Pain about 1 week before menstruation plus lumpiness in the breast likely to be?

A

Nodularity

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70
Q

which area of the breast is mostly affected by nodularity?

A

Upper outer qudrant

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71
Q

What is a ductal pappiloma?

A

Benign warty lesion just behind areola

Sometimes a sticky or bloody discharge is noted

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72
Q

Most common cancer in women?

A

Breast

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73
Q

Risk factors for breast CA?

A

Never having borne a child, or first child after age 30.
Not having breast-fed (breast-feeding is protective).
Early menarche and late menopause.
Radiation to chest (even quite small doses).
HRT - oestrogen and progestogen combined

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74
Q

MI, unstable angina and NSTEMI are linked together as what?

A

ACS acute coronary syndromes

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75
Q

Diagnostic criteria for an MI?

A 
Cardiac biomarker (troponin) above 99th centile of upper ref range
Plus  one of 
Ecg changes
Q wave appearance
Angiography
Ischaemic symptoms
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76
Q

What causes angina?

A

Ischaemic heart disease

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77
Q

typical symptoms of MI?

A

Central chest pain, epigastric… into jaw
Often into left neck or arm
Sweating, nausea, vomiting, impending doom

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78
Q

atypical mi common in?

A

Women and elderly, often abdo pain, confusion, and jaw pain

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79
Q

Symptoms of unstable angina?

A

Similar to angina, although not usually bought on by activity, and often not relieved by rest or GTN

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80
Q

Angina symptoms?

A

Chest pain and breathlessness on exertion, relieved by rest, and GTN

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81
Q

When is angina unlikely ?

A

stable angina unlikely when the chest pain is continuous or very prolonged, unrelated to activity, worse on inspiration, or associated with symptoms such as dizziness, palpitations, tingling or difficulty swallowing

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82
Q

When is Af considered acute?

A

Onset within 48hrs

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83
Q

Symptoms of AF?

A 
Breathlessness/dyspnoea.
Palpitations.
Syncope/dizziness.
Chest discomfort.
Stroke/transient ischaemic attack
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84
Q

Essential Hypertension defined as?

A

3 stages -

1: 140/90
2: 160/100
3: 180/110

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85
Q

Management of HTN?

A

Lifestyle changes- plus diet etc and salt reduction
ACE if <55 and non black
>55 or black = Calcium blocker
Second line for <55 is ARB

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86
Q

Resistant HTN step 2 choices?

A

ACE + Calcium for <55 or non black
Black = calcium plus ARB

Further steps require betablockers and thiazide diuretics

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87
Q

Which two HTN drugs not recommended together?

A

ACE and ARB

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88
Q

Target blood pressures on therapy?

A

140/90 for <80

150/90 for >80

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89
Q

DVT symptoms?

A 
Limb pain and tenderness 
Swelling of the calf or thigh (usually unilateral). 
Pitting oedema.
Distension of superficial veins.
Increase in skin temperature.
Skin discolouration
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90
Q

What well’s score suggests a likely DVT?

A

> =2

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91
Q

How many cm calf swelling difference for a well score ?

A

> 3cm

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92
Q

Investigations for DVT?

A

D-dimer and ultrasound scan (duplex)

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93
Q

Severe renal failure plus DVT? management?

A

Unfractioned heparin

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94
Q

Normal treatment of DVT?

A

LMWH- continued for 5 days can use warfarin

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95
Q

If pt over 40 with DVT think of what?

A

Cancer

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96
Q

Left sided heart failure is associated with which symptoms?

A

Decreased cardiac output
Breathlessness
Cyanosis and hypoperfusion
Orthopnea, PND and cough (frothy white)

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97
Q

Heart failure diagnosed using what blood test?

A

BNP >100 pg/ml

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98
Q

Right sided failure associated with what symptoms?

A

Oedema, ascites and liver dysfunction

Weight loss, Gi distress, congestion

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99
Q

Prognosis of heart failure?

A

Poor ~ 50% die in 4 years

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100
Q

CXR not diagnostic but provides evidence

A

heart size >2/3
pleural effusions
upper pulmonary veins

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101
Q

LVH can be cause by which valve abnormality?

A

Aortic stenosis

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102
Q

Cause of type 1 diabetes?

A

Autoimmune dysfunction

Absolute deficiency of insulin

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103
Q

Type 2 diabetes cause?

A

Due to resistance to insulin

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104
Q

What happens before type 1 crisis?

A

Autoantibodies have been circulating for a long time, can be there from 6 months of age

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105
Q

Possible triggers for type 1?

A

Dietary, environmental and viruses

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106
Q

Antibodies responsible for type 1 ?

A

Associated with HLA DR3 and DR4 and islet cell antibodies around the time of diagnosis.

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107
Q

Which is more common type 1 or 2 diabetes?

A

Type 2 85%

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108
Q

Onset of type 2 diabetes?

A

Gradual

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109
Q

Who does type two diabetes affect?

A

South Asian, African, African-Caribbean, Polynesian, Middle-Eastern more likely

older people and high BMI

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110
Q

Which has a greater genetic component 1 or 2 type diabetes?

A

2 almost 2.4 times fold increase

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111
Q

Symptoms for all diabetes types?

A

Patients with all types of diabetes may present with polyuria, polydipsia, lethargy, boils, pruritus vulvae or with frequent, recurrent or prolonged infections

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112
Q

Type 1 specific symptoms?

A

Weight loss, dehydration, ketonuria and hyperventilation

Often ketoacidotic

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113
Q

Diagnosis of diabetes? Serum glucose?

A

Abnormal plasma glucose (random ≥11.1 mmol/L or fasting ≥7 mmol/L)

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114
Q

Hba1c cut off for diagnosing diabetes?

A

48mmol/l or 6.5%

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115
Q

3/4 of those with type two diabetes die of what?

A

Heart disease

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116
Q

Initial treatment of type 2 diabetes?

A

Metformin standard release

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117
Q

Dpp4 inhibitors also known as what?

A

Gliptins

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118
Q

Sulfonylureas work how?

A

Increasing release of insulin from b cells of pancreas

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119
Q

Metformin is what type of drug?

A

Biguinide

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120
Q

Medical treatment of Hyperthyroidism?

A

Carbimazole or radio-iodine or propylthiouracil

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121
Q

Treatment of Hypothyroid?

A

Levothyroxine

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122
Q

Symptoms of hyperthyroid?

A

weight loss, irritability, confusion, lack of concentration, tremor, sweating, diarrhoea anxiety, psychosis, heat intolerance, loss of libido

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123
Q

Most common cause of hyperthyroidism?

A

Grave’s disease

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124
Q

Hypothyroid symptoms?

A

Tiredness, lethargy, intolerance to cold.
Dry skin and hair loss
Poor memory and difficulty concentrating.
Constipation
Decreased appetite with weight gain
Deep hoarse voice

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125
Q

Tyrotoxicosis symptoms?

A

Eye changes such as exophthalmas and proptosis.
Pre-tibial myxoedama
Enlargement of thyroid gland

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126
Q

Hypothyroid more common in who?

A

Women, around 60 years

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127
Q

Most common cause worldwide of hypothyroid?

A

Iodine deficiency

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128
Q

Hypothyroid signs?

A

Dry coarse skin, hair loss and cold peripheries.
Puffy face, hands and feet (myxoedema).
Bradycardia.
Delayed tendon reflex relaxation.

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129
Q

Cardiac drug causing hypothyroid and goitres?

A

Amiodarone

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130
Q

Most common cause of goitre?

A

Iodine deficiency but hashimotos and graves in UK

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131
Q

What is Cushing’s syndrome?

A

Prolonged exposure to exogenous or endogenous glucocorticoid steroids (cortisol)

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132
Q

Cushing symptoms?

A

Truncal obesity, supraclavicular fat pads, buffalo hump, weight gain.
Facial fullness, moon facies, facial plethora.
Proximal muscle wasting and weakness.
Diabetes or impaired glucose tolerance.
Gonadal dysfunction, reduced libido.
Hypertension.
Also psychiatric symptoms

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133
Q

Two types of cushings?

A

ACTH dependent and independent (usually iatrogenic)

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134
Q

Investigations to confirm cushings?

A

24hr urine
Dexamethasone suppression tests
Midnight cortisol

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135
Q

Treatment for cushings?

A

Usually surgical if due to tumour or removal of exogenous steroids.
These drugs can be used =Metyrapone, ketoconazole, and mitotane

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136
Q

Most common cause of anaemia?

A

Iron deficiency

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137
Q

Define anaemia with Hb?

A

Haemoglobin (Hb) <13 g/dL in men over 15 years old.

Hb <12 g/dL in non-pregnant women over 15 years old.

138
Q

Blood test results for iron deficiency?

A

FBC: shows a hypochromic microcytic anaemia

139
Q

What blood test as well as fbc should be measured in iron deficiency?

A

Ferritin

140
Q

Iron tablets side effects?

A

Constipation, nausea, black stools, most get better in time

141
Q

What should you check before giving a patient folic acid for deficiency?

A

B12! can cause demyelination of spinal cord so treat b12 first is needed

142
Q

Main causes of macrocytic anaemia?

A

B12 and folate, also liver failure (alcoholism) and AZA

143
Q

Macrocytic anaemia can mim another neurological disease if very severe?

A

Alzheimers and dementia, b12 deficiencey can cause neurological symptoms

144
Q

Is osteoarthritis better in morning or evening?

A

Morning, gets worse with activity

145
Q

Most common joints affected by OA?

A

Knees, Hip and Hands

146
Q

Morning stiffness last no longer than … in OA?

A

30 mins

147
Q

Age over what for OA diagnosis clinically?

A

45 years

148
Q

Pain in joints exacerbated by movement and exercise most likely?

A

Osteoarthritis

149
Q

OA symptoms

A

Joint swelling/synovitis (warmth, effusion, synovial thickening).
Periarticular tenderness.
Crepitus.
Absence of systemic features such as fever or rash.
Heberdens DIstal Bouchards proximal

150
Q

Xray findings in OA?

A

joint space narrowing, osteophytes, bone cysts

151
Q

Treatments for OA?

A

Weight loss, physio/exercise
Drugs: Topical NSAIDS
NSAID/COX-2 (PPI alongside)
Surgery if substantial impact on lifestyle

152
Q

List some risk factors for gout?

A 
Male gender.
Meat.
Seafood.
Alcohol (10 or more grams per day).
Diuretics.
Obesity.
Hypertension.
153
Q

Where is usually affected by gout?

A

50% of all attacks and 70% of first attacks affect the first MTP.

Also Knee
Midtarsal joints
Wrists
Ankles

154
Q

Symptoms of gout?

A

synovitis and swelling and extreme tenderness with overlying erythema. Untreated

155
Q

Erythema, chalky nodule beneath skin characteristic of?

A

Chronic gout … crystal deposition

156
Q

Gout treatment

A

Non-steroidal anti-inflammatory drugs (NSAIDs).
Colchicine.
Corticosteroids.

157
Q

Patients on anticoagulation with gout should receive what treatment?

A

Colchicine

158
Q

Allopurinol exhibits it affects how?

A

Xanthine oxidase inhibitory

159
Q

When can allopurinol be started?

A

At least 1-2 weeks after an attack not during

160
Q

Allopurinol side effects?

A

Can cause stone build up in kidneys

161
Q

How can pseudo-gout be differentiated from gout?

A

Joint aspiration, but x-ray too as calcium pyrophosphate radio-opaque

162
Q

Most common organism for septic arthritis?

A

Staph Aureus

163
Q

Risks for septic arthritis?

A 
Increasing age.
Diabetes mellitus.
Prior joint damage 
systemic connective tissue disorders.
Joint surgery.
Immunosuppressed
164
Q

Symptoms of septic arthritis?

A

Mainly one painful red swollen joint. Painful on active and passive movement

Usually fever and rigors present, can have bacteraemia too (vomiting and hypotension)

165
Q

Most common joint with septic arthritis?

A

Knee >50%

166
Q

ABX for septic arthritis?

A

Fluclox usually, but if allergic Clindamycin

167
Q

Joints should be splinted in septic arthritis but how?

A

In position of most use for example extension in the knee

168
Q

Slipped disc red flags?

A

Saddle anaesthesia, loss of sphincter control, weaknesses in legs.

169
Q

Lumbosacral disc herniation causes what nerve pain?

A

Sciatica

170
Q

Sciatica symptoms and signs?

A

Leg pain more severe than back and unilateral, straight leg positive, pain relieved by laying down.

171
Q

Difference between prevalent and incident delirium?

A

Prevalent is there on admission and incident is after admission or whilst there

172
Q

Male or female a risk for delirium?

A

Male

173
Q

Difference between stroke and TIA?

A

TIA symptoms resolve within 24hrs

174
Q

Main causes of Stroke/TIA?

A

Cardiac emboli(AF, Endocarditis, and MI)
Carotid Thrombis
BP, Trauma, Aneurysm rupture
Antiphospholipid syndrome

175
Q

Risk factors for Stroke?

A

HTN, Smoking, Diabetes, Heart disease

Contraceptive pill, alcohol, carotid bruit.

176
Q

Mains symptoms of stroke?

A

FAST- Face arms speech time
Neuro problems- vertigo, ataxia
Homonymous hemianopia

177
Q

Treatment of Stroke/TIA?

A 
02 therapy <95% 
Blood sugar control
Control BP
Swallowing screening
Clopidogrel-75mg
 ALTEPLASE- up to 4.5 hrs after exclude haemorrhage
178
Q

Assessing risk of stroke after TIA score?

A

ABCD2

179
Q

Most common aneurysm type to burst SAH?

A

80% saccular

180
Q

Risk factors of SAH?

A

Smoking, HTN, Alcohol misuse, bleeding disorders

Post menopausal

181
Q

SAH relatives risk?

A

3-5 times!! (close relatives)

182
Q

Symptoms of SAH?

A 
Usually sudden headache (bang)
vomiting 
collapse
seizures
coma, pupil changes
183
Q

Diagnosis of SAH ?

A

CT >90% within 48hrs

Lumbar puncture - usually blood at first- then more yellow (billirubin)

184
Q

Treatment of SAH?

A

Regular examination of CNS
Maintain cerebral perfusion
NIMODIPINE - C chanell (stops spasm)
COILING!!!

185
Q

How common is peripheral neuropathy and in who?

A

10% or population, commonest cause is diabetes!(60-70%) get it

186
Q

Causes of peripheral neuropathy?

A

Multiple- mostly diabetes, autoimmune diseases
neuromas, chemotherapy patients
viral infections
Alcoholism (deficiency of b12 and folate)

187
Q

Symptom of neuropathy?

A

Muscle weakness, altered sensation(pins and needles) neuropathic pain affects sleep
Gi problems-diarrhoea and constipation

188
Q

Diagnosis of neuropathy?

A

nerve conduction, electromyography

189
Q

Neuropathy treatments?

A

Underlying condition, lifestyle treatments
immunosupressive drugs
TENS
Neuropathic drugs(gabapentn, amitryptiline)
Diabetic (tapendalol)

190
Q

Cause of epilepsy?

A

75% idiopathic
Structural problems -scarring atrophy or brain injury
Lesions
Trauma, stroke, haemorrhage, increased icp

191
Q

Signs of seizure?

A

Aura, deja vu, smells, or just a weird feeling

192
Q

Seizure types?

A

Partial/generalised

One part of brain partial and then generalised involves all of the brain

193
Q

Epilepsy treatments- tonic clonic generalised?

A

Sodium valproate or lamotrigine 2nd line carbamazepine

194
Q

Absence seizures treatment?

A

Sodium valproate or lamotrigine

195
Q

Tonic atonic or myoclonic seizures treatment?

A

Avoid carbamazepine

196
Q

Carbamazepine useful for which seizures?

A

Partial seizures

197
Q

Levitaracetam (Keppra) used when?

A

Add on for tonic-conic or partial seizures

198
Q

Kernigs sign for meningitis?

A

Pain and resistance on passive knee extension when hip flexed

199
Q

Brudzinskis sign meningitis?

A

hip flex on bending neck forward

200
Q

Highest mortality infectious disease under 5?

A

Meningitis

201
Q

Most common headache type?

A

Tension- 4:1 in women

202
Q

What makes a tension headache chronic?

A

Greater than 15 days a month

203
Q

Features of tension headache?

A

Non pulsatile, tight band, related to neck usually, gradual onset

204
Q

Tension headache treatment?

A

Attention to anxiety, stress, depression etc
physio
Avoid opioids
NSAID and paracetamol

205
Q

Parkinsons cardinal triad?

A

Tremor, Rigidity and increased tone, Bradykinesia and hypokinesia

206
Q

Parkinsons treatment?

A

L-dopa and carbidopa mainstay of treatment
MAO-B inhibitors
Apomorphine
All either affect dopamine metabolism or increase supply

207
Q

What is ropinirol and pramipexole?

A

dopamine agonist

208
Q

COMT inhibitors used in what?

A

Parkinsons- limit l-dopa degradation in PNS

209
Q

What is the definition of a UTI?

A

Pure growth of >10^5 organism per ml fresh MSU

210
Q

Up to 1/3 or women with with symptoms of UTI have what?

A

Negative MSU

211
Q

Risk factors for UTI?

A 
Sexual intercourse
Females
Spermicide
Diabetes
Pregnancy and menopause
Catheter
212
Q

Main organism causing UTI?

A

E-coli 75% but nor so much in hospital

213
Q

Less common UTI pathogens?

A

Proteus, klebsiella, staph, pseudomonas

214
Q

Signs and symptoms of pyelonephritis?

A

High fever, rigors, vomiting loin pain and tenderness, oliguria

215
Q

Signs and symptoms of prostatitis?

A

Flu like, low back ache swollen prostate not usually many urinary symptoms

216
Q

Signs of uncomplicated UTI?

A

frequency, urgency, foul smelling and cloudy urine, distended bladder, haematuria

217
Q

What should be positive for a UTI on disptick?

A

Nitrites and leucocytes

218
Q

When should a lab MSU be sent ?

A

Symptomatic, males, children, preggers and immunosuppressed

219
Q

Causes of sterile pyuria?

A

Cancers, appendicitis, treated UTI, prostatitis

220
Q

What should pregnant women be treated with for UTI?

A

Nitrofurantoin 1st choice then trimethoprim (but give folate 5mg daily)

221
Q

Pyelonephritis initial treatment?

A

Ciprofloxacin (500mg BD)

Co-Amoxiclav (500/125) tds 7 days

222
Q

Pain in the back from pyelonephritis is located where?

A

Costo vertebral angle

223
Q

Urine of a pt with pyelonephritis could show what?

A

WBC casts

224
Q

Suprapubic tenderness and voiding symptoms more common in pyelo or cystitis?

A

Cystitis

225
Q

What are the % increases for AKI staging regards creatinine increases?

A

1= 50-99% 2= 100-199% 3=200% baseline creatinine within 7 days!

226
Q

Pre-Renal causes of AKI?

A

Hypovolaemia, blood loss
Reduced cardiac output/cardiac failure
Sepsis

227
Q

Renal causes of AKI?

A 
Drugs- 
vascular problems
Glomerulonephritis
Tubular
Interstitial disease
228
Q

Renal failure affects some anti clotting agents such as?

A

LMWH (half dose needed due to accumulation) OR use UFH

229
Q

Nephrotoxic drugs

A

Nsaid, ace inhibitors, ARBs, diuretics, contrast agent, gentamicin, metformin

230
Q

Post renal causes of AKI

A

Obstruction, pyonephrosis, cervical carcinoma, retroperitoneal fibrosis.

231
Q

What is hydronephrosis?

A

Abnormal enlargement of kidney swelling

232
Q

Causes of hydronephrosis?

A

Obstruction, Urethral stricture, vesicouretal reflux

CKD, Prostate cancer

233
Q

Symptoms of hydronephrosis?

A

Loin and back radiates to groin.

Haematuria, nausea vomiting, leg swelling shortness of breath. electrolyte imbalance

234
Q

Managment of hydroneprosis?

A

Treat underlying cause, nephrostomies and stents

235
Q

BPH stand for ?

A

Benign prostatic hypertrophy

236
Q

BPH unusual before age of?

A

45

237
Q

Signs and symptoms of BPH?

A

Nocturia, urgency, frequency, terminal dribble
hesistancy, poor stream incomplete emptying

UTI, bladder stones

238
Q

BPH prostate feels like ?

A

Hard and firm but smooth well defined median sulcus

239
Q

Investigations into BPH?

A

Imaging, u and es, PSA, LFT, MSU.

240
Q

Managing BPH?

A

Alpha blockers, tamsulosin, doxazosin
5-a reductase Finasteride (stop testosterone)
TURP

241
Q

Most common male cancer?

A

Prostate

242
Q

Most prostate carcinomas are what type?

A

Adenocarcinoma

243
Q

Presentation of carcinoma of prostate?

A

As for BPH but can have weight loss, bone pain, and prostate may be hard/irregular

244
Q

Scoring used for prostate ?

A

Gleason

245
Q

Diagnosis prostate CA?

A

Transrectal USS/Biopsy PSA bone scan and MRI

246
Q

Treatment of prostate CA?

A

<70 radical prostatectomy excellent survival
Brachytherapy
>70 active surveillance if low risk

247
Q

what is goseralin?

A

LNRH antagonist for prostate cancer

248
Q

Causes of CKD?

A

HTN, Diabetes, nephrotoxic drugs, recurrent stones, bladder voiding problems, SLE

249
Q

Definition

A

impaired renal function for >3 months egfr <60 for 3 months or more.

250
Q

Stage 3-5 Kidney failure more common in

A

women

251
Q

Management of CKD?

A

usually mild to moderate in GP, refer to nephrology for later stages

252
Q

Risk factors for asthma

A 
atopy, and family history
obesity
city environment 
premature
viral
smoking
253
Q

Peak flow in asthma acute is usually?

A

33-50%

254
Q

Management of more severe asthma GP?

A

Adding long acting b2 agonist, leukotriene antagonst, theophylline, steroid oral

255
Q

FEv1/FVC ratio for COPD

A

<0.7

256
Q

Consider COPD in who?

A

> 35, with risk factors such as smoking and have exertional cough and sputum

257
Q

Catamenial pneumothrax is what?

A

Time of menstruation, over 90% in right lung 24-72 hrs into menstruating

258
Q

Pleural surface to lung edge greater than what for pneumothorax?

A

> 2cm

259
Q

Difference between transudate and exudate?

A

Transudate <25g/l Exudate >35g/l

260
Q

Transudate is due to what?

A

cardiac failure and fluid overload

261
Q

Exudate is due to what?

A

Pneumonia, inflammation, malignancy, TB, mesothelioma

262
Q

Signs and symptoms of pleural effusion?

A

Stony dull percussion, dyspnoea, pleurit chest pain, lack of breath sounds, tactile and vocal fremitus decreased.

263
Q

In effusion trachea deviates where?

A

Away

264
Q

Most common organism for Hospital acquired pneumonia?

A

Pseudomonas and Klebsiella

265
Q

When is an infection hospital acquired?

A

> 48HRs

266
Q

Vocal resonance and tactile fremitus are what in pneumonia?

A

Increased

267
Q

What does CURB 65 mean?

A

Confusion, Urea >7 Resp >30
Blood pressure<90
>65

268
Q

Curb score of 0-1 means?

A

Manage at home

269
Q

curb score 2 means/

A

IV ABX

270
Q

Curb score 3+

A

ITU? high mortality

271
Q

Risk factors for PE?

A 
Surgery especially bones
Antiphospholipid syndrome
prolonged rest
malignancy
preggers
Pill
Previous
272
Q

What might you do if pt cant be anticoagulated?

A

IVC filter

273
Q

Most common type of oesophageal carcinoma?

A

Adeno- followed by squamous

274
Q

Risk factors for oesophageal carcinoma?

A

Tobacco and alcohol
barrets oesophagus (precursor to adeno)
chronic inflammation
Obesity, and hiatus hernia

275
Q

Gastric carcinoma is more common in who?

A

Men

276
Q

Usually gastric carcinoma is what type?

A

Adeno

277
Q

carcinoma where in stomach is increasing?

A

Gastro oesophageal junction

278
Q

95% of cases of gastric cancer in those over ..?

A

55

279
Q

What infection can double risk of gastric cancer?

A

H.pylori

280
Q

Which blood group more common to gastric cancer?

A

A

281
Q

Prognosis for gastric carcinoma?

A

Very poor

282
Q

Pancreatic cancer more common men or women?

A

Neither

283
Q

95% of pancreas tumours are?

A

Adeno

284
Q

Risks for pancreatic CA?

A

Smoking, Diet, diabetes, alcohol pancreatitis IBD

285
Q

Presentation of pancreatic CA?

A

Abdo pain, radiating to back
Obstructive jaundice - comes on quick
Dark urine pale stools
Weight loss

286
Q

Which chem used in Pancreatic CA

A

5 FU

287
Q

Colorectal death rates?

A

Second most common cause of cancer death

288
Q

Risks for Colorectal CA?

A

Polyps, genetic FAP HNPP, IBD, Cancer previous, Smoking, Diabetes

289
Q

Presentation of colorectal CA?

A

Weight loss, anaemia, masses, tenesmus, bowel habit change, malaena

290
Q

Chemo for colorectal ?

A

FOLFOX -

5 FU folinic acid, oxiplatin

291
Q

Prognosis of colorectal?

A

good >50% 5 year

292
Q

Chronic liver failure causes?

A

Acohol- most common uk
Hep BCD
genetics, wilsons, autoimmune
Methotrexate, amiodarone and methyldopa

293
Q

Presentation of chronic liver failure?

A

Fatigue lfts deranged, leuconychia (low albumin)

Clubbing, palmar erythema, loss of body hair, dupytrens

294
Q

Complications of liver failure?

A

bleeding varices, ascites, encephalopathy

295
Q

How much fluid to notice ascites?

A

1.5l

296
Q

Causes of ascites?

A

Malignancy, cirrhosis, low albumin, pericarditis, myoedema, CCF infection (TB)

297
Q

Presentation of ascites?

A

Abdo distention, weight gain, nausea and appetite supression

298
Q

Management of ascites?

A

Diuretics, loops and potassium sparing, drainage

299
Q

Coeliac disease presentation?

A

Smelly stools, steatorrhoea, diarrhoea, abdo ain, weight loss, fatigue, ostemalacia. Dermatitis herpatiformis

300
Q

Complications of coeliac?

A

Anaemia, lymphoma, myopathies

301
Q

Mid diastolic murmur best in expiration is what?

A

Mitral stenosis

302
Q

Mitral stenosis mainly cause by what?

A

Rheumatic fever ?

303
Q

Mitral stenosis treatment?

A

Diuretics lower pre-load

304
Q

Pansystolic murmur moving to axilla?

A

Mitral regurg

305
Q

Mitral regurg treatments?

A

Diuretics, rate control anticoag, replace

306
Q

Ejection systolic murmur?

A

Aortic stenosis

307
Q

Aortic regurg therapy before valve?

A

Treatblood pressure

308
Q

Most common organisms for infective endocarditis?

A

Staph and strep

309
Q

Risks for Infective endocarditis?

A

Valvular disease, valve replacement, congenital disease, previous IE, hypertrophic cardiomyopath

310
Q

Presentation of infective endocarditis?

A

New or changed murmurs?

Fevers and rigors, weight loss, sweats clubbing splinter blahblah

311
Q

Oslers nodes are where?

A

Distal phalanges

312
Q

Treatment of postural hypotension?

A

Fludricortisone or then ephdrine

313
Q

96% of those with hyperparathyroidism have ?

A

parathyroid adenoma

314
Q

Signs of hyperparathyroidism?

A

Increased calcium, weakness, thirst depression renal stone, pancreatitis

bone reabsorption, high parathyroid, fractures
Phosphorous excreted
High BP

315
Q

Tests in addisons disease?

A

low sodium High potassium, low glucose,

316
Q

Management of addisons?

A

Replace steroid (hydrocortisone)

317
Q

Symptoms of addisons?

A

Lean and tanned, tired, tearful, weakness, anorexia, low mood, nausea vomiting, palmar pigmented creases, vitiligo

318
Q

Hodgkin vs non hodgkin?

A

Reed sternberg cells

319
Q

Symptoms of lymphoma?

A

Enlarged painless rubbery lymph nodes, cervical usually
fever weight loss night sweats pruritis
spleno hepatomegaly

Alcohol induced pain!

320
Q

T score of what indicates normal bone?

A

T score > or = -1

321
Q

Osteoporosis T score?

A

-2.5

322
Q

Parotid tumour risks?

A

Latent radiation 20 yrs ago and smoking

323
Q

Red flags for parotid tumours?

A

facial nerve weakness, increase rapid, ulceration history of skin cancer

324
Q

Parotid chemo response?

A

Poor usually surgical resection

325
Q

Malignant parotid presents when?

A

over 60

326
Q

Most common cause of parotitis?

A

Mumps, then stones, tumours, sjorgens

327
Q

Proximal myopathy presents?

A

Weakness o upper or lower libs symmetrical

atrophy tone is reduced

328
Q

Proximal myopathy causes?

A

Thyroid disease, drugs such as statins

329
Q

Presentation of MS?

A

Optic neuritis, numbness tingling, ataxia, erectile dysfunction

330
Q

Diagnosis of MS?

A

2 attacks or more on 2 areas of body CSF IgG

331
Q

Bladder carcinoma risks?

A

Smoking, dyes, aromatic amines, radiation to pelvis

332
Q

Presentation of bladder CA

A

haematuria usually painless
voiding symptoms
women have worse prognosis

333
Q

Chemo for bladder cancer?

A

Cisplatin

334
Q

Renal carcinoma presentation?

A

weight loss haematuria, loin pain, abdo mass, anorexia, spreads to bone liver lung,

335
Q

Renal carcinoma from where

A

Proximal tubular epithelium

336
Q

Cannon ball chest mets from where?

A

Renal

337
Q

Risk factors for urinary stones?

A

Horse shoe
gout
dehydration hyperparathyroidism
diuretics

338
Q

Most renal stones contain what ?

A

Calcium

339
Q

Pain of renal stones?

A

Severe, radiate to anterior thigh, labia testes scrotum

340
Q

Risk factors of pulmonary fibrosis?

A

Smoking, silica asbestos heavy metal exposure
pigeon breeding
GORD Nitrofurantoin

341
Q

Presentation of pulmonary fibrosis?

A 
Hacking dry cough
Aged over 45
Breathless on exertion
Bilateral inspiratory crackles
clubbing 
weight loss
342
Q

CXR of fibrosis?

A

Reticular formation at lung peripheries

Yr3 Sam (1 decks)

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