Zero To Finals Flashcards
1
Q
Gram positive cocci
A
Staphylococcus
Streptococcus
Enterococcus
2
Q
Gram positive rods
A
Corny mike’s list of basic cars
Corneybacteria Mycobacteria Listeria Bacillus Nocardia
3
Q
Gram positive anaerobes
A
CLAP Clostridium Lactobaccilus 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)
Clindamycin
Tetracyclines
Chloramphenicol
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 amoxicillin
trimethoprim (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 tonsilitis
Fever >38*C
Tonsillar exudates
Absence of cough
Tender 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 5days
No improvement after 10 days: 2 weeks of high dose steroid nasal spray
No 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 pneumoniae
Neonates: 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 stat
300mg <1y
600mg 1-9y
1200mg >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 - cloudy
Viral / 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 viruses
High WBC for both
28
TB staining
Ziehl Neelsen stain turns bacteria bright red and background blue
TB 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 6m
Isoniazid 6m
Pyrazinamide 2m
Ethambutol 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
Malarone
Quinine sulphate
Doxycycline
41
IV tx for complicated malaria
Artesunate and quinine dihydrochloride
42
Antimalarials
Malarone (2d/during/1week)
Mefloquine (2w/during/4week) - psychotic episodes and seizures
Doxycycline (2w/during/4week) - Abx so thrush, diarrhoea
43
OA risk factors
```
Obesity
Age
Trauma
Female
Family history
```
44
OA X-ray
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
45
OA symptoms
Pain and stiffness worsened by activity
46
OA signs
Haberdens nodes DIP
Bouchards nodes PIP
Squaring of the thumb
47
OA management
Weight loss, physio
Paracetamol + topical NSAID
Add oral NSAID + PPI
Add 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 joints
Atlantoaxial subluxation
Pain, swelling, stiffness
Pain worse after rest, improves with activity
```
51
Signs in the hands RA
```
Boggy feeling
Z shaped thumb
Swan beck deformity
Boutonnières deformity (flexor digitorum superficialis works)
Ulnar deviation
```
52
Felty’s syndrome
RA, neutropenia, splenomegaly
53
DAS 28
Disease activity score
Swollen joints
Tender joints
ESR/CRP result
54
RA DMARDs
1st mono: methotrexate, leflunomide, sulfasalazine, hydroxychloroquine
2nd: 2 drugs
3rd: 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 pitting
Psoriasis plaques on skin
Onycholysis- nail separates from nail bed
Dactylitis
Conjunctivitis
Pencil 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 gene
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
65
AS features
Sacroiliac and vertebral pain and stiffness
Vertebral fractures
Pain worse at night
Morning stiffness, gets better throughout the day
Stiffness worse with rest and better with movement
66
AS associations
```
Anaemia
Anterior uveitis
Aortitis
Heart block
Pulmonary fibrosis
```
67
X ray changes in AS
```
Bamboo spine
Squaring of vertebral bodies
Subchondral sclerosis
Fusion of joints
Syndesmophytes
```
68
AS treatment
Nsaids 2-4weeks then change if no improvement
Steroids
Anti 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 disease
CRP and ESR raised in active inflammation
Increased 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
NSAIDs
Steroids (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
```
Calcinosis
Raynuaurd phenomenon
Esophageal dysmotility
Sclerodactyly
Telangectasia
```
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 of
Bilateral shoulder pain, pelvic girdle pain
Worse with movement
Wakes up from sleep
At least 45min stiffness in the morning
```
86
Polymyalgia rheumatica tx
```
15mg prednisolone /day
Until symptoms settle (3-4 weeks)
Then 12.5mg for 3 weeks
10mg for 4-6 weeks
Reduce 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 involvement
Raised CK
Corticosteroids
91
DermatoMyositis signs
Gottron lesions (knuckle hardening)
Photosensitive rash on the back and neck
Calcium deposits in subcut tissue
92
Polymyositis antibodies
Anti Jo 1
93
Dermatomyositis antibodies
Anti Mi 2
| ANA
94
Antiphospholipid syndrome antibodies
Lupus anticoagulant
Anticardioliptin antibodies
Anti 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, tears
Vaginal lubricants
Hydroxychloroquine stops disease progression
102
Vasculitis markers
ESR and CRP raised
| Anti neutrophil cytoplasmic antibody ANCA
103
pANCA
peri Nuclear anti-neutrophil cytoplasmic
Anti-PR3
Microscopic 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
Epistaxis
Hearing loss and sinusitis
Saddle shaped nose due to perforated septum
108
Kawasaki disease (medium vessel Vasculitis)
```
CRASH AND BURN
Conjunctivitis
Rash
Adenopathy /Lymphadenopathy
Strawberry tongue
Hands 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 inflammation
Immunosuppressant azathioprine
Topical (bethamethasone) and systemic (prednisolone) steroids
114
Gout aspirate features
No bacteria
Needle shaped crystals
Negative 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 crystals
Rhomboid shaped
Positive birefringent
122
Pseudogout on X ray
Chondrocalcinosis
123
Pseudogout tx
NSAID, colchicine, steroids
| +- joint washout
124
Risk factors for osteoporosis
```
Old age
Female
Low BMI
Low activity/ mobility
Alcohol and smoking
Rheumatoid arthritis
Long term corticosteroid use
Post 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 D
causes low Ca and PO4
2* hyperparathyroidism
Reabsorption 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 ALP
Normal 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 TIA
Age >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 2x
Atorvastatin 80mg
138
Crescendo TIA follow up
Within 24h specialist assessment
| ABCD2 >3 24h assessment, otherwise 1 week assessment
139
GCS
Eyes: none, Pain, speech, spont
Verbal: None, sounds, words, confused, orientalned
Motor: 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 region
Assoc w fx of temporal bone
144
Extradural haemorrhage CT
Biconvex
| Does not cross cranial sutures
145
Extradural haemorrhage hx
Young pt
Ongoing 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 headache
Neck stiffness
Photophobia
Hit on the back of head
```
149
Subarachnoid headache associations
```
Cocaine use
Sickle cell anaemia
Alcohol
Smoking
HTN
```
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 vasospasm
Lumbar 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 scotoma
Pain
Reduced colour vision
RAPD
155
MS relapse treatment
Methylprednisolone 500mg PO 1x for 5 days
| Or 1g IV daily 3-5d
156
Lower motor neurone disease
Muscle wasting
Reduced tone
Fasciculations
Reduced reflexes
157
Upper motor neurone disease
Increased tone
Brisk reflexes
Upgoing plantars
158
Management of motor neurone disease
Riluzole
159
Parkinson’s triad
Resting tremor
Rigidity
Bradykinesia
160
Parkinson’s features
```
Ansomnia
Shuffling gait
Hypomimia
Asymmetrical tremor 4-6hz
Worse at rest
Improves with movement
No 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 fibrosis
Bromocryptine
Pergolide
Carbergoline
169
MAO B Inhibitors
Block enzyme breaking down dopamine neurotransmitter
Selegiline
Rasagiline
170
Benign essential tremor tx
Propanolol (non selective beta blocker)
| Primidone (anti epileptic)
171
Tonic clinic seizure
```
Prolonged post ictal
Loss of consciousness
Confused
Drowsy
Incontinence
```
172
Focal seizures characteristics
Hearing speech memory
Deja vu
Autopilot (strange things, don’t remember)
Hallucinations
173
Focal seizure location
Temporal
174
Infantile spasms
West syndrome
full body spasms
Tx prednisolone and vigabatrin
175
Seizure treatment
(Everything but focal)
Sodium valproate
Lamotrigine/carbamazepine
Focal
Lamotrigine/carbamazepine
Sodium valproate/levetiracetam
176
Absence Seizure tx
Sodium valproate or Ethosuximide
177
Carbamazepine se
```
Agranulocytosis
P450 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
```
O2
Check blood glucose
IV access
IV 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)
Amitryptyline
Duloxetine
Gabapentin
Pregabalin
```
183
Bell’s palsy tx
Prednisolone (start within 72h)
50mg for 10days
60mg 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 loss
Tinnitus
Balance problems
187
Bromocriptine
Block prolactin secreting tumours
188
Somatostatin analogue (ocreotide)
Block growth hormone secreting tumours
189
Huntingtons genetics
```
AD
On chromosome 4
Trinuckeotide repeat disorder
mutation in HTT gene
Anticipation
```
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 / neostigmine
Stops breakdown of acetylcholine and relieves weakness
Atropine 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 cancer
Proximal muscles affected
Diplopia, 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 cavus
Inverted champagne bottle legs
Loss of ankle dorsiflexion
Weak hands
Reduced muscle tone
Peripheral neuropathy
```
200
Gillian barre triggers
-affects PNS
Clampylobacter jejuni
CMV
EBV
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 NF1
Axillary/inguinal freckles
Bony dysplasia, bowing of bones
Iris hamartomas
Neurofibromatomas
Glioma 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 - hamartin
TSC2 gene chromosome 16 - tuberin
Hamartin and tuberin control cell growth
207
Skin signs of tuberous sclerosis
```
Ash leaf spots
Shagreen patches
Angiofibromas
Cafe au lait
Poliosis
+ epilepsy and developmental delay
```
208
Migraine acute and long term management
Acute: paracetamol, sumatriptan 50mg, nsaid, metoclopramide for vomiting
Long: propanolol, topiramate (teratogenic, cleft lip and palate), amitriptyline
209
Migraine around menstruation tx
NSAIDs
Or
Frovatriptan
Zolmitriptan
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 ethnic
Age
Myopia/ near sight
214
Glaucoma tx
Latanoprost
Timolol
Dorzolamide
Brimonidine
215
Latanoprost
Prostaglandin analogue eye drops
Increase uveoscleral outflow
Eyelash growth
Eyelid 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
Oxybutynin
Solifenacin
Amitryptyline
220
Close angle glaucoma immediate management
Lie on the back
Pilocarpine eye drop (pupil contatriction)
Acetazolamide PO 500mg (carbonic anhydrase, reduces aqueous humour production)
221
Close angle glaucoma 2* care
```
Pilocarpine
Acetazolamide
Hyperosmotics (mannitol, glycerol)
Timolol
Dorzolamide
Brimonidine
```
222
Age Related Macular Degeneration presentation
```
Reduced visual acuity
Wavy appearance of straight lines
Worsening of central vision
-drusen
-scotoma
-amsler grid
```
223
Dry AMD tx
Lifestyle
Stop smoking
Control BP
224
Wet AMD
anti VEGF injected into vitreous chamber (ranibizumab, bevacizumab, pegaptanib)
225
Diabetic retinopathy pathophysiology
Blot haemorrhage
Hard exudates
Cotton 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 vision
Change in colour vision (colours more brown/yellow)
Starburts around lights
Loss of red reflex
234
Dilated pupil
Horner adie
Raised icp
3rd nerve palsy
Anticholinergics
235
Constricted pupil
Horner syndrome
Argyll Robertson pupil
Opiate
Nicotine
236
3rd CN palsy (oculomotor)
Ptosis
Dilated pupil
Down and out
237
Horner syndrome
Ptosis
Miosis
Anhidrosis
+ enophthalmos/ sunken eye
238
Anhidrosis - pre ganglionic
- Face anhidrosis
Cervical rib
Pancoast tumour
Trauma
239
Anhidrosis central
```
- Face arm trunk
Syringomyelia
Stroke
MS
Swelling (tumour)
```
240
Post ganglionic Anhidrosis
No Anhidrosis
Carotid aneurysm
Carotid artery dissection
Cavernous 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 swelling
Hot compress and analgesia
Chloramphenicol 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 B27
Ankylosing spondylitis
IBD
reactive 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 cochlea
Loss of neurons in cochlea
Reduced endolymph
Atrophy 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 spray
Surgery (grommet, ballon dilatation)
269
Otosclerosis
Remodelling of small bones of middle ear - bone hardening
AD pattern
Onset <40yo
Conductive 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 pneumoniae
Other:
Hem influenza
Moraxella catarrhalis
Staphylococcus aureus
273
Otitis media tx
Amoxicillin 5-7d
Clarithromycin (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 CF
Tx 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 dexamethasone
Severe: oral abx flucloxacillin or clarithromycin
```
278
Ototoxic drugs
Aminoglycosides (gentamicin and neomycin)
Toxic if get past tympanic membrane
Must exclude perforated tympanic membrane
279
Fungal otitis externa tx
Clotrimazole ear drops
280
Malignant otitis externa findings
Granulation tissue
281
Malignant otitis externa tx
Admission
Imaging
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
Vertigo
Ataxia
Diplopia
CN or limb symptoms
287
Cerebellar examination
```
Dysdiadochokinesia
Ataxic gait
Nystagmus
Intention tremor
Speech
Heel to shin
```
288
Head impulse test
Shaking head left or right
Asking pt to keep looking at doctors nose
If saccades, PERIPHERAL vertigo
289
Nystagmus test
Quick look right to left (repeat)
Unilateral horizontal: PERIPHERAL cause
Bilateral 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 sec
asymptomatic in between
Over several weeks
No tinnitus or hearing loss
295
Vestibular neuronitis
Vestibular nerve inflammation
296
Inner ear parts
Semicircular canals
Vestibule
Cochlea
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 loss
Vertigo
Tinnitus
- 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 nitrate
Then 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 10d
High 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 pneumonia
Other causes:
Haemophilius ibfluenza
Moraxella catarhhalis
Staphylococcus aureus
```
313
Centor criteria - probability of bacterial tonsilitis
```
3 or more (40-60%)
Fever 38*C
Tonsilar exudates
Absence of cough
Lymphadenopathy
```
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 aureus
Haemophilius influenzae
318
Quinsy treatment
Co amoxiclav
| Incision and drainage
319
Tonsilectomy indications
7 tonsilitis in 1y
5 tonsilitis in 2y
3 tonsilitis in 3y
320
Post tonsilectomy bleeding management
Hydrogen peroxide gargle
Adrenalin soaked swab
Re - 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
Mobile
Non tender
Soft
Fluctuant
327
Lipoma
Mobile
Soft
Painless
No skin change
328
Branchial cyst
```
Round
Soft
Cystic swelling
Transluminate with light
Anterior to SCM
```
329
Glossitis causes
Iron deficiency
B12, folate deficiency
Coeliac disease
330
Oral candidiasis treatment
Miconazole gel
Nystatin suspension
Fluconazole tablets
331
Leuko and erythroplakia
Leuko - white patches
Erythro - red lesions
Precancerous changes, increasing risk of squamous cell carcinoma
332
Aphthous ulcers treatment
Topical:
Choline salicylate
Benzydamine
Lidocaine
Topical corticosteroids - severe:
Hydrocortisone buccal tablets
Bethamethasone soluble tablets
Beclomethasone 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 children
Greenstick
Buckle fracture
336
Cancers that metastasise to the bone
```
PoRTaBLe
Prostate
Renal
Thyroid
Breast
Lung
```
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 canal
Reflux and oesophageal erosion
Atypical 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
Paraesthesia
Pale
High pressure
Paralysis
```
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 weeks
Clindamycin 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 - S3
Exits pelvis through greater sciatic foramen
Then 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
```
Hypopituitarism
CF
Delay in growth and development
Growth hormone deficiency
Hypothyroidism
Cushing
Hyperprolactinemia
Kallman 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 ovaries
Turner syndrome XO
367
Congenital adrenal hyperplasia symptoms
```
FEMALE with:
Tall
Facial hair
Primary ammenorhoea
Deep voice
Early puberty
```
368
Androgen insensitivity syndrome
Males
Male sexual characteristics do not develop
Results 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 hyperprolactinemja
Parkinson’s
Acromegaly
375
Primary ovarian failure bloods
High FSH
376
PCOS bloods
High LH
| High LH:FSH ratio
377
Raised testosterone conditions
PCOS
Androgen 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 lifestyle
COCP (drospirenone)
SSRI
CBT
381
Physical symptoms of PMS tx
Brest swelling
Water 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 IUS
COCP
Cyclical 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
Intramural
Submucosal
Subserosal
Pedunculated
388
Fibroids <3cm mx
IUS mirena
NSAID/ tranexamic acid
COCP
Cyclical legal progestogens
389
Surgical options for fibroids <3cm
Endometrial ablation
Resection during hysteroscopy
Hysterectomy
390
Fibroids >3cm mx
```
Referral to Gynae
NSAID/ tranexamic acid
Mirena coil IUS
COCP
cyclical progestagen
```
Uterine artery embolisation
Myomectomy
Hysterectomy
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 pain
Low grade fever
Tachycardia
Vomiting
+history of fibroids
Tx: 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
Dysmenorrhea
Menorhhoagia
Dyspareunia
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 40
Result 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 prolapse
Urinary incontinence
CVD
Stroke
```
404
Symptoms of lack of oestrogen
```
Hot flashes
Low mood
PMS
irregular and heavy/light period
Low libido
Joint pains
Vaginal 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 gain
Reduced bone density / osteoporosis
UNSUITABLE in >45yo
409
Progesterone with low risk of DVT
Norethisterone
| Levonorgestrel
410
Primenopausal symptoms management
HRT
Tibolone (steroid hormone, continuous combined HRT)
Clonidine (agonist of alpha-adrenergic and imidazoline receptors)
Testosterone for low libido
Vaginal 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 bleeds
If no periods for >12months go on continuous combined HRT
416
Non hormonal menopause tx
```
Lifestyle changes
CBT
SSRI
Clonidine (agonist of alpha adrenergic)
Venlafaxine (SNRI)
Gabapentin
```
417
Clonidine
Lowers BP and HR
Alpha 2 adrenergic receptor agonists
Used to prevent vasomotor symptoms
SE dry mouth, headaches, dizziness, fatigue
418
Alternative remedies for menopause
```
Black cohosh - cause liver damage
Dong quai - causes bleeding disorders
Red clover - oestrogenic side effects
Primrose oil - clotting disorders and seizures
Ginseng- mood and sleep benefit
```
419
HRT risks (worse in older women and longer use)
Breast cancer
VTE
Stroke
Coronary artery disease
420
HRT risks that do not apply
To women <50yo
No risk of endometrial cancer if no uterus
No 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 HRT
3) 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 libido
C21 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 device
Added benefit of contraception and treating heavy period
No progestogenic side effects or risk of breast cancer or CVD
430
Tibolone
Synthetic steroid
Oestrogen and progesterone receptors
Continuous combined HRT
Help with reduced libido
431
HRT and surgery
Stop 4 weeks before major surgery
| HRT and oestrogen contraceptive
432
Oestrogen SE
Bloating
Breast swelling
Headache
Leg cramps
433
Progesterone se
```
Mood swings
Bloating
Fluid retention
Acne
Weight gain
```
434
Rotterdam criteria for PCOS
Anovulation
Hyperandrogenism (hirsuitisn or acne)
PCOS
435
Drugs causing hirsuitism
```
Phenytoin
Cyclosporin
Corticosteroids
Testosterone
Anabolic 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 menarche
Early menopause
Pregnancy
COCP
444
Risk of malignancy index (whether ovarian mass is malignant)
Menopausal status
US
CA125
445
Ovarian cyst Simple 5-7cm
Routine gynaecology referral and annual screen
446
Meig syndrome
Women (older) with pleural effusion and ovarian mass
Ovarian fibromyalgia
Pleural effusion
Ascites
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 amenorrhoea
Light periods
Dysmenorrhoea
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 / COCP
increased vaginal discharge
Vaginal bleeding
Dyspareunia
(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 introitus
2: lowest part within 1cm of introitus
3: lowest part >1cm below introitus
4: 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
```
smoking
HIV
COCP
increased number of pregnancies
early sexual activity
not using condoms
increased number of sexual partners
```
461
CIN - grading for level of dysplasia
diagnosed at colposcopy
CIN 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 cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis
472
cervical cancer management
1A: LLETZ or cone biopsy
Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Stage 2B – 4A: Chemotherapy and radiotherapy
Stage 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 warts
strains 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 age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement
No pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
```
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 pill
Mirena coil
Increased pregnancies
Cigarette smoking
480
tx for endometrial cancer
radical hysterectomy
radio/chemo
progesterone 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 2
obesity
smoking
increased number of ovulation
recurrent use of clomifene
early periods
late menopause
no pregnancies
```
485
protective facotrs for ovarian cancer
COCP
breastfeeding
pregnancy
486
ovarian mass on obturator nerve
reffered hip or groin pain
487
ovarian cancer symptromes
ascites
pelvic mass
abdominal mass
488
Ix for ovarian cancer
CA125 (>35IU/ml is significant)
| pelvic ultrasound
489
risk of malignancy index
menopausal status
US findigs
CA125
490
germ cell tumour markers
raised:
alfa fetoprotein
hCG
491
ovarnian cancer staging
Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)
492
vulval cancer most common
squamous cell carcinoma
493
risk factors for vulval cancer
>75yo
immunosurpression
HPV
lichen sclerosus
494
frequent location of vulval cancer
labia majora
| ulceration, bleeding, irregular mass
495
Mx in vulval cancer
wide local excision
groin lymph node dissection
chemo
radio
496
BV bacteria
```
anaerobic bacteria
due to loss of lactobacilli
- Gardnerella vaginalis (most common)
- Mycoplasma hominis
- Prevotella species
```
497
BV 4
clue cells on microscopy
pH >4.5
fishy smell
grey-white discharge
498
mx of BV
Metronidazole PO - DO NOT DRINK alcohol, causes N&V, flushing, shock, angiodema
Clindamycin
499
Candidiasis
candida albicans
thick white discharge
vulval and vaginal itching, irritation, discomfort
+- erythrema, dyspareunia, dysuria
500
Risk factors for candidasis
oestrogen increase (pregnancy)
poorly controlled diabetes
immunosuppression
borad-spectrrum abx
501
pH bacterial vaginosis and trichomonas
pH >4.5
502
pH candidiasis
pH <4.5
503
candidiasis diagnosis
charcoal swab with microscopy
504
candidiasis mx
```
clotrimazole cream intravaginal (5g 10%)
clotrimazole pessary (500mg)
3 doses of clotrimazole pessaries 200mg 3 nights
oral antifungal tablets: fluconazole (150mg)
```
505
sex vs candidiasis medication
antifungals can damage latex condoms and impair spermicides: so ALTERNATIVE contraceptive for 5 days after use
506
Chalmydia trichomatis
gram -ve bacteria
intracellylar organism
MOST COMMON STI IN UK
507
Chlamydia diagnosis
NAAT - nucleic acid amplification tests
508
chlamydia tx
doxycycline 100mg 2x daily for 7 days
-contraindicated in pregnancy/brestfeeding
Azithromycin 1g stat then 500mg 1x for 2d
Erythromycin 500mg 4x day for 7d
Erythromycin 500mg 2x dayfor 14 days
Amoxicillin 500mg 3x daily for 7 days
509
LGV
painless ulcer and painful lymphadenopathy
Doxycycline 100mg 2x daily for 21 days
510
Gonnorhoea
gram -ve dipoloccus
| infects mucous membranes with columnar epithelium (endocervix, urethra, rectum, conjunctiva, pharynx)
511
gonorrhoea symptoms
discharge odourless
dysuria
pelvic pain
or epidydimo-orchitis
512
Gonorrhoea diagnossi
NAAT
513
gonorrhoea tx
A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
514
complication of gonococcal conjunctivitis in neonate
Neonatal conjunctivitis is called ophthalmia neonatorum (sepsis, blindness)
515
disseminated gonoccoal infection
```
complication of untreated gonoccoal infection, bacteria spreads to skin and joints
non-specific skin lesions
joint aches and pains
arthritis that moves between joints
Tenosynovitis
Systemic symptoms
```
516
Mycoplasma genitalium and dx
non gonococcal urethritis
First urine sample in the morning for men
Vaginal swabs (can be self-taken) for women
517
mycoplasma genitalium tx
Doxycycline 100mg 2x day for 7d
then
Azithromycin 1g stat then 500mg OD for 2 days (unless it is known to be resistant to macrolides)
If pregnant/breastfeeding: NO Doycycline
518
PID causes
Neisseria gonorrhoeae (severe PID)
Chlamydia trachomatis
Mycoplasma genitalium
519
PID symptoms
```
Pelvic tenderness
cervical excitiation
cervicitis
purulent discharge
fever
dysuria, dyspareunia
```
520
PID tx
A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)
Doxycycline 100mg 2xday for 14 days (chlamydia and Mycoplasma genitalium)
Metronidazole 400mg 2x day for 14 days ( anaerobes such as Gardnerella vaginalis)
521
complications of PID
Fitz-Hugh-Curtis syndrome
| nflammation and infection of the liver capsule, leading to adhesions between the liver and peritoneum.
522
trichomonas
```
protozoan flagella
swab from posterior fornix of vagina
pH >4.5
forthy yellow-green
fishy smell
strawberry cervix (colpitis macularis)
tx Metronidazole
```
523
HSV
cold sores (hepres labialis) and genital herpes
HSV 1 and HSV 2
multiple painful ulcers
viral PCR
524
HSV tx
aciclovir
1* genital herpes treat with acyclovir (if contracted before 28weeks gestation) - acyclovir at infection and prophylactic aciclovir from 36w. if asymptomatic -> vaginal delivery
1*genital herpes after 28 weeks treat with acyclovir until delivery, C section
525
HIV most common type
HIV -1
| virus enters and destroys CD4 T=helper cells
526
AIDS defining ilness
```
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
```
527
when to test for HIV
can be negative up to 3 months post exposure
Antibody testing for HIV
PCR testing for viral load
528
CD4 in HIV
500-1200 cells/mm3 is the normal range
| Under 200 cells/mm3 is considered end-stage HIV (AIDS) and puts the patient at high risk of opportunistic infections
529
PCP prophylaxis
co-trimoxazole (septrin)
530
HIV and birth
vaginal delivery if <50 copies/ml
C section if >50 copies
IV zidovudine given to mother >10 000
Bebo:
if mother <50: zidovudine 4w
if mother >50: zidovudine, lamivudine, nevirapine for 4w
531
PEP
ART therapy
| Truvada (emitricitabine and tenofovir) and raltegravir, for 28d
532
Syphilisi
teponema pallidum
spirochete
spiral-shaped bacteria
incubation period 21d
533
stages of syphilis
1*: painless ulcer, chancre, local painless lymphadenopathy
2* systemic symptoms, condylomata lata resolves after 3-12 weeks
3* gummas/gummatous lesions and cardiovascular and neurological complications
neurosyphilis - in CNS (ocular syphilis, tabes dorsalis)
534
syphilis dx
antibody testing
| samples for dark field microscopy or PCR
535
syphilis tx
deep IM benzathine benzylpenicillin
alternative: ceftriaxone, amoxicillin, docycyline
536
UKMEC
UKMEC 1: No restriction in use (minimal risk)
UKMEC 2: Benefits generally outweigh the risks
UKMEC 3: Risks generally outweigh the benefits
UKMEC 4: Unacceptable risk (typically this means the method is contraindicated)
537
What contraception to avoid in breast cacncer?
avoid any hormonal contraception and go for the copper coil or barrier methods
538
What contraception to avoid in cervical/endometrial cancer?
avoid the intrauterine system (i.e. Mirena coil)
539
what contraception to avoid in Wilson's disease?
avoid copper coil
540
RF to avoid COCP
Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura
History of VTE
>35yo smoking >15 cigarettes/day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus and antiphospholipid syndrome
541
when should progestogen injection (Depo provera) be stopped?
before 50yo due to risk of osteoporosis
542
lactational amenorrhoea
effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods)
543
IUS/IUD in breastfeeding?
can be inserted either within 48 hours of birth or more than 4 weeks after birth
544
COCP and rbreastfeeding
should be avoided in breastfeeding and can't be started <6w after childbrith
545
COCP MOA
prevents ovulation
progesterone thickens mucus
progesterons recued endometrial proliferation
546
2 types of COCP
monophasic (same amount of hormone in each pill)
| multiphasic (varying amounts of hormone to match normal cyclical changes)
547
COCP with lower risk of VTE
progesterone as levonorgester or norethisterone
548
1st line COCP for PMS
Yasmin - the ones with drospirenone (help with water retention, bloating, modd changes)
549
COCP in treatemtn of acne/hirsutism
Dianette - with cuproterone acetate, but high risk of VTE
550
COCP benefits
improves PMS, menorrhagia, dysmenorrhoea,
reduced risk of endometrial , ovarian, colon cancer
551
starting COCP
no additional contraception if starting in 1st 5 days of cycle
if after 5 days, requres extra contraception for 7 days
552
how to switch COCPs?
take one pack after the other with no pill free interval
553
swithing from POP to COCP
switch at any time but 7days extra contracception
unless switching from desogestrel which inhibits ovulation, then no extras
554
when to stop COCP
4 weeks before major operation
555
the only POP UKMEC 4
active breast cancer
556
POP MOA
Thickening the cervical mucus
Altering the endometrium and making it less accepting of implantation
Reducing ciliary action in the fallopian tubes
557
starting POP
if starting on days 1-5 no extras
if after day 5, additional contraception is required for 48h.
if switching from POP - extra contraception for 48h (best to switch during hormone free period)
558
progesterone only injection (DMPA)
IM or SC every 12-13 weeks, medroxyrpogesterone acetate
depo provera: IM
sayana press: SC self injection
noristerat - norethisterone for 8 weeks, altrnative
559
progesterone only injection (DMPA)
IM or SC every 12-13 weeks, medroxyrpogesterone acetate
depo provera: IM
sayana press: SC self injection
noristerat - norethisterone for 8 weeks, altrnative
560
progesterone only injection (DMPA)
IM or SC every 12-13 weeks, medroxyrpogesterone acetate
depo provera: IM
sayana press: SC self injection
noristerat - norethisterone for 8 weeks, altrnative
561
Progesterone injection MOA
inhibits ovulation
thickens mucus
alters endometrium
562
when to do progesterone injection
day 1-5 of cycle
| if after that, 7 days extra contraception
563
SE of progesterone injection
1) weight gain
2) osteoporosis
alopecia
reduced libido
delays return to fertility
mood changes
benefits: recued sickle cell crisis severity, improved endometriosis or dysmenorrhoea
564
progesterogen only implant +MOA
lasts 3 years
nexplanon (etonogestrel)
inhibits ovulation
thickens mucus
alterns endometrium
565
age of sexual consent
13 yo
566
IUD and smear - organism
actinomyces like organisms
567
UPSI
Levonorgestrel within 72 hours of UPSI
Ulipristal within 120 hours of UPSI
Copper coil within 5 days of UPSI, or within 5 days of the estimated date of ovulation
568
levonorgestrel Emergency contraception
COCP or POP can be started immediately
additional 7 days condoms COCP
additional 2 days condoms POP
569
Levonorgestrel doses
1.5mg as a single dose
| 3mg as a single dose in women above 70kg or BMI above 26
570
Ullipristal (EllaOne) emergency contraception
```
single dose (30mg)
wait 5 days until starting the combined pill or progestogen-only pill after taking ulipristal
cndoms 7days cocp, 2days pop
```
571
Ulipristal restriction
Breastfeeding - avoid 7d post ulipristal
| Avoid in pts with asthma (Severe)
572
female hormone testing in intertility
serum LH FSH days 2-5 (high LH PCOS, high FSH poor ovarian reserve)
serum progesterone on day 21 (or 7 days before period) (rise incidates ovulation)
573
how to stimulate ovulation
```
clomifene
letrozole (aromatase inhibitor)
gonadotropins
ovarian drilling
metformin
```
574
Azoospermia
absence of sperm in the semen.
575
Cryptozoospermia
very few sperm in the semen sample (less than 1 million / ml).
576
Polyspermia (or polyzoospermia)
high number of sperm in the semen sample (more than 250 million per ml).
577
Normospermia (or normozoospermia)
normal characteristics of the sperm in the semen sample.
578
Oligospermia
```
reduced number of sperm in semen sample
Mild oligospermia (10 to 15 million / ml)
Moderate oligospermia (5 to 10 million / ml)
Severe oligospermia (less than 5 million / ml)
```
579
IVF steps
```
Suppressing the natural menstrual cycle
Ovarian stimulation
Oocyte collection
Insemination / intracytoplasmic sperm injection (ICSI)
Embryo culture
Embryo transfer
```
580
Ovarian hyperstimulation syndrome
complication of ovarian stimulation during IVF infertility treatment
- increase in VEGR increased vascular permeability
- oedema, ascites, hypovolaemia
- raised renin level
- Haematocrist indicates dehydration
581
Prevention of gout
Allopurinol (inhibits xanthine oxidase)
| 100mg OD titrated to serum uric acid of 300umol/L
582
Allopurinol interactions
Azathioprine (allopurinol increases azathioprine dose so low dose allopurinol 1/4)
Cyclophosphamide (allopurinol reduces renal clearance -> marrow toxicity)
Theophylline (allopurinol inhibits it’s breakdown)
583
Alpha blockers use
HTN
BPH
SE: postural hypotension
Drowsiness
Confusion
584
Alpha blockers examples
Postural hypotension
Drowsiness
Dyspnoea
585
Sildenafil contraindications
Nitrates and nicorandil
586
Oculogyric crisis in overdose. Drug
Antipsychotics
Metoclopramide
(Extrapyramidal Side effect)
587
Lithium toxicity precipitants
```
Thiazides
Bendroflumethazide
ACE inhibitors and Angiogensin II
NSAID
Metronidazole
```
588
Digoxin antibody
Digibind
589
Lactic acidosis risk?
Suspend Metformin in illness like diarrhoea and vomiting
590
Serotonin syndrome drugs (causative)
SSRI
Ecstasy
Amphetamine
MAO inhibitors
591
Heroin overdose
Respiratory depression
| CNS depression
592
Cocaine overdose
Chest pain
Mood changes
Cardiac symptoms
593
Aminoglycoside antibiotics
Ototoxicity + nephrotoxicity
594
Severe renal impairment VTE prophylaxis
LMWH - allowed in <30 creatinine but high bleeding risk
| -> Unfractioned heparin 1st line
595
Anion gap normal and formula
10-18
| Na+ + K+) - (Cl- + HCO3-
596
Ethylene glycol toxicity
Metabolic acidosis with high anion gap
597
Cyclosporin se
```
Everything high
HTN
high fluid
High K+
Hair, gums, glucose
```
(It is immunosuppressant)
598
Which diuretics should not be combined?
Amiloride + Spironolactone
| Both potassium sparing
599
Drugs causing urinary retention
```
TCA (Amitryptyline)
Antipsychotics
Antihistamine
Opioids
NSAID
```
600
TCA overdose
Amitryptyline or dothiepin, dusolepin
```
Dry mouth
Dilated pupils
Agitation
Sinus tachy
Blurred vision
QT prolongation
Coma
Metabolic acidosis
Seizures
Arrhythmias
```
601
Tuberculosis drugs SE
Rifampicin (orange secretions, p450 inducer, hepatotoxicity)
Isoniazid (hepatitis, agranylocytosis, peripheral neuropathy B6)
Pyrazinamide (hyperuricaemia, hepatitis)
Ethambutol (optic neuritis, loss of colour vision)
602
P450 inducers
```
CRAP GPSSS
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
```
```
Griseofluvin
Phenobarbital
Sulphonylurea
Smoking
St John wort
```
603
Inhibitors of p450 (will cause toxicity)
Sick faces . Com (+ grapefruit)
```
Sodium valproate
Isoniazid
Chloramphenicol
Ketoconazole
Fluconazole
Alcohol Acute, Amiodarone, Allopurinol
Cimetidine
Erythromycin
Sulfonamides, Sertraline/Fluoxetine
.
Ciprofloxacin
Omeprazole
Metronidazole
```
604
Heparin mechanism of action
Activates: antithrombin III
Inhibits: thrombin, factors Xa, IXa, XIa, XIIa
605
LMWH mechanism of action
Activates: antithrombin III
inhibits: factor Xa
606
Salicylate overdose
Respiratory alkalosis followed by metabolic acidosis
```
Tinnitus
Anxiety
Seizures
Sweating
Lethargy
Hypervention
```
607
Serotonin syndrome
```
SSRI/ MAOI/ ecstasy
Onset hours
Hyperreflexia, Clonus, dilated pupils
Tachycardia, HTN
pyrexia, rigidity
IV fluids, benzodiazepines
Mx cyproheptadine, chlorpromazine
```
608
Neuroleptic malignant syndrome
```
caused by antipsychotics
Slow onset hours-days
Hyporeflexes, rigidity (lead-pipe) normal pupils
Tachycardia, HTN
pyrexia, rigidity
IV fluids, benzodiazepines
Mx: dantrolene
```
609
Organophopshate insecticide poisoning
Salivation
Lacrimation
Urination
Diarrhoea
+ Small pupils
Mx: atropine
610
Galactorrhoea treatment
Dopamine agonist (eg ropinirole)
611
Paracetamol overdose biochemistry
ALP and AST in 10,000
612
Ecstasy/ MDMA overdose
```
Agitation, confusion, anxiety, ataxia
Tachycardia, HTN
fever
Hyponatremia
Rhabdomyolysis
```
Mx: dandrolene
613
Aminoglycosides examples
Gentamycin
Neomycin
Tobramycin
614
ectopic pregnancy location
fallpian tube
615
ectopic pregnancy risk factors
```
Previous ectopic pregnancy
Previous pelvic inflammatory disease
Previous surgery to the fallopian tubes
Intrauterine devices (coils)
Older age
Smoking
```
616
US mass with empty gestational sac
“blob sign”, “bagel sign” or “tubal ring sign''
617
tubal ectopic pregnancy vs corpus luteum
corpus luteum moves WITH the ovary
| the tubal ectopic moves SEPARATELY to ovary
618
When should bHCG double?
Every 48h
619
when should pregnancy be visible on US?
hCG >1500 IU/L
620
Ectopic expectant management criteria
```
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
HCG level < 1500 IU / l
```
621
Ectopic medical management criteria
```
HCG level must be < 5000 IU / l
Confirmed absence of intrauterine pregnancy on ultrasound
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
```
622
Ectopic surgical management
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
-Laparoscopic salpingectomy
Laparoscopic salpingotomy
623
surgical management of ectopic - prophylaxis
Anti D to Rh negative women
624
Miscarriage dates criteria
Early <12 weeks gestation
| Late >12 weeks gestation
625
Missed miscarriage
the fetus is no longer alive, but no symptoms have occurred
626
Threatened miscarriage
– vaginal bleeding with a closed cervix and a fetus that is alive
627
Inevitable miscarriage
– vaginal bleeding with an open cervix
628
Incomplete miscarriage
retained products of conception remain in the uterus after the miscarriage
629
Complete miscarriage
– a full miscarriage has occurred, and there are no products of conception left in the uterus
630
Anembryonic pregnancy
– a gestational sac is present but contains no embryo
631
fetal heartbeat
when crown-rump length >7mm
632
<7mm, no heartbeat
repeat US after >7d
then if >7mm and no heartbeat: Non-Viable Pregnancy
633
Mean gestational sac diameter >25mm without a fetal pole
Repeat after 1 week and confirm Anembryonic pregnancy
634
Miscarriage medical management
Misoprostol (vaginal suppository or oral dose) - prostaglandin analogue, binds to prostaglandin receptions and softens the cervix, stimulates contractions.
635
Misoprostol side effects
Heavier bleeding
Pain
Vomiting
Diarrhoea
636
Surgical management of miscarriage
Manual vacuum aspiration under local anaesthetic as an outpatient OR
Electric vacuum aspiration under general anaesthetic
Prostaglandins (misoprostol) given before surgical management
637
ERPC - evacuation of retained products of conception
under GA
cervix dilated, retained products removed though vaccum aspiration and curettage
Key complication: endometritis
638
Recurrent miscarriage definition
3 or more consecutive miscarriages
investigations after: 3 1st trimester, 1 2nd trimester miscarriage
639
hereditary thrombophilias (miscarriage)
```
Factor V Leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency
```
640
uterine abnormalities (miscarriage)
Uterine septum (a partition through the uterus)
Unicornuate uterus (single-horned uterus)
Bicornuate uterus (heart-shaped uterus)
Didelphic uterus (double uterus)
Cervical insufficiency
Fibroids
641
Chronic Histiocytic Intervillositis (miscarriage)
2nd trimester miscarriage
causes IUGR and IUD death
infiltrated of mononuclear cells in intervillous space
642
Ix in recurrent miscarriage
```
Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic ultrasound
Genetic testing of the products of conception from the third or future miscarriages
Genetic testing on parents
```
643
latest legal abortion
24w
| 1990 Human Fertilisation and Embryology Act (switched from 28w)
644
Medical abortion
Mifepristone (anti-progestogen) - stops the pregnancy and relaxes cervix
Misoprostol (24-48h later) - prostaglandin analogue, softens cervix and stimulates contractions
>10w gestation, misoprostol every 3h dose until expulsion
645
Surgical abortion
Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)
Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)
Cervical priming before the procedure to dilate the cervix with Mife, Miso, Osmotic dilators
646
hyperemesis gravidarum
More than 5 % weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance
647
PUQE score
Pregnancy-Unique Quantification of Emesis
< 7: Mild
7 – 12: Moderate
> 12: Severe
648
Antiemetics in pregnancy (in order of safety)
Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide
+ginger and acupressure
649
Acid reflux treatment in pregnancy
Ranitidine or Omeprazole
650
When to admit in hyperemesis gravidarum?
Unable to tolerate antiemetics or keep down fluids
>5% weight loss
Ketones (2+) on urine dipstick
651
complete mole
2 sperms fertilise empty ovum (no genetic material) = no foetal material forms
652
Partial mole
2 sperms fertilise normal ovum = triple chromosome set, haploid cell
653
symptoms of molar pregnancy
```
More severe morning sickness
Vaginal bleeding
Increased size of uterus
abnormally high hCG
Thyrotoxicosis
```
654
Paracetamol overdose mx
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
655
Salicylate overdose mx
urinary alkalinization with IV bicarbonate
| haemodialysis
656
Benzodiazepines overdose mx
Flumazenil (risk of seizures tho)
657
TCA overdose mx
IV bicarbonate - reduced seizure risk and arrhythmia risk
| 1st step is correct the acidosis
658
Lithium overdose mx
haemodialysis
| sodium bicarbonate
659
Warfarin overdose mx
Vitamin K, prothrombin complex
660
Heparin overdose mx
Protamine sulphate
661
B blockers overdose mx
if bradycardic then atropine
| in resistant cases glucagon may be used
662
Etylene glycol
fomepizole - inhibitor of alcohol dehydrogenase
| haemodialysis
663
Methanol poisoning mx
fomepizole or ethanol
| haemodialysis
664
Organophosphate insecticides overdose/poisoning mx
atropine
665
CO2 poisoning mx
100% oxygen
| hyperbaric oxygen
666
Cyanide poisoning mx
Hydroxocobalamin
667
Iron overdose mx
Desferrioxamine, a chelating agent
668
Lithium monitoring
TFT, U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT, U&E every 6 months
669
Meig’s syndrome
Benign ovarian tumour
Ascites
Pleural effusion
670
Caplan syndrome
Swelling and scarring of lungs in RA (in people who breathed in dust, coal, silica)
671
RA histology
Fibrinoid necrosis surrounded by palisading epithelioid cells
672
Cribriform plate fx
Panda eyes/ periorbital bruising
Rhinorrhoea - CSF leaking
Do not use nasogastric tube or nasal airway adjunct - can enter the cranium
673
Disulfiram reaction
Reaction to medication (or alcohol cessation medication)
| Eg metronidazole, disulfiram
674
Homonymous quadrantopias
Superior - inferior optic radiation temporal lobe lesion (meyers loop)
Inferior - superior optic radiation in parietal lobe lesion
PITS
675
Bitemporal hemianopia
Upper quadrant defect - inferior chiasm compression, pituitary tumour
Lower quadrant - superior chiasm compression, craniopharyngioma
676
Smoking and p450
Induces metabolism
677
Tetralogy of fallot
VSD
Pulmonary stenosis
Overriding aorta
Right ventricular hypertrophy
Ejection systolic murmur left eternal border
678
Vascular dementia
Sudden stepwise deterioration of cognition
Risk factors for vascular disease
Gait disturbance and urinary symptoms
Change in mood and concentration
679
Lewy body dementia
Parkinsonian symptoms
Visual hallucinations
Sleep behaviour disorders
680
Frontotemporal dementia
```
Personality changes
Loss of insight
Stereotypes behaviours
Slowly progressive, onset <70yo
Family history
```
681
Travellers diarrhoea cause
Enterotixigenic escherichia coli
682
POPQ prolapse
Stage 1 cervix prolapses more than 1cm above hymen
| Stage 2 - prolapse between 1cm above and 1cm below level of hymen
683
Acute Subdural haematoma
Elderly on warfarin
No head trauma
Fluctuating confusions and consciousness
684
Yersinia enterocolitica
Invasive gastroenteritis
Mesenteric lymphadenitis
Erythrema nodosum
685
Schizoid personality disorder
```
Alone
Loneliness
Odd behaviour
No socialising
Flat affect
```
686
Schizotypal personality disorder
Magical and weird thinking
687
Schizophrenia and schizoaffective disorder
Have Psychotic symptoms
688
Ottawa ankle rules
X ray is required if:
1) pain
2) - medial malleolus tenderness
- lateral malleolus tenderness
- inability to bear weight
689
Absent femoral pulses
Coarctation of the aorta
Tx balloon angioplasty
Re coarctation can occur, plus HTN and CVD
690
Acute PE and shock - thrombolytic choice
Streptokinase
691
Supracondylar humerus fx nerve injury
Anterior interosseous nerve injury
| Weakness to 2nd finger
692
Musculocutsneous nerve ix
Atrophy of biceps brachii
693
Ulnar nerve injury
4th and 5th fingers loss of sensation
694
Gonorrhoea symptoms
Thick green-yellow discharge from the vagina
Painful urination
Bleeding between periods
695
Chlamydia sx
Pain on urination
Vaginal discharge
Bleeding between periods
696
Dyskinesia vs akathisia
Tardive dyskinesia - involuntary movement (chorea movement)
| Akathisia - restlesness
697
Giant cell arteritis vision loss type
Anterior ischaemic optic neuropathy
698
Cataract surgery complications
Endophthalmitis
| Posterior capsule opacification
699
1st line treatment for prolactinoma
Bromocriptine or cabergoline
| Dopamine receptor agonist
700
Cat scratch organism and symptoms
Bartonella henselae
Brownish red papules
Lymphadenopathy
701
Antistreptolysin O titer
Used to determine recent group A strep infection
702
INR 6-8, no bleeding
Stop warfarin
Check INR
Recommence warfarin if <5
703
INR >8 minor/no bleeding
Stop warfarin
5mg oral vit K, 0.5-1mg IV
Recheck INR and can re give vit K in 24h
Recommence warfarin if INR <5
704
Raised INR with major bleeding
Stop warfarin
| IV phytomenadione and fresh frozen plasma 15mg/kg
705
Shigella treatment
(Severe if bloody diarrhoea - dysentery)
Ciprofloxacin 500mg PO BD 1day
Or
Azithromycin 500mg PO OD for 3 days
Shigella is notifiable disease
706
Pre eclampsia risk factors
```
Nullparity
Previous pre eclampsia
Family history
Maternal age >40
Pregnancy interval >10
Multiple pregnancy
HTN
BMI >35
Pre existing vascular/kidney/diabetes
```
707
Hep B serology
HBsAg (positive- currently infected, negative - not currently infected)
708
If HBsAg -ve
Look at a-HBc
+ natural infection, naturally immune
- no natural infection
709
If HBsAg +
IgM a-HBc
+ acute infection
- chronic infection
710
If HBsAg -
| a-HBc -
a-HBs
+ immune from Hep B vaccine
- never had vaccine or infection
711
SLE ab
Anti-dsDNA
anti-Histone
Anti-Smith
ANA
712
Polymyositis
Anti-Jo1
713
Myasthenia gravis
Anti-acetylcholine receptor
714
Lambert Eaton ab
Anti-VGCC
715
HIV treatment drugs
2 nucleotide reverse transcriptase inhibitors
| 1 NNRTI or integrase inhibitor
716
Anatomical landmarks spine
T3 spine of scapula
T7 inferior aspect of scapula
L4 superior aspect of iliac crest
S2 PSIS
717
Scabies treatment
Caused by sarcoptes scabiei
1) permethrin 5% (whole body and wash after 8-12h, repeat after 1w)
2) malathion
718
Anterior tongue tie vs posterior tongue tie
Anterior: prominent restrictive frelunum seen in front of the tongue
Posterior: frelunum back underneath the tongue
719
Allergic rhinitis in pregnancy
Oral loratadine
720
GCS motor
```
6 obeys commands
5 localises pain
4 withdraws from pain
3 abnormal flexion
2 abnormal extension
1no response
```
721
Rubella vaccination antibodies
IgM antibody negative
| IgG antibody positive
722
Amiodarone se and tx
se: hypothyroidism, tx with levothyroxine (amiodarone ctd)
723
when to prescribe cyclical combined HRT
LMP <1y ago
724
when to prescribe continyous combined HRT
- taken cyclical combined for 1year
- at least 1y since LMP
- at least 2y since LMP in premature menopause (<40y)
725
TCA overdose
widened QRS (>160ms)
arrhythmia
(eg amiodarone and dusoleptin)
tx. IV sodium bicarbonate
726
Ethylene glycol overdose tx
Fomepizole
727
opioid detox drug
Methadone
728
lorazepam overdose (benzodiazepine) tx
gaba antagonist
| FLUMAZENIL
729
adrenaline doses
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
| cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
730
salicylate poisoning
1) resp alkalosis
| 2) metabolic acidosis
731
anaphylactoid reactions to IV acetylcysteine
stop IV acetylcysteine
give nebulised salbutamol
restart IV infusion at a slower rate
732
ciprofloxacin SE
lowers seizure threshold
| tendonitis
733
metronidazole se
reaction following alcohol ingestion
734
doxycycline se
photosensitivity
735
trimethoprim side effects
photosensitibty
pruritis
supression of haematopoiesis
736
LSD intoxication tx
Lorazepam
737
criteria for paracetamol liver transplant
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
738
CURB
739
Alcohol addiction drugs
benzodiazepines for acute withdrawal
disulfram: promotes abstinence (contraindications: ischaemic heart disease, psychosis)
acamprosate: reduces craving
740
heparin overdose tx
protamine sulphate
741
ACE inhibitors se
cough
| hyperkalaemia
742
bendroflumethiazide se
gout
hypokalemia
hyponatremia
impaired glucose tolerance
743
calcium channel blockers se
headache
flushing
ankle oedema
744
beta blockers se
bronchospasm
fatigue
cold peripheries
745
doxazosin se
postural hypotension
746
ethylene glycol toxicity
Fomepizole
747
amarurosis fugax tx
Aspirin
748
Malignant melanoma margins
749
Bishop score
750
fever followed by maculopapular rash
(Once fever resolved)
| Roseola infantum HHV6
751
Itchy red papillae lesions between toes and fingers
Scabies - sarcoptes scabiei
752
Bilateral malar erythrema
Slapped cheek syndrome / 5th disease
| Parvovirus b19
753
Papules and vesicles and pustules
Chicken pox VZV
754
Widespread erythrema and tenderness, desquamation
Scalded skin syndrome
| Staphylococcus
755
Painful vesicular lesions on hands, feet, mouth
Hand foot and moths
| Coxsackie virus
756
Erythrematous pustules with yellow crust
Impetigo
| Staph aureus
757
Erythrematous rash in nappy
```
Irritant dermatitis (spares flexures)
Candida (involves flexures)
Seborrhoeic dermatitis (scalp changes, not itchy)
```
758
Vesicles surrounded by maculopapular rash (target like)
Erythrema multiformae
759
Measles
```
Spread by droplets
Incubation 7-12d
Cough, conjunctivitis, fever
Koplik spots
Rash from behind the ears to face neck and body
Supportive treatment
```
760
Mumps
Supportive treatment
Complication- orchitis, encephalitis
Prodromal fever and malaise
Droplet, 12-21 incubation
761
Rubella
Respiratory spread
Incubation 15-20
Fever and maculopapular rash (from face to body)
Concern: congenital infection
762
2 month vaccinations
DTaP/IPV/Hib, MenB, rotavirus
763
3 month vaccinations
DTaP/IPV/Hib, PCV, rotavirus
764
4 months vaccines
DTaP/IPV/Hib, PCV, MenB
765
12 month vaccines
Hib/MenC, PCV, MMR, MenB
766
3 years vaccines
MMR/DTaP/IPV
767
12 years vaccines
HPV
768
14 years vaccines
MenACWY/DTa/IPV
769
Live attenuated vaccines
```
TB
OPV (polio vaccine)
MMR
Rotavirus
Yellow fever
```
770
Inactivated vaccines (killed antigen)
Pertrussis
| IPV
771
Inactivated toxins
Diptheria
| Tetanus
772
Paediatric fluids
0.9 NaCl and 5% dextrose
24h Na 2-4mmol/kg
24h K 1-2mmol/kg
773
developmental milestones
774
G4 P3
A pregnant woman with three previous deliveries at term
775
G1 P1
A non-pregnant woman with a previous birth of healthy twins:
776
G1 P0 + 1
A non-pregnant woman with a previous miscarriage
777
G1 P1
A non-pregnant woman with a previous stillbirth (after 24 weeks gestation
778
booking clinics
<10w
779
Dating scan
Between 10 and 13 + 6
| An accurate gestational age is calculated from the crown rump length (CRL), and multiple pregnancies are identified
780
Anomaly scan
Between 18 and 20 + 6
| An ultrasound to identify any anomalies, such as heart conditions
781
Antenatal appointments
16, 25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks
782
Oral glucose tolerance test in pregnancy
Women at risk of gestational diabetes (between 24 – 28 weeks)
783
Anti-D injections
Anti-D injections in rhesus negative women (at 28 and 34 weeks)
784
placenta praevia on the anomaly scan
Ultrasound scan at 32 weeks
785
vaccines in pregnancy
```
Whooping cough (pertussis) from 16 weeks gestation
Influenza (flu) when available in autumn or winter
```
786
FAS
```
Microcephaly
Thin upper lip
Smooth flat philtrum
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy
```
787
Smoking in pregnancy
```
Fetal growth restriction (FGR)
Miscarriage
Stillbirth
Preterm labour and delivery
Placental abruption
Pre-eclampsia
Cleft lip or palate
Sudden infant death syndrome (SIDS)
```
788
Combined test
between 11 and 14 weeks gestation
nuchal translucency >6mm
Beta‑human chorionic gonadotrophin (beta-HCG) – a higher result indicates a greater risk
Pregnancy‑associated plasma protein‑A (PAPPA) – a lower result indicates a greater risk
789
Triple test
between 14 and 20 weeks gestation
Beta-HCG – a higher result indicates greater risk
Alpha-fetoprotein (AFP) – a lower result indicates a greater risk
Serum oestriol (female sex hormone) – a lower result indicates a greater risk
790
quadruple test
between 14 and 20 weeks gestation
Beta-HCG – a higher result indicates greater risk
Alpha-fetoprotein (AFP) – a lower result indicates a greater risk
Serum oestriol (female sex hormone) – a lower result indicates a greater risk
Inhibin-A - higher inhibin-A indicates a greater risk.
791
If risk of Down syndrome 1:150
Chorionic vilious sampling >15weeks
| Amniocentesis later in pregnancy
792
Hypothyroid in pregnancy
levothyroxine dose needs to be increased during pregnancy, usually by at least 25 – 50 mcg
793
anti-epileptics safe in pregnancy
Levetiracetam, lamotrigine and carbamazepine
794
anti-epileptics safe in pregnancy
Levetiracetam, lamotrigine and carbamazepine
795
Anti epileptics to avoid in pregnancy
Sodium valproate -neural tube defects and developmental delay
Phenytoin is avoided - cleft lip and palate
796
Telogen effluvium
Increased hair shedding, hair shift from anagen/growing phase to telogen/shedding phase. Due to childbirth. trauma, ilness, bereavement
797
Anagen effluvium
Generalised hair loss associated with medications (Chemotherapy, TCA, allopurinol, beta blockers, retinoids)
798
Trichotillomania
people pull their own hair, patchy hair loss in assymetrical distribution
799
Insulinoma
Rise in insulin
Rise in C-peptide
Presents with hypoglycaemia
800
Factitious hypoglycaemia (eg exogenous insulin injection)
Elevated insulin
Low C-peptide
Presents with hypoglycaemia
801
5th disease risk
Fetal death if pregnant women infected
| - parvovirus b19
802
Measles complications
acute demyelinating encephalitis
| hearing loss
803
Rubella complications
congenital deafness (most common cause of congenital deafness)
804
Scarlet fever (group A haemolytic strep) complications
Rheumatic fever
805
Normal CSF results
```
WCC (5x 10^6) all lymphocytes, no neutrophils
RBC: 10
protein 0.2-0.4 (<1% from serum)
glucose: 3.3-4.4 (>60% from serum)
pH: 7.31
opening pressure: 70-180 mmH2O
```
806
Right homonymous hemianopia with macular sparing
left occipital visual cortex
807
Gamophobia
phobia of getting marries
808
Acrophobia
fear of heights
809
Algophobia
fear of pain
810
Kawasaki disease mnemonic and complication
CRASH and burn
coronary artery aneurysm
811
DMD treatment
steroids
812
Most common cause of genital ulcerative disease
HSV - 2
813
Tropicamide
mydriatic, pupil dilator
814
Pilocarpine
miotic eye drops
815
cyclopenolate
mydriatric, long acting eye drop
816
HSV microscopy/ also CMV and VZV
multinucleated giant cells
817
Reduced CSF glucose:plasma ratio <60% on LP
bacterial meningitis
818
Erythrema nodosum most common causes
tuberculosis and sarcoidosis
819
cavernous sinus thrombosis
visual disturbance
CNs III, IV, VI
ophthalmoplegia and diplopia
820
Aims of antiretroviral therapy
<50 copies of viral load
CD4 >350
reduce transmission
increase quality of life without drug side effects
821
Akathisia vs tardive dyskinesia
tardive dyskinesia - oral-facial movements, excessive blinking, lip smacking, grimacing, tongue movements
akathisia - restlessness, can't sit still
822
Hep C treatment
ledipasvir/sofosbuvir
823
Craniopharyngioma vs Pituitary adenoma
craniopharyngioma in young/adolescent
824
Non communicating hydrocephalus
pinealoma/ pineal gland tumour
825
Lichen sclerosus treatment
topical tacrolimus
826
Staph aureus valve infection findings
gram positive coccus
catalase +ve
coagulase -ve
827
Lacrimal gland nerve supply
Intermediate nerve (facial nerve portion)
828
Tx of hypersalivation in clozapine treatment
Hyoscine
Pirenzipine
Benzhexol
829
Gastroschisis
no sac
c section
immediate (<4h) surgery
830
Omphalocele
related to other conditions (trisomy 13, 18, 21, turner syndrome)
sac
vaginal delivery
staged surgical repair
831
Carbuncle
subcutaneous pus collection discharging via multiple sinuses
| Staphylococcal infection
832
Furuncle
Perifollicular (around hair root) abscess caused by Staphylococcus aureus
833
Beta blockers SE in pregnancy
Fetal growth restriction
Hypoglycaemia in the neonate
Bradycardia in the neonate
834
ACE inhibitors and ARBs SEs in pregnancy
Oligohydroamnios
| Hypocalvaria
835
Opiates SE in pregnancy
neonatal abstinence syndrome (NAS)
3-72h post birth
irritability, tachypnoea, fever, poor feeding
836
Lithium SE in pregnancy
Ebstein's anomaly (tricuspid is set lower in the right side so bigger right atrium and smaller right ventricle)
837
SSRI
paroxetine - strong link with congenital malformation
1st trimester - congenital heart defects
3rd trimester - PPH
838
Rubella in pregnancy
congenital rubella - infection before <20weeks gestation
- Congenital deafness, cataracts
- PDA and pulmonary stenosis
- Learning disability
839
Chickenpox in pregnancy
mother complication: hepatitis, encephalitis, varicella pneumonitis
congenital varicella syndrome (if <28 weeks gestation): foetal growth restriction, microcephaly, hydrocephalus, scarring, limb hypoplasia, chorioretinitis
840
Listeria in pregnancy
Gram positive bacteria
due to unpasteurised dairy products (eg blue cheese)
miscarriage, severe neonatal infection
841
CMV in pregnancy
congenital CMV:
- growth restriction
- vision and hearing loss
- microcephaly
- learning disability
- seizures
842
Congenital toxoplasmosis
intracranial calcification
hydrocephalus
chorioretinitis
843
Parvovirus infection in pregnancy complications
5th disease/slapped cheek/ erythrema infectiosum
- fetal anaemia
- hydrops fetalis (foetal heart failure)
- miscarriage or foetal death
844
Zika virus in pregnancy
spread by Aedes mosquitos
congenital zika syndrome: microcephaly, foetal growth restriction, ventriculomegaly and cerebellar atrophy
test with PCR and antibodies
845
Anti D injections (when)
28 and 34 (or 28 and birth)
| + sensitisation: antepartum haemorrhage, amniocentesis, abdo trauma
846
When is Anti D given in sensitisation event
72h post event
| Kleinhauer test determines if further doses are required
847
Small for gestational age
<10th centile
assesed via:
- estimated foetal weight
- foetal abdominal circumeference
848
Severe small for gestational age
<3rd centile for gestational age
849
Low birth weight
<2500g
850
Complications of foetal growth restriction
Fetal death
Birth asphyxia
neonatal hypothermia/ hypoglycaemia
851
SGA risk factors
```
Old mother <35yo
Multiple pregnancy
low PAPPA
Obesity
Smoking
Diabetes
HTN
pre-exlampsia
```
852
Tx for SGA?
Early delivery +corticosteroids
853
Large for gestational age
=macrosomia
>4.5kg
estimated fetal weight >90th centile
854
Causes of macrosomia
```
Maternal diabetes (Gestational diabetes)
maternal obesity
overdue
male bebo
previous macrosomia
```
855
LGA risks
```
Shoulder dystocia !!!
peineal tears
neonatal hypoglycaemia
clavicular facture/erb palsy/ birth injury
PPH, uterine rupture
```
856
PID treatment
1g ceftriaxone IM (single dose), 400mg metronidazole PO BD, doxycycline 100mg PO BD for 14d
857
Dichorionic diamniotic
membrane between the twins, with a lambda sign or twin peak sign
858
Monochorionic diamniotic
membrane between the twins, with a T sign
859
Monochorionic monoamniotic
no membrane separating the twins
860
Lambda sign
- twin peak sign
| membrane between twins meets the placents (dichorionic pregnancy)
861
T sign
membrane between twins abruptly meets chorion (monochorionic pregnancy)
862
twin to twin transfusion syndrome
- laser treatment to destroy connection between blood supplies
receipient foetus receives majority of blood, donor foetus is starved of blood.
Receipient: HF, polyhydramnios
Donor: anaemia, growth restriction, oligohydromnios
863
Prengnacy checks for anaemia
FBC at
Booking clinic
20 weeks gestation
28 weeks gestation
864
Additional US in multiple pregnancy
2 weekly scans from 16 weeks for monochorionic twins
| 4 weekly scans from 20 weeks for dichorionic twins
865
Monoamniotic twins birth
elective caesarean section at between 32 and 33 + 6 weeks
866
Diamniotic twins birth
37 and 37 + 6 weeks
Vaginal delivery if 1st bebo is cephalic
C section
Elective c section when 1st bebo not cephalic
867
urine dipstick nitrites and leukocytes
gram -ve bacteria
E.Coli break down nitrates into nitrites
leukocytes - test for leukocyte esterase
Nitrites are a MORE ACUTE sign of infection than leukocytes
868
UTI causing organisms
E Coli (gram-ve, anaerobic, rod-shaped), found in faeces
Klebsiella pneumoniae (gram-ve anaerobic rod)
Candida albicans
Staph saprophyticus
Pseudomonas auerginosa
Enterococcus
869
Physiological changes in pregnancy
Plasma volume increases (reduced Hb concentration)
870
Low MCV
iron deficiency
871
Raised MCV
B12, Folate deficiency
872
HB screening in pregnancy
Thalassaemia - all women tested
| Sickle cell disease - women at high risk
873
Tx options for B12
Intramuscular hydroxocobalamin injections
| Oral cyanocobalamin tablets
874
VTE risk factors in pregnancy
```
Smoking
Parity ≥ 3
Age > 35 years
BMI > 30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF pregnancy
```
875
VTE prophylaxis in pregnancy
28 weeks if there are three risk factors
| First trimester if there are four or more of these risk factors
876
LMWH examples
enoxaparin
dalteparin
tinzaparin
877
PE ix
chest X ray
ECG
CTPA in abnormal xray or VQ
CTPA-breast cancer risk, VQ childhood cancer
878
DVT ix
doppler ultrasound
879
Massive PE treatment
UnfrActioned heparin
| surgical embolectomy
880
Pre-eclampsiatriad
Hypertension
Proteinuria
Oedema
881
RF for preeclampsia and tx
Tx, aspirin from 12 weeks until birth
```
Pre-existing hypertension
Previous hypertension in pregnancy
Diabetes
Chronic kidney disease
Older than 40
BMI > 35
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre-eclampsia
```
882
pre eclampsia diagnosis
SBP above 140 mmHg
DBP above 90 mmHg
PLUS any of:
Proteinuria
Organ dysfunction
Placental dysfunction
883
proteinuria quantification
Urine protein:creatinine ratio (above 30mg/mmol is significant)
Urine albumin:creatinine ratio (above 8mg/mmol is significant)
884
HELLP
Heamolysis
Eleveated Liver enzymes
Low Platelets
885
Pre eclampsia tx
Labetolol
Nifedipine
Methyldopa (3rd line, must be stopped within 48h from birth)
IV hydralazine (antihypertensive in severe preeclampsia)
IV magnesium sulphate
886
Gestational diabetes treatment
Fasting glucose <7 mmol/l: diet and exercise for 1-2w, then metformin, then insulin
Fasting glucose >7 mmol/l: start insulin ± metformin
Fasting glucose >6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
887
Alternative for metformin in pregnancy
Glibenclamide (sylfonylurea)
888
target sugar levels in pregnancy
Fasting: 5.3 mmol/l
1 hour post-meal: 7.8 mmol/l
2 hours post-meal: 6.4 mmol/l
889
Sliding scale insulin
dextrose and insulin infusion is titrated to blood surgar levels during labour in T1D
890
Pre existing diabetes delivery
Planned beterrn 37 and 38+6
891
Babies of mothers with diabetes rf
```
Neonatal hypoglycaemia
Polycythaemia (raised haemoglobin)
Jaundice (raised bilirubin)
Congenital heart disease
Cardiomyopathy
```
892
Neonatal hypoglycaemia
aim for sugar >2mmol/L,
| if below: IV dextrose or nasogastric feeding
893
Obstetric cholestasis
```
Itching (palms and soles)
Fatigue
Dark urine
Pale, greasy stools
Jaundice
```
894
Rashes in pregnancy
Pemphigoid getationis - includes bellybutton
| Polymorphic erupion - tam gdzie majtki / stretch marks
895
Obstetric cholestasis bloods
Abnormal liver function tests (LFTs), mainly ALT, AST and GGT
Raised bile acids
896
Tx for obstetric cholestasis
Ursodeoxycholic acid,
Emollients/calamine lotion
Antihistamine (chlorphenamine)
897
Acute fatty liver of pregnancy symptoms
```
General malaise and fatigue
Nausea and vomiting
Jaundice
Abdominal pain
(lack of appetite)
Ascites !!!
```
898
Acute fatty liver of pregnancy bloods and tx
Raised bilirubin
Raised WBC count
Deranged clotting (raised prothrombin time and INR)
Low platelets
tx delivery of bebo
899
Polymorphic eruoption of pregnancy
Also / pruritic and utricarial papules and plaques of pregnancy
tx emollients, steroids, antihistamines
900
Placenta praevia
placenta over the internal cervical os
| - risk of antepartum haemorrhage
901
Low lying placenta
20mm from internal cervical os
902
foetal vessels
umbilical arteries x2
| umbilical vein x1
903
placenta praevia vs vasa praevia risk
Placenta previa: corticosteroids from 34-36w, C section 36-37
Vasa praevia: cotricosteroids 32w, C section 34-36
904
vasa previa
Foetal vessels exposed outside the umbilical cord or placenta
905
vasa praevia types
906
Superficial placenta accreta
Placenta implants in surface of myometrium
907
Placenta increta
Placenta attaches deeply into myometrium
908
Placenta percreta
Placenta invades past myometrium and perimetrium and reaches other organs (eg bladder)
909
How to assess depth/width of placental invasion?
MRI scans
910
Delivery in placenta accreta
Delivery 35-36+6
Hysterectomy
Uterus preserving surgery
911
breech types
912
ECV
50% successful
nulliparous: ECV if breech >36w
multiparous: ECV if breech >37w
Tocolysis with SC terbutaline (beta agonist) + anti D
913
Major causes of cardiac arrest in pregnancy
Obstetric haemorrhage
PE
Sepsis (metabolic acidosis and septic shock)
914
signs of labour
Show (mucus plug from the cervix)
Rupture of membranes
Regular, painful contractions
Dilating cervix on examination
915
phases of birth
latent: 0-3cm, 0.5cm/h
active: 3-7cm, 1cm/h
transition: 7-10cm 1cm/h
916
Preterm prelabour rupture of membranes (P‑PROM)
amniotic sac has ruptured before the onset of labour and before 37 weeks gestation
917
Prolonged rupture of membranes (also PROM)
amniotic sac ruptures more than 18 hours before delivery
918
Prematurity and classes
Birth before 37w
Under 28 weeks: extreme preterm
28 – 32 weeks: very preterm
32 – 37 weeks: moderate to late preterm
919
Diagnosis of PPROM
ILGFBP-1: high concentrations in amniotic fluid
| PAMG-1: alternative
920
Mx of PPROM
Prophylactic Abx (erythromycin 250mg 4x/10d or until labour ir earlier)
921
Preterm labour with intact membranes
Foetal fibronectin:if <50ng/ml, negative and preterm labour unlikely
922
Antenatal steroids regime
2 doses of IM bethametasone 24h apart
923
Main complication of induction of labour
due to vaginal prostaglanding
- -> uterine hyperstimulation
- Individual uterine contractions lasting more than 2 minutes in duration
- More than five uterine contractions every 10 minutes
It leads to: foetal hypoxia, uterine rupture, emergency C section
924
Mx of uterine hyperstimulation
Stopping oxytocin
vaginal prostaglandins
Tocolysis with terbutaline
925
IOL options
Membrane sweep (from 40w)
Vag Prostaglanding E2 (Dinoprostone)
Cervical ripening baloon
Artifical rupture of membranes with oxytocin infusion
926
Baseline rate of CTG
110-160 normal
abnormal <100, >180
927
Variability in CTG
5-25 Normal
| <5 for 50 min or >25 for 25min
928
Prolonged decelerations
2-10 min
drop of >15bpm from baseline
means: foetal hypoxia
929
Oxytocin in labour
syntocinon - oxytocin
| atosiban - oxytocin receptor antagonist (- used for tocolysis
930
Ergometrine
stimulates smooth muscle contraction in uterus and blood vessels
- SE: hypertension, diarrhoea, vomiting, angina
931
Pain relief in labour
```
Paracetamol and codeine
Gas and air (entonox)
IM pethidine/Diamorphine
Pt controlled analgesia: Remifentanil
Epidural (levobupivacaine or bupivacaine mixed with fentanyl)
```
932
Maternal infection in instrumental delivery mx
Single dose of co-amoxiclav
933
Instrumental delivery risks for baby
Cephalohematoma (ventouse)
| facial nerve palsy (forceps)
934
Instrumental delivery risks for mother
```
femoral nerve (anterior thigh weakness, knee extension weakness, patella reflex loss)
obturator nerve (hip adduction and rotation loss, numbness of medial thigh)
```
935
Lateral cutenous nerve injury
numbness of anterolateral thigh
936
lumbosacral plexus injury
foot drop and numbness of anterolateral thigh, lower leg, foot
937
common peroneal nerve injury
foot drop
938
Classification of perineal tears
1st – injury limited to the frenulum of the labia minora
2nd – perineal muscles, but not the anal sphincter
3rd – the anal sphincter, but not the rectal mucosa
4th– the rectal mucosa
939
3rd degree tear subcategories
3A - <50% external anal sphincter
3B - >50% external anal spincter
3C - external and internal anal sphincters affected
940
Antibiotics in sepsis 6
piperacillin and tazobactam (tazocin), gentamicin,
amoxicillin, clindamycin and gentamicin.
941
Mastitis treatment
flucloxacillin
| infection with staph aureus
942
Candida of the nipple
```
topical miconazole (2% after breastfeed)
Treatment for the babcy (miconazole gel or nystatin)
```
943
Sheehan's syndrome
avascular necrosis of pituitary gland ischaemia due to reduced perfusion.
Only affects Anterior pituitary.
944
posterior pituitary hormones
ADH
| oxytocin
945
Sheehan's syndrome presentation
reduced lactation (lack of prolactin)
amenorrhoea (lack of LH FSH)
adrenal infufficiency (low cortisol, lack of ACTH)
hypothyroidism (low TSH)
946
Tx of Sheehan's syndrome
Oestrogen and progesterone
Hydrocortisone for adrenal insufficiency
Levothyroxine
Growth hormone
947
GBS prophylaxis
Intrapartum haemorrhage: previous GBS, pyrexia in labour,
Swabs at 35-37w or 3-5w before delivery
Benzylpenicillin
948
Serum progesterone in infertility
Check 7 days before period
<16 repeat, treat
16-30 repeat
>30 ovulation
949
EllaOne
Ullipristal acetate
950
Urge incontinence
Bladder retraining
Antimuscarinixs (oxybutynin, tolteridone, darifenacin)
Mirabegron: for old frail
951
Stress incontinence
Pelvic floor training
Tape procedure
Duloxetine (Contraction of urethral sphincter)
952
Ullipristal acetate (EllaOne)
120h
Do not give to asthmatics
No breastfeeding for 7days
Return to hormonal contraception after 5d
953
COCP postpartum
Contraindicated in <6 weeks post Partum
954
HRT SEs
Nausea
Breast tenderness
Fluid retention
Weight gain
955
HRT complications
Risk of VTE, stroke, IHD
Risk of endometrial cancer
Increased risk of Breast cancer (due to addition of oestrogen)
956
Diagnostic tests for Downs
<13w chorionic villous sampling
| >15w amniocentesis
957
Endometriosis tx
NSAIDs
COCP
Or GnRH
958
1* PPH
IV syntocinon 10u OR IV ergometrine 500mcg
IM carboprost
Intrauterine balloon tamponade (ligation of uterine arterie or internal iliac artery)
959
Pregnancy and VTE
Do not give DOAC and warfarin
>4 rf: LMWH until 6 weeks post partum
>3 rf: 28w-6w pp LMWH
DVT before delivery: until 3 mth pp LMWH
960
Epilepsy in pregnancy drug
Lamotrigine
961
Mucinous cystadenoma
If ruptured, causes pseudomyoxoma peritonei
962
Meig’s syndrome
Benign ovarian tumour
Ascites
Plural effusion
Causes FIBROMA
963
Dermoid cyst
Most Common benigh ovarian tumour <25
964
Follicular cyst
Most Common cause of ovarian enlargment
965
Ovarian cancer RF
```
Many ovulations
Early menarche
Late menopause
Nullparity
Increased risk with all HRT
```
966
Drugs causing folate deficiency
Pnenytoin
| Methrotrexate
967
Misoprostol mode of action
Strong myometrial contractions causing tissue expulsion
968
Mifepristone mode of action
Thins uterine lining
969
Endometrial cancer rf
```
(Frail elderly - progesterone therapy)
Risk factors: periods increase risk of ovulations
- nullparity
- early menarche
- late menopause
- unopposed oestrogen
- obesity
```
970
Magnesium sulphate and eclampsia tx
IV bolus 4g 5-10m
IV infusion 1g/h
Calcium gluconate for resp depression
971
Injectable (progesterone only) contraception
Do not give >50 as reduces bone density
972
Congenital rubella syndrome
```
<16w infection
Sensorineural deafness
Congenital cataracts
Congenital Heart disease
Salt and pepper chorioretinitis
```
973
Semen analysis
Min 3 days and Max 5 days abstinence
Sample delivered within 1h
Volume >1,5ml
pH >7.2
15mln/ml concentration
974
Hep B in mother, bebo management:
Hep B vaxx <12h, 1mth, 6mth
Hep B IG 0.5ml <12h
No transmission via breastfeeding
975
Breast cancer
Increased risk when progesterone added
| Also pregnancy increased risk
976
COCP rf
Increased: Breast and cervical cancer
Decreased: ovarian and endometrial
977
Implantable contraceptive
Nexplanon or implanon
| 3y
978
Cervical excitation conditions
PID
| Ectopic pregnancy
979
Unopposed oestrogen risk
Endometrial cancer
980
N&V medication in pregnancy
Metoclopramide
| Do not use >5d
981
Desogestrel
POP
| 12h Window for taking
982
Hyperechogenic bowel
CF
Down’s syndrome
CMV
983
HRT adding progesterone
Increased Breast cancer risk
984
Increased nuchal translucency
Down’s syndrome
Congenital Heart defect
Abdominal wall defect
985
Hyperemesis gravidarum
5% weight loss
Dehydration
Electrolyte imbalabce
986
Progesterone rf
Increased risk of Breast cancer and VTE
987
Varicella zoster monitoring
IgM - chickenpox now
| IgG - chickenpox in the past
988
Drugs to avoid in breastfeeding
```
Abx (ciprofloxacin, tetracycline, chloramphenicol, sulphonamides)
Lithium
Benzodiazepines
Aspirin
Carbimazole
METHOTREXATE
Sulfonylureas
Cytotoxic drugs
Amiodarone
```
989
BV diagnostic criteria
Thin white discharge
Clue cells
pH <4.5
Whiff test +ve
Fishy grey
Oral metronidazole
990
Trichomonas vaginalis
```
Yellow green
Offensive
Strawberry cervix
Vulvovaginitis
Frothy discharge
```
Oral metronidazole
991
Gonorehoea
IM ceftriaxone
992
Felty’s syndrome generic
HLA DR4
993
Apgar score
1,5,10 min
| Pulse, resp effort, colour, tone, reflex
994
CF diet
High calorie, High fat diet
| To reduce streathorrhoea
995
Meckels diverticulum Scan
Techtenium scan
996
<1 BLS
15:2
| Two thumbs
997
>1 BLS
Lower sternum, 1 hand, 15:2
998
Thelarche
1st stage of breast development
999
Adrenarche
1st stage of pubic hair development
1000
Scarlet fever symptoms
Torso sandpaper rash
Spares soles and palms
Back to School 24h post starting Abx
1001
Impetigo School
No School until crusted over
1002
Necrotising enterocolitis signs
Rigler sign
| Football sign
1003
Kawasaki tx
Aspirin, IVIG
1004
Viral ilness + purpura
Idiopathic thrombocytopenic purpura
1005
Newborn Hearing tests
Otoacoustic emission test
| Auditory brainstem response tezt
1006
Dehydration fluids
Maintenance + 50ml/kg over 4h
1007
Fragile X syndrome
```
X linked dominant
Elongated face
Protruding ears
Otitis media
Macrocephaly
Learning difficulty
```
1008
Vesicoureteric reflux ix
Micturating cystourethrogram
1009
Noonan syndrome
Webbed neck
| Pectus excavatum
1010
Patau syndrome
Small eyes
| Polydactyly
1011
Asthma paeds tx
SABA
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + LABA
1012
Formuła baby allergy
1) Extensive hydrolysyed formuła
| 2) amino acid formuła (CMPA severe)
1013
Congenital diaphragmatic hernja
Displaced apex beat + decreased się entry + scaphoid abdomen
1014
Achondroplasia
```
Short statuę
AD
short limbs and fingers
Large head
Trident hands
```
1015
Distended abdo + bilious vomiting
Intestinal malrotation
1016
Threadworm tx
Mebendazole
1017
William syndrome
```
Elf face
Friendly
Social
Shirt stature
Elongated philtrum
```
1018
Pyloric stenosis ABG
Hypochloremic hypokalemic metabolic alkalosis
1019
Newborn resuscitation
```
Dry bebo
Assess tone RR HR
5 Inflantom breaths
Reasses
<60bpm 3:1
```
1020
Whooping cough tx
Clarithromycin/azithromycin/erythromycin
No School for 48h on Abx
Or 21 days - if No treatment
1021
Kocher criteria for septic arthritis
>38.5
Can’t weight bear
WBC >12
ESR >40
1022
ADHD drugs
Methylphenidate (stunted growth)
| Lisdexamohetamine
1023
Girl with haemophilia
Turner syndrome
1024
Bebo laxatives
Movicol
Movicol + Senna
Senna + Lactulose/Docusate
1025
Nephrotic syndrome
Proteinuria 1g/m3
Hypoalbuminaemia <25g/L
Oedema
1026
Shaken baby syndrome
Retinal haemoorhage
Subdural hematoma
Encephalopathy
1027
GORD bebo tx
2 week alginate therapy
| 4 week omeprazole trial
1028
Scarlet fever vs Kawasaki
Scarlet: phenoxymethylpenicillin and DOES NOT AFFCT CONJUNCTIVA AND LIPS
1029
Triceps reflex
C7
| Radial nerve
1030
Stills disease
Pink rash
Joint Pain
Fever
Increased Serum Ferritin and Leukocytes
Negative RF, ANA
1031
Hip fx staging
I stable
II complete, undisplaced
III displaced (AVN)
IV complete disruption of bone (AVN)
1032
Brown sequard syndrome
Ipsilateral paralysis and propioception loss
| Contralateral Pain and temp
1033
Osteonyelitis in sickle cell
Salmonella
1034
Reactive arthritis skin lesions
Circinate balanitis
| Keratoderma blenorrhagica
1035
Ehlers Danlos syndrome
```
AD connective tissue
Increased skin elasticity
Joint hypermobolity
Aorthic regurg
Pectum excavatum
```
1036
Biceps attachments
Long tendon: glenoid
| Short tendon: coracoid
1037
Anti phospholipid syndrome
```
VTE
foetal loss
Thrombocytopenia
Raised APTT
livedo reticularis
```
1038
Simmonds triad
Test for Achilles rupture
Palpation
Squeeze
Declination at rest
1039
Osteogenesis imperfecta / brittle bone disease
```
AD
Type 1 collagen abnormality
Blue sclera
Deafness
Normal bloods!!!
```
1040
Compartment syndrome pressure
20mmHg abnormal
| 40mmHg diagnostic
1041
Methrotrexate and other drugs
Do not give with co-trimoxazole or trimethoprin: causes bone marrow surpression
1042
Osteomalacia
Raised ALP
| Low Ca, PO
1043
Pott’s fx
Bimalleolar fx
| Eversion foot
1044
Monteggia fx
Ulnar fx
FOOSH
Proximal radioulnar joint dislocation
1045
Galeazzi fx
Foosh
Distal radioulnar joint
Radial shaft fx
1046
Drugs that induce lupus
Isoniazid
Phenytoin
Hydralazine
1047
Mirtazapine
NaSSA
| increased sedation and appetite
1048
Smoking cessation drug
Bupropion
1049
GAD tx
1) SSRI
2) SSRI/SNRI
3) Pregabalin
1050
Panic disorder tx
CBT or SSRI
| End step: clomipramine/imipramine
1051
Othello syndrome
Delusional jealousy that partner is unfaithful
1052
Dystonic reactions and tx
Torticollis
Dysarthia
Oculogyric crisis
Tx Procyclidine
1053
Adolescent/children SSRI
Fluoxetine
1054
New onset psychosis ix
CT head
1055
Torticollis
Wry neck
Sustained muscle contraction
Neck hyperextension
1056
Oculogyric crisis
Upward eye deviation
| Clenched jaw
1057
PTSD symptoms
>4 weeks
<4w is Acute stress reaction
Hyperarousal
Re experiencing
Avoidance of reminders
Emotional numbing
1058
Treatment of PTSD
Trauma focused CBT
EMDR
Venlafaxine/SSRI/Risperidone
1059
OCD tx
CBT
| ERP exposure and response prevention
1060
Conversion dislrder
Drop arm test
| Psych stress manifested as physical symptoms
1061
Dissociative disorder
Erasing certain disorders
1062
Tardive dyskinesia tx
Tetrabenazine
1063
Flight of ideas
Leaps from one topic to another but with link
1064
Knights move thinking
No asdociations between ideas
1065
grief stages
```
Denial
Anger
Bargaining
Depression
Acceptance
```
1066
Capgras syndrome
Pt believe someone significant in life has been replaced by imposter
1067
Fregoli syndrome
Pt believes multiple people are one person changing appearance
1068
Circumstantiality vs tangentiality
Wonder off but circumstaniality DOES RETURN TO QS/TOPIC
1069
Clang assoc
Topics are related by sounding familiar
1070
Clerambault syndrome
Delusions someone famous is in love with them
1071
Wernickes
Nystagmus
Ophthalmoplegia
Ataxia
1072
Korsakkofs syndrome
Confabulation
| Anterograde/retrograde amnesia
1073
Paranoid personality
Sensitive
Unforgiving
Questions loyalty
1074
Schizoid prrsonality disorder
Lack of interest, indifference
| Negative symptoms schuzoprenia
1075
Schizotypal
Magical weird thinking
1076
Clozapine se
```
If >48h missed, must be retitrated
Reduce dose if stopped smoking
Reduce seizure threshold
Hypersalivation
Constipation
Agranulocytosis/neurtropemia
```
1077
Central Vision loss
Age related macular degeneration
1078
Peripheral Vision loss
Primary open angle glaucoma
1079
Retinal detachment symptoms
Peripheral curtain over Vision
Spider webs
Floaters and Flashing lights
Straight lines appear curved
1080
Flashers and floaters
Vitreous detachment
1081
Red saturation Vision
Vitreous haemorrhage
1082
Red desaturation
Optic neuritis
1083
Retinal detachment
Flashers and floaters
1084
Acute angle closure glaucoma tx
IV acetazolamide
1085
Global aphasia
No speech, no comprehension
1086
Conductive aphasia
Fluent speech and comprehension
Aware of errors
Poor repetition
1087
MCA Broca’s aphasia
No speech but comprehension (expressive)
1088
MCA Wernicke’s area
Speech but no comprehension
Receptive
Word salad, neologisms
1089
Normal pressure hydrocephalus
Urinary incontinence + gait + dementia
1090
Cushing triad
Raised ICP
raised pulse pressure + bradycardia + irregular breath
1091
Brain abscess
IV cephalosporin and metronidazole
1092
Anterior circulation infarct
Total 3
Partial 2
Unilateral hemiparesis
Homonymous hemianopia
Dysphagia
1093
Otitis externa in diabetics
Ciprofloxacin for pseudomonas
1094
Audio gram
```
1) anything below 20?
NO normal, YES step 2
2) is there a gap between air and bone?
YES conductive/mixed, NO sensorineural
3) one or both below 20?
ONE conductive, BOTH mixed
```
1095
Burns fluids
% surface area x weight x 4
1/2 administered in 8h
1096
Curlings ulcer
Stress ulcer causing haematmesis
1097
Guttae psoriasis vs Pityriasis rosacea
Guttae (strep throat, tear drop rash, 2-3mth resolve)
Pityrasis (resp/viral infection, Herald patch, 6 weeks resolve)
1098
India ink stain
Cryptococcus neoformans
| in HIV
1099
CMV treatment
Gancyclovir or Valgancyclovir
1100
Toxoplasma gondii tx
Sulphadiazine and pyrimethamine
