Year 4 > Passmed 4 > Flashcards

Passmed 4 Flashcards

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1
Q

TTP presents with

A

pentad of fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure

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2
Q

Holmes Adie pupil =

A

= DIlated pupil, females, absent leg reflexes

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3
Q

myositis ab

A

anti-jo1

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4
Q

persistent ST elevation + LVF following MI

A

Left vent aneurysm

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5
Q

pericarditis vs dresslers syndrome

A
  • pericarditis: common in first 48 hrs after MI
  • dresslers: 2-6 weeks followng MI - fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.
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6
Q

A 22-year-old male falls of a ladder. He complains of neck pain and cannot feel his legs. His GCS suddenly deteriorates and a CT head confirms an extradural haematoma. What is the best imaging for his neck?

A

CT c spine

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7
Q

left v free wall rupture

A
  • cardiac tamponade symptoms - raised JVP, quiet heart sounds, pulsus paradoxsus
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8
Q

acute mitral regurg

A
  • due to ischaemia or rupture of papillary muscle
  • pulm oedema and hypotension
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9
Q

The risk factors for congenital hip dislocation include:

A
  • Female gender
  • Breech presentation
  • Family history
  • Firstborn
  • Oligohydramnios
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10
Q

rf for adhesive capsulitis

A

diabetes

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11
Q

posterior vs ant shoulder dislocations

A
  • Anterior shoulder dislocation is associated with FOOSH;
  • posterior shoulder dislocation is more likely associated with seizures and electric shock
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12
Q

painful arc between 90-120 degrees

A

subacromial impingement

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13
Q

TB drug -> lupus

A

isonazid

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14
Q

ITP is which type of HSN

A

2

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15
Q

Ottowa ankle rules

A

bony tenderness over the malleoli zones OR an inability to walk four weight-bearing step

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16
Q

For children aged 5 to 16 with suspected asthma, if the FeNO is >= 35 ppb then

A

asthma can be diagnosed

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17
Q

what should be done b4 starting ab for pyelo

A

midstream urine culture then ab

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18
Q

scleritis

A
  • EXTREMELY PAINFUL AND RED INJECTED EYE
  • associated with SLE
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19
Q

MEN 1

A

Peptic ulceration, galactorrhoea, hypercalcaemia

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20
Q

Sus venous ulcer ->

A

do ABPI before compression stockings

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21
Q

What is the most appropriate time to take blood samples for therapeutic monitoring of phenytoin levels?

A

immediatelly b4 next dose

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22
Q

BV in pregnancy

A

still use oral metro

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23
Q

de clerambaults syndrome =

A

he presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms

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24
Q

Indications for thoracotomy in haemothorax include

A
  • > 1.5L blood loss intiially
  • > 200ml per hour loss > 2 hrs
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25
Othello syndrome
delusional jealously, usually believing their partner is unfaithful
26
what can be used within an hour of aspirin OD
Activated charcoal
27
localising feature of temporal lobe seizure
- typically a rising epigastric sensation - also psychic or experiential phenomena, such as dejà vu, jamais vu - hallucinations - !! automatisms e.g. lip smacking
28
frontal lobe seizures
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
29
parietal lobe seizure =
parasthesia, sensory
30
occipital lobe seizures
floaters/ flashers
31
HAP Mx
- occurs > 48 hrs of hosp admission - co-amox
32
features of TOF
Pulm stenosis RVH Overriding aorta VSD
33
most common cause of chronic panc
alcohol
34
koebner phenomenon
psoriasis. new skin lesions at sites of injury
35
medullary thyroid cx tumour marker
- calcitonin (think medulla of bones)
36
- Returning traveller with fever, RUQ pain → ?
- ?amoebic liver abscess - ultrasound scan of the liver shows a homogeneous hypoechoic round lesion.
37
CRC - monitoring
CEA
38
Mx of a venous ulcer
compression banding
39
Persistent unexplained vulval skin lesion should
prompt 2www
40
Infant < 8 weeks, presents with milky vomits after feeds, often after being laid flat, excessive crying → ?
- GORD - CMPA presents with diarrhoea & rash
41
why should we give albumin cover with paracentesis
- to reduce mortality
42
mx of PCOS - oligmenorrhoea
- inc risk of endometrial cancer - so use a COCP, IUS or COCP to induce a withdrawal bleed
43
Mx hirtutism w PCOS
- cocp - topical elfornithine can be tried if no resp
44
tardive dyskinesia
can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics
45
flexor tendon sheath infection
- kanavels signs@ - fixed flexion, fusiform swelling, tenderness and pain on passive extension
46
most effective form of EC
IUD - not affected by BMI also
47
PD vs Essential tremor
- PD: asymmetrical worse at rest - ET: worse on arms being stretched out, made better by alcohol
48
Deaths occurring within 24 hours of admission to hospital should be
should be discussed w coroner before death certificate is ussed
49
Mx of meningitis > 60
IV ceftriaxone + amox/ ampicillin
50
Prolapsed disk Mx
- physio & NSAIDs if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
51
typical eczema sites in an infant
face and trunk
52
how is chalmydia dx
NAAT
53
troubling GI sx with alendrinate ->
change to risedronate or etidronate
54
Dukes staging of CRC
a: Tumour confined to mucosa b: tumour invading bowel wall c: lymph node mets d: distant mets
55
Patients with GORD being considered for fundoplication surgery require
oesophageal pH and manometry studies
56
epigastric hernia =
lump in the midline between umbilicus and the xiphisternum
57
para-umbilical hernia =
asymmetrical bulge directly above or below umbilicus
58
mx of aurical haematomas
urgent ENT ref for same day assessment
59
non resolving unilateral ear discharge
- suggest cholesteatoma - refer to ENT
60
main neurovascular structure that is compromised in a scaphoid fracture
dorsal carpal arch of the radial artery
61
1st line for knee arthritis
topical NSAID
62
Mx of constipation in kids
- osmotic laxative - e.g. macrogol - stimulant is 2) e.g. senna
63
is an important CF-specific contraindication to lung transplantation
chronic infection w burkholderia cepacia
64
normal CO2 in an asthma attack ->
life threatening
65
Burning thigh pain - ?
meralgia paraesthetica - lateral cutaneous nerve of thigh compression
66
marfans features
- Hypermobility, tall stature, long fingers - petus excavatum and pes planus are features - assoc w aortic dissection
67
mx of interctrochanteric/ extracapsular hip fractures
dynamic hip screw
68
? are associated with an increased risk of atypical stress fractures
bisphosphonates
69
neoplastic SCC
high dose dexamethasone then MRI
70
Features of keratitis:
red eye, photophobia and gritty sensation
71
On examination the ring and little fingers of his left hand are flexed and unable to extend completely. He is able to make a fist with the hand. Palpation reveals thickened nodules on the medial half of the palm. ->
DUPUYTRENS CONTRACTURE
72
Herbendens nodes ->
DIP swelling
73
where are keloid scars more common
sternum
74
most common type of inherited CRC
HNPCC
75
Children and young people with unexplained bone swelling or pain:
immedate xr for bone sarcoma
76
Moderate/severe psoriatic arthropathy →
methotrexate
77
most common pres of test cancer
painless testicular lump in 15-35 y.o
78
Primary hyperaldosteronism: manage with
spironolactone
79
non haem febrile reaction
- fevers, chills - slow or stop the tranfusion + paracetamol
80
minor allergic reaction to blood transfusion
- pruitis + urticaria - temp stop the transfusion - give an antihistamine
81
anaphylaxis to blood transfusion
- Hypotension, dyspnoea, wheezing, angioedema - stop tranfusion - IM adrenaline
82
acute haem reaction
- ABO incompatbile blood - fever, abdo pain, hypotension - stop transfusion + send blood for direct Coombs - fluid resus
83
TACO
- rf: fast transfuion or pre-existing HF - pulm oedema or HTN
84
Mx of TACO
IV furosemide
85
TRALI
- Hypoxia, hypotension, pulmonary infiltrates on xr - stop transfusion - give o2
86
mx of sudden onset sensorineural hearing loss
urgently refer to ENT +high dose oral steroids
87
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a
Twice daily basal insulin determir + insulin aspart bolus with meals
88
mx of animal bite
- co-amox - co for cat - doxy + metro if penicillin allergic
89
immediate mx of acute epiglottitis
- refer to hosp, consider intubation
90
useful mirtazepine side effects
sedation & increased appetite
91
mx of vg thrush
- single dose of oral fluconazole - if preg: topical comitrazole
92
late sign of CES
Urinary incontinence
93
In a patient with long-standing type 1 diabetes, impaired hypoglycaemia awareness is most commonly due to
neuropathy in the autonomic NS
94
When should amitriptyline be avoided
BPH - risk of urinary retention
95
Short stature + primary amenorrhoea ?
turners syndrome
96
definitive mx of cardiac tamponade
thoracotomy
97
Firm and well-circumscribed mass that transilluminates on the dorsal aspect of the wrist →
- ganglion - surgical excision is indicated for cysts associated with severe symptoms or neurovascular manifestations
98
Prerenal disease - raised
urea: creatnine ratio
99
pseudohallucinations
- patients understand what they're seeing is not real - part of non-pathological grief reaction
100
Ongoing loin pain, haematuria, pyrexia of unknown origin → ?
rcc
101
what to do if u get a needlestick injury
ask someone else to complete the risk assessment and take the patient's blood
102
spider naevia are assoc w
Liver disease, pregnancy, COCP
103
Abdominal pain, bloating and vomiting following bowel surgery → ?
Post-op ileus
104
first line for suspected primary hyperaldosteronism
plasma aldosterone/renin ratio
105
first line Ix for pagets
plain radiographs for pelvis and lumbar spine
106
what can precipitate renal failure in MM
naproxen
107
spirometry in PF
- Raised FEV1: FVC - impaired TLCO
108
first line ab for CAP
Amox
109
low molecular weight heparin has the greatest inhibitory effect on which one of the following proteins involved in the coagulation cascade?
factor 10a
110
LT feeding in a neuro/ stroke pt
PEG feeding
111
hypothermia is a cause of
panc
112
poor prognostic factors in schizo
- low IQ - gradual onset - Fhx - lack of obvs precipitant
113
what is classically impaired in frozen shoulder
external rotation (think of not being able to do their bra up)
114
Widespread convulsions without conscious impairment is likely to represent
pseudoseizure
115
bulbar MND vs MG
eye movements spared in MND
116
fasiculations think
mnd
117
Primary haemorrhage within hours after tonsillectomy requires
- immediate return to threatre - secondary haemorrhage: admit + antibiotics (assoc w wound infection)
118
when should intranasal steroids be considered in sinusitis
if symptoms > 10 days
119
ototoxic meds
- gentamicin - quinine - aspirin - furpsemide
120
when does a thyrglossal cyst present
usually under 20
121
soft, fluctulant and highly transilluminable neck lump
cystic hygroma
122
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is negative then they should have
sentinal node biopsy
123
bilateral cream coloured discharge ->
prolactinoma
124
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is negative then they should have
pagets -> urgent referral to BC
125
Diagnostic Ix of choice in NHL
exisional LN biopsy
126
what is used to assess drug sensitivites in TB
sputum culture
127
Mx acute, severe, symptomatic hyponatraemia (< 120 mmol/L)
- hypertonic saline - 3% NaCl
128
features of life threatening asthma
- Cyanosis Poor respiratory effort *normal CO2) Peak expiratory flow rate < 33% Silent chest Altered level of consciousness
129
First lines for opiod detox
Methadone or buprenorphine
130
Cervical cancer screening: if 1st repeat smear at 12 months is still hrHPV +ve →
- repeat smear 12 months later (i.e. at 24 months) - after 2x repeat smears -> colp
131
If new BP >= 180/120 mmHg + ? -> refer for assessment
- new onset confusion - CP - signs of HF - AKI
132
what is assoc w bisferiens pulse
HCOM or aortic stenosis/ regurg
133
common cause of MS
Rheumatic fever - prodomal illness + erythema marginatum (bulls eye rash)
134
SE of adenosine
- CP, bronchospasm, transient flushing - half life of 10s
135
HCOM inheritance
autosomal dominant
136
New onset AF is considered for electrical cardioversion if it
presents within 48 hours of presentation
137
A new left bundle branch block should prompt investigation for
ACS - do a high sensitivity trop
138
antibiotic prophylaxis for IE for dental procedures
NONE
139
AKI - stop the DAMN drugs
Digoxin and Diuretics ACEi/ ARBs Metformin and Methotrexate NSAIDs
140
In hypothermia, rapid re-warming can lead to
peripheral vasodilation and shock
141
best Ix for aoritc dissection
CT angio thorax, abdo, pelvis
142
Major bleeding on warfarin
stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate
143
which diuretics -> ED
THIAZIDE LIKE E.G. INDAPAMIDE
144
ACS symptoms but normal tropnonins ->
unstable angina
145
which drug -> anal ulcers
- nirconadil - can lead to sigmoid perforation espec in pts with diverticular disease
146
which angina drugs can lead to olerance
isosorbide monoitrate
147
In AF, if a CHA2DS2-VASc score suggests no need for anticoagulation
arrange an echo to exclude valvular HD
148
Massive PE + hypotension -
THROMBOLYSIS
149
INR 5.0-8.0 (no bleeding)
withhold 1-2 doses of warfarin and restart at a lower dose
150
? should be considered if a bradycardia doesn't respond to drugs or transcutaneous pacing
transvenous pacing
151
Asymmetric dosing regimes should be used for
Asymmetric dosing regimes should be used for standard-release ISMN to prevent nitrate tolerance
152
what type of pulse is seen in a mized aortic valve disease
bisferiens pulse
153
amiodarone skin SE
grey
154
hypercal sx
: painful bones, renal stones, abdominal groans and psychic moans
155
In the context of a tachyarrhythmia, a systolic BP < 90 mmHg →
DC cardiovert
156
NSTEMI (managed with PCI) antiplatelet choice:
- if the patient is not taking an oral anticoagulant: prasugrel or ticagrelor - if taking an oral anticoagulant: clopidogrel
157
ECG changes of hypokal
- small or absent T waves - prolonged PR interval - Long QT
158
NSTEMI management: unstable patients should have immediate
coronary angiography
159
mx of aortic dissection
- type A - ascending aorta - control BP (IV labetalol) + surgery - type B - descending aorta - control BP(IV labetalol)
160
If thrombolytic drugs are given during ALS then (CPR duration)
prolonged duration of 60-90 min should be considered
161
Mechanical valves - target INR:
aortic: 3.0 mitral: 3.5
162
Most common cause of endocarditis:
- Staphylococcus aureus - Staphylococcus epidermidis if < 2 months post valve surgery
163
what should be done in those with multiple episodes of loss of consciousness with quick recovery times
24 HR ECG
164
In ALS, if IV access cannot be achieved then drugs should be given via
Intraosseous route via proximal tibia
165
- Following a TIA, anticoagulation for AF should start immediately once
imaging excludes a TIA. Lifelong apixaban usually
166
In a hypertensive patient < 55 years old who is on an ACE-i and is intolerant to calcium channel blockers, ? are the next line therapy
thiazide-like diuretics
167
NSTEMI (managed conservatively) antiplatelet choice
- aspirin, plus either: - ticagrelor, if not high bleeding risk -clopidogrel, if high bleeding risk
168
most commonly affected valve in IE
Mitral. Tricuspid affected first
169
A patient with AF + an acute stroke (not haemorrhagic) should have
aspirin for 14 days then switch to apixaban lifelong
170
PE first line Ix
- CTPA - v/q if preg or renal impairment
171
Post MI driving advice
- cannot drive for 4 weeks
172
Most common causes of VT
- hypokalaemia 1) - hypomg
173
A contraceptive implant can be safely inserted ?after childbirth
any time
174
? is the oral antibiotic of choice to treat erythrasma
erthryomycin
175
Painful third nerve palsy =
posterior communicating artery aneurysm
176
Restless leg syndrome - management includes
dopamine agonists like ropinirole
177
standard procedure to diagnose PSC
MRCP
178
Osteomyelitis imaging
mri
179
lactic acidosis
- raised anion gap metabolic acidosis - raised lactate - haemodynamic compromise - often with metformin
180
Mx of bells palsy
oral pred within 72 hrs + artificial tears
181
? is used as prophylaxis for contacts of patients with meningococcal meningitis
Oral ciprofloxacin or rifampicin - single dose
182
Mx of neutropaenic sepsis
Piperacillin with tazobactam (Tazocin)
183
causes of bilateral hilar lymphadenopathy
- sarcoid - TB - lymphoma/other malignancy
184
UFH MAO
activates antithrombin III
185
Mx of minimal change nephrotic syndrome
- prednisolone - do not give diuretics, worsens
186
Obsessive compulsive PD
Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone Demonstrates perfectionism that hampers with completing tasks Is extremely dedicated to work and efficiency to the elimination of spare time activities Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
187
Mx of obsessive compulsive persoanlity
DBT - as for all pers dx
188
how does paralytic ileus present
occurs in the few days following surgery and can cause hypovolaemia and electrolyte disturbances BEFORE nausea and vomiting becomes apparent
189
?? is UKMEC4 for COCP
Positive antiphospholipid antibodies (e.g. in SLE) is UKMEC 4 for the COCP - unacceptably high risk -> cannot use
190
what taken alongside diltiazem or verpamil can lead to HB
bb - never combine
191
key side effect of pioglitazone
peripheral oedema
192
A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination -
ventral septal defecr
193
erythema nodosum
- painful nodules - occur in pregnancy - also assoc with sarcoid
194
Hypercalcaemia + bilateral hilar lymphadenopathy → ?
sarcoid
195
A woman suddenly falls to the ground then lays motionless -
atonic seizure
196
BV diagnostic criteria
- Thin, white, homogeneous discharge. - Vaginal fluid pH >4.5. - Clue cells on microscopy of wet mount. - Release of a fishy odour on adding alkali (potassium hydroxide).
197
Mx of metastatic bone pain
- analgesia - bisphosphonates - radiotherapy
198
what to do in COPD when maximum medical management has been reached
NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment
199
Mx of SBP - prophylaxis
ciprofloxacin
200
when should we seek thoracic surgical opinion in the context of a pneumothorax
- persistent air leak after 3-5 days: bubbling of chest drain - failure of lung to re-expand - consider VATS
201
Acute toxoplasmosis
- can mimic acute EBV infection (low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise) - MUST DO A PREGNANCY TEST!
202
Key Ix in CO poisoning
ABG
203
Chronic knee pain + swelling + locking in young active adult
osteochonditis dissecans
204
swab for chlamydia + gonorrhoea
- should be taken from the vulvo-vaginal area - introitus
205
GDM - insulin is
short acting only (less risk of hypos)
206
New B-symptoms in CLL ->
Richters transformation (CLL -> large cell lymphoma)
207
folic acid doses
- 400 microg normal - 5mg if high risk - taken for first 12 weeks
208
sick euthyroid mx
common in unwell eldery pts. No Tx needed - repeat TFTs in 6 weeks
209
Fever, facial spasms, dysphagia in an intravenous drug user → ?
- tetanus - botulism causes a flacid paralysis
210
Mx of depression with suicidal ideation
- can manage with SSRIs provided no suicidal plans or intent -> refer to crisis team
211
somatisation vs hypochondira
Somatisation = Symptoms hypoChondria = Cancer
212
first line in ITP
oral pred
213
Mx of life threatening ITP/ organ threatening bleeding
Platelet transfusion, IV methylprednisolone and intravenous immunoglobulin
214
ITP Mx depending on platet counts
- > 30 = observe - < 30 = oral prednisolone
215
hallitosis, dry mouth, pain when eating ->
- stone impacted in Whartons duct - symptoms of sialothiasis
216
subscapulris =
internal rotation
217
supraspinatus
- needed for first 20 degrees of shoulder abd - rest of abduction is done by deltoid
218
infraspinatus -
external rotation
219
teres minor =
ext rotation
220
Bile-acid malabsorption following cholesytectomy may be treated
cholestyramine
221
premature labour Mx
- admit and administer tocolytics and steroids
222
acute hep B flare up in IVDU
Hep D superinfection
223
Major bleeding on warfarin
stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate
224
what should be done in all pts with sus RA
x rays of hands and feet
225
CP of amniotic fluid embolism
- occurs in labour, during C section or after delivery - Symptoms include: chills, shivering, sweating, anxiety and coughing. - Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.
226
An 18-year-old man with a previous history of constipation presents with bright red rectal bleeding and diarrhoea. He has suffered episodes of faecal incontinence, which have occurred randomly throughout the day and night
proctitis - IBD
227
A 19-year-old man presents with bright red rectal bleeding. He has a longstanding history of irritable bowel syndrome. At flexible sigmoidoscopy a lesion is biopsied and reported as showing 'fibromuscular obliteration'.
Solitary rectal ulcer syndrome
228
most likely causes of jaundice in first 24 h
- rhesus haemolytic disease - ABO incompatbility
229
Mx of a perforated tympanic membrane
- keep the ear dry - if unresolved by 6 weeks then refer to ENT
230
Unilateral glue ear in an adult ->
refer to ENT urgently - visualisation for posterior nasal space tumour req
231
A patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound -
left vent aneurysm
232
Risk factors for thrombosis, headache, reduced consciousness, vomiting → ?
intercranial venous thrombosis
233
digozxin monitoring
none routinely except in suspected tox
234
which comb of diuretics is always CI
Amiloride and spiro - both cayse hyperkal
235
mx of a psoas abscess
IV ab + percutaneous drainage
236
insulin infusion rate in dka
0.1 unit/kg/hr
237
mx of chlamydia
- oral doxy - in pregnancy: azithromycin, erythromycin or amox
238
what to do with amiodarone in amiodarone induced hypothyroidism
continue amiodarone, start levothyroxine
239
Before the induction of anaesthesia, the following must have been checked:
Patient has confirmed: Site, identity, procedure, consent Site is marked Anaesthesia safety check completed Pulse oximeter is on patient and functioning Does the patient have a known allergy? Is there a difficult airway/aspiration risk? Is there a risk of > 500ml blood loss (7ml/kg in children)?`
240
chancroid =
- painful genital ulcer - with unilateral painful inguinal lymph node enlargement
241
cause of chancroid
haemophilus dureyi
242
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given
either oral azathioprine or oral mercaptopurine to maintain remission
243
which ejection systolic murmur is louder on inspiration
PS
244
Common cause of AIN
- NSAIDs - atients present with acute or subacute deterioration in renal function , joint pain, and hypersensitivity features (fever and rash). Urinalysis will show a raised urine white cell count.
245
stage 3 of ann arbor staging of lymphomas
- involve lymph nodes on both sides of the diaphragm - e.g. lymph nodes in neck and groin
246
For type 2 diabetics requiring treatment with GFR <30
metformin is CI. Use dapaglifozin
247
confirming acromegaly diagnosis
, if a patient is shown to have raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis
248
oligohydramnios can be a clue of
- renal agenesis - Potter sequence: severe oligohydramnios - Potter facies: wrinkly skin, low-set ears, flat noses and chins, and widely separated eyes with epicanthic folds.
249
Bronchiectasis: most common organism =
haem influenza (same as COPD exacerbation)
250
levido reticularis
- bilateral blotchy, lace-like erythematous rash - commonly seen w antiphospholipid syndrome
251
hyaline casts can be seen in
pts taking loop diuretics
252
Hypomagnesaemia: IV magnesium is usually given if
<0.4 mmol/L or tetany, arrhythmias, or seizures
253
mx of an open wound
1) intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film 2) wound debridement in theatres
254
Mx of erythema nodosum
no active tx
255
APS MX
- Antiphospholipid syndrome in pregnancy: aspirin + LMWH
256
Tricuspid regurg often occurs secondary to
pulm HTN as a result of COPD
257
mx of hayfever
- Topical antihistamines - Topical mast-cell stabilisers, e.g. sodium cromoglicate and nedocromil
258
HbA2 is raised in patients with
beta thalassaemia major
259
T2DM blood pressure targets are the same as non-T2DM. If < 80 years:
- clinic reading: < 140 / 90 - ABPM / HBPM: < 135 / 85
260
? is a cause of hypogonadotrophic hypogonadism
haemachromatosis
261
? is preferred to morphine in palliative patients with mild-moderate renal impairment
oxycodone
262
staphylococcus aureus gastroenteritis is characterised by
short incubation period and severe vomiting
263
anteriior uveitis =
- assoc w AS - Mx :steroid and cycloplegic (mydriatic) eye drops.
264
Slow growing, painless, mobile lump in the parotid gland of older female → ?
pleomorphic adenoma
265
Post-op stridor in patients after neck surgery
- emergency - urgently remove suture & call for senior help
266
severe campylobacter mx
clarithromycin
267
Acral lentiginous melanoma: - sign
Pigmentation of nail bed affecting proximal nail fold suggests melanoma (Hutchinson's sign)
268
urge incontinence mx in the elderly
- use mirabegron > oxybutynin - also the case for alz (tx w ACHi and glaucoma)
269
A child aged < 3 months with a fever > 38ºC
should be assesses urgently by paeds at the hosp
270
dose of aderenakine in cardiac arrest
1mg
271
how is the diagnosis of DMD made
genetic testing
272
cause of molloscum contagiosum
- poxvirus - well-demarcated papules with an umbilicated centre.
273
Mx of otitis externa
1: topical ab +/- steroid
274
Immunocompromised patients with toxoplasmosis are treated with
- pyrimethamine and sulphadiazine - no Tx in immunocompetent pts unless severe infection of IC
275
anaphylaxis adrenaline dose
0.5mg 1:1000 IM
276
Most imp factor in determining need for liver transplant in paracetamol OD
pH < 7.3 more than 24 hours after ingestion
277
King's College Hospital criteria for liver transplantation (paracetamol liver failure)
- 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
278
What is normal in PMR
- ESR and CRP raised - anti-CCP and CK are normal
279
Hb cut offs pregnancy
< 110: T1 < 105: T2 < 100 PP
280
Mx of DCM
- refer to spinal surgery/ neurosurgery - decompressive surgery is the main Tx
281
? is used to assess the probability of septic arthritis in children
kocher
282
type of nystagmus in BPPV
rotatory
283
sudden visual loss on diabetics ->
vitreoys haemorrhage
284
Benign ethnic neutropaenia is common in people of ? ethnicity
black African and Afro-Caribbean
285
Severe hyperkalaemia in the context of an AKI requires
immediate discussion w CC/ nephrology to consider haemodialysis
286
Symptom control in non-CF bronchiectasis -
inspiratory muscle training + postural drainage
287
when does NMS tend to occur
NMS typically develops rapidly, usually within the first two weeks of starting an antipsychotic medication or after a dose increase, rather than after prolonged treatment.
288
Mx of impetigo
- 1: hydrogen peroxide cream - 2: fusidic acid
289
DUMBELLS acronym - organophosphate poisnoning
Defecation, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Lethargy and Salivation
290
A 25-year-old patient presents to the neurology clinic. They report several episodes of involuntary twitching movement in their right hand. These episodes last for around 2 minutes and they return to normal immediately afterward. What is the most likely diagnosis?
focal aware
291
ondansteron use in pregnancy ->
small increased risk of cleft palate/lip if used in T1
292
COPD vaccinations
annual flu + one of pneumococcal
293
S1 lesion features =
Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test
294
asymptomatic bacturia in pregnant women mx
- treat with 1) nitro 2) amox or cefalexin - test of cure MSU should be sent for all preg women treated for a UTI
295
Z and T score =
- T score: young healThy Z score: Z same gender and age
296
when should urine dips not be used
women > 65 years, men and catheterised patients - culture
297
Mx of UTI > 65 woman
3 day course of ab + urine culture
298
mid to late diastolic murmur + haemoptysis =
MS
299
PTSD Mx
- CBT/ EDMR - drug: venlafaxine or SSRI - more severe: risperidone
300
fever, polyathralgia + salmon pink rash ->
stils disease
301
features of stills disease
- elevated ferritin - cyclical pyrexia - rises in late afternoon/ early evening - lymphadenopathy
302
mx of stills disease
- NSAIDs for a week then add steroids - methotrexate or anti-TNF is sx persist
303
rose spots + constipation after holiday ->
salmonella typhi - typhoid fever
304
atients with tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive
up to 3 synchronised Dc shocks
305
haematemsis following significant burn ->
curlings ulcer
306
adenocarcinomas of O
- most common type in the UK - at the lower third of O near the junction
307
Rf for an adeno
- GORD Barrett's oesophagus smoking obesity
308
Rf for SCC - O
- smoking alcohol achalasia Plummer-Vinson syndrome diets rich in nitrosamines
309
epidemiology of SCC -O
- More common in developing world - upper 2/3 of O
310
sq vs adeno mneumonic
Squamous - smoking - sachalasia, sq superior Barrets - Badenoma
311
inheritance of marfans
- autosomal dom - defect in FBN1 gene on chr 15 which codes for fibrillin 1
312
PPIs can increase risk of
fractures and osteoporosis
313
definitive mx of lithium toxicity
- haemodialysis - indicated in severe lithium toxicity (concentrations in excess of 2 mmol/L) if neurological symptoms or renal failure are prese
314
Ix for UC severe flare
In patients with severe colitis, colonoscopy should be avoided due to the risk of perforation - a flexible sigmoidoscopy is preferred
315
PMS mx
- lifestyle advise for minor symptoms: regular balanced carb rich meals - moderate: new COCP - severe: SSRI
316
Drugs causing SIADH -> hyponatreamia
carbamazepine, sulfonylureas, SSRIs, tricyclics
317
ciclosporin side effects
: everything is increased - fluid, BP, K+, hair, gums, glucose
318
Anaphylactoid reactions to IV N-Acetylcysteine are generally treated by
temp stopping transfusion and restarting at a lower rate
319
Prior to discharge, following an acute asthma attack, a patient should
have been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 h
320
obesity spirometry
- restrictive but normal TLCO
321
Chorioamnioitis =
- maternal fever, tachycardia and neutrophilia - uterine tenderness and foul smelling discharge - assoc w prolonged rupture of membranes but can occur wirh intact
322
in hypothermia, rapid rewarming can lead to
peripheral vasodilation and shock - dist shock
323
thiazides may precipitate ? toxic ity
digoxin
324
ECG signs of digoxin tox
down-sloping ST depression (commonly called 'reverse tick' sign) and flattened or inverted T waves
325
? is a contraindication to ACE-i
moderate-severe AS
326
Bilateral ? may occur in sarcoidosis
parotid gland swelling
327
sign of uterine atony
PPH most common cause) + uterus palpated high above the umbilicus
328
Ix of choice for chlamydia
NAAT
329
depo is assoc w
WG
330
lifestyle advice for hypercalcaemia 2' to malignancy
- maintain good hydration - Advise the person to avoid any drugs or vitamin supplements that could exacerbate the hypercalcaemia. Encourage mobilization where possible to avoid exacerbating the hypercalcaemia.
331
What terminology is used to describe the head in relation to the ischial spine?
STATION
332
Middle-aged adult with insidious onset dementia and personality changes/social disinhibition → ?
FTD
333
Live attenuated vaccines:
M - MMR I - Influenza (intranasal) B - BCG O - Oral rotavirus O - Oral polio T - Typhoid Y - Yellow fever
334
rf for endometrial ca
nuliparity - because during pregnancy, the balance of hormones shifts towards progesterone, which is a protective factor.
335
causes of EH
- hsv - coxsackie
336
what can be raised with lung cancer
platelets
337
Mx of an oclulogyric cris
- IV procyclidine - benztropine
338
ARDS can only be diagnosed when
Acute respiratory distress syndrome can only be diagnosed in the absence of a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised)
339
what can be seen with pancoast tumpurs
- horners - shoulder and upper limb neuro signs due to local extension of the rumour
340
ARP pupil
small irregular pupil does not respond to light. Accomodates but does not react. -> Neurospyhylis
341
Miosis vs myadrisis
- mydriasis: DIlated pupil - miosis: small word so constricted
342
what is used in non-falciparum malaria
primaquine - to destroy liver hypnozoites and prevent relapse
343
Which ab increases the anticoag effect of warfarin
metronidazole
344
NSTEMI (managed conservatively) antiplatelet choice
aspirin, plus either: ticagrelor, if not high bleeding risk clopidogrel, if high bleeding risk
345
pattern of sensory changes in subacute spinal cord degen
- loss of proprioception and vibration sense, muscle weakness, HYPERREFLEXIA - The ankle reflexes are absent and the knee reflexes are brisk.
346
Mx of benign pleomorphic adenoma
- routine surgical resection - risk of malignant transformation
347
Tx for CAP
- low severity: amox - if allergic use a macrolide or tetracycline 5 days
348
Mx of moderate seere ca
- amoxicillin +macrolide 7-10 days
349
Mx of severe CAP
co-amox
350
All diabetic patients require annual screening for? in early morning specimens
ACR for diabetic nephropathy
351
A young woman complains of feeling lonely. She has stopped seeing her old friends as she is worried about not being liked or criticised
avoidant PD
352
Most common extra renal manifestation of AKPD
liver cysts
353
Closed vs open cervical os miscarriage
- Open your I's. cervical open? = incomplete or inevitable miscarriages cervical closed? = complete, missed, threatened miscarriages
354
Triad of graft vs host disease
- painful maculopapular rash - neck, palms, soles - liver dysfunction - GI symptoms - occurs 28 days after allogenic stem cell transplant
355
diagnosing HIV
- combination test - p24 and antibody - in 4 weeks and 3 months time
356
A transaminitis (elevated ALT and AST) in the 10,000s is most commonly caused by
paracetamol OD
357
First line for tonsillitis
phenoxymethylpenicillin
358
digoxin toxicity causes ECG changes resembling
hypokalaemia
359
AKI ECG changes
- hyperkal - tall T waves, lack of P waves, broad QRS
360
Bilateral, mid-to-lower zone patchy consolidation in an older patient →
Legionella (also lymphophenia)
361
removing potassium from the body vs shifting between fluid compartments
- removing: calc resonium - shifting: insulin, salbutamol
362
COPD spirometry
FEV1 reduced, FEV1/ FVC reduced
363
Vaccinating pre-term babies
- give according to chronological ae rather than adjusting for gestational age - babies born b4 28 weeks should receive first set at hosp
364
? overdose can cause raised insulin and C peptide levels
glicazide OD (increases insulin production) C peptide low in exogenous insulin OD
365
cholesteatoma =
- conductive heating loss - chronic smelly ear discharge - recurrent glue ear
366
blister cells on blood films
GDP6 def
367
Ix of choice in genital herpes
NAAT
368
TRALI vs TACO
- TRALI: hypotension - TACO: hypertension
369
what is a common feature of schiz
insomnia - ciradian rhythm distrubance
370
1st line drug for ocular MG
pyridostigmine
371
which anti-emetic is best for post op N and V
propfol - anti-emetic
372
lower vs upper quadrant hemianopias
- upper quadrant = commonly pituitary tumour - lower quadrant = commonly craniopharyngioma
373
Herpes zoster ophthalmicus requires
urgent ophthalmological review and 7-10 days of oral antivirals
374
foot inversion commonly damages
- anterior talofibular ligament - common mechanism of ankle sprain
375
Acute exacerbation of COPD: ?is indicated if type 2 respiratory failure develops despite medical therapy
BIPAP CPAP: T1RF
376
Hypocalcaemia: prolonged QT interval is an indication for urgent
IV calcium gluconate
377
polycythemia transformation
AML or myelofibrosis
378
? ? ? are used in the treatment of delirium tremens/alcohol withdrawal
Chlordiazepoxide, lorazepam or diazepam
379
chlamydia and gonorrhoea swab
vuvlovaginal for NAAT
380
An inferior myocardial infarction and AR murmur should raise suspicions of
- Proximal AD
381
The most common explanation for short episodes (< 40 minutes) of decreased variability on CTG is
sleeping baby
382
what is pyoderma gangerosum assoc w
IBD, RA, myeloproliferative disorders and AML
383
Mx of syphilis
- IM benzp (same as scarlet fever) - alt: doxy
384
Perseveration
repeating the same words/answers.
385
echolalia =
Repeating exactly what someone has said
386
Neologism -
making new words
387
word salad =
disorganised speech, sentences that do not make sense.
388
what can be used to shrink nasal polyps
intranasal steroid spray
389
Acute pancreatitis may be diagnosed without imaging, if
, if the pain is characteristic + amylase > 3 times normal level (but imaging important for aetiology - US)
390
Whooping cough Mx
- azithromycin or clarithromycin - macrolide - if onset is within 21 days
391
which ab can cause torsades
macrolides - azithromycin, erythromycin
392
? prophylaxis can be initiated by secondary care for recurrent COPD exacerbations
azithromycin
393
when is anti-D require for a TOP
Anti-D prophylaxis should be given to women who are rhesus D negative and are having an abortion after 10+0 weeks' gestation
394
Diazepam and dosulepin OD
- obtain ECG to look for QRS widening -> give IV bicarb - flumazenil otherwise
395
modified glasgow score
- to predict severity of panc -P - Pa02 < 8 KPa A - Age > 55 N - Neutrophils (WBC > 15) C - Calcium < 2 R - uRea >16 E - Enzymes (LDH > 600 or AST/ALT >200) A - Albumin < 32 S - Sugar (Glucose >10)
396
Following medical mx of miscarriage ->
do a pregnancy test in 3 weeks
397
Catheter + UTI
7 days ab. Change catheter
398
Ix for cannon ball mes
CT abdo - RCC
399
Pathophys of achalasia
degeneration of the ganglion cells in the myenteric plexus → leading to failure of relaxation of the lower oesophageal sphincter
400
After starting an ACE inhibitor, significant renal impairment may occur if the patient has
undiagnosed bilateral renal artery stenosis
401
ectopic pregnancy sites
Ampulla - ample space - most common Isthmus - is bad, will rupture
402
primary vs secondary hypothyroid
- primary: high TSH, low T4 - hashimotos, iodine def, thyroiditis - secondary: low TSH and low T4 -> MRI of pituitary
403
Mg sulphate should be continued for
24 hrs after last seizure or delivery
404
Mx of alcohol withdrawal in the context of liver cirrhosis
lorazapam > chlordiazepoxide if cirrhosis
405
which surgical methods causes less adhesions
lap approach > open
406
most common cause of sudden onset SN hearing loss
idiopathic
407
tympanic perforation -> ? loss
conductive
408
how does hep A present
h flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
409
? is a cause of folate definiciency
phenytoin
410
? is a common cause of bilateral CTS
RA (Acromegaly also does usually after 50)
411
what is a key feature that differentiates gout from pseudogout
- chondrocalcinosis: calcification - PSEUDOGOUT
412
Haemachromatosis screening
- general population: transferrin saturation > ferritin - family members: HFE genetic testing
413
first line for acute stress disorder
- trauma focused CBT - Eye desensitisation for PTSD
414
Small cell paraneoplastic syndromes
- ACTH and ADH -> cushings syndrome and diltutional hyponatreamia - LES
415
sq cell paraneoplastic
- PTHrP -> hypercal
416
Use of 0.9% Sodium Chloride for fluid therapy in patients requiring large volumes = risk of
hyperchloraemic metabolic acidosis
417
The main complication of induction of labour is
uterine hyperstimulation
418
renal adeno
- most common renal tumours - affecr renal parenchyma - cystic center
419
transitional cell carcinoma
urothelial surfACES
420
SSRI of choice post MI
sertraline
421
causes of oligohydramnious
- pre-eclampsia - premature rupture of membranes - IUGR
422
causes of polyhydramious
- twin to twin transfusion - DM - anacephaly - oesophageal atresia
423
NMS - blood abn
raised CK and leukocytosis
424
drug induced lupus =
anti-histone ab
425
before prescribing AP - must
do an ECG to assess for CVD and QTc prolongation
426
acute deliirum in PD
- lorazapam - HALOPERIDOL IS CI IN PD
427
Measles - immediate comp
pneumonia
428
measles comps
- otitis media: most common comp - pneumonia: most common cause of death
429
high glyacemic index foods
lead to a rapid spike in BG levels, which is followed by a rapid drop
430
brocas vs wernickes
- Broca's = broken speech (can't articulate words) - Wernicke's = wer de ficke are you talking about (doesn't make sense)
431
? is a safer opioid to use in patients with moderate to end-stage renal failure
oxycodone
432
what is the main pathology that ultrasound monitoring performed between 16 and 24 weeks gestation aims to detect in twin pregnancy
twin to twin tranfusion syndrome
433
Urethritis in a male, negative for Gonorrhoea and Chlamydia →?
mycoplasma genitalium
434
gram negative diplococi =
gonorrhoea
435
antibiotic prophylaxis should be offered to all women
with a prev baby with GBS disease w/o need for testing - give IV benzylpeniicllin during labour
436
Todds paresis
- result from reduced blood flow (vasoconstriction) to the affected brain area, leading to temporary impairment.
437
boerhave syndrome Ix
- CT contrast swallow
438
Sx of boerhave
intense retrosternal pain, creptius on palpation of the chesr wall (surgical emphysema)
439
notching of the inferior border of the ribs is commonly seen with
coarctation of aorta
440
Mx of low pressure headache following LP
caffiene and fluids
441
high voltage electrical burns are assoc w
rhabdo
442
circumferential burns increase risk of
CS due limb constriction
443
common cause of contact lense keratitius
pseudominas aerguinosa
444
Wallaces rule of 9s for burn area
- Each of the following is 9% of the body when calculating surface area % if a burn: Head + neck, each arm, each anterior part of leg, each posterior part of leg, anterior chest, posterior chest, anterior abdomen, posterior abdomen
445
when does biliary atresia present
- first few weeks of life - jaundice, reduced appetite, growth dist - conjugated bilirubin is high - pale stools and dark urine
446
Acute viral labrynthitis:
sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo
447
Peristent H pylori Sx despite first line therapy
- If ongoing symptoms despite first-line therapywith PPI + amoxicillin + (clarithromycin OR metronidazole) - then repeat course but switch the clarithromycin/metronidazole
448
David Llyods stirrups + foot drop
peroneal nerve lesion
449
A 23-year-old man complains of severe groin pain several weeks after a difficult inguinal hernia repair.
ilioinguinal
450
foot drop following total hip replacement =
sciatic nerve
451
Head injuries with a suspected open or depressed skull fracture require
immediate CT head
452
URTI symptoms + amoxicillin → rash ?
- glandular fever - stop ab and start supportive care
453
medical TOP
- mifepristone - analgesia & anti-emetics - misoprostol after 48 hr
454
Asthma in children aged 5-11: if not controlled on low-dose ICS + SABA then assess if
suitable for MART
455
The nerve most likely to be injured during knee arthroplasty is
The common peroneal
456
incubation period for giardiasis
longest, up to 6 weeks
457
asymptomatic AS
annual review, only need to do AVR if symptomati or valve gradient of 40mmHg
458
Ix for syringomelia
- MRI spine - Potential causes include Chiari malformation, trauma and tumours.
459
angina Mx
1) BB or CCB (if CCB used alone then use rate limiting) 2) add ^ 3) add a third drug when awaiting assessmen for PCI or CABG: long acting nitrate, ivabradine, nicronadil, ranolazine
460
triceps innervation
radial nerve C7
461
patients assigned female at birth on testosterone
- contraceptives with oestrogen are not recommended - antagonise the effect of testosterone - progesterone and IUD are fine
462
EH - rash
can be described as monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter
463
pleural plaques on XR
- benign - do not require follow up - assoc w asbestos
464
use of mydiarti drops can predispose to
acute closed angle glaucoma
465
Action required if delayed patch change over 48 hours:
barrier contraception for 7 days and EC if required
466
Paracetamol OD: pres > 24 hrs
- if presenting > 24 hra after OD start NAC if: - jaundice - hepatic tenderness - or raised alt
467
Chronic alcoholism is a cause of
hypoMg
468
INR target for recurrent PE on warfarin
- 3.5 - Increase warfarin dose if PE
469
X-ray changes of osteoarthritis (LOSS)
Loss of joint space Osteophytes forming at joint margins Subchondral sclerosis Subchondral cysts
470
XR of RA - LESS
Loss of joint space Erosions Soft tissue swelling Soft bones (osteopaenia)
471
Aims of acute glaucoma mx
reduce aq secretion + induce pupillary const (enhances outflow)
472
hops on one leg =
3-4 yrs
473
Pulls to standing =
8-10m
474
squats to pick up a ball
18m
475
Growth failure, tachycardia and tachypnoea in the context of weak femoral pulses
coarctation of aorta
476
Mx of coarctation of aorta
- immediately give IV prostaglandin - surgery is only definitive tx
477
monitory for heparin
- LMWH: does not need monitoring - UFH: monitoring with APTT
478
PRICK VS PATCH TEST
If it goes in you its a prick test you do If it goes on you its a patch test you do e.g. contact dermatitis
479
Progressive multifocal leukoencephalopathy is caused by
- JC or BK virus
480
which airway adjunct is CI in a basal skull f#
NP
481
Patients who take a staggered paracetamol overdose should receive treatment with
Nac
482
pt presenting within 1hr of paracetamol OD
activated charcoal
483
Heart failure + receiving 2 doses of packed red cells
- give furosemide between units to prevent fluid overload
484
Hypotension, dyspnoea, wheezing, angioedema during a blood transfusion →
anaphylaxis
485
additional of dex in bac meningitis
Dexamethasone improves outcomes (by reducing neurological sequelae) in the treatment of bacterial meningitis
486
head injury ECG changes
- cushings triad: hypertension, brady, tachypnoeic - Widespread T wave inversion - cerebral T waves - QT prolongation
487
Orbital cellulitis differentiated from preseptal cellulitis by presence of
reduced visual acuity, proptosis and pain with eye movements
488
NICE recommend co-prescribing ? with NSAIDs in all patients with osteoarthritis
PPI. Celecoxib is an NSAID
489
Following referral to ENT, patients with sudden-onset sensorineural hearing loss are treated
ORAL PRED FOR 7 DAYS
490
SN hearing loss pattern
- Rinne result: Air conduction > bone conduction bilaterally - Weber result: Lateralises to unaffected ear
491
An 8-month-old child is noted to have a discrepancy between the skin creases behind the right and left hips
DDH
492
How does timolol work
decreases production of aq humor
493
how to decide if pred should be started for alcoholic hepatitis
- Maddreys function: prothrobin time and serum bilirubin
494
prophylaxis for lyme disease
- no need for asymptomatic pts bitten by a tick
495
Mx of lyme dx
- doxy (LD) - amox if CI or pregnant
496
Organophosphate insectide posioning mneumonic
SLUD - Salivation - Lacrimation - Urination - defecation/ diarrhoea - Overacttity of PNS by inhibition of AChE
497
Mx of organopsphate posioning
atropine
498
Following a fragility fracture in women ≥ 75 years,
a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate
499
Urethritis + arthritis +/- conjunctivitis =
reactive arthritis
500
keratoderma blenorrhagicum
yellow waxy pustular lesions on soles seen with reactive arthritis
501
Erythema nodosum can be caused by
strep infection
502
urine osmolality formula
2 * Na+ + glucose + urea - 2 salty snacks, 1 sweet drink and a urine check:
503
monitoring for haemachromatosis
TF - transferrin and ferritin
504
Mx of hepatorenal syndrome
Telipressin (induces splanchnic vasoconstriction)
505
The Hba1c target for patients on a drug which may cause hypoglycaemia (eg sulfonylurea)
is 53, otherwise would be 48
506
Orthostatic hypotension (A fall in SBP of >20mmHg on standing) accompanied by an exaggerated increase in HR is indicative of
ortho hypotension due to anaemia or hypovol
507
neurogenic ortho hypotension
- heart rate does not respond to fall in BP upon standing - can occur in diabetics with autonomic neuropathy
508
when can orthostatic hypotension be dx
drop in SBP of at least 20 or drop in DBP at least 10 after 3 mins of standing
509
preferred imaging for TIA
mri with diffusion weighted imaging
510
dabgiatran MAO
direct thrombin inhibitor
511
Pancoast tumours
- can compress the recurrent laryngeal nerve -> hoarse voice - CT scan, can be missed on XR
512
What should be checke for subclinical hypothyroidism
Check thyroid peroxidase antibodies in patients who have subclinical hypothyroidism as this can indicate patients who are more likely to progress to overt hypothyroidism
513
normal anion gap met acidosis
ABCD Addison's Bicarb loss Chloride Drugs
514
Most important cause of VT
hypokalamia then hypoMg
515
If patients have persistent myocardial ischaemia following fibrinolysis then
PCI should be considered
516
VF/pulseless VT should be treated with? as soon as identified
1 shock
517
HOCM inheritance pattern
50%
518
ACEi must be stopped in
pregnancy - CI & AKI
519
Suspected ACS - regardless if pain has resolved should be
given aspirin and sent emergently tohosp
520
Breathing problems with clear chest, think
pe
521
ECG findings in pericarditis
- most sensitive: PR depression - concave global ST elevation
522
Cardiac tamponade is a life-threatening medical emergency that requires
immediate percardiocentesis
523
nicronadil
- Ix: angina - SE: headaches, flushing, anal ulceration
524
Pulmonary embolism and renal impairment or pregnant
VQ scan
525
If a patient with AF has a stroke or TIA, the anticoagulant of choice should be
apixaban or warfarin
526
ECG finding of tamponade
electrical alternans (QRS alternating in height)
527
Infective endocarditis - indications for surgery:
- severe valvular incompetence - aortic abscess (often indicated by - a lengthening PR interval) - infections resistant to antibiotics/fungal infections - cardiac failure refractory to standard medical treatment - recurrent emboli after antibiotic therapy
528
common cause of torsades
- macrolides like erythromycin
529
Bleeding on dabigatran? Can use ?to reverse
idarucizumab
530
WPW ecg
- short PR - wide QRS complexes with a slurred upstroke - 'delta wave'
531
?is a contraindication to statin therapy
Pregnancy
532
What is the most sig poor prognostic factor in ACS
- cardiogenic shock: Killip class 4 - pulmonary oedema is only class 3
533
reducing mortality post MI
- Statin - BB - ACE - aspirin - nitrates do not - simply for symptomatic relief
534
what should be done during CPR for a suspected PE
Start thrombolysis e.g. alteplase
535
which diuretics cause hypocalcaemia
loop
536
Electrical cardioversion is synchronised to the ? wave
r
537
Young adult with hypertension, systolic murmur → ?
coarctation of aorta, Turners is a RF
538
Which drug is CI in VT
verapamil
539
features of coarctation of aorta
- radio-femoral delay, weak femoral pulses - mid systolic murmur, maximal over the back - apical click from the aortic valve notching of the inferior border of the ribs
540
ascending aorta dissection Mx
surgery, control BP to 100-120 systolic
541
descending aorta dissection mx
conservative management reduce blood pressure IV labetalol to prevent progression
542
AC following stroke
aspirin 300mg daily then clopidogrel 75mg lifelong
543
Early scan to confirm dates
10 - 13+6 weeks
544
first screen for anaemia and atypial red cell antibodies
8-12 weeks
545
first dose anti-D prophylaxis for rhesus negative women
28 weeks
546
bleeding with ROM ->
vasa praevia - The classic triad of vasa praevia is rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.
547
Tearfulness, anxiety 3-7 days postpartum → ?
baby blues - reassure and support
548
concerning CTG ->
emergency c section
549
Which of the following is an absolute contraindication for vaginal delivery following previous cesarean section?
vertical (classical) caesarean scars
550
PPH =
> 500ml blood loss within 24 hrs of the birth of a baby
551
first line for eclampsia
- give Mg Sulphate
552
? are the SSRIs of choice in breastfeeding women
Sertraline or paroxetine
553
GDM management
- < 7 mmol a trial of diet and exercise for 1-2 weeks, then add metformin - > 7 mmol = insulin - shirt acting
554
planned VBAC after LSCS
- appropriate at > 37 weeks gestation
555
contraindications to VBAC
include previous uterine rupture or classical caesarean scar
556
painless bleeding after 24 weeks of gestation =
placental praevia
557
Potentially sensitising events in pregnancy:
Ectopic pregnancy - Evacuation of retained products of conception and molar pregnancy - Vaginal bleeding < 12 weeks, only if painful, heavy or persistent - Vaginal bleeding > 12 weeks - Chorionic villus sampling and amniocentesis - Antepartum haemorrhage - Abdominal trauma - External cephalic version - Intra-uterine death - Post-delivery (if baby is RhD-positive)
558
prophylactic anti-D
given to non-sensities RhD women at 28 and 34 weeks
559
downs screening test results
All the serum tests are low in Down's, except for the ones which are 'HI' (hCG and inhibin A)
560
pregnanct woman not immune to rubella
- advise to stay away from anyone with rubelal - do not give MMR
561
What is measured in downs antenatal screening
Nuchal translucency + B-HCG + pregnancy associated plasma protein A
562
CI to instrumental delivery
head palpable abdominally
563
Ix for instrumental delivery
- prolonged second stage - maternal exh - fetal distress - breech position - rotate malpositioned fetal head
564
The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS:
- Fully dilated cervix generally the second stage of labour must have been reached OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure Ruptured Membranes Cephalic presentation Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally Pain relief Sphincter (bladder) empty this will usually require catheterization
565
Mx of placental abruption
- if fetus is alive, <36 weeks and not showing signs of distress :to admit and administer steroids - if fetal distress: immediate c section - > 36 weeks and happy baby: deliver vg
566
Mx of placental abruption + deceased fetus
induce vg delivery
567
The correct position for women who have a cord prolapse is
on all 4s on knees and elbows
568
first step for RFM
If a pregnant woman reports reduced fetal movements then handheld Doppler should be used to confirm fetal heartbeat as a first step
569
Women with pyrexia >38 degrees during labour should get ?as GBS prophylaxis
benzylpenicillin
570
Drugs to avoid in BF
-antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
571
Why should women > 37 weeks with singleton avoid air travel
risk of labour
572
air travel and pregnancy
- women > 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel - women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks
573
membrane sweep
- considered an adjunct to induction of labour - do before formally inducing based off bishop score
574
screening for GBM
All obese (BMI>30) women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks
575
Women who have prev had GDM
OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal. NICE also recommend that early self-monitoring of blood glucose is an alternative to the OGTTs
576
Trace glysocuria in pregnancy
reassure - common due to the increased GFR and reduction in tubular reabsorption of filtered glucose
577
categories of C sections
- Cat 1: immedate threat to life - delivery of the baby should occur within 30 minutes of making the decision - Category 2 maternal or fetal compromise which is not immediately life-threatening delivery of the baby should occur within 75 minutes of making the decision Category 3 delivery is required, but mother and baby are stable Category 4 elective caesarean
578
examples of cat 1 section indications
suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
579
first line surgical intervention for PPH
Intrauterine balloon tamponade is the first-line 'surgical' intervention if other measures fail
580
Mx of PPH
1st line (physical method) -bimanual uterine massage -empty bladder (catheter) 2nd line -oxytocin -carboprost -ergimetrine (not in hypertension) 3rd line (surgical) -balloon tamponade (do this first in surgical method) -B-Lynch suture - ligation of the uterine arteries or internal iliac arteries Last option hysterectomy
581
Carboprost CI in
asthma
582
mx of PND
- CBT - then SSRI or TCA
583
Suspected cases of rubella in pregnancy should be
Discussed with local health protection unit
584
Preterm prelabour rupture of the membranes: give IV Mg sulphate
for fetal neuroprotection if < 30 weeks
585
normal CV findings in pregnancy
- third heart sound - peripheral oedema - ESM - foreful apex beat
586
indications for ab in masitisi
- n infected nipple fissure, symptoms not improving after 12-24 hours despite effective milk removal and/or breast milk culture positive. - oral fluxoc for 10 -14 days
587
? is the recommended treatment for delayed placental delivery in patients with placenta accreta
- hysterectomy is definitive
588
rash starting in stretch marks in pregnant lady ->
- polymorphic eruption - rash often starts on the abdomen, particularly within stretch marks (striae), and can spread to the thighs and buttocks but rarely involves the face or mucous membranes
589
Inpatient treatment for erythroderma must be monitored for complications like
dehydration, infection and high-output heart failure
590
diagnosis of shingles
clinical
591
levido reticualris
- lace like rash on lower limbs - commonly from SLE
592
Anti-TB med -> pellagra
isoniazid
593
Four D's of pellagra (vitamin B3 deficiency):
Diarrhoea Dermatitis Dementia Death
594
Nikolsky sign
Stevens-Johnson syndrome exhibits Nikolsky sign in erythematous areas - blisters and erosions appear when the skin is rubbed gently
595
Children with new-onset purpura should be
referred immediately for Ix to exclude ALL and mening disease
596
Mx of chronic plaque psoriasis
- first line: potent corticosteroid applied once daily plus vitamin D analogue applied once daily - 2: vitamin D analogue 2x day if no imp after 8 weeks
597
3rd line for plaque psoriasis
- if no improv after 8-12 weeks: - a potent corticosteroid applied twice daily for up to 4 weeks, or - a coal tar preparation applied once or twice daily - short-acting dithranol can also be used
598
tx of scabies
Permethrin
599
Molluscum contagiosum in children Mx
reassure
600
rosecea Mx
- flushing: brinomide gel - mild papules/ pustules: topical ivermectin - moderate - sevre papules/ pustules: topical ivermectin and oral doxy
601
cause of EH
usually HSV1/ HSV2, rarely coxsackie
602
HHT =
- epistaxis : spontaneous, recurrent nosebleeds - telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose) - visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic - AVM, cerebral AVM, spinal AVM family history: a first-degree relative with HHT
603
Dermatophyte nail infections - use
Oral terbinafine - check LFTs first
604
common comps of seb derm
otitis externa and blepharitis
605
bullous pemphigold vs pemphigus vulgaris
Blistering rash -> - no mucosal involvement : bullous pemphigoid - mucosal involvement: pemphigus vulgaris - vulgar
606
ab used for acne in pregnancy
erthryomycin
607
break between steroid courses
4 week break
608
Seborrhoeic dermatitis - first-line treatment is
topical ketoconazole
609
safest C for migraine w aura
- Progesterone: UKMEC2 - COCP: UKMEC 4 - safest is copper IUD
610
endo is RF for
ectopic
611
SFH growth rates
> before 24 weeks: 2 cm a week - after 24 weeks: 1cm a week
612
A 24-year-old woman attends her booking scan and finds out that she is pregnant with monochorionic twins. Her general practitioner asks her specifically to report any sudden increases in the size of her abdomen and/or any breathlessness. What complication of monochorionic multiple pregnancy is the GP describing the symptoms of?
- Twin to twin transfusion syndrome
613
The Mirena intrauterine system is licensed for use as the progesterone component of HRT for
ONLY 4 YEARS
614
A 19-year-old woman presents with a two day history of central lower abdominal pain and one day history of vaginal bleeding. Her last period was 8 weeks ago. On examination her cervix is tender to touch
Ectopic
615
Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone →
AIS
616
Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency →?
FIBROIDS
617
BF and viral infection
- hep B: safe - HIV: do not BF
618
Incontinene and inconclusive bladder diary ->
urodynamic studies
619
contraindication for using epidural anaesthesia during labour?
- coagulopathy
620
All ectopic pregnancies ? should be managed surgically
>35 mm in size or with a serum B-hCG >5,000IU/L
621
SE of GnRH agonints
- induce psueodmenopause -> loss of BMD
622
Women with ? are at high risk of pre-eclampsia
- SLE or APS - take 75mg aspirin from 12 weeks to term of pregnancy (same as all high risk women)
623
The three features of Meig's syndrome are:
- a benign ovarian tumour - ascites - pleural effusion
624
The most common cause of puritus vulvae is
contact dermatitis
625
Normal laboratory findings in pregnancy:
Reduced urea, reduced creatinine, increased urinary protein loss
626
First degree tear
superficial damage with no muscle involvement do not require any repair
627
second degree tear
injury to the perineal muscle, but not involving the anal sphincter require suturing on the ward by a suitably experienced midwife or clinician
628
third degree tear
- injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS) - require repair in theatre by a suitably trained clinician
629
4th degree tear
injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa require repair in theatre by a suitably trained clinician
630
baby with adduction and internal rotation of arm ->
erbs palsy - waiters tip
631
Klumpkes palsy
Klumpke's palsy occurs due to damage of the lower brachial plexus and commonly affects the nerves innervating the muscles of the hand.
632
mx of umbilical cord prolapse
1. keep cord warm 2. push any presenting part of fetus back in 3. tocolytics 4. all 4s until CS ready
633
threatened miscarriage
- painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks the bleeding is often less than menstruation cervical os is closed
634
missed miscarriage
- a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion - mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature - cervical os is closed
635
Inevitable miscarriage
- heavy bleeding with clots and pain - cervical os is open
636
incomplete miscarriage
not all products of conception have been expelled pain and vaginal bleeding cervical os is open
637
Open cervical Os
open your Is - incomplete and inevitable
638
When investigating suspected PPROM, if there is no fluid in the posterior vaginal vault then
Test for PAMG ot IGF binding protein 1
639
If fetal movements have not yet been felt by 24 weeks then ?
refer to maternal fetal medicine
640
PCOS increases risk of
- DM - stroke - endometrial cancer
641
Mx of hyperemesis
-1: AH like promethazine or phenothiazines: oral prochlorperazine or chlorpromazine 2: oral ondansteron 2: metoclopramide for 5 days or domperidone
642
In patients with urinary incontinence, make sure to rule out
DM and UTI
643
If a breastfed baby loses > 10% of birth weight in the first week of life then
refer to midwife led BF clinic
644
best type of HRT for VTE risk
transdermal
645
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity
medical mx - (e.g. IUS, tranexamic acid, COCP
646
pueperal psychosis =
haracterised by an acute onset of a manic or psychotic episode shortly after childbirth. An abrupt change in mental state is a red flag for puerperal psychosis.
647
Female genital mutilation in under 18 -
report to police
648
first line for menorrhagia
IUS - mirena
649
cysts in early pregnancy
reassure - usually physiological cysts - corpus luteum
650
snowstorm appearance on US
hyatidiform mole - complete
651
complete vs incomplete hyatidiform mole
Complete--> snow storm appearance Incomplete/partial--> some fetal vessels/parts present
652
how is pre-ec defined
new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction
653
induction if bishop score < 5
- VGPGE2 or oral misoprostol to ripen cervix
654
bishop > 8
a score of ≥ 8 indicates that the cervix is ripe, or 'favourable' - there is a high chance of spontaneous labour, or response to interventions made to induce labour
655
when can ECV be doe up to
You can attempt external cephalic version for a transverse lie if the amniotic sac has not ruptured - until the rupture acc occurs
656
? is the medication of choice in suppressing lactation when breastfeeding cessation is indicated
cabergoline
657
AFL of pregnancy Sx
- jaundice - mild pyrxia - hepatic LFTs - raised WBC - coagulopathy - steatosis
658
Bladder still palpable after urination, think
retention with urinary overflow
659
Which of these is correct in regards to the management of endometrial cancer?
most pts present wih stage 1 disease and so amebable to surgery alone
660
Factor V Leiden in pregnany Mx
LMWH antenatally + 6 weeks PP
661
VTE prophylaxis in pregnancy
ow molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy. Direct Oral Anticoagulants (DOACs) and warfarin should be avoided in pregnancy.
662
pill free interval or withdrawal bleed Ix
no medical indication
663
Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus → ?
adeno
664
A cut-off of ?g/Lshould be used in the first trimester to determine if iron supplementation should be taken
110
665
The thyrotoxicosis phase of postpartum thyroiditis is generally managed with
propanolol alone
666
Magnesium sulphate - monitor
reflexes and RR
667
Mx of resp depression caused by Mg sulphate
calcium gluconate
668
what is contraindicated in women over 35 smoking 15 cigarettes or more a day
All methods of combined hormonal contraception, including the pill, patch and vaginal ring
669
Hypermesis TFTs
high bHCG, low TSH, high thyroxine
670
NICE recommend arranging ? in suspected pre-ec
urgent obs referral
671
NICE guidelines recommend ?in those women who has pre-eclampsia with mild or moderate hypertension after 37 weeks.
delivery within 24-48 hours
672
SFH after 20 weeks equation
weeks +/- 2
673
antidiabetic safe to BF on
metformin
674
when do we give anti-D
28 weeks and 34 weeks
675
when is EC for POP needed
If unprotected sex occurred after a missed POP and within 48 hours of restarting the POP
676
following combined test, which tests can be done
amniocenteiss - higher risk NIPT - less risk
677
pts w gastric surgery and C
Patients who have had a gastric sleeve/bypass/duodenal switch cannot have oral contraception ever again due to lack of efficacy, including emergency contraception
678
Medical treatments for postpartum haemorrhage secondary to uterine atony include
oxytocin, ergometrine, carboprost and misoprostol
679
stages of labour
- stage 1: from the onset of true labour to when the cervix is fully dilated stage 2: from full dilation to delivery of the fetus stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered
680
Current breast cancer is a contraindication for injectable
ALL hormonal contraception
681
most common SE of POP
Irregular vaginal bleeding - usually 3 months
682
C following giving birth
required 21 days from giving birth
683
Postpartum women (breastfeeding and non-breastfeeding) can start the progestogen-only pill ...
any time PP
684
Positive antiphospholipid antibodies (e.g. in SLE) is UKMEC ? for the COCP
UKMEC4
685
The intrauterine device or intrauterine system can be inserted within after delivery
within 48 hours of childbirth or after 4 weeks
686
Ulipristal timeframe
120 hours post UPSI
687
Levonestrogel after UPSI
within 72 hrs
688
how does mifepristone work
prostaglandin analogue, binds to myometrial cells → strong myometrial contractions → expulsion of products of conception
689
Second screen for anaemia and atypical red cell alloantibodies
28 weeks
690
Nuchal scan
11 - 13+6 weeks
691
Urine culture to detect asymptomatic bacteriuria
8 -12 weeks
692
when can the COCP be restarted if BF and PP
after 6 weeks
693
stopping pill before major elective surgery and all surgery involving limbs
stop 4 weeks before, switch to POP
694
Implantable contraceptive (etonogestrel) mao
INHIBITS OVULATION
695
. Copper intrauterine contraceptive device (used as a standard contraceptive) mao
Decreases sperm motility and survival
696
Ulipristal should be used with caution in patients
severe asthma
697
patients with features of acute life-threatening asthma who fail to respond to treatment,
refer to ICU - consider ventilation
698
The first line investigation for adults with suspected asthma is to
measure the eosinophil count OR fractional nitric oxide
699
Peak flow readings
- Moderate: 50-75 - Severe: 33-50 - Life threatening - <33%
700
In a mild-moderate flare of ulcerative colitis extending past the left-sided colon
oral aminosalicylates should be added to rectal
701
diarrhoea following ab, yellow plaques on scope ->
pseudomembranous colitis/ C diff
702
? should be prescribed in all patients with suspected hepatic encephalopathy
lactulose
703
Kantors string line
long segment of narrowed terminal ileum with a string like config -> CD
704
?may be used to stop an uncontrolled variceal haemorrhage
A Sengstaken-Blakemore tube
705
Which one of the following conditions is most strongly associated Helicobacter pylori infection?
Duodenal ulcers
706
Mx of bile malabs following cholecystectomy
cholestyramine
707
A strong family history of colorectal cancer and lack of adenomatous polyposis on colonoscopy point towards a diagnosis of
hereditary nonpolyposis colorectal cancer (HNPCC) - the commonest extra-colonic malignancy of HNPCC is endometrial cancer
708
autoimmune hepatitis
- women - associated with the presence of anti-nuclear and/or anti-smooth muscle antibodies.
709
What should be prescribed for alcoholic pts
oral thiamine
710
Metabolic ketoacidosis with normal or low glucose: think
alcoholic ketoacidosis
711
what increases pancreatic cancer risk
HNPCC
712
Metabolic ketoacidosis with normal or low glucose: think ->
Pseudopolyps
713
Mx of constipation
- bulk forming: isphalga husk - 2: osmotic e.g. macrogol
714
Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra →
carcinoid with liver mets - diagnosis: urinary 5-HIAA
715
confirming C diff
Stool C diff toxin
716
Notable foods which are gluten-free include:
rice, potatoes and corn (maize)
717
? is the technique to stop variceal bleeding if it is oesophageal
varicela band ligation during endoscopy
718
may cause Heinz body anaemia
sulphasalzine - used in UC an RA
719
? are the characteristic electrolyte disturbances seen in patients with refeeding syndrome
Hypophosphataemia, hypokalaemia and hypomagnesaemia
720
mx of BO
High dose PPI and endoscopic surveillance
721
which drug class other than AB increases C diff risk
PPI
722
Coeliac disease is associated with ? deficiency
iron, folate and vitamin B12 - Can see kolioncychia
723
Mx of haemachromatosis
- venesection 1) - 2)desferrioxamine
724
Acute mesenteric ischaemia causes a raised
Lactate and ABG/ VBG first line
725
better measure of acute liver failure
prothrombin time > albumin
726
The gold standard test for achalasia is
Oesophageal manometry
727
PPIs can cause
hyponatraemia, hypomg, reduced iron abs
728
Always examine? in a young man with RIF pain
testicles
729
PPI and endoscopy
stop 2 weeks before
730
most common cause of inherited CRC
HNPCC
731
Liver failure following cardiac arrest think
ischaemic hep
732
leadpipe colon
UC
733
abdominal pain, diarrhoea and flushing
carcinoid
734
mx of a liver cyst
ab and drainage
735
what to measure to determine severity of C diff
WCC
736
Dysplasia on biopsy in Barrett's oesophagus requires
endoscopic mucosal resection
737
natural infection is the only cause of
HbC
738
? to diagnose and monitor the severity of liver cirrhosis
transient elastography
739
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates then
oral steroids added
740
Early signs of haemochromatosis are
fatigue, erectile dysfunction and arthralgia
741
? is the first-line medication for primary biliary cholangitis
ursodeoxycholic acid
742
why do coelics get the pneumoccocal vaccine
splenic reticuloendotheial atrophy
743
Abdominal pain with blood and leucocytes on dipstick should prompt you to
do a non contrast CT abdo and renal tract looking for stones
744
Pharyngeal pouch requires
surgical repair
745
Primary biliary cholangitis - the M rule
- IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
746
Ascites: a high SAAG gradient indicates...
Ascites: a high SAAG gradient (> 11g/L) indicates portal hypertension
747
A 4-year-old presents with sudden onset of dysphagia. He undergoes an upper GI endoscopy and a large bolus of food is identified in the mid oesophagus. He has no significant history, other than a tracheo-oesophageal fistula repair soon after birth.
- benign O stricture - Children with tracheo-oesophageal fistulas will commonly develop oesophageal strictures following repair.
748
Triggers for decompensation in cirrhosis
- constipation - nfection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.
749
Iron defiency anaemia vs. anaemia of chronic disease:
TIBC is high in IDA, and low/normal in anaemia of chronic disease
750
ABG in severe diarrhoea
hypokal & met acidosis
751
? artery is at risk with duodenal ulcers on the posterior wall
gastroduondeal
752
loperamide MAO
Mu-opid agonist whih reduces gastric motility
753
what is associated w PJS
Hamarmatomas on colonoscopy
754
mx of achalasia
- pneumatic dilatation preferred - surgical intervention with a Heller cardiomyotomy should be considered if recurrent or persistent symptoms
755
Mx of achalasia in high surgical risk pts
intra-sphincteric injection of botulinum toxin
756
interpreting TTG
- cannot interpret w/o IgA level - in IgA deficiency cannot intrepret
757
Mx of hypophosphateamia
- mild to moderate hypophosphataemia where patients are asymptomatic, Phosphate tablets - Intravenous phosphate replacement is required for patients with severe hypophosphataemia or when symptomatic.
758
key intervention in ascites
reduce salt
759
Mx of alc ketoacidosis
infusion of saline and thiamine
760
before diagnosing IBS...
Check inflammatory markers, coeliac serology and faecal calprotectin
761
? are the investigations of choice in primary sclerosing cholangitis
MRCP/ERCP
762
Large volume paracentesis requires
- cover w IV human albumin solution
763
Patients who have had an episode of SBP require
ciprofloxacin as antibiotic prophylaxis
764
gold standard for coeliac
small bowel biopsy
765
The definition of an Upper GI Bleed is a haemorrhage with an
origin proximal to LoT
766
mx of alc hep
pred
767
double duct sign is seen in
panc ca
768
A combination of liver and neurological disease points towards
wilsons - auto recessive
769
hydrogen breath test
is an appropriate first line test for diagnosis of small bowel overgrowth syndrome
770
investigation of choice for a suspected pharyngeal pouch
Barium swallow combined with dynamic video fluoroscopy
771
UGIB scoring systems
- Glasgow Blatchford b4 endo - Rockall after they've rocked up to edo
772
mx of b12 def
IM B12 3/ 1week then every 3 months
773
folate and b12 replacment
B12 BEFORE FOLATE (B BEFORE F) to avoid subacte degen
774
Vomiting → severe chest pain, shock -
Boerhaave
775
Globus pharyngis (also known as globus hystericus) =
sensation of lump in throat. Saliva is often more diff to swallow.Symptoms are often intermittent and relieved by swallowing food or drink.
776
Duodenal ulcers characteristically
worse when hungry, relieved by eating
777
ulcer worse w food
gastric
778
most common cause of SBP
E coli
779
is a treatment option for patients with metastatic HCC
SORAFENIB
780
mutation in HNPCC
MSH2/MLH1
781
All pts with dysphagia require
endoscopy regardless of age
782
Macular mucocutaneous pigmentation of the vermillion border and intussception ->
PJS
783
? is the diagnostic investigation of choice for pancreatic cancer
High res CT
784
Bleeding gums and receding, think
Scurvy - vit C def
785
Hypotension + melaena →
bleeding peptic ulcer
786
Liver failure = triad of
encephalopathy, jaundice and coagulopathy
787
when to rpeeat adrenaline in anaphylaxis
every 5 min
788
adrenaline doses
0-6 years old: 150micrograms (0.15ml 1 in 1,000). 6-12 years old: 300micrograms (0.3ml 1 in 1,000). 13+ years old: 500micrograms (0.5ml 1 in 1,000).
789
symptoms following cervical laminectomy for degenerative cervical myelopathy
reccurent cervical myelopathy
790
when should rhytm control be used for AF
if there is coexistent heart failure, first onset AF or an obvious reversible cause. E.g. amiodarone
791
AC after catheter ablation for AF
LT AC still required according to CHADVASC
792
Mx of refractory anaphylaxis
- failure to improve after 2x IM adrenaline - seek expert help for consideration of IV adrenaline
793
when to rate control in AF
Acute onset of atrial fibrillation: if ≥ 48 hours or uncertain (e.g. patient not sure when symptoms started) → rate control
794
CES pattern of changes
LMN. UMN lesion points to SCC being above L1
795
Features of NMS
pyrexia muscle rigidity autonomic lability: typical features include hypertension, tachycardia and tachypnoea agitated delirium with confusion
796
Atrial fibrillation - cardioversion
Flecanide + amiodarone
797
MAO of tamsulosin
Alpha-1 antagonists promote relaxation of the smooth muscle of the prostate and the bladder to reduce LUTS
798
Blunt ocular trauma with associated hyphema is a high-risk scenario of
glaucoma - raised IOP
799
vitiligo associations
autoimmune - Hashimoto's thyroiditis), pernicious anaemia, systemic lupus erythematosus, alopecia areata, type 1 diabetes and Addison's disease.
800
Which NSAID is CI for all CVD
Diclofenac
801
Tx of obs cholestasis
- ursodeoxycholic acid - induction of labour at 37-38 weeks
802
An ultrasound is indicated if lochia persists beyond
6 weeks - evaluating for retained products
803
Ix for cont CTG monitoring in labour
- suspected chorioamnionitis or sepsis, or a temperature of 38°C or above severe hypertension 160/110 mmHg or above oxytocin use the presence of significant meconium fresh vaginal bleeding that develops in labour
804
How soon after MMR should a pt avoid becoming pregnant
28 days
805
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler then
immediate US should be offered
806
Bishop >8
- can reassure - cervix favourable - there is a high chance of spontaneous labour, or response to interventions made to induce labour
807
A 15-year-old boy develops sudden onset of pain in the left hemiscrotum. He has no other urinary symptoms. On examination the superior pole of the testis is tender and the cremasteric reflex is particularly marked.
torsion of testicular appendage - cremasteric reflex is preserved q
808
cremasteric reflex is absent in
torsion of spermatic cord
809
loss of motor or sensory function following significant anxiety
Functional neurological disorder (conversion disorder) - typically involves loss of motor or sensory function
810
Contraceptives - time until effective (if not first day period):
instant: IUD 2 days: POP 7 days: COC, injection, implant, IUS
811
? is the most likely SSRI to lead to QT prolongation and Torsades de pointes
citalopram
812
grunting with bronchiolitis
severe reps distress - admit for supporitve Tx
813
Pityriasis rosea often follows
a viral infection
814
Paracetamol overdose: if presentation 8-24 hours after ingestion of an overdose of more than ?start acetylcysteine even if the plasma-paracetamol concentration is not yet available
Paracetamol overdose: if presentation 8-24 hours after ingestion of an overdose of more than 150 mg/kg start acetylcysteine even if the plasma-paracetamol concentration is not yet available
815
In a teenager with primary amenorrhoea, but who experiences regular painful cycles, an ?is a leading differential diagnosis
imperforate hymen - blocks passage of menses leading to a build up of menstrual blood in the vagina -> pelvic pain and bloating
816
amenorrhoea and no secondary sexual characteristics
PCOS, chemo at a young age, Turners
817
Infertility in PCOS - ?is typically used first-line
clomifene
818
Urinary incontinence + gait abnormality + dementia =
Normal pressure hydroceph
819
Fourth nerve palsy - when looking straight ahead, the affected eye appears to
the affected eye appears to deviate upwards and is rotated outwards & head tilt
820
loss of fine motor function in bith upper limbs
degenerative cervical myelopathy,
821
Cervical cancer screening: if smear inadequate then repeat in
3 months
822
most common renal cancer
renal adenocarcinoma
823
Management of mania/hypomania in patients taking antidepressants:
stop AD, start AP
824
First line for CPP
Topical potent corticosteroid + vitamin D analogue
825
Max rate of K+ infusion that can be conducted w/o monitoring
The maximum rate of IV potassium infusion that can be conducted without monitoring is 10mmol/hour
826
GnRH agonists (e.g. goserelin) used in the management of prostate cancer may result in
gynacomastia
827
DIagnosis of PCOS needs 2 out of 3 features:
oligomenorrhoea clinical and/or biochemical signs of hyperandrogenism polycystic ovaries on ultrasound, oligomenorrhoea or amenorrhoea, and hirsutism
828
Woman with bone metastases- most likely to originate
in the breast. prostate in men
829
MOST COMMON SITE OF BONEMETS
SPINE
830
ADPKD is associated with which cardiac finding
MVP
831
placental percreta =
- the chorionic villi invade through the perimetrium - hysterectomy
832
Most common organism found in central line infections -
Staphylococcus epidermidis
833
if a rib fracture os not controlled by normal analgesia ->
regional nerve block
834
The following drugs may exacerbate myasthenia:
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
835
In palliative patients increase morphine doses by ? if pain not controlled
30-50%
836
breakthrough doses of opiods =
should be dosed between one-sixth and one-tenth of the total daily dose of maintenance opioids,
837
intraepithelial lymphocytes on intestinal biopsy ->
Crohns
838
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of
psoriatic arthritis. Also causes onchyolysis
839
testing for premature ovarian failure
- FSH - elevated FSH levels should be demonstrated on 2 blood samples taken 4-6 weeks apart - ovulation: progesterone - usually day 21
840
most common cause of discitis
staph a - same as IE
841
Third nerve palsy from raised ICP ->
Right sided ptosis, pupil dilatation and absent light reflex with intact consensual constriction
842
STEMI: fibronylsis should be done when
fibrinolysis should be offered within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes e.g. alteplase
843
Adenosine CI
- asthma - SE: causes severe chest pain which quickly resolves
844
Premature ovarian insufficiency: Mx
combined HRT until 51
845
Gonorrhoea Mz
- gram negative diploccoci - IM centriaxone first line
846
Itchy pale white patches after returning from holiday
versicolor
847
what is lost in SUFE
loss of internal rotation of the leg in flexion in slipped capital femoral epiphysis
848
Why is there increased risk of VTE in NS
Loss of antithrombin III
849
Most common comp of myomectomy
adhesions
850
Pontine haemorrhage commonly presents with
reduced GCS, paralysis and bilateral pin point pupils
851
? may be seen on the CXR of a patient with latent TB
Calcified Ghon complex
852
Mx of ramsay hunt syndrome
oral aciclover 7 days & oral pred 5 days
853
appearance of guttate psoriasis
characterised by white, scaly, red, erythematous patches that are usually <1 cm on the trunk and limbs.
854
For patients with persistent hypercapnic ventilatory failure despite optimal medical therapy,
- BIPAP - or IV theophylline
855
most likely side effect of using steroids in darker skin
skin depigmentation
856
SE of topical steroids
depigmentation (particularly in patients with darker skin), skin atrophy (thinning), and excessive hair growth.
857
Intraosseous access is most commonly obtained at the
proximal tibia (distal femur and humeral head can also be used)
858
? is the muscle relaxant of choice for rapid sequence induction for intubation
suxamethonium
859
features of colic
(colic starts in the first few weeks of life and resolves around 3-4 months of age), the timing of the crying (most often occurs in the late afternoon or evening), and arching of the back (babies often draw their knees up to their abdomen or arch their backs when crying).
860
mx of hyperacute transplant rejection
graft must be removed
861
hyperacute graft failure
- minutes to hours - due to pre-existing antibodies against ABO or HLA antigens - an example of a type II hypersensitivity reaction - leads to widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ
862
Acute graft failure (< 6 months)
- usually due to mismatched HLA. Cell-mediated (cytotoxic T cells) - usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
863
Mx of acute graft failure
Steroids and IS
864
Causes of chronic graft failure
-> 6 M - both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy) recurrence of original renal disease (MCGN > IgA > FSGS)
865
turp syndrome
-1. Hyponatraemia: dilutional 2. Fluid overload 3. Glycine toxicity
866
screening test for AKPD
US
867
Thyrotoxicosis with tender goitre =
De Quervains
868
Following treatment for syphilis: TPHA vs vdrl
TPHA remains positive, VDRL becomes negative If the syphilis test has an 'A' in it, it will Always be raised (in infected and those with resolved infection) If the syphilis test has an 'R' in it, it will be raised in Recent (i.e. current infection)
869
painful mouth at EOL
Benzydamine hydrochloride mouthwash or spray
870
Anaemia w low reticulocytes
bone marrow suppression eg. parovirus B19
871
ABG in aspirin OD
resp alk initially -> metabolic acidosis
872
Hyperemesis gravidarum, diagnostic criteria triad:
5% pre-pregnancy weight loss dehydration electrolyte imbalance
873
N&V of pregnancy
absence of ketonuria, clinical dehydration, electrolyte imbalance, and less than 5% pre-pregnancy weight loss
874
All patients with acute asthma should receive
oral prednisolone rather than IV hydrocortisone (unless vomiting etc)
875
acute pain and swelling after urological intervention + positive urine dip
epididmo-orchitis
876
A 20-year-old complains of severe pain in the right scrotal area after jumping onto his moped. He has also noticed discomfort in this area over the past few months. On examination there is a swollen, painful testis that is drawn up into the groin.
tt
877
swelling of parotid glands + tender testes
orchitis
878
inducing remission in CD
steroids
879
GDP6 defiiency
- X linked recessive - can be triggered by - anti-malarials: primaquine ciprofloxacin, nitrofurantoin sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
880
blood film findings of GDP6 def
Heinz bodies on blood films. Bite and blister cells may also be seen
881
what can be added when awaiting TURP for BPH
Oxybutynin
882
2 major causes of hypercalcaemia
malignancy and primary hyperparathyroid
883
Mx of IIH
- low salt diet, weight loss - acetazolamide
884
Sx of polycythemia
- Pruritis (worst after taking showers or hot baths). - Tingling, burning, and numbness in arms, hands, and feet. - Headaches and lethargy. - Splenomegaly. - Elevated haemoglobin on full blood count.
885
Mx of polycthemia
- aspirin to reduce VTE - venesection 1) - chemo - hydroxyurea and P-32 therapy
886
campb Mx
clarithromycin
887
Mx of infective mono
- reassure - self limiting - avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture
888
? is the treatment of choice for SLE
hydroxycholoroquinine
889
rash in SLE
butterly, SPARES NASOLABIAL FOLDS
890
NSAIDs should be stopped in AKI except
apirin at cario-protective dose
891
In the context of a tachyarrhythmia, a systolic BP < 90 mmHg →
dc cardioversion
892
Hodgkin's lymphoma: signs of poor prognosis:
B-symptoms, increasing age, male sex, stage IV disease and lymphocyte depleted subtype
893
upper quadrant more affected in a bitemoral hemianopia ->
pituitary macroadenoma
894
Management of venous ulceration -
compression banadging
895
Alcoholic neuropathy predisposes to the development of a
Charcot joint
896
first line test for MG
Testing for acetylcholine receptor antibodies
897
Features of marfans
- tall stature with arm span to height ratio > 1.05 high-arched palate arachnodactyly pectus excavatum pes planus scoliosis of > 20 degrees lungs: repeated pneumothoraces eyes: upwards lens dislocation (superotemporal ectopia lentis) blue sclera myopia dural ectasia (ballooning of the dural sac at the lumbosacral level)
898
heart findings of marfans
- dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation - mitral valve prolapse (75%),
899
what can happen in HIV leading to hyponatraemia and hyperkal
adrenal insufficiency from CMV related nec adrenalitis
900
Patient on DOAC who becomes pregnanct
swith over to LMWH e.g. enoxaparin
901
Symptom control in non-CF bronchiectasis -
inspiratory muscle training + postural drainage
902
how does neurogenic thoracic outlet syndrome present
- muscle wasting of the hands, numbness and tingling and possibly autonomic symptoms
903
Samter's triad =
asthma + aspirin sensitivity + nasal polyposis
904
Women with stage IA cervical cancer may be considered for ? if they wish to maintain their fertility
a cone biopsy with negative margins
905
Mx of quinsy
IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks
906
Features of quinsy (peritonsilar abscess )
- severe throat pain, which lateralises to one side - deviation of the uvula to the unaffected side - trismus (difficulty opening the mouth) - reduced neck mobility
907
Widened QRS or arrhythmia in tricyclic overdose - give
na bicarb
908
best test for Achilles tendon rupture
ULTRASOUND
909
Severe asthma FEATURES
PEF 33-50% best or predicted Respiratory rate ≥25/min Heart rate ≥110/min Inability to complete sentences in one breath
910
Knee locking and giving way following a twisting injury
meniscal tear
911
haem A s B
- Haemophilia A-te: 8 - Haem B: B-9 (benign)
912
haemophilia inheritance
X linked recessive
913
features of haemophilia
haemoarthroses haematomas prolonged bleeding after surgery or trauma
914
blood tests in haemophilia
- prolonged APTT - bleeding time, thrombin time, prothrombin time normal
915
Exomphalos
- a.k.a omphalocele - protruding bowel with a peritoneal cover - Mx: staged closure with completion at 6-12 months
916
exomphalos - whilist awaiting surgery bowel should be
covered with cling film
917
gastroschisis
- no peritoneal cover over the bowel - mx: vaginal delivery may be attempted - newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
918
delivery for gastrochitis ve exomphalos
- gastro: VG can be tried - Exomphalos: C section to reduce risk of sac rupture (the sac is protecting the bowel)
919
which type of melanoma Invade aggressively and metastasise early
nodular.
920
lichen planus vs sclerosus
- planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over surface. Oral involvement common - sclerosus: itchy white spots typically seen on the vulva of elderly women
921
club foot =
Inverted + plantar flexed foot which is not passively correctable.
922
infantile hemangioma =
benign condition due to proliferating endothelial cells. They can keep growing up to 18 months, and begins to involute over the next 3-10 years.
923
salmon patches =
congenital capillary malformations seen at birth. They are often small, flat patches of pink or red skin with poorly defined borders. These tend to resolve by 18 months of age.
924
port wine stains
Port-wine stains are capillary malformations seen at birth. These persist throughout life.
925
port wine stains vs salmon patches
Wine stains the carpet forever, salmon swims away
926
Achilles tendonitis management
rest, NSAIDs, and physio if symptoms persist beyond 7 days
927
UTI ab and BF
- Trimethoprim: safe - Nitro: avoid due to risk of inducing haemolysis in GDP6 def
928
Patients with a BMI that classifies them as morbidly obese (> 40) are grade ASA
3`
929
ASA 1=
patients who are considered healthy, non-smokers and non-drinkers with a BMI below 30 kg/m
930
ASA 2 =
patients with mild systemic diseases such as those who smoke, engage in social alcohol consumption, are pregnant, have obesity (BMI between 30 and 40), well-controlled diabetes mellitus, hypertension or mild lung disease.
931
ASA 4 =
patients with severe systemic disease that poses a constant threat to life. This includes conditions like ongoing cardiac ischemia or recent myocardial infarction, sepsis and end-stage renal disease.
932
ASA 5=
Patients who are moribund and unlikely to survive without surgical intervention. Examples include individuals presenting with major trauma or significant haemorrhage/bleeding.
933
ASA 6-
A declared brain-dead patient whose organs are being removed for donor purposes
934
ASA 3 =
- A patient with severe systemic disease - Poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents
935
Scoring COPD severity
- FEV1 not FE1/FVC - mild: > 80% - moderate: 50-79% - severe: 30-49% - very severe: <30%
936
Phaemchromocytoma Mx
- alpha-blocker (e.g. phenoxybenzamine), given before a - beta-blocker (e.g. propranolol) - to stabilise before surgery which is definitive
937
If a first line SSRI such as sertraline is ineffective or not tolerated, try
If a first line SSRI such as sertraline is ineffective or not tolerated, try another SSRI or an SNRI for GAD
938
XR findings of psoriatic arthritis
periarticular erosions with bone resoption
939
Erosions with overhanging edges ('rat-bite' erosions)
gout - assoc w tophi
940
cryoprecipitate major comp
factor8 - CryoprecipitEIGHT
941
carotid endartecteromy Ix
Carotid endarterectomy is considered in a patient who has had a TIA with carotid artery stenosis exceeding 50% (NASCET criteria) on the side contralateral to the symptoms
942
thyrotoxic storm tx w
beta blockers, propylthiouracil and hydrocortisone - BPH
943
Which cardiac drug can cause gingival hyperplasia
amlodipine
944
Patients with high oxygen-affinity haemoglobin variants can develop
secondary polycythemia and have increased stroke risk
945
Most common finding with dry age related maculae degen
drusen
946
weakness in index finger flexion following Colles f#
Median nerve injury is a common complication of Colles' fracture - may result in weakness or loss of thumb or index finger flexion
947
ix for erythema nodosum
Serum ACE, sputum culture, and chest x-ray
948
medical management of an incomplete miscarriage involves giving
vaginal misoprostol alone
949
first line for lithium tox
IV saline
950
A 34-year-old man reports the sudden onset of back pain after bending over to tie his shoe laces. There is tenderness over the lumbar spine on examination and leaning back worsens the pain. Neurological examination and straight leg raising is normal
facet joint pain. Not a prolapsed disc due to the normal SLR
951
Which one of the following statements regarding the use of aspirin in patients who have ischaemic heart disease is correct?
All patients with ischaemic heart disease should take aspirin if there is no contraindication.
952
Metformin should be titrated slowly, leave at least? before increasing dose
1 week
953
what should be done everyday for post-op ileus
electrolyte panel
954
The gene encoding ?is mutated in familial hypercholesterolaemia
LDL receptor
955
? hould be suspected in patients with continuous dribbling incontinence after prolonged labour
vesicovaginal fistula
956
? is a serious but rare complication of cataract surgery which needs urgent treatment
post op endophthalmitis
957
surgery done for face cancerd
Mohs micrographic surgery
958
most common causes of nephrotic syndrome in adults
membranous GN or FSGS
959
Calc paed fluid req for non neonates
- 100mL/24 hours for every kilogram from 0-10 kg - 50 mL/24 hours for every kilo from 11-20 - 20 mL per every kilo there after
960
Failure to correct childhood squints may lead to
Amblyopia - lazy eye
961
which contraceptive should be stopped after 50
depo & cocp
962
tertiary hyperparathyroidism is characterised by
extremely high serum PTH with moderately raised serum calcium
963
Malignancy + raised CK → ?
polymyositis
964
Genital wart treatment
-multiple, non-keratinised warts: topical podophyllum - solitary, keratinised warts: cryotherapy
965
HTN before 20 weeks ->
pre-existing HTN
966
Ix to assess for liver cirrhosis
Transient elastography - diagnosing and monitoring the severity of liver cirrhosis
967
how does lantoprost work
Latanoprost is a prostaglandin analog used in glaucoma. It works by increasing uveoscleral outflow
968
Tonsilar SCC is associated with ?infection
HPV
969
Mx of pleural effusion
- pleural aspirate - to determine source - then chest drain
970
Syphilis: ? should be monitored after treatment to assess the response
nontreponemal (RPR/VDRL) titres
971
adequate response to syphylis tX
defined by a fourfold or greater decline in the nontreponemal titre over 6 months in patients with primary, secondary, or early latent syphilis.
972
Rupture of the papillary muscle due to a myocardial infarction →
acute MR → widespread systolic murmur, hypotension, pulmonary oedema
973
Idiopathic pulmonary fibrosis predominately affects the
lower zones
974
CHARTS - upper lobe fibrosis
- Top the charts - C - Coal Worker's Pneumoconiosis H - Histiocytosis A - Ankylosing Spondylitis R - Radiation T - TB S - Sarcoidosis/Silicosis
975
what will be positive in a meniscal tear
McMurays
976
paeds BLS rate and depth
15:2 compressions Rate 100-120 Depth 1/3 of the chest
977
sig RF for frozen shoulder
dm
978
which subset of CCB cause ankle oedema
- nifedipine and amlodepine - Dihydropyridines
979
Mx of nec fac
immediate surgical debridement and IV antibiotics
980
Pneumothorax management: the high-risk characteristics that determine the need for a chest drain are:
- Haemodynamic compromise (suggesting a tension pneumothorax) - Significant hypoxia - Bilateral pneumothorax - Underlying lung disease - ≥ 50 years of age with significant smoking history - Haemothorax
981
All patients with suspected acute pericarditis should have
Transthoracic echo
982
Mx of intercranial N and V
cyclizine
983
Mx of N and V from chemo
apreiptant
984
what cannot be done to detect CO poisoning
pulse oximetry - do an ABG
985
Thiazide like diuretic =
indapemide
986
if SGLT2 inhibitor is being trialled for DM, must
titate metformin up to 1g first
987
arrthymia following MI
usually RCA - II, III, AVF
988
Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness - consider
HUS
989
Lateral epicondylitis worse on
wrist extension/suppination whilst elbow extended
990
step deformity on XR
AC dislocation
991
Hills sachs lesion
Glenohumeral dislocation
992
Most common rotator cuff tear
supraspinatus
993
Vit K for neonates
- can give oral or IM - IM should be recommended to parents due to reduced concerns about compliance and shorter (one-off) treatment duration
994
mx of post-thrombotic syndrome
- compression stockings - following DVT; painful heavy calves, pruitus, swelling, varicose veins, venous ulceration
995
Hypertension + hypokalaemia + hypernatreamia ->
cushings syndrome, primary hyperaldosteronism, or RAS - primary hyperaldosteronism most common
996
? can be used to distinguish vestibular neuronitis from posterior circulation stroke
- HINTS exam
997
erythema nodosum + hypercalcaemia
sarcoid
998
In hypercalcaemia secondary to malignancy what is raised
PTHrP raised PTH low
999
what should be present for ab to be prescribed for tonsillitis
Presence of tonsillar exudate Tender anterior cervical lymphadenopathy or lymphadenitis History of fever Absence of cough Should have 3 of the above
1000
Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension → ?
polycythemia
1001
Mitral stenosis patients who are asymptomatic are generally
monitored and given medical therapy rather than having percutaneous/surgical intervention
1002
Lactose intolerance can be caused by which type of GE
Lactose intolerance can be caused by Giardia lamblia. It decreases the expression of brush-border enzymes in the small intestines
1003
Most commomn side effect of isotret
dry skin
1004
Delusional disorder =
Erotomania (De Clerambault's syndrome) is the presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
1005
when can Anti-TNF be used for AS
Anti-TNF alpha inhibitors should be used in axial ankylosing spondylitis that has failed on 2 different NSAIDS and meets criteria for active disease on 2 occasions 12 weeks apart
1006
Which of the following is a cause of congenital hydrocephalus?
Arnold-Chiari malformation
1007
what suggets a meniscus tear
- Tenderness over the medial joint line suggests a medial meniscus tear. - gradual swelling of joint -> meniscal injury - twisting injury
1008
How do PCL and ACL tears present
rapid joint swelling due to bleeding within the joint capsule (haemarthrosis).
1009
Which one of the following antibodies is most specific for limited cutaneous systemic sclerosis?
anti-centromere - mere and limited mean not very much
1010
? is a normal variant in an athlete
Mobitz type 1 (Wenckebach phenomenon)
1011
U waves on ECG
hypokal
1012
pt with multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck.
Lhermitte sign
1013
cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone ->
cushings disease
1014
Normal waveform timings
- A normal corrected QT interval (QTc) is less than 430 ms in males and 450 ms in females. - A normal PR interval is 120 - 200 ms. - Normal QRS duration is 80 - 120 ms.
1015
sickle cell + fever
admit urgently for a child w sickle cell regardless of how well they look (asplenia)
1016
Achilles tendonitis management:
- rest, NSAIDs, and physio if symptoms persist beyond 7 day - do an US if achilles tendon rupture
1017
Patients who take a staggered paracetamol overdose should receive treatment with
NAC infusion - staggered if all tablets were not taken within1 hr
1018
PMR presentation
- Polymyalgia rheumatic is characterised by abrupt onset of bilateral early morning stiffness in the over 60s - PAIN but NO TRUE weakness - difficulty in rising from seated or prone positions. - weight loss and fatigue common
1019
LTOT requirements for COPD
LTOT if 2 measurements of pO2 < 7.3 kPa
1020
nuclear scintigraphy reveals patchy uptake ->
Toxic multinodular goitre
1021
an MSU should be sent for all women
> 65 with suspected UTI do not dip
1022
Addison's disease management -
hydro + fludrocortisone
1023
At what age would the average child acquire the ability to walk unsupported?
13.5 Months. Refer at 18 months
1024
meconium aspiration syndrome
- common in post term deliveries - resp distress - XR: patchy infiltrations and atelectasis
1025
live attenuated vacicnes =
M - MMR I - Influenza (intranasal) B - BCG O - Oral rotavirus O - Oral polio T - Typhoid Y - Yellow fever
1026
Send an MSU for all women with a suspected UTI if associated with
vis or non-vis haematuria
1027
mx of otitis media if ab are Ix
amox
1028
what is used to assess drug sensitivites in TB
sputum culture - gold standard
1029
non resolving OM with worsening pain ->
refer to ENT urgently
1030
painless genital ulcers
spyhillis, Lmphogranuloma venerum and donovanosis - SDL
1031
Sharp burning pain around the lateral knee joint in runers
iliotibial band syndrome
1032
Mx of TCA OD
- Charcoal if within 1 hr of ingestion - Give sodium bicarb if: - pH < 7.1 - QRS > 160 - arrythmias - hypotension
1033
when can we cardiovert for AF
iF it presents within 48 hrs on onset
1034
what can occur following an inferior MI
AV block - occlusion of RCA -> ischaemia of AV node
1035
pulses to feel in paeds BLS
brachial and femoral - BF
1036
What is the most appropriate time to take blood samples for therapeutic monitoring of digoxin levels?
at least 6 hrs after last dose
1037
NICE recommend that the following patients are given antibiotics to prevent surgical site infection:
clean surgery involving the placement of a prosthesis or implant clean-contaminated surgery contaminated surgery surgery on a dirty or infected wound (requires antibiotic treatment in addition to prophylaxis)
1038
target lesion rash
erthyema muliforme
1039
mutation in CML
Philadelphia chromosome - t(9:22)
1040
MONITORING WITH METHOTREXATE
FBC, U&Es, LFTs
1041
? is an indicator of a severe UC flare-up
fever
Year 4
flashcards
Decks in class (33)
# Cards
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