1
Q
RF for retinal detachment
A
T2DM
2
Q
How to correct hypernatremia espec in kids
A
SLOWLY
3
Q
If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI,
A
Arrange CABG
4
Q
Felty syndrome =
A
RA, splenomegaly and low white cell count
5
Q
During a lower segment Caesarian section, the following lies in between the skin and the fetus:
A
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
6
Q
? can worsen glucose tolerance
A
thiazides
7
Q
gonadotrophin independent precocious puberty
A
- FSH and LH both low
- commonly caused by adrenal hyperplasia
8
Q
Ix of choice for a psoas abscess
A
ct abdo
9
Q
Initial management for epistaxis is
A
adequate first aid- pinch the nasal ala (nostrils) firmly and lean forward for 20 minutes
10
Q
characteristically presents with posterior circulation symptoms, such as dizziness and vertigo, during exertion of an arm.
A
subclavia steal syndrome
11
Q
Aortic stenosis management:
A
: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
12
Q
most common cause of septic arthritis in young pp
A
gonorrhoea (chlamydia for epididmocorhcitis)
13
Q
big RF for retinal detachment
A
myopia
14
Q
Blue sclera + multiple #
A
Osteogenesis imperfecta
15
Q
Surgery / sulfonylureas on day of surgery:
A
- omit on the day of surgery
exception is morning surgery in - patients who take BD - they can have the afternoon dose
16
Q
Rhinitis medicamentosa
A
Rhinitis medicamentosa is a condition of rebound nasal congestion brought on by extended use of topical decongestants - only use for 7 days
17
Q
Following panretinal laser photocoagulation up to 50% of patients have
A
a reduction in visual field
18
Q
Ethylene glycol toxicity management
A
Ethylene glycol toxicity management - fomepizole. Also ethanol / haemodialysis
19
Q
most common cause of mitral stenosis
A
rheum fever
20
Q
ASD vs VSD
A
- ASD: split double
- VSD: very systolic
21
Q
mx of AMI
A
LAPAROTAMY - especially if signs of peritonitis or sepsis
22
Q
erythema marginatum is seen in
A
RF - recent sore throat, chorea (jerk, irregular movements) and polyarthralgia
23
Q
DI visual defect
A
This patient has diabetes insipidus due to a craniopharyngioma. This causes a lower bitemporal hemianopia.
24
Q
what is an absolute contraindication to laparoscopic surgery?
A
acute intestinal obst w dilated bowel loops
25
? passes anterior to the medial malleolus and is commonly used for venous cutdown
long saphenous
26
Co-presentation of iron deficiency anaemia and B12 deficiency anaemia may lead to a normocytic anaemia - differentiated from anaemia of chronic disease due to
low/ normal ferritin and wide distribution of red blood cell volume
27
DCM diagnosis
cannot be diagnosed by XR
28
Renal mass + exposure to chemicals in the textile, plastic and rubber industry.
TCC
29
A 35-year-old male presents with haematuria. He is found to have bilateral masses in the flanks. He has a history of epilepsy and learning disability.
Angiomyolipoma
30
? is associated with a decreased incidence of hyperemesis gravidarum
smoking
31
? is not recommended in the diagnosis of type 1 diabetes
hba1c
32
Blood pressure target (< 80 years, clinic reading) -
140/90
33
The following ECG changes are associated with hypocalcaemia:
corrected long QT
34
Hypokalaemia wave
u
35
proteinuric CKD mx
1) ACE/ ARB
2) SGTL2 inhibitor
36
Preterm infants with haemodynamically significant patent ductus arteriosus 1 week after birth
- give ibuprofen/indomethacin to promote duct closure
37
ASA - current smoking
2
38
Amiodarone test before initiation
- TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
39
Paeds BLS
5 Rescue breaths -> then check pulses -> compressions
40
Patients with end stage renal disease undergoing regular scheduled dialysis are classified as ASA
III
41
Cause of fungal nail infection
trichophyton rubrum
42
antismooth muscle antibodies seen in
autoimmune hep
43
Enteropathic arthritis is a seronegative spondyloarthropathy associated with
HLAB27
44
What is the first sign of puberty in boys?
Increase in tetsicular volume
45
which ab increase risk of IIH
TETRACYCLINES
46
Anisocoria worse in bright light implies a problem wit
the dilated pupil - right ciliary ganglion if the right pupil is dilated
47
twisting knee injury ->
meniscal tear
48
multiloculated and heterogenous cyst above the hyoid bone
Dermoid cyst`
49
A 16-year-old boy presents with renal colic. His parents both have a similar history of the condition. His urine tests positive for blood. A KUB style x-ray shows a relatively radiodense stone in the region of the mid ureter.
CYSTEIENE
50
Paracetamol OD: ongoing raised ALT despite NAC
Continue NAC and consult hepatologist
51
Hypocalcaemia: prolonged QT interval is an indication for
urgent IV calcium gluconate
52
what is not seen in panc
jaundice
53
Hypsarrhythmia on EEG suggests
wests syndrome - infantile spasms
54
Benign rolandic epilepsy
- focal symptoims
- including paraesthesia on one side of a child's face or mouth
- twitching
55
first line in occult hip fracture
MRI
56
Ptosis ->
CN3
57
HZO occular comp
anterior uveitis
58
dactylitis is seen with
reactive arthritis
59
Epigastric pain + steatorrhoea → ?
CP
60
MX of asymptomatic bilateral hilar lymphadenopathy.
no Tx
only treat sarcoid with pred if symptomatic
61
which antihypertensives interact with lithium
Diuretics, ACE-inhibitors and angiotensin II receptor antagonists
62
what to monitor with HUS
blood pressure and urinanalysis should be monitored to detect progressive renal involvement
63
Acute cholesystitis tx
intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis
64
The most common causes of viral meningitis in adults are
enterovirus
65
HIV seroconversion occurs from ? weeks
3-12
66
Complete heart block following an inferior MI is NOT an indication
for pacing
BUT CHB following anterior MI IS!!!!
67
URETHRAL INJURY
Urinary retention, blood at the urethral meatus and a high riding prostate on digital rectal examination are the typical features.
68
Inferior homonymous quadrantanopias are caused by lesions of the
Superior optic radiation of parietal lobe
69
? is often the most effective treatment for prominent telangiectasia in rosacea
laser therapy
70
HIV, neuro symptoms, headache, CSF India ink positive
cryptococal meningitis
71
What is the most appropriate way to confirm a diagnosis of pertussis?
per nasal awab
72
school exclusions
Scarlett fever: 24hr after Abx
Infleunza: After recovered
Chicken pox: When crusted over (usually 5 days after)
Rubella: 5 days from onset of rash
Mumps: 5 days from swollen glands
Measles: 4 days from onset of rash
Whooping cough (21 days from onset Sx or 48hrs after Abx)
Diarrhoea & Vomiting: 48 hours from settling
Impetigo: 48 hours from Abx or lesions crusted over
Scabies: Until treated
73
Low levels of which one of the following types of complement are associated with the development of systemic lupus erythemato
c3 an 4
74
can be used to guide whether patients with acute bronchitis require antibiotics
CRP
75
Syringe drivers: respiratory secretions & bowel colic may be treated
hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide
76
tx of pseudogout
same as gout - NSAID and colchicine
77
statin monitoring
lfts at baseline, 3m, 12m
78
which bb causes long qt
sotalol
79
what should be done before starting trastuzumab
echo - cardiotoxic
80
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler then
do immediate US
81
compressions and ventilations at a rate of ? newborns
3:1
82
adenoma sebaceum
benign tumour growth seen with tuberous sclerosis
83
1st stage labour
latent phase = 0-3 cm dilation
active phase = 3-10 cm dilation
84
1st line of treatment for blepharitis is
hot compresses
85
Adrenaline induced ischaemia mx
phentolamine
86
mx of dry AMRD
There is no curative medical treatment for dry AMD. High dose of beta-carotene, vitamins C and E, and zinc can be given to slow deterioration of visual loss
87
What can be diagnosed prenatally
A1AT deficiency
88
best site of access for PCI
radial artery
89
If eosinophil count/FeNO do not confirm suspected asthma, and spirometry is not available then
measure peak expiratory flow (PEF) twice daily for 2 weeks
90
When prescribing fluids, the glucose requirement is
50-100g/day regardless of weight
91
severe CP and neuro signs
aortic dissection e.g. horners syndrome
92
? is required in the investigation of all patients presenting with an AKI of unknown aetiology
renal US within 24 hrs
93
pt found to be MRSA + in pre-opp
Nasal mupirocin + chlorhexidine for the skin.
94
positive head inpulse ->
peripheral cause of vertigo - posterior stroke rules out
95
mx of opiate detox
methadone or buprenorphine
96
ectopic and PID
do salpingotomy > salpingectomy due to tube damage
97
Spirometry in obese
- FEV1 and FVC reduced
- Normal FEV1/FVC ratio
- reduced exp reserve volume!!!
98
break bone fever
fever and severe muscle ache - dengue
99
thiazides and calcium
hypercalcaemia and hypocalciuria
100
Long QT syndrome - usually due to loss-of-function/blockage o
K+ channels
101
mx of empyema
prompt chest tube drainage and ab
102
COPD does not causef
CLUBBING
103
Decreasing vision over months with metamorphopsia and central scotoma should cause high suspicion of
wet age related macular degen
104
Palivizumab
monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.
105
mx of TLS
IV fluids and IV rubricase
106
One of the cardiac complications of Ehler-Danlos is
Aortic regurg
107
is a risk factor for the development of osteoporosis and used in the FRAX assessment tool
RA
108
Most common cause of endocarditis:
Staphylococcus aureus
Staphylococcus epidermidis if < 2 months post valve surgery
109
is a cause of recurrent watery or sticky eye in neonates and usually, self-resolves by 1 year of age
Nasolactrimal duct obs
110
labetolol
used in phaechromocytima - blocks A and B receptors
111
post splenectomy sepsis
SMH - strep pneumonia, haemophilus, menigocci
112
Globus, hoarseness and no red flags → ?
reflux
113
target sign on US
intusseception - Pneumatic reduction under fluoroscopic guidance
114
COPD and Ph
the use of NIV in COPD shows that patients with a pH in the range of 7.25-7.35 achieve the most benefit. If the pH is < 7.25 then invasive ventilation should be considered
115
Disseminated gonococcal infection triad =
tenosynovitis, migratory polyarthritis, dermatitis
116
impaired fasting glycaemia
fasting plasma glucose level between 6.1 mmol/l and 6.9 mmol/l
117
Impaired glucose tolerance
IGT is diagnosed when 2-hour plasma glucose levels during an OGTT are between 7.8 and 11.mmol/l.
118
mx of AS
NSAIDs and physio -> entanercept (TNFa blocker)
119
how long does POP take to become effective
48 hrs
120
Slow growing, painless, mobile lump in the parotid gland of older female → ?
pleomorphic adenoma
121
is by far the most common form of lymphoma in the UK
diffuse large B cell
122
Wernicke's aphasia is due to a lesion of the
superior temp gyrus
123
Genital warts - 90% are caused by
6 and 11
124
mx of acute sinusitis
- Consv, analgesia
- intranasal steroids if symptoms more than 10 days
125
public lice mx
malathion or permethrin
126
small cell cancer, sudden confusion
ADH -> SIADH -> cerebral oedema
127
Which is the best assessment tool for differentiating between stroke and stroke mimics?
ROSIER
128
Tonic or atonic seizures first line in females
lamotrigine
129
distended abdomen and bilious vomiting
intestinal malrotation
130
A 1-day old child is born by emergency cesarean section for foetal distress. On examination, he has decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen but is otherwise unremarkable.
CDH
131
hrt and surg
stop 4 weeks before
132
Renal impairment, flank masses, hypertension → ?
AKPD
133
? requires therapeutic monitoring in patients with renal failure
vancomyci
134
Treatment for Wilson's disease is currently
penicillmine
135
Patients with stable CVD who have AF are generally managed on
Patients with stable CVD who have AF are generally managed on an anticoagulant and the antiplatelets stopped
136
DVT + ckd
UFH or dose adjusted LMWH
137
which anaesthetics cause malignant hyperthermia
Volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane)
138
Lithium toxicity can be precipitated by
nsaida
139
Pituitary gland tumour VFD
Pituitary gland tumour
PITS- (Parietal-Inferior, Temporal-Superior) and (PITuitary Superior)
140
Patient who has had an extensive stroke with right-sided hemiplegia
right homonomyous hemianopia
141
sign differentiates between organic and non-organic lower leg weakness
Hoovers
142
?score is recommended by BTS guidelines to be used to help identify patients with a pulmonary embolism that can be managed as outpatients
pulmonary embolism severity index
143
lupus AB
Most sensitive antibody = ANA - ana is sensitive
Most specific antibody = dsDNA - DNA has a very spec sequence
144
? is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma
biliary stenting
145
Kallmans syndrome
LH & FSH low-normal and testosterone is low
146
klinefelter vs kallman
FSH/LH fall in Kallman's
FSH/LH climb in Klinefelter's
147
giving a shock in a periarrest sit ->
unsynchronised
148
stopping AED
can be cons if seizure free >2yrs with AEDs stopped over 2-3m
149
The most common secondary brain tumours ar
lung, breast, kidney, melanoma and colorectal cancers metastases
150
? may normally have carboxyhaemoglobin levels of up to 10%
smokers
151
corneal ulcer. Which of the following is most likely to have resulted in this developing?
steroid eye drops -> fungal infections -> corneal ulcers
152
A 50-year-old man who, on examination, you notice his jaw appears deviated towards the right and he has an absent right-sided corneal reflex.
trigeminal
153
vertical diplopia
trochlear nerve
154
A 72-year-old man who has noticed a change in his voice with some difficulty swallowing. On examination, you notice his uvula deviates towards the right.
vagus (left side)
155
umbilical hernia mx
watch and wait - mos resolve by 12 months
156
should be performed in patients with suspected acute angle-closure glaucoma
tonometry and gonioscopy
157
ADPKD is associated with (cardiac)
MVP
158
Diastolic murmur + AF → ?
mitral stenosis
159
subacute cord degen reflexes
- hypereflezia
- loss of prop & vibration sense
160
? can cause hyperkalaemia
heparin - suppresses aldosterone
161
Asymptomatic renal stones < 5mm are generally managed with
watchful waiting
162
proliferative diabetic retinopathy mx
Intravitreal VEGF inhibitors may be used in addition to panretinal laser photocoagulation
163
mneumonic for paeds red flags
Really Sick Babies Get Antibiotics
1. Recessions (moderate or severe chest wall recessions)
2. Skin turgor reduced
3. Blue or mottled appearance
4. Grunting
5. Asleep (does not wake if aroused)
164
mx of organophosphate poisoning
IV atropine - a for O
165
Cervical cancer screening: if two consecutive inadequate samples then →
colp
166
) are the investigation of choice in genital herpes
NAAT
167
are used to detect occupational asthma
Serial peak flow measurements at work and at home are used to detect occupational asthma
168
Water deprivation test: primary polydipsia
urine osmolality after fluid deprivation: high
urine osmolality after desmopressin: high
169
Nebulised ipratropium bromide should be given to all patients with
severe/ life threatening asthma
170
hyperaldosteronism ABG
met alkalosis and hyperkalaemia
171
Surgery / sulfonylureas on day of surgery:
omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose
172
Metastatic malignancy can cause
addisons dx
173
Patients with MI secondary to cocaine use should be given
Patients with MI secondary to cocaine use should be given IV benzodiazepines as part of acute (ACS) treatment
174
mx of TD vs acute dystonia
Tardive dyskinesia - Tetrabenezine (both Ts)
Acute dsYtonia - procYclidine (loose Y soz)
175
Neurogenic thoracic outlet syndrome typically presents with
Neurogenic thoracic outlet syndrome typically presents with muscle wasting of the hands, numbness and tingling and possibly autonomic symptoms
176
which type of anaemia is CLL assoc w
warm
177
mx of MS
Percutaneous mitral commissurotomy is the intervention of choice for severe mitral stenosis
178
Prehn's sign
In testicular torsion the elevation of the testis does not ease pain compared to epididymitis (Prehn's sign)
179
Heart valve target INR
aortic: 3.0 Audi A3
mitral: 3.5
180
cocp and postpartum
The combined oral contraceptive pill CAN be given if requested 6 weeks postpartum even if breastfeeding. BUT they can get pregnant from day 21 postpartum so if they have had unprotected intercourse from day 21 postpartum, a pregnancy test should be performed first
181
adrenaline in ALS
In ALS, once adrenaline has been initially given it should be repeated every 3-5 minutes whilst ALS continues
182
Swabs for chlamydia and gonorrhoea in women should be taken from t
Swabs for chlamydia and gonorrhoea in women should be taken from the vulvo-vaginal area (introitus)
183
antihypertensive which causes heart racing
nifedipine - vasodilator -> tachycardia
184
tx of non-falciparum malaria t
primaquine (prevent relapse) and cholorquine
185
jaundice + splenomegaly
malaria
186
preferred method of induction of labour if the Bishop score is > 6
amniotomy and IV oxytocin
187
triad of pierre robin syndrome
iad of micrognathia (undersized jaw), glossoptosis (posterior displacement of the tongue) and cleft palate.
188
mx of acute COPD
- oral pred 5 days
- oral ab if signs of infection like purulent sputum or clinical signs of pneumonia
189
most common complication of thyroid eye disease
exposure keratopathy
190
mx of bronchtitis
doxy first line IF co-morbidities
191
warfarin - INR above 8
All patient with an INR above 8.0 should have medical reversal of warfarin with either vitamin K or prothrombin complex concentrate, depending on clinical picture
192
Systolic murmurs
MR AS
193
PICA mneumonic
'PICA can't chew' because they present with dysphagia, cause loss of PAIN
194
AICA =
ai caN'T HEAR YOU
195
signs of placental praevia
The purple lesions noted on the abdomen are the striae gravidarum and the dark line running vertically down the middle of the abdomen is the linea nigra.
196
palpitations, agitation, chest pain, mydriatic pupils, and elevated pulse rate
cocaine
197
definitive Tx for wet AMDR
VEGF
198
gene mutations are associated with hereditary non-polyposis colorectal carcinoma
MSH2/ MLH1 genes
199
FAP gene
APC
200
vaccine should be offered to patients with chronic hepatitis
one off pneumococcal
201
A 57-year-old man is coming off the cardiac bypass circuit following a successful coronary artery bypass procedure. Which drug should be administered to normalise the patients clotting prior to decannulation and chest closure?
protamine sulphate - high doses of heparin are used
202
conduction aphasia brain area
Aphasia -> Arcuate fasiculus
203
camp diarrhoea
s characterised by a prodrome, abdominal pain and bloody diarrhoea
204
constrictive pericarditis vs cardiac tamponade
Kussmals sign - JVP that does not fall with inspiration -> const pericarditis
205
Disproportionate microcytic anaemia - think
beta thalassemia trait
206
INR < 2
increase warfarin dose + start low LMWH
207
which antihypertensive can cause gingival hyperplasia
amlodpine
208
PDE5 CI
nitrates and nicronadil
209
syphyllis testing
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)
210
wilsons blood test
reduced serum copper and reduced caeroplasmin - copper is deposited into tissues
211
liver transplant criteria
Arterial pH < 7.3, 24 hours post-ingestion
OR
Prothrombin time > 100 seconds AND
Creatinine > 300 µmol/l AND
Grade III or IV encephalopathy
212
panc in men can be caused by
SV
213
most reliable method to assess a patient's response to hepatitis C treatment
iral l,oad
214
dry gangrene
Dry, shrivelled, and blackened tissue, painless. Clear demarcation between healthy and necrotic tissue → dry gangrene
215
wet gangrene
Results from a sudden lack of blood supply combined with bacterial infection.
Appearance
Swollen, moist, and blistered tissue with a foul odour.
Rapid spread and marked systemic symptoms such as fever and malaise.
Severe pain and erythema around the affected area.
Progresses rapidly and can lead to systemic sepsis.
216
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is negative then t
senital node biopsy should be done
217
Purposefully causing symptoms, for example a diabetic taking too much insulin to cause hypos, is an example of
muchausens
218
initial negative HIV test->
After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at 12 weeks
219
Water deprivation test: nephrogenic DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: low
220
mx of proximal scaphoid pole #
all require surgery
221
eGFR variables
CAGE - Creatinine, Age, Gender, Ethnicity
222
In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →
end colostomy
223
asymptomatic BV
Women with asymptomatic bacterial vaginosis do not usually require treatment unless they are undergoing termination of pregnancy
224
What can be done while awaiting C section in UC[
Retrofilling the bladder with 500-700ml of saline may be helpful in umbilical cord prolapse
225
Levonestrogel dosage
dose should be doubled to 3mg levonorgestrel for those with a BMI >26 kg/m2 or weight over 70kg
226
when can IUD be used
The copper intrauterine device can be used as emergency contraception if it is inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date.
227
Hypertonic saline (typically 3% NaCl) is usually indicated in patients with
Hypertonic saline (typically 3% NaCl) is usually indicated in patients with acute, severe, symptomatic hyponatraemia (< 120 mmol/L)
228
Heparin-induced thrombocytopenia: anticoagulation can be provided by
direct thrombin inhibitor
229
most common cause of secondary HTN
primary hyperaldosteronism
230
If fibrinolysis is given for an ACS, an ECG should be repeated after
60-90 min
231
AAlpots ->
Alports syndrome --> all ports affected: eyes, ears, urinary (renal).
232
rf
sore throat, migratory joint pains involving large joints such as knees, hips and ankles, pink ring-shaped lesions on the trunk (erythema marginatum), and jerking movements of the face and hands (Sydenham chorea) are all characteristic features of rheumatic fever.
233
malbs can be caused by chronic ? infection
Giardia
234
Those with a positive family history of glaucoma should be screened annually from aged
40`
235
basic airway in a cervical spine injury
jaw thrust > head tilt chin lift
236
side of haematoma and CNIII palsy
SAME SIDE AS BLEED
237
is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state
SERUM OSMOLALITY
238
MECHANICAL HV MED
WARFARIN
239
BIPROSTHETIC/ BIOLOGICAL HV
- usually bovine
- most older patients receive this
- long term AC not required but low dose aspirin given long term
240
mechanical valves
- young patients
- usually bileaflet
- low failure rate comp to biological
241
when is clozapine Ix
1)cases of treatment resistant schizophrenia
2) cases where patients experience negative symptoms
242
can frequently mimic a pneumothorax and therefore should be differentiated carefully when chest radiography in a smoker presents with large lucent areas.
large bullae in COPD
243
A decrease in night vision is a potential complication of
Panretinal photocoag
244
neuropathic pain drugs
Don't - Duloxetine
Get - Gabapentin
Pain - Pregabalin
Again - Amitriptyline
245
Acute heart failure not responding to treatment - consider
CPAP
246
Retinopathy of prematurity
- babies b4 32 weeks
- over oxygenatiion during ventilation ->roliferation of retinal blood vessels (neovascularization)
247
Thrombotic crises in sickle cell can be precipitated by
infection, dehydration or deoxygenation
248
mx of sus meningoencephalitis
Whilst awaiting the lumbar puncture results, IV antibiotics and IV antivirals should be started,
249
lymphocytes and low glucose ->
TB or cryptococcal
- cryptococal: v low CD4 count and raised opening pressure
250
ARound 50% of cord prolapse occurs after
artificial rupture of membranes
251
LP in SAH
The presence of red blood cells in CSF may be due to traumatic tap. The presence of breakdown products of RBC in CSF is indicative of a SAH
252
ACE i and surgery
stop 24 hrs before major surgery
253
ALS - pulesless elecrical activity
do not give atropine. Do CPR and adrenaline, check rhythm every 2 min
254
X-rays should not be taken of obvious ankle injuries if
NV compromise - immediately reduce the injury
255
Blunt ocular trauma with associated hyphema is a high-risk scenario of
raised IOP
256
RASH SEEN IN HSVr
erythema multiforme - bullseye
257
periarticular erosions ->
RA
258
Wet AMDR is characterised by
choroidal neovascularisation
259
roseola infantum
- hsv6
- 3-5 day high fever
- rash starts when fever is settling -> maculopapular rash which starts on the chest and spreads to limbs
260
which type of vit D given in CCKD
Alfacalcidol is used as a vitamin D supplement in end-stage renal disease because it does not require activation in the kidneys
261
After a change in dose, lithium levels should be taken
a week later and weekly until levels stabilise
262
calcium acetata
calcium binder used to treat hyperphosphateaemia -> hypercal
263
which nerve carries impu;se for cremasteric reflex
genitofemoral
264
paranoid PD
patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others
265
lithium and BF
MUST AVOID
266
KAWASAKI MNEUMONIC
CRASH and Burn:
Conjunctivitis & cervical lymphadenopathy
Rash
Adenopathy
Strawberry tongue
Hands and feet redness/peeling
Burn = fever > 5 days
267
Patients suffering from C. difficile need isolation for at least
48 hrs
268
mx of bronchitis
- delayed ab if: CRP 20-100
- ab if CRP > 100
- doxycycline
269
Severe hepatitis in a pregnant woman - think hepatitis
E
270
innocent murmurs
Soft, Systolic, Short, Symptomless, Standing/Sitting (vary with position).
271
Light's criteria: Effusion LDH level greater than
Light's criteria: Effusion LDH level greater than 2/3rds the upper limit of serum LDH points to exudate
272
is the commonest association for aortic dissection
HTN
273
which antihypertensive should be avoided in diabetics
thiazides - worsen glucose tolerance
274
latent TB Mx
rifampicin + isoniazid with pyroxidine for 3 months
275
active TB mx
- RIPE: 4 months
- RI: 2 months
276
Progressively worsening headache with higher cognitive function impaired =
do CT
277
NSTEMI (managed conservatively) antiplatelet choice
- aspirin, plus either:
- ticagrelor, if not high bleeding risk
- clopidogrel, if high bleeding risk
278
Facial rash plus lymphadenopathy think
sarcoid
279
. Levels of which one of the following should be checked four months later to ensure an adequate response to immunisation?
Anti-Hbs
280
mx of refractory anaphylaxis
IV adrenaline (under expert guidance) + IV fluid bolus are used for the management of refractory anaphylaxis
281
Lithium toxicity can be precipitated by
NSAIDs (impaired renal function)
282
how to confirm sickle cell diagnosis
serum electrophoresis
283
Tx of hyperphosphateamia with CKD
- Low P diet
- phosphate binders like sevelamer
284
Pleural effusions in SLE: fluid typically shows
low complement levels
285
osteomyelitis site in kids bones
Children = M inors = M etaphysis
Adults = E lders = E piphysis
286
insulin in DKA
In the acute management of DKA, insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
287
RF for lithium toxicity
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
288
initial step for manging acute urinary retention
catheter
289
All patients with severe hyperkalaemia (≥ 6.5 mmol/L) or with ECG changes:
- IV calcium gluconate
- insulin/dextrose infusion
290
ABCD2
used to assess a patient's stroke risk after a transient ischaemic attack.
291
Preventing sickle cell crisis
hydroxyurea
292
in mitral stenosis ? indicates that leaflets still have some mobility
opening snap
293
antiplatelets and dental extraction
continue aspirin as normal
294
CKD on haemodialysis - most likely cause of death is
IHD
295
Glaucoma definitive tx
acute glaucoma: iris pushed forward preventing drainage -> iridotomy - AI
open-angle: trabecular meshwork blocked -> trabeculoplasty - OT
296
Seminomas and teratomas
- 'Teratomas for the troops (20-30), - terrible (AFP and HCG rasied as with yolk sac)
- Seminomas for the Sergeants (30s/40s onwards) - sargeants dont make mess - normal tumour markers
297
In the emergency department, suspected scaphoid fractures should be managed with
In the emergency department, suspected scaphoid fractures should be managed with immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
298
In a very athletic woman, ?is a common cause of secondary amenorrhoea
hypothalamic hypogonadism
299
SS mx
- supportive including IV fluids
- benzodiazepines
- more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
300
staging of ovarian cancer
301
ALL poor prognostic factors
- Male
- age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-white ethnicity
302
reversible cause of PEA in cardiac arrest resulting from trauma
tension pneumothorax - Cardiac outflow obst
303
spinal cord compression
- severe back pain often worse at night
- progressive neuro deficits: weakness, sensory loss, bladder dysfunction
- positive babinski sign and perianal sensory loss
304
Positive babinski is not seen in
a LMN lesion like CES
305
UC flare imaging
- Abdo XR if toxic megacolon
- Colonoscopy if no toxic megacolon
306
is required in the investigation of all patients presenting with an AKI of unknown aetiology
Renal US
307
Wellens syndrome ECG
ECG finding of deeply inverted or biphasic waves in V2-3 in a person with the previous history of angina is characteristic of Wellen's syndrome. This is highly specific for a critical stenosis of the left anterior descending artery
308
PTOSIS
- Ptosis + dilated pupil = third nerve palsy;
- ptosis + constricted pupil = Horner's
309
mx of crises
Akathisia - propranolol
Acute dystonia - procyclidine.
Tardive dyskinesia - tetrabenazine.
NMS - dantrolene, bromocriptine.
SS - cyproheptadine.
310
which type of lung cancer causes gynaecomastia
adeno
311
Period of hypotension followed by renal impairment with urinary casts →
ATN
312
Gastroparesis with diabetes
- occurs secondary to autonomic neuropathy
symptoms include erratic blood glucose control, bloating and vomiting
management options include metoclopramide, domperidone or erythromycin (prokinetic agents)
313
urine output of ? classifies AKI
Urine output of < 0.5 ml/kg/hr over 6 consecutive hours constitutes an acute kidney injury
314
Recent sore throat, rash, arthritis, murmur → ?
RHEUM FEVER
315
mx of rheum fever
IM benp/ oral penicillin V
316
Silent chest ->
life threatening
317
swollen pale optic disc with blurred margins
optic neuritis
318
which prostate cancer drug can cause tumour flare
GnRH agonists may cause 'tumour flare' when started, resulting in bone pain, bladder obstruction and other symptoms
319
who should get IV dex with meningitis treatment
Anyone presenting with meningitis who does not have either meningococcal septicaemia (a non-blanching purpuric rash), septic shock, is recently out of surgery or immunocompromised, should receive intravenous dexamethasone
320
which anti diabetic can be safely used in ESRD
LINAGLIPTIN
321
when are SGLT2 CI
GFR < 30 and recurrent thrush
322
what can be seen on CT for stroke
In acute ischaemic stroke, a 'hyperdense artery' sign may be seen on CT - this is usually visible immediately in contrast to changes in the parenchyma
323
pneumonia after influenza ->
staph a!
324
Glaucoma and visual defects
Primary open-angle glaucoma is characteristically associated with myopia (near-sightedness, where far away objects look blurred).
Acute angle closure glaucoma is associated with hypermetropia (far-sightedness, where near objects look blurred). - If a child is hyper, they're acutely annoying? Hypermetropia = acute angle
325
RF for psoriatic arthritis
CVD
326
What does the BCG vaccine prevent kids against
TB meningitis (not primary TB infection)
327
medical TOP
- mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins (e.g. misoprostol) to stimulate uterine contractions
- mimicks miscarriage
328
Pneumonia, peripheral blood smear showing red blood cell agglutination →
Mycoplasma pneumonia
329
Aortic idissection Ix
CTA- chest abdo pelvis
330
MND increases risk of which type of dementia
FTD
331
EBSTEINS ANOMALY
- lithium in pregnancy
- tri regurg and tricuspid stenosis
- enlarged RA
332
If a woman with known placenta praevia goes into labour (with or without bleeding) ->
DO A C SECTION
333
which airway is best for an unconsious snoring pt
OP airway
334
mx of DI
nephrogenic: thiazide
Neurogenic: desmopressin
335
first lines for spasticity in MS
Baclofen and gabapentin are first-line for spasticity in multiple sclerosis
336
Trichomonas vaginalis + bacterial vaginosis are associated with a pH
> 4.5
337
Young adult with hypertension, systolic murmur → ?
Coarctation of aorta
338
causes of ortho hypotension
Orthostatic hypotension may be exacerbated by venous pooling during exercise (exercise-induced), after meals (postprandial hypotension) and after prolonged bed rest (deconditioning)
339
? is useful in the management of Crohn's patients who develop a perianal fistula
oral metronidazole
340
indication for emergency valve replacement surgery in IE
Infective endocarditis causing congestive cardiac failure is an indication for emergency valve replacement surgery
341
Mobile trophozites on swab ->
trichomonas vaginalis -> oral metro
342
Risk factors for the development of GAD include;
Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent
343
Man returns from trip abroad with maculopapular rash and flu-like illness - think
serocoversion
344
Subclinical hypothyroidism with TSH level of level is 5.5 - 10mU/L:
offer patients < 65 years a 6-month trial of thyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms
345
mcrobers manouvre
346
UCP position
all 4s
347
Asymptomatic MS
Mitral stenosis patients who are asymptomatic are generally monitored and given medical therapy rather than having percutaneous/surgical intervention
348
Cradle cap Mx
baby shampoo and baby oil
349
ITP in kids mx
none - self resolves (steroids in adults)
349
what is coarctation of aorta assoc w
bicuspid aortic valve
350
drug used to reduce alcohol craving, taken 3x day
acamprosate
351
sublingual tablet for opiate dependence
buprenorphine
352
Secondary amenorrhoea: low-level gonadotrophins indicate a
Hypothalamic cause
353
SVCO mx
dexamethasone
354
Patients with moderate acute severe asthma should be admitted to hospital in the presence of
prev near fatal attack
355
The main complication of induction of labour is
uterine hyperstim
356
Young adult with sore throat, fever, lethargy, cervical lymphadenopathy persisting > 1 week → ?
- mono
- rest and analgesia - VIRAL SO NO AB
357
Secondary management of MI - CRABS
Clopidogrel
Ramipril
Aspirin
Beta-blocker
Statin
358
SSRI use in first trimester - small increased chance of
congenital HD
359
Mx pf brain abscess
IV ceftiazone and metronidazole
360
testing b4 tb tx
U and Es, LFTs, vision, FBC
361
Painless, asymmetrical lymph node swelling in the neck → ?
Hodgkins lymphoma
362
In cases of hypothermia causing cardiac arrest, defibrillation is less effective and only 3 shocks should be administered before the patient is rewarmed to
30 degrees
363
first line for POAG
lantoprost
364
POAG VS COAG mx
-Open-angle glaucoma: latanoprost or timolol drops, then both together; then add dorzolamide drops then brimonidine drops as needed.
-Closed-angle glaucoma: lie patient flat, then give pilocarpine drops plus oral acetazolamide together
365
migraine triggers
CHOCOLATE is useful for remembering the common precipitants.
Chocolate
Hangovers
Orgasms
Cheese
Caffeine
The oral contraceptive pill
Lie-ins
Alcohol
Travel
Exercise
366
Drug causes of erythema nodosum
Please Stop Colouring - Penicillins, Sulphonamides, COCP
A bit stupid but I like to remember the rash as coloured in red bits, which helps remember
367
Patient with diabetes who have had two hypoglycaemic episodes requiring help needs to
surrender driving licence
368
Soap bubble appearance of bone cancer
giant cell tumour
369
If clopidogrel is contraindicated or not tolerated, give ?for secondary prevention following stroke
aspirin
370
most likely cause of an irregular broad complex tachycardia in a stable patient
AF + BBB
371
ReferRefer a child with glue ear to ENT if a child with glue ear to ENT if
Refer a child with glue ear to ENT if they have persisting significant hearing loss on two separate occasions (usually 6-12 weeks apart
372
In hypothermia, rapid re-warming can lead to
peripheral vasodilation and shock
373
typically presents with ipsilateral pain and in this case, it was the cause of a partial horner's syndrome with ipsilateral ptosis and miosis, in the absence of anhidrosis
CAROTID ARTERY DISSECTION
374
PAINFUL HORNERS =
CAROTID DISSECTION
375
ANTIEMETICS AT EOL
Meto = Motility
Cycl = Central
Hyo = Hurts
Levo, halo, ondans = chemicHOL
376
Localised headache, neck pain, and neurological signs (e.g. Horner's) are indicative of
CAD
377
If a Mirena IUS is inserted for a woman women ≥45 years it is effective until
55
378
if u cant give adenosine for SVT ->
VERAPAMIL
379
MX OF HYPERALDOSTERONISM
- spironolactone
- surgery for unilateral adrenal adeoma
380
The treatment for vaginal vault prolapse is
sacrocolpoplexy
381
mx of post-op ileus
place pt NBM and insert NG tibe
382
Indications for prescribing prednisolone in sarcoidosis: PUNCH
P- Parenchymal lung disease
U- Uveitis
N- Neurological involvement
C- Cardiac involvement
H- Hypercalcaemia
383
third nerve palsy vs horners
Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner's
384
Type of biopsy to confirm celiac
duodenal/ jejenal biopsy
385
HISS --> DC cardioversion
HF, Myocardial infarction, Shock, Syncope
386
ix for surgery in bronchiectasis
uncontrollable haemoptysis and localised disease
387
diabetes - OGTT
Normal <=7.7
Diabetes >=11.1
388
hsp
classically presents with abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs
389
screening dor DDH
< 4.5m: US
> 4.5M: XR
390
UTI in a pregnant woman in the third trimester - use
Amox or cefalexin
391
The rash from pityriasis rosea to resolve in
6-12 weeks
392
hoarse voice after thyroidectomy ->
laryngoscopy
393
Patients on warfarin undergoing emergency surgery -
give 4X PCC if surg can't wait
if surgery can wait 6-8 hrs IV 5mg vit k
394
Hypoxaemia and hypocapnia typical of
PE
395
Mnemonic for the signs and symptoms of endocarditis is “FROM JANE”:
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage (splinter hemorrhages)
Emboli
396
paeds BLS compressions
administer chest compressions over the lower half of sternum using heel of your hand
397
encircling technique
chest compressions on an infant with 2 rescuers
398
chest compressions on an infant - one rescuer
2 fingers technique
399
how long after exp should a HIV test be done
4 weeks -> if - -> repeat test at 12 months
400
acute heart failure + pansystolic murmur after MI
vsd
401
? is CI in AS
nitrates
402
good response to fluid challenge ?
pre-renal
403
use of ? alongside clopidogrel makes it less effective
omeprazole/ esomeprazole
404
screening for HIV test
viral antigen and antibodies
405
CT head in suspected stroke: a hyperdense collection is suggestive of
haemorrhage -> cannot do thrombolysis!!!
406
asbestos spirometry
restrictive deficit (FEV1 - reduced, FVC - significantly reduced, FEV1/FVC - normal or increased
407
? ongoing jaundice and pain after cholecystectomy
gallstones in CBD
408
In diabetic retinopathy, cotton wool spots represent areas of
RETINAL INFARCTION
409
410
anti-coag after catheter ablation fot stroke
risk of stroke is the same - stay on LT AC depending on chadvasc
411
what can be used LT for psoriasis
topical calcipotriol - vit d analogue
412
Facial rash plus lymphadenopathy think
sarcoidosis - raised serum calcium
413
sarcoid vs sle rash
Sarcoid: includes the nose; purple
SLE: spares the nose, red
414
Drug-induced parkinsonism compared to Parkinson's disease:
motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon
415
-navir drugs
'Navir tease a pro' - HIV drugs that end with -navir are protease inhibitors
416
gravir drugs
'It's grave/great you integrate': HIV drugs that end with -gravir are integrase inhibitors e.g. raltegravir
417
locked in syndrome artery
basilar
418
horners eye changes
ptosis, miosis, enpthalmos (sunken eye)
419
urea: creatine ratio
To calculate the urea to creatinine ratio you need to divide the urea by the creatinine divided by 1000. In this case, we need to do 16.1/(123/1000) which gives a result of 131. Urea to creatinine ratio above 100 is a landmark characteristic of a pre-renal acute kidney injury.
420
benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles
venous hum
421
Infective exacerbation of COPD: first-line antibiotics are
amoxicillin or clarithromycin or doxycycline
422
myoclonic seizures
- levetiracetam first line
423
All at-risk drug misusers should be offered vaccination against
hep B and hep A (and tetanus)
THERE IS NO HEP C
424
meningitis in community and allergic to peniicllin ->
use IV chloramphenicol
425
mx of ascending cholangitis
ERCP - relieve obstruction
426
weight bearing following hip surgery
full weight bearing immediately post op
427
early sign of LVF
S3 - gallop rhythm
428
mx of severe candidal nal infection
oral itraconazole
429
? penia is common in active SLE
lymphophenia
430
How is adrebaline given in ALS for anaphylaxis
IM into vastus lateralis
431
pagets disease mx
IV bisphopshonates
432
Undisplaced fractures of the scaphoid waist are typically managed
cast 6-8 weeks
433
Over-replacement with thyroxine increases the risk for
osteoporosis
434
mx of plantar fascitis
- rest
- stretching
- weight loss
435
Elderly patient dizzy on extending neck -
vertebrobasilar ischaemia
436
? key finding suggestive of aortic dissection on CT angiography
false lumen
437
The risk of developing schizophrenia if one monozygotic twin is affected is approximately:
50%
438
Diagnosis of a mesothelioma is made on
histology following thoracoscopy
439
Metabolic side effects of antipsychotics include
Metabolic side effects of antipsychotics include dysglycaemia, dyslipidaemia, and diabetes mellitus
440
mx of lithium tox
- IV fluid resus 1)
- 2) haemodialysis may be needed in severe toxicity: severe toxicity with levels > 4.0 mmol/L, significant renal impairment, or when there are life-threatening features like seizures and comas
441
blue vision ->
viagra - blue pill
442
thyrotoxicosis - cardiac SE
high output CO
443
What must be repeated after treating UTI in PW
msu - test of cure
444
Epistaxis that has failed all emergency management may require
ligation of the sphenopalatine artery in theatre
445
What warrent surgent opthalmolgy ref in shingles
Hutchinson's sign: vesicles extending to the tip of the nose. This is strongly associated with ocular involvement in shingles
446
most effective intervention in dry ARDMR
STOP SMOKING
447
Signs of right-sided heart failure are
raised JVP, ankle oedema and hepatomegaly
448
Jarisch-Herxheimer reaction
Fever, rash, chills and headache occurs following antibiotic administration for syphilis
449
important component of knee and hip osteoarthritis
Local muscle strengthening exercises and general aerobic fitness is an important component of knee and hip osteoarthritis
450
weaning off long term ventilation ->
tracheostomy
451
In tonsillitis, uvular deviation may indicate development o
quinsy
452
Below are the x-ray findings you would see in heart failure:
Alveolar oedema (bat's wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
453
Red or black lump, oozes or bleeds, sun-exposed skin
nodular melanoma
454
HIV, neuro symptoms, single brain lesions with homogenous enhancement -
cns lymphoma
455
SPECT + vs SPECT - brain lesion
lymphoma: SPECT positive
Tox: SPECT -
456
MX OF PANC PSEUDOCYST
CONSERVATIVE - DO NOT DRAIN INITIALLY
457
Thinning of pubic and axillary hair is seen in females with
Thinning of pubic and axillary hair is seen in females with Addison's disease due to reduced production of testosterones from the adrenal gland
458
Myeloma without metastasis is characterised by
Myeloma without metastasis is characterised by high calcium, normal/high phosphate and normal alkaline phosphate
459
PSORIATIC ARTHRITIS XR
Erosions and new bone formation at distal interphalangeal joints
460
effective and commonly used method of analgesia for patients with a neck of femur fracture
ILIOFASCIAL NERVE BLOCK
461
462
? SHOULD BE AVOIDED IN HF
VERAPAMIL - WORSENS CARDIAC FUNCTION
463
If a combined HIV test is positive it should be repeated to
Confirm the diagnosis
464
When switching from an IUD to COCP no additional contraception is needed if
removed on day 1-5 of cycle. COCP is immediately effective on days 1-5 of cycle
465
Kussmals sign
- JVP increases with respiration
- seen in constrictive periarditis
466
what should JVP do with inspiration normally
fall due to reduced thoracic pressure
467
Persistent ST elevation following recent MI, no chest pain -
left vent aneurysm
468
More than 35 years old and smoking more than 15 cigarettes/day is an absolute contraindication to
COCP
469
UTI < 3 MONTHS
REFER TO HOSP IMMEDIATELY
470
Compartment syndrome is most commonly associated with which #
supracondylar and tibial shaft fractures
471
All proximal scaphoid pole fractures require
Proximal scaphoid pole # -> surgical fixation
472
It is important to reduce an ? as soon as possible due to risk of damage to the skin
ankle #
473
monteggia vs galeazzi #
MU-GR : Monteggia --> ulna fracture , Galeazzi --> radical fracture
474
joint aspiration in reactive arthritis
cloudy yellow, culture -, WCC 20,000
ORGANISM CANNOT BE RECOVEEED FROM THE JOINT - IF IT CAN ITS SEPTIC ARTHRITIS
475
An asymmetrical presentation suggests
PA > RA
476
Radial tunnel syndrome presents similarly to
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
477
SJOGERNS MX
- artifical saliva and tears
- pilocarpine to produce saliva
478
mx of renal comps of systemic sclerosis
captopril
479
Renal impairment, respiratory symptoms, joint pain, systemic features → consider
cANCA vasculitis
480
tibia displaces post on application of force ->
PCl TEAR
481
Triad of fat embolism
- Respiratory
- Neurological
- Petechial rash (tends to occur after the first 2 symptoms)
482
Trauma + petechial rash -->
fat embolism
483
investigation of choice for avascular necrosis of the hip
MRI
484
BLOOD RESULTS IN OSTEOGENESIS IMPERFECTA
EVERYTHING NORMAL- PERFECR BLOOD RESULTS
485
Mx of APS with no prev thrombosis
daily low dose aspirin
486
Year 4
flashcards
Decks in class (33)
# Cards
-
Sexual health82
-
Flashcards17
-
child health65
-
Child health277
-
H&S4
-
child health278
-
Child Health 2339
-
Child health 3316
-
ENT280
-
Womens Health Pharmacology141
-
ENT/Opthalmology Pharmacology78
-
Neurology/ MSK Pharmacology168
-
PassMed449
-
Passmed 2436
-
Formatives62
-
PassMed 3776
-
Passmed 41041
-
PassMed 5481
-
CH ppt163
-
Basic principles HS493
-
PassMed 6857
-
CH HS198
-
Elderly Neuro MSK HS247
-
Womens Health H&S169
-
Acute Care H&S82
-
Block 31 H&S222
-
CAT8
-
PassMed 7487
-
Block 32 PPT200
-
Elderly MSK Neuro PPT231
-
Womens Health PPT178
-
Acute PPT148
-
stroke14
