ALL Flashcards
what angina medication can exacerbate GI ulceration?
nicorandil
- Patients with diverticular disease are at particular risk of bowel perforation during nicorandil treatment
what pattern of intake of angina meds impacts their effectiveness?
Continuous treatment with nitrates (such as isosorbide mononitrate) is associated with the development of tolerance, which results in reduced therapeutic effects.
it is recommended that a nitrate-free interval each day (lasting at least 4 hours) should be ensured to maintain sensitivity
what is this: A 67-year-old female undergoes an oesophagogastrectomy for carcinoma of the distal oesophagus. She complains of chest pain. The following day there is brisk bubbling into the chest drain when suction is applied.
air leak
what is this: A 20-year-old man has a protracted stay on ITU following a difficult appendicectomy for perforated appendicitis with pelvic and sub phrenic abscesses. He has now deteriorated further and developed deranged liver function tests.
portal vein thrombosis
what is this: A 63-year-old man undergoes an Ivor - Lewis oesophagogastrectomy for carcinoma of the distal oesophagus. The following day a pale opalescent liquid is noted to be draining from the right chest drain.
chyle leak
what is Gastroschisis?
Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord.
what is omphalocele?
the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.
what condition is this?
patau syndrome
when should you omit sulfonyureas before surgery?
take med on day prior to surgery + omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose
Which medical conditions means HbA1c would under-estimate her blood sugar levels?
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
Which medical conditions means HbA1c would over-estimate her blood sugar levels?
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
how do you distinguish between primary adrenal failure and secondary adrenal insufficiency?
skin hyperpigmentation
ACTH secreted in primary adrenal failure which causes pigmentation
what is the most common cause of primary hyperparathyroidism?
A solitary parathyroid adenoma
what is the most likely explanation for these results?
Raised total T3 and T4 but normal fT3 and fT4 suggest high concentrations of thyroid binding globulin, which can be seen during pregnancy
how does loperamide (anti-diarrhoea) work?
Loperamide is a µ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut
what are features of atypical UTI in under 6m old?
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms.
what are symptoms of acute digoxin toxicity?
Symptoms of acute digoxin toxicity include gastrointestinal disturbance (nausea, vomiting, abdominal pain), dizziness, confusion, blurry or yellow vision, and arrhythmias.
which antipsychotic is associated with increased VTE risk?
olanzapine
when should you be cautious of prescribing cyclizine
HF - can cause drop in CO and raise HR
what causes kaposi’s sarcoma?
HHV8
what is a key histological finding in multiple myeloma?
Increased concentrations of free light chains in serum and urine
what is a key histological finding in minimal change?
Podocyte effacement found on biopsy
what is a key finding in pre-renal causes of decreased eGFR
Increased specific gravity of urinalysis
what is a key biopsy finding in diabetic nephropathy?
Mesangial expansion,
what is a key finding in diabetic nephropahty?
Enlarged kidneys on USS
how do you work out type of hearing loss on the audiogram?
- is there anything below 20dB
yes = move to step 2
no = normal hearing - is there a gap? (b/w air and bone conduction)
yes = conductive or mixed hearing loss
no = sensorineural hearing loss - is one below or both below the 20dB line
one = conductive
both = mixed
how do you rate motor in GCS?
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
how do you rate eyes in GCS?
- Spontaneous
- To speech
- To pain
- None
how do you rate verbal in GCS?
- Orientated
- Confused
- Words
- Sounds
- None
what is the characteristic CXR finding in aspergilloma?
a crescent of air that surrounds a radiopaque mass present in a lung cavity is visible.
when should a baby be assessed for meconium aspiration syndrome?
respiratory rate above 60 per minute
the presence of grunting
heart rate below 100 or above 160 beats/minute
capillary refill time above 3 seconds
temperature of 38°C or above, or 37.5°C on 2 occasions 30 minutes apart
oxygen saturation below 95%
presence of central cyanosis
mania vs hypomania?
what cardiac abnormalities assoc with carcinoid syndrome?
right valve stenosis
what is seen with spinal cord injuries above T6?
Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level
ondansetron:
MOA and s/e
5-HT3 antagonist
headache, constipation and, importantly, QTc prolongation
what is the stronger RF for anal cancer?
HPV
which med has been shown to reduce the rate of CKD progression in ADPKD?
tolvaptan
a vasopressin receptor 2 antagonist to reduce the rate of cyst development and renal insufficiency
what smoking cessation medication cannot be used in epileptics?
Bupropion should not be used in a patient with epilepsy as it reduces seizure threshold
MOA of varenicline (smoking cessation)
a nicotinic receptor partial agonist
what ix should be done before giving flecanide in AF?
look for signs of structural heart disease before the use of flecainide in AF - do echocardiogram
what are the doses of adrenaline given in cardiac arrest?
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
what electrolyte abnormality is MDMA (ecstasy) associated with?
hyponatreamia
what form of HRT can be used in women with hx of DVT?
Transdermal HRT should be used in women at risk of venous thromboembolism
what oral diabetic medication can cause pancreatitis?
DPP4-inhibitors (rare S/E)
what abc might lower seizure threshold?
quinolones eg ciprofloxacin, levofloxacin
how do you convert oral codeine/tramadol dose to oral morphine?
divide by 10
how do you convert oral morphine to oral oxycodone?
divide by 1.5-2x
how do you convert oral morphine to s/c?
divide by 2
how do you convert oral morphine to s/c diamorphine?
divide by 3
how do you convert oral oxycodone to s/c diamorphine?
divide by 1.5
what determines prognosis in pancreatitis?
The Modified-Glasgow Score can be used to stratify patients by risk of severe pancreatitis. A score of ≥3 suggests a significant increase in likelihood of severe pancreatitis. These patients may benefit from intensive care.
following a diagnosis of asbestosis, what malignancy is the patient at risk of?
the risk of bronchogenic carcinoma is actually greater than the risk of mesothelioma
what can OSA cause?
hypertension
what can be sued to lower phosphate levels in pts with CKD + mineral bone disease?
Sevelamer is a non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease
what is Uhthoff’s phenomenon?
This describes an exacerbation of neurological symptoms and signs linked with a rise in core body temperature, often affecting the eyes of multiple sclerosis (MS) patients. Patients commonly report symptoms following exercise or hot showers/baths, which last for under 24 hours, unlike a relapse of MS.
what is Lhermitte’s sign?
describes the shooting pain some patients experience while in neck extension.
what medication can cause hypomagnesaemia?
PPIs
risk factors for regintopathy of prematurity?
born before 32 weeks and receiving oxygen treatment. Over-oxygenation can cause retinal vessel proliferation which can lead to a loss of the red reflex and neovascularisation seen in the examination.
loss of red reflex bilaterally + retinal neovascularisation
what kidney condition is HIV assoc with?
focal segmental glomerulosclerosis
who should be referred for same day cardiac specialist assessment?
patients with a new blood pressure of >180/120 mmHg and confusion, chest pain, signs of heart failure, or acute kidney injury. Other findings which may warrant a same-day specialist referral in the setting of severe hypertension include retinal haemorrhages, papilloedema (signs of accelerated hypertension) or suspected phaeochromocytoma.
indications for corticosteroid treatment in sarcoidosis?
parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement
ECG change for tricyclic overdose?
QRS complex widening, due to sodium channel blockade
prolong the QT interval
tachyarrhythmias due to their anticholinergic effects
management of new-onset atrial fibrillation
flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
amiodarone if there is evidence of structural heart disease.’
what med increases anticoagulant effect of warfarin?
Metronidazole increases the anticoagulant effect of warfarin
what med decreases anticoagulant effect of warfarin?
Phenytoin
rifampicin
what diagnostic of ARDS?
signs of puerperal sepsis/postpartum infection?
pyrexia (38.2°C), tachycardia (90/min), malodorous lochia (vaginal discharge), uterine tenderness, and suprapubic tenderness
features of benign romanic epilepsy?
which vaccines are live attenuated?
BCG
MMR
oral polio
yellow fever
oral typhoid
which vaccines are inactivated?
rabies
hepatitis A
influenza (intramuscular)
which vaccines have inactivated toxin?
tetanus
diphtheria
pertussis
examples of subunit/conjugate vaccines?
pneumococcus (conjugate)
haemophilus (conjugate)
meningococcus (conjugate)
hepatitis B
human papillomavirus
examples of mRNA vaccines>/
some COVID-19 vaccines
examples of viral vector vaccines?
some Ebola and COVID-19 vaccines
what should Patients with MI secondary to cocaine use should be given?
IV benzodiazepines as part of acute (ACS) treatment
what medications are used to treat pneumonia in children?
bacterial + viral
Erythromycin is first line in children suspected of Mycoplasma pneumonia. Otherwise, amoxicillin is first line, with co-amoxiclav indicated if the child presents with pneumonia associated with influenza.
Tramadol
dual mechanism of action, acting as both a weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrine.
what is a common complication of thyroid eye disease?
Exposure keratopathy is the most common complication of thyroid eye disease
what is the management for lower back pain?
1st = NSAIDs
if GORD and gastric ulcer, then weak opioid eg codeine
what med should be avoided in mx of lower back pain?
gabapentin
which antibody assoc with the following?
polymyositis
RA
Sjogrens
SLE
small vessel vasculitis
polymyositis = anti Jo-1
RA = anti-CCP
Sjogrens = anti La
SLE = anti-ds-DNA
small vessel vasculitis = anti-MPO
what is abx management in neutropenic sepsis/febrile neutropenia?
Tazocin (Piperacillin/Tazobactam)
if pen allergy, Teicoplanin and Aztreonam
features of immune-mediated penumonitis?
shortness of breath and dry cough and typically occurs within the first couple of months of treatment but can occur at any time whilst on treatment
when does radiation pneumonitis occur?
features?
round 8-12 weeks following completion of radiotherapy but is typically confined to the area of lung being treated and not bilateral in distribution.
features of optic neuritis/
RAPD on the affected side. A pale disc
what is SCC a tumour of?
key features?
supra-basal keratinocytes and may metastasise
commonest skin cancer in immunosuppressed patients and tends to be a painful lesion that grows quickly.
common s/e of morphine?
Common side effects include itch, histamine release, nausea and vomiting, drowsiness, reduced respiratory rate and pupiliarly miosis (constriction).
examples of stool softeners?
Lactulose and docusate
example of stimulant laxative?
senna
general features of large vessel vasculitis?
visual loss
night sweats
temporal headache
weight loss
what seen in ABG following MI?
A mixed respiratory and metabolic acidosis
Mixed acidosis as no breathing = increased PaCO2. No cardiac output = raised lactate & reduced HCO3
what may cause hypotension in sepsis?
During sepsis there is massive vasodilation (reduced systemic vascular resistance (SVR)). This causes hypotension as BP=SVRXCO
what is a common risk of epidural?
headache
what bloods may have been seen in tumour lysis syndrome?
hyperkalaemia, hyperphosphataemia, hypocalcaemia and high urate
When performing emergency pleural decompression, the proper location for needle insertion is?
Second intercostal space, mid clavicular line
what is pathology behind pemphigus vulgaris?
Acantholysis and intra-epidermal blistering with chicken wire pattern of IgG on immunofluorescence
what should you remember to prescribe when using cyclophosphamide?
cotrimoxazole as prophylaxis against pneumocystis jirovecii
what are the key side effects of prednisolone and how do you manage them?
OP - FRAX, Ca and Vit D supplement, bisphosphonates, DEXA
diabetes - blood glucose, HbA1c
dyspepsia - PPI
weight gian
skin bruising/poor healing
cataracts, glaucoma
what are anti-ro antibodies assoc with in pregnancy?
congenital heart block in the foetus
requires monitoring with echo in permpartum period + may require pacemaker
how do you determined if secondary prophylaxis is required for gout?
> 2 acute eps in 1 year
renal impairment
HF on diuretics
hx uric acid renal calculi
gouty tophi
what is isograft donation?
genetically identical eg twins
what is autograft donation?
done to yourself eg long saphenous vein for CABG
what is allograft donation?
donor not genetically identical
what causes hypercoagulable state in nephrotic syndrome?
loss of antithrombin 3
when prescribing SSRIs, what should you warn the patient of?
avoid grapefruit juice - a CYP inhibitor and can increase serum levels of SSRIs.
ECG may prolong QT interval
Patients ≤ 25 years who have been started on an SSRI should be reviewed after 1 week
continue on the medication for at least 6 months to prevent relapse.
commonest cause of hypercalcemia in older people?
dehydration
comment cause of hypocalcemia in older people?
vit D deficiency
what medication is used to induce remission in Crohn’s disease?
Glucocorticoids (oral, topical or intravenous) are generally used to induce remission of Crohn’s disease
eg prednisolone
what is the 1st line option for maintaining remission in Crohn’s disease?
azathioprine
what is the adult anaphylaxis dose?
Anaphylaxis - adult adrenaline dose = 500 mcg (0.5 ml of 1 in 1,000)
how do you manage type A aortic dissection?
ascending aorta - control BP (IV labetalol) + surgery
how do you manage type B aortic dissection?
descending aorta - control BP(IV labetalol)
what is dumping syndrome?
Dumping syndrome, which can be divided into early and late, may occur following gastric surgery. It occurs as a result of a hyperosmolar load rapidly entering the proximal jejunum. Osmosis drags water into the lumen, this results in lumen distension (pain) and then diarrhoea.
what are the exacerbating factors of myasthenia gravis?
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
what does hypocalcaemia indicate about kidney disease?
its chronic not acute
what is relapsing remitting MS?
Patients experience relapses of new or worsening symptoms. These vary in duration and often come without warning. Patients then tend to have periods of remission between attacks where there are no worsening symptoms. These periods of remission can last up to years.
what is primary progressive MS?
It is when a patient experiences worsening symptoms gradually since its onset and do not experience periods of remission in between. This is more common in the elderly population.
what is secondary progressive MS?
Secondary progressive MS is when patients who have relapse-remitting MS deteriorate and develop gradual worsening of symptoms without obvious flares or attacks.
what can be used to maintain ductus arteriosus in TGA when waiting surgery?
IV prostaglandin E1
what is indomethacin used for in neonates?
Non-steroidal anti-inflammatory drugs (NSAIDs), e.g. indomethacin, inhibit prostaglandin synthesis. This causes closure of the ductus arteriosus, resulting in cyanotic heart disease and likely death of the newborn.
what ix is needed prior to giving Herceptin?
An important major side effect of trastuzumab (Herceptin) is cardiomyopathy. Therefore patients prescribed trastuzumab require monitoring of left ventricular ejection fraction through serial echocardiograms before and during treatment.
what surgery is needed for cancer at Caecal, ascending or proximal transverse colon?
Right hemicolectomy
what surgery needed for distal transverse or descending colon surgery?
left hemicolectomy
what surgery needed for cancer of sigmoid colon?
high anterior resection
what surgery needed for upper rectum cancer?
anterior resection TME
what surgery needed for low rectum cancer?
anterior resection low TMA
what surgery needed for cancer at anal verge?
abdomino-perineal excision of rectum
how does congenital CMV present?
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
Visual impairment
Learning disability
Encephalitis/seizures
Pneumonitis
Hepatosplenomegaly
Anaemia
Jaundice
Cerebral palsy
features of congenital rubella?
Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
‘Salt and pepper’ chorioretinitis
Microphthalmia
Cerebral palsy
features of congenital toxoplasmosis?
Cerebral calcification
Chorioretinitis
Hydrocephalus
Anaemia
Hepatosplenomegaly
Cerebral palsy
s/e of anastrozole and letrozole?
osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
s/e of tamoxifen?
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes
venous thromboembolism
endometrial cancer
how do you calculate the dose of dexamethasone to give in croup?
0.15 mg/kg
management of TIA?
Patients with a TIA or minor ischaemic stroke who present within 24 hours, who are not considered suitable for DAPT, should be given clopidogrel monotherapy
what causes gingival hyperplasia?
Drug causes of gingival hyperplasia
phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)
Other causes of gingival hyperplasia include
acute myeloid leukaemia (myelomonocytic and monocytic types)
what muscles are affected in de quervain’s tenosynovitis?
inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons
what mx is required for a patient over 55 years with stage 2 hypertension and a QRisk score of >10%?
calcium channel blocker, atorvastatin and lifestyle advice as first-line therapy
what can be given in gonorrhoea if the patient refuses the injection?
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used
what should be given BEFORE endoscopy in upper GI bleed?
Both terlipressin and antibiotics should be given before endoscopy in patients with suspected variceal haemorrhage
causes of orthostatic hypotension?
primary autonomic failure: Parkinson’s disease, Lewy body dementia
secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia
drug-induced: diuretics, alcohol, vasodilators
volume depletion: haemorrhage, diarrhoea
MOA of terlipressin?
vasopressin analogue
which NSAID is contraindicated in cardiovascular disease?
Diclofenac is now contraindicated with any form of cardiovascular disease
What is the investigation of choice to look for renal scarring in a child with vesicoureteric reflux?
Radionuclide scan using dimercaptosuccinic acid (DMSA)
when is Micturating cystourethrogram (MCUG) used?
to diagnose vesicoureteric reflux itself rather than its complications like renal scarring
what is this?
vasculitis
what’s this ?
venous eczema
how do you manage alcoholic ketoacidosis?
Alcoholic ketoacidosis is managed with an infusion of saline and thiamine
how do you manage primary herpes simplex in pregnancy?
elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low
features of kleinfelter’s?
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels but low testosterone
which antihypertensives can worsen glucose control?
thiazides eg bendroflumothiazide, indapamide
causes of obesity in kids
growth hormone deficiency
hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome
consequences of obesity in kids
orthopaedic problems: slipped upper femoral epiphyses, Blount’s disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains
psychological consequences: poor self-esteem, bullying
sleep apnoea
benign intracranial hypertension
long-term consequences: increased incidence of type 2 diabetes mellitus, hypertension and ischaemic heart disease
how do you manage step-down treatment in asthma
aim for a reduction of 25-50% in the dose of inhaled corticosteroids
what is Acute disseminated encephalomyelitis (ADEM)?
an autoimmune demyelinating condition that generally occurs 1–2 weeks after viral infections like measles.
how does Acute disseminated encephalomyelitis (ADEM) present?
It presents with acute neurological symptoms such as altered consciousness, seizures, and focal neurological deficits.w
what is the most common cause of meningitis in those immunocompromised?
Cryptococcus neoformans is a fungal organism that commonly causes meningitis in immunocompromised patients, particularly those with advanced HIV infection.
how does adenosine need to be administered?
IV adenosine needs to be infused via a large-calibre vein or central route eg Insert a 16G cannula in her right antecubital vein
what meds should be stopped during C.diff infection?
opioids
what medication should be stopped when starting a macrolide and why?
Statins must be temporarily held when prescribing a macrolide antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs.
what findings warrant continuous 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
what electrolyte abnormality is seen in chronic alcohol use?
Chronic alcoholism is a cause of hypomagnesaemia
what medication is used to reduce stone formation in pts with hypercalciuria?
In a patient with hypercalciuria and renal stones, calcium excretion and stone formation can be decreased by the use of thiazide diuretics
what is MODY?
(maturity onset diabetes of the young)
A group of inherited genetic disorders affecting the production of insulin. Results in younger patients developing symptoms similar to those with T2DM, i.e. asymptomatic hyperglycaemia with progression to more severe complications such as diabetic ketoacidosis
what is the inheritance of MODY?
autosomal dominant
who should MODY be suspected in?
cases of diabetes in non-obese, young patients (adolescence or young adult) with family history of diabetes in two or more successive generations
how does MODY present?
Presents with non-ketotic, non-insulin-dependent diabetes that responds to oral glucose lowering drugs
how do you ix MODY?
C-peptide present.
Autoantibodies absent.
Genetic testing in patients with high index of suspicion identifies mutations most commonly in genes encoding glucokinase and transcription factors.
what is LADA?
The majority of patients with autoimmune-related diabetes present younger in life. There are however a small group of patients who develop such problems later in life. These patients are often misdiagnosed as having T2DM
what age group are affected by LADA?
Typical age of onset of diabetes is over 30 years old.
what is the management of LADA?
Patients are usually non-obese and respond initially to lifestyle modifications and oral agents.
Production of insulin gradually decreases (between 6 months and 5 years), such that treatment with insulin is required
ix for LADA?
Low to normal initial C-peptide level.
Can be positive for at least 1 of the 4 antibodies commonly found in type 1 diabetic patients
what can cause tumour lysis syndrome?
treatment of high-grade lymphomas and leukaemias
combination chemotherapy
steroid treatment
how does tumour lysis syndrome occur?
TLS occurs from the breakdown of the tumour cells and the subsequent release of chemicals from the cell. It leads to a high potassium and high phosphate level in the presence of a low calcium.
who should tumour lysis syndrome be suspected in?
It should be suspected in any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level.
how do you prevent tumour lysis syndrome?
IV fluids
patients are higher risk should receive either allopurinol or rasburicase
what is rasburicase?
a recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin.
why should rasburicase and allopurinol not be given together?
rasburicase and allopurinol should not be given together in the management of tumour lysis syndrome as this reduces the effect of rasburicase
what is needed to diagnose tumour lysis syndrome?
what is laboratory tumour lysis syndrome?
identify the mutation for each type of MODY
MODY 1
MODY 2
MODY 3
MODY 4
MODY 5
MODY3 (HNF1A mutation) (most common)
MODY2 (GCK mutation)
MODY1 (HNF4A)
MODY4 (PDX1)
MODY5 (HNF1B)
indications for surgery in bronchiectasis?
uncontrollable haemoptysis and localised disease
what is Zoon’s balanitis?
a benign condition of uncertain origin affecting uncircumcised men. It may be secondary to other conditions such as lichen sclerosus or erythroplasia of Queyrat. It presents with orange-red lesions with pinpoint redder spots on the glans and adjacent areas of the foreskin in uncircumcised men
what is Circinate balanitis?
chronic balanitis in men with Reiter’s syndrome, although it can occur in isolation. It presents with a well-demarcated erythematous plaque with a ragged white border.
what is Erythroplasia of Queyrat?
is an in-situ squamous cell carcinoma. It presents with single or multiple plaques with a red, velvety appearance and is often asymptomatic.
what does IV drug use put patients at high risk of and why?
significantly increase the risk of venous thromboembolism (VTE). This is due to a combination of factors including direct damage to the vein wall from repeated injections leading to endothelial injury and inflammation, as well as the potential for contamination with bacterial pathogens leading to localised infection and sepsis
aspiration pneumonia most likely in which lung lobe?
right lower
think about gravity as well as straight bronchus
what is this?
Man returns from trip abroad with maculopapular rash and flu-like illness
HIV seroconversion
how do you manage partially displaced fracture of the proximal phalanx ?
requires manual reduction and subsequent buddy-strapping, which can be done in the emergency department.
management of PAD?
statin = Atorvastatin 80 mg
clopidogrel NOT aspirin.
which medication could cause oesophageal ulceration?
alendrotnic acid
what is a concomitant squint?
Due to imbalance in extraocular muscles
Convergent is more common than divergent
what is a paralytic squint?
Due to paralysis of extraocular muscles
management of squint?
any child under the age of 4 years with suspected squint should be referred to an ophthalmologist immediately.
pharmacological options for treatment of orthostatic hypotension?
Fludrocortisone and midodrine
membranous glomerulonephritis histology
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
what is in Whipple’s triad of symptoms?
1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms
what is Whipple’s triad a hallmark for?
insulinoma
what vaccine should be offered to patients with chronic hepatitis?
one-off pneumococcal
ABG in diarrhoea
normal anion gap metabolic acidosis
what inhibits the p450 system?
ie higher INR levels because of them
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
what induces P450 system?
ie lower INR levels
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
what is given in polycythemia to reduce VTE?
Aspirin
if a patient is BMI 30-40 and pre-diabetic, what med should they be started on?
Liraglutide should be considered as an adjunct for weight loss
what is used to monitor tx in haemochromatosis?
Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
symptoms of de quervains thyroditis?
initial hyperthyroidism, painful goitre and globally reduced uptake of iodine-131
symptoms of sick euthyroid?
causes symptoms of hypothyroidism, not hyperthyroidism. It can be triggered by illness. However, it tends to occur within the same time-frame as the illness and resolves as the illness resolves.
which anti-emetic is appropriate in Parkinson’s disease?
Domperidone works by blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) of the brain, which provides anti-emetic effects. I
causes of increased AFP
Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy
causes of decreased AFP
Down’s syndrome
Trisomy 18
Maternal diabetes mellitus
mx of thyroid storm
symptomatic treatment e.g. paracetamol
treatment of underlying precipitating event
beta-blockers: typically IV propranolol
anti-thyroid drugs: e.g. methimazole or propylthiouracil
Lugol’s iodine
dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
causes of dupuytrens
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
what is the purpose of cyproterone acetate?
prevent paradoxical increase in symptoms with GnRH agonists eg bone pain, bladder obstruction
mx of genital warts
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
mx of cluster headache in person with CAD?
high flow oxygen
triptans are contraindicated in patients with CAD as they have the potential to cause coronary vasospasm
what is type 1 RTA?
inability to generate acid urine (secrete H+) in distal tubule
causes hypokalaemia
complications include nephrocalcinosis and renal stones
causes include idiopathic, rheumatoid arthritis, SLE, Sjogren’s, amphotericin B toxicity, analgesic nephropathy
what kind of HF does HOCM cause?
heart failure with preserved ejection fraction (HF-pEF)
affecting the musculature of the left ventricle, reducing the lumen of the left ventricle and preventing it fully filling with blood. This can create a backlog, leading to left-sided heart failure and pulmonary congestion, which explains this man’s respiratory symptoms. an equal reduction in both ejection systolic and end-diastolic volumes, therefore leading to a normal ejection fraction
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)
