Capsule Flashcards
1
Q
Management of adhesions that don’t respond to conservative management
A
Surgery to divide the adhesions
2
Q
Which type of inguinal hernias are more common?
A
Indirect
3
Q
What does free air under the diaphragm the day after surgery suggest?
What is the management?
A
Normal finding
Supportive management
4
Q
Monitoring of patients with total parenteral nutrition
A
Check line and dressing site daily 4 hourly obs Daily electrolyte monitoring Fluid balance Blood glucose
5
Q
Wernickes encephalopathy symptoms
A
Ataxia, confusion, ophthalmoplegia
6
Q
Management of liver abscess
A
IV abx
Insert a drain under ultrasound / CT guidance
Also supportive measures eg fluids
7
Q
Sources of liver abscess
A
Biliary / GI / Renal tract
Direct trauma or lines / procedures
8
Q
Complications of liver abscess
A
Perforation causing peritonitis, sepsis, lung empyema, cerebral abscess
9
Q
Most common organism in liver abscess
A
E. coli
10
Q
Contraindications to liver biopsy
A
Sever anaemia
High INR
Confusion
Sever ascites
11
Q
Symptoms of pancreatic abscess
A
Pain and sepsis
12
Q
What is a pancreatic pseudocyst
A
Collection of fluid, debris and pancreatic juices due to disruption of ducts in acute pancreatitis
13
Q
Treatment of pancreatic pseudocyst
A
Percutaneous drainage
Thought needs to also be given as to why this pseudocyst arose – this is often due to significant ductal disruption and an ERCP can be used to identify any leak and insert stents to reduce the progression of the pseudocyst
14
Q
Complications of chronic pancreatitis
A
Diabetes
Malabsorption
(Due to pancreatic insufficiency)
15
Q
Key investigation in bowel perforation
A
CT abdomen
16
Q
Causes of pneumoperitoneum
A
Perforated diverticulum
Perforated duodenal ulcer
Laparotomy
17
Q
Medications in acute exacerbation of ulcerative colitis
A
IV hydrocortisone
LMWH
Vitamin D (Adcal-D3) (as steroids increase risk of osteoporosis)
18
Q
Treatment of toxic megacolon
A
Urgent surgery
19
Q
Treatments of megacolon in a patient who isn’t acutely unwell
A
Treat with IV hydrocortisone as an exacerbation of IBD
20
Q
Emergency treatment of splenic injury in acutely hypotensive unwell patient
A
Laparotomy and splenectomy
21
Q
Precautions after a splenectomy
A
Pneumococcal vaccination
Meningococcal vaccination
Haemophilus influenzae vaccination
Consider long term penicillin prophylaxis
Caution travelling to areas where malaria is endemic
22
Q
Symptoms of achalasia
A
Gradually progressive dysphagia (both solids and liquids) Aspiration Cramping discomfort on swallowing Weight loss Fairly long history
23
Q
Imaging in achalasia
A
Oesophageal manometry is diagnostic
Barium swallow
Upper GI endoscopy
24
Q
Treatment of achalasia
A
Botox injection (least invasive) Endoscopic myotomy Balloon dilation Laparoscopic cardiomyotomy (most invasive)
25
Complications of gallstones
Ascending cholangitis
Mucocele of gallbladder (due to mucus being blocked in)
Porcelain gallbladder (calcification of wall)
Cancer of gallbladder
Acute pancreatitis
Small bowel obstruction
26
Causes of moderately raised serum amylase
Acute pancreatitis (usually highly raised but May fall particularly after a couple of days)
Duodenal perforation
Mesenteric infarction
Acute cholecystitis
27
What is appendix mass and how is it managed?
Omentum covering an inflamed appendix
| Managed conservatively followed by an appendicectomy at a later date
28
What is mesenteric adenitis
Inflammation of mesenteric lymph nodes
29
Symptoms of mesenteric adenitis
Similar symptoms to appendicitis
| Usually follows respiratory tract infection
30
Complications of ERCP
```
Perforation
Aspiration pneumonia
Haemorrhage
Acute pancreatitis
Ascending cholangitis
```
31
What is Chilaiditi’s syndrome?
A loop of large bowel between the liver and diaphragm (a normal variant)
32
CXR changes in TB
Chest X-Ray changes in active TB can be varied and so clinical history is of key importance. They include lobar consolidation as described here, typically in a middle and upper lobe pattern (which is often associated with reactivated latent infection alongside primary infection), cavity formation, associated empyemas and pleural effusions. Of note is that the chest X-Ray can be normal.
33
Subphrenic abscess on erect CXR
Raised hemidiaphragm with a lesion below it that has an air - fluid level. May also be a reactive pleural effusion
34
Key imaging in subphrenic abscess
Ultrasound
35
Management of subphrenic abscess
Supportive eg analgesia and fluids
IV abx
Ultrasound guided percutaneous drainage
36
Investigation to assess the anastomosis after surgery
Water soluble contrast enema (then use an X-ray to see if the enema leaks out of the bowel)
37
Management of anastomotic leak
De-function the bowel with a covering colostomy then repair the anastomoses later
38
What is the most common cause of early postoperative fever (within 24 hours of surgery)?
Systemic inflammatory response due to trauma
39
Management of early (within 24 hours) postoperative fever
Clinical examination to look for signs of an infective cause
| Symptom control and monitoring of no obvious infection is found
40
What is a Bier’s block?
A regional technique for anaesthetising the forearm
41
What happens to blood pressure in patients postoperatively and why?
BP decreases
| Due to blood and fluid loss and the vasodilation effects of anaesthesia and the inflammatory response to surgery
42
How can we test for hypotension due to hypovolaemia?
Raise the legs and if BP increases this suggests the hypotension is due to hypovolaemia
43
Causes of acute heart failure
Decompensation of pre-existing chronic heart disease/failure
Myocardial ischaemic event (often silent MI)
Acute arrythmia
Fluid overload
Anaemia
Post surgery
44
What pathway does prothrombin time measure?
Extrinsic
45
Causes of acute heart failure
Decompensation of pre-existing chronic heart disease/failure
Myocardial ischaemic event (often silent MI)
Acute arrythmia
Fluid overload
Anaemia
Post surgery
46
What pathway does prothrombin time measure?
Extrinsic
47
Cautions / contraindications for contrast
Renal impairment
Asthma
Iodine allergy
Metformin
48
How to differentiate hydrocele and an epididymal cyst
The testicle won’t be able to be felt separately in hydrocele
49
Roughly what percentage of renal stones can be seen on X-ray?
80%
(Calcium oxalate and calcium phosphate stones are typically radio-opaque, while urate and xanthine stones are typically radiolucent)
50
Risk factors for renal stones
Young male, dehydration, hot climate, immobilisation, increased BMI, gastric bypass surgery, some drugs, hypercalciuria, hyperuricosuria, hyperoxaluria and hypocitriuria and urinary tract anomalies
51
Main class of drugs in urgency incontinence
Anticholinergics
52
Management of infected, obstructed urinary system
Drainage (usually via nephrostomy)
| Stone removal at a later date
53
Indications for percutaneous nephrolithostomy
Removal of stones within the kidney
54
Complications of nephrolithotomy
Bowel, spleen or liver injury
Bleeding
Infection
Pneumothorax
55
Age group associated with testicular teratomas and seminomas
Teratomas typically 20-30
| Seminomas typically 30-45
56
Treatment of testicular teratomas
Orchidectomy
| May have chemotherapy
57
Treatment of testicular seminomas
Radiotherapy
58
Definition of cryptorchidism
Congenital undescended testes
59
Causes of polycythemia
PCKD
Hepatocellular carcinoma
Polycythaemia vera (primary polycythaemia)
COPD
60
Hb in myelofibrosis
Low
61
What ulcers do and don't need H. pylori testing?
Duodenal ulcers don't need H. pylori testing as almost all are caused by H. pylori so eradication can be started regardless. Gastric ulcers do need testing to determine if eradiation therapy is indicated
62
Management of bowel perforation
Conservative if the perforation is small without peritonitis
| Surgical in more severe cases (laparotomy)
63
What does a positive Coomb's test indicate?
Extravascular haemolysis
64
Precautions with a splenectomy
```
Annual flu vaccine
Pneumococcal vaccine prior to surgery
Hib vaccine prior to surgery
Men A and C vaccine prior to surgery
Prophylactic antibiotics in the form of Penicillin or Erythromycin for a minimum of two years after surgery and possibly lifelong thereafter
Caution with dog bites
Caution in travel to areas with malaria
```
65
First line management of nosebleeds if conservative measures fail
Nasal packing with cotton wool soaked in local anaesthetic and vasoconstrictor followed by cauterisation with silver nitrate
66
Medications given with nasal packing
Antibiotics and sedative
67
Symptoms of thrombotic thrombocytopenic purpura
fever, neurological signs, renal failure, microangiopathic haemolytic anaemia
68
Main investigation in ITP
Blood screen
69
First line treatment in ITP
Steroids
70
Second line in ITP not responding to steroids
```
Further steroid therapy
IV Ig
Rituximab
Thrombopoeitin receptor agonists
If still resistant, other immunosuppressants eg azathioprine or splenectomy
```
71
Complications of sickle cell
```
Hyposplenism
Avascular necrosis of the femoral head
Renal papillary necrosis (can cause haematuria)
Arthritis
Osteomyelitis
Chronic leg ulcers
Seizures
CVAs
Hearing loss
Visual problems
```
72
Management of combined B12 and folate deficiency
Replace B12 first
73
Treatment of polycythemia Vera
Venesection
Hydroxycarbamide (reduces RBC production)
Aspirin (reduces platelet)
74
Differentials in easy bruising
```
Aging
Anticoagulants
Steroids / Cushings syndrome
Thrombocytopenia
Vitamin C deficiency
```
75
Management of INR 5-8 and no bleeding or minor bleeding
stop warfarin and recommence when INR < 5.0
76
Management of INR over 8 and no bleeding or minor bleeding
Vitamin K. Stop warfarin, restart once INR < 5.0. The INR should be rechecked in 24 hours and if still high then repeat vitamin K
77
Management of major bleeding in patient on warfarin
ABCDE, stop warfarin, commence IV vitamin K and IV prothrombin complex concentrate
78
Components of myeloma screen
```
Protein electrophoresis
Serum free light chains
Blood smear
Bone marrow aspirate and trephine
Skeletal survey
```
79
What is vertebroplasty?
Vertebroplasty involves the image-guided injection of bone cement into a collapsed vertebral body.
80
What is kyphoplasty?
Kyphoplasty involves inflating a balloon in the collapsed vertebral space, then inserting surgical cement.
81
Management of neutropenic sepsis from a PICC line
ABCDE, sepsis six, broad spectrum abx
If patient is very unwell, remove line
If they are stable, line locks with abx
82
What is a "line lock"?
Putting antibiotics into an infected line for an extended period to try and treat the infection
83
What is a Jacksonian seizure?
A Jacksonian seizure starts with a focal seizure that then develops into a grand mal seizure
84
What does a Jacksonian seizure indicate?
Structural brain lesion
85
Performance status scoring
0= no symptoms from cancer.
1= minimal symptoms from cancer, patient able to complete light work without symptoms.
2= resting in bed/chair less than 50% of the day.
3= resting in bed/chair more than 50% of the day, able to mobilise to independently manage limited self care.
4= patient bed bound.
86
Glioma prognosis
Very poor
87
What do cannon waves on the JVP indicate?
Some arrhythmias (eg VT / heart block)
88
Initial emergency management of superior vena cava obstruction (after resuscitation)
Steroids
89
Options for managing superior vena cava obstruction
Steroids
Stent
Chemo/radiotherapy of tumour
LMWH if caused by a thrombus
90
Which zone is most commonly affected in prostate cancer?
Peripheral
91
Which zone of the prostate is most commonly affected by BPH
Transitional
92
Treatment in prostate cancer with Gleason score 6
Usually active surveillance
93
Treatment in prostate cancer with Gleason score 7+
Usually radical prostatectomy or radical radiotherapy with neoadjuvant hormone therapy
94
Smear test age and frequency
every 3 years age 24-50
| every 5 years age 50-64
95
What is CIN results from cervical screening
Abnormal, non-cancerous immature cells. It is a pre-malignant condition
96
CIN1 on cervical screening
1/3 of cells abnormal. Monitored with repeat smears.
97
CIN2 on cervical screening
2/3 of cells abnormal
98
CIN3 on cervical screening
All cells abnormal. Needs treatment
99
Cancers associated with HPV
Genital e.g. cervical, penile, vaginal, anal
| Head and neck e.g. laryngeal, tonsillar
100
Age of Perthes disease
4-7
101
Age of neuroblastoma
Under 8
102
Most common organism in septic arthritis
Staph aureus
103
Most common joint affected by septic arthritis
Hip
104
X-ray findings in septic arthritis
Typically normal for the first couple of weeks
105
What causes molluscum contagiosum?
Virus
106
Symptoms of molluscum contagiosum
Raised papules on the skin with central dimpling
107
Age affected by molluscum contagiosum
Children
108
Prognosis in molluscum contagiosum
Good, lesions clear up after around a year
109
Management of molluscum contagiosum
Reassurance
110
Osteomyelitis management
IV abx initially
Surgical debridement if not improving
Continue oral abx for at least 6 weeks
111
Symptoms of osteomyelitis
Severe pain
High fever
Tenderness over metaphysis
112
Imaging in osteomyelitis
X-ray changes may be subtle and delayed
| MRI may be useful
113
Causes of ureteric / kidney pelvis dilation
```
Vesico-ureteric reflux
Stones
Blood clot
Sludge
Tumour
```
114
Investigation for vesico-ureteric reflux
Micturating cystogram
115
What is developmental dysplasia of the hip?
Childhood condition caused by abnormal hip joint development
Femur doesn’t fit securely in acetabulum, usually because the socket is too shallow
This means femoral head can partially or fully dislocate
116
Risk factors for developmental dysplasia of the hip
Female
European
Breech delivery
Foot and spine abnormalities
117
Signs in developmental dysplasia of the hip
Shortened leg
Extra skin fold
Waddling gait
Positive trendelenburg test (pelvis tilts when standing on one leg)
118
What is ortolanis test?
Test for developmental dysplasia of the hip
| Abduct and gently pull thigh forward and listen for a “clunk” as hip relocates
119
What is Barlows test?
Test for developmental dysplasia of the hip
| Addict hip whilst pushing thigh posteriorly and feel for hip to dislocate
120
Imaging in developmental dysplasia of the hip
Ultrasound in babies under 6 months
| X-ray in babies after 6 months
121
Management of developmental dysplasia of the hip
In infants a harness, splint or brace may be used
| In older children surgery may be needed
122
Who should be screened for developmental dysplasia of the hip?
First degree family history of early life hip problems
| Breech presentation after 36 weeks or at delivery (even if actual delivery was cephalic)
123
What is used for screening for developmental dysplasia of the hip
Ultrasound at 6 weeks
124
Chest X-ray in cystic fibrosis
```
Typically normal at first
Bronchial thickening
Hyperinflation
Atelectasis
Hilar thickening
```
125
Rash associated with parvovirus
Slapped cheek rash in children
| Red lace rash in adults
126
What is Gaucher’s disease?
A lysosomal storage disorder
127
What is ileal atresia?
A malformation where there is narrowing or absence of a portion of intestine
128
What is meconium ileus?
A cause of neonatal bowl obstruction due to thickened meconium
129
What is Hirschprung’s enterocolitis?
Proximal colonic dilation secondary to obstruction in Hirschprung’s disease
130
Symptoms of Hirschprung’s enterocolitis
Fever, abdo distension, bloody diarrhoea
131
Management of Hirschprung’s enterocolitis
Fluid resuscitation
Decompression with NG and rectal tubes
Abx
Surgery is definitive management
132
Common causes of meningitis in neonates
```
Group B strep
E. coli
Pneumococcus
Listeria
Staph aureus
```
133
Common causes of meningitis in infants and children
Meningococcus
Pneumococcus
Hib
134
What joint is often painful in children with hip pathology?
Knee
135
Investigation of slipped upper femoral epiphysis
AP and frog-lateral X-ray
136
Management of slipped upper femoral epiphysis
Internal fixation
137
Typical demographic of slipped upper femoral epiphysis
Boys over 12 (often obese)
138
Complications of slipped upper femoral epiphysis
Arthritis
| Avascular necrosis
139
Symptoms of slipped upper femoral epiphysis
Limp
| Hip and knee pain
140
Medication to add after ICS in childhood asthma
Montelukast
141
APTT in haemophilia
Raised
142
INR in haemophilia
Normal
143
Platelet count in haemophilia
Normal
144
Which haemophilia is most common?
A
145
Haemophilia A inheritance
X linked recessive
146
Advice for parents of children with haemophilia
Avoid NSAIDs
Management of injury (low threshold for presenting to A&E)
SC immunisations rather than IM
Avoid some contact sports if severe
147
Neurological complication of severe neonatal jaundice
Kernicterus
148
First line treatment in severe neonatal jaundice
Phototherapy
149
What supplement is needed in treatment of neonatal jaundice to prevent anaemia?
Folate
150
Symptoms of HSP
Rash
Abdo pain
Arthritis
Glomerulonephropathy
151
Age affected by HSP
6 months to adult, though it’s most common in children
152
Rash associated with ITP
Fine petechial rash
153
HSP key investigations
FBC
Clotting screen
U&Es
Urine dipstick
154
Complications of HSP
Arthralgia
Acute renal failure
Intususseption
Pancreatitis
155
What would suggest bacterial rather than viral gastroenteritis?
No vomiting
Bloody diarrhoea
Risk factors eg contact with poultry
156
Symptoms of haemolytic uraemic syndrome
```
Thrombocytopenia (can cause petechial rash)
Haemolytic anaemia (can cause jaundice)
Renal failure (can cause oedema)
```
157
Most common trigger for haemolytic uraemic syndrome
E. coli diarrhoea
158
What should be considered in a child with diarrhoea who develops jaundice and pallor?
Haemolytic uraemic syndrome
159
PKU inheritance
Autosomal recessive
160
Symptoms of untreated PKU
Neurological problems
161
Management of PKU
Diet with low phenylalanine and supplements of missing amino acids
162
Investigation of ascites
Ascitic tap
Ovarian, pancreatic and colonic tumour markers
Abdo and pelvis USS
163
Causes of inadequate cervical smear
Failure to sample full 360 degrees
Blood
Inflammation
Age related atrophy
164
What does dyskaryosis mean?
Abnormalities of nucleus
165
What is a lletz biopsy?
Removes full circumference of transformation zone and associated abnormal area
166
What anaesthetic is needed for lletz biopsy?
Local
167
Complications of lletz biopsy
```
Cervical stenosis
Cervical incompetence
Infection
Difficulty in follow up smears
Incomplete biopsy
```
168
HPV strains associated with cervical cancer
16 and 18
169
Symptoms of uterine fibroids
Menorrhagia
| Irregular bleeding
170
Age associated with uterine fibroids
30-50
171
What typically happened to fibroids after menopause
Shrink
172
What tends to happen to fibroids in pregnancy?
Grow faster
173
Management of ovarian torsion
Surgery (may be able to remove cyst or may need to remove while ovary)
174
Symptoms of trichomonas vaginalis
Green frothy discharge
Smelly discharge
Sore vulva
Pain during intercourse
175
Bacterial vaginosis symptoms
Water grey to clear discharge smells fishy
176
What setting can most pelvic inflammatory disease be managed in?
Community
177
What is ectopy in colposcopy?
Prominent columnar epithelium in the cervix
178
What does ectopy on colposcopy suggest?
Common in pre menopausal women or women on COCP
179
Management of cervical intraepithelial dysplasia 1
Usually regresses spontaneously
180
What does factor V Leiden increase risk of?
Clots
181
Effect of POP on periods?
Lighter
182
Effect of IUS on periods
Lighter but may be irregular
183
Investigation of coil if cord can’t be found
Transvaginal USS
| If it still can’t be found, pelvic and abdominal X-ray
184
Management of coil that is in the abdomen rather than vagina
Surgical removal
185
Management of bartholin cyst
Marsupialisation (this entails draining it and suturing the inner wall to the skin to reduce risk of recurrence)
186
What are powder burn spots and what do they indicate?
Brown spots under peritoneum
| Indicates endometriosis
187
Definitive treatment of endometriosis
Ablation at time of laparoscopy
188
Options after surgery for endometriosis to manage pain
```
COCP
POP
GnRH analogue injections
NSAIDs
TENS
```
189
What is ovulatory / primary endometrial dysfunction?
Heavy menstrual bleeding with no organic cause
190
Medications in primary endometrial dysfunction
Antifibrinolytics eg tranexamic acid or mefenamic acid
Oral iron if anaemic
COCP
191
Imperforate hymen symptoms
Amenorrhoea
Lower abdominal tenderness and distension
Violet bulging vaginal membrane
Urinary retention
192
Diagnostic test in imperforate hymen
Ultrasound (shows fluid filled vagina)
193
Treatment of imperforate hymen
Incision
194
Symptoms of pelvic organ prolapse
```
Stress incontinence
Dyspareunia
Obstructed defecation
Voiding dysfunction
Backache
```
195
First line management in stress incontinence
Pelvic floor muscle training
196
Surgical options for stress incontinence
Colposuspension (suspends and stabilises urethra)
Mid-urethral sling
Urethral Bulking agent (narrows urethra)
197
Conservative management of incontinence
Fluid advice (good intake, reduce tea and coffee)
Smoking cessation
Bladder training
198
Complications of surgical management of miscarriage
```
Bleeding
Cervical trauma
Infection
Retained products of conception (may need repeat procedure)
Uterine perforation
```
199
When does obstetric cholestasis typically present?
Third trimester
200
Symptoms of obstetric cholestasis
```
Itching is most common (typically worse on hands and feet)
Insomnia
Anorexia
Abdo pain
Steatorrhoea
Pale stool
Dark urine
May have jaundice
```
201
LFTs in obstetric cholestasis
Moderate rise in liver enzymes
202
Bile acid levels in obstetric cholestasis
High
203
Bilirubin levels in obstetric cholestasis
Normal or slightly high
204
Risk factors for obstetric cholestasis
Genetics
Previous obstetric cholestasis
Asian
Pruritis on COCP
205
Complications of obstetric cholestasis
```
PPH
Liver disease
Foetal distress
Premature delivery
Macrosomia
```
206
Management of obstetric cholestasis
Monitoring of foetal growth throughout pregnancy
Vitamin K (as prophylaxis against PPH)
Ursodeoxycholic acid can reduce itching
Creams to help itching
207
Symptoms of placenta praevia
Painless PV bleeding
Post coital spotting
Transverse foetal lie
208
Risk factors for placenta praevia
```
Previous placenta praevia
Multiple pregnancy
Multiparity
Previous uterine surgery
Smoking
Older maternal age
```
209
Symptoms of placenta praevia
Abdo pain
May have PV bleeding
Foetal heart rate abnormalities
210
Risk factors for placental abruption
```
Previous abruption
Polyhydramnios
Hypertension
Sudden rupture of membranes
Smoking or drug use in pregnancy
Multiparity
```
211
Complications of placental abruption
DIC
Blood loss leading to anaemia, hypovolaemia and renal failure
PPH
212
What are late deceleration on CTG and what do they indicate?
Foetal heart rate slowing late in a contraction
| Indicates hypoxia
213
What are early deceleration on CTG and what do they indicate?
Deceleration early in contraction
| Indicates head compression
214
Complications of premature menopause
```
Autoimmune disorders eg thyroid disease
Osteoporosis
Vaginal dryness
Sexual dysfunction
Insomnia
Hot flushes
```
215
What is a first degree episiotomy tear?
Damage to perineal skin or vaginal wall
216
What is a second degree episiotomy tear?
Damage to perineal muscles but not anal sphincter
217
What is a grade 3A episiotomy tear?
Damage to anal sphincter with less than 50% thickness torn
218
What is a grade 3B episiotomy tear?
Damage to anal sphincter with more than 50% thickness torn
219
What is a fourth degree episiotomy tear?
Damage to external and internal anal sphincter and anorectal mucosa
220
What is a grade 3c episiotomy tear?
Damage to external and internal anal sphincter
221
Where to repair grade 3 and 4 episiotomy tear?
Theatre
222
Analgesia required to repair episiotomy tear
General, spinal or epidural
223
Management after anal sphincter tear repair
Antibiotics, analgesics, laxatives, physiotherapy appointment, gynae outpatient follow up
224
Most effective form of emergency contraception
Copper coil
225
Pregnancy and contraception advice following ectopic pregnancy
Risk of future ectopic
Avoid IUD as it increases risk of future ectopic
Pelvic ultrasound in early pregnancy to exclude future ectopic
Avoid POP as it increases risk of future ectopic
226
Follow up for low lying placenta at 20 week scan
Further ultrasound at 32 weeks
227
Typical first line treatment in oral cancers
Surgery (often with adjuvant chemo or radiotherapy)
228
Typical first line treatment in non-oral head and neck cancers
Radiotherapy (often with adjuvant chemo)
229
Virus often seen in head and neck cancers
HPV
230
Hypokalaemia symptoms
```
Absent reflexes
Constipation
Cramps
Weakness
Tiredness
```
231
First line in renal cancer
Nephroureterectomy
232
Do patients with testicular torsion usually have a history of testicular pain?
Yes as the testis torts and un-torts
233
Indication for treating variocele
Symptomatic
| Infertility
234
Options for varicocele treatment
Vein ligation
| Radiological vein embolisation
235
Presentation of erythema nodosum
Tender red nodules. Often bilateral and on lower limbs. May have fever and joint pain
236
Causes of erythema nodosum
```
Sarcoidosis (most common)
TB
IBD
Drugs
Haematological malignancy
Lupus
Connective tissue disease
Atypical infections eg fungal
```
237
Key investigation in erythema nodosum
Chest X-ray (as sarcoidosis most common cause and TB should be excluded)
238
What is the name for infection around the nail?
Paronychia
239
Appearance of actinic keratosis
Discrete dry, rough scaly lesions in sun exposed areas
240
Treatment of eczema herpeticum
Oral acyclovir
Stop topical steroids
Abx to prevent bacterial superinfection
241
Investigation needed for Diagnosis of pemphigoid
Skin biopsy
242
Treatment of pemphigoid
Topical steroid if localised
| Systemic steroid or immunosuppressants if more widespread
243
Investigation of fungal scalp infection
Skin sample for microbiology
244
Treatment of fungal scalp infection
Oral antifungals
245
What is tinea corporis?
Ringworm
246
Investigation of tinea corporis
Skin scraping for culture
247
Treatment of ringworm
Topical antifungal
248
Major and minor features of melanoma
```
Major: change in size
Irregular shape
Irregular colour
Minor: oozing
Inflammation
Diameter >7
Change in sensation
```
249
PCP pneumonia treatment
O2
Abx
Steroids
250
First line tests for PCP
Bronchoalveolar lavage or sputum culture
251
Ruptured bakers cyst symtpoms
Acute pain at back of knee
252
Mumps complications
Deafness, Gillian-barre syndrome, myocarditis, oophritis, orchitis, pancreatitis
253
Hep A management
Supportive, usually as an outpatient
254
Contact tracing in Hep A
sexual contacts, household contacts and those at risk from food/water contamination in previous 2 weeks. Offer Hep A vaccine. If high risk, offer Hep A immunoglobulin
255
How does acute Hep B present in children?
Usually asymptomatic
256
Hep B clinical course
Acute infection is often asymptomatic. Latent for many years. May cause liver failure
257
Hep B in pregnancy
90% of babies will be chronic carriers. Give baby immunoglobulin to reduce this
258
Contact tracing in Hep B
Sexual or needlestick contacts during acute infection. Offer immunoglobulin and vaccination. Vaccinate sexual and household contacts
259
Contact tracing in Hep C
Sexual or needle partners when in infectious period
260
Measles symptoms
Fever
Dry cough
Conjunctivitis, or swollen eyelids and inflamed eyes
Runny nose
Sneezing
A reddish-brown skin rash- starts from head and spreads to whole body
261
PCP diagnosis
Bronchoalveolar lavage
262
PCP prophylaxis
CD4 under 200 or previous PCP
263
Syphilis treatment
Benpen
264
Genital warts treatment
Topical imiquimod cream is first line. Liquid nitrogen cryotherapy second line. Surgery third line. May offer to do nothing
265
Treatment of internal genital warts
Treat external warts then review. Cryotherapy or surgery
266
Genital ulcers main cause
HSV
267
Test for HSV in genital ulcers
Swab for PCR
268
Genital ulcers management
Oral acyclovir. Topical anaesthetic. Saline baths. Counselling
269
Genital ulcers in pregnancy
Consider treating. Consider C-section if symptomatic when mother goes in to labour
270
Long term management of genital ulcers
Either treat outbreaks or consider long term therapy to reduce outbreaks
271
Bacterial vaginosis treatment
STI screen. Metronidazole
272
Recurrent thrush treatment
Induction fluconazole (around 1 week) followed by maintenance fluconazole (around 6 months)
273
Stress incontinence medication
Duloxetine
274
When to lumbar puncture in subarachnoid haemorrhage
At least 12 hours after symptoms if CT negative
275
Signs of hypercalcaemia
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Bone pain
Constipation
Anorexia
Nausea
Thirst
Treusseau’s and Chovseks sign
```
276
Confirmation of death
```
Absence of central pulse
Absence of heart sounds
No pupil response to light
No response to supra-orbital pressure
Cardiopulmonary arrest for at least 5 mins
```
277
What fracture causes teeth malignment?
Mandible
278
Which nerve is responsible for lacrimation?
Facial
279
Which nerve runs through the paritid gland?
Facial
280
Symptoms of salivary gland stones
Episodic salivary gland pain and swelling when food is anticipated
281
Most common parotid tumour
Pleomoephic adenoma (benign)
282
Parotid tumours key investigation
USS and fine needle aspiration
283
Do thyroid nodules move on swallowing and tongue protrusion?
Move on swallowing, not on tongue protrusion
284
Does a thyroglossal cyst move on swallowing and tongue protrusion?
Both
285
Does a dermoid cyst move on swallowing and tongue protrusion?
Neither
286
Thyroglossal cyst symptoms
Midline neck lump
Moves with tongue protrusion
May fluctuate in size
May cause compressive symptoms
287
Management of teeth that have been knocked out
Analgesia and count teeth found
May re-implant if adult teeth
Abx
CXR if not all teeth found incase it has been aspirated
288
What is ludwigs angina?
A dental abscess can cause airway compromise - surgical emergency
289
Peritonsilar abscess treatment
Abx
Drainage (incision or aspiration)
Offer elective tonsillectomy if 2 episodes
290
Section 5(2)
Doctor detains patient for up to 72 hours
291
Opiate overdose symptoms
Pinpoint pupils and reduces respiratory rate
292
Glue ear management
```
Initially surveillance (may resolve)
If not then grommet insertion under general anaesthetic and may remove adenoids
```
293
Nasal fracture investigation
Anterior nasendoscopy to look for septal haemotoma
294
Nasal fracture management
Clinic review in a week. May do manipulation
295
What is porcelain gallbladder and how is it treated?
Calcification of gallbladder (premalignant). Treated with elective cholecystectomy
296
What is emphysematous cholecystitis and how is it treated and prognosis?
Air in gallbladder wall. High mortality so treated with cholecystectomy
297
Bowel pseudo obstruction management
Conservative
298
Breast cyst symptom
Tender lump appears suddenly
299
Breast cyst management
Aspirate and send for cytology if bloodstained
300
Breast cyst age
Perimenoupausal
301
As well as weakness, what other symptoms can Bells palsy cause?
```
Post auricular pain
Difficulty chewing
Incomplete eye closure
Hyperacusis
Drooling
Tingling
```
302
What nerve gives taste to anterior tongue?
VII
303
What is inclusion body myositis and how does it present?
Slowly progressive myopathy in adults. Presents similar to motor neurone disease with weakness
304
Achilles rupture management
Equinus cast to hold foot in plantar flexion
305
Plummer vinson syndrome symptoms
Glossitis
Dysphagia
Anaemia
306
What is Plummer Vinson syndrome?
Oesophageal webs
307
What is Simmonds test?
Squeeze calves to look for achilles tendon rupture
308
First line in sciatica
Analgesia and mobilisation
309
When and how to investigate sciatica?
MRI if not resolving in 6 weeks
310
What is Thomas' test?
Flex normal hip and look for fixed flexion of other hip (it will raise off bed)
311
When is pain worse in carpal tunnel syndrome?
Night
312
Where may there be wasting in carpal tunnel syndrome?
Thenar eminence
313
Cranial nerve that closes the eye
VII
314
What does hypopyon indicate?
Endophthalmitis
315
Investigation after CRAO / CRVO
Carotid Doppler
316
Management of epistaxis if nasal cautery fails
Nasal packing for 24 hours
317
Erythema nodosum causes
```
Infections
Sarcoidosis
IBD
Neoplasia (leukaemia, Hodgkin’s disease)
Drugs
Pregnancy
```
318
Diagnostic test in autoimmune hepatitis
Liver biopsy
319
Sarcoisosis treatment
Monitoring if mild / asymptomatic
Rest and NSAIDs if moderate symptoms
Steroids if eye / lung / heart / neuro involvement
320
Glue ear management
Active surveillance for 3 months
| If not resolved, grommet insertion under local anaesthetic
321
Medication that can help stop smoking
Bupropion
322
opioid withdrawal symptoms
Symptoms include agitation, anxiety, dilated pupils, sweating, tachycardia, hypertension, piloerection, watering eyes-nose, yawning, cool clammy skin.
