Capsule Flashcards
Management of adhesions that don’t respond to conservative management
Surgery to divide the adhesions
Which type of inguinal hernias are more common?
Indirect
What does free air under the diaphragm the day after surgery suggest?
What is the management?
Normal finding
Supportive management
Monitoring of patients with total parenteral nutrition
Check line and dressing site daily 4 hourly obs Daily electrolyte monitoring Fluid balance Blood glucose
Wernickes encephalopathy symptoms
Ataxia, confusion, ophthalmoplegia
Management of liver abscess
IV abx
Insert a drain under ultrasound / CT guidance
Also supportive measures eg fluids
Sources of liver abscess
Biliary / GI / Renal tract
Direct trauma or lines / procedures
Complications of liver abscess
Perforation causing peritonitis, sepsis, lung empyema, cerebral abscess
Most common organism in liver abscess
E. coli
Contraindications to liver biopsy
Sever anaemia
High INR
Confusion
Sever ascites
Symptoms of pancreatic abscess
Pain and sepsis
What is a pancreatic pseudocyst
Collection of fluid, debris and pancreatic juices due to disruption of ducts in acute pancreatitis
Treatment of pancreatic pseudocyst
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
Complications of chronic pancreatitis
Diabetes
Malabsorption
(Due to pancreatic insufficiency)
Key investigation in bowel perforation
CT abdomen
Causes of pneumoperitoneum
Perforated diverticulum
Perforated duodenal ulcer
Laparotomy
Medications in acute exacerbation of ulcerative colitis
IV hydrocortisone
LMWH
Vitamin D (Adcal-D3) (as steroids increase risk of osteoporosis)
Treatment of toxic megacolon
Urgent surgery
Treatments of megacolon in a patient who isn’t acutely unwell
Treat with IV hydrocortisone as an exacerbation of IBD
Emergency treatment of splenic injury in acutely hypotensive unwell patient
Laparotomy and splenectomy
Precautions after a splenectomy
Pneumococcal vaccination
Meningococcal vaccination
Haemophilus influenzae vaccination
Consider long term penicillin prophylaxis
Caution travelling to areas where malaria is endemic
Symptoms of achalasia
Gradually progressive dysphagia (both solids and liquids) Aspiration Cramping discomfort on swallowing Weight loss Fairly long history
Imaging in achalasia
Oesophageal manometry is diagnostic
Barium swallow
Upper GI endoscopy
Treatment of achalasia
Botox injection (least invasive) Endoscopic myotomy Balloon dilation Laparoscopic cardiomyotomy (most invasive)
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
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
What is appendix mass and how is it managed?
Omentum covering an inflamed appendix
Managed conservatively followed by an appendicectomy at a later date
What is mesenteric adenitis
Inflammation of mesenteric lymph nodes
Symptoms of mesenteric adenitis
Similar symptoms to appendicitis
Usually follows respiratory tract infection
Complications of ERCP
Perforation Aspiration pneumonia Haemorrhage Acute pancreatitis Ascending cholangitis
What is Chilaiditi’s syndrome?
A loop of large bowel between the liver and diaphragm (a normal variant)
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.
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
Key imaging in subphrenic abscess
Ultrasound
Management of subphrenic abscess
Supportive eg analgesia and fluids
IV abx
Ultrasound guided percutaneous drainage
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)
Management of anastomotic leak
De-function the bowel with a covering colostomy then repair the anastomoses later
What is the most common cause of early postoperative fever (within 24 hours of surgery)?
Systemic inflammatory response due to trauma
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
What is a Bier’s block?
A regional technique for anaesthetising the forearm
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
How can we test for hypotension due to hypovolaemia?
Raise the legs and if BP increases this suggests the hypotension is due to hypovolaemia
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
What pathway does prothrombin time measure?
Extrinsic
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
What pathway does prothrombin time measure?
Extrinsic
Cautions / contraindications for contrast
Renal impairment
Asthma
Iodine allergy
Metformin
How to differentiate hydrocele and an epididymal cyst
The testicle won’t be able to be felt separately in hydrocele
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)
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
Main class of drugs in urgency incontinence
Anticholinergics
Management of infected, obstructed urinary system
Drainage (usually via nephrostomy)
Stone removal at a later date
Indications for percutaneous nephrolithostomy
Removal of stones within the kidney
Complications of nephrolithotomy
Bowel, spleen or liver injury
Bleeding
Infection
Pneumothorax
Age group associated with testicular teratomas and seminomas
Teratomas typically 20-30
Seminomas typically 30-45
Treatment of testicular teratomas
Orchidectomy
May have chemotherapy
Treatment of testicular seminomas
Radiotherapy
Definition of cryptorchidism
Congenital undescended testes
Causes of polycythemia
PCKD
Hepatocellular carcinoma
Polycythaemia vera (primary polycythaemia)
COPD
Hb in myelofibrosis
Low
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
Management of bowel perforation
Conservative if the perforation is small without peritonitis
Surgical in more severe cases (laparotomy)
What does a positive Coomb’s test indicate?
Extravascular haemolysis
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
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
Medications given with nasal packing
Antibiotics and sedative
Symptoms of thrombotic thrombocytopenic purpura
fever, neurological signs, renal failure, microangiopathic haemolytic anaemia
Main investigation in ITP
Blood screen
First line treatment in ITP
Steroids
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
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
Management of combined B12 and folate deficiency
Replace B12 first
Treatment of polycythemia Vera
Venesection
Hydroxycarbamide (reduces RBC production)
Aspirin (reduces platelet)
Differentials in easy bruising
Aging Anticoagulants Steroids / Cushings syndrome Thrombocytopenia Vitamin C deficiency
Management of INR 5-8 and no bleeding or minor bleeding
stop warfarin and recommence when INR < 5.0
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
Management of major bleeding in patient on warfarin
ABCDE, stop warfarin, commence IV vitamin K and IV prothrombin complex concentrate
Components of myeloma screen
Protein electrophoresis Serum free light chains Blood smear Bone marrow aspirate and trephine Skeletal survey
What is vertebroplasty?
Vertebroplasty involves the image-guided injection of bone cement into a collapsed vertebral body.
What is kyphoplasty?
Kyphoplasty involves inflating a balloon in the collapsed vertebral space, then inserting surgical cement.
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
What is a “line lock”?
Putting antibiotics into an infected line for an extended period to try and treat the infection
What is a Jacksonian seizure?
A Jacksonian seizure starts with a focal seizure that then develops into a grand mal seizure
What does a Jacksonian seizure indicate?
Structural brain lesion
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.
Glioma prognosis
Very poor
What do cannon waves on the JVP indicate?
Some arrhythmias (eg VT / heart block)
Initial emergency management of superior vena cava obstruction (after resuscitation)
Steroids
Options for managing superior vena cava obstruction
Steroids
Stent
Chemo/radiotherapy of tumour
LMWH if caused by a thrombus
Which zone is most commonly affected in prostate cancer?
Peripheral
Which zone of the prostate is most commonly affected by BPH
Transitional
Treatment in prostate cancer with Gleason score 6
Usually active surveillance
Treatment in prostate cancer with Gleason score 7+
Usually radical prostatectomy or radical radiotherapy with neoadjuvant hormone therapy
Smear test age and frequency
every 3 years age 24-50
every 5 years age 50-64
What is CIN results from cervical screening
Abnormal, non-cancerous immature cells. It is a pre-malignant condition
CIN1 on cervical screening
1/3 of cells abnormal. Monitored with repeat smears.
CIN2 on cervical screening
2/3 of cells abnormal
CIN3 on cervical screening
All cells abnormal. Needs treatment
Cancers associated with HPV
Genital e.g. cervical, penile, vaginal, anal
Head and neck e.g. laryngeal, tonsillar
Age of Perthes disease
4-7
Age of neuroblastoma
Under 8
Most common organism in septic arthritis
Staph aureus
Most common joint affected by septic arthritis
Hip
X-ray findings in septic arthritis
Typically normal for the first couple of weeks
What causes molluscum contagiosum?
Virus
Symptoms of molluscum contagiosum
Raised papules on the skin with central dimpling
Age affected by molluscum contagiosum
Children
Prognosis in molluscum contagiosum
Good, lesions clear up after around a year
Management of molluscum contagiosum
Reassurance
Osteomyelitis management
IV abx initially
Surgical debridement if not improving
Continue oral abx for at least 6 weeks
Symptoms of osteomyelitis
Severe pain
High fever
Tenderness over metaphysis
Imaging in osteomyelitis
X-ray changes may be subtle and delayed
MRI may be useful
Causes of ureteric / kidney pelvis dilation
Vesico-ureteric reflux Stones Blood clot Sludge Tumour
Investigation for vesico-ureteric reflux
Micturating cystogram
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
Risk factors for developmental dysplasia of the hip
Female
European
Breech delivery
Foot and spine abnormalities
Signs in developmental dysplasia of the hip
Shortened leg
Extra skin fold
Waddling gait
Positive trendelenburg test (pelvis tilts when standing on one leg)
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
What is Barlows test?
Test for developmental dysplasia of the hip
Addict hip whilst pushing thigh posteriorly and feel for hip to dislocate
Imaging in developmental dysplasia of the hip
Ultrasound in babies under 6 months
X-ray in babies after 6 months
Management of developmental dysplasia of the hip
In infants a harness, splint or brace may be used
In older children surgery may be needed
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)
What is used for screening for developmental dysplasia of the hip
Ultrasound at 6 weeks
Chest X-ray in cystic fibrosis
Typically normal at first Bronchial thickening Hyperinflation Atelectasis Hilar thickening
Rash associated with parvovirus
Slapped cheek rash in children
Red lace rash in adults
What is Gaucher’s disease?
A lysosomal storage disorder
What is ileal atresia?
A malformation where there is narrowing or absence of a portion of intestine
What is meconium ileus?
A cause of neonatal bowl obstruction due to thickened meconium
What is Hirschprung’s enterocolitis?
Proximal colonic dilation secondary to obstruction in Hirschprung’s disease
Symptoms of Hirschprung’s enterocolitis
Fever, abdo distension, bloody diarrhoea
Management of Hirschprung’s enterocolitis
Fluid resuscitation
Decompression with NG and rectal tubes
Abx
Surgery is definitive management
Common causes of meningitis in neonates
Group B strep E. coli Pneumococcus Listeria Staph aureus
Common causes of meningitis in infants and children
Meningococcus
Pneumococcus
Hib
What joint is often painful in children with hip pathology?
Knee
Investigation of slipped upper femoral epiphysis
AP and frog-lateral X-ray
Management of slipped upper femoral epiphysis
Internal fixation
Typical demographic of slipped upper femoral epiphysis
Boys over 12 (often obese)
Complications of slipped upper femoral epiphysis
Arthritis
Avascular necrosis
Symptoms of slipped upper femoral epiphysis
Limp
Hip and knee pain
Medication to add after ICS in childhood asthma
Montelukast
APTT in haemophilia
Raised
INR in haemophilia
Normal
Platelet count in haemophilia
Normal
Which haemophilia is most common?
A
Haemophilia A inheritance
X linked recessive
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
Neurological complication of severe neonatal jaundice
Kernicterus
First line treatment in severe neonatal jaundice
Phototherapy
What supplement is needed in treatment of neonatal jaundice to prevent anaemia?
Folate
Symptoms of HSP
Rash
Abdo pain
Arthritis
Glomerulonephropathy
Age affected by HSP
6 months to adult, though it’s most common in children
Rash associated with ITP
Fine petechial rash
HSP key investigations
FBC
Clotting screen
U&Es
Urine dipstick
Complications of HSP
Arthralgia
Acute renal failure
Intususseption
Pancreatitis
What would suggest bacterial rather than viral gastroenteritis?
No vomiting
Bloody diarrhoea
Risk factors eg contact with poultry
Symptoms of haemolytic uraemic syndrome
Thrombocytopenia (can cause petechial rash) Haemolytic anaemia (can cause jaundice) Renal failure (can cause oedema)
Most common trigger for haemolytic uraemic syndrome
E. coli diarrhoea
What should be considered in a child with diarrhoea who develops jaundice and pallor?
Haemolytic uraemic syndrome
PKU inheritance
Autosomal recessive
Symptoms of untreated PKU
Neurological problems
Management of PKU
Diet with low phenylalanine and supplements of missing amino acids
Investigation of ascites
Ascitic tap
Ovarian, pancreatic and colonic tumour markers
Abdo and pelvis USS
Causes of inadequate cervical smear
Failure to sample full 360 degrees
Blood
Inflammation
Age related atrophy
What does dyskaryosis mean?
Abnormalities of nucleus
What is a lletz biopsy?
Removes full circumference of transformation zone and associated abnormal area
What anaesthetic is needed for lletz biopsy?
Local
Complications of lletz biopsy
Cervical stenosis Cervical incompetence Infection Difficulty in follow up smears Incomplete biopsy
HPV strains associated with cervical cancer
16 and 18
Symptoms of uterine fibroids
Menorrhagia
Irregular bleeding
Age associated with uterine fibroids
30-50
What typically happened to fibroids after menopause
Shrink
What tends to happen to fibroids in pregnancy?
Grow faster
Management of ovarian torsion
Surgery (may be able to remove cyst or may need to remove while ovary)
Symptoms of trichomonas vaginalis
Green frothy discharge
Smelly discharge
Sore vulva
Pain during intercourse
Bacterial vaginosis symptoms
Water grey to clear discharge smells fishy
What setting can most pelvic inflammatory disease be managed in?
Community
What is ectopy in colposcopy?
Prominent columnar epithelium in the cervix
What does ectopy on colposcopy suggest?
Common in pre menopausal women or women on COCP
Management of cervical intraepithelial dysplasia 1
Usually regresses spontaneously
What does factor V Leiden increase risk of?
Clots
Effect of POP on periods?
Lighter
Effect of IUS on periods
Lighter but may be irregular
Investigation of coil if cord can’t be found
Transvaginal USS
If it still can’t be found, pelvic and abdominal X-ray
Management of coil that is in the abdomen rather than vagina
Surgical removal
Management of bartholin cyst
Marsupialisation (this entails draining it and suturing the inner wall to the skin to reduce risk of recurrence)
What are powder burn spots and what do they indicate?
Brown spots under peritoneum
Indicates endometriosis
Definitive treatment of endometriosis
Ablation at time of laparoscopy
Options after surgery for endometriosis to manage pain
COCP POP GnRH analogue injections NSAIDs TENS
What is ovulatory / primary endometrial dysfunction?
Heavy menstrual bleeding with no organic cause
Medications in primary endometrial dysfunction
Antifibrinolytics eg tranexamic acid or mefenamic acid
Oral iron if anaemic
COCP
Imperforate hymen symptoms
Amenorrhoea
Lower abdominal tenderness and distension
Violet bulging vaginal membrane
Urinary retention
Diagnostic test in imperforate hymen
Ultrasound (shows fluid filled vagina)
Treatment of imperforate hymen
Incision
Symptoms of pelvic organ prolapse
Stress incontinence Dyspareunia Obstructed defecation Voiding dysfunction Backache
First line management in stress incontinence
Pelvic floor muscle training
Surgical options for stress incontinence
Colposuspension (suspends and stabilises urethra)
Mid-urethral sling
Urethral Bulking agent (narrows urethra)
Conservative management of incontinence
Fluid advice (good intake, reduce tea and coffee)
Smoking cessation
Bladder training
Complications of surgical management of miscarriage
Bleeding Cervical trauma Infection Retained products of conception (may need repeat procedure) Uterine perforation
When does obstetric cholestasis typically present?
Third trimester
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
LFTs in obstetric cholestasis
Moderate rise in liver enzymes
Bile acid levels in obstetric cholestasis
High
Bilirubin levels in obstetric cholestasis
Normal or slightly high
Risk factors for obstetric cholestasis
Genetics
Previous obstetric cholestasis
Asian
Pruritis on COCP
Complications of obstetric cholestasis
PPH Liver disease Foetal distress Premature delivery Macrosomia
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
Symptoms of placenta praevia
Painless PV bleeding
Post coital spotting
Transverse foetal lie
Risk factors for placenta praevia
Previous placenta praevia Multiple pregnancy Multiparity Previous uterine surgery Smoking Older maternal age
Symptoms of placenta praevia
Abdo pain
May have PV bleeding
Foetal heart rate abnormalities
Risk factors for placental abruption
Previous abruption Polyhydramnios Hypertension Sudden rupture of membranes Smoking or drug use in pregnancy Multiparity
Complications of placental abruption
DIC
Blood loss leading to anaemia, hypovolaemia and renal failure
PPH
What are late deceleration on CTG and what do they indicate?
Foetal heart rate slowing late in a contraction
Indicates hypoxia
What are early deceleration on CTG and what do they indicate?
Deceleration early in contraction
Indicates head compression
Complications of premature menopause
Autoimmune disorders eg thyroid disease Osteoporosis Vaginal dryness Sexual dysfunction Insomnia Hot flushes
What is a first degree episiotomy tear?
Damage to perineal skin or vaginal wall
What is a second degree episiotomy tear?
Damage to perineal muscles but not anal sphincter
What is a grade 3A episiotomy tear?
Damage to anal sphincter with less than 50% thickness torn
What is a grade 3B episiotomy tear?
Damage to anal sphincter with more than 50% thickness torn
What is a fourth degree episiotomy tear?
Damage to external and internal anal sphincter and anorectal mucosa
What is a grade 3c episiotomy tear?
Damage to external and internal anal sphincter
Where to repair grade 3 and 4 episiotomy tear?
Theatre
Analgesia required to repair episiotomy tear
General, spinal or epidural
Management after anal sphincter tear repair
Antibiotics, analgesics, laxatives, physiotherapy appointment, gynae outpatient follow up
Most effective form of emergency contraception
Copper coil
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
Follow up for low lying placenta at 20 week scan
Further ultrasound at 32 weeks
Typical first line treatment in oral cancers
Surgery (often with adjuvant chemo or radiotherapy)
Typical first line treatment in non-oral head and neck cancers
Radiotherapy (often with adjuvant chemo)
Virus often seen in head and neck cancers
HPV
Hypokalaemia symptoms
Absent reflexes Constipation Cramps Weakness Tiredness
First line in renal cancer
Nephroureterectomy
Do patients with testicular torsion usually have a history of testicular pain?
Yes as the testis torts and un-torts
Indication for treating variocele
Symptomatic
Infertility
Options for varicocele treatment
Vein ligation
Radiological vein embolisation
Presentation of erythema nodosum
Tender red nodules. Often bilateral and on lower limbs. May have fever and joint pain
Causes of erythema nodosum
Sarcoidosis (most common) TB IBD Drugs Haematological malignancy Lupus Connective tissue disease Atypical infections eg fungal
Key investigation in erythema nodosum
Chest X-ray (as sarcoidosis most common cause and TB should be excluded)
What is the name for infection around the nail?
Paronychia
Appearance of actinic keratosis
Discrete dry, rough scaly lesions in sun exposed areas
Treatment of eczema herpeticum
Oral acyclovir
Stop topical steroids
Abx to prevent bacterial superinfection
Investigation needed for Diagnosis of pemphigoid
Skin biopsy
Treatment of pemphigoid
Topical steroid if localised
Systemic steroid or immunosuppressants if more widespread
Investigation of fungal scalp infection
Skin sample for microbiology
Treatment of fungal scalp infection
Oral antifungals
What is tinea corporis?
Ringworm
Investigation of tinea corporis
Skin scraping for culture
Treatment of ringworm
Topical antifungal
Major and minor features of melanoma
Major: change in size Irregular shape Irregular colour Minor: oozing Inflammation Diameter >7 Change in sensation
PCP pneumonia treatment
O2
Abx
Steroids
First line tests for PCP
Bronchoalveolar lavage or sputum culture
Ruptured bakers cyst symtpoms
Acute pain at back of knee
Mumps complications
Deafness, Gillian-barre syndrome, myocarditis, oophritis, orchitis, pancreatitis
Hep A management
Supportive, usually as an outpatient
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
How does acute Hep B present in children?
Usually asymptomatic
Hep B clinical course
Acute infection is often asymptomatic. Latent for many years. May cause liver failure
Hep B in pregnancy
90% of babies will be chronic carriers. Give baby immunoglobulin to reduce this
Contact tracing in Hep B
Sexual or needlestick contacts during acute infection. Offer immunoglobulin and vaccination. Vaccinate sexual and household contacts
Contact tracing in Hep C
Sexual or needle partners when in infectious period
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
PCP diagnosis
Bronchoalveolar lavage
PCP prophylaxis
CD4 under 200 or previous PCP
Syphilis treatment
Benpen
Genital warts treatment
Topical imiquimod cream is first line. Liquid nitrogen cryotherapy second line. Surgery third line. May offer to do nothing
Treatment of internal genital warts
Treat external warts then review. Cryotherapy or surgery
Genital ulcers main cause
HSV
Test for HSV in genital ulcers
Swab for PCR
Genital ulcers management
Oral acyclovir. Topical anaesthetic. Saline baths. Counselling
Genital ulcers in pregnancy
Consider treating. Consider C-section if symptomatic when mother goes in to labour
Long term management of genital ulcers
Either treat outbreaks or consider long term therapy to reduce outbreaks
Bacterial vaginosis treatment
STI screen. Metronidazole
Recurrent thrush treatment
Induction fluconazole (around 1 week) followed by maintenance fluconazole (around 6 months)
Stress incontinence medication
Duloxetine
When to lumbar puncture in subarachnoid haemorrhage
At least 12 hours after symptoms if CT negative
Signs of hypercalcaemia
Bone pain Constipation Anorexia Nausea Thirst Treusseau’s and Chovseks sign
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
What fracture causes teeth malignment?
Mandible
Which nerve is responsible for lacrimation?
Facial
Which nerve runs through the paritid gland?
Facial
Symptoms of salivary gland stones
Episodic salivary gland pain and swelling when food is anticipated
Most common parotid tumour
Pleomoephic adenoma (benign)
Parotid tumours key investigation
USS and fine needle aspiration
Do thyroid nodules move on swallowing and tongue protrusion?
Move on swallowing, not on tongue protrusion
Does a thyroglossal cyst move on swallowing and tongue protrusion?
Both
Does a dermoid cyst move on swallowing and tongue protrusion?
Neither
Thyroglossal cyst symptoms
Midline neck lump
Moves with tongue protrusion
May fluctuate in size
May cause compressive symptoms
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
What is ludwigs angina?
A dental abscess can cause airway compromise - surgical emergency
Peritonsilar abscess treatment
Abx
Drainage (incision or aspiration)
Offer elective tonsillectomy if 2 episodes
Section 5(2)
Doctor detains patient for up to 72 hours
Opiate overdose symptoms
Pinpoint pupils and reduces respiratory rate
Glue ear management
Initially surveillance (may resolve) If not then grommet insertion under general anaesthetic and may remove adenoids
Nasal fracture investigation
Anterior nasendoscopy to look for septal haemotoma
Nasal fracture management
Clinic review in a week. May do manipulation
What is porcelain gallbladder and how is it treated?
Calcification of gallbladder (premalignant). Treated with elective cholecystectomy
What is emphysematous cholecystitis and how is it treated and prognosis?
Air in gallbladder wall. High mortality so treated with cholecystectomy
Bowel pseudo obstruction management
Conservative
Breast cyst symptom
Tender lump appears suddenly
Breast cyst management
Aspirate and send for cytology if bloodstained
Breast cyst age
Perimenoupausal
As well as weakness, what other symptoms can Bells palsy cause?
Post auricular pain Difficulty chewing Incomplete eye closure Hyperacusis Drooling Tingling
What nerve gives taste to anterior tongue?
VII
What is inclusion body myositis and how does it present?
Slowly progressive myopathy in adults. Presents similar to motor neurone disease with weakness
Achilles rupture management
Equinus cast to hold foot in plantar flexion
Plummer vinson syndrome symptoms
Glossitis
Dysphagia
Anaemia
What is Plummer Vinson syndrome?
Oesophageal webs
What is Simmonds test?
Squeeze calves to look for achilles tendon rupture
First line in sciatica
Analgesia and mobilisation
When and how to investigate sciatica?
MRI if not resolving in 6 weeks
What is Thomas’ test?
Flex normal hip and look for fixed flexion of other hip (it will raise off bed)
When is pain worse in carpal tunnel syndrome?
Night
Where may there be wasting in carpal tunnel syndrome?
Thenar eminence
Cranial nerve that closes the eye
VII
What does hypopyon indicate?
Endophthalmitis
Investigation after CRAO / CRVO
Carotid Doppler
Management of epistaxis if nasal cautery fails
Nasal packing for 24 hours
Erythema nodosum causes
Infections Sarcoidosis IBD Neoplasia (leukaemia, Hodgkin’s disease) Drugs Pregnancy
Diagnostic test in autoimmune hepatitis
Liver biopsy
Sarcoisosis treatment
Monitoring if mild / asymptomatic
Rest and NSAIDs if moderate symptoms
Steroids if eye / lung / heart / neuro involvement
Glue ear management
Active surveillance for 3 months
If not resolved, grommet insertion under local anaesthetic
Medication that can help stop smoking
Bupropion
opioid withdrawal symptoms
Symptoms include agitation, anxiety, dilated pupils, sweating, tachycardia, hypertension, piloerection, watering eyes-nose, yawning, cool clammy skin.
