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Progress Tests > Capsule > Flashcards

Capsule Flashcards

1
Q

Management of adhesions that don’t respond to conservative management

A

Surgery to divide the adhesions

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2
Q

Which type of inguinal hernias are more common?

A

Indirect

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3
Q

What does free air under the diaphragm the day after surgery suggest?
What is the management?

A

Normal finding

Supportive management

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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
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5
Q

Wernickes encephalopathy symptoms

A

Ataxia, confusion, ophthalmoplegia

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6
Q

Management of liver abscess

A

IV abx
Insert a drain under ultrasound / CT guidance
Also supportive measures eg fluids

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7
Q

Sources of liver abscess

A

Biliary / GI / Renal tract

Direct trauma or lines / procedures

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8
Q

Complications of liver abscess

A

Perforation causing peritonitis, sepsis, lung empyema, cerebral abscess

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9
Q

Most common organism in liver abscess

A

E. coli

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10
Q

Contraindications to liver biopsy

A

Sever anaemia
High INR
Confusion
Sever ascites

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11
Q

Symptoms of pancreatic abscess

A

Pain and sepsis

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12
Q

What is a pancreatic pseudocyst

A

Collection of fluid, debris and pancreatic juices due to disruption of ducts in acute pancreatitis

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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

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14
Q

Complications of chronic pancreatitis

A

Diabetes
Malabsorption
(Due to pancreatic insufficiency)

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15
Q

Key investigation in bowel perforation

A

CT abdomen

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16
Q

Causes of pneumoperitoneum

A

Perforated diverticulum
Perforated duodenal ulcer
Laparotomy

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17
Q

Medications in acute exacerbation of ulcerative colitis

A

IV hydrocortisone
LMWH
Vitamin D (Adcal-D3) (as steroids increase risk of osteoporosis)

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18
Q

Treatment of toxic megacolon

A

Urgent surgery

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19
Q

Treatments of megacolon in a patient who isn’t acutely unwell

A

Treat with IV hydrocortisone as an exacerbation of IBD

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20
Q

Emergency treatment of splenic injury in acutely hypotensive unwell patient

A

Laparotomy and splenectomy

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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

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22
Q

Symptoms of achalasia

A 
Gradually progressive dysphagia (both solids and liquids)
Aspiration
Cramping discomfort on swallowing
Weight loss
Fairly long history
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23
Q

Imaging in achalasia

A

Oesophageal manometry is diagnostic
Barium swallow
Upper GI endoscopy

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24
Q

Treatment of achalasia

A 
Botox injection (least invasive)
Endoscopic myotomy
Balloon dilation
Laparoscopic cardiomyotomy (most invasive)
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25
Q

Complications of gallstones

A

Ascending cholangitis
Mucocele of gallbladder (due to mucus being blocked in)
Porcelain gallbladder (calcification of wall)
Cancer of gallbladder
Acute pancreatitis
Small bowel obstruction

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26
Q

Causes of moderately raised serum amylase

A

Acute pancreatitis (usually highly raised but May fall particularly after a couple of days)
Duodenal perforation
Mesenteric infarction
Acute cholecystitis

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27
Q

What is appendix mass and how is it managed?

A

Omentum covering an inflamed appendix

Managed conservatively followed by an appendicectomy at a later date

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28
Q

What is mesenteric adenitis

A

Inflammation of mesenteric lymph nodes

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29
Q

Symptoms of mesenteric adenitis

A

Similar symptoms to appendicitis

Usually follows respiratory tract infection

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30
Q

Complications of ERCP

A 
Perforation 
Aspiration pneumonia 
Haemorrhage 
Acute pancreatitis 
Ascending cholangitis
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31
Q

What is Chilaiditi’s syndrome?

A

A loop of large bowel between the liver and diaphragm (a normal variant)

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32
Q

CXR changes in TB

A

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.

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33
Q

Subphrenic abscess on erect CXR

A

Raised hemidiaphragm with a lesion below it that has an air - fluid level. May also be a reactive pleural effusion

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34
Q

Key imaging in subphrenic abscess

A

Ultrasound

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35
Q

Management of subphrenic abscess

A

Supportive eg analgesia and fluids
IV abx
Ultrasound guided percutaneous drainage

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36
Q

Investigation to assess the anastomosis after surgery

A

Water soluble contrast enema (then use an X-ray to see if the enema leaks out of the bowel)

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37
Q

Management of anastomotic leak

A

De-function the bowel with a covering colostomy then repair the anastomoses later

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38
Q

What is the most common cause of early postoperative fever (within 24 hours of surgery)?

A

Systemic inflammatory response due to trauma

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39
Q

Management of early (within 24 hours) postoperative fever

A

Clinical examination to look for signs of an infective cause

Symptom control and monitoring of no obvious infection is found

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40
Q

What is a Bier’s block?

A

A regional technique for anaesthetising the forearm

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41
Q

What happens to blood pressure in patients postoperatively and why?

A

BP decreases

Due to blood and fluid loss and the vasodilation effects of anaesthesia and the inflammatory response to surgery

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42
Q

How can we test for hypotension due to hypovolaemia?

A

Raise the legs and if BP increases this suggests the hypotension is due to hypovolaemia

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43
Q

Causes of acute heart failure

A

Decompensation of pre-existing chronic heart disease/failure
Myocardial ischaemic event (often silent MI)
Acute arrythmia
Fluid overload
Anaemia
Post surgery

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44
Q

What pathway does prothrombin time measure?

A

Extrinsic

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45
Q

Causes of acute heart failure

A

Decompensation of pre-existing chronic heart disease/failure
Myocardial ischaemic event (often silent MI)
Acute arrythmia
Fluid overload
Anaemia
Post surgery

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46
Q

What pathway does prothrombin time measure?

A

Extrinsic

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47
Q

Cautions / contraindications for contrast

A

Renal impairment
Asthma
Iodine allergy
Metformin

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48
Q

How to differentiate hydrocele and an epididymal cyst

A

The testicle won’t be able to be felt separately in hydrocele

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49
Q

Roughly what percentage of renal stones can be seen on X-ray?

A

80%
(Calcium oxalate and calcium phosphate stones are typically radio-opaque, while urate and xanthine stones are typically radiolucent)

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50
Q

Risk factors for renal stones

A

Young male, dehydration, hot climate, immobilisation, increased BMI, gastric bypass surgery, some drugs, hypercalciuria, hyperuricosuria, hyperoxaluria and hypocitriuria and urinary tract anomalies

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51
Q

Main class of drugs in urgency incontinence

A

Anticholinergics

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52
Q

Management of infected, obstructed urinary system

A

Drainage (usually via nephrostomy)

Stone removal at a later date

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53
Q

Indications for percutaneous nephrolithostomy

A

Removal of stones within the kidney

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54
Q

Complications of nephrolithotomy

A

Bowel, spleen or liver injury
Bleeding
Infection
Pneumothorax

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55
Q

Age group associated with testicular teratomas and seminomas

A

Teratomas typically 20-30

Seminomas typically 30-45

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56
Q

Treatment of testicular teratomas

A

Orchidectomy

May have chemotherapy

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57
Q

Treatment of testicular seminomas

A

Radiotherapy

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58
Q

Definition of cryptorchidism

A

Congenital undescended testes

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59
Q

Causes of polycythemia

A

PCKD
Hepatocellular carcinoma
Polycythaemia vera (primary polycythaemia)
COPD

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60
Q

Hb in myelofibrosis

A

Low

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61
Q

What ulcers do and don’t need H. pylori testing?

A

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

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62
Q

Management of bowel perforation

A

Conservative if the perforation is small without peritonitis

Surgical in more severe cases (laparotomy)

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63
Q

What does a positive Coomb’s test indicate?

A

Extravascular haemolysis

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64
Q

Precautions with a splenectomy

A 
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
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65
Q

First line management of nosebleeds if conservative measures fail

A

Nasal packing with cotton wool soaked in local anaesthetic and vasoconstrictor followed by cauterisation with silver nitrate

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66
Q

Medications given with nasal packing

A

Antibiotics and sedative

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67
Q

Symptoms of thrombotic thrombocytopenic purpura

A

fever, neurological signs, renal failure, microangiopathic haemolytic anaemia

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68
Q

Main investigation in ITP

A

Blood screen

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69
Q

First line treatment in ITP

A

Steroids

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70
Q

Second line in ITP not responding to steroids

A 
Further steroid therapy
IV Ig
Rituximab
Thrombopoeitin receptor agonists
If still resistant, other immunosuppressants eg azathioprine or splenectomy
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71
Q

Complications of sickle cell

A 
Hyposplenism
Avascular necrosis of the femoral head
Renal papillary necrosis (can cause haematuria)
Arthritis
Osteomyelitis
Chronic leg ulcers
Seizures
CVAs
Hearing loss
Visual problems
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72
Q

Management of combined B12 and folate deficiency

A

Replace B12 first

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73
Q

Treatment of polycythemia Vera

A

Venesection
Hydroxycarbamide (reduces RBC production)
Aspirin (reduces platelet)

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74
Q

Differentials in easy bruising

A 
Aging
Anticoagulants 
Steroids / Cushings syndrome 
Thrombocytopenia 
Vitamin C deficiency
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75
Q

Management of INR 5-8 and no bleeding or minor bleeding

A

stop warfarin and recommence when INR < 5.0

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76
Q

Management of INR over 8 and no bleeding or minor bleeding

A

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

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77
Q

Management of major bleeding in patient on warfarin

A

ABCDE, stop warfarin, commence IV vitamin K and IV prothrombin complex concentrate

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78
Q

Components of myeloma screen

A 
Protein electrophoresis 
Serum free light chains
Blood smear
Bone marrow aspirate and trephine
Skeletal survey
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79
Q

What is vertebroplasty?

A

Vertebroplasty involves the image-guided injection of bone cement into a collapsed vertebral body.

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80
Q

What is kyphoplasty?

A

Kyphoplasty involves inflating a balloon in the collapsed vertebral space, then inserting surgical cement.

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81
Q

Management of neutropenic sepsis from a PICC line

A

ABCDE, sepsis six, broad spectrum abx
If patient is very unwell, remove line
If they are stable, line locks with abx

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82
Q

What is a “line lock”?

A

Putting antibiotics into an infected line for an extended period to try and treat the infection

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83
Q

What is a Jacksonian seizure?

A

A Jacksonian seizure starts with a focal seizure that then develops into a grand mal seizure

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84
Q

What does a Jacksonian seizure indicate?

A

Structural brain lesion

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85
Q

Performance status scoring

A

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.

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86
Q

Glioma prognosis

A

Very poor

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87
Q

What do cannon waves on the JVP indicate?

A

Some arrhythmias (eg VT / heart block)

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88
Q

Initial emergency management of superior vena cava obstruction (after resuscitation)

A

Steroids

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89
Q

Options for managing superior vena cava obstruction

A

Steroids
Stent
Chemo/radiotherapy of tumour
LMWH if caused by a thrombus

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90
Q

Which zone is most commonly affected in prostate cancer?

A

Peripheral

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91
Q

Which zone of the prostate is most commonly affected by BPH

A

Transitional

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92
Q

Treatment in prostate cancer with Gleason score 6

A

Usually active surveillance

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93
Q

Treatment in prostate cancer with Gleason score 7+

A

Usually radical prostatectomy or radical radiotherapy with neoadjuvant hormone therapy

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94
Q

Smear test age and frequency

A

every 3 years age 24-50

every 5 years age 50-64

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95
Q

What is CIN results from cervical screening

A

Abnormal, non-cancerous immature cells. It is a pre-malignant condition

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96
Q

CIN1 on cervical screening

A

1/3 of cells abnormal. Monitored with repeat smears.

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97
Q

CIN2 on cervical screening

A

2/3 of cells abnormal

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98
Q

CIN3 on cervical screening

A

All cells abnormal. Needs treatment

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99
Q

Cancers associated with HPV

A

Genital e.g. cervical, penile, vaginal, anal

Head and neck e.g. laryngeal, tonsillar

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100
Q

Age of Perthes disease

A

4-7

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101
Q

Age of neuroblastoma

A

Under 8

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102
Q

Most common organism in septic arthritis

A

Staph aureus

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103
Q

Most common joint affected by septic arthritis

A

Hip

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104
Q

X-ray findings in septic arthritis

A

Typically normal for the first couple of weeks

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105
Q

What causes molluscum contagiosum?

A

Virus

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106
Q

Symptoms of molluscum contagiosum

A

Raised papules on the skin with central dimpling

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107
Q

Age affected by molluscum contagiosum

A

Children

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108
Q

Prognosis in molluscum contagiosum

A

Good, lesions clear up after around a year

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109
Q

Management of molluscum contagiosum

A

Reassurance

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110
Q

Osteomyelitis management

A

IV abx initially
Surgical debridement if not improving
Continue oral abx for at least 6 weeks

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111
Q

Symptoms of osteomyelitis

A

Severe pain
High fever
Tenderness over metaphysis

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112
Q

Imaging in osteomyelitis

A

X-ray changes may be subtle and delayed

MRI may be useful

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113
Q

Causes of ureteric / kidney pelvis dilation

A 
Vesico-ureteric reflux 
Stones
Blood clot
Sludge
Tumour
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114
Q

Investigation for vesico-ureteric reflux

A

Micturating cystogram

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115
Q

What is developmental dysplasia of the hip?

A

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

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116
Q

Risk factors for developmental dysplasia of the hip

A

Female
European
Breech delivery
Foot and spine abnormalities

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117
Q

Signs in developmental dysplasia of the hip

A

Shortened leg
Extra skin fold
Waddling gait
Positive trendelenburg test (pelvis tilts when standing on one leg)

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118
Q

What is ortolanis test?

A

Test for developmental dysplasia of the hip

Abduct and gently pull thigh forward and listen for a “clunk” as hip relocates

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119
Q

What is Barlows test?

A

Test for developmental dysplasia of the hip

Addict hip whilst pushing thigh posteriorly and feel for hip to dislocate

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120
Q

Imaging in developmental dysplasia of the hip

A

Ultrasound in babies under 6 months

X-ray in babies after 6 months

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121
Q

Management of developmental dysplasia of the hip

A

In infants a harness, splint or brace may be used

In older children surgery may be needed

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122
Q

Who should be screened for developmental dysplasia of the hip?

A

First degree family history of early life hip problems

Breech presentation after 36 weeks or at delivery (even if actual delivery was cephalic)

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123
Q

What is used for screening for developmental dysplasia of the hip

A

Ultrasound at 6 weeks

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124
Q

Chest X-ray in cystic fibrosis

A 
Typically normal at first
Bronchial thickening
Hyperinflation 
Atelectasis
Hilar thickening
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125
Q

Rash associated with parvovirus

A

Slapped cheek rash in children

Red lace rash in adults

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126
Q

What is Gaucher’s disease?

A

A lysosomal storage disorder

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127
Q

What is ileal atresia?

A

A malformation where there is narrowing or absence of a portion of intestine

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128
Q

What is meconium ileus?

A

A cause of neonatal bowl obstruction due to thickened meconium

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129
Q

What is Hirschprung’s enterocolitis?

A

Proximal colonic dilation secondary to obstruction in Hirschprung’s disease

130
Q

Symptoms of Hirschprung’s enterocolitis

A

Fever, abdo distension, bloody diarrhoea

131
Q

Management of Hirschprung’s enterocolitis

A

Fluid resuscitation
Decompression with NG and rectal tubes
Abx
Surgery is definitive management

132
Q

Common causes of meningitis in neonates

A 
Group B strep
E. coli
Pneumococcus
Listeria
Staph aureus
133
Q

Common causes of meningitis in infants and children

A

Meningococcus
Pneumococcus
Hib

134
Q

What joint is often painful in children with hip pathology?

A

Knee

135
Q

Investigation of slipped upper femoral epiphysis

A

AP and frog-lateral X-ray

136
Q

Management of slipped upper femoral epiphysis

A

Internal fixation

137
Q

Typical demographic of slipped upper femoral epiphysis

A

Boys over 12 (often obese)

138
Q

Complications of slipped upper femoral epiphysis

A

Arthritis

Avascular necrosis

139
Q

Symptoms of slipped upper femoral epiphysis

A

Limp

Hip and knee pain

140
Q

Medication to add after ICS in childhood asthma

A

Montelukast

141
Q

APTT in haemophilia

A

Raised

142
Q

INR in haemophilia

A

Normal

143
Q

Platelet count in haemophilia

A

Normal

144
Q

Which haemophilia is most common?

A

A

145
Q

Haemophilia A inheritance

A

X linked recessive

146
Q

Advice for parents of children with haemophilia

A

Avoid NSAIDs
Management of injury (low threshold for presenting to A&E)
SC immunisations rather than IM
Avoid some contact sports if severe

147
Q

Neurological complication of severe neonatal jaundice

A

Kernicterus

148
Q

First line treatment in severe neonatal jaundice

A

Phototherapy

149
Q

What supplement is needed in treatment of neonatal jaundice to prevent anaemia?

A

Folate

150
Q

Symptoms of HSP

A

Rash
Abdo pain
Arthritis
Glomerulonephropathy

151
Q

Age affected by HSP

A

6 months to adult, though it’s most common in children

152
Q

Rash associated with ITP

A

Fine petechial rash

153
Q

HSP key investigations

A

FBC
Clotting screen
U&Es
Urine dipstick

154
Q

Complications of HSP

A

Arthralgia
Acute renal failure
Intususseption
Pancreatitis

155
Q

What would suggest bacterial rather than viral gastroenteritis?

A

No vomiting
Bloody diarrhoea
Risk factors eg contact with poultry

156
Q

Symptoms of haemolytic uraemic syndrome

A 
Thrombocytopenia (can cause petechial rash)
Haemolytic anaemia (can cause jaundice)
Renal failure (can cause oedema)
157
Q

Most common trigger for haemolytic uraemic syndrome

A

E. coli diarrhoea

158
Q

What should be considered in a child with diarrhoea who develops jaundice and pallor?

A

Haemolytic uraemic syndrome

159
Q

PKU inheritance

A

Autosomal recessive

160
Q

Symptoms of untreated PKU

A

Neurological problems

161
Q

Management of PKU

A

Diet with low phenylalanine and supplements of missing amino acids

162
Q

Investigation of ascites

A

Ascitic tap
Ovarian, pancreatic and colonic tumour markers
Abdo and pelvis USS

163
Q

Causes of inadequate cervical smear

A

Failure to sample full 360 degrees
Blood
Inflammation
Age related atrophy

164
Q

What does dyskaryosis mean?

A

Abnormalities of nucleus

165
Q

What is a lletz biopsy?

A

Removes full circumference of transformation zone and associated abnormal area

166
Q

What anaesthetic is needed for lletz biopsy?

A

Local

167
Q

Complications of lletz biopsy

A 
Cervical stenosis
Cervical incompetence 
Infection
Difficulty in follow up smears
Incomplete biopsy
168
Q

HPV strains associated with cervical cancer

A

16 and 18

169
Q

Symptoms of uterine fibroids

A

Menorrhagia

Irregular bleeding

170
Q

Age associated with uterine fibroids

A

30-50

171
Q

What typically happened to fibroids after menopause

A

Shrink

172
Q

What tends to happen to fibroids in pregnancy?

A

Grow faster

173
Q

Management of ovarian torsion

A

Surgery (may be able to remove cyst or may need to remove while ovary)

174
Q

Symptoms of trichomonas vaginalis

A

Green frothy discharge
Smelly discharge
Sore vulva
Pain during intercourse

175
Q

Bacterial vaginosis symptoms

A

Water grey to clear discharge smells fishy

176
Q

What setting can most pelvic inflammatory disease be managed in?

A

Community

177
Q

What is ectopy in colposcopy?

A

Prominent columnar epithelium in the cervix

178
Q

What does ectopy on colposcopy suggest?

A

Common in pre menopausal women or women on COCP

179
Q

Management of cervical intraepithelial dysplasia 1

A

Usually regresses spontaneously

180
Q

What does factor V Leiden increase risk of?

A

Clots

181
Q

Effect of POP on periods?

A

Lighter

182
Q

Effect of IUS on periods

A

Lighter but may be irregular

183
Q

Investigation of coil if cord can’t be found

A

Transvaginal USS

If it still can’t be found, pelvic and abdominal X-ray

184
Q

Management of coil that is in the abdomen rather than vagina

A

Surgical removal

185
Q

Management of bartholin cyst

A

Marsupialisation (this entails draining it and suturing the inner wall to the skin to reduce risk of recurrence)

186
Q

What are powder burn spots and what do they indicate?

A

Brown spots under peritoneum

Indicates endometriosis

187
Q

Definitive treatment of endometriosis

A

Ablation at time of laparoscopy

188
Q

Options after surgery for endometriosis to manage pain

A 
COCP
POP
GnRH analogue injections
NSAIDs
TENS
189
Q

What is ovulatory / primary endometrial dysfunction?

A

Heavy menstrual bleeding with no organic cause

190
Q

Medications in primary endometrial dysfunction

A

Antifibrinolytics eg tranexamic acid or mefenamic acid
Oral iron if anaemic
COCP

191
Q

Imperforate hymen symptoms

A

Amenorrhoea
Lower abdominal tenderness and distension
Violet bulging vaginal membrane
Urinary retention

192
Q

Diagnostic test in imperforate hymen

A

Ultrasound (shows fluid filled vagina)

193
Q

Treatment of imperforate hymen

A

Incision

194
Q

Symptoms of pelvic organ prolapse

A 
Stress incontinence
Dyspareunia
Obstructed defecation
Voiding dysfunction 
Backache
195
Q

First line management in stress incontinence

A

Pelvic floor muscle training

196
Q

Surgical options for stress incontinence

A

Colposuspension (suspends and stabilises urethra)
Mid-urethral sling
Urethral Bulking agent (narrows urethra)

197
Q

Conservative management of incontinence

A

Fluid advice (good intake, reduce tea and coffee)
Smoking cessation
Bladder training

198
Q

Complications of surgical management of miscarriage

A 
Bleeding
Cervical trauma
Infection
Retained products of conception (may need repeat procedure)
Uterine perforation
199
Q

When does obstetric cholestasis typically present?

A

Third trimester

200
Q

Symptoms of obstetric cholestasis

A 
Itching is most common (typically worse on hands and feet)
Insomnia
Anorexia
Abdo pain
Steatorrhoea
Pale stool
Dark urine
May have jaundice
201
Q

LFTs in obstetric cholestasis

A

Moderate rise in liver enzymes

202
Q

Bile acid levels in obstetric cholestasis

A

High

203
Q

Bilirubin levels in obstetric cholestasis

A

Normal or slightly high

204
Q

Risk factors for obstetric cholestasis

A

Genetics
Previous obstetric cholestasis
Asian
Pruritis on COCP

205
Q

Complications of obstetric cholestasis

A 
PPH
Liver disease
Foetal distress
Premature delivery
Macrosomia
206
Q

Management of obstetric cholestasis

A

Monitoring of foetal growth throughout pregnancy
Vitamin K (as prophylaxis against PPH)
Ursodeoxycholic acid can reduce itching
Creams to help itching

207
Q

Symptoms of placenta praevia

A

Painless PV bleeding
Post coital spotting
Transverse foetal lie

208
Q

Risk factors for placenta praevia

A 
Previous placenta praevia 
Multiple pregnancy
Multiparity
Previous uterine surgery
Smoking
Older maternal age
209
Q

Symptoms of placenta praevia

A

Abdo pain
May have PV bleeding
Foetal heart rate abnormalities

210
Q

Risk factors for placental abruption

A 
Previous abruption
Polyhydramnios
Hypertension 
Sudden rupture of membranes
Smoking or drug use in pregnancy 
Multiparity
211
Q

Complications of placental abruption

A

DIC
Blood loss leading to anaemia, hypovolaemia and renal failure
PPH

212
Q

What are late deceleration on CTG and what do they indicate?

A

Foetal heart rate slowing late in a contraction

Indicates hypoxia

213
Q

What are early deceleration on CTG and what do they indicate?

A

Deceleration early in contraction

Indicates head compression

214
Q

Complications of premature menopause

A 
Autoimmune disorders eg thyroid disease
Osteoporosis 
Vaginal dryness
Sexual dysfunction 
Insomnia 
Hot flushes
215
Q

What is a first degree episiotomy tear?

A

Damage to perineal skin or vaginal wall

216
Q

What is a second degree episiotomy tear?

A

Damage to perineal muscles but not anal sphincter

217
Q

What is a grade 3A episiotomy tear?

A

Damage to anal sphincter with less than 50% thickness torn

218
Q

What is a grade 3B episiotomy tear?

A

Damage to anal sphincter with more than 50% thickness torn

219
Q

What is a fourth degree episiotomy tear?

A

Damage to external and internal anal sphincter and anorectal mucosa

220
Q

What is a grade 3c episiotomy tear?

A

Damage to external and internal anal sphincter

221
Q

Where to repair grade 3 and 4 episiotomy tear?

A

Theatre

222
Q

Analgesia required to repair episiotomy tear

A

General, spinal or epidural

223
Q

Management after anal sphincter tear repair

A

Antibiotics, analgesics, laxatives, physiotherapy appointment, gynae outpatient follow up

224
Q

Most effective form of emergency contraception

A

Copper coil

225
Q

Pregnancy and contraception advice following ectopic pregnancy

A

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
Q

Follow up for low lying placenta at 20 week scan

A

Further ultrasound at 32 weeks

227
Q

Typical first line treatment in oral cancers

A

Surgery (often with adjuvant chemo or radiotherapy)

228
Q

Typical first line treatment in non-oral head and neck cancers

A

Radiotherapy (often with adjuvant chemo)

229
Q

Virus often seen in head and neck cancers

A

HPV

230
Q

Hypokalaemia symptoms

A 
Absent reflexes
Constipation
Cramps
Weakness
Tiredness
231
Q

First line in renal cancer

A

Nephroureterectomy

232
Q

Do patients with testicular torsion usually have a history of testicular pain?

A

Yes as the testis torts and un-torts

233
Q

Indication for treating variocele

A

Symptomatic

Infertility

234
Q

Options for varicocele treatment

A

Vein ligation

Radiological vein embolisation

235
Q

Presentation of erythema nodosum

A

Tender red nodules. Often bilateral and on lower limbs. May have fever and joint pain

236
Q

Causes of erythema nodosum

A 
Sarcoidosis (most common)
TB
IBD
Drugs
Haematological malignancy
Lupus
Connective tissue disease
Atypical infections eg fungal
237
Q

Key investigation in erythema nodosum

A

Chest X-ray (as sarcoidosis most common cause and TB should be excluded)

238
Q

What is the name for infection around the nail?

A

Paronychia

239
Q

Appearance of actinic keratosis

A

Discrete dry, rough scaly lesions in sun exposed areas

240
Q

Treatment of eczema herpeticum

A

Oral acyclovir
Stop topical steroids
Abx to prevent bacterial superinfection

241
Q

Investigation needed for Diagnosis of pemphigoid

A

Skin biopsy

242
Q

Treatment of pemphigoid

A

Topical steroid if localised

Systemic steroid or immunosuppressants if more widespread

243
Q

Investigation of fungal scalp infection

A

Skin sample for microbiology

244
Q

Treatment of fungal scalp infection

A

Oral antifungals

245
Q

What is tinea corporis?

A

Ringworm

246
Q

Investigation of tinea corporis

A

Skin scraping for culture

247
Q

Treatment of ringworm

A

Topical antifungal

248
Q

Major and minor features of melanoma

A 
Major: change in size
Irregular shape
Irregular colour
Minor: oozing
Inflammation
Diameter >7
Change in sensation
249
Q

PCP pneumonia treatment

A

O2
Abx
Steroids

250
Q

First line tests for PCP

A

Bronchoalveolar lavage or sputum culture

251
Q

Ruptured bakers cyst symtpoms

A

Acute pain at back of knee

252
Q

Mumps complications

A

Deafness, Gillian-barre syndrome, myocarditis, oophritis, orchitis, pancreatitis

253
Q

Hep A management

A

Supportive, usually as an outpatient

254
Q

Contact tracing in Hep A

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
Q

How does acute Hep B present in children?

A

Usually asymptomatic

256
Q

Hep B clinical course

A

Acute infection is often asymptomatic. Latent for many years. May cause liver failure

257
Q

Hep B in pregnancy

A

90% of babies will be chronic carriers. Give baby immunoglobulin to reduce this

258
Q

Contact tracing in Hep B

A

Sexual or needlestick contacts during acute infection. Offer immunoglobulin and vaccination. Vaccinate sexual and household contacts

259
Q

Contact tracing in Hep C

A

Sexual or needle partners when in infectious period

260
Q

Measles symptoms

A

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
Q

PCP diagnosis

A

Bronchoalveolar lavage

262
Q

PCP prophylaxis

A

CD4 under 200 or previous PCP

263
Q

Syphilis treatment

A

Benpen

264
Q

Genital warts treatment

A

Topical imiquimod cream is first line. Liquid nitrogen cryotherapy second line. Surgery third line. May offer to do nothing

265
Q

Treatment of internal genital warts

A

Treat external warts then review. Cryotherapy or surgery

266
Q

Genital ulcers main cause

A

HSV

267
Q

Test for HSV in genital ulcers

A

Swab for PCR

268
Q

Genital ulcers management

A

Oral acyclovir. Topical anaesthetic. Saline baths. Counselling

269
Q

Genital ulcers in pregnancy

A

Consider treating. Consider C-section if symptomatic when mother goes in to labour

270
Q

Long term management of genital ulcers

A

Either treat outbreaks or consider long term therapy to reduce outbreaks

271
Q

Bacterial vaginosis treatment

A

STI screen. Metronidazole

272
Q

Recurrent thrush treatment

A

Induction fluconazole (around 1 week) followed by maintenance fluconazole (around 6 months)

273
Q

Stress incontinence medication

A

Duloxetine

274
Q

When to lumbar puncture in subarachnoid haemorrhage

A

At least 12 hours after symptoms if CT negative

275
Q

Signs of hypercalcaemia

A 
Bone pain
Constipation
Anorexia
Nausea
Thirst
Treusseau’s and Chovseks sign
276
Q

Confirmation of death

A 
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
Q

What fracture causes teeth malignment?

A

Mandible

278
Q

Which nerve is responsible for lacrimation?

A

Facial

279
Q

Which nerve runs through the paritid gland?

A

Facial

280
Q

Symptoms of salivary gland stones

A

Episodic salivary gland pain and swelling when food is anticipated

281
Q

Most common parotid tumour

A

Pleomoephic adenoma (benign)

282
Q

Parotid tumours key investigation

A

USS and fine needle aspiration

283
Q

Do thyroid nodules move on swallowing and tongue protrusion?

A

Move on swallowing, not on tongue protrusion

284
Q

Does a thyroglossal cyst move on swallowing and tongue protrusion?

A

Both

285
Q

Does a dermoid cyst move on swallowing and tongue protrusion?

A

Neither

286
Q

Thyroglossal cyst symptoms

A

Midline neck lump
Moves with tongue protrusion
May fluctuate in size
May cause compressive symptoms

287
Q

Management of teeth that have been knocked out

A

Analgesia and count teeth found
May re-implant if adult teeth
Abx
CXR if not all teeth found incase it has been aspirated

288
Q

What is ludwigs angina?

A

A dental abscess can cause airway compromise - surgical emergency

289
Q

Peritonsilar abscess treatment

A

Abx
Drainage (incision or aspiration)
Offer elective tonsillectomy if 2 episodes

290
Q

Section 5(2)

A

Doctor detains patient for up to 72 hours

291
Q

Opiate overdose symptoms

A

Pinpoint pupils and reduces respiratory rate

292
Q

Glue ear management

A 
Initially surveillance (may resolve)
If not then grommet insertion under general anaesthetic and may remove adenoids
293
Q

Nasal fracture investigation

A

Anterior nasendoscopy to look for septal haemotoma

294
Q

Nasal fracture management

A

Clinic review in a week. May do manipulation

295
Q

What is porcelain gallbladder and how is it treated?

A

Calcification of gallbladder (premalignant). Treated with elective cholecystectomy

296
Q

What is emphysematous cholecystitis and how is it treated and prognosis?

A

Air in gallbladder wall. High mortality so treated with cholecystectomy

297
Q

Bowel pseudo obstruction management

A

Conservative

298
Q

Breast cyst symptom

A

Tender lump appears suddenly

299
Q

Breast cyst management

A

Aspirate and send for cytology if bloodstained

300
Q

Breast cyst age

A

Perimenoupausal

301
Q

As well as weakness, what other symptoms can Bells palsy cause?

A 
Post auricular pain
Difficulty chewing
Incomplete eye closure
Hyperacusis
Drooling
Tingling
302
Q

What nerve gives taste to anterior tongue?

A

VII

303
Q

What is inclusion body myositis and how does it present?

A

Slowly progressive myopathy in adults. Presents similar to motor neurone disease with weakness

304
Q

Achilles rupture management

A

Equinus cast to hold foot in plantar flexion

305
Q

Plummer vinson syndrome symptoms

A

Glossitis
Dysphagia
Anaemia

306
Q

What is Plummer Vinson syndrome?

A

Oesophageal webs

307
Q

What is Simmonds test?

A

Squeeze calves to look for achilles tendon rupture

308
Q

First line in sciatica

A

Analgesia and mobilisation

309
Q

When and how to investigate sciatica?

A

MRI if not resolving in 6 weeks

310
Q

What is Thomas’ test?

A

Flex normal hip and look for fixed flexion of other hip (it will raise off bed)

311
Q

When is pain worse in carpal tunnel syndrome?

A

Night

312
Q

Where may there be wasting in carpal tunnel syndrome?

A

Thenar eminence

313
Q

Cranial nerve that closes the eye

A

VII

314
Q

What does hypopyon indicate?

A

Endophthalmitis

315
Q

Investigation after CRAO / CRVO

A

Carotid Doppler

316
Q

Management of epistaxis if nasal cautery fails

A

Nasal packing for 24 hours

317
Q

Erythema nodosum causes

A 
Infections
Sarcoidosis
IBD
Neoplasia (leukaemia, Hodgkin’s disease)
Drugs
Pregnancy
318
Q

Diagnostic test in autoimmune hepatitis

A

Liver biopsy

319
Q

Sarcoisosis treatment

A

Monitoring if mild / asymptomatic
Rest and NSAIDs if moderate symptoms
Steroids if eye / lung / heart / neuro involvement

320
Q

Glue ear management

A

Active surveillance for 3 months

If not resolved, grommet insertion under local anaesthetic

321
Q

Medication that can help stop smoking

A

Bupropion

322
Q

opioid withdrawal symptoms

A

Symptoms include agitation, anxiety, dilated pupils, sweating, tachycardia, hypertension, piloerection, watering eyes-nose, yawning, cool clammy skin.

Progress Tests (17 decks)

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