Cardio Resp etc Flashcards

Question

Transfusion: <100 !!!!!!!!!! days since transfusion skin > GI+Liver PAIN MacPap Rash -Jaundice, Diarrhoea, N+V >100 !!!!!!!!!!! days since transfusion Skin, Eye, Lung, GI dx ______________ ``` SHORTLY after transfusion START: Fever, Nausea, Back/Joint pain Burning @canula-site DARK-urine -Inc (HR RR), Low BP, Temp high ``` Delayed Heme Rxn - ? incompat = ? Gets transfusion --> towardsEND few HOURS later = hot/cold feeling ``` Collapse @transfusion- High HR RR, Low BP, Temp HIGH ________________ ``` Started transfusion then gets SOB/Wheezy Low BP, stuff swells up..

Answer 1

Acute GvH stop + steds --PAINful MacPap Rash Chronic GvH ______________ Acute Heme Rxn ABO dx - STOP, SALINE - dark urine probs cos of the broken down RBCs -> bilirubin pathway -> piss out all the hemolysed RBCs Delayed Heme Rxn - Rh incompat = STOP, IVIg Non-hemolytic rxn -STOP, Slooow, Paracetamol Infection-sepsis -Neuts ________________ Anaphlaxis - SAICA

Answer 2

Spur cells - LF / ABLP:abetalipoproteinemia Burr cells - LF/RF ________ Schistocytes - Hemolysis Target cells - ThalARremia, HbC dx, Asplenia, LF ________ Basophilic stippling - NOiron - sidero=LEAD - myelodysplasia ``` Pappenheimer - w/ Iron -sidero -myelodysplasia -Asplenia _______ ``` Teardrop - Myelofibrosis Bite cells/Heinz bodies - G6PD ``` Howell-Jolly - HypoSplenia -ENCAPSULATED: SHiN SKiS -Pneumo one/Flu annual/PMP-V prophylaxis S.pneu/H.flu/N.Men - Strep-B/KlebsIella/Sally _________________ ``` ``` body: 1st infection response - IgM surfAcEs - IgA IgE (AllErgy), fluids - IgG immature B-cell plasma membranes - IgD __________________ ``` ``` HSR: Type 1 - Anaphyl/Atopy Type 2 - antiBody Type 3 - immComplex - SLE/PAN/PSGN Type 4 - Delayed cell-meDiated -GvH, Allergic dermatitis TB/Transplant, EAA-HSRpneumonitis delayed, Scabies ```

Answer 3

Px: -Age >50 + Sig Smoke Hx -Lung dx O/E or CXR ________ Sinusitis <10d Syx - NO ABx Sinusitis >10d Syx: -nasal c.sted ABx only @ Cx: - Systemic dx - Peri-orbital/orbital cellulitis - Ophthalmoplegia - Sub-periosteal abscess - Meningitis Tx = PMP-V -> Co-Amox/ Doxy @allergy __________ 1. Fever > 38/ 3-14y 2. Purulent exudate Admit <3d 4. No cough/Coryza Inflamed tonsils 6. C.LNopathy FeverPAIN 4/5 = PMP-V Centor 3/4 = PMP-V ________ ``` Allergic Rhinitis: Mild-Mod: AHist > MastCellStab 1. AHist: - a. Intranasal Azelastine > - b. Oral AHist > ``` 2. MastCellStab-NaCromoGlic Mod-Severe/ Mild fail: -Intranasal Csted Chronic Bilat rhino-sinusitis? -saline nasal douches -Chronic UNILAT rhino-sinusitis = 2WW!!! - PERENNIAL - house dust mites - seasonal hayfever -Occupational 1. House dust mites - all the time/ALLyear #PERENNIAL 2. Pollens: - Tree = spring - Grass = early summer - Weed = spring/summer/autumn 3. Occupational

Answer 4

MA-SHg FAVRett 1. AR dx = 'METabolic' - exceptions: inherited ataxias 2. AD dx = 'STRUCTural' - exceptions: Gilbert's, HyperLipidaemia type 2 *MA-SHg Ar: Met + Ataxias AD: Struct + Hyperlipidemia 2/Gilbert _________________ ``` XLr = FAVRett Fragile X Alport Vit D Resistance #RicketsOM Rett Syndr ```

Answer 5

Crohns symptoms: Cobblestone/Creeping fat = StringSx @ B.Swallow Rectal spare / Cancer - SB/colon / Skip lesions + TMiFT* -> Fistulae Obstruction = Fistulae / Abscess-perianal-Adhesions / STricture-skin Tags Haem = duo-Fe, jej-Folate, ileum-B12 NCG+LA=PA Stones (oxalate/GB) / Sych / Systemic* *TransMuralInflam=FullThick *Dx Related: PauciArth / Asymm / OP E.Nodosum Episcleritis C>UC ``` Dx UNrelated: PolyArth / P - Symm / Clubbing = PSCholang P.gangrenosum Uveitis Smoking UC>C ``` Ileo-anal pouch reconstruction @Crohns = high risk of: -fistula formation -pouch failure Commonest disease site @crohns? - terminal ileum #b12 dx - limited ileocaecal resections. - may affect enterohepatic bile salt recycling -> increase the risk of gallstones. Severe perianal/rectal Crohns = proctectomy.

Answer 6

5Vacc <10yr + any wound -Clean/TetProne/HRisk = CLEAN+CHILL 5Vacc >10yr + Clean = CLEAN+CHILL 5Vacc >10yr + TetProne = bVacc 5Vacc >10yr + HRWound = -bVacc + Tet Ig ?/Not vacc + Clean = bVacc ?/Not vacc + TetProne/HRWound = -bVacc + Tet Ig ______________ Hep B - risk of needlestick transmission -20-30 % look at source - HBsAg Pos+ OR unknown? 1. HBsAg Pos+ : known responder = booster non-responder/being vacc: -HBIg + vaccine 2. Unknown source: -known responders = booster -non-responders = HBIg + vaccine -being vacc = accHBV vaccine _________________ Rabies: Animal in UK - NO risk = -WASH + ?CoAmox Animal bite elsewhere - HR = - WASH + ... - Already immunised: 2 vaccines - NotPrevImmunised: HRIg+FullCourse

Answer 7

Fucking P-ANCA!!! -like in PSC...PP-anca, onionSSkin-onion, uCC __________ Ulcers / NoctPoo-Urgency-Tenesmus -pseudopolyp LargeI: - JALAN Criteria* Lead pipe=ToxicMegaColon #AXR Loss of haustra - pseudoPolyp LLQ pain Clots-VTE Continuous=rectum-> IleoCecal Valve Colorectal cancer Crypt abscess - low goblets Extend proximally Red diarrhoea Sych/Systemic* *dx Related: Bone PauciArth/Asymm/OP Skin E.Nodosum Eye Episcleritis *dx UnRelated: Bone PolyArth/P-symm/Clubbing - PSC Skin P.gang Eye Uveitis ``` poorly controlled colitis = fails to respond to medical therapy --> -sub total colectomy -end ileostomy -rectum = stapled off + left in situ/ mucous fistula @oedematous-bowel ``` Dysplastic transformation of colonic epithelium + mass lesions -> procto-colectomy ________ * JALAN MEGACOLON: - Fever >38, HR >120, WCC >10.5, Anemia

Answer 8

Congenital inguinal hernia – paediatric surgery ASAP incarceration risk <6w - surg <2d <6m - surg <2w <6y - surg <2m probability of strangulation = 3% Direct V Indirect Ing Hernia -Direct = weakness @posterior wall of the inguinal canal -Indirect = persistent PVaginalis _____________ ``` Infanta UMBILICAL hernia No tx - resolve <3yrs -Syx and large = 2-3yrs -Asyx and small = 4-5yrs __________________ ``` epidural analgesia helps to accelerate the return of NORMAL bowel function after abdominal surgery Juvenile polyp hamartomas Fissure FPG - -?PMH: crohns fever + severe pain = Intersphincteric Abscess > fissure Solitary Rectal Ulcer - excl cancer #biopsy Haemorrhoids FP BDISH -No pain - unless thrombosed Rectal prolapse/intususception Chronic fissure > 6/52: triad Perinanal Hematoma Proctitis Causes: Crohn's, UC, C.difficile Ano-rectal abscess --> Fistuale Goodsall rule determines location ___________ ______________ 1 node, 2 node, b/l diaphragm, extranodal MWND: Mucosa, Wall, Node met, Distant mets A-P resection @low-rectun/anus - Anterior Resection @mid-rectum + above - High Ant Resection @sigmoid Hartmanns at @Perf ______________ FAST SCAN Diverticula most commonly at SIGMOID Thoracotomy: in haemothorax include >1.5L blood initially, OR >200ml/hr >2hr loss Subcut emphysema!! Not fkn Perf 🤦🏽‍♂️😶 SIGMOID at oldie, psychos, Parkinsons, Chagas 4-BSA-kg 8+16hrs mls.% / 1000 Spout SMALL Bowel stoma cos of enzymes!!! - Richters hernia = Strang Syx w/out Obst - SPIGELIAN HERNIA!! LLVH tense red TPN derranges LFTs!!!!! -retroperitoneal FIBROSIS Gastric MALT lymphoma - eradicate H. pylori!!! colovesical fistula - CT!!!! Bowel obstruction Ix - definitive = CT!!!!! -Abdo = initial GASTROGRAFIN

Answer 9

1. Conservative 2. Laparotomy with conservation 3. Resection ______________ PEG BEST LONG TERM!!! ____________ Hyatid Echinococcus Cysts #Eosino #Daughter - CT abdomen!!!! - MEBENDAZOLE -> ?Resection + HyperTonic swabs - Perc Asp is contraindicated Liver hemangioma Liver abscess AMOEBIC cyst = Asp anchovy paste + poorly defined boundary = METRONIDAZOLE Liver cell adenoma -OCP 30-50 y/o B12 def -Subacute Combined Degen of Spinal Cord cos #NO INTRINSIC FACTOR Urinary 5HiAA - H.pylori + Carcinoid --> Coronary-itis - TR/PS Spine epithelial defect + HIRSUTISM = pilonidal sinus ______________ Boas = shoulder/scapula excitation @cholecystitis Cullen @panc = umbilicus; Grey-Turner = flank Blumberg@appendicits = rebound tenderness Rovsing @appendicitis = touch LIF = pain RIF Claybrook@PERF -heart/breath sound @abdo = PERF SBO Ax - ACHI: adhesions/cancer/hernia/ibd-crohns LBO Ax - cancer _______________ ACUTE Cholecystitis -AUSS, AMG+Lap Chole <1wk - lap chole @syx gallstones #day-case #elective - CYSTIC DUCT!!! - Asyx NOT need op - not well for lap chole = Cholecystostomy - USDA @radio-lucent <1.5cm + funct GB @cystography -CBD stones = lap chole + CBD clearance via: ERCP or @lap chole -if ERCP fail = temporary stenting ``` cholecystectomy 6 months ago -> since the operation = experienced -chronic diarrhoea #float in the toilet Tx = CHOLESYTRAMINE - help absorb bile salts ``` Isolated hyperbilirubibemia Ix? = - FBC - check for hemolysis - UCB + CB in 1-3 months Lidocaine max dose? With Adren? 3mg/kg, 7mg/kg w/ adrenaline ______ Foregut- Oesoph -> U.Duod AoVater -Coeliac T12 Midgut- L.Duod -> prox 2/3 TC -SMA L1 Hindgut- distal 1/3 TC -> anal canal above pectinate line - Ligament of Treitz = upper GI v lower GI D-J jct - IMA L3

Answer 10

Lupus Vulgaris Scro-Fulo-Derma ______ Riedel Thyroiditis ______ 1. Graves - Eye shit, PreTib Myxoed - EYE SHIT ABSENT 30%!!!!!! FFS - SMOKER !!!!! 2. Toxic Multinodular - Plummer Dx - B4 Asyx -> now Syx - NO eye syx, NO pretib myxoed 3. Non-Toxic Goitre 4. Thyrotoxicosis -> HIGH-OUTPUT Cardiac Failure _________ ``` Graves <60 TSHrAB stim TSH receptor -anti-TPO75%-> Thyroid HYPERplasia XS T4/3 = suppress TSH ``` Toxic >60 1. Multinodular Iod def areas DENMARK ``` 2. Nodular #BenignFollicularAdenoma --> XS T4/3 synth = suppress TSH ``` Goitre: - Painful Ax? #ESR a. SadQT 1. HyperT <6w 2. Euthyroid <3w 3. HypoT b. Acute Thyroiditis #bacteria @pyriformSinus c. Preg PPT - Painless Ax= graves, toxic Amiod Induced Thyroiditis PathPhys/goitre?/tx? 1. XS iod induced T4/3 synth -> Goitre #AT drugs/K-percolate 2. Destructive Thyroiditis -> No goitre #csteds _______________ ``` ABCDE Paracetamol Propranolol PTU /Lugol Dexamethasone _______________ ``` HypoT: Dry hair-coarse/skin Menorrhagia HyperT: Pretib myxoed Oligomenorrhoea Lat malleoli oed lesions

Answer 11

``` PND ACUUUUTE pul oed Inc cardiomeg / HJR Neck vein dilate S3 gallop ``` ``` Pl effusion Ankle oed Inc HR >120 / HMeg Noct cough - pink frothy sputum SOB ``` None Slight Marked Unable ``` None 1 Slight hill/hurrying 2 MOST ppl 3 Unable to after: -100m/few mins 4 -Leave house/dressing 5 ```

Answer 12

1. PBC - AMA/SMA IgM 2. Autoimmune hepatitis ANA/SMA LKM1kids 3. PSC 4. PBC liver transplant @: - Bili >100 - Recurrent cholangitis - Refractory itching - Ascities ``` 5. Kolestyramine for ITCH Usda #FIRST-LINE BASTARD!!!!! Transplant ADEK MONITOR AFP LFT USS Stop Smoke ``` 6. PBC: HCC PSC: Cholangiocarcinoma/Colorectal/UCC ___________ - FBC - check for hemolysis - UCB + CB in 1-3 months

Answer 13

``` Wilson - AR Ix? MRI, Slit lamp, Copper: serum/ceruloplasmin LOW Copper: 24hr urine HIGH ``` ``` Tx: Penicllamine Avoid Cu foods Screen kids Transplant/Trientine/TetraThio.. _________________ ``` HChr - AR ``` Ix: HFE/C28Y/H63D/Pearl stain Image: MRI, Xray Tx: VeneSection -> ferritin/TF sats <50% Desferioxamine _____________ ``` ``` Alpha-1 antitrypsin = ACoDominant!!! Ix: PiSS>PiZZ Slow>V.slow COPD Ix and LFTs ``` Tx: IV alpha 1 antitrypsin ``` Bead sign? MRCP PSC Pearl sign? HChr PAS +? Alpha-1 antitrypsin Piecemeal necrosis? Autoimmune hep Porcelain? Cholecystitis - cancer risk ```

Answer 14

Haemorrhoid Fissure -?PMH: crohns ``` Solitary rectal ulcer Histology: -mucosal thickening -lamina propria replaced w/ collagen and SM (fibromuscular obliteration) ``` Chronic fissure > 6/52: triad Perinanal Hematoma Proctitis Causes: Crohn's, UC, C.difficile ___________ Ano rectal abscess Ano -rectal abscess --> Anal fistula Goodsalls rule determines location Rectal prolapse = childbirth and rectal intussceception. = int/external _________ Rectal=Adeno Anal cancer=Squamous

Answer 15

High Ald:Renin Ratio = HyperAldosteronism -HyperNatraemia - Surg @Adenoma - Barters - ACEi/NSAID/K+IV - Spiro @Conn's B/L hyperplasia -Bart+Git=normoten / Liddle = HTN -Bart+Git= AR / LiDDle = AD ___________________ EXPLAIN: 1. EXogenous agents - Bblock/Asp/Malaria/Pentamadine/SU-insulin 2. Pit dx / PostPraDUMPINGsynd-whipple's 3. LF 4. Addisons 5. Insulinoma/SU -> - PrePro -> Pro -> - C-pep+Insulin(munchausen) 6. Neisidoblastoma Non-panc tumour Whipple - SIN Syx Improve Syx @ Inc BM Number: <3.5 ``` Prolonged fast INSULINOMA CT panc/Diazoxide Surg/SomatoStain __________ ``` High prolactin --> low GnRH + low FSH/LH --> Amenorrhoea/ Galactorrhoea-Gonad small/ OP cos of low FSH/LH and hence low oestrogen HA/Opthalmoplegia/GCS low Metoclop, Ecstasy, AntiPsychs, Tumour (prolactinoma/craniopharyngioma/stalk dx) PCOS/Preg, low T4 -> high TRH + high Prolactin, Estrogens/eGFR=low #reduced clearance Ix: Pit profile - FSH/LH/Prolactin MRI Eye test Prolactinoma - < 10mm - Bromocriptine/Cabergoline - > 10mm - TS surg

Answer 16

Mallory-Weiss Tear Hiatus Hernia -What should NOT be associated with dysphagia or haematemesis? UnCx hiatus ORBS: Oesopghageal Rupture Boerhaave Syndome -Complete disruption of the oesophageal wall in absence of per-existing pathology. Oesophagitis Dieulafoy Lesion - can be HDunstable Diffuse erosive gastritis - can be HDunstable Pharyngeal Pouch - ZENKER DIVERTIC -herniation between thyropharyngeus and cricopharyngeus muscles #Killian's Dehiscence - BSwallow MGravis Oesophag Candidiasis ____________ Squamous cell carcinoma of the oesophagus Adenocarcinoma of the oesophagus - GAS ___________ Achalasia: MCS BED CaMP - Manometry Contrast Swallow = dilated tapered oesophagus - BalloonEndoDilation – > CardioMyotomy+PPI Peptic stricture Dysmotility disorder - 1. Oesophageal spasm - coodination messed 2. Nutcracker - all @same time

Answer 17

%.mls/1000 -568ml in pint 4*BSA*kg = half 8-hrs, half 16-hrs Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises. Beta-blockers reduce hypoglycaemic awareness Beta-blockers may cause insomnia 1 Pack year = 20 cig/d/yr

Answer 18

Organophosphates - atropine Heparin - protamine sulfate Ethylene glycol - Fomepizole/ Ethanol / Dialysis Methanol - Fomepizole>Ethanol / Dialysis Salicylates - HCO3/ dialysis Lithium - Fluids/dialysis TCA - HCO3 Cyanide - OH-cobalamin Digoxin - Dig-specific Antibodies Lead/Arsenic*- dimercaperol / edetate

Answer 19

Pathphys: High GHRH (ectopic) --> High GH (panc/pit tumour MEN) --> High IGF @liver (muscle growth) Tx: TS surg Octrotide=SS analog-stop GH release +/- RT Pegvisomant ``` Ix: IGF-1 -high-> OGTT: -Norm=GH<2 \ GH/30min -Acro=GH high AF \ IGF lvl MRI head ```

Answer 20

Perioral dermatitis, Acne/Atrophy, SkinStriae, Telangiectasia Stomach ulcer, HTN, IHD, Psychosis, DM, OP/Obesity-buffalo hump, Cushing/cataract Drop in cort -> massive ACTH rise = pit enlargment -> mass effect + Hyperpigment #NELSON SYNDROME ACTH-dependent = - 3 (Pit-Adenoma) - 4b (ectopic/carcinoid) Rest ACTH independent eg Cune-Albright/Carney syndrome, Steroids, Adr Adenoma Cushings syndrome V disease? -syndrome = positive Dexa LD -disease - PIT adenoma _____________________ Suspect cushings, what Ix? - 24hr urine cortisol - Serum/saliva - DEXAMETH SUPP TEST DEXAMETH SUPP TEST - low dose 0am 9am - high dose 0hr 48hr Low cort @LD = NORM ~ / high cort @LD = Syndrome/PseuoCush (alco/depression - insulin tol test to r/o) ``` Low cort @HD = Disease: Pit Adenoma = -high ACTH -> b/l adr hyperplasia -> -high cortisol DexaHD=high enough to suppress ACTH -> suppress cortisol ``` ``` ~ / high cort @HD: low CRH/ACTH BUT STILL: -high cortisol = Adr Adenoma -high ACTH+Cortisol = SmallCellLungCancer / Carcinoid Tx: Surg/Conazole ```

Answer 21

1. Myasthenia gravis 2. Lambert-Eaton myasthenic syndrome 4. Nonspecific screening antibody, often associated with SLE 5. SLE, antiphospholipid syndrome 6. SLE 8. Mixed connective tissue disease 9. Rheumatoid a rthritis 10. Sjogren syndrome 11. Scleroderma (Limited) 12. Diffuse scleroderma (CREST syndrome) 13. Polymyositis, dermatomyositis 14. AMA/SMA = PBC 15. ANA/SMA = Ai Hepatitis 18. Prim membranous nephropathy 21. Hashimoto thyroiditis 22. Graves disease 23. Celiac disease 24. Type I diabetes mellitus 25. Pernicious anemia 26. Goodpasture syndrome 3. Antiphospholipid syndrome 7. Drug-induced lupus* 8. Mixed Connective Tissue Dx 13. Dermatomyositis, Polymyositis - Mid Jop 14. AMA/SMA = PBC 15. ANA/SMA = Ai Hepatitis 16. Churg-Strauss Eosinophilic Granulomatosis with polyangiitis/Microscopic polyangiitis/ Ulcerative colitis 17. GPA (Wegener) 19. Bullous pemphigoid 20. Pemphigus vulgaris 24. DM1 ``` * TNF-tb/cancer Tetracyc-mino Epileptics - Phenytoin Anti-Arryhtmics - Procainimide Chlopromazine Hydralazine ```

Answer 22

Non-gran: Microscopic polyangiitis P-ANCA Large: GCA, Takayasu NONE of the medium ones!! Small: GPA, eChurg Strauss Olser Weber Rendu!!! Large: GCA/Takayasu Med: Kawasaki makes Buergers on a PAN Small: the rest... ___________ EJECTION MSys@RUSE Aortic Stenosis Sys-mid C-D EJECTION Sys=MSys@LUSE= PS, ASD fixed split, ToF, HOCM S4, innocent!!!! Late MESys @ back = coarctation Carcinoid -> PUL STENOSIS/TricInsuff ___________ PSys LLSE = TR/VSD Dias LLSE = TSten PSys = MR/MP(actually is late sys) Late Diastolic = MS = LHS Hold Breath, Opening snap ____________ PSys LLSE = TR/VSD Dias LLSE = TSten PSys = MR/MP(actually is late sys) Late Diastolic = MS = LHS Hold Breath, Opening snap

Answer 23

``` Giant cell (temporal) arteritis ``` Large vessel disease Pred 40 mg/60mg @ eye dx --> reduce dose at syx control Bisphosphonate _________________ Takayasu PULSELESS Large vessel disease

Answer 24

Buergers - medium vessel -smoking cessation. DIFF FROM BERGERS IGA NEPHROPATHY!!! IN RENAL TOPIC!!! ___________________ Kawasaki - medium vessel Aspirin Echo IVIG ____________________ Polyarteritis Nodosa - medium vessel - PALPABLE purpura - jaundice = HEP B

Answer 25

Small-vessel vasculitis: GPA (WeCener) -Cpr3-ANCA _________________ Eosinophilic GPA (ChurgStrauss) -PmpO-ANCA -high IgE ______________ Microscopic Polyangiitis ______________ HSP -Plts FUCKING FINE!!! ..... Assoc w/ lgA Berger nephropathy -(Berger dx FROM RENAL TOPIC!!).

Answer 26

``` Polymyalgia rheumatica -assoc with GCA -EXCLUDE GCA -> Pred 15 mg/10mg @ DM --> reduce dose at syx control -Bisphosphonate due to HD steds __________________ ``` ``` Rash - malar/discoid Arthralgia Serositis - MAPLe -Myocard/Alveolitis/Pericarditis/LibmanEndocarditis Haem - ANT ``` Oral - NP ulcers Renal - GNephritis PhotoSensitivity ANA IC - T3 HSR Neuro dx 1. sl3 S HIGH AF cRp~norm 2. AB v AutoAG = ImmComplexes - T3HSR ``` 3. Tx: HOH, mycophenolate Mild: csteds Mod: DMARDs Severe, Ritux, Cyclophosphamide, Sted HD -maintenance: NSAID, Azo, MTX, bElumimab -lupus nephritis = ACEi @BP high ``` PREG: AZOTHIOPRINE 4. RhF, U1 rnp, Ds-dna, Ena Ana, Smith, Histone* @drugs Ds-dna, low c3/4 -> high C3d/4d, Esr high-CRP~ ``` * TNFi-TB/cancer Tetracyclines - mino Epileptics - Phenytoin AntiArryhtmics - Procainimide Chlorpromazine Hydralazine ______________ ``` 5. APLS: - Cardiolipin/Coagulant - gp12b Clots, Livido-Retic, Obstetric cx - miscarriage TCP/APTT high paradoxical ThromboProph Tx? -APLS + NO prev VTE = Aspirin lifelong - APLS + Prev VTE = Warf lifelong - APLS + pregnancy = Aspirin + LMWH(stop after w34) - APLS + Prev VTE WHILST on AC = - --Warf lifelong + Aspirin lifelong - --LMWH @Preg + Aspirin lifelong -APLS + ArtTE = Warf LIFElong - INR 2-3 @initial/ ArtTE - INR 3-4 @recurrent ArtTE = Art ThromboEmbolism

Answer 27

``` Limited SystSclerosis Tx? -Nifedipine -ILoprost -Bosentan -Sildenafil -SYMPATHOmectomy Anti-Centromere ``` ``` Diffuse SystSclerosis - HAMBI heart - HTN @renal-crisis lung - ILD bowel dx muscles - myositis -Anti-Scl 70 -Tx: Cyclophosphamide/SCT-autologous ```

Answer 28

Dermatomyositis -anti Mi, high CK/aldolase ____________ Polymyositis -anti Jo, high CK

Answer 29

S1 = AV valves mitral/tricuspid closing soft @Regurg loud @MS ``` S2 = Aortic/pul closing soft @ASten Loud @ -HTN, Hyperdymamic states, -ASD-PulHtn ``` Wide s2- delay RV empty -(PS; PAH{MRegurg severe}; RBBB) Paradox s2 -WPW-b, AS/LBBB, RVPacing, PDA Fixed s2 - ASD S4 = atria contract against STIFF ventricle HOCM/HTN ASten ``` S3 = diastolic filling of ventricle Const pericarditis - pericard knock, X+Y, X ✔️; Dilated CM, MRegug NORMAL<30y ____________ ``` 1st and 2nd degree: K+low; IHD; myocarditis; Beta-blockers; Athletes; Digoxin 3rd degree complete block: Fibrosis; AS; Surg Trauma; IHD/Congen ____________ Pericardial rub - pericarditis Pleural rub - pneumonia/PE Pericardial knock - C. Pericarditis ____________ LBBB=CM, HTN, AS, IHD RBBB=PE, ASD, Normal

Answer 30

Diastolic murmur @ LUSE PR - Graham Steel murmur HighPitched AR - Rumbling Austin Flint Sit forward!!! Musset nodding, Austin Flint, Dariosz Fem Corrigan carotid, Traube PISTOL Fem Pulse = collapsing/wide split; Apex displaced; Quincke nail bed hemorrhage Ax of Aortic regurg = Valve dx = SLE/infection (rheum+endo), RA Aortic root dx = Ank spond, Marf/EDanlos, ADiss/HTN, syphilis _______ PDA= pul art + aorta connection inutero, baby gets O2 from mum Doesn't need lungs #pul HTN -> R->L shunt -i.e. need it go through PDA after born, Pul HTN gone -> blood go to lung for oxygenation #dont need PDA ``` If persists #uncorrected, you get: L->R shunt -> PAH + RVH -> R->L shunt @Eisenmenger --> -murmur = disappears --> infant = CYANOTIC, not shocked ``` Pulse = Bounding + COLLAPSING* Murmur = continuous MACHINE -Wide pulse pressure Tx = Indomethacin closes PDA!! Prostaglandins keeps it open @ TGA to allow some oxygenation before surgical fixing * Collapsing pulse = AR/PDA/ Incr requirement - Wide Pulse Pressure = PDA/3rd HB/AR - Narrow Pulse Pressure = ASten - slow rising pulse =ASten

Answer 31

RAD vs LAD A(R>S @ V1) - WWPW - B (S>>>R + Tinvert)+ VT AAAArm switch/dextrocardia RRRRVH - LVH Lat (circumflex) - MMMMI - Inf (RCA) TTTTall thin = RAD Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular) ``` p176 ECG John Hampton book _______ LVH: R>25mm @V5+6 Inverted T @ V5+6, 1, VL LBBB+LAD ``` RVH: R tall @ V1 Inverted T @ V1+2, RBBB+RAD Bifid/Broad P-mitrale +/- AF = LAH -MS -> LAH Peaked P-pulmonale #RAH -TS>RVH(PS/PAH) As per John Hampton p112 ____________ Tamponade/ Severe asthma: - PAH, AR/ASD, High Left EDV AS _________ AR/PDA/ Incr requirement LVF _________ HOCM/Aortic valve Dx HOCM _________ J = hypothermia HyperCalcemia Widespread ST elevate = pericarditis _________ PR depression = most sensitive for pericarditis!!!!! pericardial knock = constr pericard _______. - Collapsing pulse = AR/PDA/ Incr requirement - Wide Pulse Pressure = PDA/3rd HB/AR - Narrow Pulse Pressure = ASten - slow rising pulse = ASten

Answer 32

Romano Ward, KCN(Q1+H2) fucked K channels Jervell Nielsen Brugada = tachy-arrhythmias, sudden cardiac death. ICD!! Gene SCN5A mutation -> fucked Na Channel Not FAPS - SSRI/TCA; APsych; Li - ABx = MACROLIDES - Low Mg K Ca/ Low Temp HypoThermia - Typ>>>>Atyp Long QT Synd Tx = beta-blockers -> ICD in high risk cases ________ Aspirin Antiplatelet - inhibits thromboxane A2 production Clopidogrel Antiplatelet - inhibits ADP + plt receptor binding Enox/fonda = Activates AT3 -> -stop f8-12a Bivalirudin Reversible DTi Abciximab, eptifibatide, tirofiban GP2b/3a receptor blockers

Answer 33

mean PAP of >= 25 mHg Ix: cardiac catheterization = measure right heart pressures 1. Tx underlying condition eg chronic lung dx copd ``` 2. Acute Vasodilator Testing -Epoprostenol IV -NO inhaled -aims to decide which pts have fall in PAP after vasodilators -eg. IV epoprostenol/inhaled NO ``` AVTEN Pos = reduction of mean PAP -Nifedipine - CCB AVTEN Neg: - ILoprost - PROSTacyclins - Bosentan - ERB - Sildenafil - PDEi Progressive syx should be considered for a heart-lung transplant. __________ Prosta-ilopr, Endo-bosentan, PDEi-sildenafil - PROSTacyclins: trePROSTinil, iloPROST - ERB: Endothelin receptor blockers: bosentan, ambrisentan - decrease pulmonary vascular resistance in PPHtn - PDEi: Phosphodiesterase inhibitors: sildenafil

Answer 34

AStenosis -S4=HOCM/HTN/ASten Asyx = OBSERVE Asyx >40/50mmHg + LV sys dx = SURG Syx = valve replacement -> balloon valvuloplasty Ax Aortic stenosis: - <65 - bicuspid aortic valve - >65 - calcification - Rheumatic Fever LVH= deep S @V1-2; tall R @V5-6 -inverted T @V5-6 (I, II, VL) RVH= RAD+tall R @V1 -inverted T @V1-2, I II, aVF wave inversion in the leads looking at the right ventricle (T wave inversion is normal in lead Vl , and may be normal in lead V2, but in white adults is abnormal in lead V3) ________________ ``` For bioprosthetic valve: Inc risk of calcification >65 get aortic one >70 get mitral one Long term AC not needed, give aspirin ``` ``` For mechanical valve: Inc risk of thrombosis Give warfarin + aspirin if IHD. ____________ ____________ ``` ``` For bioprosthetic valve: Inc risk of calcification >65 get aortic one >70 get mitral one Long term AC not needed, give aspirin ``` For mechanical valve: Inc risk of thrombosis Give warfarin + aspirin if IHD. _______ RAD vs LAD A(R>S @ V1) - WWPW - B (S>>>R + Tinvert)+ VT AAAArm switch/dextrocardia RRRRVH - LVH Lat (circumflex) - MMMMI - Inf (RCA) TTTTall thin = RAD Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular) p176 ECG John Hampton book

Answer 35

WPW = AL BRt A - left sided RAD = dom R wave @ V1 B - right sided LAD = no dom R wave @ V1 ``` Assoc: MESH MVP, Ebstein anomaly, Secundum ASD, HOCM/ HyperT ``` Tx: radioFreq ablation of acc pathway FAPS Avoid sotalol @AF cos it - prolongs refractory period @AVN -> - inc transmission rate through acc pathway -> - Inc vent rate = VF

Answer 36

ProtUria >3g/dy HypoAlb Oedema - Loss or AT3, Prot C+S = VTE - Rising fibrinogen = VTE - Loss of Thyrox-Binding-Globulin Light Micro: - NORMAL - MCD - Focal Seg Sclerosis - FSGN - Green birefringent @congo-red stain - Amyloidosis - Kimmel-Wilson + MicroAlb - DM Electron Micro: - Podocyte effacement - MCD/FSGN - Spike/Dome BM thicken - MembGN - Track-Track Electron-Dense Immune-Deposits - MembProlif - Crescentic = Rapidly progressive GN = Goodpast/Wegener 1. Kids - MCD 2. Adults - Memb 3. Black/HIV/Heroin/SCDx / Alport - FSGN 4. MembProlif GN - Track-Track Electron-Dense Immune-Deposits Tx generally for nephrotic? Csteds, Immuno-supp=cyclophos, ACEi

Answer 37

River Danube -Renal Failure -Xanthochromia=Yellow palms+soles Ddx = Balkan nephropathy 1. IgA Berger Nephropathy 2. PSGN* RAG = HSP RASH - WeCeners-GPA, eChurg-Strauss-GPA, - MPA=NON-granulomatous Hemoptysis + HUria + Anti-GBM -Goodpasture Deaf, Blind(lenticonus), Piss blood -ALPORT *T3HSR= SickSerum, SLE, StrepGN, EAAlvelotisAcute AKA HSR-pneumonitis -T4HSR=GvH/GBS, Allergic dermatitis, TB, EAAlv-chronic, Scabies

Answer 38

Enlarged kidneys: PKD, HIV, Amyloidosis, DM G+ Bacilli? - Bacillus cereus - C.diff - Gardenella - TB/ List/LactoBacillus G+ Cocci - Aureus - StaphyloCOCCUS - StreptoCOCCUS - EnteroCOCCUS G- Bacilli -Errrrrything else G- Cocci -Moraxella -Neisseria Men/Gon ___________ ABx affecting: FA synth = TMP SMX -Hematopoesis, Itch, PS -RTA 4 - resistance ___________ Cell-wall synth A-peptidoglyc synth: Vanc/Bacitracin B-peptidoglyc cross-link: Penicillins/Cephalos->C.diff/Carbepenems: 1. Beta-lactam SENS: -PMP-V, BenPenG, Amox 2. Beta-lactam RESIST: -Fluclox #cholestasis ___________ ``` 30s ribosome = Aminoglycosides + Tetracyclines -Aminoglyc = Oto/Nephro toxics -Tetracyclines: PS, Oesophagitis, IIHTN, Not <12yrs Teeth discolour ``` ``` 50s ribosomes = Chloramp = Aplastic Anemia Clinda - C.diff Macrolide - P450i, long QT, Nausea Lizenolid ``` Gyrase = Quiolones P450i Seizure threshold lower Tendon dx mRRRNA synth: -RRRifampicin DNA integrity - metronidazole = Alco rxn _________ C.diff causes by Clinda + Cephalos

Answer 39

RIPE-RMFA -RNA polym, Mycolic acid, FA, Arab-transferase Rifamp = stop RNA polym -> stop mRNA synth -flu-like / orange secretions Isonoazid (+ Pyridox) = Mycolic Acid synth stop - B3Pellagra=Dementia/Diarrhoea/Dermatitis - Agranulocytosis - Neuropathy=GBS - SL3-histone Pyridox = stop FA synth Gout/Arthralgia Ethambutol - Eye dx #OpticNeuritis -stop arab-transferase ________ Latent TB screening: - New NHS employees - IC / Immigrants - Contact w/ pul/laryngeal TB pt - CXR=TB scarring/Untx fibrotic changes -> Mantoux/IGRA -> -RIpyridox 3m @34/-/high LFTs -Ipyridox 6m @IC _______ Active TB: Ix: - CXR - 3-sputum-MCS ``` Tx: -2m RIpPE -> 4m RIp #6m-RIp #10m @TB-men -DOT @Homeless/Non-compliant/Prisoner _________ ``` _______ Mantoux POS = Assx 4 active / Tx 4 latent #IFN #IGRA ``` Mantoux NEG = IFN -IFN POS = follow Mantoux POS -IFN NEG = BCG @ 0-12m, HR area, Contacts of smear + , Unvacc (35/-) / (36/+ + HCW) Mantoux/ IFN/ Tuberculin NEG ``` ``` <5mm = UNvaccinated >5mm = past TB / BCG >15mm = current TB infection ```

Answer 40

Parasaitemia = 999+PHE: >2% - severe/cx -IV Artesunate > Quinine >10% - exchange transfusion <2% non-severe/UnCx: -ACT* > Atovaquone-proguanil Doxy-Quinine ACT = AL-ArM: - ArteMether+Lume - ARteSunate+Mefloquine Non-falciparum -oral ACT / Chloroquine -Tx vivax/ovale -> dormant HYPNOZOITES @Liver? Primaquine-G6PD beware Avoid what drugs with following: - HA - chloroquine - Seizures - Chloroquine/Mefloquine - Psych dx - Mefloquine - GI dx - proguanil - Folate dx - proguanil

Answer 41

Dx? MarFIBRILLINan ``` Ehlers L A S T I N ``` -Elastin -HypermoBEIGHTON 6 @kids/5@adults /9 -L X -E X -Ret Angiod Streaks -SAH AR/MProlapse

Answer 42

``` uRinalysis uO uSs kub u+E --> ``` -NORM = Pre-Renal -Prot ± Blood = Intrinsic* -Blood = Post-Renal Waxy = CKD / Fatty = nephrotic RBC casts: g.nephritis/HTN nephropathy ``` Instrinsic --> WCC casts? -Y = Nephritis Pyelo AIN-acute interstitial nephritis -Omep/Penicillin-Quinolones-Rifamp/Spiro-Amiloride Transplant ``` ``` -N = ATN tub cells die -> can't retain Na/H20 -> urine osmo low / urine Na high -urine Na classically >30!! = FC fail + low gravity ``` -OPP happens in pre-renal dx #COlow, HYPOvol, Drugs ____________ AR= Loop - Barter - AscLoopHenle/NKCC --HypoNat/Kal AR = Thiazide/Gitelman = Prox DCT/NaCl channel - -HyperGlyc/Lipidemia/Uricemia/Calcaemia-Calciuria - -HypoNat/Kal/Mg AD = LiDDle: Met Alk HypoKal HypoChlor fucked ENaC @lumen Inc ENaC activity -> Inc Na -> 3Na/2K+ pump basally: * -3Na enter blood -> H20 follow = HTN -2K+ enter cell -> relatively NEG lumen -> --2K= leave cell -> enter lumen = HYPOkal --inc H-ATPase activity --inc H+ secretion --inc:HCO3-/Cl- : HCO3- enter blood #MET-ALK, Cl- enter cell -> enter lumen -> mop up H+ 3Na in; 2K+ and 1H+ exit = charge balanced

Answer 43

PCT: HCO3-* BM, AA, Na (ANP/AT2) PO4- (PTH) *Old tetras/Wilson's/Acetazolamide/Mannitol RTA 2 = NAMA = low K+ -HCO3- absorption dec i.e. inc secretion -> -N.A.MET ACID ____________ ``` CCD: Congen URO dx RHEUM dx Amphoterocin Painkillers - NSAID --> ``` ``` RTA 1 = NAMA = low K+ -low H-ATPase pump activity -low H+ secretion -low :HCO3-/Cl- : less HCO3- enter blood #MET-acid, Cl- enter cell -> enter lumen -> mop up H+ ``` Cx of RTA 1 ? -renal stones !!! _____________ CCD=Ald low/Resistance Ald low: Heparin/ACE-ARBs/NSAID/DM renin low/Addisons Resistance: Obst Uropathy, TMP-SMX, Spiro/Amiloride

Answer 44

5-15% 30-45% ______________ HNPCC Lynch - MSH2 gene - Gastric/SBowel - ENDOMET/Bladder FAP - Dom -Gardener Syndrome get OSTEOMAS!!! _________ ``` Peutz -Jeghers - Dom -STK11 (LKB1) -GI / Panc cancers -Gynae cancer (except Endomet) -Testicular cancers __________ ``` Cowden dx - Dom £10-bet - P-TEN - Breast, Endomet, Thyroid _________

Answer 45

Duodenal atresia -Duodenoduodenostomy Jej/ileal atresia Meconium ileus -surg Decomp / resection @serosal dx ______________ Malrotation with volvulus -Ladds procedure NEC Necrotizing Enterocolitis

Answer 46

PNEUMONIA @LOWER FKN LOBE -lower lobe pneumonia = felt as upper quadrant abdo pain ___________ Juvenile polyps - hamartomas ___________ Von Hippel-Lindau - cerebellar haemangiomas: --> SAH - retinal haemangiomas --> vitreous haemorrhage - renal cysts (premalignant) --> clear-cell RCC -phaeochromocytoma -extra-renal CYSTS: epididymal, panc/liver -endolymphatic sac tumours _________ Phaeo: Alpha block: phentolamineSA/phenoxybenzamineLA Betablock: propranolol Surg @w5=alpha block, VolExp -pre-op: phenoxybenzamine -post-op: urinary metanephrines, CT-AP, metaIBGscan ``` 1 2a 2b Para Para Phaeo Phaeo Panc/Pit tumours MEDullary cancer-RETgene ```

Answer 47

Fibromyalgia _____ Codeine to PO morphine PO morphine = to... SC moprhine /? OXYCOD PO /? SC diamorphine /? IV moprhine /? OXYCOD SC /? Alcohol units?

Answer 48

``` V - Aspirin/Amiodarone I - chloramphen/Quinolone/Sulfonamide/Tetras/Fungals - selenium, flucon, itracon N - MTX/Cytotoxics D - LITHIUM/BENZOs I - LITHIUM/BENZOs C - LITHIUM/BENZOs A - MTX/Carbimazole TE - SUs ``` Post term >42 weeks Induce > WW -HR of meconium Asp

Answer 49

Codeine to PO morphine /10 PO morphine = to... SC moprhine /2 OXYCOD PO /2 SC diamorphine/3 IV moprhine /3 OXYCOD SC /4 Alcohol units = %.mls / 1000 -make a toAST with alcohol > ALT. 2>1 _________ Monoplegia - 1 limb Hemiplegia - Unilat 2 limbs Quadriplegic - 4 limbs -Paraplegia - Bilat LOWER limbs ACA MCA PCA* L>UL ; UL>L < -- HemiParesis ........Aphasia -- > Agnosia ........Sensory ....HomoHAnopia -- > Mac-Sparing *PCA - Weber Midbrain -Same CN3, opp HemiParesis -Agnosia -Macular sparing HomoHNopia ________________ Amaurosis fugax - Retinal/Ophthalmic Artery Locked in syndrome - Basilar Artery ____________ Pontine bleed: PAMP - Absent < -- > horizontal eye-move - Miosis - Paralysis=Quadriplegia AICA: Lat Pont - Same FACE: PD/PT - ------(paralysis/deaf // pain/temp) - Opp limb - Nystagmus - Ataxia PICA: Lat Med Wallenburg - Same FACE: PD/PT (pain/temp) - Opp limb - Nystagmus - Ataxia ______________ Anterior Circulation Stroke: 3=TotalACS 2=PartialACS -UCH - Unilat sensory/motor FAL - Cog dx - VisuoSpatial/Dysphasia - HomoHNopia ``` LacACS = L-SAMP 1 of: -Sensory -AtaxicHemiParesis -Motor PURELY + HTN ``` POstCS _________ 4-6-4 H: CN4 vertical nystagmus CN3 Ptosis, Dilated, Vertical nystagmus CN6 horizontal nystagmus Nystagmus: Central v Periph: central is: - B/L - Assoc sens/motor dx - Direction = multi / purely uni or rotatory ``` Brainstem Death: Coma unknown Ax Reversible ax excluded Sedation X Electrolytes fine ``` ``` Bronchial stim -> no cough Response to sound/Supra-Orb Pressure Occ-Vestib Reflex absent Corneal Reflex absent Disconnect ventilator 5-mins -> no resp support _______ ``` -Emotions = fear, agitation -Fluct Syx = worse @night, normal periods -GCS impaired -Hallucinations/Illusions/Delusions #perception _________ Paroxysmal HemiCrania -Indomethacin __________ Wernicke Receptive - SUP Temp gyrus - Fluent + NO Sense + Comp FUCKED - Repetition Normal Broca Expressive - INF Frontal gyrus - NON-Fluent + Sense + Comp NORM - Repetition fucked ``` Conduction aphasia -Arcuate Fasciculus -Fluent + Sense + Comp NORM -Repetition fucked ______ ``` Dexa @Oed from tumour Mannitol @Raised ICP Nimodipine @SAH to reduce vasospasm ______ Gait ataxia = cerebellar vermis lesions Cerebellar hemisphere = finger-nose ataxia Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington's) Parietal lobe - sensory symptoms, dyslexia, dysgraphia Frontal lobe - motor symptoms, expressive aphasia, disinhibition

Answer 50

``` Leptospirosis -Doxy+Penicillin -CK high = myalgia _______ Balkan Nephropathy _______ ``` ``` Leishmaniasis=Kala Azar 7-21d -Similar to Histoplasmosis: --SMeg-ANT + MidZoneConsolidation ________ ?Strongyloides -rash @plantar + bum __________ ``` Yellow fever 2 - 14 days -Worse Better Worse #Councilman-bodies -Viral haemorrhagic fever ________ Dengue -hemorrhagic manifestations -4-10d _______ Typhoid - culture -SplenoMegaly+BRADYYYYcardia RRickettsii on the wRRists, TTyphus on the TTrunk. _______ a. Disseminated gonorrhoea infection b. Fitzhugh Curtis ________ Lyme disease ELISA blood serology E.Migrans+No other dx? - Doxy / Amoxi - Ceftriaxone disseminated ``` NO E.Migrans -Syx+TickBiteHx? Test antibodies = ELISA serum + = Abx - = Repeat+Refer ```

Answer 51

Amoebiasis entamoeba histolytica - fecal-oral - FRJ+Aask+bloodydiarrhoea+irregUSS margins USS->CT Metronidazole ______ Coxsackie/Polio/Rhino - Picorna MeaslesMumps - ParaMyxo CroupParaInflu - ParaMyxo Influenza - OrthoMyxo Viral warts - HPV Papova-Virus Hepatits - Hepad-virus HIV - retro -receiving anal sex ________ 1. Tuberculoid 2. Lepromatous Tx: -Dapsone + Rifampin @tuberculoid form; - +CloFaziMine @lepromatous _________ Rocky Mountain Ricketsia -spotted fever Palms and soles rash @: - CoxsackieA (hand, foot, mouth) - Rocky Mountain Ricketsia - Syphilis 2° (you drive CARS using your palms and soles). Rickettsii on the wRists, Typhus on the Trunk. ________ 1. Histo - similar 2 leishmaniasis TWICE daily SPIKEs 2. Coccidio ________ 3. Blasto 4. ParaCoccidio

Answer 52

Bartonella - catch scratch dx ________ <6 hrs ABC -Aureus/Bacillus/C.perfringens <48 hrs -Sally/E.coli 48-72 hrs -Shiggy/Campy > 7 days YAG Yersinia/AmoebiasisAnchhovy/Giardiasis All blood except -ABC+Giardiasis+TravellersDiarrhoeaEcoli diarrhoea + HypoGlycaemia = CHOLERA _________ Neg Antibody test after 3 months = UNlikely HIV infection CD4 < 500 - Cervical/HodgkinRScells ``` CD4 < 400 sweats/LNpathy BF -Bact -Fungal = Candida-oral thrush SCRAPable M.furfur-seborrh derm ``` ``` CD4 < 350 Burkitt EBV NHL High Grade SHEFCOT 1. Shingles 2. HSV 3. EBV HAIRY Leukoplakia UNscrapable EBV->CNS lymphoma -single-ring-enhancing lesions @MRI -Thallium SPECT POS 4. Fungal-CoTrimox/Atovaquone/Pentamadine/Sted @hypoxia ``` CD4 < 200 Diarrhoea Kaposi - Crypto Cocc-Meningitis / Sporid-Diarrhiea - Oesophageal Candidiasis - Toxo = brain abscess, MULT ring-enhancing lesions, Thallium SPECT neg - PyriMethAmine+SulfaDiaZine CD4 < 100 Dementia, Cerebral Lymphoma - Atyp m.avium - CMV pneumonitis retinitis conjunctivitis encephalitis - PML JC virus

Answer 53

Enlarged kidneys: PKD, HIV, Amyloidosis, DM G+ Bacilli? - Bacillus cereus - C.diff - Gardenella - List/ LactoBacillus/ TB G+ Cocci - Aureus - StaphyloCOCCUS - StreptoCOCCUS - EnteroCOCCUS G- Bacilli -Errrrrything else G- Cocci -Moraxella -Neisseria Men/Gon ___________ ABx affecting: FA synth = TMP SMX -Hematopoesis, Itch, PS -RTA 4 - resistance ___________ Cell-wall synth A-peptidoglyc synth: Vanc/Bacitracin B-peptidoglyc cross-link: Penicillins/Cephalos/Carbepenems: 1. Beta-lactam SENS: PMP-V, BenPenG, Amox 2. Beta-lactam RESIST: Fluclox #cholestasis ___________ ``` 30s ribosome = Aminoglycosides + Tetracyclines -Aminoglyc = Oto/Nephro toxics -Tetracyclines: PS, Oesophagitis, IIHTN, Not <12yrs Teeth discolour ``` ``` 50s ribosomes = Chloramp = Aplastic Anemia Clinda - C.diff Macrolide - P450i, long QT, Nausea Lizenolid ``` Gyrase = Quiolones P450i Seizure threshold lower Tendon dx mRNA synth: -Rifampicin DNA integrity - metronidazole = Alco rxn

Answer 54

Tight white ring + phimosis @foreskin tip -BXO-LSclerosis Flat-pap #ulcerate @foreskin = SqCC Red-velvet plaque = EoQ SqCC-IS Orange/ red/ pinpoint = Zoon's balanitis Reactive Arthiritis -> red plaque , ragged white border = Circinate balanitis ________ BPH tx: Conservative: - Alco/Caffeine/Fizzy drinks - Constipation - Ex/diet - Sweeteners/Smoke stop Med: - alpha-blocker Tamsulosin = post hypoTN - 5alphaReduct-i = Finasteride - Finasteride take 6 months before results Surg: TURP -> TURP syndrome #glycine #HYPOnatraemia

Answer 55

L-UTI = bladder infection (aka cystitis) UnCx UTI — Typical pathogens @normal UT + kidney function + no predisposing co-morbidities -> UTI Cx UTI — UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure) -Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC) Upper UTI = Ureters + kidneys infection #(pyelonephritis) Recurrent = Relapse/Reinfeciton - UTI 2/+ / 6 m - UTI 3/+ /12m - Relapse — same strain infection - Reinfection — different strain infection Catheter-UTI = UTI + catheter inserted last <48hr Bacteriuria = bacteria @urine = asyx/syx

Answer 56

1-Ejections* - turb OUTFLOW tract 2-Venous - turb INFLOW venous tract 3- stiLLSe - LLSE low pitched _________ *EJECTION: Pulmonary=soft blowing/Aortic=short Buzzing -Assoc w/Valsalva ``` #3 innocent murmurs ________ ``` MR - Pansys blowing high pitched -> Axilla MVP = Pansys + EMSyst click MS -opening snap + Rumbling ________ ``` Collapsing pulse = AR/PDA/ Incr requirement Wide Pulse Pressure = AR/PDA/ 3rdHB -Narrow Pulse Pressure = ASten -slow rising pulse = ASten _________ ``` Pansystolic @LLSE - louder @insp #incrVenReturn=TR - harsh=VSD

Answer 57

``` If persists #uncorrected, you get: L->R shunt -> PAH + RVH -> R->L shunt @Eisenmenger --> -murmur = DISAPPEARS --> infant = CYANOTIC #not shocked ``` CCPP: - cyanosis clubbing - polycythemia PAH Ax = VSD, ASD, PDA. _____________ ASD: RBBB+RAD = secundum dx -EMBOLUS SHOOT OFF -> STROKE!!!!!! RBBB+LAD = primum dx -prime lad __________ Coarctation - Aorta NARROW near PDA -> - HTN in Bracioceph + LSubclavian - CXR = collats eroding ribs -> notched ribs

Answer 58

Exudate: RIM -Rheum dx/Infection/Infarction/Malignancy Transudate = HM -HF, LF, RF / HypoT -Miegs / Malabsorption ________ Absence = 3Hz @EEG _____________ Motor FRONTAL lobe - Head/leg movements - ictal weakness - Posturing - Jacksonian-march ``` Non-motor: -Temporal Hallucinations, Epigastric-rising, Automatisms-LIPSMACKING/PUCKING, Deja-vu/Dysphasia ``` - Parietal lobe (sensory) = Paraesthesia - Occipital lobe (visual) = Floaters/flashes

Answer 59

Ear wax imapction Perf Tymp Memb ______ AOM: earache/TUGGING/rubbing/crying/restlessness ear reveals a BULGING tympanic membrane -H.Flu !!! OME (glue ear) — @otoscope = effusion and air fluid levels/bubbles w/ normal/RETRACTED tympanic membrane landmarks #conductive hearing loss. speech and language delay, behavioural or balance problems CSOM — 2 WEEKS!!!! persistent inflammation and PERF of the tympanic membrane with discharge Myringitis-bullous -mycoplasma -erythema/injection of tymp memb _________ Otitis Externa - Otomise -> - Fluclox/Erythro - REFER + Cipro @malig otitis ext - > Tx fail = ?dermatitis/?fungal -top c.sted/top a.fungal Viral conjunctivitis _________ Cholesteatoma -pars FLACCIDA Tympanosclerosis

Answer 60

Bastards: ``` Acoustic neuroma: #NF2 CN 5 7 8 affected -corneal reflex dx -facial nerve palsy -sensorineural vertigo tinnitus ``` MRI cerebello-pont angle -> Surg ________ Most common salivary gland tumour - parotid 80% I--> most common paroid tumour = Pleomorphic Adenoma > Warthin's tumour __________ ``` Recurrent unilat pain/swelling @EATING -submandible = Wharton -@face-side = Stenson @parotid -infected = Ludwig angina - ivdu floor of mouth dx ______________ ``` Tonsilar SCC is associated with HPV infection Audiogram: -if ONE ear low than other AND -Bone > Air Dx = MIXED hearing loss Presbycusis - Sensori A>B - HIGH-freq -B/L Otoscloersis - Conductive B>A - LOW-frew -B/L Low libido + ED -> Psycho-Somatic Normal libido + ED -> Organic cause... need to Ix (usualy vascular dx) B P P V = Vertical nystag Vestib = horizontal nysag -Still going on -> Vestib REHAB exercises!!!! Aspirin + NSAIDs taken in HIGH doses can cause tinnitus ED Ix -morning Testost > FSH/LH/Prolactin ``` UTI 4w Biopsy 6w Ex 48hr Ejac 48hr DRE 7d ``` Perf Tym Memb -NO infectoin -hx of barotrauma WW <1.5-2 months Post-tonsillectomy haemorrhages should be assessed by ENT Primary haemorrhage WITHIN HOURS hours after tonsillectomy = immediate RETURN 2 theatre Haemorrhage 5-10 days AFTER tonsillectomy = Wound infection -Tx = ABx AOM pathogen = H. Flu Branchial cyst: - benign, lateral, UNI-lateral neck mass - acellular CHOLESTEROL crystals Top decongestants for prolonged periods = TachyPhylaxis Prostate Cancer: RT risk = COLOrectal cancer Fluid AROUND testicle #CANNOT FEEL testes -TRANSILLUMINATES Dx = HYDROCELE High pressure chronic retention = deranged U+E Low pressure chronic retention = fine U+E

Answer 61

Penile fracture Which layer damaged? -tunica albuginea Urethral dx most likely @ -both corporsa cavernosum Ix @urethral injury? --Retrograde/Asc urethrogram -> SPC Ix for the actual dick? - caverno-sography - MRI ``` Tx: -Hematoma evac -Fix T.Albuginea + Urethra -SPC ________ ``` Bladder rupture: - Tx = Conservative Foley urinary catheter - LAPARATOMY @intraperitoneal __________ Phimosis: if dont clean under foreskin, 2 issues? - stones @pre-putial sac - penile cancer Conservative Steriods Circumcision ______ Bulbar rupture --Retrograde/Asc urethrogram -> SPC Membranous rupture --Retrograde/Asc urethrogram -> SPC __________ Bladder/urethral rupture - IVUrogram or Cystogram - intraperitoneal = LAPARATOMY - extraperitoneal = Conservative + Foley Catheter

Answer 62

- EBV HAIRY Leukoplakia UNscrapable EBV->CNS lymphoma - single-ring-enhancing lesions @MRI - Thallium SPECT POS - MULT ring-enhancing lesions, Thallium SPECT neg - Dx: Toxo = brain abscess, - PyriMethAmine+SulfaDiaZine Fe Anemia messes effect of EPO up --EPO = Red cell aplasia/encephalopathy Soon after completing dialysis -> headache + drowsy. ?Cx of haemodialysis here? - Dialysis disequilibrium syndrome Women with hypothyroidism may need to INCREASE their thyroid hormone replacement dose by: - up to 50% - as early as <6 weeks of pregnancy Which baseline investigation is most appropriate? -MRI WITHHH contrast The most common causes of VIRAL meningitis in Adults are ENTEROviruses -Coxsackie B virus (CMV/Cryptococc/Arbovirus/Mumps/EnterooooooCoxsackie) Herpes simplex virus is the commonest cause of viral ENCEPHALITIS in the adult population LIVE CYSTS are the commonest extra-renal manifestation of ADPKD Transient elastography is now the investigation of choice to detect liver cirrhosis young female patients + ACEi -> AKI = Fibromuscular dysplasia The most common type of inherited colorectal cancer: HNPCC-Lynch Carcinoid tumours can also secrete pituitary hormones, such as ACTH Hypoglycaemia -> focal neurological symptoms #needs to be ruled out as a MIMIC of TIA Massive PE + hypotension - thrombolyse #Alteplase suspected Lyme disease + NO history of erythema migrans = Blood test for serology #ELISA The time taken for an A-V fistula to develop is <2months -i.e. 6-8 weeks ACUTE rejection occurs < 6 months

Answer 63

Acute interstitial nephritis is classically caused by antibiotic use Alport's syndrome – Deaf, Blind (Lenticonus), Piss blood After a complicated revision of a THR an 80-year-old lady receives 2 units of packed RBCs. PMH: CCF DH: bisoprolol, ramipril and furosemide. -Tx: FUROSEMIDE - STAT dose ``` Which should be prescribed between the units?-Stat dose of furosemide Trifascicular block (incomplete) = Bifasicular + 1st/2nd degree heart block Trifascicular block (Complete) = Bifasicular + 3rd degree Heart block ``` Renal failure + Opiods = Buprenorphine or Fentanyl A combination of LF and NeuroPsych dx = Wilson's dx -get TRAPS too 'Navir tease a pro' #Protease inhibitors GGGravir = InteGGGrase-i -NRTI side-effects: peripheral neuropathy The time taken for an A-V fistula to develop is <2months -i.e. 6-8 weeks Acute rejection occurs within 6 months SIADH is treated with fluid restriction Nephrotic Syndrome + sudden flank pain = Renal Vein Thrombosis -#loss of AT3 via the kidneys Long QT beta-blockers ICD in high risk cases - Serum haptoglobins (which bind haemoglobin) and - Platelet count are decreased - in HUS ``` Parkinson's disease can lead to postural hypotension #autonomic failure ``` HOCM assoc w/ Wolff-Parkinson White WPW

Answer 64

IntraCaps # - Undisplaced - -IntFix/HA@old-frail - Displaced - -Young = ORIF - -Old = THR/HA@old-frail ExtraCaps # - InterTroch = DHS - The rest = IM Nail #I-YOOT DIM

Answer 65

Renal Stones @PUJ/ Pelvic Brim/ VUJ NC helical CT <14-24hrs / NSAID-diclofenac50mgPR AE MET @distal ureteric stone < 1cm - alpha-blocker - if <0.5cm + Aysyx = WW - >1cm = UNLIKELY 2 pass -> Tx <4w Remove @pain/not-passing: - Lithotripsy <2cm - Ureteroscopy <2cm + preg - Nephrolithotomy >2cm/staghorn-struvite/prox ureter-lowerpole - Stent/Surg = nephrostomy ABx @sepsis SO-Cysteine-low pH L-Uric-Xanthine-low pH O-Struvite Staghorn-high pH -Urea -ProteusHydrolysis> NH3 Mg PO4 O-Ca Oxal / Phosph-high pH oXal=spiky > phosphate=smooth __________ -Non-semi=Choriocarc.Embryonic.Teratoma.Yolk-sac #germ -Seminoma #germ -Non-germ=Leydig-Lymohoma.Sertoli-Sarcoma _______________ Germ = NSemi+Semi ........(NSemi......Semi)....NGerm AFP/ hcg: high ..................... Age: .....(20-30......40).......50 Prognosis:............good) ``` FHx Undesc Crypto-Orchid Kleinfelter Infertility TIN --> size/shape/texture change = 2WW + USS TESTES !!! ```

Answer 66

``` yellow/green -strawberry cervix -smelly --flagellated protozoa Dx? Trichomoniasis Tx? Metro ``` ``` Chlamydia= Doxy /Azithro 7d//////2d, respectively Refer for: -GUM -Repeat infection @25/+ y/o = high p(re-infection) -Avoid sex after ABx end/Azithro +7d -STD screen/ Safe sex -Sex-abuse < 18yrs ``` Gonorrhoea - UnCx: - anogenital gon = IM Ceft - anogenital/ pharyngeal gon + antimicrobial susceptibility known = Cipro - needle phobia = Cefix+Azithro - Asyx = NAAT 2/+w after ABx end - Syx = C+S 3/+d after ABx end Syx men = C+T: - all partners < 2w - most recent partner if >2w The rest i.e. Asyx men /Women - C+T all partners <3m _______ PID: Mycoplasma genitalium -moxifloxacin / ceftriax -> Azithro Gon high risk = Ceftriax+Doxy+Metro Gon low risk = Ceftriax/Oflox

Answer 67

EOrchitis 3 causes: - E.coli - (anal sex/ catheter) -> Cipro - STD - (Age <35) -> Ceft+Doxy /Cipro - Mumps - (supportive) - MSU/dipstix --f/u2w-> f/u = ?ABx change + Refer @UTI/ STI/ Fail ___________ WPW = AL BRt A - left sided RAD = dom R wave @ V1 B - right sided LAD = no dom R wave @ V1 Assoc: MESH MVP, Ebstein anomaly, Secundum ASD, HOCM/HyperT Tx: radioFreq ablation of acc pathway FAPS Avoid sotalol @AF cos it - prolongs refractory period @AVN -> - inc transmission rate through acc pathway -> - Inc vent rate = VF

Answer 68

Preg: ACEi = iuGR, iuRenal-Insuff, Oligohydramnios Cocaine = Small brain, Limb dx, Urine-tract dx - mum = PreEcl / Pl.Abruption - kid = Prem / Abstinence-syndrome Valproate/Carbemaz = NTDs -valproate MOST teratogenic -heart dx ______ Phenytoin = Hydantoin Syndrome = craniofacial dx -valproate MOST teratogenic Warfarin courmarins = skeletal dx Thalidomide - limb dx ______ Di-Ethyl-Stil-BESTROL @mum -vaginal adenocarcinoma in kid 14 yrs later Isotret -CNS/Cranio-Facial/Cardiac dx Misoprostol = Moebius Syndrome -cranial nerve dx _______ Downs 21 - AVSD Noonan = Pul Stenosis William 7 = Supravalvular Aortic Stenosis Turner 45XO = Coarcation DiGeorge 22q11 = Truncal dx = TOF/TGA/PulAtr-VSD _____ MIFEProgRecepBlocker ONLY USED IN Abortion BASTARD MISCARRIAGE: WMVE WW < 2w MED: Vag MMMisoProstaGlandin - > Ut Contract -Moebius Synd= Cranial Nerve dx SURG: OP: VVVacuum Asp Suction Curettage IP: Theatre EEEEEvacuation __________ ``` Med/Surg Mx @: -Haemorrhage (late T1/blood dx) -Infection -Prev preg dx _____________ ABORTION: MMSE ``` < 9 w: MM 0hrs: MifeProg-ReceptorBlocker -Moebius Synd= Cranial Nerve dx 48 hours: MisoProstaGlandin= stim ut contract < 13 w: DS Surg dilation + Suction >15-24 weeks: DE Surg dilation and Evac medical abortion = 'mini-labour' >24 - ILLEGAL MURDERRRRRRRRR

Answer 69

%.mls / 1000 Liver cirrhosis definition? -CONSTIPATION!/ Alco /NAFLD/ Viruses Decompensated Diffuse bridging fibrosis #stellate cells ``` a. Hemorrhage - varices - gut butt caput* HRS - cirrhosis/ascites/RF - terlipressin/TIPS -type 1 <2w - type 2 >2w HCC-AFP+USS/3ms b. Encephalopathy 1. irritable 2. confused 3. incoherent 4. coma c. Ascites cos of HTN - fluid extravasate d. Portal thrombosis -> HTN -bloodbackflow (start bleed @ >12 mmHg) SBP-sepsis Neut > 250 ``` ``` *PV = SV + SMV SV = IMV - SRV (butt) Left PV = PUV = (caput) off the actual PV = LGV = (gut) _________ ``` ``` Ix: HIGH: Bili/GGT ALT/AST PT -ALT>AST - normally -AST>ALT @Alco/NAFLDadvFibrosis #toAST ``` LOW: Albumin Plts -MELD(comp cirrho SURVIVAL)/C-P-Severity -Ascitic tap MCS -USS/3m +/-AFP=?HCC -LEAF: Liver Biopsy ELF blood test >10.51-NAFLD/ ElastoGraphy/Acoustic-rad Force/ MRI -OGD/3yrs @varices ElastoGraphy -@male 50+u/wk -@female 35+u/wk -@HepC __________ Tx: 1. Cirrhosis: - USDA/LiverTransplant - Pencillamine@Wilsons ``` 2. Ascites=PINT Portal.htn = TIPS* low alb = HAS Na+h20 retention -Fluid restrict -low Na diet, -Spiro-fail->Furose***** TAP-paracentesis ``` ``` ***** LF -> fail2degrade/over-produce DILATORS -> Splanchnic dilated -> blood pools -> Decrease BP -> Incr RAAS -> Na/H20 retention ``` ``` Spiro=AldBlocker -> low AdrenalAld -> lower: -Na absorption -> less h20 absorb -K secretion -H secretion ``` Furosemide -> lowers renal perfusion -> Reduces GFR -> ?HRS, so preferable to avoid ________ 3. SBP-sepsis: -Cefotax IV/Cipro proph @chp:C-P=9/+, Hx of SBP, Prot 15/- 4. Encephalopathy: -Lactulose/Rifaximin -> inc N2 bact bowel transit -> reduce ammonia -TIPS=ppts enceph -low BM = dex -Mannitol @c.oed -Bleed = vitK _________ ``` *Paracentesis+HAS onc press #circ-dysfunc >5L = AlbCover ``` SAAG >11 indicates Port HTN TIPS: - connect portal vein to hepatic vein - Bypasses portal HTN but ppts encephalopathy

Answer 70

Ruptured AAA - ?blood products? -6 units CROSSMATCH RBC >80 with ABPM >145/85 -St1 HTN = lifestyle changes + ?Tx HepatoRenal Syndrome - develops < 2 weeks - Type 1 - develops >2 weeks - Type 2 ``` Mandem had accident -> Cord injury @above T6 -> HTN + Bradycardia + ... -Flushed + Sweating #Red ABOVE shoulders -PALE BELOW shoulders Ax of HTN = Autonomic Dysreflexia ``` Mandem in accident -HTN and Bradycardia -flushed above shoulders, pale below Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level Faecal impaction / urinary retention are the most common triggers of autonomic dysreflexia Stroke is a life-threatening event associated with autonomic dysreflexia SB bacterial overgrowth syndrome = RIFAXIMIN Mandem w/ cancer -> Chemo -> U+E: - hyperrrKALaemia, -hyperrrPHOSPHataemia - HIGH creatine - Seizure/arrythmia -LOWW Calcium TLS - Allopurinol #Tumour lysis syndrome Absent corneal reflex, CN7 palsy, SVT #CN578 -Acoustic Neuroma _________ Cauda Equina Spinal Cord Compression Cancer + NEW back pain = MRI spine #spinal-mets _________ Stroke disability score prediction -BARTHEL index

Answer 71

Mandem takes MTX + wants a baby - >6m AFTER stopping tx Atypical Lymphocytes = EBV! Paget bones = Skull, Spine, Pelvis, Long bones 1ml of insulin syringe = 100 inuslin units? Venous cutdown of ankle veins - Long Saphenous -ant to medial malleolus OSAS can lead to what CV dx? HTN !!! Warfarin - NOT legit in pregnancy but - legit for breastfeeding - @APLS + prev VTEs + PREG = Asp + LMWH - -@APLS + prev VTEs = Asp + AC Type 2 Nec Fasc organism = GAS Pyogenes -Type 1 = post-surg + aerobes/anaerobes + DM Acute RA flare tx = IM MethylPred Osteogenesis imperfecta childhood with bone fractures and deformities BLUE sclera + hearing/visual problems Osteo Imperfecta = ALL BONE PROFILE BLOODS FKN NORMAL!!!!! Px: - Age >50 + Sig Smoke Hx - Lung dx O/E or CXR Leptospirosis Ix = Serology Pt with chest infection + TNFi use for rheum dx -> ABx failed -> ITU -Bronchoscopy + BAL = Invasive Aspergillosis Away: TPx, Hernia, Effusion, Mass Towards: Collpase, Hypoplasia, Pneumonectomy AF questions + ?cardioversion -> look at ? !!!! - IF HD unstable THEN legit - offer rate or rhythm control if the onset of the arrhythmia is < than 48 hours, - and start rate control if it is > than 48 hours or is uncertain -> 3wk AC elec>pharm cardiovert -Urticarial Rashes/Fever -U+E fucked AND -High Urine: WCC, IgE, Eosinophils Dx = Acute Interstitial Nephritis #Penicillins

Answer 72

Thoracic ADiss: Stanford/DeBakey A / 1+2) Asc = SURG + Labetall B)/3 Desc i.e. distal to L Subcl = TLC = Labetalol + BP 100-110 maintain Diabetes sick-day rules for insulin: -normal dose BUT more frequent checking MI #transmural -> PR dep / Saddle ST elevation: - Pericarditis @first 48 hours following MI - Dressler's syndrome @2-6 weeks following a MI t - Tx = NSAIDs Pt w/ stroke + already on AC -EMERGENCY ED imaging !!! Adrenaline dose @ >12y=0.5mg, 6-12yr=0.3mg, 6m-6yr=0.15mg, <6m=0.15mg - Cardiac arrest = 1mg Coeliac/Hyplori -> haem cancers: - coeliac = Enteropathy T-cell Lymphoma - pylori - MALT lymphoma #erad tx Orthostatic HTN = 20/10 drop after 3 fucking minutes Carotid Sinus HSR -> - Vent pause >3s - SystBP drop by 50mmHg/+ Chondrocalcinosis helps to distinguish pseudogout from gout Acromegaly can develop POS BIREFRINGENT -RHOMBOID - PseudoGout HyperParathyroidism is a risk factor for Pseudogout - #Calcium PyroPhosphate - whereas HYPOcalcaemia = cataracts Gout = needle-shape NEG birefringent Mandem = AF + chadsvasc 0: - no AC - do Echo!!!! exclude valvular dx Factor V leiden = AKA Activated Prot C RESISSSSSSSSSSSSSSSSTANCE -aProtC –x10 more Slowly INactivates--> f5a Oropharyngeal infection + Internal Jug Vein Thrombophlebitis -> Lemiere Syndrome

Answer 73

``` -BOE-CAB Bimanual uterine compression Oxytocin - stim ut contract Ergotamine( -5HT/Alpha-adr/Dop=vasc SM constrict -> reduce Uterus BF = less bleed) ``` Carboprost Atony = Balloon tamponade B-lynch UA/Iliac ligation/TAH ________________________ Premature labour: Admit Tocolytics and Steds After W20, S-F height i= -g.WEEKS +/- 2cm _______ Oligohydramnios < 500ml @ T3 AFI < 5th centile Ax: Renal agenesis / ACEi IUGR PROM/Pre-Ecl/Post-term>42w Shoulder dystocia: MESZ McRoberts' - flexion and abduct Episiotomy, Symphysiotomy, Zavanelli / Rubin Wood's Corkscrew

Answer 74

T1/2 = Ectopic / Miscarriage-Molar preg T3 = Praevia / Abruption _________________ Complete HyDatiDiForm Mole (MOLAR) Tx = EVAC -> CONTRACEP 12m COMPLETE=46 XX/XY -EMPTY egg + 1 sperm --> DNA duplicates --> ALL 23x2 male genes -Honeycomb/Grapes/SNOWstorm @USS PARTIAL=69 XXX/XXXY - haploid egg (23) + 2 sperm (23x2) - partial fetal parts Around 2-3% = develop choriocarcinoma ___________ Accreta - delayed labour #3rdstage - prev c-sec/praevia/PID 3-types = chorionic villi:- - invade PPerimetrium #PPercreta - IInvade myometrium #IIncreta - AAttach* 2 myometrium #AAccreta *-instead of decidua basalis #accreta Tx: hysterectomy w/ placenta left in-situ ___________ P.Abruption - PainFUL PV bleed -OUT OF KEEPING w/ visible loss - feta heart fucked + DIC/Pre-Ecl ____________ 1. NO fetal distress + <36w - observe+steroids - ?adjust delivery threshold 2. NO fetal distress + >36w - vag delivery 3. Fetal distress - tx? -immediate c-section _____________ P.Praevia - PainLESS PV bleed - IN PROPORTION to visible loss - Lie = abnormal Ix? - what to avoid?! -TV-USS - avoid PV exam till praevia excluded!! LLP @W-16-20 = Rescan @w34 -34 + G1/2 = TVUSS/2w -37 = high-presenting-part/abnormal life = C-SECTION 1. If low-lying placenta at 16-20 week scan - rescan at 34 weeks 2. If still present at 34 weeks and grade 1/2 then - scan every 2 weeks 3. If high presenting part at 37 weeks then - C-section 4. If abnormal lie at 37 weeks then -C-section _______________ Vasa praevia -ROM - >PVbleed + BradyBaby

Answer 75

The definition of a TIA is now TISSUE-based #imaging -NOT Syx DURATION RELATED!! Hyperventilation -> reduce CO2 -> vasoCONSTRICTion of the cerebral arteries -> reduced ICP Sweating, Pallor and N+V -> transient LOC -Suggestive of REFLEX syncope AKA neurally mediated syncope The 'double duct' sign may be seen in PANCREATIC cancer COCP use + FHx of VTE + Severe HEADACHE = more insidiously than a 'thunderclap headache', with ?subtle neurology -MR Venogram is the gold standard test for diagnosing venous sinus thrombosis Cavernous sinus syndrome Ax = Cavernous sinus tumours, OR NPC = locally invades cavernous sinus. -> Corneal Reflex Absent, Horner, Opthalmoplegia Pain, Proptosis #mass-effect -CN 3 Opthalmoplegia (ptosis/diplopia) -CN 4 Opthalmoplegia -CN 5- (V1=Corneal Reflex Absent, V2=low max sens) -CN 6 Opthalmoplegia + ICA (thrombosis) + Symp trunk (Horner's) CN3 palsy: Motor(down+out, ptosis), PSymp(dilated), ?vertical nystagmus -isch, CavSinThrom, UncalHerniate/trans-tentorial, MidbrainWeber, PComAneurysm PAINFUL third nerve palsy = posterior communicating artery aneurysm Rectal diazepam 10 mg Syncope. QRS duration is 110 ms, PR interval is 180ms and corrected QT interval is 500ms.what is the cause for the abnormality seen on the ECG? -Hypo-Mg/Ca/Kal (ssri/tca, abx-macrolide, Li low MgCaK, Typs) Behcet's syndrome is associated with erythema nodosum Haloperidol is contraindicated in patients with Parkinson's disease Anti-psychotics should be avoided in delirious patients with a background of Parkinson's disease xanthelasma secondary to hyperCHOLesterolaemia. 'Young' stroke blood tests include thrombophilia and autoimmune screening -performed in those <55 with no obvious cause of a stroke Which one of the following is the most common symptom of Crohn's disease in children? Abdominal pain T2DM blood pressure targets are the SAME as non-T2DM. If < 80 years: Pepper pot = multiple *tiny* well-defined lucencies in the calvaria caused by resorption of trabecular bone (looks like sand) #hyperparathyroidism Raindrop = multiple, well-defined lytic lesions (punched out lesions) of *various size* scattered throughout the skull #MM STEMI: Aspirin + ticagrelor + IV heparin + immediate percutaneous coronary intervention IV magnesium sulfate is used to treat torsades de pointes Hypertension is the commonest association for aortic dissection diarrhoea + hypoglycaemia = Cholera Atrial fibrillation + NO struct heart dx - cardioversion: amiodarone + flecainide Atrial fibrillation + struct heart dx - cardioversion: amiodarone (AAAmiodarone @FFFUCKED Heart - AF) ___________ most common form of brain tumours – metastases solid tumours = central necrosis + contrast enhancing rim; B-BBarrier dx -> vasogenic oedema. -most common PRIMARY brain tumours – GLIOBLASTOMA #poor prognosis tumour arising from falx cerebri -> pushing on the brain. - Well-defined border between the tumour + brain - Meningiomas develop from the DURA mater She should be offered the flu vaccination during flu season (October to January) What shown to confer a survival benefit in motor neuron disease? Riluzole Sulfonylureas (e.g. gliclazide) are the optimal treatment in HNF1A-MODY Acute Hemolytic Rxn – do Coombs test to confirm!!! _____________ Pleomorphic tumour cells border necrotic areas = Glioblast Spindle cellspsammoma bodies = Meningioma Rosenthal fibres (corkscrew eosinophilic - Pilocytic astrocytoma - most common PRI brain tumour in kids fried egg appearance = OOOligodendroma perivascular pseudorosettes = Ependymoma foam cells and high vascularity = HemangioBlastoma

Answer 76

Bradycardia < 100 -Beta-blocker / vagal tone Tachycardia > 100 -Infection / Prematurity ___________ Early Decel -head compression #normal Late Decel -asphyxia/placent insuff #hypoxia -> DO FETAL BLOOD SAMPLING -> ?c-section ___________ Variable decel -cord comp ``` Loss of baseline variablity -Prematurity / Hypoxia __________ -Anti D @Rh neg ATE ME: Abortion TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic ``` Miscarriage >12w Evac after miscarriage ___________ A. 8-12 wks - - Booking - overlap w/ Down's nuchal scan ``` B. 11-13 -Down's + Nuchal scan -overlap w/ booking __________ C. 28 wks - 1st dose of anti-D prophylaxis @RhNEG - 2nd Anemia/AlloAB test @28w ``` ``` 34 wks: 2nd dose of anti-D prophylaxis @RhNEG __________ D. 36 wks: -BFeed / Blues -ECV ?Presentation legit -Vit K ``` ``` @viral load < 50 @ w36: VAG > C-section - IF c-section, then b4 c-section: IV zidovudine After birth: < 50: PO zidovudine @neonate > 50: Triple ART @neonate ________ ``` Mother: - BabyBond - Reduce BreastCancer / PPH-risk Kid: i-AIRD - Infections - Allergy/ IBD / RA / DM 1

Answer 77

Deep peroneal nerve-failed: - fooooot EEEEEEVersion (i.e. inversion FINE!!!) - sensory loss in 1st web space - dorsiflexion / toe extension Superficial peroneal nerve-failed: -Ankle EEEEEVersion (i.e. inversion FINE!!!) - sensory loss @ANT-LAT lower leg + foot-DORSUM (NOTTTTTT the 1ST web space). L5 nerve root --> sciatic --> CPeron = S/D @lat thigh, lower leg, foot-dorsum, 1ST WEB SPACE - foot INversion + EVersion BOTH fucked - hip abduction - pain and sensory loss - Common peroneal fucked too (as above) S1 nerve root dx -weak PLANTARflex + low sensation @LAT malleolus

Answer 78

TCA use + dementia = worsening cognitive impairment Hypertonic is usually indicated in patients with SEVERE hyponatraemia (< 120 mmol/L) GTN SEs = '3 H's' 1. Headache 2. Hypotensive 3. HR increase What criteria should be used to determine whether patients who are having an excerbation of COPD require antibiotics? -Purulent sputum OR clinical signs of pneumonia ST elevation -MI / Pericarditis / brugada ST dep -isch, CVD, VH (left or right), Digoxin T-invert -isch/old, Brugada, VH (left or right), Digoxin ``` short PR interval (<120ms), wide QRS complex (>120ms) upsloping delta wave. -WPW -PR 120-200ms; QRS <120ms ``` - low k+ high sodium; high BP; high renin = RAS / other 2ndary dx - low k+ high sodium; high BP; low renin = Conn’s/Cushings >80 with >150/90 clinic + ABPM < 145/85 = lifestyle >80 with >150/90 clinic + ABPM > 145/85 = lifestyle + consider tx Recurrent infections (due to hypogammaglobulinaemia) are a complication of CLL Bog standard UTI MEN 7 FUCKING DAYS!!!!!!!!!!!!!!!! -women = 3 Acoustic neuroma Syx progressively getting worse -Stroke e.g. VertebroBasilar Insuff / POCS = sudden onset @old person+RFs Vision worse going down stairs? Think 4th nerve palsy -TROCHLEAR!!!! BHL = sarcoid / TB Breast lump + firn NON-tender (so not abscess or cyst) -stopped BF recently -USS = well-circumscribed lesion -> white fluid Dx = Galactocele

Answer 79

Which 2 beta blockers = shown to reduce mortality in stable HF? Bisop / Cardev AKI w/ UNKNOWN pathology? FUCKING USS THEM !!!! Patients with an uncertain tetanus vaccination history should be given a BOOSTER vaccine + Tet Ig, unless the wound is very minor and < 6 hours old Testing for HIV in Asyx pts should be done at 4 weeks after possible exposure ``` HIV needlestick PEP= Refer to Emergency Department + oral antiretroviral therapy < 72hrs for 4 weeks ``` Neg Antibody test after 3 months = UNlikely HIV infection gonorrhoea + scared of needles = oral cefixime + oral azithromycin #refuses IM ceftriaxone

Answer 80

``` PAINFUL ulcers -Herpes painful nodes -Behcet - uveitis VTE and painful ulcer -Chancroid-HDucreyi= painFUL Unilat Ing NODE sharply defined, ragged, undermined border. ______________ ``` PAINLESS ulcers -Syphilis=painLESS Ing node - HPV 1+2=plantar, 4=common, 6+11-anus; - solitary-cryo, multiple-podophyllum -LGC: LymphoGranulomaChlamydia= painFUL Ing nodes, ProctoColitis B/C/D - DGiK: Donovanosis Granuloma Inguinale Klebsiella - Azith Cipro Gent

Answer 81

Cluster headache = SBOT + Subcut sumatriptan --@Migraine = Intranasal sumatriptan can be used DKA can present with an 'unrecordable' BM + confusion + abdominal pain coarctation of the aorta = assoc w/ Bicuspid aortic valve Hodgkin's lymphoma: signs of poor prognosis: B-symptoms, increasing age, male sex, stage IV disease and lymphocyte depleted subtype does not undergo angioplasty DVLA advice post MI - cannot drive for 4 weeks Raised ALP + normal LFT's = raise suspicion of malignancy #bone cancer/ metastases British National Formulary recommends giving the vaccine at least 2 weeks B4 Elective splenectomy Jacksonian march (clonic movements travelling proximally) indicates Frontal lobe epilepsy HCC + nausea W/OUT vomiting -jaundice ascites bloated + BNO 2 days, but PASSING WIND -Dx = Functional BO -> metoclopramide CKD + potassium > 6mmol/L should prompt Cessation of ACE inhibitors (once other agents that promote hyperkalemia have been stopped) Carvedilol + Bisoprolol have been shown to reduce mortality in stable heart failure Beck’s triad of falling BP, rising JVP and muffled heart sound. What is the most appropriate diagnostic test for this man's condition? -Echocardiogram _______ GIRL + Amenorrhoea = Turner 45 XO -High FSH/LH KlineFortySeven 47 XXY -High FSH /LH + Low testosterone KlineFelHerTits = Pri Hypogonadism KallowwwmanOSMIA Xr - FSH/LH lowwwww + low Testost - Hypogonadotrophic(low FSH/LH) hypogonadism(low Testost) Low FSH/LH + High Testost -Testost secreting tumour AIS: -High FSH/LH + norm/high Testost XLr so MALE, bastard!! -> overall RESISTANCE to testosterone -Male karyotype (46XY) -External female PHENOtype i.e. Man with External female genitalia -breasts may develop at puberty, #testost -> oestradiol -NO internal female organs, -testicles IN ABDOMEN #groin swelling -If not identified at birth, it can present with primary amenorrhoea. ---ANDROGEN INSENSITIVITY SYNDROME ______________ Syringomyelia classically presents with cape-like loss of pain and temperature sensation due to compression of the SPINOTHALAMIC tract fibres decussating in the ANTERIOR white COMISSURE of the spine COCP use + FHx of VTE + Severe headache = more insidiously than a 'thunderclap headache', with ?subtle neurology -MR Venogram is the gold standard test for diagnosing venous sinus thrombosis CLL is associated with warm AIHA A right coronary infarct supplies the AV node so can cause arrhythmias after infarction Oral glucocorticoids are the treatment of choice for allergic bronchopulmonary aspergillosis sudden onset hypotension, fever and dyspnoea is suggestive of ABO-incompatibility haemolytic transfusion reaction. Bacterial contamination of blood products can result in a transfusion reaction, which typically develops over HOURS An INR >1.3 is a relative contraindication for chest drain insertion Clostridium difficile antigen positivity only shows exposure to the bacteria, rather than current infection - Reassure and continue monitoring bowel motions Lupus pernio = sarcoidosis - raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril Pubic lice infestation = MALATHION The SPLENIC FLEXURE is the most likely area to be affected by ischaemic colitis Diagnosis of a mesothelioma is made on HISTOLOGY, following a THORACOSCOPY If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either PO Azo/MCP = to maintain remission Pseudogout - weakly positively birefringent RHOMBOID-shaped crystals When managing patients with COPD, once the pCO2 is known to be NORMAL the target oxygen saturations should be 94-98%. absolute contraindication to thrombolysis? -Known intracranial neoplasm (VINDICATE) Chondrocalcinosis helps to distinguish pseudogout from gout The osteoporosis guidelines state if a postmenopausal woman has a fracture she should be put on bisphosphonates (there is no need for a DEXA scan). Hepatocellular carcinoma • hepatitis B most common cause worldwide • hepatitis C most common cause in Europe Cisplatin is associated with hypomagnesaemia Nephrotic syndrome is associated with a hypercoagulable state due to loss of AT3 via the kidneys Restless leg syndrome - management includes -simple measures, Tx Fe def, Ropinirole > Benzo/gabapentin The pneumococcal vaccine should be offered to patients with chronic hepatitis Sickle cell patients should receive the pneumococcal polysaccharide vaccine every 5 years Which of the following combinations of vaccinations are routinely offered to pregnant women in the UK? Influenza and pertussis pt w/ T2DM + BPH = burning pain in his feet. Tx? - DAG (if URINARY RETENTION, then NO AMITRIPTYLINE, BASTARD) In a patient with suspected anaemia of chronic disease secondary to CKD, Fe status should be checked prior to commencing EPO Statin: LFTs at 0m, 3 months and 12 months Spinal cord compression - back pain is the earliest and most common symptom High calcium, PROTEIN in urine, old person #back-pain -> fucking ?!MM

Answer 82

``` TCP - Inc p(bact infect) = ROOM TEMP: <10 + no (bleed/surg / TCP dx) <30 + bleed <50 + surg <100 + CNS-bleed/procedure ``` No major hamorrhage: - PT/APTT >1.5 / Surg - ----Fibrinogen = clot/plasma prots - Fibrinogen <1.5 / Surg 1.0 - ----Cryo = f8+13 / fibrinogen + vWF - WARFARIN Stop warfarin Vit K IV @minor bleed >5 Vit K PO @NO bleed >8 Restart @< 5.0 No bleed + 5-8 = withhold dose, reduce dose -bleed @ therapeutic lvl? Ix cause..?renal/gastro dx ``` Major Haemorrhage MHP - PTC warfarin reversal emergency - <1 hr -Stop warf / PTC + vit K / FFP @unavail - @HI / ICH ___________ ``` ``` Bone pain (all 3 bone dx - OM/OPet/Paget) Deformity (all 3 bone dx - OM/OPet/Paget) + HSM - (JUST Petrosis) -OMRicKIDS Tx: Ca+Vit D -OPetrosis:Tx: BMT, alpha-IFN, EPO -Pagets:Tx: Bisphosphonates ___________ ``` Bone pain+Deformity: -OMRicKIDS Myopathy/Myalgia ``` RicKIDS - apophysis NOT fused Vit D resistance OsteoDystrophy LF Tumour ``` X-ray sign? - LOOSERs Pseudo# Tx: Ca+Vit D ______________ ``` Bone pain, Deformity + HSM: -OPetrosis: OC dx -> bone expands = BM narrow -> ExtraMedHematopoeisis HSM Tx? BMT, alpha-IFN, EPO ______________ ``` Pagets: XS OB/C activity -> Pain+deformity Tx: Bisphosphonates

Answer 83

``` RCC -Paraneo: EPO Polycythemia, PTHrH HyperCalcemia, ACTH cushings syndrome ``` -RCC+cholestasis/HSM -paraneoplastic hepatic dysfunction syndrome AKA Stauffer syndrome #increased IL-6 Tx: - Partial/Total nephrectomy - IFN-alpha, IL2 reduce tumour size + mets - TyK = Sunitinib/sorafenib > superior efficacy IFN-alpha

Answer 84

HbA1c is not recommended in the diagnosis of type 1 diabetes -do FPG @DM1 to confirm DM2 + HTN. What ANTI-HTN? ARB or ACEi? -ACEi DM2 + HTN + Black. What ANTI-HTN? - ARB or ACEi? - ARB!!!!!!!! - losartan Teen, STD = MCS show obligate intracellular bacterium. Dx? -Chlamydia Gram Neg Intracellular Bact Systemic Sclerosis + HTN + Age > 55 + MAHA @severeSS. Tx - ACE/CCB? -ACEi Alpha1-antitrypsin deficiency can be diagnosed prenatally Mandem in accident -HTN and Bradycardia -flushed above shoulders, pale below Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level Light microscopy = ground-glass hepatocytes = CHRONIC hepatitis B infection Bisphosphonates and denosumab can be used to prevent pathological fractures in bone metastases. If the eGFR < 30, denosumab is preferred RAPD = CN2 diplopia when asked to look laterally = CN6 -LR6 SO4 R3 occupation asthma is suspected. Most appropriate diagnostic investigation? -Serial peak flow measurements @work + home 1 pack year is defined as 20 cigs/day for 1 year Mandem got CP SOBOE Syncope, narrow pulse pressure, slow rising pulse. How to tx Syx? -Furosemide Nitrates are contraindicated in aortic stenosis Swabs for chlamydia and gonorrhoea in women should be taken from the vulvo-vaginal area (introitus) pt a/w abdo pain/constipation + neuropsych syx + Anaemia -O/E: blue lines @gum margin. legs become WEAK in the past few days. ?Basophilic stippling #NOiron -Lead poisoning is often occupational ventilation -> Sudden deterioration -suggests TPx Myelodysplasia into AML CLL = Richter into NHL Prophylactic IV antibiotics are given prior to appendicectomy Hydroxychloroquine can be safely used during pregnancy in Rheumatoid Arthritis Nictonic Replacement Therapy can be safely used during pregnancy in Smoking Cessation Bupropion = NorAdr + Dopamine reuptake inhibitor, and Nicotinic BLOCKER (Blocker... Bupropion) VareNICline = NICtonic agonist Men who have sex with men should be offered immunisation against hepatitis A -ECG shows new widening QRS complexes and a -NOTCHED morphology of the QRS complexes in the lateral leads = LBBB RSR complex = RBBB CKD-mineral bone disease = Correct hyperPHOSPHataemia first -start with dietary changes before (eduction in foods like chocolate, nuts, shellfish and cola) BEFORE STARTING... -starting a phosphate binder = Sevelamer and lanthanum ``` High phosphate levels in CKD 'drags' calcium from the bones, resulting in osteomalacia -Tx = Bisphosphonates (but not under GFR< 30) ``` Patient with CKD taking calcium-based binders (Calcium acetate) can have problems -> hypercalcaemia + vascular calcification Metastatic bone pain: -bisphosphonates, analgesia, or RT Metastatic Spinal Cord Compression -Dexamethasone bumetanide = LOOPS Ascending loop of Henle

Answer 85

The most common causes of VIRAL meningitis in Adults are ENTEROviruses -Coxsackie B virus (CMV/Cryptococc/Arbovirus/Mumps/EnterooooooCoxsackie) Herpes simplex virus is the commonest cause of viral ENCEPHALITIS in the adult population -iv aciclovir = cross B-B barrier ``` Insulin -> sliding scale Li 4 days b4 AC = 5 days b4 COCP 1m ____ K spare = day of surgery Oral hypoglyc = nbm + sliding scale PRILs = day of surgery -Spiro + Rampiril = day of surgery ``` HIV needlestick PEP= Refer to Emergency Department + oral antiretroviral therapy for 4 weeks The Creatine Kinase (CK-MB) remains elevated for 3 to 4 days following infarction. Troponin remains elevated for 10 days. This makes CK-MB useful for detecting re-infarction in the window of 4 to 10 days after the initial insult HBsssssssAg: acute/chronic>6m dx --- ALTTTT@ ACTIVE #CARRIER/INFECTIOUS HBsAg Anti-HBc: prev/current --- IgM @ ACUTE -> IgG CHRONIC HBV-DNA: acute/chronic>6m (high lvls assoc with HCC) HBeeeeAg infectivity marker --> anti HBeeeee @ resolving anti-HBsss POS only -IMMUNE - vaccine anti-HBsss POS, anti-HBccc/eee POS -IMMUNE prev hep B anti-HBc only: Resolved/Acute resolving/Chronic low level / False positive BITHE > 100 Booster at 5 years 10 - 100 - 1 more vaccine dose + test @immunocomp < 10 Non-responder -testing SCDE + HBIg @fail + 3 doses again Over-replacement with thyroxine = HYPERThyr increases the risk for osteoporosis Baclofen and gabapentin are first-line for spasticity in multiple sclerosis Diplopia is not common in Parkinson's disease and may suggest an alternative cause of parkinsonism such as progressive supranuclear palsy Miliary TB is due to the spread of the bacteria through pulmonary venous system -gain entry into the pulmonary venous system via damaged alveolar squamous epithelium -> gain access to the lymphatic system using macrophages. Patients with focal seizures may experience post-ictal weakness (Todd's paresis) If there is clubbing with hyperthyroidism, think Graves' disease ACROPACHY __________ - BMI < 18.5; - unintentional WL > 10% @last 3-6 months; or - BMI < 20 + unintentional WL > 5% @last 3-6 months NAFLD = WL 10% / 6m (any faster = worsen fibrosis) WL 5% pre-preg Weight, Electrolyte dx, Dehydration __________ ``` Mandem had accident -> Cord injury @above T6 -> HTN + Bradycardia + ... -Flushed + Sweating #Red ABOVE shoulders -PALE BELOW shoulders Ax of HTN = Autonomic Dysreflexia ``` Mandem in accident -HTN and Bradycardia -flushed above shoulders, pale below Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level Faecal impaction / urinary retention are the most common triggers of autonomic dysreflexia Patients with a GCS below 8 should be considered for both i) review by an anaesthetist and ii) intubation and ventilation Coagulase-negative Staphylococcus is the most common cause of peritonitis secondary to PERITONEAL dialysis - Staphylococcus epidermis ``` Multiple myeloma + Paget's disease are typically associated with osteoLYTIC lesions - Mets =Sclerotic _______ Pregnant: - Raised ALP = NORMAL ``` Acute fatty liver of pregnancy = - jaundice, N+V, headache, and hypoGLYCaemia - ALT would typically be raised Obstetric cholestasis = pruritis + raised bilirubin _________ NICE = contrast-enhanced CT coronary angiogram for someone presenting with -non-cardiac chest pain + -resting ECG shows ischaemia = Q wave abnormality, ST-T wave changes NEVER EVER CHOOSE EXERCISE ECG FOR ANYTHING FFS Fever, weight loss, malaise, headache. - palpable-purpura - HUria -jaundice..... - no URT/LRT/lung dx... - ---Polyarteritis Nodosa = Hep B

Answer 86

The EIA = Acute IgM to syphilis - it may be NEGATIVE in reinfection. The T-pallidum particle agglutination (TPPA) test is a specific test for syphilis and often remains POSITIVE in patients who have been PREVIOUSLY infected. The rapid plasma reagin (RPR) - useful to monitor disease activity and reinfection. - 1 in 2 means it needs to be diluted twice, - 1 in 32 means it needs to be diluted 32 times (meaning disease activity is higher in the latter). - A rise by x 4 or more in a previously infected patient = no treatment response/ reinfection. Following treatment for syphilis: TPHA remains positive, VDRL becomes negative ______________ SAICA - Admit / Follow-up -BEST -MAST BP ECG SpO2 Tryptase Medic-alert ACH Skin Prick Teach Ant Lat Thigh ``` Keeping them in 24hrs: Biphasic ED access difficult Asthma severe Night/ Eve/ Unable 2 respond Continuing absoprtion Onset = slow/severe ________________________ ``` ____________MAP=CO.SVR HR PAP Hypovol______low . low..................low Cardiogen___ _low . low Anaphyl/Sepsis_low...........low..........low Neurogen_____low . low.low ``` ____________MAP=CO.SVR HR PAP Hypovol______low . low.........high.low Cardiogen___ _low . low.........high Anaphyl/Sepsis_low...........low.high..low Neurogen_____low . low.low ``` ______Fe . TFsats . Ferritin . TIBC ..Fe.......low . low .........................high .ChrDx.low . low ........high.........low .HChr...high . high ......high.........low Sidero.high . high ......high.........low ``` Syx + IlioFem DVT -Cath Directed Thrombolysis Funct status legit low p(bleed) LE >1 yr Sx < 14d ``` 30-d mortality suitability of OP tx -use of the Pulmonary Embolism Severity Index (PESI) score SUSPECT PE? -PERC criteria to r/o PE -ALL the criteria must be ABSENT to have NEG PERC to rule-out PE -this should be done when you think there is a LOW PRE-TEST probability of PE, but want more REASSURANCE that it isn't the diagnosis -this low probability is defined as < 15% ________ COPD: 2. LABA + ARave: Asthma/Resp2steds (atopy/ variable diurnal/FEV/ eosinophilia --> ``` Y=Becky --(Sx-lowQol/1severe/2mod exac/yr)-> N=LAMA--> _______________ STAMM DR MACROLIDE* 250mg x3/wk -Non-smoker -Optimum-meds -Sputum+Exac ``` ``` Before *Macrolide: -Sputum/TB C+S -CT-Thorax/Chest-physio _______________ Roflumilast -Exac 2+/yr -FEV<50% -COPD/Bronchitis _______________ 1sev/2mod exac/yr Sputum+Exac @Macrolide Exac-2+/yr @Roflumilast _______________ SpO2 < 92 PolyCythemia / PeriphOed FEV< 30% JVP high Cyanosis ``` SBOT @ severe = evidence of resp2prevTx -dont smoke = FUCKING explosion ``` LTOT @Pao2: ABG-x2/3w-apart <7.3 + stable 7.3-8.0 + ... -P.Cythemia -P.HTN-pul -P.Oed-periph -PNoct Hypoxia _______________ ``` Surg: SOB+CT Bulla 1/3HT = Bullectomy Transplant: FEV1<50+lowQoL NON-smoker FINISH -ChestPhysio LungVolRed consider**: FEV1<50+lowQoL NON-smoker FINISH -ChestPhysio -140m6minWalk after ** ''consider'' --> 'actually do' LungVolRed @: -Plethysmography = HyperInflation -CT = Emphysema __________ Adults - Kids: Ix for asthma? 1 - 3-FeNO >40 / >35 @ 5-16yrs ppb 2 - 1-Spiro FEV/FVC < 70 obstr 3 - 2-BD Inc 12% *FEV* @ 200ml SABA/Becky 4 - 4-PEFR inc 20% *VARIABILITY* in 2-4w @BD monitoring 5 - 5-Methacholine Histamine Test PC20 @8mg/ml FEV drop CC50M: @control=reduce maintenance after 3m check: BP BM-hba1c BMD; Chol Cataracts @Steds 50+ = Syx/HDsteds/1exac requiring PO steds/year --> MACROLIDE 500mg x3/wk 6-12m - ECG-QTc = 0m 1m - LFT 0m 1m 6m ``` StopSteds=reduce by 25-50%/3m __________ Pneumothorax -Age >50 + smoking Hx -Lung dx @O/E or CXR Y = 2ndary N = 1rimary ``` -N i.e. (Air Rim<2cm AIR no SOB)=d/c+OPD r/v -> 1. Stop smoke 2. Pluorodesis offer 3. Fly >2w/>1w AFTER drain AND no residual air @trauma/spont __________________ CCF: ICD @QRS<150 - LBBB+NYC 3/- CRT @QRS 120-150 + LBBB+NYC 2/+ CRT @QRS 120-150 - LBBB+NYC 4 ``` Surgery: CPT a. CResync b. Partial Ventriculectomy @non-IHD= -Chagas/CMyopathy/Valve-dx -Aim=reduce:EDV->LVstrain-> optimiseLVFunction c. Transplant ```

Answer 87

Acute Mesenteric Ischaemia -emboli @Endocard/Cancer --> block SMA LACTATE FIRST CT --> URGENT Surg ____________________ Isch. Colitis -cocaine mucosal OED/HAEMORRH --> - AXR = THUMBPRINTING --> SUPPORTIVE Tx ______ Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises. Beta-blockers reduce hypoglycaemic awareness Beta-blockers may cause insomnia suspected neoplastic spinal cord compression should have an urgent MRI of the WHOLE Spine maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour -40 mmol bag over 4hrs IVDU + DESCending paralysis + diplopia + bulbar palsy = Clostridium botulinum Phenytoin infusion = cardiac monitoring is required due to the pro-arrhythmogenic effects Peripheral NEUROPATHY is a known adverse effect of phenytoin IgA @ breast milk iAIRED Kaposi's sarcoma @kids = with only generalised lymphadenopathy #lymphoma Coeliac disease is associated with - iron, -folate , -vitamin B12 deficiency - normocytic = micro + macro #Asplenia Swallowing of saliva is often more difficult @globus pharyngis -solids + liquids are fine though Lung cancer = chemo/RT #immune-checkpoint inhibitor. Nivolumab for SOLID tumours Headache triggered by coughing -> legit? NO #investigate further @hypothermia --> cardiac arrest - defibrillation is SHIT - only 3 shocks should be administered - b4 the patient is rewarmed to 30 degrees Progressively worsening headache with higher cognitive function impaired = urgent imaging required Disproportionate MICROCYTIC Anemia = thallaemia I.e. MCV of like 60 Hyaline casts @urine = furosemide Corticosteroids are used in the management of severe ALCOHOLIC hepatitis Alcoholic ketoacidosis is managed with an infusion of SALINE + Thiamine COPD: - LTOT/Stop Smoking = improve survival - Becky = Improve: QoL, FEV1 / Reduces freq exac Stopping smoking is the most effective intervention -to slow FEV1 decrease in COPD -to improve survival Short attacks with stereotyped movement + QUICK RECOVERY = focal aware seizures Focal seizures + impaired awareness -impaired consciousness AND post-ictal state Focal dystonia would involve rigidity + writhing Relapse-Remit Secondary progressive MS -usually have relapse-remit anyway.. ``` MS = -Worsening symptoms -NO periods of remission -Elderly population PRImary progressive ``` ``` severe headache -nausea -difficulty in finding the right words. -cocp -FHx: mother had an unprovoked DVT in her 30s Dx: Venous Sinus Thrombosis Ix: MR Venogram ``` The interossei are supplied by the ulnar nerve. Vision worse going down stairs? Think 4th nerve palsy -TROCHLEAR!!!!

Answer 88

Colchicine = diarrhoea Patients don't typically tend to get Cryptococcal infection with a CD4 count that high, you would start to suspect it in the <300 range Nerve conduction studies can help in the diagnosis of Guillain-Barre syndrome -plasmapharesis, IVIg, Nerve Conduction studies, DVT proph FFS CORNEAL involvement in Grave's disease indicates severe eye pathology ``` Child Pugh: A - albumin B - bilirubin C - clotting D - distention (ascites) E - encephalopathy -ALT/AST IS SHIT !!!! ``` Lymphoma + Alcohol = painful node = HODGKINs --MIRROR image nuclei = Reed Sternberg Stains inhibit HMG-CoA = DECR chol SYNTH Phaeo = alpha block + beta block (propranlol/ labetalol) - CHOOSE NON-CARDIO SELECTIVE BB = propr #periph - cardio selective eg atenolol/ bisop NOT legit @Phaeo Gram + Catalase + Coag + = ? Gram + Catalase + Coag NEG = ? Gram + Catalase NEG = ? HOCM = sudden cardiac death from vent arrythmia AIHA Hemolysis Ix? = Direct Coombs + LOW Haptoglobin Rhesus hemolytic dx of NEWBORN = INdirect Coombs Lipophilic statins = Simva/ Atorva -> Prox-myopathy #CK-high Hydrophilic = Rosouva/ Prava/ Fluva give when lipophilic fucks muscles up SUDDEN SYNCOPE Pt = bradycardia + ... -loads of Ps + and few QRS = don't match up = 3rd HB -WIDE + DEEEEEP inverted T waves = Stokes-Adams attacks Lung cancer surgery CI - FEV < 1.5 L - Exudate MALIG pleural effusion - Vocal Cord paralysis - SVCO Acoustic neuroma = PROGressive SVT Menieres = Intermittent attacks of SVT + aural fullness Parkinon's TRAPS = -Asymmetric, pill-rolling @rest, -IMPROVE with voluntary MOVEMENT (Rememer Back 2 the Future guy ice skating?!) Tremor = WORSENS as reaches out to examiner's finger -Intention tremor = cerebellar dx ``` past-pointing - pointing BEYOND the finger @finger-nose test = cerebellar dx #Dysmetria under/over shoot ``` Tremor = worsens @OUTstetched arms = essential tremor -BIlateral + WORSEN with action Low plts + high Fibrin Degradation Products = DIC COPD = XS O2 lose hypoxic drive -> retain co2 -> -Resp Acid + Met Compensation for ABG Acidosis questions, if BE is high and CO2 is high i.e. 'mixed' -> - look at pH - then CO2 (in keeping @resp, norm/NOT in keeping @met) - THEN bicarb (low in acid, high in alk) Glomerulonephritis + VTE = AT3 loss from piss!! #VTE Orthostatic HTN = 20/10 drop after 3 fucking minutes Carotid Sinus HSR -> - Vent pause > 3s - SystBP drop by 50mmHg/+ Unilat headache + meningism (bend head back) + NO fever = SAH -Preload high - Regurg/VSD Overload -meds (Nsaid/Pioglit/Steds) -IVF -Pump failure - CM/CPericard; IHD/Ionotrope neg (CCB/AntiArrythmicFlecanide) Arrhythmia -Afterload high - Stenosis (any valve) HTN(periph/pul-corpulmonale) -High output - Preg/Anemia/Thyrotoxicosis

Answer 89

Chondrocalcinosis helps to distinguish pseudogout from gout Acromegaly can develop POS BIREFRINGENT -RHOMBOID - PseudoGout HyperParathyroidism is a risk factor for Pseudogout - whereas HYPOcalcaemia = cataracts Gout = needle-shape NEG birefringent CT scan was performed 1.5cm nodule – adrenal gland = a lipid rich core -Benign Incidental Adenoma TXA = IV bolus followed by slow infusion upper 2/3 oesophagus – SqCC lower 1/3 = adenoCC The incubation period of Ebola virus is 2-21 days CKD-mineral bone disease = Correct hyperPHOSPHataemia first -start with Dietary changes before (eduction in foods like chocolate, nuts, shellfish and cola) BEFORE STARTING... -starting a phosphate binder = Sevelamer and Lanthanum Patient with CKD taking calcium-based binders (Calcium acetate) can have problems -> -Hypercalcaemia + Vascular calcification There is no need for prophylactic antibiotics for Lyme disease in asymptomatic patients bitten by a tick ``` Pt a/w swelling of face arms trunk. PMH: this happened b4. No allergy/anaphylaxis signs or history. Serum C4 = LOW AF. Dx: Hereditary angioedema: Tx: IV C1-inhibitor concentrate / FFP ``` MS: high dose steroids can be used in the management of acute relapse If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI, urgent coronary artery bypass graft (CABG) is recommended TRALI is the specific name given for ARDS occurring within 6 hours of a transfusion. ARDS can only be diagnosed in the ABSENCE of a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised) Pulmonary capillary wedge pressure NOT raised = ARDS Pulmonary capillary wedge pressure raised = Pul Oed #cardiac In suspected spinal epidural abscess, a full spine MRI is required to search for skip lesions Intramuscular vitamin B12 -> start oral folic acid when vitamin B12 levels are NORMAL to avoid precipitating subacute combined degeneration of the cord. ``` 74M viral gastroenteritis 1 week ago -3 days of D+V -Sx settled -Ongoing nausea. -Vision = more blurry + felt dizzy -> falls HR 54/min + irregular pulse BP 119/68 mmHg PMH: IHD, HTN, AF and T2DM. -ECG: ST depression + T-invert bradycardia -Digoxin ``` Kaposi's sarcoma - caused by HHV-8 (human herpes virus 8) -Red man syndrome: stop, resolve, slower Stop vancomycin infusion until symptoms resolve re-starting a slower rate Hypothermia/K low or high/Alco is a cause of Torsades de pointes pseudohypertrophy calf muscles use his arms to help stand up from the floor #Gower-Sign Becker's muscular dystrophy is a less severe form of dystrophinopathy that presents at a later age 71F presents with 2w SOB and haemoptysis O/E: reveals a loud S1 = diastolic murmur + new-onset AF Mitral Stenosis -> raised left atrial pressure --> rupture of Bronchial Veins --> Haemoptysis i -It aint gna be AR cos AR has S3 sound remember!!!! Woman on warfarin has INR < 2 i.e. sub-therapeutic - inc warf dose - cover LMWH in meantime i.e. short-acting - monitor INR - LMWH discontinued when has adequate INR Reduction in GCS + vomiting > 1 are sinister signs in headache: urgent CT head is indicated ECG is performed that shows a - bradycardia with - intermittently non-conducted P waves - no sign of PR elongation / shortening of the waves that are conducted - Mobitz II is an indication for a pacemaker Oxycodone > morphine in palliative patients with mild-moderate renal impairment IV infusion of phosphate polyfusor is commonly used to treat acute hypophosphataemia in adults @refeed syndrome Indications for corticosteroid treatment for sarcoidosis are: - Systemic Dx - HYPERcalcaemia - NOT BHL alone emergency splenectomy. takes PMP-V on a daily basis. Which organism is he particularly susceptible to? Since he already on PMP-V, then strep pneu is covered. So H.Flu would be risky!!! ``` Temporarily lost GCS 20 secs -states feeling lightheaded this AM. -shake her limbs for a few secs -NOT bite her tongue/incontinence -she came around, she was PALE, -took few minutes B4 she felt orientated again. -This was the FIRST TIME this has happened Dx: Vasovagal syncope ``` - SHORT post-ictal period in comparison to a tonic-clonic seizure. - Syncopal episodes = rapid recovery + short post-ictal period - Seizures are associated with a far greater post-ictal period Psychogenic Pseudoseizures FACTOrs: - FHx epilepsy/Females - ALONE = don't occur - CRYING after seizure - Thrusting pelvic - Onset = GRADUAL Favour true epilep seizures: - Tongue biting - PROLACTIN __________ There is NO role for ABx in the Tx of HUS unless indicated by preceding diarrhoeal infection - Only supportive treatment e.g. fluids and dialysis as required ``` Trimethoprim --> HANDA ROTS RTA4 !!! = leading to -HyperKALaemia and -increased Creatinine -decreased urine output, and -swelling in both of her legs ``` ``` CCD: remember.... low Aldost: -Heparin -ACE/ARB -NSAID -DM Renin -Addison ``` Resistance - Obst Uropathy - TMP-SMX - Spiro/Amiloride

Answer 90

Isolated TCP + Rash in a WELL pt --> ITP MAHA + AKI + TCP#Rash = TTP Amniocentesis Alpha1-antitrypsin deficiency can be diagnosed prenatally. - Chorionic villus sampling is usually performed between 11 to 14 weeks gestation - amniocentesis @15 to 20 weeks gestation ``` PCP: • co-trimoxazole • IV pentamidine @ severe cases • aerosolized pentamidine is an alternative Tx for PCP but is LESS effective with a risk of Pneumothorax • steroids if hypoxic ``` Neurogenic Thoracic Outlet Syndrome -muscle wasting @hands, - numbness + tingling, - ?autonomic syx Arterial Thoracic Outlet Syndrome - least common subtype of thoracic outlet syndrome - pain, cold sensitivities + poor circulation @hands + extremeties Subdural haemorrhage is caused by damage to bridging veins between cortex + venous sinuses In trauma, to test if the fluid draining from the nose or ear is CSF, check for glucose 35M pain occurs AFTER he has walked for 10 mins -relieved when he sits -toes turn white, then blue and red during the COLD #Raynaud -smoking 3 - 4 PACKS of cigs/ day for 10yrs i.e. Raynaud's + extremity ischaemia + SMOKING = Buerger's Thromboangiitis obliterans Dx -medium vessel vasculitis SLE + proteinuria = consider lupus nephritis LP --> A low pressure headache - Tx: Caffeine and fluids Consider the use of pain management clinics in resistant diabetic neuropathy ``` If MSCC is suspected, high-dose oral Dexamethasone should be given ASAP WHILST AWAITINGGGG Whole spine MRI ``` Isoniazid can cause drug-induced lupus -iTEACH ``` Woman with bone metastases- most likely to originate in the breast In order of frequency: Breast Bronchus Brostate Bridney Bryroid ``` The Levine Scale: •Grade 4 = palpable THRILL •Grade 5 - palpable THRILL + steth EDGE •Grade 6 – heard WITHOUT STETH Dominant hemisphere MCA strokes cause aphasia stopping of anti-epileptic drugs (AED) is most correct? - If seizure free for > 2 years, + - AEDs being stopped over 2-3 months 'high-stepping' gait - he tends to excessively flex his knees to ensure the feet 'clear' the ground when walking. Dx: Peripheral neuropathy -high-stepping gait develops to compensate for foot drop Atorvastatin 20mg is a high-intensity statin and should be started as primary prevention against cardiovascular disease HNPCC is endometrial cancer + pancreatic cancer Overnight dexamethasone suppression testing was performed, which revealed no change in cortisol levels i.e. FUCKING SYNDROME !!! high urinary cortisol + LOW ACTH i.e. sutin suppressing pituitary (pituitary isn’t obvs making any XS ACTH so cant be pit adenoma bastard). Likely Adrenal Adenoma making loads of cortisol -> suppress ACTH @pit #CT-Abdo suspected stroke. unable to speak BUT able to follow instructions - do not know the handedness of the patient - Percentage of right (90% )and left (60%) handed individuals - making the LEFT BRAIN always > most likely affected side - MCA on dominant side supplies both Wernicke's (sup Temp Gyrus) + Broca's (inf Frontal Gyrus) areas - which are responsible for understanding and production of speech. Insulin DM1: MTRM - multiple daily Basal-Bolus -fail-> cont SC ins @12/+ yr - twice daily Detemir basal - RA analog b4 meals - metformin @BMI 25/+ 3. Insulin DM2: INDGP NPH=SA @HbA1c 75/+ Detemir/Glargine Pre-mixed w/ SA analogue man TChol of 6.2 Q-risk score to be 23%. 10 cigarettes a day His father died of a heart attack aged 50. Tx: Atorva 20 or Atorva 80? -ATORVA 20 !!!!!! HES NOT HIMSELF HAD A FUCKING MI -If non-HDL NOT drop by 40%/+ -> Titrate up provided GFR > 30

Answer 91

The investigation of choice for narcolepsy is multiple sleep latency EEG I and aVL, and slightly in V5+V6 LEFT circumflex Over the past seven days pt has received TPN + adequate Calcium replacement. DESPITE THIS, she remained HYPOcalcaemic. Patients with malabsorption may develop MAGNESIUM deficiency Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart Gilbert's syndrome is a benign condition causing a mild rise in bilirubin - NO treatment needed - Streptococcus viridans - classically linked to poor dental hygiene or following a dental procedure 2 - Streptococcus bovis - most commonly linked with colorectal cancer 3 - Coxiella burnetti - causes Q fever, an infection caught most commonly from farm animals. So, consider in any farmer or abattoir worker. 5 - Staphylococcus epidermis - most commonly associated with patients who have undergone previous PROSTETIC VALVE surgery Fever + - Headache + Photophobia + neck stiffness. #meningitis - seizure -> Recovers within 2 minutes + more tired than before #encephalitis - altered mental status #encephalitis Dx: Encephalitis = IV (Aciclovir + ABx) -meningitis = enterovirus; -encephalitis = HSV1 Hypodense collection #chronic around the convexity of the brain #subdural that is not limited to suture lines dysphagia + glossitis + iron-def anaemia -Plummer Vinson Conjunct Pallor Angular cheilosis + Atrophic glossitis koilonychia spoon-nails -Iron Def Anemia Neuro shit Angular cheilosis + Glossitis (red smooth + shiny tongue, ? ulcers) Lemon skin -B12 def CT confirms numerous bilateral calculi. Investigations urgently? -U+E #OBSTRUCTION BASTARD Arteriovenous fistulas are the preferred method of access for haemodialysis A 17-year-old girl presents with a six week history of nausea and abdominal discomfort. Routine blood tests reveal the following. ALP 262 high AF !!! -Preg V PBC? -PREGGERS!!!! Pbc = middle aged IgM etc sputum appears red and jelly-like. KLEBSIELLA pneumonia-> commonly due to aspiration Complete heart block following a MI? - right coronary artery lesion = AVN The concurrent use of MTX + Trimeth containing antibiotics may cause bone marrow suppression -> pancytopaenia Acute toxoplasmosis in the immunocompetent pt can mimic acute EBV (low-grade fever, generalised LNopathy, prominent cervical lymph nodes, malaise) -should be suspected with NEGATIVE EBV serology. -VCA neg – EBNA neg i.e. EBV antigens For thrombectomy in acute ischaemic stroke, an extended target time of 6-24 hours may be considered if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume A 28-year-old man develops nausea and a severe headache whilst trekking in Nepal. Within the next hour he becomes ataxic and confused. A diagnosis of high altitude cerebral oedema is suspected. Other than descent and oxygen, what is the most important treatment? - Acetazolamide is used more in the PREVENTION of high altitude cerebral oedema, - Dexamethasone used in TREATMENT of cerebral oedema Octreotide + cyprophetadine@diarrhoea - Octreotide is a somatostatin analogue used to treat the symptoms of carcinoid syndrome - urine 5hiaa/ plasma chromogranin Whilst using an inhaler, you should ideally hold your breath for 10 seconds AFTER PRESSING down on the canister When using an inhaler, for a second dose you should wait for approximately 30 seconds B4 REPEATING

Answer 92

Intention tremor @ cerebellar dx Dysmetria - over/undershooting @ MS/ALS ET v Parkinsons = NICE recommend 123I‑FP‑CIT SPECT Levo/carbi - Motor improve/cx increase - ADLs improve - Adverse rxns decrease (hallucinations/impulse/sleep) - Time inc = effectiveness decreaseRopinirole/CabergolineCardiacFibrosis - hallucinations/impulse/sleep Mandem = NA 154 serum osmo >300 urine osmo < 600 Ax? - Binge alco/ DM/ MDMA/ Polydipsia/ SIADH -Tx: BINGE ALCO = suppress ADH @post-pit -> polyuria Beta thalassaemia long term tx? - Life-long blood transfusions - Iron chelation to prevent iron overload #desferrioxamine Corticosteroids are used in the management of severe ALCOHOLIC hepatitis Alco+Met Acidosis+NORMAL BMs Alcoholic ketoacidosis is managed with an infusion of SALINE + Thiamine __________________ *PRAD: Pyrexia, Rigidity (high CK), Autonomic syx, Delirium - ORP 1. SeRAPIDtotonin Serotonin Syndrome - CyproPhetadine/Chlorpromazine ``` 2. NMS: Anti-pSLOOOOOOOOWcotic Stop APsych/Start Parkinson-meds, IVF, -Dantrolene/?DopAgonists - bromocriptine __________________ ``` SSRI Discontinuation Syx Paroxetine = HIGHER incidence of DISCONTINUATION syx than other SSRI ______________________ ``` Aortic dissection BICUSPID aortic valve MarfanEhlers/Turner's and Noonan -Preg/syph -> Chest pain radiate 2 back THORACIC AORTIC DISSECTion __________ ``` SUSPECT PE? - PERC criteria to r/o PE - ALL the criteria must be ABSENT to have NEG PERC to rule-out PE - this should be done when you think there is a LOW PRE-TEST probability of PE, but want more REASSURANCE that it isn't the diagnosis - this low probability is defined as < 15% Pearly penile papules are not a cause for concern and do not require intervention Bone pain + Deformity (OM / Paget..) -> X-rayX-ray generalised osteopenia, erosion of the terminal phalyngeal tufts (acro-osteolysis) and sub-periosteal resorption of bone particularly the radial aspects of 2nd + 3rd middle phalanges. -Hyperparathyroidism. STEPWISE progression of symptoms in dementia - think vascular dementia

Answer 93

IV iron should be used in patients who are found to have iron deficiency anaemia prior to surgery where oral iron either can't be tolerated or the time interval is too short Growth hormone is recommended in the treatment of Turner's syndrome Right heart failure is associated with a firm, smooth, tender and PULSATILE liver edge Paraneoplastics: - Small cell: Kulchitksy cells = SAL* - Squamous = PTHrP - Adeno = Gynaecomastia - Large = hcg * SIADH, ACTH, Lambert-Eaton(waddling gait) Lung cancer in NOn-smoker - AdeNO Lung cancer in SSSmoker - SSSquamous Hyperacute transplant rejection is caused by pre-existing antibodies against ABO or HLA antigens Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises. Beta-blockers reduce hypoglycaemic awareness Beta-blockers may cause insomnia Bile-acid malabsorption may be treated with cholestyramine Aortic regurgitation typically causes an early diastolic murmur A late diastolic murmur is associated with mitral stenosis. Charcot-Marie-Tooth disease (hereditary sensorimotor neuropathy type I) is an autosomal dominant ``` NOT FUCKING RHEUMATOID ARTHITIR SYOU FUCKONG PIECE OF FUCKING SHI !!!!!!!!!!! Upper zone -PMF-coal/beryliosis HSRpneumonitisAKAExtAllAlveolitis, AnkSpond, RTherapy !!!!!!!!!!!!!! , TB ``` Mid Zone - Sarcoid - Silicosis-EGGSHELL/Caplan@RA - Histoplasmosis Lower Zone - IdiopathPF - Asbestosis - Amiodarone/Bleomycin/MTX/Nitro Arnold-Chiari malformation can cause non-communicating hydrocephalus Status epilepticus: rule out hypoxia and hypoglycaemia before thinking of other causes: LLPR but fucking choose BM man orlistat = Pancreatic lipase inhibitor MTX 6m AFTER tx #preg CN3 palsy: Motor(down+out, ptosis), PSymp(dilated), ?vertical nystagmus -isch, CavSinThrom, UncalHerniate/trans-tentorial, MidbrainWeber, PComAneurysm Ulcerative colitis - the rectum is the most common site affected -Diverticu = sigmoid most affected (dont get mixed up !!!) low-grade temperature.extensive painful ulceration of his mouth and gums. 37.4ºC submandibular lymphadenopathy. -HSV 1 !!! Sudden weight loss is associated with non-alcoholic fatty liver disease - MANDEM got roux-en-y, gastric bypass, lost 30kg. Suddenly got jaundice - Acute on chronic NAFLD !!! PSGN develops 1-2 weeks after URTI. IgA nephropathy develops 1-2 days after URTI

Answer 94

HYPERthyroidism = oligomennorhoea, or amennorhoea, whereas HYPOthyroidism = menorrhagia - patient has proximal muscle weakness (difficulty getting out of chair and combing hair) consistent with myopathy - This type of myopathy can be due to drugs (glucocorticoids), connective tissue disease (e.g. polymyositis), neuromuscular (e.g. myasthenia gravis) disease or endocrine (e.g. hypo or hyperthyroidism). Myelodysplastic syndrome -> leading to ANT Myelofibrosis neutropaenia, WITHOUT anaemia/TCP -> @early disease: spleen compensate for RBC + Plts production. @dx progression: spleen production tapers off = RBC + Plts numbers begin to fall ``` _____Hb WCC Plt | Philadel JAK2 Hb high high high - JAK2 WCC low high high - 9,22 Plts ASP + HOHuria FibroBlasts low = HSM/Teardrop/Bone -PRV / CML / ET / MyeloFib ``` Polycythemia - RBC mass: -low = Relative: Acute=Dehydration Chronic=HTN/Alco/Obesity/ ``` -high = Absolute Pri = PRV* 2ndry = Altitude/ COPD/ EPO-OSAS ``` *(Abnormal bleed, SMeg, HTN/Hyperviscos, Itch @shower/ Plethoric) ULTx @: - Two/+ attacks/yr // Tophi/joints - Urate stones - RF GFR <60 - Proph @cytotoxics/diuretics/pyrazinamide the British Society of Rheumatology Guidelines = advocate offering ULT to all patients after their FIRST BASTARD attack of gout -Offer allopurinol TWO weeks AFTER attack with colchicine cover ``` Hyperacute transplant rejection -minutes to hours -is caused by pre-existing ABs against ABO or HLA antigens ``` Acute graft failure (< 6 months) = mismatched HLA - Cell-mediated (cytotoxic T cells) - Tx = steroids + immunosup Chronic graft failure (> 6 months) = both AB + cell-mediated mechanisms -> fibrosis to the transplanted kidney #chronic allograft nephropathy -get recurrence of original renal disease (MCGN* > IgA > FSGS) -MesangioCap/MembProlif GN ``` S-SSI-S G=Stop+Steds A=Stop+Saline D=Stop+IVIg N=Stop+Slow+Paracetamol ``` Acute GvH stop + steds --PAINful MacPap Rash Mandem w/ Ai PMH + join pain + RhF neg = ?HLA-B27 dx 25-year-old male attends his GP with myalgia and flu-like symptoms. - Toxo IgM + IgG positive - NOT immunocomp = DON’T TREAT - Immunocomp = Pyrimethamine and sulphadiazine Sunlight is a common trigger for cold sores ``` Erb's palsy = fell (waiters TIP)-> pronated + medially rotated = brachial trunks C5-6 -ERB'S HAS 4 LETTERS but just add one FFS... ``` ``` Klumpke's paralysis = slip, hung on -> weakness of the hand intrinsic muscles + Horner’s = brachial trunks C8-T1 -KULMPKE'S HAS 8 LETTERS ``` Confabulation/Apathy-AmnesiaRetro/Psychosis are features of Korsakoff's psychosis ``` Which RTA dyou get renal stones in?! Type 1 renal tubular acidosis (distal) complication – RENAL stones Congen URO dx RHEUM dx Amphoterocin Painkillers – NSAID ``` Leptospirosis Ix = Serology Fever on alternating days, think MALARIA - headache, myalgia, HMeg - history of foreign travel Acute hepatitis B - anorexia, nausea and - RUQ pain + tender HMeg - fever Typhoid fever classically presents with 4 phases. - ROSE spot rash + Constipation - BRADYcardia - dry cough, fever, EPISTAXIS and malaise - Ix = CULTURES Dengue fever (high ALT/ low Plts) - Febrile phase - critical phase (abdo pain, vomiting and incr RR) - recovery phase. Viral haemorrhagic fever can also present with fever and non-specific flu-like symptoms. However, it does not typically cause hepatomegaly and does not cause this pattern of fever. Most neurologists now start antiepileptics following a SECOND epileptic seizure. Following a FIRST seizure, anti-epileptic drug treatment should only be started before specialist review in exceptional circumstances including: SDSU 1. SEIZURE activity observed on EEG 2. Presence of a neurological DEFICIT 3. Presence of a STRUCTURAL brain abnormality 4. Patient, parent or carer considers the risk of a further seizure to be UNACCEPTABLE - prescribe LORAZEPAM to use in the event of status epilepticus. Positron Emission Tomography (PET) demonstrates Glucose uptake dissecting aneurysm of the ascending aorta which originates at the aortic valve -Aortic root replacement Mandem when strokes his face/shaves/brushes care - gets tingling pain - He's < 40 years of age - Sensory changes - Deafness ear problems - Skin / Oral LESIONS = ?spread perineurally - Pain @OPHTHALMIC V1 division of the trigeminal (socket, forehead, nose) - Optic neuritis / FHx of MS ---Tx? NOT carbemazapine straight away.. URGENT REFERRAL for specialist assessment rather than treatment. Has had several episodes where she becomes suddenly tearful --> -period of unresponsiveness: -wanders the house = unaware of what she is doing -sleeps for around 2 hours Patients may display AUTOMATISM during a COMPLEX FOCAL SEIZURE #TEMPORAL lobe Anterior MI -> Complete heart block Tx = pacing inferior MI -> Complete heart block NOT an indication for pacing Nasal mupirocin + chlorhexidine for the skin CT = ANT CIRC ischaemic stroke + LIMITED (I.E. not completely fucked !!) infarct CORE - thrombectomy in acute ischaemic stroke, - extended target time of 6-24 hours - CTperf/MRd-w =?SAVE brain tissue

Answer 95

A 31-year-old woman is diagnosed with a primary herpes infection at 35+2 weeks gestation. She does not have any other medical problems. She has had a normal pregnancy up to this point. A Caesarean section is planned for delivery at 39 weeks. What treatment should be initiated? -Oral Aciclovir 400 mg tds until DELIVERY The oral contraceptive pill is associated with drug-induced cholestasis Helicobacter pylori infection is also associated with duodenal ulceration > gastric ADENOcarcinoma + atrophic gastritis + MALT lymphoma Hoover's sign differentiates between organic and non-organic lower leg weakness Parkinsons disease should only be diagnosed, and management initiated, by a specialist with expertise in movement disorders - Don’t just start levodopa - Refer URGENTLY bastard!!! In sickle-cell, acute painful vaso-occlusive THROMBOTIC crises should be diagnosed clinically #dactylitis #peripheries in pain – infarcts of bone etc - Oxygen, Hydration, Analgesia - HOHuria = PREVENTION of crises Eosinophilia is a feature of ALLERGIC bronchopulmonary aspergillosis Look at isoelectric lead -> find lead perp to isoelectric lead -> find direction of that perp lead - If positive = LAD - If negative = RAD - If neither = normal A 22-year-old man is referred to urology with possible urinary retention. He is passing huge amounts of urine. Post void bladder ultrasound is normal. -This patient has diabetes insipidus due to a craniopharyngioma. This causes a lower bitemporal hemianopia.

Answer 96

``` Sarcoidosis can cause a false negative Mantoux test -Causes of false-negative Mantoux test • immunosuppression (miliary TB, AIDS, steroid therapy) • sarcoidosis • lymphoma • extremes of age • fever • hypoalbuminaemia, anaemia ``` Impaired hypoglycaemia awareness occurs due to neuropathy of parts of the autonomous nervous system Thyrotoxic storm is treated with beta blockers + PTU + hydrocortisone Glucocorticoid treatment can induce neutrophilia Stroke is a life-threatening event associated with autonomic dysreflexia An ICD can be inserted to reduce the risk of sudden cardiac death in HOCM ``` classically worse on standing + IMPROVE when lying flat CHILLING --> Low CSF headaches = Spontaneous Intracranial Hypoootension (not necessarily post-LP) ``` Yellow fever is present in Kenya but you would expect more significant jaundice and bleeding 1/3 of patients have infrequent relapses and 1/3 of patients have frequent relapses a majority (2/3) will have later recurrent episodes #MCD HSP = full recovery !!! DEXA scans: the Z score is adjusted for age, gender and ethnic factors Headache linked to Valsalva manoeuvres = e.g. coughing or lying down etc raised ICP until proven otherwise so LP is contraindicated Persistent ST elevation following recent MI, NO chest pain ?pitting oedema to both ankles + slight distension of the neck veins. -LV Aneurysm Sickle cell patients should receive the pneumococcal polysaccharide vaccine every 5 years Which of the following combinations of vaccinations are routinely offered to pregnant women in the UK? Influenza and pertussis In the UK the commonest cause is autoimmunity. Worldwide, however, the most common cause is infection (typically tuberculosis). Severe sepsis may result in neutropenia Steroids may result in neutrophilia Dysplasia on biopsy in Barrett's oesophagus requires an endoscopic intervention In the treatment of anaphylaxis, you can repeat adrenaline every 5 minutes Barrett's oesophagus: High dose PPI + endoscopic surveillance. -The metaplastic mucosa needs to be monitored on a regular basis to check for dysplasia/ malignancy ``` deranged LFTs + secondary amenorrhoea @young female strongly suggest autoimmune hepatitis ``` Tetracyclines can cause black hairy tongue Localised disease is an indication for surgery in bronchiectasis SMALL CELL lung cancer is associated with LAMBERT EATON syndrome, a rare paraneoplastic syndrome, which features autonomic symptoms, limb-girdle weakness (manifesting as a WADDLING gait), and hyporeflexia. Old person painful frontal headaches -pale oedematous optic disc Dx: Temp Arteritis + AION *Domperidone does NOT cross the blood-brain barrier and therefore does NOT cause EPSEs ! A low dose dexamethasone suppression test showed a lack of appropriate suppression of plasma cortisol. However, cortisol was suppressed during a high dose dexamethasone suppression test. Plasma ACTH was elevated. A pituitary MRI was normal. - What is the most likely diagnosis? - Cushing's disease (Pit MRI = TOO SMALL TO BE PICKED UP !!!!!!!!!!!) Azathioprine + Allopurinol have a severe interaction causing bone marrow suppression amiodarone Is a common cause of thrombophlebitis HENCE should ideally be given into CENTRAL veins IV adenosine needs to be infused via a large-calibre vein or central route Pseudo Pelger-Huet cells arise in CML. If a pleural effusion is drained too quickly, a rare but important complication that can develop is re-expansion pulmonary oedema Budd-Chiari syndrome presents with the triad of sudden onset abdominal pain, ascites, and tender hepatomegaly BG: Polycythaemia vera

Answer 97

Syringomyelia is associated with the Arnold-Chiari malformation Non-contrast CT for stroke BASTARD!!!! Klebsiella can cause empyema formation shaft of the humerus = radial nerve dx Supracondylar fracture of humerus = ulnar nerve damage. Proximal humerus Fracture = axillary nerve damage. 3 month history of numbness and paraesthesia in his feet. On examination there is widespread numbness of both feet which does not fit a dermatomal distribution. A recent gamma-glutamyl transpeptidase (gamma GT) is 4 times the upper limit of normal. -What is the most likely diagnosis? -Alcoholic peripheral neuropathy Pulmonary rehabilitation is recommended to start early in the course of COPD, as soon as patients start feeling shortness of breath with regular activity The AST/ALT ratio in alcoholic hepatitis is 2:1 number of features in keeping with a diagnosis of ARDS - ACUTE onset within the past day, on the background of a known risk factor (e.g. pneumonia) - B/L pulmonary oedema (crackles, x-ray changes) - CRACKLES heard (in collapse/atelectasis, don't get crackles) - DESPITE oxygen therapy = hypoxia Central pontine myelinolysis is a complication of correcting hyponatraemia too rapidly COPD: - LTOT/Stop Smoking = improve survival - Becky = Improve: QoL, FEV1 / Reduces freq exac Stopping smoking is the most effective intervention -to slow FEV1 decrease in COPD -to improve survival Septic arthritis - most common organism: Staphylococcus aureus Patients with sickle cell disease are at increased risk of Salmonella spp septic arthritis. Dermatomyositis is associated with ANA Another clue is the fact that the patient is a retired sushi-chef and is likely to have consumed a fair quantity of fish which is known to be high in nitrosamines - a known carcinogen #oesophageal cancer 4-year-old son to you the GP. She says her son has not been growing relative to his peers in school. -Axillary freckles are indicative of neurofibromatosis 1 Opioids should be stopped in Clostridium difficile infections A positive femoral nerve stretch test may indicate referred lumbar spine pain as a cause of hip pain productive cough = worsening / 6 months. IVDU + multiple episodes of pneumonia in the past. O/E conjunctival pallor and bilateral wheezing -lots of eosiniphils -Sputum CS: Eosinophils and fungal hyphae Dx = ABPA --Tx=Steds Reactive arthritis is not typically acute - it can develop up to 4 weeks after precipitating infection and can run a relapsing-remitting course over several months -Oral prednisolone is the correct answer. Haemodialysis is the most common form of renal replacement therapy. The usual first line option for INDEPENDENT patients for renal replacement is a form of peritoneal dialysis. Haemofiltration is only used in the acute setting, often only being available in critical care departments for very sick patients. Farmer, fever, transaminitis ?Q fever Levodopa and other antiparkinsons drugs are 'critical' medicines which should not be stopped on acute admissions and must be delivered on time -Acute withdrawal of levodopa can precipitate neuroleptic malignant syndrome.

Answer 98

First-line treatment for ITP is oral prednisolone Hepatitis E is spread by the faecal-oral route and is most commonly spread by undercooked pork The neurologist decides to initiate treatment that will provide initial symptomatic relief. Pyridostigmine ong-acting acetylcholinesterase inhibitor emporarily improving symptoms of myasthenia gravis C8 is the ONLY cervical nerve root that comes out BELOW the vertebra A HIV test should be offered to all patients with TB The postural hypotension and ataxia makes the Parkinson's plus disorder progressive multi-system atrophy the most likely diagnosis. Warfarin may rarely cause skin necrosis Which of the following combinations of vaccinations are routinely offered to pregnant women in the UK? Influenza and pertussis In infective endocarditis, - Mitral valve is most commonly affected - IVDUs get Tricuspid regurg Seizures are characteristically provoked by hyperventilation Pt w/ myasthenia gravis is due for an elective abdominal hysterectomy. Which commonly used anaesthetic agent would she most likely be resistant to? -Suxamethonium PMH: rheumatoid arthritis, is -scheduled to have a laparoscopic cholecystectomy. What imaging should be performed pre-operatively? -Ant + Post + Lateral c-spine radiographs -Atlantoaxial subluxation is a rare complication of rheumatoid arthritis, but important as it can lead to cervical cord compression. -goes to surgery in a C-spine collar and the neck is NOT HyperExtended on intubation. Penicillamine can cause membranous glomerulonephropathy in patients with Wilson's disease Which is the best assessment tool for differentiating between stroke and stroke mimics? ROSIER If a pituitary incidentaloma is found within the sellar, laboratory investigation must be done to determine if it is functional or non-functional Hypoglycaemia is commonly mistaken for being ‘drunk’ and so blood glucose measurement should always be part of initial assessment. low HbA1c = Hemolysis / RF / WL high HbA1c = Haematinics/ Splenectomy Ask her GP to repeat thyroid function tests (TFTs) in 6 weeks Sick euthyroid is common in unwell, elderly patients and often needs no treatment Syringomyelia - wasting SMALL muscle hands - Pain + Temp FUCKED - ARNOLD CHIARI Frontotemporal dementia is associated with motor neurone disease The ketogenic diet is a high fat, low carbohydrate, controlled protein diet. It is an established treatment for children with epilepsy that is hard to control and is generally unresponsive to antiepileptic medications. FODMAP) diet - This is used in treating irritable bowel syndrome (IBS) Herpes + Preg = Oral aciclovir until delivery and delivery by caesarean section