Clinical conditions bible Flashcards
PCOS triad
Hyperandrogenism
Anovulation
Cystic ovaries on US
Cystic ovaries on US characteristics
12+ follicles 2-9mm
PCOS associated conditions
T2DM
Obesity
Ectopic pregnancy presents with
Abdominal/pelvic pain
Amenorrhea
Cervical motion tenderness
Manage ectopic surgically
Laparoscopic salpingectomy
Cystocele
Bladder into front vaginal wall
Rectocele
Rectum into posterior vaginal wall
Enterocele
Prolapse of posterior vaginal wall involving small bowel
Urethrocele
Prolapse of lower anterior vaginal wall involving urethra only
Vault prolapse
Top of vagina bulging down
When do you get a vaginal vault prolapse?
Post hysterectomy
Complete vaginal eversion AKA
Procidentia
POP-Q is in relation to the
Hymen
Nocturia is a sign of
OAB
OAB?
Urinary urgency +/- incontinence with increased frequency/nocturia
Overflow incontinence management?
Specialist
Male vs female c/g test
VVS women
First pass urine male
Manage chlamydia new guidelines
Doxy 7
Gonorrhea infects what?
Mucus membranes
Chlamydia infects
Male urethra and female endocervix/urethra
Most common non-viral STI worldwide
Trichomoniasis
What does trichomonad vaginalis look like?
Flagella
Strawberry cervix
TV
Test for trichomoniasis
Charcoal swab with microscopy
Manage TV
Metranidazole for 5-7 days
BV is caused by overgrowth of what?
Anaerobic organisms and loss of lactobacilli
BV test
High vaginal swab
Spriochete bacterium
Syphilis
How does syphilis spread?
Gets through skin and mucous membranes, replicates, disseminates throughout bloodstream and lymphatics
Can you give syphilis to baby?
Yes
How do you know if syphilis has been treated?
RPR value decreases 4 fold
Treat syphilis?
Parenteral IM benzylpenicillin
Candiadasis test
Charcoal swab
Charcoal swab
Thrush / BV / TV / Group B strep
Pupils with syphilis
Argyl-Robertson
Most common non-gonococcal urethritis
Mycoplasma genitalium
NAATS for non-gonococcal
HVS women
First pass men
Treat non-gonococcal
Doxy 1 week
When is itch worse with crabs?
Night time
HIV primary infection undergoes __________, then what happens?
Seroconversion, flu like symptoms present
During seroconversion, the patient is not/is contagious
Is VERY contagious
What does viral load mean?
Number of copies of HIV RNA per ml of blood
“Undetectable viral load” AKA
50-100 copies / ml
HIV, CT shows multiple ring enhancing
Toxoplasmosis
Manage cyst premenopausal
<5cm
5-7cm
>7cm
Resolve in 3 cycles
Routine referral, yearly US
Consider MRI or surgery
Persisting or enlarging cysts require
Laparoscopy, ovarian cystectomy +/- oophorectomy
Meigs syndrome
Fibroma, pleural effusion, ascites
How do you treat ovarian torsion?
Laparoscopic surgery
PID is caused by
Gonorrhea, chlamydia, mycoplasma
How do you treat non-STI PID?
Ceftriaxone and doxycycline
What is FHC syndrome?
Perihepatitis
Inflammation and infection of liver capsule resulting in adhesions between liver and peritoneum = RUQ pain
HPV produces what that inhibits P53?
E6 and E7
What can cervix look like in cervical cancer
Inflamed or friable !
Protective factor in endometrial cancer?
Smoking
Exam for endometrial cancer pathway
TVUS
Pipelle biopsy
Hysteroscopy with biopsy
GI tract in ovary tumour
Krukenberg - signet ring on histology
When do you give IV hydralazine?
Critical care with hypertension in pregnancy
Early vs late miscarriage
<13 weeks
13-24 weeks
Diagnose miscarriage
TVUS
Manual vs electric vacuum
LA
GA
APH measurements
<50
50-1000
>1000 or shock
Placenta praaevia over internal os manage
C-section 36-37 weeks
Woody hard uterus
Placental abruption
Vasa previa delivery
C section
Asymptomatic vasa previa manage
Corticosteroids and Csection
Placenta accreta diagnosis via
Antenatal USS
PPH is prevented how?
Active manage
Syntocinon IM/IV + tranexamic acid IV (C/S)
Continuous assessment in PPH chart
MOEWS chart
What is McRoberts manoeuvre?
Hyperflexion of hip to provide a posterior pelvic tilt to lift pubic symphysis up and out of way
Rubins manoeuvre
Reaching into vagina to apply pressure on posterior aspect of baby’s shoulder to move it under pubic symphysis
Wood’s screw
Performed during Rubins, hand into vagina
Pressure on posterior shoulder
Top shoulder is pushed forward and bottom backwards to rotate baby and help delivery
Manouvre to push baby back in so you can perform CS
Zavaneli
Cord prolapse most significant risk factor
Abnormal lie at 37 weeks
Cord prolapse treat
CS
Uterine fibroids are non/tender
Non tender
Fibroid management
<3cm IUS, COCP, NSAIDS
>3cm myomectomy, uterine artery embolization
Endometriosis in myometrium
Adenomyosis
Endometriosis symptoms
Deep dyspareunia, dysmenorrhea, infertility
Confirm vulval lichen sclerosis
Vulval biopsy
Vulval lichen sclerosis treat
Clobetasol Propionate
Breast mouse or
Fibroadenoma
Do phyllodes tumours require intervention?
Yup - excision
BRCA breast cancer common mets
Lungs liver breast brain
DCIS usually seen on
Mammogram
LCIS seen in who? How do you detect?
Premenopausal women
Not seen on mammogram - accidental finding
Manage LCIS once found
6 monthly exam and yearly mammogram
Tethering nipple
Pagets
Paeu d’orange
Inflammatory breast cancer
Pitting oedema of breast
Diagnosis of breast cancers
<40 = US
>40 = mammogram
Core biopsy
Tumours of frontal lobe causes changes in
Personality/behaviour
Most common brain mets are from
Lung
Extradural tumours are
Secondary mets
Intradural tumours are
Meningiomas, schwannoma
Intramedullarly are
Astrocytoma, gliomas
Investigate meningioma
MRI +/- CTA
Acoustic neuromes gene
Tumour supressor gene on Ch 22
Schwanomma removed surgically typically by
Gamma knife radiotherapy
Craniopharyngiomas are seen in who?
5-14 year olds and 50-70 year olds
Does chemo work in craniopharyngiomas?
No
Primary CNS lymphomas are usually
Large B cell lymphomas
Test in CNS lymphomas
Test for HIV
Manage primary CNS lymphoma
Manage with chemo with radiotherapy
Dexamethasone
Most common malignant CNS tumour in kids
Medulloblastoma
What do medulloblastomas arise from?
Cerebellar stem cells between brainstem and cerebellum
Medulloblastomas are _______ _______ _________ tumours
Malignant primitive neuroectodermal
How do medulloblastomas present?
Cerebellar signs and diplopia
Commonest benign tumour in kids?
Pilocytic ast rocytoma
What is meningitis?
Inflammation of Pia and arachnoid mater meninges of brain and spinal cord
Encephalitis
Inflammation of brain tissue itself
Neisseria meningitis causing meningitis mostly capsule group
B
Kernig’s sign
Unable to fully extend at the knee when hip is flexed (spinal pain/resistance)
Brudzinski’s sign
Patient’s knees and hips flex involuntarily when neck is flexed
Post exposure prophylaxis of meningitis
Single dose ciprofloxacin or rifampicin
Silent stroke
Radiological or pathological evidence of infarction without history of dysfunction
Why would oral COMT be given in Parkinson’s?
Given to improve compliance
Phenytoin causes what deficiency?
Folate
Diagnosis of GB by what criteria?
Brighton
Huntington’s triad and other motor signs
Mental disturbance
Cognitive disturbance
Motor disturbance
Chroea, myoclonus, eye movement disorders, dysarthria, dysphagia
MG is a what type of sensitivity ?
II
What antibiotic is CI in MG?
Gentamicin –> reduce effectiveness of NMJ transmission, exacerbating symptoms
LEMS ________ muscle weakness
Prominal lower limb
Botulism causes
Rapid onset weakness without sensory loss
Monitor ICP with what?
Mannitol or hypertonic saline
How long do you need to have symptoms to diagnose shiz?
1 month and 6 months of functional decline
Atypical blocks 2 what
D2
5HT2a
What antipsychotic causes hyperprolactinaemia
Risperidone
How many ml of alcohol is a unit
10
3 screening for autism
3di
DISCO
ADOS
Inflated sense of self importance
Narcissism
Place of safety order
Used by police to transport psych patients when they are in public (135)
Emergency detention allows up to
72 hours
Short term is to what?
Administer psychiatric treatment
MI in elderly may present at ______ or ______
Syncope or delirium
Vd is what?
Amount given/amount in 1L of blood
High Vd is ______ and therefore ______ release from fatty stores
Lipophilic
Slow
Axonal injury involves a reaction in
Cell body
________ degeneration of axon during injury
Anterograde
Acute neuronal injury when?
Hypoxia
Ischemia
When does gliosis happen?
1-2 weeks
What infarcts do hypertensives get?
Lacunar
Presenilin 1 vs 2 chromosome
14
21
What can help stain Lew Body’s
Ubiquitin
How many weeks does neural tube form?
4 weeks
Glial or ______ cells
Glue
What are grey matter in brain?
Somas, synapses, and cell bodies
What is inter ventricular foraemen also known as ?
Foramen of Munro
Basilar artery is from
Vertebral arteries
Ganglia vs nucleus
Ganglia outside CNS
Nucleus in CNS
Cerebellar input cells
Cerebellar output cells
Granular
Purkinje
Aphasia definition
Inability to use language
Lacunar stroke comes into the ER with symptoms since this morning, what’s the management?
Urgent CT of the head and aspirin 300 MG within 24 hours if ischaemic stroke is confirmed
Wilson’s disease, ceruplasmin and 24 hour urinary copper levels
Low and high 
Three first line drugs for dementia
Galantamine
Rivastigmine
Donezepil
If someone is on sodium valproate and is continuing to have seizures, what do you do?
Withdraw drug
Unable to stand on your toes and ankle reflexes are reduced, which nerve root
S1
Another antibody for MG
Musk
You have given lorazepam to a patient, they have still been seizing for five minutes. What do you do?
Wait until 10 minutes have passed and give a second dose of lorazepam
A 67-year-old female is concerned about a tremor that she is developing in her hands. It is the same in both hands and worse when she’s using it. She thinks her mother had a similar
Benign, essential tremor
An 82-year-old female with type two diabetes and hypertension develops a wild flailing movements on one side of his body
Subthalmic stroke
A seven-year-old male notes he is losing his hand dexterity, an examination, you know what a tremor in the left hand, while he performs task with his right hand
Parkinson’s disease
79-year-old male with a history of previous strokes, has two episodes of shaking in one hand, each lasting less than two minutes no tremors a parent on examination between episode
Partial seizure
27-year-old female presents with gradual onset of a tremor in both hands, her family has noticed a change in her voice was variation in speed and volume
Wilson’s disease
52-year-old male has a daily headache, present and waking from sleep with Jesus through the day. This is associated with nausea and vomiting. It is worse on coffee.
Space occupying lesion
19 year old university student has headache. It is constant bilateral in reading to the front region and into his neck. He described it as a pressure sensation. He is worried as it is interfering with his revision for his upcoming exams.
Tension headache
18-year-old university student is brought into the hospital by her flat mate with a headache. It worse throughout the day and radiates into her neck. She is drowsy and febroile on examination.
Meningitis
20–year-olds wakes up with a unilateral headache. Throbbing, he is tired and photophobic. He has vomited twice.
Migraine
