Corrections 1 Flashcards by Esme Cosham

What are the 3 top organisms causing post-splenectomy sepsis?

1) H. influenzae

2) Strep. pneumoniae

3) Meningococci

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What is actinic keratoses considered a precursor to?

Squamous cell carcinoma

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Cause of actinic keratoses?

Chronic UV exposure

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Features of actinic keratoses?

Rough, scaly patches or papules on sun-exposed skin, predominantly in fair-skinned, elderly individuals.

Google it!

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Mx of actinic keratoses?

1) prevention of further risk e.g. sun avoidance

2) fluorouracil cream

3) topical diclofenac

4) topical imiquimod

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What is Bowen’s disease considered a precursor to?

SCC

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Mx of Bowen’s disease?

Topical 5-fluorouracil

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Bowen’s disease vs actinic keratoses?

Bowen’s disease tends to be isolated and well demarcated.

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How do neuromuscular disorders present on pulmonary function tests?

Restrictive pattern

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How does bronchiectasis present on pulmonary function tests?

Obstructive pattern

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What score is used to identify patients at risk of pressure sores?

Waterlow score

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What are flame and blot haemorrhages on fundoscopy characteristic of?

Central retinal vein occlusion

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When using an inhaler, how long should you wait for before repeating the second dose?

30 seconds

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MSM should be offered which vaccination?

Hep A

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Mx of anterior uveitis?

Steroid & cycloplegic eye drops

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Role of steroid eye drops in anterior uveitis?

Reduce inflammation

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Role of cycloplegic eye drops in anterior uveitis?

Dilate the pupil which helps with pain relief and photophobia.

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example of cycloplegic eye drops?

1) atropine
2) cyclopentolate

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In anal fissures, what can be considered for cases that don’t respond to conservative management?

Sphincterotomy

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What does a loop ileostomy involve?

Taking a loop of the ileum, performing a horizontal incision and bring it up to the skin.

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Indication for a loop ileostomy?

It is indicated to defunction the colon, for example, after rectal cancer surgery.

Eventually, it can be reversed.

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What is the key diagnostic test in Guillain Barre?

LP –> elevated protein with normal WCC

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Mx of human bites that have broken the skin and drawn blood?

Treat as animal bites –> co-amoxiclav

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Mx of human bites that have broken the skin and NOT drawn blood but are in a high risk area (e.g. hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation)?

Treat as animal bites –> co-amoxiclav

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Mx of human bites that have broken the skin and NOT drawn blood but patient is immunocompromised?

Treat as animal bites --> co-amoxiclav

In the emergency setting where the bowel has perforated, the risk of colon-colon anastomosis is much greater. Why is this? What should be used instead?

As it may lead to an anastomotic leak, resulting in the release of the bowel contents into the intraabdominal space. End colostomy should be used instead.

Location of Wernicke's area?

Temporal lobe

Location of Broca's area?

Frontal lobe

Features of Broca's dysphasia?

- speech non-fluent - comprehension normal - repetition impaired

1st line mx of acute angle-closure glaucoma?

Combination eye drops: - direct parasympathomimetic eyedrops e.g. pilocarpine - beta blocker eye drops

Role of pilocarpine eye drops in AACG?

Induce pupillary constriction --> widens the iridocorneal angle and allows for humour to drain (reduce IOP)

Role of beta blocker eye drops in AACG?

Reduce aqueous humour production (reduce IOP)

What class of medication should be avoided in myasthenia gravis?

Beta blockers --> cause a worsening of myasthenia gravis and result in reduced FVC

When should patients with CKD be commenced on ramipril?

ACR >30 mg/mmol

When can patients with COPD be considered for LTOT?

pO2 <7.3 or 7.3 - 8 kPa plus: - 2ary polycythaemia - peripheral oedema - pulmonary HTN

What is the most common cause of peritonitis secondary to peritoneal dialysis?

Coagulase negative Staphyloccocus e.g. Staph. epidermis

Following ACS, what should all patients be offered?

1) Dual antiplatelet therapy 2) ACEi 3) Beta blocker 4) Statin

Alzheimer's disease causes widespread cerebral atrophy mainly involving which areas of the brain?

Cortex & hippocampus

How to differentiate between acute and chronic Hep B infection on serology?

Acute & chronic --> positive HBsAg Acute only --> positive anti-HBc IgM

What marker would be positive on Hep B serology in previous vaccination?

anti-HBs

1st line mx of rosacea for patients with severe papules and/or pustules (e.g. evidence of scarring)?

Topical ivermectin + oral doxycycline

1st line mx of mild-mod rosacea?

Topical ivermectin only

Prior to discharge, following an acute asthma attack, what should a patient's PEFR be?

>75% of best/predicted

Mx of patients with obstructive urinary calculi and signs of infection?

Urgent renal decompression + IV abx (high risk of sepsis)

What imaging is used to diagnose dementia?

MRI head

1st line investigation if vascular dementia is suspected?

MRI head

How long may treatment of BPH with finasteride take before results are seen?

6 months

1st line medication for intractable hiccups in palliative care?

Chlorpromazine

What movement in lateral epicondylitis makes the pain worse?

Wrist extension whilst elbow extended

What movement is painful in supraspinatus tendonitis?

1) Painful arc of abduction between 60 and 120 degrees 2) Tenderness over anterior acromion

When is the peak incidence of delirium tremens following alcohol withdrawal?

72 hours

When should you consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer?

People aged 45 and over with: a) persistent unexplained hoarseness or b) an unexplained lump in the neck

When should you consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer?

In people with either: a) unexplained ulceration in the oral cavity lasting for more than 3 weeks or b) a persistent and unexplained lump in the neck.

Mx of a perforated tympanic membrane caused by barotrauma?

Reassurance - will likely resolve after 6-8 weeks.

Mx of an acute flare of RA?

Oral or IM steroids (prednisolone oral or methylprednisolone IM)

What should be co-prescribed when starting allopurinol?

NSAID or colchicine cover (to prevent an acute flare up of gout)

When is cervical screening in pregnancy delayed until?

3m post partum

What do all proximal scaphoid pole fractures require?

Surgical fixation

Mx of acute otitis media with perforation?

Oral abx (5-7 day course of amoxicillin)

What should be used 1st line for acute stress disorders?

Trauma focused CBT

What is the preferred method of induction of labour if the Bishop score is ≤ 6?

Vaginal prostagladins or oral misoprostol

Mx of CML?

Tyrosine kinase inhibitors e.g. imatinib

Mx of transverse lie before vs after 36 weeks gestation?

<36w gestation: no mx required (most foetuses will spontaneously move into longitudinal lie during pregnancy) >36w gestation: appt to discuss e.g. ECV, elective c-section

What are some contraindications to ECV?

1) maternal rupture in the last 7 days 2) multiple pregnancy (except for the 2nd twin) 3) major uterine abnormality

Success rate of ECV?

50%

How long should patients with schizophrenia not drive for?

Must notify the DVLA, until stable and well for 3 months and following a suitable psychiatristy report

What is the SSRI of choice in children and adolescents?

Fluoxetine

What 2 tests can be used to assess ACL injuries?

1) Lachman's test (superior) 2) Anterior draw test

What is an exchange transfusion?

This is the process of removing the patient's blood and replacing it with non-sickle donor red cells, in order to support oxygenation and reduce tissue destruction due to the sickle cell crisis.

Mx of SCFE?

Internal fixation

S1 lesion causes weakness in what movement?

Plantarflexion of the foot

What reflex is reduced in an S1 lesion?

reduced ankle reflex

What is a positive sciatic nerve stretch test?

If the pain is reproduced by elevation of a straight leg and incremented by dorsiflexion at the point of pain.

Mx of Pxseudomonas aeruginosa in CF?

Oral ciprofloxacin + inhaled abx

What is the preferred treatment for chronic symptoms in vestibular neuronitis?

Vestibular rehabilitation exercises