Corrections 1 Flashcards
What are the 3 top organisms causing post-splenectomy sepsis?
1) H. influenzae
2) Strep. pneumoniae
3) Meningococci
What is actinic keratoses considered a precursor to?
Squamous cell carcinoma
Cause of actinic keratoses?
Chronic UV exposure
Features of actinic keratoses?
Rough, scaly patches or papules on sun-exposed skin, predominantly in fair-skinned, elderly individuals.
Google it!
Mx of actinic keratoses?
1) prevention of further risk e.g. sun avoidance
2) fluorouracil cream
3) topical diclofenac
4) topical imiquimod
What is Bowen’s disease considered a precursor to?
SCC
Mx of Bowen’s disease?
Topical 5-fluorouracil
Bowen’s disease vs actinic keratoses?
Bowen’s disease tends to be isolated and well demarcated.
How do neuromuscular disorders present on pulmonary function tests?
Restrictive pattern
How does bronchiectasis present on pulmonary function tests?
Obstructive pattern
What score is used to identify patients at risk of pressure sores?
Waterlow score
What are flame and blot haemorrhages on fundoscopy characteristic of?
Central retinal vein occlusion
When using an inhaler, how long should you wait for before repeating the second dose?
30 seconds
MSM should be offered which vaccination?
Hep A
Mx of anterior uveitis?
Steroid & cycloplegic eye drops
Role of steroid eye drops in anterior uveitis?
Reduce inflammation
Role of cycloplegic eye drops in anterior uveitis?
Dilate the pupil which helps with pain relief and photophobia.
example of cycloplegic eye drops?
1) atropine
2) cyclopentolate
In anal fissures, what can be considered for cases that don’t respond to conservative management?
Sphincterotomy
What does a loop ileostomy involve?
Taking a loop of the ileum, performing a horizontal incision and bring it up to the skin.
Indication for a loop ileostomy?
It is indicated to defunction the colon, for example, after rectal cancer surgery.
Eventually, it can be reversed.
What is the key diagnostic test in Guillain Barre?
LP –> elevated protein with normal WCC
Mx of human bites that have broken the skin and drawn blood?
Treat as animal bites –> co-amoxiclav
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
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
