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Revision Notes - Year 3 > Data revision notes > Flashcards

Data revision notes Flashcards

1
Q

Name the structures that pass through the femoral triangle

A

Femoral nerve
Femoral artery
Femoral vein
Lymphatics

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2
Q

What nerve innervates the medial compartment of the thigh?

A

Obturator

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3
Q

What nerve innervates the anterior compartment of the thigh?

A

Femoral

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4
Q

What nerve innervates the posterior compartment of the thigh?

A

Sciatic

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5
Q

What nerve innervates the lateral compartment of the leg?

A

Superficial branch of common fibular nerve

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6
Q

What nerve innervates the anterior compartment of the leg?

A

Deep branch of the common fibular nerve

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7
Q

Name 2 screening questionnaires that can be used for alcoholism

A

CAGE and AUDIT

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8
Q

What symptoms can occur 6-12 hours after alcohol withdrawal in an alcoholic?

A

Shaking, sweating, nausea, vomiting, headache, insomnia

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9
Q

What symptoms can occur 12-24 hours after alcohol withdrawal in an alcoholic?

A

Visual, auditory and tactile hallucinations (can usually be distinguished from reality)

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10
Q

What symptoms can occur 24-48 hours after alcohol withdrawal in an alcoholic?

A

Withdrawal seizures

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11
Q

What symptoms can occur 48-72 hours after alcohol withdrawal in an alcoholic?

A

Delirium tremens -> usually peak at 5 days. Patient suffers confusion, disorientation, hallucinations and seizures

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12
Q

What are the triad of symptoms in Wernicke’s encephalopathy?

A

Confusion, ataxia, ophthalmoplegia (paralysis of muscles surrounding eye)

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13
Q

Name some hand signs seen in patients with chronic liver disease

A
  • Clubbing
  • Terry’s nails (proximal 2/3 white, distal 1/3 red)
  • Meuhrcke’s lines
  • Palmar erythema
  • Asterixis
  • Dupuytren’s contracture
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14
Q

What is the most common cause of acute pancreatitis?

A

Gallstones

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15
Q

What does the mnemonic PANCREAS stand for in acute pancreatitis?

A 
PaO2
Age
Neutrophilia
Calcium
Renal - urea
Enzymes
Albumin
Sugar
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16
Q

Name some drugs that can cause acute pancreatitis

A 
Azothiaprine
Thiazides
Trimethoprim
Tetracyclines
Metronidazole
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17
Q

What is Grey Turner’s sign?

A

Bruising of the flanks - due to retroperitoneal haemorrhage. Causes = acute pancreatitis, pancreatic haemorrhage, ruptured aaa, ruptured ectopic

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18
Q

What is Cullen’s sign?

A

Umbilical bruising and superficial oedema. Causes = acute pancreatitis, blunt trauma, ruptured aaa, ruptured ectopic

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19
Q

What are 4 causes of large bowel obstruction?

A

1) Diverticulitis
2) Malignancy
3) Sigmoid volvulus
4) IBD -> UC, toxic megacolon

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20
Q

What are 3 causes of small bowel obstruction?

A

1) Adhesions
2) Hernias
3) Malignancy

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21
Q

How big do both small and large bowel have to be on AXR to be classed as dilated?

A

Small >3cm

Large >6cm

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22
Q

What is a Phlebolith?

A

A small calcification within a vein - common finding on AXR in the pelvis

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23
Q

What is an ileus?

A

An intestinal blockage caused by a lack of peristalsis. It can happen after surgery, due to electrolyte imbalance or acid-base abnormalities. Most resolve with ‘watchful waiting’

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24
Q

If both the small and large bowel are dilated, what does this suggest?

A

Ileocaecal incompetence

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25
Q

When might you see thumb printing on AXR?

A

In UC - caused by bowel wall thickening as a result of actor inflammation

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26
Q

If you see bilateral hilar lymphadenopathy and right paratracheal lymphadenopathy what should your differential include?

A

Sarcoidosis!

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27
Q

A double shadows over the right heart border on CXR suggests what?

A

A posterior mediastinal mass. CT needed to evaluate

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28
Q

What can air bronchograms signify on CXR?

A

Pulmonary consolidation, pulmonary oedema, interstitial lung disease, malignancy, pulmonary infarct, pulmonary haemorrhage.

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29
Q

If someone has fractured a long bone and then develops a petechial rash, neurological problems and respiratory problems, what might of happened?

A

Fat embolism

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30
Q

What malignancies can metastasise to bone?

A 
Breast
Bronchus
Prostate
Kidney
Thyroid
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31
Q

Name 2 different types of fracture commonly seen in children

A

Greenstick

Buckle

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32
Q

What are the haematinics and where are they absorbed?

A

Iron - duodenum and jejunum
B12 - terminal ileum
Folate - SI

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33
Q

What is the best test for iron deficiency?

A

Serum ferritin

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34
Q

Describe the: 1) location of the apex, 2) first heart sound and 3) third heart sound in mitral regurgitation.

A

Apex - thrusting and displaced
First heart sound - soft
Third heart sound - present

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35
Q

Describe the: 1) location of the apex, 2) first heart sound and 3) third heart sound in mitral stenosis.

A

Apex - tapping, undisplaced
First sound - loud
Third sound - absent

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36
Q

Describe the: 1) pulse, 2) location of the apex, 3) systolic thrill, 4) Ejection systolic murmur and 5) BP pulse pressure in aortic stenosis.

A 
Pulse - slow rising
Apex - Undisplaced, heaving 
Systolic thrill - Present
Ejection systolic murmur - harsh and loud
Pulse pressure - narrow
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37
Q

Describe the: 1) pulse, 2) location of the apex, 3) systolic thrill, 4) Ejection systolic murmur and 5) BP pulse pressure in aortic regurgitation.

A 
Pulse - collapsing 
Apex - 6th IC space, ant. axillary line, thrusting
Systolic thrill - absent 
Ejection systolic murmur - softer
Pulse pressure - wide
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38
Q

What criteria is used for helping confirm a diagnosis of infective endocarditis?

A

Duke’s

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39
Q

Name 5 examination findings you might see in a patient with infective endocarditis

A

Osler’s nodes - painful, raised red lesions on fingers or toes
Janeway lesions - non-tender flat red lesions on palms and soles
Splinter haemorrhages
Signs of emboli (peripheral or central)
Pyrexia
Petechial rash
Cotton wool spots

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40
Q

Before prescribing a statin what blood test must you do and and why?

A

LFTs as they are hepatotoxic. Must be checked as a baseline, at 3 months and then again at 1 year

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41
Q

What hormone is significantly raised in heart failure?

A

BNP - brain natriuretic peptide

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42
Q

What 2 drugs are the first line treatment for heart failure?

A

ACEI and B-blocker (maybe ARB and B blocker)

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43
Q

What electrolyte abnormalities can thiazide diuretics cause?

A 
Hyponatraemia
Hypokalaemia
Hyperuricaemia (can cause gout)
Hypercalcaemia
Hyperglycaemia
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44
Q

What 2 blood tests can be done to check synthetic liver function?

A
  • INR/PT

- Albumin -> hypoalbuminaemia is seen in chronic liver disease, it is this that results in ascites and peripheral oedema

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45
Q

List 3 abdominal signs of chronic liver disease

A
  • Ascites
  • Hepatomegaly
  • Splenomegaly
  • Caput medusae
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46
Q

Where in the GI tract does Crohn’s disease most typically affect?

A

Terminal ileum and ascending colon

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47
Q

What layers of the bowel does UC affect?

A

Just the bowel mucosa

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48
Q

What layers of the bowel does Crohn’s affect?

A

All layers - it is transmural which can lead to fistulas.

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49
Q

Give 4 extra intestinal manifestations of IBD

A
  • Mouth ulcers (aphthous)
  • Skin - erythema nodosum, pyoderma gangrenosum
  • Eyes - conjunctivitis, uveitis
  • Joints - acute arthritis
  • Finger clubbing
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50
Q

Give 6 contraindications to the OCP

A
  • History of DVT/PE
  • Breast cancer
  • Currently breastfeeding
  • Previous stroke
  • Migraine with aura
  • Liver disease
  • IHD
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51
Q

Name a drug that is used to treat infertility in women

A

Clomifene

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52
Q

Give some signs and symptoms of hyponatraemia

A 
Anorexia
Malaise
Nausea and vomiting
Muscle cramps
Confusion, seizures
Coma
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53
Q

What does it suggest about the cause of hyponatraemia if urinary sodium is high? Give some examples of causes

A

That sodium and water are being lost from the kidneys.

  • Diuretic overuse
  • Renal failure
  • Addison’s disease
  • Osmotic diuresis
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54
Q

Give some non-renal causes of hyponatraemia

A
  • D+V
  • Burns
  • Small bowel obstruction
  • Heat exposure
  • Iatrogenic
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55
Q

Why must you not correct hyponatraemia too quickly?

A

Can cause cerebral oedema and central pontine myelinolysis

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56
Q

How do you manage hyponatraemia?

A

IV 0.9% saline, gradually. Furosemide if v. severe to reduce risk of heart failure

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57
Q

Give some signs and symptoms of hypernatraemia

A
  • Thirst
  • Lethargy
  • Irritability
  • Weakness
  • Confusion
  • Reduced consciousness, seizures, coma
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58
Q

Give 4 potential causes of hypernatraemia

A
  • D+V
  • Burns
  • Osmotic diuresis (hyperosmolar hyperglycaemia state)
  • Diabetes insipidus
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59
Q

How do you manage a patient with hypernatraemia due to diabetes insidious?

A

Desmopressin

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60
Q

How do you treat hypernatraemia?

A

Slowly! Oral water but if not tolerated 5% dextrose.

61
Q

Give 4 signs/symptoms of hypokalaemia

A
  • weakness / fatigue
  • constipation / ileus
  • paraesthesia, tetany, muscle weakness
  • paralysis (starting distally)
62
Q

Give 3 drugs that can cause hypokalaemia

A
  • Salbutamol
  • Insulin (drives it intracellularly)
  • Thiazide diuretics and loop diuretics
  • High dose corticosteroids
63
Q

What other electrolyte often needs replacing with K+?

A

Mg as depletion makes it difficult to replace K+

64
Q

Give some signs/symptoms of hyperkalaemia

A

Muscle weakness, oliguria, respiratory distress, ECG changes, areflexia

65
Q

What are 4 potential causes of hyperkalaemia?

A

Addison’s disease
Renal damage and renal failure
RBC transfusion nearing expiry
Drugs

66
Q

Give 4 examples of drugs that can cause hyperkalaemia

A 
B blockers
ACEI
ARBs
Digoxin
NSAIDS
Aldosterone antagonists
67
Q

What can you give to protect the heart in emergency hyperkalaemia?

A

Calcium gluconate

68
Q

How do you treat hyperkalaemia as an emergency?

A

Insulin in dextrose
Salbutamol
Calcium resonium
Dialysis

69
Q

What autoantibody screen would you do in someone you expect has Coeliac disease?

A

Anti-transglutaminase

70
Q

What is the most common cause of a benign breast lump?

A

Fibroadenoma

71
Q

Describe how breast cancer can spread nodally

A
  • Axillary nodes (75%)
  • Deep cervical nodes
  • Parasternal nodes
  • Infraclavicular nodes
72
Q

How might a surgeon distinguish between an indirect and a direct hernia in surgery?

A

An indirect inguinal hernia will be lateral to the inferior epigastric artery

73
Q

What veins are dilated in a varicocele?

A

Veins of the Pampiniform plexus

74
Q

What structure is ligated when sterilising a man?

A

The ductus deferens

75
Q

How might you distinguish between a gastric and duodenal ulcer based on the history?

A
  • Duodenal ulcers -> pain is better with food and then returns a few hours after eating. Nocturnal pain
  • Gastric ulcers -> pain worse on eating
76
Q

What is the most common cause of portal hypertension?

A

Liver cirrhosis

77
Q

Which muscle is most likely to be torn in childbirth?

A

Pubococcygeus

78
Q

Which nerve is most commonly involved in foot drop?

A

Common fibular (peroneal) nerve

79
Q

Name 5 causes of peripheral neuropathy

A
  • Diabetes - most common
  • Charcot Marie Tooth
  • Guillain Barre
  • Vasculitis
  • Hypothyroidism
  • Excess alcohol intake
  • Shingles
80
Q

Give 4 potential causes of high opening CSF pressure

A
  • Meningitis
  • Tumour/space occupying lesion
  • Intracranial haemorrhage
  • IIH
81
Q

What does the presence of xanthochromia in CSF (with the absence of jaundice) indicate?

A

Subarachnoid haemorrhage -> must be done 12hours later

82
Q

What can you look for in the CSF to help confirm a diagnosis of MS?

A

Oligo-clonal bands

83
Q

What antibiotics can be used to treat bacterial meningitis in hospital?

A

IV cefotaxime

IV amoxicillin

84
Q

Give 4 clinical signs suggestive of venous insufficiency

A
  • Venous eczema
  • Haemosiderin deposits
  • Venous ulceration
  • Varicose veins
  • Lipodermatosclerosis (inverted champagne bottle sign)
85
Q

Give 4 retinal signs in a patient with hypertensive retinopathy

A
  • Silver wiring
  • AV nipping
  • Cotton wool spots
  • Flame haemorrhages
  • Papilloedema
86
Q

Give 4 retinal signs in a patient with diabetic retinopathy

A
  • Cotton wool spots
  • Neovascularisation
  • Dot and blot haemorrhages
  • Hard exudates
87
Q

What mnemonic can be used to ascertain the cause of metabolic acidosis?

A 
MUDPILES
Methanol/metformin
Uremia
DKA
Paracetamol
Iron
Lactic acidosis
Ethylene glycol
Salicylates
88
Q

What are the sepsis 6?

A

1) High flow O2
2) Blood cultures
3) IV Abx
4) Lactate (and FBC)
5) IV fluids
6) Urine output -> catheterise

89
Q

Why do pudendal nerve blocks not completely abolish sensation during childbirth?

A

The ilio-inguinal nerve provides sensation to the anterior part of the perineum and is not blocked

90
Q

Fractures to the epiphyseal plate during childhood are called what type of fracture?

A

Salter-Harris

91
Q

What nerve damage does a positive trendelenburg test suggest? Which muscle is involved?

A

Superior gluteal nerve

Gluteus medius

92
Q

What nerve roots are responsible for the babinski reflex?

A

L4, L5, S1, S2

93
Q

Ankle sprains are almost always due to which kind of injury and what ligament is commonly affected?

A

Inversion injury

Anterior talofibular ligament

94
Q

If Weber’s lateralises to the left and Rinne’s is negative in the left what does this suggest?

A

Conductive hearing loss in the left ear

95
Q

If Weber’s lateralises to the left and Rinne’s is positive in the left what does this suggest?

A

Sensorineural hearing loss in the right ear

96
Q

If an asthmatic requires a salbutamol inhaler, steroid inhaler and still isn’t well controlled what is the next step?

A

Add a LABA (e.g. salmeterol)

97
Q

What is step 4 in asthma management?

A
  • Leukotriene receptor antagonist
  • Theophylline
  • Increasing steroid dose
98
Q

What is the normal respiratory rate and heart rate in a newborn?

A

RR - 30-60

HR - 110-150

99
Q

How much feed do babies require/day?

A

150ml/kg/day

100
Q

What is the FEV1:FVC ratio in obstructive lung disease? (e.g. COPD, asthma, bronchiectasis?

101
Q

What histological/pathological findings might be seen in the neural tissue of a patient with Alzheimer’s disease?

A

Neurofibrillary tangles and amyloid plaques

102
Q

Describe 2 changes that can be seen in the histological slices of a Parkinson’s brain

A

1) Lewy bodies - these look like purple circles within neurones
2) Loss of pigmentation in the substantial nigra in the midbrain

103
Q

In what disease might Reed-Sternberg cells be found in the blood?

A

Hodgkins Lymphoma

104
Q

What is a Signet ring cell and when might it be seen?

A

A cell with a large vacuole. Seen in carcinomas, most commonly gastric and colorectal.

105
Q

Describe some histological and pathological changes seen in UC

A

Superficial ulcers

Crypt abscesses

106
Q

Describe some histological and pathological changes seen in Crohn’s disease

A

Cobblestone appearance
Skip lesions
Granulomas

107
Q

Where are plaques most commonly seen in psoriasis? What other manifestations (non-skin) might be apparent?

A

Extensor surfaces

  • Pitting of the nails
  • Oncholysis
  • RA
108
Q

What is the causative agent of Pityriasis versicolor, what does the condition look like and how is it treated?

A

M. fur fur
Flat depigmented lesions
Ketoconazole shampoo

109
Q

How might erythema multiform be easily recognised? What is the most common trigger?

A

Target lesions.

Herpes simplex virus is most common trigger

110
Q

How is Steven’s Johnson Syndrome often recognised?

A

Affects the lips and mucus membranes - necrosis

111
Q

What is the most likely cause of rhinophyma? (and what is it?)

A

Bulbous looking nose

Untreated rosacea

112
Q

What type of hypersensitivity reaction is urticaria due to?

A

Type 1 (IgE)

113
Q

What is Henoch-Schonlein purpura?

A

Small vessel vasculitis, IgA.
A triad of: purpura, arthritis and abdominal pain.
Mostly affects children, usually resolves on its own

114
Q

How is scabies treated?

A

Permethrin cream from head down.

115
Q

What cream can be used to treat Tinea infections?

A

Terbinafine

116
Q

What other signs/symptoms might a patient with scleroderma have?

A

Raynauds -> treat w/ Ca channel blockers
Facial telangiectasia
Sclerodactyly
Dilated nail fold capillaries

117
Q

Name the 2 muscles that supinate the hand and what innervates them

A
  • The supinator -> radial nerve

- Biceps brachii -> musculocutaneous nerve

118
Q

What nerve injury can cause a winged scapula and what muscle is involved?

A

Injury to the long thoracic nerve

Serratus anterior

119
Q

What nerve roots for the superior part of the brachial plexus and what problems can damage to this cause?

A

C5 and C6

- Erb’s palsy. Limb hangs in medial rotation

120
Q

What nerve roots for the inferior part of the brachial plexus and what problems can damage to this cause?

A

C8 and T1

- Klumpke’s palsy -> claw hand (ulnar nerve)

121
Q

What injury results in a popeye deformity?

A

Rupture to the tendon of the long head of biceps brachii

122
Q

What sodium and potassium abnormalities will be seen in a patient with Addison’s disease?

A

High K+

Low Na+

123
Q

In which vein is a central line usually placed?

A

The right or left subclavian

124
Q

Horner’s syndrome is caused by a lesion in the parasympathetic or sympathetic trunk in the neck?

A

Sympathetic

125
Q

Loss of the corneal reflex can occur if either of 2 nerves are damaged. Which nerves?

A

CNV1 -> ophthalmic nerve

CNVII -> facial nerve

126
Q

Which nerves can be involved in an acoustic neuroma?

A

CNVIII
CNVII
CNV

127
Q

A lesion in what nerve will result in palatal deviation to the unaffected side (uvula off centre), absence of taste to the posterior third of the tongue, changes in swallowing and an absent gag reflex?

A

Glossopharyngeal nerve

128
Q

What is the skyline test in a knee exam looking for?

A

PCL rupture

129
Q

What is the Lachman test for?

A

ACL damage

130
Q

How should hypertension managed medically according to NICE guidelines?

A

It differs for people over 55 and those under 55

131
Q

What medical treatment is recommended for people <55 years with htn?

A

ACEI or a low cost ARB (candesartan)

132
Q

What medical treatment is recommended for people >55 years with hypertension? (Step 1)

A

Ca channel blocker (amlodipine)

133
Q

What drug can be added in for step 3 of hypertension treatment?

A

Thiazide like diuretic

134
Q

What drug us most commonly used for treating hypertension in pregnancy?

135
Q

What does the CHA2DS2VAS score stand for and what is it used for?

A 
It is used to evaluate the stroke risk of patients with AF 
C - congestive heart failure
H - hypertension
A - Age (>75yrs) +2
D - diabetes
S - stroke or TIA +2
V - vascular disease
A - Age (65-74 +1)
S - sex - female +1
136
Q

If the CHADVASC score is +1 in a man and women, what is the appropriate action?

A

In a man a score of 1 would usually mean anticoagulation

In a women a score of 1 is usually managed conservatively

137
Q

Name 6 risk factors for endometrial cancer

A
  • Obesity
  • Nulliparity
  • Late menopause
  • FH of ovarian, breast or colon ca
  • Unopposed oestrogen therapy
  • Diabetes
  • PCOS
  • Tamoxifen
138
Q

Name 5 risk factors for ovarian cancer

A
  • BRCA1 or BRCA2 genes
  • Jewish
  • Nulliparity
  • Age >45
  • Oestrogen only HRT
  • Endometriosis
  • Obesity
139
Q

Name some protective factors for ovarian cancer

A
  • Multiparty
  • Young age at first child and late age at last child
  • Breast feeding
  • COCP use
  • Tube ligation
140
Q

What is the most common cause of cushion’s syndrome?

A

Steroid use - glucocorticoids.

141
Q

Give some methods used to diagnose Cushing’s

A
  • Measuring cortisol in 24 hour urine collection -> if Cushings then cortisol high
  • Measure cortisol in late night salivary sample -> if Cushings cortisol high
  • Dexamethasone supperssion test -> high cortisol = cushings
142
Q

How can Addison’s disease be diagnosed?

A
  • Short synacthen test. Poor rise in cortisol if Addison’s
  • Insulin tolerance test -> induces hypoglycaemia which should stimulate GH and cortisol. Poor cortisol response in Addison’s
143
Q

What is sick euthyroid syndrome?

A

In an acutely unwell patient TFTs can become abnormal -> normal/low TSH with low T3+T4. This resolves when recovered

144
Q

What autoantibodies might be seen in someone with SLE?

A

anti - dsDNA, lupus anticoagulant, anti-Ro, ANA

145
Q

What autoantibodies are often seen in Sjogren’s?

A

Anti-Ro, anti-La

146
Q

What autoantibodies are best for diagnosing RA?

A

Anti - CCP and rheumatoid factor

147
Q

c-ANCA and p-ANCA are often found in what autoimmune condition?

A

Wegner’s granulomatosis

148
Q

Other than myocardial injury - name some potential causes of a raised Troponin T

A
  • PE
  • Sepsis
  • AF
  • Renal failure
  • Myocarditis
  • Heart failure

Revision Notes - Year 3 (2 decks)

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