Derm + Surg Flashcards

Question

PolyNeuropathy, CCF Wernicke-Korsakoff syndrome Alcoholic hepatitis = ? Alcohol DKA = ? + ? 1. Confusion, Lillepution, Tremor 2. NOAC nystagmus, ophthalmoplegia, ataxia, confusion - PolyNeuropathy 3. Konfabulaton, Amnesia, Memory 4. DT syx + autonomic HYPERactivity - high GGT, high MCV-megalo, CDT Syx < 12 hrs Seizures < 36hrs DT < 72 hrs Ix: Low red cell tranSKETOLase MRI = petechial haemorrhages @mamillary bodies and ventricle-walls.

Answer 1

Thaimine Vit B1111111111 Ber1 Ber1 -B1T Alcoholic hepatitis = steroids Alcohol DKA = IVF + Thiamine 1. Delirium Tremens 2. Wernicke 3. Korsakoff 4. Alco withdrawal

Answer 2

Pellagra Niacin B3 def -B3NP -Assoc with mets carcinoid!!! ________ Keratoderma blennorrhagica ________ Corynebacterium Pitted keratolysis ___________ Palmo-Plantar Pustulosis ________ Juvenile plantar dermatosis SHINY, Sweaty feet syndrome (Sweaty feet = IVA remember!!!) PomPholyx Dyshidrotic Eczema -BLISTERS

Answer 3

Pyridoxine B6 Biotin 7/8 _________ Folic acid B12 CyanoCobalamin _________ Tocopherol - Vit E Vit K -Breast-fed babies @risk _______ Riboflavin - B2 ``` Anabolic steds Buserelin Cimetidine/Cannabis-WEED Digoxin Estrogens Finasteride Goserelin HyperT/Hcg-seminoma Isoniazid Jaundice-LF KleinFeltHerTits K-sparing-SPIRO Ketoconazole ```

Answer 4

1. AOM: earache/TUGGING/rubbing/crying/restlessness ear reveals a BULGING tympanic membrane. 2. 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 3. CSOM — 2 WEEKS!!!! persistent inflammation and PERF of the tympanic membrane with discharge 4. Myringitis — @otoscopy = erythema/injection of tympanic membrane

Answer 5

Pityriasis versicolor Ix: skin scraping MCS Preg/BFeed CI: Selenium / Flucon/Itracon Tx: - Advise - recurrence @hot temp - Selenium sulfide shampoo @EXT - Ketocon shampoo @EXT / Preg/Bfeed - Imidazole @SMALLarea=MICE - Flucon/Itracon PO @tx fail --> Refer RelapsePrev/Proph: Repeat ASKIF or Ketocon ______ ``` Pityriasis ALBA Erythematous patch -> HypoPigmented --resolving 1 month to 1 year. _______ Pit ROSACEA - self limiting MACCCC -resolve in 6-12 weeks _______________ ``` Guttate - self limiting PAPPPP Scale - GGGuttate-GAS - PPPyogenes-PAP

Answer 6

Polymorphic Eruption of Preg -AHist, Csteds top/po, Emollients -Pruritic -3rd trimester -ABDO Striae --> spread -ACE ___________ PemphigOOOOOid gestation - POOOOO steds O looks like fkn belly-button!!! and blisters too!!! ______ pemphigOLD = no mucous membranes -Anti-HEMI-DESmosome pemphiGUS - nikolsy sign -Anti-desmoGLEIN (anti-desmosome) ***GUS GUIL(ein)-FOY *** LOL

Answer 7

1. Epidermoid = cyst lining 2. Pilar = Outer-root sheath HAIR-FOLLICLE ``` #BOTH SEBACEOUS ________ ``` ``` Dermoid cyst _______________ Desmoid tumours -should be managed in a similar manner to soft tissue sarcomas. _________ ``` Necrobiosis lipoidica diabeticorum ___________________ Erythromycin - Erythrasma Tx ____________ Lipoma - Ultrasound @ > 5cm Liposarcoma ________ Dermatofibroma _____ Ganglion Cyst ______ Orf - PoxVirus ________ Folliculitis -@shave = pseudoFolliculitis #Barbae ________ ``` E.Nodosum = PAIN No Cause - idiopathic Occult cancer Drugs - -Sulf,OCP,Allop,Penicillins Other = Pregnancy/GAStrepPyog Sarcoid UC/Crohns Myobact ``` erythema nodosum Mx - No active treatment - Arrange routine FOLLOW-UP

Answer 8

Venous ulceration -above MED malleolus Superficial venous insuff = varicose veins Deep venous insuff = prev DVT and venous insufficiency --> Venous HTN --> - capillary FIBRIN cuff / - ?? sequestration DoppleRRR USS = for RRReflux and Duplex USS = for Anatomy/ Flow ``` Tx: Exclude ART dx --> Pentoxifylline OR 4 layer compression banding --> Grafting @: - Fail to heal after 12 wks or - >10cm^2 skin ``` Prev: Grad Comp Stocking @healed _____________________ ``` ART ulcers - LOW ABPIs Occur on the toes and heel PainFUL-punched out ?gangrene Cold with NO palpable pulses Low ABPI measurements ______________ ``` ``` Neuropathic ulcers Commonly over PLANTAR surface of: -metatarsal head / hallux Due to PRESSURE Management includes CUSHIONED shoes to reduce callous formation -CHARCOT joints _____________ ``` Keratoacanthoma _______ Marjolin ULCER

Answer 9

``` 1. Aluminium iontophoresis - palmar/plantar/pits Botox Surgery-Sympathectomy ___________________ 2. Top csted + Top Vit D3 calcipotriol ________________ 3. sun cream imiquimod cryo/curettage 5FU+hydrocort/diclofenac top @mild ``` similar to BCC __________________ Melanoma: 1. Superficial 2. LentigOLD 3. Nodular AGGRESSIVE melanoma: Red or black lump, oozes or bleeds, sun-exposed skin 4. Acral - Subungual pigmentation (Hutchinson's sign) Hutchinson - HZO - corneal dx @nosetip V1 - Pupil = uncal / TTentorial herniation - acral melanoma ___________________ Morphoeic BCC - MOH microgaphic surgery

Answer 10

1. Hydrogen peroxide Fusidic acid Mupirocin 2. Fusidic acid Mupirocin Fluclox/Erythro 3. Fluclox/Erythro Stay away from school/work till -crusted/dry/healed -48hr after ABx _________________ Hidradenitis suppurativa: Smoke Alco WL/ Hygiene Csteds: intra-lesional/ PO - Acute: Fluclox I+D - Chronic: Top Clinda/ PO lymecycline

Answer 11

Alopecia Areata Hair regrowth – short/fine/depigmented = No tx Tx? No hair regrowth - <50% = WW No hair regrowth - >50% = -potent / v.potent 3m csted --> refer CiP Refer = C i P A - Csteds: intralesional/po - immunotherapy/supp, - PUVA - TAPD screen #Ai dx: thyroid addisons pernicious dm _____________ Male pattern baldness - FAMILIAL - Alopecia AndrogenETIC - bitemporal - central Chemo/ISup/RT -> rapid hair-loss -Anagen Effluvium Infection/hormonal #RECENT BRITH stress -> hair move to tologen/dormant phase #loss -Telogen Effluvium XS pulling on hair shafts -TRACTIONAL Alopecia #Sidra

Answer 12

Vitiligo: Top csted + ci-tacrolimus NB-UVB Lichen planus: Top csted + ci-tacrolimus ____________ ____________ Lichen Sclerosis: Top csted + emollient

Answer 13

For all fungal - captia/corpora/cruris/pedis - Ix???? Scraping MCS + contacts ``` Capitis - ScrapingCS pt + contacts: Urban Tricophytan - TERBINAF PO - LFTs Rural Microsp RUBRUM - GRISEO/Itracon PO Transmission reduce: selenium sulf/ketocon Refer @CDTFail ``` Painful, PUSTULAR boggy masses = THICK crust (KERION) - REFER _________________ Tinea INCOGNITO — inappropriate top csted use --> ext spread + change in lesion morphology __________________ mild: MICE/TopTerb +/- csted mild potent 7d @itch/inflame --> severe/ext: PO Terbinafine>Griseoful/Itracon mild: MICE/TopTerb/UndeCenoic/Tolnaftate +/- csted mild potent 7d @itch/inflame --> severe/ext: PO Terbinafine>Griseoful/Itracon __________________ ``` Self-care: SAAdc Amorolfine: 6m finger / 9+m toe -even on area of paronychiaaaaa Antifungal PO - Terbin / Itra (TI-IT) > Griseo -Dermatophyte: 1. PO Terbinaf <3m finger/<6m toes 2. Itracon x2 finger/ x3 PULSED toes -Candia: 1. Itracon x2 finger/ x3 PULSED toes 2. PO Terbinaf <3m finger/<6m toes Monitor nail growth 3-6m after tx ```

Answer 14

SINGLE - Mild-mod: RAC 8-12wks Top Retinoid Adapalene +/- BPO Top Azelaic acid Top Clinda + BPO = prevent bac resist COMBO - Mod: 8-12wks - Doxy/Lyme 3m > Erytho - COCP @women ABx x2 fail / Scar - ?Isotret refer ``` Refer @ CAP -conglomata/fulminans/ -ABx x2 fail / Scar - ?Isotret refer -psych dx __________________ ``` Isotret - dry skin/terato/depression

Answer 15

``` Surgery/RT imiquimod curettage/cryo 5-FU similar to actinitc keratoses tx ``` Squamous CC Keratoses -acitinic (on any sun-exposed area eg forehead, feet, arms, back, ears) -sq in situ - Bowen = WELL-DEMARCATED + isolated -keratoacanthoma MARJOLIN!!! Type of SqCC

Answer 16

``` Hirsutism: PCOS CAH Obesity Syndrome CUSHING ``` ``` Hypertrichosis: Porph cut tardis Anorexia nervosa - lanugo Congen Languinosa Congen Terminalis _____________ ``` 5-15% 30-45% ______________ HNPCC Lynch - MSH2 gene = DNA mismatch - Gastric/SBowel - ENDOMET/Bladder FAP - Dom = APC gene -Gardener Syndrome get OSTEOMAS!!! _________ ``` Peutz -Jeghers - Dom -STK11 (LKB1) -Breast/Panc/Ovarian cancers -Gynae cancer (except Endomet) -Testicular cancers __________ ``` Cowden dx - Dom £10-bet - P-TEN - Breast, Endomet, Thyroid _________

Answer 17

Rosela 6th HHV6 -Nagayamu NagPap EBV Measles Rubella (back+forth...MAC+Forsch...) GERMAN MEASLES aka Rubella!!! -FORSCHEIMER WAS GERMAN!!!

Answer 18

Optimise: - Bone: Ortho/ Rheum - Endocrine: HYPOthyroid/ Acromeg Avoid REPETITIVE move / SLEEP on arm BREAK from gardening @Syx onset Splinting @neutral position Ortho/Rheum referral - ?csted injection -Avoid NSAD/diuretics

Answer 19

Vascular disease Ix? Pulses --> ABPI --> Duplex USS -->MR/CT angio ABPI range? 0.9-1.3 1. 3 or mooooore = DM/RF-->Art Stiff 0. 9 or less = IC 0. 6 or less = CLI Rest-pain/Mix Art-Ven dx 0. 3 or less = ulcer/gangrene/ARTERIAL!!!!!! _______________ What vessels mainly affected? - Iliac - Fem=Calf How can iliac be split up? Int - (Bum=gluteal, ED=pudendal) - LERICHE Ext - Thigh ________________ MOST IMPORTANT RF 4 PAD? -SMOOOOOKING Atheroscl -> Stenosis -> PAD --------------------|--> Stenosis -> Embolus/Thrombus Acute Limb Isc = RAPID decr @limb perfusion - pAin, pAllor, pAraesthesia - pErishing, pOwer, pUlseless Ax: Embolus V Thrombus 1. Embolus due to Surg/AF -> CLAPS - CLaudication NONE - Acute, - Profound isch cos not collats formed, - Skin marbling mottling 2. Thrombolysis -> Thrombus = opposite... ________________

Answer 20

IC and Critical LI IC: @Walk - cramp - pedis X @Rest - relief - pedis felt @Walk - cramp - pedis X ``` CLI: @rest = Pain > 2weeks!!!!! @elevate = PAllor --> @flat = Red @wound HUG = PUlseless -heal/ulcer/gangrene ```

Answer 21

ALI tx: OHAP PEAR SCOLD Oxygen, Hydration, ACs-lmwh, Paracetamol etc ``` PCI thrombolysis Embolectomy Amputation @UNsalvageable Revasc = Ix-Duplex USS -->MR/CT angio: -Endo: Viable limb -Surg: NON-viable limb ``` ``` SmokeStop Clopi 75mg Obesity tx Lipids 80mg Atorva DM tx ______________________ Revasc of irrevers isch/necrotic limb --> Inflamm mediator release --> Reperfusion Syndrome - multiorgan dx/death ```

Answer 22

REDs PUDI - REvasc = Duplex USS-->MR/CT angio-->ABAN* - Ex=supervised/unsupervised - push past pain!!! - DVLA - bus/lorry inform -> SCOLD + RF decr *ABAN: Angioplasty/Bypass/Amputate/NaftiDrofUryl ___________________________ Pain tx = Paracetmol opiods etc - pain team Urgent vasc referral DVLA - bus/lorry... INFORM -wound HUG -> death: dry = necrosis = Revasc ± amputate wet = necrosis + infection = debride ± amputate gas = c.perfringens = Amputate/BenPen/O2 hyperbaric ___________________________ When Primary Stent Placement okay? - CritLI=Aorto-Iliac COMPlete dx Do not offer PRIM STENT PLACEMENT for Crit LI limb caused by: -aorto-iliac dx (partial) -fem-pop dx

Answer 23

European 1. Stop smoking/SCOLD 2. SCREEN = Aortic USS self-refer @: -Men 66/+ Women 70/+ : PMH: COPD / CAD PAD Stroke / HTN/lipids DHx: Smoke / Ex-smoker FHx of AAA ____________ @abdo palpation = ?Asyx AAA --> Aortic USS Refer people with Asyx AAA that is - 3 - 5.4 cm < 12w - 5.5/+ cm 2ww What tests for: 1. ElectiveAAA surgical repair? - CardioPul Ex Test - CT-Angio CETSAP* *Contrast-Enhance Thin-Slice Art-Phase CT Angio 2. -Prevention=reduce rupture risk=SCOLD -Monitoring - Aortic USS ____________ @UNNNruptured/Asyx AAA --> Aneurysm repair @SAAg -Syx -Asyx >5.5/+ cm -Asyx >4cm + GGGGrown >1cm/yr UNNNruptured AAA Repair options? Open Surgical Repair > EVAR ``` EVAR @Abdo dx HASH: -hostile abdo/ -anaesthetic risk/comorbidities -stoma -horshoe kidney/ _____________________ ```

Answer 24

?Syx/Rupt AAA: ARC - Aortic USS --> - Refer ASAP (RESTRICTIVE vol resus) -> - CT-Angio CETSAP @ ?surg-repair* -AAAs = more likely to rupture in WOMEN ____________ ``` Repairing rupppptured aneurysms: - Men <70 - Open Surg Repair - Old Men >70 - EVAR - Women all ages - EVAR _____________________ ``` Cx of Open Surgical Repair? -TrashFoot Chol Emboli Cx of EVAR = ENDOLEAK -Prev ENDOLEAK: Duplex / CT-Angio-CE #SurveillanceImaging -Suspect ENDOLEAK: (CT-Angio/USS)=CE --> -Type 1 - Open-Repair / EVAR/PCI -Type 2+EVAR -> expansion - ? - intervention... -Type 3 - Open-Repair / EVAR/PCI _______________

Answer 25

Thoracic Dissection 1) to neck/jaw - Aortic arch 2) to intraScapular area - Desc aorta PMH: - Marfan/EhlerDanlos-Noonan/Turner - Syphillis/Preggers - HTN/Bicussssspid aortic valve Other features: coronary arteries → angina, spinal arteries → paraplegia, distal aorta → limb ischaemia Tx: Stanford/DeBakey A / 1+2) Asc = SURG + Labetall B)/3 Desc i.e. distal to L Subcl = TLC = Labetalol + BP 100-110 maintain

Answer 26

SALSA GEW ``` Refer for Varicose vein tx @HDPLUGS=SALSA -Sclerotherapy -Ablation RF/Laser -Ligation -Strip @saph ANT-MED calf -Ablation RF/Laser ``` Decline referral / NOOO HDPLUGS? GEW - GCS** class 2>1 - Ex+WL b4 giving stockings -CHECK ABPI excl. Art Insuff ``` *Heavy Dermatitis Eczema Pigmentation brown LipoDermatoSclerosis Ulcer Gangrene ``` **GradCompStocking

Answer 27

- Fibre/Fluids / StoolWitholdingXX/Hygiene!!!! - Pain=Paracet/Nsaid/Top Lidocaine @PooPain - GTN <2m @adults ``` R/v: kids @2w --failed-tx--> Paeds adults @<2m --failed-tx--> UNHEALED +... --@Syx improve -> Repeat GTN --@SyxNOTimprove/CDT - Top Dilit? --GenSurg ?sphincterotomy ____________________ ``` JL-SMN proJECT->proLAPSE/Trude 1. ProJect 2. ProLapse/TRUDE + reduce SPONT 3. ProLapse/TRUDE + reduce MANUAL 4. ProLapse/TRUDE + reduce NOT POSS 1. FP - Fibre/Fluids/ StoolWitholding+HygieneALLOW!!!! - Pain=Paracetacmol/Nsaid/Top CALL* @PooPain ``` Grades 1 +2 = B-DISH Band Ligate/Botox Diathermy electrotx InfraRed/Photo Coag ScleroTherapy Haemorrhoidectomy LEASt -Lords strerch/Excisional/ArtLigat/STapled ``` *Csted/Astringent/Lidocaine/Lube

Answer 28

Acute Mesenteric Ischaemia -emboli @Endocard/Cancer --> block SMA LACTATE FIRST CT --> URGENT Surg ____________________ Isch. Colitis -cocaine mucosal OED/HAEMORRH --> - AXR = THUMBPRINTING --> SUPPORTIVE Tx

Answer 29

Venous ulceration -above MED malleolus venous insufficiency --> Venous HTN --> - capillary FIBRIN cuff / - ?? sequestration Deep venous insuff = prev DVT and Superficial venous insuff = varicose veins DoppleR USS looks for REFLUX and Duplex USS looks at ANATOMY/FLOW ``` Tx: Exclude ART dx --> Pentoxifylline OR 4 layer compression banding --> Grafting @: - Fail to heal after 12 wks or - >10cm^2 skin ``` Prev: Grad Comp Stocking @healed _____________ ``` ART ulcers Occur on the toes and heel PainFUL-punched out ?gangrene Cold with NO palpable pulses Low ABPI measurements ______________ ``` Neuropathic ulcers -Commonly over plantar surface of metatarsal head and plantar surface of hallux -Due to pressure -Tx = CUSHIONED shoes = reduce callous formation _________ MARJOLIN ULCER _____________________ Keratoacanthoma

Answer 30

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 - LGVChlamydia 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!!!!! HypoMAGnesia -retroperitoneal FIBROSIS Gastric MALT lymphoma - eradicate H. pylori!!! colovesical fistula - CT!!!! Anorectal fistula = MRI Bowel obstruction Ix - definitive = CT!!!!! -Abdo = initial GASTROGRAFIN

Answer 31

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 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 Lidocaine max dose? With Adren? 3mg/kg, 7mg/kg w/ adrenaline __________ Foregut: esophagus to upper duodenum Midgut: lower duodenum to proximal 2/3 of transverse colon. Hindgut: distal 1/3 of transverse colon to anal canal above pectinate line.

Answer 32

Lupus Vulgaris -face lesions + hx of TB inoculation Scro-Fulo-Derma -Skin Overlying TB foci = fucked ______ 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 33

Papillary cancer - --papillary projections - --pale empty nuclei - --NOT encapsulated LN mets common ________ follicular adenoma Follicular carcinoma ________ Medullary carcinoma -Lymphatic and haematogenous metastasis -Poor prognosis _______ Anaplastic - ANNA the old woman ________ MEN 1 MEN 2a RET Men 2b RET

Answer 34

What fractures are compartment syndrome associated with? -Supracondylar + Tibial shaft _________ 1. Colles - R-D dx -DINNER fork deformity ____ 2. Smith (reverse colles) - R-VP dx -GARDEN-spade deformity ____ 3. Barton - R-RC _____ 4. Galleazzi - R-RU ________ ________ 5. Monteggia - U-RU ______ 6. Bennet - 1st MCP ___ 7. Scaphoid fracture ____ 8. Radial head fracture @elbow _____ 9. Pott's fracture

Answer 35

De Quervain's tenosynovitis – finkelstein to diagnose Pain @: Flex thumb THEN Ulnar deviate and flex wrist Extensor pollicis brevis Adductor pollicis longus __________ Infective flexor tenosynovitis AB’s, RICE, debridement ________ Osteopetrosis ________ Osteogenesis imperfecta ___________ Rickets osteomalacia

Answer 36

Ewing ____ Osteosarcoma ______ Liposarcoma - >5cm , deep ______ Malignant Fibrous Histiocytoma ________ Stenosing Tino synovitis A.k.a. trigger finger -Analgesias/steds _________ Dupuytrens contracture -Peyeonie/Ledderhose __________ Giant cell tumour

Answer 37

Piriformis Sydrome -sciatic come out of foramen BELOW piriformis -> liable to comp _______ ``` ACL - Lachman PCL - Post drawer Meniscal tear - McMurray Thomas - FFD hip Trendelenburg - hip abduction _______ ``` Hip dysplasia _______ ``` 4. Transient synovitis ______ 5 Perthes dx _______ 6. ``` ``` JIA – PauciArticular most common _____ a. Septic arthritis -> Washout -S.Aureus ``` b. Osteoyelitis: -Staph. aureus - @sickle-cell anaemia = Salmonella Ix: MRI Tx: Fluclox/Clinda ____ Slipped Upper Femoral Epiphysis _____ Avascular necrosis

Answer 38

Greater trochanteric pain syndrome AKA Trochanteric bursitis. ______ Transient idiopathic osteoporosis ______ 3. Pubic symphysis dysfunction _______ _______ Posterior hip dislocation _____ NOF # _____ Anterior hip dislocation _____ Pelvic fractures

Answer 39

Femoral nerve -Patellar reflex loss ___ Lumbosacral trunk 1st Web + Eversion dx = deep C.peroneal Lateral foot sensory + Eversion = superficial C.peroneal L5 nerve root --> sciatic --> CPeron = S/D Eversion AND inversion + - hip abduction (gluteal muscles - superior gluteal nerve) - - pain and sensory loss @lat thigh, lower leg, foot-dorsum and toes 1-3 - Common peroneal fucked too (as above) Cant plantar flex + lateral aspect sensory dx= S1 ____ Sciatic nerve ____ Obturator -adduction + medial thigh shit -Adductor + gracilis + obt internus ______ Sup>Inf Gluteal Nerve: Weak hip ABduction -positive trendelenburg Ipsi gluteals fucked -> contralat pelvic drop Eg. Left gleuts fucked -> RIGHT pelvic drop ______ ``` Talipes EquinoVarus (CLUB foot) -Manipulation + Casting STRAIGHT ``` _____ Pes Cavus - high arched foot!!!!

Answer 40

P/PM/PE/PME/Crush P=Physis, M=Metaphysis, E=Epiphysis __________ Meniscal Tear Medial > Lateral MedMen attached to MCL+jointcaps MRI!!! ``` ODonnaghue triad=Torn(MedMen+MCL+ACL) ________ 3. OsgoodSchlatter osteochondrosis + traction apophysitis = can’t extend ``` ``` Sinding Larson syndrome _____ 4. Subchondral AVN -> bone/cart detach -> microracture BUT no remodelling _____ 5. Patellar SubLux Syndrome ____ 6. Chondromalacia Patellae ______ 7. Patella dislocation ______ 7. Tib Plateau Fracture -Schatzker Classification system -VaLLLgus – LLLat plateau -Varus – med plateau ______ 8. Morton's neuroma _____ 9. Achilles rupture -USS!!!! ```

Answer 41

Facet joint ____ Spinal stenosis ____ Ankylosing spondylitis _______ Peripheral arterial disease _____ Cervical spondylosis - Lhermitte sign - Physio, analgesias, brace, surgery General theme for prolapsed disc type shit is PHYSIO and analgesia ______ Cervical spondylo LisThesis Cervical vertebrae DISPLACED anteriorly and deformity and narrow vertebral canal

Answer 42

Radial tunnel syndrome – post interosseous Similar to lateral epicondylitis ______ Cubital tunnel syndrome - Ulnar nerve compression Dx @ wrist = 2 medial lubicrals fucked so can’t flex MCP and ext D/PIP so there will be lots of clawing Dx @ elbow = medial aspect of FDProfundus only fucked so there’ll be less clawing cos it’s still got its lateral (median nerve) supply _______ Adhesive Capsulitis __________ Parsonage – Turner syndrome ______ Supraspin-ABd, infraspin-ER, teres Minor-ER= GREATER tubercle Supscapularis-IR = less tubercle _____ Supraspinatus= suprascap nerve Subscap = subscap nerve Teres minor = axillary nerve ______ 0-15 = supraspin - suprascap nerve 15-100 = deltoid - axillary nerve >90 = trapezius - accessory > 100 = serratus anterior - long thoracic

Answer 43

(1.)Vit A def (2.) Ret pigmentosa __________ Gastric cancer ________ Lymphoma __________ 4. Glucogonoma ________ 5. RA AML IBD Myeloprolif ______ 6. Haem cancers, myelodysplasia ________ Oesophageal cancer _______ 7. GI and Lung _________ 8. Ovarian and lung cancer __________ 9. Lung cancer

Answer 44

Gram-negative diplococci | -GONORRHOEA

Answer 45

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

Answer 46

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 - 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 as above EXCEPT - paralysis and deafness ______________ Anterior Circulation Stroke: 3=TotalACS 2=PartialACS - Unilat sensory/motor FAL - Cog dx - VisuoSpatial/Dysphasia - HomoHNopia ``` LacACS Assoc w/ HTN 1 of: -Sensory -AtaxicHemiParesis -Motor PURELY _________ ``` 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 ```

Answer 47

-Bodily sensation CONTROLLED by ext influence = passivity phenomenon -Object is perceived --> Sudden Intense Delusional Insight into the objects meaning -------Delusional perception wakes up and less often when he is falling asleep he is 'PARALYSED' and UNABLE 2 MOVE. 'hallucinations' such as seeing another person in the room -Dx = Sleep paralysis Clozapine = OPPOSITE of SLUDs -reduces SEIZURE threshold -Smoking CESSATION can cause a rise in clozapine blood levels -CONSTIPATION /intestinal OBSTRUCTION -If clozapine doses are missed > 48 hours the dose will need to be restarted AGAIN SLOWLY Li = causes both: HypoT i.e. CONSTIPATION + HyperCalc i.e. CONSTIPATION Paroxtene = Discont Synd -PURSM + GI dx DIARRHOEA Stopping of voluntary movement or staying still in an unusual position = catatonia narcissistic personality disorder have a heightened impression of self-importanceunlimited abilities to succeed, become powerful lack empathy and will happily take advantage of others to achieve their own need. -NARCISITIC PD Chronic insomnia may be diagnosed after 3 months Tetra-benazine = tardive dyskinesia Propranolol = akathisia Procyclidine benztropine = acute dystonia Lorazepam = calm psychotic episode Which of the following features is needed to make a diagnosis of a personality disorder? Over 18 years of age CT head scan should be considered in elderly patients with new sudden onset psychosis to rule out an organic cause for their presentation EUBPD = dialectical behaviour therapy (DBT) Clinical Institute Withdrawal Assessment for Alcohol (CIWA) = alcohol withdrawal severity Chlordiazepoxide is used in the treatment of delirium tremens Pseudohallucinations are more common after bereavement and do not imply psychosis --HAS INSIGHT OCD = marked/severe functional impairment e.g. loses job etc = refer + iapt/CBT + ssri-clomi GAD: Persistent, ‘free-floating’ anxiety, with associated features. Treatment with SSRIs + CBT is key. Panic disorder: a panic disorder is more associated with RANDOM panic attacks, on a background of no anxiety usually. lower back pain, constipation, headaches, low mood, and difficulty concentrating. i.e. bones stones moans psychic groans #hypercalcemia = Lithium ``` Circadian rhythm disturbance is a feature of schizophrenia #INSOMNIA ``` wife died WITHIN LAST < 6 months. reports being tearful 'picking fights' he has on occasion described HEAR HIS WIFE talking to him and on one occasion he prepared a meal for her. -NORMAL grief reaction People can hear voices it's perfectly normal. Train of thought = voice in your head. CONFUSION about source of voice = what makes it a hallucination wife died >6m ago SUDDENLY…. i.e. fkn ages ago bro reports being tearful 'picking fights' he has on occasion described hearing his wife talking to him and on one occasion he prepared a meal for her. -ATYPICAL grief reaction #delayed/prolonged M1 O2D2 G3 S4 (PTSD also 4 too!!) D24

Answer 48

Lithium = NEPHROgenic DInsipidus ; HypoT, Ebstein Check levels -12 hours after the last dose - -> -7 days after dose change Cotard syndrome is associated with severe depression patient is in a public place and threatening violent behaviour. The police should be contacted to be brought in + assessed hypomania = Delusions of grandeur - 4d + no Hosp/Funct dx/Psych dx Copro-praxia = involuntary performing of obscene or forbidden gestures e.g. inappropriate touching ''Coppring a feel... he he he " Echopraxia = imitation of the movements of OTHERS Pali-lalia automatic repetition of one's OWN words Folie à deux - shared hallucinations/delusions between individuals De Clerambault AKA Erotomania Delusional disorder presence of delusion (of a FAMOUS person being in love with them) with ABSENCE of other psychotic symptoms ---like that girl in love with joey #Drake Ramoray Melanosis Coli = Purging behaviours in bulimia are not only vomiting, can be use of LAXATIVES or Diuretics or Exercising SSRI: TIC Cont 6m after remission -> reduce dose over 4 week period Mania = Refer urgent @DMSA !!! danger mania severe-depression adv st8ments Illness anxiety disorder AKA CHONDRIASIS=CANCER !!! A 14-year-old patient presents to her GP complaining of unexpected weight gain and tiredness. She has been in contact with mental health services recently for treatment of anorexia nervosa. -Dx = HypoThyroidism Anorexia can cause HypoThyroidism in some individuals Antisocial personality disorders more often affects men -steal 'because they can' -do not see why they should obey the rules of society -enjoyed hurting their younger siblings -killed the family pet ANTISOCIAL PD – ?DialecticalBT ``` Patients with poor oral compliance to antipsychotics should be considered for once MONTHLY IM antipsychotic depot injections ``` Paroxtene = Discont Synd -PURSM + GI dx diarrhoea GRADUAL onset schizophrenia is a poor prognostic indicator fluoxetine when used in the T3 -Persistent pulmonary hypertension hypomania describes decreased / increased function for 4 days or MORE ffs !!!! but NO FHP !!!!!

Answer 49

TCA -Opp of SLUDS: Blurred vision + dry mouth These antimuscarinic side-effects are more common with IMIPRAMINE than other types of -OVERFLOW incontinence !!!!!!!! Selective serotonin reuptake inhibitor = Sertraline/Citalopram SNRI = Venlafaxine Serotonin and Noradrenaline reuptake inhibitor ``` clozapine olanzapine: higher risk of dyslipidemia and obesity risperidone quetiapine amisulpride aripiprazole ``` Clozapine -reduces SEIZURE threshold -Smoking CESSATION can cause a rise in clozapine blood levels -constipation/intestinal obstruction -If clozapine doses are missed > 48 hours the dose will need to be restarted AGAIN SLOWLY Li = causes both: HypoT i.e. CONSTIPATION + HyperCalc i.e. CONSTIPATION Paroxtene = Discont Synd -PURSM + GI dx DIARRHOEA ECT – -cardiac arrhythmias are a short term side effect -AntiDEPRESSANT medication should be REDUCED NOT STOPPED when pt = about to commence ECT treatment -ECT = Retrograde amnesia #memory impairment Aripiprazole has the MOST TOLERABLE side effect profile of the atypical antispsychotics, particularly for prolactin elevation Mirtazapine = Specific Serotonergic + NorAdr antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors -useful side effects (sedation + increased appetite) -i.e. useful for those who can’t sleep + low BMI Antipsychotics in the elderly - increased risk of STROKE + VTE Zopiclone increases the risk of falls in elderly patients Avoid TCA/MAOi in people using brimonidine alpha ag @ACAG -FOVL / iNFLAMM-Itch / TCA-MAOi SSRIs and MAOis (phenelzine) should never be combined as there is a risk of serotonin syndrome Triptans/MAOi/Ecstasy should be avoided in patients taking a SSRI Citaloproam = the most likely SSRI to lead to long-QT + Torsades de pointes SSRI @preg = Sertaline/Fluox-parox --still cause CONGEN Heart dx TCA = antimusc = opposite of SLUDS -OVERFLOW incontinence !!!!!!!! Pt on Long-term atypical ANTIPSYCHOTICS -gets polyuria, polydipsia etc can lead to the development of Glucose dysregulation and DIABETES Schizophrenia = Cognitive behavioural therapy Alcohol withdrawal symptoms: <12 hours seizures: 36 hours delirium tremens: 72 hours

Answer 50

IV fluids should be given in 2nd degree aka Partial thickness Superficial or more that cover 15% BSA Superficial dermal burns covering >3% TBSA in ADULTS must be referred to secondary care In KIDS, IVF are recommended when burns cover 10% body surface area. Pityriasis rosea often follows a VIRAL infection. Streptococcal throat infection tends to trigger GUTTATE psoriasis Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures Horner's syndrome – (ptosis miosis ±anhydrosis) ANHYDROSIS determines site of lesion: •head, arm, trunk = central lesion: stroke, syringomyelia •JUST face = pre-ganglionic lesion: Pancoast's, cervical rib •ABSENT = post-ganglionic lesion: carotid artery _________ patient reports NO new findings on history including normal vision. Fundoscopy = abnormality in both eyes. -What abnormality is most likely in this patient: Cotton wool spots / Retinal neovascularisation? Cotton wool spots = NORMAL vision patient reports NEW VISUAL LOSS findings. Fundoscopy = abnormality in both eyes. -What abnormality is most likely in this patient? Cotton wool spots / Retinal neovascularisation Retinal neovascularisation = FUCKED vision _________ POAG = Disc Haemorrhages/Pallor = Atrophy Optic disc = SWOLLEN = CRVO / Papilloedema Paton’s Concentric Radial RETinal lines = CASCADE from optic disc = Papilledema Papilloedema = BLURRED Optic disc margin = LOSS of optic CUP + LOSS of venous PULSATION Increased ARTERIAL REFLEX = feature of HTN retinopathy. ``` The use of antivirals for shingles may reduce the incidence of POST HERPETIC NEURALGIA particularly in older people Antivirals will NOT affect the virulence of the patient, ``` ``` Those with a POS FHx of glaucoma should be screened ANNUALLY from aged 40 years ```

Answer 51

- LONG-sighted #HyperMetropia = ACAG - Short-sighted #Myopia = POAG Afro-Caribbean origin = skin type VI Fitzpatrick --never burns/tans In diabetic retinopathy, cotton wool spots represent areas of retinal INFARCTION - Pre-capillary arteriolar occlusion ``` Erysipelas is a bacterial infection caused by Streptococcus PYOGENES - GAS FLUCLOXACILLIN ---It is differentiated from cellulitis due to its raised and well defined BORDER. # s.aureus=cellulitis ``` Bilateral gritty eye 1. -WORSE @MORNING BLEPHARITIS 2. -WORSEN @THROUGHOUT day = Dry eyes Lund and Browder chart is the most accurate way to asses the burns area Lund > Wallace 9 Cataracts are not an acute problem so carry no urgency. Cataract removal operations should NEVER be rationed on the basis of visual acuity I.E. SEND THAT DAMN referral ROUTINELY The most common dermatosis in pregnancy is atopic eruption of pregnancy SUP-VL: 1. -CANNOT SEE see retina @fundoscope = Vitreous haemorrhage #vitreous is full of blood. 2. - severe retinal haemorrhages @fundoscope = CRVO HZO = ADMIT -> PO Aciclovir HZO -> Ant Uveitis #CORNEAL involvement pemphigOLD = no mucous membranes -Anti-HEMI-DESmosome pemphiGUS - nikolsy sign -Anti-desmoGLEIN (anti-desmosome) ***GUS GUIL(ein)-FOY *** LOL

Answer 52

Lipomas = >5cm = USS ?sarcoma MACROprolactinomas >1cm = TS surg B/L adrenal hyperplasia = Spiro @Hyperldosternosim centre, spider naevi • liver disease • pregnancy • cocp skin rash under her new wrist watch. An allergy to nickel is suspected. - PATCH test = HSR 4 builder presents with sore and itchy skin on his hands and wrists. He has noticed it gets better when he is not in work and wonders if it is something he is coming into contact with at work causing the irritation -Skin Patch - Type 4 hypersensitivity (Delayed Th1 Cell-mediated) This history suggests a delayed reaction to an irritant at work (Allergic contact dermatitis) so is likely to require a longer period of exposure to elicit a reaction, so needs patch testing female who has JUST started work as a cleaner presents with a rash on her hands. On examination there is a generalised erythematous rash on the dorsum of both hands. There is no evidence of scaling or vesicles. What is the most likely diagnosis? - Irritant contact dermatitis 1. Cataract - halos in cataract + ACAG ffs Actinic keratoses may develop on ANY sun-exposed area -Bowen's isolated and well demarcated.

Answer 53

alopecia areata = screen for other Ai dx TAPD: thyroid addisons pernicious dm ``` Blunt ocular trauma + hyphema (blood @ant chamber) --> high-risk of raised IOP #intraocular pressure-Glaucoma ``` erythema nodosum Mx -No active treatment, arrange routine follow-up Anterior uveitis TOP steroid + TOP cycloplegic (mydriatic) drops ARMD Ix = Fluorescein angiography Inpatient treatment for erythroderma must be monitored for complications like dehydration, infection and high-output CCF P.Ganrenosum = PPU Dx Unrelated = -RAIM: RA AML IBD MyeloProflif 2. Dry Eye WMD ALI If pt use > 6 drops/day --> consider PRESERVATIVE-free drops -cos preservatives = FURTHER damage cornea/conjunctiva-epith @mod-severe, PRESERVATIVE TOXICITYpotential = is higher due to MORE frequent dosing and REDUCED tear secretion. -@severe: PUNCTAL plugs @tear ducts --> increase tear film 8-year-old girl noticed a small growth on the sole of her foot for the last 3 months that has become painful. O/E small, firm, hyperkeratotic growth + tiny overlying black dots. -Salicylic acid Wallace 9 rule - Whole UPPER limbs FRONT+BACK = 9 - Chest/abdo/lower limb FRONT = 9 Pyoderma gangrenosum = -RA AML IBD MyeloProflif Hyphaema = Red ``` -Blunt ocular trauma + Hyphema --> high-risk of raised IOP #intraocular pressure-Glaucoma ``` Hypopyon = pus _______ Ramus MAXILLARY fracture ______ Comminuted MAXillary fracture ---Blowout ______ Depressed zygomatic fracture - --CHEEK - --BINOCULAR vision