Everything else Flashcards
What is atrophie Blanche
Star shaped atrophic scar with surrounding hyperpigmentation seen in venous ulcers
Hairless and pale skin on lower legs indicates which type of ulcer
Arterial
Solid lump in testis which age for each tumour
Teratoma in troops - Ie young 20-35
seminoma in Sargents - 35-45
10-year-old with rigidity, dystonia and resting tremor
Wilsons disease
Most common cause of acromioclavicular dislocation
Fall onto shoulder tip
Most common cause of posterior shoulder dislocation
Seizures
Most common cause of supraspinatus tear
Weight lifter jerking lift weight
Normal hearing is ? What would happen in noise-induced hearing loss?
Presbycusis?
Able to hear <20db
Noice induced - loss at 4000hz with notch at 4000
Presbycusis - loss of high frequencies
Symptoms of OA. What age do you not need to investigate
> 45 - clinical diagnosisi
Anterior spinal artery thrombus clinical picture
Loss of pain and temp below lesion
Spastic paresis
Child with abdo mass, splenomegaly, night sweats. Normal urine studies =
Burkitt’s lymphoma
Antibodies pemphigoid vs pemphigus
Goid - haemosiderin
Gus - desmoglein
Goi hae
Gus des
AS murmur located
2nd space R sternal edge
Kid with frequent URTIS. Nasal stuffiness and nasal voice
Adenoidal enlargment
38 persistent runny nose for 2 years. Allergy testing negative
swollen inferior turbinates
nasal polyps
Ideal management of thyrotoxicosis in someone planning preg
Thyroidectomy
What is in an annual diabetic eye check
Acuity and retinal photography
Unexplained syncope - how long no drive
6 months
Multiple hypos on insulin driving
Banned long term
Stroke fully resolved driving
1 month
Who get no treatment for shingles, who gets oral only
Children - if healthy
Health adult gets oral
P450 Inducers
CRAPGPS - Crap as you get less drug
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
P450 inhibitors
SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Angina symptom relief rx
B blockers
CBB
GTN
(Nitrates if any above contraindicated)
Posterior MI on ECG
V1 v2 ST depression and tall R waves
What is worth 2 points each in chadsvasc
Age >75
Prev stroke / tia
Which leads for anterolateral mi
V2-6
1 avl
What is the modified dukes criteria used for
Diagnostic classification of infective endocarditis
[Not predictor of prognosis]
Acute coronary syndrome going for PCI should all get? If not suitable for PCI or thrombolysis?
Aspirin + prasugrel
Aspirin + ticagralor
Aspirin + clopidogrel if high bleeding risk
When is prasugrel contraindicated in MI going for PCI
Prev stroke/ TIA
MI going for PCI with prev stroke taking Aspirin should get
Aspirin + clopidogrel
Chadsvasc points
Tumor found in Anterior neck triangle in high altitude persons
Carotid body
Conductive hearing loss that’s dominant inheritance
Otosclerosis
Parkinsons develops dyskinesia despite dopa therapy rx?
Dopamine agonist
Eg Ropinirole, rotigotine, pramipexole
Seizure free for how long before considering stopping antiepileptics
2 years
Baby who had period of asphxia at birth now having episodes of drawing up legs =?
West syndrome
[salaam attacks]
Juvinile myoclonic epilepsy also called
Janz syndrome
TIA hx in GP plan?
Aspirin 300
Admit
1st line generalised tonic clonic seizure rx
valproate
[Lamotrigine / keppra second line]
1st line acne
Topical benzyl peroxide
+Adapaline / clindamycin
Raised itchy lesions on wrists with white lacy pattern in mouth
Lichen planus
intensly itchy bullous rash on elbows and ankles? rx?
dematitis herpetiformis
dapsone
diabetic with well defined red tender area? usual cause
erysipelas
strep pyogenes
elderly female with red reticulated rash over forarms =
Erythema ab igne
[due to heat eg by fire]
Compare appearance of SCC and BCC on scalp
SCC - ulcerated crusting lesion
BCC - pearly nodule with rolled edge
Slow growing scaly red plaque in old person
Bowens disease
palmar psoriasis 1st line?
emollients
acne rosacea 1st line topical rx
ivermectin
[metronidazole alternative]
Psoriasis already on intermittent steroids + emollients
Calcitrol ointment
middle age scaly red rash on face and around eyebrows =? rx?
seborrhoec dermatitis
malasezzia furfur
hydrocortisone + miconazole cream
2 psoriasis creams that stain clothes bad
coal tar
dithranol
started on med for skin condition. Now has hair loss, nose bleeds, dry lips
retinoids
psoriasis now features of bone marrow supression most likely drug
methotrexate
When give vit k 1-3mg with warfarin
INR >5 with minor bleeding
INR > 8 no bleeding
what are drepanocytes
sickle cells
what is rouleux formation
Clumped RBCs which stick together because of high levels of acute phase proteins
antiphospholipid rx? if pregnant?
Warfarin
Aspirin + LMWH
40-60 with WCC 90 and splenomegally most likely
CML
What are smear cells seen in
CLL
[Ruptured lymphocytes during blood film prep]
tear drop cells seen in
Myelofibrosis
myelodysplastic syndrome
metastatic marrow infiltration
Mild depression 1st line ?
CBT
Which hormones are raised in anorexia
Cortisol
growth hormone
Which cognition assessement takes 20 minutes and is best for different types of dementia?
Which doesnt need english as first language
Addenbrookes
GPCOG
MMSE score for dementia
<24
Which cognitive assement has 10 questions with monark and ww2 dates
AMT
Which is first line depot injection for schitz
risperidone
[2 weekly]
nephrotic syndrome in adults most likely
FSGN
Bilat hydronephrosis and uti in kid key ix
micturating cystogram
Herpes cold sore + pneumonia bug?
viral infection -> pneumonia?
COPD?
herpes - strep pneumo
viral - S aureus
COPD = Haemophilis influenza
What is dacryocystitis
Inflammation of tear sack
Which eye condition do you get charles bonnet hallucinations
Macular degeneration
AV nipping seen in
hypertensive retinopathy
Severe eye pain after sunbeds =? rx?
damage to cornea -> high risk of infections
Antibiotic ointment and analgesia with eye rest
What gives you blue tinged vison
sildenafil
[blue pill]
blue / green urine and blurred vision
amitriptyline
HIV vision issues with white deposits and small haemorrhages on fundoscopy
CMV
Diabetic drug that makes you fart loads
Acarbose
Antihypertensive that cause impaired Glucose tolerance
Thiazides
B blockers a bit
Tumor secreting what gives low sodium
ADH
Which NSAID worst for cauing an MI
Diclofenac
HRT in woman who gets migranes
Estradiol patch
[Continuous release doesn’t trigger migranes]
Systemic eostrogen HRT contraindication
Recent thromboembolic disease
Eg MI
Montelukast key side effects
Vivid dreams
Diarrhoea
Pysch issues
What is xylometazoline
Nasal decongestant
Which ssri has a long half life and so needs a gap of 1 week before starting other SSRIs / SNRIs
Fluoxetine
The flu lasts several days
Which asthma medication can worsen asthma if not taken with a steroid
Salmeterol - LABA
MUST be taken with a inhaled steroid
Which b blockers worsen asthma
No cardioselective eg propranolol
Cellulitis then has an MI which abx
Clarithromycin
Which class of medication in IHD have to be weaned slowly to prevent rebound MI
B blockers
Which drugs cause liver enzyme inhibition ?
Get more drug SICK
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Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Which drugs cause liver enzyme induction
thats crap, less drug
CRAPGPS
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
Thickend glomerular basement membrane with IgG /C3 deposits + nephrotic syndrome =?
Assoc?
Membranous glomerulonephritis
10% either GI adenocarcinoma or Bronchial SCC
Paraneoplastic syndrome which ca ?
Hypovolaemic hyponatraemia
Raised ACTH
HyperCa
Gynaecomastia
HyperThyroid
Lambert eaton
Hypertrophic pulmonary osteoathripathy
Hypovolaemic hyponatraemia -[SIADH] Small cell
Raised ACTH - small cell
HyperCa - Squamous (bony mets +/- PTH producing)
Gynaecomastia - adenocarcinoma / large cell
HyperThyroid - Squamous (TSH)
Lambert eaton - small cell
Hypertrophic pulmonary osteoarthropathy - adenocarcinoma
Plasma / urine osmolalitis in DI vs psychogenic polydipsia? Differentiate cranial and nephrogenic + Rx
DI- High plasma low urine
Psychogenic - low plasma low urine
Cranial - low levels ADH
Nephro - resistance to ADH in kidneys
Give DDAVP. In cranial -> increases urine osmolality
Nephrogenic - Treat cause, then bendoflumethazide if still requires rx
COPD and clubbing
NONE
Rheum A on new drug and now heart failure?
Infliximab
What is high does ICS in asthma
1000mcg / day
[>800 at minumum]
Why hyponatraemia in DKA
glucose and ketones interfere with assay
[ie its erroneous]
purple/blue/red lesions on nose/ears/fingers/toes =
Sarcoid
[lupus pernio]
2 key drugs which worsen psoriasis
lithium
b blockers
Severe HAP rx 1st line
Taz
Woman with bloating and weight loss + mouth ulcers
coeliac
epigastric pain 2 hours after eating. Relieved by eating snacks
DU
When is it barrets on biopsy
metaplasia to Collumnar epithelium
[from squamous]
Paraneoplastic syndromes which lung Ca ?
Hypovolaemic hyponatraemia
Raised ACTH
Hyper Ca
Gynaecomastia
Hyperthyroid
Lambert-eaton
Hypertrophic pulmonary osteoarthropathy
Hypovolaemic hyponatraemia - SIADH = small cell
Raised ACTH - Small cell
Hyper Ca - Squamous - from bony mets [rarely produces PTH too)
Gynaecomastia - Large cell (large breasts) and adenocarcinoma
Hyperthyroid - Squamous (produces TSH)
Lambert-eaton - Small cell
Hypertrophic pulmonary osteoarthropathy - Adenocarcinoma
Chemo drugs side effects TOXMAN
C (ears) - Cisplatin carboplatin -> Ototoxicity
T (eyes) - Tamoxifen
->Reduced acuity
B (lungs) - bleomycin, bulsupham
->Fibrosis
D with T (heart) - Doxorubicin
Tratasizumab
-> cardiac
M liver - methotrexate
Liver toxiticy
C - kidney. Cisplatin and carbocystine
O bladder (cycle) - cyclophosphamide - haemorrhage cystitis
V - Vincristine - peripheral neuropathy
5,6,MPH - Bone marrow suppression
5-fluorouracil
6-mercaptopurine
Methotrexate
Paclitaxel
Hydroxyurea
Bromocriptine key side effects
cardiac / pulm / retroperitoneal fibrosis
drug-induced dystonia rx? key side effect
procyclidine
anticholinergic
symptoms of tia which have resolved by time of presentation to GP plan?
stroke team rv within 24 hrs
painless loss of vision with haemorrhages that change colour from orange/yellow to red/ pink
Vitreous haemorrhage
Pink mild pigmented plaque on lower leg
Bowens
Needs biposy
Sharply defined erythematous lesion
Erysipelas
Non itchy hypopigmented scales on back ? bug?
Maassezia furfur
Ptyriasis versicolour
New red lump in baby which has continued to grow? Rx?
Capilliary haemangioma
No treatment unless interferes with vision. Usual complete regression by age 5
Port wine birth mark management
Laser therapy
[usually just camouflage]
most common skin condition in HIV
Warts
Women in 30s with scaly red patches which heal to leave hypopigmented areas. May have some in mouth too.
Discoid lupus
Actinic keratoses rx 1st line if few lesions? multiple?
What if most treated with 1st line therapy and then there is just 1 which lingers?
If severe eczema?
few - cryotherapy
multiple- 5-FU
1 lingering - excision as risk if SCC
Severe eczema - diclofenac gel
Which deficiency when resected
duodenal?
Jejunum?
Ileum?
Dude I just feel ill bro
D - Iron
J - Folate
I - B12
Stomach - b12
Key coag in antiphospholipis
Prolonged APTT
Thrombocytopenia
Normal PT usually
Key side effect of chloramphenicol
Bone marrow suppression -> aplastic anaemia
woman on COCP gets DVT rx?
Apixaban 3 months only
Tripple positive antiphospholipid gets DVT rx?
LMWH + warfarin
Then warfarin for 3 months and review
Gingival hypertrophy usually caused by?
Calcineurin inhibitors
- Eg ciclosporin
Antihypertensive -> lithium toxicity?
Thiazides
Neuroleptic malignant syndrome pharma rx?
Bromocriptine
Dantrolene
Which class of antidepressant -> HypoNa
SSRI eg paroxetine
OCD mainstay therapy
Exposure and response prevention
Type 1 vs 2 bipolar
1 - usual
2 - Depressive symptoms usually predominate with only hypomania (still manic)
Depression scoring tool? Mild moderate and severe scores?
Patient health questionnaire PHQ-9
5-9 Mild
10-19- moderate
>20 severe
IgA nephritis vs post strep differentiate?
Post stretp haematuria 10 days after.
IgA at same time
Gold standard Ix for renal artery stenosis
Digital subtraction angiography
Constant wet pants following hysterectomy / obstructed labour
Vesicovaginal fistua
Bladder Ca most common Uk? Worldwide?
TCC
SCC
Urge incontinence surigcal rx
Sacral nerve stimulation
Cystoplasty
Botox injection
Chronic sinusitis and haematuria
GPA
Vaccination schedule for babies
8 weeks
-6-in-1 vaccine
-Rotavirus vaccine
-MenB vaccine
12 weeks
-6-in-1 vaccine (2nd dose)
-Pneumococcal vaccine
-Rotavirus vaccine (2nd dose)
16 weeks
-6-in-1 vaccine (3rd dose)
-MenB vaccine (2nd dose)
Vaccines given at 1 year
Hib/MenC vaccine (1st dose)
MMR vaccine (1st dose)
Pneumococcal vaccine (2nd dose)
MenB vaccine (3rd dose)
Cavvines at 4 years
MMR vaccine (2nd dose)
4-in-1 pre-school booster vaccine
-diphtheria
-tetanus
-whooping cough
-polio
Whats in the 6 in 1 vaccine
diphtheria
hepatitis B
Hib (Haemophilus influenzae type b)
polio
tetanus
whooping cough
Vaccines at age 65
Flu vaccine (given every year after turning 65)
Pneumococcal vaccine
Shingles vaccine (if you turned 65 on or after 1 September 2023)
Vaccines age 13
HPV
Drug induced lupus antibody
ANTI -HISTONE
Dermatomyositis antibody
Anti Mi-2
Post exposure flu prophylaxis options
Oseltamivir
Zanamivir
Painless loss of vision looks like ‘stormy sunset’
CRVO
rx wet macular degenerarion
VGEF inhibitors
HLA B5 japanese and eye symptoms
bechets
Long term sun exposure and now large growth on nasal aspect of eye beginning to involve cornea?
What are smaller, yellowish and do not involve cornear
Pterygium
pinguecula
red bump on your eyelid. It is sometimes called an eyelid cyst or a meibomian cyst?
Chalazion
Longstanding chalazion which has responded to treatment for months and now has eyelash loss
Sebaceous cell carcinoma
Most common eyelid tumur
BCC
6 weeks irritated red swelling eye lids which are watering more than usual
blephritis
Pain and swelling over medial part of lower lid with low grade fever
dacrocystitis - inflamation lacrimal sac, typically caused by obstruction of the nasolacrimal duct.
cut off in prolactin for micro vs macro adenoma for MSRA
> 2000mU/L
Bilat adrenalectomy -> Sx of pituitary tumour =? What is the usual first symptom?
Nelsons syndrome
- ACTH secreting pituitary macroadenoma
Hyperpigmentation
30% of people on octreotide develop?
Gallstones
Primary vs secondary hypothyroidism bloods
Primary - High TSH
Secondary - Low TSH
[Both low t4]
Who gets an islet transplant in T1DM
<50 units / day
2 or more severe hypoglycaemia attacks in 2 years
Most common medication causing hypoMg
PPIs
prev PE and now pregnant ->
Heparin
Antidepressant that gives you withdrawal sx after missing for 1 day? Other one with worst withdrawal Sx ?
venlafaxine
Paroxetine
Which antiepileptic most likely to cause agranulocytosis
Carbamazepine
Psoriasis then develops rash with rings and double edges whats happened
Steroid cream on fungal infection
common antibiotic where alcohol will make you feel shite
metronidazole
Which SSRI increases QTc the most
citalopram
egg allergy - which vaccines CI
Flu / Hep A (egg free versions do exist)
Yellow fever
antimalarial with most neuro psych side effects
mefloquine
Prostatitis then gets vasovagal striaght after new medication
tamsulosin
What criteria for CCF
Framingham
Anaemia with tachy and wide pulse pressure is developing
High output cardiac failure
Foreign kid, pink ring-shaped lesions, joint pain and movement disorder is? Caused by? Criteria for Dx?
Rheumatic fever
Strep pyogenes
Jones criteria
Baby with PDA should get?
Cardio ref
NSAID - eg ibuprofen
Early diastolic murmur - L sternal edge vs left upper sternum
Tricuspid stenosis
Pulm regurg
when can you not drive with aortic aneurysm
> 6.5cm
5.5 if HGV
HIV, bird exposure now lymphadenopathy and pulm sx
histoplasmosis
UC with reduced sperm count
Sulfasalazine
Which is UC drug that 5% have severe reaction to
Infliximab
UC which cancer? which disease?
Primary sclerosing cholangitis
-> cholangiocarcinoma
The most common benign liver tumour ?
Haemangioma
carcinoid 2 common locations? ix? rx?
Bronchi / Jejenum
Urinary 5-haii
somatostatin
Painful lesions in mouth and widespread target lesions which painful blistering widespread
SJS
Pustular tonsilitis -> widespread blanching red rash starting on torso
Scarlet fever ->
Rash is bacterial exanthem
Scalp psoriasis not responding to topical corticosteroid
Add in topical vit d analogue
Eg calcipotriol + betnovate cream
Lung Ca now with pedunculated hyperpigmented lesions on back
seborrhoeic keratoses
[leser-trelat sign]
CHOP chemo is
cyclophosphamide, hydroxydanorubicin, vincristine, prednisolone
cooleys anaemia is
b-thalassaemia major
CML curative rx
only BMT - should be for al young pts
[imatinib - non curative for older]
single drug for CLL in someone not fit for big rx
Chlorambucil
Thalassaemia with reduced growth hormone despite good iron chelation compliance
somatotropin [growth hormone]
Most common blood finding HIV
Lymphopenia (loss of CD4)
Diabetic with sudden loss of vision, pale swollen optic disk on fundoscopy
Anterior ischemic neuropathy
H pylori rx ? penicillin allergy?
PPI amox, clary
PPI Metrondiazole, clary
Depression
+ IBS / Chronic pain?
+ recent MI?
+ Bipolar on lithium?
+ IBS / Chronic pain - tricyclics eg amitriptyline
+ recent MI - Sertraline
+ Bipolar on lithium - citalopram
Bilat small irregular pupils that dont react to light
argyll robertson
Right pupil constricts with light test. Then when left eye shown light both dilate
Marcus gunn
Lung function test for pulmonary fibrosis progression
Lung diffusion test - measures gas exchange of CO
2 mins into blood transfusion -> hypotension, SOB
Acute haemolytic reaction
[need angioedema + urticaria for anaphylaxis]
High pitched diastolic murmur loudest on expiration
Aortic regurg
ejection systolic murmur which doest radiate to carotids
Aortic sclerosis
Which therapy for family who all argue and shout at each outer
Systemic therapy
Which therapy for addiction issues
group therapy
Which therapy anxiety disorders
CBT
Which therapy for relationship issues at work and school
Interpersonal therapy
Therapy for bereavement
one-to-one councilling
Therapy for autism
Social learning programme
lateral epicondylitis is tennis or golfers elbow?
Tennis
Sciatica rx
Analgesia and rest
If ongoing at 6 weeks -> physio
teratoma vs seminoma produce? Rx?
Tera - AFP + bHCG
- Surg + chemo
Seminoma - bHCG only
- Surg + radiotherapy
Prostate issues
When transurethral incision of prostate?
When open prostatectomy?
Insicion - BPH < 30g no Ca
Open - >80g as an option - usually still TURP
Penis now bends in the middle when gets an erection? assoc with?
Peyronies disease
Dupyutrens contracture
Prostae ca which tablet and which injection cause gynaecomastia
flutamide/finasteride
[F for feminism]
gosereline - injection
Which prostate drugs must use a condome if women going to be pregnant? Or even touch a leaking capsule
Finasteride
Dutasteride
Rx for low / intermediate / high-risk prostate Ca
Low - active surveillance
Int/high - prostatectomy
Androgen-dependent prostate mets rx if wants to continue having sex? if not?
Sex - Bicalutamide (worse survival than below)
Longer survival - goserelin / bilat orchidecotmy
Prostate spinal mets with pain despite radiotherapy
Bisphosphonates
Prostate Ca starts therapy then gets spinal compression symptoms
goserelin - initial LH stimulation in first 2 weeks then suppression after
-> get flare of sx in first bit
Abx worsen myasthenia
-mycins
-cyclines
Most common B cell deficiency ? leads to?
IgA deficiency
-> Encapsulated gram positive bacilli infections
guillian barre antibody
Anto-ganglioside
Low ocular pressure, blood in anterior chamber, irregular pupil
Globe rupture
HSV with blisters from eye to nose tip which nerve
Trigeminal - opthalmic branch
Most common eye allergy
perennial allergic rhinoconjunctivitis
[summer - pollen
All year - dust]
Sudden shower of floaters in eye
retinal tear
What is dumping syndrome? when do you often get it?
food quickly bypass the stomach -> pancreas overproduces insulin -> hypoglycaemia
Usually following gastric surgery -> damages gastric nerves
Which pit tumour is eosinophilic
GH producing
raised prolactin but no Sx
macroprolactinaemia
- macro-prolactin is not biologically active
[Not to be mistaken with macroprolactinoma]
Gout treatment
Which causes D&V?
Ischemic stroke?
D&V - colchicine
Stroke - cox-2 Eg celocoxib
On warfarin for AF - when can you switch to apixaban?
When INR <2
DMARD causing retinopathy?
Nephropathy ?
Needs check for signs of infection before each dose?
Needs height and weight checks?
Insomnia and altered taste?
Blood glucose and pressure?
Retinopathy Hydroxychloroquine
[think SLE rash around eyes]
nephropathy - Penicillamine
[P kidney and ureter]
Signs of infection - adalimumab
[a agranulocytosis]
Height and weight - leflunomide
[left
insomnia and taste - sulfasalazine
[tastes like sulfuric]
glucose + BP - tacrolimus
[tacrolimus tummy]
Lots of steroids - how to wean from 30mg daily
Down to 7.5mg over 1 month [0.1mg/kg]
down to 0 month after
Difficult to control HTN. Starts new med and develops hypoglycaemia?
Hyperglycaemia?
Hypo - B blocker - inhibits hepatic gluconeogenesis [beta 2 adrenoceptors]
Hyper - indapamide / thiazide
How to wean off any benzo?
switch to diazepam first - 50hr half life
Then wean
takes drug for aeroplane flight anxiety and becomes aggressive and hostile?
Diazepam - paradoxical reaction
Which antidiabetic med causes UTIs?
Bladder Ca?
UTIs - SLGT2
bladder Ca - Pioglitazone
How to switch from methadone to buprenorphine
Stop methadone,
Wait for withdrawal sx then start buprenophine
b12 deficient then takes med which rapidly causes subacute degeneration of the spinal cord?
Folate
If deficient in both MUST replace B12 first
