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Finals Revision > Final Push! > Flashcards

Final Push! Flashcards

1
Q

Define Antepartum Haemorrhage?

A

Bleeding from the genital tract after 24 weeks gestation before delivery of the foetus

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2
Q

Why should you never do a vaginal examination in large APH?

A

There is a risk you can cause a massive bleed

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3
Q

Where is the pain in placental abruption?

A

Lower abdominal pain

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4
Q

What is the most common presentation in placental abruption?

A

Longitudinal lie cephalic presentation (this is the most common presentation in anyone)

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5
Q

Mx of placental abruption with foetal or maternal distress?

A

Cat 1 C-section

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6
Q

What is vasa praevia?

A

The foetal blood vessels run in front of the presenting part, this causes bleeding and foetal bradycardia following rupture of membranes

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7
Q

What is the earliest a pregnant uterus can be palpated if there is a single foetus?

A

12 weeks

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8
Q

What screening should you offer to all mothers at the booking visit

A

FBC, Blood group + rhesus status, Hep B and syphilis screen, haemoglobinopathies for sickle cell/thalassaemia and alloantibodies. Also offer HIV screen

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9
Q

Apart from Down’s syndrome what can cause thickened nuchal translucency?

A

Congenital heart defects and abdominal wall defects

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10
Q

What does the quadruple test show in Down’s Syndrome?

A

Low alpha fetoprotein and unconjugated oestradiol
High beta hCG and inhibin A

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11
Q

Name 5 risk factors for developing gestational diabetes?

A

Previous baby >4.5kg, BMI >30, previous gestational diabetes, first degree relative with diabetes and South Asian/Middle-Eastern origin

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12
Q

How does gestational diabetes cause macrosomia in the foetus?

A

Increased glucose is delivered to the foetus via the umbilical vein leading to hyperinsulinemia in the foetus which causes increased fat deposition

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13
Q

How does gestational diabetes affect future diabetic risk?

A

Increased risk of Gestational DM in future pregnancies and increased risk of developing DM in the future

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14
Q

When does post-partum psychosis typically develop? What is the risk of reoccurance?

A

Within the first 2-3 weeks following birth, usually around day 3-5
25-50% risk of reoccurrence. It also increases the risk of other mental illnesses

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15
Q

RFs for post-partum depression (starts within 1 month and peaks at 3 months)

A

Previous depression/bi-polar, previous episode of post-partum depression, lack of social support, recent stressful life event

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16
Q

What medical condition should you rule out in someone presenting with post-partum depression? Mx?

A

Post-partum thyroiditis.
Mx = propranolol in the thyrotoxic phase and thyroxine in the hypothyroid phase

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17
Q

RFs for ectopic pregnancy?

A

IUD/IUS in situ, previous PID, previous ectopic, endometriosis, IVF, previous fallopian tube surgery

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18
Q

Where is the most common site of ectopic pregnancy? Where is the most dangerous?

A

Most common = ampulla
Most dangerous = isthmus

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19
Q

How should you deliver methotrexate and anti-D immunoglobulin in the medical management of a Rhesus negative woman?

A

Both by IM injection

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20
Q

Name some important blood tests to perform in hyperemesis gravidarum?

A

U&Es, FBC, TFTs, LFTs and ABG

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21
Q

Mx of severe hyperemesis gravidarum?

A

IV fluids, Vitamin B1 to prevent Wernicke’s and LMWH
Antiemetics include prochlorperazine, cyclizine, ondansetron and metoclopramide

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22
Q

Define missed miscarriage?

A

There is a uterus containing a dead foetus, cervix is closed and there may have been light bleeding but no pain

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23
Q

Name some causes of recurrent spontaneous miscarriage?

A

Anti-phospholipid syndrome, uterine abnormality e,g, uterine septum, parental chromosomal abnormality, smoking and cervical incompetence

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24
Q

What investigations should you do in menorrhagia?

A

FBC, TFTs and clotting studies
Also TVUS and endometrial sampling/hyteroscopy

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25
Q

Name some contraindications (UKMEC 4) to the COCP?

A

> 35 years old smoking >15/day, migraine with aura, Hx DVT/PE, Hx stroke/IHD, uncontrolled HTN, current breast cancer, breast feeding <6 weeks post partum and positive antiphospholipid antibodies

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26
Q

Mx Menorrhagia which can be used in a patient who has completed their family?

A

IUS, Endometrial artery ablation and hysterectomy

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27
Q

What does the BRCA gene increase the risk of?

A

Breast, ovarian and prostate cancer

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28
Q

What is CIN (seen on cytology of cervical smear)? Mx?

A

Cervical intraepithelial neoplasia, it is pre-malignant
Mx = large loop excision of the transformation zone (LLETZ), test for cure 6 months after treatment

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29
Q

What are the two histological types of cervical cancer?

A

Squamous cell and adenocarcinoma

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30
Q

What should you always give pre-operatively to patients who take regular prednisolone and are awaiting moderate/major surgery?

A

Hydrocortisone IV

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31
Q

Dactylitis can be seen in psoriatic arthritis and what?

A

Reactive arthritis

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32
Q

What is the initial imaging for ?achilles tendon rupture?

A

USS

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33
Q

Name a cause of nephrogenic and craniogenic DI?

A

Cranuogenic = pituitary surgery
Nephrogenic = Lithium

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34
Q

What should you suspect if there is proximal muscle weakness with no rash but a riased CK? Ix and Mx?

A

Polymyositis
Ix = anti-Jo-1 (also seen in dermatomyositis)
Mx = steroids and methotrexate

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35
Q

Sx of Progressive Supranuclear Palsy?

A

Postural instability, impaired vertical gaze, parkinsonism and frontal lobe dysfunction

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36
Q

What is the most common presentation of Peutz-Jegher’s syndrome? Name another Sx?

A

SBO is the most common presentation
There will be dark blue/brown macules on the skin and mouth

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37
Q

What are the parameters of a severe asthma attack?

A

PEFR 33-50% predicted, RR >25, HR >110, can’t complete full sentences

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38
Q

What can cause gingival hyperplasia?

A

Phenytoin, ciclosporin, CCBs and AML

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39
Q

How long should you wait before re-starting hormonal contraception when taking ulipristal acetate?

A

5 days

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40
Q

Mx Non-Hodgkin’s lymphoma?

A

R-CHOP chemotherapy.
Unless it is gastric malt then just eradicate H.Pylori

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41
Q

What is seen in heparin induced thrombocytopenia?

A

> 50% reduction in platelets, thrombosis and skin allergy

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42
Q

Where should the contraceptive implant go?

A

Subdermally in the non-dominant arm

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43
Q

If you have AKI and proteinuria where is the problem?

A

Intrinsic (in the kidneys themselves)

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44
Q

Mx of patients with GI bleeds who have had multiple endoscopic therapies already?

A

Laparotomy and surgical exploration

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45
Q

What should you do if a salpingotomy fails to manage an ectopic pregnancy?

A

Give methotrexate or do a salpingectomy

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46
Q

Define Pre-eclampsia? Mx? Prevention?

A

New onset BP >=140/90 after 20 weeks of pregnancy with one or more of proteinuria and organ dysfunction
Mx = Labetalol and delivery
Prevent with 75-150mg aspirin daily from 12 weeks until birth

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47
Q

What is Wallen’s Syndrome?

A

Critical LAD stenosis characterised by self-resolving cardiac chest pain with a Hx of IHD and deeply inverted T waves in V2-V3.
Give PCI!

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48
Q

What must be true for a patient to have a bundle branch block?

A

They must have a widened QRS!

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49
Q

Mx of diverticulitis which has not responded to oral Abx?

A

IV ceftriaxone and metronidazole

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50
Q

Why should you never prescribe azathioprine and allopurinol together?

A

It can cause bone marrow suppresion

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51
Q

What is intestinal angina?

A

AKA chronic mesenteric ischaemia
Presents with severe colicky post-prandial abdo pain, weight loss and an abdominal bruit

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52
Q

Describe familial hypercholesterolaemia?

A

AD
Causes a mutation in LDL receptors leading to high cholesterol at a young age

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53
Q

How can you differentiate between haemophilia and von Wilebrand’s disease?

A

Haemophilia = Prolonged APTT, normal bleeding time
vWD = Prolonged APTT and prolonged bleeding time

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54
Q

What increases the risk of hepatotoxicity in paracetamol excess?

A

Enzyme inducing drugs (e.g. Rifampicin, Phenytoin, Carbamazepine, Chronic alcohol XS and St John’s wart) or if they are malnourished

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55
Q

What should you offer to patients presenting within 4.5 hours vs 6 hours of ischaemic stroke?

A

Thrombolysis and thrombectomy
If between 4.5-6 hours offer thrombectomy only

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56
Q

What should you do if a patient on the COCP experiences migraine with aura?

A

STOP COCP

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57
Q

What is the most common cause of amaurosis fugax? Will it be ipsilateral or contralateral

A

Atherosclerosis of the internal carotid artery is most common
It will be ipsilateral

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58
Q

Sx anterior inferior cerebellar stroke?

A

Sudden onset vertigo, vomiting, ipsilateral facial paralysis and deafness

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59
Q

What is Dermatitis Herpetiformis?

A

Itchy vesicular rash on the extensor surfaces, it is associated with Coeliac’s disease due to IgA skin depositis

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60
Q

What should you do if a patient has had an inadequate respond to the Hep B vaccine?

A

If anti-HBs levels are 10-100 give one further dose
If anti-HBs levels are <10 give a full course extra (3 further doses)

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61
Q

What is the most common type of renal cell carcinoma?

A

Clear cell carcinoma

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62
Q

Describe Chronic Pancreatitis?

A

Abdo pain after eating, steatorrhoea and DM
Most commonly caused by alcohol XS
Ix = CT abdo, if inconclusive do a faecal elastase
Mx = analgesia and pancreatic enzyme supplements

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63
Q

Where is the lymphadenopathy in rubella?

A

Suboccipital and post auricular

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64
Q

Describe subclinical hyperthyroidism?

A

Normal T3 and T4 but low TSH.
There is an increased risk of AF, osteoporosis and dementia

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65
Q

Describe the abortion laws?

A

Abortions can be done up to 24 weeks unless it is necessary to save the woman’s life, there is evidence of extreme foetal abnormality or there is risk of serious mental/physical harm to the woman

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66
Q

How can we perform abortions?

A

<9 weeks medically with mifepristone followed 48 hours later by misoprostol
After this surgically with dilation and suction

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67
Q

Describe mesenteric adenitis?

A

Appendicitis symptoms (RLQ pain, fever, nausea and vomiting) but with a recent sore throat

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68
Q

How can neuroleptic malignant syndrome affect creatinine kinase?

A

It causes it to rise as there is rhabdomyolysis

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69
Q

How can we differentiate between Neuroleptic Malignant Syndrome and Serotonin Syndrome?

A

NMS = Reduced reflexes, led pipe rigidity and normal pupils
SS = increased reflexes, clonus and dilated pupils
Both will have tachycardia, hypertension, pyrexia, rigidity and sweating

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70
Q

Define spondylosis and spondylolisthesis?

A

Spondylosis = vertebral stress fracture of the pars interarticularis
Spondylolisthesis = displacement of the vertebrae which may be secondary to spondylosis

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71
Q

Should we offer surgery to women with breast cancer?

A

In most cases yes
Unless they are frail/elderly with metastatic breast cancer

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72
Q

When is the latest you would expect a child to sit unsupported by?

A

12 months

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73
Q

What are some general symptoms of SLE?

A

Fatigue, fever, mouth ulcers, lymphadenopathy, arthritis, pleurisy, protein/hematuria, pericarditis and butterfly rash

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74
Q

How can we calculate number needed to treat?

A

1/(control event rate - experiment event rate)

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75
Q

How should we induce labour?

A

Bishops score =<6 = vaginal prostaglandin E2 (Dinoprostone) or oral misoprostol
Bishops score >6 = amniotomy or IV oxytocin
Membrane sweep is an adjunct to IOL NOT IOL itsself

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76
Q

Describe delusion disorder?

A

A patient has >= 1 non-bizzare delusional though for >= 1 month which are not explained by any other condition

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77
Q

What is the most common cause of ABO incompatibility on blood transfusion?

A

Patient being identified incorrectly

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78
Q

What is the most common primary malignant bone tumour? Who is it seen in?

A

Osteosarcoma
Seen in children and adolesents

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79
Q

Describe transposition of the great arteries?

A

Cyanosis, tachypnoea and a single loud S2 heart sound seen in new borns
Mx = give prostaglandin E1 e.g. Alprostadil to maintain the PDA until surgery

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80
Q

What should you do with a child presenting with an unexplained petechial rash and hepatosplenomegaly?

A

Urgently refer to paeds assessment unit ?ALL

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81
Q

Mx of PPH?

A

Manual decompression of the uterus
IV oxytocin ,2nd line drugs include Ergometrine (not if HTN), Carboprost (not if asthma) or misoprostol
Finally balloon tamponade

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82
Q

What is the cause of a painful arc between 60-120 degrees?

A

Supraspinatus tendonitis (aka subacromial impingement)

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83
Q

What type of data is BMI an example of?

A

Continuous data

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84
Q

What virus is associated with tonsil cancer?

A

HPV

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85
Q

Mx of breathlessness in palliative care?

A

IV Morphine

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86
Q

What hormone spikes to cause ovulation?

A

LH

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87
Q

True or false, GCA can cause fever, weight loss and night sweats?

A

TRUE

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88
Q

When can we use the unpaired T-Test?

A

To analyse a sample and determine if there is any difference between 2 unrelated groups

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89
Q

When do we use procyclidine?

A

In the Mx of EPSEs and drug induced Parkinsonism

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90
Q

Mx of finger trauma?

A

Finger splint

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91
Q

When do diabetics require a variable rate insulin infusion?

A

In a major surgery

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92
Q

1st line Mx for lower back pain?

A

NSAIDs

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93
Q

How can we reverse neuromuscular blocks?

A

Neostigmine (this can also be used in MG)

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94
Q

Which analysis of data provides the highest quality evidence?

A

Meta analysis of trials

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95
Q

How are the electrolytes deranged in tumour lysis syndrome?

A

Increased potassium, increased phosphate, increased uric acid and low calcium

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96
Q

How long does passive immunity last in babies?

A

Around 6 months

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97
Q

Describe a fibroadenoma?

A

A mobile, firm, smooth breast lump (breast mouse)

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98
Q

Mx of thrombotic (painful) crises in sickle cell?

A

Supportive and analgesia

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99
Q

Name some causes of postural hypotension?

A

Antihypertensive drugs, diuretics, sedatives, antidepressants, hypovolaemia, DM, Parkinson’s

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100
Q

Name some management options for postural hypotension?

A

Education (advise to stand up slowly and teach to recognise symptoms), high salt diet, compression stockings, fludrocortisone and midodrine

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101
Q

Define Delirium?

A

An acute transient and reversible state of confusion, disturbed cognition and impaired consciousness

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102
Q

How can we differentiate delirium from dementia?

A

Confusion Assessment Method

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103
Q

How do penicillin antibiotics work? How have bacteria developed resistance to them?

A

They inhibit the production of the bacterial cell wall
Bacteria now produce beta-lactamase this stops penicillin’s from working - to combat this you should prescribe drugs such as co-amoxiclav or tazocin which are beta-lactamase inhibitors

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104
Q

How can dementia present?

A

Memory loss, personality/behavioural changes, mood changes, inattention and disorientation

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105
Q

Name 8 reversible causes of dementia?

A

Hypoglycaemia, hypothyroidism, normal pressure hydrocephalus, B12/thiamine deficiency, SDH, brain tumour and depression

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106
Q

What is seen on MRI in alzheimer’s disease?

A

Cerebral atrophy of the cortex and hippocampus

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107
Q

What are the first and second line treatments for Alzheimer’s dementia?

A

1st line = acetylcholinesterase inhibitors (e.g. Donepezil, Galantamine or Rivastigmine)
2nd line = NMDA receptor antagonists e.g. memantine

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108
Q

Name 2 drugs which may precipitate urinary incontinence?

A

Diuretics and sedatives e.g. opioids

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109
Q

Name 4 causes of pelvic floor muscle weakness?

A

Pregnancy, child birth, chronic constipation, chronic cough

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110
Q

Mx of stress incontinence?

A

Pelvic floor exercises, avoid caffeine and smoking, weight loss
Duloxetine (An SNRI, increases the noradrenaline and serotonin concentration in the pudendal neve causing increased urethral sphincter tone)

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111
Q

How can ACEis worsen stress incontinence?

A

They can cause a dry cough which may worsen symptoms

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112
Q

How does warfarin work?

A

Inhibits active vitamin K regeneration and so inhibits the production of clotting factors 2,7,9 and 10

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113
Q

Name some drugs which can cause mania?

A

Amphetamines, cocaine, steroids and levodopa

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114
Q

Which tests should you do before starting lithium therapy?

A

U&Es to check renal function (it is renally excreted), TFTs (it can affect thyroid function) and ECG (it can cause long QT syndrome)

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115
Q

Name 6 symptoms of lithium toxicity?

A

Coarse tremor, hyperreflexia, acute confusion, polyuria, seizures and coma

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116
Q

How are scores such as PHQ-9 and HADS useful? What are their drawbacks?

A

They can be diagnostic and allow symptom monitoring and assessment severity.
However they can be very subjective and are only validated for use within hospitals

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117
Q

Name 4 conditions which can be associated with depression?

A

Addison’s, hypothyroidism, bipolar, psychotic depression

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118
Q

What are some features of atypical depression?

A

Increased appetite, increased weight, catatonia and mood improves with positiv events

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119
Q

Name 5 ways you can differentiate delirium from dementia?

A

Features that point to delirium = acute onset, impaired consciousness, fluctuation of symptoms (often worse at night), abnormal perceptions (hallucinations and delusions), agitation/fear

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120
Q

List 6 causes of dementia?

A

Alzheimer’s, Vascular Dementia, Lewy Body Dementia, Frontal-Temporal dementia Parkinson’s dementia, Huntington’s disease

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121
Q

What are some risks associated with giving sedation to elderly patients?

A

Increased risk of falls, increased risk of confusion, can cause respiratory depression and hypotension

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122
Q

Define alcohol abuse?

A

Excessive alcohol consumption which is continued despite causing physical, mental, social or financial harm to the patient

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123
Q

Sx of Delirium Tremens?

A

Coarse tremor, confusion, delusions, visual/auditory hallucinations, fever and tachycardia

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124
Q

Why must we give B/C vitamins (Pabrinex) to patients withdrawing from alcohol?

A

To prevent progression to Wernicke’s encephalopathy and Korsakoff syndrome

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125
Q

Briefly describe how we can identify different types of cysts easily?

A

Epidermoid cysts = black heads
Sebaceous cysts = white heads
Dermoid cysts = contain hair
Desmoid cysts = benign tumours of connective tissue

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126
Q

Describe Ramsay Hunt Syndrome?

A

Caused by reactivation of VZV
Post-auricular pain, facial nerve palsy, vesicular rash, vertigo and tinnitus
Mx = acyclovir and prednisolone

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127
Q

What should you consider as the cause of dropping saturations post-intubation? How do we check for this

A

intubation of the oesophagus
Monitor with capnography

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128
Q

What is the most common cause of OE?

A

Pseudomonas aerginosa

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129
Q

Describe gall stone ileus?

A

SBO secondary to gall stone impaction, leading to abdo pain, distension and vomiting

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130
Q

Describe small bowel overgrowth syndrome?

A

Chronic diarrhoea, flatulence and abdominal pain associated with DM and scleroderma
Ix = hydrogen breath test
Mx = rifampicin

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131
Q

Describe a anal fissure?

A

Very painful rectal bleeding on defecation. Fissures are often seen at 6 o’clock position, DRE may be impossible due to pain

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132
Q

True or false, DRE can be normal in haemarrhoids?

A

TRUE

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133
Q

Mx of organophosphate poisoning?

A

Atropine

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134
Q

Which beta blockers can reduce mortality in heart failure?

A

Carvedilol and bisoprolol

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135
Q

Which diabetes drug can cause fournier’s gangrene (necrotising fasciitis of the genitalia/perineum)?

A

SGLT 2 inhibitors

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136
Q

Which position is best to place a patient with ARDS in?

A

Prone position

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137
Q

What do PHQ-9 and HAD assess?

A

PHQ-9 = depression
HAD = anxiety

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138
Q

What is seen in posterior STEMI?

A

ST depression, tall broad R waves in V1-V3 and upright T waves

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139
Q

Sx of hereditary spherocytosis?

A

Jaundice within the first 24 hours of life, gall stones, splenomegaly, haemolytic crises and if acutely unwell consider splenic rupture

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140
Q

What should you suspect in a patient with HIV, neuro symptoms and a brain lesion with homogenous enhancement?

A

CNS lymphoma

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141
Q

What are ‘orange-peel skin lesions’?

A

Pre-tibial myxoedema, associated with Grave’s

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142
Q

How long must you avoid driving for after a seizure? Should you inform the DVLA?

A

First seizure = 6 months
Epileptic seizure = 12 months
MUST inform DVLA

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143
Q

Mx of (occular) myasthenia gravis?

A

Pyridostigmine

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144
Q

True or false, high birth weight is a RF for neonatal sepsis?

A

FALSE! Low birth weight is a RF

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145
Q

What are the oxygen targets in acute asthma?

A

94-98%

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146
Q

Where is an inferior STEMI? Which vessel is affected?

A

Inferior = II, III and aVF = Right coronary artery
Can also cause AV node block

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147
Q

Where is an anterior STEMI? Which vessel is affected?

A

V1-V4
LAD artery

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148
Q

Where is a lateral STEMI? Which vessel is affected?

A

I, aVL, V5 and V6
Left circumflex

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149
Q

Which drug can worsen plaque psoriasis?

A

Beta blockers

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150
Q

How long should you receive aspirin for after a stroke? What should you give after that?

A

14 days of 300mg aspirin
After this give clopidogrel or anticoagulant if AF

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151
Q

Describe placenta accreta, placenta increta and placenta percreta?

A

Accreta = chorionic villi attach to the myometrium
Increta = chorionic villi invade the myometrium
Percreta = chorionic villi invade through the perimetrium

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152
Q

What is seen in wet ARMD?

A

Neovascularisation (new vessel formation)

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153
Q

What is the most common cause of hypopituitarism?

A

Non-secreting pituitary macroadenomas

154
Q

What should you consider the cause of loss of fine motor function in both upper limbs? Ix? Mx?

A

Degenerative cervical myopathy
Ix = MRI
Mx = decompressive surgery

155
Q

Which movement is affected first in adhesive capsulitis?

A

External rotation

156
Q

What should you suspect if Schober’s test is <5cm in a young person?

A

Ankylosing spondylitis

157
Q

Mx intermittent testicular torsion?

A

Prophylactic fixing

158
Q

What is erysipelas? Mx?

A

Superficial cellulitis
Mx = flucloxacillin

159
Q

How can we differentiate between bullous pemphigoid and pemphigus vulgaris?

A

Bulla/blisters with no mucosal involvement = bullous pemphigoid
Mucosal involvement = pemphigus vulgaris

160
Q

True or false, finasteride can cause gynaecomastia?

A

True

161
Q

Mx absence seizures?

A

Ethosuxamide

162
Q

Mx focal seizures?

A

Lamotrigine or Levitiracetam

163
Q

What is takotsubo cardiomyopathy/

A

ST elevation but no obstructive coronary artery disease

164
Q

Where do inhaled foreign bodies most frequently become lodged?

A

R main bronchus

165
Q

Describe a posterior cerebral artery stroke?

A

Contralateral homonymous hemianopia with macular sparring and visual agnosia

166
Q

Describe Anti-HBs and Anti-HBc?

A

Anti-HBs = safe, have immunity
Anti-HBc = caught, have previously acquired the infection

167
Q

Describe transfusion related lung injury?

A

Hypoxia, pulmonary infiltrates, fever and low blood pressure after blood transfusion

168
Q

How can reticulocytes help us differentiate between haemolytic and aplastic crises?

A

Haemolytic = high
Aplastic = low

169
Q

Is warfarin safe in AKI and breast feeding?

A

YES

170
Q

What type of contraceptive pill is desogrestrel? How late can it be?

A

POP
But it can be up to 12 hours late without issue

171
Q

Secondary prevention of MI?

A

ACEi, Beta blocker, Statin, Dual anti-platelet therapy (aspirin + ticagrelor/prasugrel)

172
Q

Ix of chlamydia/gonorrhoea?

A

NAAT
In women = vulvovaginal swab
In men = 1st catch urine sample

173
Q

How long before surgery can you drink fruit juice without pulp?

A

2 hours, it counts as a clear liquid

174
Q

Where is the pulmonary fibrosis in TB?

A

Upper zone

175
Q

What is pabrinex made of?

A

B and C vitamins

176
Q

Mx of ?Neutropenic sepsis?

A

IV tazocin, give before blood test results are back

177
Q

How are urea, creatinine and urinary protein affected in pregnancy?

A

Urea and creatinine go down, urinary protein increases

178
Q

What does having a normal libido suggest about the cause of erectile dysfunction?

A

Suggests it is an organic cause

179
Q

SE of doxycycline?

A

It can cause photosensitivity

180
Q

Describe Adie’s tonic pupil?

A

Uneven sized pupils which are worse in bright light

181
Q

Sx of an anterior cerebral artery stroke?

A

Leg weakness but no facial weakness or speech issues

182
Q

How long can a pregnancy test remain positive after a TOP?

A

up to 4 weeks

183
Q

What should you consider as the cause of a pansystolic murmur with a low grade fever?

A

Infective endocarditis

184
Q

Sx of myxoedemic coma?

A

Hypothermia, hyporeflexia, bradycardia and seizures

185
Q

What is seen on X-ray in ankylosing spondylitis??

A

Syndesmophytes
Subchondral erosions, sclerosis and squaring of the lumbar vertebrae

186
Q

What is seen on BM aspirate in myeloma?

A

Plasma cells

187
Q

Name 2 side effects of triptans?

A

Tightness of the throat and chest

188
Q

When is a fluid exudate?

A

Pleural fluid protein:serum protein >0.5
Pleural fluid LDH:serum LDH >0.6
Pleural fluid LDH >2/3rds upper limit of normal

189
Q

Define Acute dystonia, Akathisia and Tardive Dyskinesia?

A

Acute Dystonia = Sustained muscle contraction - manage with procyclidine
Akathisia = severe restlessness
Tardive Dyskinesia = late onset abnormal and involuntary movements e.g. chewing

190
Q

What is the most common cause of bronchiolitis and how do you detect it?

A

Respiratory Syncytial Virus
Detect with immunofluorescence of nasopharyngeal secretions

191
Q

When should you immediately refer a child to hospital with bronchiolitis?

A

Apnoea, child looks very unwell to a healthcare professional, severe respiratory distress (grunting, marked chest recessions or RR > 70), central cyanosis or oxygen sats <92% on air

192
Q

Mx of bronchiolitis in hospital?

A

Humidified oxygen via a head box, NG feeding, suction of airway secretions

193
Q

What is the most common cause of croup?

A

Parainfluenza virus
May also be caused by adenovirus

194
Q

Mx of croup which does not respond to oral dexamethasone?

A

High flow oxygen and nebulised adrenaline

195
Q

Sx of severe croup?

A

Marked sternal wall retractions, significant distress/agitation or lethargy/restlessness, tachycardia, cyanosis

196
Q

When does pyloric stenosis normally present?

A

1st 2-4 weeks of life

197
Q

Name the 4 areas of the stomach?

A

Fundus, body, cardia and the pylorus

198
Q

What age does SUFE typically occur?

A

10-15

199
Q

Name some risk factors for SUFE?

A

Male, obesity and local trauma

200
Q

What cartilage is seen in the epiphyseal plate?

A

Hyaline cartilage

201
Q

Causes of jaundice in the first 24 hours of life?

A

Rhesus haemolytic disease, ABO haemolytic disease, Hereditary spherocytosis, G6PD deficiency

202
Q

What does the direct antiglobulin (Coomb’s test) screen for?

A

Autoimmune haemolytic anaemia

203
Q

What is an important complication of neonatal jaundice? How do we prevent it?

A

Kernicterus
Prevent with UV therapy or exchange transfusion

204
Q

How do we classify heart failure severity?

A

New York Hear Association Classification

205
Q

Sx of Left ventricular failure?

A

SOB, reduced exercise tolerance, paroxysmal nocturnal dyspnoea, orthopnoea, pink frothy sputum and cough

206
Q

How does furosemide work?

A

It inhibits the Na-K-2Cl co-transporter so reduces uptake of these salts in the ascending limb so reduces water uptake in the descending limb

207
Q

Name some SEs of ACEi?

A

Dry cough, first dose hypotension, hyperkalaemia, renal impairment and angiooedema

208
Q

How do statins work?

A

They inhibits HMG-CoA reductase which is the rate limiting step in cholesterol synthesis

209
Q

Sx of hypercholesterolaemia?

A

Xanthalesmata, corneal arcus and tendon xanthoma

210
Q

Name some common causes of AF?

A

Pneumonia, MI, PE, hyperthyroidism, alcohol XS, HF and endocarditis

211
Q

Complications of AF?

A

Ischaemic stroke, TIA, HF, systemic emobli and falls

212
Q

Describe Roth Spots?

A

Boat-shaped retinal haemorrhages with a pale centre seen in IE

213
Q

What criteria is used in IE?

A

Modified Duke Criteria

214
Q

Name some symptoms of aortic regurg?

A

Early diastolic murmur, wide pulse pressure, collapsing (waterhammer) pulse, nailbed pulsation and head bobbing

215
Q

How do you take blood cultures in ?IE

A

Take 3 blood cultures from 3 separate sites at 3 separate times

216
Q

RFs for IE? How do we prevent it in these patients?

A

IVDU, mechanical heart valves, bicuspid aortic valves, PDA, VSD
Offer prophylactic antibiotics before surgery (often amoxicillin)

217
Q

What is the incidence of CF in the UK?

A

1 in 2500 live births, 1 in 25 are carriers

218
Q

Define bronchiectasis and name 5 causes?

A

Chronic lung infection/inflammation leading to chronic and permanent dilation of the airways
Causes = CF, infection (TB/pneumonia), bronchial obstruction (lung CA or foreign body), Allergic Bronchopulmonary Aspergillosis and Immune deficiency

219
Q

Which 2 organisms commonly colonise the lungs in CF?

A

Staph aureus and pseudomonas aerginosa

220
Q

Name 2 tests which can confirm PE?

A

CTPA or V/Q scan (done in renal impairment when contrast can not be given)

221
Q

Where does lung cancer commonly metastasise to? How can we assess the cancer and its spread?

A

Brain, liver, bones and adrenal gland
CT thorax and a PET scan

222
Q

What is Pemberton’s sign?

A

Plethora/cyanosis when raising the arms as high as possible
Associated with thoracic inlet obstruction e.g. SVCO, retrosternal goitre e.t.c

223
Q

What is seen on CXR in idiopathic pulmonary fibrosis?

A

Ground glass appearance, later there may be honeycombing

224
Q

Name 3 respiratory and 3 non-respiratory causes of idiopathic pulmonary fibrosis?

A

Resp = extrinsic allergic alveolitis (pigeon fanciers lung, farmers lung, bakers lung)
Non-resp = RA, SLE, UC, Systemic sclerosis

225
Q

Name 8 causes of clubbing?

A

Cyanotic heart disease, Cystic Fibrosis, Lung cancer, Lung abscess, Ulcerative Colitis, Bronchiectasis, Idiopathic Pulmonary Fibrosis and Infective Endocarditis

226
Q

How can we assess OSA? Name some risk factors?

A

Epworth sleepiness score
RFs = obesity, large tonsils/adenoids, acromegaly and nasal polyps

227
Q

What can be seen on CXR and ECG in Cor Pulmonale?

A

CXR = enlarged right ventricle/atrium
ECG = right axis deviation and increased P wave amplitude

228
Q

What do you see on biopsy in sarcoidosis?

A

Non-caseating granulomas

229
Q

Give 5 extra-pulmonary manifestations of sarcoidosis?

A

Erythema nodosum, lupus pernio, facial nerve palsy, anterior uveitis/conjunctivitis and cirrhosis

230
Q

Name 10 side effects of steroids?

A

Impaired glucose regulation, weight gain, abdominal striae, thin skin, osteoporosis, proximal myopathy, avascular necrosis of the femoral head, immunosuppression, psychosis, peptic ulceration, acute pancreatitis and glaucoma

231
Q

When performing a pleural tap should you put the needle above or below the ribs?

A

Above as the neurovascular bundle is below

232
Q

What can you do to treat recurrent pleural effusions?

A

Pleurodesis with bleomycin

233
Q

What should you do if a pleural effusion has a pH <7.2?

A

Insert a chest drain

234
Q

How can we differentiate between gastric and duodenal ulcers?

A

Gastric = pain soon after eating
Duodenal = pain when hungry, relieved by eating

235
Q

Mx of trace glycosuria in pregnancy?

A

Non needed - it is common so no need to do OGTT

236
Q

Ix of AKI with unknown cause?

A

Renal USS

237
Q

What is a good option for post operative pain relief?

A

PCA

238
Q

What may you see on ECG in severe mitral stenosis?

A

A bifid P wave (P mitrale) due to left atrial hypertension and strain

239
Q

What should you consider the cause of a ?seizure in a child where recovery is rapid?

A

Reflex anoxic seizure

240
Q

Describe the paraneoplastic symptoms of lung cancers?

A

Small cell = ADH secretion, ACTH secretion and lambert-eaton syndrome
Squamous cell = PTHrP secretion, TSH secretion, clubbing and HPOA
Adenocarcinoma = HPOA and gynaecomastia

241
Q

What is meralgia parasthetica?

A

Pain and numbness over the lateral thigh skin

242
Q

What is it called if you have Perthe’s disease in adults?

A

Avascular necrosis of the femoral head

243
Q

Describe Budd-Chiari syndrome?

A

Sudden onset abdo pain, ascites and tender hepatomegaly often seen secondary to a tumour or hypercoagulable state causing a clot in the hepatic vein

244
Q

How does loperamide work?

A

Stimulates opioid receptors to reduce bowel motlitity

245
Q

How likely are you to pass on the BRCA 1 gene

A

50%

246
Q

What causes anaphylaxis?

A

IgE mediated mast cell release

247
Q

What investigation should you always do in new dermatomyositis?

A

CT TAP ?Malignancy

248
Q

Which antibiotic is known to cause IIH? Name 4 symptoms?

A

Tetracyclines
Sx = Raised ICP, enlarged blind spot, papilloedema, 6th nerve palsy

249
Q

Sx of viral labyrinthitis?

A

Sudden onset horizontal nystagmus, sensorineural hearing loss, nausea and vomiting and vertigo

250
Q

How is Marfan’s an Ehler-Danlos inherited?

A

AD

251
Q

When can you stop anti-epileptics? How should you stop them?

A

When you have been seizure free for at least 2 years
Stop over 2-3 months

252
Q

Antibodies in diffuse and central systemic sclerosis?

A

Diffuse = anti-scl-70
Central = anti-centromere

253
Q

Define felt need?

A

Individual perceptions of deviation from normal health

254
Q

Define expressed need?

A

Individual seeks help to overcome variation in normal health

255
Q

Define normative need?

A

Professional defines intervention appropriate for the expressed need

256
Q

Define comparative need?

A

Comparison between severity, range of interventions and cost

257
Q

Define primary, secondary and tertiary prevention?

A

Primary = preventing a disease before it has occured
Secondary = catching a disease in a pre-clinical or early phase to prevent it progressing
Tertiary = Preventing complications of a disease

258
Q

Define sensitivity?

A

The proportion of people with a disease who are correctly identified by the screening test

259
Q

Define specificity?

A

The proportion of people without a disease who are correctly excluded by the screening test

260
Q

Positive predictive value?

A

The proportion of people with a positive test who actually have the disease, this increases with prevalence

261
Q

Negative predictive value?

A

The proportion of people with a negative test who do not have the disease, this decreases with prevalence

262
Q

What is a cross section study?

A

Divides those with a disease and those without a disease and collects data at that specific point in time about associations

263
Q

Case-control study?

A

Compares someone with a disease with someone without and looks back retrospectively to look at risk factor exposure

264
Q

Cohort study?

A

Takes a population without a disease and watches them over time to see what risk factors they come across and if they develop the disease - prospective

265
Q

Randomised control trial?

A

Split patients into groups, one is given an intervention where as the other is given a control. The results are then compared

266
Q

Ecological study?

A

Uses routinely collected data to show trends and allow a hypothesis to be formed

267
Q

Define relative risk and relative risk reduction?

A

Relative risk = how many times more likely it is that an event will occur in the intervention group as compared to the control

Relative risk reduction = reduction in the rate of outcome in the prevention group as compared to the control

268
Q

Define number needed to treat?

A

The number of people needed to treat for a condition in order to prevent one bad outcome

269
Q

What are the 5 stages of change?

A

PC PAM
Precontemplation, Contemplation, Preparation, Action and Maintenance

270
Q

Name 8 causes of acute pericarditis?

A

Viral infections (e.g. coxsackie virus), TB, uraemia, post-MI, SLE, RA, trauma and malignancy

271
Q

Mx of tension pneumothorax?

A

Needle decompression with a large bore cannula in the mid clavicular line 2nd intercostal space

272
Q

How long does pneumothorax typically take to resolve? When can you fly?

A

1.25% of the lung volume can correct each day
Do not fly until full resolution is confirmed on x-ray

273
Q

Which gene causes ADPKD?

A

PKD 1 gene

274
Q

Why is ADPKD associated with bleeds on the brain?

A

Berry Aneurysms lead to SAH, there is also hypertension which increases this risk further

275
Q

Name 4 examination findings and 6 complications of ADPKD?

A

Examination findings = enlarged irregular kidneys, hepatomegaly, HTN and mitral valve prolapse
Complications = CKD, haematuria, renal stones, livery cysts (most common), berry aneurysms and chronic pain

276
Q

Who should you screen for ADPKD and how?

A

First degree relatives of someone with a confirmed diagnosis, screen with abdo USS

277
Q

What are the main 2 investigations to perform in a cushingoid patient?

A

Overnight dexamethasone suppression test first line
Also 24 hour urinary free cortisol

278
Q

Why can cushing’s syndrome lead to tanned skin?

A

ACTH stimulates melanocytes as there is an affinity for the MSH receptor, this causes darkening of the skin

279
Q

Name 6 causes of acute pancreatitis?

A

Alcohol excess, gall stones, trauma, ERCP, hyperlipidaemia and scorpion venom

280
Q

Name the 3 scoring systems to identify pancreatitis severity? Name some common factors in them?

A

Ranson score, Glasgow score and APACHE II
Age >55 years, hypocalcaemia, hyperglycaemia and hypoxia

281
Q

Mx acute pancreatitis?

A

Aggressive fluid resuscitation, IV opioids, do not make NBM but consider enteral nutrition

282
Q

What causes Grey-Turner’s and Cullen’s sign?

A

Retroperitoneal and intra abdominal bleeding secondary to acute pancreatitis

283
Q

Name 5 complications of acute pancreatitis?

A

ARDS, pancreatic pseudocysts, pancreatic necrosis, pancreatic abscess and multi-organ failure

284
Q

Name 5 autoimmune conditions associated with MG?

A

SLE, RA, Grave’s disease, Hashimoto’s thyroiditis and pernicious anaemia

285
Q

What is the defining feature of muscle weakness in MG?

A

Fatiguability, gets worse with use and better with rest

286
Q

Compare the symptoms to CA in the right colon vs left colon?

A

Left = bleeding/mucus per rectum, tenesmus and altered bowel habit
Right = weight loss, anaemia and abdo pain

287
Q

What causes a thyroglossal cyst? Name some differentials?

A

Thyroglossal duct carries the thyroid gland from the foramen caecum to the tongue base. If it does not atrophy a cyst can form
Differentials = dermoid cyst, thymus mass and malignancy

288
Q

Ix of thyroglossal cyst?

A

USS mass, TFTs, radioactive iodine scan

289
Q

Name RFs for PPH?

A

Previous PPH, prolonged labour, pre-eclampsia, placenta praevia/accreta, polyhydramnios and increasing maternal age

290
Q

How is female continence maintained?

A

The external urethral sphincter and the pelvic floor pressures exceed detrusor pressure

291
Q

Name 2 medical problems which can worsen urinary incontience?

A

DM and UTI

292
Q

Ix of incontinence and non-medical management?

A

Ix = urodynamics
Mx = reduce caffeine intake, pelvic floor exercises if stress incontinence and bladder retraining if urge incontinence

293
Q

Mx of acute asthma?

A

Nebulised salbutamol, oral prednisolone
Nebulised ipratropium bromide and IV magnesium sulphate if severe/life-threatening
Consider IV aminophylline

294
Q

Name 5 resp and 5 non-resp complications of cystic fibrosis?

A

Bronchiectasis, recurrent pneumonia, pneumothorax, pulmonary HTN and nasal polyps
Cirrhosis, meconium ileus, malabsorption, constipation/intussusception and infertility

295
Q

Name the fat soluble vitamins

A

A, D, E, K

296
Q

What is the best way to estimate the body surface area affected by burns?

A

Lund and Browder chart

297
Q

Describe the Parkland formula?

A

( Weight (kg) x Burn surface area (%) ) x4
This is the total volume of Hartmann’s over 24 hours, give half in the first 8 hours!

298
Q

What are the 2 most common causes of death in burns patients?

A

Infection and dehydration

299
Q

Mx of severe urticaria?

A

Short course of oral steroids alongside non-sedating anti-histamines

300
Q

Addison’s vs Conn’s?

A

Addison’s = primary adrenal insufficiency
Conn’s = primary hyperaldosteroneism

301
Q

What is the diagnosis if there is a normal/raised total gas transfer with raised transfer coefficient?

A

Asthma or pulmonary haemorrhage

302
Q

Mx acute limb ischaemia?

A

Analgesia, IV heparin and vascular review

303
Q

When is DKA classed as resolves?

A

pH >7.3, ketones <0.6 and bicarbonate >15

304
Q

Mx nasal polyps?

A

TOP internasal steroids and routine ENT referal

305
Q

What can cause ischaemic hepatitis?

A

Acute hypoperfusion

306
Q

What is sodium like in DI and SIADH?

A

DI = hypernatraemia
SIADH = hyponatraemia

307
Q

What is the most common cause of septic arthritis?

A

Staph aureus. Except in young sexually active people when it is N. gonnorhoea

308
Q

Mx of a new diagnosis of RA?

A

Methotrexate and consider a short course of oral steroids

309
Q

Describe Still’s disease?

A

A maculopapular salmon pink rash with pyrexia which is worse in the evenings

310
Q

What is acanthosis nigricans?

A

Black velvety skin lesions associated with GI cancer, DM and anything which increases insulin resistance (e.g. PCOS, cushings and acromegaly)

311
Q

What is the cause of a pneumonia with low sodium, low lymphocytes and a raised ALT?

A

Legionella

312
Q

Describe rheumatic fever?

A

A recent sore throat with erythema marginitum, arthritis and a heart murmur
Most commonly caused by strep pyogenes
Mx = Penicillin V

313
Q

Describe retinopathy of prematurity?

A

Neovascularisation and loss of the red reflex in a premature baby

314
Q

What is impaired fasting glucose?

A

FPG >= 6.1 but <7.0

315
Q

What is impaired glucose tolerace?

A

FPG <7.0 but OGTT >= 7.8 but <11.1

316
Q

When should you definitely offer a liver transplant in paracetamol OD?

A

If the blood pH is <7.3 after 24 hours

317
Q

What should you consider as the cause of infection in someone who has received a renal transplant?

A

CMV

318
Q

Name 3 drugs which should be avoided in PD?

A

Metoclopramide, Haloperidol (most anti-psychotics should be avoided) and anti-histamines

319
Q

When should a child have developed a pincer grip by?

A

12 months

320
Q

What are the kidneys like in CKD?

A

Small unless secondary to DM then they are normal sized to large

321
Q

When are hyaline casts in the urine considered normal?

A

If the patient is on loop diuretics

322
Q

What are bloods like in refeeding syndrome?

A

Low phosphate, low potassium and low magnesium

323
Q

What are the most common cause of small and large bowel obstruction?

A

Adhesions = SBO
Malignancy = LBO

324
Q

What is ludwig’s angina?

A

Neck swelling, dysphagia and a fever with recent dental surgery
This requires urgent hospital admission

325
Q

1st line medical Mx of anal fissures?

A

Bulk forming laxatives

326
Q

What is Weber’s syndrome?

A

A midbrain stroke causing ipsilateral CN III palsy and a contralateral hemiparesis

327
Q

Ix ?gall stone pathology?

A

Abdo USS

328
Q

What most commonly causes impetigo?

A

Staph Aureus

329
Q

What is seen in severe congenital adrenal hyperplasia?

A

Shortly after birth there is hyponatraemia, hyperkalaemia and hypoglycaemia (due to low aldosterone and cortisol)
Also ambiguous genitalia if female (due to increased androgens)

330
Q

Which type of testicular cancer is associated with raised alpha fetoprotien and beta hCG?

A

Non-seminoma

331
Q

Which non-testicular cancer is alpha fetoprotein raised in?

A

Hepatocellular cancer

332
Q

Acne Mx?

A

TOP retinoids/benzoyl peroxide
TOP retinoid/benzoyl peroxide + TOP antibiotic (e.g. clindamycin)
PO tetracycline or COCP
Refer to derm ?isotretinon

333
Q

Ix ?ADPKD?

A

Abdo USS to visualise renal tract

334
Q

Can gall stone pain be epigastric?

A

YES

335
Q

When should you never give duloxetine?

A

If eGFR is <30

336
Q

Sx scleritits?

A

Red painful eye, watering/photophobia and gradually reducing visual acuity

337
Q

Sx episcleritis?

A

Red eye which is not painful (although there may be some discomfort, watering or photophobia), vessels are mobile when gentle pressure is applied

338
Q

Above what albumin:creatinine ratios should you give ACEi?

A

ACR >3 if diabetic
ACR >30 if HTN
ACR >70 regardless of other medical conditions

339
Q

What should you always rule out in painless jaundice and a palpable epigastric/RUQ mass?

A

Pancreatic cancer until proven otherwise!!

340
Q

Serum osmolality calculation?

A

2xsodium + glucose + urea

341
Q

Mx of pitting oedema?

A

PO Furosemide

342
Q

Sx optic neuritis?

A

Reduced visual acuity, red desaturation, pain worse on eye movements, RAPD and central scotoma

343
Q

Which side is the deviation if there is a defect in the following cranial nerves?
Trigeminal, Vagus, Accessory and Hypoglossal?

A

Trigeminal = deviation of the jaw towards the weaker side
Vagus = deviation of the uvula away from the weaker side
Hypoglossal = tongue deviation towards the weaker side
Accessory = weakness in turning the head away from the weaker side

344
Q

DKA Mx?

A

First = IV isotonic saline (NaCl 0.9%)
IV insulin (0.1 units/kg/hr)
10% dextrose once BMs <14
K+ as required (<20mmol/hr)
Continue long acting insulin but stop short acting insulin

345
Q

Sx IPF?

A

Progressive exertional dyspnoea, bibasal fine end-inspiratory crepitations, dry cough and clubbing

346
Q

What should you consider the diagnosis if there is erratic blood glucose levels, bloating and vomiting?

A

Gastroparesis

347
Q

Mx of temp >38 degrees whilst in labour?

A

IV benzylpenicillin as GBS prophylaxis

348
Q

How can sarcoidosis cause bilateral facial nerve palsy? How can we manage?

A

It causes parotid swelling
Steroids will resolve it

349
Q

Name some symptoms of mumps other than parotid gland swelling?

A

Pancreatitis, orchitis, reduced hearing and meningoencephalitis

350
Q

Describe rickets in adults?

A

Osteomalacia
There will be bone pain, tenderness and proximal myopathy

351
Q

SEs of suxamethonium?

A

Fasciculations before complete muscle paralysis, malignant hyperthermia and suxamethonium apnoea

352
Q

Ix of PSC?

A

pANCA positive and beaded appearance of ERCP

353
Q

How can you differentiate clinically between Horner’s syndrome and a CN III palsy?

A

Horner’s syndrome = ptosis and pupil constriction
CN III = ptosis and pupil dilation

354
Q

How much should you increase levothyroxine by in pregnancy?

A

Up to 50%

355
Q

How long should you continue HRT till in premature menopause?

A

50

356
Q

How do you interpret the Well’s score for DVT?

A

> = 2 DVT likely, do proximal leg vein USS
<2 DVT unlikely, do D-dimer

357
Q

When should you assess APGAR score?

A

At 1 min and 5 mins after birth

358
Q

Mx of breast cancer when there are positive axillary lymph nodes or tumour noted at the resection margins post mastectomy?

A

Offer ipsilateral chest wall and lymph node radiotherpay

359
Q

Where can you palpate epididymal cysts? Can they be painful?

A

Posterior to the testicle and palpated separately from the testicle
Yes they can be painful

360
Q

What urine output is considered AKI?

A

<0.5ml/kg/hr for at least 6 hours

361
Q

1st line Mx for hyperhidrosis (sweaty hands)?

A

Aluminium chloride

362
Q

SEs of oestrogen receptor positive breast cancer treatments?

A

Tamoxifen can cause VTE and endometrial cancer
Anastrozole can cause osteoporosis

363
Q

Most likely cause of a central line infection?

A

Staph Epidermidis

364
Q

Ix of Premature Prelabour Rupture of Membranes?

A

Do a speculum examination looking for pooling of amniotic fluid in the posterior vaginal vault. If non is seen do an amnisure sample

365
Q

Sx of central vs diffuse systemic sclerosis?

A

Central = CREST syndrome (Calcinosis, Raynaud’s, oEsophageal dysmotility, Sclerodactyly and Telangiectasia)
Diffuse = Scleroderma of the trunk and proximal limbs

366
Q

SE of the 1st line Mx for SLE?

A

Hydroxychloroquine can cause retinopathy

367
Q

Mx and prevention of venous ulcers?

A

Mx = compression bandaging
Prevention = compression stockings

368
Q

Mx tonic or atonic seziures?

A

F = lamotrigine
M = sodium valporate

369
Q

Mx myoclonic seizures?

A

F = levetiracetam
Mx = sodium valproate

370
Q

Mx focal seizures?

A

Levetiracetam or lamotrigine

371
Q

Mx tonic clonic seizures?

A

M = Sodium Valproate
F = Levetiracetam or lamotrigine

372
Q

What should you consider if an ECG shows inferior MI but there is also aortic regurg?

A

Proximal aortic dissection

373
Q

Sx of subacute combined degeneration of the spinal cord (B12 deficiency)?

A

Loss of proprioception and vibration, hyperreflexia but loss of the ankle jerk reflex, gait abnormalities and Rhomberg’s positive

374
Q

Describe factor V leidin?

A

The most common inherited cause of thrombophilia, it increases the risk of clots as there is activated protein C resistance leading to slower inactivation of of factor V

375
Q

Describe ITP?

A

Isolated thrombocytopenia with epistaxis and petechiae
In children management is generally not required but in adults give PO prednisolone

376
Q

How can HF affect Na+?

A

It can cause hyponatraemia

377
Q

When should you monitor digoxin levels?

A

At least 6 hours after the last dose

378
Q

Mx of women >20 weeks pregnant with VZV exposure but no previous VZV antibodies?

A

If they present within 24 hours of rash onset give PO acyclovir immediately
If they present after this give PO acyclovir or VZIG after 7-14 days

379
Q

Describe a dermatofibroma?

A

A solitary nodule which dimples on pinching

380
Q

How can amiodarone affect the lungs?

A

It can lead to lower zone fibrosis

381
Q

Whooping cough Mx?

A

Azithromycin or Clarithromycin

Finals Revision (23 decks)

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