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5th Year > General > Flashcards

General Flashcards

1
Q

What hormone therapies is breast cancer a contraindication for?

A

progesterone only contraception.

HRT

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2
Q

What can you use to assess someones alcohol dependance?

A

CAGE
Have you ever thought that you should cut down?

Do you get annoyed at people commenting on your drinking?

do you ever feel guilty about your drinking?

Eye opener - do you ever drink first thing in the morning?

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3
Q

Blood results in liver disease?

A

Raised ALT/AST
Raised gamma GT
ALP raised in late disease

Raised bilirubin in cirrhosis
Low albumin due to reduced function of liver.

Elevated PTT due to reduced liver function

Raised MCV on FBC suggests alcoholism

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4
Q

Signs of vernickes encephalopathy?

A

Confusion
Ataxia
Oculomotor dysfunction

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5
Q

Differentials for generalised abdominal pain?

A

Peritonitis
Ruptured AAA
Bowel obstruction
Ischaemic colitis

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6
Q

Differentials for generalised abdominal pain?

A

Peritonitis
Ruptured AAA
Bowel obstruction
Ischaemic colitis

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7
Q

Differentials for RUQ pain?

A

Biliary colic
Acute cholecystitis
Acute cholangitis

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8
Q

What is charcots triad and which condition is it associated with?

A

Acute cholangitis

RUQ pain
Fever
Jaundice

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9
Q

What should you think about in a septic patient with known liver disease (ascites)

A

SBP

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10
Q

What are the 3 main causes of bowel obstruction?

A

Adhesions (peritonitis, surgery, infection)

Hernias

Malignancy

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11
Q

Management of bowel obstruction

A

Drip & Suck

  1. NBM
  2. IV fluids
  3. NG tube with free drainage
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12
Q

What should be considered with AF and abdo pain?

A

Mesenteric ischaemia

Clot in SMA - diagnosed by contrast CT

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13
Q

What makes you think gallstones?

A

Fat
Female
Forty
Fair

Worsened by fatty foods.

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14
Q

Imaging for gallstones?

A

Abdo USS
ERCP if needed (biliary)

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15
Q

What is Murphys sign and what does it suggest?

A

Palpation of right subcostal area whilst asking patient to take deep inspiration

Gallbladder lowers during inspiration and hits off hand causing pain in cholecystitis

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16
Q

Causes of microcytic anaemia?

A

Thalassemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia

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17
Q

Causes of macrocytic anaemia?

A

B12 and folate deficiency

Normoblastic =
alcohol
liver disease
hypothyroid
azathioprine

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18
Q

Causes of normocytic anaemia?

A

Acute blood loss
anaemia of chronic disease
aplastic anaemia
haemolytic anaemia
hypothyroid

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19
Q

What are specific symptoms of iron deficiency?

A

Pica - cravings for specific foods

Hair loss

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20
Q

Investigations of iron deficiency anaemia?

A

Bloods - FBC (haem & MCV)
B12, folate, ferritin
Blood film
Urgent OGD/colonoscopy

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21
Q

Management of iron deficiency anaemia?

A

Premeopausal or pregnant woman - iron trial for 2-4weeks

Men and postmenopausal woman need GI causes of bleeding excluded

Check TTG for coeliac

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22
Q

What must you check if folate is low?

A

B12

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23
Q

Should b12 or folate be replaced first and why?

A

B12
risk of subacute combined degeneration of the cord

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24
Q

What is guillian barre?
What triggers it?

Concerns?

Management?

A

Symmetrical ascending peripheral nerve neuropathy

Usually triggered by infection (campylobacter/CMV/EBV)

Worried about ascending to diaphragm - respiratory weakness, Increases risk of VTE.

IVIG, plasma exchange, VTE prophylaxis

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25
Q

Red flags for headaches?

A

New onset >55 years old
Known/prev malignancy
Early morning
Exacerbated by valsalva
disturbing sleep

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26
Q

Investigations and management of migraine?

A

If no red flags.

Headache diary to identify potential triggers.

pain relief - paracetsamol/ibuprofen
Triptan to take at onset.
Propanolol/topiramate/amitriptyline for prophylaxis

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27
Q

What long term drugs are expected after an ischaemic stroke?

A

Aspirin first 14 days then clopidogrel
atorvastatin/rosuvastatin
anticoagulant - DOAC/warfarin

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28
Q

What classification system is used for strokes?

A

Bamford

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29
Q

Scoring tools for stroke?

A

ROSIER
FAST

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30
Q

Scoring tools for stroke?

A

ROSIER
FAST

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31
Q

What common drugs should be stopped when pregnant?

A

Statin
ACEi/ARB

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32
Q

What changes to normal antenatal care occur if diabetic?

A

Oral meds changed to insulin.
HbA1c checked at booking.

scan at 20 weeks for fatal anomaly.

induction @ 37-38 weeks.

Blood testing every 2-4 hours in the newborn

Discharged after 24 hours if suitable blood glucose.

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33
Q

Cervical cancer info and risk factors

A

Associated with HPV
- unprotected sex
- numerous partners

Women of childbearing age
COCP >5 years

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34
Q

Cervical cancer presentation?

A

Intermenstrual/post coital/post menopausal bleeding

Vaginal discharge

Pelvic pain/dyspareunia

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35
Q

Investigation/management of cervical cancer?

A

Speculum (ulceration, inflammation, bleeding)

Urgent colposcopy under cancer referra

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36
Q

how frequently should a smear be performed?

A

every 3 years (25-49)
every 5 years (50-64)

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37
Q

What prompts colposcopy after smear results?

A
  1. Inadequate sample (repeat) but if continued inadequate sample then colposcopy.
  2. HPV +ve result with abnormal cytology
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38
Q

Management of simple ovarian cysts?

A

surgery to anyone symptomatic

Asymptomatic:
<5cm leave alone
5-7cm repeat scan in 12 months
=>7cm surgery due to risk of torsion

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39
Q

When should ca125 be checked?

A

complex cyst (premenopausal)
any cysts in post menopausal women

unexplained bloating, satiety

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40
Q

Management of fibroids

A

<3cm & no cavity distortion
1. mirena
2. TXA/NSAIDs, COCP/POP
3. endometrial ablation/hysterectomy

> 3cm
1. TXA, mefanamic acid
2. mirena
3. uterine artery embolisation
GnRH analogues given to reduce size before surgery

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41
Q

Risk factors for endometrial cancer?

A

Obesity
T2DM
Nulliparity, early menarche, late menopause
Tamoxifen
PCOS
HNPCC

42
Q

Protective factors for endometrial cancer?

A

COCP
Smoking

43
Q

Presentation of endometrial cancer?

A

Post menopausal bleeding
altered intermenstrual bleeding
rare - pain & discharge

=>55 y/o refer via urgent cancer pathway

44
Q

Investigations for endometrial cancer?

Management?

A

TVUS
(normal endometrial thickness <4mm)

hysteroscopy & endometrial biopsy

Total hysterectomy + bilateral sapling-oophrectomy + post op radio if high risk

progestogen therapy if frail/unsuitable for surgery

45
Q

Investigations for ectopic pregnancy?

A

TVUS (haemoperitoneum/free fluid)

hCG measured 48 hours apart
- increased >60% suggests intrauterine pregnancy but TVUS required 7-14 days later to locate pregnancy

  • Decrease >50% pregnancy unlikely to continue
  • decrease <50 or increase <60% = review @ EPAC within 24 hours
46
Q

Management options for ectopic?

A

Expectant
- stable tubal ectopic, no heartbeat

Medical (methotrexate)
- no sig pain, enraptured and <35mm, serum hug < 5000
- side effects include PV bleeding, abdominal pain/cramping, N&V

Surgical (salpingectomy)
- Pain
- >35mm
- ectopic with visible heartbeat
- serum hcg >5000
- antiD required if rhesus neg

47
Q

Management of chlamydia?

A

Doxy 100mg bd for 7 days
abstain from sex
contact tracing

48
Q

Gonorrrhoea management?

A

1g IM ceftriaxone
test of cure

49
Q

Symptoms of endometriosis

A

cyclical pain
Dyspareunia
Bleeding (heavy menstruation)
Non cyclical pain from adhesions
infertility

50
Q

Management of endometriosis?

A

analgesia
COCP, POP, depo, mirena - stop ovulation and reduce endometrial thickening

GnRH agonist (goserelin)

Surgery

51
Q

Treatment of syphilis?

A

IM Benzylpenicillin
Contact tracing

52
Q

Presentation of molar pregnancy ?

A

Severe hyperemesis
Hypertension
++ hCG
Variation in bleeding
- grape like tissue
- dark brown/red
Thyrotoxicosis
abdominal pain/swelling

53
Q

Diagnosis of molar pregnancy?

A

USS
- bubble
- snowstorm

Serum hCG

54
Q

Management of molar pregnancy?

A

Surgical evacuation with histology performed on tissues.

urine & serum hCG 4 weeks post evacuation
- contraception must be used whilst undergoing follow up

55
Q

Management options for miscarriage?

A

Expectant

vaginal misoprostol
- bleeding should occur within 24 hours
- neg pregnancy test after 3 weeks
- pain relief and antiemetic

surgical
- MVA
- EVA

56
Q

Indications and contraindications for COCP?

A

Indications
- menorrhagia/endo
- reduces risk of ovarian, endometrial and colorectal cancer
- works immediately if day1-5 of cycle (otherwise 7 days)
- can help acne

Contraindications
- Migraine with aura
- VTE history
- <6 weeks post partum
- >35 and smoking >15/day
- hypertension
- AF
- Age =>50

Cons
- human error
- increased cervical and breastr cancer risk
- hormonal side effects
- irregular bleeding

Cautions
age => 40
obesity

57
Q

How does transdermal patch work?

A

oestrogen and progesterone
pros and cons similar to COCP

changed every 7 days, 7 day patch free period allows a bleed.

if falls of less than 48 hours then no need for emergency contraception

58
Q

Pros and cons of levonorgestrel IUS ?

A

Pros
- Safe when breast-feeding
- fertility returns to normal after immediate cessation
- dont need to remember to take a pill
- fewer side effects as hormones act locally on endometrium not systemically
- generally 5 years (3 for some types - jaydess)
- mirena useful for menorrhagia approx 50% amenorrheoic

Cons
- Needs to be inserted within first 7 days of cycle
- 7 days to become effective
- small risk that device will move
- increased risk of ectopic

59
Q

Pros and cons of Copper IUD

A

Pros
- fitted at any point in cycle
- reliable immediately after insertion
- can be fitted immediately after childbirth or 4 weeks later
- effective up to 10 years
-suitable for emergency contraception

Cons
- pain
- perforation of uterine wall
- variable bleeding especially in first 3- months
- risk of ectopic/PID

60
Q

Emergency contraceptive options?

A
  1. Copper IUD
    - most effective
    - <= 5 days UPSI
    - can be left in as LARC
    - if not acting as LARC it must be kept in until next MP
  2. Levonorgestrel
    - <72 hours after UPSI
    - Can immediately start hormonal contraception
  3. Ullipristal (EllaOne)
    - <120 hours post UPSI
    - can reduce effectiveness of hormonal contraception (start 5 days later or use barrier methods)
    - use with caution in asthma
    - cannot breastfeed until 7 days after
61
Q

Indications for digital examination (vagina)?

A

Coil insertion
Bleeding

62
Q

Symptoms to screen for preeclampsia?

A

Headaches
Visual disturbance
Swelling of hands, feet, face
Vomiting

63
Q

Investigations for pre-eclampsia ?

A

BP
Urinalysis - proteinuria
protein/albumin:creatinine ration
Bloods - FBC U&E, LFT, coag, crossmatch & resus if unstable?

Examination
- Reflexes (brisk)
- if clonus present then CCU/HDU
-listent ot chest for pulmonary oedema

64
Q

Management of hypertension/pre-eclampsis?

A
  1. Labetalol
  2. Nifedipine (1st line in asthma)
  3. Methyldopa

If mild/mod pre-eclampsia = delivery within 48 hours

Severe pre-eclampsia = IV mgSulph and immediate delivery

65
Q

Approach to a presentation of hyperemesis?

A

Differentials
- Hyperemesis gravidarum
- Molar pregnancy
- pre-eclampsia

Focused history

investigations
- BP, urinalysis, ophthalmoscopy
- examine - check reflexes listen to chest
- ECG & bloods to assess electrolytes

management - likely admission for rehydration and investigation
- tolerating oral fluids/meds
- managing foods?
- worried about pre-eclampsia or HG
- oral anti-emetics not helping (suggests HG)

66
Q

Drug treatment for hyperemesis?

A
  1. cyclizine/prochlorperazine
  2. metoclopramide/ondansetron
67
Q

Symptoms of ovarian cancer?

A

BEAT
Bloating
Early satiety
Abdo pain
Tell GP

68
Q

Investigations for diagnosis of ovarian CA?

A

Ca125 >35
Pelvic USS (mass)

Calculate RMI
>200 refer to gynae under cancer pway

69
Q

Which gynaecological malignancy has worst prognosis?

A

Ovarian

  • 5 year survival 42%
  • 1 year survival 71%
70
Q

What are you going to ask for any paediatric history taking stations?

A

PC
HPC
- neck stiffness
- N&V
- rashes/bruising
- fever

71
Q

What are reassuring aspects of febrile convulsions?

A

Occur only once
short duration
generalised seizure involving whole body

these simple seizures are generally response to fever from viral infection and often do not warrant any further investigation

Tell parents:
febrile convulsions do not affect developmental delay
They are relatively common
The increased risk of epilepsy following febrile convulsions is very small (2%) compared with 0.5-1% if no febrile convulsions

Discuss importance of recovery position and phoning an ambulance if the parent wants to know how to manage the seizures

72
Q

What is a differential for AF?

A

Ventricular ectopic

73
Q

What investigations would you do for new AF presentation?

A

ECG
Look for cause - bloods,cultures, TFTs

If ECG normal but paroxysmal AF suspected then 24 hour ambulatory monitor

echo if valvular disease suspected/heart failure or cardioversion

74
Q

When is delayed cardio version performed for AF management?

A

Presenting >48 hours after onset but stable.

3 weeks of anticoagulation before cardioversion

75
Q

When is immediate cardioversion indicated for AF and what options are there?

A

Presentation <48 hours or unstable

Electrical cardioversion

Pharmacological - flecanide or amiodarone

76
Q

When is amiodarone preferred for pharmacological cardioversion in AF?

when should flecanide be avoided?

A

Structural heart disease

Atrial flutter

77
Q

Rate control in AF

A

One of:
b-blocker (bisoprolo, atenolol)
Ca channel blocker (verapamil/diltiazem)
- avoided in heart failure
Digoxin

78
Q

When is rhythm control indicated for AF?

A

reversible cause
new onset <48 hours
no response to rate control
heart failure due to the AF

rhythm control is cardioversion or long term therapy with:
1. b-blocker
2. Droneradone (after successful cardioversion)
3. Amiodarone (HF/LV dysfunction)

79
Q

Other than rate/rhythm control what other medication is required for AF?

A

Anticoagulation
1. DOAC
2. Warfarin if doac unsuitable

80
Q

What scoring tools are used in AF?

A

CHADsVASC
ORBIT

81
Q

Management of NSTEMI

A

Beta blocker
Aspirin
Ticagrelor/clopidogrel
Morphine
Anticoagulant (fondaparinux)
Nitrate (GTN)

82
Q

What are complications of an MI?

A

Death
Rupture of papillary musvles
Oedema
Arrhythmia/aneurysm
Dressslers

83
Q

Management of STEMI?

A

PCI within 2 hours
Thrombolysis is 2 hour window passed but still within 12
medical - aspirin & ticagrelor

84
Q

Medications for secondary management post MI?

A

Aspirin
Antiplatelet (clopidogrel)
Atorvastatin
ACEi
Atenolol
aldosterone antagonist (eplerenone) if reduced LVEF

85
Q

Management of pericarditis?

A

ECG

Bloods
- FBC, U&E, LFTs
- Troponin
- CRP
-TFTs

Blood cultures

Treatment = NSAID (& Abx if bacterial)

86
Q

investigation for suspected stable angina?

A

CT coronary angiogram

87
Q

Medical management of stable angina?

A

GTN for acute attack

B-blocker (5mg bisoprolol) or
CCB (5mg amlodopine)

88
Q

Management of unstable angina?

A

300mg aspirin
Fondaparinux

Calculate grace score
if high risk then immediate angio and consideration for PCI

low risk (clopidogrel & aspirin)

89
Q

How would you investigate and manage a new hypertension diagnosis?

A

Investigations
BP - home readings/ambulatory
ECG
Bloods - HbA1c, U&E, cholesterol
ophthalmoscopy - signs of hypertensive retinopathy
?urine dip for protein

calculate risk if greater than 10% give statin

meds

annual review

90
Q

Important symptoms to screen for HF?

A

Orthopnoea
PND
SOB
Oedema

91
Q

Management of HF?

A

ACEi (10mg ramipril)
B-blocker (10mg bisoprolol)
40mg Furosemide (helps with symptoms)
Spiron (aldosterone antagonist) if reduced LVEF or not controlled by A&B

92
Q

Investigations for HF

A

NT-pro BNP
Echo & ECG

93
Q

How does acute LVF differ from HF?

A

Blood cannot move into aorta from LV so get backlog from LV to lungs causing:

Acute breathlessness (worse on lying)

May have S3 and basal crackles (pulmonary oedema)

Cardiomegaly

T1 rest failure

Management:
Stop IV fluids
Sit up
Oxygen
Diuretics (40mg IV furosemide)

Inotropes in HDU

94
Q

What scoring system is used to decide if PE likely?

A

Wells

95
Q

How should a patient be managed with a Wells score suggestive of PE?

A

CTPA

96
Q

How should a patient be managed if a Wells score suggests PE is unlikely but clinically you still suspect?

A

D-dimer
Consider CTPA

97
Q

What will an ABG show for an acute PE?

A

Resp alkalosis

98
Q

Management of PE
- Regular
- Massive

How long does treatment continue?

A

Anticoagulation - apixaban/rivaroxiban/LMWH
(LMWH in pregnancy or malignancy)

Thrombolysis

3months if obvious reversible cause
6 months if no clear cause/recurrent/malignancy

99
Q

UMN signs

A

Hypertonicity
Hyperreflexia
Spastic gain
Extensor plantar reflex

100
Q

LMN signs

A

Muscle wasting
Weakness
Fasciculations
Absent or reduced reflexes

101
Q

When should motor neurone disease be considered?

A

Motor symptoms
absence of sensory. symptoms

102
Q

Acute MS flare

A

steroids - methylpred IV

5th Year (5 decks)

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