General Flashcards
1
Q
Fever, diarrhoea (non bloody, yellow green) , abdo pain, constipation, rose spots (small pink spots on abdomen) - organism
A
Salmonella typhi - typhoid
2
Q
2 types systemic sclerosis, symptoms and Abs associated with each
A
Limited cutaneous = raynauds, scleroderma affects face + distal limbs first. Anti-centrometer abs. CREST Syndrome
Diffuse cutaneous systemic sclerosis = scleroderma affects trunk and proximal limbs. Anti-scl-70 Abs. Most common cause death is respiratory involvement
3
Q
In the context of tachyarrhythmia and SBP<90 what is the immediate management
A
DC cardio version
4
Q
Acute HF not responding to treatment - what might be useful to use when severe dyspnea
A
CPAP
5
Q
Flashes and floaters with no redness or pain - dx
A
Vitreous/retinal detachment
6
Q
Acute vs prophylaxis migraines
A
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
7
Q
Inguinal hernia in infants vs umbilical hernia mx
A
Inguinl hernia in infants = urgent surgery
Umbilical - can be left up to a year as can resolve
8
Q
Mx of symptomatic bradycardia if atropine fails
A
External pacing
9
Q
Raised ICP causing third nerve palsy - how?
A
Trans-tentorial herniation
The combination of a fixed and dilated pupil with an eye deviated inferiorly and laterally (‘down and out’) is indicative of a third nerve palsy. In the context of a decreasing conscious level and an intracranial mass (the haematoma) this is indicative of a trans-tentorial, or uncal, herniation.
10
Q
What is cerebellar tonsillar herniation
A
Cerebellar tonsillar herniation affects the medulla oblongata and is often a terminal event in an unconscious patient resulting in asystolic cardio-respiratory arrest. Although a classical cause of a third nerve palsy, a posterior communicating artery aneurysm is not the most likely cause here given the history of trauma and an intracranial mass. Frontal eye field injury would cause a functional ocular paralysis and the eye would tend to the neutral position in a state of reduced consciousness. Optic nerve compression would not cause deviation of the eye.
11
Q
Scoring system for acute pancreatitis
A
There are several scoring systems used to identify cases of severe pancreatitis which may require intensive care management. These include the Ranson score, Glasgow score and APACHE II.
The specifics of each scoring system will not be repeated here. However, some common factors indicating severe pancreatitis include:
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
Note that the actual amylase level is not of prognostic value.
12
Q
IgA nephropathy vs Post-strep glomerulonephritis
A
IgA nephropathy - visible haematuria after recent URTI
Post strep glomerulonephritis 1-2 weeks after URTI and ass with proteinuria. From bacteria (strep)
13
Q
Rapidly enlarging aneurysm or over 5.5cm needs surgery - which type surgery (not blown)
A
Elective end-vascular aneurysm repair
I blown (unstable) need urgent and that has to be open
14
Q
What type of stoma is used to defunciton colon to protect anastomosis
A
Loop ileostomy
15
Q
Episcleritis vs scleritis
A
Scleritis is painful
16
Q
Caput Succedaneum vs cephalhaematoma
A
Caput succedaneum is a puffy swelling that usually occurs over the presenting part and crosses suture lines
(Starts with s so spreads)
Cephalhaematoma - haemorrhage between skull and peritoneum and limited by boundaries of cranial bones.
(starts with h so halts at suture lines)
17
Q
At what age do you refer women with unexplained breast lump for cancer referral
A
Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral
18
Q
First line treatment delirium tremens
A
Chlordiazepoxide
19
Q
Acute reactive arthritis (eg with urination prob, itchy eyes etc after stomach bug) management
A
nsaid- ibUPROFEN IF NO ci
(can’t see can’t see can’t climb a tree with reactive arthritis)
20
Q
Miscarriage mx
A
NICE guidelines recommend expectant management as first line in the treatment of miscarriage, unless one of the following factors is present: there is an increased risk of bleeding, there are previous adverse experiences associated with pregnancy, there is increased risk from the effects of haemorrhage or there is evidence of infection. The most appropriate option in the above case, which represents an infected miscarriage with the patient progressing to septic shock, is to evacuate the pregnancy as soon as possible through surgical management.
21
Q
Symptoms hypomania in primary care - mx
A
Routine referral to CHMT
22
Q
If neoplastic spinal cord compression is suspected, what is Mx
A
High dose oral dexamethasone
23
Q
Hypercalcaemia vs hyperkalaemia on ecg
A
Hypercalcaemia = shortening QT interval but
Hyperkalaemia is tall tented t waves
24
Q
In step down treatment asthma what to do with ICS
A
In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids
ie, half ICS dose and review in 6m
25
Confirmed miscarriage vs threatened
A transvaginal ultrasound demonstrating a crown-rump length greater than 7mm with no cardiac activity is diagnostic of a confirmed miscarriage
Threatened = get pains etc but stilll have signs life
26
Sinusitis prophylaxis if recurrent episodes is...
Intransala corticosteroids
27
Myxoedemic coma treatment
Thryoxine and hydrocortisone
28
Thyrotoxic storm tx
Beta blockers,
Propylthiourical
Hydrocortisone
29
Ectopic pre first surgery
Salpingectomy is first line for women with no other RFs for infertility
30
Intrahepatic cholestasis mx
Increases risk still birth so elective induction of el from 37 weeks
Tx of the condition is ursodeoxycholic acid
31
Common drugs for causes of urinary retention
Opioid analgesia (tramadol) and anticholinergic drugs
32
DKA - what insulin do you have and continue vs stop
In the acute management of DKA, insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
33
what is the status
Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg implies chronic HBV infection
34
Initial bloods/tests for screening when erectile dysfunction
HbA1C
Lipids
Testosterone
35
When to add a second drug in T2DM
A second drug should be added in type 2 diabetes mellitus if the HbA1c is > 58 mmol/mol
36
Anterior uveitis treatment
Steroid eye drops with mydriatic eye drops
37
Vestibular neuronitis vs viral labyrinthitis
VN + layrinthtis = Dizziness, off balance, sickness, tinnitus
But unaffected hearing points more to vestibular neuritis and in viral labyrinthitis you would expect a preceding viral infection
38
Correcting sodium levels rapidly - the complications (hypo correction vs hyper correction)
Correcting sodium levels rapidly is dangerous:
Hyponatraemia correction - osmotic demyelination syndrome
Low to high- brain will die
Hypernatreamia correction - cerebral oedema
High to low brain will blow
Because if you have high sodium then u must be dehydrated so if you correct you pump loads of water and it swells
39
Acute dystonia secondary to antipsychotics - management
Procyclidine
40
Psoriasis - which medication can worsen it???
A. Lithium
B. Amoxicillin
C. Clindamycin
D. Methotrexate
E. Amlodipine
Lithium
Also BBlockers
41
Resus fluids for paeds
10ml/kg over <10
42
What Ix to do before starting biologics fro RA
CXR- to check for TB as biological can cause reactivation
43
If metformin is not tolerated due to GI side effects, what do you do
If metformin is not tolerated due to GI side-effects, try a modified-release formulation before switching to a second-line agent
44
Most common secondary cause of hypertension and the Ix
Primary hyperaldosteronism (Conns syndrome)
Renin aldosterone ratio
45
Whilst a patient is receiving PCA opioids then what drugs to stop in normal meds
Stop all other opioid to avoid toxicity
46
When babies are suspected cows milk protein intolerance, what might you prescribe for mum when she is cutting out cows milk from diet
Calcium and vitamin D
47
Investigating a PE: If the CTPA is negative then what Ix is next steps
Proximal leg vein doppler US
48
Bonocular vision post facial trauma - what type of fracture and which bone does this suggest
Bonocular vision post facial trauma is suggestive of depressed fracture of zygoma
49
Interpretation of pupillary findings in head injuries
50
where should IV amiodarone be given and why?
Into central vein as it is a common cause of thrombophlebitis
51
Confidentiality regarding HIV diagnoses to partner
You may disclose information to a known sexual contact with a patient with a sexually transmitted serious communicable disease if you have reason to think that they are at risk of infection and that the patient has not informed them and cannot be persuaded to do so.
(Give pt opportunity to tell them and inform them that if they don't you will have to)
52
Pt presents with bones, stones, abdomen groans and psychic moans. Their bloods show raised calcium, low phosphate and PTH may be raised (or inappropriately normal due to raised calcium)
Pepperpot skull
Diagnosis
Primary hyperparathyroidism
53
Features of heparin induced thrombocytopeniaa and what Abs are presents
- Abs form against completes of platelet factor 4 and heparin
- - These abs binds and indie platelet activation
- Usually doesn't develop until after 5-10 days of treatment
- Despite low platelets association it is prothombrotic
54
Sudden painless loss vision, severe retinal haemorrhages on fundoscopy - diagnosis
Central retinal vein occlusion
55
A 49-year-old man is brought into ED after he was found on the side of the road unconscious. The paramedics give a history of alcohol abuse. You ask the nurse to perform a set of basic observations, capillary blood glucose (CBG) and an ECG.
His basic observations are: a temperature of 35.9ºC, blood pressure 190/110 mmHg, heart rate 51 beats/min, respiratory rate is 24 breaths/min (Cheyne-Stokes breathing), oxygen saturations 95% on air. His Glasgow coma scale is 4/15 (E1V1M2).
Capillary blood glucose comes back as 10.1.
The ECG shows T wave inversion in all leads and QT prolongation.
What is the most likely diagnosis?
Head injury
(Global T wave inversion - think non cardiac cause of abnormal egg)
56
T2DM initial therapy - if metformin is contraindicated and patient has a risk of CVD, established CVD or chronic HF then what medication to start
SGLT-2 mono therapy
57
A 57-year-old man presents to the emergency department with a 2-day history of right upper quadrant abdominal pain. His past medical history is remarkable for type 2 diabetes mellitus and alcohol excess.
There are no clinical signs of jaundice, and the patient denies pale stools or dark urine.
An ultrasound of the biliary tree shows no gallstones, demonstrating some regional lymphadenopathy. Further imaging is suggestive of extramural compression of a branch of the biliary tree.
Given this information, where is the most likely location of the lesion?
Ampulla Vater, common bile duct, common hepatic duct, cystic duct, sphincter odd
Cystic duct - blockage of cystic duct or gallbladder doesn'tcause jaundice
58
Pt presents with petechia, pupa, bleeding and isolated thrombocytopenia - what is dx and mx
ITP
Orla prednisolone
59
In compartment syndrome - what biochemical abnormality is most likely seen and why
Alkalosis, hypercalcaemia, hypocalcaemia, hyperkalaemi, hyponatraemia
Hyperkalaemia - muscle death causes release potassium and probably degree of renal impairment
60
Headaches, amenorrhoea, visual field defects- dx
Prolactinoma
61
What is useful for helping prevent attacks of Menderes disease vs acute attacks
Betahistine and vestibular rehab for prevention
Acute - buck or IM prochlorperazine
62
What Abs has a side effect of rash with infectious mononucleosis
Amoxicillin
63
What Abs have side effect cholestasis
Co-amox
Flucloxiicllin
64
Side effects trimethoprim
Rashes - photosensitivity
Prutitis
oppression haeamtopeisis
65
Most common organism causing cholangitis
E.COLI
66
Question 44 of 50
An 83-year-old male is referred to the ophthalmology clinic by his general practitioner with a new-onset inability to see objects near to him, especially at night. On fundoscopy, the doctor notices well-demarcated red patches. He has a past medical history of hypertension and he is a life-long smoker.
Given the most likely diagnosis, which one of the following is the most appropriate treatment?
AMD - Anti VEGF
This patient has the characteristic signs and symptoms: a reduction in visual acuity, particularly for near field objects, worse at night and red patches representing intra-retinal or sub-retinal fluid leakage or haemorrhage visible on fundoscopy.
67
What monitoring is needed on methotrexate
FBC U&E LFT
68
Monitoring needed on levetiracetam
No routine monitoring needed
69
monitoring needed on amiodarone
TFT LFT
70
Pacenta accrete, increta, percreta
Accrete = chorionic villi attach to myometrium, rather than being restricted within decide basalts
Increate = chorionic villi invade into myometrium
Percreta = chorionic villi invade through perimetruym
71
A 48-year-old man presents to his GP with a number of symptoms that have come on over the past few days. His vision is blurred and his right eye is painful, as well as having a generalised headache.
On examination, the right eye has deviated inferiorly and laterally. There is visible ptosis of the upper right lid, and the pupil is dilated. It does not respond to light. This eye does not follow movements well, but the left eye appears unaffected and is normal upon testing.
Where is the most likely location of the lesion?
Posterior communication artery (aneurysm) - painful third nerve palsy
72
Loss of vibration sense, ataxia and absent ankle reflexes with recent gastrectomy - dx
Subacute degeneration of cord
73
2nd most common ass cancer in HNPCC after CRC
Endometrial cancer
74
Mechanism of controlled hyperventilation as a management in raised ICP
Hyperventilation -> reduce co2 -> vaoconstrict cerebral arteries -> reduce ICP
75
Hypokalaemia EGC findings
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
76
A baby is noted to have micrognathia (post displacement of tongue) and a cleft palate. He is placed prone due to upper airway obstruction. There is no family history of similar problems
Diagnosis
Pierre robin syndrome
77
If a mild-mod flare of UC doesn't respond to topical OR oral aminosalicylates then what to add
Oral corticosteroids
78
Acriomioclavicular joint injury - grades and mx
Injury to the AC joint is relatively common and typically occurs during collision sports such as rugby following a fall on to the shoulder or a FOOSH (falls on outstretched hand).
AC joint injuries are graded I to VI depending on the degree of separation.
Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling.
Grade IV, V and VI are rare and require surgical intervention.
The management of grade III injuries is a matter of debate and often depends on individual circumstances.
79
Young females with suspected appendicitisis - next step in iX
US abdomen - helps rule out ovarian pathology and/or increase suspicion of appendicitis
80
Young females with suspected appendicitisis - next step in iX
US abdomen - helps rule out ovarian pathology and/or increase suspicion of appendicitis
81
Young females with suspected appendicitisis - next step in iX
US abdomen - helps rule out ovarian pathology and/or increase suspicion of appendicitis
82
MRCG grading for muscle weakness
83
In tx anaphylaxis - how often can you repeat adrenaline and salbutamol inhalers?
Every 5 mins
84
In people with achalasia and the dysphagia has worsened with a mass on oesophagus - what type of cancer
Squamous cell carcinoma - this is increased risk in achalasia
85
NYHA Classification of CHF
NYHA Class I
no symptoms
no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations
NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
86
Contact lens wearers with red painful eye - mx
refer to eye casualty to exclude microbial keratitis
87
Confusion, pink mucosa - dx
CO poisoning
88
A 42-year-old male presents to her general practitioner with a 2-week history of asymmetrical oligoarthritis predominantly affecting his lower extremities, associated with dysuria and conjunctivitis. He is usually well apart from suffering from a diarrhoeal illness 1 month ago.
What is the most appropriate first-line management of this patient?
NSAIDs - acute reactive arthritis
89
Scleritis vs episcleritis
Scleritis = Red eye, classically painful, watering and photophobia are common, gradual decrease in vision
Episcleritis is classically not painful
90
Hypertensive retinopathy on fundosocpy - grading system
I - arteriolar narroing and tortuosity, increased light reflex (silver wiring)
II - AV nipping
III - cotton wool exudates, flame and blot haemorrhages
IV - Papilloedema
91
Cholangiocarcinoma vs pancreatic cancer
Cholangio - may present with persist symptoms of biliary colic and very rare ass with IBD
Pancreatic - lost weight, onset fatigue, Rfs liek DM, jaundice, enlarged gallbladder (may feel mass). No pain
92
Tx diabetic maculopathy (if proliferative retinopathy also)
Panretinal photocoagulation and intravitreal VEGF.
VEGF - maculopathy
Panretinal photocoagulation for proliferative retinoopathy
93
rules for weight bearing after hip fracture surgery
immediate unrestricted weight bearing in all
94
Mx HUS
supportive - fluids + dialysis as example
95
Mx ACS when o2 >94% and hypotensive and going PCI
Aspirin + ticagrelor + fondaparinux
no nitrates as hypotensive
96
clubfoot - position of foot
Inverted + plantar flexed foot which is not passively correctable
97
Women with suspected PCOS should have which Ix....
Pelvic US, FSH, LH, Prolactin, TSH, Testosterone, sex hormone binding globulin
98
Factors fvaoruign rhythm control in AF
Age <65
First presentation
Symptomatic
99
BMI >50 first line mx
Bariatric surgery
100
When is a missed pOP - desogestrel vs traditional
Traditional <3hrs
Desogstrol <12hrs
101
Wells score and cut off for CTPA
PE likely = >4 points - CTPA
PE unlikely = <4 points - D dimer (if neg then stop anticoagulant)
102
Treatment for salicylate overdose
Urinary alkalisation with iV bicarb, haemodialysis
103
Opioid overdose Tx
Naloxone
104
Benzodiazepine overdose tx
Flumazenil
105
Tricyclic antidepressant overdose tx?
No specific antidote but IV bicarb can help educe risk seizures etc
Might need dialysis to help remove
106
Heparin overdose mx
Protamine sulphate
107
Ethylene glycol and methanol poisoning antidote
Ethanol (now fomepizole mosltyly)
108
Organophosphate insecticide overdose mx
Atropin
109
Digoxin overdose mx
Digoxin specific antibody fragments
110
Mx PPH order
RCOG guidelines then suggest to initially use Syntocinon 5 Units by slow IV injection.
This should then be followed by ergometrine (contraindicated in hypertension) and
then a Syntocinon infusion.
Carboprost (contraindicated in asthma) and then misoprostol 1000 micrograms rectally are then recommended. If pharmacological management fails then surgical haemostasis should be initiated.
111
High uric acid and renal impairment following chemo - what s the diagnosis and how to prevent
tumour lysis syndrome
If high risk then IV Allopurinolc or IV rasburicase prior and during first days of she,o
(high potassium and high phosphate in presence low calcium_
112
Bets induction agent for haemodynamically unstable patients in anaesthesia
Ketamine
113
Downs syndrome on combined screening test
Increased HCG, Decreased PAPP-A, thickened nuchal translucency
114
Pt develops acute heart failure 5 days after MI. New pan-systolic murmur is noted on exam -dx
VSD
115
Carpal tunne syndrome - what happens in nerve conduction evlauation (to action potential in sensory and motor axons)
Prolongs
116
Renal failure, sensorineural hearing loss and ocular abnormalities in a child - dx
Alport syndrome
117
Suspected DVT and raised D dimer but scan negative - what to do (already on anticoagulant)
Stop anticoagulant and repeat scan in 1 week
118
Pain on radial side wrist/ tenderness over radial styled process - dx
De Quervains tenosynovitis
119
Trnsvers myelitis vs GBS on reflexes
GBS = hyporflexia
Transverse myelitis= hyperreflexia
120
What score is useful to assess hypemrobility
Beighton score - positive if at least 5/9 in adults or least 6/9 in children
121
S/E Isoniazid
Peripheral neuropathy, hepatitis, agranulocytosis
122
S/E pyrazinamide
Hyperuricaemia causing gout
Arthralgia, myalgia, hepatitis
123
S/E ethambutol
Optic neuritis - check visual acuity before and during
124
S/E Rifampicin
Hepatitis, orange secretions, flu-like symptoms
125
Signs digoxin toxicity
Generally unwell - lethargy, N&V, anorexia, confusion, yellow-green vision, arrhythmias (av BLOCK), GYNAECOMASTIA
126
Inferior mI and aortic regurgitation murmur with taring chest pain - dx
proximal aortic dissection
127
A 78-year-old man presents to emergency department with sudden onset, severe, diffuse abdominal pain at 7:30pm after finishing his evening meal. It is intermittent and severe in nature. However the abdomen is soft on examination. While in hospital he suffers from 1 episode of non-bloody emesis. Initial imaging does not yield any diagnosis. He has a history of GORD, hernia repair, hypertension, myocardial infarction and atrial fibrillation. What is the most likely diagnosis?
ischaemia colitis - pain after meal, with predisposing factors
128
What might be one of the earliest symptoms in aspirin overdose
Tinnitus
129
Reversal agent for dabigatran/ bleeding on dabigatran
Idarucizumab
130
A 65-year-old man presents with difficulty swallowing which has been present for 6 months and has been getting worse over the past few weeks. The dysphagia occurs to both solids and fluids equally. He has also noticed some chest pains recently, especially after eating. A barium swallow shows a dilated oesophagus that tapers at the lower oesophageal sphincter.
What is the most likely diagnosis?
Achalasia
131
What ECG abnormality ub Subarachnoid space
Polymorphic ventricular tachycardia
132
Which gene translation is bursitis lymphoma ass with
C-Myc gene translocation
133
What is the risk of SSRI + NSAID and how to treat this
Increased risk gI bleeding when aspirin/ NSAIDs are combine with SSRIs so offer PPI like lansoprazole (as in IHD you can't just stop aspirin)
134
Red facial rash which looks greasy and fine scale over affecting cheeks, nasolabial folds, eye brows, nasal bridge and scalp
Dx
Seborrheic dermatitis
135
if the Bishop score is
vaginal PGE2 or oral misoprool for induction labour
score 5 or less suggests labour unlikely o start without induction
136
If Angie is not controlled with a Beta blocker - what do we use
Longer acting dihydropyridine CCB like amlodipine
137
lentigo maligna
138
Addisons with intercurrent illness - does glucocorticoids and fludrocortisone dose stay same
No
Double hydrocortisone, same fludrocortisone
139
Small bowel obstruction
140
Bone pain, tenderness, proximal myopathy (waddling gait) and low calcium, low phosphate, high ALP, low Vit D, high PTH
osteomalacia
141
Prolactinoma Tx
Mostly treated with dopamine agonist (bromocriptine) which inhibit release prolactin from pituitary gland.
Surgery si for those who can't tolerate or fail to respond to medical therapy (transphenoidal)
142
A 65-year-old lady has recently had a colonoscopy and been found to have a malignant tumour in the most distal portion of the rectum, involving the anal sphincter.
which surgical procedure
Abdominoperineal (AP) resection
Rectal cancer on anal verge - abdomino-perineal excision of rectum
143
Blood stained nipple discharge
Duct papilloma
144
Grene brown discharge of the nipple + red, swollen
Duct ectasia
145
Upper rurinary tract obstruction causing hydronehrosis - primary mx
nephrostomy
146
A 35-year-old woman presents with a one week history of progressive leg swelling. Her past medical history includes type 2 diabetes which is diet-controlled. On examination, there is bilateral pitting oedema up to her knees and periorbital oedema. Her observations are heart rate 88/min, blood pressure 151/91mmHg, oxygen saturations 97%, temperature 37.1ºC, and respiratory rate 14/min. Urine dipstick shows protein +++. Two days later, she complains of left-sided flank pain and haematuria.
What complication has occurred?
A. Haemorrhage into renal cyst
B. Splenic infarction
C. Renal vein thrombosis
D. Haemolytic crisis
E. Ureteric stone
Nephrotic syndrome Is ass with hyper coagulable state due to loss of antithrombin III via kidneys and therefore here - renal vein thr0ombpsis has occurred
147
Stooping of vol movement or staying still in unusual position with schizophrenia
= Catalonia
148
A 21-year-old male presents to the emergency department with a cough, fever and dyspnoea. On examination he is hypoxic. Pulmonary infiltrates are seen on chest x-ray. He has suffered with anaemia, jaundice and general weakness since the age of 3 months, as well as severe pain when exposed to cold conditions.
sickle cell disease
Acute chest syndrome is a complication of sickle-cell disease and presents with dyspnoea, chest pain, cough, hypoxia and new pulmonary infiltrates seen on chest x-ray
149
What would you see on synovial fluid for reactive arthritis
Cloudy yellow colour, Culture negative, No crystals, White cell count: 20,000/mm
150
What is the threshold for platelet transfusion
Platelet transfusion is appropriate for patients with a platelet count < 30 x 109 and clinically significant bleeding
151
Which cancer can CLL transofrm into and what is this called
Richeters transformation - high grade lymphoma (non Hodgkins)
152
Bilious vom in kids
153
All breech babies at, or after 36 weeks gestation - what do they need
DDH screening at 6 weeks regardless mode del
154
What is the main benefit of prescribing albumin when treating large volume ascites'?
A. Reduce postparacentesis circulatory dysfunction
155
Patients who have had an episode of SBP require antibiotic prophylaxis
which one
ciprofloxacin
156
Primary hgyperaldosteronism (conn syndrome) treatment
Spironolactone
157
Acut edelirium tx when Parkinson's disease
lorazepam
158
A 55-year-old woman presents to the emergency department with a sudden onset of central chest pain while she was at rest. The pain was not relieved by her glyceryl trinitrate spray. She has a past history of angina and hypertension. ECG and cardiac biomarkers were positive for an ST-elevation myocardial infarction (STEMI).
A few minutes later, she complained of worsening shortness of breath. On examination, her pulse was weak and thready. Her jugular venous pressure is increased. On chest auscultation, there was a new systolic murmur. Her pulse rate was 130 beats per minute and blood pressure was 80/55 mmHg. There were no new acute changes to the ECG.
mitral regurgitation
159
Next course of action after WLE with sentinel LN biopsy Neg
radiotherapy
160
first line for stroke
non contrast ct head
161
How do BB work in open angle glaucoma
Reduced aqueous section by ciliary body
162
PANCREAS severity scoring system for pancreatitis
P - PaO2 <8kPa
A - Age >55-years-old
N - Neutrophilia: WCC >15x10(9)/L
C - Calcium <2 mmol/L
R - Renal function: Urea >16 mmol/L
E - Enzymes: LDH >600iu/L; AST >200iu/L
A - Albumin <32g/L (serum)
S - Sugar: blood glucose >10 mmol/L
163
preferred anti platelet for secondary prevention after stroke
clopidogrel
164
otitis externa mx
Topical gentamicin + hydrocortisone drops
165
A 55-year-old woman presents to the emergency department with progressive weakness of the arms and legs bilaterally that started today. She has also been getting progressively more tired, with some episodes of sweating. Her past medical history includes hypertension, diabetes and a transient ischaemic attack (TIA) 6 months ago. She is taking clopidogrel, metformin, gliclazide and ramipril. On examination, she appears confused and drowsy. She has 4/5 power on both arms and legs.
most appropriate next ix in this patient
capillary blood glucose
166
Widened QRS or arrhythmia in tricyclic overdose mx
iv bicarb
167
acute flare mx ra
methylprednisolone iM
168
in palliative patients - what is the pain relief choice when renal impairment
Oxycodone
169
when is clinical jaundice on bilirubin level
when it hits 50
170
props in household contacts meningitis
ciprofloxacin
171
In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked before commencing EPO
Iron status
172
A 72-year-old patient presents to her general practitioner complaining of a 6-month history of unexplained weight loss. She reports that she has also noted yellowing of her eyes and skin over the same time period, but denies any abdominal pain or fever. Her past medical history is significant for ulcerative colitis (UC) and primary sclerosing cholangitis (PSC), both of which presented in her 30's.
On examination, the woman is cachectic and jaundice. Her abdomen is soft and non-tender, with palpable peri-umbilical lymph nodes. The gallbladder is non-palpable.
dx
cholangiocarcinoma
173
>= 75 years following a fragility fracture
mx
Start alendronate in patients >= 75 years following a fragility fracture, without waiting for a DEXA scan
174
dose adrenaline in ALS
Recommend Adult Life Support (ALS) adrenaline doses
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
175
Which is a depolarising muscle relaxant
Suxamethonium
176
MOA flumenazil
GABA antagonist
177
Sudden onset vertigo and vomiting, dysphagia, ipsilateral facial pain + temp loss, contralateral limb pain and temp loss and ataxia
Which artery is the stroke in
Posterior inferior cerebellar artery
178
Mx status epilepticus
1. ABC
2. IV benzos or in pre hospital rectal (diazepam/lorazepam).
3. In hospital IV lorazepam mostly used and can be repeated once after 10-20mins
4. If ongoing then phenytoin/phenobarbitl infusion
5. If no response in 45mins from onset then induction general anaesthesia
179
What can GBS be triggered by
surgery involving GI or respiratory tract, infection
180
Symptoms GBS
Weakness ascending
Reflexes reduced or absent
Sensory symptoms tend to be mild
Hx gastroenteritis poss
May have Resp muscle weakness, CN involvement, autonomic involvement...
181
Ix in GBS
Lumbar puncture - rise in protein, normal WBC
Nerve conduction studies - decreased motor nerve conduction velocity, prolonged distal motor latency, increased F wave latency
182
Defintion malnutrition
unintentional weight loss greater than 10% in last 3-6months
183
Breast cancer referral - urgent vs non urgent
Cance pathway =
30 + with UE lump or without pain OR
50+ with any: changes in one nipple (discharge/retraction/othe changes of concern)
Non urgent if <30 with UE breaks lump with or without pain
184
Initial mx od open fractures
IV ABS, photography of wound, application of sterile soaked gauze and impermeable film
185
Women aged >30 with dysmenorrhoea, menorrhagia, enlarged boggy uterus = dx
Adenomyosis - endometrial tissue grows in myometrium. More common in older females approaching menopause
186
normal as all above green line
187
Horners syndrome - how does anihydrosis determine lesion
Horner's syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast's, cervical rib
absent = post-ganglionic lesion: carotid artery
188
When ACEi aren't tolerated - which medication next
ARB
189
7. A 28-year-old man is playing tennis when he suddenly collapses and has a GCS of 4 when examined.
which type haemorrhage
Subarachnoid - sudden collapse and loss consciousness
190
A 78-year-old man is brought to the emergency department by the police. He is found wandering around the town centre and is confused. His family report that he is usually well apart from a simple mechanical fall 3 weeks previously from which he sustained no obvious injuries.
which type haemorrhage and acute vs chronic
Chronic sub dural haematoma
191
Hepatic encephalopathy mx
Lactulose
192
Diagnosis:
Younger females, Asian
Systemic features - malaise, headache
Unequal bloo depressor ein upper limbs
CAROTI BRUIT + TENDERNESS
absent or weak peripheral pulses
Upper and lower limb claudication one exertion
Aortic regurgitation in some
Takayasus arteritis -
Ix - MRA/CTA
mx is steroids
193
Flush to the skin stoma - which type
Colostomy
194
What is the most common cause primary headache in children
Migraine - unilateral, pulsating, 4-72hrs, exacerbation by routine activity
195
Cluster headache mx
Acute = 100% o2, submit triptan
Trophy = verapamil
196
Mx of abdominal wound dehiscence
Coverage of wound with saline impregnated gauze + iV broad-spectrum Abxs
197
Which type pneumonia is as with eryisipelas
Streptococcus pyogenes
198
dysentery, liver abscesses, colonic abscesses, or inflammatory masses in the colon
which organism
Entamoeba histolytica
199
cause of recurrent watery or sticky eye in neonates and usually, self-resolves by 1 year of age
Congenital tear (lacrimal) duct obstruction
200
Primary VS Secondary vs Tertiary Hyperparathyroidism
Primary = hypercalcaemia with raised o inappropriately normal PTH. PTH levels are generally elevated. Renal impairment commonly seen in it as a consequence of dehydration
Secondary hyperparathyroidism is incorrect. This occurs as the physiological response to hypocalcemia. Kidney failure and vitamin D deficiency are the most common causes of secondary hyperparathyroidism. The key biochemical features are hypocalcemia and a raised PTH. A raised ALP also occurs due to excessive bone resorption. Phosphate levels will vary with aetiology e.g. raised in kidney failure and decreased in vitamin D deficiency.
Tertiary hyperparathyroidism is incorrect. This occurs when an excess of PTH is secreted by the parathyroid glands, usually after longstanding secondary hyperparathyroidism results in hyperplasia of the parathyroid glands. It biochemically presents the same as primary hyperparathyroidism with raised calcium and elevated PTH. Although this remains a possibility, the patient only has mild renal impairment making this a less likely diagnosis. Furthermore, the phosphate level would generally be high in tertiary hyperparathyroidism (due to reduced renal clearance).
201
For moderate/severe OCD + SSRI is contraindicated - what is the drug to use
Clomipramine
202
Clustered erythematous papule around the mouth (perioral) but also perinatal and pericoular. Skin immediately adjacent to vermillion border of lip is often spared. What is the dx and mx
Perioral dermatitis
Topical and oral antibiotics
Steroids can worsen symptoms
203
Obese T2 diabetic is on metformin but HbA1C is 64. What second line meds may be helpful
DPP-4 inhibitors
204
What are the grades of hepatic encephalopathy
Grade I - irritability
Grade II - confusion, inappropriate behaviour
Grade III - incoherence, restless
Grade IV - coma
205
In SIADH what happens to Sodium
Low
206
Ulcerative colitis and cholestasis - diagnosis
PSC
207
Brigade syndrome vs arrhythmogenic right ventricular cardiomyopathy (ARVC)
ARVC = T wave inversion V1-3
Brigade - ST elevation V1-3
208
Patient with AF and acute stroke - when to start anticoagulant therapy after event
2 weeks
209
Which class is liraglutide and how it is given
GLP-1 receptor - protons weight loss - injections
210
Class of meds that empagliflozin is and s.e
SGLT-2 inhibitor - weight loss.
211
Less severe vs more severe depression on the pHQ-9 score
Score <16 = less severe
More severe s >/16
212
What level do you need a platelet transfusion
90 x 10^9/L
213
ECG changes in hyperkalaemia
Tall tented t waves
Small p waves
Widened QRS - sinusoidal pattern and asystole
214
Plummer vinson syndrome
Dysphagia, glossiis, IDA
215
First line treatment for lichen plants
Topical steroids
216
Greek boy develops pallor and jaundice after having a lower respiratory tract infection. He has a history of neonatal jaundice. The blood film shows Heinz bodies
G6PD Def
217
Tx of choice for Toxic multi nodular goitre
Radioactive iodine
218
Tx uveitis
Steroid and cycloplegia (mydratic) drops
219
,Mx pts with acute ischaemic stroke presenting in 4.5hrs
Thrombolysis AND thrombectomy
220
Acute dystonia - what is this
Sustained muscle contraction like torticollis or uculogyric crisis
221
Which type of stoma is spouted
Ileostomy - prevent skin coming into contact with enzymes in small intestine
222
Aspirin overdose mx
Activated charcoal if <1hr ingestion
IV bicarb - can be used later down the lie
223
Pruritis (worst after taking showers or hot baths).
Tingling, burning, and numbness in arms, hands, and feet.
Headaches and lethargy.
Splenomegaly.
Elevated haemoglobin on full blood
dx and mx.
Polycythaemia vera
Venesection first line
224
How to decide which surgery needed for ectopic
Sapingectomy first line for women with no other RFs for infertility
225
Dyspepsia (indigestion) and nausea and elevated platelet count - next step mx
Urget upper gastro endoscopy
Thrombocytosis can occur in context malignancy as reaction to inflammation
226
cAPUT SUCCEDANEUM VS Cephalohaematoma
Succedanum = cross suture lines
Haematoma - H for halt os doesn't cross suture lines
227
Which Abx for brain abscess
Ceftriaxone and metronidazole
228
Reverse agent rivaroxaban
Andexanet alfa
229
Cerebellar signs, contralteral sensory loss and ipsilateral Horners
Lateral medullary syndrome - Posterior inferior cerebellar artery
(App side artery to the leg/arm problems)
230
Crown rump length greater than 7mm with no cardiac activity - what is this
Diagnostic of miscarriage
231
High reticulocyte count - what can this suggest
Increased destruction (eg haemolytic) or increased los (bleeding) of red cells
232
A/E of aromatase inhibitors (anastrozole)
Osteoporosis, hot flushes, arthralgia, myalgia, insomnia
233
First and second line meds for GAD
1. SSRI
2. SSRI or SNRI
234
Communicating hydrocele mx in newborn males
Uuslaly resolv
Reassurance, surgical repair if doesn't resolve in 1-2 years
235
Lights criteria for transudative vs exudative
Exudates - protein >30g/l
Transudates <30
If 25-35 then lights criteria...
Exudative likely if at leats one met...
- Pleural fluid protein divided by serum protein >0.5
Pleural fluid LDH divided by serum LDH >0.6
Pleural fluid LDH more than 2/3 the upper limits of normal serum LDH
236
A 25-year-old man attends with a 3-month history of numbness in his right hand. On examination, you note the loss of sensation to the palmar and dorsal aspect of the 5th digit. Sensation of the forearm is preserved.
What is the most likely diagnosis?
Cubital tunnel syndrome
Ulnar nerve supplies sensory to palmar and dorsal aspects 1 and 1/2 fingers medially
237
A 17-year-old girl presents with a sore throat. On examination she has inflamed tonsils covered in white patches. Tender cervical lymphadenopathy and a low grade pyrexia are also present. Which one of the following organisms is most likely to be responsible?
Streptococcus viridans
Streptococcus agalactiae
Streptococcus pneumoniae
Staphylococcus aureus
Streptococcus pyogenes
Streptococcus pyogenes
238
Typical distribution eczema in 10month old child
Face and trunk
239
Which medication ahs been overdosed on and mx...
GIT: nausea, vomiting, anorexia, diarrhoea
Visual: blurred vision, yellow/green discolouration, haloes
CVS: palpitations, syncope, dyspnoea
CNS: confusion, dizziness, delirium, fatigue
Digoxin (toxicity) - yellow/green discolouration
Administer digoxin specific antibody fab fragments (digibind iV)
240
Absestosis vs pleural plaques on CXR
Pleural plaques = all over (image) - benign, do not go malignant
Asbestosis is more lower lung fibrosis
241
What medications can treat orthostatic hypotension
Fludrocortisone and midodrine
242
Medication to treat bowl colic in palliation
Hyoscine hydromromide
243
Most common S/E isotretinoin
Dry skin
244
chronic infection with hep b
hbsag if >6m can be chronic!!
245
mx pre menstrual syndrome
mild symptoms can be managed with lifestyle advice
apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg)
severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)
246
Which medication for glaucoma causes increased eyelash length
Prostaglandin analogues alongside iris pigmentation an dperiocular pigmentation
247
WHta is best for motion sickness
Hyoscine then cyclizine/cinnarizine if not good
248
High serum PTH with moderately raised serum calcium and CKD - type hypoparathyroidism
Tertiary hyperparathryoidism
249
Chlamydia in pregnancy - mx
Azithromycin, erythromycin, or amoxicillin may be used
250
Most common cause PPH
Uterine atony
251
First line test acromegaly
Serum IGF-1 levels
252
Recurrent episodes natal cleft pain with discharge - mx
pilonoidal cystectomy
253
GCS
254
Antifreeze antidote
Fomepizole
255
A 45-year-old man presents to the emergency department with pain in his lower back, buttocks, and legs over the last 5 days that persists at rest. Today he has noticed weakness and pins and needles. He has a history of ischaemic heart disease, type 2 diabetes, and an episode of gastroenteritis 2 weeks ago. He has a family history of ankylosing spondylitis. The patient works as a builder.
He is afebrile, his pulse is 85 bpm, and his blood pressure is 135/75 mmHg. Despite having paraesthesia, lower limb sensation is intact. There is bilateral lower limb weakness and hyporeflexia.
What is the most likely diagnosis?
Gullain barre syndrome - back/ leg pain is seen in majority pts with GBS
256
Blue vision - which drug is this a S/E of
Sildenafil
257
Yellow - green vision = which is this a S/E of
Digoxin
258
What positioning can help in Acute respiratory distress syndrome
Prone position - improves oxygenation and decreases mortality rates
259
Hernias that are superior and medial to pubic tubercle
Inguinal hernias
260
Baby blues mx
Reassurance and follow up
261
Speech non fluent, comprehension normal, repetition impaired
Brocas dysphasia, frontal lobe
262
which type fracture
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.
Potts
263
which type fracture
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.
Potts
263
which type fracture
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.
Potts
264
Which type fracture
A 22-year-old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.
Bennetts
265
46. A 73-year-old woman presents with pain in her wrist after falling on to an outstretched hand. On examination there is dorsal displacement and angulation. An x-ray shows a transverse fracture of the radius around 2 cm proximal to the radio-carpal joint.
Colles fracture
266
Visual field defect in glaucoma
Common in peripheries
267
Low grade MALT lymphoma management
Eradicate H.Pylori
268
A 45-year-old woman attends the ear, nose and throat clinic with a 3-month history of left-sided hearing loss. She describes an occasional ringing in her left ear and feels off-balance. Her past medical history includes type 1 diabetes which is well-controlled and she denies any recent infective symptoms.
On examination, Rinne's test is positive in both ears with Weber's test lateralising to her right ear. There is no evidence of nystagmus and her coordination remains intact. Aside from an absent left-sided corneal reflex, the remainder of her cranial nerve examination is unremarkable.
What is the most likely diagnosis?
acoustic neuroma - always think of this with loss of corneal reflex
269
If 2 level PE wells score is 4 or less and D dimer is negative then what to do
Stop anticoagulant and consider alternative dx
270
First line treatment of heart failure
ACE inhibitor and B Blocker
(2nd line is aldosterone antagonist like spironolactone and third line is things like ivabradine by specialist)
271
Furosemide - MOA and location
Inhibits Na-K-Cl co transporte rin thick ascending limb of loop of hence
272
HTN in diabetes - which is the first line medication
ACEP/ARB (regardless age)
273
S/E of calrithromycin which can cause ECG changes
Torsades de Pointes
274
Diastolic murmur + AF -> which murmur
mitral stenosis
275
How to differentiate cardiac tamponade and constrictive pericarditis
Kussmauls sign (raised JVP that doesn't fall in insporation) with constrictive pericarditis
276
Mx symptomatic bradycardia
Atropine 500mcg IV first line
If not good enough then atropine up to 3mg. Transcutaneous pacing. Isporenaline/adrenaline infusion titrated to response
277
Pericarditis vs myocarditis
Myocarditis = <50, recent viral illness, inflammatory markers and torpnonin raised, ECG shows non specific ST segment and T wave changes. Can manifest as new onset CHF
Pericarditis = similar but doesn't cause symptoms left ventricular dysfunction and troponin less likely to be raised with more global ST elevation rather than focal
278
Type murmur for aortic regurgitation
Early diastolic murmur
279
When are you advised to take statins
Last thing in an evening
280
New onset haemoptysis and mid late diastolic murmur = cause
Mitral stenosis
281
MOA Fondaparinux
Activates antithrombin III
282
Recent sore throat, rash, arthritis, murmur (systolic) - dx
Rheumatic fever
283
What medication can cause torsades de pointes
Macrolides like clarithromycin
284
Which murmur is turners syndrome ass with
Bicuspid aortic valve - systolic, loudest over aortic alve. Also prone to aortic valve stenosis and coarctation
285
What 2 meds should be given with peripheral arterial disease
Antiplatelet and statin
286
What do Q waves suggest on ECG
Prev MI
287
Neutropenic sepsis Abx choice
IV Piperacillin with tazobactam (Tazocin)
288
Large U waves - what can this suggest
Hypokalaemia
289
Hydrogen breath test - what is it used for
Small bowel overgrowth syndrome, lactose eintolerance etc
290
H.Pylori test
Urea breath test
291
When to use anterior resection vs abdominoperineal resection
Anterior resection = rectal tumours (high ones)
APR = distal 8cm of rectum (low) and into sphincters
292
Any unstable tacky needs
Synchronised cardio version
293
What Ix in Kawasaki to screen cx
ECHO
294
Mastoiditis in ear infeciton can lead to....
meningitis
295
in preterm prelabour rupture of membranes what need to be given to reduce rsik resp distress syndrome
Dexamethasone
296
In a miscarriage with missed or incomplete with closed os - what medicaiton to given
Vaginal misoprostol
297
Which type of stoma is faeculant matter in bag with flush to skin
Colostomy
(ileosotmy is spouted)
298
Symptoms of mania - what to do referral wise
urgently to community mental health team
299
Bilious vomiting on first day life - what is it mostly likely to be
Duodenal atreesa (or intestinal atresia)
300
n haemothoax when >1.5L blood initially lost or losses >200ml per hour for >2hrs then what is the mx
thoracotomy
301
dx postural hypotension
drop systolic >20 or diastole >10
302
in paeds BLS what is the ratio CPR to breaths
15:2
303
serum amylase in pancreatitis
>900 ish as normal is 300 so x3
304
Stages of COPD
305
osteoporosis bone labs
NORMAL all
306
How often mammography for breast screening
every 3 years
307
salicylate poisoning - what abg
resp alkalosis
308
mx asymptomatic bacteriuria in pregnant women
Abx therapy asap
309
what can recipitste digoxin toxicity
thiazides
310
is statin allowed in pregnancy
NO
311
what drugs can trigger G6PD def
Sulph containing drugs - sulphonamides, sulphasalazine, sulfonylureas - can trigger haemolytic
312
if a pt is on anti-coag or bleeding disorder and they are suspected tIA what is immed mx
Exclude haemorrhage - CT!!!!! then maybe aspirin
313
metabolic abnormality in bushings
hypokalaemic met alkalosis
314
first line ix for preterm prelabour rupture of membranes
careful speculum exam
315
Anaphylactoid reaction to IV NAC - mx (urticaria and facial flushing)
Anaphylactoid reactions to IV N-Acetylcysteine are generally treated by stopping the infusion, then restarting at a slower rate
316
pts with cellulitis and penicillin allergy
erythromycin
317
A 73-year-old man attends the emergency department with sudden-onset visual loss in the left eye. He reports no pain or headache, and there was no history of preceding trauma. There are no neurological symptoms.
He has a past medical history of poorly-controlled type 2 diabetes, and hypertension.
On examination, he his just about able to distinguish light from dark with the left eye. His red reflex is absent. You are unable to gain any view of the retina with fundoscopy. His neurological examination is otherwise normal.
vitreous haemorrhage
318
what medication is lined to new fasciitis of genitalial or peirneum (fourniers gangrene)
dapagliflozin
319
When Is the time out stage of Who checklist
before ski incision
320
tx acute pancreatitis (even with bruising in flank- grey turnerss)
fluids and analgesia
321
first-line for patients mild papules and/or pustules and rosacea
ivermectin
322
pts with acute, severe, symptomatic hyponatraemia - mx
hypertonic saline
323
if CBT or EDMR therapy ineffective in PTSD then what is first line drug tx
venlafaxine or ssri
324
A 72-year-old man has been an inpatient on the elderly care ward for the last 2 weeks. He has a new diagnosis of metastatic lung cancer. On the morning ward round, he complains that his pain is not being adequately controlled. He currently takes oral morphine sulphate 20mg four times a day along with codeine 30mg four times a day and regular ibuprofen.
Breakthrough dose = 1/6th of daily morphine dose
Oral codeine to morphine (divide by 10). Therefore, oral codeine 10mg = oral morphine 1mg.
30mg x 4 = 120mg codeine. This equals 12mg morphine.
20mg x 4 = 80mg morphine.
Total morphine = 80mg + 12mg = 92mg.
The breakthrough dose of morphine is 1/6th of the total dose of morphine in 24 hours. This main takes 92mg of morphine in 24 hours. 1/6th of this is 15mg.
325
Symptom control in non-CF bronchiectasi
inspiratory muscle training + postural drainage
326
A 70-year-old man comes to the GP surgery with his wife because she is growing increasingly concerned about his health. Five years ago he began to suffer from periods of confusion and sleepiness that seemed to come and go at random. More recently he has also developed a unilateral tremor in his right hand.
Upon questioning, his wife tells you that she has slept in a separate bed for the last 30 years because her husband suffers from bad nightmares.
Lewy body
327
Otitis externa in diabetics
treat with ciprofloxacin to cover Pseudomonas
328
tx trichomonads vaginalis - trophozoites
mETRONIDAZOLE
329
HOW to take hydrocortisone in Addisons
hydrocortisone split with majority given in first half day 9try mimic natural)
330
IN statu sepilepticus, the stepwise mx
1. Buccal midazolam/ IV lorazepam
2. IV Lorazepam
3. IV phenytoin
Rapid sequence induction anaesthesia with thiopental sodium
331
Neurogenic thoracic outlet syndrome
typical presents with muscle wasting of hands, numbness, and tingling and possiblyy autonomic symptoms
332
aBS IN see
ANA positive - sensitive (good to rule ou)
some RF +
Anti-dsDNA highly specific
Anti smith specific...
