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General 3 Flashcards

1
Q

When to refer for recurrent miscarriage?

A

3 or more

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2
Q

What investigations may women be offered following recurrent miscarriage?(4)

A

Thrombophillia
Lupus
Antiphospholipid syndrome (treat with haspirin plus heparin until K34)
TFTs
Check for chromosomal abnormalities

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3
Q

Explain antiphospholipid syndrome

A

Disorder which causes an increased risk of thrombosis, recurrent fetal loss and thrombocytopenia.

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4
Q

Ix (3) for antiphospholopid syndrome and mx (2)

A

Ix anti-cardiolipin, lupus, clotting
aspirin +/- warfarin

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5
Q

How to manage hirsutism? (5)

A
  1. Weight loss
  2. Methods of hair removal
  3. Reassure - usually no additional rx is required
  4. Facial - topical eflornithine
  5. COCP - dianette - 6 months, if ineffective refer
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6
Q

Counselling topical eflornithine (3)

A
  1. If no benefit after 4 months stop and refer
  2. Noticeable results take 6-8 weeks
  3. If effective - to continue otherwise hair growth will return to pretreatment state within 8 weeks
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7
Q

Hyperhydrosis mx

A
  1. Avoid tight clothing and manmade fabrics
  2. Wear white/ black to minimise signs
  3. Underarm pads to absorb excess sweat
  4. Moisture wicking socks
  5. Avoid occlusive footwear
  6. Alternate shoes
  7. Aluminium salts/ 20% aluminium chloride roll on antiperspirants
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8
Q

Aluminium salts/ 20% aluminium chloride roll on antiperspirants - how to apply (5)

A
  1. Apply at night before sleep to axilla, feet, hands
  2. Wash off in the morning
  3. Apply every day until symptoms improve
  4. Avoid shaving area within 12 hours of application
  5. Review in 6 weeks
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9
Q

Advice on febrile seizures (6)

A
  1. Most grow out of it by age 6yo
  2. Risk of developing epilepsy is low
  3. Short seizures are not harmful
  4. 1 in 3 will reoccur
  5. No evidence for paracet/ ibuprofen intermittent use
  6. Nil indication for epileptics
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10
Q

GORD when to suspect and age range

A

Up to 1yo with regurgitation AND at least one of:
1. Distressed behaviour
2. Chronic cough/ hoarse voice
3. Unexplained feeding difficulties
4. Faltering growth

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11
Q

RF for GORD paeds (5)

A

prematurity, FH, obesity, hiatus hernia, neurodisability

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12
Q

occurs in infants less than 3 months old and is characterised by bouts of excessive crying and pulling-up of the legs, often worse in the evening.

A

= colic

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13
Q

How to tell the difference between colic and GORD?

A

Colic bouts of crying, GORD - regurg

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14
Q

Reflux Paeds breastfed mx (4)

A
  1. Breastfeeding assessment and advice
  2. Trial 2 weeks of gaviscon then review
  3. If improvement continue, trial stopping every 2 weeks to see if it can be stopped.
  4. Trial PPI for 4 weeks if not effective refer
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15
Q

Reflux formula fed mx (5)

A
  1. Reduce volume of feeds if total volume is >150mls/kg
  2. Trial two weeks of frequent but smaller feeds
  3. Trial feed thickeners 2 weeks
  4. Then stop 3 and trial gaviscon
  5. Trial PPI for 4 weeks if not effective refer
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16
Q

Allergic rhinitis mx (5)

A
  1. Saline washes
  2. Allergen avoidance
  3. Intranasal steroids/ antihistamines (4 weeks)
  4. Check technique
  5. If failure and BG of asthma consider LTRA/ steroids
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17
Q

Allergic rhinitis what to always ask

A
  1. Cocaine/ recreational drugs
  2. Decongestants
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18
Q

BV management (1)
Three things to avoid

A
  1. Metronidazole BD for 5-7 days OR intravaginal gel OD for 5/7
  2. Avoid douching/ bubble baths/ smoking
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19
Q

Vaginal candida recurrent mx

A
  1. PO fluconazole every day for 72 hours as induction
  2. Maintenance once a week for 6 months
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20
Q

Pityriasis rosea - what is it?

A

Self limiting rash that starts with a herald patch, commonly after an URTI/ infection. Usually in young adults. Resolved in 6-10 weeks. Chest abdo and back usually affected. Salmon coloured, slightly raised.

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21
Q

Mx pityriasis rosea (6)

A
  1. Self limiting
  2. Can get new lesions for first 6 weeks
  3. Hypo/hyperpigmentation can take months to resolve
  4. Emmolients/ soap substitute
  5. Can trial antihistamine if itchy
  6. Mild/mod steroid for 4 weeks if itching
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22
Q

Pityriasis veriscolor what is it?

A

Fungal infection of the skin causing discoloured patches on chest, neck and back - not contagious. Usually asymptomatic.

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23
Q

Mx pityriasis versicolor (2)
Relapse (1)
Prophylaxis (1)

A
  1. Ketoconoazole shampoo OD for 5/7 - lather on skin, leave on for 3-5 minutes before rinsing off.
  2. If small area - topical antifungal
  3. If relapse - repeat step 1/2 OR shampoo once every 1-2 weeks for 6 months
  4. Pre holiday OD for three days as prophylaxis
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24
Q

Acne rosacea mx (4)
When to review and what to do?

A
  1. For flushing brimonodine gel PRN (works within 30 minutes and lasts 3-6 hours). Telangiectasia may be accentuated as erythema reduced.
  2. For mild- mod acne topical ivermectin/ metronidazole for 8-12 weeks
  3. For mod-severe acne - topical ivermectin with PO doxy OD for 8-12 weeks 40mg MR
  4. Inflamed phymatous disease - PO doxy for 6 weeks

Review at 8-12 weeks if not fully clear but effective continue for 12-16 weeks

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25
Q

What may dermatology offer for acne rosacea? (2)

A
  1. Light therapy
  2. Roaccutane
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26
Q

SE of roaccuatane (5)

A
  1. Increased risk of suicidal ideation
  2. Pancreatitis
  3. Joint aches
  4. Rash
  5. Dry skin
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27
Q

Vasectomy counselling
Pro (3)
Cons (9)

A

Pros
1. Low failure rate (0.05%)
2. Permanent procedure
3. No increased risk of testicular cancer, impotence, or heart disease

Cons
1. Irreversible on the NHS
2. Risk of regret
3. Contraception cover for 12 weeks post procedure
4. Needs semen analysis at 12 and 16 weeks to confirm
5. Surgical procedure local anaesthetic
6. Risk of bleeding and infection
7. Risk of chronic pain 15% >3 months post op
8. No sex for 1 week post procedure
9. No protection against STIs

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28
Q

Tubal occlusion counselling (5)

A
  1. Risk of failure 0.5%
  2. Ectopic pregnancy
  3. Surgery
  4. No protection against STIs
  5. Not reversibile
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29
Q

Whooping cough explained

A

Respiratory infection that has three stages to it - cold like sx (1-2 weeks)
- coughing gits (10 weeks)
- gradual improvement (3 weeks)

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30
Q

Vitiligo mx general (5)

A
  1. Avoid triggers
  2. Vitiligo society
  3. Changing faces - camouflage services
  4. Sun protection
  5. Psychosocial
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31
Q

Medical mx of vitiligo when to offer and what would you offer?

A

Offer if <10% of body surface area
Topical steroid for 1-2 months then review
If not effective can refer and consider intermittent regime, break 2 weeks, steroids 3 weeks etc

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32
Q

Secondary care mx of vitiligo (3)

A
  1. Topical tacrolimus
  2. Phototherapy
  3. PO steroids/ MTX/ ciclosporin
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33
Q

Varicose veins RFs (6)

A

Obesity
Pregnancy
Increasing age
Prolonged sitting/standing
FH
DVT

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34
Q

Varicose veins mx general/ counselling (6)

A
  1. Discuss RF, eg obesity, prolonged sitting, increasing age
  2. Discuss complications - bleeding, DVT, pigmentation, reduced QoL, ulcers
  3. Lose weight
  4. Regular exercise
  5. Raise legs
  6. Avoid triggers
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35
Q

When to refer varicose veins? (3)

A
  1. Primary/recurrent VV with symptoms/ skin changes/ ulcers
  2. Superficial vein thrombosis (hard, painful veins)
  3. Healed venous leg ulcer
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36
Q

What to offer for VV if referral not offered? (Ix) (2)

A
  1. Compression stockings
  2. ABPI to r/o arterial insufficiency
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37
Q

What may be offered by the vascular team for VV?

A
  1. Duplex USS
  2. Endothermal ablation
  3. Foam sclerotherapy
  4. Surgery
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38
Q

How can you manage venous skin changes? medical mx (2)

A
  1. BD emmolients
  2. Topical steroids
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39
Q

Warts mx medical (6)

A
  1. Sexual health clinic for STI screen and examination
  2. Can do nothing - will resolve on its own usually after 6 months
  3. Podophyllotoxin solution BD for three times per week for 5 weeks until wart has gone
  4. Imiquimod - three times a week for up to 16 weeks
  5. Cryo
  6. Surgery
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40
Q

Podophyllotoxin counselling (4)

A

1 Make sure you have washed the area with water and pat dry first
2. Ensure Podophyllotoxin only touches area of the wart
3. You can use vaseline/ barrier cream to surrounding area to aid in this
4. Local irritation is common

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41
Q

Anogenital warts counselling (4)

A
  1. Spread skin to skin contact/ sexually transmitted
  2. Use condoms
  3. Appears a few weeks to months after infection
  4. Asymptomatic
  5. Don’t share sex toys
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42
Q

Explain varicocele

A

Scrotal swelling - varicose veins of the spermatic cord/ vessels in the spermatic cord. (Dilated veins). Caused by incompetent veins. Very common

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43
Q

Risks associated with varicocele (2)

A
  1. Risk of reduced fertility
  2. Pain
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44
Q

Mx varicocele (2)

A

Grade 1 - no treatment
Grade 2 annual examinations - refer to urology, risk of testicular growth arrest and therefore may need surgery.

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45
Q

General advice varicocele (3)

A
  1. Recommend supportive underwear
  2. Simple analgesia
  3. 2/3 will not have fertility issues
46
Q

Pain, dragging, heavy sensation, bag of worms =

A

varicocele - usually on left side

47
Q

Mx inguinal hernia <18yo?

A

Refer urgently to surgeons to be seen within 2 weeks

48
Q

Suspected testicular cancer mx

A
  1. Refer under 2ww
  2. Bloods AFP, LDH, hCG
49
Q

Epididymo-orchitis Ix (3)

A

Urine dip, STI screen, check for mumps

50
Q

Epididymo-orchitis Mx (4)
When will the lump resolve after treatment?

A
  1. Condom use until STI screen
  2. Cipro BD 14/7 (counsel)
  3. Simple analgesia
  4. Supportive underwear
  5. Lump resolves by 3 months
51
Q

FU Epididymo-orchitis

A

Review at 3/7 if no improvement
Review at 2 weeks to ensure resolution

52
Q

Explain an epididymal cyst

A

Fluid filled cyst - nil treatment required
Usually asymptomatic

53
Q

soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
the swelling is confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates with a pen torch

A

Hydrocele

54
Q

Congenital hydrocele mx

A

Reassure, usually resolves by 1yo

55
Q

Undescended testes counselling

A

Increased risk of testicular cancer therefore you should do regular testicular self checks

56
Q

Undescended testes screening (3)

A

At birth
At 6 week check
Re-examination at 4-5 months if found to be undescended

57
Q

When to refer for undescended testes at 6-8 weeks?

A

If bilateral - refer to be seen within 2 weeks

58
Q

If unilateral undescended testes 6-8 week check what are the next steps?

What is done next?

A
  1. Re-examine at 4 months to refer and to be seen at 6 months
  2. Surgery orchidopexy
59
Q

Teething mx (7)

A
  1. BD brushing once teeth erupt
  2. Dentist by 6 months
  3. Gentle rubbing with clean hands
  4. Bite on clean, cool object, teething rings
  5. Sugar free products
  6. OTC simple analgesia >3months
  7. Bonjela > 5months
60
Q

Enuresis

<5yo (5)

> 5yo (3)

A

<5yo w/o day time symptoms
1. Reassure
2. Fluid intake - avoid caffeine
3. Encourage using the bathroom
4. Positive reward system
5. Avoid lifting and waking

> 5yo w/o day time symptoms
1. General measures
2. Enuresis alarms - 4 week trial
3. Desmopressin if short term

61
Q

When to refer bedwetting?

A

Anyone with day time symptoms
OR
Secondary betwetting (>6 months night sx free)

62
Q

When to give desmopressin for bedwetting? (2)

A

If sleepover/ overnight event which requires a dry night.
Give once nightly for the week prior
OR
If they want it
Start low dose and review every 2 weeks, increasing as needed. Trial for four weeks.

62
Q

CKD mx

A
  1. ACE
  2. Annual bloods and urine ACR, urine dip
  3. BMI, nutritional status, BP, HBa1c, lipid profile
  4. Check DH, renal USS
63
Q

ACR interpretation

A

<3 no CKD
3-70 - repeat at 3 months
>70 significant proteinuria refer to renal

64
Q

Age range viral induced wheeze –>
Age range croup –>
Age range bronchiolitis –>

A

6 months - 5yo
6 months - 3 years (parainfluenza)
<12 months (peak incidence 3-6 months) (RSV)

65
Q

Asthma generalmx (9)

A
  1. Peak flow
  2. Avoid triggers/ symptom diary
  3. Stop smoking
  4. SABA with spacer
  5. Inhaler technique
  6. Vaccinations
  7. Personalised action plan
  8. Weight loss
  9. MH
66
Q

Name an ICS inhaler requiring a spacer –>
Name an ICS inahler dry powder–>

A

Clenil modulite (beclometasone)
Easyhaler OR Pulmicort (budesonide)

67
Q

Name two combined ICA+LABA and what type is it?

A

Symbicort - dry powder. (budesonide/formoterol)
Fostair NEXT inhaler dry powder
Fostair with spacer (beclometasone/formoterol)

68
Q

Asthma mx

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS+LTRA
  4. SABA + ICS +LABA +/- LTRA
  5. SABA + MART low
  6. SABA + MART mod (refer if paeds at this point)
  7. SABA + MART high OR MART+LAMA/ theophylline
69
Q

How to diagnose asthma <5yo

A

SABA
Trial of moderate ICS 8 weeks then stop
If return of symptoms within 4 weeks then restart low ICS
If sx resolves but didn’t return after 4 weeks then repeat trial

70
Q

Squint mx secondary care(5)

A
  1. Corrective glasses
  2. Occlusion therapy
  3. Penalisation therapy (drops in one eye to encourage lazy eye to do more work)
  4. Eye exercises
  5. Surgery
71
Q

Limping, but mobile, well and afebrile aged 3-9yo think?

A

Transient synovitis/ reactive arthritis

72
Q

When might you give aciclovir for chickenpox?

A

> 14yo or adult presenting within 24 hours of onset of rash - 7/7 800mg five times per day

73
Q

General mx chickenpox (8)

A
  1. Infective until all lesions have crusted over
  2. Avoid itching
  3. Antihistamines
  4. Calamine solution
  5. Keep nails short
  6. Hydration
  7. Cotton clothing
  8. Avoid immunocompromised and school until crusted over
74
Q

Exposure to chickenpox in pregnancy

A

If already had chickenpox then they are fine
If unsure then for blood test to check for antibodies and likely will be given immunoglobulin
If definitely haven’t then can have immunoglobulin up to 10 days post exposure

75
Q

PCOS what to discuss (8)

A
  1. Weight loss
  2. Smoking
  3. Aim to get regular periods x4 times per year
  4. Increased risk of CVD and DM and NAFLD
  5. Difficulty in getting pregnant
  6. Increased risk of endometrial cancer
  7. Increased risk of pregnancy complications
  8. Increased risk of psychiatric disorders
76
Q

How to diagnose PCOS

A

2/3
1. Irregular periods
2. Acne/ hirsutism
3. PCOS on US

77
Q

What can be used for PCOS?

A
  1. COCP
  2. Metformin
  3. Clomiphene to induce ovulation
78
Q

General advice heart failure

A
  1. Avoid excessive salt
  2. Stop ACE if unwell
  3. Smoking
  4. ETOH
  5. Check DVLA
79
Q

CP when to have same day assessment?

A

Within 72 hours

80
Q

CP when to have assessment within 2 weeks?

A

If >72 hours

81
Q

Suspected AF within 48 hours?

A

Refer in to hospital

82
Q

AF > 48 hours?
HR aim
When to refer (no symptom control after X weeks?)

A

Start on:
1. BB/ rate limiting CCB (e.g diltiazem/ verapamil)
2. DOAC after CHADVASC
60-80 pulse
Otherwise add BB/CCB/dig
If sx not controlled within 4 weeks

83
Q

Stable angina mx

A
  1. GTN
  2. BB/CCB
  3. BB/CCCB
  4. ISMN
    Refer
    Review at 2 weekly intervals
84
Q

Extra medications for angina?

A

Aspirin +/- ACE +/- statin

85
Q

Erectile dysfunction counselling and investigations (3)

A
  1. Examination of external genitalia
  2. Bloods to HbA1c, lipid profile, CVD, TFT, LFT, U+E, PSA
  3. Lifestyle: smoking, ETOH, weight loss, exercise, cycling <3hrs
86
Q

Counselling viagra (3)

A

50mg viagra - take one hour before sexual activity, dose can be increased to 100mg or decreased to 25mg
One per 24 hours
FU in 6-8 weeks

87
Q

Which drugs can cause erectile dysfunciton? (6)
Think groups instead of specifics

A

BB
Thiazides
SSRIs
Opiates
Anti-histamines
Anti-HTN

88
Q

HRT Risks (4)

Benefits (2)

A
  1. Increased risk of CVD + stroke
  2. Increased risk of breast ca
  3. Increased risk of abnormal bleeding
  4. Increased risk of VTE
  5. Bone protection
  6. Fixed menopausal sx
89
Q

Gout acute mx (3)

A
  1. Naproxen (750mg first dose, then 250mg TDS until 2/7 post flare) OR
  2. Colchicine OR
  3. Prednisolone 30mg OD for 5/7
90
Q

Gout prevention

A
  1. Allopurinol OR febuxostat - until urate level <360 - check levels monthly
    Stop if rash
91
Q

Gout general acute (3)
General prevention

A

Rest, ice, elevate
Reduce red meat, ETOH, fatty meals

92
Q

Tension headache mx (8)

A
  1. Simple analgesia - avoid overuse headache
  2. Exercise
  3. Stress
  4. Hydration
  5. Acupuncture
  6. CBT
  7. Amitryptilline 10mg ON increase every 1-2 weeks
  8. Headache diary
93
Q

Medication overuse mx (5)

A
  1. Stop abruptly
  2. May get SE for first few weeks
  3. May take 2-3 months before symptoms resolve
  4. If acute headache reoccurs after this take for 2/7 in the week max
  5. Consider TCA as prophylaxis
94
Q

Cluster headache mx
What is it

A
  1. Triptans for acute attacks
  2. High flow oxygen therapy
  3. Verapamil as prophylaxis (neuro)
    Usually lasts between 2 weeks and 3 months 1-3 attacks per day, occurs every 2-3 years
95
Q

Non pharmacological mx migraines (7)

A
  1. Exercise
  2. Triggers/ diary
  3. Stress
  4. CBT
  5. Mindfulness/ relaxation techniques/ meditation
  6. Riboflavin (vitamin b2)
  7. Acupuncture
96
Q

Diabetes diagnosis counselling (8)
General stuff

A
  1. Risks to eyes, kidney, feet - annual checks
  2. Immunisations
  3. Free prescriptions
  4. Carrying identification
  5. Increased risk of CVD - therefore annual bloods and CVD screen
  6. Weight loss/ diet/ exercise
  7. Structured education programme
  8. Advise about sexual health/ pre pregnancy counselling
  9. Sick day rules - stop metformin, gliclazide, SGLT2
97
Q

What is polycythaemia?
Who to refer to and what will they do?
Sx (4)

A

Increased blood cells leading to higher risk of clots - and therefore heart attacks and strokes
Need to be referred to haematologist who will likely start them on daily aspirin
Can get sx of headache/ clots/ bleeding gums/ plethora (reddening of hands and feet)

98
Q

Polycythaemia general counselling

A
  1. Smoking
  2. ETOH
  3. Obesity
  4. Stop thiazides as reduced plasma volume
99
Q

Seb derm mx adults

A
  1. Ketoconazole shampoo twice a week for four weeks then reassess
  2. Soap free wash on affected areas
  3. Avoid make up that blocks comedones
  4. Betnovate if inflammation to the scalp OD for 5 days then review
100
Q

Seb derm babies/ cradle cap

A
  1. Emmolients + brushing to remove scale
  2. Reassure
  3. Topical clotrimazole for 4 weeks OD
  4. Can give HC for 1-2 weeks if needed
  5. Soap substitute
101
Q

Hydradenitis mx (6)

A
  1. Pain relief
  2. PO abx if infected
  3. PO steroids if severe
  4. Octenisan as antimicrobial wash OD
  5. Consideration of topical clinda OD for 3 months then review
  6. I+D if severe
102
Q

Sleep hygiene mx (7)

A
  1. Avoid bright lights/ screens before bed
  2. Warm bath a few hours before bed
  3. Avoid exercise late in the day
  4. Sleep schedule, same time in bed every night
  5. Relaxation techniques/ read a book
  6. Avoid caffeine
  7. CBT-I
103
Q

ADPKD explain (5)
Sx (5)

A

uncommon hereditary condition autosomal dominant –> 50% chance of inheriting the condition

Cysts form in the kidneys causing scarring and damage and risk of kidney failure

Can lead to HTN, headaches, haematuria, UTIs, and AP

104
Q

ADPKD mx

A
  1. Avoid caffeine
  2. Monitor BP/ bloods/ urine etc
  3. Hydrate
  4. Refer
105
Q

ADPKD extra renal manifestations (4)

A
  1. Liver cysts
  2. Pancreatic cysts
  3. Berry berry aneurysms
  4. Male infertility
106
Q

Parkinsons disease sx/ what to ask (5)

A
  1. Movement (bradykinesia
  2. Depression
  3. Constipation
  4. Stiffness/ rigidity/ tremor
  5. Sleep disturbance
107
Q

Sciatica mx (6)
When does it usually resolve?

A
  1. Simple analgesia +/- PPI +/- codeine
  2. Physiotherapy
  3. Group exercise therapy
  4. Work adjusments
  5. Local heat
  6. Keep active
    Usually resolves by week 6 - if not then refer
108
Q

Ramadan rules meds
Metformin
Sulfonylureas
SGLT2

A

Switch metformin to BD dosing - heavier at the end of the day
Sulfonylureas - switch to evening only, or if BD reduce morning dose
SGLT2 take in the evening ++ hydration
Insulin will likely need to be modified/ reduced and switched to the evening dose.

109
Q

Ramadan rules general (4)

A
  1. Well balanced meal in the morning, and not to miss it. High fibre.
  2. Ensure well hydrated in the day
  3. Avoid fasting if unwell
  4. Avoid strenuous exercise before sunset

SCA (3 decks)

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