Go Through Flashcards
Scarlet fever spares
The mouth, palms and soles
Rubella back to school?
5/7 after rash onset
When can we use sumatriptan?
> 12 if nasal
18 if oral
Small testes in precocious puberty =
Adrenal cause of precocious puberty (they enlarge due to FH and LSH, adrenal hyperplasia increases hormone output so lower FH and LSH)
Knee pain with clicking and swelling in adolescent =
Osteochondritis dissecans rather than chondromalacia patellae
Mx Kawasaki?
Aspirin
Duodenal atresia…
Duodenal atresia usually present with bilious vomiting within the first day of life. It would not cause bloody stools.
Kawasaki presentation?
High fever lasting >5 days, red palms with desquamation and strawberry tongue are indicative of Kawasaki disease
Stillbirth vs miscarriage?
A stillbirth is when a baby is born dead after 24 completed weeks of pregnancy.
If the baby dies before 24 completed weeks, it’s known as a miscarriage (or late foetal loss)
Murmur in Turner’s?
ES murmur due to bicuspid aortic valve
Osgood-Schlatter disease presentation
Osgood-Schlatter disease is a common cause of knee pain in growing adolescents but typically presents with localized pain and swelling at the tibial tuberosity (the bony prominence just below the kneecap). The patient’s symptoms do not fit this description.
I see up and down stairs, I pick Chondromalacia patellae
.
Firstline dysmenorrhagia?
NSAIDs - not Mirena (menorrhagia)
1o vs 2o dysmenorrhoea
In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period
Refer gynae
Most likely cause 2o amenorrhoea
Adenomyosis is a condition where endometrial tissue grows within the myometrium of the uterus, causing uterine enlargement and heavy, painful menstrual periods. Secondary dysmenorrhoea is characterised by menstrual pain that develops after a history of pain-free periods, typically due to underlying pathology. Adenomyosis commonly presents in multiparous women in their late 30s and 40s with progressively worsening menstrual pain, making it a classic cause of secondary dysmenorrhoea.
An ultrasound done on a 23-year-old female for recurrent urinary tract infections incidentally shows a 3 cm ‘simple cyst’ on the left ovary. She is asymptomatic
Follicular cyst
COCP started w/in day 4 after period-onset
Protected until d5
Second-line for htn in preg
Second-line for htn in preg
rcommend nifedipine and methyldopa as alternatives to labetalol. Methyldopa is contraindicated in depression.
chlorampenicol in pregnancy
It has been associated with ‘grey baby syndrome’, characterised by cardiovascular collapse, cyanosis and death due to immature liver enzymes in neonates and young infants which are unable to metabolise and excrete chloramphenicol effectively.
Nexplanon, also known as the etonogestrel contraceptive implant, primarily works
Inhibit ovulation
When should foetal movements be felt by?
24w
When give Anti-D
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
Uterine fibroid vs ovarian cyst?
Fibroids cause heavy bleeding
How does POP work?
IUS?
All inhibit ovulation, except:
- POP: thickens cervical mucus (other than desogestrel)
- IUD copper: kills sperm
- IUS: prevents endometrial proliferation (get amenorrhea with this)
Tx pregnant women with chickenpox?
Aciclovir if present w/in 24hrs of rash
When combined test when triple/quadruple?
The combined test which includes the nuchal scan is done at 11-13+6 weeks.
If the patient requests the screening later in the pregnancy, either the triple or quadruple test should be offered between 15 and 20 weeks.
How much vitD?
10 Micrograms
When do postmenopausal women need contraception?
If under 50
Medical mx ectopic?
missed miscarriage
oral mifepristone. Mifepristone is a progesterone receptor antagonist → weakening of attachment to the endometrial wall + cervical softening and dilation + induction of uterine contractions
48 hours later, misoprostol (vaginal, oral or sublingual) unless the gestational sac has already been passed. Misoprostol is a prostaglandin analogue, binds to myometrial cells → strong myometrial contractions → expulsion of products of conception
if bleeding has not started within 48 hours after misoprostol treatment, they should contact their healthcare professional
incomplete miscarriage
a single dose of misoprostol (vaginal, oral or sublingual)
women should be offered antiemetics and pain relief
a pregnancy test should be performed at 3 weeks
When deliver baby pre-ecl?
34w once steroid course completed
LH surge causes
Ovulation
How does oral levonorgestrel work?
Inhibit ovulation
How does desogestrel work?
Inhibit ovulation (unlike other POPs which thicken cervical mucous)
Raised FSH/LH in primary amenorrhoea
consider gonadal dysgenesis (e.g. Turner’s syndrome)
COCP impact on breast milk production?
Decrease
Why do we avoid aspirin in breastfeeding?
Risk of Reye’s syndrome
Screening tool for postnatal depression?
Edinburgh scale
A 25-year-old primigravida presents to her General Practitioner at 25-week gestation following a referral from her midwife who found glucose present during a routine urinalysis
Fasting 6.8
Tx?
Diet/exercise 1/52
Then metformin
HPV genital warts?
6, 11
What causes itching from scabies?
The intense itching associated with scabies isn’t caused by the mites themselves but by an allergic reaction (type IV hypersensitivity) to their bodies, eggs and faeces.
What is lipoatrophy?
It presents as localised loss of subcutaneous fat at insulin injection sites and can significantly impact insulin absorption and glycaemic control.
Drugs causing erythema nodosum
Drugs causing erythema nodosum- Painful Coloured Shins
Penicillin
COCP
Sulphonamides
Tx pityriasis versicolor?
Ketoconazole shampoo
What is pompholyx eczema?
Pompholyx eczema (also known as dyshidrotic eczema) is a type of vesicular hand dermatitis. It is more common in young adult females and is commonly related to sweating, with flares during hot weather and humid conditions.
Erythema multiforme looks like
Target lesions
Seborrheic keratoses?
Stuck-on
Which meds exacerbate plaque psoriasis?
Beta blockers
Normal result ABPI?
0.9-1.2
What is lymecycline?
Tetracycline
Menieres hearing loss?
Sensorineural
|Howlong does bppv last for
A few seconds at a time
Ototoxic drugs
Bring the Toxic Gentleman for the Queen ASAP
Toxic = ototoxic drugs
Gentleman = Gentamycin
For = Furosemide
Queen= Quinine
ASAP = Aspirin
Common cause bacterial otitis media?
H influenzae
Poorly controlled hypertension, already taking an ACE inhibitor…
add a calcium channel blocker or a thiazide-like diuretic
Venlafaxine =
Venlafaxine mechanism of action = serotonin and noradrenaline reuptake inhibitor
Sect 136
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
135 = into house
All hypos can cause
TdP
TdP tx?
IV mag sulph
Statins + erythromycin/clarithromycin =
This macrolide antibiotic is known to interact with statins, particularly simvastatin, which the patient is taking. The interaction between clarithromycin and simvastatin can increase the risk of myopathy or rhabdomyolysis, a severe muscle condition that can lead to kidney damage.
U wave
Hypocalcaemia
Electric alternans =
Cardiac tamponade
Obesity impact on bnp?
Reduce - metabolise bnp
Posteriolateral MI?
There is some ST elevation in leads I, aVL and V6, which is consistent with a lateral MI. ST depression in V1-V3 (significant in V3) and large, broad R waves in several leads are consistent with a posterior myocardial infarction.
Causes of raised prolactin?
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
PTH =
phosphate trashing hormone
Dx addisons?
Short synacthen
10% or 20% dextrose for hypo
20%
Bromocriptine?
Dopamine agonist
Sitagliptin?
DPP-4
Pioglitazone may cause
fluid retn
SGLT-2 inhibitors (like dapaglifozin) have been linked to
necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
T2DM mx w/ risk of CVD
T2DM initial therapy: if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure → SGLT-2 monotherapy
Mx T2DM range?
f the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
Hormone changes in Kallman’s?
Kallman’s syndrome - LH & FSH low-normal and testosterone is low
x-linked
Dx Coeliac’s? (gold standard)
Endoscopic intestinal biopsy is the gold standard for diagnosis of coeliac disease and should be performed in all patients if the diagnosis is suspected following serology - jejenum
Crypt hyperplasia
Villous atrophy
Inc goblet cells
Crohns
.
Coeliac disease is more common than Crohn’s by a factor of around 100. In exams there are also usually more clues to point towards a diagnosis of Crohn’s (e.g. mouth ulcers etc).
A 72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa. Her temperature is 37.8ºC. She has a past history of constipation.
Diverticulitis
Crpohns flare-up
Corticosteroids
Abdominal mass palpable in the right iliac fossa.
Crohn’s or UC?
Abdominal mass palpable in the right iliac fossa. Crohn’s disease can affect any part of the gastrointestinal tract from mouth to anus, but it most commonly affects the terminal ileum. This can lead to inflammation and thickening of the bowel wall, leading to the formation of an abdominal mass that can often be palpated in the right iliac fossa. Furthermore, Crohn’s disease is characterised by transmural inflammation which may result in complications such as strictures, abscesses or fistulas, which could also contribute to a palpable mass.
Which transfusion has the highest risk of bacterial contamination?
Platelet transfusions have the highest risk of bacterial contamination compared to other types of blood products
most common inherited thrombophilia?
Activated protein C resistance (Factor V Leiden) is the most common inherited thrombophilia
haemarthrosis + long APTT
Haemophilia
A 43-year-old man, currently an inpatient on a surgical ward for acute pancreatitis, develops episodic epistaxis
DDIC –> schistocytes
Reversal agent heparin?
Protamine –> heparin
When to use cryoprecipitate in bleeding?
A low fibrinogen level is the major criteria determining the use of cryoprecipitate in bleeding
The transfusion threshold for patients with ACS is 80 g/L
.
C perfringens
Key features often begin with pain and then become systemic (fever, dehydration). This progresses on to skin changes, which are often seen as blisters which can burst produced a foul smelling discharge. Often crepitus can be heard on movement.
raised anti-streptolysin O titres
Post-streptococcal glomerulonephritis: raised anti-streptolysin O titres are used to confirm the diagnosis of a recent streptococcal infection
Most common cause of peritonitis secondary to peritoneal dialysis?
Coagulase-negative Staphylococcus
Niacin (B3 deficiency)
Pellagra
dermatitis
diarrhoea
dementia
Hyperacute transplant rejection is caused by
Hyperacute transplant rejection is caused by pre-existing antibodies against ABO or HLA antigens
.
CKD on haemodialysis - most likely cause of death is IHD
Wernickes =
temporal lobe
frontal for brocas
mydriasis
dilated pupil
Ropinirole =
Dopamine agonist
Dose rectal diazepam?
10mg
gcs
Motor response 6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
Verbal response 5. Orientated
4. Confused
3. Words
2. Sounds
1. None
Eye opening 4. Spontaneous
3. To speech
2. To pain
1. None
Dx GBS?
Nerve conduction studies
Unlike UMN conditions of the face, in LMN conditions the entire side of the patients face is affected
Upper spares upper (UMNL - forehead sparing)
Scary things raise eyebrows
A 72-year-old man develops visual problems. He is noted to have a left homonymous hemianopia with some macula sparing.
Occipital cortex lesion
Levodopa vs dopamine agonist in PD
Finally, a dopamine agonist, such as pramipexole or ropinirole, could be considered an alternative initial treatment option for some patients with Parkinson’s disease; however, it is less likely to be offered initially in this case. Dopamine agonists directly stimulate dopamine receptors, mimicking the effects of dopamine. They are generally used for younger patients or those with mild symptoms as they have a lower risk of motor complications compared to Levodopa. In this scenario, the patient’s symptoms are significantly affecting his ability to work and his quality of life, making Levodopa the most appropriate initial treatment option.
Wallenberg vs webers
wallen’burg’ / ice’burg’ - loss of temperature + facial pain
Weber’s syndrome is the correct answer. This is a type of brainstem stroke, specifically in the midbrain. It occurs due to an occlusion in a branch of the posterior cerebral artery. The syndrome is characterised by an ipsilateral cranial nerve III palsy (oculomotor nerve) and contralateral hemiparesis (weakness).
COPD prophylaxis?
Azithromycin prophylaxis is recommended in COPD patients who meet certain criteria and who continue to have exacerbations
Alpha-1 antitrypsin deficiency on spirometry?
Alpha-1 antitrypsin deficiency shows an obstructive picture on spirometry
Tx Hiccups in palliative care?
Hiccups in palliative care - chlorpromazine or haloperidol
Which opioid do we use in pts with renal impairment?
Buprenorphine as it is the safest opioid choice in patients with renal impairment.
Bupropion should not be used in a patient with epilepsy as it reduces seizure threshold
TLCO reduced =
Impaired gas exchange
Intracranial N&V
Cyclizine
How do we treat nausea caused by drugs/toxins?
Metoclopramide and haloperidol are useful for nausea induced by drugs (such as chemotherapy) and toxins.
How do we treat nausea due to gastric stasis?
Domperidone and metoclopramide are useful for nausea and vomiting when caused by gastric stasis.
Tx opioid nausea?
Ondansetron is good for chemically mediated symptoms, for example, from opioids
What is postural drainage?
Postural drainage is a technique that uses gravity to help clear mucus from the lungs by positioning the patient so that the affected lung segments are above the trachea.
A 45-year-old man presents with a history of recurrent sinusitis, nasal crusting, and blood-streaked sputum. He also reports fatigue and unintentional weight loss over the past few months. Physical examination reveals tenderness over the sinuses and crackles on lung auscultation. A chest X-ray shows multiple cavitary lesions, and a blood test is ordered to help confirm the diagnosis.
ANCA antibodies
highly specific for granulomatosis with polyangiitis (GPA, formerly Wegener’s). The patient’s recurrent sinusitis, respiratory symptoms, cavitary lung lesions, and systemic features such as weight loss are characteristic of GPA.
Causes of dupuytrens
Specific causes include:
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
How does radial tunnel syndrome present?
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
How does cervical radiculopathy present?
Cervical radiculopathy would cause a burning pain radiating from shoulder to fingers. There may be reduced cervical range of motion or pain as clues in the history.
How do we distinguish gout from pseudogout on XR?
Chondrocalcinosis helps to distinguish pseudogout from gout
A 52-year-old male patient presents to the GP surgery with a 3-year history of progressively worsening hip and back pain. He reports the hip pain is worse on weight-bearing and improves with rest. On examination, you noticed frontal bossing and bowing of the legs.
Pagets –> bisphosphonates
How do we treat extracapsular proximal femoral fracture?
Dynamic hip screws are the preferred surgical management for intertrochanteric (extracapsular) proximal femoral fracture
nside the capsule - need to replace hip or internal fixation
outside the capsule - hip screw if intertrochanteric or im nail
How does meralgia paraesthetica present?
Burning thigh pain - ? meralgia paraesthetica - lateral cutaneous nerve of thigh compression
anti-scl-70
CREST
Low serum calcium, raised serum phosphate, raised ALP and raised PTH
CKD –> hypoca
In secondary hyperparathyroidism PO4 is high because ‘the kidneys being unable to activate vitamin D and excrete phosphate, meaning calcium is ‘used up’ in calcium phosphate.’
Penicillamine causes
Proteinuria and exacerbate mysasthenia gravis
A knee radiograph identifies a triangular area of new subperiosteal bone in the metaphyseal region of the femur, with a ‘sunburst’ pattern.
osteosarcoma
Slipped disc OE?
straight leg raising positive = slipped disk
Where do you see anti-histone antibodies?
Antihistone antibodies are associated with drug-induced lupus
Chalazion vs stye?
The patient has an infection of the glands of the external eyelid. This is hordeolum externum, which is a type of stye.
A chalazion is also called meibomian cyst and is typically on the internal eyelid.
A 67-year-old gentleman presented to your GP surgery with pain and stiffness in his knee joints, pain when passing urine and a red eye with circumcorneal redness and hypopyon with photophobic symptoms.
Which ONE is the most likely cause of his red eye?
Iritis/uveitis
n diabetic retinopathy, cotton wool spots represent areas of retinal infarction
n diabetic retinopathy, cotton wool spots represent areas of retinal infarction
First line for POAG?
Latanoprost - reduces outflow of aqueous humour
.
The main distinction is between non-proliferative (which includes background and pre-proliferative) and proliferative diabetic retinopathy. The key feature of proliferative diabetic retinopathy is the development of new blood vessels (neovascularisation).
A 24-year-old male presents to the emergency department with an acutely painful red eye, which is associated with photophobia, lacrimation and reduced visual acuity. He has a past medical history of ankylosing spondylitis. Examination identifies a small, irregularly shaped pupil
Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops
WAMD presn?
Decreasing vision over months with metamorphopsia and central scotoma should cause high suspicion of wet age-related macular degeneration
.
Subconjunctival haemorrhage could be an early and clinically important tool in detecting warfarin over anticoagulation
A 3-year-old child is brought to surgery as her mother has noticed that she is ‘cross-eyed’. The corneal light reflection test confirms this. What is the most appropriate management?
Refer - delay can damage eyesight
.
If metformin is not tolerated due to GI side-effects, try a modified-release formulation before switching to a second-line agent
An important adverse effect of aminoglycosides is ototoxicity
E.g. gentamicin
COCP + carbamazepine?
No
Patients with MI secondary to cocaine use should be given IV benzodiazepines as part of acute (ACS) treatment
Dilated eyes = diazepam
CA 15-3
Breast
A 19-year-old man is attacked outside a club and beaten with a baseball bat. He sustains a blow to the right side of his head. He is brought to the emergency department and a policy of observation is adopted. His Glasgow coma score (GCS) deteriorates and he becomes comatose. Which of the following haemodynamic parameters is most likely to be present?
Hypertension and bradycardia, which represents the classic Cushing’s triad (hypertension, bradycardia, and irregular breathing) seen in raised intracranial pressure (ICP). In this scenario, the patient has likely developed an extradural haematoma following the trauma, leading to increased ICP.
A 72-year-old woman complains of ‘eczema’ on her left nipple. On examination the areola is erythematous and thickened.
Paget’s disease of the breast
breast cysts should be aspirated
Risk of ca
.
An incarcerated femoral hernia would present as a non-reducible mass inferolateral to the pubic tubercle. These hernias are at high risk of strangulation but they have not lost their blood supply yet.
A 66-year-old man is diagnosed with a 3cm sliding hiatus hernia during an oesophagogastroduodenoscopy. He initially presented with ‘burning’ chest pain, halitosis and frequent belching. The patient does not smoke or drink alcohol and has a BMI of 34 kg/m².
What is the most appropriate management plan for this patient?
lifestyle advice and omeprazole
.
Breast fibroadenoma: surgical excision is usual if >3cm
.
A unilaterally dilated pupil that responds sluggishly to light requires immediate CT scan to assess for raised ICP and tentorial herniation
A 2% strength liquid medicine means that 2g of the drug are dissolved in 100ml
A 2% strength liquid medicine means that 2g of the drug are dissolved in 100ml
20ml s2% lidocaine = 400mg
lidocaine 1% = 10 mg/ml
.
Volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane) may cause malignant hyperthermia
Haemorrhagic shock
Class I shock would be completely compensated for.
Class II shock would cause tachycardia.
Class III shock causes tachycardia and hypotension as well as confusion.
Class IV shock causes loss of consciousness as well as severe hypotension.
Fluctuating confusion/consciousness? - subdural haematoma
Fluctuating confusion/consciousness? - subdural haematoma
