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1
Q

what is the pathophysiology of acne?

A

chronic inflammation +/- localised infection in pileosebaceous units within the skin. increased sebum preduction traps keratin and blocks the pulosebaceous unit leading to swelling and inflammation. Androgenic hormones increase production of sebum => increased in puberty

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2
Q

what are macules?

A

flat marks on skin

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3
Q

what are papules?

A

small lumps on skin

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4
Q

what are pustules?

A

small lumps with pus

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5
Q

what are comedones?

A

skin coloured papules due to blocked pilosebaceous units

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6
Q

what are blackheads

A

open comedones with black pigmentation in the middle

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7
Q

what are ice pink scars?

A

small indentations that remain in skin after acne lesion heals

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8
Q

what are hypertrophic scars?

A

small lumps in skin that remain after acne lesions heal

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9
Q

what are rolling scars?

A

irregular wave like irregularies of the skin that remain after acne lesions heal

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10
Q

what acne medication if teratogenic?

A

retinoids

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11
Q

what is general advice for acne?

A

avoid overwashing
use non-alkaline synthetic detergent BD
avoid oil based cosmetics and suncream
avoid picking
treatment may irritate skin initially
not enough evidence to support diets for acne

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12
Q

what treatments can be used for acne?

A

Topical benzoyl peroxide - reduces inflammation toxic to p.acnes bacteria
Topical retinoids - slow sebum production
Topical Abx - clindamycin (+benzoyl peroxide)
Oral Abx - lymecycline
OCP - stabilise female hormones

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13
Q

what contraceptive pill is best at reducing acne?

A

COCP (co-cyprindiol (Dianette)) - anti-androgenic effect

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14
Q

what is the last line option for acne (specialist)?

A

oral retinoids (isotretinoin(accutane))

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15
Q

what are 4 side effects of accutane?

A

dry skin and lips
photosensitivity of skin
depression, anxiety, aggression, suicidal ideation
Stevens-johnson syndrome and toxic epidermal necrolysis

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16
Q

what are the WHO ranges for anaemia?

A

Hb <11 g/dL <5 years
Hb <11.5 g/dL 5-11
Hb <12 women + 12-14 yo
Hb <13 g/dl >15 males

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17
Q

what are 5 causes of normocytic anaemia? mnumonic

A

AAAHH

Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism

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18
Q

what are 5 causes of microcytic anaemia?

A

TAILS

Thalassemia
Anaemia of chronic disease
Iron deficiency
lead Poisoning
Sideroblasticanaemia

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19
Q

what are 6 causes of macrocytic anaemia?

A

FAT RBCs

Foetus
Alcohol
Thyroid disease - hypo
Reticulocytosis
B12 and folate deficiency
Cirrhosis and liver disease

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20
Q

where is iron absorbed?

A

mainly duodenum and jejunum

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21
Q

what is the normal range for MCV?

A

80-100 femtolitres

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22
Q

what are 5 specific signs of IDA?

A

Pica
hair loss
koilonychia
angular cheilitis
atrophic glossitis

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23
Q

what change occurs in barret’s oesophagus?

A

stratified squamous to simple columnar epithelium

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24
Q

what are 5 triggers for GORD?

A

greasy/spicy/acidic food
tea and coffee
alcohol
NSAIDs
Stress
Smoking

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25
Q

what are GORD red flags?

A

Dysphagia

> 55 yo
weight loss
Reflux
Treatment resistance

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26
Q

what is the medical management for GORD?

A

PPIs - omeprazole, lansoprazole
Histamine h2 receptor antagonists - famotidine

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27
Q

what are 4 investigations for H Pylori?

A

stool antigen tet
urea breath test
H.pylori antibody test
rapid urease test - during endoscopy

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28
Q

what is the management of h pylori?

A

triple therapy

PPI
2x ABx - amoxicillin + clarithromycin

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29
Q

what are the 4 types of hiatus hernia?

A

1 - sliding
2 - rolling
3 - combination
4 - large opening allowing additional abdo organs into thorax

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30
Q

what surgery can be done for hiatus hernia?

A

laparoscopic funcoplication

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31
Q

what are 3 management options for barrets oesophagus?

A

PPIs
endoscopic monitoring
endoscpoic ablation

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32
Q

what is metaplasia?

A

change in type of cells

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33
Q

what is dysplasia?

A

change to abnormal cells

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34
Q

what is zollinger-ellison syndrome?

A

rare condition of duodenal or pancreatic tumours which secrete excess gastrin causing severe dyspepsia, diarrhoea and peptic ulcers

may be associated with MEN1 which also causes parathyroid and pituitary tumours

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35
Q

what are 4 risk factors for diverticular disease?

A

increased age
low fibre diets
obesity
NSAIDs

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36
Q

what kind of laxatives should be avoided in diverticulosis?

A

stimulant laxitives

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37
Q

what is the management of uncomplicated diverticulitis?

A

oral co-amoxiclav 5 days
analgesia
clear liquids and no solid food until symptoms improve
Follow up in a few days

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38
Q

what is the management for severe diverticulitis?

A

nil by mouth or clear fluids only
IV Abx
IV fluids
Analgesia
Urgent investigations +/- surgery

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39
Q

what are 6 complications of diverticulitis?

A

perforation
peritonitis
peridiverticular abscess
large haemorrhage
fistula
ileus/obstruction

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40
Q

what is the blood supply to the anal cushions?

A

rectal arteries

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41
Q

what are 4 treatments for heamorrhoids?

A

anusol - astrigents shrink haemorrhoids
anusol HC - + hydrocortisone
germoloids - contain lidocaine
proctosedyl ointment - cinchocaine and hydrocortisone

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42
Q

what are 4 non-surgical options for haemorrhoids?

A

rubber band ligation
injection sclerotherapy
infra-red coagulopathy
bipolar diathermy

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43
Q

what are 3 surgical options for haemorrhoids?

A

haemorrhoidal artery ligation
haemorrhoidectomy
stapled haemorrhoidectomy

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44
Q

what are thrombosed haemorrhoids?

A

strangulated haemorrhoids - very painful but will resolve with time (several weeks)

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45
Q

what tool is used for cardiovascular risk assessment?

A

QRISK3

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46
Q

what counts as high blood pressure in clinic?

A

> 140/90 mmHg

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47
Q

what counts as hypertension in ambulatory monotoring?

A

> 135/85 mmHg

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48
Q

what 4 tests can be done for end organ damage in HTN diagnosis?

A

Urine sample for estimated albumin:creatinine ratio and haematuria
HbA1c, electrolytes, eGFR, creatinine, cholesterol
Fundoscopy - for retinopathy
ECG

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49
Q

what is the first line intervention for HTN?

A

LIFESTYLE ADVICE

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50
Q

what is the first line medication for HTN in those with T2DM or <55 and of non-african family origin?

A

ACEi (ramipril) or ARB (candestartan)

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51
Q

what is the first line medication for HTN in someone >55 or of african family origin?

A

Calcium channel blockers - amlodipine

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52
Q

what can be used for HTN if a calcium channel blocker isn’t tolerated or as 3rd line medication?

A

thiazide-like diuretic (indapamide, bendroflumethiazide)

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53
Q

what is the management of HTN uncontrolled by one agent?

A

+ CCB/ACEi

OR Thiazide-like diuretic

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54
Q

what is the management of HTN uncontrolled by two agents?

A

CCB + ACEi AND Thiazide-like diuretic

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55
Q

what is the management of HTN not controlled by three agents?

A

Consider Spironolactone (If K+ <4.5)

Consider Beta blocker/Alpha blocker (if K+ >4.5)

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56
Q

what is classed as severe hypertension?

A

180/120 mmHg

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57
Q

what is stage 1 HTN?

A

Clinical - 140/80 mmHg to 159/99mmHg

Home - 135/85 - 149/94

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58
Q

what is stage 2 HTN?

A

Clinical - 160/100 - 180/120
Home - 155/95 - 175/115

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59
Q

what is stage 3 HTN?

A

180/120 +

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60
Q

what is the white coat effect?

A

discrepancy of 22/10mmHg between clinical and home BP

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61
Q

what are 5 renal causes of HTN?

A

CKD
Chronic pyelonephritis
Diabetic nephropathy
Glomerulonephritis
Polycystic kidney disease

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62
Q

what are 2 vascular causes of secondary HTN?

A

coarctation of aorta
rental artery stenosis

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63
Q

what are 5 endocrine causes of HTN?

A

Primary hyperaldosteronism
Phaeochromocytoma
Cushings syndrome
Acromegaly
Hyper/Hypothyroid

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64
Q

what are 5 drugs that can cause HTN?

A

alcohol + other substances
COCP/Oestrogens
Eythropoietin
corticosteroids
NSAIDs

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65
Q

what are 3 things that conjunctivitis will not cause?

A

Pain
Vision loss
Photophobia

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66
Q

what is the presentation of viral conjunctivitis?

A

clear discharge from eyes, associated with cold symptoms

may have tender periauricular lymph nodes

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67
Q

what are 3 differentials of painless red eye?

A

conunctivitis
episcleritis
subconjunctival haemorrhage

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68
Q

what are 7 differentials for painful red eye?

A

glaucoma
anterior uveitis
scleritis
corneal abrasions or ulceration
keratitis
foreign body
trauma or chemical injury

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69
Q

what medication can be given for bacterial conjunctivitis?

A

chloramphenicol and fuscidic acid eye drops

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70
Q

which patients should always be referred to ophthalmology with conjuncitivitis?

A

<1 month
could be gonococcal infection - can cause sight loss and pneumonia

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71
Q

what is the management of allergic conjunctivitis?

A

antihistamines
mast cell stabilisers - with chronic seasonal symptoms

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72
Q

what is stage 1 HTN?

A

140/80 mmHg to 159/99mmHg CLINICALLY

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73
Q

what is stage 2 HTN?

A

160/100 mmHg to 180/120mmHg CLINICALLY

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74
Q

what is stage 3 HTN?

A

> 180/120 mmHg

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75
Q

what is the middle ear?

A

between tympanic membrane and inner ear (cochlea, vestibular apparatus and nerves)

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76
Q

what is the most common causative organism for otitis media?

A

strep pneumoniae

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77
Q

what are 3 other common causative organisms for otitis media?

A

H. Influenzae
Moraxella catarrhalis
Staph aureus

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78
Q

what are 5 presenting features of otitis media?

A

ear pain
reduced hearing
feeling generally unwell - fever
URTI symptoms
balance issues

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79
Q

what are 8 complications of otitis media?

A

hearing loss
perforated tympanic membrane
labrynthitis
mastoiditis
abcess
fascial nerve palsy
meningitis

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80
Q

what is the first line treatment for otitis media?

A

amoxicillin 5-7 days

clarithromycin - in penicillin allergy

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81
Q

what is the management of otitis media in pregnant women allergic to penicillins?

A

erythromycin

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82
Q

what are the two most common causes of otitis externa?

A

pseudomonas aeruginosa
staph aureaus

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83
Q

what kind of bacteria is pseudomonas aeruginosa?

A

gram neg aerobic bacilli

naturally resistant to many antibiotics - tx with aminoglycosides (gent) or quinolones (ciproflox)

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84
Q

what are 4 typical symptoms in otitis externa?

A

ear pain
discharge
itchiness
conductive hearing loss

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85
Q

what 4 things can be seen o/e in otitis externa?

A

erythema and swelling
tenderness
pus/discharge in ear canal
lymphadenopathy

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86
Q

what is the treatment for mild otitis externa?

A

acetic acid 2% (earcalm)

can also be used prophylactically

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87
Q

what is the management of moderate otitis externa?

A

topical Abx + steroid

neomycin + dexamethasone and acetic acid (OTOMISE)

Gentamicin and hydrocortisone
ciproflaxacin and dexamethasone

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88
Q

what is a contraindication to using gentamicin/neomycin in otitis externa?

A

perforated tympanic membrane - they are ototoxic

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89
Q

what is the management of sever/systemic otitis externa?

A

oral Abx - fluclox/clarithromycin

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90
Q

what is the treatment for fungal otitis externa?

A

clotrimazole ear drops

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91
Q

what is malignant otitis externa?

A

severe otitis externa where infection spreads to temporal bone. Causes severe persistant headache and fever

granulation tissue is found at junction between bone and cartilage in ear canal

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92
Q

what is the most common causative organism of bacterial tonsilitis?

A

Group A strep - strep pyogenes

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93
Q

What is the treatment for bacterial tonsilitis?

A

1st - penicilin V (phenoxymethylpenicillin) 10 days

penicillin allergy - clarithromycin

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94
Q

what is the second most common bacterial cause of tonsilitis?

A

strep pneumnoniae

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95
Q

what 2 criteria can be used to determine the probability that tonsilitis is bacterial?

A

Centor criteria
FeverPAIN score

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96
Q

what is the centor criteria?

A

for bacterial tonsilitis

fever >38
tonsillar exudates
absence of cough
tender anterior cervical lymph nodes

score >3 => offer Abx

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97
Q

what is the feverPAIN score

A

for bacterial tonsilits

Fever in last 24 hours
Purulence
Attended in 3 days of onset
Inflamed tonsils
No cough or coryza

score >4 - consider Abx

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98
Q

what are 6 complications of bacterial tonsilits?

A

peritonsillar abcess (quinsey)
otitis media
scarlet fever
rheumatic fever
post-streptococcal glomerulonephritis
post-streptococcal reactive arthritis

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99
Q

what is acute sinusitis?

A

<12 weeksw

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100
Q

what is chronic sinusitis?

A

> 12 weeks

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101
Q

what are the 4 pairs of paranasal sinuses?

A

frontal - above eyebrows
maxillary - either side of nose
ethmoid - in middle of nasal cavity
sphenoid - in back of nasal cavity

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102
Q

what are 4 causes of sinusitis?

A

infection
allergies
obstruction of drainage - foreign body, polyps
smoking

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103
Q

what is the typical presentation of acute sinusitis? 5

A

nasal congestion and discharge
facial pain/headache
facial pressure
facial swelling
loss of smell

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104
Q

what 5 things may be seen o/e of sinusitis?

A

tenderness to palpation
inflammation and oedema of nasal mucosa
discharge
fever
signs of systemic infection

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105
Q

how long should you wait to give abx for sinusitis?

A

10 days

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106
Q

what is the management of sinusitis?

A

high dose steroid nasal spray for 14 days - 200mcg Mometasone BD

Delayed till day 17 phenoxymethylpenicillin

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107
Q

what are 4 risk factors for vaginal thrush?

A

increased oestrogen (high in preggo)
Poorly controlled diabetes
immunosupression
Broad spectrum Abx

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108
Q

what is the presentation of vaginal thrush?

A

thick white unsmelly discharge
vulval and vaginal itching, irritation or discomfort

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109
Q

what are 6 complications of vaginal thrush?

A

erythema
fissures
oedema
dysparaunia
dysuria
excoriation

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110
Q

what is the vaginal pH of candida?

A

<4.5

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111
Q

what is the vaginal pH of trichomonas?

A

> 4.5

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112
Q

what is the management of vaginal thrush?

A

antifungal cream - clotrimazole (one off)
pessary - clotrimazole (one off 500mg or 3 doses 200mg)
oral - fluconazole (one off 150mg)

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113
Q

what is a warning that should be given with antifungal creams/pessaries?

A

can damage latex condoms and prevent spermacides - use alternative protection for 5 days

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114
Q

what is the most common fungus that causes ringworm?

A

trichophyton

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115
Q

what the name of ringworm?

A

tinea

tinea pedis - athletes foot
tinea capitis - ringworm of scalp
tinea cruis - groin
tinea coporis - body
onchomycosis - nail

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116
Q

what does ringworm look like?

A

itchy rash
erythematous, scaly and well demarcated
one or multiple rings with more prominent edges

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117
Q

what is the management of cutaneous fungal infections?

A

cream - terbinafine, clotrimazole, miconazole
shampoo - ketocanazole
oral - fluconazole, griseofulvin, itraconazole
nail laquer - amorolfine (6-12 months)

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118
Q

what is a kerion?

A

an abscess caused by a fungal infection most often causes by tinea capitis - causes boggy pus filled lump on scalp with localised alopecia

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119
Q

what are 6 risk factors for nappy rash?

A

delayed changing
irritant soaps/vigorous cleaning
poorly absorbant nappies
diarrhoea
oral Abx - predispose to candida
pre-term infants

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120
Q

what is the difference between nappy rash and candida infection?

A

candida doesnt spare skin folds
candida has larger red macules
candida has a well demarcated scally border
candida has satelite lesions

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121
Q

what are the 3 most common bacteria in cellulitis?

A

staph aureus
group A strep (pyogenes)
group C strep (dysgalactiae)

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122
Q

what classification is used for cellulitis?

A

eron classification

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123
Q

what is the management for cellulitis?

A

1 - flucloxacillin

clarithromycin
clindamycin
co-amox

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124
Q

what are 6 risk factors for OA?

A

obesity
age
occupation
trauma
female
Fhx

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125
Q

what are 5 x-ray findings of OA? mneumonic

A

JOSSA

joint space narrowing
osteophytes
Subarticular sclerosis
Subchondral cysts
Abnormalites of bone contour

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126
Q

what are 3 hand signs in OA?

A

heberden’s nodes
bouchard’s nodes
squaring at base of thumb

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127
Q

what joint does heberden’s nodes affect?

A

DIP

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128
Q

what joint does bouchard’s nodes affect?

A

PIP

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129
Q

what are 4 side effects of NSAIDs?

A

GI - gastritis, ulcers
renal - AKI (acute tubular necrosis), CKD
CV - HTN, heart failure, MI, stroke
exacerbation of asthma

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130
Q

how do NSAIDs cause HTN?

A

block prostaglandins which cause vasodilation => use with caution in HTN

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131
Q

what antibodies are in RhA?

A

rheumatoid factor
anti-CCP (cyclic citrullinated peptide) - most specific and sensitive

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132
Q

what is atlantoaxial sublaxation?

A

complication of RhA where the axis and odontoid peg shift within atlas causing localised sinovitis and damage to ligaments which can cause spinal cord compression

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133
Q

what are RhA signs in the hands?

A

Z shaped deformity of thumb
swan neck deformity (hyperextended PIP and flexed DIP)
boutonnieres deformity - hyperextended DIP with flexed PIP
ulnar deviation

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134
Q

what are 10 extra-articular manifestations of RhA?

A

pulmonary fibrosis (caplan’s syndrome)
Bronchiolitis obliterans
Feltys syndrome (RhA, neutropenia, splenomegaly)
Secondary Sjogren’s syndrome
anaemia of chronic disease
CVD
episcleritis and scleritis
rheumatoid nodules
lymphadenopathy
carpal tunnel
amyloidosis

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135
Q

what are 4 x-ray features of RhA?

A

erosions
synovitis
deformity and joint destruction
symmetrical pattern

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136
Q

what is felty’s syndrome?

A

complication of RhA

RhA + neutropenia +splenomegally

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137
Q

what is caplan’s syndrome?

A

complication of RhA

pulmonary fibrosis in people with RhA usually in relation to particulate exposure

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138
Q

which joint is spared in rheumatoid?

A

Distal interphalangeal

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139
Q

when is urgent referral for RhA needed?

A

if small joints of hands and feet are affected
if multiple joints are affected
if symptoms >3 months

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140
Q

what score can be used to objectively measure severity of RhA?

A

disease activity score (DAS) 28

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141
Q

what score can be used to measure subjective severity of RhA?

A

health assessment questionaire

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142
Q

what is the long term treatment of RhA?

A

Acute - NSAIDs/Coxibs (+PPI), glucocorticoids (only in confirmed)

long term
1st - DMARDs (methotrexate, leflunomide, sulfasalazine), hydroxychloroquine consider in mild disease
2nd - combination DMARDs
3rd - DMARD + biologics (TNF inhibitor, JAK inhibitors)
4th - DMARD + rituximab

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143
Q

how long can it take for DMARDs to work?

A

2-3 months

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144
Q

what is a side effect of biological agents?

A

immunosuppression

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145
Q

what are 4notable side effects of methotrexate?

A

mouth ulcers and mucositis
liver toxicity
bone marrow suppression and leukopenia
teratogenic

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146
Q

how is methotrexate taken?

A

orally once a week
OR
Injection once a week

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147
Q

what should always be co-prescribed with methotrexate?

A

folic acid 5mg OW - to be taken on different day to methotrexate

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148
Q

how does methotrexate work?

A

interferes with folate metabolism

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149
Q

what are 5 notable side effect of leflunomide?

A

raised BP
rashes
peripheral neuropathy
teratogenic
bone marrow suppresion

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150
Q

how does leflunomide work?

A

interferes production of pyrimidine used to make RNA and DNA

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151
Q

how does hydroxychloroquine work as an immunosuppressant?

A

interferes with toll-like receptors disrupting antigen presentation

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152
Q

what are 4 notable side effects of hydroxychloroquine?

A

nightmares
macular toxicity
liver toxicity
skin pigmentation

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153
Q

what is a notable side effect of sulfasalazine?

A

male infertility - reduction in sperm count

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154
Q

what is a notable side effect of anti-TNF?

A

reactivation of TB and hepatitis B

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155
Q

what are 2 notable side effects of rituximab?

A

night sweats
thrombocytopenia

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156
Q

what are 9 LUTS in BPH?

A

storage - urgency, frequency, nocturia

voiding - hesitancy, weak flow, terminal dribbling, intermittency, straining, incomplete emptying

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157
Q

what is the initial investigations of suspected BPH?

A

DRE
abdo exam
urinary frequency volume chart
urine dip
PSA

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158
Q

what are 6 causes of a raised PSA?

A

prostate cancer
BPH
prostatitis
UTI
vigorous exercise
recent ejaculation or prostate stimulation

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159
Q

what are 2 options for medical management of BPH?

A

alpha blockers (tamulosin) - relaxes muscle rapid symptom improvement

5-alpha reductase inhibitors (finasteride) - gradually reduces size of prostate over time

160
Q

what are 4 surgical options for BPH?

A

transurethral resection of prostate
transurethral electrovaporisation of prostate
holmium laser enucleation of prostate
open prostatectomy

161
Q

what is a side effect of alpha blockers?

A

postural hypotension

162
Q

what is the most common side effect of finasteride?

A

sexual dysfunction

163
Q

what are 6 complications of TURP?

A

infection
urinary incontinence
erectile dysfunction
retrograde ejaculation

164
Q

what is the name of the extra-articular manifestationof gout which causes lumps to be seen in skin?

A

gouty tophi - subcutaneous uric acid deposits

165
Q

what are 8 risk factors for gout?

A

male
FHx
obesity
high purine diet - meat and seafood
alcohol
diuretics
CVD
kidney disease

166
Q

what be seen on joint aspiration in gout?

A

needle shaped negatively bifringent monosodium urate crystals

167
Q

what crystals cause gout?

A

monosodium urate

168
Q

what are 4 x-ray findings in gout?

A

maintained joint space
lytic lesions
punched out erosions
erosions may have sclerotic borders with overhanding edges

169
Q

what is the acute management of gout? (3)

A

1 - NSAIDs + PPI
2 - Colchicine
3 - oral steroids (pred)

170
Q

when might NSAIDs be contraindicated in acute gout treatment?

A

renal impairment, significant heart disease

use colchicine instead

171
Q

what are 2 side effects of colchicine?

A

abdo symptoms and diarrhoea

172
Q

what is the prophylactic management of gout?

A

allopurinol

or Febuxostat

173
Q

what medication is allopurinol?

A

xanthine oxidase inhibitor

174
Q

what crystals cause pseudogout?

A

calcium pyrophosphate crystals

175
Q

what do calcium pyrophosphate crystals look like?

A

rhomboid shaped positively birefringent

176
Q

what classical X-ray change can be seen in pseudogout?

A

chondrocalcinosis - calcium deposits in joint cartilage

177
Q

what gene is linked to seronegative spondyloarthropsthies?

178
Q

what are 4 other symptoms associated with reactive arthritis?

A

bilateral conjunctivitis
anterior uveitis
urethritis/balantitis

CANT SEE, CANT PEE, CANT CLIMB A TREE

179
Q

what are the 2 most common causes of reactive arthritis?

A

GI infection
STI

180
Q

what are 5 risk factors for IE?

A

IVDU
Structural heart pathology
CKD
immunocompromised
Hx of IE

181
Q

what is the most common causative organism of IE?

182
Q

what are 8 signs on examination of IE?

A

new/changing murmur
splinter haemorrhages
petichae
janeway lesions
osler nodes
roth sponts
splenomegaly
clubbing

183
Q

what investigation is used to diagnose IE?

A

echo - transoesophageal (TOE) is more sensitive and specific that transthoracic

184
Q

what are 2 investigations that can be does in those with prosthetic valves for IE?

A

18F-FDG PET/CT
SPECT-CT

185
Q

what criteria is used to diagnose IE?

A

Duke criteria

186
Q

what are the 2 major Duke’s criteria for IE?

A

+ve blood cultures
image findings (ECHO vegitations)

187
Q

what are the 5 minor Duke’s criteria for IE?

A

risk factors
Fever >38
vascular phenomena (splenic inferct, intracranial haemorhage, janeway lesions)
immunological pheomena (osler nodes, roth spots, glomerulonephritis)
microbiological phenomena

188
Q

what is the management for IE?

A

IV broad spectrum Abx - Amox + gent

4 weeks for native valves
6 weeks for prosthetic valves

189
Q

what are 4 complications of IE?

A

heart valve damage
heart failure
infective/non-infective emboli - abcess, stroke, splenic infarct
glomerulonephritis

190
Q

what two conditions are encompassed with COPD?

A

chronic bronchitis
emphysema

191
Q

what scale is used to grade COPD?

A

MRC dyspnoea scale

192
Q

what is grade 1 on the MRC dyspnoea scale?

A

breathless on strenuous exercise

193
Q

what is grade 2 on the MRC dyspnoea scale?

A

breathless walking up hill

194
Q

what is grade 3 on the MRC dyspnoea scale?

A

breathless walking on the flat

195
Q

what is grade 4 on the MRC dyspnoea scale?

A

breathlessness walking less than 100m on flat

196
Q

what is grade 5 on the mrc dyspnoea scale?

A

unable to leave house due to breathlessness

197
Q

what will be seen on spirometry with COPD?

A

obstructive => FEV1:FVC <70%
little/no reversibility

198
Q

how can severity in COPD be measured?

199
Q

what is the non-medical management of COPD?

A

annual flu and pneumococcal vaccine
pulmonary rehab
stop smoking

200
Q

what is the medical management of COPD?

A

1 - SABA or SAMA (ipratropium bromide)

2 - un steroid responsive - LABA + LAMA
2- steroid responsive - LABA and ICS (fostair, seretide)

3 - LABA, LAMA, ICS combo - trimbow, trelegy

201
Q

when might someone with COPD need LTOT?

A

if chronically hypoxic - O2 SATs <92%
polycythaemia
cyanosis
cor pulmonale

202
Q

what is cor pulmonale?

A

R sided heart failure causes by resp illness - COPD, pulmonary embolism, ILD< CF, pulmonary hypertension

203
Q

what is the first line management of trigeminal neuralgia?

A

carbamazepine

204
Q

how long does kidney function need to be reduced to define it as chronic?

205
Q

what are 5 risk factors for CKD?

A

diabetes
hypertension
meds - NSAIDs, Lithium
glomerulonephritis
polycystic kidney disease

206
Q

what is eGFR in stage one CKD?

A

> 90 ml/min/1.73 m2

207
Q

what is eGFR in stage 2 CKD?

A

60-89 ml/min/1.73 m2

208
Q

what is eGFR in stage 3a CKD?

A

45-59 ml/min/1.73 m2

209
Q

what is classed as CKD?

A

eGFR <60 ml/min/1.73 m2
or Urine albumin:creatinine ratio >3 mg/mmol

for 3 months

210
Q

what is stage 3b eGFR in CKD?

A

30-44 ml/min/1.73 m2

211
Q

what is stage 4 eGFR in CKD?

A

15-29 ml/min/1.73 m2

212
Q

what is stage 5 eGFR in CKD?

A

<15 ml/min/1.73 m2

213
Q

what are 6 complications of CKD?

A

anaemia
renal bone disease
CVD
peripheral neuropathy
end stage kidney disease
dialysis related complications

214
Q

what tool can be used to estimate 5 year risk of kidney failure requiring dialysis?

A

kidney failure risk equation

215
Q

what is the management of CKD?

A

Tx underlying conditions
BP <130/80 - ACEi, SLGT-2 inhibitors (dapagliflozin)
lifestyle
Atorvostatin 20mg

Tx complications

216
Q

what is the management of renal bone disease?

A

low phosphate diet
phosphate binders
active form of vit D
ensure adequate ca intake

217
Q

what is the most common cause of hypothyroidism in developed world?

A

Hashimotos thyroiditis

218
Q

what antibodies are seen in hashimotos?

A

anti-thyroid perxidase (anti-TPO) antibodies

anti-thyroglobulin antibodies

219
Q

what is the most common cause of hypothyroid in developing world?

A

iodine deficirency

220
Q

what are 4 meds that can cause hypothyroidism?

A

carbimazole - over tx for hypert
propylthiouracil - over Tx for hyper
LITHIUM
Amiodarone - can also cause thyroidtoxicosis

221
Q

what are 5 causes of secondary hypothyroidism?

A

tumours
surgery to pituitary
radiotherapy
sheehan’s syndrome - major PPH causes avascular necrosis of pituitary
Trauma

222
Q

what medication is used to manage hypothyroidism?

A

levothyroxine - titrate dose to response

223
Q

what antibodies are present in graves disease?

A

TSH receptor antibodies

224
Q

what are 4 signs that are specific to graves disease?

A

exophthalmos (bulging eyes)
pretibial myxoedema
diffuse goitre
thyroid acropachy (hand swelling and finger clubbing)

225
Q

what are 4 causes of thyroiditis?

A

de quervains thyroiditis
hashimotos
post partum thyroiditis
drug induced thyroiditis

226
Q

what is the first line management for hyperthyroidism?

A

carbimazole

227
Q

what are 2 complications of carbimazole?

A

pancreatitis
agranulocytosis

228
Q

what is the 2nd line management for hyperthyroidism?

A

propylthiouracil

229
Q

what are the 2 shockable pulseless rhythms?

A

ventricular tachycardia
ventricular fibrilation

230
Q

how long should the QRS complex be?

A

0.12 seconds

3 small squares

231
Q

what are the 4 main causes of narrow complex tachycardias?

A

sinus tachy
supraventricular tachy
AF
Atrial flutter

232
Q

what is the management for suraventricular tachycardia?

A

vagal manoeuvres - valsalva, diving reflex

adenosine

233
Q

what is a prolonged cQT interval?

A

> 0.44s in men
0.46s in women

234
Q

what is torsades de pointes?

A

type of ventricular tachycardia caused by long QT which causes progressive changing heights of QRS complexes with ventricular tachycardia which can either revert to sinus rhythm or progress to ventricular tachycardia

235
Q

what are 3 causes of long QT?

A

long QT syndrome
medications
electrolyte imbalances - hypokalaemia, hypomagnesaemia, hypocalcaemia

236
Q

what are 6 meds that can cause long QT?

A

antipsychotics
citalopram
flecainide
sotalol
amiodarone
macrolides

237
Q

what is the acute management of torsades du pointes?

A

correct underlying cause
magnesium infusion
defibrilation

238
Q

what PR interval indicates 1st degree heart block?

A

> 0.2 s (one big square)

239
Q

what is 2nd degree mobitz type 1 heart block?

A

PR interval gets progressively longer until conduction fails and then the cycle repeats

240
Q

what is 2nd degree type 2 heart block?

A

intermittent failure of conduction in a certain ration of P waves to QRS complexes

241
Q

what is 3rd degree heart block?

A

no relationship between p waves and QRS complexes

242
Q

what is sick sinus syndrome?

A

dysfunction of SA node often causes by idiopathic degenerative fibrosi s

243
Q

what arrhythmia carry risk of asystole?

A

mobitz type II
3rd degree HB
previous asystole
ventricular pauses longer than 3s

244
Q

what medication can be used first line in unstable patients at risk of asystole?

A

IV atropine

245
Q

what are 4 features of AF?

A

irregularly irregular hr
tachycardia
heart failure - due to impaired filling in diastole
increased risk of stroke (5X)

246
Q

what are 5 common causes of AF? mneumonic

A

SMITH

Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension

Alcohol and caffeine

247
Q

what are 3 ecg findings in AF?

A

absent p waves
narrow QRS complex tachycardia
irregularly irregular ventricular rhythm

248
Q

what is the first line management for AF?

A

rate control
1 - beta blocker - propanolol

2 - calcium channel blockers (diltiazem or verapamil), digoxin

249
Q

what score is used to assess need for anticoagulation in AF?

A

CHA2DS2-VASc

250
Q

what is the first line anticoagulant to be used in AF?

A

DOAC - apixiban, edoxaban, riveroxaban

2 - warfarin

251
Q

how do DOACs work?

A

direct factor Xa inhibition

252
Q

what is the antidote to apixiban?

A

andexanet alfa

253
Q

what is he target range for INR?

254
Q

what does chad2ds2-Vasc stand for?

A

Congestive heart failure
Hypertension
Age >75 (2+)
Diabetes
Stroke or TIA (+2)

Vascular disease
Age 65-74
Sex (female)

255
Q

what is the ORBIT score?

A

bleed risk in anticoag in af

Older age >75
Renal impairment
Bleeding previously
Iron - low haemoglobin/haematocrit
Taking antiplatlets

256
Q

what can be seen on ecg with supraventricualar tachycardia?

A

tachycardia with narrow complex QRS COMPLEXES (<0.12s)

257
Q

what is wolff-parkinson white syndrome?

A

caused by extra electrical pathway connecting atria and ventricles which leads to episodes of supraventricular tachycardia

258
Q

what ecg changes are seen in woff-parkinson white syndrome?

A

short PR <0.12s
Wide QRS complexes >0.12s
delta waves - slurred upstroke in QRS complexes

259
Q

what is a major complication of wolff-parkinson white syndrome?

A

if in combination with AF can cause polymorphic wide complex tachycardia which is lifethreatening

260
Q

what medications are contraindicated in wolff-parkinson white syndrome?

A

most anti-arrythmics as increase risk of conduction through acessory pathways

261
Q

what is the stepwise management of supraventricular tachycardia?

A

vagal manoeuvers
adenosine
verapamil/beta blocker
Synchronised DC cardioversion

262
Q

in what conditions is adenosine contraindicated?

A

Asthma or COPD
COPD
Heart failure
heart block
severe hypotension
potential atrial arrhythmia with underlying pre-excitation (WPW syndrome)

263
Q

what is the stepwise dosage of adenosine?

A

6mg

12mg

18mg

264
Q

what is a side effect of adenosine bolus?

A

feeling of impending doom like dying

265
Q

what is the secondary prevention for cardiovascular disease?

A

4As

Antiplatelets - aspirin, clopi, ticagrelor
Atorvostatin 80mg
Atenolol - or other beta blocker
Acei - ramipril

266
Q

what is the antiplatelet of choice in peripheral arterial disease?

A

clopidogrel

267
Q

what are 6 features of critical limb ischaemia?

A

6Ps

Pain
Pallor
Pulseless
Paralysis
Paresthesia
Perishingly cold

268
Q

what are 7 features of arterial ulcers?

A

smaller than venous
deeper than venous
well defined borders
punched out appearance
occur peripherally
reduced bleeding
painful

269
Q

what are 7 features of venous ulcers?

A

occur after minor injury
larger than arterial
more superficial than arterial
irregular gently sloping borders
affect gaiter areas - mid calf to ankle
less painful
occur with other signs of chronic venous insuficciency

270
Q

what are 3 investigations for peripheral vascular diseae?

A

ankle branchial pressure index
duplex uss
angiography - ct or mri

271
Q

what medication can be used in peripheral vascular disease that acts as peripheral vasodilator?

A

naftidrofuryl oxalate - 5-HT2 receptor antagonist

272
Q

what condition is polymyalgia rheumatica associated with?

A

giant cell arteritis

273
Q

what is the presentation of polymyalgia rheumatica?

A

2 weeks of

pain and stiffness in shoulders, pelvic girdle or neck

worse in morning and after rest, interferes with sleep, takes 45mins+ to ease with activity

systemic symptoms
muscle tenderness
carpal tunnel
peripheral oedema

274
Q

what is the management of polymyalgia rheumatica?

A

15mg prednisolone daily for 1 week then follow up till symptoms controlled then slowly reduce steroid over time

usually dramatic response to steroids

275
Q

what is the management for patients on long term steroids?

A

Don’t STOP

Don’t - steroid dependance after 3 weeks - DONT STOP ABRUPTLY

S ick day rules
T reatment card
O steoporosis prevention - bisphosphonates +
calcium + vit D immediately
P roton pump inhibitors

276
Q

what is the management of bursitis?

A

rest
ice
compression
analgesia
protect joint from pressure/trauma
?aspirate to relieve pressure
?steroid injection

277
Q

what is a t-score for osteoporosis?

278
Q

what is the t-score for osteopenia?

A

-1 to -2.5

279
Q

what are 5 medications that increase risk osteoporosis?

A

Corticosteroids (long term 7.5mg+ for 3 months+)
SSRIs
PPIs
antiepileptics
anti-oestrogens

280
Q

what are 3 chronic diseases that increase risk of osteoporosis?

A

ckd
hyperthyroidism
rheumatoid arthritis

281
Q

what are 7 risk factors for osteoporosis?

A

older age
post menopausal
reduced mobility and activity
lower bmi <19
low calcium or vitamin d
alcohol and smoking
FHx or personal history

282
Q

what is the management of osteoporosis?

A

Address reversible risk factors Add calcium and vitamin D

1 - Bisphosphonates (alendronate, risendronate, zoledronic acid)

283
Q

what are 4 side effeccts of bisphosphonates?

A

reflux and oesophageal erosions
atypical fractures
osteonecrosis of the jaw
osteonecrosis of external auditory canal

284
Q

how shoes bisphosphonates be taken?

A

on an empty stomach
with full glass of water
sit upright for 30 mins before moving or eating

285
Q

what are 4 medications for osteoporosis started by a specialist?

A

denosumab - MAB targeting osteoclasts
Romosuzumab
Teriparatide - acts as parathyroid hormone
HRT
Raloxifene - selective oestrogen receptor modulator
strontium ranelate

286
Q

what are 2 side effects of strontium ranelate?

A

increased VTE risk
increased MI risk

287
Q

what is menopause?

A

12 months no period

288
Q

when iis the average menopause?

289
Q

what is premature menoopuse?

290
Q

what are 8 perimenopausal symptoms?

A

hot flushes
emotional lability/low mood
premenstrual syndrome
irreular periods
joint pain
heavier or lighter peiods
vaginal dryness and atrophy
reduced libido

291
Q

what are 4 conditions that reduced oestrogen increases the risk of?

A

CVD and stroke
osteoporosis
pelvic organ prolapse
urinary incontinence

292
Q

what are 5 good contraceptive options in women approaching menopause?

A

barrier methods
mirena or copper coil
progesterone only pill
progesterone implant
sterilisation

293
Q

what are 2 side effects of the progesterone depot injection?

A

weight gain
reduced bone mineral density

294
Q

what are 8 management options for perimenopausal symptoms?

A

HRT
tibolone - only after 12 months amenorrhoea
clonidine
CBT
SSRIs
testosterone - for libido
vaginal oestrogen
vaginal moisturisers

295
Q

what are the 2 most common mets sites for prostate cancer?

A

lymph nodes
bone - spine v comon

296
Q

what is the first line investigation for prostate cancer?

A

multiparametric mri

297
Q

what are 2 methods of prostate biopsy?

A

transrectal ultrasound guided biopsy
transperineal biopsy

298
Q

what grading system is used for prostate cancer>

A

gleason grading system

299
Q

what are 2 hormone therapies used in prostate cancer?

A

androgen receptor blockers - bicalutamide
GnRH agonists - goserelin or leuprorelin

300
Q

what are 4 types of psoriasis?

A

plaque - normal psoriasis plaques
guttate psoriasis
pustular psoriasis - med emergency
erythrodermic psoriasis - extensive erythema which peels in large patches - med emergency

301
Q

what is guttate psoriasis?

A

common in children, many small papules on trunk and limbs that develop to plaques. usually after strep throat infection

302
Q

what are 3 specific signs of psoriasis?

A

auspitz sign - small points of bleeding when plaques scraped off
koebner phenomenon - psoriatic lesions in areas of trauma
residual pigmentation once lesions resolve

303
Q

what is the management of psoriasis?

A

topical steroids
topical vitamin D
topical dithranol
topical calcineurin inhibitors - tacrolimus
phototherapy with narrow band uv b light

304
Q

what are 2 potent steroid + vitamin d

A

dovobet and enstilar

305
Q

what are 5 hand signs of psorisis?

A

nail pitting
oncholysis
dactylisis
nail thickening
swollen joints

306
Q

how many tender sites must be identified in fibromyalgia?

A

11/18 designated tender point sites

307
Q

How often is diabetic eye screening?

A

annually from age of 12

308
Q

in what age range is cervical screening every 3 years?

A

25-49 = every 3 years

309
Q

in what age range is cervical screening every 5 years?

A

50-70 = every 5 years

310
Q

in what age range is breast screening offered?

A

50-70 years

311
Q

how often is breast screening?

A

every 3 years

312
Q

In what age range is bowel screening offered?

A

60-74 years

313
Q

How often is bowel screening done?

A

every 2 years

314
Q

at what age are men screened for AAA?

315
Q

what happens if HPV is found on a smear?

A

another smear in 1 year

316
Q

what happens if there is inadequate results on a smear?

A

another smear in 3 months

317
Q

what happens if HPV is detected on a smear twice in a row?

A

colposcopy

318
Q

what are 4 screening tests in pregnancy?

A

Hep B, HIV and syphilis screen
Down’s, pataus and edwards screen - combined/quadruple test
sickle cell/thallsaemia test
20 week anomaly scan
diabetic eye screen - if have diabetes

319
Q

what are 3 new born screening tests?

A

NIPE
hearing test
blood spot heel prick test

320
Q

what is the presentation of anal fissure?

A

severe pain on defecation - like passing broken glass
fresh blood on stool
O/E - spasm of sphincter muscles and significant tenderness

321
Q

what is the management of anal fissures?

A

Conservative - high fibre diet, fluids, baths. topical analgesia, stool softeners

topical glyceryl trinitrate or diltiazem

surgery in severe resistance

322
Q

what is acute bronchitis?

A

LRTI - usually resolves in 3 weeks

323
Q

when do you offer Abx in acute bronchitis?

A

if CRP >20 offer delayed prescription
if CRP >100 offer ABx now

324
Q

what is the first line abx in acute bronchitis?

A

doxycycline

not in preggos or children - Amoxacillin

325
Q

what is acute stress disorder?

A

features of ptsd - intrusive thoughts, dissociation, negative mood, avoidance, arousal

in the first 4 weeks after a traumatic even

326
Q

what is the management of acute stress disorder?

A

trauma focused CBT

Benzodiazepines - used for acute symptoms

327
Q

what is a Meibomian cyst?

A

internal infection of meibomian glands in eyelid causing lump - like what dan had - hot compress and analgesia should go away on own

328
Q

what is lyme disease caused by?

A

Borrelia burgdorferi spirochaete

329
Q

what are 2 early (<30 days) features of lyme disease?

A

erythema migrans - bullseye rash develops 1-4 weeks after bite usually painless and >5cm

systemic features - headache, lethargy, fever, arthralgia

330
Q

what are 5 late (>30 days) features of lyme disease?

A

cardiovascular
- heart block
- peri/myocarditis
Neuro
- facial nerve palsy
- radicular pain
- meningitis

331
Q

what is the 1st line investigation for lymes disease?

A

enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi

332
Q

what is the gold standard test for lyme disase?

A

immunoblot test

333
Q

what is the management of lyme disease?

A

Doxycycline if early disease (amox if contraindicated)

Ceftriaxone if diseminated disease

334
Q

what is Jarisch-Herxheimer reaction?

A

fever, rash and tachycardia after 1st dose Abx in spirochaete disease - lyme disease and syphilis

335
Q

what is the management for gingivostomatitis (ulcers) in HSV?

A

oral acyclovir and chlorohexadine mouth wash

336
Q

what is the management for genital herpes?

337
Q

what is the management of herpes in pregnancy?

A

elective c-section if primary genital infection >28 weeks

338
Q

which herpes virus is most commonly responsible for herpes encephalitis?

339
Q

BMI =

A

weight/height squared

340
Q

what is the medical management of obesity?

A

orlistat
liraglutide

341
Q

when is orlistat used?

A

BMI >28 with 2+ risk factors
BMI >30

with continued weight loss of 5% at 3 months
use for <1 year

342
Q

how does orlistat work?

A

pancreatic lipase inhibitor

343
Q

How does liraglutide work?

A

glucagon-like peptide mimetic used in T2DM given OD SC injection

344
Q

when is liraglutide used?

A

BMI > 35 kg/m²
prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)

345
Q

what are varicose veins?

A

distended superficial veins measuring more than 3mm in diameter, usually affecting the legs.

346
Q

what are reticular veins?

A

dilated blood vessels in the skin measuring less than 1-3mm in diameter

347
Q

what is Telangiectasia?

A

dilated blood vessels in the skin measuring less than 1mm in diameter. They are also known as spider veins or thread veins.

348
Q

what are 3 signs of chronic venous insuficiency that can be seen in the lower legs?

A

brown discolouration due to haemosiderin
venous eczema
lipodermatosclerosis

349
Q

what are 5 special tests for varicose veins?

A

Tap test
cough test
Trendelenburghs test
Perthes test
Duplex ultrasound

350
Q

what are 3 surgeries for varicose veins?

A

Endothermal ablation
Sclerotherapy – injecting the vein with an irritant foam that causes closure of the vein
Stripping

351
Q

what is the ideal blood glucose conc?

A

4.4-6.1 mmol/L

352
Q

what are 4 macrovascular complications of DM?

A

coronary artery disease
Peripheral ischaemia
Stroke
HTN

353
Q

what are 3 microvascular complications of DM?

A

peripheral neuropathy
retinopathy
kidney disease

354
Q

what are are 4 infection related complications of DM?

A

UTI
Pneumonia
skin and soft tissue infection
fungal infection

355
Q

How often do diabetics get their HbA1c measured?

A

every 3-6 months

356
Q

what is the name of the darkening skin on neck axilla and groin seen in insulin resistance?

A

acanthosis nigricans

357
Q

what HbA1c level is pre-diabetes?

A

42-47 mmol/mol

358
Q

what is the HbA1c level for diabetes?

A

> 48 mmol/mol

359
Q

what is the 1st line treatment for T2DM?

360
Q

what medication can be added to patients on metformin with an existing CVD or QRisk >10%?

A

SGLT-2 inhibitor - dapagliflozin

361
Q

what is the second line management of T2DM?

A

sulfonylurea

pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor

362
Q

what is the MOA of metformin?

A

increases insulin sensitivity and decreases glucose production - a biguanide

363
Q

what are 2 side effects of metformin?

A

GI symptoms
Lactic acidosis - secondary to AKI

NOT hypos NOT weight gain

364
Q

what is the MOA of SGLT-2 inhibitors?

A

prevent sodium glucose co-transporter 2 protein from reabsorbing glucose in proximal tubules allowing for greater excretion

365
Q

what are 8 side effects of SGLT-2 inhibitors?

A

Glycosuria
Increased urinary output and frequency
UTIs + genital infections
weight loss
DKA
Lower limb amputation
Fourniers gangrene
Hypoglycaemia

366
Q

what are 4 side effects of pioglitazone?

A

weight gain
heart failure
increased risk bone fractures
small increase risk bladder cancer

367
Q

what are 2 side effects of sulfonylureas?

A

weight gain
hypoglycaemia

368
Q

what is a rapid acting insulin and how long does it work for?

A

Novorapid - works after 10 mins for 4 hours

369
Q

what is a short acting insulin and how long does it work for?

A

Actrapid - works after 30 mins for 8 hours

370
Q

what is an intermediate acting insulin and how long does it work for?

A

Humulin I - works after 1 hour for 16 hours

371
Q

what is a long acting insulin and how long does it work for?

A

Levemir and lantus - works after 1 hour for 24 hours

372
Q

what is the 1st line antihypertensive in T2Dm?

373
Q

what are 4 signs of PE? (CXR and ECG)

A

Fleischner sign = dilated central pulmonary vessel. Westermark sign (collapse of vasculature distal to PE) Hampton’s hump - wedge-shaped infarct
ECG features - sinus tachycardia and/or ST depression.

374
Q

what is the management of pericarditis?

375
Q

what is the MOA of N-acetylcysteine?

A

Replenishes body stores of glutathione preventing hepatocyte damage.

376
Q

what is the moa of methotrexate?

A

competitively inhibits dihydrofolate reductase

377
Q

what drug can be used to reverse heparin?

378
Q

what medication can be used to reverse DOACs?

379
Q

what is the chronic management for ACS?

A

Block An ACS

Beta Blocker + ACEi + Aspirin + Clopidogrel + Statin

380
Q

what is the MOA of aspirin?

A

Cox-1 inhibitor

381
Q

what is the MOA of clopidogrel?

A

P2Y12 inhibitor

382
Q

what are 6 symptoms of glandular fever?

A

fever
lymphadenopathy
sore throat
non-specific rash
hepato/splenomegaly

383
Q

what is stage 1 AKI?

A

Creatinine is 1.5-1.9 times higher than baseline/ urine output < 0.5ml/kg for > 6 consecutive hours

384
Q

what is stage 2 AKI?

A

Creatinine is 2-2.9 times higher than baseline/ urine output < 0.5ml/kg for > 12 consecutive hours

385
Q

what is stage 3 AKi?

A

Creatinine is >3 times higher than baseline / urine output < 0.5ml/kg for > 24 consecutive hours/ anuria for > 12 hours

386
Q

what is conn syndrome?

A

adrenal hypertrophy causing increased aldosterone leading to hypertension, hypernatraemia and hypokalaemia

387
Q

what is the management of conn syndrome?

A

spironolactone

388
Q

what is severe asthma in adults?

A

PEF 33–50% best or predicted
RR ≥25/min
HR ≥110/min
inability to complete sentences

389
Q

what is life threatening asthma in adults?

A

PEF <33% best or predicted
SpO2 <92%
PaO2 <8 kPa
‘normal’ PaCO2 (4.6–6.0 kPa)
altered conscious level
exhaustion
arrhythmia
hypotension
cyanosis
silent chest
poor respiratory effort

390
Q

what is chronic suppurative ottitis media?

A

otitis media >2 weeks with recurrent ear discharge

391
Q

what is the 1st and 2nd line management of UTI in men and women?

A

1 - Nitrofurantoin OR Trimethoprim

2 - Nitro (if not used) or Pivmecillinam

Treat for 3 days BD in women and 7 days BD for men

392
Q

what risk score is used for pressure ulcers?

A

Waterlow score

393
Q

what risk score is used for upper GI bleeds?

A

Glasgow-Blatchford

394
Q

what is the name of the sign where muscle twitching is elicited in the face by tapping in front of the ear which is indicative of hypocalcaemia?

A

Chvostek sign

395
Q

what is examination finding in otitis media with effusions?

A

grey tympanic membrane
fluid level
loss of cone of light reflex

AKA glue ear

396
Q

what is examination findings in suppurative otitis media?

A

mucopurulent discharging ear

Phase 3A (7 decks)

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