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1
Q

What things should be asked when investigating a possible malignant hypertension?

A

Any obvious symptoms indicating accelerating or malignant HTN- Headache, visual disturbances, seizures, nausea and vomitting, chest pain

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2
Q

What things should be asked for when investigating kidney disease as a cause of hypertension?

A

Visable blood or frothy urine (indicative of proteinuria)
Lower limb swelling
Tenderness and pain in flank
Weight loss

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3
Q

What should be asked when taking a history for hypertension?

A
  • Family history
  • Medications
  • Menstrual cycle
  • Any symptoms
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4
Q

What clinical findings would indicate autosomal dominant polycystic kidney disease?

A

Enlarged palpable kidneys when balloting the kidneys

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5
Q

What clinical findings would indicate renal artery stenosis?

A

Renal bruits heard when auscultating over the area of the renal arteries

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6
Q

What clinical findings would indicate coarctation of the aorta?

A

Systolic murmer in the left infraclavicular region under the left scapula

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7
Q

What clinical findings would indicate cushings syndrome?

A

Moon faces, abdominal purple striae and bruising

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8
Q

What clinical findings would indicate hypothyroidism?

A

Brittle nails, dry skin and thin hair

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9
Q

What clinical findings would indicate hyperthyroidism?

A

Fine tremor, palmar erythema and a neck goitre

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10
Q

What clinic blood pressure indicates stage one hypertension?

A

> 140/90 mmHg

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11
Q

What clinic blood pressure indicates stage two hypertension?

A

> 160/100 mmHg

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12
Q

What clinic blood pressure indicates stage three hypertension?

A

180/120 mmHg

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13
Q

What is ABPM?

A

Ambulatory blood pressure monitoring

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14
Q

What is HBPM?

A

Home blood pressure monitoring

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15
Q

What extra investigations should be given to someone with hypertension?

A

Urinalysis= for haematuria and proteinuria (Renal disease)
Urine albumin creatinine ratio (End organ damage)
ECG for cardiac arrhythmias
Blood U&E for renal impairment
HbA1c for diabetes

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16
Q

What lifestyle changes can improve hypertension?

A 
Improving diet with less salt
Cut back on alcohol
Have a healthy BMI
Exercise regularly 
Cut down on caffeine 
Stop smoking
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17
Q

What medications can be used for hypertension?

A 
ACE inhibitors
Angiotensin-2 receptor blockers (ARBs)
Calcium channel blockers
Diuretics
Beta blockers
Alpha blockers
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18
Q

What are some risk factors for hypertension?

A

Obesity, high salt, caffeine, alcohol, low exercise, over 65, family history, black African or Caribbean descent, the pill etc.

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19
Q

What things should be discussed/ checked during a postnatal check?

A
  • Any pain
  • Breastfeeding?
  • Mental wellbeing
  • Periods/discharge
  • Contraception
  • Check stitches
  • Check BMI and BP
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20
Q

What contraception can be used immediately after birth?

A
  • Progesterone only pill
  • Injection and implant
  • Condoms
  • IUD and IUS if inserted within 48 hrs of birth
  • LAM
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21
Q

What things may affect mothers contraception choice after birth?

A
  • Whether she wants more children
  • Breastfeeding
  • Personal preference
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22
Q

What is checked during an 8 week baby check?

A
  • Babys head circumference
  • Babys weight
  • Babys heart and breathing
  • Babys hips
  • Babys spine
  • Babys genitals
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23
Q

What is the red book?

A

A personal record of a childs health

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24
Q

When are the infanrix hexa vaccines administered?

A

8 weks
12 weeks
16 weeks

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25
Q

What is vaccinated against with the infanrix hexa vaccine?

A
  • Diptheria
  • Tetanus
  • Pertussis
  • Polio
  • Haemophillius influenzae type b
  • Hepatitis B
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26
Q

When is bexsero vaccine adminisered?

A

8 weeks
16 weeks
1 year

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27
Q

What is vaccinated against using the bexsero vaccine?

A

Meningococcal group B

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28
Q

What is vaccinated against using rotarix?

A

Rotavirus gastroenteritis

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29
Q

When is rotarix virus administered?

A
  • 8 weeks

- 12 weeks

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30
Q

What is vaccinated against using prevenar 13 vaccine?

A

Pneumococcal

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31
Q

When is prevenar 13 administered?

A

12 Weeks

1 year

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32
Q

What is vaccinated against using menitorix?

A

Hib

Men C

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33
Q

What is vaccinated against using MMR?

A

Measles
Mumps
Rubella

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34
Q

When is MMR vaccine given?

A

1 year

3 years and 4 months

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35
Q

When is the HPV vaccine given?

A

Boys and Girls aged 12-13 years

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36
Q

What is vaccinated against using revaxis?

A

Tetanus, diptheria and polio

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37
Q

When is revaxis vaccine given?

A

14 years old

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38
Q

What is the PRISMS system for exploring key rheumatological symptoms?

A
  • Pain
  • Rashes, skin lesions and nail changes
  • Immune
  • Stiffness
  • Malignancy
  • Swelling and sweats
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39
Q

What questions should be asked when taking a history of rheumatological systems?

A
  • Radiation of pain?
  • Where is pain?
  • When did it start?
  • Characteristics of pain
  • Associations
  • Time course- morning vs evening pain?
  • Severity of pain
  • Rashes, skin lesions and nail changes
  • Exacerbating or relieving factors?
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40
Q

What does GALS stand for?

A

Gait
Arms
Legs
Spine

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41
Q

What are the pharmacological steps of rheumatoid pain?

A

Step one= Non-opioid analgesics (paracetamol, NSAIDs)
Step 2= Mild opioids (Codeine, dihydrocodeine)
Step 3= Strong opioids (Morphine, Pethidine, Methadone, Tramadol etc)

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42
Q

List some non-pharmacological steps of managing rheumatoid pain?

A
  • Heat/ice
  • Massage therapy
  • Physiotherapy
  • Relaxation techniques
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43
Q

Briefly explain how NSAIDs work

A

NSAIDs targets Cyclooxygenase-2 (COX-2) enzymes and inhibit COX-mediated conversion of arachidonic acid to prostaglandins and thromboxanes which cause vasodilatation, oedema and pain. The overall effect if this is reduced hyperanalgesic and vasodilatory effects in acute inflammation

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44
Q

A patient complains of a severe, sharp, sudden pain in their big toe. What is a likely diagnosis?

A

Gout

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45
Q

A patient complains of stiffness in joints. Their are in pain and find mobility hard. The joint is hot to touch and the patient feels tired and unwell. The pain is often worse in the morning. What is it likely to be?

A

Rheumatoid arthritis

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46
Q

A patient complains of joint stiffness in one knee. It is an achy pain that is worse later in the day after activities. What is it likely to be?

A

Osteoarthritis

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47
Q

What are some possible symptoms of DMT2?

A
  • Weight gain or loss
  • Polyuria
  • Weakness/fatigue
  • Skin or other infections
  • Blurred vision
  • Abdominal pain
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48
Q

What checks can be done into the complications of diabetes?

A
  • Weight gain/ loss= BMI
  • Hypertension= BP monitoring
  • Cholesterol monitoring
  • Diabetic nephropathy= Urine albumin:creatinine ratio
  • Diabetic retinopathy= Eye checks
  • Foot ulceration= Foot clinic checks
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49
Q

What issues can happen to do with diabetic injection sites?

A
  • Infection
  • Lipohypertrophy
  • Bruising
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50
Q

What is the first line treatment for DMT2?

A

Diet and exercise modifications

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51
Q

What is the second line treatment for DMT2?

A

Diet and exercise modifications

Metformin

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52
Q

What is the third line treatment for DMT2?

A

Diet and exercise modifications
Metformin
SGLT2 inhibitors, glp analogues, Sulphylurea

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53
Q

List some common complications of diabetes

A 
Retinopathy
Nephropathy
Hypertension 
Diabetic foot ulceration
Numbness
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54
Q

List some primary preventative methods for DMT2

A

Population-based healthy lifestyle programmes
Exercise
Prevention of obesity

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55
Q

List some secondary preventative methods for DMT2

A

Screening of populations in NHS health checks and at risk groups
Early intervention

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56
Q

When is DMT2 screening performed?

A
  • At NHS Health checks
  • During pregnancy
  • People at risk= First degree relative, obesity, certain ethnicities (African-Caribbean, Middle Eastern or South Asian)
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57
Q

What test is used for DMT2 screening?

A

IGT

  • 6.0-6.4= pre diabetic
  • 6.5 and over= Diabetic
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58
Q

List some thoracic differentials for chest pain?

A

MI (STEMI, NSTEMI)
Stable angina
Pericarditis
Thoracic aortic dissection

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59
Q

List some respiratory differentials for chest pain?

A

Pneumonia
Spontaneous pneumothorax
Pulmonary embolism

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60
Q

List some GI differentials for chest pain?

A
  • GORD
  • Oesophageal spasm
  • Gallstones
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61
Q

List some MSK differentials for chest pain?

A
  • Rib fracture

- Muscle sprain/tear

62
Q

What is the typical presentation for acute MI?

A
  • Chest pain which is severe and constant. It may radiate to the left arm, jaw and chest
  • Nausea, vomitting, dyspnoea, fatigue
  • Distress and anxiety
63
Q

How is a STEMI diagnosed on ECG?

A
  • ST elevation, tall T waves, L bundle branch block, T wave inversion, Pathological Q waves follow
  • After afew days the ST segment returns to normal
  • After weeks, the T wave may return but the Q wave remains
64
Q

How is a NSTEMI diagnosed?

A

Diagnosis is retrospective

  • ST depression and T wave invesion
  • Troponin I or T increased
  • Myoglobin increased
65
Q

Where should V1 chest lead be placed?

A

4th intercostal space at the right sternal edge

66
Q

Where should V2 chest lead be placed?

A

4th intercostal space at the left sternal edge

67
Q

Where should V3 chest lead be placed?

A

midway between the V2 and V4 electrodes

68
Q

Where should V4 chest lead be placed?

A

5th intercostal space in the midclavicular line.

69
Q

Where should V5 chest lead be placed?

A

Left anterior axillary line at the same horizontal level as V4

70
Q

Where should V6 chest lead be placed?

A

Left mid-axillary line at the same horizontal level as V4 and V5

71
Q

Where should the red limb lead be placed?

A

The ulnar styloid process of the right arm

72
Q

Where should the yellow limb lead be placed?

A

The ulnar styloid process on the left arm

73
Q

Where should the green limb lead be placed?

A

The medial or lateral malleolus of the left leg

74
Q

Where should the black limb lead be placed?

A

The medial or lateral malleolus of the right leg

75
Q

What blood tests would be done if a MI is suspected?

A
  • FBC
  • U&Es
  • Troponin T
  • Lipid profile
  • Serum glucose
76
Q

What tests are done if a MI is suspected?

A

12 lead ECG
Blood tests
CXR

77
Q

What would be the immediate treatment for MI?

A
  • Aspirin
  • GTN sublingual for pain relief
  • Oxygen if needed
  • Morphine for pain relief
78
Q

What are the risk factors for MI?

A

High age, male, history of premature CHD, Diabetes, menopause, smoking, obesity, sedentary lifestyle, hypertension, hyperlipidaemia

79
Q

List the risk factors for suicide

A 
Family history of suicide.
Family history of child maltreatment.
Previous suicide attempt(s)
History of mental disorders, particularly clinical depression.
History of alcohol and substance abuse.
Feelings of hopelessness.
Impulsive or aggressive tendencies
80
Q

What are the classes of antidepressants?

A

SSRI
SNRI
TCA
MAOI

81
Q

What are the common SSRIs?

A

Fluoxetine (first line)
Paroxetine (Better for anxiety)
Citalopram

82
Q

What are the main side effects of SSRIs?

A

GI Irritation
Weird dreams/ Sleep disturbances
Can increase suicide risk in the first couple of weeks

83
Q

What are the common SNRIs?

A

Venlafaxine

Duloxetine

84
Q

What are the main side effects of SNRIs?

A

Raised BP. Increased anxiety. GI upset.

85
Q

What are the common tricyclic antidepressants?

A

Lofepramine (Most commonly used for depression)

Amitriptyline (Used for nerve pain/ sleep problems at a lower dose)

86
Q

What are the main side effect of lofepramine antidepressants?

A

Conduction disorders= TCA have a higher risk profile in overdose

87
Q

What is the most common MAOI?

A

Phenelzine

88
Q

What are the main side effects of MAOIs?

A

Acute prophyria

Interact with alot of other medications and foods

89
Q

List some common psychological therapies used to treat depression

A
  • Mindfulness
  • CBT
  • Combined/ Group therapy
  • Psychodynamic therapy
90
Q

What is a mental state examination?

A

A structured tool and process that allows you to observe and assess a patient’s current mental state

91
Q

What food should be avoided in a patient with IBS?

A
  • Fatty, spicy and processed food
  • Excessive fruit
  • Excessive tea or coffee
  • Alcohol or fizzy drinks
92
Q

What drugs can be used to treat IBS?

A
  • Antispasmodic drugs e.g. mebeverine and peppermint oil
  • Laxatives e.g. Mavicol
  • Anti motility agents e.g. Loperamide
  • Tricyclic antidepressants
93
Q

What things are checked for during a rectal exam?

A
  • External signs= Skin tags, haemorrhoids, fissure or fistula
  • Prostate gland
  • Rotate the finger and inspect for lumps etc
  • Withdraw finger and inspect for blood or mucous
94
Q

What causes IBS?

A

Dysfunction in the brain-gut axis resulting in a disorder of intestinal motility and/or visceral hypersensitivity

95
Q

What are the common symptoms of IBS?

A
  • Abdominal pain= Relieved by defecation
  • Bloating
  • Change in bowel habit; diarrhoea or constipation
  • Urgency, mucous in stool, nausea
96
Q

What are the risk factors for IBS?

A
  • Female
  • Previous severe and long diarrhoea
  • Anxiety/ stress
97
Q

List some differentials for IBS

A
  • Coeliac disease
  • Lactose intolerance
  • IBD
  • Colorectal cancer
  • Appendicitis
  • Infection
98
Q

What are some self help methods for IBS?

A
  • Dietary changes, low fodmap diet
  • Food diary
  • Exercise
  • Water
  • Probiotics
  • Over the counter medications
99
Q

What are the classic clinical features of OA?

A

Joint pain exacerbated by exercise.
Joint stiffness at rest (transient in morning)
Reduced functionality
Sometimes bony swellings in distal interphalangeal (Heberden’s) and proximal interphalangeal (Brouchards)
Sometimes warm
Can affect any joint, but is more often larger, weight bearing joints . Often starts as a single joint (generally progressing to involve more as time goes on). Not particularly symmetrical.

100
Q

What are the classic clinical features of RA?

A

Symmetrical joint pain in the distal small joints. Symptoms worse in the morning and cold
Joints warm and tender. Red.
Systemic symptoms of lethargy, tiredness, fever, weight loss.
Limited movement and muscle wasting.
Morning stiffness (More than 30 mins)
Deformities; Ulnar deviation of fingers, swan neck and boutonniere
Can involve lungs, heart, eyes, kidneys etc.

101
Q

What are the classic clinical features of gout?

A

Sudden pain, swelling and redness

Typically in 1st MTP

102
Q

What are the classic clinical features of septic arthritis?

A

Hot, (very) painful, red joint. Decreased range of movement. Localised swelling.
Can be systemically unwell (septicaemia)

103
Q

What are the classic clinical features of psoriatic arthritis?

A

Asymmetrical oligoarthritis
Pain, swelling, stiffness. Reduced range of movement
Systemic symptoms such as lethargy
Most usually, the distal joints of fingers and toes, and lower back.
‘sausage’ fingers and toes. Pitted nails.

104
Q

What are the classic clinical features of ank spon?

A

Back pain and stiffness. Worse with rest and in the morning/overnight (may wake during night due to pain in the back and buttock region)
Can improve with exercise. Takes >30mins for stiffness to improve in the morning

105
Q

A patients test results come back showing

  • Raised WCC
  • Raised serum uric acid
  • Rasied CRP and ESR
  • Needle shaped crystals on joint aspiration
  • No autoantibodies

What is it likely to be?

106
Q

A patients test results come back showing

  • Raised WCC
  • Raised CRP, Raised ESR
  • Bacteria in aspiration of joint

What is it likely to be?

A

Septic arthritis

107
Q

A patients results come back showing

  • Raised WCC
  • Anaemia
  • Raised CRP and ESR
  • Crystals on aspiration
  • Anti CCP and rheumatoid factor autoantibodies

What is it likely to be?

A

Rheumatoid arthritis

108
Q

A patient with joint pain’s results come back showing

  • Raised CRP
  • No autoantibodies
  • No raised WCC
  • No anaemia

What is it likely to be?

A

Osteoarthritis

109
Q

What is the first line treatment of rheumatoid arthritis?

A

DMARDS= Sulfasalazine and methotrexate

110
Q

A patient presents with fever, rigors, nausea and loin pain. On dipstick, she has haematuria and leukocytes. What is it likley to be?

A

Pyelonephritis

111
Q

A patient presents with urinary frequency and haematuria. She has no leukocytes or nitrates on dipstick. What investigation should you send for?

A

CT (likely to be bladder stones)

112
Q

A patient presents with frequency, dysuria, pain and haematuria. On dipstick, she also has leukocytes. She is young and not pregnant. How would you treat her?

A

Trimethoprim or nitrofurantoin (Likely to be a lower UTI)

113
Q

An elderly gentleman presents with frequency, nocturia, post void dribbling and incontinence. How would you examine him?

A

Digital rectal exam
= Smooth, enlarged prostate would be PBH
= Hard irregular prostate would be prostate carcinoma

114
Q

What are the two week wait symptoms for prostate cancer?

A
  • Raised PSA

- Hard, irregular prostate

115
Q

What are the two week wait symptoms for lung cancer?

A 
2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:
• cough
• fatigue
• shortness of breath
• chest pain
• weight loss
• appetite loss
116
Q

What are the two week wait symptoms for oesophageal cancer?

A 
Unexplained symptoms 
• with dysphagia or
• aged 55 and over with weight loss and any of the following:
－ upper abdominal pain
－ reflux
－ dyspepsia.
117
Q

What two classes of drugs can be prescribed for BPH?

A
  • Alpha-1 antagonists e.g. tamsulosin

- 5 alpha-reductase inhibitor e.g. Finasteride

118
Q

What is the gold standard surgical repair of BPH?

A

Transurethral resection of prostate

119
Q

What are the two week wait symptoms for colon cancer?

A

Unexplained

  • Weight loss and abdominal pain
  • Rectal bleeding
  • Over 60 with iron deficiency anaemia or changes in bowel habit
  • Tests show occult blood in their faeces
120
Q

What are the main side effects of tamsulosin and how does it work?

A

Relaxes smooth muscle in bladder neck and prostate

= Hypotension, erectile dysfunction

121
Q

What are the main side effects of finasteride and how does it work?

A

It blocks the conversion of testosterone to DHT to prevent prostate enlargement
= Hot flushes, reduced libido, gynaecomastia

122
Q

How long do episodes of syncope typically last?

A

Less than 30 seconds

123
Q

How long do seizures typically last?

A

More than 30 seconds

124
Q

What investigations may you perform to diagnose epilepsy?

A
  • Electoencephalogram
  • Brain imaging= MRI and CT
  • ECG to rule out long QT syndrome
  • Blood tests to rule out differentials
125
Q

What is the first line treatment for generalised tonic-clonic seizures?

A

Sodium valproate

126
Q

List some commom triggers of epileptic seizures

A
  • Flashing lights
  • Alcohol
  • Tiredness
127
Q

What are the risk factors for epilepsy?

A
  • Family history
  • Premature born babies
  • Abnormal blood vessels
  • Alzheimers or dementia
  • Drugs and alcohol
  • Stroke/ brain tumour/ trauma/ infection
128
Q

What are the rules for driving with epilepsy?

A

If you have epilepsy you must stop driving and tell the DVLA. The license is taken away until the seizures are under control. If the seizure has caused you to lose consciousness, you will not be able to reapply until you have not had a seizure for at least a year

129
Q

What is SUDEP

A

Sudden unexpected death in epilepsy

130
Q

What is absence epilepsy?

A

Caesing activity, staring and pales. Typically in children

131
Q

How would you test CNI?

A

Smell test

132
Q

How would you test CNII?

A

Visual test, examine with light

133
Q

How would you test CNIII, CNIV or CNVI?

A
  • Examine pupillary reflex

- Move eyes in H pattern

134
Q

How would you test CNV?

A

Touch face at various areas for sensation

135
Q

How would you test CNVII?

A

Identification of different tastes. Check the patient can smile and show teeth.

136
Q

How would you test CNVIII?

A

Hearing test

137
Q

How would you test CNIX?

A

Gag reflex and taste test

138
Q

How would you test CNX?

A

Swallowing

139
Q

How would you test CNXI?

A

Ask the patient to move his/her head against a mild resistance and shrug shoulders

140
Q

How would you test CNXII?

A

Movement of tongue (Stick out)

141
Q

List some symptoms of breast cancer

A
  • Nipple discharge
  • Lump
  • Nipple inversion
  • Erythema
  • Dimpling
  • Ulceration
  • Weight loss, malaise
  • Lymphadenopaty
142
Q

What is the 2 week wait criteria for breast cancer?

A
  • If aged 30 yrs and unexplained breast lump with/without pain
  • Aged over 50 with any of the following symptoms in one nipple only; Discharge, retraction or other changes of concern
143
Q

What is a mammogram?

A

Low-energy X-rays used to examine the breasts

144
Q

What is a breast ultrasound?

A

High frequency sound waves to produce an image of the inside of the breasts, showing any lumps or abnormalities

145
Q

What is a breast biopsy?

A

A sample of tissues is taken from the breast

146
Q

When is a mammogram given?

A

To patients with symptoms that have been referred to the specialist breast unit
As part of the national screening program

147
Q

When is breast screening performed?

A

Aged 50-71

148
Q

What happens during breast screening?

A

Two X-rays are taken of each breast

149
Q

What is BRCA2 associated with?

A

Breast cancer

150
Q

Where is BRCA1?

A

Chromosome 17

151
Q

Where is BRCA2?

A

Chromosome 13

Phase 2a (31 decks)

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