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Phase 3a > GP > Flashcards

GP Flashcards

1
Q

Positive impacts of ADHD diagnosis?

A
  • Signpost to appropriate services
  • Identify the reason for the behaviour
  • Be given treatment to manage symptoms
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2
Q

Negative impacts of ADHD diagnosis?

A
  • Stigma

- Labelling

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3
Q

Factors to take in when planning ADHD treatment?

A
  • Previous history of epilepsy or mental health conditions
  • Existing heart condition
  • Weight, Height, BP, HR
  • Other medication
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4
Q

Minimum age children can be prescribed medication for ADHD?

A

5 years old

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5
Q

Examples of questions that can confirm a diagnosis of ADHD?

A
  • Duration of symptoms
  • How are the symptoms affecting their lives
  • Examples of inattention, hyperactivity or impulsivity
  • School report or observation of behaviour from others
  • Other mental health or neurological conditions
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6
Q

What is the shared care protocol?

A

When a patient is under the care of both secondary and primary care. In ADHD, the diagnosis and medication is the responsibility of the secondary care team and the primary care team to monitor the patient, looking for side effects an seeing how effective the medication is

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7
Q

What is the GP’s role in supporting people with hidden disabilities?

A
  • Empower them to take ownership of their own health
  • Make sure the patient understands their condition so they can explain
  • Signpost to relevant services
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8
Q

3 Main signs of ADHD

A

Inattention
Hyperactivity
Impulsivity

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9
Q

Ddx of ADHD?

A 
Anxiety
Depression
Bipolar
BPD
Substance abuse 
Epilepsy
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10
Q

What should the GP monitor for a patient with ADHD?

A

Weight
Height
BP
HR

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11
Q

1st line management of ADHD in children

A

Methylphenidate

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12
Q

1st line management of ADHD in Adults

A

CBT or Lisdexamfetamine

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13
Q

3rd line management of ADHD in adults

A

Dexamfetamine

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14
Q

What is a maintenance dose?

A

Balancing between drug administration and drug elimination. Dose administered to maintain therapeutic concentrations

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15
Q

3 CI of ADHD medication?

A

<5 years old
Pregnant
Breastfeeding

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16
Q

Max units of alcohol per week?

A

14

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17
Q

3 complications of alcoholism?

A

Accidents
Korsakoff
Psychiatric illness
Substance abuse

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18
Q

2 questionnaires that can be used to assess the severity of alcoholism?

A

AUDIT - Alcohol use disorders identification test

SADQ - Severity of alcohol dependence questionnaire

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19
Q

3 signs of severe alcoholism?

A

Seizure
Ataxia
Confusion
Coma

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20
Q

How long can withdrawal symptoms begin?

A

4 to 6 hours or up to 24 hours

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21
Q

What medication can be given to people who have completed the detoxification programme?

A

Acamprosate

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22
Q

FRAME guidance for structured brief advice?

A 
Feedback 
Responsibility 
Advice 
Menu 
Empathy 
Self-efficacy
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23
Q

3 causes of B12 deficiency?

A

Pernicious anaemia
GI: Gastrectomy or Zollinger-Ellison syndrome
Intestinal: Crohns, Coeliac, Fish tapeworm
Vegan

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24
Q

3 causes of folate deficiency?

A

Decreased inatke
Increased usage e.g. pregnancy
Liver disease
Malabsorption disease

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25
Q

3 Symptoms of macrocytic anaemia?

A 
Insidious headache
Weakness
Confusion 
Decreased appetite 
Palpitations
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26
Q

3 signs of Macrocytic anaemia?

A 
Glossitis 
Angular stomatitis 
Confusion 
Weakness 
Brown nail beds 
Neuropathy
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27
Q

Describe the blood film of a patient with macrocytic anaemia?

A

Oval macrocytes with hypersegmented neutrophils

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28
Q

3 Ddx of macrocytic anaemia?

A

Severe hypothyroidism
Myelodysplasia
Liver disease
Alcohol abuse

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29
Q

4 complications of macrocytic anaemia?

A

Neuropathy
Neurological symptoms
Heart failure
Neural tube defects

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30
Q

Management of B12 deficiency?

A

Hydroxocobalamin or Cyanocobalamin

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31
Q

2 medications associated with B12 deficiency?

A

Colchicine, Metformin

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32
Q

2 medications associated with folate deficiency?

A

Nitrofurantoin, Trimethoprim, Methotrexate, Sulfasalazine

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33
Q

Symptoms of asthma?

A

Cough (at night or after exercise)
Wheeze
Chest pain
SOB

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34
Q

What can be used to confirm a patient has an eosinophilic airway?

A

Fractional exhaled nitric oxide

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35
Q

Asthma red flags in adults?

A 
Systemic features
Crepitus 
Clubbing 
Blood eosinophilia
Can't finish sentences
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36
Q

Ddx of asthma?

A

COPD, PE, GORD, HF, TB, Pneumonia, Brochiectasis, CF

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37
Q

1st line management of asthma?

A

ICS + SABA

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38
Q

3 SE of salbutamol?

A

Fine tremor of hands, Hypokalaemia, Palpitations, Headache, Anxiety, Arrhythmia

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39
Q

3 SE of ICS?

A

Sore throat, Horase voice, Oral thrush, cough

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40
Q

MOA of SAMA and give an example?

A

The short-acting muscarinic antagonist of acetylcholine causes smooth muscle relaxation. inhibit parasympathetic activity

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41
Q

MOA of LTRA and give an example?

A

Leukotriene receptor antagonist of Leukotriene D4 causes bronchodilation and decreased inflammation

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42
Q

MOA of theophylline?

A

Phosphodiesterase type 3 + 4 inhibitors cause bronchodilation and inhibit adenosine-induced bronchoconstriction

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43
Q

Royal college of physicians 3 asthma questions?

A

Is your asthma disrupting your sleep?
Are your usual asthma symptoms occurring during the day?
Is your asthma interfering with your usual activities?

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44
Q

Management of acute asthma exacerbation?

A

O2 to be between 92 and 96%
Nebulised Salbutamol then Ipratropium
x4 ICS or prednisolone

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45
Q

Features of life-threatening asthma?

A

PEFR <33%
PO2 <92%
Altered consciousness, Confusion, Silent chest

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46
Q

Features of moderate asthma exacerbation?

A

PEFR >50%
Able to speak fine
Normal PO2

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47
Q

Features of acute severe asthma exacerbation?

A

PEFR 33 - 50%
PO2 min 92%
RR 25,30,40 (12+, 12-5, 5-2)
HR (110,125, 140)

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48
Q

What is atrial fibrillation?

A

Supraventricular arrhythmia characterised by irregularly irregular pulse

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49
Q

Which major blood vessel is the foci located that can cause atrial fibrillation?

A

Pulmonary vein

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50
Q

3 symptoms of atrial fibrillation?

A 
Palpitations 
Breathlessness
Chest discomfort
Dizziness
Syncope 
Decreased exercise tolerance
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51
Q

3 causes of atrial fibrillation? - 1 cardiac, non-cardiac and diet/lifestyle

A

Rheumatic valvular disease

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52
Q

3 cardiac causes of AF?

A

Rheumatic valvular disease
Heart failure
Sick sinus syndrome

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53
Q

1 complication of AF?

A

Thromboembolism

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54
Q

3 investigations conducted when investigating AF?

A

TTE
ECG
Bloods

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55
Q

3 features of an ECG that confirms a diagnosis of AF?

A

Missing P waves
Irregularly irregular Rhythm strip
Ventricular tachyarrhythmia 160 - 180

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56
Q

What scoring system is used to determine if a patient is at risk of thromboembolism if they have non-rheumatic atrial fibrillation?

A

CHA2D-VaSc >2

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57
Q

3 Ddx of AF?

A

Sinus tachycardia
AVNRT/ AVRT
Atrial flutter

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58
Q

1st line treatment if a patient has had symptoms for <48 hours and is hemodynamically unstable?

A

DC cardioversion

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59
Q

What is autism?

A

A spectrum of neurodevelopemental condition characterized by difficulties in social interaction and communication

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60
Q

Clinical features of autism?

A 
Difficulties communicating 
Restrictive and fixed interests 
Repetitive behaviours 
Lack of interest in conversation 
Inflexible adherence to daily routines
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61
Q

Ddx of autism?

A 
Anxiety 
ADHD
Bipolar
OCD
Developmental regression 
Child abuse
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62
Q

Risk factors of autism?

A 
Genetics/ Affected relative 
Parents with schizophrenia 
Down's syndrome 
Muscular dystrophy 
Birth defects associated with the nervous system 
Encephalopathy
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63
Q

Complications of autism?

A 
Unemployment
Challenging behaviour 
Strained relationships 
Poor attainment in school
At the risk of mental health problems
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64
Q

What is Aspergers?

A

A form of ASD with normal or above-average intellect with no learning difficulties. Just some difficulties understanding language and speech

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65
Q

What is meningitis?

A

Inflammation of the leptomeningies (pia and arachnoid)

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66
Q

3 causative organisms of bacterial meningitis?

A

Neisseria Meningitidis
Strep pneumonia
Haemophilus influenza B

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67
Q

Describe the rash seen in suspected bacterial meningitis?

A

Non-blanching purpuric rash distributed on soles, palms, eyelids, abdomen or roof of the mouth

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68
Q

3 specific symptoms of bacterial meningitis?

A

Rash
Neck stiffness
Photophobia

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69
Q

How is bacterial meningitis transmitted?

A

Aerosol
Droplets
Direct contact

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70
Q

Describe Kernig’s sign?

A

Patient laid on their back
Hip flexed and leg flexed at the knee
+ve = Patient is unable to extend the leg at the knee

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71
Q

Describe Brudzinski sign?

A

Forced flexion of the neck causes the the thigh and the knee to flex

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72
Q

Management of bacterial meningitis in primary care?

A

999

Benzylpenicillin

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73
Q

6 categories of fever <5?

A 
Behaviour 
Respiration 
Hydration and circulation 
Temp 
Skin
Disease-specific symptoms
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74
Q

Complications of meningitis?

A 
Cerebral infarctions 
Hearing loss
Seizures
Amputations 
Cognitive/ Motor/ Visual impairment 
Hydrocephalus
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75
Q

Important questions to ask a patient with breastfeeding problems?

A

Infant history - feeding behaviour, weight, sleep, crying
Maternal PMH
Current medication
History of breastfeeding and what happens usually

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76
Q

Management of thrush for breastfeeding mother and baby?

A

Fusidic cream + Flucanozole

Miconazole for 10 to 14 days

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77
Q

How long does it take for medication to start treating the symptoms of thrush in breastfeeding mothers and their babies?

A

2 - 3 days

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78
Q

How would you differentiate between mastitis and thrush?

A

Mastitis - Unilateral wedge shape redness
+ slight fever

Thrush - crack nipples and bilateral pain + baby has a white coating on their tongue or around their mouth

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79
Q

Key features of blocked ducts?

A

Bilateral breast pain relieved by breastfeeding and white spots on the nipple

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80
Q

Causes of decreased milk production?

A

Maternal depression or anxiety
Infrequent feeding
Prolactin deficiency

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81
Q

Management of ductal infection?

A

Flucloxacillin or Erythromycin or Clarithromycin

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82
Q

Management of mastitis?

A

Continue breastfeeding
Reassurance
Heat packs/ Cool packs
Pain relief

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83
Q

Medication that can be used for mothers struggling to breastfeed due to Raynaud’s syndrome?

A

Nitroprusside

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84
Q

Signs of candida infection in babies?

A

White coating on the tongue, roof of mouth or lips
Unsettled baby
Breastfeeding pain lasts >1 hour after feeding

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85
Q

4 causes of breastfeeding problems?

A

Breast pain
Nipple pain
Underproduction of milk
OVer production of milk

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86
Q

What indicates a galactocele is present?

A

Smooth painless mass that when pressed expressed milky discharge
Patient also has white spots on the nipple

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87
Q

How many months should a child be breastfed?

A

6 months

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88
Q

What are the benefits of breastfeeding?

A

Less likely to be obese or have eczema

Increased immunity

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89
Q

What 2 HPV strains are most associated with cervical cancer?

A

16 + 18

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90
Q

How long can the spontaneous resolution of HPV take?

A

1 to 2 years

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91
Q

How is HPV transmitted?

A

Sexual intercourse

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92
Q

Complications of CIN?

A 
Pain
Renal failure 
Leg lymphoedema 
Bleeding
Malodour from necrotic tissue or fistulae
Urinary or faecal incontinence
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93
Q

How would the cervix appear in a patient with suspected cervical cancer?

A

Inflamed and bleed easily

Mucoid/ purulent vaginal discharge

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94
Q

Ddx of CIN?

A 
Cervical ectropion 
Endometriosis 
Endometrial cancer 
STI 
Hormonal contraception
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95
Q

Stage 1 CIN?

A

CIN remains confined in the cervix

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96
Q

Stage 2 CIN?

A

CIN extends past cervix to upper 2/3 of the vagina but not invaded pelvic wall

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97
Q

Stage 3 CIN?

A

CIN has extended to lower 1/3 of the vagina and invaded pelvic wall

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98
Q

Stage 4 CIN?

A

CIN has metastasized or invaded the rectum or bladder

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99
Q

Management of confirmed cervical cancer?

A

Colposcopy - Excision and biopsy
Lymphadenectomy
Chemo + radio
Chemo and palliative

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100
Q

3 preventative measures of HPV infection?

A

HPV vaccination
NHS cervical cancer screening
Safe sex practice

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101
Q

Risk factors of HPV infection?

A 
Increased sexual partners 
Age at first sexual intercourse 
Immunocompromised
Co-existing STI
Family history  
High parity 
Smoking
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102
Q

Symptoms of CIN?

A 
Pelvic pain
Intermentrual/ Post-menopausal/ Post-coital bleeding 
Blood stained discharge 
Leg lymphoedema 
Purulent dischatge 
Incontinence
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103
Q

3 criteria for CKD?

A

ACR>3
eGFR<60
Urine sediment abnormalities

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104
Q

3 examples of nephrotoxic drugs?

A

ACEi
NSAIDs
Diuretics

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105
Q

Causes of CKD?

A 
Hypertension 
Diabetes
Glomerulonephropathies 
Nephrotoxic drugs 
Obstructive uropathy 
Multisystem disease
CVD
Obesity and metabolic syndrome
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106
Q

Complications of CKD?

A 
AKI
Hypertension 
Renal anaemia 
Renal bone disease
Metabolic acidosis 
Malnutrition 
Peripheral oedema
Peripheral neuropathy
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107
Q

Signs of CKD?

A 
Uraemic frost
Uraemic odor
Pallor
Dehydration
Tachy
Cachexia
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108
Q

Symptoms of CKD?

A 
Disturbed urine output 
Sleep disturbances
Lethargy 
Itch
Breathlessness
Bone pain 
Abdo cramps
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109
Q

Investigations used to confirm CKD?

A 
ACR
eGFR
Urinalysis
Serum and urine electrolytes 
Renal ultrasound
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110
Q

A patient with hypertension with an ACR>3 should be given what antihypertensive medication?

A

Lisinopril or Losartan

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111
Q

What is accelerated CKD?

A

eGFR change >25%/15 over 12 months

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112
Q

4 factors to be measured when assessing a patient’s nutritional status?

A

BMI, BP, HbA1c, Lipid profile

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113
Q

What causes peripheral paresthesia in pregnancy?

A

Fluid retention compresses the peripheral nerves

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114
Q

Management of pelvic girdle pain in pregnancy?

A 
Osteo manipulative therapy
Exercises
Belts
Crutches 
Pain resolves 6 months post-delivery
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115
Q

Talking to a patient on the phone, how would you be able to determine they don’t have a chest infection and no treatment is needed?

A 
Normal dyspnoea, cough and wheeze
Sputum is clear and regular in volume 
No chest pain 
Able to finish the sentence 
Able to move around
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116
Q

Talking to a patient on the phone, how would you be able to determine they have an infective exacerbation of COPD and how will you treat them over the phone?

A

Purulent sputum
Increased volume of sputum
Increased breathlessness
Description of fever

Safety net the patient if emergency kit doesn’t work

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117
Q

Talking to a patient on the phone with diagnosed COPD, what factors would make you call 999?

A 
Unable to finish a sentence
Loss of consciousness 
Increased dyspnoea 
Increased depth of cough 
Increased sputum production 
Emergency kit not relieving symptoms 
Altered consciousness
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118
Q

1st line treatment of COPD?

A

SABA - Salbutamol

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119
Q

2nd line treatment of COPD if the patient also has a history of asthma?

A

ICS (Butclometasone) or LABA (Formoterol)

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120
Q

2nd line treatment of COPD if the patient’s main complaint is breathlessness?

A

LAMA (Tiotropium) or LABA (Formoterol)

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121
Q

Side effects of prolonged use of steroids?

A 
Easy bruising
Osteoporosis  
Skin Thinning 
Immunocompromised 
Oral thrush 
Sore throat 
Adrenal insufficiency  
Diabetes
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122
Q

Ddx of acute exacerbation of COPD?

A 
PE
Pneumonia
Pneumothorax
Chronic congestive heart failure 
Asthma 
Bronchiectasis 
Rib fracture 
Pleural effusion
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123
Q

2 methods of classifying COPD?

A

FEV1 and MYC dyspnoea scale

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124
Q

What is included in the triple therapy of COPD and provide an example of each?

A

LABA + LAMA + ICS

Formoterol + Tiotropium + Betclometasone

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125
Q

What is in the emergency kit of a COPD patient?

A

SABA
Prednisolone
Abx - Amoxicillin

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126
Q

Non-pharmacological management of COPD?

A

Smoking cessation
Respiratory exercises
Dietary changes

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127
Q

Acceptable O2 sats for a patient with COPD?

A

88 - 92%

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128
Q

Duration of acute cough?

A

<3 weeks

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129
Q

Duration of subacute cough?

A

3 to 8 weeks

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130
Q

Duration of chronic cough?

A

> 8 weeks

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131
Q

Ddx of acute cough?

A

Coronavirus
Asthma
Viral URTI
Bronchitis

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132
Q

Ddx of subacute cough?

A

Post-infection e.g. Bortadella Pertussus or Mycoplasma pneumonia

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133
Q

Ddx of chronic cough?

A 
COPD
Eosinophilic bronchitis 
ACEi
GORD
Hypersensitivity syndrome 
Smoking
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134
Q

Risk factors for dementia

A 
Down's syndrome 
Alcohol abuse 
Strokes + TIA
Mental illness 
Genetics (amyloid proteins)
Increasing age
Parkinsons
Huntington's 
Cardiovascular disease
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135
Q

3 examples of improving communication for people with intellectual disabilities

A

Videos
Allowing extra time
Images
Not using complicated medical terms and explain in simple terms

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136
Q

3 examples of community support available for people with intellectual disabilities

A

Support worker
Local charity support groups
Friends and family

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137
Q

How does dementia present in people with down’s syndrome compared to people with normal intellect?

A

Instead of loss of memory, they experience personality change e.g. not enjoying the things they used to, agitated, not wanting to talk

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138
Q

Example of a questionnaire used to diagnose dementia in people with down’s syndrome

A

Dementia screening questionnaire for individuals with intellectual disabilities

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139
Q

5 key principles of the MCA?

A 
Assume capacity
Maximise decision-making capacity 
Freedom to make seemingly unwise decisions 
Best interest 
Least restrictive option
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140
Q

Definition of dementia?

A

Clinical syndrome of deteriorating mental function that affects 2 or more areas of life with no other identifiable cause

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141
Q

How can cognition be assessed?

A

GPCOG

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142
Q

Examples of cognitive impairment found in patients with dementia?

A

Memory loss
Dysphasia
Lack of co-ordination
Difficulty making decisions

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143
Q

Symptoms specific to vascular dementia?

A

Visual impairment
Problems with gait
attention
Personality change

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144
Q

Symptoms specific to lewy body dementia?

A

Parkinsonian features
syncope
Falls
Memory loss occurs later

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145
Q

How can cognition be assessed?

A

GPCOG

6 item cognitive impairment test

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146
Q

Ddx of dementia?

A 
Delirium 
Depression 
Anxiety 
Bipolar
Hypothyroidism
Substance abuse 
UTI
Mild cognitive impairment 
DKA
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147
Q

Causes of delirium?

A 
UTI
Constipation 
Infection
Hypoxia 
Benzodiazepines 
Electrolyte imbalance
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148
Q

2 medications used for dementia and their MOA?

A

Acetylcholinesterase inhibitors e.g. Rivastigmine
Memantine - Inhibit glutamate receptors to alleviate the behavioural symptoms of dementia such as aggression and hallucinations

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149
Q

7 categories found in the MMSE?

A 
Orientation 
Registration (repeat 3 objects)
Attention 
Calculation (-7 from 100 and continue)
Recall
Language 
Copy
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150
Q

What is included in a confusion screen?

A 
Vitals 
CT
Blood 
Urine 
CXR
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151
Q

Difference between delirium and dementia?

A

Onset

Fluctuations

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152
Q

Management of delirium?

A

Treat underlying cause
Supportive reorientaiton + aids
Haloperidol or Loarzepam

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153
Q

Complications of dementia?

A

Disability + dependence
Institutionalization
Financial hardship

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154
Q

The difference in symptoms between Alzheimer’s and Lewy body dementia

A

A - Memory loss is usually the initial symptoms whereas LB -memory loss occurs later in disease progression, mostly parkinsonian features

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155
Q

What is DoLS?

A

When you restrict a patient’s right to make their own decisions and live without supervision

Decisions are made for them by others, with the patients best interests in mind

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156
Q

What is a lasting power of attorney?

A

An individual appointed by the patient to make decisions for them. Required documentation

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157
Q

What is a court of protection?

A

When a patient doesn’t have a LPA and the court makes decisions about the patient’s finances and welfare

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158
Q

What is an advanced decision?

A

Living will

Detailed plans made by a patient with regards to their care, while they still have capacity. It can include DNACPR, Hospitalization, Nutrition, Hospital admission

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159
Q

Medications that can cause dementia-like symptoms?

A 
Benzodiazepines 
Analgesics 
Antidepressants
Antipsychotics 
Antiepileptics 
Anticholinergics
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160
Q

Symptoms specific to frontotemporal dementia?

A

Insidious change in personality + behaviour

Memory and perception remain intact

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161
Q

What is delirium?

A

Sudden confusion/ disturbance in mental abilities resulting in confused thinking and reduced awareness

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162
Q

What is depression?

A

Persistent low mood +/- pleasure in most activities causing significant impairment to the patient’s life

> 5/9 symptoms over the past 2 weeks

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163
Q

What are the symptoms of depression?

A 
Decreased appetite
Low mood 
Sleep disturbances 
Agitation 
Fatigue 
Cognitive symptoms 
Withdrawal 
Self-harm
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164
Q

Risk factors of depression?

A 
Male 
Certain professions
Experience of abuse 
Grief 
Substance abuse 
Deprivation 
Involved in justice system 
Genetics
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165
Q

How to assess the risk of suicide?

A

THOUGHTS
PLANS
PROTECTIVE FACTORS
RISK FACTORS

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166
Q

4 questionnaires that can be used to assess the severity of depression?

A

Patient health questionnaire 9
Hospital Depression and anxiety scale
Beck’s Depression Inventory
Depression thermometer

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167
Q

What is dysthymia?

A

Persistent sub threshold depression (<5/9) for >2 years

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168
Q

Prevalence of depression in the UK?

A

4.4 - 4.5% of the population

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169
Q

Complications of depression?

A

Increased perceived pain
Unemployment
Difficulty maintaining relationships
Increased risk of other mental illnesses

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170
Q

Ddx of depression?

A 
Anxiety 
Bipolar 
Grief
MND
Dementia 
Parkinsons
BPD
Hypothyroidism
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171
Q

Prognosis of depression?

A

Episodes last 3 to 6 months with treatment

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172
Q

1st line anti-depressant for a patient who also takes anti-epileptics?

A

Sertraline

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173
Q

A patient takes anticoagulant medication, what is the recommended antidepressant?

A

Mirtazapine

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174
Q

What is Reboxetine used for?

A

NRI used for acute severe depression

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175
Q

What is moclobemide used for?

A

MAOI used for depression and social anxiety

2nd line for patient’s on anti epileptics after sertraline

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176
Q

What factors should be considered when prescribing antidepressants?

A 
Patient preference 
Toxicity 
Side effects 
PMH
Drug history
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177
Q

2 most toxic SSRI?

A

Citalopram and Escitalopram

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178
Q

What group of antidepressants has the greatest likelihood of toxicity?
A. SSRI
B. Mitarzapine
C. TCA

A

TCA

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179
Q

Which SNRI is associated with arrhythmia?

A

Venlafaxine

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180
Q

3 useful organisations that can help people with depression?

A

MIND
Depression UK
Samaritans

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181
Q

How long can a patient be confined under the MHA 3?

A

6 months (with family consent)

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182
Q

When prescribing sertraline to the elderly, what other medication should be prescribed?

A

PPI for gastroprotection

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183
Q

Common side effects of SSRI?

A 
Dry mouth 
Nausea
Abdo pain 
Constipation 
Tremor 
Suicidal ideation 
Palpitations 
Anxiety 
Insomnia
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184
Q

What 5 things should be monitored when prescribing antidepressants?

A 
Hyponatremia 
Suicidal thought 
suicide attempts 
BP
Cardiac disorders
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185
Q

How often should a patient started on antidepressants be reviewed?

A

2 to 4 weeks for the next 3 months

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186
Q

What antidepressant is contraindicated in <18 year olds?

A

Mitarzapine

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187
Q

A patient takes sodium valproate, what 2 options of antidepressants can be prescribed to them?

A

Sertraline

Moclobemide

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188
Q

What are examples of antimuscurinic effects that can be caused by TCA?

A 
Dry mouth
Sweating 
Blurred vision 
Difficulty urinating 
Sexual dysfunction
Dry skin 
Tachy
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189
Q

What is serotonin syndrome?

A

When a patient takes too many antidepressants resulting in an accumulation of serotonin which can be fatal
Headache, nausea, fever, hypertension, tachy, confusion = coma and convulsions

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190
Q

Withdrawal effects of abruptly stopping antidepressants?

A 
Decreased appetite
Disturbed sleep 
Low mood 
Agitation 
Nausea
Fatigue
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191
Q

Example of an antidepressant that can be stopped abruptly?

A

Fluoxetine at 20mg

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192
Q

What antidepressant should be avoided when breastfeeding?

A

Doxepin

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193
Q

2 antidepressants that can be used during breastfeeding in severe cases?

A

Sertraline

Paroxetine

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194
Q

1st line treatment of confirmed DVT?

A

Apixaban or Rivaroxaban

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195
Q

Symptoms of DVT?

A

Unilateral calf welling
Red
Warm
Tender

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196
Q

Risk factors of DVT?

A 
Immobile 
Long haul flights 
OCP
Obesity 
Recent surgery/ Trauma 
Pregnancy 
HRT
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197
Q

2 main risk factors that need to be screened for when unprovoked DVT confirmed?

A

Antiphospholipid syndrome

Thrombophilia

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198
Q

What is unprovoked DVT?

A

DVT that occurs in the absence of risk factors

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199
Q

What is D-dimer?

A

Fibrin degradation product

It Shows clots are being broken down in the body. Associated with DVT or PE

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200
Q

Complications of DVT?

A

PE

Anticoag bleeding or induced thrombocytopenia

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201
Q

CI of DOACs?

A

Recent history of active bleeding
Bacterial endocarditis
Heparin induced thrombocytopenia
High risk of uncontrolled bleeding

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202
Q

How long are patients with confirmed DVT given medication for?

A

3 months

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203
Q

Baseline tests used for patients on anticoagulation?

A 
FBC
Renal function - U+E, eGFR
LFT
PT
APTT

within 24 hours of starting treatment

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204
Q

2nd line treatment of confirmed DVT?

A

LMWH

Dabigatran or Edoxaban

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205
Q

3rd line treatment of DVT?

A

LMWH

Vitamin K antagonist

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206
Q

2 situations that would require an urgent referral if DVT suspected?

A

Pregnant

6 weeks post-partum

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207
Q

What percentage of people develop PE from DVT?

A

1/3

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208
Q

What is a DVT?

A

Formation of a thrombus in deep veins of legs/ pelvis that can partially or completely obstruct blood flow back to the heart

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209
Q

MOA of Dabigatran?

A

Direct thrombin inhibitor

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210
Q

Prolonged risk factors of DVT?

A 
History of DVT
Cancer
>60
Overweight 
Male 
Heart failure 
Thrombophilia 
Inflammatory disease 
Varicose veins 
Smoking
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211
Q

Ddx of DVT?

A 
Thrombophlebitis 
Cellulitis 
Trauma 
Post-thrombotic syndrome 
Vascultits 
Ruptured baker's cyst
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212
Q

Other atopic disease associated with eczema?

A

Hayfever + Asthma

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213
Q

3 complications of eczema?

A

Impetigo - staphy aureus
Herpes simplex - eczema herpeticum
Psychosoicla problems - anxiety, depression, poor self image

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214
Q

The difference in rash distribution of eczema between infants and children

A

Infants - scalp, face, extensor surface of limbs

Children - localised in flexures of limbs

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215
Q

Signs of chronic eczema?

A

Skin has become thick, discoloured, lichenified due to repeated scratching

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216
Q

Signs of infected eczema?

A

Weeping
Crusted
Malaise
Fever

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217
Q

Ddx of eczema?

A

Impetigo
Psoriasis
Contact dermatitis
Cows milk allergy

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218
Q

MOA of Calcineurin inhibitors?

A

Immunosupressive effects by inhibiting production of IL2 and it’s receptors meaning decreased T-cell activation

Tarcolimus or Pimecrolimus or Cyclosporine

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5
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219
Q

Eczema patient experiencing redness and inflammation?

A

Emollient

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220
Q

Eczema patient experiencing dryness?

A

Ointment

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221
Q

Eczema patient experiencing itch?

A

Lauromacrogols - anaesthetic and antipruritic effects

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222
Q

What is endometriosis?

A

When endometrial tissue grows outside of the uterus and symptoms are associated with menstruation + hormones

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223
Q

5 causes of endometriosis?

A
  • Retrograde menstruation
  • Lymphatic + Circulatory dissemination
  • Genetic disposition
  • Metaplasia
  • Environmental factors e.g. red meat, early menarche, late menopause, delayed childbearing, late first intercourse
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224
Q

Prevalence of endometriosis?

A

1 in 10 women of reproductive age

Most common gynae issue

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225
Q

Complication of endometriosis?

A 
Endometriomas (ovarian cysts of blood)
Infertility 
Adhesion 
Bowel obstructions 
Chronic pain
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226
Q

Symptoms of endometriosis?

A 
Dysuria 
Dysmenorrhoea 
Dyschezia 
Dyspareunia
Chronic pelvic pain
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227
Q

Gold standard diagnosis of endometriosis?

A

Laparascopy

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228
Q

Ddx of endometriosis?

A

PID
Ovarian cysts
Ovarian cancer
Ectopic pregnancy

Interstitial cystitis
Recurrent UTI

Fibroids
Primary dysmenorrhoea
Uterine myoma

IBD
IBS
Appendicitis
Coeliac

Congenital abnormalities of reproductive tract

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229
Q

Management of endometriosis?

A

3 month paracetamol +/- NSAIDS
Contraception
Screen for complications
Ultrasound + Laparoscopy

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230
Q

A patient has deep endometriosis that involved the bowel, bladder and ureter. What medication can be given?

A

GnRH agonist

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231
Q

Surgical management of endometriosis?

A

Laparoscopic excision

Hysterectomy

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232
Q

What is generalised anxiety disorder?

A

Disproportionate widespread worry that can manifest into physical symptoms such as restlessness, palpitations and sweating

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233
Q

How does drinking affect anxiety?

A

Temporarily relieves anxiety symptoms but once effects wears off, the symptoms come back + hungover. Reliance then can turn into an addiction

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234
Q

Main symptoms of anxiety?

A 
Sweating 
Overwhelming worry 
Palpitations 
Expressing fears 
Muscle tense
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235
Q

How can you differentiate between anxiety and depression?

A

Depression - low mood, lack of interest, slow movement, fatigue, suicidal ideation

Anxiety - Palpitations, worry about events or situations, muscle tense, sweating

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236
Q

Diagnostic tool used for generalised anxiety disorder?

A

Generalised Anxiety Disorder 7

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237
Q

1st line pharmacological treatment of GAD?

A

SSRI - Sertraline, Paroxetine, Escitalopram

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238
Q

Ddx of anxiety?

A 
Depression 
Substance abuse 
OCD
Bipolar
Dementia 
Hyperthyroidism 
Phaechromocytoma
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239
Q

Risk factors of GAD?

A 
Childhood abuse 
Trauma 
Female 
Substance abuse 
Co-morbidities
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240
Q

DSM5 criteria of GAD?

A

Symptoms for 6 months + 3 months restlessness, muscle tension + sleep disturbances

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241
Q

ICD10 criteria of GAD?

A

Generalised and persistent symptoms of anxiety in any environment including restlessness, muscle tension, sweating and expression of fears

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242
Q

3 types of anxiety disorder?

A

OCD
Panic disorder
PTSD

243
Q

Main risk of giving a pregnant woman SSRI or SNRI during pregnancy?

A

Persistent pulmonary hypertension of newborn

Withdrawal effects

244
Q

What are the symptoms of GORD?

A

Burning central retrosternal chest pain
Nausea
Vomiting
Cough

245
Q

Risk factors of GORD?

A 
Alcohol 
Smoking 
Obesity 
Pregnancy 
Spicy food 
Hiatus hernia 
Stress
246
Q

Complications of GORD?

A 
Barret's oesophagus 
Haemorrhage 
Ulcers
Strictures 
Positions 
Oesophageal cancer
247
Q

Lifestyle advice that can be given to manage GORD?

A 
Cut back smoking and drinking 
Eat 2 to 3 hours before sleeping 
Eating more frequent smaller portions 
Manage anxiety and stress
Sleep on elevated pillow
248
Q

2nd line management of GORD if omeprazole is ineffective?

A

H2RA x2 for 1 month

Ranitidine 2 weeks

249
Q

Surgical procedure used to manage severe GORD?

A

Laporascopic fundoplication

250
Q

What is Barrett’s oesophagus?

A

When the epilethium of the oesophagus changes from squamous to columnar due to repeated exposure to gastric contents

251
Q

Ddx of GORD?

A 
Angina 
Achalasia
Gastritis 
Cancer
Oesophageal motility disorders
252
Q

What 2 things are people on long term PPI at risk of?

A

Osteoporosis

Hypomagnesia

253
Q

PPI can increase the potency of which 4 medications?

A

Digoxin
Warfarin
Phenytoin
Methotrexate

254
Q

PPIs can decrease the potency of which 2 medications?

A

Clopidogrel

Azole Antifungals

255
Q

Red flag upper GI symptoms?

A

Haematemesis
Malaena
Dysphagia
Weight loss

256
Q

Common side effects of PPI?

A 
Dizziness
Headache
Diarrhoea
Constipation 
Abdo pain
257
Q

How long should a patient stop taking PPIs before having an endoscopy?

A

2 weeks

258
Q

Management of recurrent endoscopic-ve reflux disease?

A

H2RA for 4 weeks

259
Q

Who are PPI and H2RA CI in and why?

A

People about to have endoscopies because they can mask the symptoms of GI malignancy

260
Q

3 examples of specialist tests that can be used to investigate the oesophagus?

A

Oesophageal manometry
Ambulatory 24 hours oesophageal pH testing
Barium Swallow

261
Q

At what age does GOR usually begin in infants?

A

8 weeks

262
Q

What is the difference between GORD + regurgitation?

A

GORD >1 year with symptoms of reflux disease

Regurgitation <1 year old and not pathological

263
Q

Red flags of reflux disease in infants?

A 
Projectile vomiting 
Bile in vomit 
Excessive crying 
Crying while feeding 
Chronic cough 
Gagging
264
Q

1st line management of reflux disease in infants?

A

Gaviscon for 1 to 2 weeks

265
Q

2nd line management of reflux disease in infants?

A

4 week omeprazole suspension

266
Q

Complications of reflux disease in infants?

A 
Aspirational pneumonia 
Barrett's oesophagus 
Oesophagitis 
Ulcers 
Dental erosions 
Acute otitis media
267
Q

Risk factors of reflux disease in infants?

A

Congenital atresia
Congenital hiatus hernia
Premature
Parents with reflux disease

268
Q

Ddx of reflux disease in infants?

A

Raised ICP
UTI
Sandifer syndrome
Cow’s milk allergy

269
Q

What is Sandifer syndrome?

A

Torticollis with neck extension and rotation found in infants with GORD or hiatus hernia

270
Q

What is gout?

A

Disorder of purine metabolism caused by raised uric acid levels in blood resulting in uric acid crystals depositing in joints and other tissue

271
Q

3 stages of gout attacks?

A

Long period of asymptomatic hyperuricaemia
Acute attack of gouty arthritis
Chronic tophaceous gout where nodules start affecting joints

272
Q

Risk factors of gout?

A 
Thiazide diuretics 
Myeloproliferative disorders 
Increased age 
Renal disease 
Obesity 
Alcohol 
Red meat
273
Q

Complications of gout?

A 
Tophi 
Urinary stones 
CKD
Hypertension
Osteoarthritis
Obesity 
Diabetes 
Progressive joint damage
274
Q

Prognosis of gout?

A

Self-limiting can resolve within 1 to 2 weeks

275
Q

Symptoms of Gout?

A

Swollen 1st metatarsophalangeal joint but can also affect midfoot, ankle, knee, fingers , wrist and elbow
Rapid onset swelling, redness, warmth and tenderness

276
Q

Microscopy difference between gout and pseudogout?

A

Gout - Crystal shaped negatively birefringent monosodium urate

Pseudogout - Rhomboid shaped positively birefringent calcium pyrophosphate dihydrate

277
Q

Diagnosis of gout?

A

Microscopy of synovial fluid
Serum uric acid
X-ray
Assess potential CVD or renal disease risk

278
Q

Ddx of gout?

A 
Septic arthritis 
Cellulitis 
Pseudogout 
Oesteoarthritis 
Reactivate arthritis 
Haemochromatosis 
Trauma
279
Q

1st line management of gout?

A

NSAIDs + Colchicine

280
Q

2nd line management of gout?

A

Joint aspiration and intra articular corticosteroids

281
Q

What should be checked 4 to 6 weeks after a diagnosis of gout?

A

Serum uric acid
HbA1c
Renal function
Lipid profile

282
Q

1st line prevention medication of gout?

A

Allopurinol

283
Q

2nd line prevention medication of gout?

A

Febuxostat

284
Q

MOA of colchicine?

A

Inhibits neutrophil activation and adhesion

285
Q

MOA of allopurinol?

A

Purine analogue which acts as a xanthine oxidase inhibitor that prevents the conversion of xanthine to uric acid

286
Q

SE of allopurinol?

A

Precipitate acute attacks of gout
Rash
Vertigo
Ataxia

287
Q

MOA of febuxostat?

A

Non-competitive inhibitor of xanthine oxidase

288
Q

MOA of NSAIDs?

A

COX1 + COX2 inhibitor to decrease prostaglandins that mediate platelet aggregation and inflammation

289
Q

What are haemorrhoids?

A

Abnormally vascular mucosal cushions present in the canal. Anal cushions help maintain anal continence

290
Q

Difference between internal and external haemorrhoids?

A

External - richly innervated pain fibres + itch

Internal - painless but become painful when strangulated

291
Q

Risk factors of haemorrhoids?

A 
Straining 
Heavy lifting 
Pregnancy 
Chronic cough 
Exercising 
Low fibre diet
292
Q

Complications of haemorrhoids?

A

Perianal thrombosis
Incarceration of prolapse haemorrhoidal tissue = pain
Skin tags
Ischaemia, thrombosis or gangrene of haemorrhoid
Anal stenosis
Anaemia from continuous bleeding

293
Q

Symptoms of haemorrhoids?

A 
Bright red blood on toilet paper, bowl or outside stool - not mixed in 
Anal itch or irritation 
Feeling incomplete bowel evacuation 
Soiling 
Pain
294
Q

Diagnosis of haemorrhoids?

A

Observation
Digital rectal exam
Proctoscopy
FBC

295
Q

Ddx of haemorrhoids?

A 
Diverticulitis
IBD
Anal/ Colorectal cancer 
anal fissure 
Pruritus ani 
Rectal prolapse 
STI
296
Q

1st line management of haemorrhoids?

A 
Fibre + balanced diet 
Adequate fluid intake 
Good hygiene 
Paracetamol 
Topical haemorrhoid preparation e.g. Anusol
297
Q

What is heart failure?

A

Inability of the heart to pump blood to the body - reduced cardiac output that doesn’t meet the demands of the body

298
Q

3 main causes of heart failure?

A

Arrhythmia
Abnormal loading
Diseased myocardium

299
Q

Epidemiology of heart failure?

A

1 - 2% of the population and 10% of over 70s

300
Q

Symptoms of heart failure?

A

Breathlessness
Fatigue
Ankle swelling

301
Q

Signs of heart failure?

A 
Paroxysmal nocturnal dyspnoea
Orthopnoea 
Syncope
Oedema 
Raised JVP
Cardiomegaly 
Tachypnoea
302
Q

ABCDE CXR showing heart failure?

A 
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Dilated upper vessels
Pleural effusion
303
Q

Investigations used to confirm Heart failure?

A 
Pro-BNP
ECG
Echo
Full bloods 
CXR
Urine
304
Q

Factors that can decrease BNP?

A 
Obesity 
Afro-Caribbean 
Diuretics 
ACEi
ARB
BB
Spironolactone
305
Q

Factors that can increase BNP?

A 
Diabetes 
>70
LVH
Hypoxaemia 
eGFR<60
Liver Cirrhosis 
Sepsis 
COPD
306
Q

Prognosis of heart failure?

A

50% die within 5 years

307
Q

Management of HF in a patient with a reduced EF

A

ACEi
BB
Spironolactone

308
Q

Why are ACEi used to manage heart failure?

A

Decrease preload

Help repair cardiac muscle

309
Q

CI of ACEi?

A

Renal artery stenosis
Aortic stenosis
Hyperkalaemia
Severe renal impairment

310
Q

Most people with heart failure usually die of what?

A

Ventricular tachycardia

311
Q

Risk factors of heart failure?

A 
Obesity 
Smoking 
Diabetes 
Hypertension
Cardiovascular event before 65
High BMI
312
Q

What 2 medications decrease mortality in heart failure?

A

BB

CCB

313
Q

2 drugs that can be used to manage impotence in men who are on heart failure medication?

A

Sildenafil

ARB

314
Q

Which calcium channel blockers are CI in heart failure?

A

Verapamil or Diltiazem

315
Q

Min ejection fraction that can be classed as heart failure with preserved ejection fraction?

A

45%

316
Q

What is accelerated hypertension?

A

Severe increase in BP >180/120 or higher with signs of end-organ damage

317
Q

What is masked hypertension?

A

Clinical BP normal but home BP higher

318
Q

AMBP classed as stage 1 hypertension?

A

135/85

319
Q

Factors that can result in referral to secondary care?

A 
Very young 
>80
Pregnant 
suspected phaeochromocytoma 
Accelerated hypertension
320
Q

Examples of secondary causes of hypertension?

A 
Diabetes 
OSA
Pre-eclampsia 
Coarctation of aorta
Cushing's
Hyperthyroidism  
Acromegaly 
Renal disease 
Phaeochromocytoma
321
Q

65, T2DM, Male, new diagnosis of hypertension. What is the 1st line treatment?

A

ACEi

322
Q

Examples of end-organ damage of hypertension?

A

Stroke
Renal failure
MI
Hypertensive retinopathy

323
Q

3 scenarios where standing and sitting BP would have to be measured?

A

Postural hypotension
>80 years old
T2DM

324
Q

Qrisk3 score required to start statins?

A

> 10%

325
Q

If the patient has K+ <4.5mmol/l what additional medication can be added to control hypertension?

A

Spironolactone

326
Q

If the patient has K+ >4.5mmol/l what additional medication can be added to control hypertension?

A

Alpha-blockers/ Beta-blockers

327
Q

Potential side effects of ACEi?

A

First dose hypotension
Cough
Urticaria

328
Q

What 2 medications are most likely to cause impotence in men?

A

Diuretics

BB

329
Q

What medication can be used to treat impotence in men who take antihypertensive medication?

A

Sildenafil or ARB

330
Q

Common side effects of statins?

A

Myalgia
Headache
Nausea

331
Q

Atrial fibrillation and hypertension management?

A

BB or Diltizem for rate control

332
Q

What kind of virus is HIV?

A

Lentivirous with a long incubation period

Attacks CD4 T lymphocytes

333
Q

What is a window period?

A

Time between getting infected and antibodies appearing

334
Q

2 things that should be monitored in a patient with suspected HIV?

A

CD4 count

Viral load

335
Q

CD4 count classed as AIDS?

A

<200 per microlitre

336
Q

3 phases of HIV?

A

Seroconversion illness - 10 days to 6 weeks of flu like illness

Asymptomatic phase - last up to 10 years

AIDS - opportunistic infection, Malignancies, CD4 <200

337
Q

Risk factors of HIV?

A 
MSM
Frequent sexual partners
Sex worker 
IV drug users 
Needlestick injury
High
338
Q

When to suspect HIV?

A 
Prolonged recurrent infections 
Conditions related to immunosuppression 
Lymphadenopathy 
Pyrexia 
Weight loss 
Risk factors
339
Q

The causative organism of pneumonia in patients with HIV?

A

Pneumocystitis Jirovecii

340
Q

Constitutional symptoms of HIV?

A 
Flu-like symptoms 
Fever
Weight Loss
Sweats
Lymphadenopathy
341
Q

4 neurological conditions associated with HIV?

A

Cryptococcal Meningitis
Cerebral Toxoplasmosis
Cerebral Lymphoma
CMV Retinitis

342
Q

4 malignancies associated with HIV?

A

Lymphoma
Kaposi Sarcoma
Cancer of skin or oropharynx
Cervical cancer

343
Q

Management of newly diagnosed HIV?

A

Referral within HIV clinic within 48 hours
Safer sex
Support groups

344
Q

1st line management of HIV?

A

Triple therapy NRTI
Tenofovir
Disoproxil
Emtricitabine

345
Q

5 groups of antiviral therapy that can be prescribed to a HIV patient?

A
  • Nucleotide Reverse Transcriptase Inhibitors
  • Non-nucleotide reverse transcriptase inhibitors
  • Protease inhibitors
  • Integrase inhibitors
  • Entry inhibitors
346
Q

What is PrEP?

A

Pre-exposure prophylaxis

- Drug to take before and after for HIV-ve people

347
Q

What is PEP?

A

Post-exposure prophylaxis
- HIV-ve has sex with HIV+ve within 24 hours

Follow up 8 to 12 weeks

348
Q

Thyroid function testing for hypothyroidism measures T4 rather than T3. Patients may attend and ask for testing of T3 based on internet searches. What evidence is available to explain why T4 is measured, and why T3 may not be a suitable biochemical marker for hypothyroidism?

A

T3 is more potent than T4 but more T4 is released by the thyroid which gives a better indication of thyroid function
T3 mostly made peripherally and can be affected by liver or renal disease

349
Q

What are the risks of overtreatment with levothyroxine and what changes could be present in patients?

A

Hyperthyroidism - Tremor, palpitations, diarrhoea, fatigue, hypertension

350
Q

3 causes of hypothyroidism?

A

Drug Iodine deficiency
Infiltration
Post-partum thyroiditis
Autoimmune - Hashimoto’s

351
Q

3 Ddx for hypothyroidism?

A

Anaemia
Coeliac
T1DM

352
Q

How often should TFT be conducted for patients on levothyroxine?

A

Every 3 months

353
Q

3 medications associated with hypothyroidism?

A

Amiodarone
Carbimazole
Lithium

354
Q

2 complications of hypothyroidism?

A

Dyslipidaemia

Increased fatigue affecting the quality of life

355
Q

What diabetic medication has been associated with secondary hypothyroidism?

A

Metformin

356
Q

Implications of hypothyroidism on pregnancy?

A

Pre-eclampsia
Low birth weight
Still born

357
Q

How does myxoedema madness present?

A

Hypothermia
Bradycardia
Seizure
Coma

358
Q

The incubation period of measles?

A

10 days

359
Q

Timeline of measles from first contact to recovery

A

10 day incubation period
2 - 4 days fever, malaise, conjunctiva, runny nose
3 -5 days after prodromal then rash appears

360
Q

4 complications of measles?

A

Panencephalitis
Pneumonia or Pneumonitis
Otitis media
Seizure/ Convulsions

361
Q

Which group of patients have the greatest risk of panencephalitis after getting measles?

A

Unvaccinated patients

362
Q

High-risk groups of measles?

A

Pregnant
Immunocompromised
Unvaccinated adolescence
Infants

363
Q

Signs of measles?

A 
Fever
Other prodromal signs - Bilateral conjunctiva, runny nose, malaise, unsettled 
Koplik spots 
Erythematous Maculopapular rash 
Bark like cough
364
Q

Symptoms of measles?

A 
Fever
Unsettled baby 
Rash 
Bark like cough 
Runny nose 
Conjunctiva of both eyes 
Not sleeping 
Poor feeding
365
Q

When do Koplik spots appear?

A

3 to 5 days of prodromal symptoms starting

366
Q

Describe the rash seen in measles and its distribution?

A

Erythematous Maculopapular rash that becomes confluent
Not-itchy
Starts at the head/ neck working down then torso with hands and wrists last

367
Q

Who needs to be notified of measles cases?

A

Health protection team

Recent contacts of the affected patient

368
Q

Ddx of measles?

A 
Early Meningococcal disease 
Meningitis 
Parvovirus (slap cheek - no koplik)
Strep infection (maculopapular rash, sore throat, strawberry tongue)
Rubella - maculopapular rash but not confluent and starts behind the ears then face  
Herpes encephalitis 
UTI
Kawasaki disease (5 days fever)
369
Q

How can you differentiate between meningococcal disease and measles?

A

Distribution and features
Measles - Erythematous Maculopapular rash that becomes confluent, starts at the head/ neck then down to the torso and lasts affects hands/ wrists

Meningococcal disease - Non-blanching purpuric rash on soles, palms, eyelids, abdo and roof of the mouth + other signs of meningitis

370
Q

Describe the management of measles to a mother of a child with measles?

A

Self-limiting
Self-isolate
Fluids, Paracetamol or ibuprofen to settle the child
Safety net

371
Q

Management of a patient who has been in contact with possible measles?

A

Notify the health protection team
Check vaccination history
Vaccinate within 3 days of contact + 1 month later if not already done

372
Q

When is measles most infectious?

A

4 days before rash to 5 days after rash

373
Q

What observations should be done for a child with fever in primary care?

A 
Temp 
BP
HR
RR
CRT
374
Q

What is the fever pain score used for?

A

Criteriod if antibiotic should be given to patients >3 years old who present with sore throat. Aims to use a targeted antibiotics approach and improve patient symptoms
0 -1 - not antibiotics
2 -3 delayed antibiotics
4 -5 immediate antibiotics

Fever
Purulence 
Attend within 3 days 
severely Inflamed tonsils 
No cough or coryza
375
Q

What is the traffic light system used for?

A

Assess the risk of a child <5 years old + fever if they are low, medium or high risk and need to be admitted to secondary care. It looks at skin, behaviour, resp, hydration + circulation, disease-specific symptoms

376
Q

Traffic light: skin colour difference between amber and red risk?

A

Amber - Pale

Red - Mottled, Blue

377
Q

Traffic light: activity difference between amber and red risk?

A

Amber - Wakes on prolonged stimulation, No smile, No response to social cues, Decreased activity

Red - unresponsive, no smile, no activity, high pitched continuous cough

378
Q

Traffic light: Resp signs showing amber risk?

A 
RR>50 for <1 year old
RR>40 for >1 year olds 
Nasal flare 
O2 sats <95
Crackles on the chest
379
Q

Traffic light: Resp signs showing high risk?

A

RR>60
Intercostal breathing
Head bobbing
Grunting

380
Q

Traffic light: Heart rate showing tachycardia in 11-month-old?

A

> 160

381
Q

Traffic light: Heart rate showing tachycardia in 1-year-old?

A

> 150

382
Q

Traffic light: Heart rate showing tachycardia in 2 to 5-year-olds?

A

> 140

383
Q

Traffic light: Circulation change that shows high risk?

A

Reduced skin turgor

384
Q

Traffic light: babies aged 3 to 6 months with temp of >39 degrees, what risk category?

A

Amber

385
Q

Traffic light: Babies <3 months with temp of >38 degrees, what risk category?

A

Red

386
Q

Traffic light: normal CRT?

A

<2 seconds

387
Q

Antibiotics used for 2-month-old with fever if admitted to hospital?

A

3rd gen cephalosporin - Ceftriaxone

388
Q

What O2 sats would require a child to be given oxygen?

A

<92%

389
Q

Traffic light: Amber signs for circulation and hydration?

A

CRT>3 seconds
Dry mucous membranes
Poor feeding
Reduced urine output

390
Q

What is insomnia?

A

Difficulty getting to sleep, Maintaining sleep, Waking up early or non-restorative sleep resulting in impaired daytime functioning

391
Q

Complications of insomnia?

A 
Cognitive difficulties e.g. impaired memory, attention, concentration 
Decreased quality of life 
Psychiatric complications 
Increased risk fo CVD + T2DM
Increased risk of mortality
392
Q

Diagnosis of insomnia?

A

History - triggers, behaviour, sleep patterns, impact on life
2 week sleep diary

393
Q

Ddx of insomnia?

A

OSA
Parasomnia - unpleasant experiences or behaviors associated with sleep
Restless leg syndrome
Narcolepsy
Circadian rhythm disorders e.g jet leg or shift work

394
Q

Short term management of insomnia?

A 
Sleep clinic + hygiene
Address concerns/ stressors 
3 - 7 days non-benzodiazepine 
CBT
z drug or prolonged-release melatonin
395
Q

Management of chronic insomnia?

A 
Alert DVLA
Sleep clinic 
CBT
1 week hypnotic 
Modified release melatonin
396
Q

Examples of Z-drugs + MOA?

A

Zopiclone or Zolpidem

Sedatives that work by binding to GABA-A receptors and slow down activity of the brain

397
Q

3 categories of LUTS?

A

Storage - Urgency, frequency, incontinence, feeling the need to urinate again just after passing urine

Voiding - Hesitancy, weak stream, dribble, splitting, spraying, terminal dribble

Post-micturition - Dribble, sensation of incomplete emptying

398
Q

Conditions associated with LUTS?

A 
BPH
Prostate/ bladder/ rectal cancer 
Bladder outlet obstruction 
Overactive bladder 
Antimuscuruics 
Diabetics autonomic neuropathy
Stree incontince 
Neurological conditions 
LUTI, STI, prostitis
399
Q

Risk factors of LUTS?

A 
Diabetes 
Increase serum dihydrotestosterone 
Obesity 
Increase size of prostate 
Bladder decompensation
400
Q

Diagnosis process of a patient with LUTS?

A
  • History
  • Examination: Abdo (bladder), External genitalia, - Digital rectal exam, Perineum and lower limbs for motor and sensory function
  • International prostate symptom score
  • Urine, eGFR, PSA
401
Q

What is PSA?

A

Prostate-specific antigen is a glycoprotein produced by both normal and cancerous prostate cells into prostatic fluid to allow spermatozoa to move more freely

402
Q

Factors that can increase PSA?

A 
Prostate enlargement 
Prostate manipulation 
Exercise 
Cancer
DRE
Ejaculation
403
Q

Factors that can decrease PSA?

A 
5ARI
Aspirin
Statins 
Thiazide
Obesity
404
Q

The scoring system used to assess the severity of LUTS and impact on quality of life?

A

International prostate symptom score >8

405
Q

1st line management of voiding problems?

A

Alpha blocker - Tamsulosin, Alfuzosin, Doxazosin, Terazosin

406
Q

2nd line management of voiding problems?

A

5-alpha reductase inhibitor - Finasteride or Dutasteride

407
Q

1st line + 2nd line medication for voiding problems has been ineffective. What other medication can be used?

A

Antimuscarinic - Oxybutynin, Tolterodine, Darifenacin

408
Q

What is Mirabegron?

A

Used for an overactive bladder when antimuscrinics are not effective

Beta3 agonist that help the bladder relax

409
Q

Management of acute on chronic urinary retention?

A

Alfuzosin for 24 hours before catheter then remove the catheter and see if they can void freely

410
Q

Management of post micturition dribble?

A

Milk urethra after urinating (if not caused by obstruction) - press fingers behind the scrotum and gently massage bulbar urethra in forwards and upwards motion

Urine containment products

411
Q

Signs of lung cancer?

A 
Haemoptysis 
SOB
Chest pain 
Weight loss
Bone pain 
Fatigue 
Loss of appetite 
Chest infection
412
Q

Prognosis of lung cancer?

A

<10% survive 5 years after diagnosis

413
Q

Risk factors of lung cancer?

A 
Smoking 
Asbestos exposure 
Occupational exposure 
COPD
Lung fibrosis
414
Q

Diagnosis of lung cancer?

A

History
CXR + CT
Biopsy

415
Q

What is a Pancoast tumour?

A

Tumour found in the apex of the lung that can invade the sympathetic nervous system e.g. horner’s syndrome and damage brachial plexus

416
Q

Examples of paraneoplastic effects of small cell lung cancers?

A

SIADH
Hypercalcaemia
Ectopic ACTH
Lambert-eaten myasthenic syndrome

417
Q

Where do lung mets travel to?

A

Bone
Brain
Liver
Adrenals

418
Q

Management of lung cancer?

A
  • Biopsy and stage
  • Chemo or radio
  • Lobectomy or pneumonectomy
  • Smoking cessation
  • Palliative care
419
Q

What is menopause?

A

When menstruation stops due to loss of ovarian follicular activity. 12 months of amenorrhoea

420
Q

Causes of premature menopause?

A

Bilateral oophorectomy

Premature ovarian insufficiency

421
Q

Physiology of menopause?

A
  • Ovarian follicles begin to fail
  • Oestrogen + Inhibin decrease so reduce -ve feedback effect of FSH + LH
  • Decreased oestrogen causes hot flushes and night sweats (vasomotor symptoms)
  • Decreased Estradiol so endometrium not stimulated enough an period stops
422
Q

Risk factors of early menopause?

A 
Early menarche 
Nulliparity or Low parity 
Smoking 
Being underweight 
Premature ovarian insufficiency
423
Q

Complications of menopause?

A 
Osteoporosis + rib fracture 
CVD
Stroke 
GU symptoms 
T2DM
424
Q

Symptoms of menopause?

A

Change in menstrual pattern
Vasomotor symptoms (hot flush and night sweat)
Mood changes
Cognitive impairment
Vulvovaginal irritation, dryness, dysuria, dyspareunia, low libido
Sleep disturbance

425
Q

Diagnosis of menopause?

A

Amenorrhoea for 12 months
FSH <45 + symptoms, x2 samples 4 - 6 weeks apart
Osteoporosis risk
BP + BMI

426
Q

Ddx of menopause?

A

Secondary amenorrhoea
Irregular bleed - fibroids, polyps, hyperplasia
Hot flush - Hyperthyroidism, carcinoid, alcohol, anxiety, TB
Vaginal atrophy

427
Q

SE of HRT?

A 
Fluid retention 
Bloating 
Breast tenderness/ enlargement 
Nausea
Headache
Cramps 
Dyspepsia 
Unschedules vaginal bleeding
428
Q

CI of HRT?

A 
Breast cancer history 
Oestrogen dependant cancer
Undiagnosed vaginal bleeding 
Endometrial hyperplasia 
Thromboembolic disease 
Thrombophilic disorder
429
Q

Management of vasomotor symptoms of menopause?

A

Oral or transdermal Estradiol +/- progesterone

430
Q

What are migraines?

A

Primary headaches not associated with an underlying condition. Usually unilateral and described as throbbing or pulsating

431
Q

Associated symptoms of migraines?

A 
Photophobia 
Phonophobia 
Nausea
Vomiting 
\+/- Aura
432
Q

Causes of migraines?

A 
Cheese
OCP
Caffeine 
Alcohol
Anxiety 
Travel 
Exercise 
Obesity 
Sleep disorders 
Stress
Anxiety and Depression
433
Q

Complications of migraines?

A 
Medication overuse headaches 
Progress into chronic headaches 
Status migrainosus - attack lasting >72 hours 
Seizure 
Increased risk of stroke
434
Q

Examples of atypical aura?

A 
Motor weakness
Double vision 
Poor balance 
Visual symtoms only affecting 1 eye 
Decreased level of consciousness
435
Q

Prodromal symptoms of migraines?

A 
Fatigue
Poor concentration 
Neck stiffness
Yawning 
1-2 days before
436
Q

Postdromal symptoms of migraines?

A

Fatigue
Change in mood
Lasting 48 hours

437
Q

Full headache assessment?

A

SOCRATES
Dx
Examination: vitals, fundoscopy, cranial + peripheral nerves, extracranial structures

438
Q

Ddx of migraines?

A

Trigeminal neuralgia
Tension headache
Cranial or cervical vascular disorders (GCA or haemorrhage)
Substance withdrawal

439
Q

Management of migraines?

A

Avoid triggers
Headache diary
Good sleep hygiene
Paracetamol or Ibuprofen

440
Q

2nd line migraine management?

A

Triptan (sumatriptan) at the start of the headache

441
Q

3rd line migraine management?

A

Triptan + Paracetamol/ NSAID

442
Q

1st line migraine prophylaxis?

A

Propanolol or Topiramate (inhibit glutamate pathway and increase GABA by blocking calcium and sodium channels)

or Riboflavin

443
Q

What medication is given alongside Triptans?

A

Antiemetics e.g. Prochlorperizine or Metoclopramide

444
Q

How does the incidence of migraines change before and after puberty?

A

Before puberty - equal between males and females

After puberty - More females than males

445
Q

CI of triptans?

A 
Cardiovascular disease
Arrhythmia 
Hypertension 
Cerebrovascular disorders 
Severe hepatic impairment 
on MAOI
446
Q

Migraine medication CI in < 18-year-olds and pregnant women?

A

Topiramate

447
Q

What are the 4 variations of motor neurone disease?

A
  • Amyotrophic lateral sclerosis
  • Progressive bulbar palsy
  • Progressive muscular atrophy
  • Primary lateral sclerosis
448
Q

Order of progression of MND symptoms?

A

Limb onsent - Bulbar onset - Resp onset

449
Q

Medication used to treat fasciculations of MND?

A

Riluzole - inhibits glutamate release and inhibit ach receptors

450
Q

Symptoms of MND?

A

Weakness of distal limbs
Bulbar onset - difficulty swallowing, talking, chewing
Difficulty holding objects
Fasciuclations
Gait disorder
Difficulty rising from chair
Bladder, bowel and oculomotor function affected in later stages

451
Q

4 medications used in palliative care and their uses?

A

Opioids
Hyoscine butylbromide
Diazepam
Anti-depressants

452
Q

3 factors that make up the el escorial criteria to diagnose MND

A

Evidence of LMN + UMN
Progressive spread of symptoms or signs within a region or other regions
Absence of other causes of LMN +/- UMN

453
Q

What is advanced planning and what does it involve?

A

Documents that states the wishes of the patient while they still have the capacity to make decisions. It can include DNACPR, hospital admissions, place of death, feeding, medication that prolongs life

454
Q

What do most people with MND die of?

A

Resp failure

Pneumonia

455
Q

How would ALS differ in presentation to progressive bulbar palsy?

A

ALS - fasciculations, stiff muscles, muscle wasting (limb onset - Bulbar onset - Resp onset)

PBP - lesions of UMN of 9,10,12 so only difficulty swallowing, talking or chewing

456
Q

Difference between progressive muscular atrophy and primary lateral sclerosis?

A

PMA - only affects small muscles of hands and feet

PLS - involved UMN of legs (bladder, bowel and extraocular muscles are spared)

457
Q

Ddx of MND?

A 
Gulllain-Barre
Diabetic amyotrophy
Myasthenia gravis 
Diabetic neuropathy 
Spinal cord tumours 
Polymyositis or Dermatomyositis
458
Q

Diagnosing MND?

A

Electrophysiological studies + nerve conduction studies
CT/ MRI
Bloods
Muscle biopsy

459
Q

What do electrophysiological studies show when a patient has MND?

A

Fibrillation + Fasciculations - High amplitude and duration

460
Q

Pathophysiology of MND?

A

Lesions involving UMN + LMN of the anterior horn cells of the spinal cord
Sporadic MND associated with mutation of superoxide dismutase-1 gene

461
Q

What is polymyalgia rheumatica?

A

Chronic systemic inflammatory disease characterised by aching and morning stiffness in the neck, shoulder and pelvic girdle in people aged 50+

462
Q

Causes of polymyalgia rheumatica?

A

Genetic and environmental

Synovitis of proximal large joints, tenosynovitis and bursitis

463
Q

Complications of polymyalgia rheumatica?

A

GCA

Long term corticosteroid use

464
Q

Symptoms of polymyalgia rheumatica?

A

> 50 + 2 week history
Bilateral shoulder pain (tender) radiates to elbow
Pelvic girdle pain
Hip pain radiating to the knee
Neck pain
Morning stiffness
other: Low-grade fever, fatigue, weight loss, depression

465
Q

Ddx of polymyalgia rheumatica?

A

Inflammatory: RA, SLE, Spondyloarthropathy, Poly or dermato
Thyroid disease
Degenerative disorder: Osteo, Spondylosis, Adhesive encapsulates
Osteomalacia
Fibromyalgia
Chronic fatigue syndrome
Osteomalacia

466
Q

Management of polymyalgia rheumatica?

A

1 to 2-year course of oral prednisolone

PMR support groups e.g. versus arthritis

467
Q

What is rheumatoid arthritis?

A

Chronic systemic inflammatory disease. Inflammatory symmetrical arthritis of the small joints of hands and feet

468
Q

Extra-articular manifestations of rheumatoid arthritis?

A 
Vasculitis 
Keratoconjunctivitis 
Parenchymal lung disease
Rheumatoid nodules 
Oesophagitis
Pericarditis 
Peripheral Neuropathy 
Anaemia 
Glomerulopathies
469
Q

Symptoms of rheumatoid arthritis?

A

Symmetrical synovitis of small joints of hands and feet
Pain worse at rest, better by movement
Early morning stiffness lasting >1 hour
Rheumatoid nodules found on extensor surfaces

470
Q

Ddx of rheumatoid arthritis?

A 
Osteoarthritis
Connective tissue disorders e.g. SLE
Fibromyalgia 
Polymyalgia rheumatica
Psoriatic arthritis 
Reactive arthritis 
Septic arthritis
Seronegative spondyloarthritis
471
Q

Bloods required to confirm a diagnosis of rheumatoid arthritis?

A

Anti-cyclic Cirtrullinated peptide

Rheumatoid factor

472
Q

classic hand signs of rheumatoid arthritis?

A 
Swan neck deformity 
Boutonniere 
Z shaped thumbs 
Ulnar deviation 
MCP subluxation
473
Q

Management of suspected rheumatoid arthritis?

A

referral within 3 weeks

NSAIDs + PPI

474
Q

Management 1st line management of confirmed rheumatoid arthritis?

A

Methotrexate

475
Q

What is T1DM?

A

Autoimmune destruction of the beta cells of the islet of langerhans resulting in no/ decreased insulin production and chronic hyperglycaemia

476
Q

When are most people diagnosed with T1DM?

A

During childhood between 10 and 14

477
Q

Counterregulatory hormones of insulin?

A

Cortisol
Glucagon
Catecholamines
GH

478
Q

Blood glucose measurement that confirms hypoglycaemia?

A

<3.5mmol/L

479
Q

What other autoimmune conditions are associated with T1DM?

A

Autoimmune thyroid disease
Pernicious Anaemia
Addison’s disease

480
Q

What is DKA?

A

Diabetic ketoacidosis

Hyperglycaemia + Metabolic acidosis + Ketonaemia

481
Q

Signs of DKA?

A 
Polyuria, polydispsia
D+V
Visual disturbances 
Lethargy 
Acidotic breathing (Kussmaul respiration)
Dehydration signs 
Sunken eyes
482
Q

Signs of hypoglycaemia?

A 
Confused with being drunk 
Hunger
Irritability 
Sweating 
Palpitations 
Tremor
Weakness 
Lethargy 
Confusion 
Irrational behaviour
483
Q

What is DAFNE?

A

Dose Adjustment For Normal Eating

- Self-education programme for T1DM to live normal lives, manage risk and understand their condition

484
Q

Examples of rapid-acting insulin?

A

Humalog or Novorapid

15 min onset lasting 2 to 5 hours

485
Q

Examples of short-acting insulin?

A

Actrapid or Humulin S

30 to 60 min onset lasting 8 hours

486
Q

Examples of intermediate-acting insulin?

A

Isophane, Humulin I, Insuman Basal, Insulatard

1 to 2-hour onset lasting 11 to 24 hours

487
Q

Examples of long-acting insulin?

A

Insulin Glargine, Insulin detemir, Insulin Degludec

Last 24 hours with steady-state achieves after 2 to 4 days

488
Q

What is the multiple daily injections of basal-bolus insulin?

A

Short/ rapid acting before a meal + intermediate/ long for basal requirement

489
Q

What is the biphasic regimen for insulin?

A

1,2,3 insulin injections of short/rapid mixed with an intermediate action

490
Q

How does an insulin pump work?

A

Regular continuous basal-bolus by SC cannula or needle

491
Q

What is DESMOND?

A

Diabetes Education for Self-Management for Ongoing and Newly Diagnosed

492
Q

What is T2DM?

A

Metabolic disorder characterised by persistent hyperglycaemia due to peripheral insulin resistance or decreased insulin production

493
Q

Risk factors of T2DM?

A 
Obesity 
Dyslipidaemia 
Asian or Afro-Caribbean 
PCOS
History of gestational diabetes  
Metabolic syndrome 
Endocrine disorders
494
Q

1st line management of T2DM?

A

Metformin

495
Q

Order of T2DM medication?

A 
Biguanide - metformin 
DPP4 inhibitors - Sitagliptin 
Thiazolidinediones - Pioglitazone 
Sulfonylureas - Gliclizide
SGLT2 Inhibitors - Canagliflozin
496
Q

Symptoms of TB?

A 
Fever
Malaise
Night sweats 
Fatigue 
Loss of appetite 
Breathlessness
Haemoptysis
497
Q

How long after exposure can symptoms of TB develop?

A

3 weeks

498
Q

3 examples of extrapulmonary manifestations of TB?

A 
Renal TB
TB meningitis 
Lupus vulgaris 
Hepatitis
Addisons disease
499
Q

What is a ghon complex?

A

Caseous granuloma found in the mid/lower lobes that has spread to nearby lymph nodes which have also become caseated

500
Q

What is a ranke complex?

A

When ghon complex undergoes fibrosis and calcification

501
Q

Risk factors of TB?

A 
Migrating to another country 
immunocompromised 
Elderly 
<5 
Close contact 
Recent travel
502
Q

How is TB transmitted?

A

Respiratory droplets and contaminated food

503
Q

2 methods of screening for TB?

A

Tuberculin test

Interferon-gamma release assay

504
Q

Stain used to confirm the presence of TB and what colour does it go?

A

Ziehl-Neelsen

Bright red rods

505
Q

Ddx of TB?

A 
Pneumonia
Lung cancer 
COPD
Asthma 
Occupational lung disease
506
Q

What investigations can be done to differentiate between TB, Pneumonia and Lung cancer?

A 
Tuberculin test 
Interferon-gamma release assay 
CXR
Sputum culture 
Blood culture 
Tumour markers in blood 
History
507
Q

What would be positive on a urine dipstix of a patient that has suspected renal TB?

A

Sterile pyuria

508
Q

Management of TB?

A 
4 months RIPE, 2 months RI
Rifampicin 
Isoniazid (Pyridoxine)
Pyrazinamide 
Ethambutol
509
Q

What medication has to be given alongside isoniazid and why?

A

Pyridoxine - isoniazid can decrease B6 leading to peripheral neuropathy

510
Q

How is reactivated TB able to spread to other parts of the lungs or even systemic circulation?

A

When a patient gets older or becomes immunocompromised, it can spread to the upper lobes of the lung where there is greater concentrations of oxygen and replicate

Cavities form to the bronchioles and systemic circulation

511
Q

Suspected TB patient, what factors would be important in the initial consultation?

A 
Recent travel 
Contact with people
Occupation
Smoking 
Living situation 
Immunocompromised 
Duration of symptoms
512
Q

What are some difficulties immigrants face when accessing healthcare?

A 
Language barrier 
No contact details 
No fixed address
Not knowing where to access help 
Transport
513
Q

Groups of people who are not ordinary residents who can still have access to free secondary care?

A 
Asylum seekers 
Victims of human trafficking 
Prisoners 
Children under local protection 
Detained immigrants
514
Q

What type of hypersensitivity is TB?

A

Type 4 - granuloma formation

515
Q

What can be causing a rise in TB infection?

A

Increasing HIV+ve patients
People not complete the whole 6 months of medication
Increasing migrants from TB high countries
Increasing homeless

516
Q

Uncomplicated UTI?

A

Caused by typical pathogens in people with normal urinary tract and kidney function with no predisposing co-morbidities

517
Q

Complicated UTI?

A

Increased likelihood of complications such as persistent infection, treatment failure and recurrent infection
Catheter
Structural abnormalities of UT
Virulent organism
Comorbidities e.g Diabetes or Immunosuporessed

518
Q

Recurrent UTI?

A

2+ UTI within 6 months or 3+ in 1 year

519
Q

Relapse UTI?

A

Infection due to the same organism

520
Q

Cause of UTI?

A

Bacteria of the GI tract e.g. retrograde, blood or instrumentation

521
Q

Risk factors of UTI?

A 
Sexual intercourse 
Childhood UTI history 
Urinary incontinence 
Catheter 
Urological instrumentation 
DM or immunosuppressed
522
Q

Complications of UTI?

A

Ascending infections e.g. pyelonephritis, renal or perirenal abscesses, renal failure, Urosepsis

523
Q

Symptoms of UTI?

A 
Frequency 
Urgency 
Dysuria 
Odor 
Change in urine consistency + colour 
Nocturia 
Delirium in elderly
524
Q

Ddx of UTI?

A

Pyelonephritis
STI
Reactive arthritis
Urolithiasis

525
Q

1st line management of UTI?

A

Nitrofurantoin or Trimethoprim

526
Q

2nd line management of UTI?

A

Nitrofurantoin or Pivmecillinam or Fosfomycin

527
Q

Management of UTI if haematuria present?

A

Restates urine sample after antibiotic and if it persists then refer to specialist

528
Q

Non-pharmacological management of UTI?

A

Avoid douching or occlusive underwear
Wipe front to back after defecation
Poet-coital urination
Increased hydration

529
Q

Pregnant + UTI management?

A

Nitrofurantoin or Amoxicillin or Cefalexin

530
Q

1st line treatment of catheter-associated UTI?

A

Nitrofurantoin / Trimethoprim

Amoxicillin

531
Q

2nd line treatment of Catheter-associated UTI?

A

Pivemcillinam

532
Q

Vaginal discharge caused by bacterial vaginosis?

A 
pH>4.5 
Fishy smelling 
Thin
Grey/ white 
No itch or soreness
533
Q

Vaginal discharge caused by vaginal candidiasis?

A 
pH<4.5 
White 
Odourless
Cottage cheese 
Vulval itch + soreness
534
Q

Vaginal discharge caused by Trichomoniasis?

A 
pH>4.5 
Fishy smelling 
Yellow/ green 
Frothy
Itching 
Soreness 
Dysuria
535
Q

Examination of a patient with abnormal vaginal discharge?

A
  • Palpate abdomen
  • Inspect vulva - lesion, tender, mass, discharge
  • Speculum examination
  • pH sample from the lateral wall of the vagina
  • High vaginal swab (Amies transport medium with charcoal)
  • Pregnancy test
  • Urine dipstix
536
Q

Strawberry cervix?

A

Trichomoniasis

537
Q

What is cryptorchidism?

A

Incomplete descent of 1 or both testes from the abdomen to the scrotum through the inguinal canal

538
Q

True cryptorchidism?

A

Testes lie along the normal path of descent in the abdomen or inguinal region but not made it to the scrotum

539
Q

Ectopic testis?

A

Testes lie outside the normal path of descent, outside of the scrotum e.g. femoral region, perineum, penile shaft, opposite hemiscrotum

540
Q

Ascending testes?

A

Previously made it to the scrotum but moved to a higher position over time

Persistent processus vaginalis which prevents the elongation of testicular vessels and vas deference

541
Q

Absent or atrophic testis?

A

Missing testis, seen at birth then disappear

Atrophy can be due to lack of testicular blood supply

542
Q

Causes of cryptorchidism?

A

Disruption in hormonal control of testicular descent during fetal development

Disorder of sexual development e.g. congenital hypogonadism, lack of androgen, congenital adrenal hypoplasia

543
Q

Risk factors of cryptorchidism?

A 
Family history 
Preterm 
Low birth weight 
Endocrine disorders 
Disorders of sexual development 
Maternal smoking
544
Q

Complications of undescended testes?

A

Impaired fertility (scrotum is cooler than lower abdomen)
Testicular cancer
Testicular torsion
Inguinal hernia

545
Q

Screening for undescended testes?

A

within 72 hours of birth and 6-8 weeks after

Re-examine at 4-5 months

546
Q

Management of palpable undescended testes?

A

Orchidopexy - Freeing the testes and implanting them into the scrotum

547
Q

Management of non-palpable undescended testes?

A

Inguinal exploration and diagnostic laparoscopy

548
Q

What are the 2 phases of testicular descent?

A

Transabdominal phase - testicular hormone

Inguinal scrotal phase - androgens

549
Q

Prehn’s sign indicates what?

A

Pain and tenderness of testes relieved by elevation

550
Q

Testicular cause of scrotal pain/ swelling?

A

Testcicular torsion (torsion of spermatic cord)
Torsion of testicular or epididymal appendage
Testicular cancer
Squamous cell carcinoma of the scrotum
Indirect inguinal hernia
Epididymo-orchitis

551
Q

Extra-testicular causes of scrotal swelling?

A 
Haematocele 
Varicocele 
Hydrocele
Epididymal cyst 
Indirect inguinal hernia 
Idiopathic scrotal oedema in children 
Squamous cell carcinoma of the scrotum
552
Q

Haematocele?

A

Sudden or chronic onset
Painful and tender
Doesn’t illuminate as well as hydrocele
Usually occur with trauma but can occur with cancer

553
Q

Epididymal cyst/ Spermatocele?

A

Chronic onset
Painless, non-tender, smooth, soft, round nodule of epididymis
No transillumination

554
Q

Varicocele?

A

Dilation of internal spermatic veins + pampiniform plexus of spermatic cord
Painless, non-tender but dull discomfort
Bag of worms
There when standing then disappears when lying down

555
Q

Hydrocele?

A

Ovoid swelling enveloping the testis or located above testis along spermatic cord
Transilluminates
Common in neonates

556
Q

Indirect inguinal hernia?

A

Painless unless strangulated or incarcerated
Dull/ dragging discomfort in scrotum
Enlarge with valsalva manoeuvres and disappear when laying down
Can’t get above swelling or palpate spermatic cord

557
Q

Squamous cell carcinoma of the scrotum?

A

Chronic onset
Painless
Raised papule/ plaque on scrotal wall that is purulent
Inguinal lymphadenopathy

558
Q

What cause of scrotal swelling appears clear on transillumination?

A

Hydrocele

559
Q

Testicular torsion?

A 
Neonatal or around puberty 
History of undescended testis 
Sudden onset 
Severe unilateral pain + Nausea/ vomiting 
Absent cremesteric reflex
560
Q

Torsion of appendix testis or appendix epididymis?

A

Embryological remnants that become tort during adolescence
Pain on head of testis or epididymis not associated with nausea or vomiting
Nodule grows to generalised scrotal oedema
Cremesteric reflex normal

561
Q

Epididymo-orchitis?

A

Gradual onset over days
Prehn sign +ve
Swelling
Urethral discharge and vomiting/ nausea

562
Q

Blue dot sign?

A

Infarcted appendage of testis or epididymis

563
Q

Management of testicular torsion?

A

Urgent admission to urology or paediatric surgery

564
Q

What age do hydroceles normally resolve by?

A

2 years old

565
Q

complication of testicular torsion?

A

Segmental ischaemia of testis

566
Q

What can be measured in blood to confirm testicular cancer?

A

Alpha feto-protein

Human Chorionic gonadotropin levels

567
Q

Causes of contraception failure rates?

A

User failure - not used properly

Method failure - Even when the method was used, pregnancy still occurred

568
Q

Things to consider when discussing contraceptive choices?

A 
Age
Patient preference 
Co-morbidities 
Other medication taken 
BMI
History of cancers 
Pregnancy 
Protection against STI
569
Q

MOA of COCP?

A

Combined synthetic oestrogen and progesterone

  • Suppress synthesis and secretion of FSH + LH needed for ovarian follicles and ovulation
  • Thicken cervical mucus
  • Inhibit blastocyst implantation in the endometrium
570
Q

Potential side effects of COCP?

A 
VTE risk 
BTB
Mood swings 
MI
Stroke 
Breast cancer
571
Q

Benefits of COCP?

A 
Effective 
Reversible 
Relief of menstrual problems 
Can protect against PID
Reduced incidence of breast, ovarian and endometrial cancer
572
Q

Examples of progesterone-only contraceptive pill?

A

Levonorgestrel or Desogestrel

Levonelle - emergency contraception

573
Q

MOA of POCP?

A

Inhibit ovulation
Delay ovum transport
Thick cervical mucus
Endometrium becomes unstable for implantation

574
Q

3 types of progesterone-only injectable contraceptives and how long they last?

A

Depo - 12 weeks
Sayana - 13 weeks
Noristerat - 8 weeks

575
Q

What form of contraception is not easily reversible?

A

Progesterone-only injectable contraceptive

576
Q

What is the progesterone-only subdermal implant?

A

Etonogestrel (Nexplanon)

Long-acting reversible contraceptive combined in a rod that is slowly released into systemic circulation

577
Q

MOA of IUD-Cu?

A

T shaped device that is inserted into the uterus

  • Prevents fertilisation due to copper effect on ova or sperm
  • Cu affects cervical mucus so reduced sperm penetration
  • Induces endometrial inflammation giving anti-implantation effect
578
Q

Types of Levonogestrel-releasing IUD?

A

Mirena - 5 years

Jaydess - 3 years

579
Q

CI of COCP?

A 
>35 and smokes >15 a day 
Migraine with aura 
BP >160/100
Cardiovascular disease
Thromboembolic conditions 
Breast cancer 
BMI >35
Immobile 
Diabetes 
Gall bladder disease
580
Q

What is the age of consent?

A

16

581
Q

What is the difference between Gillick competence and Fraser guidelines?

A

Gillick - <16 can make any medical decisions without the consent of the parents

Fraser guidelines - <16 makes medical decisions with regards to contraception and contraceptive advice without parental consent

582
Q

Male symptoms of chlamydia?

A

Urethral discharge
Dysuria
Urethral discomfort
Reactive arthritis

583
Q

Female symptoms of chlamydia?

A

Cervix/ Urethral/ vaginal discharge
Post-coital or intermenstrual bleeding
Dyspareunia
Pelvic pain

584
Q

What can NAAT be used to confirm the presence of?

A

Chlamydia or Gonorrhoea

585
Q

1st line management of chlamydia?

A

Doxycycline

586
Q

Complications of chlamydia?

A 
PID
Epididymo-orchitis 
Adult conjunctivitis 
Reactive arthritis 
Neonatal infections 
Low birth weight
587
Q

1st line management of Gonorrhoea?

A

Refer to GUM + Ceftriaxone

588
Q

Male symptoms of Gonorrhoea?

A

Purulent urethral discharge
Rectal discharge/ Pain/ Tenesmus/ Bleeding
Pharyngeal infection

589
Q

Female symptoms of Gonorrhoea?

A 
Vaginal discharge 
Lower abdo pain 
Dysuria
Dyspareunia 
Endocervical bleeding 
Abdo tender 
Mucopurulent discharge
590
Q

What organism causes Chlamydia?

A

Chlamydia Trachomatis

591
Q

What organism causes Gonorrhoea?

A

Neisseria Gonorrhoea

592
Q

Complications of Gonorrhoea?

A 
PID
Miscarriage 
Congenital infections 
Epididymo-orchitis
Prostitis 
Urethral stricture 
Infertility
593
Q

How does syphilis enter the blood?

A

Through skin abrasions or intact mucous membranes then into the blood. Inoculation period of 3 months

594
Q

What organism causes syphilis?

A

Treponema Pallidum

595
Q

1st line management of syphilis?

A

Benzathine Penicillin or Azithromycin

596
Q

Difference between primary and secondary syphilis?

A

Primary - Localised painless papule that becomes an ulcer

Secondary - Generalised headache, malaise, fever, polymorphic non-itchy rash of palms, soles, face

597
Q

3 main systems affected tertiary syphilis?

A

Cardiovascular - Aortic root dilation, regurg, aneurysm
Gummatous - inflammatory fibrous nodules which are locally destructive
Neuro - Dementia

598
Q

What organism causes Trichomoniasis?

A

Trichomoniasis Vaginalis

599
Q

Symptoms of Trichomoniasis?

A 
Fishy green/ yellow frothy discharge 
Strawberry cervix 
Purulent urethral discharge 
Dysuria 
Frequency
600
Q

Investigations used to confirm Trichomoniasis?

A 
Abdo exam 
High vag swab 
pH + speculum 
Urethral swab
First void urine
601
Q

What STI can be detected using blood tests?

A

Syphilis + HIV

602
Q

Management of Trichomoniasis?

A

Refer to GUM

Metronidazole

603
Q

Complications of Tichomoniasis?

A 
Perinatal complications 
Postpartum sepsis
Low birth weight 
PID
Increased risk of cervical cancer 
Infertility 
Prostatitis

Phase 3a (8 decks)

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