GP / Acute management Flashcards
what blood test results would you see in osteoporosis
Normal ALP, Normal calcium, normal phosphate, normal PTH
what can be used to reduce blood pressure during induced labour
Epidural anaesthesia
causative organism for pyelonephritis
e. coli
what should be used in the diagnosis of UTI in women over 65, men and catheterised patients
urine culture
what are the important risk factors for the development of osteoporosis
steroids
RA
Alcohol
history of hip fracture
Low BMI
smoking currently
give an example of a medication that should be stopped for 48h after a CT with contrast
Metformin
is the forehead affected in bells palsy
yes
from when to when should women with risk factors take aspirin in pregnancy
aspirin 75-150 mg daily from 12 weeks until birth
what is the triad of symptoms seen in pre-eclampsia ?
New onset HTN
proteinuria
oedema
when can Lyme disease be diagnosed clinically and how is it managed
if erythema migrans is present - prescribe doxycycline
what are the red flags presenting with trigeminal neuralgia
sensory changes
deafness
history of skin or oral lesions
pain only in ophthalmic division
optic neuritis
fhx of MS
age of onset < 40
what is the first line investigation to diagnose Lyme disease
ELISA
are antibiotics recommended for tick bite
no - only if lyme disease
how is disseminated Lyme disease managed
ceftriaxone
what pain makes lateral epicondylitis worse
resisted wrist extension with elbow extended
what 8is the first line investigation for chlamydia and gonorrhoea
vulvovaginal swab in women
urine is first line in men
NAAT
what is the first line management of chlamydia ? does this change if the woman is pregnant
doxycycline - 7 day course
if pregnant - azithromycin, erythromycin, amoxicillin
what are they key features of parkinson’s
assymetrical features
bradykinesia
tremor - improves with voluntary movement
rigidity
what is the most common psychiatric feature of Parkinson’s
depression
what are the features of drug induced parkinsonism
more symptoms, rapid onset and bilateral
rigidity and rest tremor uncomonnon
how can u distinguish between essential tremor and parkinsons
single photon emission computed tomography
what medication slows disease progression in ADPKPD
tolvaptan
what are the features of Lewy Body dementia ?
progressive cognitive impairment
parkinsonism
visual hallucinations
fluctuating cognition?
Lewy Body dementia
what risks to the mother does chicken pox come with
pneumonitis
what is the management of chicken pox exposure in pregnancy
check varicella antibodies
oral aciclovir for PEP = given at day 7 to day 14 after exposure
what is the management of chicken pox in pregnancy
specialist advice
oral aciclovir if women is >20 weeks and presents within 24h of onset
< 20 weeks : consider aciclovir with caution
guidelines for checking urine sample in child
symptoms suggesting UTI
Unexplained fever of 38 or higher
alternative site of infection but remain unwell
what is the urine collection method for uti in child
clean catch is preferable
if not possible then urine collection pads should be used
cotton wool balls, gauze and sanitary towels are not suitable
invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible
management of UTI in child
< 3m = refer immediately to paeds
>3 or more w Upper UTI = refer for admission/ oral abx ( cephalosporin and co-amoxiclav)
> 3 m with lower UTI = oral abx for 3 days
what should be corrected before giving alendronic acid
correct hypocalcaemia/ vit d deficiency
what are the primary , secondary and tertiary features of syphilis
primary - chancre ( painless ulcer at site of sexual contact)
local non tender lymphadenopathy
secondary = systemic , rash, buccal snail track ulcers, condylomata lata ( warty lesions on genitals)
tertiary : gummas,, aneurysms, argyll robinson pupil
what is cubital tunnel syndrome caused by? what are its features
compression of ulnar nerve leading to intermittent tingling in the 4th and 5th finger
what is the management of pertusssis
oral macrolide indicated if onset of the cough is within the previous 21 days - clarithromycin, azithromycin, erythromycin
what are the school exclusion rules regarding pertussis
48 h after commencing antibiotics - or 21 days from onset of symptoms if no antibiotics
what is the z score adjusted for
age, gender and ethnic factors
what is the management of catheterised patients who are asymptomatic
no treatment needed
how to check if uti has resolved in pregnant women
urine culture
what is the first line management of syphilis
IM benzathine penicillin
how do the following present -
active syphilis
negative syphilis
false negative syphilis
false positive syphilis
successfully treated syphilis
active = positive treponemal and non-treponemal test
negative = both tests negative
false negative = both tests being negative but patient has disease
false positive = positive non-treponemal test, negative treponemal ( due to pregnancy, SLE,APL,TB)
Successfully treated = treponemal positive, non treponemal negative
most commonly diagnosed STI in the UK
chlamydia
which nerve root compression produces with reduced ankle reflex
S1 nerve root compression
how to distinguish L3 and L4 nerve root compression
L3 - anterior thigh
L4 - anterior knee and medial malleolus
L5 root compression
no loss of reflexes
sensory loss on the dorsum of the foot
What is the management of uti in pregnancy close to term ?
amoxicillin
what is the management of primary genital herpes during 3rd semester
oral aciclovir and delivery by c section
what is the adult dose of adrenaline
500 mcg ( 0.5 ml of 1 in 1000)
what is the management of trichomonas vaginalis ?
metronidazole for 5-7 days
what are the key signs of trichomonas vaginalis
vaginal discharge
vulvovaginitis
strawberry cervix
pH > 4.5
urethritis in men if symptomatic
which antibiotic can cause achilles tendon disorders
ciprofloxacin
what dose of adrenaline is prescribed in anaphylaxis depending on age band
< 6m 100-150
6m-6y 150
6-12y 300
adult and child > 12 500
what stage of prostate cancer is ass,. with a histologically aggressive form of cancer
gleason score of 10
at what bp do you admit women w htn in pregnancyy
160/110
how is jarisch herxheimer reaction managed
antipyretics
what is the second line management of gonorrhoea if patient refuses IM Ceftriaxone
cefixime and azithromycin
which diabetic drug causes -
fractures
pancreatitis
glitazones
gliptins
what is the complication of using SSRI in the
1st trimester
third trimester
small increase of congenital heart defects, paroxetine can cause congenital malformations
Persistent pulmonary HTN
what values does the Modification of diet in renal disease use?
Creatinine, age, gender, ethnicity- CAGE
what is the first line laxative prescribed for constipation in children? what is added next ?
Osmotic laxative
Stimulant laxative
what is the management of bells palsy
prednisolone and lubricating eye drops
how does gonorrhoea present under the microscope? what is the treatment of choice?
gram negative diplococci
IM ceftriaxone
what does Simmonds triad include
Calf squeeze test
observation of the angle of declination
palpation of the tendiin
what is finkelsteins test? what condition does it diagnose
forced adduction and flexion of thumb is elicited- de quervains tenosynovitis
how is a severe polyarthritis managed
systemic steroids
Osgood-Schlatter disease
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
what is the presentation of Panic attack on ABG
normal pO2
low CO2
raised ph
bicarb on the higher side
what is flash pulmonary oedema and what does it present after?
occurs with acute mitral regurgitation due to an MI - early to mid diastolic murmur is heard
what are the features of Mycoplasma pneumoniae ( abbreviation)
multiforme ( erythema)
IgM haemolytic anaemia
Myocarditis
meningo-encephalitis and other immune mediate disease
macrolide treatment : erythromycin
what are the features of legionella ( abbrvt))
Lymphocytosis
Low sodium
look at the pee to diagnose
LFT’s deranged
what is the oxford stroke classification
- unilateral hemiparesis and / or hemisensory loss of face arm and leg
- homonymous hemianopia
- higher cognitive dysfunction ( dysphasia)
Pneumonia, peripheral blood smear showing red blood cell agglutination →
Mycoplasma pneumoniae
how can MI present in diabetic patients
without chest pain
what ABG picture is typical in a COPD patient who has received too much Oxygen
low pH and raised bicarb
what are the components of the ORBIT score?
anaemia -2
age > 74-1
bleeding history - 2
renal impairment -1
treatment with anti-platelet agents -1
bilateral pleural effusions
patchy infiltrates
new systolic murmur loudest at the apex radiating to the axilla
mi —> flash pulmonary oedema –> acute mitral regurgitation
how does a chronic subdural haematoma appear on CT
hypodense, crescentic collection around convexity of the brain
what describes the appearance of a large acute subdural haematoma
Hyperdense, crescentic collection with evidence of mass effect
Metabolic alkalosis + hypokalaemia → ?
prolonged vomiting
which seizures are managed first line by sodium valproate ?
Tonic clonic , Tonic
Atonic
Myoclonic
what is the first line management of absence seizures ?
ethosuximide
what is the management of myoclonic seizures in women
levetiracetam
Tonic or atonic seizures: first line for females
Lamotrigine
what are the signs of right sided heart failure
raised JVP
ankle oedema
hepatomegaly
first-line investigation for a suspected osteoporotic vertebral fracture.
X-ray spine
how does DKA present on ABG
metabolic acidosis with increased anion gap.
If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI —>
coronary artery bypass graft (CABG)
what is the management of raised ICP
head elevation to 30º
controlled hyperventilation
aim is to reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP
leads to rapid, temporary lowering of ICP. However, caution needed as may reduce blood flow to already ischaemic parts of the brain
Causes of raised SAAG
liver disorders ( cirrhosis, failure, mets)
cardiac ( RHF, Constrictive pericarditis)
budd chiari
portal vein thrombosis
causes of low SAAG
hypolbuminaemia
malignancy
infection
pancreatitis
obstruction
ascites
lymphatic leak
severe pancreatitis signs
age > 55
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
increased LDH, AST
which scoring system is most specific for acute pancreatitis
glascow
examples of other features of aortic dissection depending upon location
coronary arteries → angina
spinal arteries → paraplegia
distal aorta → limb ischaemia
mx of nutrition in moderate-severe pancreatitis
oral nutrition and do not keep nil by mouth unless moderate to severe in which case enteral nutrition
how does a fibroadenoma present ? when is surgical excision recommended?
mobile, firm, smooth breast lump
if > 3 cm = surgical excision
most common cause of pelvic inflammatory disease in the UK
chlamydia trachomatis
what is the management of PID
Oral ofloxacin + oral metronidazole / IM ceftriaxone, oral doxy and oral metronidazole
what is fitzhughcurtis syndrome
peri-hepatitis characterised by RUQ and may be confused with cholecystitis - seen in PID
what investigations are performed in PID
pregnancy test
high vaginal swab - negative
screen for chlamydia and gonorrhoea
mx of testicular torsion
emergency bilateral orchidopexy
what is the surgical management of breast cancer
depends on axillary lymphadenopathy :
if palpable - axillary node clearance at primary surgery
not palpable - ultrasound and biopsy
radiotherapy for anyone who has had wide-local excision
when is trastuzumab useful
HER2 +ve
what is a systemic complication of acute pancreatitis
ARDS
What are the features of testicular torsion
tender testis retracted upwards
cremasteric reflex lost
elevation of the testis does not ease the pain ( Prehn’s sign)
when are prosthetic valves the choice vs when are mechanical valves the right choice ?
old ppl - prosthetic ( > 65 for aortic , > 70 for mitral)
mechanical - younger ( thrombosis needed)
how does mastitis present ?
painful, tender and hot breast
fever + general malaise
1st line management of mastitis
keep breastfeeding, warm compress and analgesia etc
abx for mastitits - when and what
if after 12-24 h symptoms dont improve give oral flucloxacillin
what is the investigation of choice for chronic venous disease
venous doppler ultrasound- demonstrating retrograde venous flow
management of varicose veins
Leg elevation
weight loss
regular exercise
graduated compression stockings
what investigation is suggested for persons with suspected aortic dissection who are too unstable for CT scanning
TOE
When is a referral to secondary recommended in a patient with a varicose vein / chronic venous insufficiency
troublesome lower limb symptoms
bleeding
skin changes like pigmentation and eczema
superficial thrombophlebitis
active / healed venous ulcer
epigastric hernia
: lump in the midline between umbilicus and the xiphisternum
umbilical vs paraumbilical hernia
umbilical : under umbilicus
para-umbilical : above or below umbilicus
Periductal mastitis
recurrent episodes of infection
smoking
s/e of colchicine
diarrhoea
common side effect of verapamil
constipation
management of bell’s palsy
eye care
oral pred
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
who should have a frax assessment
They advise that all women aged >= 65 years and all men aged >= 75 years should be assessed.
when should younger patients be considered for frax assessment
previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
other causes of secondary osteoporosis
low body mass index (BMI) (less than 18.5 kg/m²)
smoking
alcohol intake of more than 14 units per week for women and more than 14 units per week for men.
investigation of choice for ectopic pregnancy
TV USS
what is the criteria for expectant management of an ectopic pregnancy
Size < 35 mm
Unruptured
asymptomatic
no foetal Heartbeat
hCG < 1,000 IU/ L
what is expectant management of an ectopic
Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.
what is the criteria for medical management of ectopic pregnancy
Size < 35 mm
Unruptured
minimal pain
no foetal Heartbeat
hCG < 1,500 IU/ L
what is the medical management of an ectopic
methotrexate + patient available for follow up
criteria for surgical mx of ectopic
size > 35 mm
can be ruptured
foetal heartbeat
hcg > 5000
what is the management of cardiogenic shock
1) inotropic agents such as dobutamine should be considered for patients with severe ventricular dysfunction who have potentially reversible cardiogenic shock
2) vasopressor agents : norepinephrine , only if insufficient response to inotropes and evidence of end organ hypoperfusion.
causes of metabolic acidosis with raised anion gap
lactate : shock, sepsis, hypoxia
ketosis
renal failure
poisoning
causes of metabolic acidosis with normal anion gap
diarrhoea
renal tubular acidosis
addisons
what vessels are damaged in an epidural haemorrhage
middle meningeal artery
what vessels are damaged in SAH
circle of Willis - such as basilar and anterior circulating arteries
what is the management of chronic symptomatic subdural
surgical decompression with burr holes
how is TCA overdose investigated
ECG - shows widening of the QRS complex
mx of TCA overdose
IV Bicarbonate
what is the pattern of acid base disturbance seen in salicylate overdose
resp acidosis followed by met acidosis
how does seretonin syndrome present and how is it managed
hyperreflexia, myoclonus , rigidity
hyperthermia + sweating
confusion
what is the mx of seretonin syndrome
iv fluids and benzos
how to differentiate between serotonin syndrome and neuroleptic malignant syndrome
neuroleptic malignant syndrome has a slower onset and presents with reduced reflexes and rigidity and normal pupils whereas serotonin syndrome presents with dilated pupils and increased reflexes
mx of neuroleptic malignant syndrome
dantrolene
what type of arrest rhythm does tension pneumo cause
PEA reversible
what is the management of salicylate overdose
charcoal
urinary alkalinzation with iv sodium bicarb
what is the acceptable daily amount of glucose
50-100 g
how to tell prerenal aki
high urine to creatinine ratio
If a patient with AF has a stroke or TIA, the anticoagulant of choice should be ____________
apixaban, warfarin or direct thrombin / factor Xa inhibitor
what drugs should a patient be offered for secondary prevention of MI
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
which patients are at risk of developing hepatotoxicity post paracetamol overdose
liver enzyme inducing drugs -
malnourished patients
chronic alcohol excess
which meds interact with SSRI’s to cause seretonin syndrome
tramadol
what is a normal anion gap?
8-14 mmol/L
how to calculate anion gap
sodium + potassium - bicarb + chloride
which ivx is most important when assessing a patient with bilateral UTI
u+e
which type of stroke causes torsades de pointes
sah
Idiopathic intracranial hypertension signs -
papilledema, 6th nerve palsy
can u continue aspirin in aki
yes
how does narcolepsy present
cataplexy in which patient suddenly loses muscle control , usually triggered by some form of +ve emotion
what abg result does aspirin toxicity give
mixed primary respiratory alkalosis and metabolic acidosis
which bridging veins does a subdural haemorrhage damage
between cortex and venous sinuses
what are the signs of aspirin overdose
hyperventilation
tinnitus
lethargy
sweating
vomiting
seizures coma
shortest time over which 40 mmol of potassium can be administered
4h
what feature of COPD can mimic pneumothorax
large bullae
what is the most common pulmonary manifestation of methotrexate use? how does it present
pneumonitis, presenting with hypersensitivity pneumonitis , non productive cough, dyspnoea malaise and fever
which malaria is associated with nephrotic syndrome
plasmodium malariae
what are the general features of malaria
fever headache splenomegaly
cyclical fever
most common cause of non falciparum malaria
Plasmodium vivax
management of malaria
ACT therapy or chloroquine followed by primaquine to prevent relapses
how often should chest physiotherapy and postural drainage be conducted in the mx of cystic fibrosis
twice daily
mirror image nuclei - what condition ?
hodgkins lymphoma
at what t score would you start bisphosphonates with patients on steroids
- 1.5
where are struvite calculi normally formed
pelvis - stag horn
action of tamoxifen
oestrogen receptor selective antagonism
diagnostic investigation of ankylosing spondilytis
pelvic xray
why do patients with coeliac disease need pneumococcal
due to functional hyposplenism
contraindication to surgery for lung cancer
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction
how is colorectal cancer staged
CEA
CT CAP
how is a cancer of the caecal, ascending or proximal transverse colon resected
Right hemicolectomy
how is the cancer of distal, transverse or descending colon resected
left hemicolectomy
how to exclude diabetes insipidus
urine osmolality of > 700 mOsm/kg
what picture is seen on blood tests in polycythaemia vera
isolated rise in Hb
define volvulus
Torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction
what is the management of volvulus
sigmoid : rigid sigmoidoscopy with rectal tube insertion
caecal : operative with right hemicolectomy
how does sigmoid volvulus present
large bowel obstruction = large dilated loop of colon , often with air fluid levels and coffee bean sign
how does caecal volvulus present
small bowel obstruction
when would you refer to ENT - bells palsy
no sign of improvement after 3 weeks
features associated with bell’’s palsy
post-auricular pain
altered taste
dry eyes
hyperacusis
what feature can be used to differentiate between primary and secondary hypoadrenalism
skin hyperpigmentation
diff between primary secondary and tertiary hypoadrenalism
Primary - Pigments (skin and mucosa)
Secondary - Spares (no pigmentation)
Tertiary - Treatment (iatrogenic, steroid use)
what sign is seen with a mid shaft humeral fracture
radial nerve affected causing wrist drop
_____________should be considered for the prevention of calcium stones
potassium citrate
where should adrenaline be given
anterolateral aspect of the thigh
what type of hypersensitivity reactions are autoimmune conditions
type 3
diagnosis of mesothelioma
histology, following a thoracoscopy
‘egg-shell’ calcification of the hilar lymph nodes
Silicosis
Symptoms of leprosy
hypo-pigmented patches, loss of sensation in fingers and toes, thickening of peripheral nerves, and thickening of the skin on the hands and face. Muscle weakness is also a relevant symptom.
signs and symptoms of meralgia paraesthesia
burning, tingling coldness or shooting pain
numbness
deep muscle ache
aggravated by standing and relieved by sitting
rf’s for meralgia paraesthesia
obesity, pregnancy , sports, trauma, iatrogenic
gastric volvulus
vomiting, pain and failed attempts to pass an NG tube
management of colonic cancer in patient with HNPCC
panproctocolectomy
how is a cancer of the sigmoid colon managed
high anterior resection
how is cancer of the rectum managed
anterior resection
how are cancers of the anal verge managed
abdomino-perineal excision of the rectum
when is Hartmann’s procedure is used in the resection of cancer
when bowel has perforated then the risk of anastomosis is greater so a Hartmann’s procedure is used
what is a sign of chronic hepatitis on light microscopy
Ground glass hepatocytes
why does a fixed and dilated pupil develop in extradural haematoma
compression of the parasympathetic fibers of the third cranial nerve.
how does neurogenic thoracic outlet syndrome present
muscle wasting of the hands, numbness and tingling, autonomic symptoms
what osseous abnormality can be present in thoracic outlet syndrome
cervical rib
primary lateral sclerosis
UMN signs only
progressive muscular atrophy
LMN only
progressive bulbar palsy
palsy of tongue, muscles of chewing, swallowing and facial muscles.
explain homonymous hemianopias based upon location
incongruous : lesions of optic tract
congruous : lesions of optic radiation/ occipital cortex
macula sparing : occipital cortex
which condition has a poor response to a fluid challenge
acute tubular necrosis
what is a common presentation of haemophilia
haemoarthroses
what are pancreatic pseudocysts and how are they managed ?
collection of peripancreatic fluid typically occurring after an attack of acute pancreatitis
generally managed conservatively but can be managed with endoscopic or surgical cyst gastrostomy or aspiration
mx of pancreatic abscess
trans-gastric drainage or endoscopic drainage
how is HER2 receptor breast cancer managed
Trastuzumab, often known by its brand name Herceptin, is a monoclonal antibody that acts to block HER2
how is latent TB managed
3 months of isoniazid w pyridoxine and rifampicin for 3m
or 6m of isoniazid with pyridoxine
most common cause of large bowel obstruction
cancer
characteristic feature of anal fissures
pain and bleeding
definitive management of SAH aneurysm
coiling
action of aromatase inhibitors
reducing peripheral synthesis of oestrogen
appropriate ivx for appendicitis
abdominal ultrasound
how can nutrition be supported in patients with MND
PEG
Progressive multifocal leukoencephalopathy is caused by
JC virus or BK virus
Mx of CMPA
formula fed - extensive hydrolysed formula, amino acid based formula
breastfed -
continue breastfeeding
eliminate cow milk from mumms diet
prognosis of CMPA
IgE - 55% milk tolerant by 5
non IgE - most tolerant by 3
Ivg for SAH
Non contrast CT head -
if done within 6h of symptom onset no need for LP
if its done > 6h of symptoms then do LP
early x-ray feature of rheumatoid arthritis
Juxta-articular osteoporosis/osteopenia
Schistosomiasis is a risk factor for
squamous cell carcinoma of the bladder
Sister Mary Joseph nodule -
sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary
Functional tricuspid regurgitation often occurs secondary to
pulmonary hypertension
when should LP be done post suspected SAH
at least 12 hours following the onset of symptoms to allow the development of xanthochromia
grading of haemorrhoids
grade 1 - no prolapse
grade 2 - prolapse on defecation but reduce spontaneously
grade 3 - manually reduced
grade 4 - cannot be reduced
ivg for suspected bowel obstruction
abdo xray first line
CT diagnostic
AAA screening UK
single abdominal ultrasound aged 65
most common cause of small bowel obstruction
adhesions
small bowel obstruction vomiting
bilious, early
Caecal volvulus associations
all ages
adhesions
pregnancy
which oral symptom can methotrexate cause
Mucositis
The most common site of metatarsal stress fractures
2nd metatarsal shaft
HIV-associated nephropathy
focal segmental glomerulosclerosis
Management of necrotising fasciitis
immediate surgical debridement and IV antibiotics
What is the most effective single step to reduce the incidence of MRSA?
hand hygiene
what is the indication for ABG in patients with acute asthma
sats < 92
which neurovascular structure is compromised in scaphoid fracture
dorsal carpal branch of the radial artery
mx of chronic vs acute anal fissure
acute : dietary changes and stool softeners –> topical anaesthetics
chronic : topical GTN –> sphincterotomy
Which is associated with a good prognosis in rheumatoid arthritis?
Rheumatoid factor negative.
most common breast tumour
Invasive ductal carcinomas
What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?
Loss of antithrombin III.
herpes simplex encephalitis- CT
CT head showing temporal lobe changes
Joint aspirate in rheumatoid arthritis shows
high WBC count, predominantly PMNs.
lumbar puncture show a yeast and a capsule in the CSF stained with India ink.
Cryptococcus neoformans
Perianal abscess- symptoms
severe pain in the perianal region, and may have spiking temperatures
treatment of perianal abscess
incision and drainage
risk factors for anorectal abscesses
anorectal abscesses
diabetes mellitus
underlying malignancy
what marker can be raised in small bowel obstruction
Serum amylase levels
greatest rf for bells palsy
Pregnant
Electrical cardioversion is synchronised to
R wave
what medications cause gingival hyperplasia
phenytoin
ciclosporin
CCB’s
management of heparin induced thrombocytopenia
switch to direct thrombin inhibitor such as argatroban
VTE prophylaxis in kidney failure
unfractionated heparin
left ventricular aneurysm
persistent ST elevation 4 weeks after MI
exam shows bi-basal crackles and 3rd and 4th heart sound
What is the best drug to prescribe that both improves symptoms and prognosis in heart failure?
spironolactone
NIV should be considered in all patients with an acute exacerbation of COPD in whom
respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment
when is adrenaline given in VF/VT
adrenaline 1mg to be given once chest compressions have restarted after third shock
which medications should be stopped in C.diff
Opioids- meds that are anti-motility and anti-peristaltic
features of periarticular juvenile idiopathic arthritis
joint pain and swelling, ANA +ve
who needs an MSU
aged > 65
visible/non-visible haematuria
men
when is adrenaline given in VF/pulseless vt
after 3 shocks
mx of herpes in 3rd trimester of pregnancy
oral acyclovir 400 mg TDS
less severe vs more severe depression on PHQ9
< 16 - less severe
> 16 more severe
what is important to co-prescribe prostate cancer when it is being managed with Goserelin
bicalutamide, cyproterone acetate , abiterone
these are anti androgen treatments
Medications that may worsen osteoporosis
SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole
gene mutation associated with HNPCC
MSH2/MLH1
which medication is prescribed after NSTEMI if patient is on oral anticoagulation
clopidogrel instead of prasugrel/ticagrelor
how to differentiate between prerenal uraemia and acute tubular necrosis
pre-renal uraemia :
raised urea : creatine ratio
high urine osmolality
low urine sodium
acute tubular necrosis :
raised urine sodium
low urine osmolality
which ccb’s do not cause worsening of HF
Nifedipine, amlodipine etc
type 1 vs type 2 bipolar
type 1 - mania
type 2 - hypomania
Adhesions from previous surgery are the most common cause of
small bowel obstruction
when is the pneumococcal vaccine given for a patient undergoing elective splenectomy
2 weeks prior to surgery
how to distinguish between toxoplasmosis and lymphoma on CT
toxoplasmosis -
multiple lesions
ring/nodular enhancement
thalliaum spect negative
lymphoma
single lesion
solid enhancement
thallium spect positive
Whichis the most likely result if a fetus is homozygous for alpha-thalassaemia
hydrops fetalis
At what pH is the patient with COPD most likely to receive benefit from non-invasive ventilation?
7.25-7.35
Refractory anaphylaxis
respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline
mx of refractory anaphylaxis
IV fluids + call for help for IV adrenaline
side effects of warfarin
haemorrhage
teratogenic
skin necrosis
monitoring of methotrexate
FBC, U+E, LFT every 3 months
what causes cranial diabetes
craniopharyngioma
which scoring system is helpful in diagnosing secondary osteoporosis
Z score
mx of localised prostate cancer
conservative- active monitoring and watchful waiting
radical prostatectomy
radiotherapy - external beam
s/e of radiotherapy for prostate cancer
proctitis and increased risk of bladder, colon and rectal cancer
what are complement levels in SLE useful for
monitoring flares - low in active disease
what does MS show on MRI
demyelinating lesions disseminated in time and space
which laxative to avoid in IBS
lactulose
How should a patient be screened for MRSA?
nasal swab and skin lesions or wounds
the swab should be wiped around the inside rim of a patient’s nose for 5 seconds
Suppression of MRSA from a carrier once identified
Nasal mupirocin + chlorhexidine for the skin
hep E in pregnancy
reduced GCS, Flapping tremor, DIC, deranged lfts - fulminant hep E
explain Hartmanns procedure
end colostomy
most common cardiac manifestation of SLE
pericarditis
radial nerve palsy
wrist drop , known as Saturday night palsy due to compression of the radial nerve against humeral shaft
what are the CSF findings in SAH
bilirubin and normal opening pressure
polymyositis antibody
Anti Jo 1
polymyositis features
proximal muscle weakness and tenderness
Raynaud’s
ILD
no rash
Proximal muscle weakness + raised CK + no rash → ?
polymyositis
which types of shock cause warm peripheries
neurogenic, septic and anaphylactic
which infection is polyarteritis nodosa associated with
Hepatitis B
pellagra
dermatitis
diarrhoea
dementia
delusions
death
due to vitamin B3 deficiency
epididymal cysts
most common cause of scrotal swellings
separate from the body of the testicle and posterior to it
ass. w/ PKD, VHL
varicocele
left sided
bag of worms texture
CT head showing temporal lobe changes -
herpes simplex encephalitis
___________is the most common cause of diarrhoea in patients with HIV infection.
cryptosporiduium
Gait ataxia is caused by cerebellar
cerebellar vermis lesions
most common cause of dysphagia in HIV patients
oesophageal candidiasis
The gene encoding the __________ is mutated in familial hypercholesterolaemia
low-density lipoprotein (LDL) receptor
Adductor pollicis is innervated by
ulnar nerve
duke classification
Dukes’ A Tumour confined to the mucosa 95%
Dukes’ B Tumour invading bowel wall 80%
Dukes’ C Lymph node metastases 65%
Dukes’ D Distant metastases
is the strongest risk factor for anal cancer
HPV infection
Axillary freckles are indicative of
neurofibromatosis type 1
mx of renal cell carcinoma
RCC > 7cm → radical nephrectomy
RCC < 7cm → partial nephrectomy
mx of acute prostatitis
cipro
In acute uncomplicated sinusitis, first-line therapy as per NICE guidelines would be
phenoxymethylpenicillin
