GP part 1 Flashcards

Question

what are specific signs of haemolytic anaemia

Answer 1

bone deformities

Answer 2

oedema hypertension excoriations on the skin

Answer 3

Full blood count for haemoglobin and mean cell volume Reticulocyte count (indicates red blood cell production) Blood film for abnormal cells and inclusions Renal profile for chronic kidney disease Liver function tests for liver disease and bilirubin (raised in haemolysis) Ferritin (iron) B12 and folate Intrinsic factor antibodies for pernicious anaemia Thyroid function tests for hypothyroidism Coeliac disease serology (e.g., anti-tissue transglutaminase antibodies) Myeloma screening (e.g., serum protein electrophoresis) Haemoglobin electrophoresis for thalassaemia and sickle cell disease Direct Coombs test for autoimmune haemolytic anaemia Colonoscopy and OGD in unexplained iron deficiency anaemia Bone marrow biopsy

Answer 4

insufficient dietary iron reduced iron absorption increased iron requirements - pregnancy loss of iron through bleeding - cancer/ulcer

Answer 5

blood loss - menstruation - cancer - oesophagitis or gastritis - peptic ulcers - inflammatory bowel disease - angiodysplasia

Answer 6

dietary insufficiency

Answer 7

anything that reduces stomach acid - PPIs

Answer 8

duodenum and jejunum

Answer 9

inflammation liver disease iron supplements haemochromotosis

Answer 10

travels round the blood bound to the carrier protein transferrin. the total iron binding capacity is the space for the iron to attach to on all the transferring molecules combined and is therefore directly related to how much transferrin is in the blood.

Answer 11

serum iron/total iron binding capacity

Answer 12

it is a protein that stores iron inside cells it is an acute phase protein released with inflammation

Answer 13

this indicates the total iron in the body

Answer 14

haemochromotosis iron supplements acute liver damage

Answer 15

new iron deficiency in adulthood without a clear cause should be investigated further: colonoscopy and OCD - oral iron (ferrous sulphate or ferrous fumarate) - iron infusion (IV CosmoFer) - blood transfusion in severe anemia

Answer 16

black stools constipation

Answer 17

allergic reactions anaphylaxis should be avoided in infections as there is a potential for it to feed bacteria

Answer 18

pernicious anaemia insufficient dietary B12 medications that reduce absorption (PPI and metformin )

Answer 19

Pernicious anaemia is an autoimmune condition involving antibodies against the parietal cells or intrinsic factor.

Answer 20

The parietal cells of the stomach produce a protein called intrinsic factor. Intrinsic factor is essential for the absorption of vitamin B12 in the distal ileum. In pernicious anaemia, autoantibodies target either the parietal cells or intrinsic factor, resulting in a lack of intrinsic factor and a lack of absorption of vitamin B12.

Answer 21

Peripheral neuropathy, with numbness or paraesthesia (pins and needles) Loss of vibration sense Loss of proprioception Visual changes Mood and cognitive changes

Answer 22

Intrinsic factor antibodies - first line Gastric parietal cell antibodies

Answer 23

IM hydroxocobalamin injections are initially given to all patients with B12 deficiency, depending on symptoms - with neurological sx: alternate days until there is no further improvement in the symptoms - without neurological sx: 3 times weekly for two weeks and then maintenance

Answer 24

pernicious anaemia: 2-3 monthly injections for life diet related - oral cyanocobalamin or twice yearly injections

Answer 25

the B12 deficiency

Answer 26

giving patients folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord, with demyelination in the spinal cord and severe neurological problems

Answer 27

this is anaemia caused by the destruction of red blood cells, resulting in a low haemoglobin concentration

Answer 28

hereditary spherocytosis hereditary elliptocytosis thalassaemia sickle cell anaemia G6DP deficiency

Answer 29

autoimmune haemolytic anaemia alloimmune haemolytic anaemia (transfusion reactions and haemolytic disease of the newborn) paroxysmal nocturnal haemoglobinuria microangiopathic haemolytic anaemia prosthetic valve related haemolysis

Answer 30

anaemia splenomegaly - filled with destroyed red blood cells jaundice

Answer 31

full blood count - normocytic anaemia blood film - schistocytes direct coombs test is positive in autoimmune haemolytic anaemia

Answer 32

hereditary spherocytosis

Answer 33

autosomal dominant

Answer 34

a genetic condition which causes fragile, sphere shaped red blood cells that easily break down when passing through the spleen

Answer 35

anaemia jaundice gallstones splenomegaly aplastic crisis in the presence of parvovirus

Answer 36

raised mean corpuscular haemoglobin concentration on a full blood count raised reticulocyte count spherocytes on a blood film

Answer 37

folate supplementation blood transfusions when required splenectomy cholecystectomy if gallstones become a problem

Answer 38

this is caused by a defect in the gene coding for glucose 6 phosphate dehydrogenase, which is responsible for protecting the cells from oxidative damage

Answer 39

in an X linked recessive pattern

Answer 40

mediterranean, asian and african patients

Answer 41

causes acute episodes which is triggered by infections, drugs or fava beans. This is due to an increase in ROS

Answer 42

ciprofloxacin sulfonylureas sulfasalazine

Answer 43

jaundice gallstones anaemia splenomegaly

Answer 44

Heinz bodies

Answer 45

this is when there is antibodies created against the patients own red blood cells leading to red blood cell destruction

Answer 46

warm and cool - based on what temperature at which the auto-antibodies destroy the red blood cells

Answer 47

haemolysis occurs at normal or above normal temperatures - usually idiopathic

Answer 48

called cold agglutinin disease - at lower temperatures (less than 10 degrees) the antibodies attach to the red blood cells causing agglutination. The immune system is activated and the red blood cells are destroyed

Answer 49

lymphoma leukaemia SLE infections - mycoplasma, EBV, CMV, HIV

Answer 50

blood transfusions prednisolone rituximab splenectomy

Answer 51

this occurs due to foreign red blood cells or foreign antibodies

Answer 52

transfusions reactions haemolytic disease of the newborn

Answer 53

caused by a specific genetic mutation in the haematopoietic stem cells in the bone marrow which occurs during the patients lifetime. The mutation results in a loss of the proteins on the surface of red blood cells than inhibit the complement cascade, allowing the activation of the complement cascade on red blood cells and their destruction

Answer 54

red urine in the morning - contains haemoglobin and haemosiderin anaemia thrombosis smooth muscle dystonia

Answer 55

eculizumab - monoclonal antibody which targets complement component C5 bone marrow transplant

Answer 56

it involves destruction of red blood cells as they travel through the circulation this most often is caused by abnormal activation of the clotting system, with thrombi partially obstructing small vessels these obstructions churn the red blood cells causing haemolysis

Answer 57

it is normally secondary to an underlying condition such as: haemolytic uraemic syndrome disseminated intravascular coagulation thrombotic thrombocytopenic purpura SLE cancer

Answer 58

schistocytes

Answer 59

it is a key complication of prosthetic hear valves, which can occur in both bioprosthetic and metallic valve replacement

Answer 60

caused by turbulent flow around the valve and the shearing of the red blood cells, the valve churns up the cells and they break down

Answer 61

monitoring oral iron and folic acid supplementation blood transfusions if severe revision surgery may be required in severe cases

Answer 62

During fetal development, at around 32-36 weeks gestation, fetal haemoglobin (HbF) production decreases, and adult haemoglobin (HbA) increases. There is a gradual transition from HbF to HbA. At birth, around half the haemoglobin is HbF, and half is HbA. By six months of age, very little HbF is produced, and red blood cells contain almost entirely HbA. Patients with sickle-cell disease have an abnormal variant called haemoglobin S (HbS). HbS results in sickle-shaped red blood cells

Answer 63

autosomal recessive

Answer 64

chromosome 11

Answer 65

it is tested as part of the newborn blood spot screening test at around 5 days of age

Answer 66

Anaemia Increased risk of infection Chronic kidney disease Sickle cell crises Acute chest syndrome Stroke Avascular necrosis in large joints such as the hip Pulmonary hypertension Gallstones Priapism (painful and persistent penile erections)

Answer 67

it refers to a spectrum of acute exacerbations caused by sickle cell disease

Answer 68

dehydration infection stress cold weather

Answer 69

low threshold for hospital admission treating infections that may have triggered the crisis keeping them warm good hydration with IV fluids analgesia (avoid NDAIDs where there is renal involvement)

Answer 70

this is also known as a painful crisis and is caused by sickle shaped red blood cells clogging capillaries causing distal ischaemia

Answer 71

pain and swelling in the hands or feet can affect the chest, back associated with a fever can cause priapism in men - urological emergency

Answer 72

this is caused by red blood cells blocking blood flow within the spleen and causes an acutely enlarged and painful spleen, which can lead to aaemia and hypovolaemic shock due to blood pooling in the spleen

Answer 73

emergency - ABCDE blood transfusions fluid resuscitation

Answer 74

this is a temporary absence in the creation of new red blood cells and it is normally triggered by infection with parvovirus B19

Answer 75

this occurs when the vessels supplying the lungs become clogged with red blood cells can be triggered by fat embolism or infection

Answer 76

fever shortness of breath chest pain cough hypoxia

Answer 77

pulmonary infiltrates

Answer 78

medical emergency - treatment of underlying cause Analgesia Good hydration (IV fluids may be required) Antibiotics or antivirals for infection Blood transfusions for anaemia Incentive spirometry using a machine that encourages effective and deep breathing Respiratory support with oxygen, non-invasive ventilation or mechanical ventilation

Answer 79

Avoid triggers for crises, such as dehydration Up-to-date vaccinations Antibiotic prophylaxis to protect against infection, typically with penicillin V (phenoxymethylpenicillin) Hydroxycarbamide (stimulates HbF) Crizanlizumab Blood transfusions for severe anaemia Bone marrow transplant can be curative

Answer 80

it is a drug which works by stimulating the production of fetal haemoglobin which doesnt lead to the sickling of red blood cells unline HbS

Answer 81

it is a monoclonal antibody that targets P selectin, which is an adhesion molecule found on endothelial cells on the inside walls of blood vessels and platelets it prevents red blood cells from sticking to blood vessel walls and reduces the frequency of vaso-occlusive crisis

Answer 82

this is a stress response that can happen within a month of experiencing a traumatic event

Answer 83

Anxiety. Intense fear or helplessness. Experiencing flashbacks or nightmares. Feeling numb or detached from one’s body. Avoiding situations, places or other reminders related to the traumatic event.

Answer 84

Natural disasters, such as a tornado, fire or flood. Sexual assault. Physical assault. Verbal abuse. Witnessing bodily harm or death. Serious accidents, such as a car accident. Experiencing a severe injury or sudden illness. War.

Answer 85

the main difference is the length of the symptoms - acute stress reaction involves stress reactions that happen three days - 4 weeks after a traumatic event - stress reactions lasting longer than four weeks may meet the criteria for PTSD

Answer 86

this is a mental health condition that happens in response to a stressful life event. the emotional and behavioural symptoms are generally considered more intense that what would be expected for the type of event that occurred

Answer 87

the stressful event that happens in adjustment disorder is typically less traumatic than an event that causes acute stress reaction

Answer 88

Recurring, uncontrollable and distressing memories of the event. Recurring nightmares. Flashbacks of the traumatic event. Intense psychologic or physical distress when you’re reminded of the event. Persistent difficulty feeling positive emotions, such as happiness, contentment or loving feelings. An altered sense of reality, like feeling you’re in a daze or as if time is passing in slow motion. Memory loss regarding important aspects of the traumatic event. Efforts to avoid distressing memories, thoughts or feelings associated with the event. Efforts to avoid external reminders associated with the event (people, places or things). Disturbed sleep. Irritability or anger outbursts. Excessive attention to the possibility of danger (hypervigilance). Difficulty concentrating. An exaggerated response to loud noises, sudden movements or other stimuli (startle reflex).

Answer 89

history of prior mental health conditions catastrophic worry avoidant coping style minimal support system

Answer 90

clinical diagnosis = DSM-5

Answer 91

psychotherapy - CBT exposure therapy may offer SSRI/SNRI

Answer 92

it is a crack or tear in the lining of your anal canal

Answer 93

chronic constipation and straining obstructed defecation syndrome infant dyschezia chronic diarrhoea childbirth penetration

Answer 94

sharp pain when defecating burning or itching with defecating fresh blood in stool anal muscle spasms lump on the skin near the tear rectal itching

Answer 95

prior surgery STIs IBD anal cancer TB diaper rash

Answer 96

occur when they dont heal properly - chronic anal fissures if they continue to go unhealed they can lead to fecal impaction, anal stenosis due to narrowing of anal canal, and anal fistula

Answer 97

clinical diagnosis plus examination DRE

Answer 98

most go away on their own - self help such as increasing fibre, avoiding dehydration, soaking cream - lidocaine glyceryl trinitrate ointment - cream which can help to restore blood flow and relax the anal sphincter calcium channel blockers botox - last resort laxatives - bulk forming to help soften stool surgery with chronic anal fissures that dont respond to medications - internal sphincterotomy

Answer 99

urticaria itching angio-oedema with swelling of the eyes and lips abdominal pain shortness of breath wheeze swelling of the larynx tachycardia lightheadedness collapse

Answer 100

ABCDE IM adrenaline - repeated after 5 minutes if necessary antihistamines can be given steroids can be given

Answer 101

it can be confirmed by measuring the serum mast cell tryptase within 6 hours of the event

Answer 102

given to all children and adolescents with anaphylactic reactions may be given to children with generalised allergic reactions with certain risk factors: asthma requiring inhaled corticosteroids poor access to medical treatment nut or insect sting allergies significant co-morbidities

Answer 103

1. prepare the devise - remove the safety cap on the non needle end 2. grip the device with needle end pointing down 3. administer the injection by firmly jabbing the device into the outer portion of the mid thigh until the device clicks 4. remove the device and gently massage the area for 10 seconds 5. phone an ambulance

Answer 104

tis refers to a fast hear rate with a QRS complex duration of less than 0.12 seconds (three small squares on ECG)

Answer 105

sinus tachycardia supraventricular tachycardia atrial fibrillation atrial flutter

Answer 106

looks like QRS immediately followed by a T wave, then a QRS, then a T wave etc - there are P waves but they are buried in the T waves - no saw tooth pattern

Answer 107

vagal manoeuvers adenosine

Answer 108

absent P waves irregularly irregular ventricular rhythm

Answer 109

rate control/rhythm control

Answer 110

atrial rate is normally around 300 bpm saw tooth pattern QRS at regular intervals

Answer 111

this refers to a fast heart rate with a QRS complex duration or more than 0.12 seconds/3 small squares on an ECG

Answer 112

ventricular tachycardia/unclear cause polymorphic ventricular tachycardia such as torsades de pointes atrial fibrillation with bundle branch block supraventricular tachycardia with bundle branch block

Answer 113

IV amiodarone

Answer 114

IV magnesium

Answer 115

a re-entrant rhythm in either atrium, causing the electrical signal to re-circulate in a self perpetuating loop due to an extra electrical pathway in the atria

Answer 116

radiofrequency ablation

Answer 117

when its more than 440 milliseconds in men more than 460 milliseconds in women

Answer 118

prolonged repolarisation of the heart muscle cells after contraction

Answer 119

waiting for a long time for repolarisation can result in spontaneous depolarisation in some muscle cells. These abnormal spontaneous depolarisations before repolarisation are known as afterdepolarisations. These spread throughout the ventricles causing a contraction before proper repolarisation, which is also known as torsades de pointes

Answer 120

long QT syndrome medications such as antipsychotics, citalopram, flecainide, sotalol, amiodarone and macrolide antibiotics electrolytic imbalances such as hypokalaemia, hypomagsesaemia and hypocalcaemia

Answer 121

stopping and avoiding medications that prolong the QT interval correcting electrolyte imbalances beta blockers (NOT SOTALOL) pacemakers or implantable defibs

Answer 122

correcting the underlying issue magnesium infusion defibrillation

Answer 123

these are premature ventricular beats caused by random electrical discharges outside the atria

Answer 124

reassurance and no treatment in otherwise healthy people with infrequent ectopics specialist advice in those with underlying heart disease, frequent or concerning symptoms beta blockers are sometimes used

Answer 125

this is when there is a delay in conduction through the atrioventricular node despite this every atrial impulse leads to a ventricular contraction - every P wave is followed by a QRS

Answer 126

PR interval greater than 0.2 seconds (5 small or 1 big)

Answer 127

some atrial impulses done make it through the atrioventricular node to the ventricles

Answer 128

mobitz type 1 mobitz type 2

Answer 129

this is where condution through the atrioventricular node takes progressively longer until it finally fails after which is resets and the cycle restarts

Answer 130

this is where there is intermittent failure of conduction throuhg the atrioventricular node, with an absence of QRS complexes following P waves the PR interval remains normal

Answer 131

this is a complete heart block where there is no observable relationship between P waves and the QRS complexes there is significant risk or asystole

Answer 132

slow heart rate typically less than 60 bpm

Answer 133

medications - beta blockers heart block sick sinus syndrome

Answer 134

it encompasses many conditions that causes dysfunction in the sinoatrial node

Answer 135

often caused by idiopathic degenerative fibrosis of the sinoatrial node and can result in bradycardia, arrhythmia and prolonged pauses

Answer 136

it is the absence of electrical activity in the heart

Answer 137

those with: mobitz type 2 heart block third degree heart block previous asystole ventricular pauses longer than 3 seconds

Answer 138

intravenous atropine (1st) inotropes (isoprenaline or adrenaline) temporary cardiac pacing permanent implantable pacemaker)

Answer 139

transcutaneous pacing - pads on patients chest transvenous pacing - catheter fed through venous system to stimulate the heart

Answer 140

it is an antimuscarinic medication that works by inhibiting the parasympathetic nervous system

Answer 141

pupil dilation dry mouth urinary retention constipation

Answer 142

it is a long lasting skin condition leading to dry, itchy and inflamed skin

Answer 143

dry, cracked skin itchiness rash on swollen skin that varies in colour depending on skin colour small, raised bumps on brown or black skin oozing and crusting thickened skin darkening of the skin around the eyes raw, sensitive skin from scratching

Answer 144

before the age of 5 and may continue into teen and adult years

Answer 145

atopic dermatitis - eczema contact dermatitis seborrheic dermatitis - dandruff

Answer 146

having had eczema, allergies, hay fever or asthma in the past family history

Answer 147

asthma and hay fever food allergies chronic itchy, scaly skin (neurodermatitis/lichen simplex chronicus) patches of skin that is darker/lighter than surrounding skin due to post inflammatory hyperpigmentation/hypopigmentation skin infections irritant hand dermatitis allergic contact dermatitis mental health conditions

Answer 148

moisturise skin regularly take a daily bath or shower use gentle, non soap cleansers pat dry after bathing identify and avoid irritants

Answer 149

Rough wool fabric Dry skin Skin infection Heat and sweat Stress Cleaning products Dust mites and pet dander Mold Pollen Smoke from tobacco Cold and dry air Fragrances Other irritating chemicals

Answer 150

clinical history and examination of the skin patch testing

Answer 151

emollients topical steroids 'wet wraps' treating any complications such as bacterial or viral infection

Answer 152

zinc impregnated bandages topical tacrolimus phototherapy systemic immunosuppressants - corticosteroids, methotrexate and azathioprine

Answer 153

E45 Diprobase cream Oilatum cream Aveeno cream Cetraben cream Epaderm cream

Answer 154

50:50 ointment (50% liquid paraffin) Hydromol ointment Diprobase ointment Cetraben ointment Epaderm ointment

Answer 155

Mild: Hydrocortisone 0.5%, 1% and 2.5% Moderate: Eumovate (clobetasone butyrate 0.05%) Potent: Betnovate (betamethasone 0.1%) Very potent: Dermovate (clobetasol propionate 0.05%)

Answer 156

atopic dermatitis contact dermatitis dyshidrotic eczema - dries out skin and can cause burning sensation, blisters and rashes neurodermatitis - small patches of skin nummular eczema - small, rounded lesions all over the body but especially on arms and legs seborrheic dermatitis stasis dermatitis - skin discolouration on the legs which looks similar to varicose veins

Answer 157

some people with atopic dermatitis have a mutation in a gene responsible for filaggrin, a protein which helps to maintain a healthy skin barrier. Without which moisture can escape and pathogens can enter in those with atopic dermatitis the immune system becomes disordered, and damages the skin barrier leaving it dry and prone to itching/rashes

Answer 158

in childhood, usually in the first 6 months of life

Answer 159

this is when the skin becomes irritated or inflamed after coming into contact with a substance that triggers an allergic reaction - doesnt run in families and isnt linked to other allergic conditions

Answer 160

irritant allergic

Answer 161

doesnt involve an allergic reaction occurs when skin cells are damaged by exposure to irritating substances such as solvents, detergents, soaps, bleach or nickel containing jewelry

Answer 162

this is a delayed allergic reaction that appears a day or two after the skin is exposed to an allergen. common examples are poison ivy, nail polish and poison oak

Answer 163

itchy, crusty or scaly skin and lesions and vesicles in affected areas hypersensitivity to the sun increased risk of sunburn and irritation from suncream

Answer 164

hydrocortisone and other steroids identify and avoid irritant

Answer 165

this is a skin condition causing small blisters on the palms of the hands, soles of the feet and edges of the fingers and toes

Answer 166

metals - nickel stress laundry detergent hot, humid weather sweaty palms

Answer 167

flares only happen on the hands and the feet begin with a rash of painful deep seated blisters as the blisters heal, the skin dries and often reddens and peels

Answer 168

wash the affected skin with mild cleanser and pat dry apply heavy emollient creams to repair skin remove jewelry when washing hands stress management steroids

Answer 169

neurodermatitis is extremely itchy patches of skin which is confined to one or two patches of skin on the body

Answer 170

occurs most commonly on feet, ankles, hands, wrists, elbows, shoulders, neck and scalp itching can com and go, and people often feel itchiest when relaxing or trying to sleep, or when they are stressed or anxious develops as thick leathery patches of skin pronounced skin lines, scales and discolouration thats often red, brown or gray scratching can cause bleeding and scarring

Answer 171

healing the skin and ending the scratch itch cycle - corticosteroids, and non steroidal topicals (calcineurin inhibitors/salicylic acid) lidocaine

Answer 172

it is also known as discoid eczema and features scattered circular, often itchy and sometimes oozing patches

Answer 173

coin shaped lesions on the arms, legs, torso or hands itching and burning lesions that are oozing liquid or have crusted over red, pinkish or brown scaly inflamed skin around the lesions

Answer 174

mid to high potency topical corticosteroid with a topical antibiotic

Answer 175

eczema that occurs on the body where there are a lot of sebaceous glands like the upper back, nose and scalp

Answer 176

stress recovery from a stressful life event, like losing a loved one or a heart attack hormonal changes or illness harsh detergents, solvents, chemicals and soaps cold, dry weather or a change in the season some medications, including psoralen, interferon and lithium certain medical conditions, such as HIV and Parkinson’s disease

Answer 177

Flaking skin or dandruff; Patchy of flaky white or yellow scales on top of greasy skin; A irritable rash which looks dark in brown and Black skin and lighter in white skin; Ring-shaped rash for those with petaloid seborrheic dermatitis; Itchiness.

Answer 178

wash affected areas with gently, zinc containing cleanser dandruff shampoo which should include: Pyrithione zinc. Selenium sulfide; Ketoconazole 1%; Tar; Salicylic acid if the condition is more severe topical corticosteroids may be required

Answer 179

this is when there is venous insufficiency or poor circulation in the lower legs causing changes to the skin

Answer 180

ankle swelling orange-brown discolouration (cayenne pepper spots) redness in lighter skin tones, may appear brown, purple or gray in darker tones itching scaliness dryness heavy or aching feeling after long periods of sitting or standing increased risk of developing contact dermatitis

Answer 181

compression stockings to reduce swelling elevating legs above heart every two hours to reduce swelling avoid foods high in salt supplementation of vitamin C and rutin topical cortcosteroids topical or oral antibiotics

Answer 182

dryness and atrophy of the vaginal mucosa related to a lack of oestrogen

Answer 183

the epithelial lining of the vagina and urinary tract responds to oestrogen by becoming thicker, more elastic and producing secretions as women enter menopause, oestrogen levels fall, resulting in the mucosa becoming thinner, less elastic and more dry there are also changes in the vaginal pH and microbial flora that can contribute to localised infections

Answer 184

itching dryness dyspareunia (discomfort or pain during sex) bleeding due to localised inflammation also consider it in older women presenting with recurrent UTI, stress incontinence or pelvic organ prolapse

Answer 185

pale mucosa thin skin reduced skin folds erythema and inflammation dryness sparse pubic hair

Answer 186

vaginal lubricants can help symptoms of dryness - sylk, replens and YES topical oestrogens - estriol cream, pessaries, tablets (vagiem) or ring (estring)

Answer 187

breast cancer angina venous thromboembolism

Answer 188

it is an overgrowth of bacteria in the vagina, specifically anaerobic bacteria

Answer 189

loss of the lactobacilli in the vagina, which produce lactic acid and maintains the low vaginal pH as the low pH prevents other bacteria growing. When there is a loss in lactobacilli the pH rises, allowing anaerobic bacteria to multiply

Answer 190

Gardnerella vaginalis (mc) mycoplasma hominis prevotella species

Answer 191

multiple sexual partners (not an STI) excessive vaginal cleaning recent antibiotics smoking copper coil

Answer 192

fishy smelling watery grey or white discharge half of women with BV and asymptomatic

Answer 193

confirm typical discharge can be used to complete a high vaginal swab

Answer 194

vaginal pH can be tested via swab or pH paper charcoal vaginal swab for microscopy - will give 'clue cells' on microscopy

Answer 195

asymptomatic BV doesnt normally require treatment metronidazole is 1st line - can be given orally or via vaginal gel clindamycin is 2nd but less optimal choice always assess risk of additional pelvic infections

Answer 196

they should avoid alcohol for the duration of the treatment as it can cause a disulfiram like reaction, with nausea, vomiting and sometimes severe symptoms of shock and angioedema

Answer 197

increased risk of STI it is also associated with several complications in pregnant women: Miscarriage Preterm delivery Premature rupture of membranes Chorioamnionitis Low birth weight Postpartum endometritis

Answer 198

it refers to inflammation of the eyelid margins

Answer 199

bilateral symptoms of; ocular irritation foreign body sensation burning redness sandy feeling crusting there may be paradoxical watering of the eye due to the reflex tear secretion

Answer 200

atrophic dermatitis (staphylococcal) seborrheic dermatitis acne rosecea demodex infestation (mites)

Answer 201

dysfunction of the meibomian glands which are responsible for secreting meibum (oil) into the surface of the eye

Answer 202

lid hygiene: warm compression of the eyelids eyelid massage to empty glands of debris eyelid cleaning with cotton wool topical antibiotic ointments (chloramphenicol) extended course of low dose oral tetracyclines and regular omega 3 fatty acid supplements may have a useful anti-inflammatory effect

Answer 203

external hordeolum is caused by a staphylococcal infection of an eyelid follicle and is more commonly known as a stye internal hordeolum is an infection of a meibomian gland and is less common

Answer 204

glands of Zeis which are sebaceous glands at the base of the eyelashes glands of moll which are sweat glands at the base of the eyelashes

Answer 205

tender, red lump along the eyelid which may contain pus

Answer 206

hot compresses and analgesia removal of the eyelash associated with it topical antibiotics (chloramphenicol) or oral antibiotics (co-amoxiclav) if the style is recurrent or severe

Answer 207

it is a granulomatous inflammatory lesion that forms in an obstructed meibomian gland - non infectious

Answer 208

presents as a painless red eyelid cyst in the internal eyelid if they are infected they may become an internal hordeolum

Answer 209

often resolve spontaneously patients should be encouraged to perform warm compression of the eyelid and eyelid massage persistent chalazion should be referred to ophthalmology for consideration of incision and curettage

Answer 210

an entropion is an inward turning of the eyelid, with inward turning eyelashes which may irritate the eye causing ulceration and risk of sight loss

Answer 211

age related degenerative changes eyelid irritation scarring trachoma - bacterial eye infection

Answer 212

examination for any corneal abrasions and ulcers prescribed frequent lubricants to reduce the risk of corneal abrasions and advised to perform eyelid taping as a temporary measure refer to ophthalmology for surgical correction

Answer 213

this is when the eyelid turns outwards exposing the inner aspect of the lid

Answer 214

age related degenerative disorder to the lower lid facial palsy (bells palsy)

Answer 215

can result in exposure keratopathy, which is damage to the cornea due to ocular dryness caused by inadequate lid closure - can cause sight loss

Answer 216

lubricating eye drops and taping the eyes shut at night severe cases may need corrective surgery patients should be referred to ophthalmology if there is evidence of exposure keratopathy

Answer 217

this is when eyelashes grow inwards due to damaged eyelid follicles which can irritate the cornea and result in ulceration and risk of sight loss

Answer 218

mostly caused by eyelid inflammation

Answer 219

epilating the eyelash however recurrence may occur electrolysis or laser ablation can destroy the lash follicle and may provide a permanent solution same day referral to ophthalmology if there is a risk to sight

Answer 220

it is an eyelid and skin infection in front of the orbital septum (in front of the eye)

Answer 221

swollen, hot, red skin around the eyelid and the eye

Answer 222

need to distinguish it from orbital cellulitis systemic antibiotics - oral or IV

Answer 223

it is an infection around the eyeball involving the tissues behind the orbital septum

Answer 224

pain with eye movement reduced eye movements vision changes abnormal pupil reactions proptosis

Answer 225

emergency admission under ophthalmology and intravenous antibiotics surgical drainage may be needed if an abscess forms

Answer 226

it is a condition which causes hyperplasia of the stromal and epithelial cells of the prostate and usually presents with lower urinary tract symptoms

Answer 227

lower urinary tract symptoms : hesitancy weak flow urgency frequency intermittency straining terminal dribbling incomplete emptying nocturia

Answer 228

international prostate symptom score

Answer 229

Digital rectal examination abdominal examination urinary frequency volume urine dipstick prostate specific antigen

Answer 230

it is known to be unreliable with a high rate of false positives (75%) and false negatives (15%)

Answer 231

Prostate cancer Benign prostatic hyperplasia Prostatitis Urinary tract infections Vigorous exercise (notably cycling) Recent ejaculation or prostate stimulation

Answer 232

smooth symmetrical and slightly soft prostate which has a maintained central sulcus

Answer 233

firm or hard asymmetrical craggy irregular loss of the central sulcus

Answer 234

patients with mild and manageable symptoms may not require interventions medical options are: alpha blockers (tamsulosin) to relax the smooth muscle 5-alpha reductase inhibitors (finasteride) which will reduce the size of the prostate surgery

Answer 235

takes up to 6 months

Answer 236

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

Answer 237

postural hypotension

Answer 238

this is where parts of the prostate are removed from inside the urethra using a resectoscope - uses a diathermy loop

Answer 239

Bleeding Infection Urinary incontinence Erectile dysfunction Retrograde ejaculation (semen goes backwards and is not produced from the urethra) Urethral strictures Failure to resolve symptoms

Answer 240

it is inflammation of the breast tissue and is a common complication of breastfeeding it can occur with or without infection

Answer 241

obstruction in the ducts and accumulation of the milk infection where bacteria enters at the nipple and back tracks into the ducts

Answer 242

staphylococcus aureus

Answer 243

Breast pain and tenderness (unilateral) Erythema in a focal area of breast tissue Local warmth and inflammation Nipple discharge Fever

Answer 244

where is is caused by a blockage, management is conservative with continued breastfeeding, expressing milk and massage heat packs, showers and simple analgesia can help symptoms where conservative management isnt working or infection is suspected antibiotics should be started: flucloxacillin first line fluconazole can be used in suspected candida

Answer 245

breast abscess if the mastitis isnt properly treated and will require incision and drainage to treat it

Answer 246

this is candidal infection of the nipple which can occur after a course of antibiotics and lead to recurrent mastitis

Answer 247

cracked skin on the nipple oral thrush and nappy rash in the infant sore nipples bilaterally particularly after feeding nipple tenderness and itching cracked, flaky or shiny areola

Answer 248

both mother and baby need treatment - topical miconazole 2% on the nipple after each breastfeed - treatment for the baby is either oral miconazole gel or nystatin

Answer 249

it is a painful swelling in a small fluid filled sac called a bursa, usually around your joints. it is more common in the shoulders, elbows, knees and feet

Answer 250

the most common cause it overuse and putting too much pressure on a bursa - repetitive motions - spending time in positions that put pressure on a specific part of your body

Answer 251

shoulders - subacromial bursitis elbow - olecranon bursitis knees - prepatellar bursitis feet - heel, big toe or ball of foot hips - iliopectineal or trochanteric buttocks - ischial

Answer 252

pain especially when moving affected area limited range of motion swelling if infected you may have dicolouration or redness of the skin, heat, fever

Answer 253

athletes physical or manual labour musicians those with arthritis, diabetes and thyroid disease

Answer 254

physical examination and clinical history X ray Ultrasound or MRI to detect swollen bursae bloods to look for infection aspiration if infection is suspected

Answer 255

avoid the activity/positions that irritate the bursa elevate the area over the counter analgesia ice area/apply heat to area support injured area with brace or sling antibiotics if infection suspected - flucloxacillin first line with clarithromycin as alternative physical therapy corticosteroids surgery to resect bursa if other treatments are not effective and still experiencing symptoms for 6 months or longer

Answer 256

vaginal infection with a yeast of the candida family, most commonly candida albicans

Answer 257

increased oestrogen (higher in pregnancy, lower in pre-puberty and menopause) poorly controlled diabetes immunosuppression broad spectrum antibiotics

Answer 258

thick white discharge that doesnt typically smell vulval and vaginal itching, irritation or discomfort erythema fissures oedema dyspareunia dysuria excoriation

Answer 259

often treat empirically based on presentation testing the vaginal pH using swabs and pH paper may be helpful differentiating between thrush, BV and trichomonas charcoal swab and microscopy

Answer 260

antifungals: antifungal cream (clotrimazole) inserted into the vagina - single dose at night (5g 10% cream) antifungal pessary - single dose at night (500mg) or three doses over three nights (200mg) oral antifungal tablets (fluconazole) - single dose (150mg)

Answer 261

canesten Duo - has single dose fluconazole and clotrimazole cream to use externally

Answer 262

when there is more than 4 a year - can be treated with induction and maintenance regime over 6 months with oral or vaginal antifungals (of label use)

Answer 263

that it can damage latex condoms and prevent spermicides from working so alternative contraception is required for at least 5 days after use

Answer 264

it is defined as abnormal kidney function or structure present for greater than three months, with subsequent implications for health

Answer 265

diabetes vascular disease

Answer 266

glomerular disease - IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis nephrotic drugs obstructive uropathy or reflux nephropathy multisystem diseases with renal involvement hereditary kidney disease

Answer 267

aminoglycosides bisphosphonates calcineurin inhibitors (ciclosporin) lithium proton pump inhibitors mesalazine NSAIDs

Answer 268

structural renal tract disease neurogenic bladder benign prostatic hypertrophy urinary diversion surgery recurrent urinary tract infections pathology inside the urinary tract such as malignancy or retroperitoneal fibrosis

Answer 269

chronic kidney disease us the end stage for any cause of severe and or long standing kidney injury damage to the kidneys reduces the number of functioning nephrons. This leads to hyperfiltration at the glomeruli, and increased permeability leading to proteinuria it also causes activation of the renin angiotensin aldosterone system causing an increase in blood pressure which furthers the hyperfiltration the increase in the capillary pressure within the glomerulus and inflammatory mediators causes chronic inflammation, reducing the filtration ability of the glomerulus

Answer 270

the eGFR and the amount of proteinuria

Answer 271

this is when the GFR is normal with the filtration rate being >90 mL/min/1.73m2

Answer 272

when there is mild impairment GFR is between 60-89 mL/min/1.73m2

Answer 273

when there is mild-moderate impairment GFR is between 45-59 mL/min/1.73m2

Answer 274

when there is moderate to severe impairment GFR is between 30-44 mL/min/1.73m2

Answer 275

when there is severe impairment GFR is between 15-29 mL/min/1.73m2

Answer 276

age greater than 50 history of acute kidney injury history of childhood kidney disease family history of CKD stage 5 diabetes mellitus cardiovascular disease obesity with metabolic syndrome gout solitary functioning kidney smoking black or Hispanic ethnicity male gender

Answer 277

when there is established renal failure GFR is < 15mL/min/1.73m2 or they are on renal replacement therapy

Answer 278

it is primarily asymptomatic and symptoms develop in advanced stages fatigue nausea cramps insomnia restless legs taste disturbance bone pain pruritis oliguria, polyuria, nocturia dyspnoea and orthorpnoea sexual dysfunction severe uraemia can cause hiccups, pericarditis, coma and seizure

Answer 279

ammonia like smell on the breath pallor due to anaemia cachexia cognitive impairment tachypnoea due to fluid overload or anaemia hypertension volume disturbance - overload or depletion peripheral neuropathy fundoscopy may reveal microvascular damage in patients with diabetes or hypertension

Answer 280

bilateral masses suggestive of polycystic kidney disease palpable bladder suggestive of obstructive uropathy, with prostatic enlargement in men

Answer 281

though the presence of hypertension, haematuria and or proteinuria, reduction in the GFR with an increase in serum creatinine

Answer 282

bedside investigations: blood pressure, urinalysis, plasma glucose, ECG labs: Bloods - FBC, U+E, serum albumin, calcium, phosphate, PTH, alkaline phosphatase, cholesterol and triglycerides urinary albumin serology hepatitis B, C and HIV imaging: abdominal radiograph, renal ultrasound, CT or MRI

Answer 283

A diagnosis of CKD requires evidence of kidney damage and/or a persistent reduction in renal function. CKD stages 3-5 can be diagnosed based on the eGFR alone stages 1-2 require additional evidence of renal disease

Answer 284

this is defined as a persistent decrease in eGFR of 25% or more and a change in CKD category within 12 months, or a persistent decrease in eGFR of 15mL/min/1.73m2 within 12 months

Answer 285

exercise weight loss smoking cessation good glycaemic control control of blood pressure immunisations: influenza and pneumococcus avoidance of nephrotoxic medication diet: adequate protein intake, restricted sodium and phosphate intake

Answer 286

1. statins and antiplatelet drugs for prevention of CVD 2. ACEi or ARB to aid blood pressure control in those with diabetic renal disease or significant proteinuria 2. SGLT2 inhibitor if ACEi or ARB is not doing enough 4. dietary phosphate restriction and phosphate binders (calcium acetate) to control hyperphosphataemia 5. 1-alpha-hydroxycholecalciferol given if secondary hyperparathyroidism is present

Answer 287

monitoring requirements include full blood count and iron studies, serum calcium, phosphate and PTH levels monitoring level is done dependent on the risk level (determined by eGFR and albuminuria) low-moderate: monitor annually high risk: monitor every 6 months very high: monitor ever 3-4 months

Answer 288

this is an important aspect in the treatment of end stage CKD and includes dialysis and kidney transplantation

Answer 289

when there eGFR reaches approximately 5-10 mL/min/1.73m2

Answer 290

this involves pumping blood from the patients body through a dialyser, and solutes from the blood diffuse into the dialysate and are removed together with fluid - typically 4 hours three times a week

Answer 291

they require a good blood flow and so they need either an arterio-venous fistula or a tunnelled central venous catheter

Answer 292

access related: infection, venous stenosis or access failure haemodynamic instability nausea and vomiting, headache, cramp reactions to dialysis membranes

Answer 293

it involves infusing dialysate into the peritoneal cavity through a tunnelled catheter. Solutes and fluid from the peritoneal vessels move across the peritoneal membrane into the dialysate and are removed

Answer 294

continuous ambulatory peritoneal dialysis: manual dialysate exchanges performed about four times per day automated dialysis: a machine performed the exchange overnight

Answer 295

patients may not be suitable if they have had any previous intra-abdominal pathology like peritonitis, surgery or adhesions as a functional peritoneal membrane is needed

Answer 296

Bacterial or fungal peritonitis Catheter problems: infection, blockage, kinking, leaks, displacement (more likely if a patient becomes constipated) Weight gain Worsening glycaemic control in patients with diabetes Failure of peritoneal membrane requiring a switch to haemodialysis Encapsulating peritoneal sclerosis

Answer 297

transplantation

Answer 298

active or recent malignancy active infection significant co-morbidity such as heart disease

Answer 299

operative complications: infection, bleeding, thrombosis, problems with ureteric anastomosis stenosis of graft vessels or ureter side effects from immunosuppressive therapy opportunistic infections malignancy recurrent of original disease in the transplant graft rejection (hyperacute or acute) chronic allograft nephropathy

Answer 300

A WET BED 1. Acid base balance - metabolic acidosis 2. Water removal - pulmonary oedema 3. Erythropoiesis - anaemia of chronic disease 4. Toxin removal - uraemic encephalopathy 5. BP control - cardiovascular disease 5. Electrolyte balance - hyperkalaemia 6. Vitamin D - bone mineral disorder of CKD

Answer 301

it is a lung disease characterised by persistent respiratory symptoms and airflow obstruction

Answer 302

emphysema chronic bronchitis small airway fibrosis

Answer 303

it is a productive cough for at least three months in 2 consecutive years

Answer 304

tobacco smoking indoor air pollution alpha 1 antitrypsin deficiency

Answer 305

it is an autosomal dominant condition which presents in younger patients, caused by a deficiency in alpha 1 antitrypsin, a protease inhibitor

Answer 306

alpha 1 antitrypsin is a protease inhibitor which prevents neutrophil elastase breaking down alveolar structures. In alpha 1 antitrypsin there is increased destruction of alveolar structures and results in early onset emphysema it also leads to cirrhosis of the liver

Answer 307

progressive dyspnoea - initially exertional but can progress to resting chronic productive cough - usually colourless sputum recurrent lower respiratory tract infections fatigue headache due to CO2 retention

Answer 308

it is a scale used to measure level of dyspnoea grade 1 = breathlessness during strenuous exercise only grade 2 = breathlessness when hurrying or walking up a slight incline grade 3 = walks slower than other people of the same age, or needs to pause for breath when walking at own pace grade 4 = pauses after walking 100m/a few minutes on the level grade 5 = too breathless to leave house, or breathless when dressing

Answer 309

this is a test used to assess the impact of the patients COPD on their wellbeing and daily life the score ranges from 0-40 with 40 being the highest score you can get the higher the score the greater the impact on a patients life

Answer 310

tachypnoea wheeze on auscultation pursed lip breathing barrel chest peripheral cyanosis cor pulmonale CO2 retention flap

Answer 311

asthma bronchiectasis congestive heart failure lung cancer tuberculosis

Answer 312

spirometry - FEV1/FVC <70% pulse oximetry - aim for SpO2 = 88-92% sputum culture ECG Bloods, ABG imaging: Chest X ray

Answer 313

mild = <80% moderate = 50-80% severe = 30-50% very severe = <30%

Answer 314

smoking cessation pulmonary rehabilitation annual influenza vaccine and one off pneumococcal vaccine personalised self management plan

Answer 315

inhalers 1. starts with SAMA or SABA when needed 2. if having exacerbations still with asthmatic features then add LABA and ICS. If having exacerbations with no asthmatic features add LABA and LAMA 3. if there are still daily symptoms then do LABA, LAMA and ICS Long term oxygen therapy surgical management - lung volume reduction surgery or lung transplant

Answer 316

if their SpO2 is <88% or PaO2 is <7.3 kPa

Answer 317

hypercapnic respiratory failure secondary polycythaemia due to chronic hypoxia cor pulmonale bronchiectasis anxiety and depression osteoporosis sleep disturbance

Answer 318

itis inflammation of the conjunctiva, the external layer covering the outer surface of the globe and the inner surface of the eyelids

Answer 319

infections and non infectious

Answer 320

viral bacterial

Answer 321

most cases of viral conjunctivitis is caused by adenovirus, with herpes virus causing it as well other less frequent causes include measles, mums, rubella, enterovirus and coxsackievirus

Answer 322

direct contact with contaminated skin or objects lead to spread of infection

Answer 323

both eyes affected profuse watery discharge tender preauricular lymphadenopathy concurrent upper resp tract infection (sometimes)

Answer 324

pharyngoconjunctival fever: pharyngitis, conjunctivitis and fever epidemic keratoconjunctivitis: more severe with corneal involvement and photophobia

Answer 325

clinical history and examination occasionally swabs are required

Answer 326

tends to be self limiting and rarely requires treatment important to adopt hygiene measures to prevent the spread

Answer 327

staphylococcus streptococcus haemophilus chlamydia trachomatis neisseria gonorrhoea

Answer 328

contact with contaminated skin and objects in cases o chlamydia and gonorrohea unprotected sexual intercourse

Answer 329

one eye affected develops rapidly very inflamed conjunctiva sticky purulent discharge gonococcal infections associated with very profuse discharge chlamydia conjunctivitis tend to be associated with follicles and pre-auricular lymphadenopathy

Answer 330

clinical history and examination conjunctival scrapes in patients with high risk of atypical organisms

Answer 331

supportive and antibiotic drops (chloramphenicol) are used rarely in cases secondary to gonorrhoea and chlamydia azithromycin is used

Answer 332

Certain bacteria such as Neisseria have a propensity to invade the cornea, which can lead to keratitis and endophthalmitis.2 These conditions can subsequently cause reduced vision or blindness if not treated promptly.

Answer 333

allergic chemical injury

Answer 334

it is the most common type of non infective cause and occurs secondary to a type 1 hypersensitivity reaction

Answer 335

itching both eyes affected diffuse redness and watery discharge papillae in the eyelid which can give a cobblestone appearance

Answer 336

Seasonal allergic conjunctivitis: secondary to hay fever, therefore most common in summer months due to the presence of pollen Perennial allergic conjunctivitis: caused by allergens such as house dust mite Vernal keratoconjunctivitis: most common in young males living in hot dry climates Atopic keratoconjunctivitis: most common in middle-aged men

Answer 337

Treatment includes allergen avoidance, topical and oral antihistamine as well as topical mast-cell stabilisers and occasionally, mild steroids

Answer 338

alkaline - more significant damage acids - denature and precipitate proteins in the cornea both are an ophthalmic emergency

Answer 339

investigate any underlying cause identify any faecal impaction advise lifestyle measures - drink more water, increase dietary fibre, exercise oral laxatives - bulk forming first line such as ispaghula, if stools remain hard then switch to osmotic laxative such as macrogol. If stools are soft but difficult to pass then add stimulant laxative

Answer 340

dont prescribe bulk forming laxatives offer osmotic or stimulant laxative

Answer 341

consider secondary causes identify faecal loading or impaction advise on lifestyle measures laxatives - same as in acute consider treatment with prucalopride if at least two laxatives from different classes have been tried at the highest tolerated recommended doses for at least 6 months

Answer 342

if there are hard stools, consider prescribing a high dose of oral macrogol if there is ongoing hard stools with oral macrogol consider starting or adding oral stimulant laxative if its inadequate or too slow consider prescribing suppository or mini enema if it is still slow then sodium phosphate or arachis oil retention enema

Answer 343

act by retaining fluid within the stool and increasing faecal mass, stimulated peristalsis - ispaghula husk - methylcellulose

Answer 344

increasing the amount of the fluid in the large bowel producing distension, which leads to stimulation of peristalsis - lactulose - macrogols - phosphate and sodium citrate enemas

Answer 345

cause peristalsis by stimulating colonic nerves or colonic and rectal nerves - senna - bisacodyl and sodium Picosulfate - docusate

Answer 346

they are a group of joint disorders due to the deposition of crystals in and around joints which lead to joint destruction and soft tissue masses

Answer 347

gout pseudogout and other rarer causes

Answer 348

it is a crystal arthropathy caused by urate crystals depositing in joints causing them to become inflamed

Answer 349

Male Family history Obesity High purine diet (e.g., meat and seafood) Alcohol Diuretics Cardiovascular disease Kidney disease

Answer 350

The base of the big toe – the metatarsophalangeal joint (MTP joint) The base of the thumb – the carpometacarpal joint (CMC joint) Wrist

Answer 351

single acute hot swollen and painful joint

Answer 352

made clinically, supported by a raised serum urate level on blood tests it is essential to exclude septic arthritis aspiration - shows monosodium urate crystals which are needle shaped and negatives birefringent of polarised light

Answer 353

Maintained joint space (no loss of joint space) Lytic lesions in the bone Punched out erosions Erosions can have sclerotic borders with overhanding edges

Answer 354

NSAIDS first line (co-prescribed with a PPI) colchicine second line oral steroids third line

Answer 355

abdominal symptoms diarrhoea

Answer 356

xanthine oxidase inhibitors allopurinol febuxostat

Answer 357

losing weight staying hydrated minimising the consumption of alcohol and purine based food such as meat and seafood

Answer 358

calcium pyrophosphate crystals collecting in the joints

Answer 359

many patient are asymptomatic chronic pain and stiffness in multiple joints over 65 years old with a rapid onset hot, swollen, stiff and painful knee

Answer 360

need to exclude a medical emergency joint aspiration - calcium pyrophosphate crystals which are rhomboid shaped and positively birefringent of polarised light

Answer 361

chondrocalcinosis - calcium deposits in the joint cartilage show up as a thin white line in the middle of the joint space

Answer 362

superficial fungal infections subcutaneous fungal infections deep fungal infections

Answer 363

ringworm (dermatophytosis) - skin, hair and nails onychomycosis - fingernails and toenails candidiasis tinea versicolor/pityriasis versicolor

Answer 364

under the surface of the skin sporotrichosis chromoblastomycosis eumycetoma

Answer 365

itching, soreness, redness or rash on the affected area discoloured, thick or cracked nails pain while eating, loss of taste or white patches in the mouth or throat painless limp under skin

Answer 366

dermatophytes - live off keratin in hair, nails and skin candida environmental fungi - Histoplasma, Coccidioides, Blastomyces and Aspergillus.

Answer 367

clinical history and examination samples of skin or other affected tissue, nails, blood, sputum, secretions, urine, discharge

Answer 368

keep affected area dry and clean - wash daily clean shower/bath hot wash socks, bathmats, towels etc

Answer 369

It is extensive or severe. It resists topical antifungal therapy. It affects hair bearing areas (tinea capitis and tinea barbae).

Answer 370

Itraconazole ketoconazole fluconazole

Answer 371

- terbinafine 1% cream (once or twice a day for 1-2 weeks) - clotrimazole 1% cream (2-3 times a day for at least 4 weeks) - miconazole 2% cream (twice a day for 10 days) - econazole 1% cream (twice a day until healed)

Answer 372

these are small, rough growths that are caused by infection of keratinocytes with HPV

Answer 373

this is a wart that is on the sole of your foot

Answer 374

Common wart (Verruca vulgaris). Flat wart or plane wart (Verruca plana). Plantar wart — wart on the sole of the foot (Verruca plantaris). Periungual wart — wart around the fingernails or toenails.

Answer 375

they are spread by direct skin to skin contact or indirectly via contact with contaminated floors or surfaces

Answer 376

if skin is damaged a wart is scratched or knocked and bleeds occupation involves regular handling of meat or fish if the person is immunosuppressed

Answer 377

can clear spontaneously at any time or persist for years about 60-70% resolve within 2 years and 95% within 4 years

Answer 378

typical appearance and usually clinical if there is any diagnostic doubt then referral can occur

Answer 379

firm, raised papules with rough surface which resembles a cauliflower

Answer 380

for most people there is not a strong case for treatment consider treating if the wart is painful, the wart is cosmetically unsightly or if the person request treatment and the wart is persisting

Answer 381

facial warts - referral to dermatology non facial warts: - topical salicylic acid applied daily for 12 weeks - cryotherapy - combination of salicylic acid and cryotherapy (not to use cryotherapy in younger children)

Answer 382

it is a pouch or pocket in the bowel wall, ranging in size from 0.5-1cm

Answer 383

it refers to the presence of diverticula without inflammation or infection. it may be referred to as diverticular disease when patients experience symptoms

Answer 384

inflammation and infection of diverticula

Answer 385

the wall of the large intestine contains a layer of muscle called circular muscle the points where this muscle layer is penetrated by blood vessels are areas of weakness increased pressure in the lumen can cause a gap to form in these areas of the muscle these gaps allow the mucosa to herniate though the muscle layer and pouches to form diverticula

Answer 386

because it had an outer longitudinal muscle layer that surrounds the diameter of the rectum adding extra support

Answer 387

increased age low fibre diets obesity use of NSAIDs

Answer 388

lower left abdominal pain constipation rectal bleeding

Answer 389

increase fibre in diet bulk forming laxatives surgery to avoid affected area

Answer 390

stimulant laxatives

Answer 391

inflammation in the diverticula

Answer 392

Pain and tenderness in the left iliac fossa / lower left abdomen Fever Diarrhoea Nausea and vomiting Rectal bleeding Palpable abdominal mass (if an abscess has formed) Raised inflammatory markers (e.g., CRP) and white blood cells

Answer 393

Oral co-amoxiclav (at least 5 days) Analgesia (avoiding NSAIDs and opiates, if possible) Only taking clear liquids (avoiding solid food) until symptoms improve (usually 2-3 days) Follow-up within 2 days to review symptoms

Answer 394

happens when a patient is in severe pain or complications Nil by mouth or clear fluids only IV antibiotics IV fluids Analgesia Urgent investigations (e.g., CT scan) Urgent surgery may be required for complications

Answer 395

Perforation Peritonitis Peridiverticular abscess Large haemorrhage requiring blood transfusions Fistula (e.g., between the colon and the bladder or vagina) Ileus / obstruction

Answer 396

Age: >40 years old, although now being seen more in younger people Sex: slightly more common in men than women Ethnicity: South Asian, Black African and Black-Caribbean groups have a higher risk Family history: especially having first-degree relatives with T2DM

Answer 397

Obesity: encompasses increased body mass index (BMI)/waist circumference, sedentary lifestyle and consumption of processed carbohydrate/sugary foods. Alcohol excess: beer and cocktails are high in calories and sugar, and alcoholism causes liver damage, which reduces the hepatic uptake of glucose. Smoking: a potent CVD risk factor itself and also associated with insulin resistance. Poor sleep/stress: both promote insulin resistance and increase hyperglycaemia through chronically raised cortisol levels and poor dietary/exercise habits.

Answer 398

PCOS gestational diabetes mental health conditions steroid induced diabetes

Answer 399

raised BMI and waist circumference acanthosis nigricans diabetic retinopathy on fundoscopy diabetic neuropathy and PVD on foot exam

Answer 400

Capillary blood glucose urinary glucose, ketones and protein HbA1C U+E, LFT, cholesterol and lipid urine albumin creatinine ratio

Answer 401

if their HbA1C is above 48mmol/mol - if symptomatic one result is significant - if asymptomatic then repeat HbA1C in two weeks

Answer 402

weight loss of >5% diet - low sugar especially with low carbohydrate and low ultra processed diet foods exercise reduced alcohol intake stop smoking improve sleep and stress

Answer 403

metformin - reduces insulin resistance of target cells - reduces liver gluconeogenesis

Answer 404

SGLT2 inhibitors (dapagliflozin) 2nd line Sulfonylureas (gliclazide) DPP4 inhibitors (sitagliptin) GLP-1 analogues (liraglutide)

Answer 405

reduce renal glucose reabsorption

Answer 406

UTI and genital thrush doesnt cause hypoglycaemia itself but should be paused in acute illness

Answer 407

GI upset dont use in renal failure or post MI due to risk of lactic acidosis

Answer 408

increase endogenous insulin secretion by stimulating pancreatic B islet cells causes rapid reduction in HbA1C

Answer 409

hypoglycaemia weight gain abnormal LFTs hyponatraemia

Answer 410

blocks dipeptidyl peptidase 4 which would normally break down GLP-1 increasing the insulin release effect

Answer 411

weight neutral can cause pancreatitis has less effect in reducing HbA1C compared with other options

Answer 412

also work on the incretin effect to enhance GLP-1 action major weight loss effect

Answer 413

significant weight loss can cause pancreatitis harder to access currently

Answer 414

if above treatment fails (already on triple therapy) or rapid control is required then subcut insulin injections may be needed

Answer 415

Macrovascular - MI, TIA/stroke, peripheral vascular disease Microvascular - diabetic nephropathy, retinopathy and neuropathy

Answer 416

HbA1C and individualised target lifestyle advice and education bedside parameters - BP, BMI, urine dip labs - U+E, lipids, QRISK diabetic foot review annual diabetic retinopathy screen

Answer 417

DVLA has specific driving regulations for diabetes - if it is managed with lifestyle alone or medications done cause hypoglycaemia the DVLA does not need to be informed - if they are on hypoglycaemic drugs (gliclazide, insulin) then the DVLA needs to know

Answer 418

it is when there is a blood pressure above 140/90 in the clinical setting, confirmed with ambulatory or home readings above 135/85

Answer 419

also known as primary hypertension and means a high blood pressure has developed on its own and does not have a secondary cause - accounts for 90% of hypertension

Answer 420

ROPED Renal disease Obesity Pregnancy induced or Pre eclampsia Endocrine Drugs (alcohol, steroids, NSAIDs, oestrogen and liquorice)

Answer 421

renal disease - when blood pressure is very high or doesnt respond to treatment consider renal artery stenosis

Answer 422

hyperaldosteronism

Answer 423

Ischaemic heart disease (angina and acute coronary syndrome) Cerebrovascular accident (stroke or intracranial haemorrhage) Vascular disease (peripheral arterial disease, aortic dissection and aortic aneurysms) Hypertensive retinopathy Hypertensive nephropathy Vascular dementia Left ventricular hypertrophy Heart failure

Answer 424

sustained and forceful apex beat felt

Answer 425

NICE recommends measuring BP every 5 years to screen for htn (should be measured more in borderline cases and every year in patients with T2DM) patients with a clinic BP between 140/90-180/120 should have a 24 hour BP or home readings to confirm the diagnosis

Answer 426

clinic reading - above 140/90 ambulatory or home reading - above 135/85

Answer 427

clinic reading - above 160/100 ambulatory or home reading - above 150/95

Answer 428

clinic reading - above 180/120 no at home reading

Answer 429

end organ damage

Answer 430

urine albumin creatinine ratio for proteinuria and dipstick for microscopic haematuria bloods for HbA1C, renal function and lipids fundus examination for hypertensive retinopathy ECG for cardiac abnormalities including left ventricular hypertrophy

Answer 431

QRISK which estimates the percentage risk a patient will have a stroke or MI in the next 10 years

Answer 432

should be offered a statin - atorvastatin 20mg daily

Answer 433

healthy diet stop smoking reduce alcohol reduce caffeine reduce salt intake regular exercise

Answer 434

step 1. Aged under 55 or type 2 diabetic of any age or family origin, use ACE inhibitors. Aged over 55 or black african use Calcium channel blocker step 2. ACEi plus CCB. Alternatively ACEi + Thiazide like diuretic or CCB + diuretic step 3. ACEi + CCB + thiazide like diuretic step 4. ACEi + CCB+ diuretic + fourth agent which depends on potassium levels in all of this ARBs are recommended instead of ACEi in patients of black african or african caribbean family origin and in those than cant tolerate ACEi

Answer 435

dependent on serum potassium level 1. less than or equal to 4.5mmol/L consider a potassium sparing diuretic like spironolactone 2. more than 4.5mmol/L consider an alpha blocker or a beta blocker

Answer 436

spironolactone is potassium sparing and can cause hyperkalaemia ACE inhibitors can also cause hyperkalaemia thiazide like diuretics can cause electrolyte disturbances and hypokalaemia

Answer 437

under 80 - below 140/90 over 80 - below 150/90

Answer 438

also referred to as malignant hypertension it refers to blood pressure above 180/120 with retinal haemorrhages or papilloedema - need same day referral !

Answer 439

1. patients need same day assessment for confusion, heart failure, suspected acute coronary syndrome or AKI 2. patients need assessing for secondary causes and end organ damage 3. IV sodium nitroprusside, labetalol, glyceryl trinitrate and nicardipine can be used

Answer 440

it is a common skin condition where the hair follicles become infected or inflamed

Answer 441

activities such as shaving, hot tub, excess sweating bacterial infection

Answer 442

1. Staphylococcus aureus folliculitis 2. Pseudomonas aeruginosa (hot tub) 3. Malassezia folliculitis (yeast) 4. Pseudofolliculitis barbae (razor bumps) 5. Sycosis barbae (severe shaving related) 6. Gram negative folliculitis (antibiotic use) 7. Boils (furuncles - deep infection) 8. Carbuncles (several boils in one spot) 9. Eosinophilic folliculitis (immunosuppressed)

Answer 443

red bumps that look like pimples can look like while filled bumps or can be pustules itchy and uncomfortable

Answer 444

frequent shaving oral antibiotics for long period of time overweight or obese diabetes activities where you sweat a lot and dont fully shower off after spending time in hot tum or sauna that isnt properly cleaned

Answer 445

it is where the acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus, where it irritates the lining and causes symptoms

Answer 446

squamous epithelial lining

Answer 447

greasy and spicy food coffee and tea alcohol non steroidal anti-inflammatory drugs stress smoking obesity hiatus hernia

Answer 448

dyspepsia heartburn acid regurgitation retrosternal or epigastric pain bloating nocturnal cough hoarse voice

Answer 449

dysphagia - difficulty swallowing at any age aged over 55 weight loss upper abdominal pain reflux treatment resistant dyspepsia nausea and vomiting upper abdominal mass on palpation low haemoglobin raised platelet count

Answer 450

anything suspicious of cancer required a two week wait referral for further investigation It is also possible to refer from primary care for an urgent direct access endoscopy

Answer 451

Gastritis Peptic ulcers Upper gastrointestinal bleeding Oesophageal varices (in liver cirrhosis) Barretts oesophagus Oesophageal stricture Malignancy of the oesophagus or stomach

Answer 452

it is the herniation of the stomach through the diaphragm which can cause reflux

Answer 453

type 1: sliding type 2: rolling type 3: combination of sliding and rolling type 4: large opening with additional abdominal organs entering the thorax

Answer 454

reduce tea, coffee and alcohol intake weight loss avoid smoking smaller, lighter meals avoid heavy meals before bedtime stay upright after meals rather than staying flat

Answer 455

antiacids - Gaviscon, Pepto-Bismol, Rennie (short term) PPIs - omeprazole and lansoprazole Histamine H2 receptor antagonists - Famotidine

Answer 456

laparoscopic fundoplication - tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

Answer 457

it produces ammonium hydroxide as well as several toxins. these cause gastric mucosal damage, and can cause gastritis, ulcers and increased risk of stomach cancer

Answer 458

gram negative aerobic bacteria - has flagella

Answer 459

offer H.pylori test to anyone with dyspepsia - stool antigen test - urea breath test using radiolabelled carbon 13 - h.pylori antibody bloods - rapid urease test performed during endoscopy

Answer 460

triple therapy with a PPI and two antibiotics for 7 days - Omeprazole - amoxicillin - clarithromycin

Answer 461

this is when the lower oesophageal epithelium changes from squamous to columnar epithelium caused by chronic acid reflux into the oesophagus (metaplasia)

Answer 462

endoscopic monitoring proton pump inhibitors endoscopic ablation - destroy abnormal cells

Answer 463

this is a rare condition where a duodenal or pancreatic tumour secreted excessive quantities of gastrin which stimulated stomach acid secretion. This excess production results in severe dyspepsia, diarrhoea and peptic ulcers

Answer 464

multiple endocrine neoplasia type 1 (MEN1)

Answer 465

they are enlarged anal vascular cushions

Answer 466

they are specialised submucosal tissue that contains connections between arteries and veins, making them very vascular. they are supported by smooth muscle and connective tissue. they help to control anal continence, along with the internal and external sphincters

Answer 467

1st degree: no prolapse 2nd degree: prolapse when straining and return on relaxing 3rd degree: prolapse when straining, do not return on relaxing but can be pushed back 4th degree: prolapsed permanently

Answer 468

may be asymptomatic can be associated with constipation and straining painless bright red bleeding on the toilet tissue or seen after opening the bowels (not mixed with stool) sore/itchy anus feeling a lump around or in the anus

Answer 469

External: visible on inspection as swellings covered in mucosa internal: may be felt on PR examination they may appear if the patient is asked to bear down during examination

Answer 470

proctoscopy - inserting a hollow tube into the anal cavity to visualise the mucosa

Answer 471

Anusol - contains astringents which help shrink the haemorrhoids Anusol HC - also contains hydrocortisone (only use for a short time) Germoloids cream (contains lidocaine) Proctosedyl ointment (contains cinchocaine and hydrocortisone - short term use only)

Answer 472

rubber band ligation (fitting a tight rubber band around the base of the haemorrhoid) injection sclerotherapy (phenol oil injection) infra-red coagulation bipolar diathermy (electrical current)

Answer 473

haemorrhoidal artery ligation - using a proctoscope and suturing blood supply haemorrhoidectomy - can result in incontinence stapled haemorrhoidectomy

Answer 474

these are caused by strangulation at the base of the haemorrhoid resulting in thrombosis in the haemorrhoid

Answer 475

purplish very tender swollen PR examination unlikely due to the pain

Answer 476

tingling and burning sensation followed by development of vesicular then ulcerative lesions involving the oropharynx and perioral mucosa

Answer 477

HSV HSV-1 is typically associated with cold sores and can be associated with genital herpes HSV-2 typically causes genital herpes

Answer 478

can be asymptomatic ulcers or blistering lesions burning, tingling or shooting pain flu like symptoms dysuria inguinal lymphadenopathy

Answer 479

HIV infection immunosuppressive medications female sex higher risk sexual behaviour black race increasing age lack of condom use

Answer 480

clinical history and examination - ask about sexual contacts in the case of genital herpes viral swab and PCR reaction Viral culture Glycoprotein G based type specific serology

Answer 481

Acyclovir - 400mg orally three times daily for 7-10 days should be started 48-72 hours after symptom onset consider symptomatic treatment: paracetamol, ibuprofen, lidocaine topical (5% ointment)

Answer 482

Aciclovir - 200mg orally five times daily for 7-10 days, should be started 48-72 hours after symptom onset symptomatic treatment: paracetamol, ibuprofen, lidocaine topical (5%) 2/3 times per day 2nd line: topical antivirals - docosanol topical (10%) five times a day at first sign of symptoms (also peniciclovir (1%) and aciclovir (5%) can be used)

Answer 483

aciclovir - 400mg orally twice daily for 12 months

Answer 484

IV aciclovir

Answer 485

is where the thyroid produces inadequate thyroid hormones. THS will be raised, T3 and T4 are low

Answer 486

central hypothyroidism, is where the pituitary behaves abnormally and produces inadequate TSH resulting in under stimulation of the thyroid gland and insufficient thyroid hormones. TSH, T3 and T4 will be low

Answer 487

Hashimotos is the most common cause - presence of anti-TPO and anti-Tg antibodies iodine deficiency lithium use inhibits the production of thyroid hormones amiodarone interferes with thyroid hormone production and metabolism

Answer 488

Carbimazole Propylthiouracil Radioactive iodine Thyroid surgery

Answer 489

Tumours (e.g., pituitary adenomas) Surgery to the pituitary Radiotherapy Sheehan’s syndrome (where major post-partum haemorrhage causes avascular necrosis of the pituitary gland) Trauma

Answer 490

Weight gain Fatigue Dry skin Coarse hair and hair loss Fluid retention (including oedema, pleural effusions and ascites) Heavy or irregular periods Constipation iodine deficiency causes a goitre hashimotos can initially cause a goitre

Answer 491

serum thyroid stimulating hormones look at free serum thyroxine, antithyroid peroxidase antibodies RBC fasting blood glucose

Answer 492

replacement dose levothyroxine: 1.6 micrograms/kg/day orally, just dose in increments of 12.5 to 25 micrograms to normalise the TSH in patients with pre existing coronary artery disease or aged over 65 use low dose levothyroxine sub-clinical hypothyroidism use low dose levothyroxine

Answer 493

it is a clinical syndrome most commonly caused by EBV, characterised by a triad of fever, pharyngitis and lymphadenopathy

Answer 494

triad of fever, pharyngitis, cervical/generalised lymphadenopathy malaise splenomegaly rash signs of hepatitis jaundice myalgia

Answer 495

kissing sexual behaviour

Answer 496

clinical history and exam FBC antibodies - EBV specific antibodies LFTs PCR ultrasound/CT of abdomen

Answer 497

supportive care - paracetamol and NSAIDs (no aspirin in children due to reyes syndrome) patient to refrain from strenuous activity and contact sports in the initial 3-4 weeks of illness if there is upper airway obstruction, haemolytic anaemia, and thrombocytopenia use corticosteroids (and IvIg)

Answer 498

if they have been treated with ampicillin, amoxicillin or beta-lactam antibiotics

Answer 499

A, B and C A and B are the most common type A has different H and N subtypes

Answer 500

people aged 65 or older young children pregnant women those with chronic health conditions such as asthma, COPD, heart failure and diabetes healthcare workers and carers

Answer 501

the delay between exposure and symptoms is typically 2 days: fever lethargy fatigue anorexia muscle and joint aches headache dry cough sore throat coryzal symptoms

Answer 502

testing may be considered to confirm diagnosis, and monitor circulation and outbreaks. The UK Health Security Agency monitors the number of flu cases and provides guidance when numbers are high point of care tests using swabs are available and give rapid results detecting viral antigens viral nasal or throat swabs can be sent for PCR analysis

Answer 503

healthy patients who are not at risk of complications dont need treatment - self care, good fluid intake, rest if someone is at risk of complications there are two treatment options: - oral oseltamivir (twice daily for 5 days) - inhaled zanamivir (twice daily for 5 days) these treatments need to be started within 48 hours of onset of symptoms

Answer 504

when patients meet a certain criteria: - it is started within 48 hours of close contact - increased risk to the patient - the patient isnt protected by vaccination (less than 14 days since they were vaccinated/not vaccinated)

Answer 505

oral oseltamivir 75mg daily for 10 days inhaled zanamivir 10mg daily for 10 days

Answer 506

Otitis media, sinusitis and bronchitis Viral pneumonia Secondary bacteria pneumonia Worsening chronic health conditions, such as COPD and heart failure Febrile convulsions (young children) Encephalitis