Guidlines Flashcards

Question 1

Q

AWISE
FACES
BODEC
BCSAND
DSP

ChronicBronchitisBlueBloater
MucousGland ? ->
CoughCP > ? m/yr > ? yr

PinkPuffer-Emphysema
Neutrophils->inc ? : ? -->
ReducedElastin = 
-R...
-A...
-C...
-E... = prev ?

Answer

A

Age > 35
Wheeze/WL
Infective bronchitis
Sputum CP >3m/w>2yr
EX-SOBOE/Intol

FBC, ABG, CXR-barrelchest, ECG, SpiroPostBD

BMI / TLCO, 
ObstAirflow-spiroPostBD, 
DyspnoeaMRC, 
EX-cap/acerbate
Corpulmonale/Comorbidities-frailty

Breathless - COPD
CoughCP - COPD
Smoke Hx - COPD
Age<35 - Asthma
NightSyx-SCW - Asthma
Diurnal  - Asthma

-DyspnoeaMRC-3+ -> PulRehab 
(CI=MI/Angina/Can't walk)
-StopSmoke / SelfMxPlan
-Pneumococc-Once/Influ-Annual / PHYSIO-chest
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ChronicBronchitisBlueBloater
MucousGlandHyperPlasia->
CoughCP >3m/yr >2yr

PinkPuffer-Emphysema
Neutrophils->incElastase:alpha1AT -->
ReducedElastin = 
-Recoil Reduced
-AirSpace inc
-Compliance inc
-ExhalePursedLips=prev Alv Collapse!

Question 2

Q

DeWS SPFJC
STAM-DR

SABA/SAMA ->
LABA + ARafe:
A?/ Resp2?
(? / ? / ? ) –>

Y=Becky –(? / ? / ?)->
N=LAMA–>

LABA LAMA Becky –>

S?
T?
A?
M?
MACROLIDE* ?mg x? /wk
-N?
-O?
-S?

Before *Macrolide:

? / ? C+S
CT-?/Chest-?

Diuretics-CorPulmonale
Roflumilast
-E? ?+/yr
-FEV < ?%
-? / ?

1sev/2mod exac/yr
Sputum+Exac @Macrolide
Exac-2+/yr @Roflumilast
_______________

SpO2 < ?
P? / P? Oed
FEV< ?%
JVP ?
C?

SBOT @ ? =
evidence of ?
-dont smoke = FUCKING explosion

LTOT @Pao2: ABG-x? / ?w-apart
<7.3 + ?
7.3-8.0 + ...
- ?
- ?
- ?
- ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Surg:
?Syx+CT Bulla ?HT = ?

Transplant:
FEV1< ?+low ?
NON-?
FINISH ?

LungVolRed consider**:
FEV1< ?+low ?
NON-?
FINISH - ? - ?

after ** ‘‘consider’’ –> ‘actually do’ LungVolRed @:

?Ix = shows what?
CT = ?

Answer

A

Delivery system
When+How
Spiro Post BD

SABA/SAMA ->
LABA + ARave:
Asthma/Resp2steds
(atopy/ variable diurnal/FEV/ eosinophilia –>

Y=Becky –(Sx-lowQol/1severe/2mod exac/yr)->
N=LAMA–>

LABA LAMA Becky –>

Supplements
Theophylline
Antidepressants
Mucolytics
MACROLIDE* 250mg x3/wk
-Non-smoker
-Optimum-meds
-Sputum+Exac

Before *Macrolide:

Sputum/TB C+S
CT-Thorax/Chest-physio

Diuretics-CorPulmonale
Roflumilast
-Exac 2+/yr
-FEV<50%
-COPD/Bronchitis

1sev/2mod exac/yr
Sputum+Exac @Macrolide
Exac-2+/yr @Roflumilast
_______________

SpO2 < 92
PolyCythemia / PeriphOed
FEV< 30%
JVP high
Cyanosis

SBOT @ severe =
evidence of resp2prevTx
-dont smoke = FUCKING explosion

LTOT @Pao2: ABG-x2/3w-apart
<7.3 + stable
7.3-8.0 + ...
-P.Cythemia
-P.HTN-pul
-P.Oed-periph
-PNoct Hypoxia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Surg:
SOB+CT Bulla 1/3HT = Bullectomy

Transplant:
FEV1<50+lowQoL
NON-smoker
FINISH -ChestPhysio

LungVolRed consider**:
FEV1<50+lowQoL
NON-smoker
FINISH -ChestPhysio -140m6minWalk

after ** ‘‘consider’’ –> ‘actually do’ LungVolRed @:

Plethysmography = HyperInflation
CT = Emphysema

Question 3

Q

.HlRB: LT | Severe |. Mod
.... < 33% | 33-50% | 50-75%
.................. | BD fail .. | BD fail + HxFatalAtak 
...............<5y | 5-12y | >12y
...HR ? | 140 | 125.....| 110
........RR 40 . 30 . 25
.BP ?
SpO2 < ?
\_\_\_\_\_\_\_\_\_\_

Ix for asthma? Order in adults + kids
Fuck's Sake BP:
-FeNO >? / >? @ ?-?yrs ppb
-Spiro FEV/FVC < ? obstr
-BD Inc ?% in ?WHAT @ ?ml ?/?
-PEFR inc ?% ? in 2-4w @BD monitoring
-Methacholine Histamine Test PC? @?mg/ml FEV drop

Asthma <5yr tx:
SABA, BeckyMed ?w then stop->
-recur <4w -> ?
-not resolve=??
-recur >4w -> ? ?
\_\_\_\_\_\_\_\_\_\_

Asthma tx in adults -> CC50M
1-
2-
3-SABA±Monty + Becky high> ?mic / LAMA-Theo / RespDoc-(Esp @?Asthma**)

Esp@OccAsthma - iso?/ ?

wheeze @work, no wheeze @home/hols
-?Ix and where?

CC50M:
control=reduce maintenance after ?m
check: ? @Steds
50+ = Syx/HD?/ ?exac requiring ? /year –>

MACROLIDE ?mg x? / wk ?m

ECG-QTc = ?m ?m
LFT ?m ?m ?m

StopSteds=reduce by ?% / /m
\_\_\_\_\_\_\_\_\_\_
Pneumothorax
-Age >? + ? Hx
-Lung dx @? or ?
Y = ?
N = ?

Y: 
Air Rim >2cm / SOB?
-Y= ?
-N= ?cm?
--Y= ? Successful?
(Y=?, N=?)

–N=?

N:
Aim Rim >2cm/SOB?
-Y= ? Successful?
(Y=Air Rim <2cm and NO SOB = ?
(N=Air Rim >2cm OR SOB -> ?)

N i.e. (Air Rim<2cm AND no SOB)=d/c+OPD r/v ->
1. Stop ?
2. ? offer
3. Fly > ?w/ > ?w AFTER ? AND ? @trauma/spont

Answer

A

.HlRB: LT | Severe |. Mod
.... < 33% . 33-50% . 50-75%
.................... | BD fail .. | BD fail + Hx of Fatal attack 
...............<5y | 5-12y | >12y
HR low 140  | 125.....| 110
........RR 40 . 30 . 25
.BP low
SpO2 <92
\_\_\_\_\_\_\_\_\_\_

Adults - Kids: Ix for asthma?
1 - 3-FeNO >40 / >35 @ 5-16yrs ppb
2 - 1-Spiro FEV/FVC < 70 obstr
3 - 2-BD Inc 12% FEV @ 200ml SABA/Becky
4 - 4-PEFR inc 20% VARIABILITY in 2-4w @BD monitoring
5 - 5-Methacholine Histamine Test PC20 @8mg/ml FEV drop

Asthma <5yr tx:
SABA, BeckyMed 8w then stop->
-recur <4w -> BeckyLow
-not resolve=?ddx
-recur >4w -> BeckyMed8w repeat
\_\_\_\_\_\_\_\_\_\_

Asthma tx in adults -> CC50M
1-SABA + Beckylow<400 + Monty + LABA
2-SABA±Monty + ICS lowdose MART ->
ICS meddose MART/LABA+Beckymed 400-800

3-SABA±Monty + Becky high>800mic / LAMA-Theo / RespDoc-(Esp @OccAsthma**)

*Esp @ OccAsthma - iscocyanates/bakers
wheeze @work, no wheeze @home/hols
-Serial Peak Flows @work + home

CC50M:
@control=reduce maintenance after 3m
check: BP BM-hba1c BMD; Chol Cataracts @Steds
50+ = Syx/HDsteds/1exac requiring PO steds/year –>

MACROLIDE 500mg x3/wk 6-12m

ECG-QTc = 0m 1m
LFT 0m 1m 6m

StopSteds=reduce by 25-50%/3m
\_\_\_\_\_\_\_\_\_\_
Pneumothorax
-Age >50 + smoking Hx
-Lung dx @O/E or CXR
Y = 2ndary
N = 1rimary

Y: 
Air Rim >2cm / SOB?
-Y=chest drain
-N=1-2cm?
--Y=needle decomp. Successful?
(Y=chest-drain, N=Admit 24hr obs, O2-HF, observe)

–N=Admit 24hr obs, O2-HF, observe

N:
Aim Rim >2cm/SOB?
-Y=needle decomp. Successful?
(Y=Air Rim<2cm and NO SOB = d/c+OPD r/v+SFP
(N=Air Rim >2cm OR SOB -> chest drain)

N i.e. (Air Rim<2cm AIR no SOB)=d/c+OPD r/v ->
1. Stop smoke
2. Pluorodesis offer
3. Fly >2w/>1w AFTER drain AND no residual air @trauma/spont

Question 4

Q

Check aCa @:

?
?
?

Severe: tx?
-URB-C
Metastatic BONE pain?
MSCCompression?

Mild: Asyx + mild/mod HyperCa >2.?

Refer ?
Exclude FHH - ?
Confirm Pri PTH - URD: ?, ?, ?

SAGa:
Surg @: Syx/Asyx?, Age< ?, GFR< ?, aCa> ?
Conservative@: ?
? / ?
? / ? -->

–AfterSurg–> check ? + what 2 times?:

@NoSurg+HyperPT ?

? @ high p(#frag)
-when NOT give this?

Answer

A

Check aCa @:

Syx bones stones moans groans
Renal stones/nephrocalcinosis
OP/#frag

Severe: 
Underlying ax, 
Rehydrate, 
Bisphosphonates, 
Chemo@Cancer / Steds@Sarcoid 
Metastatic BONE pain: BARt
-bisphosphonates, analgesia, or RT
MSCC = Dexamethasone

Mild: Asyx + mild/mod HyperCa >2.6

Refer 2WW (cancer-MEN1), Endo, Resp(Sarcoid)
Exclude FHH - 24hr Urine Ca / Ca:Creat serum/urine
Confirm Pri PTH - URD: U+ECreat, R-USS, DEXA

SAGa:
Surg @: Syx, Age<50, GFR<60, aCa>2.85
Conservative@: Asyx, Age>50, aCa<2.85 
Renal stones/Nephrocalcinosis
OP/#frag -->

-AfterSurg–> check aCa + what 2 times?:
+PTH after surg
3-6 after surg

@NoSurg+HyperPT = Cincalcet @:
-Ca: >2.85 + Syx / >3.0 + Asyx

Bisphosphonates @ high p(#frag)
-NOT @chronicHyperCalc

Question 5

Q

CCF suspect:

Ix?

What decreases BNP?

What increases BNP?

Monitor? F/u?

How to initiate/progress meds?
- Ix for certain meds?

NSMU

2 meds groups that fuck CCF up?
-What meds exacerbate CCF in these 2 groups?

Causes of CCF: Preload, Pump fail, Afterload?

Answer

A

IX:

Pro-BNP >2000 = cardio/TTE 2ww
-400-2000=cardio/TTE <6w

DiureticsABCD
Obesity
Blacks

RF (fred frimston @GP)
Age > 70
Hypoxia 
IHD / Infection
LVF / RVO

Monitor?
1. Monthly for 1st 3m
2. Every 6m

-F/u? MUFFFC
Meds
U+E
FLuid status
FOod status
FUnct capacity
Cardiac rehab

Start low dose
Titrate up

HuB
HR and BP = beta-blockers
U+E and BP = A+C*+D
1-2m b4/after start/titrate

*Candesartan+Digoxin/Diuretics

None Slight Marked Unable
__________

Neg Inotropic + Fluid retention:
-Neg inotrope:
CCB - verapamil
Antiarryhtmic - flecainide

-Fluid retention:
NSAIDs
Pioglit 
Steds
\_\_\_\_\_\_\_\_\_\_\_

Causes of HF - ROCIA SH (Rocio always tells us to sshhh in the teaching ffs 😂)

-Preload high -
Regurg/VSD
overload -meds -IVF

-Pump failure -
CM/CPericard;
IHD/Ionotrope neg
Arrhythmia

-Afterload high -
Stenosis (any valve)
HTN(periph/pul-corpulmonale)

-High output - Preg/Anemia/Thyrotoxicosis

Question 6

Q

HF tx?

Preserved EF
Reduced EF
–Spiro @?d after MI
-Electronic

? @QRS<150 - LBBB+NYC ?/-
? @QRS 120-150 + LBBB+NYC ?/+
? @QRS 120-150 - LBBB+NYC ?

Surgery?

PVent = ?heartDx type, ?Which diseases
-Aim?

Give what after MI? WHEN?

Acute pul oedema?
-ACUTE DFGI ACh

Answer

A

Preserved EF

low/med dose LOOP
<80mg Furosemide

ACEi + Beta-block
- (not @valve-dx)+(bisop/cardev)
Candesartan
- ARB
- Spiro @3-14d after MI
- Hydralazine+Nit @NYC3/+
Digoxin @AF
- lastDose–> 8-12hrs –> measure

Ivabradine

HR>75
EF<35%
NYC2/+
Systolic dx

SacubitrilSartan @syx
__________________

Electronic:

ICD @QRS<150 - LBBB+NYC 3/-
CRT @QRS 120-150 + LBBB+NYC 2/+
CRT @QRS 120-150 - LBBB+NYC 4

Surgery: CPT
a. CResync 
b. Partial Ventriculectomy @non-IHD=
-Chagas/CMyopathy/Valve-dx
-Aim=reduce:EDV->LVstrain-> 
optimiseLVFunction
c. Transplant
\_\_\_\_\_\_\_\_\_\_\_\_\_

ABG, CXR, U+E, Trop/BNP, ECG/Echo-->
-Diamorphine-Furosemide
-GTN / Isosorbide Dinitrate @BP>90 -->
ABCDE
CPAP
HELP

Question 7

Q

VTE tx:

Normal

Massive PE + HYPOtn - ?

Renal dx CrCl< ?

CKD+non-valvular AF

Cancer

Unprovoked PE

Syx+IlioFem DVT

Provoked = ?m
Cancer = ?m
Unprovoked PE = ?m
________

DVT prophylaxis whilst travelling?

Answer

A

Coag Studies:
1. Apix / Rivarox
2a. LMWH -5d-> Dabigat CrCl30+ / Edox
2b. LMWH -+++APLS-> +Warf 5d -INR 2.0 x2-> 
Stop LMWH/Cont Warf

*CrCl 15-50

Massive PE + HYPOtension - thrombolyse

Renal dx CrCl<15 =
LMWH/UFH +/- Warf 5d -INR 2.0 x2->
Stop LMWH/Cont Warf

CKD+non-valvular AF = Apix>Warf @CHADSVASC 1+

Cancer = 1, 2b, LMWH

Unprovoked PE:
-FBC/U+E/LFT / Coag +
-?APLS ABs / Thrombophilia Screen @ FDR VTE
@ ?stop AC

Syx+IlioFem DVT:
Catheter-Directed-Thrombolysis @:
-Funct status LEGIT
-low p (bleed)
-LE > 1yr
-Syx <14d

Provoked - 3m
Cancer = 3-6m
Unprovoked PE = 6m

2PT -10a-> 2aT -Hep-> AT3
AT3 = reduce 2, 7, 9, 10, 11, 12 = LMWH
10=UFH

Oxidised VitK -EpoxReductase-> Reduced Vitk ->
Turn 2,7,9,10,c+s –> a2,7,9,10,c+s
_______

DVT prophylaxis whilst travelling?
-give TED stockings !!!

Question 8

Q

Anaphylaxis SAICA

.................Adr -------- Chlor ---- HydrC
>12yr     
6y-12yr  
6m-6yr  
<6m

Admit for how long minimum?

Why 24hrs?

Answer

A

T1-HSR -> IgE Mast cells Histamine Release ->
Urticaria, Cyanosis/Confusion, Oedema, Wheeze

Stop offending agent 
Adr 
IVF
Chlorphen Hydrocort*
Admit for 6hrs / 24hrs **
-BP, ECG, SpO2, Tryptase
F/u = Medic-alert/ACH/Skin-PrickTest/TeachAnt-Lat Thigh

……………..Adr ——– Chlor —- HydrC
>12yr 0.5mg 10mg 200mg
6y-12yr 0.3mg 5mg 100mg
6m-6yr 0.15mg 2.5mg 50mg
<6m 0.15mg 0.25mg/kg 25mg

** <24hrs:
Bi-phasic Hx
ED access hard
Asthma severe
Night / Eve / Unable2Respond
Continued Absorption
Onset = slow + severe

Question 9

Q

STEMI:

> 1mm ? lead
2mm ? leads

Pt had DE stent put in, 
on aspirin and ticagrelor. 
Gets breathless. What to do? Why?
-Ticag = stops ? -> 
incr adenosine --> ? sx
-Sub ticag for ?
\_\_\_\_\_\_\_

LAD = ?
Circ lat = ?
RCA = ?
-STEMI + ? waves = Post MI
\_\_\_\_\_\_\_\_

iNITIAL Tx?

MONA? ?mg +

eligible for PCI:

-> ? = Asp + already on ?
Y = ? + ?
N = ? + ? / ? or ? @ ?Age/+ + HR of ?

For the poor fuckers 
NOT eligible 
for reperfusion therapy 
--> ? : ? + HR ?
Y = ? ± ? 
N = ? + ?

Can PCI be done < ?hr
when ?
COULD have been given?
- Y = ? = ?type @Syx <12hr
#Asp?- ?blood vessel > ?blood vessel 
#Syx >12hr = consider ?
@Cont?/?

N = ? + ?
ECG < ? mins -> ?STEMI improve 50%
NO = ?implication -> ?Tx

GPi bailout @PCI via

Radial = ?
Femoral = ?

STEMI + Multivessel dx + Cardiogen shock = ?

STEMI + Multivessel dx + NO Cardiogen shock = ?

B4 d/c:
-? testing in all NSTEMI/STEMI #Echo

(look at pictures on 18/1/21 for written notes)

Answer

A

> 1mm limb lead
2mm chest leads

-Ticag = stops adenosine clearance ->
incr adenosine –> SOB sx
-Sub ticag for clopi

*CI to fibrinolysis
V - Stroke/ADiss/HTN>180/ICH
I - endocarditis
Neoplasm
D - AC
I - Preg
Congen AVM
Ai x
T - HI/ICH/Surg
E x
\_\_\_\_\_\_\_

LAD = V1-4
Circ lat = V5 V6 1
RCA = 2 3 avF
-STEMI + R waves = Post MI
\_\_\_\_\_\_\_\_

iNITIAL Tx?

MONAsp 300mg + …

eligible for PCI:

-> DAPT: Asp + already on AC?
Y = Asp+ Clop
N = Asp + Prasugrel / Ticag or Clopi @75/+ + HR bleed

For the poor fuckers 
NOT eligible 
for reperfusion therapy 
--> DAPT: Asp + HR bleed?
Y = Asp ± Clopi 
N = Asp + Ticag

Can PCI be done < 2hr
when Fibrinolysis
COULD have been given?
- Y = Angio + PCI = DES @Syx <12hr
#AspThrombus-Radial>Fem
#Syx >12hr = consider Angio + PCI 
@ContIsch/CardioShock

N = Fibrinolysis#tPA + UFH/LMWH #AT
ECG < 60-90 mins -> ?STEMI improve 50%
NO = failed thrombolysis -> Refer for Angio + PCI

GPi bailout @PCI via

Radial = UFH (ruff ruff like a dog… )
Femoral = Bivilarudin

STEMI + Multivessel dx + Cardiogen shock =
-Culprit Vessel Revasc

STEMI + Multivessel dx + NO Cardiogen shock =
-COMPLETE Vessel Revasc

B4 d/c:
-LVF testing in all NSTEMI/STEMI #Echo

(look at pictures on 18/1/21 for written notes)

Question 10

Q

Anaemia

Fe def Ix? Tx

Folate Tx?

B12 Tx?

Duo - ?
Jej - ?
Ileum - ?
____________

Micro: TICS?

Normo: MATCH?

Macro: FB’d RALPH?

Megalo ?
Non-Megalo ?

Answer

A

FBC, Iron profile, Coeliac screen TTG IgA, HUria, Stool (parasite/pylori)

FF/FS
Ax underlying - 2ww/gastro.gynae
Diet
Sidero (lead) - Transfuse, Chelate, Pyridoxine

Refer:
-Fe low:
2ww @ 50+ rectal bleed / 60+
Gastro @ Men / PMP

-Gastro @ <50 PMP / 50+ :
Anemia/BCD/FHx colonic syx

-Gynae @ menorrhagia tx fail/PMB 2ww/Preg

Folate: DUM (drugs/usage inc/malabsorption)
Diet - broccoli/sprouts/cereals
Oral Folate 5mg

B12: PIM (pernicious/infection/malabsorption)
Neuro Syx = Admit +/- IM HCB
NO Neuro Syx = IM HCB x3/w/2w -> 
-DietRelated = Oral CyanoCobalamin
-DietUnRelated = IM HCB

Duo - Fe
Jej - Folate
Ileum - B12 prox term ileum
________________

Micro: TICS
Thal, Iron def, ChrDx late, Sideroblast

Normo: MATCH
Marrow dx
Acute blood loss
Thyroid dx
CKD/ChrDx early
Hemolytic

Macro: FB’d RALPH
-Megalo:
Folate/B12/Drugs:
-Allopurinol Phenytoin OHcarbimide

-Non-Megalo:
Reticulocytosis
ALCOHOL
LF
Preg
HypoT

Question 11

Q

Angina

GTN relief < ? min
? discomfort @?
? chest-pain

0-1 = ?
2 = ?
3 = ?

What features decrease p(stable angina)?

CA SpaZm = ?
- Tx = ?

Decibitus @lying

Ix?
Initial 3 Ix? ?ECG signs/scores -> ?imaging
-if this fails? And if this fails?

Initial Mx:
?Tx/?mins x? -> 2nd dose fail, do what? 
-1 2ndary prev drug = ? 
\+
1 aAG = ? 
--?dose--?--(switch RL to ?*)-> 
3rd aAG @ ? +? 
-->

CCB:
@HF/ObstOutflow
-? is preferred > what?
- if decide to use CCB, which CCB to use in HF?
1. RL: 2 egs, effect on heart? CI? Care @what?
2. DHP: 2 classes? SE of SA?

Angina drug SEs = ?/?:

-? constipation/ankle swell

-?
Inc HA / HR tachy / HypoTN=LooowBP /. TOLerance

-?=Inhibit ?
EyeSyx

-? - Inc QT, CCF, Under ?kg

? - Anal ulcers
–?CI

CI for sildenafil?

left main stem/? vessel dx --> 
Tx*: ? v ? --> Fail?
-*which ones is cost effective? 
-*Which one has lower recurrence rate?
-*@?VesselDx / Age> ? / ? do what?

Answer

A

Angina

GTN relief <5min
Constricting discomfort @jaw/arm/shoulder
Exertional chest-pain

**0-1 = Non-anginal
2 = Atyp
3 = Typ

Decreases p(stable angina)?

Activity UNrelated
Breathing Related
Continuous
Dizzy/Palp/Swallow/Tingling

CA SpaZm = PrinZmetal
- Tx = DHP Amlodipine

Decibitus @lying

Bloods - FBC #Hb
ASPirin 75mg till confirm,
ECG @ ?ddx O/E –>

**0-1 + ST-low/Q / 2-3 –> 64-slice CT-Angio
-FAIL->
NIV-FT = Perfusion (SPECT/Scinto / MR-FPCE)
IV-FT = CAngio

Initial Mx:
GTN/5mins x2 -> 2nd dose fail? 999!!!
-1 2ndary prev drug = 
ACEi @HTN+DM/ Asp 75mg/ Atorva 80
\+
1 aAG = B/CCB-RL 
--maxDose--combo--(switch RL to DHP*)-> 
3rd aAG @Tx fail + PCI/CABG A/W
-->

CCB:
@HF/ObstOutflow 
-Bblock preferred>CCB (DHP>RL: but both CCB still bad @HF) 
1. RL 
[Verap-constip/Dilit]=[Dec HR/Contractility] -->
CI* = 
-HB / HF/OverloadObstruction 
-HRlow/AF AFlutter/SickSinus

DHP SA=reflex tachy*/LA-amlodipine
* Airway suction @neonates = reflex bradycardia

Angina drug SEs = HA/Flushing:

-CCB constipation/ankle swell

-LAN IMononitrate-SR:
Inc HA / HR tachy / HypoTN=LooowBP /
TOLerance

-Ivabradine=InhibitFunnyChannels
EyeVabradine

-Nolazine - Inc QT, CCF, Under 60kg

-Korandil - Anal ulcers
Sildenafil-HypoTN_HF=CI

CI for sildenafil?
Nitr/Nik
Stroke / LowBP / MI

left main stem/3 vessel dx -->
- PCI (cost-effective)
-CABG (RecurrenceRateLower)
@MultiVesselDx / Age>65 / DM -->
CARDIAC SYNDROME X

Question 12

Q

NSTEMI:

MONAsp ?mg
? \_\_\_\_ \ ? @
@angio  \ Creat >265
ASAP
-->

GRACE ?m mortality

Bloods ?
?
?

Angio ± PCI + ? @cardiac cath lab = DES @
1)-?

2)-Stable AND GRACE 1.5 - 3% #Low Risk
AND ? / ?

3)-Stable AND GRACE >3% #Inter/High Risk < ?

GRACE 1.5 - 3% #Low Risk 
For the poor fuckers 
NOT eligible 
for reperfusion therapy 
--> ?: ? + HR bleed?
Y = ? ± ? 
N = ? + ?

GRACE >3% #Inter/High Risk

?: ? + already on AC?
Y = ? + ?
N = ? + ?/?

B4 d/c:

? if conservative tx
? testing in all NSTEMI/STEMI #Echo

Answer

A

NSTEMI:

MONAsp  300mg
Fonda  \ UFH @
@angio  \ Creat >265
ASAP
-->

GRACE 6m mortality

Bloods: Trop I or T / FBC U+E BM
Hx / Ex
ECG

Angio ± PCI + UFH @cardiac cath lab = DES @
1)-HD UNSTABLE

2)-Stable AND GRACE 1.5 - 3% #Low Risk
AND Isch exp/demonstrate @testing

3)-Stable AND GRACE >3% #Inter/High Risk < 72hr

GRACE 1.5 - 3% #Low Risk 
For the poor fuckers 
NOT eligible 
for reperfusion therapy 
--> DAPT: Asp + HR bleed?
Y = Asp ± Clopi 
N = Asp + Ticag

GRACE >3% #Inter/High Risk

DAPT: Asp + already on AC?
Y = Asp+ Clop
N = Asp + Prasugrel / Ticag

B4 d/c:

isch testing if conservative tx @NSTEMI
LVF testing in all NSTEMI/STEMI #Echo

Question 13

Q

Peri-arrest:

Initial Ix?

Adverse signs?

UNSTABLE tx?

Bradycardia?
@Adverse Sx
@NOadverse sx

Answer

A

ABCDE

Bloods = electrolytes
IV x 2
SpO2
T12-ECG 24 Holter
O2

Adverse signs?
-Shock
-HF
-AF >48hrs
Not DC sync shock
TOE*/AC*
-MI
-Syncope

*TOE = excl Left Atrial Appendage Thrombus
AC = 3wb4 cardioversion

UNSTABLE:
-Sync DC shock x3 Repeat
-Amiodarone–300mg/10-20mins–900mg/24hr
@VF=NONsync-DC shock

Bradycardia?
@Adverse Sx: 
-Atrop 500 mic -> Atrop 500mic/3mg -> 
-TransCut Ext Pacing
-Isoprenaline
-Adr-Aminophyline/
-Dopamine/Glucagon @ Bblockers

@NOadverse sx = RCMV –> ATIAD

Recent Asystole
Complete HB
Mobitz 2
Vent pause > 3sec

Question 14

Q

Peri-arrest:

@Stable = QRS < ? ms

Narrow SVT

-Reg: 
V? 
A? 
-@H?/A? /S? = ?Tx
M?

Y=ProbParoxRe-entryAF

SVT=?
?Ix

N=Probable AFlutter
?

-Irreg:
Probable AF =? 
-@HF=? 
Assx VTE - AC tx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Broad VT

-Reg:
VT/?Rhythm

SVT+RBBB=?

-Irreg:
Pre-Excited AF =? 
AF+BBB=? 
POLYMORPHIC=
-T-invert =? 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SpO2, Thermia, Vol, K-high/low

Tamponade, Px, Toxin, Thrombosis

*Thrombosis/Tamp - Px-poxin
_________________

4H 4T

Answer

A

@Stable = QRS < 120 ms

Narrow SVT

-Reg: 
Vagal - Valsalva/CSM
Adenosine 6mg 12mg/repeat
-@HB/Asthma/SinoAtrialDx=Verap
Monitor ECG --> SINUS RHYTHM?

Y=ProbParoxRe-entryAF

SVT=AntiArrhythmics
T12-ECG

N=Probable AFlutter
-Bblocker

-Irreg:
Probable AF = Bblock/Dilit
-@HF=Amiod/Digox
Assx VTE - AC tx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Broad VT

-Reg:
VT/?Rhythm
-Amiod 300mg/20-60mins
-Amiod 900mg/24 hrs

SVT+RBBB=NarrowRegSVT-tx

-Irreg:
Pre-Excited AF = Amiodarone
AF+BBB=NarrowSVT-tx
POLYMORPHIC=
-T-invert = low K + Alco = MgSO4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SpO2, Thermia, Vol, K-high/low

Tamponade, Px, Toxin, Thrombosis

*Thrombosis/Tamp - Px-poxin

Question 15

Q

Arrest Rhythm? 1 2 3

VF
VT puseless

1 shock / ? shock @CCU 
#stacked/monitored

? min CPR+
Adr ? mg alt CPR cycles = 3-5mins 
#?/?

? /+ shock:

? ?dosemg -> ? mg @5
Adr ? mg alt CPR cycles = 3-5mins

SpO2, Thermia, Volume, K high/low
Thrombosis/Tamp-Px/Poxin

Answer

A

VF
VT puseless

1 shock / 3 shock @CCU 
#stacked/monitored

2minCPR+1mgAdr alt CPR cycles - 3-5mins 
#PEA/Asystole

3/+ shock:

Amiod 300mg -> 150mg @5
Adr 1mg alt CPR cycles = 3-5mins

Question 16

Q

UGIB - after you resuscitate them…

Types of UGIB? Tx
-TIPS = join what 2 vessels?

Prev?

*CMFT - COAT FUR - PEAN

Ext: Coag/Tissue Factors i-PBL

immune cells/ placenta/ brain/ lung
factor 7

Int: Endothelial Trauma BM Collagen
-12, 11 —-> 9 10 -> 2hrombin -> Fibrin

Fibrin –Plasmin*–> PolyPeptides

Plasminogen –tPA-> Plasmin*FibrinolyticSystem
-TXA stops tPA #hemostasis
-Altepase IS tPA #thrombolysis

_______________
PT –10a–> 2hrombin

2hrombin –Heparin–>
Upregulate AT3 –> stop f8-12

Ox Vit K –EpoxReduct–> Red Vit K –>af2,7,9,10,ProtC+S
_________

_____PT APTT BT Plts
Warf high

Hep…………..high

Asp/BS/GM…………high…low
txa2, gp1a, gb2b3b

ITP/TTP/HUS………high…low

DIC…high…high….high…low

Haemoph…high

Vit k…high..high
Def

vWD………….high…..high

Answer

A

Non-Variceal = Endo <24hr

Clips - Mechanical + …
Fibrin / Thrombin +/- …
Thermal coag +/- …

…Adr =

PPI 80mg IV
Repeat Endo?

PPI 80mg IV

Recent bleed stigmata
Not b4 endo

Repeat Endo @
-Inc p(Rebleed)
-Rebleed
-IR @ Unstable/Rebleed
\_\_\_\_\_\_\_\_\_\_\_\_\_

Variceal = Endo <24hrs
-COAT-FUR

1-Catheter UO
2-Octreotide
3-ABx = cipro/Taz/erythro
Erythro 
<2hr b4 
Endo
4-Terlipresin Till: Hemostasis/5days

-Urgent Endo:
Oesophageal = Band ligation
Gastric = Sclerotherapy/Nb2c –>
TIPS = join portal vein + hepatic vein

-Fail @embolisation
-Uncontrolled - SB tube
-Rebleed/check 15 mins:
—Repeat endo / Surg/Lap
_______________

Prev:
Propranolol / PPI
EVL
APlts - Forrest
- 1-2a = Hemostasis -3d-> Asp
NSAID AVOID

Question 17

Q

UGIB initial mx

4 grades of bleeding?

UGIB scoring systems?
_________

TCP - Inc p(bact infect) = ROOM TEMP:
<10 + ? 
<30 + ? 
<50 + ? 
<100 + ?

No major hamorrhage:

PT/APTT > ? / ?
—-? = contents?
Fibrinogen < ? / ?
—-? = contents?

- WARFARIN 
Stop ? 
Vit K  route? @minor bleed > ? 
Vit K route? @NO bleed > ? 
Restart @ < ? 
No bleed + 5-8 = ? 
-bleed @ therapeutic lvl?

Major Haemorrhage MHP

PTC warfarin reversal emergency
< ? hr
SPF
@ ?

Answer

A

Raise legs
O2 HF / HELP
IV x 2
inTubate –>

Aim:

HR <100 +10-15ml/kg
UO >0.5ml/kg/hr 500ml bolus
BP >90/60

–>

ABCDE + NBM
Bloods
Coag
CM+GS
\+
CM, O-ve request 4-6 units
FFP : RBC 1:1
Aim:
-Plts >50
-Fibrinogen >1
-TXA 1g

Blatchford 0 = PPI + d/c
Rockall = Pre + Post Endo
-Rebleed/Death Risk

1 = 10-15
2 = 15-30---UO 20-40
3 = 30-40---UO<20/HR>120
4 = >40
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Transfuse
@Hb <70 @ACTIVE-BLEED
Target 70-90 -TNM

TCP - Inc p(bact infect) = ROOM TEMP:
<10 + no (bleed/surg / TCP dx)
<30 + bleed
<50 + surg 
<100 + CNS-bleed

No major hamorrhage:

PT/APTT >1.5 + normal / Surg
—-Fibrinogen = clot/plasma prots
Fibrinogen <1.5 / Surg 1.0
—-Cryo = f8+13 / fibrinogen + vWF
WARFARIN
Stop warfarin
Vit K IV @minor bleed >5
Vit K PO @NO bleed >8
Restart @< 5.0
No bleed + 5-8 = withhold dose, reduce dose
–bleed @ therapeutic lvl? Ix cause = ?renal/gastro dx

Major Haemorrhage MHP

PTC warfarin reversal emergency
<1 hr
Stop warf / PTC + vit K / FFP @unavail
@HI / ICH

Question 18

Q

Crohns tx?

SMOKE
1 exac/yr / ?presentation

2+ exac/yr / steds status?

? activity test:

–deficient (v.low/absent) / cant tol Azo/MCP = add what?

–LOW = add what?

–Norm = add what?

Adv Prog Factors:
-P?
-E?
-What @ presentation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Biologics?
-How to give this shit? With what else?

Surgery when (in terms of anatomy and in whom)?

Remission?

-After surgery =
Ileo-ColonicDx + Comp macro resection
< ?m = ? + ?ABx

ICV: IleoCecal Valve/R colon dx
DID: Distal Ileal Dx
ICD: IleoColonicDx

Answer

A

Tx:

Smoke NOT
MDT - psych/ADLs
OP RFs
Kalprotectin
Kontraceptive*
Education

*Kontraception
-Inflix 6m
-MCP/MTX 3m
Preg @uncontrolled dx
Inflix/Sulfasal = reduce sperm motility
FA 5mg -> w12
Surg - Ejac/ED-TuboFallop dx = ?c-section
____________________

1 exac/yr
1st presentation:
-Csteds/Budenoside/ASA
-DICT - Ileocecal valve/R colon dx

2 exac/yr
steds NOT tapered:
-TMPT activity 
--deficient (v.low/absent) / cant tol Azo/MCP = +MTX
--LOW = +Azo/MCP LD
--Norm = +Azo/MCP

Adv Prog Factors:
-Perianal dx
-Early age dx
-Steds @ presentation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Biologics: single/combo
-Adalimumab
-Infliximab
-Combo v/ ImmunoSupp
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Surg @
Distal ILEAL Dx + ...
-Adults 
-Kids b4/early puberty @:
---------growth/f2t 
---------refractory dx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Remission:
-Green box - TMPT stuff ^^
-After surgery = 
IleoColonicDx + Comp macro resection <3m = 
Azo+METRO

Question 19

Q

UC tx? SMOKE
__________

mild/mod
induce
remission:

Proctitis induce/maintain= ?
-ProctoSigmoidItis maintain

ProctoSigmoidItis induce?

Ext UC?

Biologics?
__________

Severe: Surg Assx @
P? / Poo ?/+ day
AXR = colon ?
Inc CRP > ?
Inc ?obs        Dec Alb/Anemia
Inc ?FBCvalue 
-fail-> ?Tx / ? < ?d/worsen

Left UC/EXT REMISSION:
? –fail-> ? @
-? acute severe
-?/+ exac/yr requiring ?

Answer

A

Smoke LEGIT
MDT - psych/ADL
OP RFs
Kalprotectin
Kontraception:
-Infliximab 6m ) PIFS*
-MCP/MTX 3m ) PIFS*
Education

*Preg @ controlled dx
Inflix/sulfasal=reduce sperm motility
FA 5mg -> W12
Surg @ ED/Ejac-Tubo-Fallop dx = ?c-section
\_\_\_\_\_\_\_\_\_\_

mild/mod / induce remission:

Proctitis =induce/MAINTAIN
-ProctoSigmoidItis maintain:
ASA top 
--4w-> 
ASA top+po/po @topDCT 
\+/- 
Csted top/po 
--fail-> 
Biologics*

ProctoSigmoidItis/ LeftUC:
ASA top 
--4w-> 
ASA top+PO HD / ASA PO HD+Ctsed top  
--fail-> 
StopTop + ASA PO + Csted PO 
--fail-> 
Biologics*

Ext UC:
ASA top+PO HD 
--4w-> 
Stop top + ASA PO HD + Csted PO
--fail->  
Biologics*

Biologics:
TNFi - Toffee itinib
UstaadMAB
VideoMAB
\_\_\_\_\_\_\_\_\_\_

Severe: Surg Assx @
Pyrexia / Poo 8/+ day
AXR = colon dilated
Inc CRP >45
Inc HR      Dec Alb/Anemia
Inc Plts 
---IV csted
-DCT/fail->
---IV ciclosporin 
-3d-fail-> 
---IV combo <3d/worsen

Left UC EXT remission:
ASA PO LD –fail-> Azo/MCP @
-1 acute severe
-2/+ exac/yr requiring csteds

Question 20

Q

Cirrhosis: Alcohol units

HEAPS
BAP-AP MAULeaf
CASE

Common precipitants? 
Histology? 
Anatomy?  
HRS tx?
-type 1 v type 2?
Encephalopathy stages? 
Ascites pathphys? 
Portal thrombosis pathphys? 
-When start bleeding from portal HTN?

SBP - neut > ?

Anatomy?

Answer

A

%.mls / 1000

Liver cirrhosis definition?
-CONSTIPATION!/ Alco /NAFLD/ Viruses

Decompensated
Diffuse bridging fibrosis
#stellate cells

a. 
Hemorrhage - varices - gut butt caput*
HRS - cirrhosis/ascites/RF - terlipressin/TIPS
-type 1 <2w - type 2 >2w
HCC-AFP+USS/3m
b. Encephalopathy 
1. irritable
2. confused
3. incoherent
4. coma
c. Ascites cos of HTN - fluid extravasate
d. Portal thrombosis -> HTN -bloodbackflow (start bleed @ >12 mmHg)
SBP-sepsis Neut > 250

*PV = SV + SMV
SV = IMV - SRV (butt)
Left PV = PUV = (caput)
off the actual PV = LGV = (gut)
\_\_\_\_\_\_\_\_\_

Question 21

Q

Cirrhosis Ix:
Bloods: what’s high? What’s low?
AST/ALT relationship?

Scoring (?survival V ?severity) 
Ix for sepsis? 
Ix for ?malignancy? NAFLD? 
Imaging in Cirrhosis? 
How often OGD @varices?

-When offer elastography?
______

Answer

A

Ix:
HIGH:
Bili/GGT
ALT/AST
PT
-ALT>AST - normally
-AST>ALT @Alco/NAFLDadvFibrosis #toAST

LOW:
Albumin
Plts

-MELD(comp cirrho SURVIVAL)/C-P-Severity
-Ascitic tap MCS
-USS/3m +/-AFP=?HCC
-LEAF:
Liver Biopsy
ELF blood test >10.51-NAFLD/
ElastoGraphy/Acoustic-rad Force/ MRI
-OGD/3yrs @varices

ElastoGraphy -@male 50+u/wk -@female 35+u/wk -@HepC
__________

Question 22

Q

Cirrhosis Tx? What a Wilsons?
Ascites pathphys? Tx?
________
SBP sepsis? When to give proph ABx?
Encephalopathy Tx?
-TIPS=?
-low BM =?
-? @c.oed
-Bleed =?
_______

*Paracentesis+ ? 
#circ-dysfunc > ? L = ?

SAAG > ? indicates Port HTN

What 2 things to know about TIPS?
_________

LF -> fail2degrade/over-produce DILATORS ->
Splanchnic dilated -> blood pools ->
Decrease BP -> Incr RAAS ->
Na/H20 retention

Spiro=AldBlocker -> low AdrenalAld ->
lower:
-Na absorption -> less h20 absorb
-K secretion
-H secretion

Furosemide -> lowers renal perfusion ->
Reduces GFR -> ?HRS, so preferable to avoid

Answer

A

Tx:

Cirrhosis:
- USDA/LiverTransplant
- Pencillamine@Wilsons

2. Ascites=PINT
Portal.htn = TIPS* 
low alb = HAS
Na+h20 retention
-Fluid restrict
-low Na diet, 
-Spiro-fail->Furose*****
TAP-paracentesis

*****
LF -> fail2degrade/over-produce DILATORS ->
Splanchnic dilated -> blood pools ->
Decrease BP -> Incr RAAS -> 
Na/H20 retention

Spiro=AldBlocker -> low AdrenalAld ->
lower:
-Na absorption -> less h20 absorb
-K secretion
-H secretion

Furosemide -> lowers renal perfusion ->
Reduces GFR -> ?HRS, so preferable to avoid
________

SBP-sepsis:
-Cefotax IV/Cipro proph
@chp:C-P=9/+, Hx of SBP, Prot 15/-
Encephalopathy:
-Lactulose/Rifaximin -> inc N2 bact bowel transit -> reduce ammonia
-TIPS=ppts enceph
-low BM = dex
-Mannitol @c.oed
-Bleed = vitK
_________

*Paracentesis+HAS onc press 
#circ-dysfunc >5L = AlbCover

SAAG >11 indicates Port HTN

TIPS:

connect portal vein to hepatic vein
Bypasses portal HTN but ppts encephalopathy

Question 23

Q

NAFLD tx?

WHAC PET DEBATE PIG

WL ? %/6m
-faster WL does what? 
? screen
Alco? 
Comorbidities

P?
?- Vitamin
Transplant-DEBATE hehe

ELF blood test >? / ?

What scan? Indication?

Non-paracetamol liver transplant criteria?
DEBATE PIG:
D? / H? 
E? 
Bili > ? 
Acidosis/Alkalosis? 
Time > ? d jaund -> ? 
Everyone aged ?/- OR  ?/+
-PT/INR= ? ; Gluc  ?

King's paracetamol criteria?
pH < 7.? 
Creat ? 
G? encephalp
INR > ? / PT> ?
\_\_\_\_\_\_\_\_\_\_

BMI < ?;
unintentional WL > ?% @last 3-6 months; or
BMI < ? + unintentional WL > ?% @last 3-6 months

? = WL 10% / 6m (any faster = worsen fibrosis)

WL ?% pre-preg Weight, Electrolyte dx, Dehydration

Answer

A

WHAC PET DEBATE PIG

WL 10%/6m
-faster=inc fibrosis
HCC screen
Alco low
Comorbidities

Pioglit
E-vit
Transplant-DEBATE hehe

ELF blood test >10.51 / NAFLD

Elastography @

male 50/+u/wk
female 35/+u/wk
HepC

DEBATE PIG
Drugs/Hep
Encephalo
Bili >300
Acidosis
Time >7d jaund->enceph
Everyone aged 10/- OR 40/+
-PT/INR=high ; Gluc low

Kings paracetamol:
pH < 7.3
Creat 300
G3/4 encephalp
INR >6.5 / PT>100
\_\_\_\_\_\_\_\_\_\_\_\_

Malnutrition:

BMI < 18.5;
unintentional WL > 10% @last 3-6 months; or
BMI < 20 + unintentional WL > 5% @last 3-6 months

NAFLD = WL 10% / 6m (any faster = worsen fibrosis)

HyperEmesis Gravidarum
WL 5% pre-preg Weight, Electrolyte dx, Dehydration

Question 24

Q

PrREEEEE-Diabetes BM ranges

FPG ?
OGTT ?
Random ? = DM
HbA1c ?

Syx/ ?? :
-FPG ? / Random ? /HbA1c?

Low HbA1c = ?
High HbA1c = ?

Peripheral Sensory Neuropathy =
?sensory modality most common?
______

Fever Incr BM
N+V/D+V Lowers BM

Sick day rules:

what with eating pattern?
? supplies
glucose ? / ?
? drinks
monitor BMs more/less often
DKA: monitor BM+Ketone/ ? hrs + ORT/ ? L fluid
_____________

MetAMPK = biguanide 
- GFR< ? = reduce dose, stop @< ?
Inc Peripheral util of ?
Inc insulin ?
Dec ?
\_\_\_\_\_\_\_\_

Pio-PPARalphaAgonist- ?

SU=insulin=Stim Beta-islets
-close Katp = Inc Ca -> depol
________
For the fat people:

SGLTFlozin = ?

GlipDD4i:
-Dec ?,
-Inc ? (GIP/GLP) = satiety feel ? -> eat less so ?
________

GLP-1 agonists:

meal/high BM -?cell @?->
GLP-1 release -? effect->

-Dec Glucagon/ Inc Insulin
-Dec Gastric-empty/ Appetite
____________
____________
____________
____________

Lactic Acidosis/ GI Dx
________

BMI incr + ?LFT fuck up
Fluid retention
Bladder Ca

OP risk + Anaemia Hb low

-high BMI + ALT = Cholestasis
-low BM + Na = SIADHypo
________
For the fat people:

Fourniere’s, UTI, DKA, WLoss
Pancreatitis/Pemphigoid bullous

Answer

A

PrREEEEE-Diabetes BM ranges

FPG 6.1-6.9
OGTT 7.8-11.0
Random 11.1/+ = DM
HbA1c 42-47

Syx/Asyx x 2:
FPG >6.9 / Random >11.0 / HbA1c 48/+

Low HbA1c = Hemolysis/RF-WL
High HbA1c = Haematinics / Splenectomy

Peripheral Sensory Neuropathy = 
Experience:
-PAIN - feel lots 
-LIGHT touch LOSS
common sensory modality most

Sick day rules:

maintain NORMAL eating pattern
insulin supplies
glucose gels/ glucagon
sugary drinks

-monitor BMs more often
-DKA: monitor BM+Ketone/3hrs + ORT/3L fluid
___________

MetAMPK = biguanide 
- GFR<45 = reduce dose, stop @<30
Inc Peripheral util of BM
Inc insulin sensitivity
Dec GlucoNeoGenesis

Pio-PPARalphaAgonist-Periph resistance Reduce

SU=insulin=Stim Beta-islets
-close Katp = Inc Ca -> depol

SGLTFlozin = reduce PCT BM absorption

GlipDD4i:

Dec Glucagon,
Inc Incretins (GIP/GLP) = satiety feel full -> eat less so WL

GLP-1 agonists:

meal/high BM -Lcell @bowel->
GLP-1 release -incretin effect->

-Dec Glucagon/Gastric-empty/appetite
-Inc Insulin
____________
____________
____________
____________

Lactic Acidosis/ GI Dx = Metformin
________

BMI incr + ?LFT fuck up
Fluid retention
Bladder Ca
-Pio-ThioZolid

OP risk + Anaemia Hb low = Pio-ThioZolid

-high BMI + ALT = Cholestasis
-low BM + Na = SIADHypo
—–SulfonylUreas
________
For the fat people:

Fourniere’s, UTI, DKA, WLoss = SGLTFlozin
Pancreatitis/Pemphigoid bullous = GlipDPPtins

Question 25

Q

DM1 tx:

DIFFICULTY distinguishing DM1 from other types of diabetes. Ix?

Recommended HbA1c ? / measure ?m
-account for:
?

BM measure how often?

before ?/?
? = b4 meals
? = @wake
? = after meals 90mins

(? @surg illness)

R/V:
B? 
?mental health issues
Cx? 
Other Ai dx? 
Stop what? 
? @foot exam

Insulin ?

DM2 + CVD = ?Atorva
DM2 - CVD = ?Atorva @:
- ?

Insulin 
-m? daily Basal-Bolus -fail-> cont ? @ ? /+ yr
-twice daily ? basal 
-? b4 meals 
-? @BMI 25/+
\_\_\_\_\_\_\_\_\_\_

Metabolic Syndrome?

Answer

A

DM1 tx:

DM1 v OTHERS = C-Peptide

Recommended HbA1c 48 / measure 3-6m
-account for:
Cx/Comorbidities
Hypo risk
ADLs
Occupation

BM measure QDS

before meals/bedtime
4-7 = b4 meals
5-7 = @wake
5-9 = after meals 90mins

(5-8 @surg illness)

R/V:
BMI/BM-hba1c
Anx/Dep/Eat dx
Neuropathy + Micro/MacroVasc dx
Thyroid + coeliac/addison/pernicious
StopSmoke
-10g monofilament + ABPI @footexam

Insulin:
Mixed B-B daily -fail-> cont SC @ 12/+ y/o
Twice daily injections
RA b4 meals
Metformin @BMI 25/+

DM2 + CVD = 80 Atorva
DM2 - CVD = 20 Atorva @:
-CVD established
-Age >40
-Nephropathy
-DM >10yrs

Insulin DM1
-multiple daily Basal-Bolus -fail-> cont SC ins @12/+ yr
-twice daily Detemir basal 
-RA analog b4 meals 
-metformin @BMI 25/+
\_\_\_\_\_\_\_\_\_\_\_\_\_

WTH-G
Waist size high
Triglyc high
HTN/HDL low
Glucose high

Question 26

Q

DM2 tx:

Recommended HbA1c targets: /
measure ?-?m/ ?m @stable

? = HbA1c target ?
HbA1c ?/+ = maintain ?
- Metformin ?type / ?type @ GI dx
- ?Blood test / ?=lower p(GI dx)
- GFR <45=?; <30 = ?
HbA1c ?/+ = maintain ?:
?
-WHAT TO GIVE IN DM+FAT PEOPLE?!
HbA1c ?/+ = maintain ?
?
-WHAT TO GIVE IN DM+FAT PEOPLE?!

5a. HbA1c ?/+ = maintain ?
? @:
BMI + ? =
work issues/WL benefit obesity cx

BMI >? + ?cx (med/psych)

*Continue GLP-1 ag if:
-HbA1c Lower by ?/+
AND
-WL ?% BW/ ?m

5b.
Insulin:
?

DM2 + CVD = ?Atorva
DM2 - CVD = ?Atorva @ ?
__________________

Metformin intolerance?

?
? - any 2
- ? > ? @Pio/SU CI
Insulin?
_______

WHAT TO GIVE IN DM+FAT PEOPLE?!

Answer

A

DM2 tx:

Recommended HbA1c targets: /
measure 3-6m/6m @stable

Lifestyle - d/e = HbA1c target 48
HbA1c 48/+ = maintain 48
- Metformin SR/MR @ GI dx
- U+E/Titrate up=lower p(GI dx)
- GFR <45=lower dose; <30 = stop

3. HbA1c 58/+ = maintain 53:
GlipDPP4I
Pio
SU
SGLT2i

DM + FAT PEOPLE:

GlipDPP4s
SGLTFlozins

4. HbA1c 58/+ = maintain 53
Glip DPP4i NOT Pio
Pio + SU
SU + SGLT2i
GlipDPP4i + SU
Pio + SGLT2i (not dapaglif)
GlipDPP4i + SGLT2i = Ertuglif @Pio/SU CI

DM + FAT PEOPLE:

GlipDPP4s
SGLTFlozins

5a. HbA1c 58/+ = maintain 53
- Metformin
- SU
- GLP-1 ag*@:

BMI <35 + insulin =
work issues/WL benefit obesity cx

BMI >35 + obesity cx (med/psych)

*Continue GLP-1 ag if:
-HbA1c Lower by 11/+
AND
-WL 3% BW/ 6m

5b.
Insulin:
NPH=SA @HbA1c 75/+
Detemir/Glargine
Pre-mixed w/ SA analogue

DM2 + CVD = 80 Atorva
DM2 - CVD = 20 Atorva @
- 84/- + Q10+
- 85/+ 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Metformin intolerance?

GlipDPP4i/Pio/SU/SGLT2i
GlipDPP4i/Pio/SU/SGLT2i = any 2
- SGLT2i > GlipDPP4 @Pio/SU CI

3. Insulin DM2:
NPH=SA @HbA1c 75/+
Detemir/Glargine
Pre-mixed w/ SA analogue
\_\_\_\_\_\_\_

WHAT TO GIVE IN DM+FAT PEOPLE?!
-GlipDPP4s
-SGLTFlozins
#Gliptins/Flozins/Gliptins/Flozins/Gliptins/Flozins/Gliptins/Flozins

Question 27

Q

GDM - booking appt:

PUBB-G:

Prev
1. ?
2. GDM -> ?Ix/ ?Ix @booking
-ifNormal–> ? @ w?

-Urine BM ? /+ x?

-BMI > ? +
Birth < ?w recommended +
Anesthetic r/v @? / ? +
? @fetal lung mat

B? /GDM in who?
-> do what Ix?:

FPG ? OR OGTT ?
- ? + ?blood-test < ?wks / ?-? wks

FPG 6.1-6.9 =

Lifestyle d/e -2wk/fail->
Metformin
a. –cant tol-> Insulin alone
b. –CAN tol but BM control fail-> + Insulin
c. -Insulin –can’t tol/fail-> Gliben (?discontinued)

FPG 7.0/+ OR ?/? + 6.1-6.9 = ? ± ? + ?

measure:
- ? @DM2/GDM = NOT@multiple daily injections

? @DM2/GDM @multiple daily injections
? @DM1 @multiple daily injections

cap BM target:
-Fasting ?, AND
-1hr Post Meal ?
-2hr Post Meal ?
Hba1c 48/+ = ?
\_\_\_\_\_\_\_\_\_\_\_\_\_

Pre-Existing DM @preg
1a. Renal Assx: 
Creat > ? 
Urine Alb:Creat > ?  -->   >? #?proph
TProt > ? g/d -> ? g/d #?proph

1b. Retinal Assx:
digital image w/ ? w/ ?
@1stANC –DiabRetinopath–> w? –> w?

Anomaly scan @w? + ?Ix =
w?-? // USS/?wk
WL @BMI >?/+

4. 
Birth @?w recommended 
Anaesthetic r/v @?
Steds @?
-FPG @?w post-natal check

Answer

A

GDM - booking appt:

Prev
1. macrosomia 4.5kg /+
2. GDM -> selfBM/OGTT @booking
-ifNormal–> OGTT @w24-28

-Urine BM ++ / + x2

-BMI >30 + 
Birth <40+6w recommended + 
Anesthetic r/v @obesity/auto neuropathy + 
steds/tocolysis @fetal lung mat
-BAME/GDM FDR

–> do 2hr-OGTT:

FPG 5.6/+ OR OGTT 7.8/+
-GDM ANC + HbA1c <1wk / 1-2wks

FPG 6.1-6.9 =

Lifestyle d/e -2wk/fail->
Metformin
a. –cant tol-> Insulin alone
b. –CAN tol but BM control fail-> + Insulin
c. -Insulin –can’t tol/fail-> Gliben (?discontinued)

FPG 7.0/+ // PolyHydramnios/Macrosomia+6.1-6.9 =
INSULIN ± Metformin + d/e

measure:
-Fasting + Post Meal-1hr
@DM2/GDM NOTTTTTT@multiple daily injections

-Fasting, Pre + Post Meal-1hr, Bedtime
@DM1 / DM2/GDM @multiple daily injections

cap BM target:
-Fasting 5.3, AND
-1hr Post Meal 7.8
-2hr Post Meal 6.4
Hba1c 48/+ = HRisk
\_\_\_\_\_\_\_\_\_\_\_\_\_

Pre-Existing DM @preg
1a. Renal Assx: 
Creat > 120 
Urine A:C >30 -->  >220 #VTEproph
TProt >0.5g/d -> 5g/d #VTEproph

1b. Retinal Assx: 16, 28
digital image w/ mydriasis w/ procainimide
@1stANC–DiabRetinopath–> w16-20 –> w28

Anomaly scan @w20 + 4-chamber heart view = 28
w28-36 / USS/4wk
WL @BMI >28/+

4. 
Birth @37 - 38+6w recommended 
Anaesthetic r/v @obesity/auto neuropath
Steds/Tocolysis @fetal-lung-mat
-FPG @6w post-natal check (6-13 w PP)

Question 28

Q

HHS:

? ) Normal
? ) ?+?
? ) ?

0-1hrs:
BP <90 = ?

Insulin ? u/kg/hr @
-Keton uria ? / gen >?

Ix?

Hx = ?
Ex = ?
FOOT EXAM

1-6hrs = <3L+FB

high Na + osmo:
1. dec by <3/inc = ?
legit = ?
not legit = ?
2. dec by 3-8 mosmol/kg/hr = ?
3. dec by >8 = ?

Na dec by ? mmol/L/?
K <3.5 = ? / 3.5-5.3 = ?

BM ? BY /hr
-Aim ?
-Aim ?/hr 
-->
\+FB:
-legit = ?
-not-legit = ?

6-12hrs = <6L +FB
-BM <14 = ?
Aim = Avoid ?
Aim ? in 1st ? hrs

>12hrs:
Drink+Eat/? if not
?->? @Resolve/Ready2eat -?min-> ?IV
Check ?
?CHECK
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

HHS Cx?

Answer

A

Hypovol ) Normal
Osmo >320 ) pH+HCO3 >15
BM >30 ) Ketones

BP <90 = 500ml NaCl / stat ->
- >90 = 1L / 1 2 2 4 4 6hrs = 
slower @y/o/preg/HF-LF-RF
prev c.oed/cerebral pontine mylineolysis
- <90 = senior/icu/repeat

Insulin 0.05 u/kg/hr @
-Keton uria 2/+ / gen >1

U+E, obs, Fluids-UO
EWS, LMWH, ABG, NG @obtunded/vomit, ECG

     BM FBC, U+E, MCS(blood), ECG
     MSU

Hx = vasc/infection
Ex = dehydration
FOOT EXAM

1-6hrs = <3L+FB

high Na + osmo:
1. dec by <3/inc = check +FB
legit = 0.45% NaCl
not legit = inc 0.9% rate
2. dec by 3-8 mosmol/kg/hr = 0.9% Nacl
3. dec by >8 = dec 0.9% rate +/- FRIII

Na dec by 10mmol/L/d
K <3.5 = senior / 3.5-5.3 = 40mmol/L

BM dec BY <5/hr
-Aim 10-15
-Aim 4-6/hr 
-->
\+FB:
-legit = FRIII 0.05u/kg/hr -> 
0.1 u/kg/hr if already on
-not-legit = 0.45% / inc 0.9% rate if osmo dec by <3/inc  w/ +FB

6-12hrs = <6L +FB
-BM <14 = DexSaline 10%/0.9% @125ml/hr
Aim = Avoid Hypo
Aim 10-15 in 1st 24-hrs

> 12hrs:
Drink+Eat/Senior if not
IV->SC @Resolve/Ready2eat -30min-> stop IV
Check K+ high/low / Oed cerebral/pul / BM low
FOOT CHECK
______________

Lactic Acid
Oed cerebral/pul
Stroke-VTE
Triglyc
Rhabdo
RF-AKI

Question 29

Q

DKA:

0-1hrs:

BP <90 ? / K+ ?
- ? later for kids
Insulin
Bloods
__________

1-6-hrs: check hourly BKH-KA
BM ?          ? mmol/L/hr
Ketone ?-   ? mmol/L/hr
HCO3- ?-   ? mmol/L/hr
_
K <3.5 / >5.3 = check ?
AVOID ?

Ix?

-FAIL->

?
?
__________

12-24hrs:
BM = ?
-Aim=Avoid ?
-Aim ? @1st 24hrs

–> Cont ? till resolve:
pH >? ; HCO3 >?
Ketones
?

DKA RESOLUTION?

DKA pathphys:

HAKAI:
Hyperglyc >?
HyperKal > ? –> @severe

Acidosis met

pH –> @severe*
HC03 –> @severe*

Keton

breath
uria +?
gen >? –> >? @severe*

Amylase/Abdo pain

Infection 
*severe:
HR >?/ 
Anion-gap ?/+ (high anion)
SpO2 
low GCS ?/-
BP

Answer

A

DKA:

0-1hrs
1. BP <90 = 500ml NaCl/stat -> 
- >90 = 1L/1 2 4 4 6 hrs
slow @ y/o/preg/ HF LF RF
prev c.oedema/CPMyelinolysis

<90 = senior/ICU/repeat

K <3.5 = senior
K 3.5-5.3 = 40mmol/L
-1hr later for kids

ACTRAPID 0.1 u/kg/hr = 50u/50ml
-FIXED-RATE
-IM stat @delay
+
LONG ACTING continue
-stop SA
```
 BM FBC U+E MCS (blood) ECG
 MSU \_\_\_\_\_\_\_\_\_\_
```

1-6-hrs: check hourly
BM Dec -           3 mmol/L/hr
Ketone Dec - 0.5 mmol/L/hr
HCO3- Inc -       3 mmol/L/hr
_
K <3.5 / >5.3 = check hrly
AVOID HYPO

U+E, obs, Fluid-UO
EWS, LMWH, ABG, NG @obtunded/vomit, ECG

-FAIL->

check Pump Connected Working
Inc insulin by 1u/hr
__________

12-24hrs:
BM <14 = DexSaline 10%/0.9%
-Aim=Avoid Hypo +
-Aim 10-15 @1st 24hrs

--> Cont FRIII till resolve:
pH >7.3; HCO3 >15
Ketones <0.6
Drink+Eat/Senior if not #VRIII
\_\_\_\_\_\_\_\_\_\_

DKA RESOLUTION:

Drink+Eat/Senior if not #VRIII
IV -> SC @Resolve/Ready2eat -30mins-> Stop IV
Check K+ high/low, Oed cerebral/pul, BM hypo
FOOT EXAM

DKA pathphys:
Uncontrolled catabolism ->
-Lipolysis = high ketones
-HyperGlyc = high: serum osmo + osmo diuresis 
--> dehydration/hypovol 
\_\_\_\_\_\_\_\_

Hyperglyc >11
HyperKal > 5.3 –> <3.5 @severe

Acidosis met

pH<7.3 –> <7.1 @severe*
HC03 <15 –> <5 @severe*

Keton

breath
uria +2
gen >3 –> >6 @severe*

Amylase/Abdo pain

Infection

*severe:
HR >100 / <60
Anion-gap 17/+
SpO2 <92
low GCS 11/-
BP <90

Question 30

Q

HyperT Tx: What to do if:

HypoT AFTER antithyroid drugs?

RAI -6m-> still HyperT = infer what -> ?

TSH >20 for 1/+ m = ?
TSH <0.1 x2/3m = ?

Drug monitoring?

RAI monitoring?

If euthyroid for 6m, measure TSH when?
If euthyroid for 12m, measure TSH when?
________________

How to diff between HypoT and HyperT?

Grave =

Acropachy clubbing,
Exophthalmos - Ophthalmoplegia,
Pretibial Myxoedema

Answer

A

What to do if:

HypoT AFTER antithyroid drugs?
?reduce doses

RAI -6m-> still HyperT = ?suboptimal tx ->
AT drugs till 6m appt

TSH >20 for 1/+m = ?LTX
TSH <0.1 x2/3m = just refer ffs
________

Drug monitoring:

TSH/T43 /

6w –until range–>
12w till stop –after stop–><8w –>
12w for 1yr -> annually

TSH/T43 /

6w -6m-> till TSH in range ->
HyperT=?suboptimal tx=ATd till 6m appt
HypoT=?LTx

Euthyroid @
-6m = TSH @9m+12m
-12m = TSH/6m
_________________

HypoT:
Dry hair-coarse/skin
Menorrhagia

HyperT:
Pretib myxoed
Oligomenorrhoea
Lat malleoli oed lesions

Grave =

Acropachy clubbing,
Exophthalmos - Ophthalmoplegia,
Pretibial Myxoedema

Question 31

Q

HyperT Tx?

Bblock 4 Adr Syx ->
AT drugs =
preferred substrate 4
? by ?

T-B:
Carbimazole #? #?
PTU #? #?

B-R:
? +? @? in range

Thyrotoxicosis V HyperT
Thyrotoxicosis: ? #tx?

HyperT: ? V ? = Trust - Ix?

RAI contraindicated when?
AT drugs when? How long?
TT @?

Answer

A

Bblock 4 Adr Syx ->
AT drugs =
preferred substrate 4
iodination by TPase

T-B:
Carbimazole #Agran #Pancreatitis #T2+3preg
PTU #T1preg #ThyroToxCrisis

B-R:
Carbimazole + LTx @T4 in range

Thyrotoxicosis V HyperT
Thyrotoxicosis: TransientThyroiditis #supportiveB-block

HyperT: Graves V Toxic = TRUst
TSHrAB, Radionuclide scan, USS Thyroid doppler

RAI CI @ comp syx, orbitopathy, malignancy, preg <6m/father <4m/close-contact kids preggers <3w
AT drugs @high p(remission) 12-18m
TT @:
- HT @nodule
- Malignancy
- RAI CI
- Comp syx

Question 32

Q

HypoT:

Bloods and that table of causes? (check pic)

Overt TSH ? + T4 ?
Subclin TSH ? + T4 ? x?/?m:

LTx / RV ? = ?months
-adjust acc Syx reduce+reduceTFTs->
Stable TSH-T4,3 x?/?m in range / RV ? ?m +/- ?

Subclin:
-Syx, Age <65, TSH 4-10 -->
? -> Syx NOT improve ->
-TSH NOT improve = ?
-TSH improve = ?

Untx subclin/Stop LTx -> ?:

annually @ ?
2-3yrs @ ?

Answer

A

HypoT:

FBC/HbA1c/AntiTPO #/grave75% / Lipids/
TgAB#-TSHrAB=graves

Overt TSH >10 + T4 low
Subclin TSH >10 + T4 fine x2/3m
-for subclin MEASURE AGAIN @3m you fkn idiot i.e. x2/3m !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :

LTx / RV TSH-T4,3 = 3months
-adjust acc Syx reduce+reduceTFTs->
Stable TSH-T4,3 x2/3m in range / RV TSH 12m +/- ?lipids

Subclin:
-Syx, Age <65, TSH 4-10 -->
LTx 6m -> Syx NOT improve ->
-TSH NOT improve = ?overt tx
-TSH improve = stop LTx + ?ddx

Untx subclin/Stop LTx -> TSH check:

annually @ Thyroid dx, anti-TPO, RT/chemo
2-3yrs @ no thyroid dx

Question 33

Q

Causes HypoT:
VI:
ND: 1. 2. 3.

I: ?
C: ?
Ai: Goitre:
-Y=?
-N=?

How to differentiate between HypoT+HyperT:

Answer

A

Causes HypoT:
VI: viral -> SadQT:
1. HyperT <6w 2. Euthryoid <3w 3. HypoT HypoT @10-20yrs l8r +
2. Thalidomide, Rifamp, Amiod, Li +
3. 2ndary HypoT #MRI pit/brain = TITS SHAT
-Trauma/RAI/Surg
-Infarction pit
-Tumour pit
-Sheehan/Hypothal dx
+SystScler/Sarcoid, HChr, Amyloidosis, TB

I: RAI, iod def LEDCs, Preg-PPT
C: underdevelopment > hypoplasia
Ai: Goitre:
-Y=Hashimoto
-N=Atrophic/Myxoed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

HypoT:
Dry hair-coarse/skin
Menorrhagia

HyperT:
Pretib myxoed
Oligomenorrhoea
Lat malleoli oed lesions

Neuro, eyes, ears, tongue dx
CHD, HF. DM/Dyslipidema
Miscarriage, Anemia, Pph/PreEcl/PlacAbruption, Infertiliy,
Neonate: congen dx/hypoT, low BW, ARDS, preterm delivery

Question 34

Q

Diabetes insip:
If you get rid of Water via Wee, blood becomes ?

Urine ?L/day -> ?Test
MeasuredPO - CalcPO* <10 = ?
*CalcPO formula
–>

PO >? - ?
UO - ?
–>

Respond 2
Desmopressin
2mic #ADHanalog
–>

Y - ?: Tx?
N - ?: Tx?

*NSAID=COXi=lowPGs= ?

DI Ax?
Pathphys?

Answer

A

Diabetes insip:
If you get rid of Water via Wee, blood becomes SALTIER

Urine 3L/day -> 8hr Deprivation Test
Measured-Calc*<10 = true hyponat
*2(Na+K)-(BM+Urea)

–>
PO >300 - conc
UO<600 - dilated
–>

Respond 2
Desmopressin
2mic #ADHanalog
–>

Y - Cranial: PO<300 , UO>600 = Desmopressin
N - Nephrogenic: Ax tx, Bendro, NSAID*

*NSAID=COXi=lowPGs=Inc kidney ADH response

DI Ax:
V-hemorrhage
I-MeningoEnceph
N-cranipharyngioma=LQ.BT.HA/mets/pituitary dx
Demeclocycline+Li #nephrogenic
I Hypophysectomy
C DIDMOAD
Ai - Hypophysitis/SARCOID
Trauma
E: HYPERCalc/hypoK+ /RF

Pathphys:
Cranial: Dec ADH @postpit
Nephrogen: Dec kidney ADH response
-->
lowADH=lowH2O absorption/highH20secrete
-HYPERnat, polydipsia/uria/thirst

Question 35

Q

Addison’s tx?

Androgens: ?
Glucocort: ? =AM?mg, PM?mg, PM?mg
-resemble ?
Mineralocort: Fludrocort=?dose @ ?
-prevent ?

Self-care:

?
?
Syringes - ?
Travel - ?, ?

Doses:
5-10mg
-strenuous ex (low=? / high=? x2 fluids, glucocort, mineralo)

20mg
-?

x2 dose

?
dental-GA = ?

Answer

A

Addison’s tx?

Androgens: DHEA
Glucocort: Hydrocort=AM10mg, PM5mg, PM5mg
-resemble nat c.sted cycle
Mineralocort: Fludrocort=inc @inc Na loss in humidity
-prevent postural hypoTN

Self-care:

Medic-alert/Sted card/Crisis letter
Other Ai dx screen
Syringes - IM teach @vomit/emergency
Travel - Extra meds, Emerg Hydrocort Kit

Doses:
5-10mg
-strenuous ex (low=hike, high=marathon - x2 fluids, glucocort, mineralo)

20mg
-major injury/nausea

x2 dose

illness/fever/surg-endo
dental-GA = double 1hrb4 procedure = cont 24hr only

Question 36

Q

SL3
S
CR

Question 37

Q

Bone pain (?which dx?)
Deformity (?which dx?)
\+
HSM (?which dx?)
-OMRicKIDS Tx: ?
-OPetrosis:Tx: ?
-Pagets:Tx: ?
\_\_\_\_\_\_\_\_\_\_\_\_

Bone pain+Deformity:
-OMRicKIDS
My?

RicKIDS - ? NOT fused
V?
O?
L?
T?
X-ray sign? - LOOSERs Pseudo#
Tx: ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Bone pain, Deformity + HSM:
-Dx?:
PathPhys?
Tx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Bone pain+Deformity:
PathPhys? Tx?
-Skull, Spine, Pelvis
-Long bones = femur/tibia

Answer

A

Bone pain (all 3 bone dx - OM/OPet/Paget)
Deformity  (all 3 bone dx - OM/OPet/Paget)
\+
HSM - (JUST Petrosis)
-OMRicKIDS Tx: Ca+Vit D
-OPetrosis:Tx: BMT, alpha-IFN, EPO
-Pagets:Tx: Bisphosphonates
\_\_\_\_\_\_\_\_\_\_\_

Bone pain+Deformity:
-OMRicKIDS
Myopathy/Myalgia

RicKIDS - apophysis NOT fused
Vit D resistance
OsteoDystrophy
LF
Tumour

X-ray sign? - LOOSERs Pseudo#
Tx: Ca+Vit D
______________

Bone pain, Deformity + HSM:
-OPetrosis:
OC dx -> bone expands = BM narrow ->
ExtraMedHematopoeisis
                HSM
Tx?
BMT, alpha-IFN, EPO
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Pagets:
XS OB/C activity -> Pain+deformity
Tx: Bisphosphonates

Question 38

Q

OA syx?

Ix:

Tx:

Answer

A

OA syx?
Weakness
Effusions
Instability
ROM low
Deformity
Swelling/synovitis

Ix:
MDT - pSych/pOdiatry/pAin team
Education 
TENS
Hot-Cold comp

Tx:
Paracetamol
Capsaicin
Opioids
IA injections
NSAID top(hand knees)/oral 
Surg - THR/HR Spine stuff

Question 39

Q

St 1, St 2, St 3 HTN

180/120/+ w/ what 3 things?

NO = ?
YES = (1.) ? (2.) ? :
- 1. Tx?
- 2. Syx?

160/110

160/100
160/90
150/90

140/90
140/90
140/90

130/80
130/80
______________

BP tx when?

<40 = ?*
<60 + ?
<80 + ?
> 80 ?

Ix?

Tx?

Answer

A

St 1: 140/90 -ABPM-> 135/85
St 2: 160/100 -ABPM-> 150/95
St 3: 180/120
________

180/120/+ w/ PapOed/RetHaem/LT syx*
*Confusion/ChestPain-CCF/AKI

NO = 
-CVD RF - Lipid profile/Q10
-Lifestyle
-EODx Assx = 
HUria/HbA1c, Urine ACR/U+E, Fundoscopy, ECG:
Y = Tx-ABPM
N = BP 7d repeat

YES = 1. 999 Malig Acc HTN 2. Suspected Phaemo:
- 1. Rest, Atenolol, Nitroprusside/Labetalol, DBP drop <100/12-24hrs

- 2. Suspected Phaemo:
HA/HTN, Anxiety, Sweat 
\+
pHoresis, pALlor/pALp, pOst HypoTN
\_\_\_\_\_\_\_\_

160/110 / 2/+ PUria = refer @preg
-@PPartum BP > 150/100 start anti-HTN tx =
E/NAm ENAtLab

160/100 -ABPM-> 150/95 = St 2
160/90 = Isol Syst HTN
150/90 -ABPM-> 145/85 St 1 >80y

140/90 = gHTN/PreEcl
140/90 -ABPM-> 135/85 St 1 <80y
140/90 CKD + ACR <70

130/80 CKD + ACR >70
130/80 DM = AlbuminUria + 2/+ WTHG
___________________

BP tx when?

<40 = 2ndary cause find*
<60 + Q10/-
<80 +
- CVD established
- DM
- EODx
- Renal dx
- Q10/+ = 20mg Atorva
> 80 >150/90

*Ix:
CVD - Coarc/RAS
Renal dx = LUMP*
Eye dx Keith Wagner
ECG
Endo - Thyroid/Acromeg/GFR** dx
Drugs

*
Lump - RCC
Urine: PUria/AlbUria = DM / HUria = g.nephritis
Mass = obst uropathy/RCC @loin
Pyelo

**G(Ald:Renin/synACTHen)
F(DexaSuppTest)
R
Catechol (urine metaneph/CT-AP/meta-IBG)
\_\_\_\_\_\_\_\_\_\_\_\_\_

Age<55/DM Age>55/Black

ACE/ARB C/D @ccb-CI e.g.CCF
A+C > A+D
A+C+D
K 4.5/- = Spiro / 4.51/+ = alpha/beta-block
Refer specialist

Question 40

Q

Gout tx?

Initially? - i.e. lifestyle stuff
–>

?
3 types of meds? Continue what?

–DCT = fail =max dose/switch–>

f/u ?wks

?blood test
?CVD stuffBLUH
? discuss

–>

ULTx @ ?

T?/yr // T?
? stones
RF GFR < ?
Proph @CDP

the British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy to all patients after their ? attack of gout
–>

? (?risk of starting this) / ? (?blood test)

start ? -> titrate/?w -> Aim < ?
>

ULT for yeeeeears:
Titrate to ? - ? 
Stop @:
? uric acid
low ?
Cure = defined as ? + ?
Explain ?

Person has gout but is TAKING Diuretic for:

BP, what to do?
HF what to do?

Answer

A

Gout tx?

Weight loss, Hydrate, Alco, Meat (fish kidney liver), Smoke
->

RICE
Colchicine (slower acting) <
NSAID+PPI (quicker)
Csteds - IA IM PO
-Cont Allop/Febuxo if already on

–DCT = fail =max dose/switch–>

f/u 4-6wks

Uric Acid level
BP, Lipids, U+E, HbA1c, CVD/Kidney assx/year
Pri/2ndary Prev d/w

–>

ULTx @:

Two/+ attacks/yr // Tophi/joints
Urate stones
RF GFR <60
Proph @cytotoxics/diuretics/pyrazinamide

the British Society of Rheumatology Guidelines = advocate offering ULT to all patients after their FIRST BASTARD attack of gout

Offer allopurinol TWO weeks AFTER attack with colchicine cover
->

Allopurinol (GoutAttackRisk)/Febuxo(LFT)

start low -> titrate/4w -> Aim <300
>

ULT for yeeeeears:
Titrate to 300-360
Stop @:
Norm uric acid
low RFs
Cure = acute attacks stop + no tophi
Explain no guarantee of syx return

Person has gout but is TAKING Diuretic for:

BP, what to do? - switch
HF what to do? - continue!!

Question 41

Q

Rheumatoid arthiritis
-?PSS
-AM/? 
-MCP ?
-JUBZ?
----Z-deformity = IPJ=?, MCP=? similar to boutonnire
\_\_\_\_\_\_\_\_\_\_\_\_

SUSPECTED RA basically give ?
-?Size JOINTS )
- ?/+ JOINTS    ) Refer < ?d
-Delay in:         )
sx onset/docs = ? m
\+
?Analgesia + ?gastro-protection
Perisistent ? 
-refer ? ww

CONFIRMED RA #flare basically give ?
-Exclude ?
-?routes of csteds
± ?Analgesia + ?gastro-protection
-vaccines?
\_\_\_\_\_\_\_\_\_\_\_\_

?Size/ ?/+ joints, Delay ?/? ?m = refer < ?d
PT/OT
Aim - reduce remission/activity 
Tx < ?m 
-->

? = Surg assx @:
Bone - ?Cx
? / ? exclude
Nerve - ?Cx
TENdon - ?Cx
\_\_\_\_\_\_\_\_\_\_\_\_
Tx: 
1. ? ± csteds routes?
2. ?-FA + Biologics @DAS > ? * **
*-single @ ?
-switch @ ?

?-FA + ?
- CD20i/6m

**S ACEi T+BA
S?- IL6i
\_\_\_\_
A?
C?             TNFi-TB/cancer
E?       EULAR 6m
I?                 #monitor
\_\_\_\_\_\_\_\_
T? - IL6i 
\+
B? - JAKi
A? - TCo

Answer

A

Rheumatoid arthiritis
-pain/swelling/stiff
-AM/inactivity 
-MCP squeeze
-Joint swell
-Ulnar deviation
-Boutonniere(dip ext, pip flex), Swan-neck (dip flex, pip ext)
-Z-deformity = IPJ=HExt, MCP=Flex similar to boutonnire
\_\_\_\_\_\_\_\_\_\_\_\_

Suspected basically give NSAID/Coxib
-Small JOINTS )
-1/+ JOINTS      ) Refer <3d
-Delay in:          )
sx onset/docs = 3m)
\+
NSAID/Coxib LD+PPI
Perisistent synovitis 
-refer 3WW

Confirmed #flare basically give csteds
-Exclude Septic Arth
-IA IM PO csteds
± NSAID/Coxib LD + PPI
-Pneumo-one off/Flu annual
\_\_\_\_\_\_\_\_\_\_\_\_

Single/ 1/+ joints, Delay sx/docs 3m = refer <3d
PT/OT
Aim - reduce remission/activity 
Tx <3m 
-->

Persistent Prog Worsening = Surg assx @:
Bone - stress #
SA/DCM exclude
Nrve - compression
TENdon - rupture
\_\_\_\_\_\_\_\_\_\_\_\_
Tx: 
1. cDMARDS ± csteds IA IM PO
2. MTX-FA + Biologics  @DAS > 5.1 * **
*-single @mtx CI
-switch @ rituximab CI

MTX-FA + Rituximab
- CD20i/6m

**
Sarilumab - IL6i
\_\_\_\_
Adalimumab
Certo             TNFi-TB/cancer
Etanercept       EULAR 6m
Inflix                  #monitor
\_\_\_\_\_\_\_\_
Tocolix - IL6i 
\+
Baricitinib - JAKi
Abatercept - TCo

Question 42

Q

RA Ix

RA Cx?
_________

OroPharyngeal ulcers = Mucositis
ANT = MyeLosupp
       LF/Lung dx
FA 1/wk IM/PO - @diff-times
Avoid ?ABx

LF + HTN
Lung dx

Sperm motility
         SJS-rash
Heinz body Hb low #G6PDavoid
Avoid ?Analgesia/ ABx
Lung dx

(lung dx basically @ which 3? )
(LF basically @which 2? )

? - eyes

ProtUria?
-? –> MGravis
______

‘Can’t see, pee or climb a tree’
Tx?

Pencil in cup, fucked nails

Tx done by rheum
Tx as ?
(severe deformity fingers/hand, ‘TELESCOPING fingers’)

Answer

A

CRP, DAS >5.1, ESR, FBC
LFTs, U+E, RhF-IgM, Anti-ccp, X-ray
-Loss of JS
-Osteopenia
-Soft tissue swelling
-Erosions
-Deformity

Widespread
Relapse-Remit
Sudden/systemic
Extra-Art

Cx:
Cardio: Pericarditis, Effusion-pericardial, IHD
Lung: Pleuritis, Effusion-pleural, BOOP
Eye: SiccaKC > Scleritis > Conjunctivitis
Felty: RA, Neutropenia, SMeg
\_\_\_\_\_\_\_\_\_\_
MTX
Mucositis
MyeLosupp
       LF/Lung dx
FA 1/wk IM/PO - @diff-times
Avoid Trimeth

Leflunamide
LF + HTN
Lung dx

SulfaSperm motility
         SJS-rash
Heinz body Hb low #G6PDavoid
Avoid Asp/Sulfonamides
Lung dx

(lung dx basically @MLS: MTX, Leflu, Sulfasal)
(LF basically @ML: MTX + Leflu)

HOHchloroquine - eyes

ProtUria = Penicllamine/gold
Penicllamine –> MGravis
________

‘Can’t see, pee or climb a tree’
NSAIDS
Csteds IA
-MTX/Sulfasalazine

Pencil in cup, fucked nails

Tx done by rheum
Tx as RA
arthritis mutilans (severe deformity fingers/hand, ‘TELESCOPING fingers’)

Question 43

Q

Ank Spond - Gene?
-NEED IMAGING TO CONFIRM!!!!!! FUCK THE GENE SHIT!!!

MSPEAQ-APICES-BLOCKERS

-MSPEAQ
M gender?
Spine dx + lig-vertebrae esthesis fuse
Pain where?
Extra-Art*
A?
Q? posture
-LBP < ?5
-improve @?Analgesia/ ?
-Night pain @? half
-Burn
\+
Psoriatic/ Enthesitis/ Arthiritis/ Recurrent flares #biologics
#LINB PEAR

-APICES:
A...? / A?
Pul ? upper lung #apex
I - eye dx?
Costal cartilage dx..? /Conduction dx
Enthesitis-> ? FUSE-> Ankylosis

-BLOCKERS
B? spine
LOrdosis ?
Compensatory
K?
E?
Radiate SI joint -> ?
Schober < ?cm

Tx:
(summary of the shit below)
1. ANALGESIA?+?gastroprotect + ?/? –FAIL–> ? +/- ?
2. ?Bisphosphonates
3. Uncontrolled = ? (which one?)
4. Surg: Hip-THR/HA, Spine #/deformity
5. Ensure that a person with axial spondyloarthritis receives an Assx for OSTEOPORISIS every ? years.

SCRAN MEAL
BUSES

Syx ?
Cure ?
Refer ?
Ant Uveitis ?
ANALGESIA? --FAIL-> ? +/- ?

MDT - pt/ot
Education - swim/stretch
ADLs
Life Quality Assx
-pain/mood/sleep
-ExtraArt dx
-Adverse drug effects

Bisphosphonates
Uncontrolled = TNFi-TB/Cancer
-secukinab
Syndesmophytes 
Enthesitis
Surg: Hip-THR/HA, Spine #/deformity

Answer

A

HLA-B27
-NEED IMAGING TO CONFIRM!!!!!! FUCK THE GENE SHIT!!!

MSPEAQ-APICES-BLOCKERS

-MSPEAQ
Males
Spine dx + lig-vertebrae esthesis fuse
Pain-LBP @BUM
Extra-Art*
Anklyosis
Question-mark posture
-LBP < 35
-improve @NSAID/moving
-Night pain @2nd half
-Burn
\+
Psoriatic/Enthesitis/Arthiritis/Recurrent flares #biologics
#LINB PEAR

-APICES:
*Amyloidosis/Aortitis
Pul fibrosis
Iritis-uveitis
Costochondritis/Conduction dx=AVN
Enthesitis-> SynDesmoPhytes FUSE-> Ankylosis

-BLOCKERS
Bamboo spine
LOrdosis Loss
Compensatory
Kyphosis
Enthesitis 
Radiate SI joint -> Hips
Schober <5cm

Tx:
(summary of the shit below)
1. NSAIDs/coxib+PPI + PT/OT --fail--> Paracet +/- cod
2. ?Bisphosphonates
3. Uncontrolled = TNFi =(TB/Cancer)
-SECU-KINAB
4. Surg: Hip-THR/HA, Spine #/deformity
5. Ensure that a person with axial spondyloarthritis receives an assessment for OSTEOPORISIS every 2 years.

Scran Meal Buses:
Syx variation
Cure X
Refer rheum
Ant Uveitis refer
NSAIDs/coxib + PPI --fail--> Paracet +/- cod

MDT - pt/ot
Education - swim/stretch
ADLs
Life Quality Assx
-pain/mood/sleep
-ExtraArt dx
-Adverse drug effects

Bisphosphonates
Uncontrolled = TNFi-TB/Cancer
-secukinab
Syndesmophytes 
Enthesitis
Surg: Hip-THR/HA, Spine #/deformity

Question 44

Q

SL3
     S ? 
   CRP? 
T3HSR
AB v AutoAG

Tx?

Ix?
-histone AB drugs?

Syx?

APLS- ABs?

C?
L?
Obst Cx =?
T?

Answer

A

SL3
     S  high
   CRP~
T3HSR
AB v AutoAG

Tx:
HOH
Mycophenolate
Mild: csteds/sunblock
Mod: DMARDs
Severe: Rituximab/Cyclophosph/Sted HD
Maintenance: NSAID/Azo/MTX/bElumimab

Ix:
RhF
U1 RNP
Ds-Dna
ENA
ANA
Smith
Histone*

Ds-dna
low c3/4 -> high c3d/4d
ESR high, CRP norm

*
TNFi-TB/Cancer
Tetracylc-mino
Epileptic - phenytoin
AntiArryhtmics - Procainimide
Chlorpromazine
Hydralazine

Syx? 
Rash - malar/discoid
Arthralgia
Serositis - percard/pleuritis/myocarditis
Haem ANT

OroPharyngeal ulcers
Renal g.nephritis

PS
ANA
IC T3HSR
Neuro dx

APLS- Cardiolipin/Coagulant/gp12b

Clots VTE
Livido Reticularis
Obst Cx = miscarriage
TCP/APTT high paradox

Question 45

Q

OP Bisphosph @GFR > 30!!!!!!! Bisphosph @GFR > 30!!!!!!! Bisphosph @GFR > 30!!!!!!! Bisphosph @GFR > 30!!!!!!! Bisphosph @GFR > 30!!!!!!!

‘Long-term Csted’ definition = ?

Before diagnosing OP, what 2 things?
-Exclude ?
+
- ? Assx

–> 1. ?Ix or 2. ?Ix

1a. DEXA @ ?

1b.
When to Tx w/out doing DEXA

QFrac / FRAX:

QFrac >10 ~10 / FRAX R O: 
?Ix 
?-score
Assess what in the bone? :
( -1, -2.5) = ?Dx = what 3 things < ?yrs
(< -2.5) = ?Dx = BSC Surg*
- (< -1.5 + ?) 
--(3 criteria) 
\+ 
--(?cm height loss/ ?osis #vertebral f# Assx)

Porosis -> BSC Surg:
-B? + PPI @GFR > ? =
r/v ?(zolend)-?(alend and others) years = QFrac + DEXA

When to Tx w/out DEXA = Alend 10yrs / Rised 7yrs

Bone mets = ? + ?
used to prevent ?
-GFR < 30, ? is preferred

SERM / Strontium:

PMP 2ndry prev frag# = ? / ?
PMP Pri/2ndry prev frag# = ?

-PreMP = ? ASAP to reduce p(?)

Ca intake:
-legit = ?
-shit = 
?  + ? 
? + ?

Surg:
?@?healed AND pain
_________

Low Risk = QFrac < 10 / FRAX G
-MDT
-Education
-Weight-? ex
-? exposure 
\_\_\_\_\_\_\_\_\_

HRisk groups:

women ‘’? - ? w/ RFs’’ OR ‘’?/+’’
__ men ‘’? - ? w/ RFs’’ OR ‘’?/+’’

Sun exp low / Burqa =
?units / ?units @Old Vit D + Ca 1g/d

<50 -> <40

S? –40-> ?steds
Hx of ? –40-> ?/ ?/ ?/ 2/+
Early ? untx –40-> HRT ASAP = reduce p(frag #)

Answer

A

op
‘Long-term Csted’ definition = Sted HD for 3m

Before diagnosing OP
Exclude 
non-OP # Ax
-mets/met bone dx/MM
\+
Frag # Assx

–> 1. DEXA or 2. QFrac/FRAX:

1a. DEXA @:
>50 + frag #
< 40 + RFs
Bisphosphonates 3-5 yrs #AtypFem#

1b.
-75/+ + already on -> cont tx
Hip frag #
Spine frag #
–> Tx w/out doing DEXA

QFrac / FRAX:

QFrac >10 ~10 / FRAX R O: 
DEXA 
T-score
BMD:
( -1, -2.5) = Penia = modify RFs + stop bisphosph if already on + DEXA < 2yrs
(< -2.5) = Porosis = BSC Surg*
- (< -1.5 + steds) 
--(PMP, Men >50, Sted HD) 
\+ 
--(4cm height loss/kyphosis #vertebral f# Assx)

Porosis -> BSC Surg:
-Bisphosphonates + PPI @GFR > 30!!!!!!! =
r/v 3 (zolend)-5(alend and others) years = QFrac + DEXA

75/+ + already on -> cont tx
Hip frag #
Spine frag #
-> Tx w/out DEXA = Alend 10yrs / Rised 7yrs

Bone mets = Bisphosphonates + Denosumab
used to prevent Pathological #
-GFR < 30, denosumab is preferred

SERM / Strontium:

PMP 2ndry prev frag# = Raloxifene/Teriparitide
PMP Pri/2ndry prev frag# = Denusomab

-PreMP = HRT ASAP to reduce p(frag #)

Ca intake:
-legit = 10 mic Vit D @low sun-exposure
-shit = 
10 mic Vit D  + Ca 1g/d 
20 mic @Old + Ca 1g/d

Surg:
VertebroPlasty / Kyphoplasty @ UNhealed AND pain
_________

Low Risk = QFrac < 10 / FRAX G
-MDT
-Education
-Weight-bear ex
-SUN exposure 
\_\_\_\_\_\_\_\_

HRisk groups:

women ‘‘50 - 64 w/ RFs’’ OR ‘‘65/+’’
__ men ‘‘50 - 74 w/ RFs’’ OR ‘‘75/+’’

Sun exp low / Burqa =
10units / 20units @Old Vit D + Ca 1g/d

<50 -> <40

Steds –40-> HD steds
Hx of frag # –40-> arm/spine/hip / 2/+
Early MP untx –40-> HRT ASAP = reduce p(frag #)

Question 46

Q

AKI:
Pre Renal Ax?

Intrinsic Ax?
V: ?
IND: ?
IC: ?
Ai: ?
Trauma x
E: ?

Post renal Ax?
________

What causes f+ for AKI i.e. 
rises in creatinine but aren't actually AKI?
-Trimeth = f+
-CKD prog = f+
-Preg = f+

Baseline V Creat:
St1             St2         St3
x? / ?d      x? / ?d      x? / ?d
?/+ /?d                  St?+?
Pre-test probablitiy:
1. low 2. high
1. ?d              ?d           ?hr
2. ?d             ?h           ?

Pt has CKD and Anemia - starts experiencing:
-BONE aches, 
-FLU-like syx
-RASHes 
WHAT medication pt started on>
\_\_\_\_\_\_\_\_\_\_

Refer -nephro for ? -uro for ?

Cx of RRT: HD > PeritD
-HD: 
ischemic ..?
F?
low ?
Syndrome..?
Time high/low taken?

-PD: H?/ I?/P?
____________

ADPKD (1=chr ?; 2=chr ?)
What Ix? @FHx ..?

Tx @CKD ?/?

Extra-renal manifestations of AD-PKD:

most common = LIVER cysts #HMegaly!!
Brain - ?
Heart - ?
Liver - ?

Answer

A

Pre Renal AKI ax:
CO low = HF LF RF + sepsis
Vol low = burns/3rd space loss/vomit
Drugs:
Pain-NSAID
aHTN-ACEi/ARB
Diuretics-Loops
DiMLi: Digox, Metformin, Lithium

Intrinsic:
V: isch/chol emboli
IND: nephrotoxics/RadioIodContrast
IC: glomerulonephritidies
Ai: vasculitis
Trauma
E: gout

Post renal:
Inside, on tube, outside

Inside: stones, sloughed renal papillae, clots
On: cancer / fibrosis
Outside:
-BPH, PC
-Aneurysm
-Nodes
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

What causes f+ for AKI i.e. 
rises in creatinine but aren't actually AKI?
-Trimeth = f+
-CKD prog = f+
-Preg = f+

Baseline V Creat:
St1             St2         St3
x1.5 / 7d  x2 / 7d   x3 / 7d
26/+ /2d                  St1+354
Pre-test probablitiy:
1. low 2. high
1. 3d             1d           6hr
2. 1d             6h           now

CKD + low Hb = Bone ache, FLU, Rashes
- EPO started on !!!

_________________

Refer

nephro for RRT
uro for ObstUropathy
RRT= HD > PeritD
ISCHAEMIC HEART DX
HD: iHD/Fistula/ low BP/ Syndrome Disequil-DIC/ Time lots
PD: Hernia/ Infection/ Peritonitis

-Met Acidosis
Anemia = EPO, Anorexia @uremia, RBC life low @HD, Stress Ulcer UGIB
DysLIPIDemia
-High K+ = patiromer/zirconium @gfr<45
-Uremia = pericarditis/encephalo/asterixis
-Na/H20 retention = POed/Overload
Growth low
EPO=Anemia
RODystrophy

OR

Refer @
A - Acidosis, 
E - Electrolyte HIGH K, 
I - dIalysis, 
O - Overload, 
U - Uraemia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ADPKD (1=chr 16; 2=chr 4)
AUSS @FHx 
<30 = 2/+
30-59 = 2/+ B/L
>60 = 4/+ B/L

Tx: Tolvaptan
@CKD 2/3
Prog fast

Extra-renal manifestations of AD-PKD:

Brain - Berry -> SAH
Heart - Aort Sinus Dilation/ MVP
Liver - cysts/ LF

Question 47

Q

CKD:
? m GFR < ? + ACR > ?
-GFR stages
-ACR stages

MDRD equation?

Refer: GA-RCGP
GFR? when dodgy?
ACR?
RAS suspect when?
Cx?
Genetic?
Poor HTN control @ ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Cx of RRT: HD > PeritD
-HD: 
ischemic ..?
F?
low ?
Syndrome..?
Time high/low taken?

-PD: H?/ I?/P?
____________
_______________

? + ?  @CKD Pri/2ndary prev of CVD
>?/+% drop in ? -->
do what to Statin dose 
PROVIDED GFR 30/+
-if GFR 30/- then ? b4 increasing dose

When give ACEi/ARB in CKD?
CKD + ACR 3/+ + ?
CKD + ACR 30/+ + ?
CKD + ACR 70/+
--> Tx?

Drop + Rise in what is norm @ACE/ARB starting?
Drop GFR ? %/ - = norm
Inc Creat ? %/+ = norm

BP targets:
ACR <70 = < ?
ACR >70 = < 130/80

Answer

A

CKD:
3m GFR<60 + ACR>3

MDRD equation?
Creat, Age, Gender, Ethnicity

90/+ 1
60/+ 2
45/+ 3a
30/+ 3b
15/+ 4
0/+ 5

<3 = A1
3-30 = A2
>30 = A3

Refer:
*GFR: 30/-
Drop 25/+ % / yr
Drop 15/+ /yr
*Dodgy @ Arny/Steak/Preggers

-ACR 70/+
-ACR 30/+ @ HUria
1/+ 2/3 exclu UTI

RAS suspect - Poor HTN control

GFR drop >25/+ % < 3m of ACE-ARB start/dose-inc
Pul Oed
Refractory HTN
RENAL BRUIT

Cx:

Anemia=EPO, Anorexia @uremia, RBC life low @HD, Stress ulcer @UGIB
Renal ODystrophy

Genetic PKD
Poor HTN control @ 4/+ meds
____________

RRT= HD > PeritD
HD: Fistula/ low BP/ Syndrome Disequil-DIC/ Time lots
PD: Hernia/ Infection/ Peritonitis STAPH EPIDERMIS !!!!!!!!!!!
_______________

APlts + Atorva 20mg @CKD Pri/2ndary prev of CVD
>40/+% drop in non-HDL ->
Statin dose inc
PROVIDED GFR 30/+
-if GFR 30/- then refer to specialist b4 increasing dose

-When give ACEi/ARB in CKD?
CKD +
-ACR 3/+ + DM
-ACR 30/+ + HTN
-ACR 70/+
--> ACEi/ARB

-Drop + Rise in what is norm @ACE/ARB starting?
Drop GFR 25%/- = norm
Inc Creat 30%/+ = norm

BP targets:
ACR <70 = <140/90
ACR >70 = <130/80

Question 48

Q

Dizzy
SOB
Palp/CP ->

AF Ix? (DONT MISS THIS BASTARD)

Pt w/ AF + HD unstable

(shock, hf, MI syncope)
-> ?

@VF=?sync-DC shock
__________

AF = acute/NLT =
?Tx initially
–>

< 48hr ?
- PO AC @ ?rhythm/risk?/stroke?
> 48hr / ?
-CVert techniques?
-Dronderone when?
Tx @permanent AF/CVDx?

______________

Rate - ?
a. How to give this shit?
b. CI of Rate control?
c. CI if combo B+Verap/Dili?
Rhythm = ?
struc HD = ?
No struct HD = ?
?
____________

CardioThoracic Surg --> AF
R?
Anticoag V no anticoag
Prevention meds?
Correct what?

For stroke prev:

AC: ?
no AC = ?

Answer

A

Dizzy
SOB
Palp/CP ->

AF Ix?

Pulse /
ECG -if parox-> 24 Holter /
Echo TTE excl valve dx

Pt w/ AF + HD unstable 
-(shock, hf, MI syncope)
--> Sync DC Shock 
-Sync DC shock:--x3--Repeat
-Amiod:--300mg---900mg
\_\_\_\_\_ /10-20mins_ /24hr

@VF=NONsync-DC shock
__________

AF = acute/NLT
Heparin 
start + cont 
till full assx
-->

< 48hr:
Rate/Rhythm + PO AC
-SR not restored
-HR AF*
-Prev stroke
*Recurrence/CardioVertFails/StructHD#exclTTE-valve dx/Time >12m
> 48hr/?

Rate -consider 4 LTRhythmControl->
3w AC / 4wk ?Amiod** (CI @CCF) ->
CardioVert = TOE guided/conventional ->

?Amiod <12m (CI @CCF) 
\+
LTRhythm control
-BetaBlock/Dronederone @
CHADSVASC 1/+
LADiam >5/+mm
Not CCF
-->

LAAblation/Pace AVN Ablation
@perm AF/CVDx

**If there is a high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion
______________

Rate - B/CCB/Dig
- verap/dili* /Dig @non-parox+sedentary

a. -single - combo

b. CI to rate control tx: 
Reversible Ax
AF -> HF
AFlutter, 
New onset AF

c. *(B+Verap/Dili=CI @:
- HB HF/ObstOutflow
- HR-low/AF/Flutter)

Rhythm = E > Pharm
struc HD = Amiod
No struct HD = Amiod/Flec
-LAAblate -Pace AVN Ablation

____________

CardioThoracic Surg –> AF

Rhythm = E v P
AC
Prev = B/Dili/Amdio
Electrolyte/Hypoxia correct

For stroke prev:

AC: DOAC/DabigaTHROMBINi/Warf
no AC = LA Appendage Occlusion

Question 49

Q

Stroke:
BP <185/110
BP high
BP 150-220 
\_\_\_\_\_\_\_\_\_

-Thrombectomy < #hrs
-Thrombolysis < #hrs
@#

-@AIS + #Circ @ #imaging
+ CT#/MR# = # ->
do what
@when?

<24hrs/wake up stroke:
@AIS + Prox?Circ -?vessel -?vessel
@?imaging
\+
? /? = ?
\_\_\_\_\_\_\_

Thrombolysis < ?hrs @:
- ?/? exclude = ?Ix @BIGHAM
BP < ?/110 –>

?drug ?mg -?w->
-? 
-? 
-? @AF
\_\_\_\_\_\_\_\_

Exclude ? 
? outside
? inside
Homeostasis:
-BM ?-? 
-BP high + AIS + PANIC* = ? Tx (?PANIC)

*P?
A?
N?/ E?
ICH < ?hr/BP ?-? -> BP tx** lower = Aim ?-? < ?hr ?d 
CCF/MI

**Fucked ?
GCS < ?
H?
-major = ?
-neurosurg ?
-->

CT-head exclude bleed=BIGHAM
->
SCAN types

Answer

A

Stroke

Thrombectomy <6hrs
Thrombolysis <4.5hrs
@pre-stroke \
func status <3\NIHSS>5

@AIS + ProxAntCirc
@CT/MR angio 
\+ CTperf/MRd-w = ?save brain tissue ->
Thrombectomy
@6-24hrs/wake up stroke

<24hrs/wake up stroke:
@AIS + ProxPostCirc -basilar -PCA
@CT/MR Angio 
\+
CTperf/MR d-w = ?save brain tissue
\_\_\_\_\_\_\_

Thrombolysis < 4.5hrs

Hypo/Bleed exclude = CThead @BIGHAM
BP <185/110 –>

Asp 300mg -2w->
-Clopidog
-Dyp+Asp
-AC @AF
\_\_\_\_\_\_\_\_

Exclude hypo/bleed
FAST outside
Rosier inside
Homeostasis:
-BM 4-11
-BP high + AIS + PANIC* = BP tx
-->

CT-head exclude bleed:
Bleed tendency 
ICP high 
GCS <13 
HA
AC
Meningism 
-> 
CT/MR angio 
CT Angio / MR d-w = ?save brain tissue

*Pre-Eclampsia
ADiss
Nephro/Encephalopathy
ICH <6hr/BP150-220 -> 
-BP tx** lower = Aim 130-140 <1hr 7d 
CCF/MI

**Fucked struct
GCS <6
Hematoma
-major = poor prog
-neurosurg evac

Question 50

Q

ICH (types?)
-?refer to who

-?dx process warrants surg->

SURG:
MCA infarct - ?Tx @
-MCA > ?0%
-NIHSS > ?
-GCS ?
\_\_\_\_\_\_\_\_\_

PTC @?

ICH < ?hrs/BP ?-? ->
BP Tx* = Aim BP ?-? < ?hr ?d

*Fucked ?
GCS < ?
Hematoma
-major = ?
-neurosurg ?
\_\_\_\_\_\_\_\_\_

iF HAVE ICH + VTE?
________

TCP - Inc p(bact infect) = ROOM TEMP:
<10 + ? 
<30 + ? 
<50 + ? 
<100 + ?

No major hamorrhage:

PT/APTT > ? / ?
—-? = contents?
Fibrinogen < ? / ?
—-? = contents?

- WARFARIN 
Stop ? 
Vit K  route? @minor bleed > ? 
Vit K route? @NO bleed > ? 
Restart @ < ? 
No bleed + 5-8 = ? 
-bleed @ therapeutic lvl? Ix cause..?renal/gastro dx

Answer

A

ICH (subdural/extradural)
-neurosurg/stroke docs

-HYDROCEPHALUS->

SURG:
MCA infarct - Decomp HemiCraniotomy @
-MCA >50% territory 
-NIHSS >15
-GCS dropping
\_\_\_\_\_\_\_

PTC
@emergency
Warfarin reveal
<1hr =
Stop Warf
PTC + Vit K
FFP @unavail
\_\_\_\_\_\_\_

ICH <6hrs/BP 150-220 ->
BP Tx* = Aim BP 130-140 <1hr 7d

*Fucked struct
GCS <6
Hematoma
-major = poor prog
-neurosurg evac
\_\_\_\_\_\_\_\_\_

IF HAVE ICH + VTE?
-AC / IVC filter
_______

TCP - Inc p(bact infect) = ROOM TEMP:
<10 + no (bleed/surg / TCP dx)
<30 + bleed
<50 + surg 
<100 + CNS-bleed/procedure

No major hamorrhage:

PT/APTT >1.5 / Surg
—-Fibrinogen = clot/plasma prots
Fibrinogen <1.5 / Surg 1.0
—-Cryo = f8+13 / fibrinogen + vWF
WARFARIN
Stop warfarin
Vit K IV @minor bleed >5
Vit K PO @NO bleed >8
Restart @< 5.0
No bleed + 5-8 = withhold dose, reduce dose
-bleed @ therapeutic lvl? Ix cause..?renal/gastro dx

Question 51

Q

If suspect TIA, initial mx?
What do they do at the latter of above answer?
What to do is MR d-w confirms?
What does the latter answer of q2 entail?
________

Venous Sinus Thrombosis = ???
-MR Venogram

Art Diss = ???

Prosthetic valve –>
stroke AND ICH risk –> ???

HR bleed (surg) + 
HR stroke (AF/prev stroke) --> ???

Stable CVD + AF –> ???

Isch stroke –> AF = ???

For stroke prev:
-AC = ?
-no AC = ?
_______

iF HAVE ICH + VTE?

Answer

A

If suspect TIA, initial mx?
- 300mg + REFER <24hr TIA clinic
What do they do at the latter of above answer?
- MR diff-weighted + carotid imaging/doppler
What to do is MR d-w confirms?
- Statin @48hr
- Clopi > MR Dyp + Asp
What does the latter answer of q2 entail?
@Carotid Doppler Imaging
-Stable Neuro + Stenosis >50% NASCET =
Carotid Endarterectomy
- Stenosis <50% / <70% ESCT = 2ndary Prev
________

Venous Sinus Thrombosis =
LMWH -5d-> Warf 2-3

Art Diss = AP/AC

Prosthetic valve –>
stroke AND ICH risk –>
Stop AC, Start AP

HR bleed (surg) + 
HR stroke (AF/prev stroke) -->
Stop AC, Start LMWH

Stable CVD + AF –> Stop AP, Start AC

Isch stroke –> AF =
Asp 300 mg 2w –> AC

For stroke prev:
-AC: DOAC/DabigaTHROMBINi/Warf
-no AC = LA Appendage Occlusion
____

iF HAVE ICH + VTE?
-AC / IVC filter

Question 52

Q

Lesion -> SPEECH = FLUENT 
sentences that make NO Sense
-word sub / neologisms #word-salad
-Normal REPETITION
Pt Comprehension FUCKED

Lesion -> SPEECH = NON-FLUENT
sentences that make Sense
-Laboured + Halting 
-Poor REPETITION
Pt Comprehension NORMAL

Lesion -> SPEECH = FLUENT  
sentences that make Sense
-Poor REPETITION 
-AWARE of Errors making 
Pt Comprehension NORMAL 
\_\_\_\_\_\_\_\_

? @Oed from tumour
? @Raised ICP
? @SAH to reduce vasospasm
__________

Gait ataxia = ?

? = finger-nose ataxia

? - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)

? - sensory symptoms

? - dyLEXia, dysGRAPHia

? - motor symptoms

? expressive aphasia

? - disinhibition
________

suspected stroke. unable to speak BUT able to follow instructions

do not know the handedness of the patient
percentage of right and left handed individuals
with a dominant left hemisphere is 90% and 60% respectively,
making the left always the most likely affected side
? on dominant side supplies both Wernicke’s (sup Temp Gyrus) and Broca’s (inf Frontal Gyrus) areas
which are responsible for understanding and production of speech.

Answer

A

Wernicke Receptive

SUP Temp gyrus
Fluent + NO Sense + Comp FUCKED
Repetition Normal

Broca Expressive

INF Frontal gyrus
NON-Fluent + Sense + Comp NORM
Repetition fucked

Conduction aphasia
-Arcuate Fasciculus
-Fluent +  Sense + Comp NORM
-Repetition fucked 
\_\_\_\_\_\_

Dexa @Oed from tumour
Mannitol @Raised ICP
Nimodipine @SAH to reduce vasospasm
______

Gait ataxia = cerebellar vermis lesions
-Vermillion Gate

Cerebellar hemisphere = finger-nose past-pointing ataxia
-hemisPhere=PastPoint

Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)

Parietal lobe - sensory symptoms, dyslexia, dysgraphia

Frontal lobe - motor symptoms, expressive aphasia #BrocaInfFrontGyrus, disinhibition
________

suspected stroke. unable to speak BUT able to follow instructions

do not know the handedness of the patient
percentage of right and left handed individuals
with a dominant left hemisphere is 90% and 60% respectively,
making the left always the most likely affected side
MCA on dominant side supplies both Wernicke’s (sup Temp Gyrus) and Broca’s (inf Frontal Gyrus) areas
which are responsible for understanding and production of speech.

Question 53

Q

Fever (alternating/diurnal on - off between days),

HeadAche, myalgia,

Hepatomegaly + Foreign travel hx

Dx? Ix?
_____________

Parasaitemia = 999+PHE:

> 2% - severe/cx?

> 10% ?

<2% non-severe/UnCx:
-?* > ?

ACT =

?
?

Non-falciparum
-?

-Tx vivax/ovale -> dormant HYPNOZOITES @Liver?

Avoid what drugs with following:

HA - ?
Seizures - ?
GI dx - ?
Folate dx - ?
Psych dx - ?

Answer

A

Malaria!!!

Giesma thick and thin blood films
___________

Parasaitemia = 999+PHE:

> 2% - severe/cx
-IV Artesunate > Quinine

> 10% - exchange transfusion

<2% non-severe/UnCx:
-ACT* >
Atovaquone-proguanil
Doxy-Quinine

ACT = AL-ArM:

ArteMether+Lume
ARteSunate+Mefloquine

Non-falciparum
-oral ACT / Chloroquine

-Tx vivax/ovale -> dormant HYPNOZOITES @Liver?
Primaquine-G6PD beware

Avoid what drugs with following:

HA - chloroquine
Seizures - chloroquine/Mefloquine
GI dx - proguanil
Folate dx - proguanil
Psych dx - Mefloquine

Question 54

Q

Tet: Clean v TetProne v HRWound
??? : Non-penetrating <6hrs
??? : Puncture, Fract/FB, Burn/Bite
??? : Contaminated/FUCKED
Ask pts what?

5Vacc <10yr + Clean = ???
5Vacc <10yr + TetProne = ???
5Vacc <10yr + HRWound = ???
-5Vacc <10yr + any wound = ???

5Vacc >10yr + Clean = ???
5Vacc >10yr + TetProne = ???
5Vacc >10yr + HRWound = ???

?/Not vacc + Clean = ???
?/Not vacc + TetProne = ???
?/Not vacc + HRWound = ???
___________

bVacc @:

1a) ???
1b) ???

Tet Ig + bVacc @:

2a) ???
2b) ???
2c) ???

Answer

A

Tetanus:
Clean: non-penetrating <6hrs
TetProne: Puncture, Fract/FB, Burn/Bite
HRisk: Contaminated/FUCKED
Ask pts 
5vacc <10yrs OR 
5vacc >10yrs OR 
?/Not vacc ?

5Vacc <10yr + Clean = CLEAN+CHILL
5Vacc <10yr + TetProne = CLEAN+CHILL
5Vacc <10yr + HRWound = CLEAN+CHILL
-5Vacc <10yr + any wound = CLEAN+CHILL

5Vacc >10yr + Clean = CLEAN+CHILL
5Vacc >10yr + TetProne = bVacc
5Vacc >10yr + HRWound =
-bVacc + Tet Ig

?/Not vacc + Clean = bVacc
?/Not vacc + TetProne = 
-bVacc + Tet Ig
?/Not vacc + HRWound = 
-bVacc + Tet Ig
\_\_\_\_\_\_\_\_\_\_\_

bVacc @:

1a) Clean wound + ?/Not vacc
1b) TetProne + 5Vacc >10yr

bVacc + Tet Ig @:

2a) TetProne + ?/Not vacc
2b) HRWound + 5Vacc >10yr
2c) HRWound + ?/Not vacc

Question 55

Q

Subunit conjugate?

Toxoid inactivation toxins?

Inactivated preps?

Live attenuated

Rabies:
Animal in UK - ? risk =
-Tx?

Animal bite elsewhere - ? risk = 
-Tx + ...
-Already immunised: ???
-Not prev immunised: ???
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Summary:
BIG brain , BIG balls, LONG face/ears

MacroCephaly - big brain
Macro-Orchidism - big balls
Looooooong face+ears

Retarded
____________

PEP:
Hep A: ? / ? vaccine

Hep B - risk of needlestick transmission - ?%
look at source - ? OR ?

HBsAg Pos+ :
- known responder = ?
- non-responder = ?
- being vacc = ?
Unknown source:
- known responders = ?
- non-responders = ?
- being vacc = ?

Hep C -
? /monthly –>
@seroconversion = ?
_________

Exp to Varicella @ preggers:

NOT had chickenpox = ? + ?
IC = ?

Answer

A

STIL: NSHhh, DTaP, RAHIM:

Subunit conjugate =
-Neisseria, S.pneu, H.flu + Hep-B/HPV

Toxoid = DTaPertussis

Inactivated = R A-H IMflu
-Rabies/A-Hep/IMflu

Rest live attenuated

Rabies:
Animal in UK - NO risk =
-WASH + ?CoAmox

Animal bite elsewhere - HR = 
-WASH + ...
-Already immunised: 2 further doses
-NotPrevImmunised: HRIg+Fullcourse
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Fragile X
-big brain, big balls, long face/ears

Sotos=
XS Phys Growth
MacroDOLICHOcephaly
-head>expected
\_\_\_\_\_\_\_\_\_\_

PEP:
Hep A: HNIg / HepA vaccine

Hep B - risk of needlestick transmission - 20-30%
look at source - HBsAg Pos+ OR unknown?

HBsAg Pos+ :
- known responder = booster
- non-responder = HBIg + vaccine
- being vacc = HBIg + vaccine
Unknown source:
- known responders = booster
- non-responders = HBIg + vaccine
- being vacc = accHBV vaccine

In summary:
1. Booster @ known responders 
2. HBIg + Vacc:
@non-responders+beingVaccHBsAgPOS 
3. AccHBV+Vacc:
@unknown+beingVacc

Hep C -
PCR/monthly –>
@seroconversion = IFN +/- Ribavirin

Exp to Varicella @ preggers:

NOT had chickenpox = check 4 ABs + VZIg
IC = VZIg

Question 56

Q

Hep A tx?
____________

General Mx 4 hep b/c?

Specific Hep B tx?

Specific Hep C Ix? Tx?
-Acute? 
-Chronic?
\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_

Latent TB screening?
->

Tests?
->

Tx?
________
________

Active TB:

Ix?

Tx:
-? -> ?
#?m-RIp #?m @TB-men
-DOT @?

Answer

A

Hep A tx?
-nothing -> f/u/2w LFTs/3m
____________

General Mx 4 hep b/c?
Refer: -Gastro, -GUM 4 Sex-screen, -PHE=Cont-Trace
Bloods + AFP-HCC

Specific Hep B tx?
-Peg IFN alpha > tenof/entac

Specific Hep C Ix? Tx?
-Acute? - 15-45% ppl resolve in 6m
-Chronic? - DAAS=Direct-Acting AntiviralS
\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_

Latent TB screening:

New NHS employees
IC / Immigrants
Contact w/ pul/laryngeal TB pt
CXR=TB scarring/Untx fibrotic changes

->

Mantoux/IGRA
->

-RIpyridox 3m @34/-/high LFTs
-Ipyridox 6m @IC
__________
__________

Active TB:

Ix?

Tx:
-? -> ?
#?m-RIp #?m @TB-men
-DOT @?

Question 57

Q

UTI ?
Biopsy ?
Ex ?
Ejac ?
DRE ?

vHU, LUTS, ED
Age 50/+, FHx, Obesity, Black/Back-bone-WL ->

DRE (hard/nodular)
PSA 3/+ (age 50/+) -2ww->

SUSPECT= ?Ix ->

1. Likert 1/2
Systematic ? = NO ? / ?
-PSA @?m
-low p(PC)= ? + PSA/?
-? @FHx/PSAhigh

Likert 3:
?
-@neg= ?
-@PIN/PGIN/ainar = ?

—–Gleason….PSA
LR ^ ^
IR ?………….?–?
HR V V

LR= Tx?

IR/ HR-LAPC/ highPSAafterProstatectomy-RT
= Tx?
-LAPC=?

Mets=HRelapsed:

?
?
-want boners? = ?
-fail-> back to ?

HRelapsed:

? /? /?
?
? /? /?

Mets: Ix?
-LHRHblocker = ?
-? @bone-protection
-? @pain
-?/ ? 
\_\_\_\_\_\_\_\_\_\_

AS:

?Ix /?m @Y1; ?m @Y2
?Exam /12m
?Ix @12m

WW when?
-high PSA/ bone-pain + LPC -> ?

Hot-flushes = ?
TUMOUR FLARE RISK
-Goserelin + Cyproterone acetate 1st 3wks

Answer

A

UTI 4w
Biopsy 6w
Ex 48hr
Ejac 48hr
DRE 7d

vHU, LUTS, ED
Age 50/+, FHx, Obesity, Black/Back-bone-WL ->

DRE (hard/nodular)
PSA 3/+ (age 50/+) -2ww->

SUSPECT=mpMRI ->

Likert 1/2
Systematic biopsy = NO TRUS/Tp-template / TRUS/Tp-template
-PSA @3-6m
-low p(PC)=GP PSA referral level + PSA/6m-yearly-2yearly@neg-biopsy
-TRUS/Tp-template @FHx/PSAhigh
Likert 3
mpMRI biopsy
-@neg=d/w MDT ± repeat biopsy
-@PIN/PGIN/ainar = d/w pt high p(PC)

—–Gleason….PSA
LR ^ ^
IR 7…………10-20
HR V V

LR= AS + Radical HIFU/Cryo -> Prostatectomy/RT(EBR/BT)

IR/ HR-LAPC/ highPSAafterProstatectomy-RT
= Radical (HIFU/Cryo): Prostatectomy/ RT(EBR/BT)
-LAPC=DEGARELIX-LRHRblocker @HDependent
–> PSA @w6/6m @2yrs/12m after

Mets=HRelapsed:

Docetaxel
ADT = orchidectomy > Goserelin LHRHag
-want boners? = Bicalutamide a.androgen
fail-> back to ADT

HRelapsed:

Abiraterone(a.blocker)/ Enzalut(a.androgen)/ DEXAMETH @3rd-line
Cabaz
Docetax/ Abiraterone(a.blocker)/ Enzalut(a.androgen)

Mets: Spinal-MRI @Spinal Mets
-LHRHblocker = Degarelix
-Zolend @bone-protection
-Bisphosphonates @pain
-Radium/Strontium 
\_\_\_\_\_\_\_\_\_\_

AS:

PSA /3m @Y1; 6m @Y2
DRE /12m
mpMRI @12m

WW @older/slow-tumour/comorbidities/elderly:
-high PSA/ bone-pain + LPC -> Urology MDT

Hot-flushes = MedroxyProg/ CyproAcetate

Hot-flushes = ?
TUMOUR FLARE RISK
-Goserelin + Cyproterone acetate 1st 3wks

Question 58

Q

Renal Stones: 3 places stones get stuck?

Ix < ? hrs / ?analgesia
AE

MET @ ? < ? cm

Tx?
if < 0.5cm + Aysyx = ?
> 1cm = prognosis? -> Tx < ? w

Remove @ ? / ? :

Lithotripsy < ? cm
Ureteroscopy < ? cm + ?
Nephrolithotomy > ? cm/ ? / ?
Stent/Surg = ?

? @sepsis

Radiograph finding-Type-pH?:
?-Cysteine-? pH

?-Uric-Xanthine-? pH

?-Struvite Staghorn-? pH
-Urea –ProteusCHEM-Rxn?-> NH3 Mg PO4

?-Ca Oxal / Phosph-? pH
oXal=Appearance? > phosphate=Appearance?
________

-Non-seminomatous? #?
-Seminomatous? #?
-Non-germ?
_______________

…… ……(NSemi……Semi)….NGerm

AFP/ hcg: highorlow
………………..

Age: ………(? -? ……….? )……….?

Prognosis:……………..? )

RFs?
–> size/shape/texture change = ?

Answer

A

Renal Stones @PUJ/ Pelvic Brim/ VUJ

NC helical CT <14-24hrs / NSAID-diclofenac50mgPR
AE

MET @distal ureteric stone < 1cm

alpha-blocker
if <0.5cm + Aysyx = WW
> 1cm = UNLIKELY 2 pass -> Tx <4w

Remove @pain/not-passing:

Lithotripsy <2cm
Ureteroscopy <2cm + preg
Nephrolithotomy >2cm/staghorn-struvite/prox ureter-lowerpole
Stent/Surg = nephrostomy

ABx @sepsis

SO-Cysteine-low pH

L-Uric-Xanthine-low pH

O-Struvite Staghorn-high pH
-Urea -ProteusHydrolysis> NH3 Mg PO4

O-Ca Oxal / Phosph-high pH
oXal=spiky > phosphate=smooth
__________

-Non-semi=Choriocarc.Embryonic.Teratoma.Yolk-sac #germ
-Seminoma #germ
-Non-germ=Leydig-Lymohoma.Sertoli-Sarcoma
_______________

……..(NSemi……Semi)….NGerm

AFP/ hcg: high
…………………

Age: …..(20-30……40)…….50

Prognosis:…………good)

FHx
Undesc
Crypto-Orchid
Kleinfelter
Infertility
TIN 
--> size/shape/texture change = 2WW + USS TESTES !!!

Question 59

Q

yellow/green
-strawberry cervix
-smelly 
Dx? Tx?
\_\_\_\_\_\_\_\_
Cda-Gcc

Chlamydia Tx?
Refer for:
-GUM
-Repeat infection @?/+y/o = high p(re-infection)
-Avoid sex till when?
-STD screen/ Safe sex
-Sex-abuse < ?yrs

Gonorrhoea Tx?

Asyx = ?Ix ?/+w after ABx end
Syx = ?Ix ?/+d after ABx end

Syx men = C+T:

all partners < ?w
most recent partner if >?w

The rest i.e. Asyx men /Women
- C+T all partners < ?m
_____

PID:

Mycoplasma genitalium?

Gon high risk?
Gon low risk?

Answer

A

yellow/green
-strawberry cervix
-smelly
Dx? Trichomoniasis Tx? Metro

Chlamydia=
Doxy /Azithro
7d//////2d, respectively 
Refer for:
-GUM
-Repeat infection @25/+ y/o = high p(re-infection)
-Avoid sex after ABx end/Azithro +7d
-STD screen/ Safe sex
-Sex-abuse < 18yrs

Gonorrhoea=Ceftriax IM /Cipro

Asyx = NAAT 2/+w after ABx end
Syx = C+S 3/+d after ABx end

Syx men = C+T:

all partners < 2w
most recent partner if >2w

The rest i.e. Asyx men /Women
- C+T all partners <3m
_______

PID:

Mycoplasma genitalium
-moxifloxacin / ceftriax -> Azithro

Gon high risk = Ceftriax+Doxy+Metro
Gon low risk = Ceftriax/Oflox

Question 60

Q

When to USS testicle?
_________

Varicocele - Refer:
_________

When 2 refer for Urology:
_________

Fluid AROUND testicle
#CANNOT FEEL testes
-TRANSILLUMINATES
Dx?

For CONGEN hydrocele:
-when 2 reassure - @?yrs

-when 2 refer for paeds?
Hydrocele @?
Hernia = ?

For non-CONGEN hydrocele?
__________

Varicoceles - how 2 manage:
-G1/subclin = ?

-@G2/3
Symmetrical - ?
Asymm = ?

Syx OR Abnormal semen = ?
Asyx AND Normal semen = ?

Most are on the left,
left varicocele = RCC cos left testicular vein drains into left renal vein
_________

Lump in INGUINAL groin area
Reducible disappears when laying flat scrotum fine

<6w - surg < ?
<6m - surg < ?
<6y - surg < ?
__________

BLACK kid
symmetrical bulge
@UMBILICUS

Dx? Tx? Resolve by?
Assoc w/?
-If syx/ large = Surg @ ? -? yr
-If Asyx+Small = ?Surg @ ? -? yr

Answer

A

When to USS testicle?
Hematocele @non-trauma
-if < x3 V contralat = chill
Hx of pain/ persistent/ trauma
Hydrocele = 20-35
Uncertain ddx
Testicle = ETvTesticle ?
\_\_\_\_\_\_\_\_\_

Varicocele - Refer:
-Sudden pain 
-Not drain @supine
-R-sided varicocele
-TGA = low volume
\_\_\_\_\_\_\_\_\_

When 2 refer for Urology:
-Torsion
-AEOrchitis
-StrangHernia
-Hematocele TRAUMA
\_\_\_\_\_\_\_\_\_
Dx = Hydrocele

For CONGEN hydrocele:
-Reassure < 2yrs

-when 2 refer for paeds:
Hydrocele @SCord /Abdo-Scrotal Hernia
Hernia = Inguinal /Strang

For non-CONGEN hydrocele:
-Surg/Sclero/Asp
__________

Varicoceles - how 2 manage:
G1/subclin
-Reassure, Analgesia, Infertile 33.3%, Supportive underwear

-@G2/3
Symmetrical - Annual exam
Asymm = Urology ref

Syx OR Abnormal semen = Urology ref
Asyx AND Normal semen = Semen analysis
__________

Congenital inguinal hernia – paediatric surgery ASAP incarceration risk
<6w - surg <2d
<6m - surg <2w
<6y - surg <2m 
\_\_\_\_\_\_\_\_\_\_\_\_\_

Infanta UMBILICAL hernia
No tx - resolve <3yrs
-Assoc with HypoT !!!
If Syx/ Large = Surg @2-3yr
-If Asyx+Small = ?Surg @4-5yr

Question 61

Q

EOrchitis

3 causes:

? - anal sex/ catheter -> Tx?
? - Age < ? -> Tx?
? - supportive - Tx?

–f/u ?w->

f/u = ? + Refer @?
___________

WPW
A - which sided pathway ->?AD = dom R wave @ which lead??
B - which sided pathway ->?AD = dom R wave @ which lead??

Assoc:?

Tx:?

Avoid sotalol when? Why?
_______

Answer

A

EOrchitis

3 causes:

E.coli - (anal sex/ catheter) -> Cipro
STD - (Age <35) -> Ceft+Doxy /Cipro
Mumps - (supportive) - MSU/dipstix

–f/u2w->

f/u = ?ABx change + Refer @UTI/ STI/ Fail
___________

WPW = AL BRt
A - left sided RAD = dom R wave @ V1
B - right sided LAD = no dom R wave @ V1

Assoc: MESH
MVP, Ebstein anomaly, Secundum ASD, HOCM/HyperT

Tx: radioFreq ablation of acc pathway
FAPS

Avoid sotalol @AF cos it

prolongs refractory period @AVN ->
inc transmission rate through acc pathway ->
Inc vent rate = VF

Question 62

Q

? = bladder infection (aka cystitis)

?:
Typical pathogens @normal:
-UT + kidney function + no predisposing co-morbidities -> UTI

?: UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure)
-Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC)

? = Ureters + kidneys infection #(pyelonephritis)

Recurrent = Relapse/Reinfeciton

UTI 2/+ / ? m
UTI 3/+ /? m
? — same strain infection
? — different strain infection

? = UTI + catheter inserted last <48hr

? = bacteria @urine = asyx/syx

Answer

A

L-UTI = bladder infection (aka cystitis)

UnCx UTI — Typical pathogens @normal UT + kidney function + no predisposing co-morbidities -> UTI

Cx UTI — UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure)
-Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC)

Upper UTI = Ureters + kidneys infection #(pyelonephritis)

Recurrent = Relapse/Reinfeciton

UTI 2/+ / 6 m
UTI 3/+ /12m
Relapse — same strain infection
Reinfection — different strain infection

Catheter-UTI = UTI + catheter inserted last <48hr

Bacteriuria = bacteria @urine = asyx/syx

Question 63

Q

UTI ?
Biopsy ?
Ex ?
Ejac ?
DRE ?

vHU, LUTS, ED
Age 50/+, FHx, Obesity, Black/Back-bone-WL ->

DRE (hard/nodular)
PSA 3/+ (age 50/+) -2ww->

SUSPECT= ?Ix ->

1. Likert 1/2
Systematic ? = NO ? / ?
-PSA @?m
-low p(PC)= ? + PSA/?
-? @FHx/PSAhigh

Likert 3:
?
-@neg= ?
-@PIN/PGIN/ainar = ?

—–Gleason….PSA
LR ^ ^
IR ?………….?–?
HR V V

LR= Tx?

IR/ HR-LAPC/ highPSAafterProstatectomy-RT
= Tx?
-LAPC=?

Mets=HRelapsed:

?
?
-want boners? = ?
-fail-> back to ?

HRelapsed:

? /? /?
?
? /? /?

Mets: Ix?
-LHRHblocker = ?
-? @bone-protection
-? @pain
-?/ ? 
\_\_\_\_\_\_\_\_\_\_

AS:

?Ix /?m @Y1; ?m @Y2
?Exam /12m
?Ix @12m

WW when?
-high PSA/ bone-pain + LPC -> ?

Hot-flushes = ?
TUMOUR FLARE RISK
-Goserelin + Cyproterone acetate 1st 3wks

maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour
-I.e. 40mmol bag over 4 hours

Answer

A

UTI 4w
Biopsy 6w
Ex 48hr
Ejac 48hr
DRE 7d

vHU, LUTS, ED
Age 50/+, FHx, Obesity, Black/Back-bone-WL ->

DRE (hard/nodular)
PSA 3/+ (age 50/+) -2ww->

SUSPECT=mpMRI ->

Likert 1/2
Systematic biopsy = NO TRUS/Tp-template / TRUS/Tp-template
-PSA @3-6m
-low p(PC)=GP PSA referral level + PSA/6m-yearly-2yearly@neg-biopsy
-TRUS/Tp-template @FHx/PSAhigh
Likert 3
mpMRI biopsy
-@neg=d/w MDT ± repeat biopsy
-@PIN/PGIN/ainar = d/w pt high p(PC)

—–Gleason….PSA
LR ^ ^
IR 7…………10-20
HR V V

LR= AS + Radical HIFU/Cryo -> Prostatectomy/RT(EBR/BT)

IR/ HR-LAPC/ highPSAafterProstatectomy-RT
= Radical (HIFU/Cryo): Prostatectomy/ RT(EBR/BT)
-LAPC=DEGARELIX-LRHRblocker @HDependent
–> PSA @w6/6m @2yrs/12m after

Mets=HRelapsed:

Docetaxel
ADT = orchidectomy > Goserelin LHRHag
-want boners? = Bicalutamide a.androgen
fail-> back to ADT

HRelapsed:

Abiraterone(a.blocker)/ Enzalut(a.androgen)/ DEXAMETH @3rd-line
Cabaz
Docetax/ Abiraterone(a.blocker)/ Enzalut(a.androgen)

Mets: Spinal-MRI @Spinal Mets
-LHRHblocker = Degarelix
-Zolend @bone-protection
-Bisphosphonates @pain
-Radium/Strontium 
\_\_\_\_\_\_\_\_\_\_

AS:

PSA /3m @Y1; 6m @Y2
DRE /12m
mpMRI @12m

WW @older/slow-tumour/comorbidities/elderly:
-high PSA/ bone-pain + LPC -> Urology MDT

Hot-flushes = MedroxyProg/ CyproAcetate

Hot-flushes = ?
TUMOUR FLARE RISK
-Goserelin + Cyproterone acetate 1st 3wks

maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour,

Question 64

Q

Catheter UTI = ? ?d
-what to do @ Asyx bacteria @catheter pts?

Recurrent UTI = ? (?? >?? ) proph SD @:

?
?

Preg:

Asyx BU == ? ?d
UTI @preg = ? ?d

Bog-standard UTI w/ no catheter/preg
-man = ? ?d
-woman = ? ?d
________

Kids:
1. UTI < 3m U or L-UTI = ?+?+?

UTI > 3m = ?Ix ->
- nitrite POS AND leukocyte POS = ?
- nitrite POS + leukocyte NEG = ?
- nitrite NEG + leukocyte POS = ?

–@infants and toddlers =
?type of sample -> ?

Kids >3m Upper-UTI #fever + flank-pain
- Pyeloneph = ? / ?

Kids >3m Lower-UTI

?
@recurrent?

Kids < 3m U or L-UTI = ?+?+?
_______

?Ix @:
Flow dx / Mass
Atyp org
Sepsis
Tx fail
Recurrence, USS-KUB @:
- acute infection if ?age @recurrent
- <6w if ?age @recurrent

Acute infection @Recurrent /Atyp<3y
–? - ?m-> ?Ix #parenchymal dx

For reflux = ?
________

Recurrence:
x2 (L-UTI + U-UTI)
x1 (L-UTI + U-UTI) AND x1 (L-UTI)

Answer

A

Catheter UTI = TANP 7d
-do NOT Tx Asyx bacteria @catheter pts

Recurrent UTI = TANC (TN>AC) proph SD @:

expose2trigger
ON

Preg:

Asyx BU == NAC 7d
UTI @preg = NAC 7d

Bog-standard UTI w/ no catheter/preg
-man = NT 7d
-woman = NT-PF 3d
_________

Kids:
1. UTI < 3m = Refer asap + ABx + C+S

UTI > 3m = dipstick ->
- nitrite POS AND leukocyte POS = ABx
- nitrite POS + leukocyte NEG = ABx
- nitrite NEG + leukocyte POS = UrineMCS

–@infants and toddlers, sample =
Clean Catch Urine -fail-> Suprapubic

Kids >3m Upper-UTI #fever + flank-pain
- Pyeloneph = Cefalexin/ Co-amox

Kids >3m Lower-UTI

TANC (TN>AC)
Even recurrent = -TANC (TN>AC) /6m-r/v

Kids < 3m U or L-UTI = Refer asap + ABx + C+S
_______

USS-KUB @:
Flow dx / Mass
Atyp org
Sepsis
Tx fail
Recurrence, USS-KUB@:
- acute infection if < 6m/o @recurrent
- <6w if > 6m/o @recurrent

Acute infection @Recurrent /Atyp< 3y
–4-6m-> DMSA #parenchymal dx

For reflux = MCUG

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