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IDDIBIDDI Flashcards

1
Q

Angina Rx

A
  1. BB or RateCCB (verapamil/diltiazem)
  2. BB and long acting DHP (amlodipine/nifedipine)
  3. ONLY IF AWAITING PCI, add long acting nitrate (ivabradine, nicorandil, ranolazine)
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2
Q

Angina 1st line

A
  1. BB or RateCCB (verapamil/diltiazem)
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3
Q

Angina 2nd line

A

2.BB and long acting DHP (amlodipine/nifedipine)

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4
Q

Angina 3rd line

A
  1. ONLY IF AWAITING PCI, add long acting nitrate (ivabradine, nicorandil, ranolazine)
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5
Q

What Rx for CVA if cannot tolerate clopidogrel?

A

Aspirin + dypiridamole

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6
Q

Thrombectomy AND thrombolysis within how many hours for anterior?

A

6

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7
Q

Within 6 hours can you perform thrombectomy AND thrombolysis for what type of CVA?

A

Anterior

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8
Q

Within how many hours can you perform JUST thrombectomy for anterior CVA?

A

6-24

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9
Q

Within 6-24 hours, for what type of CVA can you perfom JUST thrombectomy?

A

Anterior

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10
Q

Thrombolysis AND thrombectomy, how many hours for POSTERIOR

A

<4.5 (consider)

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11
Q

For what type of CVA can Thrombolysis AND thrombectomy be offered if <4.5 hours?

A

Posterior

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12
Q

When can endarterectomies be done?

A

> 50%

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13
Q

Dizziness and electric shock symptoms post stopping what medication?

A

SSRI

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14
Q

Which do you replace first B12 or folate?

A

B12 first

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15
Q

Can topiramate be given to pregnant ladies?

A

No Teratogenic

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16
Q

Teratogenic migraine Rx

A

Topiramate

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17
Q

Can pregnant ladies receive MMR?

A

NO, only post-natally

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18
Q

How long for IUD to take effect

A

Immediately

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19
Q

How long for POP to take effect

A

2 days

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20
Q

How long for COCP to take effect

A

7 days

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21
Q

How long for implant to take effect

A

7 days

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22
Q

How long for injection contraceptive to take effect

A

7 days

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23
Q

How long for IUS to take effect

A

7 days

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24
Q

Which contraceptives take 7 days to take effect

A

COCP, implant, injection, IUS

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25
Q

Which contraceptive takes 2 days to take effect

A

POP

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26
Q

Which contraceptive is immediate

A

IUD

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27
Q

When can you restart COCP postnatally?

A

No breastfeeding - 21 days
Breastfeeding - 6 weeks

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28
Q

A woman has given birth a week ago, can she take COCP

A

No, 21 days

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29
Q

Which drug causes corneal opacities?

A

Amiodarone

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30
Q

Amiodarone does what to your eyes?

A

Corneal opacities

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31
Q

Can a breastfeeding woman take:
Lithium

A

No

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32
Q

Can a breastfeeding woman take:
Tetracyclines

A

No

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33
Q

Can a breastfeeding woman take:
Chloramphenicol

A

No

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34
Q

Can a breastfeeding woman take:
Sulfonamides

A

No

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35
Q

Can a breastfeeding woman take:
Lithium and benzos

A

No

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36
Q

Can a breastfeeding woman take:
Aspirin

A

No Reyes

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37
Q

Can a breastfeeding woman take:
Carbimazole

A

No

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38
Q

Can a breastfeeding woman take:
Methotrexate

A

No

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39
Q

Can a breastfeeding woman take:
Sulfonylureas

A

No

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40
Q

Can a breastfeeding woman take:
Amiodarone

A

No

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41
Q

What do you do with a squint?

A

Refer opthal

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42
Q

What effect does smoking cessation have on clozapine?

A

Rise in levels

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43
Q

Fasting glucose >7 in a preggo lady

A

INSULIN

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44
Q

Dominant R wave in V1

A

WPW TYPE A

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45
Q

Features of WPW type A on ECG

A

Dominant R wave in V1

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46
Q

Effect of thiazides on lithium

A

Lithium toxicity

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47
Q

Spasticity in MS Rx

A

Gabapentin
Baclofen

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48
Q

2 most common causes of status epilepticus

A

Hypoxia, hypoglycaemia

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49
Q

Poor feeding in an infant, whaddayadoo

A

Even if losing weight, trial:

  1. Gaviscon
  2. Omeprazole / ranitidine
  3. Paed referral
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50
Q

Side effect of nicorandil?

A

Nicorandil gives you nicks all over the GI tract - ulceration + GIB

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51
Q

Baby is born
Xray shows fluid in the horizontal fissure and hyperinflation

A

TTofN

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52
Q

Xray sign for transient tachypnoea of newborn

A

Xray shows fluid in the horizontal fissure and hyperinflation

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53
Q

Rx for displaced hip fracture

A

Hemi / THR

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54
Q

Rx for extracapsular hip fracture

A

DHS

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55
Q

How long do you review sertraline in <25yo

A

ONE week
Risk of suicide on starting in young

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56
Q

SEVERE eye pain
HALOs
Reduced vision
HAZY cornea
Semi-dilated

A

Acute angle CLOSURE glaucoma

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57
Q

Halos
Hazy cornea

A

Acute angle CLOSURE glaucoma

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58
Q

Acute angle CLOSURE glaucoma Sx

A

SEVERE eye pain
HALOs
Reduced vision
HAZY cornea
Semi-dilated

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59
Q

EYE

Acute onset
Pain
Blurred vision
Photophobia
Small, FIXED OVAL pupil
Ciliary flush

A

Anterior Uveitis

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60
Q

Small, FIXED OVAL pupil
Ciliary flush

A

Anterior Uveitis

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61
Q

Anterior Uveitis Sx

A

Acute onset
Pain
Blurred vision
Photophobia
Small, FIXED OVAL pupil
Ciliary flush

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62
Q

Scleritis Sx

A

Severe eye pain on movement
AI disease

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63
Q

Severe eye pain on movement
AI disease

A

Scleritis

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64
Q

Rheumatoid eye disease

A

Keratoconjunctivitis sicca

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65
Q

Keratoconjunctivitis sicca

A

Rheumatoid eye disease

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66
Q

Purulent or clear eye discharge

A

Conjunctivitis

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67
Q

Conjunctivitis

A

Purulent or clear eye discharge

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68
Q

What causes subconjunctival haemorrhage

A

Trauma/coughing

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69
Q

Eye disease with trauma/coughing

A

Subconjunctival haemorrhage

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70
Q

Endopthalmitis

A

AFTER SURGERY
Red, painful, decreased vision

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71
Q

Eye disorder
AFTER SURGERY
Red, painful, decreased vision

A

Endopthalmitis

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72
Q

<55 or T2DM
First line

A

ACE or ARB

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73
Q

<55 or T2DM
2nd line

A

ACE or ARB + CCB or thiazide

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74
Q

<55 or T2DM
3rd line

A

ACE or ARB + CCB AND thiazide

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75
Q

<55 or T2DM
4th line

A

<4.5 Spiro
>4.5 Beta or alpha blocker

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76
Q

> 55 or afro
1st line

A

CCB

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77
Q

> 55 or afro
2nd line

A

CCB + ARB/ACEi or thiazidie

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78
Q

> 55 or afro
3rd line

A

CCB + ACEi/ARB AND thiazide

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79
Q

Anterior MI what artery

A

LAD

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80
Q

Inferior MI what artery

A

RCA

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81
Q

RCA causes what MI

A

Inferior

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82
Q

LAD causes what MI

A

Anterior

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83
Q

What target HbA1c for lifestyle

A

48

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84
Q

What target HbA1c for metformin

A

48

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85
Q

What target HbA1c for hypoglycaemic

A

53

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86
Q

1st line DM

A

Metformin + SGLT2(if CVD/HF risk)

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87
Q

2nd line DM

A

Add DPP4 or SGLT2

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88
Q

3rd line DM

A

Add another or insulin

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89
Q

4th line DM

A

Switch one for GLP1 if BMI > 35

IE if on 3/4 hypoglycaemics OR insulin and no result consider GLP1 if BMI >35

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90
Q

How often cervical cytlology in HIV

A

Yearly

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91
Q

General rule for autosomal dominant

A

Structural things
EXCEPTIONS = gilberts + hyperlipidaemia

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92
Q

General rule for autosomal recessive

A

Metabolic things
EXCEPTIONS = ataxias

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93
Q

Persistent ST elevation post MI with NO chest pain?

A

LV aneurysm

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94
Q

How does LV aneurysm present

A

Persistent ST elevation post MI with NO chest pain

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95
Q

Rx whooping

A

Clarithromycin / azithromycin

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96
Q

Rx for baby meningitis

A

ceftriaxone

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97
Q

What drug avoid in HOCM?

A

ACEi

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98
Q

Rx for labial adhesions in children

A

Oestrogen cream

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99
Q

What causes falsely elevated HBA1c?

A

Splenectomy
IDA
B12/folate deficiency

Increased lifespan of RBCs

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100
Q

Splenectomy
IDA
B12/folate deficiency

Do what to HBA1c

A

Falsely elevated

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101
Q

Sickle cell
G6PD
Hereditary spherocytosis
B thalassaemia

What effects on HBA1c

A

Falsely LOW

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102
Q

What causes falsely low HBA1c?

A

Sickle cell
G6PD
Hereditary spherocytosis
B thalassaemia

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103
Q

Asbestosis / mesothelioma
What is notable about death certificate?

A

NEEDS coroner referral

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104
Q

Structural heart disease pharmacological cardioversion

A

AMIODARONE

NOT
flecainide

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105
Q

DEVELOPMENTAL MILESTONES

Quietens to voice
Squeaks
Turns to parents

A

3 months

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106
Q

DEVELOPMENTAL MILESTONES

Double syllables

A

6 months

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107
Q

DEVELOPMENTAL MILESTONES

Mama/dada

A

9 months

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108
Q

DEVELOPMENTAL MILESTONES

Knows name

A

12 months

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109
Q

DEVELOPMENTAL MILESTONES

2-6 words
Understands simple commands

A

12-15 months

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110
Q

DEVELOPMENTAL MILESTONES

Combine 2 words
Points to body parts

A

2 years

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111
Q

DEVELOPMENTAL MILESTONES

200 words

A

2.5yrs

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112
Q

DEVELOPMENTAL MILESTONES

Short sentences
What/who
Colours
1-10

A

3 yrs

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113
Q

DEVELOPMENTAL MILESTONES

Why, when, how

A

4 yrs

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114
Q

Rx for recurrent hiccups

A

Chlorpromazine

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115
Q

Xray signs of rheumatoid

A

Periarticular erosions
Juxta-articular osteoporosis

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116
Q

Periarticular erosions
Juxta-articular osteoporosis

A

Xray signs of rheumatoid

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117
Q

Alcohol withdrawal

A

Reduced inhibitory GABA, increased glutamate

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118
Q

Reduced inhibitory GABA, increased glutamate

A

Alcohol withdrawal

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119
Q

Rx Ramsay Hunt

A

Oral acyclovir and prednisolone

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120
Q

Most common cause otitis media

A

H influenza

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121
Q

Other (not most common) causes of otitis media

A

Moraxella
Strep

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122
Q

Risk factors for SIDS

A

Sleeping in same bed
Prone sleeping
Smoking
Prematurity
Hyperthermia and head covering

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123
Q

Sleeping in same bed
Prone sleeping
Smoking
Prematurity
Hyperthermia and head covering

A

Risk factors for SIDS

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124
Q

Barlow DDH

A

Dislocate

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125
Q

Ortlani DDH

A

Relocate

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126
Q

DDH investigations

A

> 4.5 months XRAY
<4.5 months US

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127
Q

Rx DDH <4.5 months

A

Pavliks
BUT MOST SPONTANEOUS STABILISE at 3-6 weeks

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128
Q

Pavliks harness
BUT MOST SPONTANEOUS STABILISE at 3-6 weeks

A

Rx DDH <4.5 months

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129
Q

When in parvovirus BAD in pregnancy

A

<20 weeks

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130
Q

Section someone in GP
What section?

A

4

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131
Q

How do you treat cows milk allergy in a baby?

A

Extensively hydrolysed formula

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132
Q

Extensively hydrolysed formula

A

Cows milk allergy

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133
Q

What audio test is done in schools?

A

Pure tone audiometry

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134
Q

Pure tone audiometry, done when?

A

Schools

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135
Q

Newborn hearing test?

A

Otoacoustic emission

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136
Q

Otoacoustic emission

A

Newborns

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137
Q

Low LH/FSH
Low testosterone
Anosmia
Delayed puberty

A

Kallman

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138
Q

How to treat a cut in an unknown tetanus Hx?

A

Give booster / immunoglobulin if cant

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139
Q

What one off vaccine for hep C patients?

A

Pneumococcal

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140
Q

Obstetric cholestasis, main risk to baby?

A

Stillbirth

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141
Q

Features of a lacunar infarct?

A

Purely motor or sensory

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142
Q

Rx pagets

A

Bisphosphonates

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143
Q

Diclofenac contraindicated with what?

A

CVA

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144
Q

Keratitis from what

A

KONTACT LENSE

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145
Q

Rx raynaulds?

A

Nifedipine
BB cause raynaulds

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146
Q

Risk of glandular fever

A

Splenic rupture

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147
Q

Seborrheic dermatitis can randomly cause what? (melassazia fur fur)

A

Ear ache!

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148
Q

Fetal varicella features

A

Scarring, eye defects, limb defects, microcephaly, LD

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149
Q

Scarring, eye defects, limb defects, microcephaly, LD

A

Fetal varicella features

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150
Q

Psoriatic Arthritis, which HLA

A

B27

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151
Q

Which clotting factors are reduced in liver failure?

A

All apart from 8

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152
Q

Which clotting factors are not reduced in liver failure?

A

8
All others reduced

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153
Q

All clotting factors apart from 8 are reduced in what?

A

Liver failure

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154
Q

Normal calcium, phosphate, ALP and PTH

A

Osteoporosis

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155
Q

Osteoporosis biochem

A

Normal calcium, phosphate, ALP and PTH

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156
Q

Osteomalacia biochem

A

ALP and PTH appropriately high, calcium and phosp low

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157
Q

ALP and PTH appropriately high, calcium and phosp low

A

Osteomalacia biochem

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158
Q

Primary HPTHism biochem

A

PTH high, Ca high, Phosp low, ALP high

PTH high cos HPTism, causes high Ca/low phos, ALP high cos PTH stimulates osteo

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159
Q

PTH high, Ca high, Phosp low, ALP high

A

Primary HPTHism biochem

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160
Q

CKD biochem, PTH

A

PTH High, Ca low (cant be absorbed in kidney) Phosphate high (cant be excreted, ALP high

IE makes sense that PTH is high and Ca cannot be absorbed, phosp exrected, and ALP is high

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161
Q

PTH High, Ca low (cant be absorbed in kidney) Phosphate high (cant be excreted, ALP high

A

CKD biochem

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162
Q

Osteopetrosis biochem

A

PTH ALP CA and PO4 normal

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163
Q

A wee barn has a recurrent sticky eye. What do you do?

A

Refer if >1
If <1 it is normal

Nasolacrimal obstruction

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164
Q

Serious cystadenoma

A

SERIOUSLY COMMON

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165
Q

Mucinous cystadenoma explodes and the patient gets a sore tummy

A

Psuedomyxoma Petronei

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166
Q

Gradual blurring after cataract surgery

A

Posterior capsule opacification

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167
Q

Posterior capsule opacification

A

Gradual blurring after cataract surgery

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168
Q

Bilateral sciatica

A

Cauda equina

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169
Q

Dramatic response to steroids

A

PMR

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170
Q

Dry ARMD

A

Drusen
Yellow spots in brusches membrane

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171
Q

Drusen
Yellow spots in brusches membrane

A

Dry ARMD

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172
Q

Exudative
Neovascularisation and leakage of serous fluid and blood

A

Wet ARMD

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173
Q

Wet ARMD

A

Exudative
Neovascularisation and leakage of serous fluid and blood

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174
Q

Rx Dry ARMD

A

Zinc + Vitamins ACE

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175
Q

Rx Wet ARMD

A

Anti VEGF or laser photocoagulation (has a risk of acute visual loss)

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176
Q

ASA 1

A

Healthy non smoker

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177
Q

ASA 2

A

Mild disease

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178
Q

ASA 3

A

Severe disease

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179
Q

ASA 4

A

Severe disease, but constant threat to life

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180
Q

ASA 5

A

Moribund, expected not to live without operation

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181
Q

ASA 6

A

Brain dead

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182
Q

What is Fomepizole for?

A

Fomepizole For antiFreeze

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183
Q

Rx antifreeze

A

Fomepizole

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184
Q

Disproportionate microcytosis

A

B thalassaemia trait

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185
Q

When is jaundice in neonates pathological

A

First 24hrs
After 2 weeks

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186
Q

When is jaundice in neonates normal

A

2-14 days

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187
Q

Causes of jaundice >2weeks neonates

A

Breast milk, biliary atresia, UTI, galactosaemia, hypothyroidism, prematurity, CMV, toxoplasmosis

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188
Q

Breast milk, biliary atresia, UTI, galactosaemia, hypothyroidism, prematurity, CMV, toxoplasmosis

A

Causes of jaundice >2weeks neonates

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189
Q

Rx phaeo and what is importants

A

PHenoxybenzamine
ALWAYS A blockade before Beta

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190
Q

OLDBEN VOICE EYES

A

OBEY
LOCALISE
DRAW AWAY
BEND
EXTEND
NONE

ELEGANT
CONFUSED
INAPPROPRIATE
OBSCURE
VOICELESS

SPONTANEOUS
EAR PIERCING NOISE
YOUCH
EYES SHUT

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191
Q

OLDBEN

A

OBEY
LOCALISE
DRAW AWAY
BEND
EXTEND
NONE

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192
Q

VOICE

A

ELEGANT
CONFUSED
INNAPPROPRIATE
OBSCURE NOISES
VOICELESS

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193
Q

EYES

A

EYES SHUT
YEOUCH
EAR PIERCING
SPONTANEOUS

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194
Q

Monitor fibroadenomas if

A

<3cm

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195
Q

Peutz jeghers what is it

A

AD
MultiPle PolyPs
Pigmented lesions on hands and feet

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196
Q

AD
MultiPle PolyPs
Pigmented lesions on hands and feet

A

Peuts-jeghers

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197
Q

18yo hasn’t had Men ACWY do ya give it

A

YEA

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198
Q

What are the rules with live vaccines?

A

> 4 weeks apart

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199
Q

Turners heart disease

A

Bicuspid aortic valve

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200
Q

Brushfields spots

A

Downs syndrome

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201
Q

When can you start POP and COCP after birth?

A

POP immediately
COCP 6 weeks

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202
Q

Sudden onset sensorineural deafness, whaddayado

A

ENT urgent

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203
Q

Statins? Pregnancy?

A

Contraindicated

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204
Q

Croup caused by, and Rx

A

Parainfluenza
Steroids

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205
Q

Parainfluenza
Steroids

A

Croup

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206
Q

Key SE of carbimazole?

A

Agranulocytosis

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207
Q

Features Patau
Tri 13

A

Polydactyly, cleft Palate, small PeePing eyes

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208
Q

Polydactyly, cleft Palate, small PeePing eyes
Tri 13

A

Patau

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209
Q

Edwards
Tri 18

A

Ed the rocker likes low basses

Rockerbottom feet, low set ears, overlapping fingers [for playing guitar]

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210
Q

Rockerbottom feet, low set ears, overlapping fingers [for playing guitar]

A

Edwards
Ed the rocker likes low basses
Tri 18

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211
Q

Fragile X

A

XTRA LARGE
head, ears, testicles, face

takes a LONG time to learn - LD

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212
Q

XTRA LARGE
head, ears, testicles, face

takes a LONG time to learn - LD

A

Fragile X

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213
Q

Noonan

A

Noo noo vacuUM

Short, pectus excavatUM, pulmonary stenosis (ie hoover)
Clears away the cobwebbed neck

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214
Q

Short, pectus excavatUM, pulmonary stenosis (ie hoover)
Clears away the cobwebbed neck

A

Noonan

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215
Q

Pierre robin

A

Palate-robin

Cleft palate, tiny mouth like a robin

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216
Q

Prader willi

A

Fat
Hungry
Floppy

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217
Q

Fat
Hungry
Floppy

A

Prader-willi

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218
Q

Williams

A

Think of will
Happy, friendly extrovert, short stature, LD, aortic stenosis

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219
Q

Happy, friendly extrovert, short stature, LD, aortic stenosis

A

Williams

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220
Q

Cri du chat

A

CrI - Eyes far apart
Loud cry
Hard to feed

This cri-du-chat is hard to feed!

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221
Q

Eyes far apart
Loud cry
Hard to feed

A

Cri-du-chat

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222
Q

1st stage of puberty in girls

A

Breast development

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223
Q

Bow legs, when do they get better?

A

Bow legs Better By 4

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224
Q

Whooping cough

A

RSV

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225
Q

RSV

A

Bronchiolitis

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226
Q

All breech babies get what

A

US scan

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227
Q

FEVER then red rash

A

Roseola HHV6

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228
Q

Fever, head+trunk then rest of body macular to papular to vesicular

A

Chickenpox VCZ

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229
Q

Measles features

A

Koplik spots mucosa
Rash BEHIND ears
Conjunctivtis, fever

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230
Q

Rash BEHIND ears
Conjunctivtis, fever

A

Measles

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231
Q

How many days off for measles?

A

4 days from rash onset

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232
Q

Unilateral parotitis then b/l
FEVER

A

Mumps

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233
Q

Mumps features

A

Unilateral parotitis then b/l
FEVER

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234
Q

How many days off for mumps

A

5 days since gland onset

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235
Q

Rubella features

A

RUBELLA RS
Rubella Starts on the face
Lymphadenopathy

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236
Q

Rash starting on face -> elsewhere
LNs

A

Rubella

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237
Q

How many days off school rubella?

A

5 days since rash onset

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238
Q

Slapped cheek
Red arms

A

YOU SLAP WITH YOUR ARM
Parvovirus B19/erythema infectiosum

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239
Q

Parvovirus B19/erythema infectiosum features

A

Cheek + arms rash

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240
Q

Strawberry tongue, rash spares the mouth,

A

GASSY Scarlet
Kiss gassy scarlet and give her a strawberry

Group A strep

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241
Q

Scarlet fever features, GAS

A

Strawberry tongue, rash spares the mouth

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242
Q

How many days off school for scarlet?

A

24hrs onset of ABx
Penicillin V

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243
Q

HAND FOOT N MOUTH

A

COX
Coxsackie A16
Vesicles in HFM

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244
Q

When can you go to school with hand foot and mouth

A

No time off

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245
Q

When can you go to school after whooping?
And what Rx eh?

A

2 days after ABX
Azithromycin
Clari

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246
Q

What reduces absorption of levothyroxine?

A

Iron

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247
Q

Keratocanthoma. Whaddyado

A

Refer to derm as could be SCC

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248
Q

Low B6 and high B6 can cause what?

A

Peripheral neuropathy

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249
Q

How many rescue breaths in paediatrics?

A

5
Most likely hypoxic cardiac arrest

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250
Q

Anti TPO are seen in hashimotos, what else?

A

Graves interestingly

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251
Q

Rouleaux

A

MM

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252
Q

Blepharitis and conjunctivitis 1st + 2nd

A

Clean eyes
ABx if failure

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253
Q

Vincristine SE

A

Peripheral neuropathy

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254
Q

What do you need to monitor when giving magnesium sulfate

A

RR
Reflexes

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255
Q

What is the TT380

A

Not a plane
Its a copper IUD

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256
Q

Distinguish between hashimotos and de quervains subacute thyroiditis OE

A

Tender in de quervains

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257
Q

AST:ALT in alcohol

A

2:1

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258
Q

AST:ALT in paracetamol

A

1:1

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259
Q

SE of cyclophosphamide

A

Pee in cycles
TCC, haemorrhagic cystitis

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260
Q

SE of bleomycin

A

Bliff
Lung fibrosis

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261
Q

SE of Doxorubicin

A

dOxO
CardiOmyopathy

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262
Q

SE of 5FU

A

FU sneezy itchy mess
Mucositis
Dermatitis

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263
Q

SE of cytarabine

A

cytArAbine
Ataxia

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264
Q

SE of vincristine

A

Crystals in your poop n legs
Paralytic ileus
Peripheral neuropathy

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265
Q

SE of Cisplatin

A

Cis men can pee or hear

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266
Q

Rx PPROM

A

ABx Steroids

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267
Q

Pregnancy dates

8-12 weeks

A

Booking and bloods

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268
Q

Pregnancy dates

10-13+6

A

First scan

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269
Q

Pregnancy dates

11-13+6

A

Downs nuchal thickness

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270
Q

Pregnancy dates

16

A

Clinic, results

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271
Q

Pregnancy dates

25

A

SFH, clinic

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272
Q

Pregnancy dates

28

A

BP check
Anti D

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273
Q

Pregnancy dates

31

A

Routine care clinic

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274
Q

Pregnancy dates

34

A

Second Anti D

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275
Q

Pregnancy dates

38

A

Routine
Preg planning

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276
Q

Pregnancy dates

40

A

Options for prolonged preg

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277
Q

Pregnancy dates

41

A

Induction

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278
Q

Pregnancy dates

Anti D

A

28
34

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279
Q

SE of aminosalicylates

A

Agranulocytosis

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280
Q

Cluster headache Rx

A

Verapamil

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281
Q

Young, Sx of peripheral neuropathy
Ass with raynaulds

A

Buergers

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282
Q

How long can copper coil be used for EMERGENCY contraception?

A

5 days

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283
Q

Perthes disease, dont treat until what age?

A

6 yrs

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284
Q

What biomarker for medullary thyroid carcinoma?

A

Calcitonin

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285
Q

B12 or folate first

A

B before F

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286
Q

Bronchiolitis onset?

A

<1yo
RSV
Supportive

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287
Q

Imposter syndrome

A

Capgras

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288
Q

Belief one is dead

A

Cotard

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289
Q

Someone high ranking loves you

A

De Clarembauld

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290
Q

Everyone is one person

A

Fregoli

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291
Q

Not tested in neonatal prick test?

A

Galactosaemia

YEAHAHA

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292
Q

Size of kidneys in diabetic nephropathy

A

BIG

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293
Q

Duputryns caused by what antiepileptic

A

Phenytoin

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294
Q

Rx rosacae

A

Mod: ivermectin
Severe ie pustular: ivermectin and doxy

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295
Q

When does PDA close

A

First FEW BREATHS

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296
Q

How to close a PDA

A

Indomethacin/ibuprofen

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297
Q

How to keep a PDA open

A

Prostaglandins

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298
Q

Amster grid testing,
Looking at wavy lines

What is it for?

A

Dry ARMD

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299
Q

11+6 check your dicks

A

Warts

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300
Q

16+18 get the cervical vaccine/screen

A

Cervical cancer

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301
Q

CRAZY MASSIVE SPLEEN
What lymphoma

A

CML

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302
Q

Someone gets bad eye pain after mydriatic drops

A

Acute angle CLOSURE glaucoma

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303
Q

Fat boi, groin knee thigh pain

A

Slipped femoral epiphysis

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304
Q

Tumour in the anal verge

A

AP

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305
Q

Tumour in the rectum

A

Anterior resection

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306
Q

Tumour in the sigmoid

A

High anterior resection

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307
Q

Contraception NEEDED after pregnancy

A

21 days
(NB POP instant, COCP contraindicated for 6 weeks)

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308
Q

Claudication like pain legs, back pain
Better with rest

A

Lumbar canal stenosis

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309
Q

If you have an allergy to sulfsalazine, what else can you not take?

A

Aspirin
SALICYLATES

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310
Q

Dont what after a hip replacement

A

Cross ya legs

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311
Q

Big interaction with statins

A

Macrolides, eg clarithromycin

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312
Q

Pemphigus vulgaris also affects

A

VULVA
Mucosal surfaces

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313
Q

Most common cause of newborn jaundice

A

Rhesus incompatibility

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314
Q

Aspirin is ingested
Suicide attempt

Timeframe for charcoal

A

<1hr

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315
Q

Most common complication of meningitis

A

Sensorineural hearing loss

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316
Q

Bridging vein affected
Crescent shaped CTH

A

Subdural

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317
Q

Soft, systolic, symptomless, short, Sitting->Standing

A

Innocent murmur

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318
Q

Metabolic acidosis with increased ketones but LOW glucose?

A

Alcoholic ketoacidosis

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319
Q

Common cancer after transplantation

A

SCC

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320
Q

Lateral rectus controlled by what nerve

A

CN6

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321
Q

Superioroblique controlled by

A

CN4

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322
Q

Diltiazem causes what toxicity

A

DIGOXIN

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323
Q

Samters triad

A

Aspirin sensitivity, nasal polyps, asthma

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324
Q

Shaken baby syndrome features

A

Subdural
Retinal haemorrhages
Encephalopathy

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325
Q

Subdural
Retinal haemorrhages
Encephalopathy

A

Shaken baby syndrome

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326
Q

Active crohns disease rash?

A

Erythema nodosum

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327
Q

1st line paediatric migraine

A

Ibuprofen <12

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328
Q

AAA screening

A

Single US at 65

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329
Q

Fever pain scoring

A

FEVER
Purulent
Attend rapidly <3days
Inflamed tonsils
No cough

0-1 no Abx
2-3 delayed ABx
4-5 ABx

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330
Q

FEVER
Purulent
Attend rapidly <3days
Inflamed tonsils
No cough

What are the Rx thresholds

A

0-1 no Abx
2-3 delayed ABx
4-5 ABx

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331
Q

1st line to maintain remission in crohns

A

Azathioprine

332
Q

SE depoprovera

A

Reduced BMD

333
Q

Provoked vs unprovoked

334
Q

TIA Rx

335
Q

How to monitor haemochromatosis

A

Ferritin
TF sat

336
Q

Initial Rx RhA

A

DMARD
Bridging corticosteroid

337
Q

One eye cant adduct and the other gets nystagmus

A

INO
Lesion in the MLF

338
Q

Pain on longitudinal compression of the thumb

A

Scaphoid fracture

339
Q

NSTEMI Mx

A

Aspirin (+fondaparinux if no PCI immediately)

340
Q

NSTEMI Mx
GRACE score explanation?

A

<3% - ticagreol
>3% - PCI in 72hrs, UFH, Prasugrel OR ticagrelor

341
Q

NSTEMI Mx
Grace <3%

A

Ticagrelor no PCI

342
Q

NSTEMI Mx
Grace >3%

A

> 3% - PCI in 72hrs, UFH, Prasugrel OR ticagrelor

343
Q

If a patient has an NSTEMI and is on anticoagulation, what happens to the antiplatelet?

A

Swap ticagrelor/prasugrel for clopidogrel

344
Q

STEMI Mx

A

Aspirin 300mg
Is PCI possible in 120mins?
YES-> prasugrel, UFH, glp2b/3a
NO-> fibrinolysis + antithrombin + ticagrelor after procedure

345
Q

STEMI Mx
PCI not possible in 120mins

A

NO-> fibrinolysis + antithrombin + ticagrelor after procedure

346
Q

STEMI Mx
PCI possible in 120mins

A

YES-> prasugrel, UFH, glp2b/3a

347
Q

STEMI
If high bleeding risk what antiplatelet is recommended?

A

Clopidogrel

348
Q

Do you do PCI if pt presents after 12 hours?

349
Q

Herceptin
What main SE?

A

Cardiotoxicity

350
Q

Stress incontinence treatment

A

Duloxetine

351
Q

1st line Rx for scalp psoriasis

A

Potent corticosteroid
EG
Clobetasol propionate 0.05%: Dermovate
Diflorasone diacetate 0.05%:
Fluocinonide 0.1%:
Halobetasol propionate 0.05%:
Betamethasone valerate 0.1%: (Betnovate)
Betamethasone dipropionate 0.05%: (Diprosone)

352
Q

What is a curlings ulcer?

A

Stress ulcer after burns (GI)

353
Q

Stellwag sign

A

Reduced blinking

354
Q

Reduced blinking sign

355
Q

IM influenza vaccine, what type of vaccine?

A

Inactivated

356
Q

Intranasal influenza vaccine, what type of vaccine?

A

Live attenuated

357
Q

Which coronary artery, complete HB?

A

RCA
Inferior

358
Q

Antiemetic of choice for brain mets?

359
Q

HER2 drug

A

Trastuzumab

360
Q

Trastuzumab

361
Q

Eye disease and RhA

A

Keratoconjunctivitis sicca

362
Q

Urinary 5HIAA

363
Q

Cerazette desonorgestrel MOA

A

Inhibits ovulation

364
Q

Gottrons papules (hands)
Heliotrope rash

A

Dermatomyositis

365
Q

Absolute contraindications to thrombolysis

A

Hx ICH
Seizure
IC neoplasm
Stroke or TBI in last 3 months
LP within 7 days
GI haemorrhage in last 3 weeks
Hx of varices
Active bleeding
Uncontrolled HTN >200/120

366
Q

Hx ICH
Seizure
IC neoplasm
Stroke or TBI in last 3 months
LP within 7 days
GI haemorrhage in last 3 weeks
Hx of varices
Active bleeding
Uncontrolled HTN >200/120

A

Absolute contraindications to thrombolysis

367
Q

Spared in MND

368
Q

Purple, pruritic, papular, Polygonal rash on extensor surfaces
Oral involvement

A

Lichen Planus

369
Q

Lichen Planus

A

Purple, pruritic, papular, Polygonal rash on extensor surfaces
Oral involvement

370
Q

How long stop COCP for before surgery

371
Q

Rx broad complex tachycardia

A

Amiodarone

372
Q

Neonatal blood spot, when?

A

5-9 days of age

373
Q

Causes torsades de points

A

Hypokalaemia
SSRIs (mainly citalopram)

374
Q

Which SSRI causes torsades de points?

A

Citalopram

375
Q

Non invasive prenatal testing for what

A

Increased nuchal thickness

376
Q

FEV1:FVC in restrictive

377
Q

FVC in restrictive

378
Q

Diactylitis
What arthritis

379
Q

Replacement of normal bone with spongy bone.
Hyperaemia of cochlear and membrane
Schwartz sign = prominent vascularity

A

Otosclerosis

380
Q

What is otosclerosis

A

Replacement of normal bone with spongy bone.
Hyperaemia of cochlear and membrane
Schwartz sign = prominent vascularity

381
Q

Schwartz sign

A

prominent vascularity in ear

382
Q

Thiazides cause what electrolyte abnormality

A

Hypocalcaemia

383
Q

Classification UC

A

Mild <4
Mod 4-6
Severe >6

384
Q

Rx mild mod severe UC

A

Mild <4 - rectal salicylates
Mod 4-6 - rectal and oral
Severe >6 - steroids

385
Q

Rx mild UC

A

Mild <4 - rectal salicylates
Mod 4-6 - rectal and oral
Severe >6 - steroids

386
Q

Rx mod UC

A

Mild <4 - rectal salicylates
Mod 4-6 - rectal and oral
Severe >6 - steroids

387
Q

Rx severe UC

A

Mild <4 - rectal salicylates
Mod 4-6 - rectal and oral
Severe >6 - steroids

388
Q

Target cells
Siderotic granulated acanthocytes
Pappenheimer
Howell-jolly bodies

A

Hyposplenism

389
Q

Tear drop poikilocytes

A

Myelofibrosis

390
Q

Contraception in menopause whens it needed?

A

<50 24 months
>50 12 months

391
Q

Why does seminoma have better prognosis than teratoma?

A

Responds to radiotherapy

392
Q

Prognosis, whats better seminoma vs teratoma?

A

Seminoma - responds better to radiotherapy

393
Q

BV Rx

A

5 days metronidazole

394
Q

Ear more prominent and ear infection

A

SHIT THIS IS MASTOIDITIS ADMIT EM FOR IVABx

395
Q

ST depression, raised R waves, tented T waves

A

Do posterior ECG
?Posterior MI

396
Q

Can pregnant ladies have pertussis vaccine?

A

Yes but ONLY 16-32 weeks

397
Q

BL acoustic neuromas
Which type of neurofibromatosis

A

Type 2
Bilateral
Ya got 2 ears

398
Q

Serum progesterone for ovulation, when?

A

7 days before the expected period

399
Q

When progesterone for POF

400
Q

Rx of HUS

A

Supportive

401
Q

Bradyarrythmia and no shock

402
Q

Bradyarrythmia and shock

A

500mcgs atropine

403
Q

Pregnant lady with varicella, what do you do?

A

Check immunity
If doubts - blood test
If no immunity and exposed - aciclovir at 7-14 days post exposure
Rx needed: ORAL acyclovir if >20 weeks
If under - consider

404
Q

Tiny white papules on eyelids

A

Milia
Often seen in newborns and disappears
Can be seen in adults

405
Q

Rx milia

A

None in babies

Adults - retinoids or cryotherapy/curettage

406
Q

Avoid which acne Rx in pregnancy

407
Q

Argyll Robertson

A

ARRRRRR
Pirate

Squinting eye
Pupils constricted
Syphilis

408
Q

What electrolyte abnormality can cause cataracts?

A

Hypocalcaemia

409
Q

Organophosphate poisoning DUMBELS

A

Diaphoresis/defecation
Urinary incontinence
Miosis
Bradycardia
Emesis
Lacrimation
Salivation

410
Q

How to tell between epi/scleritis

A

Scleritis more painful

Phenylephrine eye drops, scleritis no change, epi blanches

411
Q

What heart defect in downs

A

AV septal defect

412
Q

BL hypodensities in the temporal lobes

A

HSV encephalitis

413
Q

Pain over radial styloid on forced flexion/abduction of the thumb
Finklestein positive

A

De Quervains tenosynovitis

414
Q

De Quervains tenosynovitis

A

Pain over radial styloid on forced flexion/abduction of the thumb
Finklestein positive

415
Q

What is the point of irradiated blood products?

A

Avoid transfusion related graft vs host disease

416
Q

1st line hyperhidrosis

A

Aluminium chloride

417
Q

Isoniazid SE

A

PerIpheral Neuropathy
Izzagots peripheral neuropathy

418
Q

Red flags back pain

A

<20
>50
Hx malignancy
Night pain
Trauma
Systemic features

419
Q

<20
>50
Hx malignancy
Night pain
Trauma
Systemic features

A

Red flags back pain

420
Q

Offer statins if what?

A

T1DM and:
>40
DM >10yrs
Nephropathy
Obesity/HTN

421
Q

Dual antiplatelets for how long post MI?

422
Q

Sodium valproate + raised amylase?

A

Pancreatitis induced by sodium valproate

423
Q

Acrocyanosis, what is it?

A

Blue fingers/tips
Normal in babies

424
Q

Pt being induced
Increased in end tidal CO2
Flexion of muscles
Rhabdomyolysis
Mottling of skin
Genetic disorder

A

Malignant hyperthermia

425
Q

When do you use cyclical HRT first?

A

Always
UNLESS
Tried for 1yr
1 year since LMP
2 yrs cince LMP if premature menopause (pre 40yo)

426
Q

Scaphoid pole fracture treatment

A

Fixation every time

427
Q

Which is the only contraceptive to cause weight gain?

A

Progesterone injection

428
Q

> 40 urinary sodium
Reduced urinary osmolality
Normal urea:creatinine ratios
Poor response to fluid challenge
Brown granular casts

429
Q

Features of ATN

A

> 40 urinary sodium
Reduced urinary osmolality
Normal urea:creatinine ratios
Poor response to fluid challenge
Brown granular casts

430
Q

Most common extra-intestinal manifestation of IBD

431
Q

Pathophysiology of cholesteatomas

A

Result from chronic ear infections / glue ear

432
Q

When do you restart COCP after emergency contraception with levonorgestrel?

A

Immediately

433
Q

Total dose for syringe driver?

A

Total in a day / 2

434
Q

Can nitrofurantoin be used in CKD?

A

NOT CKD 3
Needs to be concentrated in urine to work therefore likely to fail if CKD 3

435
Q

Hand preference when is it normal?

A

After 1 year
If before - abnormal - refer to paeds

436
Q

TFTS:
Graves

A

TSH: low
T4: high

437
Q

TSH: low
T4: high

438
Q

TFTS: Primary hypothyroidism

A

TSH: high
T4: low

439
Q

TSH: high
T4: low

A

TFTS: Primary hypothyroidism

440
Q

TFTS:
Secondary hypothyroidism

A

TSH: low
T4: low

441
Q

TSH: low
T4: low

A

TFTS:
Secondary hypothyroidism

442
Q

TFTS:
Sick euthyroid

A

TSH: low/Normal
T4: low (predominance for T3)

No symptoms

443
Q

TSH: low/Normal
T4: low (predominance for T3)

No symptoms

A

TFTS:
Sick euthyroid

444
Q

TFTS:
Subclinical

A

TSH: high
T4: normal

445
Q

TSH: high
T4: normal

A

TFTS:
Subclinical
OR poor compliance

446
Q

TFTS:
Poor compliance

A

TSH: high
T4: Normal

447
Q

TFTs:
Steroid Rx

A

TSH: low
T4: Normal

448
Q

TSH: low
T4: Normal

A

TFTs:
Steroid Rx

449
Q

Most common cause nephrotic syndrome in young adults / children

A

Minimal change disease

450
Q

SE cabergoline

A

Pulmonary fibrosis

451
Q

What vitamin should breastfeeding women take?

452
Q

White PV discharge in babies up to 3 months

453
Q

Peripheral artery disease, what drugs should they be on?

A

Clopidogrel
Atorvastatin

454
Q

Rx scarlet fever

A

Penicillin V (phenoxymethylpenicillin)

455
Q

Contact with rat urine
Farmers
Fever, viral type symptoms
Later renal/liver failure
Subconjunctival haemorrhages

A

Leptospirosis

456
Q

Most important factor for liver transplant

A

Arterial pH <7.3

457
Q

Otitis externa Rx

A

Corticosteroid and aminoglycoside drop

458
Q

Hordeola Externam

459
Q

Homonymous hemianopia
How do you work out the lesion

A

PITS
Parietal inferior
Temporal superior

460
Q

PITS
Parietal inferior
Temporal superior

A

Homonymous hemianopia
How do you work out the lesion

461
Q

BROCA lesion location

A

Frontal (near mouth)

462
Q

Wernickes

A

Temporal lobe (near ear)

463
Q

What is given before fibroid surgery

A

GnRH analogues
Levoproline

464
Q

When does progesterone peak?

A

Luteal phase

465
Q

AST:ALT 2:1

466
Q

What sort of line is TPN given through

A

Subclavian

467
Q

COCP MISSED PILLS
1x pill missed

A

Take 2 pills in one day
No contraception needed

468
Q

COCP MISSED PILLS
2x missed in week one

A

Take an extra missed pill (2/day)
Barrier for 7 days

Consider emergency contraception if had sex

469
Q

COCP MISSED PILLS
2x missed in week two

A

Take an extra missed pill (2/day)
Barrier for 7 days

No emergency needed

470
Q

COCP MISSED PILLS
2x missed in week 3

A

Take an extra missed pill (2/day)
Barrier for 7 days

Omit the pill free interval

471
Q

What to monitor in haemochromatosis

A

TF sat
Ferritin

472
Q

Severe Cdif Rx

A

Oral vanc and IV metronidazole

473
Q

ER +ve Rx

A

Postmenopausal - anastrozole
Premenopausal - tamoxifen

474
Q

DRUG MONITORING
ACE

475
Q

DRUG MONITORING
Amiodarone

476
Q

DRUG MONITORING
Methotrexate

A

FBC LFT U+Es

477
Q

DRUG MONITORING
Azathioprine

478
Q

DRUG MONITORING
Lithium

A

Levels
TFTs
U+Es

479
Q

DRUG MONITORING
Sodium Valproate

480
Q

DRUG MONITORING
Glitazones/thiazolidinediones
Pioglitazone

481
Q

Hypokalaemia ECG signs

A

U have no T but a long PR and QT

U waves
Absent T waves
Long PR
ST depression
Long QT

482
Q

U have no T but a long PR and QT

U waves
Absent T waves
Long PR
ST depression
Long QT

A

Hypokalaemia ECG signs

483
Q

If has vasomotor but doesn’t want HRT

A

Fluoxetine

484
Q

Referral for BRCA gene testing

A

FHx <40
B/L breast Ca
Male
Ovarian Ca
Jewish ancestry
Sarcoma <45
Glioma/childhood adrenal carcinoma
Multiple cancers at young age
2x breast Ca on dads side

485
Q

FHx <40
B/L breast Ca
Male
Ovarian Ca
Jewish ancestry
Sarcoma <45
Glioma/childhood adrenal carcinoma
Multiple cancers at young age
2x breast Ca on dads side

A

Referral for BRCA gene testing

486
Q

Rx and Mx bleeding in pregnancy

A

Anti D
Kleihaur (works out the amount of fetal cells in maternal circulation and whether more anti D is needed)

487
Q

N+V and red eye

A

Acute angle closure glaucoma

488
Q

Traveller with orchitis Rx

A

Cef IM and 10-14 doxy

489
Q

Perthes onset

490
Q

What is erysipelas

A

Infection of the upper dermis
Commonly caused by strep pyogenes

491
Q

What often precedes orbital cellulitis

A

Ethmoidal sinus infection (thin membrane)

492
Q

Domperidone doesnt what

493
Q

Near immediate rejection of transplant?

A

ABO/HLA incompatibility

494
Q

6months+ and rejection of the transplant?

A

T cell mediated

495
Q

Statins + macrolides cause what?

A

Rhabdomyolysis

496
Q

Rhabdomyolysis is caused by what drug combination?

A

Statins + macrolides

497
Q

HHV7
Viral infection precedes

A

Pityriasis rosea

498
Q

Pityriasis rosea cause

499
Q

What cancer is associated with coeliacs

A

Enteropathy associated T cell lymphoma

500
Q

Cervical smear when?

A

25-49 3 yearly
50-64 5 yearly

501
Q

Hydroxychloroquine serious side effect

A

Retinopathy

502
Q

Well demarcated waxy atrophic patches on the anterior shin

A

Necrobiosis lipoidica
Associated with DM

503
Q

Late sign in cauda equina

A

Urinary incontinence

504
Q

CONTACEPTIVE MOA
COC

A

Inhibits ovulation

505
Q

CONTACEPTIVE MOA
Desogestrel

A

Inhibits ovulation

506
Q

CONTACEPTIVE MOA
Implantable

A

Inhibits ovulation

507
Q

CONTACEPTIVE MOA
IUS

A

Decreases endometrial proliferation

508
Q

CONTACEPTIVE MOA
IUD

A

Sperm motility and survival

509
Q

CONTACEPTIVE MOA
POP

A

Thickens cervical mucous

510
Q

Thickens cervical mucous

511
Q

Decreases sperm motility and survival

512
Q

Prevents endometrial proliferation

513
Q

Inhibits ovulation

A

COCP
Desogestrel
Implantable

514
Q

Drugs causing erythema nodosum
Hint: Painful Coloured Skin

A

Penicillins
COCP
Sulfonamides

515
Q

Erythema nodosum causes
SORE SHINS

A

Strep
OCP
Rickettsia
Eponymous Behcets

Sulfonamides
Hansens disease (leprosy)
IBD
NHL
Sarcoid

516
Q

Rx glandular fever

A

Self limiting

517
Q

Myopic

A

Small pupils OPIUM

518
Q

Mydriatic

A

Those pupils are actually huge

519
Q

Second line Rx BV

A

Topical clindamycin

1st line metronidazole

520
Q

BV cause

A

Gardenella vaginalis

521
Q

ANTIPLATELET SUMMARY
ACS

A

DAPT 1 year, aspirin lifelong

522
Q

ANTIPLATELET SUMMARY
TIA/STROKE/PAD

A

Clopidogrel lifelong

523
Q

Acute limb ischaemia Rx

A

IV unfractionated heparin

524
Q

Ovarian cyst, <5cm <35

A

Repeat US in 8 / 12 / 52 weeks

525
Q

Ovarian cyst, PM

A

Refer gynae

526
Q

Drug Rx PTSD

A

Venlafaxine / SSRI

527
Q

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

A

Drugs causing tinnitus

528
Q

Drugs causing tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

529
Q

SSRIs in pregnancy?

A

Try to avoid

530
Q

What is telogen effluvium

A

Hair loss in response to stress

531
Q

Low BP, increased JVP, muffled heart sounds

A

Becks triad
Seen in tamponade

532
Q

Becks triad
Seen in tamponade

A

Low BP, increased JVP, muffled heart sounds

533
Q

Seen in priests, swelling of knee

A

Infrapatellar bursitis

534
Q

AF < 48 hours and systemically well

A

Admit for electrical cardioversion

535
Q

AF >48 hours

A

TOE vs 3 weeks anticoagulation and cardioversion, with anticoagulation for 4 weeks after
(ADD AMIODARONE/SOTALOL IF HIGH CHANCE FAILURE)

536
Q

Cushings triad

A

Bradycardia
Wide pulse pressure/HTN
Irregular breathing

537
Q

Bradycardia
Wide pulse pressure/HTN
Irregular breathing

A

Cushings triad

538
Q

Promotes hyperuricaemia by increasing uric acid absorption in the proximal tubule

A

Furosemide
Can cause gout

539
Q

VareNICline MOA
Aids smoking cessation

A

Partial nicotinic agonist

540
Q

Buproprion MOA
Aids smoking cessation

A

NA and dopamine reuptake inhibitor
and nicotinic antagonist

541
Q

Cannot have IUS if what

542
Q

HPV+ve after 2x HPV and NORMAL cytology

A

Colposcopy

543
Q

Anastrozole causes

A

Osteoporosis

544
Q

Consider what if HF not responding to to diuresis

545
Q

Highly contagious conjunctivitis

A

Adenovirus

546
Q

Staph aureus food poisoning is what

A

Rapid onset

547
Q

What is secondary amenorrhoea

A

Pelvic problems

548
Q

Plasma paracetamol levels <4 hours are what

A

Not reliable

549
Q

After how long before plasma paracetamol levels can be done

A

4 hours post ingestion

550
Q

COPD severity levels
FEV1

A

Mild >80
Mod 50-80
Severe 30-50
Very severe <30

551
Q

Carbemazepine cyp inducer or inhibitor

552
Q

How many tear degrees?

A

4
1 - mucosa
2 - muscle
3 - anal complex
4 - anal epithelium

553
Q

Triptan and SSRI

A

NONONONONON NOOOOOOO

554
Q

How to tell between capilliary haemangioma and port wine stain

A

Capilliary haemangiomas get bigger then resolve

555
Q

Which part of the bone do osteosarcomas occur

A

Metaphysis

556
Q

Does transdermal HRT increase VTE risk

557
Q

How many total doses of tetanus

558
Q

Omeprazole and clopidogrel, what happens

A

Reduced effectiveness

559
Q

Prolactinoma causes
PPPPPP

A

Pregnancy
Prolactinoma
Prochlorperazine, metoclopramide, domperidone
Physiological
PCOS
Primary hypothyroidism

560
Q

How long does methotrexate need to be stopped for before trying to conceive? And who?

A

6 months
Both male and female

561
Q

Kawasaki Rx

A

High dose aspirin (even though aspirin normally contraindicated)

562
Q

How to tell between viral labyrinthitis and vestibular neuronitis?

A

Viral labyrinthitis - hearing loss and dizziness
Vestibular neuronitis - dizziness

563
Q

Isoniazid and rifampicin, inhibit or induce cyp?

A

Isoniazid inhibits
Rifampicin Raises

564
Q

Actinic keratosis Rx

565
Q

Atorvastatin primary vs secondary prevention doses

A

Prim - 20mg
Sec - 80mg

566
Q

HBSAg

A

Acute or chonic disease

567
Q

AntiHBS

568
Q

HBeAg

A

Infectivity

569
Q

AntiHBc

A

Prev or current infection depending on M vs G

570
Q

Most common cause meningitis in neonates

571
Q

Fever, rash, arthritis, raised eosinophils

572
Q

Thrombopheblitis of saphenous

A

US doppler, even before D DIMER or if Wells negative

573
Q

Opiate of choice for neuropathic pain

574
Q

Problem with bupropion

A

Reduces seizure threshold

575
Q

Imagery of choice for achilles rupture

576
Q

Colorectal screening, which ages

A

FIT 2yrly 60-74 England
50-74 in Scotland

577
Q

Corticosteroids in dark skin

A

Causes depigmentation

578
Q

Pseudopolyps IBD

579
Q

Oral rotavirus, what type of vaccine

A

Oral
Live attenuated
Given at 2 months + 3 months

580
Q

Oral rotavirus, when cant it be given

A

1st dose after 15 weeks, second dose after 24 weeks - increased risk of intussiception

581
Q

Achilles tendonitis Rx

A

Rest
>7 days - physio

582
Q

Drug induced lupus antibody

A

Antihistone

583
Q

Antihistone antibody

A

Drug induced lupus antibody

584
Q

Akylosing spondylitis AAAAAA

A

Apical fibosis
Anterior uveitis
Aortic regurg
Amyloidosis
Achilles tendonitis
AV node block

585
Q

Apical fibosis
Anterior uveitis
Aortic regurg
Amyloidosis
Achilles tendonitis
AV node block

A

Ankylosing spondylitis

586
Q

Sebacious cyst needs

A

Needs surgery to fully cut out otherwise comes back with a VENGEANCE

587
Q

Should you give metoclopramide in BO?

A

NEVER
Worsens and can cause perforation

588
Q

What increases BNP?

A

LVH
Ischaemia
Tachycardia
COPD
GFR reduced
RV overload
Sepsis
DM
Age >70
Cirrhosis

589
Q

LVH
Ischaemia
Tachycardia
COPD
GFR reduced
RV overload
Sepsis
DM
Age >70
Cirrhosis

A

Increases BNP

590
Q

What reduces BNP

A

Obesity

Diuretics
ACEi
BBlockers
ARB
Aldosterone antagonists

591
Q

Obesity

Diuretics
ACEi
BBlockers
ARB
Aldosterone antagonists

A

Reduce BNP

592
Q

OA Xray findings

A

LESS
Loss of joint space
Erosions
Subchondral sclerosis
Subchondral cysts

593
Q

LESS
Loss of joint space
Erosions
Subchondral sclerosis
Subchondral cysts

A

OA Xray findings

594
Q

On examination, there is a full range of movement of the knee. There is sharp pain on palpation over the lateral epicondyle of the femur, particularly with the knee at 30 degrees of flexion.

A

Iliotibial band syndrome

595
Q

alternation of QRS complex amplitude between beats

A

Electrical alternans

Cardiac tamponade

596
Q

alternation of QRS complex amplitude between beats

A

Electrical alternans

Cardiac tamponade

597
Q

form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

A

Weber’s syndrome

598
Q

form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

A

Weber’s syndrome

599
Q

This presents with ipsilateral facial pain and temperature loss. Along with contralateral limb/ torso pain, ataxia and nystagmus.

A

Lateral medullary syndrome, wallenburgs

600
Q

Facial paralysis and deafness are common findings on the same side as the infarction. This is accompanied by contralateral weakness.

A

Lateral pontine syndrome. This is a stroke affecting the pons meaning the cranial nerve nuclei arising from the pons are affected here.

601
Q

Facial paralysis and deafness are common findings on the same side as the infarction. This is accompanied by contralateral weakness.

A

Lateral pontine syndrome. This is a stroke affecting the pons meaning the cranial nerve nuclei arising from the pons are affected here.

602
Q

Dermatophyte nail infections Rx

A

Oral terbinafine

603
Q

Gliptin MOA

A

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

604
Q

When is the peak incidence of seizures following alcohol withdrawal?

A

Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

605
Q

Gingival hyperplasia drugs

A

Gingival hyperplasia: phenytoin, ciclosporin, calcium channel blockers and AML

606
Q

Classic triad of sensorineural deafness, eye abnormalities and congenital heart disease. Caused by what infection?

A

Rubella - congenital rubella syndrome

607
Q

Triad of congenital rubella syndrome

A

classic triad of sensorineural deafness, eye abnormalities and congenital heart disease

608
Q

Triad of congenital rubella syndrome

A

classic triad of sensorineural deafness, eye abnormalities and congenital heart disease

609
Q

Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level

A

Non-seminomatous testicular cancer

610
Q

A 71-year-old woman is diagnosed with polymyalgia rheumatica. She is started on prednisolone 15mg od. What is the most appropriate approach to bone protection?

A

Bone protection for patients who are going to take long-term steroids should start immediately

611
Q

A 38-year-old woman presents with a litany of symptoms that have been ongoing for the past four months. These include weight gain, which particularly bothers her around the abdomen, with troubling purplish stretch marks, thin skin and easy bruising. She has been noticing increased swelling in her ankles and poor mood. In the diagnostic work-up, a range of laboratory tests is taken.

What is the expected electrolyte abnormality in this patient?

A

hypokalaemic metabolic alkalosis

This patient has Cushing’s syndrome, a disease characterised by cortisol excess. Most commonly, it is related to exogenous glucocorticoid therapy but may also stem from autonomous overproduction by the adrenal glands or increased production of adrenocorticotrophic hormone. Cortisol at high levels can simulate the effects of aldosterone. There is increased sodium and subsequently water retention and increased potassium excretion, resulting in hypokalaemia. Bicarbonate resorption is increased in the tubules with potassium depletion causing metabolic alkalosis. Due to the potassium excretion, there is a hypokalaemic metabolic alkalosis

612
Q

A 59-year-old man is diagnosed with Parkinson’s disease after being referred with a tremor and bradykinesia. His symptoms are now affecting his ability to work as an accountant and are having a general impact on the quality of his life. What treatment is he most likely to be offered initially?

A

Levodopa should be offered for patients with newly diagnosed Parkinson’s who have motor symptoms affecting their quality of life

614
Q

Eye drops causes brown pigmentation

A

Latanoprost and brown pigmentation= Latina-prost

615
Q

Thyroid storm treatment

A

In thyroid storm with IV beta-blockers are a important first-line treatment

Beta B4 alpha

616
Q

What is the most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation?

A

Endometrial cancer

617
Q

Electrolyte abnormality Cushing

A

Cushing’s syndrome - hypokalaemic metabolic alkalosis

618
Q

What is the most common cause of childhood hypothyroidism in the United Kingdom?

A

Autoimmune thyroiditis

619
Q

How long stop COCP before surgery?

A

Advise women to stop taking their COCP/HRT 4 weeks before surgery

620
Q

Anterior uveitis Rx

A

Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops

621
Q

MRI shows:
Normal alignment and segmentation.
There is a small left para-central L4/5 disc prolapse causing compression of the transiting L5 nerve root. There is no compression of the cauda equina with CSF visible around all nerve roots.
All other discs are normal and there are no bony abnormalities visible.

What do you do?

A

The duration of symptoms is less than 4 weeks and conservative management has not been attempted yet so this should be the first-line management at this point in time. This comprises a trial of NSAIDs and physiotherapy. Approximately 90% of cases of sciatica settle within 3 months with conservative management and it is rare to actually need a referral to specialist services.

622
Q

Rx salmonella

623
Q

Folic acid, diabetes

A

She should be taking folic acid 5mg once a day 3 months before conception to 12 weeks of pregnancy.

Women with diabetes are considered at high risk of conceiving a child with neural tube defects

624
Q

P450
Induce SCARS

A

Smoking
Chronic alcohol
AED (except Sodium valproate)
Rifampacin
St Johns Wort

625
Q

Inhibit p450 ASSzoles

A

Inhibit ASSzoles
ABx (exc Rifampicin)
Sodium Valproate
SSRIs
omeprazole, ketoconazole, fluconazole

626
Q

Colchicine SE

627
Q

Down’s syndrome HCG, PAPP-A, nuchal translucency

A

Memory technique: In Down’s the papa leaves (the others are high)

628
Q

SCREENING for polycystic kidneys

630
Q

Which contraceptives are unaffected by epilepsy drugs?

A

Examples of contraceptives that are unaffected by EIDs are:
Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system

631
Q

Bladder cancer, which antidiabetic is contraindicated?

A

Pioglitazone

632
Q

Rx chlamidya in pregnancy

A

Azithromycin, erythromycin or amoxicillin may be used to treat Chlamydia in pregnancy

633
Q

Which one contraceptive does the Faculty of Sexual and Reproductive Healthcare (FSRH) recommend should be discontinued after the age of 50 year

A

Injectible progesterone

634
Q

Nsaids and lithium, what about em?

A

Lithium toxicity can be precipitated by NSAIDs

635
Q

Methotrexate
Sulfasalazine
Leflunomide
Penicillamine and gold
Infliximab

Rheum side effects
Clue = same letter

A

Methotrexate: Myelosuppression
Sulfasalazine: Sperm low
Leflunomide: Liver, Lung disease
Penicillamine and Gold: Proteinuria
Infliximab: Infection TB

636
Q

Length of time for depressive episode

A

Over 2 weeks

637
Q

What are glucose levels in Addison’s?

A

Often see hypoglycaemia

638
Q

Which ligament is most commonly sprained in inversion injuries of the ankle?

A

The anterior talofibular ligament is the most commonly sprained ligament in inversion injuries of the ankle

639
Q

Which ligament is most commonly sprained in inversion injuries of the ankle?

A

The anterior talofibular ligament is the most commonly sprained ligament in inversion injuries of the ankle

640
Q

Ventricular tachycardia - what drug is contraindicated

A

Ventricular tachycardia - verapamil is contraindicated

641
Q

1st line frozen shoulder

642
Q

Which side are congenital inguinal hernias more common on?

643
Q

Huntingtin gene, what chromosome?

A

Huntington’s disease is due to a defect in the huntingtin gene on chromosome 4

644
Q

CKD bones

A

Osteoporosis

645
Q

Boxers fracture

A

5th metacarpal

646
Q

Abx of choice for otitis externa

A
  1. cipro
  2. fluclox/taz
647
Q

ABx and POP

A

no interactions, continue as normal

648
Q

MI drugs

A

DABS
have dabs after an MI
DuApTs - Asp / ticag
ACE
Bblocker
Statin

649
Q

Rose spots

A

Salmonella

650
Q

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

A

Examples of UKMEC 4

651
Q

Down and out

A

3rd nerve palsy

653
Q

When should nocturnal enuresis stop?

A

Children under the age of 5 years who have nocturnal enuresis can be managed with reassurance and advice

654
Q

Polycystic kidney heart disease

A

MVP
Mitral regurg

655
Q

C peptide levels T1DM

A

C-peptide levels are typically low in patients with T1DM

656
Q

Urea breath test - how long after ABx

A

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

657
Q

When do you check LFTs statins

A

2014 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

658
Q

Urea breath test - how long after PPI

A

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

659
Q

Gastroschisis vs exomphalos

A

Whereas gastroschisis tends to be a stand alone bowel condition, exomphalos is associated with cardiac and kidney diseases

660
Q

4 features of TOF

A

TOF is a result of anterior malalignment of the aorticopulmonary septum. The four characteristic features are:
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

662
Q

Chocolate ovarian cyst

A

Endometriotic cyst

663
Q

What electrolyte abnormality predisposes to digoxin toxicity

A

Hypokalaemia predisposes patients to digoxin toxicity

664
Q

Wernicke’s encephalopathy quadiad

A

Confusion, gait ataxia, nystagmus + ophthalmoplegia are features of Wernicke’s encephalopathy

665
Q

DVLA RULES HTN

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

666
Q

Angioplasty DVLA rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

667
Q

ACS driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

668
Q

Catheter ablation driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

669
Q

ACS driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

670
Q

Angina driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

671
Q

ICD driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

672
Q

Heart transplant driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

673
Q

Heart transplant driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

674
Q

AAA driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

675
Q

Catheter ablation driving rules

A

Specific rules
hypertension
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
implantable cardioverter-defibrillator (ICD)
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review.
an aortic diameter of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA

676
Q

Secondary causes of bile acid malabsorption

A

Secondary causes are often seen in patients with ileal disease, such as with Crohn’s. Other secondary causes include:
cholecystectomy
coeliac disease
small intestinal bacterial overgrowth

677
Q

Test for bile acid malabsorption

A

SeHCat test

678
Q

What is bile acid malabsorption

A

Bile-acid malabsorption is a cause of chronic diarrhoea. This may be primary, due to excessive production of bile acid, or secondary to an underlying gastrointestinal disorder causing reduced bile acid absorption. It can lead to steatorrhoea and vitamin A, D, E, K malabsorption.

Secondary - coeliac, cholecystectomy, SBBovergrowth

679
Q

Treatment of bile acid malabsorption

A

Management
bile acid sequestrants e.g. cholestyramine

680
Q

M rule of PBC

A

Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

681
Q

Bilateral red swelling of the nasal septum - what do you do?
RX?
SEQUELAE?

A

Urgent ENT referral

Features
may be precipitated by relatively minor trauma
the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea are also seen
on examination, classically a bilateral, red swelling arising from the nasal septum
this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm

Management
surgical drainage
intravenous antibiotics

If untreated irreversible septal necrosis may develop within 3-4 days. This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis. This may result in a ‘saddle-nose’ deformity

682
Q

Investigation of choice for acromegaly

A

In the investigation of acromegaly, if a patient is shown to have raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis

683
Q

SBP cell count

684
Q

Epilepsy breast feeding

A

All drugs safe except barbiturates

685
Q

Developmental milestones
3/6/9/12
HRCC

15/18/2/3/4
WSRTH

A

3, 6, 9, 12: Head → Roll → Crawl → Cruise.
15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.

686
Q

Developmental milestones
3/6/9/12
HRCC

15/18/2/3/4
WSRTH

A

3, 6, 9, 12: Head → Roll → Crawl → Cruise.
15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.

687
Q

3/6/9/12
HRCC
15/18/2/3/4
WSRTH

A

3, 6, 9, 12: Head → Roll → Crawl → Cruise.
15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.

688
Q

3/6/9/12
HRCC

15/18/2/3/4
WSRTH

A

3, 6, 9, 12: Head → Roll → Crawl → Cruise.
15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.

689
Q

Parkland formula, burn fluid formula

A

Volume of fluid = total body surface area of the burn % x weight (Kg) x 4ml

690
Q

What is refractory anaphylaxis and how is it treated?

A

Adrenaline infusion

Refractory anaphylaxis is defined as respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline

691
Q

Allergic conjunctivitis management

A

first-line: topical or systemic antihistamines
second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate

692
Q

Red orange PEE and TB what med

A

Rifampicin

693
Q

HF, a drug is given to a patient and their psoriasis worsens. What drug?

A

Beta blockers

694
Q

Antiemetic of choice in migraine

A

Metoclopramide
Slows transit of gastric contents

695
Q

When do you treat stage one hypertension?

A

ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)
treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater
in 2019, NICE made a further recommendation, suggesting that we should ‘consider antihypertensive drug treatment in addition to lifestyle advice for adults aged under 60 with stage 1 hypertension and an estimated 10-year risk below 10%. ‘. This seems to be due to evidence that QRISK may underestimate the lifetime probability of developing cardiovascular disease

696
Q

When do you treat stage one hypertension?

A

ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)
treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater
in 2019, NICE made a further recommendation, suggesting that we should ‘consider antihypertensive drug treatment in addition to lifestyle advice for adults aged under 60 with stage 1 hypertension and an estimated 10-year risk below 10%. ‘. This seems to be due to evidence that QRISK may underestimate the lifetime probability of developing cardiovascular disease

697
Q

Gout is can be caused by what loop diuretic?

A

Furosemide

698
Q

A 45-year-old man undergoes a renal transplant from a deceased donor due to renal failure. The on-call doctor is asked to review the patient 2 hours after the procedure. His observations show temperature of 40ºC, heart rate 114/min, respiratory rate 23/min, saturations of 97% in room air, blood pressure of 81/62mmHg.

Considering the most likely diagnosis, what is the appropriate management for this patient?

A

No treatment is possible for hyperacute transplant rejection - the graft must be removed

699
Q

Management of bilateral adrenal hyperplasia

A

Spiro

Not adrenalectomy as it is bilateral

700
Q

What do all these drugs have in common?

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

A

Worsen psoriasis

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

701
Q

Which drugs worsen psoriasis

A

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

702
Q

A 32-year-old man attends eye casualty following an eye injury to his right eye whilst playing squash.

On examination of the right eye, there is blood in the anterior chamber, proptosis, a stiff eyelid, and a relative afferent pupillary defect. A diagnosis of orbital compartment syndrome is suspected.

What is the most appropriate management?

A

Immediate canthotomy

703
Q

Azathioprine and allopurinol, what happens?

A

Neutropenic sepsis if coprescribed

704
Q

How long do symptoms need to be present for before diagnosing chronic fatigue syndrome

A

Chronic fatigue syndrome: the symptoms should be present for 3 months before making a diagnosis

705
Q

The ECG performed on scene by the paramedics shows ST depression in V1-V3 with tall, broad R waves and upright T waves

A

Posterior MI

706
Q

Stroke/Tia NO atrial fibrillation.
Clopidogrel not tolerated. What Rx?

A

Aspirin instead

707
Q

Hypercalcaemia ECG findings

708
Q

Normal anion gap metabolic acidosis

A

Normal anion gap ( = hyperchloraemic metabolic acidosis)
gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

709
Q

Normal anion gap ( = hyperchloraemic metabolic acidosis)
gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

A

Normal anion gap metabolic acidosis

710
Q

lactate:
shock
sepsis
hypoxia
ketones:
diabetic ketoacidosis
alcohol
urate: renal failure
acid poisoning: salicylates, methanol

A

Raised anion gap metabolic acidosis

711
Q

Raised anion gap metabolic acidosis

A

Raised anion gap
lactate:
shock
sepsis
hypoxia
ketones:
diabetic ketoacidosis
alcohol
urate: renal failure
acid poisoning: salicylates, methanol

712
Q

Lactic acidosis type B

A

Metformin related

713
Q

Cyst at the nail bed

A

Mxyoid cyst

714
Q

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

A

L3 nerve root compression

715
Q

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

A

L4 nerve root compression

716
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

A

L5 nerve root compression

717
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

A

S1 nerve root compression

718
Q

Benzo MoA

A

Benzodiazepines enhance the effect of GABA, the main inhibitory neurotransmitter

719
Q

Acute epiglottitis is caused by Haemophilus influenzae type

720
Q

Erythema chronicum migrans

A

lyme disease

721
Q

Lyme disease rash

A

Erythema chronicum migrans

722
Q

How to differentiate between IgA and post-strep glomerulonephritis

IE recent cough and then haematuria

A

IgA - INstant

Post-strep - haematuria 2 weeks later

724
Q

Communicating hydroceles are common in newborn males, what do you do?

A

Communicating hydroceles are common in newborn males and often resolve spontaneously

725
Q

Treatment for capillary haemangioma

A

Propranolol is the treatment of choice in capillary haemangiomas requiring intervention

726
Q

When to offer ECV for breech

A

36 weeks nulliparous
37 weeks multiparity

727
Q

Marfan’s painless visual loss

A

Lens dislocation

728
Q

BRCA2 associated with what male cancer

729
Q

AAA <3cm

730
Q

AAA 3-4.4cm

A

12 monthly scans

731
Q

AAA 4.5-5.4

A

3 monthly scan

732
Q

AAA >5.5cm

A

2w referral for probable intervention

733
Q

Impaired glucose tolerance definition

A

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

734
Q

A 38-year-old woman and her partner come to the GP surgery after failing to conceive their first child. After what period of time of regular sexual intercourse should you begin to investigate?

A

6 months if over 35

735
Q

CKD diagnosis for stages 1 + 2 hinges on what?

A

Chronic kidney disease is only diagnosed in this situation if supporting tests such as urinalysis or renal ultrasound are abnormal

736
Q

Clindamycin + clarithromycin can both cause C dif, but which is more associated with it?

A

C-Dif, ClinDamycin

737
Q

Which raises INR, P450 inhibition or induction?

A

A raised INR is a result of inhibited liver enzymes

738
Q

When can copper IUD be inserted for emergency contraception?

A

The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later

739
Q

Staggered doses of paracetamol, what do you do?

A

Immediate NAC

740
Q

1st line threadworms

A

MEBENDAZOLE

741
Q

Chest drain for secondary pneumothorax if what?

A

The correct answer for a secondary pneumothorax which is >2cm and/or the patient is breathless is a chest drain.

742
Q

ABx in acute pancreatitis yes or na?

A

Antibiotics should not be offered routinely to patients with acute pancreatitis

743
Q

Fatty liver on US, what test next?

A

Enhanced liver fibrosis blood test

744
Q

benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.

Overview
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light

Often absent knee reflex

A

Holmes adie

745
Q

Flexural psoriasis Rx

A

Mild-mod corticosteroid
NO VIT D ANALOGUE - THIS IS ONLY FOR EXTENSOR

747
Q

Drug induced lupus causes

A

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

748
Q

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

A

Drug induced lupus causes

749
Q

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago

A

no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

750
Q

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago

A

if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

751
Q

If vaccination history is incomplete or unknown

A

reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

752
Q

What number of years is key to working out tetanus management with cuts?

A

10 years
<10 - nil needed
>10 - booster +/- immunoglobulin dependent on severity
Unknown - booster and immunoglobulin

753
Q

1st line legionella

A

Macrolides

754
Q

Effect of rheumatoid factor negativity on rheumatoid arthritis

A

Less severe if RF -ve

755
Q

Bacterial conjunctivitis treatment IF PREGNANT

A

topical fusidic acid

756
Q

Anion gap equation

A

Na+K minus cl + bicarbonate

757
Q

Anion gap raised if

758
Q

A 29-year-old man presents with a rash on his trunk. Around two weeks ago he describes developing a patch of ‘eczema’ on his torso the size of 50 pence piece. Around a week later a number of smaller, red patches started to appear as well

A

The earlier lesion represents a classical herald patch. This image demonstrates the ‘fir tree’ appearance often seen in patients with pityriasis rosea.

759
Q

Light’s Criteria

A

Light’s Criteria for exudative effusion requires one of more of the following:
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal
Glucose is not used in Light’s Criteria.

760
Q

Cipro and epilepsy?

A

Ciprofloxacin lowers the seizure threshold

761
Q

Check what else with rhabdo

A

Calcium and phosphate

762
Q

Panic disorder RX

A

SSRIs are the most commonly used drug treatment in panic disorder

763
Q

Reduced fetal movements, no heartbeat on doppler, >28 weeks

A

If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler then an immediate ultrasound should be offered

764
Q

Secondary dysmenorrhoea management

A

All patients with secondary dysmenorrhoea need to be referred to gynaecology for investigation

765
Q

1ST LINE RX for regular broad complex tachycardias without adverse features

A

IV amiodarone is the first-line treatment for regular broad complex tachycardias without adverse features

766
Q

Staggered paracetamol overdose definition

A

staggered overdose is defined as taking paracetamol over more than a 1 hour period

767
Q

Bradycardia and shock Rx

A

Patients with bradycardia and signs of shock require 500micrograms of atropine (repeated up to max 3mg)

Atropine 500mcg IV is the first-line treatment in this situation. If the patient does not respond, then up to 3mg of atropine can be given. If this fails as well, transcutaneous pacing can be considered.

768
Q

Contraception after vasectomy?

A

Vasectomy isn’t an immediate form of contraception; semen analysis must be performed and azoospermia confirmed before used as contraception

769
Q

When can COCP be started after emergency contraception?

A

Hormonal contraception can be started immediately after using levonorgestrel (Levonelle) for emergency contraception

770
Q

Most APPROPRIATE Ix in pt with bronchiectasis stable obs with creps and SOB

A

Sputum culture

771
Q

Otitis externa with itchy ear and patient well

A

Topical antibiotic and steroid drops, not antifungal

772
Q

A 39 year old woman presents with a 6 month history of amenorrhoea. She has schizophrenia. She denies sexual intercourse over the past 2 years and reports some episodes of lactation. Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are within normal limits, prolactin is 1125 (normal range < 500).

A

Adverse reaction to antipsychotics

773
Q

A 14 year old boy presents with a one month history of bilateral nasal blockage, sneezing and a clear bilateral nasal discharge. The family have recently purchased a cat.

A

Itranasal beclometasone

774
Q

A 28 year old man presents with a 1 day history of right-sided low back pain. On examination, he has a straight leg raise of 55° on the right side and 85° on the left side, with a bilateral negative sciatic stretch test. There is no bony tenderness and no neurological signs of note.

A

Self management advice > analgesia

775
Q

Cardiac toxicity, which MAB?

A

Trastuzumab (Herceptin) - cardiac toxicity is common

776
Q

Cholestasis with DM drug

A

Gliclazide
(Sulphonylureas may cause cholestasis)

777
Q

Contraindication to triptan

A

Cardiovascular disease is a contraindication to triptan use

778
Q

Rx MND

779
Q

Anti Phospholipase A2 antibodies may be positive
● Mainstay of management - ACEi/ARB - reduce proteinuria
● Most common cause of nephrotic syndrome in adults

A

Membranous nephropathy

780
Q

Renal disease
● Causes: HIV, Heroin use, Alports
● High rate of recurrence

781
Q

Management IPF

A

Management: Nintedanib, pirfenidone.

782
Q

CFs: Parkinsonism plus autonomic dysfunction, manifesting as
○ Falls due to postural hypotension
○ Impotence
○ Loss of bladder control/retention

783
Q

● Autosomal dominant disorder
● CFs: Sudden cardiac death, syncope. More common in Asian ethnicities.
● ECG: Convex ST elevation in V1-3 followed by T wave inversion, RBBB.
○ ST changes increase with flecainide/ajmaline provocation

A
  • Brugada syndrome
784
Q

● CFs: Mononeuritis multiplex, livedo reticularis
● Invx: Commonly Hep B positive, p-ANCA

A

Polyarteritis nodosa

785
Q

Anti-Mi-2, anti-SRP

A

Dermatomyositis

786
Q

cANCA (PR3)

A

Granulomatosis with polyangiitis: cANCA (PR3)

787
Q

pANCA (MPO)

A

Eosinophilic granulomatosis with polyangiitis: pANCA (MPO)

788
Q

Anti-U1 ribonucleoprotein

A

Sharp’s syndrome (MCTD): Anti-U1 ribonucleoprotein

789
Q

Anti-centromere antibodies

A

Limited cutaneous systemic sclerosis: Anti-centromere antibodies

790
Q

Anti-SCL-70 antibodies

A

Diffuse cutaneous systemic sclerosis: Anti-SCL-70 antibodies

791
Q

Mutation on Chr 17:
o Café au lait spots
o Axillary freckling
o Peripheral neurofibromas
o Phaeochromocytoma

792
Q

Antithyroid Rx in pregnancy

793
Q

Primary open-angle glaucoma: management

Increases uveoscleral outflow
Once daily administration

Adverse effects include brown pigmentation of the iris, increased eyelash length

A

Prostaglandin analogues (e.g. latanoprost)

794
Q

Primary open-angle glaucoma: management

Reduces aqueous production Should be avoided in asthmatics and patients with heart block

A

Beta-blockers (e.g. timolol, betaxolol)

794
Q

Primary open-angle glaucoma: management

Reduces aqueous production and increases outflow Avoid if taking MAOI or tricyclic antidepressants

Adverse effects include hyperaemia

A

Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)

795
Q

Primary open-angle glaucoma: management

Reduces aqueous production
Systemic absorption may cause sulphonamide-like reactions

A

Carbonic anhydrase inhibitors (e.g. Dorzolamide)

796
Q

Primary open-angle glaucoma: management

Increases uveoscleral outflow Adverse effects included a constricted pupil, headache and blurred vision

A

Miotics (e.g. pilocarpine, a muscarinic receptor agonist)

796
Q

Primary open-angle glaucoma: management

1st line Rx

A

NICE guidelines
offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg NICE
360° SLT can delay the need for eye drops and can reduce but does not remove the chance they will be needed at all
a second 360° SLT procedure may be needed at a later date
prostaglandin analogue (PGA) eyedrops should be used next-line NICE

the next line of treatments includes:
beta-blocker eye drops
carbonic anhydrase inhibitor eye drops
sympathomimetic eye drops
surgery in the form of a trabeculectomy may be considered in refractory cases.

797
Q

most common precipitating factors of DKA

A

infection, missed insulin doses and myocardial infarction.

798
Q

Key points
glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick

A

Diagnostic criteria for DKA

799
Q

an intravenous infusion should be started at 0.1 unit/kg/hour
once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime

800
Q

Lead poisoning Rx

A

Dimercaprol, calcium edetate

801
Q

Cyanide poisoning Rx

A

Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

802
Q

Pulmonary fibrosis, which parkinsons drug

A

cabergoline, dopamine agonist

803
Q

Most common UK hepatitis

A

hepatitis C most common cause in Europe

804
Q

Sleep disturbance, what HF medication?

A

Betablockers

805
Q

how to tell cystic hygroma vs branchial cyst

A

Branchial - older patients, after cough
cystic hygroma - babies

806
Q

AEIOU dialysis indications

A

Acidosis (<7.1)
Electrolyte abnormalities (K>6.5)
Ingestion
Overload
Uraemia (pericarditis/encephalopathy)

807
Q

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

A

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

808
Q

COCP missed pills week 1
?emergency contraception
?what to do

A

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

809
Q

COCP missed pills week 2
?emergency contraception
?what to do

A

if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*

810
Q

COCP missed pills week 3
?emergency contraception
?what to do

A

if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

811
Q

POP (apart from deso=cerazette) what is the timeframe that matters?

A

> 3 hours

Contraception only established after 48hr pills

812
Q

What is the timeframe that matters for missed cerazette?

813
Q

electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
acute myocardial infarction
myocarditis
hypothermia
subarachnoid haemorrhage

A

Long QT causes, predisposes to torsades

814
Q

How to differentiate POAG and PCAG

A

OPEN - insideous, painless
CLOSED - Sudden, Painful

POAG may present insidiously and for this reason is often detected during routine optometry appointments. Features may include
peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

815
Q

Anti HBC AND ANTI HBS

A

Immune due to natural infection

If there’s surface antigen: current infection
If there’s core antibody (anti-HBc): previous or current infection
If there’s surface antibody (anti-HBs): immunisation or infection

So, remember that the vaccine only has the surface antigen (therefore you can only make anti-surface antibody). From there it’s easy.

816
Q

core antibody (anti-HBc)

A

If there’s core antibody (anti-HBc): previous or current infection

817
Q

infection may cause marked right iliac fossa pain mimicking appendicitis

A

campylobacter

818
Q

Treating mild-to-moderate ulcerative colitis

proctitis

A

topical (rectal) aminosalicylate: for distal colitis rectal mesalazine has been shown to be superior to rectal steroids and oral aminosalicylates
if remission is not achieved within 4 weeks, add an oral aminosalicylate
if remission still not achieved add topical or oral corticosteroid

819
Q

Treating mild-to-moderate ulcerative colitis

proctosigmoiditis and left-sided ulcerative colitis

A

topical (rectal) aminosalicylate
if remission is not achieved within 4 weeks, add a high-dose oral aminosalicylate OR switch to a high-dose oral aminosalicylate and a topical corticosteroid
if remission still not achieved stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid

820
Q

Treating mild-to-moderate ulcerative colitis

extensive disease

A

topical (rectal) aminosalicylate and a high-dose oral aminosalicylate:
if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid

821
Q

Treating Severe ulcerative colitis

A

should be treated in hospital
IV steroids are usually given first-line
IV ciclosporin may be used if steroids are contraindicated
if after 72 hours there has been no improvement, consider adding IV ciclosporin to IV corticosteroids or consider surgery

822
Q

Cervical cancer screening: if smear inadequate

A

Cervical cancer screening: if smear inadequate then repeat in 3 months

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