Last min Flashcards
Seborrhoeic dermatitis - first-line treatment is
topical ketoconazole
A 38-year-old woman with a 4.5cm fibroid has been listed for a myomectomy following a 5 month history of heavy menstrual bleeding.
What drug should be prescribed to be taken whilst awaiting surgery?
For patients with uterine fibroids, GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
Acute heart failure not responding to treatment -
consider CPAP
which bacterial infection common after influenza
staphylococcus aureus
Whooping cough management
- azithromycin or clarithromycin if the onset of cough is within the previous 21 days
Nancy, 72, is diagnosed with chronic obstructive pulmonary disease (COPD). Despite using a short-acting beta agonist along with a short-acting muscarinic antagonist, she is still breathless at rest. Her current FEV1 is found to be 45%.
On reviewing the full blood count she had at the time of diagnosis you note a raised eosinophil count.
Which of the following would be the most appropriate next step in her management?
A. Long acting beta agonist B. Inhaled corticosteroid C. Inhaled corticosteroid and long-acting muscarinic antagonist D. Inhaled corticosteroid and long-acting beta agonist E. Long-acting beta agonist and Long acting muscarinic antagonist
D. Inhaled corticosteroid and long-acting beta agonist
A 12 day old infant is brought to the emergency department by his anxious mother who notices that he has developed a right sided groin swelling. On examination the testes are correctly located but it is evident that the child has a right sided inguinal hernia. It is soft and easily reduced.
What is the most appropriate management?
A. Surgery over the next few days B. Reassure and discharge C. Surgery at 1 year of age D. Surgery once the child is 6 months old E. Application of a hernia truss
A. Surgery over the next few days
Inguinal hernia in infants = Urgent surgery
The high incidence of strangulation necessitates an urgent herniotomy be performed. In infants with a reducible hernia this can be performed on a daycase list during the same week. Deferring surgery on the basis of age is not justified.
A 56-year-old gentleman is brought in by paramedics. The patient fainted this morning and has not regained consciousness. No injuries reported from his faint. On examination his heart rate is 37 beats/minute, respiratory rate is 16 breaths/minute, blood pressure is 105/70 mmHg. The ambulance crew gave the patient six doses of IV atropine while on route to the hospital. You order an ECG:
The ECG shows prolonged PR interval.
What would be the initial management?
A. Synchronised cardioversion B. Implant pacemaker C. IV amiodarone D. External pacing E. IV adenosine
External pacing is used for symptomatic bradycardia if atropine fails
A 42-year-old woman falls off her horse and sustains a head injury. A CT scan on admission to the Emergency Department demonstrates a skull fracture and an associated extra-dural haematoma overlying the left parietal lobe. She has a Glasgow coma score of 12; E3 V4 M5, on arrival with no apparent neurological deficits. At the time both pupils are 4mm in diameter with intact pupillary light responses. She deteriorates within an hour to a Glasgow coma score of 8; E2 V2 M4. Her left pupil is now fixed at 7mm and her right pupil is 3mm and reacts to light. Additionally, her left eye is deviated inferiorly and away from the midline.
What is the most likely pathology responsible for her clinical findings?
A. Trans-tentorial herniation B. Cerebellar tonsillar herniation C. Posterior communicating artery aneurysm D. Frontal eye field injury E. Optic nerve compression
Trans-tentorial herniation
Raised ICP can cause a third nerve palsy due to herniation
IgA nephropathy vs Post-streptococcal
IgA- presents within days
Post-strep- presents 1-2 weeks after
The three criteria for aneurysm surgery are:
- An asymptomatic aneurysm larger than 5.5 cm in diameter.
- An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
- A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.
A patient who presents to their GP within 7 days of a clinically suspected TIA should have
300mg aspirin immediately (and be referred for specialist review within 24h)
You have been called to see a 36-year-old lady, Saira, on the acute medical admissions ward. The nurse started her blood transfusion two minutes ago, and now Saira is complaining of chills, abdominal and chest pain and dizziness. On examination, you cannot visualise a rash or any angioedema, however, her blood pressure has fallen from 115/75 mmHg to 80/60 mmHg and her temperature has risen to 38ºC. She is beginning to become agitated.
Which one of the following management options would be most suitable to treat this patient?
A. Temporary transfusion termination and an antipyretic B. Permanent transfusion termination and high dose immune globulin therapy. C. Permanent transfusion termination, generous fluid resuscitation with saline solution and inform the lab D. Temporary transfusion termination and an antihistamine E. Permanent transfusion termination, intramuscular adrenaline, corticosteroids and supportive care
Acute haemolytic transfusion reaction should be treated with generous fluid resuscitation and termination of the transfusion.
caput succedaneum vs cephalohaematoma
Caput succedaneum is a subcutaneous, extraperiosteal, collection of fluid that collects as the result of pressure on the baby’s head during delivery.
A cephalhaematoma is a haemorrhage between the skull and periosteum. Because the swelling is subperiosteal, it’s limited by the boundaries of the baby’s cranial bones.
when to 2 week wait a women with breast lump
women>30
A 78-year-old male is recovering on the ward following a partial thyroidectomy to remove a thyroid nodule 48 hours previously.
He complains of muscle cramps and a ‘tingling sensation’ around his mouth. An ECG is performed on the ward.
Given the likely cause of his symptoms, which of the following abnormalities may be observed on his ECG?
A. Prolonged PR interval B. Shortened ST segment C. Prolonged QT interval D. Tall, peaked T wave E. ST elevation
Prolonged QT interval
Complications of thyroid surgery - damage to parathyroid glands can result in hypocalcaemia
management of reactive arthritis
ibuprofen
Acute reactive arthritis can be treated with NSAIDs, as long as there are no contraindications
A 30-year-old woman who is 41 weeks pregnant is being induced in the labour ward. She has an artificial rupture of membranes, but the midwife notices that the umbilical cord is visibly protruding from the vagina. She is brought for an emergency caesarean section.
What is the correct position for her to be in while being prepared for surgery?
A. Flat on her back B. McRobert's position C. On her back with head lowered and lower half of bed raised D. On her knees and elbows E. Standing
The correct position for women who have a cord prolapse is on all fours, on knees and elbows
This is an example of cord prolapse, the majority of which occur after artificial rupture of membranes. The correct position for a woman to be in while being prepared for caesarean is on all fours (on knees and elbows), while someone pushes the presenting part of the fetus up. McRobert’s is a manoeuvre used during shoulder dystocia.
A 40-year-old woman attends for a routine appointment for a review of her blood pressure. When attending for a blood test she was incidentally found to have a blood pressure of 160/80mmHg. She has completed a home blood pressure diary which shows similar results. There is no past medical history of note and she denies any additional symptoms. She is not currently taking any medications. Her body mass index (BMI) is 24kg/m2.
What is the most appropriate investigation to request?
A. 24 hour urine metanephrines B. Renin-aldosterone ratio C. Ultrasound of the kidneys D. 9am cortisol E. Doppler of the renal arteries
A plasma aldosterone/renin ratio is the first-line investigation in suspected primary hyperaldosteronism
The most common secondary cause of hypertension is primary hyperaldosteronism (often called Conn’s syndrome). This tends to present with hypertension and hypokalaemia, although potassium can often be normal. The first line screening test is the renin-aldosterone ratio. Ideally, this should be taken whilst the patient is not taking any antihypertensives - if needed doxazosin is the only drug known not to affect the result.
describe
b) Distal radial fracture (1 mark) with dorsal angulation (1 mark) and dorsal displacement (1 mark)
MEDIAN NERVE AT RISK
AKI staging
