Learning Points from Questios Flashcards
1
Q
3 Conditions in MEN 1 (Werner’s Syndrome)
A
PaPaPi
Parathyroid hyperplasia
Pancreatic tumour
Pituitary Adenoma
2
Q
3 Conditions in MEN2A (Sipple Syndrome)
A
PaMePhe
Parathyroid hyperplasia
Medullary Thyroid Cancer
Phaeochromocytoma
3
Q
1st Line treatment of seborrheic dermatitis?
A
Topical ketoconazole
4
Q
3 Conditions in MEN2B
A
MaMePhe
Marfarnoid Body Habitus
Medullary Thyroid Cancer
Phaeochromocytoma
Mucosal Neuromas
5
Q
1st Line treatment of allergic conjunctivitis?
A
Topical Antihistamines
Oral if rhino sinusitis also
6
Q
Causes of acanthosis nigricans?
A
o Gastric Cancer
o Obesity
o Insulin Resistance
o Diabetes Mellitus
o PCOS
o Metabolic Syndrome
7
Q
Weight loss aim in NAFLD?
A
5-10% in 6 months
8
Q
UMN Lesion Signs?
A
Spastic
Hyperreflexic
Hypertonic
Disuse atrophy
No fasciculations
Babinski positive
9
Q
LMN Lesion Signs?
A
Flacid paralysis
Hyporeflexic
Hypotonic
Wasting atrophy
Fasciculations
Small area
10
Q
Bone profile bloods in Osteoporosis?
A
Ca - normal
PO4 - Normal
ALP - Normal
11
Q
Bone profile bloods in Osteomalacia?
A
Ca - Low
PO4 - Low
ALP - Raised
12
Q
Bone profile bloods in Paget’s?
A
Ca - Normal
PO4 - Normal
ALP - Very raised
13
Q
Bone profile bloods in Myeloma?
A
Ca - Raised
PO4 - Normal or raised
ALP - Normal
14
Q
Bone profile bloods in primary hyperparathyroidism?
A
Ca - Raised
PO4 - Low
ALP - Normal/Raised
15
Q
Main side effect of hydroxychloroquine?
A
Retinopathy
16
Q
1st line treatment in acute urticaria?
A
Non sedating antihistamines (cetirizine, fexofenadine, loratidine)
17
Q
1st Line treatment for prolactinomas?
A
Dopamine Agonists (bromocriptiline, cabergoline)
18
Q
Definition of Fitz Hugh Curtis Syndrome?
A
Perihepatitis with violin string adhesions associated with pelvic inflammatory disease (PID)
19
Q
Definition of Meig’s Syndrome?
A
Benign ovarian tumour (fibroma) + Ascites + Pleural Effusion
20
Q
Types of HSV in oral and genital ulcers?
A
o HSV 1 (oral)
o HSV 2 (Genital)
21
Q
HSV implicated in VZV?
A
HH3
22
Q
HSV implicated in EBV?
A
HH4
23
Q
HSV implicated in roseola?
A
HH6
Affects children younger than 3 years of age.
Mild rhinorrhoea, sore throat, and sudden onset of high fever.
As the fever subsides, typical rash of tiny pink papules or is maculopapular, and not usually itchy
It starts on the trunk before spreading peripherally to the face and limbs.
24
Q
HSV implicated in Kaposi Sarcoma?
A
HH8
25
Definition of Jarisch Herxheimer Reaction?
Common causes?
o Caused by release of endotoxin-like substances when large numbers of bacteria killed by antibiotics
o Most commonly in treatment of Syphilis, but also Lyme Disease, leptospirosis
o Reaction 1-12 hours after first antibiotics, lasts for few hours to a day
o Malaise, pyrexia, flushing, tachycardia
26
How to confirm ovulation, what blood test?
- Confirm ovulation – Serum progesterone 7 days before next expected period
27
Management of intermittent squint in <3 months old?
Normal - reassure
28
Guidance for urea breath test? Abx and PPI
No Abx for 4 weeks
No PPI for 2 weeks
29
Definition of hyperemesis gravidarum?
5% WL + Electrolyte imbalance + dehydration (ketosis)
30
SSRI of choice post MI?
Sertraline
31
Blood film appearance in G6PD?
Auer rods
32
Blood film appearance in Myeloma?
Rouleau formation
33
Management of inguinal hernia in children?
Refer to paediatric surgery
34
Common side effect of vincristine?
Peripheral neuropathy
35
What medication should be avoided in HOCM?
ACE inhibitors
36
Blood gas analysis in Cushing's syndrome?
Hypokalaemic metabolic alkalosis
37
Long term prophylaxis of cluster headaches?
Verapamil
38
Acute management of cluster headaches?
Sumatriptan SC
Sumatriptan nasal
Zolmitriptan nasal (off licence)
Short burst oxygen therapy
39
Management of depression - less severe - score? and Mx?
PHQ-9 < 16 – less severe depression
Does not want treatment – active monitoring, consider treatment at any time
Wants treatmet – guided self help 1st line, then group/individual CBT, offer SSRI if wants antidepressant
40
Management of depression - more severe - score? Mx?
o PHQ-9 >16 – more severe depression
– SSRI + CBT
41
Management of hip fractures - intracapsular undisplaced?
Internal fixation or hemiarthroplasty if unfit
42
Management of hip fractures - intracapsular displaced?
Arthroplasty (THR favoured over hemiarthroplasty, if were able to walk independently, not cognitively impaired, fit for procedure)
43
Management of hip fractures - extra capsular stable?
Stable intertrochanteric fractures – dynamic hip screw
44
Management of hip fractures - extra capsular reverse, oblique, subtrochanteric, transverse?
If reverse oblique, transverse or subtrochanteric – intramedullary device
45
When is BCG not offered?
Over age of 35
46
Starting contraception after EC - for both Ella One and Levonelle?
Ella One - after 5 days
Levonelle - immediately
47
When is EC indicated?
UPSI of any day of natural menstrual cycle
UPSI after compromised or incorrect use of hormonal contraception
From day 21 post partum, unless lactational amenorrhoea criteria met (complete amenorrhoea, fully breastfeeding and 6 months or less post partum)
From day 5 after miscarriage, abortion, ectopic pregnancy or uterine extraction for gestational trophoblastic disease
48
When can Copper Coil be given?
Within 5 days (120 hours) after first UPSI in cycle or within 5 days of earliest estimated date of ovulation whichever is later
49
When can Ulipristal Acetate (EllaOne) be given?
Within 5 days (120 hours) after UPSI or contraception failure?
50
When can levonorgestrel (Levonelle) be given?
Within 72 hours after UPSI or contraception failure, can be used off label up to 96 hours
51
First line EC?
Copper IUD
52
When should you avoid using Ella One?
If taking liver enzyme inducing medications (rifampicin, carbamazepine)
Severe asthma controlled by oral steroids
53
When should you avoid Levonelle?
Severe hepatic dysfunction
BMI >26
54
1st line antiemetic in palliative care - reduced gastric motility?
Metoclopramide
Domperidone
55
1st line antiemetic in palliative care - chemically mediated?
Ondansetron/haloperidol/levomepromazine
56
1st line antiemetic in palliative care - visceral causes?
Cyclizine or levopromazezine
57
1st line antiemetic in palliative care - raised ICP?
Cyclizie
Dexamethasone added if not working
58
1st line antiemetic in palliative care - vestibular cause?
Cyclizine
59
1st line antiemetic in palliative care - cortical cause?
Anticipatory - benzos
Or cyclizine
60
Side effects of carbemazepine?
P450 inducer
Leukopenia and agranulocytosis
Hyponatraemia
Auto induction - may get return of seizures after 3-4 weeks
61
Side effects of phenytoin?
P450 inducer
Gingival hyperplasia
Megaloblastic anaemia
Teratogenic
62
Side effects of sodium valproate?
P450 inhibitor
Weight gain
Alopecia (curly)
Hepatotoxicity/Pancreatitis
Hyponatraemia
63
Colorectal tumour marker?
CEA
64
Hepatocellular tumour marker?
AFP
65
Pancreatic tumour marker?
Ca19-9
66
Ovarian tumour marker?
Ca125
67
Breast tumour marker?
Ca15-3
68
Germ cell tumour marker?
AFP, HCG
69
Melanoma tumour markers.
SCC
70
Thyroid tumour marker
Thyroglobulin
71
Management of mild to moderate acne?
12 week course of OD evening:
Topical adapalene with topical benzoyl peroxide
Topical tretinoin with topical Clindamycin
Topical benzoyl peroxide with topical clindamycin
Topical benzoyl peroxide (if tretonoin/Abx CI or not wanted)
72
Management of moderate to severe acne?
Severe = widespread pamphlets, pustules, nodules or cysts or scarring
12week course of:
Topical adapalene with topical Benzoyl peroxide
Topical tretinoin with topical clindamycin
Topical adapalene with topical benzoyl peroxide with oral doxycycline/lymecycline
Topical azelaic acid with lymecycline/doxycycline
73
Necrobiosis lipoidica
What is it?
Irregularly shaped lesions with reddish brown pigmentation progressing to yellow and central atrophy
Pretibial area
Can occur with diabetes
Potent topical steroids is treatment
74
Mollescum Contagiosum
What is it?
Who does it affect?
Causes?
Treatment?
When to refer?
Localised clusters of umbilicated epidermal papules
Infants and kids under 10
Caused by poxvirus- spread direct, indirect, autoimnoculation, sexual
Often none and self limiting in 18 months
Imiquimod, podophyllotoxin, cryotherapy
Refer - urgent HIV, eyelid or ocular with red eye, anogenital lesions
75
Alopecia acreta
What is it?
Sign?
Treatment?
Non scarring allopecia, scalp and beard, patchy with circular areas of hair loss
Exclamation mark hairs
Watchful waiting
Potent topical steroid (betamethasone)
Or very potent
Referral to dermatologist
76
Pityriasis Rosea?
Multiple salmon pink patches scaly, circular, symmetrical and on trunk
Starts with herald patch
Caused by viral infections
No treatment and settles in 2-3 months
Symptomatic itch with emollients and mild steroid
77
Pityriasis versicolor
What is it?
Cause?
Rash?
Management
Known as tines versicolor
Fungal infection of epidermis
Causes by malassezia yeasts
Multiple round macules and confluent patches seen - extensive and often noticed as doesn’t tan in sun
Occurs in upper trunk, upper arms and neck
Extensive - ketokonazole shampoo , selenium shampoo
Small area - imidazole cream (clotrimazole)
78
What is retinitis pigmentosa?
Symptoms?
Inherited eye condition
Trouble with night vision and decreased peripheral vision in adolescence
79
Age related macular degeneration- wet treatment
Anti-VEGF (ranibizumab)
Laser photocoagulation
Photodynamic therapy
80
Age related macular degeneration- dry treatment
No treatment
High dose vitamins C, E, lutein, zexanthin, zinc, copper (AREDS2)
81
What is telogen effluvium?
Excessive shedding of telogen hair
It occurs around 3 months after a triggering event and is usually self-limiting, lasting for about 6 months.
Triggers include childbirth, severe infection, excessive diets, major surgery, and drug treatment (for example antidepressants, anticoagulants, or chemotherapy).
Usually widespread hair loss.
In the active phase, the hair pull test may be positive. Later, regrowth with tapered short hairs may be seen.
82
What is Trichotillomania?
Psychiatric condition in which people pull their hair out
Associated with OCD
More common in women than in men
Hair loss is asymmetrical and has an unusual shape. Single or multiple areas can be affected, including eyebrows and eyelashes.
83
What is traction alopecia?
Hair loss caused by constant pulling, such as from hair being persistently pulled back in styles like a ponytail or long-term use of hair rollers
Affects frontal hairline
84
What is Anagen effluvium?
Hair shedding that happens during growth phase of hair cycle
Due to acute injury to follicles, sudden diffuse hair loss
Common in 2-3 weeks post chemotherapy
Usually grows back if chemotherapy related but could be curly
85
When to refer child - late walkers?
Red flag features.
Delayed walking at age more than 18 months, especially in boys.
Waddling gait, enlarged muscle bulk, or proximal muscle weakness (consider muscular dystrophies).
Frequent falls or clumsiness.
Delay or regression of milestones (for example speech, communication, feeding).
A family history of delayed walking or muscle disease.
86
Red flag childhood milestone at 5 months?’
Not able to hold an object
87
Red flag childhood milestone at 9 months?’
Not sitting unsupported
88
Red flag childhood milestone at 18 months?
Not standing independently
89
Red flag childhood milestone at 18 months?’
No words
No interest in others
90
What age to refer child if not sitting unsupported?
8 months
91
What age to refer child if not walking independently?
15 months girls
18 months boys
92
What age to refer child if showing preference to asymmetric hand function?
Before 1 year
93
Key features in rosacea?
Phymatous change
Erythema
Flushing
Papules and pustules
Telangiectasia
Ocular rosacea
Skin stinging or dryness
94
Management of rosacea?
If erythema - topical brimonidine 0.5% gel OD
If mild papules or pustules - topical ivermectin for 8-12 weeks (alternative metronidazole cream/acetic acid)
If moderate to severe papules or pustules - topical ivermectin with oral doxycycline for 8-12 weeks
If phymatous - oral doxycycline
95
Definition of postpartum haemorrhage
Primary vs secondary?
Causes of each?
Blood loss >500mls after vaginal delivery
Primary - within 24 hours
- Tone (uterine atony MC), Trauma (perineal tear), Tissue (retained placenta), Thrombin (clotting problem)
Secondary - between 24 hours and 6 weeks - due to retained placental tissue or endometritis
96
Management of primary postpartum haemorrhage
ABCDE approach
Lie woman flat, IV fluids
Mechanical - palpate uterine fundus to stimulate contractions, catheterise
Medical
1) IV Oxytocin
2) IV/IM ergometrine
3) IM Carboprost (CI asthma)
Surgical if medical management fails
- intrauterine balloon tamponade
- B lynch suture, ligation of uterine arteries, hysterectomy
