Miscellaneous Flashcards
1
Q
Mx of salicylate overdose? (e.g. aspirin, ibuprofen, diclofenac)
A
- urinary alkalinization w IV bicarb - Haemodialysis if AEIOU
2
Q
Mx of TCA overdose?
A
- IV bicarb to reduce risk of seizures/ arrhythmias dialysis is ineffective in removing TCAs
3
Q
Mx of Lithium overdose?
A
Fluids, haemodialysis in severe toxicity
4
Q
Mx of Beta Blocker overdose?
A
Atropine. If resistant to atropine, glucagon
5
Q
Mx of Ethylene glycol poisoning?
A
1st line: fomepizole (Alcohol dehydrogenase inhibitor) haemodialysis if refractory.
6
Q
Mx of digoxin overdose
A
Digoxin-specific antibody fragments
7
Q
Mx of lead poisoning?
A
Dimercaprol, calcium edetate
8
Q
Mx of organophosphate insecticide poisoning?
A
Atropine
9
Q
Mx of cyanide poisoning?
A
hydroxocobalamin
10
Q
Antiplatelet mx after ischaemic stroke?
A
Aspirin 300mg daily for 2 weeks + Clopidogrel 75mg daily lifelong -> if clopidogrel contraindicated, Aspirin & dipyridamole lifelong
11
Q
Antiplatelet mx after medically treated ACS?
A
Aspirin lifelong, Ticagrelor for 12 months. if aspirin contraindicated, clopidogrel lifelong
12
Q
Antiplatelet mx after PCI?
A
Aspirin lifelong, Prasugrel or Ticagrelor for 12 months. if aspirin contraindicated, lifelong clopidogrel
13
Q
Antiplatelet mx after TIA?
A
Lifelong clopidogrel 2nd line: lifelong aspirin & dipyridamole
14
Q
Antiplatelet mx for peripheral arterial disease?
A
Lifelong clopidogrel 2nd line: lifelong aspirin
15
Q
Mx of Bell’s palsy?
A
10 days of prednisolone 1mg/kg within 72 hours of onset. + artificial tears
16
Q
what could falsely lower BNP levels?
A
spironolactone, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics. + obesity
17
Q
classic presentation of primary biliary cholangitis?
A
itching in a middle-aged woman - autoimmune condition causing progressive cholestasis which progress to cirrhosis
18
Q
conditions assoc with Primary biliary cholangitis?
A
Sjogrens (in up to 80%), rheumatoid arthritis, systemic sclerosis, thyroid disease
19
Q
diagnosis of Primary biliary cholangitis?
A
anti-mitochondrial antibodies M2 subtype (highly specific, seen in 98% of patients), smooth muscle antibodies (~30%), raised serum igM
20
Q
management of primary biliary cholangitis?
A
pruritus: cholestyramine, fat soluble vitamin supplementation, ursodeoxycholic acid, liver transplant (e.g. if bili>100)
21
Q
Complications of primary biliary cholangitis?
A
cirrhosis, osteomalacia and osteoporosis, significantly increased risk of hepatocellular carcinoma
22
Q
lifestyle advice for managing hypertension?
A
low salt diet (<6g/day, ideally <3g), reduce caffeine intake, stop smoking, less alcohol, balanced diet, more exercise, lose weight
23
Q
Mx of NAFLD?
A
weight loss and monitoring. those with advanced fibrosis should be referred to liver specialist for liver biopsy for staging.
24
Q
Investigation of NAFLD as recommended by NICE?
A
enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis
25
when to put a chest tube in with a pleural effusion?
- if fluid is purulent or turbid/ cloudy - if pH\<7.2
26
what electrolyte abnormalities may cause Long QT?
HypoK, HypoCa, hypoMg
27
Mx of Long QT syndrome?
beta blockers (except for sotalol), implantable cardioverter defibrillators in high risk cases
28
Most likely cause of death of pt with CKD on haemodialysis?
IHD - CV events account for 50% mortality in patients receiving dialysis
29
features of left ventricular aneurysm post-MI?
persistent ST elevation and LV failure. need anticoagulation due to risk of stroke (thrombus may form within the aneurysm)
30
Most useful investigation to diagnose ankylosing spondylitis?
Plain X-ray of sacroiliac joints. May include changes: sacroilitis: subchondral erosions, scelrosis; squaring of lumbar vertebrae, bamboo spine
31
If Xray negative for sacroiliac joint involvement, but suspicion for ankylosing spondylitis remains high, what investigation to do next?
MRI - inflammation involving sacroiliac joints, radiographs may be normal in early disease.
32
spirometry results in ank spond? Why?
Restrictive defect. Combination pulmonary (apical) fibrosis, kyphosis and ankylosis of costovertebral joints
33
Mx of Ank Spond?
1st line: NSAIDs + Physiotherapy, regular exercise
34
If no response to NSAIDS in Ank Spond, what mx?
Anti-TNF therapies e.g. etanercept, adalimumab
35
Mx of PTSD?
watchful waiting if mild symptoms lasting \< 4wks. Trauma focused Cognitive behavioural therapy or eye movement desensitisation and reprocessing therapy.
36
Medical mx of PTSD if CBT/ EMDR not enough?
1st line: Venlafaxine or SSRI (Sertraline). If severe: risperidone
37
Adverse effects of St johns wort?
Serotonin syndrome, P450 inducer
38
How does St John's Wort work?
mechanism thought to be similar to SSRIs. beneficial for mild-moderate depression
39
Charcot's triad?
Fever, Jaundice, RUQ pain -\> Ascending cholangitis
40
Reynolds pentad?
in ascending cholangitis. Fever + RUQ pain + Jaundice (Charcots triad) + Hypotension + confusion
41
Mx of ascending cholangitis?
IV antibiotics, ERCP after 24-48h to relieve any obstruction
42
Most common cause of ascending cholangitis?
gallstones
43
What medications might induce acute pancreatitis?
Azathioprine, mesalazine, didanosine, Bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
44
the As of ankylosing spondylitis?
Apical fibrosis, Anterior uveitis, Aortic regurgitation, Achilles tendonitis, AV node block, Amyloidosis
45
1st line medical mx of Raynauds?
CCB e.g. nifedipine.
46
Mx of Raynauds?
Keep hands warm, stop smoking
47
High risk patients of developing pre eclampsia in pregnancy?
hypertensive disease during previous pregnancies, CKD, autoimmune disorders such as SLE or antiphospholipid syndrome, type 1 or 2 diabetes mellitus
48
What medication to give pts at high risk of developing pre-eclampsia in pregnancy?
low-dose aspirin, start at 12-14 wks gestation
49
1st line mx of acute prostatitis?
Ciprofloxacin / Trimethoprim
50
1st line antibiotic choice for cellulitis near eyes/ nose?
co-amoxiclav
51
1st line antibiotic choice for erysipelas?
Flucloxacillin
52
1st line antibiotic choice for Campylobacter diarrhoea?
Clarithromycin
53
1st line antibiotic choice for salmonella gastroenteritis (non typhoid)?
ciprofloxacin
54
1st line antibiotic choice for shigellosis diarrhoea?
ciprofloxacin
55
1st line antibiotic choice for syphilis?
benzathine benzylpenicillin (or doxycycline/ erythromycin)
56
1st choice antibiotic choice for gonorrhoea?
IM ceftriaxone
57
1st line antibiotic choice for chlamydia?
doxycycline (or azithromycin)
58
Mx of PID?
Oral ofloxacin + Oral metronidazole OR IM ceftriaxone + oral doxycycline + Oral metronidazole
59
1st line antibiotic choice of otitis media?
Amoxicillin
60
1st line antibiotic choice of otitis externa?
Flucloxacillin
61
1st line antibiotic choice for acute necrotising ulcerative gingivitis?
Metronidazole
62
1st line mx of DVT? (new 2020 NICE guidelines)
DOACs- apixaban or rivaroxaban if unprovoked - 6 months. Provoked - 3 months
63
1st line mx of DVT in pt with active cancer? (New 2020 NICE Guidelines)
DOAC. for 3 to 6 months unless severe renal impairments (CrCl\<15) -\> LMWH, Unfractionated heparin or LMWH followed by Warfarin
64
1st line mx of DVT in pt with antiphospholipid syndrome?
LMWH followed by warfarin
65
Mx of Kawasakis?
High dose aspirin, IV Ig, Echo to screen for coronary artery aneurysms
66
Mx after being bitten by animal in at-risk countries for rabies?
Wash wound. If already immunised -\> 2 further doses of vaccine. +/- abx. If not immunised: Human rabies Ig + full course of vaccination +/- abs
67
titubation?
head tremor. most common cause is essential tremor
68
Causes of bilateral parotid gland swelling?
viruses: mumps; sarcoidosis; Sjogren's syndrome; lymphoma; alcoholic liver disease
69
1st line treatment of onychomycosis (dermatophyte infection)?
oral terbinafine.
70
1st line treatment of onychomycosis (candida infection)?
Topical antifungals (e.g. amorolfine) if mild. Severe infections - oral itraconazole
71
features of Stevens Johnson?
Rash - target lesions, which may develop into vesicles or bull.ae, mucosal involvement, fever, arthralgia
72
Adjuvant hormonal therapy for ER+ve patients with breast cancer?
if pre-menopausal: Tamoxifen (SERM) if post menopausal: Aromatase inhibitors e.g. anastrozole
73
1st line antihypertensive in pre-eclampsia?
oral labetalol. (nifedipine if asthmatic, or hydralazine)
74
what may clopidogrel interact with?
PPIs may make clopidogrel less effective. e.g. omeprazole, esomeprazole (lansoprazole is ok)
75
what is the 1st line SSRI in mother with postpartum depression and breastfeeding?
Paroxetine preferred due to low milk/plasma ratio.
76
Fundoscopy showing black bone spicule shaped pigmentation of peripheral retina
Retinitis pigments
77
features of retinitis pigmentosa
night blindness often initial sign. Tunnel vision.
78
What type of lung cancer is associated with SIADH?
small cell lung cancer
79
Mx of SIADH?
Fluid restrict. Can consider demeclocycline (reduces responsiveness of collecting tubule cells to ADH), ADH receptor antagonists
80
What ix is used in venous ulcers?
ABPI: to assess for poor arterial flow which could impair healing.
81
Mx of venous ulceration?
Compression bandaging, usually four layer + Oral pentoxifylline (peripheral vasodilator which improves healing rate)
82
what is CMV chorioretinitis?
- inflammation of choroid and retina - form of posterior uveitis - pizza pie appearance on fundoscopy - can also be caused by syphilis, Toxoplasmosis, sarcoidosis, TB
83
most specific ECG marker for pericarditis?
PR depression
84
Ix of Pericarditis?
ECG: Widespread saddle shaped ST elevation, PR depression. ALL should have an echo
85
Mx of acute pericarditis?
treat the underlying cause, NSAIDS+ colchicine as first line (if acute idiopathic/ viral cause)
86
Adverse effects of hydroxychloroquine?
Bull's eye retinopathy -\> may result in severe and permanent visual loss. Annual screening is recommended.
87
presenting features of cholangiocarcinoma?
Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen
88
What blood tests are raised in anorexia?
Growth hormone levels, glucose (impaired glucose tolerance), salivary glands swollen, cortisol, cholesterol, carotinaemia
89
management of vestibular neuronitis?
vestibular rehabilitation exercises, prochlorperazine for rapid relief in severe cases,
90
If acanthosis nigricans develops rapidly and in atypical locations such as in the oral cavity...?
internal malignancy should be suspected, particularly gastric cancer.
91
mx of c diff?
1st line: 10-14 days oral metronidazole, 2nd: oral vancomycin (if severe or not responding). If still not responding: fidaxomicin. life threatening: oral Vancomycin + IV metronidazole
92
most common reason for revision of total hip replacement?
aseptic loosening of the implant
93
what drugs are assoc w erythema nodosum?
penicillin, sulphonamides e.g. sulfasalazine, COCP
94
risk factor for Vit K deficiency in newborns?
exclusive breastfeeding. maternal use of antiepileptics. (all newborns in the UK are offered Via K)
95
what electrolyte abnormality can cause cataracts?
hypocalcaemia
96
melanosis coli?
a disorder of pigmentation of the bowel wall. histology demonstrates pigment laden macrophages. associated with laxative abuse esp Senna
97
what chemotherapy agent may cause dilated cardiomyopathy?
doxorubicin
98
side effects of cyclophosphamide?
haemorrhage cystitis, myelosuppression, transitional cell carcinoma
99
side effect of bleomycin?
lung fibrosis
100
side effects of methotrexate?
BM suppression, mucositis, lung fibrosis, liver fibrosis
101
side effects of cisplatin?
ototoxicity, peripheral neuropathy, hypomagnesaemia
102
side effects of vincristine?
peripheral neuropathy, paralytic ileus
103
first line mx for Idiopathic thrombocytopenic purpura?
oral pred
104
what is Evans syndrome?
ITP in association with AIHA
105
palliative confusion +/- psychosis, 1st line mx?
oral haloperidol. if terminal agitation-\> subcut midazolam
106
mx of psoriatic arthritis?
should be managed by a rheumatologist, treat as rheumatoid arthritis but better prognosis
107
main joints affected in psoriatic arthritis?
DIPs
108
types of psoriatic arthritis?
1. rheumatoid-like polyarthritis: (30-40%, most common type) 2. asymmetrical oligoarthritis: typically affects hands and feet (20-30%) 3. sacroilitis 4. DIP joint disease (10%) 5. arthritis mutilans (severe deformity fingers/hand, 'telescoping fingers')
109
Causes of transient or spurious non-visible haematuria/
urinary tract infection menstruation vigorous exercise (this normally settles after around 3 days) sexual intercourse
110
Spurious causes (- red/orange urine, where blood is not present on dipstick) of haematuria?
foods: beetroot, rhubarb drugs: rifampicin, doxorubicin
111
urgent 2ww referral re haematuria?
Aged \>= 45 years AND: unexplained visible haematuria without UTI, or visible haematuria that persists or recurs after successful treatment of UTI Aged \>= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test
112
assessment tools recommended by nice to assess cognition in ?dementia
10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)
113
most common drug causes of drug induced lupus?
procainamide hydralazine less common: isoniazid, minocycline, phenytoin
114
Adverse effects of metformin?
- GI upsets are common (nausea, anorexia, diarrhoea), intolerable in 20% - reduced vitamin B12 absorption - rarely a clinical problem - lactic acidosis\* with severe liver disease or renal failure
115
bone protection management for patient starting long term prednisolone?
if \>7.5mg pred for 3 or more months: - if \>65, offer bone protection immediately: alendronic acid + ensure ca / vit D replete - if \<65, DEXA scan. if bone protection
116
most common psychiatric problem in Parkinson's disease is....?
depression
117
what are the different features in drug induced Parkinsonism compared to Parkinson's disease?
- motor symptoms are generally rapid onset and bilateral - rigidity and rest tremor are uncommon
118
what Ix can help distinguish between essential tremor and Parkinson's?
NICE recommend considering 123I‑FP‑CIT single photon emission computed tomography (SPECT).
119
Mx of trichomonad vaginalis?
oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole
120
drug ototoxicity?
Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
121
features of acoustic neuroma?
can be predicted by the affected cranial nerves - cranial nerve VIII: hearing loss, vertigo, tinnitus - cranial nerve V: absent corneal reflex - cranial nerve VII: facial palsy Bilateral acoustic neuromas are seen in neurofibromatosis type 2
122
mx of peripheral arterial disease?
1st line: supervised exercise programme 2. atorvastatin 80, clopidogrel
123
mx in critical limb ischaemia/ severe peripheral arterial disease?
angioplasty, stenting, bypass surgery
124
after how many mins can u repeat im adrenaline in anaphylaxis?
5 min
125
usual site of anterior epistaxis
Kiesselbach’s Plexus
126
1st line mx in epistaxis?
Pinch the cartilaginous (soft) area of the nose firmly and consistently for at least 20 minutes + lean forward
127
mx of epistaxis If bleeding does not stop after 10-15 minutes of continuous pressure on the nose?
1. Cautery- if the source of bleed is visible and cautery is tolerated- not so well-tolerated in younger children! 2. Packing- if cautery is not viable or the bleeding point cannot be visualised
128
most common cause of childhood hypothyroidism?
autoimmune thyroiditis (iodine deficiency most common in the developing world)
129
associations of spider naevi?
liver disease pregnancy combined oral contraceptive pill
130
Antibiotic management for severe cellulitis?
co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.
131
Management of guttate psoriasis in children?
- most cases resolve spontaneously within 2-3 months - no firm evidence to support the use of antibiotics - topical agents as per psoriasis - UVB phototherapy - tonsillectomy may be necessary with recurrent episodes
132
mx of fibroadenoma?
If \>3cm surgical excision is usual, Phyllodes tumours should be widely excised (mastectomy if the lesion is large)
133
mx of breast cyst?
Cysts should be aspirated, those which are blood stained or persistently refill should be biopsied or excised
134
what is lymphogranuloma venereum?
caused by Chlamydia trachomatis. Typically infection comprises of three stages stage 1: small painless pustule which later forms an ulcer stage 2: painful inguinal lymphadenopathy stage 3: proctocolitis
135
PSA tests should not be done when?... (as can cause false positives)
6 weeks of a prostate biopsy 4 weeks following a proven urinary infection 1 week of digital rectal examination 48 hours of vigorous exercise 48 hours of ejaculation
136
mx of palliative hiccups?
chlorpromazine or haloperidol dexamethasone is also used, particularly if there are hepatic lesions
137
mx of suspected candidal nappy rash?
topical imidazole. Cease the use of a barrier cream until the candida has settled
138
Lens dislocation in Marfans vs homocystinuria?
Marfan's syndrome: upwards homocystinuria: downwards
139
features of ecstasy poisoning?
neurological: agitation, anxiety, confusion, ataxia cardiovascular: tachycardia, hypertension hyponatraemia hyperthermia rhabdomyolysis
140
Management of ecstasy poisoning?
supportive dantrolene may be used for hyperthermia if simple measures fail
141
mx of suspected pneumonia in children?
1st line: amoxicillin if suspected mycoplasma or pen allergic: clarithromycin if assoc influenza: co-amoxiclav
142
breast cancer screening?
women aged 47-73 years, mammogram every 3 years.
143
what clotting factors are low in liver failure?
all clotting factors are low, except for factor VIII which is paradoxically supra-normal. - factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells. - liver required to clear activated factor VIII from the blood stream -\> leading to increases in circulating factor VIII. - increased risk of bleeding AND clotting
144
DVLA guidance on driving after an acute coronary syndrome?
If successfully treated by coronary angioplasty, driving may recommence after 1 week provided: LVEF\>40%, no other urgent revascularisation planned within 4 wks If not successfully treated by coronary angioplasty: 4 wks If the patient in this scenario was a bus, taxi or lorry driver inform DVLA + cease driving for at least 6 weeks.
145
DVLA guidance after elective angioplasty?
1 week off driving
146
DVLA guidance after CABG?
4 wks off driving
147
DVLA guidance in someone with angina?
driving must cease if symptoms occur at rest/at the wheel
148
DVLA guidance after pacemaker insertion?
1 week off driving
149
DVLA Guidance after ICD insertion?
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
150
DVLA guidance after successful catheter ablation for an arrhythmia?
2 days off driving
151
DVLA guidance for pt with aortic aneurysm (\>6cm)?
notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving
152
DVLA guidance for heart transplant?
do not drive for 6 weeks, no need to notify DVLA
153
factors associated with poor prognosis for schizophrenia?
strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant
154
Heberdens vs Bouchards?
Heberden's nodes - swelling of the distal interphalangeal joints. Bouchard's nodes - swelling of proximal interphalangeal joints
155
What HbA1c might warrant addition of diabetic medications?
58 mmol/mol (7.5%)
156
1st line diabetic medication after lifestyle interventions?
metformin
157
2nd line diabetic medication after addition of metformin + HbA1c \> 58mmol/mol?
a second drug should be added from the following list: sulfonylurea gliptin pioglitazone SGLT-2 inhibitor
158
triple therapy options: diabetic medication if HbA1c still \> 58mmol/mol?
1. metformin + gliptin + sulfonylurea 2. metformin + pioglitazone + sulfonylurea 3. metformin + sulfonylurea + SGLT-2 inhibitor (-gliflozin) 4. metformin + pioglitazone + SGLT-2 inhibitor OR insulin therapy should be considered
159
features of seborrhoeic dermatitis?
- eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds - otitis externa and blepharitis may develop
160
Scalp management in seborrhoeic dermatitis?
- OTC preparations containing zinc pyrithione ('Head & Shoulders') and tar ('Neutrogena T/Gel') are first-line - 2nd line: ketoconazole - selenium sulphide and topical corticosteroid may also be useful
161
What conditions are assoc w seborrhoeic dermatitis?
HIV, Parkinsons disease
162
Management of body+ face in seborrhoeic dermatitis?
- Topical antifungals: e.g. ketoconazole - topical steroids: best used for short periods - difficult to treat - recurrences are common
163
management of acne rosacea?
1. mild - topical metronidazole 2. predominant flushing but limited telangiectasia: topical brimonidine gel 3. more severe disease: systemic antibiotics e.g. Oxytetracycline
164
1st line management of angina?
Beta blocker or CCB. if CCB alone: verapamil / diltiazem if used w CCB: use modified release nifedipine
165
medications one can give in renal stone management?
1st line: diclofenac IM alpha-adrenergic blockers can aid ureteric stone passage
166
causes of bradycardia in Cardiotocography?
HR\<100. Increased fetal vagal tone, maternal beta-blocker use
167
causes of tachycardia in Cardiotocography?
HR\>100. Maternal pyrexia, chorioamnionitis, hypoxia, prematurity
168
causes of Loss of baseline variability in cardiotocography?
\< 5 beats / min. Prematurity, hypoxia
169
causes of variable decelerations independent of contractions in cardiotocography?
May indicate cord compression
170
causes of early decelerations in cardiotocography? (ie. Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction)
Usually an innocuous feature and indicates head compression
171
Causes of late decelerations in cardiotocography? (ie. Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction)
Indicates fetal distress e.g. asphyxia or placental insufficiency
172
Booking visit? when?
8 - 12 wks, ideally \<10
173
What happens at booking visit?
Booking visit: - general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes - BP, urine dipstick, check BMI - Booking bloods/urine: FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies - hepatitis B, syphilis - HIV test is offered to all women - urine culture to detect asymptomatic bacteriuria
174
Dating scan?
10 - 13+6 wks. To exclude multiple pregnancy
175
When does nuchal scan for downs syndrome screening occur?
11 - 13+6 weeks
176
when is anomaly scan?
18 - 20+6 weeks
177
What happens at 28 wks for antenatal care?
Second screen for anaemia and atypical red cell alloantibodies. First dose of anti-D prophylaxis to rhesus negative women
178
When is the second dose of anti-D prophylaxis given?
34 weeks
179
causes of painless genital ulcers?
C. trachomatis causes lymphogranuloma venereum; T. pallidum causes syphilis; K. granulomatis causes granuloma inguinale.
180
Chancroid features?
- tropical disease caused by Haemophilus ducreyi. - painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. - The ulcers typically have a sharply defined, ragged, undermined border.
181
typical features of neuroleptic malignant syndrome?
- pyrexia - muscle rigidity - autonomic lability: typical features include hypertension, tachycardia and tachypnoea - agitated delirium with confusion - may see raised CK, AKI, raised WCC
182
management of neuroleptic malignant syndrome?
1. stop antipsychotic 2. IV fluids to prevent renal failure 3. dantrolene may be useful in selected cases (decreasing the release of calcium from the sarcoplasmic reticulum) 4. bromocriptine, dopamine agonist, may also be used
183
trigger for cluster headache?
alcohol
184
prophylaxis for cluster headaches?
verapamil
185
what medication can you use for stress incontinence?
duloxetine: a combined noradrenaline and serotonin reuptake inhibitor - mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction
186
how to monitor response to treatment in rheumatoid arthritis?
CRP + DAS28
187
mx of flares of rheumatoid arthritis?
oral or intramuscular corticosteroid
188
what TNF inhibitors can u use in rheumatoid arthritis?
Etanercept, infliximab, adalimumab
189
features of rhabdomyolysis?
- acute kidney injury with disproportionately raised creatinine - elevated creatine kinase (CK) - myoglobinuria - hypocalcaemia (myoglobin binds calcium) - elevated phosphate (released from myocytes) - hyperkalaemia (may develop before renal failure) - metabolic acidosis
190
Causes of rhabdomyolysis?
seizure collapse/coma (e.g. elderly patients collapses at home, found 8 hours later) ecstasy crush injury McArdle's syndrome drugs: statins (especially if co-prescribed with clarithromycin)
191
Ix for suspected age related macular degeneration?
1st line: slit-lamp microscopy - to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD. 2. fluorescein angiography if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy. This may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation. 3. ocular coherence tomography is used to visualise the retina in three dimensions, because it can reveal areas of disease which aren't visible using microscopy alone.
192
features of post thrombotic syndrome?
- painful, heavy calves - pruritus - swelling - varicose veins - venous ulceration
193
management of post thrombotic syndrome?
- elastic graduated compression stockings - keep leg elevated
194
Risk factors of prostate cancer?
increasing age, obesity, Afro-Caribbean ethnicity, family history
195
initial empirical therapy for suspected meningitis in \<3 months old or \>50 years old?
IV cefotaxime + amoxicillin
196
initial empirical therapy for suspected meningitis in 3 months - 50 years old?
IV cefotaxime OR Children \> 3m (updated guidelines): IV ceftriaxone
197
Empirical therapy for meningococcal meningitis?
IV Benzylpenicillin or Cefotaxime
198
empirical therapy for pneumococcal / haemophilus influenza meningitis?
IV cefotaxime
199
Empirical therapy for meningitis caused by listeria?
IV amoxicillin + Gentamicin
200
What is used in empirical treatment of meningococcal meningitis if patient has immediate hypersensitivity reaction to penicillin/ cephalosporins?
Chloramphenicol
201
what happens to pregnant women who are not immune to MMR?
MMR cannot be given during pregnancy. She needs to keep away from people who might have M/M/R and be offered the MMR vaccination in the postnatal period.
202
Rubella in pregnancy: Risk to fetus ?
- up to 90% risk of damage in first 8-10 wks. - sensorineural deafness - congenital cataracts - congenital heart disease (e.g. PDA) - growth retardation - hepatosplenomegaly - purpuric skin lesions - 'salt and pepper' chorioretinitis - microphthalmia - cerebral palsy
203
CMV infection in pregnancy: risk to baby?
cerebral calcification, microcephaly and sensorineural deafness
204
Risk of Varicella Zoster infection in pregnancy: risk to baby?
Fetal varicella syndrome: skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities
205
Mx of patient who presents within 7 days of clinically suspected TIA?
300mg Aspirin immediately + Refer for specialist review within 24h
206
management of congenital inguinal hernias?
- resulting from a patent processus vaginalis Should be surgically repaired soon after diagnosis as at risk of incarceration
207
management of acute otitis externa? in mild cases - mild discomfort, no deafness or discharge
consider topical acetic acid 2% spray.
208
management of acute otitis external with severe inflammation e.g. with deafness/ discharge?
7 days of a topical antibiotic +/- topical steroid.
209
causes of otitis externa?
infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal, seborrhoeic dermatitis, contact dermatitis (allergic and irritant)
210
posterior vitreous detachment vs retinal detachment?
PVD: flashes of light in peripheries, floaters (often on temporal side). Retinal detachment: dense shadow that starts peripherally progresses towards central vision. Veil/ curtain. Straight lines appear curved, central vision loss
211
Vitreous haemorrhage features?
large bleeds can cause sudden visual loss. moderate bleeds can cause numerous dark spots. small bleeds may cause floaters
212
management of perforated tympanic membrane?
- watch and wait. usually heals after 6-8 weeks. - Prescribe antibiotics to perforations which occur following episode of acute otitis media - refer to ENT for consideration of tymapnoplasty at 6-8 wks if it persists for 1 mo
213
features of patent ductus arteriosus
left subclavicular thrill, continuous machinery murmur, wide pulse pressure, large volume bounding collapsing pulse, heaving apex beat
214
What is Foucher's sign?
increase in tension of Baker's cyst on extension of the knee
215
neonatal blood spot screening tests for?
- congenital hypothyroidism - cystic fibrosis - sickle cell disease - phenylketonuria - medium chain acyl-CoA dehydrogenase deficiency (MCADD) - maple syrup urine disease (MSUD) - isovaleric acidaemia (IVA) - glutaric aciduria type 1 (GA1) - homocystinuria (pyridoxine unresponsive) (HCU)
216
Mx of Bacterial vaginosis in pregnancy?
Symptomatic BV assoc w late miscarriage and preterm delivery. Oral metronidazole 400mg BD for 5-7 days
217
Features of Peutz-Jeghers syndrome?
hamartomatous polyps in GI tract (mainly small bowel), pigmented lesions on lips, oral mucosa, face, palms and soles, intestinal obstruction e.g. intussusception, GI bleeding
218
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers
Edward's syndrome (trisomy 18)
219
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions
Patau syndrome (trisomy 13)
220
Micrognathia , Posterior displacement of the tongue (may result in upper airway obstruction), Cleft palate
Pierre-Robin syndrome \*this condition has many similarities with Treacher-Collins syndrome. One of the key differences is that Treacher-Collins syndrome is autosomal dominant so there is usually a family history of similar problems
221
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
Fragile X
222
Hypotonia Hypogonadism Obesity
Prader-Willi syndrome
223
Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis
Williams syndrome
224
Characteristic cry due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hypertelorism
Cri du chat syndrome (chromosome 5p deletion syndrome)
225
management of lithium toxicity?
mild-moderate: volume resuscitation severe: haemodialysis
226
features of digoxin toxicity?
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia
227
Ansel criteria for BV?
- clue cells on saline smear (most specific) - ph \>4.5 - characteristic thin, grey homogeneous discharge - positive whiff test (up to 70%)
228
choice of anti epileptic in pt on warfarin?
lamotrigine
229
First line treatment for capillary haemangioma?
Propranolol If topical beta blockers used, may use timolol
230
Potential complications of capillary haemangiomas aka strawberry naevus?
- mechanical, e.g. obstructing visual fields or airway - bleeding - ulceration - thrombocytopenia
231
What vitamin supplementation is recommended to all pregnant and breastfeeding women?
Vitamin D
232
Contraindications to gentamicin?
Myasthenia gravis
233
Treatment of acne rosacea? Mild vs severe
Mild/ moderate: topical metronidazole Severe/ resistant: oral tetracycline e.g. oxytetracycline
234
Causes of hemiballismus?
Stroke, SOL, traumatic brain injury, non ketotic hyperglycaemia (diabetes)
235
Most common symptom of posterior circulation stroke?
Dizziness
236
Common symptoms in posterior circulation stroke?
Often gets misdiagnosed as migraine. - double vision, disorientation, visual disturbance, confusion, memory loss, dizziness
237
What is alopecia areata?
An autoimmune condition causing localised, well demarcated (usually coin shaped) patches of hair loss.
238
Management of alopecia areata?
- hair will regrow in 50% of patients by 1 year and in 80-90% eventually. - Careful explanation of natural course of condition - in 50% with no regrowth: trial of topical corticosteroids - referral to dermatologist if hair loss not responsive/ child/ pregnant or breast feeding
239
mx of acne vulgaris in pregnancy?
erythromycin - doxycycline/ lymecycline CI in pregnancy/ breastfeeding - topical/ oral retinoid CI
240
MX of suspected Meniere's Disease?
- routine referral to ENT to establish diagnosis - DVLA: cease driving until control of symptoms - acute attacks: buccal or IM prochlorperazine - prevention: betahistine and vestibular rehabilitation exercises may be of benefit
241
mx of muscle spasticity in multiple sclerosis?
- Baclofen and gabapentin are first-line. - Other options include diazepam, dantrolene and tizanidine - physiotherapy
242
Mx of Bladder dysfunction in multiple sclerosis?
- 1st line US. - if significant residual volume → intermittent self-catheterisation - if no significant residual volume → anticholinergics
243
Mx of oscillopsia in multiple sclerosis? (visual fields apper to oscillate)
gabapentin is first-line
244
Mx of CML 1st line?
imatinib
245
primary thromboprophylaxis in antiphospholipid syndrome?
aspirin
246
which type of testicular cancer has better prognosis?
seminomas \> teratomas
247
risk factors of testicular cancer?
infertility (increases risk by a factor of 3) cryptorchidism family history Klinefelter's syndrome mumps orchitis
248
Asherman's syndrome?
intrauterine adhesions may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would -\>\> secondary amenorrhoea
249
lateral epicondylitis: what movements are restricted?
pain worse on: wrist extension against resistance with the elbow extended + supination of the forearm with the elbow extended
250
antidote for rivaroxaban?
Andexanet alfa: recombinant form of human factor Xa protein
251
antidote for overdose of dabigatran?
Idarucizumab
252
Pioglitazone: side effects?
- weight gain - liver impairment -\> monitor LFTs - fluid retention: CI in HF - increased risk #s - increased risk Bladder Ca
253
Starting ACEi: what rise in Cr will you tolerate?
up to 30% rise from baseline
254
Starting ACEi: what rise in K+ will you tolerate?
up to 5.5
255
what antibiotic lowers seizure threshold in patients with epilepsy?
ciprofloxacin
256
What should u do with someone's Metformin medication (ideally) if they are due investigation containing contrast media?
Stop it on the day and for 48 hours after due to risk of renal impairment
257
ankle inversion injury: what ligament is likely to be strained?
anterior talofibular ligament: it is the weakest of the lateral ligaments
258
vaginal thrush in pregnancy - mx?
Clotrimazole pessary (local only). oral treatments are contraindicated
259
What to prescribe as first line for Heart failure if pt has asthma (not tolerating BB) and HF?
amlodipine or felodipine
\*Rate-limiting CCBs, such as verapamil and diltiazem, have the additional action of decreasing myocardial contractility and heart rate -\> so not recommended in patients with heart failure
260
effect of menstrual cycle on body temperature?
Rises following ovulation in response to higher progesterone levels
Falls prior to ovulation due to the influence of oestradiol
261
management of endoscopically proven oesphagitis?
full dose PPI for 1-2 months
then low dose tx as required.
if no response then double dose PPI for 1 month
262
mx of endoscopically negative reflux disease?
full dose PPI for 1 mo then low dose treatment PRN
if no response then H2RA or prokinetic for 1 mo
263
what is ropinirole?
or bromocriptine, cabergoline
a dopamine agonist
- uesd in parkinsons
264
what is selegiline?
used in Parkinsons
- a MAO-B inhibitor
265
What is entacapone?
COMT inhibitor
- used in Parkinsons
266
long acting reversible contraceptive of choice for young people?
Nexplanon - the progesterone-only implant
267
treatment of microprolactinoma?
dopamine agonist (e.g. bromocriptine, cabergoline) which inhibits prolactin release from pituitary gland
268
What is the PERC rule?
all criteria must be present to rule out PE
269
what is the abx of choice for prophylaxis of IECOPD?
azithromycin
270
Malignancies assoc with EBV infection?
Burkitt's lymphoma\*
Hodgkin's lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
271
first line mx of threadworm?
mebendazole to pt and all household members
272
Examples of Non sedating antihistamines?
loratidine and cetirizine
273
Diagnostic investigation of choice for pancreatic cancer?
High resolution CT scan
274
what malignancy is
## Footnote
Acquired ichthyosis
assoc with?
Lymphoma
ichythosis - widespread and persistent thick, dry, "fish-scale" skin
275
what malignancy is tylosis assoc with?
oeosphageal SCC
tylosis = hyperkeratosis of the palms and soles
276
what malignancy is associated with
## Footnote
Migratory thrombophlebitis?
pancreatic cancer
277
what malignancy is associated with erythroderma?
lymphoma
278
what malignancy is associated with
## Footnote
Erythema gyratum repens?
Lung cancer
- type of annular erythema with a distinctive figurate ‘wood-grain’ appearance
279
what malignancies are associated with Dermatomyositis?
ovarian, lung ca
280
what malignancy is assoc w Sweet's syndrome?
Haematological malignancy e.g. Myelodysplasia - tender, purple plaques
Sweet's syndrome = (aka acute febrile neutrophilic dermatosis) fever + tender red or purple lumps or patches that may ulcerate
281
what malignancy is assoc w
## Footnote
Necrolytic migratory erythema?
Glucagonoma
282
what maligancies assoc w
## Footnote
Acquired hypertrichosis lanuginosa?
GI and lung ca
development of excessive, long, fine, nonpigmented hairs, preferentially located on the face.
283
sewage worker/ farmer/ returning traveller with
fever, myalgia
subconjuctival haemorrhages,
+/-
AKI,
hepatitis,
aseptic meningitis
Leptospirosis
+/-
Weil's disease
284
Mx of Leptospirosis?
high-dose benzylpenicillin or doxycycline
285
Main ix of leptospirosis?
serology: antibodies to Leptospira develop after about 7 days
286
Mx of Allergic Bronchopulmonary Aspergillosis?
oral glucocorticoids
itraconazole is sometimes introduced as a second-line agent
287
Drug causes of gynaecomastia?
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
288
mx for prophylaxis with recurrent copd exacerbations?
consider azithromycin (usually 250 mg 3 times a week)
289
Risks of Hormone Replacement therapy to treat postmenopausal symptoms?
with oral HRT vs transdermal
Oral:
VTE, stroke
Coronary heart disease, breast ca, ovarian ca
Transdermal:
Coronary heart disease, breast ca, ovarian ca
290
first line mx of gestational diabetes if plasma glucose fastin \>7
insulin
if plasma level between 6.0-6.9 + evidence of complications such as macrosomia or hydramnios -\> insulin too
291
Mx of head lice?
Dimeticone 4% lotion
- applied twice, with 7 days between
Wet combing
- four applications over 2 weeks
Permethrin no longer recommended due to resistance
292
Caplans Syndrome?
pulmonary fibrosis, usually in coal miners with rheuamtoid arthritis.
CXR shows multiple, well definied round nodules
293
Mx of Caplans Syndrome?
steroids
- exlcude TB first
294
1st line ix for Cushing's syndrome?
overnight dexamethasone suppression test
or
24h urinary free cortisol test
295
telogen effluvium?
physiological (ie. infection) or stress
general thinning of hair
296
anagen effluvium?
when chemo, immunotherapy or radiotx causes rapid hair loss
hair will return within a few months of stopping tx
297
What is Ewart or Pins sign?
- in pts w large pericardial effusions
- an area of dullness, with bronchial breath sounds and bronchophony below the angle of the left scapula
298
Mx of TB meningitis?
isoniazid, rifampicin, pyrazinamide, streptomycin
299
when to organize an ultrasound of urinary tract of child \>3 mo?
if atypical or recurrent UTI
atypical:
seriously ill, raised Cr, septicaemia, failure to respond to tx within 48h, non e coli organisms
recurrent:
2 or more with acute pyelo
3 or more lower UTI
1 pyelo + 1 or more lower uti
300
anti-U1RNP antibodies?
Mixed connective tissue disease
- features of scleroderma, SLE, rheumatoid arthrtits and myositis
301
What drugs are associated with lichenoid eruptions ie. lichen planus?
ACEi
NSAIDs
Methyldopa
Chloroquine
Oral antidiabetics
Thiazide diuretics
Gold
302
what. causes constipation in Parkinsons disease?
lewy body degeneration in the myenteric plexus of the colon -\> slow transit times, megacolon, intestinal pseudo-obstruction, volvulus
exacerbated by medication e.g. dopamine agonist & antimuscarinics
303
most common organism in erysipelas?
superficial form of cellulitis
- Stretococcus pyogenes
304
cracked red lips, mouth ulcers, angular cheilitis, sore throat
what vitamin deficiency?
RIbaflavin (B2)
- can also cause dry scaling skin, IDA, bloodshot itchy eyes.
- angular cheilitis, photophobia and scrotal dermatitis
305
rubbery subcutaneous swelling on lateral aspect of the right eyebrow?
Dermoid cyst
- cystic teratoma containing developmentally mature skin
- usually occur in young children
- near lateral aspect of the eyebrow
benign
306
what extraintestinal features of IBD are related to activity of colitis?
Erythema nodosum
aphthous ulcers
episcleritis
acute arthropathy
307
what extraintestinal features of IBD are not related to activity of colitis?
sacroiliitis
ank spond
primary sclerosing cholangitis
308
what do you see in wet exudative age related macular degeneration?
choiroidal neovascularisation
- development of immature blood vessels that grow between the retinal pigment epitheial cells and the photoreceptor cells
309
twice daily spike in temp causes?
Visceral leishmaniasis
adult Stills disease
310
advice if missed progestogen only pill?
missed pill = \>3h overdue (except for Cezarette- desogestrel where 12h period allowed
take missed pill now and extra protection for next 48h
311
medication to help cancer related anorexia?
steroids
- pred 15-30mg daily or dexamethasone 2-4mg daily
312
medication for palliative related constipation?
co-danthramer (combination laxative stimulant/softener)
313
1st line mx of partial seizures
carbmazepine
314
1st line mx of myoclonic seizures?
sodium valproate
315
1st line mx of generalized tonic clonic seizures?
sodium valproate
lamotrigine (ie. in pregnancy)
316
1st line mx of absence seizures?
ethosuximide
sodium valproate
317
mx of refractory convulsive status epilepticus?
IV midazolam
318
rose colored rash after several days of fever?
roseola (aka exanthem subitum)
caused by HHV 6
319
what antihypertensive worsens glycaemic control?
thiazides e.g bendroflumethazide
beta blockers
320
which lung cancer is most assoc w hyperca?
Squamous cell lung cancer
-\> PTHrP -\> Hyperca
321
what blood group is assoc w increased risk of gastric ca?
blood group A
322
what antidiabetic medication causes increased risk UTI?
Dapagliflozin
- sodium glucose co transporter 2 inhibitor
- increases excretion of excess glucose in urine
323
mx of ethmoidal sinusitis?
surgical drainage of the sinuses
followed by abx
- ethmoidal sinusitis is one of the most common causes of orbital cellulitis
324
MOA of pioglitazone?
reduces peripheral insulin resistance
325
MOA of DPP4 inhibitors e.g. sitagliptin?
increases insulin secretion
lower glucagon secretion
326
what is a furunculosis?
infection of a hair follicle in the external canal
- \> usually staph
- severe pain exacerbated by pressure on tragus/ movement of pinna
usually runs their course within 4-10 days
327
what is bullous myringitis?
painful vesicles on the tympanic membrane
- assoc with viral resp infections, mycoplasma
- often occurs w bacterial otitis media
Mx: abx, analgesia, surgical drainage of vesicles
328
earliest sign of diabetic retinopathy\>
microaneurysms
- outpouching of capillaries
329
milk alkali syndrome?
triad hyperCa, renal failure, met alkalosis
secondary to ingestion of large amts of calcium and absorbable alkali
historically due to milk and alkali given for peptic ulcer disease
330
comminuted fracture of the metacarpal base of thumb?
rolando fracture
331
Pitted keratolysis
- affects people who sweat excessively
- damp, smelly feet
- corynebacterium
- white with clusters of punched out pits
332
Palmoplantar pustulosis
- affects palms and soles
- crops of sterile pustules, with thickened, red skin
- skin scaly, may crack
more common in smokers
333
juvenile plantar dermatosis
- affects children
- more common in atopy/ eczema
- shiny, hard soles with cracks causing pain
worse in the summer
334
verruca/ mosaic wart
- secondary to HPV
- firm, hyperkeratotic
- pinpoint petechiae centrally within lesion
335
Which lipid lowering drug acts as a bile acid sequestrant, binding bile in the GI tract to prevent its reabsorption?
Cholestyramine
- increased bile excreted in faeces
- as bile acids are excreted, plasma cholesterol -\> bile acid to normalize bile acid levels thereby lowering plasma [cholesterol]
- can also be used to treat itching that occurs w liver failure due to liver's inability to eliminate bile
336
SEs of cholestyramine (bile acide sequestrant)?
most frequent: constipation
increased risk of gallstones
tooth discoloration/ erosion/ decay from prolonged oral exposure to suspension
337
mx of hyperthyroidism in pregnancy?
pre-conception: Thyroidectomy
- ablation w radiotx can be offered, but cannot become pregnant in next 6 mo
1st trimester: Propylthiouracil
(Carbimazole high risk of congenital abnormalities)
2nd trimester: Carbimazole
(PTU risk of severe hepatic injury)
338
most common pathogen in Fournier's gangrene?
Strep pyogenes
339
Asbestosis - Highest risk of developing which cancer?
1. Lung Cancer
(mesothelioma rarer)
340
what can precipitate wernickes encephalopathy?
infusion of glucose
341
which antidepressant is first line in obese patient?
fluoxetine
342
which antidepressants have lowest drug interactions and thus best for elderly?
citalopram, sertraline
343
best antidepressant post MI?
sertraline
344
what is the ABCD2 score?
determines the risk of stroke within first 2 days post TIA
345
what makes up the ABCD2 score?
**A: Age \>/= 60 (1)**
**B: BP (\>140 syst/ \>90 diastolic) - 1**
**C: Clin features**
- unilateral weakness = 2 pt
- speech disturbance w/o weakness = 1 pt
**D: duration of symptoms**
60 or more mins: 2 pt
10 -59 = 1 pt
**D: diabetes = 1 pt**
**Total score:**
6-7 pts = high risk
346
first line antiemetic for n+v in advanced cancer due to:
mechanical obstruction
raised ICP
motion sickness
cyclizine
347
first line antiemetic for N+V in advanced cancer due to metabolic causes ie.
renal failure, hyperCa?
haloperidol
348
preferred SSRIs in breastfeeding ladies?
Paroxetine, **sertraline**
349
advice re: diet to reduce risk of kidney stones?
normal calcium intake, low oxalate intake
- reduce tea, chocolates, nuts, strawberries, rhubarb, spinach
- drink plenty of fluids
350
When would u do ERCP \> cholecystectomy?
- too high risk for cholecystectomy if:
- recent cholangitis or recent acute pancreatitis or in the presence of jaundice
- abnormal LFTs (ALP \> 2x Normal)
- dilated CBD \>10mm
351
cataracts, muscle weakness, frontal balding
myotonic dystrophy
- autosomal dominant
- degree of anticipation
352
features of myotonic dystrophy?
facial weakness
hollowing of temples
atrophy of jaw muscles
frontal balding
grip myotonia (often 1st symptom)
progressive muscle weakness and wasting -\> scm, distal limb muscles first
353
Mx of UTI in patient with CKD (eGFR\<45)?
Trimethoprim
- AVOID nitrofurantoin as risk of peripheral neuropathy + ineffective bc of inadequate urine concentrations
354
Mx of acute dystonic reactions following administration of antipsychotic?
Procyclidine
355
acne conglobata?
unusually severe form of acne
- characterized by **burrowing and interconnecting abscesses** and **irregular scars**
can be induced by anabolic steroid abuse
assoc w hydradenitis suppurativa
356
Freiburg's syndrome?
osteochondritis affecting the toes - articular surfaces of the 2nd/ 3rd metatarsal heads collapse
commonest in girls, 12-15 yo
pain on weight bearing
357
Most likely pathogen in Fournier's gangrene?
Strep pyogenes
358
Ottawa knee rules - when to order a knee XR?
1. Age 55 or over
2. Isolated tenderness over the patella
3. Tenderness at the head of the fibula
4. Inability to flexto 90 degrees
5. Inability to weight bear both immediately and in ED
359
If CCB is not tolerated due to ankle swelling, what is the medication to prescribe next for HTN?
thiazide-like diuretic
ie. indapamide
360
which conditions cause a twice daily spike in temperature?
Visceral leishmaniasis
Adult Stills disease
361
management of head lice?
dimeticone lotion
- applied twice w 7d in between
wet combing
362
intractable cough in palliative care?
oral morphine
363
SE of aromatase inhibitors for ER+ve Breast Cancer?
ie. anastrazole, letrozole
reduces peripheral oestrogen synthesis
- Osteoporosis
- hot flushes
arthralgia, myalgia, insomnia
364
What is screened for in heel prick test?
phenylketonuria
congenital hypothyroidism
Sickle cell
cystic fibrosis
MCADD
Maple syrup urine disease
homocystinuria
glutaric acidaemia type 1
isovaleric acidaemia
365
Defect in amino acid metabolism
- very fair child with pale blue eyes
- general learning disability
- behavioural problems including self mutilation
unusual musty odour
Phenylketonuria
- autosomal recessive deficiency of phenylalanine hydroxylase -\> build up of phenylalanine
tx: diet low in foods containing phenylalanine
366
Amino acid disorder
- sweet odour of maple syrup found in urine and sweat
- encephalopathy and progressive neurodegeneration
- infants seem health at birth, developing poor feeding and vomiting in 1st wk of life -\> lethargy and coma with brain damage
if untreated - death occurs in first 5 months
Maple syrup urine disease
- auto recess
- build up of branched chain aas (leucine, isoleucine, valine)
tx: diet low in foods that contain branched chain amino acids
367
amino acid disorder
multi-systemic disorder of CNS, msk, cardiovasc systems
- appear normal at birth, serious complications in childhood
- learning disability, seizures, psych disorder
- marfanoid, dislocation of lens downwards and medially, myopia, glaucoma
Homocystinuria
- auto reccess, accumulation of homocysteine
- no cure
- tx w high doses of vit b6 (pyridoxine)
368
amino acid disorder
- movement disorder in first 2 years of life
- increased Head circumference in infancy
- neurological decompensation (basal ganglia neuronal loss)
glutaric acidaemia type 1
- auto recess
- build up of lysine, hydroxylysine, tryptophan
- causing basal ganglia neuronal loss
369
amino acid disoder
- apparent within few days after birth
poor feeding, vomiting, seizures, lack of energy -\> coma
in some: episodic features triggered by infection/ eating increased amt of protein-rich foods
- distinctive odour of sweaty feet
isovaleric acidaemia
- auto recess
- build up of isovaleric acid which is toxic to CNS
\*distinctive odour of sweaty feet
tx: diet low in leucine
370
amino acid disorder
- episodic neurologic and dermatologic features
(provoked by change of season w increasing sunlight, febrile illness, poor nutrition, increased physical activity)
- symptoms progress over several days and last 1-4 wks before spontaneous remission
- cutaneous signs preceding neurologic / psych symptoms
Hartnup disease
- auto reccess
- defective renal and intestinal absorption of amino acids
- tx with high protein diet to overcome defective absorption, supplement with nictotinic acid and avoid excessive exposure to sunlight
371
typically presents in milk fed infants shortly after birth
results in cataracts, hepatosplenomegaly, intellectual disability
galactosaemia
- failure to break down galactose to glucose
372
perennial allergic rhinitis
cause?
house dust mites
symptoms occur throughout the year
373
interaction between simvastatin and amlodipine?
concurrent use of amlodipine and simvastatin causes significant increase in blood lvls of simvastatin
as simvastatin is metabolized by CYP3A4 & amlodipine is a weak inhibitor of CYP3A4
