Mixed practice review Flashcards
Visual field defects:
Define congruous vs incongruous:
Homonymous hemianopia - sites of:
Incongruous defect:
Congruous defect:
Macular sparing:
A congruous defect: complete or symmetrical visual field loss
Incongruous defect: incomplete or asymmetric.
Incongruous defect: Lesion of optic tracts
congruous defect: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex
Visual field defects:
Homonymous quadrantopias:
Superior vs inferior
superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe
mnemonic = PITS (Parietal-Inferior, Temporal-Superior)
Bitemporal hemianopia: sites of compression
Lesion site?
Upper quadrant defect
Lower quadrant defect
lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
Bell’s Palsy
Forehead:
Treatment:
Not spared - lower MN lesion thus forehead affected by paralysis
Oral prednisolone and artificial tears
Urge incontinence management:
1) Bladder re-training for 6 weeks
2) Anti-muscarinics: Oxybutinin (immediate release) or tolterodine (immediate release)
Oxybutinin should be avoided in frail elderly people
Mirabegron may be used if concerned about anti-cholinergic side-effects
Stress incontinence management
Pelvic floor excercises
surgical procedures: e.g. retropubic mid-urethral tape procedures
Duloxetine may be offered to women if they decline surgical procedures
Features of essential tremor
Management
Postural tremor:
Worst when arms outstretched
Improved by alcohol and rest
Most common cause of titubation (head tremor)
Management: Propranolol
Hypertrophic obstructive cardiomyopathy (HOCM)
Management:
Drugs to avoid:
ABCDE
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defib
Dual chamber pacemaker
Endocarditis prophylaxis
Nitrates
ACEis
Inotropes
T2DM Diagnosis
1) If symptomatic:
2) If asymptomatic
1) Fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test
2) On two occasions: HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus
HbA1c value of less than 48 mmol/mol (6.5%) does not exclude diabetes (i.e. it is not as sensitive as fasting samples for detecting diabetes)
In patients without symptoms, the test must be repeated to confirm the diagnosis
Impaired glucose tolerance criteria:
A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)
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
Factors affecting HbA1c
1) Falsely elevated
2) Falsely reduce
1) Due to increased RBC lifespan: IDA, Splenectomy, Vit B12 and folic acid def.
2) Due to reduced RBC lifespan: Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
AF pharmacologic cardioversion methods:
Which cannot be used in structural heart disease
Amiodarone
Flecainide (if no structural heart disease)
others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone
Genital ulcers:
single painless:
single painful:
Multiple painless:
Multiple painful:
single painless: syphilis
single painful: Haemophillus ducreyi (chancroid)
Multiple painless: HPV warts
Multiple painful: Herpes Simplex
Potential class of side effects of Donepezil
May be exacerbated by:
Bradycardia -> SA/AV block
Rate limiting CCBs -> Verapamil
Acute ischaemic stroke management:
If within 4.5 hours of symptoms on-set = thrombolysis AND thrombectomy
If within 6 hours = thrombectomy
if well within 6-24 hours = thrombectomy
SVT with haemodynamic compromise Tx.
SYNCHRONISED DC Cardioverson
Apple core sign seen in:
Oesophageal cancer
Most common endogenous cause of Cushing’s
PITUITARY adenoma
Endometrial cancer risk factors:
Protective factors:
Excess oestrogen (nulliparity,early menarche,late menopause,unopposed oestrogen
Metabolic syndrome (obesity, diabetes, PCOS)
Smoking, multi-parity, COCP
Acute epiglottitis
Causative organism:
Diagnosis
Treatment:
Haemophilus I. type B
Clinically or may use X-ray (thumb-sign)
Oxygen + IV antibiotics
Red eye:
Answer:
pain or no pain?
visual acuity affected?
Pupil size/dilated?
other features
Acute angle closure glaucoma
Anterior uveitis
Scleritis
Endophthalmitis
Acute angle closure glaucoma:
Severe pain
Reduced VA, patient sees haloes
Semi-dilated pupil
Hazy cornea
Anterior uveitis
Acute onset, pain, blurred vision and photophobia
Small fixed oval pupil, ciliary flush
Scleritis
Severe pain, worse with movement
Endophthalmitis
Painful red eye, visual loss following intraocular surgery
Rinne’s and Weber’s
Normal
CHL
SNHL
Normal: Rinne = AC>BC // Weber= midline
CHL: Rinne = BC>AC (affected ear) Weber: Lateralised to affected ear (contrary to instinct)
SNHL = AC>BC Weber: Lateralises to unaffected ear
Blurring of vision again years after cataract surgery may be due to:
Posterior capsule opacification
Cauda Equina:
Causes - most common:
Discs affected:
Most common cause is central disc prolapse L4/L5 or L5/S1
Other causes: tumours, infection, trauma, haematoma
Degenerative cervical myelopathy
Risk factors:
Symptoms
Hoffman’s sign
Test of choice
smoking, genetics, occupation (high axial loads)
Pain (affecting the neck, upper or lower limbs)
Loss of motor function
Loss of sensory function causing numbness
Loss of autonomic function (urinary/faecal incontinence)
Gently flicking one finger on patients hand
MRI -> to then be referred to orthopaedic spinal team
Accumulation of acetylcholine features (SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
Also small pupils, muscle fasciculation
Malignant otitis externa
Most common organism:
Key features:
Investigation:
Antibiotics
Pseudomonas aeruginosa
Diabetes (90%) or immunosuppression
Severe, unrelenting deep-seated otalgia, purulent otorrhoea, dysphagia, hoarseness, and/or facial nerve dysfunction
CT scan
Ciprofloxacin
BMI classes:
<18.5
18.5 - 24.9
25 -29.9
30 -34.9
35 - 39.9
>40
<18.5 underweight
18.5 - 24.9 Normal
25 -29.9 Overweight
30 -34.9 Obese ( I )
35 - 39.9 Clinically obese ( II )
>40 Morbidly obese ( III )
Phaeochromocytoma:
Secretes:
Where:
Features:
Tests:
Treatment:
Catecholamines
Adrenals
Hypertension, headaches, palpitations, sweating, anxiety
24 hour urinary collection of metanephrines
Phenoxybenzamine (alpha blocker) given BEFORE Beta blocker e.g propranolol
Preferred SSRI in MI
Sertraline
Suspected colorectal cancer pathway:
Change
Now use FIT tests more widely rather than colonoscopy first line:
NICE recommend a FIT is used to guide referral in the following scenarios:
with an abdominal mass, or
with a change in bowel habit, or
with iron-deficiency anaemia, or
aged 40 and over with unexplained weight loss and abdominal pain, or
aged under 50 with rectal bleeding and either of the following unexplained symptoms:
abdominal pain
weight loss, or
aged 50 and over with any of the following unexplained symptoms:
rectal bleeding
abdominal pain
weight loss, or
aged 60 and over with anaemia even in the absence of iron deficiency
Which cognitive impairment may present with intermittent confusion/fluctuating cognition:
Lewy Body dementia
Asthma initial tests
FeNO and bronchodilator reversibility test
Most common cause of traveller’s diarrhoea
Profuse watery diarrhoea, NOT common amongst travellers
Flu-like prodrome followed by crampy abdominal pains - may mimic appendicitis. Complications include GBS
2 types: vomiting within 6 hours (rice) or diarrhoeal illness occurring after 6 hours
Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last several weeks
Prolonged non-bloody diarrhoea
E.coli
Cholera
Campylobacter
Bacillus Cereus
Amoebiasis
Giardiasis
STEMI -> PCI: drugs to give
Fibrinoysis for MI:
what should be given at same time:
Following procedure:
Prasugrel with unfractionated heparin and bailout glycoprotein IIb/IIIa inhibitor
Antithrombin (Fondaparinux)
Ticagrelor
Vaccinations:
Live attenuated viruses:
Inactivated form
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
rabies
hepatitis A
influenza (intramuscular)
Pneumonia causing skin rash (erythematous lesions on trunk)
Treatment:
Mycoplasma Pneumoniae
Doxycycline or macrolide (clindamycin (C.diff risk) or erythromycin)
Pneumonia organism secondary to influenza infection:
Staph aureus
Capgras syndrome:
Delusion that people have been replaced by an identical imposter
Cluster headaches:
Acute management:
Prophylaxis
100% oxygen + Sc triptan
Prophylaxis: Verapamil
Asthma steps of therapy:
1) SABA
2) SABA ICS
3) SABA ICS LTRA
4) SABA ICS LABA
5) SABA LTRA MART
6) SABA LTRA med dose MART
7) SABA LTRA high dose MART
MART is ICS plus LABA in single inhaler
Pneumonia with cavitation on XR organism:
Klebsiella Pneumoniae
Asthma assessment of severity features:
Moderate:
Severe:
Life threatening:
Moderate:
PEFR 50-75% best or predicted
RR < 25 / min
Pulse < 110 bpm
Severe:
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
Life threatening:
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Time restrictions for delivering PPCI in STEMI
Within 12 hours of symptoms on-set
and within 2 hours of presentation
Gout management
Acute:
ULT: When offered
What it involves: first line agent
Second line agent
monosodium urate
NSAIDs or colchicine are first line
Oral steroids may be considered if NSAIDs or colchicine contraindicated
If patient taking allopurinol already it should be CONTINUED
After first attack of gout
2 weeks after exacerbation - ALLOPURINOL first line
Colchicine cover should be considered when starting allopurinol.
Febuxostat (also a xanthine oxidase inibitor)
Overstimulation of parasympathetic system (as seen in organophosphate poisoning) symptoms : DUMBELS mnemonic
Defecation and diaphoresis
Urinary incontinence
Miosis (pupil constriction)
Bradycardia
Emesis
Lacrimation
Salivation
More in depth than SLUD
Examples of dopamine receptor antagonists
Commonly used in
side effects
Bromocriptine, ropinirole, cabergoline
Parkinson’s
Impulse control disorder, hallucinations, daytime somnolence
Cabergoline and bromocriptine may cause pulmonary, retroperitoneal and cardiac fibrosis
Features of Tetralogy of Fallot (4)
VSD
RV hypertrophy
Overriding aorta
RV outflow tract obstruction
Difference between DKA and alcoholic ketoacidosis
Normal or low glucose in AKA
5 red rashes of childhood:
Cold with fever which is followed 1-2 weeks later by erythematous rash across the trunk and limbs:
Starts with erythematous rash behind the ears and spreads to rest of body. Associated with fever, conjunctivitis, coryzal symptoms and white Koplik spots inside the mouth:
Rash first appears on the cheeks, spreading to trunk and arms, preceded by 2-5 days of mild fever and non-specific viral symptoms
Caused by group A strep usually begins as tonsillitis, red-pink rash that begins on the trunk. Associated with fever, strawberry tongue and cervical lymphadenopathy
Roseola infantum
Measles
Parvovirus B19
Scarlet fever
Hypersensitivity reaction, commonly caused by infections. Commonly caused by herpes simplex virus.
Appears as target lesions, initially seen on the back of hands before spreading to the torso.
Also seen as a drug reaction to penicillin, NSAIDs, COCP, SLE, sarcoidosis and malignancy
Erythema multiforme
Marker of acute infection in Hep B
How long does this typically last
Antibody implying immunity
Antibody implying current or previous infection.
Which immunoglobulin is seen in acute infection, which one persists
HBsAg
1-6 months
Anti-HBs - negative in chronic disease
Anti-HBc
IgM -> IgG
Monomorphic punched out lesions
Caused by
Eczema herpeticum
HSV 1or 2
Management of varicella zoster (shingles)
Main benefit of antivirals
Antivirals within 72 hours unless <50 with mild truncal rash
Reduced incidence of post-herpetic neuralgia
Most common testicular swelling with posterior swelling, separate to testicle
Soft non-tender swelling of the hemi-scrotum, usually anterior to and below the testicle, transilluminates with pen torch
Most common on the left side, bag of worms associated with subfertility
Epidiymal cyst
Hydrocele
Varicocele
Definitions of conditions:
Rubbery, painless lymphadenopathy, night sweats, organomegaly, pain while drinking alcohol (uncommon)
More common in patients <20, usually in the mid-line, moves upwards with protrusion of tongue
More common in older men, usually not seen, may gurgle on palpation, symptoms of dysphagia, regurgitation, aspiration, chronic cough.
Congenital lymphatic lesion typically found in the neck on the left side, most evident at birth, 90% before aged 2 years.
Oval mobile, cystic mass, develops between SCM. Due to failure of the obliteration of second branchial cleft in embryonic development. Presents in early adulthood.
More common in females, may cause thoracic outlet syndrome
Lymphoma
Thyroglossal cyst
Pharyngeal pouch
Cystic hygroma
Branchial cyst
Branchial cyst
Cervical rib
Side effects of which drug:
Angioedema, hyperkalaemia, first dose hypotension, cough
ACEi
Paediatric squint management:
Refer to secondary care for further management
Pneumonia causing: Dry cough, confusion, hyponatraemia, bradycardia and deranged LFTs
Treat with
Legionella pneumophilia
Erythromycin or clarithromycin
1) DVT management if Wells greater than 2 ->
2) If investigation can not occur for 4 hours:
3) If US is negative but D-dimer positive
1) Proximal leg vein ultrasound should be carried out within 4 hours -> if negative, a D-dimer should be sent.
2) D-dimer should be sent and interim anti-coagulants started
3) Stop interim DOAC offer repeat leg vein US 6-8 days later
Most common organsim for COPD exacerbation
Haemophilus influenzae
Migraine management:
Acute vs prophylaxis
Acute: NSAID or triptan
Prophylaxis: Propranolol (not if asthmatic) or topiramate (not in women of child bearing age)
1) Dysphagia to both solids AND liquids from the beginning with heartburn
2) Process:
Achalasia
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter due to degenerative loss of ganglia from Auerbach’s plexus
Most effective form of contraception
Are additional contraception methods required for this after insertion
Main adverse effects:
Nexplanon
If not inserted between days 1-5 of woman’s menstrual cycle.
Irregular/heavy bleeding
Progestogen effects (headache, nausea, breast pain)
COPD step up therapy
1) SABA or SAMA
2) DEPENDS ON ATOPY
-> If atopic, SABA or SAMA plus LABA and ICS
-> If not, SABA or SAMA plus LABA plus LAMA
3) SABA LABA LAMA ICS
Infertility - How long should couples be having regular intercourse for before referral to specialist
First line investigation -
1 year
Day 21 progesterone (7 days prior to next expected period)
1) Name the condition:
Acute onset, ocular pain, pupil may be small and irregular due to sphincter muscle contraction, photophobia, blurred vision, red eye, lacrimation with ciliary flush, hypopyon (pus in anterior chamber)
2) Associated conditions:
3) Management
1) Anterior uveitis
2) HLA B27 -> ankylosing spondylitis, reactive arthritis, UC, Crohn’s, Sarcoidosis
3) Urgent review ophthalmology -> Cycoplegics (dilate pupil which relieves pain and photophobia) e.g atropine or cyclopentolate
Steroid eye drops
Eczema which commonly shows up in the hands due to high humidity and increased temperatures
Pompholyx eczema
Name the condition:
Painful red eye, watering and photophobia, gradual reduction in vision. Risk factors include Rheumatoid arthritis, SLE, GPA
Management:
Scleritis
Same day assessment by ophthalmology
Oral NSAIDs
Oral glucocorticoids
Metabolic acidosis causes:
Normal anion gap:
Raised anion gap:
Norma (hyperchloraemic metabolic acidosis): GRAAD
GI bicarbonate loss
Renal tubular acidosis
Addison’s
Ammonium chloride injection
Drugs
Raised: LUKA
Lactate: shock, sepsis, hypoxia
Urate: Renal failure
Ketones : DKA, AKA
Acid poisoning: Salicylates, methanol
Arteries implicated:
1) POCI (posterior circulation infarcts)
2) Lacunar
Vertebrobasilar arteries
Perforating arteries around the internal capsules
TACI and PACI: Middle and anterior cerebral arteries (partial anterior = smaller arteries)
Name the disease: Thromboangitis obliterans. Small and medium vessel vasculitis which is strongly associated with smoking.
Extremity ischaemia, superficial thrombophlebitis, Raynaud’s
Buerger’s disease
Courvoiser’s law:
A palpable non tender enlarged gallbladder accompanied with PAINLESS jaundice is unlikely to be gallstones. Instead consider malignancy.
RAPD:
Define:
Seen in:
The affected and normal eye appear to dilate when light is shone on the affected eye
Retina detachment and optic neuritis (common first sign of MS)
Angina management:
BB or CCB (rate limiting) first line -> dose maximised before switching/adding.
If adding CCB to BB, a dihydropyridine CCB should be used.
If patient cannot tolerate BB and CCB, add one of: Long-acting nitrate, Ivabradine, Nicorandil, Ranolazine
Vitamin name and effects of deficit:
A
B1
B3
B6
B9
C
D
retinoid - night blindness
Thiamine - Beriberi, Wernicke, heart failure
Niacin - Pellagra (dermatitis, diarrhoea, dementia)
Folic acid - Megaloblastic anaemia, NTDs
Scurvy - gingivitis, bleeding
chole/ergocalciferol - rickets, osteomalacia
Testicular cancer:
95% of tumours are:
These are divided into:
Examples of each:
Markers:
Germ cell tumours
Seminoma and non-seminoma
Non-seminoma: embryonal, yolk sac, teratoma, choriocarcinoma
Non-germ cell tumours include: leydig cell tumours and sarcomas
Seminoma: hCG
Non-seminoma: AFP or b-hCG
LDH is raised in around 40% of germ cell tumours
1st line anti-platelet in PAD
What should be co-prescribed
Clopidogrel
Atorvastatin 80mg
Heart murmur:
Early diastolic murmur: intensity increased by handgrip manoeuvre
Wide pulse pressure
Quincke sign (nailbed pulsation)
De Musset’s sign (head bobbing)
Common causes:
Aortic regurgitation
Disease: Rheumatic fever (developing world)
CTDs
Infective endocarditis
Structural: Bicuspid aortic valve, spondyloarthropathies, hypertension
Aortic dissection
Presents in the first 24-48 hours of life with abdominal distension and bilious vomiting, more common in cystic fibrosis
Meconium ileus
Vertigo , hearing loss, tinnitus, absent corneal reflex:
Location
Nerves implicated:
Acoustic neuroma (vestibular schwannoma)
Cerebellopontine tumour
V,VI, VIII
Time from myocardial infarction to complication:
0-4 hours
4-24 hours
1-3 days
4-7 days
Months:
0-4 hours: Cardiogenic shock, CHF, Arrhythmia
4-24 hours: Arrhythmia
1-3 days: Pericarditis
4-7 days: Rupture of free wall, septum or papillary muscle (causes mitral regurgitation)
Months: Dresslers, aneurysm, thrombus
Surgical management of cancer:
1) Colorectal cancer with perforation treated with which procedure?
2) Caecal, ascending or proximal transverse colon?
3) Distal transverse, descending colon
4) Sigmoid
5) Upper rectum
6) Low rectum
7) Anal verge
1) Hartmann’s
2) Right hemi-colectomy
3) Left hemi-colectomy
4) High anterior resection
5) Anterior resection (TME)
6) Anterior resection (low TME)
7) Abdomino-perineal excision of rectum
Primary amenorrhoea, little or no pubic hair, undescended testes showing as groin swellings
Breast development as a result of testosterone breakdown to oestradiol
Genotype:
How does this differ from congenital adrenal hyperplasia
Androgen insensitivity syndrome
46XY - but raised as female
Development of male characteristics in females (hirsutism, deep voice) Body is still responsive to testosterone. No bilateral lower pelvic swellings (no undescended testes)
Arthritis occurring in someones <16 years old that lasts for more than 3 months
Associated skin sign
Pauciarticular JIA refers to cases where X or less joints are affected
Juvenile idiopathic arthritis
Salmon pink rash
4
Serotonin syndrome vs NMS main difference:
NMS occurs hours to days after starting:
Reflexes in NMS vs SS
Pupils in NMS vs SS
Which one do you get rigidity in?
serotonin syndrome presents over hours rather than days like in NMS.
Anti-psychotic
Reflexes are reduced in NMS and increased in SS
Normal in NMS, dilated in in SS
NMS
Breast disorders:
1) Common in women under the age of 30 years ‘breast mice’ discrete, non-tender, highly mobile lumps
2) Most common in middle-aged women ‘Lumpy’ breasts may be painful. Symptoms worsen prior to menstruation
3) Tender lump around the areola +/- a green nipple discharge. Most common around menopause
4) May present with blood stained discharge
5) obese women with large breasts
May follow trivial or unnoticed trauma, Mimic breast cancer so further investigations required
1) Fibroadenoma
2) Fibroadenosis
3) Mammary duct ectasia
4) Duct papilloma
5) Breast cancer
Heparin monitoring: Does it require it
LMWH does not
Unfractionated heparin required monitoring with aPTT
Contraceptives: Time till effective
IUD:
POP:
COC, injection, implant, IUS
IUD: instant
POP: 2 days
COCP, injection, implant IUS: 7 days
Pregnant women with BP over XX/YY should be admitted and observed
160/110
Lung cancer:
Most common Ca:
Cavitating lesions
ADH/ACTH secreting
PTrH secreting
Gynaecomastia
Lambert Eaton Syndrome
Adenocarcinoma
Squamous carcinoma
Small cell
Squamous cell
Adenocarcinoma
Small cell
Sectioning under the mental health act: Which number
1) Admission for assessment for up to 28 days, not renewable. treatment CAN be given against a patient’s wishes
2) Admission for treatment for up to 6 months, can be renewed. Treatment CAN be given against patient’s wishes
3) 72 hour assessment order, used as an emergency, when section 2 would cause delay
4) Person can be taken from a public place to a place of safety if they appear to have a mental disorder only used for up to 24 hours
5) Allows patients to break into property to remove a person to a place of safety:
6) CTO - may be used to recall a patient to hospital if they do not comply with conditions of the order in community
Section 2
Section 3
Section 4
Section 136
Section 135
Section 17a
Iron studies:
Raised in IDA, normal in anaemia of chronic disease
Raised in inflammatory disorders but low in IDA
TIBC
Ferritin
Primary hyperaldosteronism
Features: signs and electrolytes
Investigations:
Treatment:
Hypertension, Hypokalaemia
Plasma aldosterone/renin ration (high aldosterone with low renin levels)
Then high resolution CT abdmoen and adrenal venous sampling is used to differentiate between unilateral adenoma or bilateral hyperplasia
Adrenal adenoma: surgery
Bilateral adrenocortical hyperplasia: Aldosterone antagonist
Hormonal therapy for breast cancer: which is used when
Tamoxifen if PRE-menopausal
Anastrozole for post-menopausal
As aromitisation accounts for the majority of oestrogen production in post-menopausal women.
COCP:
Increases risk of which cancers:
Decreases risk of which cancers:
Breast and cervical
Colorectal, Ovarian and endometrial
Breast cancer risk factors:
(early/late) menarche
(early/late) menopause
Early menarche
Late menopause
Think of oestrogen exposure
Dermatomyositis: Typically associated with which cancers ->
Characteristic antibodies
Breast, Ovarian, lung cancer
Most are ANA positive
Anti-jo 1
Folic acid in pregnancy should be started when and stopped when?
pre-conception till 12th week of pregnancy
Chlamydia: First line investigations:
Male: Urine test
Female: Vulvovaginal swab
