Mock Questions Flashcards
What is the difference in the onset of URTI symptoms and the condition in IgA Nephropathy and Post-Streptococcal Glomerulonephritis?
IgA - 1-2 days after URTI
PSGN - 1-2 weeks after URTI
What is the presentation of Giardisis?
Foreign Travel
Long incubation time
Non-bloody diarrhoea
Steatorrhea
Bloating
Abdominal pain
What is the treatment for severe Cellulitis?
I.V Flucloxacillin
What is the treatment for Acute Otitis Media?
Reassure
Give paracetamol
Safety netting
What is the first line management for Conjuctivitis?
Reassure, should resolve within a week without treatment
What is an antiviral that can destroy wart tissue?
Podophyllotoxin
What is the treatment of DKA?
IV Fluids
FRII
Monitor electrolytes
What bacteria are commonly involved in COPD exacerbation?
Haemophilus Influenzae
Moraxella catarrhalis
How often should diabetics b screened for nephropathy and how?
Yearly - using ACR > 2.4 = microalbuminaemia
What are the complications of peritoneal dialysis?
Weight gain
Absorption of carbohydrates in the dextrose solution can cause weight gain
What is typically the first line drug given for Rheumatoid Arthritis?
Prednisolone for flare up
Methotrexate for remission
What is an early sign of RA on xray?
Periarticular osteopenia
What is the management for SLE?
Sun protection - Sunscreen, reduce sun exposure
Avoid triggers - stress, sunlight, Infections, COCP
Reduce CVS Risks - smoking cessation, HTN control
Improve bone health - Calcium and Vitamin D
Mainstay treatment depends on severity of disease
Mild - NSAIDS and hydroxychloroquine, short course of Prednisolone for flare-ups
Organ involvement ( Kidneys, Lungs etc) - Long term corticosteroids , with Hydroxychloroquine as a steroid-sparing agent
What must be co prescribed with Steroids?
Bone protection -
Bisphosphonates
Vitamin D and Calcium
Which antibodies are specific for SLE?
Anti-dsDNA
Anti-Smith
What antibodies are raised in SLE?
Anti-dsDNA
Anti-Smith
ANA
What blood disorder often occurs secondary to SLE?
Antiphospholipid Syndrome
What is the management of Rosacea?
General measures (avoiding triggers, sun protection)
Topical Metronidazole
What are the signs of Rosacea?
Facial redness, telangiectasia, and papulo-pustular lesions
What is Tuberous Sclerosis?
Mainly non-cancerous (benign) tumours to develop in different parts of the body. The tumours most often affect the brain, skin, kidneys, heart, eyes and lungs
Ash Leaf macules ( hypopigmentation)
Shagreen patches
Ungual fibromas ( flesh coloured papules around the nail bed)
What is the advice about contraception following a vasectomy?
Avoid secual intercourse fro 7 days after surgery
Use contraception for the following 8-12 weeks
What is first line for BPH?
Alpha-1 adrenergic blockers , e.g. Tamsulosin
If problems persist, can add on 5a-reductase inhibitors
What are the treatments for Urge Incontinence, Stress Incontinence and OAB?
Urge - Oxybutynin
Stress - Duloxetine
OAB - Mirabegron in older people with no hypertension
What are the side effects of Rifampicin?
Orange secretions
Induces cytochrome P450
What are the side effects of Isoniazid?
Peripheral neuropathy ( Give Pyridoxine 10mg o.d)
Hepatotoxicity
What are the side effects of Pyrazinamide?
Hepatotoxicity
What are the side effects of Ethambutol?
Decreased visual acuity
Colour blindness
E for eyes
Do you always treat Addison’s with both Hydrocortisone and Fludrocortisone?
Yes , even if there are no urinary symptoms
Who is contrast contraindicated in?
Those with eGFR < 45
Why is contrast bad for the kidneys?
It can cause an AKI
Reduces Renal blood flow
Induces free oxygen radicals
What would be a better alternative for a patient with CKD to confirm PE rather than a CTPA?
V/Q scan
What is the recommended contraception for menorrhagia and fibroids?
COCP
What is first line for Allergic Conjuctivitis?
Eye drop/topical antihistamines
What is the best imaging for visualising Meckel’s Diverticulum?
Abdo CT
How do you diagnose Impetigo?
Usually clinical
Can use skin swab and gram stain to confirm
What drug class is Oxybutynin? What are some side effects of Oxybutynin?
It is an anticholinergic drug, specifically an antimuscarinic drug
Competitively inhibits binding of Ach to Muscarinic receptors. This mainly effects the PNS ( involuntary processes e.g. bronchospasm, vasodilation, reduce heart rate, exocrine gland secretion) . Basically the rest and digest actions.
Therefore the side effects are
-Dry mouth
-Constipation
-Headache
What is the most common cause of food poisining in the UK?
Campylobacter Jejuni
- caused by raw or improperly cooked poultry
If Meningitis presents with Meningism what is the likely cause?
Bacterial - Neisseria Meningitidis
What does lead pipe sign look like on an xray?
Chronic inflammation leads to muscularis mucosal hypertrophy, reduced lumen
Over how long should the dose of Sertraline be tapered down?
4 weeks
What are the treatments for Impetigo?
Localized non-bullous = Fusidic Acid
Bullous = Oral Flucloxacillin
What type of urine sample is used in Chlamydia or Gonorrhea?
First catch urine sample for NAAT
When should DOACs be stopped before surgery?
Low bleeding risk surgery - 24 hours
High bleeding risk surgery - 48 hours
What are the common side effects of local anaesthesia?
Dizziness, headaches, blurred vision, paraesthesia
Which local anaesthetic has the longest duration of action?
Bupivacaine
What are the rules for Paracetamol Overdose?
Presents within 1 hour of ingestion and <150mg/kg dose = Activated Charcoal
Ingestion <4 hours ago: Wait until 4 hours to take a Paracetamol level and treat with N-acetylcysteine based on level
Otherwise should start N-Acetylcysteine
Staggered Overdose - Start N-Acetylcysteine
If dose not known - Start Start N-Acetylcysteine
1 Paracetemol tablet = 500mg
What are signs of poor asthma control?
Waking up at night because of asthma symptoms
Getting asthma symptoms 3 or more times a week
Using your reliever inhaler 3 or more times a week
Having frequent asthma attacks or chest infections
What are the classifications of the NYHA?
1 - Asymptomatic at rest and on exertion
2 - Asymptomatic at rest, dyspnea on moderate intensity or prolonged exercise
3 - Asymptomatic at rest, dyspnea on slight exertion
4 - Symptomatic at rest
What is the Salter-Harris classification for?
A method used to grade fractures that occur in children and involve the epiphysial plate of a long bone
What are the classifications in the Salter-Harris classification?
1 - slip of epiphyseal plate
2 - fracture through epiphyseal plate with triangle of shaft attached
3 - fracture through the epiphysis extending through the epiphyseal plate
4 - fracture of shaft an epiphyseal plate, crossing obliquely through both
5 - damage to epiphyseal plate
What are some side effects of the progesterone injection?
Irregular bleeding
Weight gain
May potentially increase risk of osteoporosis:
Not quickly reversible and fertility may return after a varying time
Which breats condition presents with yellow/green discharge and a palpable mass?
Duct Ectasia
What is the tumour marker for breast cancer?
Ca15-3
Which infection presents with rose spots
Enteric fever ( Salmonella Typhi)
What are some signs of Legionella infection?
Hyponatraemia
Low ALP
What is the MRC Dyspnoea score?
Grade 1 – breathless on strenuous exercise
Grade 2 – breathless on walking up hill
Grade 3 – breathless that slows on the flat
Grade 4 – stop to catch their breath after walking 100 meters on the flat
Grade 5 – unable to leave the house due to breathlessness
What are the classifications of haemorrhoids?
1st Degree- Remain in the rectum
2nd Degree- Prolapse through the anus on defecation but spontaneously reduce
3rd Degree- Prolapse through the anus on defecation but require digital reduction
4th Degree- Remain persistently prolapsed
What is the lifestyle advice for managing haemorrhoids?
Increasing daily fibre and fluid intake to avoid constipation
Prescribing laxatives if necessary
Topical analgesia (such as lignocaine gel)
What is the management of thrombosed haemorrhoids?
Sitting on ice packs
Topical lidocaine gel
What is the surgical treatment for symptomatic 1st or 2nd degree haemorrhoids?
Rubber-band ligation
What is the surgical treatment for 2nd or 3rd degree haemorrhoids?
Haemorrhoidal artery ligation - artery identified with doppler and is tied off
What is the surgical treatment for 3rd or 4th degree haemorrhoids?
Haemorrhoidectomy, especially those not suitable for banding or injection
What are the main complications of surgical treatment for haemorrhoids?
Recurrence
Anal stricturing
Faecal incontinence
What grading system is used in Prostate cancer?
TNM
Gleason is also used but for lookng at the relative differnentiation of the biopsy
What is Rosacea? and what is it treated with?
A skin condition presenting with facial flushing
Ivermectin
What type of stoma is used for a Hartmann’s Procedure?
End colostomy - Affected part of colon resected and rectal stump is sewn shut This will defunction and decompress the bowel, and the stoma can be reversed at a later date
Which drugs can cause Acute Pancreatitis?
Azathioprine
Mesalazine
Bendroflumethiazide, Furosemide
Steroids
Sodium valproate
Which organism most commonly causes Bronchiolitis?
Respiratory syncytial virus
What is Bronchiolitis?
Bronchiolitis refers to a viral infection of the lower respiratory tract that primarily affects the bronchioles, and causes airway inflammation and obstruction
Most commonly caused by Respiratory Syncytial Virus also be causes by Parainfluenza virus.
Common in under 2s
What is the Rockwood frailty score?
A tool used to estimate an individual’s degree of frailty from 1 (very fit)- 9 ( terminally ill)
What is Barlow and Ortolani’s Test?
Barlow’s test attempts to dislocate an articulated femoral head. Ortolani’s test attempts to relocate a dislocated femoral head to confirm its dislocated
Confirms developmental dysplasia of the hip
What is the treatment for severe hyperkalaemia? ( >6.5) need to know dose!!
IV Insulin (Actrapid) 10 units with Glucose 25mg
Nebulised Salbutamol 20mg
IV Calcium Gluconate 10% - stabilises cardiac membrane
What are the risk factors for RCC?
Smoking
Hypertension
Obesity
Fhx
What paraneoplastic conditions can RCC cause?
Polycythaemia ( Ectopic EPO production)
What can RCC metastasis to?
Lung
Bone ( Haematogenous)
Liver
Brain
Adrenal gland ( Local spread)
What are some red flags for nasal polyps?
Unilateral
Nose bleeds
Systemic symptoms of cancer
What is the treatment for nasal polyps?
First line - nasal corticosteroid 2 weeks
Second line - Oral prednisolone
Third line - Nasal polypectomy
What are the risk factors for a silent MI ( no symptoms)
Older
Diabetes
What are the categories of Croup?
Mild — seal-like barking cough but no stridor or sternal/intercostal recession at rest. Managed in primary care
Moderate — seal-like barking cough with stridor and sternal/intercostal recession at rest. There is no (or little) agitation or lethargy. Requires hospital admission and 0.15mg/kg dexamethasone
Severe — seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy. Requires hospital admission and 0.15mg/kg dexamethasone
What are some features on a mammogram of DCIS?
Does not invade basement membrane/BM
Displays prominent central necrosis
Displays microcalcifications on mammogram
What are some features on a mammogram of invasive ductal carcinoma?
Displays nests of glandular tissue surrounded by dense fibrous stroma
Spiculated/spiky mass on mammogram
Displays clustered microcalcifications on mammogram
What are the treatments for DCIS?
Wide Local Excision is <4 cm
Mastectomy if >4 cm
What is the pathophysiology of Acne?
Triggered by androgens
Can have genetic and non-genetic (dietary, stress) factors
Chronic inflammation in pilosebaceous units
with or without infection
Increased sebum production
Blockage of pilosebaceous units with keratin
How are HIV patients monitored?
CD4+ count (500-1200 cells/mm is the normal range. Under 200 cells/mm is considered end stage HIV / AIDS)
Viral load (number of copies of HIV RNA per ml of blood)
What is the definitive test most used by hospitals in the UK to diagnose HIV?
Antibody blood test
Why do females with HIV have yearly smear tests?
HIV predisposes you to HPV infection, which can cause cervical cancer)
What prophylactic antibiotics are given to patients with AIDS?
Id CD4 < 200 = Co-trimoxazole ( Prevents pneumocystis jirovecii pneumonia)
If CD4 is <50 = Azithromycin ( Prevents MAI)
What time frame must PEP be commenced by? What is the current medication regime?
<72 hours after exposure
It involves a combination of ART therapy. The current regime is Truvada (emtricitabine / tenofovir) and raltegravir for 28 days.
What illnesses are common in those with a low CD4 count?
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
What are some risk factors for biliary colic?
Obesity
Female sex
Pregnancy
Oral contraceptive
Family history of biliary colic
Crohn’s disease
Diabetes mellitus
What type of cancer are patients with PCOS most at risk from?
Endometrial Cancer
What is the scoring criteria for PCOS?
Rotterdam
What are some risk factors of prolonged steroid use?
Increased appetite
Thinning of skin
Muscle weakness
withdrawal e.g. Addisonian crisis
Delayed wound healing
Cushing’s syndrome
Osteoporosis,
Glaucoma
HTN
DIabetes
What are some macroscopic features of Crohn’s?
Aphthous ulcers, cobblestone appearance of the bowel, bowel wall thickening, fistulae and fissures, skip lesions
What are some microscopic features of Crohn’s?
Non-caseating granulomas
Transmural inflammation
What complications does a closed loop obstruction increase the risks of?
Ischaemia
Perforation
When is surgical intervention of a laparotomy indicated for obstruction?
Suspicion of ischaemia
Closed loop bowel obstruction
If no improvement with conservative management after 48h <
What are the symptoms of Blepharitis?
sore eyelids
itchy eyes
a gritty feeling in the eyes
flakes or crusts around the roots of the eyelashes
eyelids sticking together in the morning when you wake up
What is Reynold’s Pentad?
Reynold’s = Charcot’s Triad + hypotension + altered mental status
What is the obstructive jaundice picture on LFTS?
Elevated total bilirubin
Elevated ALP
Elevated GGT
What complication of ascending cholangitis would present with increasing AST and ALTs?
Liver abscess formation
What does ERCP stand for?
Endoscopic Retrograde Cholangiopancreatography
What is the screening tool for depression?
PHQ-9
What are some specific complications of Alcoholism?
Wernicke’s encephalopathy
Korsakoff syndrome
Liver cirrhosis
Chronic pancreatitis
What is the initial treatment for mild depression?
Advise appropriate mental health services, support groups and charities
Encourage physical activity
Wellbeing books, apps and other services
Prescribe SSRIs first line ( Sertraline, Fluoxetine, Citalopram, Escitolopram)
2 – 4 week review
What are some side effects of SSRI?
Suicidal thoughts at the start of treatment
Dizziness
Light headedness
Difficulty concentrating
Impotence
What is the antibiotic first line treatment for spontaneous bacterial peritonitis?
I.V Cefotaxime
What is the CHA2DS2-VASc score?
Congestive Heart Failure (one point)
High blood pressure (one point)
Age (two points if above 75)
Diabetes (one point)
Stroke or clot previously (two points)
Vascular disease (one point)
Age >65 ( one point )
Sex = Female ( one point )
What is the first line treatment for Acute Sinusitis?
Antihistamine
Nasal Saline
Allergen avoidance advice
If not resolved after 10 days can give nasal corticosteroid
Which drug is given as blind therapy for Infective Endocarditis ( before you have culture results)?
Native valve = I.V Amoxicillin and Gentamicin
Prosthetic Valve = Vancomycin + Rifampicin + low-dose Gentamicin
What do you give if Infective Endocarditis is caused by a HACEK organism?
Endocarditis caused by Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella species
Amoxicillin + Low dose Gentamicin
What do you give if Staph Aureus is the cause of Infective Endocarditis?
Native = Flucloxacillin for 4 weeks
Prosthetic = Flucloxacillin + rifampicin + low-dose gentamicin for 6 weeks
When can COCP be offered post-partum? And is it okay in breastfeeding?
6 weeks postpartum
Fine in breastfeeding
What are the risk factors for genital thrush?
Recent antibiotic use.
COCP
Pregnancy
Diabetes
Immunosuppressive medications.
Ho w do you swab for Trichomoniasis?
High vaginal swab ( Charcoal swab) of posterior fornix for NAAT
What is the Modified Glasgow Criteria?
Pa0₂ <8 kPa (<60 mmHg)?
Age >55 years?
Neutrophils - WBC >15x10⁹/L?
Calcium <2mmol/L (<8 mg/dL)?
Renal - Urea >16 mmol/L or BUN >45 mg/dL?
Enzymes - AST >200 U/L or Lactate Dehydrogenase (LDH) >600
Albumin <32g/L (<3.2 g/dL)?
Sugar - Blood Glucose >10 mmol/L (>180 mg/dL)?
What should be given first line for uncomplicated P.Falciparum malaria?
I.V Artesunate
What should be given first line for severe P.Falciparum malaria?
IV Artesunate ( Check for G6PDH deficiency)
2nd line - IV Quinine
What should be given for non-falciparum malaria?
PO Chloroquine
If P.Vivax or P.Ovale also give Primaquine ( Check for G6PDH deficiency)
What is the management for Acute Cholycystitis?
Analgesia and antiemetic
IV antibiotics
Lap cholecystectomy within 1 week ideally 72 hours
What is Mirizzi syndrome?
Stone located in hartmann’s pouch or in cystic duct compresses common hepatic duct and causes obstructive jaundice
WHat are the complications of acute cholycystitis?
Mirizzi Syndrome
Gallbladder empyema
Chronic cholecystitis
Complications due to cholecystoduodenal fistula: bouverets syndrome and gallstone ileus
Where are haemorrhoids most likely to occur?
3, 7, 11 o’clock position in the lithotomy position
What are some complications post-op for haemorrhoids?
Recurrence
Anal stricture
Faecal incontinence
What is the treatment of Chickenpox?
Keep cool, trim the nails, distract the child (with toys etc.) to stop them from itching
Paracetamol/ Calpol
Topical aqueous calamine lotion
Chlorphenamine
What tests are included in the delerium screen?
FBC
U&Es
LFTs
Coagulation screen- any intracranial bleed
TFTs- hypothyroidism
B12/ Hemanitics- b12 deficiency
Blood Glucose- hypoglycaemia
Blood cultures- sepsis
What is delerium
Acute, transient and reversible state of confusion ( global disorder of cognition and consciousness). often due to other cause (infection, drugs, dehydration).
What are the causes of
delirium?
Infection ( e.g Sepsis)
Medications
Constipation
Hypoxia
Sleeplessness
Pain
Hypothermia,
Metabolic disturbances
Organ dysfunction
Environmental changes
What are the causes of nephrotic syndrome?
Focal segmental glomerulosclerosis
Membranous nephropathy
Amyloidosis, myeloma, diabetes
Minimal Change disease
What are some complications of Nephrotic Syndrome?
Venous thromboembolism
Progression to CKD
Hypertension
Hyperlipidaemia
Hypocalcaemia
AKI
Heart disease
What are some indications for renal biopsy?
Significant proteinuria/nephrotic syndrome with 2 normal sized, non-obstructed kidneys and no obvious cause
AKI with 2 normal sized, non-obstructed kidneys and no obvious cause
CKD 2 normal sized, non-obstructed kidneys and no obvious cause
Renal transplant dysfunction
What are some complications of renal biopsy?
Bleeding, bruising
Hitting nearby organ/structure
Infection
What are some reasons why spinal anaesthesia may be used over general ?
Lower cost
Better post-operative pain
Allergy to general
Contraindication e.g COPD
What nerve injury results in foot drop?
Common peroneal nerve splits into superficial peroneal nerve and deep peroneal nerve
Damage to it results in foot drop and loss of sensation over the dorsum of the foot, and lateral side of the leg
Superficial supplies the lateral aspect of the leg ( Eversion)
Deep supplies the anterior compartment ( Dorsiflexion, Extension of toes)
Which cancers does obesity increase the risk of?
Ovarian
Breast
Endometrial
Bowel
What are the benefits of exercise?
Increases basal metabolic rate
Reduces risk of diabetes
Reduces risk of CVD
Improves mental health
What is concordance?
Treatment negotiation between a patient and docter
What are the types of adherence related behaviour?
Unintentional non-adherence e.g practical problems, can’t afford it
Intentional non-adherence
What is social learning theory?
People learning by observations.
Influence of family, friends, media figures of health related behaviours
What is classical conditioning?
Environmental cues that trigger a response to associate bad behaviour with an unpleasant repsonse
What is operant conditioning?
Peoples actions influenced by consequences e.g rewards or punishment
What are the extra-articular manifestations of RA?
Dry eyes
Dry mouth
Lung nodules
Interstitial lung disease
Carpal tunnel syndrome
What are the differentials for an inguinal hernia?
Lymphadenopathy
Sebaceous cyst
Lipoma
Femoral artery aneurysm
Saphena Varix
Where is the deep inguinal ring?
Half way between ASIS and pub tubercle
What behavioural measures could be introduced to manage a child with constipation?
Scheduled toileting
Use of a bowel habit diary
Rewards system
Addressing potential psychosocial problems
What is the treatment for simple constipation?
Macrogrol e.g Movicol
What is a health visitor?
They offer support to families through the early years, can advise on diet and behavioral techniques and monitor progress.
What indicates poor asthma control?
Waking up in the night
Using SABA more than once a week
Interfering with usual activities
What could be the cause of a reduced peak flow?
Non-adherence to medications
Recently started or increased smoking
Triggers e.g new place of work, new pet
What indicates statistical significance?
The 95% confidence interval does not include the null value of 1
What are some contraindications to the COCP?
Previous breast cancer
Migraine with aura
BMI>35
History or thrombosis
What advice should be given when starting the COCP?
How/when to start
Missed pill advice
Interaction with antibiotics
Effect of vomiting on efficacy
Potential side effects
Must continue barrier methods
How does the COCP work?
Prevents ovulation
Thins endometrium
Thickens cervical mucous
What are some causes of vertigo other than BPPV and how would you distinguish between them?
Acute Labyrinthitis - vertigo lasts for hours/days not minutes
Meniere’s - More prolonged vertigo, also associated with tinnitus and hearing loss
What are some contraindications to the DIx-Hallpike maneuver?
MSK Problems
Carotid Sinus syncope
WHat is the pathophysiology of BPPV?
Calcium carbonate crystals are deposited in the inner ear. When your head is still they sit and the bottom of the semicircular canals, but certain head movements cause them to be moved along the canals and disrupt the stereocilia, which the brain interprets as incorrectly as vertigo as it thinks you are unbalanced.
What is some advice for BPPV?
Avoid sudden changes in position
Rest
Adequate hydration
Do not drive whilst symptomatic
Do not operate heavy machinery at work ( occupational)
What is the MOA of Aspirin?
It is a Irreversible COX inhibitor
It prevents platelet aggregation
Where does lower limb ischaemic pain typically affect?
Toes
Feet
What is the difference between peritonitic pain and uteric colic?
peritonitic pain - exacerbated by movement
ureteric colic - pain makes patient writhe in agony
What are some clinical signs of sepsis?
Intractable pain
Pyrexia
Tachycardia
Hypotension
Reduced urine output
Tachypnoea
Rigors
What tests must be done before starting RIPE therapy?
LFTs ( causes hepatitis)
Visual Acuity testing ( causes decreased)
What are some risk factors for palpiatation?
Hypertension
OSA
Obesity
Coronary artery disease
Metabolic syndrome
Electrolyte abnormalities
Hyperthyroidism
What are the 5 aspects of metabolic syndrome?
High blood pressure
High blood sugar levels
Excess fat around the waist
High triglyceride levels
Low levels of HDL
What detect hypovolemia and trigger the thirst response?
Osmoreceptors
What are the complications of hypernatremia?
Stroke
Loss of consciousness
Seizure
Thrombotic episode
What are the risk factors for Ischaemic Heart Disease?
Hypertension
Diabetes
Smoking
Hypercholesterolaemia
Male
Obesity
Family History
What medications should patients be started on after an MI?
ACEi
Aspirin 75mg
Atorvastatin 80mg
B-Blocker
Clopidogrel if PCI performed
ST elevation in which leads are indicative of a lateral STEMI?
Leads I, aVL and V5-V6
What blood tests can be done for a MI?
Troponin T/I
CK-MB
CK
AST
LDH
Will all be raised
What are the signs on an ECG post-STEMI?
T Wave inversion
Pathological Q Wave
How long can a patient not drive for following a MI?
4 weeks
What are some complications of a coronary angiography?
Bleeding
Infection
Myocardial infarction
Coronary artery dissection
Stroke
Allergy to contrast
What can trigger stable angina?
Exertion
Cold weather
Emotion
What blood tests will be done for Stable Angina?
FBC - anaemia
Lipid profile - hypercholesterolaemia
U&Es - renal disease
HbA1c - diabetes
What is the MOA of Aspirin?
Irreversible COX inhibitor that prevents platelet aggregation
What are some signs of pulmonary oedema?
Tachypnoea
Tachycardia
Raised JVP
Fine lung crepitations
Wheeze
Dullness to percussion
Cyanosis
Decreased vocal resonance
Pink frothy sputum
What medications can help acute pulmonary oedema?
Furosemide
GTN Spray
Oxygen
Above what is a prolonged QRS Complex?
> 120ms ( 3 small squares)
What is a normal PR interval?
120-200ms (<1 big square)
What are signs of heart failure on xray?
Alveolar oedema
Kerley B Lines
Cardiomegaly
Upper lobe Diversion
Pleural Effusions
What is the MOA of Furosemide?
Loop diuretic
Inhibits the Na+/K/2CL cotransporter on the thick ascending limb of the Loop of Henle
How do you calculate BMI?
Weight(kg) / Height (m)^2
What are signs of hypertensive retinopathy?
Flame haemorrhages
Papilloedema
Cotton wool spots
What are signs of hypercholesterolaemia?
Xanthelasma
Tendon xanthoma
Corneal Arcus
Types of cardioversion that come be done in Acute Atrial FIbrillation?
Medical - Flecainide
Electrical - DC Cardioversion
Most common organism in Infective Endocarditis?
Most common generally - Staph Aureus
IVDU - Staph Aureus
Poor dental hygiene - Viridans Streptococci
Following prosthetic valve surgery - Staphylococcus epidermidis
Why might you do a urine dipstick in infective endocarditis?
Microscopic haematuria - indicates kidney involvement
Which conditions can predispose to infective endocarditis?
Prosthetic Valves
Mitral valve disease
Aortic valve disease
Coarctation
VSD
What is the method of action of Salbutamol?
Stimulates B2 receptors on bronchial smooth muscle causing relaxation
What are signs of consolidation ( Pneumonia ) on examination?
Reduced chest expansion
Dull to percussion
Bronchial breathing
What are some causes of increasing TB cases?
MDR TB
Increased immigration from TB incidence countries
HIV prevalance
What is bronchiectasis?
Chronic infection of the large airways ( bronchi) causing permanent dilation
What are some causes of bronchiectasis?
Post infective ( TB, Pertussis)
Post obstructive ( Foreign body, tumour)
Congenital ( Young’s, Kartegener’s, Primary Ciliary Dyskinesia, Cystic Fibrosis)
a1-antitrypsin deficiency
What are some complications of Bronchiectasis?
Recurrent LRTIs
Septicaemia
Respiratory failure
Cor Pulmonale
Where does liver cancer most commonly metastasize to?
Brain
Bone
Liver
Adrenals
What might be seen on CXR in idiopathic pulmonary fibrosis?
Reduced lung volume
Reticulonodular shadowing
Honeycomb lung
What are types of extrinsic allergic alveolitis?
Bird Fancier’s Lung
Farmer’s Lung
Mushroom worker’s Lung
What are some causes of clubbing?
Idiopathic Pulmonary Fibrosis
Lung cancer
Bronchiectasis
What is Cor Pulmonale?
Right sided heart failure caused by chronic pulmonary hypertension
What are some abnormalities you may see on CXR in Cor Pulmonale?
DIlation of the right atrium
Enlarged right ventricle
Prominent pulonary arteries
What abnormalities you may see on ECG in Cor Pulmonale?
Right axis deviation
Inverted T wave in cheat leads
What are some causes of bilateral hilar lymphadenopathy?
Lymphoma
Tuberculosis
Sarcoidosis
What is seen on biopsy in Sarcoidosis?
Non-caseating granulomas
What are some extrapulmonary features of Sarcoidosis?
Erythema Nodosum
Arthralgia
Anterior Uveitis
What advice should be given before starting steroids?
Don’t stop them suddenly
Carry steroid card at all times
Doses need to be increased in times of illness
What are some side effects of long term steroids?
Where is the neurovascular bundle on the ribs?
Below the rib
Any aspirations should be done above the rib
What tests are done on pleural fluid aspirate?
What drug is used after an aspiration to ‘plug the gap’?
Pleurodesis with Bleomycin
What are the causes of CKD?
Hypertension
Diabetes
Glomerulonephritis
ADPKD
Pyelonephritis
Renovascular disease
What are signs of CKD on examination?
Pallor
Uraemic tinge
Excoriation
Hypertension
Cachexia
Complications of peritoneal dialysis?
Bacterial peritonitis
Local infection at catheter site
Sclerosing Peritonitis
Weight gain
What is the boundary for if renal transplant rejection is chronic?
Over 6 months
How does PTH cause increased calcium levels?
Stimulates osteoclasts and causes increased resorption of bone
Increased hydroxylation of Vitamin D causes increased calcium reabsorption in bowel and kidney
Where is vitamin D hydroxylated to its active form?
Kidney
Lungs
What is the bone condition caused by CKD called?
Renal osteodystrophy
What investigations would you do for AKI?
ECG
Urinalysis
U&Es
CXR
Renal USS
ABG
What are some complications of AKI?
Hyperkalemia
Pulmonary oedema
Haemorrhage
What are the indications for dialysis in AKI?
Refractory pulmonary oedema
Refractory hyperkalaemia
Severe metabolic acidosis
Uraemic encephalopathy
Uraemic Perdicarditis
What does rhabdomyolysis cause high levels od?
Creatinine Kinase
WHat test would you use to confirm rhabomyolysis?
Urinary myoglobin
What does ATN cause on microscopy?
Muddy brown casts
What are causes of Rhabdomyolsis?
Excessive exercise
Crush injuries
Long periods of immobilisation
Statins
What is the treatment for severe hyperkalaemia?
10ml 10% Calcium Gluconate IV over 5 minutes
IV Insulin + dextrose
Salbutamol nebulisers
What is the most common cause of nephrotic syndrome in adults?
Membranous nephropathy
What are some complications of nephrotic syndrome
Increased susceptibility to infections - give antibiotics
Increased risk of VTE - give TED stockings and anticoagulation
Hypecholersteramia - give a statin
What is the recommended diet for Nephrotic syndrome?
Low sodium, normal protein diet
Where is ADH made?
PPG
Why does ADH increase water reabsorption?
It increases the number of aquaporin channels on the collecting duct to increase permeability and allow more water to be reabsorbed
What are risk factors for UTIs?
Diabetes
Female
Sexual intercourse
Urinary catheterisation
Pregnancy
Immunosuppression
What is some advice for avoiding UTIs?
Wipe front to back
Keep well hydrated
Post-coital voiding
What investigations do you do for pyelonephritis?
FBC
U&Es
CRP
Urine MCS
Blood cultures
Renal USS
What are contraindications of renal biopsy?
Abnormal coagulation studies
Single functioning kidney
SBP>160mmHg
DBP>90mmHg
CKD with small kidneys
What are some complications of renal biopsy?
Flank pain
Macroscopic hematuria
Hematoma
What are causes of purpura?
Henoch-Schonlein Purpura
Septicaemia ( Meningococcal)
Amyloidosis
Steroids
Disseminated Intravascular Coagulation
What are the extra-articular manifestation of RA?
Carpal Tunnel Sydrome
Scleritis
Pleural effusion
Pulmonary fibrosis
Amyloidosis
Rheumatoid nodules
Raynaud’s Phenomenon
What is the method of action of NSAIDs?
COX inhibitor that reduces prostaglandin synthesis and therefore inflammation and pain
What might you see on x ray of Gout?
Normal joint space
Soft tissue swelling
Periarticular erosions
Where does Pseudogout most commonly affect?
Knee
Hip
Wrist
What are some risk factors for Pseedogout?
Haemochromatosis
Older
Hypothyroidism
Wilson’s Disease
What are some precipitating factors for Gout?
Dehydration
Alcohol
Trauma
Purine rich foods
Which antibodies are positive in Lupus with Antiphospholipid syndrome?
ANA
Anti-dsDNA
Anti-Smith
Anti-cardiolipin
Lupus coagulants
What antibodies are raised in Polymyositis?
Anti-Jo1
Anti-Mi2
Rheumatoid Factor
ANA
What is Raynaud’s Phenomenen?
Peripheral digit ischaemia caused by vasospasm , precipitated by cold or emotion
Causes of Raynaud’s Phenomenen?
Raynaud’s Disease
Scleroderma
Rheumatoid Arthritis
SLE
Dermatomyositis
Polymyositis
What is CREST syndrome ( Limited Scleroderma, Limited Systemic Sclerosis) ?
Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
What are the x ray findings in Ankylosing Spondylitis?
Sacroiliitis
Squaring of lumbar vertebrae
‘bamboo spine’
What may be heart in an examination of AnkSpond?
FIne inspiratory crackles
Early diastolic murmur ( AR)
What are the types of Psoriasis?
Chronic plaque psoriasis - well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
Guttate psoriasis - transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
Flexural psoriasis - in flexors, smooth
Where does chronic plaque psoriasis usually affect?
Scalp
Sacrum
Extensor surfaces
What is severe psoriatic arthritis ‘ pencil in cup” deformity called?
Arthritis Mutilans
What is Reiter’s syndrome of Reactive Arthritis?
Conjunctivitis
Urethritis
Arthritis
What organisms commonly cause Reactive Arthritis?
Campylobacter Jejuni
Salmonella Typhi
Chlamydia Trachomatis
What are the small vessel vasculitides?
Microscopic Polyangiitis ( P-ANCA)
Granulomatosis with Polyangiitis ( C-ANCA )
Eosinophilic Granulomatosis with Polyangiitis ( P-ANCA)
IgA Vasculitis / Henoch-Schonlein Purpura
What are the medium vessel vasculites?
Kawasaki Disease
Polyarteritis Nodosa
What are the large vessel vasculitides ?
Giant Cell Arteritis
Takayasu’s Arteritis
What are some systemic conditions with vasculitis as a feature?
Infective Endocarditis
SLE
Rheumatoid Arthritis
What are some causes of Mononeuritis Multiplex?
Granulomatosis with Polyangiitis
Diabetes
Sarcoidosis
Rheumatoid Arthritis
HIV/AIDS
What are some signs/symtpoms of Acromegaly?
Macroglossia
Frontal bossing
Headache
Sweating
Prognathism
Hypertension
Bitemporal hemianopia
What is the OGTT in Acromegaly?
Rapid increase in blood sugar levels should decrease GH, but it remains high in Acromegaly.
What condition should people with acromegaly also be checked for?
Diabetes Mellitus
GH is an anti-insulin , so acromegaly can cause insulin resistance
What are some signs of hypothryoidism?
Dry/thinning hair
Bradycardia
Loss of lateral 1/3 of eyebrows
Goitre
Ataxia
What conditions are associated with hypothyoidism?
Can increase risk of developing other autoimmune e.g
Vitiligo
Coeliacs disease
RA
Pernicious Anemia - may get macrocytic anaemia
Where does the thyroid gland originate from?
Foramen Caecum
What signs are specific to Grave’s Disease?
Thyroid eye disease ( Exopthalmos)
Pretibial Myxoedema
Thyroid acropachy
What is hypopituitarism due to postpartum haemorrhage called?
Sheehan’s Syndrome
What are
Confusion
Drowsiness
Seizures
Hemiparesis
Coma
How do you conduct an Fasting Oral Glucose Tolerance test?
Patient is fasted overnight
Measure blood sugar
A high glucose content drink is given
Measure blood sugar after 120 minutes
If >11.1mmol/L positive
Why do patients with Prolactinomas get bitemporal hemianopias?
Compression of the optic chiasm
What are the treatments for prolactinomas?
Transphenoidal resection
Cabergoline/Bromocriptine
Radiotherapy
What investigations might you do for hypercalcaemia?
DEXA scan
Abdo X-ray
MRI Neck
What signs might be seen on a diabetic foot exam
Neuropathic ulcer
Charcot’s Joint
Diminished reflexes
What sensation is lost fist in diabetic neuropathy?
Vibration
What is the pathophysiology of DKA?
Insulin deficiency causes gluconeogenesis and lipolysis. Gluconeogenesis further raises the blood glucose levels. Lipolysis causes fatty acids to be broken down to ketone acids, which causes a metabolic acidosis. In response there is respiratory compensation of hyperventilation ( Kussmaul’s respiration).
Acidosis causes patient to vomit, which causes further electrolyte disturbance
Excess glucose causes polyuria due to osmotic diuresis effect
What are some long term complications of Crohn’s?
Perianal abscess
Fistulae
Colonic carcinoma
Malnutrition
How does Infliximab work?
Its a TNF-a inhibitor
So it binds to TNF-α and prevents TNF-α from interacting with its receptors, preventing the inflammatory cascade
What medications are associated with upper GI bleeds?
NSAIDs
Anticoagulants
Corticosteroids
What does a raised Urea in proportion to Creatinine imply?
Upper GI Bleed
What anastomoses are associated with liver cirrhosis?
Superior rectal vein shunts - cause haemorrhoids
Paraumbilical vein shunts - cause Caput Medusae
What is the Urease breath test?
H.Pylori produce urease to break down urea into ammonia and CO2. A radioisotope form of carbon is ingested C-13 ( In a urea powder mix with juice ). If urease is present then urea will be broken down and the radioisotope CO2 can be measured in breath.
What is the treatment for severe GORD?
Nissen’s Fundoplication
What is the Gold standard for diagnosis of GORD?
24 hour pH monitoring
What happens in nissen fundoplication?
GOJ and hiatus are dissected and the fundus wrapped around the GOJ, recreating a physiological lower oesophageal sphincter making it harder for contents to reflux
What complications occur due to long term jaundice?
Pruritus
Acute renal failure
Increased susceptibility to infection
Fulminant hepatic failure
Cholestasis
Cirrhosis
Hepatocellular Carcinoma
What conditions are associated with Coeliac’s?
Type 1 Diabetes
Thyroid disease
Why does pain move from central to RIQ in acute appendicitis?
Irritation of visceral peritoneum by inflamed appendix is felt in the T10 dermatome, which is the periumbilical region. Visceral peritoneum has no somatic innervation so the brain interprets the pain as being in the same dermatome as where the visceral signals enter the spinal cord. As the disease progresses, the parietal peritoneum gets irritated also, as this receives somatic innervations the pain is well localised to the RIF
What are the differentials for appendicitis?
Ectopic pregnancy rupture
Ovarian cyst rupture
PID
Testicular torsion
Ureteric stones
Crohn’s Disease
What is a diverticuli?
Outpouching of mucosa through the muscle wall
Where are the majority of diverticula?
Sigmoid colon - most of the water has been reabsorbed by here so there is high luminal pressure
What are investigations for diverticulitis in the acute phase?
FBC
CRP
Blood cultures
Abdo CT
COLONOSCOPY SHOULD BE AVOIDED DUE TO RISK OF PERFORATION
What is the management of Diverticulitis in the acute phase?
Analgesia
Antibiotics
Adequate hydration
What is the embryology behind an indirect inguinal hernia?
During foetal development, the testes descend from the posterior abdomen wall following the processus vaginalis , attached via the gubernaculum. If this connection fails to close there is a patent processus vaginalis through which indirect inguinal hernias can occur
What investigation should be done for haemorrhoids
FBC
Proctoscopy
What are complications of haemorrhoids?
Ulceration
Stricture
Thrombosis
Anaemia
Skin tags
What blood tests are raised in acute mesenteric ischaemia?
Lactate
WCC
Amylase
What is the definitive treatment of acute mesenteric ischaemia?
Resection of the ischemic bowel and revascularisation of bowel ( e.g. angioplasty)
What does the red pulp of the spleen do?
Acts as a filter to destroy defunt RBCs
What are the indications for splenectomy?
Trauma
Splenic rupture
Neoplasia
Hypersplenism
What does the white pulp of the spleen do?
Its lymphoid tissue, part of the immune system.
What are some acute complications of Acute Pancreatitis?
ARDS
Sepsis
DIC
Renal failure
What are some long term complications of Acute Pancreatitis?
Pancreatic Pseudocyst
Pancreatic Abcess
Chronic Pancreatitis
What is the management of Acute Pancreatitis?
IV FLuids
Analgesia
NG Tube
How to differentiate between Paralytic Ileus and Bowel obstruction?
Ileus - absent bowel sounds
BO - tinkling bowel sounds
What are the lobes of the liver?
Right
Left
Caudate
Quadrate
What ligament connects the anterior part of the liver to the ventral wall of the abdomen?
Falciform ligament
What is post-catheter care?
Document residual volume
take specimen for CSU
Retract foreskin back over glans penis
What complication can occur post-catheterization to relieve acute urinary retention?
Post-obstructive diuresis
Fluid balance chart to monitor
BPH Medications and MOA?
a1-blocker = Tamsulosin ( Relaxes prostatic smooth muscle)
5-alpha reducase inhibitor ( Finasteride) = Prevents conversion of Testosterone to Dihydrotestosterone , which is the more potent version that is responsible for prostatic hyperplasia
What investigations are used to investigate haematuria?
Urinalysis
Baseline bloods
PSA if appropriate + counselling
Urine cystoscopy
Renal Tract USS
Flexible cystoscopy
CT Urogram
What are the treatments for Bladder carcinoma?
TURBT
Intravesical agents e.g BCG
Where can bladder cancers metastasize to?
Iliac lymph nodes
Paraaortic lymph nodes
Uterus
Rectum
Liver
Lungs
Bone
Non-malignant causes of a raised PSA?
DRE
Prostatitis
Catheterisation
UTI
What are the criteria for a screening programme?
Cost-effective
The course of the disease should be known
There should be a test that is easy to perform and interpret
What is positive predictive value?
Number of positive tests who actually have the disease
What is sensitivity?
Percentage of people who have the disease that test positive
What is specificity?
The percentage of people who do not have the disease that test negative
What is active surveillance in prostate cancer?
Regular PSA testing
What are the three layers of the scrotum?
Skin
Dartos Fascia
External Spermatic fascia
Cremaster Muscles
Internal Spermatic Fascia
Tunica Albuginea
What is the most common renal cancer in adults , what about in children?
Renal Cell Carcinoma
Wilm’s Tumour
What are some risk factors for RCC?
Smoking
Hypertension
VHL
Obesity
ADPKD
Advantages of laparoscopic surgery over open?
Reduced post-op pain
Smaller scars
Reduced bleeding
Shorter hospital stays
Advantages of open surgery over laparoscopic?
Better views
Need for specialist equipment and training
Increased length of operation
Why is renal or ureteric calculi pain referred to the groin?
The visceral nerve supply to the kidneys/ureter follows a similar course to the somatic nerve supply of the gonads and flank
Why does ureteric obstruction cause pain?
Ureteric spasm arises from peristalsis attempting to push the stone alone to relieve the obstruction. This causes local ischaemia and hence pain.
What is a hydrocele?
Abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis
Congenital = due to patent processus vaginalis
In older males, hydroceles may be primary (idiopathic) or secondary due to trauma, infection, or malignancy
Who should undergo investigation for a hydrocele?
Those presenting with a hydrocoele aged between 20-40yrs (or where the testis cannot be palpated) should undergo urgent ultrasound scan
What is the surgical treatment for BPH?
TURP
What are some complications of a TURP?
TURP syndrome
Sexual dysfunction, Retrograde ejaculation
Urethral stricture
What is TURP syndrome?
Use of hypoosmolar irrigation during the procedure which can result in significant fluid overload and dilutional hyponatremia as the fluid enters the circulation through the exposed prostatic venous beds
What is Stress Incontinence?
Urine leaks due to raised IAB as the pelvic floor and pelvic fascia fail to support the urethra. IAB and vesical pressure exceeds that of urethral closure
What is urge incontinence?
Urine leaks associated with sudden urge to micturate. Thought to be due to overactive nerves supplying the detrusor.
What are the common organisms associated with UTI?
E.Coli
Staphylococcus Saprophyticus
Proteus species
Klebsiella
What are some causes of urethral stricture?
Instrumentation
Long term catheter
Pelvic trauma
Gonorrhea/Chlamydia
What are symptoms of a urethral stricture?
Urgency
Frequency
Chronic retention
Overflow incontinence
Recurrent UTIS
What are complications of a urethral stricture?
Calculi
Prostatitis
Epididymo-orchitis
Bladder diverticula
How do you escalate care in an asthma exacerbation?
- Oxygen
- Salbutamol nebulisers
- Ipratropium bromide nebulisers
- Hydrocortisone IV OR Oral Prednisolone
- Magnesium Sulfate IV
- Aminophylline/ IV salbutamol
What therapies can be used to treat exzema?
Emollients
Topical steroids
Sedating antihistamines (chlorphenamine)
What is the classic appearance of plaque psoriasis?
Scaly
Erythematous
Well demarcated
Plaques
On extensors
What are the treatments for Psoriasis?
Emollients
Topical steroids
Vitamin D analogues
Phototherapy
What is Pemphigus Vulgaris?
An autoimmune condition that causes blisters on the skin and mucous membranes throughout the body
Treatment = high dos steroids
What is Nikolsky’s sign?
Separation of skin layers when skin is rubbed
Positive in Pemphigus Vulgaris
What are some types of malignant melanoma?
Nodular malignant melanoma
Superficial spreading malignant melanoma
What are some other sites malignant melanoma can occur other than the skin?
Choroid of the eye
CNS
GI Tract
Treatment for Malignant Melanoma?
Wide local excision
What are some differentials for BCC?
SCC
Amelanotic Melanoma
Actinic Keratosis
What does a BCC look like?
Small, pearly nodule
Rolled edges
Telangiectasia
What is the treatment for BCC?
Mohs Micrographie surgery
What advice should be given when starting someone of Isotretinoin?
Use effective contraception as it its teratogenic
Complications of Isotretinion?
Dry skin
Dry lips
Dry eyes
Depression
What are some differentials of a SCC?
BCC
Malignant Melanoma
Pyogenic granuloma
What is the name for a SCC in situ?
Bowen’s Disease
What is the treatment of SCC?
Excision
What is the characteristic appearance of shingles?
Vesicles
Crusting
Erythematous
Along a single dermatome
What is the most common complication of Shingles?
Post hepatic neuralgia
What is Ramsey-Hunt Syndrome?
VSV infection of the facial nerve
What are the grades of a pressure ulcer?
1 - Non-blanching erythema
2- Partial thickness skin loss
3 - Full thickness skin loss, extends into subcutaneous fat
4 - Extensive destruction with involvement of muscle or bone
What are some risk factors for a pressure ulcer?
Elderly
Obesity
Poor nutrition
Smoking
What is Lichen Sclerosus?
A condition causing white , itchy patches of skin around the genitals
What is the treatment for Lichen Sclerosis?
Topical steroids
Emollients
What are complications of Lichen Sclerosus?
SCC
Dyspareunia
Constipation
What are the 5 distressing end of life symptoms and how can you treat them?
Pain - Morphine
Agitation - Midazolam
Nausea - Cyclizine
Respiratory secretions - Hyoscine Hydrobromide
Dyspnoea - Morphine
What are some side effects of Bisphosphonates?
Dyspepsia
Nausea
Oesophageal ulceration
Upper GI Bleed
What are the locations of fragility fratures?
Hip
Pubic ramus
Distal radius
Proximal humerus
Vertebrae
Which drugs can worsen stress incontince?
Diuretics
How does Duloxetine work?
Its an SNRI , so it inhibita the reuptakes of NA at the synapse, meaning there is increased tone of the IUS
How do bacteria gain resistance to Penicillins?
They produce beta-lactamase , which breaks down the beta-lactam ring
How do penicillin combination drugs ( Co-Amoxiclav, Tazocin) work?
They are beta-lactamase inhibitors. So they can be used for resistant bacteria
What tool helps distinguish between delirium and dementia?
CAM score ( Confusion Assessment Method)
What can cause postural hypotension?
Nitrates
Antihypertensives
Hypovolaemia
Autonomic failure ( Parkinson’s, Diabetic Nephropathy)
What is the criteria for diagnosing PH?
Drop in SBP > 20mmHg or
Drop is DBP > 10mmHg
Within the first 10 minutes of standing
What is some management for postural hypotension?
Full length compression stockings
Increasing salt in diet
Fludrocortisone
Midodrine
What is Osgood-Shlatter’s DIsease
Small avulsion fractures of the patella tendon on the tibial tuberosity during forceful contractions of the quads. Happens before tibial tuberosity has undergone ossification
- Ossicles or enlarged tubercle may form so pain and swelling/lump occurs below kneecap which is worse on activity like running and jumping
- Develops slowly and severe exacerbations
Usually unilateral
More common in boys and with skeletal maturity it will disappear. Exacerbation usually settles after a few weeks to months
Analgesia
Ice packs 10-15mins TDS
Knee pads
- Reassure parent symptoms will settle but may persist until growth spurt
What is the treatment for Allergic Rhinitis?
Allergen avoidance
Nasal irrigation with saline
Oral non-sedating antihistamine
What is the treatment for threadworms?
Give all household members the OTC Mebendazole on the same day
How is GORD treated in kids?
Reassure parents symptoms will improve over time
Give Gaviscon infant to breast fed infants for 1-2 weeks
- Reduce the volume of feeds/thicken the feeds with Carobel if formula fed then Gaviscon
If treatment doesn’t work try a 4 week trial of omeprazole or ranitidine
What is a newborn baby check?
Done within first 24 hours then repeated at 6 weeks but advise vaccinations and ask how feeding
What are some reflexes in kids?
Babinksi
Grasping
Blinking
What are the 4 types of developmental milsteones`/
Gross motor
Vision and fine motor
Hearing, speech and language
Social, emotional and behavioural
3-4 months - Coos
6-8 months - Put food in mouth
9 months - Crawling
12 months - Walk independently , Two to three words, Drink from cup with two hands
18 months - hold spoon and get food to mouth
2 years toilet training
2.5 years - Runs , Simple senetences
What are some post natal appointments that occur in the community?
Newborn baby check within 72 hours
Heel prick screening 5-8 days
Health visitor will come to advise safe sleeping, vaccines, feeding after 1-2 weeks
What is bronchiolitis and some signs?
Viral infection of the bronchioles, usually respiratory syncytial virus
Usual onset less than 2
Subcostal recession/nasal flaring/grunting are serious signs
Fever
Cough
Wheeze
Tachypnea
Crackles
How does Croup present?
Usually between 6months to 6 years
Inspiratory stridor
Barking seal like cough
Hoarseness
Resp distress
Need single dose PO dexamethasone regardless of the severity
What is chickenpox and its presentation?
Varicella Zoster Virus
Incubation 1-3 weeks with most infectious a few days before rash
Starts with nausea, malaise, headache, myalgia, anorexia, high temp and flu like symptoms before rash
Small erythmatous macules that progress to itchy vesicles/pustules which then crust at 5 days and fall off in 1-2 weeks
Rash more pronounced in flexures
What is the treatment for chickenpox?
Topical calamine lotion for itch
Chlorphenamine for itch if >1year
Keep nails short to minimise scratching
Keep hydrated
Keep child out of school until vescicles have crusted over
When is chickenpox most contagious?
1-2 days before rash appears
What would stop someone from receiving a vaccination on the day that they were scheduled to have it?
Previous severe allergy
Severely immunocompromised e.g cancer
Chronic condition e.g cancer
A sniffle or cough doesn’t mean you shouldn’t be able to get a vaccination.
What is 1st-6th disease?
FIrst - Measles
Seconds - Scarlet fever
Third - Rubella
Fourth - Filatow-Dukes
Fifth - Parvovirus B19
Sixth DIsease - Roseola Infantum
