more Flashcards
cause of BPPV
otoconia that become displaced into the semicircular canals
may be displaced by viral infection, head trauma, ageing or without clear cause
menieres diseae cause
excessive buildup of endolymph in the semocircular canals, causing higher pressure
management of BPPV
epley manoeuvre
prochlorperazine
antihistamines
meniere’s disease management
prophylaxis: betahistine
short term management:
Prochlorperazine
Antihistamines
heberden nodes
bony growths which suggest osteoarthritis
trigger finger
thumb locks during flexion and extension at the distal and proximal intraphalangeal joints
treatment of childhood obstructive sleep apnoea
adenotonsillectomy
SUFE management
urgent surgery to pin the femoral head to prevent further slipage
presentation of damage to recurrent laryngeal nerve during thyroidectomy
hoarseness
polymyositis
condition of chronic inflammation of muscles
dermatomyositis
connective tissue disorder where there is chronic inflammation of the skin and muscles
key investigation in diagnosing myositis
creatine kinase
telogen effluvium
condition where there is increased hair shedding due to a disruption in the normal hair cycle
investigation for acromegaly
insulin-like growth factor1
oral glucose tolerance test
MRI brain for pituitary tumour
treatment for acromegaly
trans-sphenoidal through the nose and sphenoid bone
Somatostatin analogues: Sandostatin LAR/ Lanreotide- first line
lateral border of the anatomical snuffbox
extensor pollicis brevis and the abductor pollicis longus tendons
presentation of cushing’s disease
weight gain
fatigue
presence of abdominal striae
hirsutism
most common endogenous cause of cushing’s syndrome
pituitary adenoma
presentation of Niacin B3 deficiency
dermatitis
diarrhoea
dementia
presentation of adrenal insufficiency
fatigue nausea cramps abdominal pain reduced libido hyperoigmentation hypotension
test of choice for adrenal insufficiency
short synacthen test
red flags for child developement at 6 months
not reaching for object
red flags for child developement at 10 months
no smile or speech
red flags for child developement at 12 months
cannot sit unsupported and has preferential use of one hand (cerebral palsy)
red flags for child developement at 18 months
cannot walk
causes of cerebral palsy
TORCH - toxoplasmosis - rubella - CMV - Herpes simplex intrapartum- hypoxia, focal distress post-natal - anything that affects the brain
presentation of cerebral palsy
spasticity - increased tone and reflexes - reduced power dyskinetic - slow writing, convoluted movements of fingers, hands and toes - ataxia
management of cerebral palsy
oral diazepam
oral baclofen
gower’s sign
using hands to push on legs to stand upright
duchene muscular dystrophy
X-linked recessive condition
malformation of dystrophin gene
presentation of duchene musclar dystrophy
boys aged 1-6 who are struggling to walk (waddling gait)
proximal muscle wasting
pseudohypertrophy of calves
gowers sign
investigation for duchene muscular dystrophy
CK
management of duchene muscular dystrophy
poor prognosis
usually die in 20s duee to cardiac/resp failure
physical examination for suspected meningitis
kernig’s test
brudzinski’s test
management of bulging fontanelle
mannitol
management of meningitis community
IM/IV benzylpenicillin
hospital management of meningitis in kids
LP + bloods for culture
<3 months Cefotaxime + Amoxicillin
> 3 months 1st dose Cefotaxime followed 6 hours later with once daily Ceftriaxone + dexamethasone
cause of measles
RNA virus- paramyxovirus
presentation of measles
koplick spots (white spots on buccal mucosa) rash starting behind the ears
management of measles
supportive and tell PH
most common complication of measles
otitis media
cause of rubella
togavirus
presentation of rubella
fever
rash- pink-red maculopapular rash
lymphadenopathy
chicken pox management
calamine lotion for the itch
scarlet fever presentation
strawberry tongue
find punctuate erythema (starts on trunk)
presentation of open angle-glaucoma
gradual onset vision loss (beginning peripherally)
fluctuating pain, headaches, blurred vision and halos around light
investigations for open angle glaucoma
visual field assessment and acuity
fundoscopy
tonometry
management of open angle glaucoma
latanoprost eye drops
bb- reduce aqueous production
carbonic anhydrase inhibitors
surgery
presentation of acute angle-closure glaucoma
rapid onset vision loss
painful, red, teary eye with semi dilated pupil
symptoms worse in dark room
halos around light
investigations for acute angle closure glaucoma
visual field assessment and acuity
fundoscopy
tonometry
management of acute closure glaucoma
urgent referral
pilocarpine eye drops
IV acetozolamide
surgery is definitive
symptoms of dry ARMD
gradual worsening central vision loss
reduced visual acuity
wavy appearance of line
investigation for dry ARMD
snellen chart
amsler grid test
fundoscopy
optical coherence tomography
biochem for primary hyperparathyroid
high calcium
low phosphate
PTH raised or normal
sometimes low vit d
bence jones proteins
in the urine with multiple myeloma
main features of multiple myeloma
calcium (raised)
renal failure
anaemia
bone lesions/pain
investigation for myeloma- BLIP
bence-jones proteins- urine electrophoresis serum- free Light chain serum Immunoglobulins serum Protein electrophoresis bone marrow biopsy imaging
xray signs for multiple myeloma
punched out lesions
lytic lesions
raindrop skull
management of multiple myeloma
chemotherapy with bortezomid thalidomide dexamethasone myeloma bone disease- bisphosphonates
lichen planus management
emollients
topical steroid cream- first line ?
steroid mouthwash
oral prednisolone- for flare ups
behcet disease presentation
oral ulcers, genital ulcers and uveitis
management of trigger finger
steroid injection
finger splint
surgery
presentation of trigger finger
thumb, middle or ring finger
initially stiffness and snapping when extending a flexed digit
nodule may be felt
anterior uveitis presentation
unilateral dull, achy painful red eye ciliary flush floaters and flash pain on movement photophobia hypopyon
management of anterior uveitis
same day referral to ophthalmology
steroids
cyclopegic-mydriatics
immunosuppressants: DMARDs, TNF inhibitors
Weakness of hip abduction and foot drop, no specific reflex lost
L5 radiculopathy
herald patch
singular, large plaque that appears several days before general rash
pityriasis rosea
management of pityriasis rosea
self-limiting disease
symptomatic relief- aqueous cream, antihistamines
sudden sensorineural hearing loss management
immediate referral
high dose oral steroids
Retinitis pigmentosa
congenital inherited condition where there is degeneration of the rods and cones in the retina
presentation of retinitis pigmentosa
night blindness
loss of peripheral vision first- tunneling vision
management of otitis media that has lasted >3-4 days
amoxicillin
clarithromycin- if allergic
management for recurrent epistaxis (not acute management)
prescribe naseptin nasal cream- contains PEANUTS
lump which is anterior to the sternocleidomastoid muscle, round, soft and non-tender
branchial cyst
first line investigation in suspected primary hyperaldosteronism
aldosterone/renin ratio
first line investigation for secondary hypothyroidism
MRI pituitary gland
normal hyperparathyroid by high calcium
parathyroid is the cause- most likely adenoma
raised calcium means the PTH should be suppressed
child crying in direct sunlight
erythropoietic protoporphyria
build up of what occurs in porphyria cutanea tarda
Urophorphinogen
first line treatment for acne rosacea
topical metronidazole
first line treatment for acne vulgaris
benzoly peroxide
what is epidermolysis bullosa?
breakdown of anchoring between epidermis & dermis
which diabetic drug is weight neutral
DPP4 Inhibitors
Pagets electrolytes
normal calcium, phosphate and PTH
increased ALP
osteomalacia results
decreased calcium and phosphate
increased alp and PTH
what can aggravate psoriasis
BB
primary hyperparathyroid results
increased calcium
decreased phosphate
increased ALP
normal or increased PTH
CKD causing secondary hyperparathyroid
decreased calcium
increased phosphate, ALP, PTH
hormone to test for pregnancy
HCG
hormone peaks before ovulation
LH
hormone to test for fertility
progesterone
osteomalacia treatment
vit D therapy with calcium and phosphate supplements
waddling gait
osteomalacia (rickets in kids)
DMARD that can cause interstitial pneumonitis
methotrexate
Visual loss, mouth ulcers and genital ulcers
Behcets syndrome
vertigo seconds to minutes
BPPV
diagnosis of BPPV??
Hallpike
treatment of BPPV
epley manoeuvre
compression of CNVII causes
Bells palsy
ramsay hunt syndrome
reactivation of varicella zoster virus in geniculate ganglion of CN7
third nerve palsy (eye)
looking down and out
fixed pupil
proptosis and ptosis
fourth nerve palsy
eyes look upwards
vertical diplopia
cannot look down and in
sixth nerve palsy
horizontal diplopia
eyes medially deviated and cannot move laterally from midline
first line treatment for BPH
alpha blocker- tamsulosin
second line- 5 alpha reductase- finestride
first line investigation for hydrocele
doppler us with colour
first line investigation for osteomyelitis
MRI
achilles tendon rupture investigation
US
Propylthiouracil side effects
agranulocytosis
drugs that may be used to control the symptoms and signs of Cushing’s Syndrome?
Metyrapone [blocks cortisol synthesis]
urinary tract obstruction management
nephrostomy
investigation for bullous pemphigoid
immunofluorescence- show IgG and C3 at dermoepidermal junction
linear IgG deposits
management of bullous pemphigoid
oral corticosteroids
tetracycline antibiotics
topical corticosteroids, immunosuppressants
investigation for pemphigus vulgaris
immunofluroscence- intra-epidermal deposition of IgG and C3 (Chicken wire)
biopsy- loss of intercellular adhesion sites
management of pemphigus vulgaris
steroids- prednisolone
immunosuppressants
large vessel vasculitis
takaysau arteritis and GCA
vasculitis associated with resp tract and kidneys
GPA
young woman with absent pulses?
takaysau
male baldness with positive family history
androgenic alopecia
venous ulcer infection
strep pyogenes?
first line in back pain with red flag
Xray
haematuria
flank pain
palpable mass
renal cell carcinoma
non-tender painless lumb in testicles
hard
irregular
testicular cancer
