MRSA Flashcards
which drugs is
- small s/e risk of breast ca
- have have sexual dysfun within 1yr (less than1%)
Finsateride/Dutasteride
- 5 alpha rectase inhib for BPH
Example of atypical and typical antipsychotics
Atypical = Clozapine (agranulo, prolact), Olanzipine (dyslip + obesity). rispiderdone
Typical = haloperidol, chlopromazine (good sedaiv if agitated)
- EP S/Es, hyperprolac
tx of mild/mod C.Diff
metro 400mg TDS 10-14days
1st lines
- GTC
- absence
- SV, alternative is lamotrigene
- ethosuximide
35 - 40 BMI
Obesity 2
> 40 = 3 (morbid)
- could get surgery
post partum complications for SGA babdies
Rx to get it
hypoglycaemia nec enteri polycytheamia - chronic intraurtine hypoxia thrombocytopenia - BM/hepatic comprise hypocalcamia
maternal substance abuse, con infection (rubella), >40 years
verbal fluency estimation response inhibition (copy tapping) clock drawing abstract thinking
frontal lobe function - executive thinking
what is MOE + treatment
temporal bone oestisis, caused by pseudo.ergo
–> IV Abx (ciprflox)
14yr old - asthma not controlled
- currentlly on SBA + low dose ICS + LTRA
stop LTRA, used LABA in combo with low dose ICS
still not working - change to MART regime
ix of tinea capitits
woods lamp –> bright green fluoscrence of hairs, tx oral antifundal
Painful arc is a sign of ?
Rotator cuff issue - supraspinatous
copd test to differenitae between bacterial and non-bacterial exacerbation
procalcitonin - CRP, ESR< WBC will go up in both
example of 20g short acting carbs
3 tablets, 5 jelly beans, small carton of juice
example of low GI foods
fruit, veg, peanuts
white rice etc high
rosacea
- tx
topical metero or azelaic acid or ivermeticn cream
brimonidine (mirvaso) topicl gel good for flushing
2nd line = oral tetracycline or eryhtomycin (for 3mo)
where are heinz seen
where are burr seen
tear drop cells (dacrocyte)
splenomeg, g6pd def, suplhonamides
burr - uraemia
myelofibrosis
paeds ALS - Ratio and shock
5 breaths, 15:2, 4j/kg
vs adults 30:2, mon 360j shock
150-360 biphasic
Tx line for CML
Young for for BMTx
Or imatimb
viterous haem
vs post viterous haemorrhage
vs ret detach
Posterior vitreous detachment
- Flashes of light (photopsia) - in the peripheral field of vision
- Floaters, often on the temporal side of the central vision
Retinal detachment
= Dense shadow that starts peripherally progresses towards the central vision
- A veil or curtain over the field of vision or FLOATERS
- Straight lines appear curved
Central visual loss
Vitreous haemorrhage
- uusually painless
cold aggulatans
increase titre of complement
found in mycoplasma –> haemollytic anaemia
psuttascosis
bladder cancer
- most common type WORLD WIDE
- some risk factors
Transitional cell carcinoma = developed countries. Smoking, Exposure to aniline dyes, Rubber manufacture, Cyclophosphamide
Squamous cell carcinoma = most in world: Schistosomiasis, Smoking
pain in knee walking up and down the stairs
tennage girl
chondromalacia patella
toxoplasmpos effects on baby - CHICM
chonoreintis
HYDROCEPHalus
INtracranial CALICficaion
MICROcephaly
vs CMV = periventri calc, sens HL, microceph
coeliac disease
- antibodies
- how long on glut
- important to check for
IgA tTGA IgA EMA
6 weeks BD – or it needs to be a biopsy
IgA def
UKMEC 4
Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
step wise decline in function
1st line for alzethimers
more likley vascular dementia
the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
- momentine is 2nd line
tx of thrush in paeds
miconazole gel 7 days
then nystain 7 days
DVLA - time off in CV disorders - annual review 1 wee 4 weeks 6mo/lifelong
annual review = AAA >6
1 week = angio, pacemaker, ablation (2days)
4 weeks = CABG, ACS, H transplant (6)
6monghs/life = ICD insertion, AAA >6.5
casues of hyperprolaectaemia
- women : period problems and galatoorhoea
- men : ED and low libido
pit tumours preg excessive exercise hypothryoid chronic renal failure cushings drugs: risperidone, metocholpramide, domperidone, TCA
ulcerated, crusty lesion - can be there for a few years . rarely mets
on leg = marjolins ulcer
suncream prevents recuurence
squamous cell carcinoma
- on eye, more likely is a basal cell carcinoma
which tropical illness will give you all over body pain
dengue
Most common cause of hypogond
Klinefeleters (47 XXY)
Nondisjuctioj meiosis
best tx for personality disorders
psychotherapy
step wise tx of psoarsis
emollients –> betamethasone
- salicyclic acid can by used if ++scaling
- coal tar
- vit d analogues e.g.. calcipotriol
UV light
Ciclosporin, methorexate
Common Abx okay to give in Pen Anaphylaxis
amikacin, cipro, clari, clindamycin, co-trimazole, doxy, erthrmycin, gent, metro, rifampicin, vanc, nitro, trimeth
contraception
- within 72hrs
- wtihin 120
- iwthin 5 days (or on d 5 to 14 ov)
Levongrestrol
Uliprsitol
Copper IUD
adren dose for 11yr old boy
0.3ml of 1/1000 solution IM
- 15 is <6
- 5 if >12
DDx of Beckers to Duchenes
- beckers cramping, able to walk
- duchenns delayed motor mile stones, big old calfs
bacterial conjunctivitis
- when to treat?
after 3 days
chlorprmphencial for 5 days
low Ca
high PO4, ALP, PTH
CKD
Contras for live vaccines
Pret, symptomatic HIV, radiation
Other - prev anaphalyxis
- intercurrent illness
Gardnerella leads to
whats on thr mivcropsy
what does tric vaginalis have
baci vag
clue cells
motile trophozoites
what type of eye drops to help elivate pain
mydriatics (dilate) rest the pupil - cyclopentolate
- precents posterio syntheaia in anterior uveitits
change of an ulcer - painful, slough
?marjolins
- malignancy
progressive dysphagia from solids to liquids and PAIN on swallowing
hypopharyngeal ca
v sunexplainined hoarsness = squamous larngeal ca
pressure sore that you can see fat
grade 3
2 - 4 = warm moist enviroment
bullous pemphigoid vs pemphigus
BP - blisters, elderly, not involving mucosa - tx steroids
PV - blisters involving mucosa, jews - tx steroids
- not itchy
Dyspepsia assessment + treat
Trial OTC antacids
Eradication treatment
Hyplori
S/Es : Hair loss, nose bleeds, sore lips, dry mouth, lipids and eyes
tetrogenic
oral retinoids
?thyroid nodule but assymetatic
- most useful IX
fine needle aspira
hot - adeneno
cold - malignant non-sec adeno
Parkinsons treat - on l dopa
- symptoms not controlled
- dyskinesia due to therapy
- add in a dopamine agaonist (bromocriptine, cabergoline) to use a long side
rx - pulmonary fib
*offer MAO-B (selegiline) or COMT (entacapone)
what causes rheumatic fever
group a strpetococcus
Most common cause bone primary
- most common site
Name the childhood one
Osteosarcoma
- metaphyes of long bones
Ewing’s only in children (peristeal gives onion appearance)
Schwartz sign
Otosclerosis
What doesn’t reduce relapse RATE in MS
IVMP reduces duration and severity but not rate or long term disability
choice in SSRI in 1st depressive epiosdes
- but if has triptan
- when would you give PPI
an SSRI (e.g citalopram)
- would giver mirtazapine
- older adults also on NSAIDs or aspirin
Treatment algorithm for those tolerant for metformin and Hba1c is >6,5%
- i.e second line options
Metformin up to 1g BD
2nd line
Pioglitazone (thiazolidinediones)
- Issues: weight gain, avoid in Bladder Ca , HF, Xrisk and macular oedema
Sulphonurea: gliclazide, glipizide
- issues: weight gain, high hypo risk, avoid in renal failure
DDP4 inhibitors: Gliptins
- weight neutral, low hypo risk
- GI upset with panc
SGLT2: canagliflozin
referral to genetic services
1st degree relative <45
two close relatives <60
3 or more with similar cancers <60
a hx of a predisoping conditions e.g FAP
H.pylori erd tx
PPI
amox
clarith or met
for 7 days
if persists - use Abx not used initally
alternate includes levoflaxcin
measures to red rx of hiv in preg/deliv
(1%)
observing baby - how many tests
meds, ideally c -section atfer 39 weeks
can do vaginal if load <50
don;t breast feed
HIV DNA PCR at 48hrs. 6 weeks and 12weels
then anitbody test at 18months
tx for hyperemesis gravidarum
1st line = promethazine, cyclizine or prochloperazine
2nd line = metoclopramide or ondasterom
hosp - dehydrated, hypotenisve, urinary ketone
post coital bleeding
if persistence = urgent gynae ref
orbital cellulitis - features that make likely
painful eye movements
loss of colour vision
proptosis
full dilation ?
10cm
COPD FEV 35%
severe
50-79% mod, <80% mild
Ix if suspect Lyme?
just start doxy
only do ELISA if you aint got a rash
causes of clubbing
lung ca fibrosing alveolitits bronchiectasis, empyema lung abscess CF mesothelioma Cyanotic CHD IE!! cirrhosis IBD coeliac dissease thyroid acropathy
Ovarian torsion vs cyst
torsion shrap onset that doesnt resolve
cyst will then self-resolve
low thyroid levels, goitre (which is a bit tender)
hashimotos - Antithyroid peroxidase antibodies positive
de quervians - POST VIRAL, tender (high then low)
When and what is in the combined screening
11 + 13 weeks
- nuchal transluency
- bHCG + PAPP-A
- maternal age`
criterica for PCOS
tx for hirsuitism
clinical hyperandrogeism or test raised
oligomenorrhoea
US showing polystic
- test up, oest up, LH up, FSH normal
weight loss, hiar removal then topical eflornithine or fianette
What part of ear does otosclerosis affect
Type of hearing loss
Stapes
Conductive
when should aspirin be given in preg
> 40, bmi >35
fhx preeclamp
Side effects of viagra (sildenfail)
4
When to avoid
Headaches
Facial flushing
Dyspepsia
Blue green vision
Avoid - recent stroke or MI, low BP, nitrates or nicorandil
poor prognosis factors for schizo
Factors associated with poor prognosis strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant
PAIN meds: morphine PO to SC to oxycodone to diamorphine (SC/IM) to tramadol to fentyl patch
divide 2 times by 2/3 divide 3 times 10 half 24 dose and then go for patch lower
HAS BLED
Hypertension Abnormal renal and liver function Stroke Bleeding Labile INR Elderly Drugs or alcohol
Digoxin toxicity
Measure levels within 8-12hrs of dose
Cl - unwell, confused, green/yellow vision, arrhythmias, gynaecomastia
Causes - hypokalaemia, age, RENAL failure, MI
Drugs - amidoarone, verapamil, diltiazem, spiro, thiazides, loop
Tx - digibind
low PO4
high Ca, ALP, PTH
prim hyperPTH
anaemia of chronic disease
low Hb and rest within normal limits
viral warts on vagina causes by ___
- tx is
Cervical cancer called by ____
HPV 6, 11
- imiquimod
HPV 16, 18
amnesia types
anterograde is inability to make new memories after the event
retrograde is loss of memories before event
timeframe of chest pain to be seen on same day
12 to 72hrs
if longer within 2weeks and consider starting aspirin, statin and GTN
ECG changes in hypocalacemia
prolonged QT + ST seg
heterophile antibodies in serum indicate
mono
Ix of SAH
non-contrast within 6hrs
- if negative LP
section 2 section 3 section 4 section 5(2) section 135
28 days –> by pyschiatrist, for tx
6months
72hrs assessment order - GP, bring in to hosp
preventing a patient leaving for 72hrs
police remove someone from house if concerns
Achondroplasia Gilberts Huntingtons Neurofirbeom Protein C def osteogen imperfecta
AD
IVDU with patchy consolifation
- orgainsim?
likely staph aeurus
NES vs serotonin syndrome
NEW: haloperidol
hyperthermia, fluctuating consiousness, muscle ridigity, tachy, sweating, redcue reflex
Tx = stop drug, given bromocriptine (can last 5days)
SS - SSRIs, MAOIs, ectasy
fatser onsent, increase relfex, clonus
Tx = IV fluids, benzos, cyprohepatine/chloropromazine in severe
drug causes of HTN
Endocrine causes
EtOH, COCP, ciclosporin, prednisolone. venlaflaxine and celecoxib
conns, cushings, phaeochromovytome
Chronic pancreatitis vs ca
Streathorroea
Jaundice
Perthes disease
- what is the classic examintion findinig
ABDuction and INTERNAL rotation is limited
- 4-8yrsm ANN
leser-trelat sign
lots of seb. kerotsisis
?internal maliganacy
Tx for Diabetes insidious
Cranial - desmopressin
Nephrology- bendrofluothiazide
(Demeclocycline is SIADH)
safe choice of antiepl for preg
(if seziure>2yrs, look at stopping)
drug choice in hyperthry
carabamezamine
lamotrigene
proplochouricl PTU
Sciatica stepwise tx
Rest, paracetamol and NSAIDs
Physio if remains at 6weeks
what does colummnar epith indicate
due to which type of ca
metasplasia –> barrtets (pre-maliganant)
adenocar (more common that squa which is upper 2/3rd)
keratoacanthoma features
erupting volcano
dome shape - slowing grow
Priapism
prostatitis
uro emergency - take blood from it and given iv phenylephrine
ciprofloxacin 500mg BD for 14 days
30 - 35 BMI
Obesity 1
leflunomide is an immunodul drug for RA
- 3 S/Es
HTN, GI upset, hepatitis
Dx - renal failure, haemoptysis and nose bleeds
GPA (Wegners) is more likley than goofpastures
- c-anca positive
- nephritic syndrome
bone pain, bossing of skul
high ALP
pagets
strabismus
- esotropia
- hypertropia
eye turns inwards
eye turns upwards (but would turn turn downwards in uncover test)
Bladder Ca Tx
- non invasive
- invasive
- spread m/non operable
Intravesicl BCG and TURBT
Radial cystectony + formation of ileal conduit
Chemotherapy (also if recurrence)
squints
- what would an eye going out in a conver uncover test mean
if only seen in cross cover
Convergent squint (esotropia)
eeophoria
sentinel node biopsy is done when positive node on US
when is clearance performed
if there is clinically palpable lymph nodes
migraine tx
NSADs, paracetamol or triptan - try dual
ergotamine = avoid in pill, PVD, IHD + preg
preventive = propranolol, amitrtirpylline, topiramtae (pill interferevce), pizotifien
What is chlormbucil used in
NHL or CLL
as less aggressive
- Rituximab is alternative for b cell lymphm (also in ITP)
two options for postponing peroids
Norethisterone
- start 3 days before period
Medfroxyprogresterone acetate
- if >35 or rx for VTE, smoker, overweight
what nerve supplies diaphragm
phrenic nerve!
- from C3=5 +> ?significant SC injury
ER+ breast Ca –> what are you going to give
Tamoxifen = oesteogen antagonis/agonist Anastrozole = aramotase inh --> OP
auer rods
rouleaux formation
smear cells
AML
high esr –> infections, maliganacy
CLL
UKMEC catergories for breastfeeding women
1 for everything apart from
COCP - is 4 within first 6 weeks, then 2 till 6months
Drugs to induced abortions
Mifepristone then misoprostol 7 days later (PG anaologues)
empirical Abx for treatment of ?PID
ofloxacin + metro for 14days
who is at risk of pseudomaonas?
- treatment
- bacteria in kids
CF + bronchiectasis patients
azithro neb or clipro oral with neb colomycin
- staph is more in childhood cf => flucox
- burkia is tramsmissiable
what level causes hearing loss at long periods of time
90 decibles
Conditions with koebner phenomenon
[spriasis, lichen planus, viral warts, molluscum
What is Galeazzi sign
Unequal knees on examination
Used after 3 months for DDH
changes seen in proliferative retinopathy
cotton wool spots
cluster haemorrhages
rubeosis iridis - neovascularisation
What are high rx women offered (from combined test)
CVS if 11 to 14
Aminocentesis after 15weeks
- riskier for misscarriage in 1st
Features of lichen planus
shiny flat topped plaques at FLEXORS
itchy, koebner phenom
wicken striae = fine white lines on plaques and in oral cavity
tx = itch relifey or steroids
gastritits that improves with eating
commonest cause
duodenal
h.pylori
Churg straus- 3 features
Sinusitis
Asthma
had/GI pain/renal issues
P anca
extended breech
flexed breech
fetal heart lying in the flank
buttocks first
mix of but and feet first
transverse lie
stress ECG
for those with KNOWN CAD disease to quanitify risk
CI for an exercise ECG - recent MI, AS, HF, pul oedema, unstable angina
painful vision loss acruate scotoma (lower half) haloes, N/V + headache semi-dilated pupil disc cupping
Dx, Rx + treatment
Acute angle closure glaucoma (>20)
LANTANOPROST (PG analogue)
Timolol or bromide drops
to reduce aqueus formation carbonic anhydrase inhibitor — e.g. acetazolamide 500mg IV started
Rx - myopia, HTN, DM, TCAs
g positive coccus, black disgusting foot, unwell pt
- ?
nec fas - group A strep!
ddx: gas gangrene (c.perfing) –> crepitius + g rod
all over body pain, weakness in shoulder/legs, maybe some tingling
calcium is around 2 and ALP is raised
osteomalcia second to vit d def
pagets - ca would be normal, again pain
What happens at 28 week appointment
OGTT is at risk of GD (would start aspirin if so)
1st anti D proph if rhesus negative
Vaccinations - whooping cough etc
CES vs SC compression
CES is BELOW level of L2
a lesion T10 to L1 would have loss of reflexes
when fasting glucose is more than 7, but OGTT is between 7.8 and 11.1
IGT
IFG is fasting between 6 and 7
B12
C
D
E
Cyanocobalamin= Megaloblastic anaemia, peripheral neuropathy
Ascorbic acid Scurvy, gingivitis, bleeding
Ergocalciferol, cholecalciferol Rickets, osteomalacia
Tocopherol, tocotrienol Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
Asthma pt not controoled on SBA, ICS, TRA and LABA
- whats the max dose of steroids
can go to 100mcg
Felty syndrome
RA
Neutropenia
Splenomegaly —> low Plt and Hb from hypersplenism
Need a splenectomy
Can give rituximab and leflunomide
when should patients with TIA be referred to hosp
score >4 (also start 300mg asp)
2 or more within 1 week
has symptoms on warfarin
<3 = see within a week
rem long term clopi
most DIAGNOSTIC test for Acromegaly
OGTT + GH measure
Insulin like factor = screening
post bilateral adrenelctomy - hyperpig + bitmpo hom heminopeia
nelson syndrome
chlamydia - tx for sti
- test
- ulcer on penis: other symptoms
doxy 7 days (consider stat azithroymycin in young man who might not take it all)
NAAT + 2weeks after exposure
Lymphogranuloma venereum - chalmaydia trachomatis (same as STI)
- also with painful lymph nodes + erythema nodosum
what is sialolithiases
submandiular gland stone - radio-opaque
scalp psoarsisi tx plan
can get itchy plaques under boobs (
topical steroids
oral steorid + vit d analogue
gential herpes = painful ulcers + blisters
causes by ____
HSV 2 (1 is cold sores)
leading cause of blindness in the world
trachoma
- can lead to trichalisis (in ward growth of lases)
OCD medication options
Sertraline max dose (or fluxo)
then clomipramine
paraphimosis
unretractable foreskin - push back with pain relief
Where would you find q fever
cattle farm! likely with GI upset and flu like symptoms
Tx - classical atypical with erythro (marcolade)
chicken pox in preg - now with signs
acyclovir, too late for Ig
eye defects, hypoplasia, microcephaly
Treatment of mets breast ca
Chemo - to prolong life (if too far gone)
tx for liver mets
usually inoperable (unless single from CRC), tx with pallative rxt doesnt work
1st line for symptomatic ventricular extra systole
beta blocker
Trastuzimab is what?
hercpertin, Her 2. Rx of HF
actinis keratosis
tx for a few lesions
tx for lots of lesions (>4)
- cryotherapy
- topical 5-fluroacil cream
(mild cases can try topical dicolfenac)
pre-malig => safe sun + remove
acute severe asthma exacerbation
RR >25
Tachycardic
struggling to complete sentences
PEFR 33-50
IQ of moderate LD
35 - 49
- greater is mild (>69 is normal)
- profound is <20
Transudate causes (prot <25) - disruption of hydrostatic and oncotic pressures across pleural membrane
HF, liver cirrhosis, renal failure, hypothryoid
low albymin and meig (ovarian tumour) and malabortopns
What is the most common cancer in men
Prostate - Afro Caribbean is a major risk and age
focal seizures
or partial seizures
carbamazepine or lamotrigine
- then keppra, oxcarbaezmine of epilem
What can be treated with steroids, regaine, fintserdie (BPH)
alopecia
what conditions require higher dose of folic acid in preg (5mg vs 400mcg)
Up till 12weekd
anti-epileptics BMI >30 DIabetes Sickle or Thalassaemia - take till term FHx or personal hx of NTD
when are brachial cysts commonly seen
3rd decade
slowly grow
indications for dialysis
hyperkalaemia >7
met acidosis
pulmonary oedema
ureaemia
lupus Abs
- most prevalent
- most specific
- in between the both
- DRUG induced (procaniamide, HYDRALAZINE, isonisizid, phenytonin)
- ANA
- smith
- dsDNA
- anti-histone
addinsons crisis
just IV hydro –> flucort when stable
T2DM aims
- BP
- HbA1c
- fasting glucose
140/80
7.5% (58mmol)
- 6.5% if diet controlled or single drug
4 - 7
paronychia tx (staph aureus)
fluclox or clair with I+D
preg/bfeeding + pen aller - erythroymucin
Raised PTH, but low Ca
And then high phosp
Also short fingers
Pseudo hyper parathyroid sun
Pseudo pseudo is with normal Biochem
antibitocis causes of cholestatsis
NITROFURONIN, co-amox + fluxoc
lower GI Ix
- pilles
- UC
- Crohns
- Coelic
- proctoscopy
- flex sig
Complications of haemochromo
- 2 reversible
- 4 not
Skin discolouration, cardiomyopathy
Liver cirrhosis, DM, hypogonatriphic hypogondaism, arthropathy
MGravis - treatment options x5
Ab against Ach receptors at NMJ
- Thymectomy
- Pyridostigmine cholinesterase inhibitor (stops enzyme breaking down ACh)
- aziothioprine
- steroids
- plasma exchange
Chronic granulomatous disease causes by klebsiella
Rhinoscleroma
Enlarging nose - tx tetracycline
slow growing pulastile lump which can move side to side in neck
carotid body tumour
- an aneursym would may have features of CV insuff
apnoea during ENT surgery likley cause
displaced tracheal tube
what can myelofibrosis porgress to ?
AML
INR: 5-8 with no bleeding
- if minor bleeding
- with-hold 1-2doses and reduce next dose
- give 1-3mg vit k and restart once inr <5
high BP, low K, high Na
low renin + raised aldo
Conns = primary hyperaldo due to adrenal adenoma tx = sprio
pallative - boney pain
NSAIDDs better
radiotherapy only used to shrink a tumour causing pain
tx of discoid lupus
how would diff from discoid ecezema
topical steroids or fluconidide cream
discoid ecezema wouldnt affect face - mostly extremitiites, also hyperpig (no hypopig like lupus)
RA with picture pulmonary fibrosis
Caplans syndrome
- May cavitate and resemble TB
lots of sweatinf after parotid surgery
freys syndrome
causes ataxia
cerbellar lesion - stroke, lesion infection - varicella malignancy/paraoneoplastic proptiception sensory loss - b12 def, b1/wernickes peripheral neuropathy medications - baributates
inheritence - frereichs
finklestein test
de quervains tenosynovitis
what hypersensivity would ABO/MG/haemoylsis/goodpastures be in
type 2 (antibody) 3 is RA/SLE (immune) 4 is delayed contacted dermattis
Extrapyramidal side effects
- most common in (x3)
- symtpoms
prochlorperazone, heloperidol and depot injections
- PD symtoms, dystonia, dyskinesia, akasthasia, tardic dyskindesia
awareness vs incomplete paralysis in surgery
awareness - finger twitching + increase BP –> give midaz post op
incomplete paralysis - tachycardia and more general muscle spasms
1st rank schizo
drug of choice
- delusional perception = deluge of false belief that can’t be corrected by logic
- auditory hallucinations
- thought disorder
- passivity/delusion of control
- somatic hallucinations
risperidone - i/m injection every 2weeks
or chlorpramizine
nicotine withdrawl
drugs tx
when to r/v
can be up to 3 weeks
weight gain, irrtibaility
r/v 2 weeks
NRT - 16hr or 24hrs
vareniciline - start BEFORE quite day, partial recptor agonsit => reduces affects
bupropion
COPD patient is on a SABA or a LABA
- next stage is asthma features
- if no asthma features
LABA with ICS
LABA with LAMA
final stage is all 3 - esp if recent hospital admission
STEMI treatment
is presenting within 12hrs (+PCI can be given in 120mins) –>prasugrel or tig with aspirin
- Glycoprotein IIb/IIIa Inhibitors (tibfrian)
if PCI not possible = fibro with reteplase/alteplase/streptokinase (and with heparin in fusion)
LTOT conditions
hypoxia <7.3 (or <8 with polycthaemia/pulHTN) COPD, ILD, Crhonic HF, Pul HTN severe chronic asthma CF bronchiectasis Pulmonary vacular diease pumonary maliganacy
ovarian ca
- risks
- tx
- pallative tx
anything increasing oestogen
BRCA1 or the BRCA2 gene, early menarche, late menopause, nulliparity
surgery and chemo
pallative is radiothepat
Swollen pale turbinate
Mobile mass
Allergic rhinosinustis
Nasal polyp
rx for placenta praevia
maternal age, soking, prev praevia increase pariety, prev c -section
cl - painless bleeding after 20th week
tumours for WLE
- RxT offered
solitary lesion
peripheral
small in a large bood
DCIS <4cm
<6mon old has an atypical uti
<3 - admit to paeds
US during acute
DMSA within 6 weeks
(if it was typical - then just US within 6weeks)
two types of bipolar
1 - manic episodes with major depressive, manic presenting often needs hospitalisaion
2 - hypomania with severe depression
When is the repeat anomonly scan
When is second rhesus
32 weeks
34
bipolar tx options
litium –> thyroid disorders, cognitive impairment
carbamazepine if unresponsive
LFTs: whats most raised in cholestaisis
- acute liver damage (viral, hepatits)
- ALP
- ALT
BMI 25 - 30
Overweight
polcytgemia vera tx
asymp = venesection + aspirin
symp = immunosupression, then last resort is splenoecomy
pretibial myoxemedam + thyroid acropathy are features of
graves
seborrhoeic dermatitis - red scaly rash around scalp, nasolabial folds, cheeks
daktacort (fungal with steroid)
4th CN lesion (trochelar)
innverates SO
- vertical diplopia, worse on looking down or AWAY from lesion side
Tx for ADHD
Pyshcoloscoail
Methylphendiate (ritalin), second line dexamfetamine
Sickle cell, CF, Tay sachs, McArdlers, Wilsons, PKU all examples of
AR
rheum disease associated with hep B and high BP
polyarteris nodusa
medium cell vasculitis
Oesophageal cancer
- signs to refer
Ref - Wright loss + dysphagia
Or - weight loss + >55, with upper abdo pain, reflux or dyspepsia
Endoscopy if dyspepsia + >55 and Anaemia, Loss of weight, anorexia, recent onset, melanoma, swallowing diff
Squamous most common (adeno is lower down)
Ex - etoh, smoking, GORD, achalasia (solids + liquids with cough), Plummer-vinson, fatty diet, vit A C def
best thing for OCD tx
exposure and response prevention
drug - fluoxetine
Dupuytrens risk factors
Manual labour Trauma Phenytoin Peyronie’s disease Myxoedema Norther Europeon FHx Smoking and alcohol Diabetes and epilepsy Lipids
Injecting enzyme therapy sometimes tried (Xiapex) or surgery
causes of polydraminos
- anecphaly
- oedophageal or duodenal atresia
- anaenia
- spina bidifia
- maternal diabeets
- multiple preg
diff between cushing syndrome and disease
syndrome = excess steroids (usually pre etc) - acth will be low disease = overproduction by pituitary adenoma (acth high, with bilateral adrenal hyperplasia)
disease is suppressed by hig dose dex meth
drugs that can flare psoariasis
BB, hydroxychloroquine, lithium, NSAIDs + alcohol
indications for statins
Dose for primary prev
T1DM >40 or diabetes >10yrs or CVRx CKD Qrisk >10% Atrovstatin 20 Increases to 80 is for secondary prev (has stroke)
what drug is interferon used in
liver
hep c
IBS
- conspitation is an issue
- diarrhoea
- abdo cramping
- all measure tried and till pain
- Movicol (avoid lactose)
- codeine or loperamide
- pepp oil and mebvereine
- TCAs, amitrpylline
aplastic anaemia causes
Carbamazepine, phenytoin
quinine, chloramphenicol
features of a innocent murmur
change in intensity
venous hum can have ‘machinary’ quality - chanegs with neck posture
systloic - likley ejection
- pansystolic is more likley to be abnormal
things that alter PSA levels
ejaculation or exercise wtihin 48hrs
UTI
prostated biopsy 6 weeks ago
current tx with finasteride
changes seen in background retinopathy
micro anuerysma and haemoorhages
NO MACULA involvement
Multiple system atrophy
orthostatic hypotension
incontinet of urine
dry mouth and skin
Most common hormonal producing pituitary tumours
Eosinophilia GH adenoma - adults
Basiophillic ACTH
Prolactin Adenoma - children
describe boutinerres deformity
button hole deform
PIP felx with DIP hyperestension
rupture of central slip of extensor
tx of hyperprolactaeimae
cabergoline
bromocriptine
feautres of SCLC vs NSCLC
tx
SCC - SIADH, ACTH smokers, central , Lamberton-eton (MG-like picture)
- tx Chemo + radiation v good
NSCC
- Sqaumous = HPOA, PTHr
- adeno (non-smok), gynaecomas
- large cell (bchcg)
- surgery better
Swallowing worse after few bites
Bit of a chronic cough
Pharyngeal pouch
- elderly
NF - inhertiance, how many cafe au lait sports
tumours
AD, >6 is characteriayic
pupberty - neurofibroma
children - optic glioma (brain tumour from astrocyst) –> casues squint and vision problems
unstable angina
load aspitin
LMWH (dalt/fond)
work out grace score –>PCI /angio within 72hrs if high
Ann arbour staging 3?
nodes at eith side of diaphram
first line contracep in young with no risk factors
cocp
meds used in GAD
1st line Antidepressant = SSRI => Paroxetine, sertaline, fluxo in younger
if s/es –> Vanlafaxine or Duloxetine (SNRII
Propanolol and diazepam used but technically not an antidepressant
notifiable diseases
anyone with vaccine scarlet fever TB malaria invasive strep
NO: HIV, opthal neonatrium, lepto
Causes for each
Eosinophilia
Neutrophils
Lymphocytes
Lymphopenia
E - Gold, penicillin, parasites, allergy
N - bacteria, L viral
L - aids, steroids, malignancy, liver disease, renal, sarcoidosis
3rd line option for diabetic control (still >6.5%)
GLP-1 mimetic
- dulaglutide, exenatide
- issues: slows gastric emptying (weight loss!), its injectional, cholecystitis and pancreatitis rx
Acarbose - fltulence + diarrhoea s/e
indications for RRT
CKD 4 malnutrion ureamia enceph hyperkaelaemic not responsive to tx pleuritits and pericarditis
tx of prostatitis
Ix too
cipro 500mg BD for 14days
- ofloxacin alterative
Is - multiparameteic MRI
What is v jaundice, frontal bossing and haemolytic anaemia likely to be
Beta thalassemia - major/cooley’s
Alpha more Asian/African
3 genes - moderate anaemia (2 mild)
4 genes - barts hydros
ims at 2 months
same at 3 but whatinstead of ____
4 - same as 2 without
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
PCV at 3
no rota at 4
When is ECV
After 36
HF when the cardiac output can increase with exertion
peripheral oedema, raised jvp and ascites
low output heart failure
right-sideded
most common for on newborn intensital obstruction
1/10000
hirschsprung
What dizziness lasts for few hours
Menieres
Few mins BBPV or central vertigo
Days more Labyrinthitis
<5yr with asthma
- 8 week trial of mod dose ICS
- continues to be poor depsite low ICS
if improvement - stop
- if retur, after 4 weeks, re-start low odse as maintenance
- if return <4, repeat the 8 week trial
add in LTRA
tx for renal osteodystrophy
low ca and high phsopha
tx = ca + vit d (alfacalcidol)
risk for gout - 3main drugs
alternative for allopurinol
Thiazide, ACEi, BB, ciclosporin hyperuricaemia FHx obesity diet - red meet
febuxostat
AF anticoag rules
if CHA2DS2 VSc is >2
- most won’t have antiplatet prescribed along side NOAC (unless v high risk)
screening test for cognitive function
score for ?dementia
MMSE - <10 = severe (max score 30)
<24 ?dementia
Sulfasalazine: inhibits output of TNF + cytokines
3 s/es
infliximab s/e
S/Es: hepatotoxic, Steven Johnson Syndrome, reduced sperm count
- CCF
PANCREAS
GET SMASHED
PaO2 <8kPa Age <55y, Neutrophils>15, Calcium <2 Urea >16 Enzymes - ldh ast Albumin <30 Sugars >10 >3 = needing icy
GallstonesEthanol, Trauma , Steroids, Mumps + other infections, Autoimmune Scorpion, Hyperlipidaemia/hypercalacaeima/hypothermia, ERCP, Drugs – thiazides, azathioprine, metoclop, diabetic drugs, valporate
Systolic murmur vs Diastolic
Sys = AS, MR/TR (pans), MVP (late sys)
Dias = AR(early), MS(mid), TS (early + large a waves) PR = graha steel due to pul HTN = early dais
tx to induce rem for UC
1st 5ASA (mesalazine –> pred –> azathioprine
maintaining is sulf/5asas
hypertensive eye disease
AV nipping flame haemorrhages hard educates cotton wool (retinal infracts macular oedema
rules for switchign SSRIs
rule for trying
cross titrate over 4-6 week
except fluxoteine - need 4-7day wash out period (i.e can just stop)
x2 diff SSRI or mirtaz then switch to SNRI (e.g venalfaxine) or tca
1st line Abx for UTI in preg
NITRO, can give amox or cefalaxine
treatment of radiation pneumonitits
prednisolone
positive anti-HBs, rest negative
immunization
what is most freq type of testicular ca
markers
most germ-cell tumours.
- Seminomas Senior (>35) maybe bHCG
- non-seminomas: teratoma Teen (25) and embryonal, yolk sac, AFP LDH
Non-germ cell tumours include Leydig cell tumours and sarcomas.
thrush
>16
pessary and topical for 7days
- can be oral in not preg
- no pessarys for <16
graunula casts in urine micrcopsy
CKD
hyaline can be normal
where are target cells seen
IDA, liver disease, thalassaemia post splen
tx of graves opthalopathy
high dose steroids
compression if threatened vision
pyleo vs uti
flank pain
would given co-amox or trimeth for 7-14days
painless ulcer, lymph nodes up and now a maculopapular rash
syphillis (t2)
tx for acute iritis
steroid drops + cyclopentolate or atropine
what type of bacteria is gonorrhoea
Tx
G negative diplococcus
IM ceftriaxone
- can given azithromycin with IM cef in young man
autoimmune hepatitis antbodies in T1
what about T2
anti-smooth muscle
ANA
- ? if pt has goitre (autoimmune link)
T2 - antibodies to liver and kidney
what is lights criteria
but what singificance is ph?
(pro >0.5, LDH >6, pleural ldh >2/3)
?empyema and ph <7.2 –> CT
when is glucose levels self-monitored
on insulin
hypoglycaemic epiosdes
meds with hypo risk
pregs
chloramphenical vs chlorpheniramine
antibiotic
antihistamine (sedating), non-sedating - loratadine or sertraline
Alports
- inheritance
- issues
X, AR or AD
SHL + CKD
eye provlems
when mastectomy is done
- RXT if t3.4 or lots of positive nodes
multifocal, central
DCIS >4cm
stepwise tx for endometerosis
1 - paracetamol, nsaids
2 - COCP, POP, Implant or mirena
3 - ablation
4 - hysterectomy
tx pf lewy body dementia
what makes it worse
rivastigmene
l-dopa
OA: Bouchard vs herbens
bouch proximal, herbens distal
proximal muscle weakness in a diabeteic
vs
glove/stocking distrubtion loss and painful lower limbs (tx)
amyotrophy ‘proximal neuropathy’
sensory polyneuropathy –> TCAs, gabapentin
TB drug S/Es
lenght of TX
- inclu miliary/mengitits or pericarditis
Active = all RIPE for 2 months, then R + I for 4 months
Active TB meningitis/ military TB or pericarditis = 10months of R + I plus oral pred
Rifampicin = cytochrome P450 induced, hepatic metabolism
- Rash, hepatitis, yellow/orange discolouration of bodily fluids, flu-like symp
Ioniazid = hepatic metabolism
- Rash, hepatitis, peripheral neuropathy, agranulocytosis
- Co-prescribed with Pyridoxine (Vit B6) to prevent neurological S/Es
Pyrazinamide = hepatic metabolism
- Rash, hepatitis, arthralgia & gout (hyperuricemia)
Ethambutol = renal metabolism
- Optic neuritis => monitor acuity during therapy
Mutation in chromosome 7
neonatal presentation
Transmembrane conductor regulator gene = CF df508 = commonest mutation meconium ileus haemorrhagic disease of newborn constipation failure to thrive
TLS bloods - whats low
Calcium
diagnostic imaging for RAS
digital subtraction angiograpghy
most common causes Fibromuscular dysplasia or athersclerosis
how long have to use condoms if starting POP after day 5
48hrs (COCP is 7days)
When is dating scan
10-13 weeks
tx of bells palsy
50mg pred for 10day (within 72hrs)
which virus is related to laryngeal papillomatosis
tx for wa
HPV
Gest DM associations
polyhydro, macrosomia, hypogly, hyperbilirubineam, pre-eclpasia
BPH tx
Alpha-1 antagonists e.g. tamsulosin, alfuzosin, tarazosin
- decrease smooth muscle tone (prostate and bladder)
- adverse effects: dizziness, postural hypotension, dry mouth, depression
5 alpha-reductase inhibitors e.g. finasteride (simil s/e risk to thalaiodmide)
- block the conversion of testosterone to DHT
- slow disease progression. (reduced prostate size)
-adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
defitinvitve tx for stress incontinence
urge
mesh cling/surgery options
- duloxetine is alternative
- solficaicin
Bladder retraining
Oxybytynin (old mirabegron), botux or sacral nerve stimulation
scleritis vs episcleritits
episcler = blanches, mild pain/none, often self-limiting
scler - painful+, needs steroids + nsaids + opthal r/v
statins upper limit in lfts
- checked at 3 and then 12mo
expected affect on HDL chol
x3
should also be stopped in preg (and 3mo prior)
> 40% reduction (if not, increase dose)
Bariatric surgery indications
> 40 BMI
35-40 but with a comorb that would benefit from weight loss T2DM
White marks on tongue you can’t scrap off
leukoplakia –> need ot biospy as pre-maligant
anastmotic leak in the peri-operative period
gastrogaffin enema
- CT is some time after surgery
ERCP use as IX
for CHRONIC pancreatits problems, not acute
also GB/Bile duct
Step wise pain management for SCD
Simple paracet and NSAID
If more than 2 morphine, need PCA
Where a J waves seen
hypercalaemia
brugada syndrome
hypothermia
slow growing red scaly plaque
squamous cell carcinom ain situ
bowens disease
Tx cryotherapy or topical 5-flurouracil cream
post-natal depression drug choices
SSRI (flux the safests), oestorgens contravesial
TCAs
avoid benzos
DVLA - time off in neuro disorders
1 month : syncope explainined, stroke/tia recovered
3 month - multiple TIAs
6months: syncope unexplained, first seziure in normal brain , withdrawl of antiseziure meds, post pit brain surgery
1 yr : Knonw epilesy + further seziure, two or more syncopes and craiotomy
LFTS for alcoholic LD
for hepatitis
increase AST
increase more ALT (acute Liver)
Tx of quinsy
I&D, or Aspiration
IV Abx
BG if tonsillitis - then do a tonsillectomy
Mycosis Fungoides - dry itch plaques
?
Cutaneous form of T-Cell lymphoma
absences
SV or ethosuximbe
- defs avoid carbamazepine
bp measurements for pre-eclamp
rised >30/20
reading is >160/90
140/90 (HTN normall) but with protein or signs of IUGR
dermatomyositisis antibodies
anti-jo, anti-MI
dacryocystitis vs dacryoadenitis
Lac sac,medial swelling
Lac gland, lateral swelling
antibodies in APL syndrome
coag signs
anti-cariolipin
anti-b2-glycoprotein
lupus anticoagulant
prolonged APTT (intrisinic)
Dose for Citalorpram
sertraline
mirtazepine
fluxoteine
10mg anxiety, 20mg depression up to 40mg
sert - if recent mi, 50mg max 200mg
mirtazepine - 30mg up to 45/45
fluxo = 20 up to 40
lymphoma work up - 3 things
Ann Arbor Staging = from both HL + NHL, via CxR, CT/PET + biopsy
I = single region, one lymph node to IV = disseminated involvement (liver, BM)
ix of haemoatospermia
PSA test (if>40) mid-stream urine microscopy + culture
Phaeochromcytomas link to 3 malignancies
Von Hippel Landu
MEN
NF
what vitamin is Naphthoquinone
Vit K –> Haemorrhagic disease of the newborn, bleeding diathesis
drugs causing renal stones
acetzaolamide, allopurinol. laxatives, asorbic acid
pain after exercise, with swelling and locking
osteochondritis dissecans
- empty stomach
- > 200mls of water + whole table
- stay upright for 30mins
- dental check
bisphosphonates
what Ix for erectile dysfunction
Testesterone, BP, BM, Lipidis, exam (?peynoids)
- if LUTS add in PSA
renal cancer most common type
assoications
clear cell
asso: TS, VHL syndrome, smoking
diagnosis of amylodosis
AL + AA
congo red stain
red/green poisitive birefrigmeent
10% of myeloma will develop AL
Tx: Oral Melphalan + prednisolone
AA will not affect heart, more chronic inflam disease
as and when tx for allergic rhinitis
IN aselastime spray
- if not for nasal = certirizine/loratadine
cutaenous lava migrans
pediculscapularis
hookworm (cats/dogs) –> topical bezdazole
head lice –> malathion, permethin
tx of typid fever
fever, malasia, hepatspleno, rose spots, bradyacaria
salmoneall virsus
CIPROFLOXACIN of azthromycin
what drugs are avoided in g6pd def (3)
Ix
diuretics - indapamide
fava beans
ciprofloxacin
Ix: non-immune haemolytic crisis (neg direct coombs) +heinz bodies
low Ca, PO4
high ALP, PTH
osetomalacia
- bone pain
- proximal myopathy
- looser zones (pseudo#)
respiatroy test for upper airway function
test for lung function in IPF
spirometery
lung diffusion
causes of gynaecomastia
Kidney or liver failure
Endocrine disturbances - hyperthyroid
Malignancy
Drugs - spiral, finasteride, cimetidine, digoxin, Gostelin, anaebolic steroids
whats needed for diagnosis of ank spond
radiological sacroillitis
Gentamicin, cipro, quinine, aspirin and furosemide (IV) all cause what
Tinnitus
Painless ulcer in the most
Think SCC before aptholous (which would be painful)
rx for prostate ca
fhx
black
brca1/2
increasing age
COCP
- UKMEC 3
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
ddx between hydrocele and epididymal cyst
cyst can be seperated - excisoin
both translum
tx for viral conjunctivitis
- small follicles seen in eyelid
self-limiting
sterile water cleaning
Travellers diarrhoea
E Coli
choices of antidepressant
- co-exisiting chronic pain
- post MI
- acute depressive episodes in bipolar
- Amitriplyine
- Seraline
- citalopram
Treatment for GTC seziures
SV (obvs not if pregs)
then lamotrigine or carbamaezpine
pt with active ca develops clot - tx?
just lmw hep for 6months
current acute Hep B infection
anti-IgM HBc
allergic conjunctivits
conjunc erythema, chemosis (swelling), itch
seasonal = summer/spring
perennial = dust mites
first-line: topical or systemic antihistamines
second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
13-18 years
‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
13-18 years
‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
Associations with acanthosis nigricians
Obesity
Diabetes
Stomach Ca - also oesophageal, lymphoma and pancreatic
what is cholrprozamine used in
s/e
schizo
- shaky, abnormal body movements
what does minocycline cause
anx for acene
drug induced lupus! others: Isoniazid. Hydralazine. Procainamide. Tumor-necrosis factor (TNF) alpha inhibitors (such as etanercept, infliximab and adalimumab) Quinidine.
Smith vs colles
Monteggia vs Galeazzi
Smith - distal radius is tilted anteriorly
Colles - posteriorly
Mon - #ulna and dislocation of radial head
Gal - #radial shaft and disclosure of inferior radio-ulnar joint
simple ecezema on chin
1% hydrocortisone
if signs of infection - dakacort or another with abx
Pulsus paradoxous Slow rising/plataeu Collapsing Pulsus alternans Bsferiens '2 peaks' Jerky
severe asthma or cardiac tamponade aortic stenosis aortic regurg or PDA severe LVF mixed aortic valve disease HOCM
INR >8 and no bleeding
- if bleeding
give vit k oral and restart once inr <5
- give 1-3mg vit k and restart once inr <5
major bleed = IV vit k with prothrombin complex
febrile seziures - incidence of further piosdes
peak ages
1 in 3
12 to 18months
Epididymo-orchitis tx
- if likely chalr/gon
ceftriaxone 500mg IM single dose, plus doxycycline 100mg by mouth BD for 10-14 days
Dodgy nose
Evucate haematoma
Then manipulate under GA within 1 weeks
Bladder Cancer referral criteria
non-visible haematuria, - direct in >60, or if still present <60
WBC or dsyuria in absent of UTI
Diff between microscopic polyangitis and wegnes?
And antibodie
P anca (wegner c-anaca) Eosinophilia
H pylori
Test with breath or stool
Can re check after eradication (stool will remain positive)
Abc
when is islet transplant indicated
multiple hypo epiosdes, icnluding impaired response
good pastures has which antibodies
anti-gbd
can progress to rpgn
Mx of tension headache
simple analegesia
prev: 10weeks acupunture
- low dose amitripyline (off label)
12-13 months ims
Hib/Men C
MMR
PCV
Men B
time frame a nasal trauma nose can be manipulated
2 weeks ->after it needs rhinoplasty
what is pulm oedema 6hr after lots of transfusion
transfusion related acute lung injury
1degree temp increase is just febrile reaction –>slow the rate
when is quadruple
15 to 20 weeks (2nd tr)
- AFP, uncog estradiol and inhibin A, along with bHCG
Necorsis looking ulcer
attempt debridement/maggot –> amuptation
CI to POP
active liver disease
breast ca within 5yrs
which herina passes THROUGH the internal ring of the inguinal canal
- 80%
Indirect - neonates
(direct older people, weight lifting)
open surgical repair for most (mesh)
laprscopic if bilaterlal
CHOP for NHL with s/es
?Hodgkins - ABVD
Cyclophosphamide (cysitis/hair loss/bm supp)
Hydroxyurbic (doxrubacin/Adriamycin) - cardiomyopathy
Vincristin - perip neuropathy
Prednisone
Adriamycin (doxrubacin),
Bleomycin (pulmonary fibrosis),
Vinblastine, Darcarbazin)
Induction of labour
IV and one oral
IV oxytonin Oral misoprostol (or vaginally)
whats needed prior to anti-tnf
when x2 dmardshave failed
cxr, hep screen, hiv
what can hamartoma of the post hypothalamus causes
precocious puberty in a girl <2
tx to induce remission for crohns
- glucosteroids, budesonide if ileocaeacl
then its meslaazine %ASA
perianal = metrondiazole
maintaining woud be azathioprine or metotrexate
Myolconics
SV
- then clonaezpam or lamotrigine
- avoid carbamazepine
features of SCC skin
bleeds, slow growings, asymmetrical, can met
can occur after transplant
what is the 1 st line tx for aortic valve replacementin children
balloon valvuplasty (also those not fit for valve placement or TAVI in adults)
tx of acute sinusitis
avoid abx, paracetamol
>10days - nasal steroid, nasal decongest, lavage
test for ACL
- pop, swelling, difficult weight bearing
lachman’s test
what can focal dystonia be treated with
e.g. writers cramp
betablocker or botulin injections
Diagnostic criteria for IBS
Abdo pain, bloating, change in bowel habit
Or abdo pain with
Altered stool passage (straining)
Abdo distension
Worsening from eating
Mucous stools
myopia vs hypermyopia
myo = short sighted, CONCAVE lense
- risk of detahcmenet, glucoma and cataract
hyper = long sighted, CONVEX
in an UMN facial palsy - where must the lesion be
above pons - i.e. stroke
duodeneal vs gastric ulcer
DU - more common, 2-3hrs after meal or at night, easised with snack
- more common
- 90% hpylroi
GU - worse with eating, 60% hpyori, will need biopsy
Ix of haemorrhoids
PROCTOSCOPY
Low Ka, Low Chloride and met alkalosis
?
Bartters syndrome
- inherited (AR) like furosemide
Vs conns where BP is rasied
tired all the time bloods
FBE, CRP/ESR, LFTs, UEC, TFT, HBA1c, IgA tissue transglut
only vit d if muscle ache/body pain
- course is 400 IU all yeat
A = keratomalacia B1 - th B3 - ni the 4Ds B6 - B7 0 bio B9 - fol
Retinoids Night-blindness (nyctalopia)
Thiamine Beriberi
polyneuropathy, Wernicke-Korsakoff syndrome
heart failure
Niacin Pellagra
dermatitis, diarrhoea, dementia
B6 Pyridoxine Anaemia, irritability, seizures
B7 Biotin Dermatitis, seborrhoea
B9 Folic acid Megaloblastic anaemia, deficiency during pregnancy - neural tube defects
positive anti-HBs and HBsAg
prev infection of hep b and carrier
antigen neg would not be arrier
smooth annular plaque which is red-pink in colour
asso DM
granuloma annular
= delayed sensitivity reaction
causes of exudate effusion (pro >35)
maligancy, infection, sepsis and inflammation
features of BCC
most common, pearly and slow growing
non-urgent referral
Most common type of thyroid cancer is ___
Most common in elderly is ___
Papillary
Anaplastic type
tx of Polycythenia
venesection
low dose aspirin
whic Ig is:
first in infection
most prevalent
IgM first and biggets
IgG everywhere and crosses placenra
anorexia nervosa bloods
diagnosis wieght
everything low apart from - GH - glucose - cholesterol carotin cortisol
below 15% of normal (17.5)
slow growing painless lump in superfifcal lobe of parotid gland
pleomorphic adenoma
ddx warthins tumour
TIA
- if suspected to have occured within last week
- if >1week ago
- if more than one episode
refer to stroke specailist and start 300mg Asp
- in already on, just continue
- assessment within 1 week
- urgent referral today
eyes stye vs chalazion
if eye lases are lost
stye ‘ouch’ tender lump, eyelash
chaz - clogged firm gland
worried its a cancer
ischaemic/arterial ulcer
vs
venous
aterial rx factors, punched out edges, LATERAL side/pressure points, reduced pulses
- tx hydrocolloid dress (moist)
MEDIAL aspect, v painful
diffuse systemic sclerosis
vs
limited systemic sclerosis
(CREST) - calcinosis, raynuads, oesophageldysmotility, sclerodactly, telangiectasia
anti-scl-70
anti-centromere
where is folate and b12 absorderd
duodenum and prox jejnum
termal ileum
travellers diarrhoea
- watery
- blood
- prolonged and non-bloodr
- e.coli most common
- campylobacter (flu sym) or shigella
- giardiasis
3 different samples for stool cultutre
dont routinely offer abx
hyperemisis rx factors
multiple preg mola preg hx of eating disorders primiparous (non-smoking)`
Hearing test in newborns
6-9months?
Speech/performance testing till 2.5, what after
Otoacustic emission
Then brain stem response if abnormal
Distraction
Pure tone once >3yrs
stoma care for conspitation and diarrhoea
constipation –> osmotic laxative like mag sulp
diarrhoea –> loperamide + codeine
what is thomas test used in
achilles tendon rupture - squeeze calf
return from peru, flu like symptoms
slow pulse and elevated fever (fagets)
yellow fever
causes of bm failure
Aquired = radiation, drugs, chloramphenicol, EBV, hep B, CMV, preg, Graft-verus-host disease
b12 and folat def
Inherited + malignancy
prostate advances tx
- 2 diff options, types and some s/es
Flutamide = anti-androgen tablet, can cause gynaemoastia
Gosreline is a LHRH analague injection
- also cause gyanemaotasia but can casue tumour flare
Bone pain - give bisphosphates
ddx of propotsis
unilateral = orbital myositis
Bilat + slower = thyroid eye disease
red = orbital cell
ecezema v v itch
?scabies incontigo
Wilms tumour vs Neuroblastoma
Wilms:
- asso WAGR syndrome (aniridia) + Beckwith-weidrman
- doesn’t cross midline
- microscopic haematuria, may have HTN
Neuroblastoma - asso ospoclonus myoclonus, blueberry muffin skin, anaemia - can cross midline - urine catechilamines - HTN, fever From neural crest of adrenal medulla 75% retroperitoneum
1 point about each thyroid cancer
- anaplastic
- medullary
- papillary
old people, v. ill = pallative
hypocalacomia – calcintonin, men 2 related
most common, young gals
Rubella congenital features - T, J, H, C
When is highest risk
Thrombocytopenia, jaundice, hepatosplenomegaly, cerebral calcification (=> cerebral palsy)
1st trimester
tx for SEVERE legionella
erthyromycin/clarith + rifampicin
screening
- glasgow vs ransons
- waterlow
- SCOFF
pancreatitis GS + alocholol panc
pressure sores
eating disorders
2 screening tests for CVD
qrisk and framingham
PAD
- what pressure is claudification
- tx options
acute limb ischaemi tx options
- thombosis (hours)
- embolus (sudden)
- <0.9
- aspirin/clop
- angioplasty
thrombolysis iafter dx from angio
embolectomy, and then warfarin
recommeded weekly units
beer vs wine
single spirit and then bottle of wine
14
2, 1
1, 10
ca risks in coeliac
lymphoma
SB carcinoma NOT colon ca
10 year absolute risk of osteoporotic fractures
what age of people without the risk factures
qfratcure
FRAX (with or without BM)
65 women
75 men
right sided infarct
left hom hemiphonia
left sided weakness
diff in blood for subclinical and clinical hypothy
subclinical = TSH is HIGH to keep T4 in normal range clinical = T4 is low , with raised tsh
WHO PAIN LADDER
1 -
2 -
3 -
paracetamol with an NSAID
then add weak opiod eg codeine 60mg QDS
then add strong opiod
- morphine
- if still, ?change route e.g fentyl patch (total dose in 24hr /2)
Cushing syndrome vs disease
Syndrome is ectopic ACTH secretion - often predict => NOT able to be suppressed
Disease is pit adenoma -> high dose suppresses
