msra Flashcards
Unilateral nasal polyps are a red flag and require ENT referral, True or False?
True
Rhinosinusitis is typically bilateral, if unilateral then refer.
What is the treatment for bilateral nasal polyps?
Saline nasal douch + Intranasal steroids (effective in 80% of cases at shrinking the polyp)
What is Samter’s triad?
Association of nasal polyps with aspirin sensitivity + asthma.
What percentage of dementia is Lewy Body Dementia? What are the early signs?
~20%
Visual hallucinations
Attention / Executive function deficits
Cognitive then motor deficit
What are the features of Vertebrobasilar ischaemia?
Elderly person
Dizziness on extension of neck
What are the features of Meniere’s?
Hearing loss
Tinnitus
Fullness in one/both ears
What are the features of acoustic neuroma? What condition is it associated with?
Hearing loss
Tinnitus
Absent corneal reflex
Associated with neurofibromatosis T2
What are the features of BPPV? What is the first line treatment?
Gradual onset
Associated with change in head position
Vertigo lasting 10-20 seconds
Epley Maneuver
What is the difference in presentation between Vestibular neuritis and Viral Labyrinthitis?
Both associated with recent viral infection, however viral labyrinthitis is associated with nausea/vomiting and may have hearing loss. There is no hearing impairment in vestibular neuronitis and less common to have nausea/vomiting.
Give a risk associated with Gentamicinglycoside)
Ototoxicity
Avoid giving in otitis externa/media if ear drum has ruptured!
Define vertigo
False sense that body or environment is moving
If a patient is on cardiac monitoring in CCU and enters Ventricular Fibrillation, what is the initial treatment?
3 successive stacked shocks then CPR.
Normally in VF or Pulseless VT you give one shock, but if on monitoring (witnessed) then give 3.
What are the shockable and non-shockable rhythms? When do you give adrenaline for each?
Shockable: VF / Pulseless VT
- Adrenaline 1mg IV/IO 1 in 10,000 post 3rd shock + 300mg amiodarone then adrenaline every 3-5 minutes. Consider amiodarone 150mg IV post 5th shock.
Non-shockable: PEA, Asystole
- Immediately 1mg adrenaline
- Every 3-5 minutes.
NB: 30:2 ratio compressions
What are the 4 Hs and 4 Ts in cardiac arrest?
Hypoxia
Hypovolaemia
Hyper/Hypokalaemia
Hypothermia
Thrombus
Tension Pneumothorax
Tamponade
Toxins
What is the test for anaphylaxis?
Serum Tryptase (raised for 12 hrs)
When is it safe to discharge a patient post anaphylaxis?
> 2hrs if responded well to 1 dose adrenaline (500mcg; 0.5ml 1 in 1000) ant lat middle 1/3rd thigh.
> 6hrs if 2 doses adrenaline required or if previous biphasic reaction
> 12hrs if on-going symptoms or if severe reaction or if severe asthma, or presenting late at night.
Give a non-drowsy antihistamine you could give someone in recovery from anaphylaxis?
Cetirizine
Fexofenadine
Loratadine
NB:
What operation would you perform for caecal, ascending colon, or proximal 1/3rd transverse colon cancer?
Right hemicolectomy
What is a Hartmann’s procedure?
Complete resection of the rectum and sigmoid + formation of end colostomy (emergency bowel obstruction or perforation)
What surgery would you use for upper rectal tumours?
High anterior resection
Lower anterior resection is for low rectal tumours (<5cm from anus).
What surgical procedure would you use for a cancer of the distal 2/3rds of the transverse colon, or the descending colon?
Left hemicolectomy
True or false, all anaphylaxis cases should be referred to specialist allergy clinic?
True
What is Sialadenitis?
Inflammation of the salivary gland due to an obstruction e.g. malignancy or stone
Which salivary gland is most commonly affected by cancer?
Parotid - 80% of cases
Pleomorphic adenoma (benign) = 80% of these
What are the management steps for asthma treatment?
1) SABA
2) SABA + Low Dose ICS
3) SABA + Low Dose ICS + Leukotriene receptor Antagonist (LTRA) e.g. Montelukast
4) SABA + Low Dose ICS + LABA +/- LTRA
5) SABA +/- LTRA + MART (Maintenance + Reliever) + ICS
6) SABA +/- LTRA + Moderate dose ICS MART
7) SABA +/- LTRA + High dose ICS +/- Theophylline (musc rec antagonist)
What is Ludwig’s angina?
Cellulitis of the mouth/neck due to a blocked salivary duct. Typically red, swollen under mandible. Urgent referral to ENT + antibiotics.
With inhaled corticosteroids, what constitutes low, moder and high dose?
E.g. Budesonide
Low: <400mg
Moderate: 400 - 800mg
High: >800mg
What is Warthin’s tumour?
Benign neoplasm of salivary gland
Tends to be softer and fluctuant
What is the treatment for otitis externa (‘swimmer’s ear’)?
Topical antibiotic drops + steroid drops
Avoid aminoglycosides e.g. gentamicin if rupture of ear drum
If treatment fails then ENT referral
Which drugs for congestive heart failure increase long-term survival rate?
ACE inhibitors
Beta Blockers
ARBs
Aldosterone antagonist e.g. spironolactone
What are the 1st, 2nd and 3rd line treatments for CHF? What vaccinations should they be given?
1st: ACEi + Beta blocker (start one at a time).
- BB e.g. Bisoprolol, Carvediolol, Nebivolol.
2nd: Aldosterone antagonist e.g. spironolactone or eplerenone
+/- SGLT-2 Inhibitor e.g. dapagliflocin or empagliflocin.
3rd: Sacubatril Valsartan, Hydralazine.
Remember to give annual influenza and pneumococcal vaccines.
What is the triad of symptoms for Optic Neuritis?
What pupil sign would you look for?
Visual loss (hours/days) - Central scotoma (key feature!)
Periocular pain (worse on eye movement)
Dyschromatopsia (change in colour perception e.g. red desaturation.
Look for Relative Afferent Pupillary Defect (RAPD) aka Marcus Gunn Pupil - lack of constriction in affected and non-affected pupil when light is swung to affected eye.
Give two common causes of optic neuritis. What investigation would you order if discovered?
Multiple Sclerosis
Diabetes
Syphylis
Bloods/Sexual health screen
MRI: if >3 white matter lesions then 50% get MS in 5 years!
What is the treatment for optic neuritis?
High dose steroids. IV methylprednisolone 30mg/kg for 3-5 days.
Expect resolution in 4-6 weeks.
What is the test for Addison’s?
Short Synacthen Test:
Measures serum cortisol levels after ACTH stimulation is administered (Synacthen).
What are the key signs of addison’s? What is the treatment?
Hypotension
Hyperpigmentation
Vitiligo
Hyponatraemia
Hyperkalaemia
Treat with IV hydrocortisone
A 70 year old, heavy smoker presents with painless, loss of vision in one eye. Fundoscopy shows pale, swollen optical disc, cotton wool spots and peripapillary haemorrhages. What is the most likely diagnosis?
Ischaemic Optic Neuropathy
Give two risk factors for vitreous detachemnt. What are the key features?
HTN
Diabetes
Floaters/Flashes
Loss of vision ‘curtain fall’ / peripheral
Painless
What are the common features of macular degeneration?
Distortion of vision e.g. straight lines appearing curved
Blurring
Central loss of vision
Drusen (yellow spots) on the retina (in Dry Macular Degeneration)
Dry MD is more common and less severe than Wet MD. In wet MD blood vessels are leaky and vision loss is more severe.
MD is the most common cause of blindness
What are the features of Temporal Arteritis? How is it managed?
AKA Giant Cell Arteritis
Rapid onset, headache, jaw claudication, blurred/loss of vision, tenderness around temporal nerve.
Oral Prednisolone 40-60mg/day with temporal artery biopsy within a week.
What is the best prevention for contrast induced nephropathy?
Saline IV 0.9% pre and post administration of contrast
(1ml/kg/hr 12hrs pre and post)
Contrast nephrotoxicity = 25% increase in creatinine within 3 days of contrast
What is the most common cause of diarrhoea in HIV?
Cryptosporidium
What vitamin supplement is given to alcoholics with dietary insufficiency?
Thiamine
Which visual pathology is associated with a cherry red spot on fundoscopy?
Central Retinal Artery Occlusion
What is the treatment for BPPV?
Dix Hallpike
What is the treatment of choice for:
1) Alcohol withdrawal acute
2) Antabuse
3) Reducing cravings
1) Benzodiazepines (chlordiazepoxide)
2) Disulfiram (inhibits acetaldehyde dehydrogenase enzyme)
3) Acamprosate NMDA receptor antagonist
How quickly are IUD, POP and [COCP, Implant, IUS,] effective?
IUD Instant
POP 2 days
COCP, Implant, IUS 7 days.
A patient has bacterial meningitis and is started on ceftriaxone. What other drug would you give and why?
Dexamethasone as it reduces the risk of neurological sequelae e.g. deafness
What vaccines do you not give to patients with HIV?
Live attenuated vaccines e.g.
BCG
Yellow Fever
Oral polio
Intranasal influenza
Varicella
MMR
What are relative and absolute contraindications to COCP?
Relative:
- BMI >35
- FHx VTE in 1st deg <45yrs
- Immobility e.g. wheelchair
- BRCA1/2
- Controlled HTN
- > 35 and smokes <15 /day
Absolute:
- >35 and smokes > 15/day
- Migraine with aura
- CVA hx
- Breast feeding <6 weeks
- Uncontrolled HTN
- Major surgery
- SLE
- Active breast ca
A patient presents with painful, monomorphic, punched out erosions on face. They are diagnosed with Eczema Herpeticum, what is the causative pathogen and what is the treatment?
Herpes 1/2
IV Aciclovir
How do you investigate ectopic pregnancy?
Pregnancy Test
Transvaginal US
A patient who previously had TB presents with a mass within a lung cavity and haemoptysis, what is the most likely diagnosis?
Aspergilloma
A fungal mass in a lung cavity commonly secondary to TB, lung cancer or cystic fibrosis.
Does Growth Hormone increase or decrease in annorexia nervosa?
Increases
Gs and Cs increase. Everything else decreases
Growth hormone
Glucose
Salivary Glands
Cortisol
Cholesterol
Carotinaemia
Which of the following is associated with decreased fertility in men? Epididymitis, hydrocoele, varicocoele.
Varicocoele
Dilatations of the pampiniform plexus. Most common on left side (80% of cases). “Bag of worms”.
US Doppler and conservative management in most cases.
What is the best treatment for vaginal thrush in pregnancy?
Clotrimazole pressary 500mg
Oral antifungals are contraindicated
What is the best treatment for vaginal candidiasis?
Oral fluconazole 150mg single dose.
If pregnant then clotrimazole pessary 500mg.
Give two risk fators for vaginal candidiasis
Diabetes
Pregnancy
Steroids
Antibiotics
Is sickle cell disease associated with higher or lower Hba1c and why?
Lower. Faster turnover of RBC which means reduced glycation time.
Before starting a patient on aromatase inhibitors for ER+ve breast ca, what scan should you arrange?
DEXA
Aromatase inhibitors e.g. anastrazole may cause osteoporosis by reducing peripheral oestrogen activity.
What is conversion disorder?
Loss of motor or sensory function caused by stress
What is the difference between somatisation and conversion?
Somatisation affects multiple physical systems, whereas conversion is typically one complaint with no explanation.
What is the difference between Malingering and Munchausen (Factitious disorder)?
Malingering is to falsely claim to have a condition or complaint for gain.
Munchausen’s is to deliberately induce a symptom to adopt a sick role.
A 43yr old 3cm dilation at 27 weeks presents. How do you manage?
Admit
Tocolytics (delay labour)
- Atosiban (oxytocin antagonist)
- Magnesium Sulfate
- Ca blockers e.g. nifedipine
- Betamimetics e.g. Terbutaline
- Prostaglandin inhibitors e.g. ketoralac.
- Nitroglycerine
Steroids (matures foetus’ lungs in case pregnancy cannot be avoided) as premature.
What does syntocinon do in labour?
Strengthens contractions
What muscle is overactive in Urge incontinence? How do you treat it?
Detrusor muscle
Muscarinic antagonist e.g. oxybutynin, solifenacin, tolteradine.
Investigate with bladder diary for >3 days, vaginal examination to exclude prolapse, urine dip and culture, urodynamic studies.
Give two antimuscarinic side effects
Blurred vision (cant see)
Urinary retention (cant pee)
Dry mouth (cant spit)
Constipation (cant shit)
In bacterial meningitis, what is the antimicrobial treatment of choice for:
- Neonates (<3months)
- 3months - 50 years
- >50 years
- Community meningococcal
- Hospital meningococcal
- Listeria
- Pneumococcal
- Haemophilus influenzae
- Prophylaxis
- Neonates (<3months) - Cefotaxime + Amoxicillin
- 3months - 50 years Cefotaxime/Ceftriaxone
- > 50 years Cefotaxime/Ceftriaxone + Amoxicillin
- Community meningococcal Benzylpenicillin
- Hospital meningococcal Cefotaxime/Ceftriaxone
- Listeria Amoxicillin
- Pneumococcal Cefotaxime/Ceftriaxone
- Haemophilus influenzae Cefotaxime/Ceftriaxone
- Prophylaxis Ciprofloxacin / Rifampicin (close contact within 7 days e.g. in same house hold).
If a mother has previously had Group B Strep infection and is pregnant again but is otherwise well, should you give antibiotic treatment?
Yes. Prophylactic Benzylpenicillin
What is the best treatment for cluster headaches?
100% O2
Triptan Subcutaneous
Verapamil and tapered prednisolone can be effective prophylaxis.
What is the 1st line test for Lyme disease?
ELISA for antibodies to Borrelia burdoferi
Repeat this 4-6 weeks after
When should you commence antibiotic therapy for Lyme disease?
If erythema migrans is present (clinical diagnosis) or systemically unwell following a tick bite.
Skin lesions e.g. bull’s eye lesion usually show 1-4 weeks post bite.
Treat with Doxycycline unless contraindicated e.g. pregnancy, then use Amoxicillin.
If patient is asymptomatic, you dont treat tick bites.
What is Jarisch Hexheimer reaction?
Tachycardia, and fever following commencement of antibiotics for certain infections e.g. syphilis or lyme’s disease.
What is the difference in how you manage asthma in <5yr olds vs over 5 years old?
If SABA doesn’t work, then <5yrs you trial 8 weeks of MODERATE ICS. In 5yrs and over you treat with LOW dose ICS.
A smoker presents with a white patch on his oral mucosa which cannot be rubbed off. A biopsy rules out squamous cell carcinoma, give another differential, what is the diagnosis of exclusion?
Oral Candidiasis
Lichen Planus
Dx of exclusion is Leukoplakia
- premalignant condition. 1% will transform into malignancy. Therefore this requires monitoring.
What blood test must you review before starting an ACE i?
U&Es
What blood test must you review before starting methotrexate?
FBC
LFT
U&E
What blood test must you review when starting Lithium?
Lithium levels (weekly until stable then 3 monthly, then 6 monthly)
TFT
U&E
What blood test must you review before starting Sodium Valproate?
LFT
What blood test must you review before starting Gliclazide?
LFT
What blood test must you review before starting Azathioprine?
FBC
LFT
What is the first line treatment for lichen planus?
Corticosteroids
What is the difference between Erbs palsy and Klumpke’s palsy?
Erbs palsy = inward rotation of arm, with extended elbow ‘waiters tip’. Upper brachial plexus injury (C5, C6).
Klumpke’s palsy = flexed IP joints and extended MCPJs. Often caused by hyperextension of arm e.g. holding onto a rail when falling. Lower brachial plexus injury (C8, T1)
Following shoulder dystocia, a child has an inwardly rotated right arm with an extended right elbow? What is the name for this palsy?
Erb-Duchenne Palsy
Upper brachial plexus injury (C5, C6)
Which nerve is most commonly affected by a mid shaft humeral fracture?
Radial nerve
Which nerve is commonly injured with proximal humerus injuries e.g. dislocation?
Axillary nerve
What is the function of the following nerves?
- Musculocutaneous
- Axillary
- Radial
- Median
- Ulnar
- Long Thoracic
Musculocutaneous
Elbow flexion (C5-7)
Axillary
Shoulder abduction (C5, C6)
Radial
Wrist extension (C5-8)
Median
LOAF muscles of hand (C6, C8, T1)
Ulnar
Intrinsic muscles of hand (C8, T1)
Long Thoracic
Serratus anterior
What are the LOAF muscles of the hand? Which nerve innervates them?
Lateral two umbricals
Opponens Pollis
Abductor policis brevis
Flexor policis brevis
Median nerve
Which nerve is tested when you trigger the triceps tendon?
Radial nerve
An, obese, moderate drinker (17 units a week) presents with mildly abnormal LFTs and increased hepatic echogenicity on US. What is the most likely diagnosis?
Non-alcoholic Fatty Liver Disease
(NAFLD)
Obesity with deranged LFTs suggests NAFLD. 17 units of alcohol is not significantly high
What blood tests are suggestive of active Hepatitis B infection?
HBsAg (surface antigen) positive suggests infection. First marker to appear. Appears as early as 1 week.
Anti HB positive suggests previous vaccination.
What is the best treatment of improving survival in COPD?
Long term oxygen therapy
What is the first line treatment for diabetic neuropathy pain?
Duloxetine
Inhibits reuptake of serotonin and noradrenaline which increases their pain suppression
What is the treatment approach for COPD?
1st line SABA or SAMA
2nd line add LABA + LAMA if non asthmatic features
If asthmatic features add LABA + ICS.
Theophylline, Mucolytics, Azithromicin, and PDE-4 inhibitors (reduce exacerbations) can also be added.
Annual flu vaccination
One off pneumococcal vaccination
A patient with cellulitis has a penicillin allergy, what would you treat him with?
Typically flucloxacillin is first line.
If penicillin allergy then Clarithromycin, Erythromycin, Doxycycline are good alternatives.
80% of vulval carcinomas are what type of cancer?
Squamous Cell Carcinoma
How do you differentiate strangulated and incarcerated femoral hernia?
Inferolateral to pubic tubercle = femoral hernia.
Incarcerated is non-reducible but patient is well
Strangulated is when the blood supply is compromised and the patient is sick with it.
What is the pathway of direct vs indirect inguinal hernias? Which is more common?
Direct goes directly through the posterior wall and out the superficial ring of the inguinal canal.
INdirect goes IN the deep ring and through the superficial ring of the inguinal canal. 2/3rds of inguinal hernias are indirect.
What feature of migrain is more common in children than in adults?
Gastrointestinal disturbance
What is the antibiotic treatment for GBS in pregnancy?
Intrapartum Benzylpenicillin
Clindamycin is an alternative.
True or false, vincristine (chemotherapy agent) is associated with peripheral neuropathy (tingling in peripheries) as well as urinary retention due to bladder atony?
True
Give a serious side effect of methotrexate
Myelosuppression
Liver / Lung fibrosis
Define menopause. How long does it last on average? What is the management?
Permanent cessation of menstruation for 12+ months. Symptoms last 2-5 years.
HRT - Combination therapy if still has a uterus (unopposed oestrogen increases risk of endometrial cancer).
If no uterus then oestrogen only therapy is fine.
How might you treat a woman going through menopause with flushes (vasomotor symptoms) if she does not want HRT?
SSRI e.g. fluoxetine
Weight loss, regular exercise and reduced stress are also advised.
What is the best test for asymptomatic H pylori?
13C Urea Breath Test
CLO test if symptomatic and doing a gastroscopy
Give two risks associated with HRT
Coronary Heart Disease
VTE risk
Stroke
Breast ca
Ovarian ca
Give two contraindications for HRT
Current/Prev breast ca
Oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
How do you treat Hashimoto’s thyroiditis? What do you monitor to determine treatment success?
Autoimmune vs thyroid gland
Treat with Levothyroxine
Monitor TSH levels to ensure they are in normal range. This determines when the levothyroxine is at appropriate levels.
What is the treatment for Premature Ovarian Insufficiency?
Hormone Replacement Therapy / COCP until 51 (age of menopause).
Combined hormone therapy if has uterus as unopposed oestrogen increases risk of endometrial cancer.
Look for raised gonadotrophins e.g. FSH and low oestrogen on bloods. Bloods should be checked again 4-6 weeks apart.
If occus <40 years then the ovarian failure is “premature”. This occurs in 1% of women, and is mostly idiopathic.
How would you manage urge incontinence?
Bladder retraining for 6 weeks (aim is to increase time between voids).
Kegel exercises
Anti-muscarinics e.g. Oxybutynin, or Tolterodine
If elderly and concerned about ant-muscarinic side effects then Mirabegron (Beta-3 agonist).
What is the best prophylactic for cluster headaches?
Verapamil
True or false, antibiotic prophylaxis should be given for dental extractions in patients at risk of infective endocarditis?
False. No prophylaxis is given
What happends to body temperature during menstruation?
It is lower in the first stages of menstruation and rises following ovulation (due to rising progesterone levels).
What are the four stages of the menstrual cycle?
Mentruation 1-4
Follicular phae (proliferation) 5-13
Ovulation 14
Luteal (secretory phase) 15-28
What hormone spikes just before ovulation?
LH spike
(FHS rises modestly)
What happens to Oestrogen and Progesterone levels during the menstrual cycle?
Oestrogen (oestradiol) rises gradually up to ovulation which triggers the leutenising hormone spike and then oestrogen levels decrease.
Following ovulation progesterone is released by the corpus luteum (this causes increased body temperature and makes cervical mucus thick and tacky.
A well, 16 year old complains of knee pain, with locking and swelling at rest. What is the most likely diagnosis?
Why is it not Juvenile Idiopathic Arthritis, Osgood Schlatter, Osteosarcoma, or Chondromalacia patellae?
Osteochondritis dissecans
- Loose bone fragment in knee due to poor blood supply. Moves around under cartilage causing joint to lock, swell and be painful. Common in young active people. Mostly heals with rest.
JIA: Typically affects multiple joints, with morning stiffness which improves and systemic signs e.g. rash.
Osgood Schlatter: Inflammation at tibial tuberosity where patellar tendon attaches. No pain at rest. Sporty teenagers.
Osteosarcoma: Severe bone pain typically at night time. Associated with B symptoms/Red flags.
Chondromalacia patellae: ‘Grinding/clicking’ in the knee with quadriceps weakness. No locking or swelling.
True or false, patients with Fragile X syndrome tend to have smaller heads?
False. They tend to have larger heads.
What is microcephaly? Give 2 causes
Occipito-frontal head circumference <2nd percentile.
Congenital infection
Patau
Fetal alcohol syndrome
Family inheritance
Craniosynostosis (early fusion of bones of skull)
If a patient is not tolerating metformin due to gastrointestinal upset, what should you do?
Switch to modified release Metformin first before considering second line treatments.
Why are sulphonylureas like gliclazide and tolbutamide not first line treatments for T2DM?
Risk of Hypoglycemia and Weight gain
What is the mechanism of Metformin? What effect does it have on insulin sensivity, liver gluconeogenesis, and GI absorption of carbohydrate?
AMP-activated protein kinase (AMPK) activation
Increases insulin sensitivity
Decreases liver gluconeogenesis
Decreases GI absoption of carbohydrates
What renal function would lead you to change metformin dose?
EGFR <45 - Reduce
EGFR <30 - Stop
NB: GI side effects are common with metformin which is why you titrate the dose up. Lactic acidosis is a less common side effect.
True or false, gestational diabetes is treated with insulin in most cases?
False. Lifestyle change is the first line treatment in most cases.
True or false, gestational diabetes is associated with small babies?
False. It is associated with macrosomia (large for gestational age). Indeed, previous macrosomia is a risk factor for gestational diabetes.
True or false, certain ethnicities are more likely to develop gestational diabetes?
True. Afro-Caribbean and South asian are at higher risk.
What is the best test for gestational diabetes? What are the diagnostic levels?
Oral Glucose Tolerance Test (OGTT)
Fasted: > 5.6
2hr glucose: > 7.8
Drusen are associated with Dry or Wet macular degeneration?
Drusen = Dry (aka atrophic)
Drusen are yellow retinal deposits in Bruch’s membrane.
Optic disc cupping on fundoscopy is associated with which condition?
Glaucoma
A 70 year old patient complains of gradually worsening vision with flickering/glare around lights and worsening night vision (dark adaptation). What is this suggestive of?
Macular degeneration
fluctuating, gradually deteriorating vision, with poor dark adaptation. Can also present with Charles Bonnet hallucinations and photopsia (flickering lights).
A woman with cold sores, presents with a watery (epiphora), red eye and photophobia. You see a dendritic ulcer on examination. What is the probable diagnosis and treatment?
Herpes Simplex Keratitis
Topical Aciclovir Drops
Refer to ophthalmology urgently
Which cancers does the COCP increase and decrease the risk of?
Increases risk of:
Breast and Cervical cancer
Decreases risk of:
Ovarian and Endometrial cancer
What is Hoover’s sign?
A test for organic vs in-organic paresis.
If a patient claims right leg paresis. Perform a straight leg raise on the left leg with your hand under the heel of the right leg. If you feel pressure then it suggest the muscles of the right leg are operative and counterbalancing. This suggests a non-organic cause e.g. conversion.
What is Brudzinski’s sign?
When flexion of the neck induces flexion of the hips. This is suggestive of meningitis, encephalitis or Subarachnoid Haemorrhage .
What is the Meyerson’s sign aka Glabellar tap sign?
A test for Parkinsons.
Tap the glabellar region (between eye brows). Healthy individuals will blink for the first few times. If they are unable to resist blinking after this then it is suggestive of PD.
What is the Babinski sign?
UML test
Over 2yrs. Plantar stimulation should cause plantarflexion and curling of toes. If it causes dorsiflexion and extension of toes [Positive Babinski] it is suggestive of UML e.g. stroke.
In <2yr old Babinski is normally +Ve.
What is the Lasegue sign?
Test for disc herniation and radiculopathy.
If radiating leg pain can be induced by a straight leg raise then this suggests disc herniation as the cause.
A 75 year old attends your clinic with multiple, pink/brown, small crusty, skin lesions on his bald scalp, which have been there for over a year. What is the most likely diagnosis and treatment?
Actinic keratosis
AKA solar keratosis
Florouacil cream +-/ hydrocortisone cream for inflammation.
Topical imiquimod
Curettage / Cautery
How would you treat a UTI in a pregnant woman during the first trimester? What antibiotic should you avoid?
Nitrofurantoin (avoid at term) 7 days
Trimethoprim is contraindicated due to teratogenicity / neural tube defects.
When would you send a urine culture in a UTI case?
Pregnancy
Male
Haematuria
>65 years old
How long do you treat uncomplicated UTI in women and in men?
Women 3 days
Men 7 days
What is the treatment for acute pyelonephritis?
Cefalexin 7-10 days PO
If unable to tolerate e.g. vomiting or severe illness then IV Cefuroxime
Co-amoxiclav is only advised if you have culture results.
True or false, you should treat all cases of asymptomatic bacteruria in catherised patients?
False. Don’t treat it if they are asymptomatic.
How would you investigate Grave’s thyrotoxicosis? What would you see on the results?
TSH Low
T4 / T4 Raised
TSH receptor Autoantibodies +Ve
What is De Quervain’s Thyroiditis?
Subacute thyroiditis commonly caused by certain infections. Lasts for several weeks.
Triphasic - Presents with temporarily rasied thyroid levels then low levels then they normalise.
What is Courvoisier’s sign?
Painless, Palpable gall bladder with jaundice.
Unlikely to be gall stones. Likely to be pancreatic or biliary tree cancer.
What are normal and abnormal fasting glucose levels?
Normal = < 5.6
Pre-diabetic = 5.6 - 6.9
Diabetic = > 7
What is Whipple’s resection?
Removal of pancreas and duodenum. Mostly often due to pancreatic cancer. 80% of which affect the head of the pancreas.
What is the gold standard diagnostic test for coeliacs?
Intestinal Tissue Biopsy
Following a positive Anti Tissue Transglutaminase (Anti TTG) and IgA serology.
What skin condition is associated with coeliacs? How is it investigated and treated?
Dermatitis Herpetiformis - caused by IgA deposition in the dermis. Extensor surfaces e.g. knees, elbows. Vesicular, itchy.
Skin biopsy
Gluten free diet
Dapsone
A patient presents with flakey, scaley kin lesions around his eyes, nasolabial folds and on his scalp. What is the most likely diagnosis?
Seborrhoeic Dermatitis
Caused by a fungus (Malassezia furfur)
Treated with Head and Shoulders or Neutrogena shampoos [1st line].
Second line is topical ketoconazole
Risk factors associated HIV and Parkinsons.
What pathogen causes Hand Foot and Mouth disease?
How does it typically present?
Coxsackie A16
Sore throat, fever, vesicular rash on palms and soles.
What pathogen causes Slapped Cheek or Fifth’s disease?
Parvovirus B19
What causes scarlet fever? What is the treatment?
Group A Haemolytic Strep
Strawberry tongue and rash
Penicillin 10 days.
A child presents with watery, red eyes, fever and white spots on the buccal mucosa and a rash which starts behind the ears and progresses to the body. What is the likely diagnosis?
Measles
Koplik spots are a key feature
What is the order of lesion evolution for chicken pox?
Macular –> Paupular –> Vesicles
Incubation is around 2 weeks.
A patient presents with discoid rash, fatigue, arthralgia, malar rash, photosensitivity. They have normal CRP and raised ESR. What is the likely diagnosis?
SLE
What is Dupuytren’s Contracture? How does it present? how is it treated?
Thickening of the palmar aponeurosis. Causes moderate flexion of the medial digits. No sensory or motor component.
Consider surgical management if hand cannot be extended fully e.g. placed flat on a table.
A well 34yo male presents with left flank pain radiating to groin. Systemically well but appears sweaty. What is the diagnosis? How do you investigate? What is the management?
Renal colic
Non-contrast CT KUB within 14hrs.
Diclofenac 75mg IM
Stone <5mm expectant will pass in 4 weeks
Stone >5mm Lithotripsy
If pregnant then Ureteroscopy
If staghorn calculi or complex renal calculi then Percutaneous Nephrolithotomy.
What constitutes blindness on the Snellen chart?
<3/60 while wearing prescribed glasses.
What spirometry results indicate COPD? What are the stages?
FEV1/FVC ratio <0.70
FEV1 >80 = Mild (Stage 1)
FEV1 50 - 79 = Moderate (Stage 2)
FEV1 30 - 49 = Severe (Stage 3)
FEV1 <30 = Very Severe (Stage 4)
True or false, pulomonary fibrosis is an obstructive condition? What would you expect to see on Spirometry?
False. It i restrictive.
Expect FEV1/FVC >0.7
But FEV1 and FVC to be <0.80 of predicted
Give two examples of Obstructive and Restrictive lung disease?
Obstructive:
- COPD
- Bronchiectasis
- Emphysema
- Asthma
Restrictive
- Pulmonary Fibrosis
- Pulmonary Oedema
- Pneumoconiosis
How do you test reversibility for asthma?
400mcg Salbutamol with a repeat 15minutes later. If 12% improvement in FEV1 or FVC.
What would you expect to see on an ECG of a patient with pericarditis? How would you exclude myocarditis? What is the treatment?
Global ST and PR changes across ECG
Saddle ST elevation
PR depression (most specific sign)
Troponin should be normal in pericarditis and raised in Myocarditits.
Treatment for pericarditis is NSAID + Colchicine.
What is the most common viral cause of pericarditis? Give another cause
Coxsackie
Radiotherapy
Trauma
SLE
TB
MI (Dressler Syndrome)
What is Dressler Syndrome?
Pericarditis 1-3 days post MI
True or false, alcohol is a commom trigger of cluster headaches?
True
NB: They are more common in men and smokers.
True or false, aspirin is contraindicated in breast feeding?
True. Risk of Reye’s syndrome.
Other contraindications:
ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
lithium,
benzodiazepines
Clozapine
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
True or false, vision and hearing problems are common in Down’s Syndrome?
True.
Cataracts
Glaucoma
Blepharitis
Strabismus
Otitis media
Glue ear (otitis media + effusion)
What is Chancroid?
Tropical disease. Genital ulcer with ragged border. Caused by Haemophilus ducreyi. Treated with azithromycin, ceftriaxone, ciprofloxacin etc.
A woman presents with foul smelling vaginal discharge (yellow green) after intercourse 1 week earlier. What is the likely diagnosis?
What is the treatment?
Trichomonas vaginalis, a sexually-transmitted disease classically causing offensive vaginal discharge, dysuria and vulval itching. Speculum examination may reveal a ‘strawberry cervix’ caused by multiple punctate haemorrhages of the cervix.
Treatment is metronidazole 5-7 days.
A young boy is noted to have learning difficulties, macrocephaly, large ears and macro-orchidism - what is the diagnosis?
Fragile X
A child presents with severe congenital malformations including microcephaly, cleft lip/palate, polydactyly, cardiac defects and severe intellectual disability. What is the likely genetic disorder?
Patau (Trisomy 13)
A child presents with a triad of micrognathia (small lower jaw), glossoptosis (downward displacement or retraction of the tongue) and airway obstruction, what is the likely genetic disorder?
Pierre Robin Syndrome
A child presents with growth retardation, severe intellectual disability, microcephaly, overlapping fingers, rocker-bottom feet, congenital heart disease and other anomalies. What is the likely genetic disorder?
Edward’s Syndrome (Trisomy 18)
A child presents with,
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis.
What is the likely genetic condition?
Noonan Syndrome
A child presents with
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
What is the likely genetic condition?
William’s Syndrome
Which heart murmus is associated with Turner’s syndrome? (45XO)
Ejection systolic murmur
Due to bicuspid aortic valve
Female with missing second sex chromosome.
A child presents with strange cry due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism (increased distance between body parts e.g. eyes).
What is the likely genetic condition?
Cri du chat
(Chromosome 5p deletion)
True or false, SSRIs are associated with hyponatraemia?
True
True or false, antidepressants should be continued for 6 months after symptom resolution to reduce risk of relapse?
True
True or false, SSRIs can increase the risk of congenital heart defects if used during pregnancy?
True. In the first trimester. However, SSRIs are still used in pregnancy with caution.
What is the most common cause of sudden, painless loss of vision in patient’s with Marfan’s syndrome?
Lens dislocation
A patient requires emergency contraception. They have asthma. She doesnt want a coil. Which of Levonorgestrel or Ullipristal (EllaOne) should she be given?
Levonorgestrel is better (must be taken within 3 days (72hrs)
EllaOne can exacerbate asthma.
Must be taken within 5 days (120hrs).
The IUD can also be used. Must be given within 5 days or 5 days after the likely ovulation date.
In a child 5-16yo with asthma. If SABA, LTRA and Low dose ICS arent working, what do you do?
Stop LTRA and trial LABA e.g. salmeterol.
If that doesnt work, swap the (ICS+LABA) for MART (maintenenace and reliever e.g. Fostair, or Symbicort).
If that doesnt work then switch the MART to moderate steroid MART and then high dose steroid MART.
An 8-year-old boy who is known to have asthma is reviewed. His current treatment is a salbutamol inhaler as required and beclometasone inhaler 100mcg bd. Despite this, he regularly requires salbutamol for exacerbations and suffers with a night time cough.
Following NICE guidance, what is the most appropriate next step in management?
Trial LTRA
True or false, rheumatoid factor is associated with a worse prognosis and more severe form of rheumatoid arthritis?
True
What is a serious complication of Kawasaki disease? What investigation must you therefore do?
Coronary Artery Aneurysm
Echocardiogram
How do you treat hypoglycemia in the conscious and unconscious patient?
Conscious and alert then oral glucogel.
Unconscious or not able to tolerate oral medication. Then IM glucagon or IV 20% Glucose.
What is Kawasaki disease? How is it managed?
Vasculitis presenting with:
High-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
Treatment is high dose aspirin (one of the few indications for use of aspirin in children <16)
IV immunoglobulin.
It is importantto do an echocardiogram to rule out coronary artery aneurysm!
How do you manage SVT?
Vagal maneuvers
IV bolus Adenosine 6mg then 12mg then 18mg.
SVT characterised by sudden onset narrow complex tachycardia.
Which virus causes shingles? What is the treatment? What time-frame should it be treated?
Varicella Zoster
Oral antiviral e.g. oral famciclovir within 72hrs of start.
Remain infective until crusted over. Typically in 5 days.
A 5 year old presents with a limp. An Xray shows widening of the joint space, and flattening of the femoral head. What is the most likely diagnosis?
Perthes disease
Common 4-8 years old
Avascular necrosis of the femoral head, resulting in widening of the joint space and flattening of the femoral head on X-Ray.
It is 5x more common in boys.
A 5 year old child, has had a recent viral infection and is now complaining of unilateral hip pain. What is the most likely diagnosis?
Transient Synovitis
The most common hip problem in children. Common ages 2-10.
Typically presents after a viral infection.
An obese 10 year old presents with unilateral hip pain and reduced internal rotation of the hip in flexion. What is the most likely diagnosis?
Slipped Upper Femoral Epiphysis
A 15 year old presents with 3 joint pains which have lasted 5 months. What is the likely diagnosis?
Juvenile Idiopathic Arthritis
Typically multiple joints affected.
Must be <16 years old
JIA is associated with anterior uveitis
What secondary prevention treatment would you give a patient who has had a stroke (ischaemic)?
Aspirin 300mg
Clopidogrel
Statin (if Cholesterol >3.5)
Thrombolysis if within 4.5hrs and not contraindicated.
What is the difference between Bouchard’s and Heberden’s nodes? What condition are they associated with?
Osteoarthritis
Bouchard’s affect proximal IPJs
Heberden’s affect distal IPJs
What is the time window for thrombolysis for stroke?
Give two contraindications
4.5 hrs from onset give Alteplase or Tenecteplase
Pregnancy
Active bleeding
LP in last 7 days
Prev ICH
Seizure at onset of stroke
Intracranial Neoplasm
Uncontrolled HTN >200
Oesophageal varices
Stroke in prev 3 months
Traumatic brain injury in prev 3 months
What are the treatment doses for suspected meningococcal rash in children?
<1yr 300 mg Benzylpenicillin IM
1-10 600 mg Benzylpenicillin IM
>10 yrs 1.2 g Benzylpenicillin IM
True or false, morning stiffness which improves through the day is associated with Osteoarthritis?
False. Morning stiffness which improves is typical of rheumatoid arthritis.
How long should a patient be put on anticoagulants following a provoked or unprovoked VTE?
DOAC (Apixaban or Rivaroxaban) for 3 months if provoked.
3-6 months if provoked by cancer.
6 months if unprovoked. Then reassessed as to whether to continue for life.
When is it appropriate to use rapid tranquilisation?
If restraint is required for more than 10 minutes and the patient is a risk to themselves or others.
When would it be appropriate to refer a patient with T2DM for bariatric surgery?
If their BMI is >35 kg/m2
If a patient is not responding to metformin or gliclazide, what is the next step?
Pioglitazone
DPP-4 Inhibitor
SGLT-2 Inhibitor
You start with metformin + lifestyle. At this point the target is Hba1c of <48 mmol/mol (<6.5%)
Only add a second drug e.g. gliclazide (sulfonylurea) if Hba1c rises above 58 (7.5%). Then the target is 53mmol/mol (7.0%) as there is an increased risk of rebound hypoglycemia.
Hba1c should be reviewed every 3-6 months until stable then every 6 months.
A patient with T2DM who is on metformin has a QRisk of 15%. What is the best additional antidiabetic medication to add?
SGLT-2 inhibitor e.g. Dapagliflozin.
These are the best choice if the patient has a raised risk of CVD or existing CVD history. QRisk >10% would indicate this.
True or false, metofrmin should be titrated?
True. To reduce risk of GI distubance.
A patient has a Qrisk of 15%, what would be your initial treatment?
Artovastatin 20mg ON
How do you manage TIA/Stroke?
Thrombolysis within 4.5hrs if CT rules out haemorrhagic stroke.
If low risk ABCD 3 or less.
Aspirin 300mg OD 14days
Atorvastatin 40mg OD on-going
Clopidogrel 75mg OD to replace aspirin after 14 days and given life-long.
If high risk ABCS 4-7.
Immediate Clopidogrel 600mg + Aspirin 300mg.
Dual Antiplatelet Therapy (DAPT) of Clopidogrel 75mg and Aspirin 75mg OD for 21 days. Then Clopidogrel only 75mg OD on-going.
Atorvastatin 40mg OD on-going.
ACEi +/- Thiazide diuretic to lower blood pressureto < 130/80
What is the first line antihypertensive used in T2DM?
ACEi
ARB if Black/Afrocaribbean
Target:
140/90 (<80yrs)
150/90 (>80yrs)
What is the treatment for listerosis in pregnancy?
Ampicillin or penicillin G and gentamicin.
Listerosis is 20x more common in pregnancy
How do you diagnose listeria in pregnancy?
Bloods test for listeria IgM
NB Listeria is Gram +ve
Differentiate the following:
Gallstone ileus
Ascending Cholangitis
Biliary Colic
Acute Cholecystitis
Acute Pancreatitis
Pancreatic Cancer
Ascending cholangitis typically triad of RUQ pain, Jaundice and Fever (Charcot’s Triad)
Gallstone ileus typically presents with abdominal distension as it is an obstruction.
Pancreatic cancer presents as a painless jaundice typically.
Acute pancreatitis presents as severe epigastric pain with vomiting.
Biliary Colic presents as on/off RUQ pain related to eating.
Acute Cholecystitis is similar to biliary colic but is more persistent and often radiates to shoulder.
How do you differentiate cephalohaematoma from subgaleal bleeds or caput succedaneum?
Cephalohaematoma is a bleed/swelling on a baby’s head secondary to labour/extraction with forceps. Typically on the parietal bone. Unlike the others, it does not cross suture lines. It can take months to resolve.
What cancer is common in patients who have had renal transplant and why?
Squamous Cell Carcinoma
Immunosuppression and sun exposure.
True or false, cushing’s is associated with Hyperkalaemic, metabolic acidosis?
False.
HypOkalaemic, metabolic acidosis.
What is the gold standard test for Cushing’s?
Low-Dose Dexamethasone Suppression test.
In patients with Cushing’s their Cortisol spike in the morning is not suppressed by Dexamethasone.
A woman has a +ve HPV smear result and shows dyskariosis on examination? What is the next step?
Colposcopy referral
Any woman with an abnormal cytology and +ve HPV should be referred.
If the smear was inconclusive then a repeat should be offered in 3 months.
If the smear was +ve but cytology is normal then repeat screen in 12 months.
True or false, infertility is the most common complication of PID or Gonorrhoea infection
True
What pathogen causes Gonorrhoea? What is the investigation? What is the treatment?
Gram-negative diplococcus Neisseria gonorrhoeae.
Nucleic Acid Amplification Test (NAAT) or by Culture (swab/MSU)
IM Ceftriaxone (due to increased resistance)
PO Cefixime or Azithromicin if needle-phobic.
Which antibody test is done for Sjogren’s? What is a treatment?
Anti-Ro
Artificial tears
Pilocapine (may increase saliva)
What is the treatment for CIN? When should a follow up test of cure (TOC) screen be done?
Cervical Intraepithelial Neoplasia
CIN1 - <1/3 thickness of epithelium
CIN2 - 1/3 to 2/3rd thickness
CIN3 - >2/3rd thickness
Large LoopExcision of Transformational Zone (LLETZ) is the standard treatment.
TOC review 6 months after.
What is the test for scleroderma?
ANA (Antinuclear Antibody) Test
What is Schirmer’s test?
Test in Sjogren’s (lymphocytic infiltration of exocrine glands)
Dry mouth
Dry eyes
Arthralgia
Vaginal dryness
Filter paper to conjunctiva to assess tear production
What would you expect to see on blood screening for sarcoidosis?
Elevated ACE
Elevated Calcium
Low WCC
SOB and persistently dry cough
Bilateral hilar lymphadenopathy is most common XR finding.
When is cervical smear screening done?
6 months before turn 25
25 - 49 every 3 years
50 - 64 every 5 years
65+ only if recently abnormal test
What is the risk of unopposed oestrogen in HRT?
Endometrial cancer
Differentiate these strokes:
Lacunar
Posterior Circulation
Total Anterior Circulation
Partial Anterior Circulation
Lacunar: Pure sensory, Pure motor or mixed sensory/motor only.
Posterior Circulation: LOC, Cerebellar/Brain stem signs, isolated Hononymous Hemianopia.
Total Anterior: Unilateral weakness of face, arm, legs, Homonymous Hemianopia, higher cerebral signs.
Partial Anterior: 2 of the above for Total.
NB: Higher cortical signs e.g. aphasia, agnosia, neglect, apraxia, or hemianopsia
What is homonymous hemianopia?
Loss of the same hemifield of vision in each eye.
Which pituitary hormone increases signalling menopause?
FSH
What is Argyll-Robertson Pupil response? What is the most common cause in the UK? What is a serious alternative cause?
Accommodation reflex present e.g. constricts on near vision.
Pupil reflec to light not present i.e. no change with light exposure.
Most common in Diabetes
Classically found in Neurosyphylis!
What nerve is affected in Bell’s palsy? What is the treatment? What is the recovery time?
7th cranial nerve
Prednisolone
4 months
NB: 15% have residual weakness if not treated.
If no improvement after 3 weeks of treatment then refer to ENT
Cause unknown. ? Herpes simplex
How does bacterial vaginosis present? What is the treatment?
Amsel’s criteria:
Thin, white discharge
Clue cells on microscopy: stippled Vaginal epithelial cells
pH > 4.5
Positive whiff test (addition of potassium hydroxide results in fishy odour)
PO Metronidazole
If aspirin and clopidogrel are contraindicated, what antiplatelet could you give for a stroke patient?
Modified Release Dipyridamole
What vaginal infection is associated with Clue cells on mincroscopy?
Bacterial Vaginosis
Green vaginal discharge with ‘strawberry cervix’ suggests what diagnosis? What is the treatment?
Trichomonas vaginalis
Oral metronidazole
What is the treatmentfor gonorrhoea?
IM ceftriaxone 1g single dose
A pregnant woman develops an itchy rash and stretch marks over her abdomen during her third trimester. What is the likely diagnosis?
Polymorphic eruption of pregnancy. No treatment is needed.
A woman presents with cottage cheese discharge, vulvitis, and itch? What is the likely diagnosis and treatment?
Vaginal candidiasis
Oral Fluconazole
True or false, all oral antiglycemics should be continued around surgery?
True
Surgical patients may consume clear fluids up to 2 hrs prior to the operation. True or false, the following count as clear fluids: water, fruit juice without pulp, coffee or tea without milk and ice lollies?
True
True or false, depression is the most common mental health disorder associated with Parkinsons?
True. Occurs in ~40%
A 3 yr old with known eczema attends GP clinic with worsening rash spreading around his body (monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter), is not himself and has a temperatureof 39. What do you do?
Refer to hospital.
Sounds like Eczema herpeticum which is potentially life threatening and requires IV aciclovir. This is an HSV 1 or 2 infection which can take hold in patients with eczema.
A patient presents with fever, confusion, headache, vomiting and seizure. CSF shows raised lymphocytes, raised protein and normal glucose. What is the likely diagnosis? What treatment should be started?
Viral encephalitis
95% of encephalitis is caused by Herpes Simplex Virus
IV aciclovir
What is the triad of Parkinson’s features?
Bradykinesia
Rigidity (Lead pipe rigidity or Cogwheel rigidity)
Resting Tremor (pill-rolling; 3-5 Hz)
True or false, quinine can cause tinnitus?
True
What is the first line treatment for Parkinsons? How is it diagnosed?
What would you see in the substantia nigra?
Levodopa
Diagnosed clinically. However, if unclear then SPECT can be done.
Lewy Bodies (made of alpha synuclein)
What is pyoderma gangrenosum?
A rare skin ulceration on the lower legs associated with Ulcerative Colitis. Oral steroids is first line or other immune suppression.
What is the difference between Lichen planus and lichen sclerosis?
Lichen planus is a purpuric, polygonal rash on flexor surfaces, genitals and oral mucosa.
Liceh sclerosis affects older women and men and involves white patches on the vulva or penis.
A 34-year-old man presents with an itchy rash on his genitals and palms. He has also noticed the rash around the site of a recent scar on his forearm. Examination reveals papules with a white-lace pattern on the surface. What is the diagnosis? How is it treated
Lichen Planus
Planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae (white lines) over surface. Oral involvement common
Koebner’s phenomenon is a rash caused by skin injury.
Oral steroids
True or fale, scabies is most itchy at night time? What is the treatment
True.
Sarcoptes scabiei
Trail burrows often inbetween webbed spaces of hands.
Permethrin cream
A self-limiting rash thought to be viral in origin. The initial presentation is often a single pink or red oval ‘herald patch’, followed by the development of smaller similar lesions arranged along skin cleavage lines creating a ‘Christmas tree’ pattern on the trunk. What does this describe?
Pityriasis rosea
Of Anti HBs and HBsAg which implies seroconversion i.e immunity and which implies active infection
Anti HBs = immunity
HBsAg = active infection
‘HBs what a breeze, HBSag what a drag!’
Teue or false, back pain in <20 year old is a red flag?
True
Back pain Red Flags :
<20 or >50
Previous malignancy
Systemically unwell
Trauma
Night pain
A 30 year old presents with back pain described as ‘aching/crawling’ which affects both legs and is made worse by walking and better by crouching or sitting down. Clinical examination is otherwise normal. What does this suggest?
Spinal stenosis
Needs an MRI
How do hormonal contraceptives work?
COCP / Oestrogen inhibit oulation
Progesterone thickens cervical mucus
What is the gold standard test for renal colic?
Non-contrast CT KUB
