MSRA Flashcards
Criteria for AKI
Rise in creatinine of 26µmol/L or more in 48 hours OR
>= 50% rise in creatinine over 7 days OR
Fall in urine output to < 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR
>= 25% fall in eGFR in children / young adults in 7 days.
Diabetic drug causing SIADH
SU - gliclazide, end in -ide
Night blindness, tunnel vision, black pigmentation in peripheral retina
Retinitis pigmentosa
Most common nephritic syndrome
IgA nephropathy - presents following upper respiratory tract infection - treat proteinuria with ACEi
Lump in ear canal associated with cold water swimming
Osteoma
First line neuropathic pain killers
Pre-gabalin, amitriptyline, gabapentin, duloxetine
Cushings triad
Irregular breathing, hypertension, bradycardia
Example of dopamine agonist
Ropinirole
What can help with rigidity, tremors in particularly in drug induced Parkinsonism
Procyclidine
When to treat campylobacter
> 8 stools per day, high fever, lots of blood in stool, last >1w
Amiodarone monitoring
Liver and thyroid function tests on a 6 monthly basis. Chest x-rays should be performed prior to starting
Stemi criteria on ECG
M, <45 - > 2.5mm in V2-3
M, >45 - > 2mm in V2-3
W - > 1.5mm V2-3
Elsewhere >1mm
New LBBB
What is used to treat bacterial conjunctivitis in pregnant woman
Fusidic acid
C.diff mx
- first-line therapy is oral vancomycin for 10 days
- second-line therapy: oral fidaxomicin
- third-line therapy: oral vancomycin +/- IV metronidazole
- If recurrent episode within 12w - oral fidaxomicin, after 12w oral vancomycin
- Can consider faecal transplant if 2 or more episodes
Obstruction of what artery can cause 3rd degree heart block
R coronary artery
How soon before surgery to stop COCP
4w
Cause of persistent ST elevation post MI with no chest pain
Ventricular aneurysm
Post MI - acute heart failure associated with a pan-systolic murmur
VSD
Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness that turns bloody after several days
HUS - most likely triggered by E.coli
Most common cause of acute renal failure in kids
Retinal haemorrhages, subdural haematoma and encephalopathy in baby
Shaken baby
What to do if high risk tetanus exposure and had vaccines >10yr ago or unknown vaccination history
Give vaccine + tetanus immunoglobulins
M/F ages for precocious puberty
F - 8yo
M - 9yo
Itching after hot shower
Polycythemia vera
Cough, haemoptysis many years after TB - air crescent sign on CXR
Aspergilloma
First line tx for scalp psoriasis
topical potent corticosteroids. If no improvement in 8w try topical vitamin D
QTC changes with hypo/ hypercalcaemia
Hypo - Prolonged QTC
Hyper - Short QTC
Cluster headache tx
100% O2 and SC triptan, Verapamil used as preventative.
Obstetric cholestasis tx
- ursodeoxycholic acid is used for symptomatic relief
- weekly liver function tests
- women are typically induced at 37 weeks
What medication causes dupuytrens
Phenytoin
Tender, oedematous skin with haemorrhagic blebs and bullae. Crepitus may present on palpation
Gas gangrene - C perfringens
How long to wait for LP to detect xanthachromia
12 hours
Treatment for SAH vasospasm
Nimodipine
Small irregular pupil that do not react to light but accommodate normally
Argyll Robinson pupil
Baby with double bubble sign
Duodenal atresia
ABPI cutoff for PVD
<0.9
What is somatisation disorder
person experiences excessive distress due to a variety of physical symptoms, with no identifiable cause.
What does antipsychotic in elderly increase risk of
Stroke
What abx increases risk of Achilles tendon rupture/ tendinopathy
Ciprofloxacin/ levofloxacin
SSRI of choice in children and adolescents
Fluoxetine
Older person, bowing of legs, bone pain, isolated ALP rise
Pagets - bisphosphonate
Osteomalacia has bone pain, fracture, proximal myopathy, low vit D level
IM adrenaline dose anaphylaxis
0.5ml 1in1000
First line management for immune thrombocytopenia pupura
Oral prednisolone
Triad of normal pressure hydrocephalus
Ataxia (wide shuffling gait), memory problems, urinary incontinence
What can occur after E coli
HUS
What can occur after Campylobacter
Guillain Barre
Most common cause of death in those with CKD on dialysis
Ischaemic heart disease
What drug reduces the effectiveness of clopidogrel
PPI (omeprazole)
Anti Jo/ anti Mi
Polymyositis/ dermatomyositis
Anticentromere
limited systemic sclerosis
Antihistone
Drug induced SLE
Anti-Scl70, anti topoisomerase 1
Diffuse systemic sclerosis
Anti ro/ Anti la
Sjogrens
Anti Smith/SM, Anti DS DNA
SLE
Treatment for headlice
Dimeticone
Normal D-dimer level
0.5 or less
High fever for 3-4 days followed by rose coloured non itchy macular rash
Roseola infantum - sixth disease
What childhood rash can precipitate an aplastic crisis
Slapped cheek - parvovirus
Unsteady, <20, East Asian or American Indian
Friedereich’s ataxia - autosomal recessive
Peak age for kids with bronchiolitis
3-6m
What drug can mask warning signs for hypoglycaemia
B-blocker
What organism causes epiglottitis, sign on X-ray and management
Haemophilus influenza type B, thumb sign, ceftriaxone, steroids
What is dissociative fugue
memory loss and ends up in an unexpected place
What must you do for all babies in breech position after 36w
US hip at 6w
tietze vs costochondritis
tietze is swelling
what is the max permitted dose of lidocaine
3mg/kg or 7mg/kg with ephedrine
what is Asherman’s syndrome
adhesions within uterus causing amenorrhoea - occurs after dilation and curretage for miscarriage
bg of eczema, blistering rash, fever - cause, mx
Eczema herpeticum - admit to hospital, may need IV acyclovir
Drugs that increase lithium levels
NSAID, ACEi, Metronidazole, diuretics (Thiazides) - treat with IVI, dialysis
Benign fibrous skin lump. small, rubbery, usually solitary- dimple when pinch
Dermatofibroma
Raised purple plaques/ papule, HIV
Kaposi Sarcoma
HRT contraindications
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Reed-sternberg cells
Hodgkins lymphoma
Alcohol causes LN pain - cause
Hodgkins lymphoma
Raised WCC, splenomegaly causing early satiety, abdomen pain - cause?
CML - philadelphia chromosome 9,22
confusion, ataxia, nystagmus/ ophthalmoplegia (abducens N palsy)
Wernickes
Dementia, ataxia, urinary incontinence
normal pressure hydrocephalus
When to do urine antigen tests in pneumonia
If suspect legionella or pneumococcal
Headache, diurnal fever 1w after returning from Africa
Malaria
Bone/ spine pain, proximal muscle weakness and hypocalcaemia
Osteomalacia
what shouldn’t be given prior to thiamine replacement
IV glucose
Main complication of neonatal jaundice
Kernicterus
Breast lump that changes size with periods
Breast cyst
Bleeding, mildly prolonged APTT, normal PT - cause and tx
Von willebrands
- tranexamic acid
- desmopressin
- platelet transfusion
What organism causes hand foot and mouth
Coxsackie
What organism causes chancroid
Haemophilus ducreyi
Drugs that worsen glycemic control
Beta blocker, thiazide, furosemide, antipsychotic, steroids
infections that cause bloody diarrhoea
salmonella, e.coli, entamoeba, campylobacter, shigella, yersinia enterocolita
Diarrhoea, followed by liver failure/ abscess - causative organism
entamoeba histolytica
Old, weight loss, fear of eating due to abdominal pain - cause?
Chronic mesenteric ischaemia
Raised calcium, low phosphate, normal PTH - cause
Primary hyperparathyroidism - most common cause of hypercalcaemia
SE of adenosine
Bronchospasm, flushing, chest pain
Amiodarone SE
Pulmonary fibrosis, grey skin discolouration, corneal deposits, altered taste
Digoxin SE
dizziness, blurred/yellow vision, arrhythmia, insomnia, gynaecomastia
Headache, flu like illness, rising and falling fever following travel - how to confirm?
Malaria - Giemsa thick and thin peripheral blood films
flushing, high fever, skin mottling, rash over face, thorax, flexors, abdo pain and hemorrhagic manifestations. Hx of recent travel - cause?
Dengue fever - serology to diagnose
What is pellagra, how does it present, what deficiency causes it and what type of tumour is it associated with
Deficiency of niacin (vit D3) causes dermatitis, diarrhoea, dementia. Associated with carcinoid syndrome due to neuroendocrine tumour - most commonly in GI tract
Neuroendocrine tumours can present with flushing, wheeze, diarrhoea
Delayed puberty and reduced sense of smell
Kallmans syndrome
Formula for plasma osmolarity
2xNa + Glucose + urea
Quick forming red lump with keratin, dip in centre
Keratoacanthoma
Hepatomegaly, diabetes and tan coloured skin
Haemochromatosis - autosomal recessive - diagnosed with raised transferrin saturation >45%
Most common inherited thrombophilia
Factor V leiden
Overdose causing Hyperventilation, nausea, confusion, tinitus and mild deafness - what drug and how to treat
Aspirin overdose - urine alkalisation, dialysis
Failure to thrive, symmetrical poor weight/ length, umbilical hernia
Congenital hypothyroidism
Poor height in child, subcut fat around trunk, immature face - cause?
Growth hormone deficiency
Patient on ITU with meningococcal septicaemia - develops adrenal insufficiency - cause?
Waterhouse friderichsen syndrome
Patient has hypokalaemic alkalotic hypertension - not on any diuretics - cause?
Conns/ primary aldosteronism
Widespread pain on both sides of body, upper and lower for at least 3m, fatigue, multiple localised tender areas (11 of 18) - cause
Fibromyalgia
How long after conception does a pregnancy test become positive
9 days
Thyroid lump in upper lobe, facial flushing, diarrhoea, raised calcitonin - cause
Medullary thyroid cancer
Slow growing painless irregular thyroid lump, LN spread, previous irradiation - cause?
papillary thyroid cancer
Most common cause of sterile pyuria
Partially or recently treated UTI - it is presence of leukocytes in urine without demonstrable infection
Pinworm infection - presentation and treatment
Itchy anus, worse at night - mebendazole
Skin pigmentation, weight loss, hypotension - cause
Addisons
Bilateral hydronephrosis with drawing together of ureters in midline - cause
Retroperitoneal fibrosis -
How to treat hypercalcaemia
IV NACL, bisphosphonates
Common causes of hypocalcaemia
Renal failure, vit d deficiency, acute pancreatitis, tumour lysis, parathyroid gland removal
common drugs that cause erectile dysfunction
Beta blocker, thiazides, finasteride, spironolactone, SSRI
Mild anaemia, low MCV and normal ferritin - cause
Thalassaemia trait
Low renin, hypertension, low potassium - cause
Conns syndrome
How to differentiate bowel obstruction from ileus
Obstruction - high pitch tinkling bowel sounds, ileum - absent bowel sounds
Pain and swelling in one hand - associated with skin atrophy/ skin colour changes
Reflex sympathetic dystrophy (regional pain syndrome)
Cause of bright green on Congo red staining
Amyloidosis - extracellular deposition of abnormal proteins
Measles - cause and presentation
paramyxovirus - prodromal conjunctivitis, coryza, cough - then develops rash starting on face - white koplik spots on mucosa
How to manage potential scaphoid fracture
Cast anyone with pain in snuffbox - re Xray at 7-10 days
Young person with muscle wasting in hands, loss of pain and temperature sensation over arms and trunk in shawl distribution
Syringomyelia- fluid filled cyst in spinal cord
Difficulty chewing, swallowing and slurred speech - associated with MS, MND
Pseudobulbar palsy
When to not use DOAC
eGFR <15-30
Pregnancy or breast feeding
Hepatic impairment - transaminase >2x ULN or bilirubin >1.5x ULN
Mechanical heart valve
Weight >120kg
When to commence metformin and SGLT2
If known CVD or Risk >10%
20-30 yo, difficulty whistling and sucking through straw, winging of scapula. Eyes remain open when asleep.
facioscapulahumeral muscular dystrophy
Eye deviated upwards, difficulty going downstairs - which cranial nerve
IV - trochlear nerve
Headache associated with sexual activity
Coital cephalgia
If have asbestosis - what cancer most at risk of?
Lung cancer - not mesothelioma (is a lot more rare)
Pizza fundus - flame and blot haemorrhages - patient has HIV - cause
Chorioretinitis - due to CMV retinitis (are other causes)
What condition does Keratoconjunctivitis sicca occur in
Sjogrens
What genetic condition pre-disposes to COPD in younger individuals
Alpha-1-antitrypsin deficiency
Anaemia, bleeding/ bruising and recurrent infections in child - may also be bone pain, splenomegaly
ALL
Bilateral progressive symmetrical weakness, increased protein, normal cells in CSF
GBS
Recurrent rest infections, diarrhoea, sinusitis - need to warn Dr if have blood transfusion or IVIG
IgA deficiency
Dermatitis, recurrent infections of all types (particularly candida, otitis media/ pneumonia and viral infections), chronic diarrhoea, absent or small tonsils/ LN and failure to thrive
SCID - treat with bone marrow transplant
What is the cause of hereditary angioedema
low plasma protein c1 inhibitor - allows activation of complement pathway
pregnancy - severe abdominal pain, bruising, swelling after coughing
epigastric vessel rupture - rectus muscle haematoma
Repetitive, involuntary, purposeless movements
Tardive dyskinesia
what test to do for acromegaly
insulin like growth factor 1 levels
What blood pressure medication limits statin to 20mg
Amlodipine
Serotonin syndrome presentation
Neuromuscular excitation, altered mental status, autonomic effects
delusion that are loved by celebrity
De clerambault syndrome
Delusion when identifies strangers as close friend or family member
Fregoli syndrome
Delusion family member has been replaced by identical stranger
Capgras syndrome
Delusion part of body has disappeared
Cotards syndrome
Flushing, dizziness, splenomegaly, itching worse after hot shower
Polycythaemia vera - causes thrombosis
what electrolyte change does rhabdomyolysis cause
Hyperkalaemia
3 most common causes of late onset HAP
Pseudomonas aeruginosa, staph aureus, klebsiella
Common causes of early onset HAP (<5d)
Strep pneumoniae, haemophilus
When to do urine antigen testing in pneumonia
If legionella or pneumococcal pneumonia suspected
What organism that causes CAP is associated with bulls myringitis
Mycoplasma pneumonia
Most common cause of SIADH
Idiopathic
when to do knee X-ray in trauma
Age > 55
Isolated patella tenderness
Tenderness of fibula head
Inability to flex to 90 degrees
Inability to weight bear
Child < 2 presents with failure to pass meconium within 48hrs, longstanding constipation, abdominal distension and vomiting
Hirschprungs disease
What pain killer can cause short, self limiting tonic clonic seizures
Tramadol
What is prinzmetal syndrome
Cyclical angina at rest due to vasospasm also known as variant angina
First line treatment for biliary colic
NSAID e.g. naproxen
When is lithium contraindicated
Cardiac disease
Renal failure
Addisons, low sodium
untreated hypothyroidism
1st trimester pregnancy
Breastfeeding
X linked condition causing sensorineural deafness at birth, haematuria, eyes abnormalities, pyelonephritis and renal failure
Alport syndrome
Foreign travel, abdominal pain, bloating, constipation, fever, rash on abdomen - cause
Salmonella typhi (typhoid) - diagnose with blood culture - treat with ciprofloxacin
watery nasal discharge that turns purulent and bloody. Swelling of lymph nodes in neck causing bulls neck. Inflamed pharynx with grey membrane
Diphtheria - treat with antitoxin and IV ben pen for 10-14d
Intestinal polyps and pigmented freckles on the lips, face, palms and soles. - cause?
Peutz-jeghers syndrome
Aggressive rapidly growing lung cancer associated with paraneoplastic syndromes
Small cell lung cancer - SIADH, ACTH
red/purple bumps that become Yellow brown plaque on shin of patient with diabetes - surrounded by telengectasia
Necrobiosis lipoidica - can ulcerate and transform to SCC
Small red/ skin colour bumps on wrist, hands, ankles - form rings/ circles
Granuloma annulare is associated with thyroid disease, hyperlipidaemia and diabetes
yellow/white papule/pustules with erythematous base on 3d-2w old baby who is otherwise well - cause
erythema toxic neonatorum
When Is pericardial friction rub best heard
Left lower sternal boarder, sat up during expiration
medical management of ectopic
Methotrexate
Termination of pregnancy drugs
Mifepristone and 48hr later misoprostol
Give anti-D if after 10w if rhesus D negative
Multilevel pregnancy test that detects HVG level should be done 2w after
lateral epicondylitis - common name
Tennis elbow
Diagnosis and treatment of scarlet fever
antistreptolysin antibodies, pen V for 10 days
antistreptolysin also raised in post strep glomerulonephritis
Carbamazepine - what need to monitor and why - what drug need to be careful about interaction with
Monitor FBC as can cause aplastic anaemia - careful about interaction with COCP
How to treat supra ventricular tachycardia
Vagal manœuvre, if not then adenosine 6mg, 12mg, 18mg - 1to 2 min intervals
Condition causing rash and febrile seizures
Roseola infantum
Patient with arthritis, diabetes develops lump behind knee after twisting ankle
Bakers cyst
Yellow waxy rash on feet of people with reactive arthritis
keratoderma blenorrhagica
Pregnancy glucose diagnostic levels - fasting and 2hr, treatme
Fasting 5.6, 2hr 7.8
Fasting > 7 start insulin
Fasting 5.6-7 - 1-2w diet and exercise, if no improvement then commence metformin
What drug can cause anal ulceration
Nicorandil
Older man with bone pain, isolated raise ALP, bossing of skull and bowing of legs - cause and tx
Pagets, tx = Bisphosphonate
Dose of atropine for bradycardia
0.5-1mg IV repeated every 3-5min to max 3mg
What organism causes peritonsillar abscess
Strep pyogenes - treat with benpen and metro
Antepartum haemorrhage after artificial rupture of membranes - cause
Vasa praevia
Which diabetic drug can cause B12 deficiency
Metformin
what drug can interact with azathioprine to cause myelosupression?
Ace inhibitor
CKD eGFR definition
eGFR < 60 on 2 or more occasions separated by 90 days
Child pulling on ears, red swollen bulging tympanic membrane - cause?
Otitis media
Most common nephrotic syndrome in adults and kids
Adult: membranous, kids: minimal change disease
Most common cause of nephritic syndrome
IgA
White lump in external auditory meatus, hearing loss, ear pain, associated with cold swimming
Osteoma
when and how to treat campylobacter infection
> 8 stools per day, high fever, blood in stool, >7d length - clarithromycin
MI ECG definition
2.5mm V2-V3 in men <40, 2mm >40, 1.5mm women
1mm all other leads
New LBBB
what diuretics can precipitate gout attack
Thiazide like diuretic, furosemide
Treatment for breast candida
Topical miconazole applied to nipple and baby mouth after feeding
When to stop COCP prior to surgery
4w
When can start COCP post partum
6w
Cephalohaematoma vs caput succadeneum
Cephalo - forceps delivery, not present at birth, not cross suture lines
Caput - present at birth, crosses suture lines - associated with prolonged labour
Definition of hypertension in pregnancy
After20w: > 140/90
rise >30 systolic or >15 diastolic
Contraindications to External cephalic version and when to perform
Perform if breech after 36w
Contraindications:
* where caesarean delivery is required
* antepartum haemorrhage within the last 7 days
* abnormal cardiotocography
* major uterine anomaly
* ruptured membranes
* multiple pregnancy
punctate fluoroscein staining of cornea - cause
Dry eye
Cervical screening
25-49 every 3 years
50-64 every 5 years
Tender oedematous skin, hemorrhagic blebs and bullae, crepitus on palpation - cause
Gas gangrene - Clostridium perfringens
what meds contraindicated in HOCM
ACEi, Nitrates, Ionotropes
Meds for PVD
Statin and clopidogrel
How long after SAH does xanthachromia take to develop. What drug is given in SAH to prevent vasospasm
12 hr, nimodipine
Treatment for whooping cough
<6m old - admit
If <21d Clarithromycin - treat family, exclude from school for 48hrs after abx
DKA diagnostic criteria and mx, resolution criteria
Glucose >11/ known diabetes, pH <7.3, Ketones >3 or ++ on dipstick, bicarb <15. commence insulin at 0.1 unit/kg/hour. Once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime. Replace K+ (>5.5 nil, 3.5-5.5 40mmol/L in each bag, <3.5 - ITU). Fluid: 1,2,2,4,4,6. Resolution when pH >7.3, Ketones <0.6, bicarb >15.
Diabetic with shiny, painless areas of yellow/red/brown skin typically on the shin. often associated with surrounding telangiectasia
Necrobiosis lipoidica
Causes of postpartum haemorrhage and definition
> 500ml blood loss
Uterine atony
Trauma - tear
Tissue - retained placenta
Thrombin - clotting disorder
PPH management
Bimanual compression
IV oxytocin
Ergometrine - not give if HTN
IM carboprost - not give if asthma
Rectal misoprostol
Balloon tamponade
Common cause of recurrent UTI in children, how to diagnose
Vesicoureteric reflux - micturating cystourethrogram
When to give dexamethasone in meningitis?
- frankly purulent CSF
- CSF white blood cell count greater than 1000/microlitre
- raised CSF white blood cell count with protein concentration greater than 1 g/litre
- bacteria on Gram stain
Cut off for normal ABPI
<0.9 = PVD
Pain when walking, improves when sitting or leaning forward. No pain when walking up hill - cause
Canal stenosis
If similar symptoms but normal straight leg raise = facet joint disease
hormone levels in premature ovarian failure - how to test is ovulating
Oestrogen/ progesterone Low
FSH/LH high
Mid luteal progesterone (7d prior to period)
white cyst in mouth, mistaken for tooth - name?
Epsteins pearl - spent resolve
Fever, LUTS, lower abdominal/ back pain, urethral discharge and pain on ejaculation - cause and tx
Acute prostatitis - Ciprofloxacin 500mg BD for 14d
Bleeding, bruising and non blanching petechial rash post viral illness - cause (mainly in kids)
Immune thrombocytopenic purpura
Safety net time period for forgetting POP
3 hours unless taking desogestrel which is 12 hours
Wide (>120ms) QRS in V1
LBBB
Abdominal distension, constipation, fever, pain, rose coloured spots on abdomen - organism
Salmonella typhi
Treatment for latent TB
3m of isoniazid and rifampicin or 6m rifampicin
Treatment of hypercalcaemia
1st - IV NaCl
2nd - Biphosphonate
If sarcoid - steroid
Drugs that cause bulls eye retinopathy
Chloroquine and hydroxychloroquine - can also cause whorl like corneal deposits
What does CHADSVAS stand for
Congestive HF 1
Hypertension 1
Age - >75 (2), 65-74 (1)
Diabetes 1
Stroke/ TIA/ VTE (2)
Vascular disease (1)
Sex - female (1)
2 or more anticoag
Male 1 - consider anticoagulant
Female 1 - do not offer
What electrolyte can show kidney disease is chronic
Hypocalacaemia - due to reduced active Vit D
Graves disease, orange peel skin lesions - name
pretibial myxoedema
Physical developmental milestones when to refer
Baby should be able
- to sit at 7-8 months refer if not able at 12m
- to walk at 13-15m, refer if not able at 18m
- Refer if unable to smile at 10w
How to treat chlamydia in pregnancy
Azithromycin, erythromycin or amoxicillin
What additional drug should those having a MI due to cocaine have - dilated pupils, hypertonia and hyper-reflexia
IV benzo and GTN
Reduces vasospasm which is the cause of MI
Bishop score and induction
Bishop <6
- vaginal prostoglandins or oral misoprostol
- mechanical e.g. balloon catheter
Bishop >6
- Amniotomy and IV oxytocin
Endometrial cancer RF
nulliparity
early menarche
Late menopause
Unopposed oestrogen
tamoxifen
PCOS
Diagnostic values for gestational diabetes - also targets
- fasting glucose is >= 5.6 mmol/L, or
- 2-hour glucose level of >= 7.8 mmol/L
- If fasting >7 go straight onto insulin
Targets
- Fasting 5.3
- 1 hr post meal 7.8
- 2 hr post meal 6.4
What antibiotic do you need to stop statin whilst taking
Erythromycin, clarithromycin
Centor scoring (out of 4) - when to give abx?
Fever
Tonsilar exudate
Tender lymphadenopathy
Absence of cough
Give abx if >3
At what age is intermittent squint normal
<3m
What meds can reduce levothyroxine absorption so should be taken 4hr apart
Iron and calcium carbonate
Neurosyphilis/ DM, small irregular pupil that accommodates but not react to light
Argyll-robinson pupil
neonatal resp distress syndrome - cause, how can be presented, what can be given to wean from ventilator
Lack of surfactant, give steroids to mother, caffeine can help wean from ventilator
Overdose, hyperventilations, sweating, tinnitus - cause and tx
Aspirin overdose - urine alkalisation, haemodialysis.
Baby 1-2m old presents with episodes where turns blue, tachypnoeic and faint - cause, tx
Tet spell - caused by tetralogy of fallow - treat with beta blocker
Child: Pallor, dizziness, frequent infections, bruising, fever, bone pain - cause
Acute lymphoblastic leukaemia - all 3 cell lines involved
- leukopenia
- thombocytopenia
- Anaemia
what can be used to ease pain associated with constricted pupil in anterior uveitis
Cyclopentolate
Also treat with steroid drops
sharply defined, ragged, painful ulcer on genitals with undermined border and tender LN - cause
Chancroid - Haemophilus ducreyi
Common ph/ electrolyte disturbance in cushings syndrome
Hypokalaemic metabolic alkalosis
Red eye, gritty foreign body sensation, photophobia, hypopyon - cause and tx
Keratitis (staph or pseudomonas in contact wearer), topical ciprofloxacin, cyclopentolate for pain relief
Overgrowth of what bacteria causes BV
Gardnerella vaginalis
How to differentiate IgA and post strep glomerulonephritis as causes of nephritic syndrome (haematuria, hypertension, oliguria)
IgA - 1-2d post, strep 1-2w
1st line treatment for CML
Imatinib
Cutoff for cup disc ratio being abnormal
0.7 (0.4-0.7 normal)
Intense itchy, burning blisters/ vesicles on palms - worse in hot sweaty environment
pompholyx eczema - emollient, avoid irritants and potent steroids
pustules on palms and feet with thick red scaly skin and hx of psoriasis
palmoplantar pustulosis
definition of neutropenic sepsis
Neutrophil <0.5, Temp >38
newborn child with dry erythematous rash on scalp with yellow scale
Cradle cal (seborrheic dermatitis) - emollient, reassurance, can consider imidazole cream
Second line gout urate lowering therapy
Febuxostat
RUQ pain in patient with history of chlamydia/ gonorrhoea
Fitz - Hugh- Curtis syndrome
- scar tissue and peri-hepatic adhesion formation
What diabetic med C/I in HF
Pioglitazone
Xray findings in child with surfactant deficiency
Ground glass
Only drug that prolongs survival in MND
Riluzole
May eventually require BiPAP/ PEG
Raised C-peptide - T1 or T2
T2
Thiazide like diuretic - electrolyte disturbance
hyponatraemia, hypokalaemia, hypercalcaemia
What diabetic drug increases risk of bladder cancer
Pioglitazone
what antimalarial can cause anxiety, depression
mefloquine
papular lesions on back of hands, hyper pigmented and depressed centrally
Granuloma annulare
First line for raynauds
CCB e.g. nifedipine
What medication should be stopped when giving iodine containing contrast
Metformin
Heliotrope rash and gottrons papule are signs of what
Dermatomyositis
How to differentiate neuroleptic malignant syndrome and serotonin syndrome
NMS - muscle rigidity and normal pupils - treat with dantrolene
Serotonin - increased tone and dilated pupils
What lung cancers produce SIADH, ACTH, Lambert eaton, PTHrP
Small cell - SIADH, ACTH, Lambert
Squamous PTHrP
What to do if DVT US normal but D-dimer raised
Stop Interim anticoagulant and repeat scan in 6-8d
Acute dystonia vs akathisia vs tar dive dyskinesia
- acute dystonia - sustained muscle contraction (e.g. torticollis, oculogyric crisis). may be managed with procyclidine
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
Drug/ dose for trigeminal neuralgia
Carbamazepine 100mg BD
Pred course in asthma vs COPD
COPD 30mg 7d
Asthma 40-50mg for 5d
Best antiemetic for Parkinson’s disease
domperidone
Hb lower limit normal, very low MCV
Beta thalassaemia trait
Dexamethasone dosing croup
0.15 mg/ kilogram.
What ligament is injured in a ankle inversion injury?
Talofibular
lymes disease management
Doxycycline
Raised LFTs and ferritin in patient with diabetes
Haemochromatosis
Liver, transaminases in non-alcoholic fatty liver disease and alcoholic disease
ALD AST>ALT
NAFLD ALT>AST
Small painless lesion that forms, and heals within few days, swollen LN, adenopathy and proctocolitis
Lymphogranuloma venerum
What antibiotic should be avoided when taking methotrexate
Trimethoprim and co-trimoxazole
How long after taking methotrexate, should men and women wait to get pregnant
6m
1st line mx of dermatomyositis
steroid
What drug should be given before for fibrinolysis to prevent clotting
fondaparinux
anticoagulant used during PCI
UFH with bailout GPI
Chalky white plaque on tympanic membrane
tympanosclerosis = calcification due to repeat/ chronic infections
How to convert oral to SC morphine dosing
divide by 2
screening tool for postnatal depression
Edinburgh scale
Name of bulls eye rash with tic bite
erythema migrans
First line treatment for prolactinoma
Dopamine agonist e.g. bromocriptine, capergoline
HRT contraindications
Prev breast cancer or oestrogen sensitive cancer
History of VTE
Undiagnosed vaginal bleeding
Polygonal rash with white lines on surface
Lichen planus - treat with steroid
Can cause scaring alopecia
Fever >5d, red tongue, desquamation, conjunctival injection, lymphadenopathy - cause and treatment, necessary ix
Kawasaki - give aspirin, do echo
What abx can cause cholestasis
co-amox
Abdo pain, arthritis, haematuria, purpuric rash over buttocks
Henoch-schonlein purpura
Treatment of acute angle closure glaucoma - acute and definitive
pilocarpine (constricts pupil), IV acetazolamide (reduces secretions)
Laser peripheral iridotomy
Xray findings rheumatoid vs osteo
Rheum
- soft tissue swelling
- junta-articular osteoporosis
- joint space narrowing
- erosions
Osteo
- joint space narrowing
- subchondral cysts
- subchondral sclerosis
- osteophyte
eye pain/swelling, proptosis, rock hard eyelids, RAPD - cause and treatment
Orbital compartment syndrome - urgent canthotomy
what changes in eGFR/ creatinine are acceptable when commencing ACEi
25% drop in eGFR and 30% rise in creatinine
When is FIT testing offered
Every 2 years between 60-74
What conditions are associated with ankylosing spondylitis - all the A’s
Aortic regurgitation
Apical fibrosis
Ant uveitis
Achilles tendonitis
Amyloidosis
AV node block
CE
Management of POAG
360 selective laser trabeculoplasty
Prostoglandin analogue e.g. latanoprost
Beta blocker e.g. timolol
Carbonic anhydrase inhibitor e.g. brinzolamide
Sympathomimetic - brimonidine
Knee pain associated with prolonged kneeling
Prepatellar (more upright, housemaids) and infra patellar (more leant forward, clergyman) bursitis
Injury from anterior force hitting proximal tibia e.g. dashboard of car
Posterior cruciate ligament
At what point in pregnancy should nitrofurantoin be avoided
Near term
How long to treat UTI/ asymptomatic UTI in pregnancy
7d
<55 or diabetic what BP med
ACEi
> 55 or black what BP med
CCB
Dose of atorvastatin if known CVD
80mg
What electrolyte level should be measured following long lie/ rhabdomyolysis and is it high or low
Hypocalcaemia - binds to myoglobin when being excreted
Can also get hyperkalaemia from myocyte breakdown
Older female presents with petechia, purpura, epistaxis. FBC shows low platelets - cause and tx
Idiopathic thrombocytopenia purpura - treat with prednisolone, IVIG
Teenage girl or older person with arthritis, knee pain walking up and down stairs or getting up from sitting
chondromalacia patellae
Sporty teen, pain and swelling on tibial tubercle
Osgood schlatter
Knee pain after exercise, locking and intermittent swelling
Osteochondritis dissecans
Anterior knee pain worse after running, tender below patella - teenage boy
Patellar tendonitis
Small red lump in umbilicus - name and treatment
Umbilical granuloma
- application of salt/ cautery
Persistent urachus vs vitello-intestinal duct
urachus - urine from umbilicus
vitello - faeces from umbilicus
Most common extra-articular manifestation of IBD
Arthritis
How to reduce insulin for surgery
Once daily dose - reduce by 20%
Twice daily long acting - half morning, evening dose as normal
Burn - dry, red, painful, blanching - thickness
Superficial, 1st degree
Burn - weeping, blistering, painful, blanches with pressure - thickness?
Superficial partial thickness
Burn - red, leathery, only painful with pressure, non blanching - thickness?
Deep partial thickness
White leathery/ charred burn, painless, stiff - thickness?
Full thickness
Pregnant woman exposure to VZV - how to manage - no sx
Check vaccine status/ immunity
If neither of above:
acyclovir day 7-14 post exposure
Left homonymous hemianopia - cause
R optic tract lesion
L Homonymous quadrantinopia
Upper - R Temporal
Lower - R parietal
SCC margins
4mm if <20mm
6mm if >20mm
Painful heavy calves, pruritis, ulcers, swelling, varicose veins post DVT - cause and tx
Post thrombotic syndrome causing venous insufficiency
Treat with compression stockings
Very painful ulcer on lower leg bg of arthitis/ IBD/ haematological condition
Pyoderma gangrenosum - treat with oral steroids, infliximab, cyclosporin
What drugs can be used for cholestatic itch
Rifampicin, cholestyramine, sertraline
What antidepressant to give in diabetes/ Parkinson’s - why
Mirtazepine - Give as SSRI reduce hypo awareness
Patient presents with epistaxis, rectal bleeding and skin/ mucosal telangiectasia. Family member with same - cause
Hereditary hemorrhagic telangiectasia - Autosomal dominant.
AV nicking on fundoscopy
Hypertensive retinopathy
Treatment of epipidymo-orchitis old vs young
Old - ciprofloxacin or ofloxacin for 14d
Young ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
CAP with erythema multiform and haemolytic anaemia - cause
Mycoplasma pneumonia
Autosomal dominant condition causing exertion dyspnoea, angina, syncope. Systolic murmur that quietens on squatting and becomes louder on valsava. Bifid double apex pulse
HOCM
- Most common cause of sudden cardiac death in young people
- Treat with Ca channel blocker, Beta blocker
- Heart transplant
How to differentiate radial tunnel syndrome and lateral epicondylitis
Radial tunnel - tenderness distal to epicondyle and pain worse on pronation
Lateral epicondylitis - pain over condyle, worse on supination
Drugs causing tinnitus
- Aspirin/ NSAID
- Aminoglycosides e.g. gentamicin
- Loop diuretic
- Quinine
What organism causes CAP with flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
Legionella - urine antigen test, treat with clarithromycin
Chest pain, SOB, exertional syncope, ejection systolic murmur
Aortic stenosis
Apixaban/ rivaroxaban reversal agent
Andexanet alfa
Dabigatran reversal agent
Idarucizumab
Older patient presents with episodic sweating, palpitations, headache and hypertension - cause
Phaeochromocytoma
What electrolyte disturbance typically triggers digoxin toxicity
Hypokalaemia
What drugs precipitate digoxin toxicity
amiodarone, thiazide like, quinidine, CCB, spironolactone, furosemide
What chromosome is Huntingtons gene on
4
Farmer, sewage worker, river fisherman etc with:
- fever
- myalgia
- subconjunctival haemorrhages
Leptospirosis - contact with infected rat urine
Dry cough, headache, aching muscles
Can then develop Weil’s disease
- AKI, jaundice
- Hepatitis
- Aseptic meningitis
Treat with benpen or doxy
Salmonella/ typhoid abx management
Ciprofloxacin
Cellulitis second line abx if pen allergic
Clarithromycin
What type of RBC seen on blood film in DIC
Schistocytes
Young female with amenorrhoea, stigmata of liver disease and deranged LFT - cause
Autoimmune hepatitis
What drugs falsely lower BNP
Acei, aldosterone, beta blocker, diuretic
Haemophilia a - what factor deficiency
Factor 8
Haemophilia b - what factor deficient
Factor 9
Type of pneumonia that causes cavitating upper lobe disease in diabetics and alcoholics
Klebsiella
Has only been demonstrated to improve mortality in patients with NYHA class III or IV heart failure who are already taking an ACE inhibitor
Spironolactone
What drug is strongly indicated if co-existing HF and AF
Digoxin
Peripheral cyanosis in otherwise well baby
acrocyanosis
How long to wait between MMR doses
3m
Groin pain, limited range of movement in 3rd trimester of pregnancy
Transient idiopathic osteoporosis
Groin pain, Femoral nerve stretch test positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee.
Referred lumbar back pain
All clotting factors low except factor VIII
Liver failure
When and how to treat bradycardia
If shock, MI, HF, syncope
Atropine 500mcg, repeat up to 3mg
Transcutaneous pacing
isoprenaline/ adrenaline infusion
Transvenous pacing
Neonate with feeding intolerance, abdominal distension, bloody stool, discoloured abdomen
Necrotising enterocolitis
On XR:
bowel wall oedema
pneumatosis intestinalis (intramural gas)
air both inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)
what helps differentiate episcleritis and scleritis
Scleritis causes pain, episcleritis does not
Cushings ulcer
Stomach ulcer after head trauma
Curlings ulcer
Stomach ulcer after severe burn
Advice for hip replacements to reduce dislocation risk
- avoiding flexing the hip > 90 degrees
- avoid low chairs
- do not cross your legs
- sleep on your back for the first 6 weeks
First line for excess sweating
Aluminium chloride
Iontophoresis - electric current
Botulinum injection
Young male smoker with cold, poorly perfused finger tips, ulcers - or patient with reynauds develops new ischaemia - cause and findings on angio
Buergers disease - corkscrew collaterals
Pain and tenderness over lateral thigh middle aged woman worse when lying on affected side, tender to palpation
Greater trochanteric pain syndrome
Burning/ paraesthesia over antero-lateral thigh, nerve affected
Meralgia parasthetica - lat cutaneous nerve of thigh
First line treatment of VTE in pregnancy
LMWH
Older woman presenting with bruising, epistaxis and petechiae - FBC shows isolated low platelets - cause and tx
ITP, oral prednisolone
Malignant otitis externa mx
Ciprofloxacin
Breast screening programme
50-70 every 3 years
Medical mx of PPH, which drug is contra-indicated in asthma
- IV oxytocin: slow IV injection followed by an IV infusion
- ergometrine slow IV or IM (unless there is a history of hypertension)
- carboprost IM (unless there is a history of asthma)
- misoprostol sublingual
- there is also interest in the role tranexamic acid may play in PPH
How to differentiate crohns and UC
UC more bloody diarrhoea, faecal urgency and tenesmus
Crohns more malabsorbtive, whole GI tract sx
Pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter. Lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet)
Molluscum contagiosum - pox virus- no active treatment
What drug to give in phaeochromocytoma crisis
Phentolamin
White tongue, bleed when scraped, changes in taste, cracking at corner of mouth - cause and tx
Candidiasis - nystatin
Drugs to reduce alcohol consumption
Acamprosate - reduce cravings
disulfram - severe symptoms when drink
Treatment for atypical pneumonia
clarithromycin
Persistent ST elevation following MI with no chest pain
Ventricular aneurysm
What nerve damaged?
motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact
Sciatic
most common reason total hip replacements need to be revised
Aseptic loosening
Child with asymptomatic flank mass
Wilms tumour
When to offer urgent PCI for NSTEMI
GRACE > 3 or unstable
Common drugs that precipitate psoriasis
Alcohol, beta blocker, ACEi, NSAID, lithium
What level measure to confirm anaphylaxis
Tryptase
Sildenafil contraindications
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
Can cause blue discolouration of vision
What drug used to open/ close patent ductus arteriosus
Keep open - prostaglandins
Close - indomethacin or ibuprofen
Coarse tremor, hyper-reflexia, polyuria, weakness, seizures, diarrhoea, vomiting, abdominal pain, muscle twitches and blurred vision
Lithium toxicity - treat with IVI
dry red regions become plaques with adherent scale - can cause scarring and alopecia associated with lupus
discoid lupus
Multiple misscarriages, skin rash - cause, APTT level and treatment
Antiphospholipid syndrome
Raised APTT
Low dose aspirin prophylaxis, warfarin after ischaemic event INR 2-3, if recurrent 3-4
What is pseudocushings
Symptoms of cushings associated with alcohol consumption that improve on cessation
Ptosis and pupil constriction
horners
Ptosis and pupil dilation
3rd nerve palsy
What to do if young person with hydrocele
2ww referral for testicular cancer
Neonate with
- SOB
- Sweating
- Hepatomegaly
HF
What to give women if GBS grown in urine during pregnancy
IV benpen during labour
When can you insert IUD/ IUS post pregnancy
48hr or 4w
Hypopigmented lesions more noticeable following sun tan
pityriasis versicolour - treat with ketoconazole
If pneumonia secondary to influenza what abx should be added
Amox + fluclox as caused by staph aureus
Tender swelling near edge of external ear canal
furunculosis - infected hair follicle
What type of testicular cancer causes raised AFP
teratoma (non-seminonatous testicular cancer)
Treatment for organophosphate poisoning
Atropine
How to treat breastfed infants who have persisting symptoms of frequent regurgitation associated with marked distress
Alginate therapy (gaviscon)
What to do if Sudden onset sensorineural hearing loss
Same day ENT referral
Can HIV mothers breast feed
No
How to convert from codeine to morphine
Codeine/10 = morphine
transfusion threshold for patients with ACS
< 80
Metformin contraindications
Recent MI, Sepsis, AKI
dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)
Iodine containing contrast
Alcohol abuse
How long to exclude from school the following
- scarlet fever
- whooping cough
- measles
- rubella
- mumps
- impetigo
- scarlet - 24hrs post abx
- whooping - 48hrs post abx
- measles - 4d after rash
- Rubella - 5d after rash
- Mumps - 5d after swollen gland
- Impetigo - until crusted and healed or 48hr post abx
Mx of Alzheimers
Acetylcholinesterase inhibitor e.g. rivastigmine, donepezil
Memantine if can’t tolerate above
How to manage rheumatoid flares
oral or IM steroids
How to treat genital wart
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
How to maintain remission if severe UC flare or >2 in last year
Azathioprine or Mercaptopurine
Do newborn inguinal hernias need surgical treatment
Yes
Excessive cough and lump in epigastrium
Epigastric hernia
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect
Richter hernia
Amenorrhoea at 15, little or no pubic hair, groin swellings - cause
Androgen insensitivity syndrome - treat with counselling, orchidectomy and oestrogen therapy
Best antiemetic for Parkinson’s
Domperidone
What organism commonly causes CAP in cystic fibrosis patients
Pseudomonas aeurginosa
How to treat venous ulcer - normal ABPI >9
Compression bandages
How to take bisphosphonate
swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
Child with AKI, bloody diarrhoea, abdominal pain, vomiting
HUS
Child presenting with petechiae but no fever following recent viral illness
Immune thrombocytopenia
Scleritis treatment
Oral NSAID first line, 2nd line steroid
Most common cyanotic heart disorder present at birth
Transposition of great vessels
Hip pain, stiffness and snapping sensation, previous perthes disease - active young adult
femoral acetabular impingement
Vasculitis associated with asthma and raised eosinophilia
Churg strauss
Should PPI be given prior to endoscopy in non vatical bleeds
No
What drug can cause protein in the urine (nephrotic syndrome) and exacerbation of myasthenia gravis
Penicillamine - have urinalysis 3monthly
What are reflexes like in severe pre-eclampsia
Hyper-reflexia, can also have papilloedema, low platelet
Army recruit/ runner presents with tender lump on top (dorsum) of foot
March fracture - due to repetitive walking - 2nd MT shaft
Badly swollen, deformed knee with bruising following trauma
Tibial plateau fracture
Weakness worse in morning that improves with movement, reduced reflexes, autonomic sx (dry mouth, impotence) - bg of lung cancer
Lambert eaton syndrome
- Small cell LC
- Spares resp muscles and face muscles
- steroids, azathioprine
Toddler with delayed milestones, calf hypertrophy, proximal hip girdle tenderness, raised CK
DMD - X linked recessive
25yo patient presents with long haggard face, bilateral ptosis, cataracts, frontal balding, distal weakness, myotonia, DM, testicular atrophy - cause
Myotonic dystrophy - autosomal dominant
Microcytic anaemia with normal ferritin
Beta thalassaemia trait
Two causes of pancytopenia
Aplastic anaemia (reduced stem cell production) and Myelodysplastic syndrome (abnormal stem cell production)
MDS commonly caused by chemo/radio and can become AML
What bacteria does a splenectomy expose you to
Encapsulated backteria
- Salmonella
- Haemophillus
- Neisseria
- GBS
- Strep pneumonia
- klebsiella
Management of intracranial abscess
Craniotomy
IV abx - cef+metro
Dex to reduce pressure
L sided neck lump present at birth/ early life - posterior triangle of neck
soft and compressible
typically not painful
no movement on swallowing
transillumination is detected
may interfere with respiration or compromise the airway
Cystic hygroma
Oval mobile painless cystic mass that sits between sternocleidomastoid and pharynx. Presents in early adulthood, slowly growing
Branchial cyst
When to screen neonatal hips with US
- first-degree family history of hip problems in early life
- breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
- multiple pregnancy
When to refer for cerebral palsy during babies development
- Not sitting by 8 months
- Not walking by 18 months
- Early asymmetry of hand function before 1 year
- Persistent toe-walking
When is Men B vaccine given
2,4,12m
First line for urticaria
Antihistamines
How to treat hiccups in palliative care
Chlorpromazine or haloperidol
Round red lesion on scalp causing alopecia, becomes pustular and boggy - cause and tx
Tinea capitis - boggy pustular change is called a kerion
Treat with terbinafine, ketoconazole shampoo, oral griseofulvin
Erythematous, scaly plaques with an active, advancing, and often pruritic border. The centre of the lesion clears up as expands, resulting in ring-like appearance,
Tinea corporis
- oral terbinafine, clotrimazole
Tinea pedis management
Topical terbinafine/ miconazole
Othello syndrome
Othello syndrome is the irrational belief that one’s partner is having an affair with no objective evidence.
Itchy tense blisters without mucosal involvement
Bullous pemphigoid
- steroid
Flaccid blisters progressing to erosions affecting mucosal membranes
pemphigus vulgaris
- steroid
Systemic sepsis and changing lower lim neurology
Epidural abscess
When to refer fibroadenoma for surgery
> 3cm
Recurrent watery/ sticky eye in neonates
Congenital lacrimal duct obstruction - self resolves by 1yo - reassure, massage lacrimal duct
Left subclavian thrill, continuous machinary murmur, large volume bounding pulse with wide pulse pressure
patent ductus arteriosus- give indomethacin or ibuprofen
only method of contraception which has a proven link with weight gain
Depo Provera - injectable contraception
Management of meningitis across ages
<3m or >50 Cefotaxime and amoxicillin
3m-50 Cefotaxime
IM benpen if meningococcal suspected
IV dexamethasone to reduce neurological sequelae
Hairless following stressful period
telogen effluvium
trichotillomania
compulsive desire to pull ones hair out
How to decide between alpha/beta blocker and spironolactone as antihypertensive
K < 4.5 - spirono
K >4.5 - alpha or beta blocker
Decolonisation regime for MSRA
nasal mupirocin and chlorhexidine wash for the skin
When to double levonorgestrel dose, how soon after can take hormonal contraception, how affect breast feeding
if BMI >26 or weight > 70kg
Can start immediately
Nil affect
When to avoid ellaone and how soon after can start hormonal contraception, how affect breastfeeding
Severe asthma, 5d
Delay breastfeeding for 1w
Anti-Hbs after hep B vaccine course
> 100 - good response
<10 - poor response, repeat full vaccination series
10-100 - booster
What ix for adult with hydrocele
US to exclude testicular cancer
Combined pill - increase/ decrease risk of what cancers
Increase breast and cervical
Reduce endometrial and ovarian
Hep B antigens - what do they mean
HbsAg - active infection
Anti-Hbc - previous or current infection
Anti-Hbs - marker of immunity (previous vaccine/ infection)
HbeAg - marker of infectivity
Flushing, diarrhoea, bronchospasm, hypotension, and weight loss. Cause and investigation?
Carcinoid syndrome
investigation for this is urinary 5-HIAA, as the tumour will secrete serotonin. Treat with octreotide.
Octreotide also used for acromegaly
Metabolic ketoacidosis with normal or low glucose
Alcohol
Patient presents with confusion, hypothermia, non pitting periorbital and leg oedema, anaemia, reduced resp drive - bg of weight gain - cause and mx
Myxoedema coma
IVI
IV thyroxine
IV steroid
Bowed legs in <3yo - normal or abnormal
Normal
Main side effect of colchicine
Diarrhoea
Downs screening dates
- The combined blood sample can be taken from 10w - 14w + 1d PAPPA-A and BHCG
- US 11w + 2d and 14w + 1d
- The quadruple test 14 + 2 to 20 + 0
- High risk women: offer them diagnostic testing using either NIPT, chorionic villus sampling (if less than 13 weeks of gestation) or amniocentesis (if beyond 15 weeks of gestation).
What mutation is associated with prostate cancer in men
BRCA 2
Pigmentation of bowel wall - name and cause
Melanosis coli - caused by laxative abuse e.g. Senna
Pigment laden macrophages
When does pregnancy count as para/ + for miscarriage
After 24w counts as para irrespective of whether child is born alive
When to treat subclinical hypothyroidism
> 10
5.5-10 on 2 occasions over 3m, age >65 and symptoms
What is Bennett fracture
Fracture of base of thumb into 2 parts
What to consider if otitis external not respondant to abx
consider aspergillus/ candida
flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
hepatitis A
What drug should be used in caution for patients with sick sinus syndrome
Donepazil
Needle stick in someone who not completed hep b vaccinations
accelerated course of the hepatitis B vaccine and administration of hepatitis B immune globulin
What is used to calculate GRACE score
age, ECG, troponin, renal function.
What phototherapy is first line for psoriasis
narrowband ultraviolet B light
Patient presents with ophthalmoplegia followed by areflexia and ataxia. Associated descending weakness - after recent campylobacter
Miller Fisher syndrome
When to start statin in T1 DM
older than 40 years, or
have had diabetes for more than 10 years or
have established nephropathy or
have other CVD risk factors
When to increase statin dose in CKD
<40% reduction, eGFR >30
CURB 65
Confusion
Urea >7
RR > 30
BP < 90/60
Age >65
Newborn with SOB, CXR shows hyperinfalated lungs with fluid in horizontal fissure
Transient tachypnoea of newborn
Fluid in lung, more common post C-section
Newborn with SOB, CXR shows ground glass
RDS - surfactant deficiency
Pre-term babies
Newborn with SOB, CXR shows patchy consolidation
Meconium aspiration
Post term babies
Heinz bodies - cause
G6PD deficiency
- Bone pain, muscle tenderness, proximal myopathy causing waddling gait.
- Low ca, low phos, raised ALP
- Translucent bands on XR
Osteomalacia
Due to Vit D deficiency
Give calcium and vit d replacement
RLQ pain with prodrome of fever, bloody diarrhoea
Campylobacter
What drugs cause corneal opacities
Amiodarone, indomethacin
What drugs cause retinopathy
chloroquine, quinine
What drugs cause optic neuritis
- ethambutol
- amiodarone
- metronidazole
First line Abx for COPD non-smokers with recurrent infections
Azithromycin
Baby in first 24-48 hours of life presents with abdominal distension and bilious vomiting
Meconium ileus - most common in cystic fibrosis
Waxy yellow/brown papule on feet associated with joint pain
Reactive arthritis - keratoderma blenorrhagica
When to measure plasma paracetamol level after overdose
4 hours
Osler vs Janeway lesions
Osler on finger tips, painful
Janeway on palm, non-painful
Most common ovarian cyst
follicular
Contraindication to triptan use
CVD
Causes of spider navi
Liver disease, COCP, pregnancy
When to women need contraception post birth
21 days
What type of eye drop causes brown pigmentation of iris and elongation of eyelashes
Latanoprost (prostoglandin)
What eye drop should be avoided if taking TCA or MAOi
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
What is seen on a blood smear in DIC
Schistocytes
CCB - what used in angina
Monotherapy - Verapamil or diltiazem
With B-blocker - nifedipine, amlodipine
What is puerperal pyrexia, what concerned about and how to treat
Temp > 38 within 14 days post partum
Concernded about endometritits
Treat with IV clindamycin and gentamicin
Incarcerated vs strangulated hernia
Incarcerated - irreducible
Strangulated - ischaemia
How to treat methanol poisoning
- fomepizole or ethanol
- haemodialysis
Abrupt onset of haemoptysis, cough, shortness of breath, peripheral oedema, dark urine and oliguria.
Goodpastures
Painless, monocular loss of vision in Marfan’s syndrome
Lens dislocation
How to confirm h pylori eradication
Urea breath test
Cause of hand foot and mouth disease
Coxsackie A19
Electrolyte changes in rhabdomyolysis
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Hyponatraemia
Raised CK > 5x ULN
Myoglobinuria
Acidosis
Treatment for Toxic epidermal necrolysis
IVIG
Painless vision loss - starting peripherally and moving centrally
retinal detachment
Schirmers test
Used to test for sjogrens
Epididymo-orchitis - unknown cause
IM cef 500mg IM single dose, doxy 100mg BD for 10-14d
Patient presents with :
Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
Lateral medullary syndrome (posterior inferior cerebellar artery)
Patient presents with
* ipsilateral III palsy
* contralateral weakness
Weber’s syndrome
Midbrain stroke
Most common cause or erysipelas
Strep pyogenes
- has sharp boarders
Patient with bleeding/ bruising has large platelets, low platelet count and prolonged bleeding time
Bernard soulier syndrome
amenorrhea, short stature and webbed neck - condition, heart defect, chromosomal cause
Turners, Single X, associated with bifid aortic valve causing systolic murmur
Pink, irregularly shaped mark on back of babys neck
Stalks kiss - telengectatic naevus
IIH management
Carbonic anhydrase inhibitor - acetazolamide, topiramate, repeat LP, shunt
Boggy enlarged tender uterus - US shows ectopic endometrial tissue in myometrium - what condition
Adenomyosis
What vitamin deficiency causes angular cheilitis, mouth ulcers, inflammation of oral mucosa, red sensitive eyes
Riboflavin - Vit B2
Molluscum contagiosa cause
Pox virus
Sever acne with burrowing and interconnected abscesses and irregular scars
Acne conglobata
At what age should all children with suspected UTI be urgently admitted/ referred
<3m
How to treat upper UTI in child
Cefalexin or co-amox
How long after last drink does alcohol withdrawal occur
10-72hrs
- tachycardia, HTN
- tremor
- confusion
- seizure
Conjunctivitis within first 4w of life
Think about chalmydia/ gonorrhoea
Superior vs inferior Quadrantanopia - cause
Superior - temporal
Inferior - parietal
Hypertension stages
Stage 1
- 140/90 - 159/99
- Home BP 135/85-149/94
Stage 2
- 160/100 - <180/120
- >150/95
Stage 3
- > 180/120
Malignant hypertension
- >180/120
- Signs of retinal haemorrhage or papilloedema
Colorectal screening
FIT from 60-74 - every 2yr
Patient with symptoms of COPD but no smoking history, raised LFT on bloods
Alpha 1 anti-trypsin deficiency
Iron studies in patient with haemochromatosis
- transferrin saturation > 55% in men or > 50% in women
- raised ferritin (e.g. > 500 ug/l) and iron
- low TIBC
Treatment for haemochromatosis
phlebotomy or Deferoxamine
Travel history, recurrent UTI not improving with abx, sterile pyuria, fever
Genitourinary TB
First line tx for impetigo
Hydrogen peroxide 1%, second line fuscidic acid - if systemically unwell flucloxacillin
How is HOCM inherited
Autosomal dominant
Upper and lower resp tract symptoms and glomerulonephritis
Granulomatosis with polyangiitis
What vitamin deficiency causes bleeding of the gums
Vitamin C Ascorbic acid
What vitamin deficiency causes Dermatitis, seborrhoea
Vit B7 Biotin
What vitamin deficiency causes mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
Vit E
What vitamin deficiency causes anaemia, irritability, seizures
Vit B6 Pyridoxine
What is used to treat conjunctivitis in pregnancy
Fuscidic acid
Papular rash with scales after tonsillitis/ strep infection
Guttate psoriasis
Woman presenting with amenorrhoea, loss of libido, milky discharge from breast - endocrine problem and drug that causes
Raised prolactin - metopclopramide, prochlorperazine, domperidone
Patient with AF and acute stroke - when to start anticoagulant
After 2w
How to treat pain in corneal ulcer
Oral analgesics - don’t give topical as can cause further injury
What investigation must be done prior to starting biologics for rheumatoid or other
CXR for TB
2 level wells cutoff for US - time period to get done
Greater or equal to 2 - do within 4hrs
Unpredictable, irregular bleeding that can range from spotting to larger volume bleeding - ix show no identifiable cause - diagnosis and mx
Dysfunctional uterine bleeding
1 - mirena coil
2 - tranexamid acid, NSAID, COCP
3 - Norethisterone
4 - <10w size ablation, >10w size uterine artery embolization or myomectomy
5. Hysterectomy
Blood vessels on iris - cause and mx
rubeosis iridis - caused by retinopathy/ retinal ischaemia - treat with pan retinal photocoag, anti-VEGF - can cause angle closure glaucom
Lump over Childs lateral eyebrow, contains mixture of tissues including fat, bone, nails, teeth
dermoid cyst - cystic teratoma
If in midline consider MRI for intracranial extension
Young East Asian <20 presents with ataxia, kyphoscoliosis, clumsiness and deterioration in athletic performance
Friedreichs ataxia - autosomal recessive
Young child 1-5yo presents with ataxia, recurrent infections and telengectasia
Ataxic telengectasia
Primary vs secondary vs tertiary hyperparathyroidism
Primary - raised PTH due to pituitary adenoma
Secondary - raised PTH due to condition causing hypocalcaemia
Tertiary - raised PTH due to longstanding secondary - due to autonomous secretion following long period of hypocalcaemia - can cause hypercalcaemia
Primary vs secondary vs pseudohypoparathyroidism
Primary - reduced production due to post excision, di George, pernicious anaemia, vitiligo
Secondary - due to hypercalcaemia
Pseudo - Due to failure of target cells to respond to PTH
Bruising, epistaxis, purpura following infection/ immunisation in child
ITP - often not need tx, repeat FBC in 10d
Lymphadenopathy, night sweats, splenomegaly, weight loss, fatigue
Non Hodgkins lymphoma
Hodgkins vs non-hodgkins differences
Hodgkins - less common, upper body lymphadenopathy, spreads from one group of LN to another
Non Hodgkins - more common, affects LN all over body, spreads discontinuously, may be rash or CNS involvement
Diagnostic level FENO
> 35 in kids
40 in adults
Cushings disease vs syndrome
Disease = due to pituitary secreting ACTH
Syndrome = any cause
Conns vs Addisons electrolytes
Conns - hypokalaemia, hypernatraemia
Addisons - Hyperkalaemia, hyponatraemia
Characteristics of innocent murmur
Soft, continuous or during systole, change with position, otherwise healthy, no thrill
Diastolic murmur always pathologic
Graves treatment during pregnancy
- Propylthiouracil in 1st trimester
- Switch to carbimazole in 2nd trimester for rest of pregnancy (PTU has small risk of hepatotoxicity)
UTI - nitrites +ve vs -ve
+ve in E coli, gram negatice
-ve in staph, gram positive
What investigations to do for older person with persistent back/bone pain, renal damage, raised calcium or unexplained fracture
Myeloma screen - M protein (serum free light chains), ESR/CRP, FBC (low cell counts due to bone marrow infiltration - anaemia, bleeding ), Calcium, hence jones, U&E, blood film showes rouleaux formation
Blood film finding in myeloma
rouleaux formation
Rain drop vs pepper pot skull
Rain drop = myeloma
Pepperpot = primary hyperparathyroidism
Asymmetrical loss of motor/ sensory function of individual nerves, associated deep aching pain worse at night
Mononeuritis multiplex- associated with diabetes
Recent tonsillitis, presents with lymphocytosis and neutropenia
EBV - glandular fever
Steroid responsive features for COPD management
Prev diagnosis of asthma or atopy
>20% diurnal variation
Raised eosinophils
Substantial variation in FEV1 (400ml)
What is Evans syndrome
ITP with autoimmune haemolytic anaemia
Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.
Olecranon bursitis
When to consider Familial hypercholesterolaemia
in adults total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l or children TC > 6.7 mmol/l and LDL-C > 4.0 mmol/l, plus:
for definite FH: tendon xanthoma in patients or 1st or 2nd degree relatives or DNA-based evidence of FH
for possible FH: family history of myocardial infarction below age 50 years in 2nd degree relative, below age 60 in 1st degree relative, or a family history of raised cholesterol levels
Often treat with high dose statin - autosomal dominant
Dextrocardia and bronchiectasis
Kartagners syndrome - primary ciliary dyskinesia
Asthma, vasculitis, sinusitis, mononeuritis multiplex
Churg straus - Eosinophilic granulomatosis with polyangiitis
vasculitis - pANCA vs cANCA
pANCA - churg straus (Eosinophilic granulomatosis with polyangiitis)
cANCA - Wegeners (granulomatosis with polyangitis)
also differ as churg has raised eosinophils
How many antenatal visits in first and second pregnancy if uncomplicated
1st - 10
2nd - 7
When to give first and second dose of rhesus D
28,34 weeks
When is booking visit in pregnancy
8-12w
When is dating scan pregnancy
10-13+6w
When is anomaly scan
18-20+6 week
When to check baby presentation and consider ECV
36w
When to consider iron in pregnancy
Hb <110 at 16w
Hb <105 at 28w
What anti diabetic drug can cause cholestasis
Sulphonylurea
What BP is an absolute contraindication for thrombolysis and how to manage
> 200/120
Give Labetalol
Triad of longstanding CO2 retention on ABG
pH normal
CO2 high
HCO3 high
Oral lichen planus mx
Benzydamine spray
Flu like symptoms proceed a dry cough with cold AI haemolytic anaemia, vesicles on ear drum - Cause + treatment
Mycoplasma pneumonia - doxycycline
BG of HIV, few chest signs, exertion dyspnoea
Pneumocystic jirovecci
Treatment/ Ix for Giardia
Metronidazole
Stool microscopy for ovum and parasites, stool antigen tests
Medial knee pain and increased movement of patella
Patella subluxation
Heart defects in TOF
Overriding aorta
Pulmonary stenosis
VSD
RV hypertrophy
What murmur is seen in turners syndrome
Ejection systolic due to bicuspid aortic valve
High yield features of MND
Eyes spared
Fasciculations
No sensory involvement
Often get wasting of the small muscles of hand
Palpable enlarged gallbladder in presence of painless jaundice - cause
Pancreatic cancer
Cancer site and type of bowel resection
Anal verge - abdomino-perineal resection
Lower rectum - anterior resection (low TME)
Upper rectum - anterior resection (TME)
Sigmoid - High anteior resection
Distal transverse descending - left hemi
Caecal, ascending or proxcimal transverse - right hemi
Overdose - lacrimation, salivation, urination, diarrhoea, hypotension, bradycardia, small pupils , muscle fasciculation - cause and tx
Organophosphide poisoning - treat with atropine
What ix should be done to screen for cause of discitis
Echo for endocarditis
Early vs late pericarditis post MI
Early - fibrous pericarditis (1-3d)
Late - dressler (w to month)
What drug is used to prevent RSV infection in children at high risk
Palivizumab
painful nodule on ear
chondrodermatitis nodularis helicis
When to refer sore throat under 2ww
If last >4w
Hashimoto vs subacute thyroiditis
Hashimoto non tender thyroid
Subacute - tender thyroid
What drug sensitivity is associated with asthma and nasal polyps
Aspirin
Proteinuria cutoff for pre-eclampsia
> 0.3g/24hrs
Indication for 5mg folic acid replacement in pregnancy
Obesity with BMI >30
Previous NTD child in either parent
Family history
Anti-epileptics
Coeliac
Diabetes
Thalassaemia trait
Vision changes including flashers and floaters - cause
Vitreous/ retinal detachment
With retinal detachment get associated dense shadow across vision
Target like lesions initially on back of hands, feet, spreads to mucosa - can involve mucous membranes - can occur post strep/ mycoplasma infection, herpes/ viral infection or due to drugs e.g. COCP
Erythema multiform
What type of drug is bumetanide
Loop diuretic
Cause of cold sores
HSV 1
How to treat TCA overdose
IV bicarb
Ethylene glycol antidote
Fomepizone
cyanide antidote
Hydroxycobalamin
most common primary malignant bone tumour - sun burst appearance, conman triangle on XR, pRB gene
Osteosarcoma
Benign overgrowth of bone, mainly on skull associated with gardners syndrome, FAP
Osteoma
Most common benign bone tumour - cartilage cap on XR
Osteochondroma
Child with severe pain in long bone, blue cells, XR shows onion skin appearance
Ewings sarcoma
Becks triad Cardiac tamponade
Muffled heart sounds
Hypotension
Raised JVP
Baby born with patent ductus arteriorsus, congenital cataract, sensorineural deafness - what infection
Rubella
Polycythema vera mutation and tx
Jak2
Aspirin, venesection
Higher risk get hydroxycarbamide and interferon Alfa or jak2 inhibitors
puristic rash that appears in last trimester of pregnancy - may start in abdominal striae
Polymorphic eruption of pregnancy
Excruciating pain, absent reflexes on bg of poorly controlled diabetes
Diabetic amyotrophy
influenza after contact with dead/unwell bird
Chlamydophilia psittaci
Examination findings in cerebellar disease
Dysdidokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
st line for excess sweating
topical aluminium chloride - other options include botulinum, CCB, anticholinergics
Hb and platelet threshold in pregnancy
Hb <110
Platelet <100
well circumscribed round patches of hairless
Alopecia acreta
- watchful wait
- Topical steroids or steroid injections
- minoxidil
Young person with Weight loss, diarrhoea, RLQ pain
Crohns
Recent infection, fever, painful thyroid and hyperthyroidism followed by hypothyroid
De quervains thyroiditis
Congenital disorder with high forehead, large testicles, large low set ears, long thin face, hypotonia, mitral valve prolapse
fragile X syndrome - tri-nucleotide repeat
Elf like facial appearance, cardiac defects
Williams syndrome - chromosome 7
Psudopolys on colonoscopy/ barium enema - cause
UC
Cutoff in temperature rise to warrant stopping transfusion
> 1 degrees
What blood test should be done in all women with hyperemesis
TSH - BHCG can act to increase T3/T4 in same way to TSH
Presenting symptoms of compartment syndrome
Increasing pain despite resting
Sensory defecit
Swelling and tenderness
Pain on passive stretch of muscles
Grey-white line around corneal margin - name and cause
Arcus senilis - hypercholesterolaemia
Type of breathing seen in metabolic acidosis
Kussmauls - at first rapid and shallow, then becomes deep and slow, laboured and gasping
What is a sign of septic arthritis rather than transient synovitis
Pain on passive movement, joint held in position that maximises joint space (flexion, abduction and external rotation for the hip)
Forefoot pain, most commonly in the third inter-metatarsophalangeal space. Feels as though has pebble in shoe
Mortons neuroma - nerve compression between metatarsal heads
Click noise on metatarsal squeeze
- metatarsal pad, referral if still ongoing pain at 3m
What marker to use to assess for repeat MI
CK-MB
Recreational drug causing dilated pupils, sweating, fits, tachycardia, nausea, nose bleed
Amphetamines
Options for fungal nail treatment
Topical nail liquor
Oral terbinafine - 6w-3m for finger, 3-6m for toe
Oral itraconazole - 1w on 3w off
Anion gap calculation
Na - Cl+HCO3
Behaviour changes, headache, urinary incontinence in DKA - what has happened
Cerebral oedema
First line abx for bronchitis
Doxycycline
Impulsivity, emotional instability, intense and unstable relationships, suicidal thoughts, pseudohallucinations - type of personality disorder
Borderline
Pseudohallucination = hallucinations that individual recognises aren’t real
Change to TB abx if TB meningitis
Use streptomycin instead of ethambutol
Painful cutaneous nodules with gelatinous consistency - red/brown apple jelly appearance - bg of TB
Lupus vulgaris
Painless skin nodules, abscesses overlying LN in patient with TB
Scrofuloderma
Young female with chronic pelvic pain develops sudden onset pain following fall, trauma, sexual intercourse - tenderness and guarding on exam
Ruptured ovarian cyst
Intermittent episodic severe retrosternal pain associated with dysphagia and feeling of food stuck in throat - corkscrew appearance on barium swallow
Oesophageal spasm
Haemophilia a/b inheritance pattern
X linked
Child with rose pink rash or trunk, back and buttocks, each macule surrounded by halo, fever, mild pharyngitis - cause
Roseola infant - human herpes virus 6
Drug that commonly increases and reduces sulphonyl urea function
Rifampicin reduce
Fluconazole increase
Definition of simple febrile seizure
Generalised tonic clonic
Last <15mins
Not recur within 24hr
Back to normal within 1h
Name for most common damage to kidney in AKI
Acute tubular necrosis lido
Horners syndrome, unilateral arm oedema, facial engorgement, hoarse voice - cause
Pancoast tumour
Antidepressant of choice post MI
Sertraline
Length of phenoxymethylpenicillin course for tonsillitis
7-10d
1st and second line gestational HTN mx
1st labetalol
2nd nifedipine or hydralazine
XR of child shows double bubble/ soap bubble sign in long bone
Giant cell tumour
Valproate monitoring
LFT
Pioglitazone monitoring
LFT
Lithium monitoring
TFT, U&E, lithium level
Methotrexate monitoring
FBC, LFT, U&E
Azathiprine monitoring
FBC, LFT
How long does ear drum take to heal, when to refer
At 6-8w
FEV1 reduced, FEV/FVC >0.7
restrictive
FEV1 reduced, FEV/FVC <0.7
Obstructive
most common SE of varenicicline
Nausea
Ipsilateral loss of motor and proprioception, contralateral loss of pain and temperature
Brown sequard syndrome
Upper/lower resp tract (ulcers, sinusitis, pulmonary nodules/ ILD), pulmonary haemorrhage, saddle shaped nose and glomerulonephritis
Wegeners (Granulomatosis with Polyangiitis)
White/yellow nodule on nasal side of cornea - name and what is it called if it grows over the edge of the cornea
pinguecula - if over cornea = pterygium
White inflammatory patches on genitalia causing constriction/ phimosis
lichen sclerosis (aka Balanitis xerotica obliterans)
What is used to stage Hodgkins/ NH lymphoma
Ann arbor staging
FBC findings in myeloma
Anaemia, thrombocytopenia and neutropenia
What vitamin is deficient in wernickes
Vitamin B1
Asymmetrical tremor, rings in eyes, severe depression
Wilsons disease
How to differentiate caput medusae from portal hypertension vs IVC obstruction
Blood flows towards umbilicus in IVC
Away from umbilicus in portal HTN
Flasher, floated, reduced visual field and acuity
Retinal detachement
Bartonella henselae - what is it
Catch scratch disease - fever, constitutional sx and lymphadenopathy
What types of jaundice is always pathalogical in newborns
Conjugated billirubinaemia is always pathological, rule out obstruction - duodenal atresia
Within first 24hrs always pathalogical
- Haemolysis
- infection
- abo compatability
- Maternal SLE
When can measure transcutaneous vs serum bilirubin level in newborn
Transcutaneous - >35w, >24hrs old, level <250
Serum - <35w or <24hrs old or level >250
Stop phototherapy once >50 below line
What allergy is associated with penicillins
Cephalosporins e.g. ceftriaxone
Small for gestational age cutoff
<10th centile
Oligoclonal bands in CSF - diagnosis
MS
Breast lump that changes size with period
Breast cyst
Patient presents with amino acid, glucose, phosphate in urine and signs of rickets/ osteomalacia
Fanconi syndrome
What do red cells look like on blood film in hereditary spherocytosis
small, round, hyper chromatic RBC without a central area of pallor
Episodes of haemolysis and anaemia following infections - pallor, jaundice, abdo pain, splenomegaly
G6PD deficiency - X linked
MS: Uhtoffs vs Lhermitte
- Uhtoffs - worsening symptoms with increase in temperature
- Lhermittes - electric shock sensation down spine when flex neck
neurogenic vs nephrogenic Diabetes inspidus
Neurogenic = absence of ADH - low urine osmolality on water deprivation test that improves with ADH
Cranial = insensitivity to ADH - low osmolality on water deprivation with no improvement when given ADH
Bloody diarrhoea, abdo cramps, fever and hepatomegaly -cause
entamoeba histolytica
What can give to women with anti phospholipid syndrome if 3 or more pregnancies lost
LMWH and low dose aspirin
Abdo pain out of proportion with clinical findings
Mesenteric ischaemia
Focal liver lesion >2cm and raised AFP in patient with cirrhosis
HCC
SOB, chest pain, tachypnoea after trauma but no acute signs on XR - cause
Pulmonary contusion
Coin shaped lesions - begin as itchy/ vesicular/ papular - ooze and crust over - recur at same site
Discoid eczema
What supplement for breastfeeding women
Vitamin D 10mcg daily
What contraceptive should be stopped if older than 50
Injectable e.g. depro provera
What antiepileptic can cause weight gain
Sodium valproate
Newborn with blue/ purple marks all over body - cause
TORCH infections
Toxoplasmosis mx
Pyrimethamine, sulfadiazine
most common cause of otitis external
pseudomonas
Short stature, short neck, shortened 4th metacarpals, obesity, dental hypoplasia
pseudohypoparathyroidism
Ca low
PTH and phos high
- Suprasternal continuous murmur
- Different BP on R/L
- Radial radial delay
- Hypertension
Coarctation of aorta
= narrowing of a section of the aorta
Gravida, Para X+Y - define
Gravida = number of pregnancies
Para:
X = number of pregnancies after 24w - twins count as 1
Y = number of pregnancies lasting <24w
‘good baby’ poor feeding, poor weight gain, constipation, coarse facial features, macroglossia, large fontanelle, umbilical hernia may be present
Hypothyroidism - levothyroxine
Short child achondroplasia vs GH deficiency
Achondroplasia - asymmetrical
GH deficiency - symmetrical - immature face, prominent forehead, puberty delayed
Treatment for stable VT
amiodarone 300mg IV over 10-60mins
What to consider if not on diuretics and presents with hypokalaemia metabolic alkalosis and hypertension
Conns
Causes of nephrogenic diabetes insipidus and treatment
Lithium
Hypokalaemia
Hypercalcaemia
CKD
Demeclocycline
Desmopressin, Thiazides, NSAID, Sodium restriction
Size cutoff for toxic megacolon
> 6cm dilation on AXR
Rapidly growing thyroid lump commonly associated with hoarseness and dyspnoea
Anaplastic thyroid cancer
Testicular microlithiasis
Small intratesticular calcifications, asymptomatic and seen incidentally on US
Thickened, intensely itchy plaque forms from long term itching in patient with eczema
Lichen simplex
A HIV test at what time rules out HIV
3m
First line treatment of allergic rhinitis in pregnant women
Topical intranasal steroid
Abnormal PSA levels
50-59 - >3
60-69 - >4
>70 - >5
Cause of :
- Dull flank pain
- Hypertension due to obstruction of ureters
- Renal insufficiency
- Bilateral hydronephrosis with drawing together of ureters in midline
- Peri-aortic mass on CT/MRI
Retroperitoneal fibrosis
Elderly person, not opened bowels, gradual abdominal distension , XR shows dilated bowel loops with gas in rectum
Pseudo-obstruction
Patient presents with fever, cough, purulent sputum, weight loss - has been to GP and had multiple courses of abx with no improvement
Lung abscess - treat with clindamycin for 4-6w
What kidney condition can cause berry aneurysms
PKD
First line for absence seizure
Ethosuximide
First line for myoclonic seizure M/F
M - valproate
F - Levetiracetam
First line for tonic/ atonic seizure M/F
M - vlaproate
F - lamotrigine
First line for Tonic/clonic seizure M/F
M - valproate
F - levetiracetam/ lamotrigine
First line for Focal seizures
Levetiracetam/ lamotrigine
What drug may exacerbate absence seizures
Carbamazepine
Cutoff for giving anti D in spont misscarriage
12 w
- need to give in any medical/ surgical TOP or treatment of miscarriage
- Need to give in amniocentesis, CVS, ECV and ectopic
- threatened miscarriage > 12w
Most commonly affected valve in IVDU with endocarditis
Tricuspid - otherwise is mitral
Most common non STI causes for epididymis-orchitis
Ecoli, pseudomonas
Best investigation to exclude Crohn’s flare
Faecal calprotectin
Best antiemetic for metabolic causes of nausea
Haloperidol
what type of drug is first line for BPH
Alpha blocker
Patient presents with diabetes, diarrhoea, DVT, depression and widespread rash
Gluconoma
What organism from undercooked poultry can cause diarrhoea and reactive arthritis
Campylobacter
No urine output following urology surgery
Clot retention
Treatment of anal fissure
Topical GTN/ diltiazem
Most common epilepsy syndrome in children
Benign Rolandic epilepsy - seizures occur at night
First line for shoulder dystocia
McRoberts manoeuvre (hyperflexion of the maternal legs) is the first management approach
Auer rods on blood film
acute myeloid leukaemia
What can long term overdose of vitamin B6 cause?
Peripheral neuropathy
when to consider pneumonia in patients with bronchiolitis
Fever over 39° or persistent focal crackles
What drug causes Heinz body anaemia?
Sulfasalazine
What rheumatoid drug can cause demyelination
Etanercept
What cytotoxic, drug causes peripheral neuropathy?
Vincristine
How many hours after paracetamol ingestion to measure level
4- should give NAC by 8hrs
Most common presenting symptom of posterior circulation stroke
Dizziness
What eye drops should be avoided if taking a MAOBi
Brimonidine
What diabetic drug can cause pancreatitis
Gliptin
Pioglitazone side effects
Weight gain, fluid retention, liver dysfunction and fractures
Skin rash seen in rheumatic fever
Erythema marginatum
What is erythema ab igne associated with
Exposure to infrared
First investigation to identify if ischaemic or non-ischaemic priapism
Cavernosal blood gas
What vessels are affected in posterior circulation stroke
Vertebrobasilar arteries
How long should wait for d-dimer before starting doac
4 hours
What to do if scan is negative but d-finer positive
Stop anticoagulant and repeat scan in 1w
What rheumatoid drug can cause demyelination
Etanercept
Lumpy breast with pain worse around period
Fibroadenosis
How to treat severe otitis external
Flucloxacillin
Definition of premature ovarian failure
Menopausal symptoms and raised FSH/LH before 40
When is bow legs normal
<3 years old
Are out toeing and knock knees normal
Yes - out toeing resolves by 2years, knock knees resolves spontaneously
When to treat stage 1 hypertension
If age <80 and any of:
Target organ damage
Diabetes
Renal disease
Cardiovascular disease
Qrisk >10%
Most common ocular manifestation of rheumatoid arthritis
keratoconjunctivitis sicca - dry gritty eyes
Definition and causes of oligohydramnios
<500mls at 32-36w
- PROM
- potters: renal agenesis and pulmonary hypoplasia
- IUGR
- Post Term Gestation
-Pre eclampsia
Cause of poly-hydramnios
Tracheo-oesophageal fistula
Diabetes
Multiplepregnancy
Duodenal atresia
Salmonella presentation
Severe vomiting and high fever, can cause bloody diarrhoea, 12-48 hour incubation period
Dry cough and bilateral painless parotid swelling
Sarcoidosis
Causes of unilateral parotid swelling
Tumour (pleomorphic adenoma), stone, infection
How to adjust once daily insulin for surgery
Reduce by 20% on day of and day prior to surgery
How to adjust twice daily insulin for surgery
Reduce morning by 50%, keep evening as normal
How does IUS prevent pregnancy
Prevents endometrial proliferation
What to do if child with squint in GP
Refer to ophthalmology
What type of ovarian cyst if ruptures can cause paeudomyxoma peritonei
Mucous cystsdenoma
Most common type of ovarian epithelial cell tumour
Serous cystadenoma
Painful bruises on shins - cause
Erythema nodosum
How to treat toxoplasmosis
If immunocompetent no treatment needed
If immunocompromised - pyrimethamine and sulphadiazine
What should all children with asthma exacerbation be given
Prednisolone - 3-5 days
10mg if <2
20mg if 2-5
30-40 if >5
Young child presents with pellagra, red scaly photosensitive rash , neuro involvement with fainting followed by stiffness and spasticity.
Hartnup disease
Risk of dapagliflozin
LL amputation
fourniers
Normoglycaemic ketoacidosis
UTI
Whooping cough tx
Clarithromycin if within 21 days of cough onset
CT head showing temporal lobe changes - cause
Herpes encephalitis
Most common cause of argyll Robinson pupil
Diabetes
What can affect urea breath test
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
What can artificially increase/ decrease HbA1c
Increase - B12/ folate, splenectomy, IDA
Decrease - sickle, thalassaemia, G6PD, spherocytosis
Night blindness and tunnel vision with family history - cause
Retinitis pigmentosa
Lithium monitoring
Weekly after every dose change - 12 hours post dose. Once stable monitor 3 monthly
TFT, U&E every 6m
Drugs causing lung fibrosis
Amiodarone, bleomycin, methotrexate, sulfasalazine, nitrofurantoin, bromocriptine, cabergoline
Croup cause
parainfluenza virus
Ix for renal colic, 1st line pain relief
Non contrast CT, IM diclofenac
When to give platelets/ ffp
Platelets if bleeding + <30, surgery + <50, no symptoms and <10
ffp if fibrinogen <1 of PT > 1.5x normal
women that should be started on low dose aspirin for pre-eclampsia prophylaxis - when to start
AI condition
Diabetes
CKD
HTN in previous pregnancy
Chronic hypertension
Take from 12 w
HSV 1 vs 2
1 - oral ulcers
2 - genital ulcers
What to do if primary herpes attack at > 28w gestation
Elective C section
Young person with bilateral vision loss colour desaturation - no pain, -optic disc oedema on fundoscopy
Lebers optic neuropathy
Gentamicin - what to do if peak/ trough level are high
Peak - reduce dose
Trough - increase dose interval
What drug to give in SVT if patient has asthma
Verapamil
Causes of aortic stenosis in children
Williams, turners, coarctation of aorta
When can fly post pneumothorax
1w after check Xray if complete resolution
What GRACE score indicates need for coronary angiography +/- PCI
> 3%
Baby with pulmonary stenosis, pectus excavatum
Noonans syndrome
When to start DOAC if stroke, found to be in AF
After 2w
Symptoms of Hodgkins that represent poor prognosis
Weight loss >10% in last 6m
Temp >38
Night sweats
What should be given to patient if ascites and protein < 15
Ciprofloxacin for SBP prophylaxis
Diagnostic neutrophil value for SBP - treatment
> 250 - IV cefotaxime
How long during pregnancy to take folic acid replacement
until 12w
Diagnosis if fever headache, psychiatric symptoms, seizure and vomiting - most common cause
Encephalitis - most common cause = HSV-1
Section 2
Admission for assessment up to 28d 2 doctors
Section 3
Admission for treatment up to 6m, can be renewed
Section 4
72 hour assessment order, single healthcare professional
section 17a
Community treatment order, can recall to hospital
Section 136
Taken from public place to place of safety for up to 24hrs
Most common bacterial cause of endocarditis
Staphylococcus aureus
Unilateral dilated pupil, sluggish response to light - what ix and why
CT head to assess for raised ICP and tentorial herniation causing 3rd nerve palsy
Most common cause of bacterial endocarditis, following prosthetic valve surgery
Staphylococcus epidermidis
How to treat genital warts - multiple vs solitary
Multiple, non keratinised - podophyllum
Solitary, keratinised - cryotherapy
What drug can cause acute dystonia in children?
Prochlorperazine
How to treat anorexia in palliative patients
Prednisolone or dexamethasone
What is decubitus angina
Angina when lying flat
What kind of murmur occurs in mitral regurg
Pansystolic
What size of AAA should have 3 monthly surveillance, what size should be referred urgently via 2ww
> 4.5cm - 3m
5.5 - urgent surgical review 2ww
3-5.5 - vascular review within 12w
What 2 vaccines need to be given 4w apart
Yellow fever and MMR
Patient has longstanding transient synovitis - >6w - what has happened
Developed perthes disease
Treatment of narcolepsy
Modafinil
Child presenting with headache followed by cough, wheeze and crackles on chest - cause and tx
Mycoplasma pneumoniae - oral clari
Inspiratory stridor: high-pitched and crowing. This is usually intermittent, occurring in the supine position e.g. when the child lies on its back, when feeding or when agitated
Laryngomalacia
Contraindications for POP
Acute porphyria and current breast cancer
Young child presents with anaemia, failure to thrive and frontal bossing
Thalassaemia
Monochorionic (identical) - why should have US every 2w
To check for twin twin transfusion syndrome
Painless genital ulcer with lymphadenopathy later patient develops pustular urethral discharge and pain when passing stool
Lymphogranuloma venereum
Teardrop cells on blood film
Myelofibrosis
What can precipitate a G6PD crisis
Thiazides, ciprofloxacin, fava beans
Child with haemarthrosis, bleeding into joints/ muscles - cause
Haemophilia
Elderly person sat next to heater presents with reticulated erythematous rash
Erythema ab igne
Rash treated with steroid worsened rapidly - why
Infected
TIBC in IDA vs anaemia of chronic disease
TIBC raised in IDA as want more iron, low or normal in anaemia of chronic disease
Defect of what immune component can make susceptible to recurrent meningococcal infection
Complement defect
Child turns blue and LOC when crying - cause and mx
Breath holding attack, reassurance - most grow out of it by 5yr
Young person presents with falls, difficulty running, pes cavus, muscle atrophy/ weakness, loss of ankle reflexes and loss of sensation
Charcot marie tooth - motor sensory neuropathy
Young child presents with sensorineural hearing loss, cerebral palsy, developmental delay and CT head shows intracranial calcification - cause
Congenital CMV infection
Childhood condition with sensorineural deafness and hypothyroid/ goitre
Pendred syndrome
Most common cause of diarrhoea in those with HIV
Cryptosporidium - treat with Nitazoxanide
How to take bisphosphonates
Empty stomach 30 mins before breakfast, stand or sit upright for 30mins after taking
How much to increase TSH in pregnancy
25-50mcg
Erythematous oval scaly lesions - starts with single patch then spreads across trunk following lines of langer
Pityriasis rosea
Rash more noticeable following a sun tan
Pityriasis versicolour
Visual hallucinations and worse vision at night
Charles bonnet syndrome due to macular degeneration
Painless loss of vision, swollen eyelid, proptosis, swollen optic disc - cause
Posterior scleritis
What test can differentiate between cardiac and non cardiac causes of hypoxia in neonates
Nitrogen washout test - give 100% O2 for 10 mins, if pO2 < 15 on gas then is cardiac - TOF, transposition or tricuspid atresia
Deficiency causing red crusted lesions, alopecia, short stature, hypogonadism, hepatosplenomegaly, geogaphia (ingesting clay/soil)
Zinc deficiency
When can treat ectopic medically
No rupture
<35mm
No heart beat
No symptoms
B-HCG <1000
Emotional lability, depression, asymmetrical tremor and stigmata of liver disease - cause
Wilsons disease
What does the heel prick test look for
Cystic fibrosis, MCADD, PKU, sickle cell, congenital hypothyroidism
How to treat severe propranolol overdose not responding to atropine
Glucagon
Recurrent episodes of pruritis, jaundice, abdo pain and fever. Bg of IBD
Primary sclerosing cholangitis
Patient presents with lethargy, constipation, non pitting oedema of ankles. FBC shows monochromic macrocytic anaemia - cause
Hypothyroid
Lemon tinge to skin and glossitis
B12/ folate deficiency
What diabetic drug increases fracture risk
Pioglitazone
Pulmonary fibrosis in coal miners who have rheumatoid arthritis - cause and signs on CXR
Caplan’s syndrome - multiple, round, well defined nodules
What is given as prophylaxis for contacts of meningococcal meningitis
Ciprofloxacin
Toxoplasmosis mx during pregnancy
If mum affected spiramycin
If baby also infected then pyrimethamine and sulfadiazine
Treatment of organophosphate poisoning
Atropine
Example alpha blocker used for phaeochromocytoma
Phenoxybenzamine
Definition of impaired glucose tolerance
Fasting <7, OGTT 2hr value 7.8-11.1
Definition of impaired fasting glucose
Fasting >6.1, <7
What abx lowers seizure threshold
Ciprofloxacin
How to differentiate Parkinson’s from dementia with Lewy bodies
Depends if motor/ rigidity/ tremor develop first or dementia, confusion etc - often have REM sleep disorders in patients with DLB
How to treat flexural psoriasis
Steroid cream
What type of blood product has the highest risk of bacterial contamination
Platelets
Child presents with triad of infrequent generalised seizures, daytime absences and involuntary shock like jerking movements
Janz syndrome, juvenile myoclonic epilepsy
What cytotoxic agent causes hypomagnesaemia
Cisplatin
What methods of contraception are unaffected by enzyme inducing drugs
Examples of contraceptives that are unaffected by EIDs are:
Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system
Marker associated with anti phospholipid syndrome
Anti- cardiolipin
What eye drop can cause low potassium, paraesthesia and dyspepsia and should be avoided in pregnancy ?
Dorzolamide (carbonic anhydrase inhibitor)
Recurrence of cloudy vision following cataract surgery
Posterior capsule thickening
3d old presents with scaphoid abdomen, poor feeding and bilious vomiting
Duodenal atresia
10d old baby presents with abdominal distension and mass, hx of prolonged meconium passage, may have bleeding from the rectum
Intussuseption
Painful growth within longstanding ulcer
Marjolins ulcer - a cutaneous malignancy
What criteria is used to diagnose rheumatic fever
Jones’ criteria
Non cystic manifestations of PKD
Berry aneurysms, mitral valve prolapse, colonic diverticula, renal cell carcinoma
Proximal fibula and malleolar fracture - cause
Maisonneuve fracture
How to differentiate viral and bacterial meningitis from the CSF
Bacterial - low glucose, neutrophils and raised protein
Viral - normal glucose, lymphocytes and raised/ normal proteins
Rockall scoring - GI bleed - factors
Age, comorbid status, signs of haemorrhage on endoscopy, SBP
What is functional incontinence
Physical or mental disability that stops from passing urine normally despite normal urinary tract e.g. parkinsons
Causes of overflow incontinence
BPH causing obstruction, neurological conditions, neuropathy due to diabetes mellitus
Cause of hemiballismus - how presents
Unilateral involuntary flailing movements - caused by infarct/ haemorrhage in sub thalamic nucleus
Patient presents with features of meningitis, CSF sample shows organism that stains positive with India ink
Cryptococcosis
Criteria for pre-eclampsia referral
Rise in BP >30/20 over booking, >160/120 or >140/90 with proteinuria, symptoms, IUGR
Patient with endometritis symptoms has ongoing fevers despite abx and resolution of pain
Septic pelvic thrombophlebitis - Treat with heparin
Foetal scalp pH that indicates possible foetal distress and hypoxia
pH < 7.19 - immediate C-section
What should be done if meconium stained liquor
Immediate induction with continuous CTG
Patient in late pregnancy presents with painless bleeding
Placenta praevia
Acute pain and swelling in cheek
sialolithiasis
When should foetal poles be visible
6w
Condition causing telengectasia, recurrent epistaxis with positive family history
osler webber rendu (hereditary hemorrhagic telengectasia)
Low grade fever and SOB up to 48hrs post op
Atelectasis
Laxatives to use in ileostomy vs colostomy
Ileostomy - magnesium sulphate (osmotic)
Colostomy - bulk forming (ispaghula husk)
What symptom is a good indicator of dengue fever
Facial flushing
Most common cause of glomerulonephritis in adults
Focal segmental glomerulonephritis
Organism causing scarlet fever
Strep pyogenes
Rash that starts behind the ears
Measles
How to treat pain due to tumour nerve compression
Dexamethasone
What SSRI has a long half life and is most likely to cause serotonin syndrome when changing medication
Fluoxetine
Common side effect of methylphenidate
Reduced growth
What abx increases risk of cardiac events and strokes due to rupture of existing plaques
Clarithromycin
What medication needs to be slowly weaned due to risk of rebound myocardial ischaemia
Beta blocker
Abx causing oesophagitis, severe pain on swallowing
Doxycycline
What asthma treatment can cause vivid bad dreams
Monteleukast
What asthma treatment if taken alone can cause severe asthma attacks
LABA e.g salmeterol - should be taken with inhaled steroid
Abx that can cause ototoxicity
Erythromycin, gentamicin
UTI abx that can cause pulmonary fibrosis
Nitrofurantoin
Medication causing low magnesium levels
PPI
Antidepressants most likely to cause withdrawal symptoms
Venlafaxine - short half life
Paroxetine
Symptoms of clozapine toxicity
Hyperthermia, drowsiness, confusion, hypersalivation, seizures
What abx interacts with clozapine
Ciprofloxacin
What drug liscenced for children with insomnia and autism can cause odd dreams
Melatonin
For what antibiotics should alcohol be avoided
Metronidazole - for at least 48hrs after - can cause arrhythmia, cardiotoxicity and hepatotoxicity
Doxycycline- reduces effectiveness
What ssri and abx prolong QT
Citalopram, escitalopram, clarithromycin
What contraception is contraindicated in hepatocellular carcinoma
Combined pill as oestrogen can increase malignancy
Vaccines contraindicated in egg allergy
Hep A, yellow fever, influenza
What drug can cause first dose hypotension
Tamsulosin, ACEi
What drug when taken with opioid can cause resp depression
Benzodiazepines
Cause of pityriasis versicolor
Malassezia furfur
First line for urticaria
Cetirizine 10mg OD and Prednisolone 40mg daily
Skin lesions that heal to leave pigmented or hypopigmented atrophic skin
Discoid lupus
What tx not available on NHS can help with hair loss
Minoxidil
Actinic keratosis mx singular vs many
Singular - cryotherapy
Many - 5FU
What to give during cardiac arrest if PE suspected
Altaplase
Doses of adrenaline for anaphylaxis
<6 - 0.15mg
6-12 - 0.3mg
>12 - 0.5mg
What kind of virus is HIV
Double stranded RNA virus
Rust coloured sputum - cause
Strep pneumoniae
Redcurrent jelly sputum cause
Klebsiella
Infective causes of cardiomyopathy
Chagas
Coxsackie
Travel hx with slow pulse and raised temp, muscle pain, n+v -cause
Yellow fever
Foreign travel, itchy rash, fever, cough, wheeze, muscle aches - cause
Schistosomiasisis
Sub-Saharan Africa - present with skin changes, itching, nodules, alterations in vision -cause
Onchoceriasis
What TB drug can precipitate gout
Pyrazinamide
Green coloured sputum cause
Pseudomonas, haemophilus, pneumococcal
Hx of foreign travel, Hepatosplenomegaly, jaundice, fever, low platelets
Malaria
What is testosterone used for post menopause
To increase libido
Definition of PPH
Vaginal bleeding >500mls
C-section >1000mls
Primary vs secondary pph
Primary - within 24hrs
Secondary - 24hrs to 12w
What analgesic should be used for symphysis pubis dysfunction during pregnancy
Paracetamol or codeine
Type of anaemia in rheumatoid arthritis
Normochromic normocytic anaemia
What skin condition is associated with RA, SLE, lymphoma, TB, polymyositis, raynauds
Livedo reticularis
Drug causes of gingival hyperplasia
Phenytoin
Ciclosporin
Nifedipine
What is Charcot triad in MS
Nystagmus, intention tremor and staccato speech
What can precipitate megaloblastic crisis in hereditary spherocytosis
Folate deficiency
Brief sharp stabbing pain or longer lasting dull ache in lower abdomen/ groin of women in late stage pregnancy
Round ligament pain
Condition where body can’t make iron into haemaglobin
Sideroblastic anaemia - see ring sideroblast on blood film
What is a bartons fracture
Fracture of distal radius with intra-articular involvement and dislocation of radiocarpal joint - can be volar or dorsal
What is a rolando fracture
Fracture of base of thumb into 3 parts
Gamekeeper/ skiers thumb
Avulsion fracture of thumb at site of insertion of ulnar collateral ligament
How to treat local anaesthetic overdose
Lipid emulsion
What is echopraxia
Psychiatric condition when someone can’t stop copying you
Pinna cellulitis vs perichondritis
Cellulitis affects ear lobe, perichondritis doesn’t
What fluid to use in bladder washout
0.9% saline
Most common cause of significant pleural effusion
Malignancy
When should colchicine be avoided for acute gout
Blood disorder
eGFR < 10
Severe hepatic impairment
Pregnancy or breastfeeding
Taking clarithromycin or erythromycin, verapamil, ketoconazole
Learning disability, behavioural problems including self harm, must odour and pale complexion compared to family
Phenylketonuria - treat with low phenylalanine diet
Encephalopathy, neurodegeneration, sweet smelling urine and sweat
Maple syrup urine disease
Poor feeding, vomiting, seizure and odour of sweaty feet
Isovaleric acidaemia
PCOS hormone levels
LH raised
Testosterone raised
Low Sex hormone binding globulin
What is tested for on Guthrie test (blood spot test)
CF
PKU
Sickle Cell
Congenital Hypothyroid
Downs is not tested
Disease with pancytopenia, hepatosplenomegaly, jaundice and lipid laden macrophages
Gauchers disease
Triad of symptoms in budd chiari
Abdo pain, hepatomegaly and ascites
Triad of rheumatoid, splenomegaly and neutropenia
Felty syndrome
What drug precipitates gout
Thiazide like diuretics
Name for cold sores
Herpes labialis
What pulse change is common in severe asthma and cardiac tamponade
Pulsus paradoxus
Most common causes of drug induced SLE
Hydralazine, procainamide, phenylbutazone, isoniazid
When do you see red cell casts in urine
Glomerulonephritis
If on 2x DMARDS what is next step for RA
Anti TNF
What to start in mild SLE not improving with steroids
Hydroxychloroquine
What medication is given to reduce intracranial pressure
Mannitol
What antidepressant is contraindicated with tamoxifen
Fluoxetine, paroxetine, bupropion
What to do if switching from warfarin to apixaban and INR >2.5
Wait for it to drop to less than 2
What rheumatoid drug can cause agranulocytosis and therefore requires screening for infection e.g. chicken pox before admin
Adalimumab
How to wean off steroid
Rapid wean to a physiological dose of 7.5mg daily - reduce by 2.5 every 3-4 days
Then reduce by 2.5mg every 7-28 days
What antiemetic used 3rd line in pregnancy has increased risk of cleft lip and heart defects
Ondansetron
Switching to what drug helps with benzodiazepine withdrawal
Diazepam
What drug can cause paradoxical aggression and hostility
Diazepam
What drug can cause delayed wound healing and infections following tooth extraction
Bisphosphonate
What drug can cause euglycaemic diabetic ketoacidosis
SGLT2 inhib
What drug reduces hypo awareness and precipitates psoriasis
Beta blockers
When to commence buprenorphine patch when switching from methadone
Once withdrawal symptoms develop
What can happen if replace folate before b12
Subacute combined degeneration of the cord - paraesthesia, leg weakness, ataxia, loss of sensation
What weight loss drug can increase INR
Orlistat
What is ranson criteria
Used to predict pancreatitis mortality
ECG changes in digoxin overdose
St depression and inverted T waves in V5/6 (reverse tick)
ECG changes in PE
Right axis deviation
RBBB
Sinus tachy
S1Q3T3
What ECG change is seen in hypothermia
J wave
ABG finding in CKD
Metabolic acidosis with resp compromise
Cataracts, muscle weakness and frontal balding in young male
Myotonic dystrophy
Unable to close eyes after blepharoplasty
Lagopathalmos
What is globus
Sensation of lump in throat
Infantile spasms with drawing up of knees, 3-8m of age
West syndrome
make a w with legs
What STIs cause pH > 4.5
BV and TV
How to manage bcc on eyelids or nasal ala
Urgent referral for removal
Tylosis - associated malignancy
Oesophageal
Acquired ichthyosis - associated malignancy
Lymphoma
Treatment for widespread pityriasis versicolor
Ketoconazole shampoo
What do haemolytic anaemias e.g. spherocytosis increase risk of
Gallstones
Finger infection in herpes
Herpetic whitlow
Allergic vs irritant dermatitis
Irritant is just red
Allergic is red, scaly, blistering, weeping
What epworth score for sleep apnoea requires further investigation
> 10
What score on MMSE and addenbrookes suggests dementia
MMSE < 24
Addenbrookes 82-88
Cause of Burr cells
Uraemia
Agoraphobia
Anxiety in big crowds
Smear cells on blood film
CLL
Precocious puberty, unilateral cafe au lait spots, fractures
McCune-Albright syndrome
Most common cause of oesophageal cancer in upper oesophagus vs lower
Upper - Squamous cell carcinoma
Lower - Adenocarcinoma
What diet should be used for ascites
Low salt
Criteria for bariatric surgery
BMI > 40
BMI > 35-40 + co-morbidity that would be improved by weight loss e.g. diabetes
Red/ white discolouration of inside of cheek in patient who smoked and drinks
Squamous cell carcinoma
painful, clearly defined, round or ovoid, shallow ulcers that are confined to the mouth and are not associated with systemic disease.
Aphthous ulcer
First line investigation for haemorrhoids
Proctoscopy
Choriocarcinoma tx
Methotrexate
Most common parotid tumour
Pleomorphic adenoma
Beaded appearance on ERCP
Primary sclerosing cholangitis
How to treat pernicious anaemia
B12 replacement - IM hydroxycobalamin
What is beri beri
Thiamine deficiency causing polyneuropathy and heart failure
What laxative to use in opioid induced constipation
Osmotic and stimulant laxative
Ankle and knee reflex dermatomes
Ankle S1-2
Knee L3-4
IM benzylpenicillin dose for meningitis in kids
<1 - 300mg
1-10 - 600mg
>10 - 1200mg
Most common benign ovarian tumour in women under 30
Dermoid cyst
Ovarian tumour associated with ascites and pleural effusion
Meigs’ syndrome - caused by fibroma
Jaundice and anaemia following infection, new medication or broad beans
G6-PD
Recurrent clots with prolonged APTT and low platelets
Anti phospholipid
Macrocytic anaemia with hypersegmented polymorphs on blood film
B12 / Folate deficiency
If terminal ileum resection what vitamin won’t be absorbed
B12
What is a rare complication of chloramphenicol eye drops
Aplastic anaemia, bone marrow suppression
Transfusion - develop fever, hypotension, red coloured urine
Immediate haemolytic transfusion reaction
Treatment of essential thrombocytopenia
If platelets >1000 commence aspirin 75mg OD
If age > 60 or previous thrombosis give hydroxycarbamide
ABG in aspirin overdose
1st resp alkalosis then develop acidosis from metabolites
Drugs for post exposure prophylaxis of flu
Oseltamavir and zanamivir
How to test for acromegaly
Oral glucose tolerance test with growth hormone
Painless vision loss with colour changing haemorrhages, streaky dark shadows
Vitreous haemorrhage
What condition is associated with uveitis and HLA B5
Bechets
Punched out lesion on macula
Macula hole
Stage 1 not need treatment
Stage 2 or more need vitrectomy
Cover uncover vs cover test
Cover test shows tropia - always present squint
Cover uncover shows phoria - not always present
Lump on upper eyelid with eyelash loss and no improvement with hot compress or abx ointment
Sebaceous cell carcinoma
Pain, swelling of medial lower eyelid with increased tear production and possible purulent discharge
Dacrolytis - refer to opthalm for incision and drainage
What causes pupil to be irregular and dilated poorly in anterior uveitis
Posterior synechiae - pupil sticks to lens
Best test for aortic dissection
Transoesophageal echocardiogram
Barter’s syndrome
Inherited hypokalaemia, low sodium and low chloride with normotension
What type of bilirubinaemia in newborns is always pathological
Conjugated
Incoordination of rapidly alternating movement
Dysdiadochokinesis
Hypertension that can’t be controlled with medication, sudden renal failure when commencing ACEi
Renal artery stenosis
How does HIV affect HbA1c and diabetes diagnosis
Can’t use HbA1c as is underestimated
Bone infections in child with sickle cell disease - what organism
Non- typhi salmonella
Bone infections in child with sickle cell disease - what organism
Non- typhi salmonella
Bone infections in child with sickle cell disease - what organism
Non- typhi salmonella
When to consider retreating scabies
Itching can take 6w to settle. Only repeat treatment if further burrows or rashes
What NSTEMI patients should have coronary angiography
immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3% i.e. those at intermediate, high or highest risk
coronary angiography should also be considered for patients if ischaemia is subsequently experienced after admission
Causes of Dupuytrens contracture
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
What antidepressant shouldn’t be prescribed with warfarin
SSRI
First line for spasticity in MS
Baclofen and gabapentin
What antihypertensive causes altered taste sensation
Amlodipine
Diagnostic test for necrotising enterocolitis
Abdo XR - treat with IVI, NG tube, NBM,
IV Abx
Pituitary tumour following adrenalectomy
Nelson’s disease
Child <3 starts to develop pubic hair
Hamartoma of post pituitary- treat with GNRH analogue
45 XO
Turners - gonadal hypoplasia and short stature, wide nipples, webbed neck, bicuspid aortic valve, primary amenorrhoea
Short synatchen test use
Adrenal insufficiency
Primary vs secondary hypothyroidism
Primary - problem with thyroid so T3/4 not produced and TSH high
Secondary - problem with pituitary/ hypothalamus so TSH not produced and T3/4 low
Patient with pituitary tumour develops rapid onset headache and drop in GCS
Pituitary apoplexy - bleed into pituitary
What drug is used for HER2 positive breast cancer and needs cardiac monitoring
Trastuzumab
Hernia at lateral edge of rectus sheath
Spigelian
Test used to assess for level of venous valve deficiency in varicose veins
Trendelenburg test
Hammans sign when listening to chest
Crunching sound in time with heart - due to mediastinal emphysema caused by oesophageal rupture
Delusion of infestation with insects
Ekboms syndrome
Young Asian women with renal artery stenosis/ aneurysm
Takayasus arteritis
Bipolar 1 vs 2
1 - Depression and Mania
2 - Depression and Hypomania ( no delusions, no hallucinations, no impairment in functioning, <7d)
What antidepressant to try if already tried 2x SSRI without benefit
SNRI e.g. venlafaxine
Parkinsons meds that can cause visual hallucinations
Levodopa and amantadine
What Parkinson’s meds cause pulmonary, retroperitoneal and pericardial fibrosis
Ergot derived dopamine agonist e.g. bromicriptine
Howell jolly bodies
Post splenectomy, coeliac
Tingling, deadness, pain in hand associated with wasting of intrinsic muscles, clawing of fingers
Ulnar nerve lesion
Richters vs maydl’s hernia
Richters is when one of bowel walls goes through defect - can become strangulated and necrotic without obstructing
Maydl’s is when bowel comes out in 2 loops forming a w shape
Bloods in polycythemia Vera
High Hb, PCV, may have raised platelets and WCC
Ferritin may be low
How to differentiate holmes-adie and Argyll-Robinson pupils
Holmes adie = dilated pupil and reduced tendon reflexes
Argyll Robinson = small pupil
Antibodies raised in graves vs hashimotos
Graves - TSH receptor antibodies
Hashimotos - Thyroid peroxidase and thyroglobulin antibodies
Schwartz sign on eardrum
Pink patch - seen in otosclerosis
Patient from Africa presents with nasal symptoms nodules and nose enlargement
Rhinoscleroma - Klebsiella
Sweating over cheeks, temples and facial flushing after parotid surgery
Freys syndrome - damage to auriculotemporal nerve
Cause of progressive dysphagia from solids to liquids
Hypopharyngeal cancer
What age do children achieve night and day continence
3-4 years
When to consider valve replacement in aortic stenosis
- Symptomatic
- Asymptomatic with valvular pressure gradient > 40 and features of systolic dysfunction
Diabetes mellilitus, optic atrophy, deafness in child
Wolfram syndrome
Does lithium cause cranial or nephrotic diabetes insipidus
Nephrogenic
Type 1 vs 2 AI liver disease
Type 1 - Anti smooth muscle antibodies, ANA
Type 2 - anti LMK (liver/kidney microsome), anti LC
Anorexia - what’s raised
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Brief spasms/ jerks in first year of life
Infantile spasms (west syndrome)
First line treatment for benign Rolandic epilepsy
Carbamazepine
Normal sodium and potassium values
Sodium 135-145
Potassium 3.6-5.2
What abx can cause c.diff
Clindamycin
Salt intake in hypertension
<6g/day, but ideally <3g/day
Red flags for back pain
Red Flags for back pain include -
Thoracic pain
Age <20 or >55 years
Non-mechanical pain
Pain worse when supine
Night pain
Weight loss
Pain associated with systemic illness
Presence of neurological signs
Past medical history of cancer or HIV
Immunosuppression or steroid use
IV drug use
Structural deformity
Perthes disease presenting features, age
4-8, progressive hip pain, limp, stiffness
When can copper coil be inserted
Up to 5 days after sex
Or up to 5 days after earliest estimated date of ovulation
Painful arc with/ without weakness - cause
With weakness - rotator cuff tear
Without - subacromial impingement
Popping, clicking, swelling of shoulder and positive scarf test
Acromioclavicular degeneration
When can deliver vaginally in HIV
Viral load <50 at 36w
What drug is given to neonate and as infusion to mother for HIV during C-section
Zidovudine
How to treat b12 deficiency
1mg IM hydroxycobalamin 3x weekly for 2w then once every 3m
Acute onset fever, strider and drooling, no choking
Epiglottitis
What to do if >2 exacerbations of UC in last 12m
Azathioprine or oral mercaptopurine
Flu prodrome, RUQ pain, tender hepatomegaly, jaundice, deranged LFT
Hepatitis A
What drug can be used in COPD if FEV1 < 50% and 2 or more exacerbations whilst on triple therapy
PDE- 4 inhibitor - roflumilast
Oedema, raised JVP, heave and loud S2 on background of COPD - cause and tx
Cor pulmonale - treat with loop diuretic, LTOT
Wilson’s disease - diagnostic test and treatment
Reduce caeruloplasmin, reduced serum total copper, raised free copper, confirmed by genetic analysis
Treat with penicillamine
What to do after tried LTRA for child < 5 with asthma
Refer
Cellulitis near eyes/ nose
Co-amox
Raynauds, dysphagia and telengectasia on exam
Systemic sclerosis
Abx for sinusitis
Phenoxymethylpenicillin
Vitreous vs retinal detachment vs vitreous haemorrhage
Vit detachment - flasher/ floater no vision loss
Vit haemorrhage - as above with vision loss
Retinal detachment - shadow across vision from periphery inwards
When to give abx for otitis media
Age <2, bilateral
More than 4 d
Unwell
Immunocompromised
Discharge or perf
Colles vs smith fracture
Colles - dorsal displacement
Smith - volar displacement
