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
