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MSRA > MSRA > Flashcards

MSRA Flashcards

1
Q

IgA Deficiency

A

Increased incidence of mucousal infections
Obstructive spirometry from Chronic mucousal infections
Anti IgA antibodies = 40% - can get allergic reactions (blood transfusion)
Otitis, sinusitis, bronchitis, pneumonia + some get chronic diarrhoea and GI infections
3/4 are asymptomatic

Vaires with Ethnicity 1 in 150 spanish, 1 20000 swedish

Increased risk of autoimmune
Cannot screen for Coaeliac as false negative

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2
Q

IgG Deficiency

A

At Risk of infection by encapsulated bacteria

This is essentially Meningitis / Pneumonia (N. Menigococcus, Strep Pneumonia and Haemophilus influenza)

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3
Q

SCID

A

Very rare
Abnormal T and B cells
Poor Prognosis

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4
Q

Anal Fissures / Anal Fistulaes preferred imaging modality

A

MRI - can see where the tracts go - Remember the black guy from ward 2 with Dr Kwame

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5
Q

Likely Haemorrhoids (red blood with no b symptoms in young person) imaging

A

Step wise:

  • Rigid
  • Flexy
  • Colonoscopy

If haemorrhoids found then no need to progress, however, need to rule out Ca as cause

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6
Q

IBD imaging

A

Colonoscopy to visualise whole colon

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7
Q

Tetralogy of Fallot

A

Congenital heart disease
Can be undiagnosed (aka patients can compensate)
Essentially, Pulmonary stenosis –> Atresia* means reduced blood flow to the lungs. This causes increased work for RV - RV Hypertrophy. There is a VSD* and there is also an overiding aorta** - this means that Aorta blood is from LV and RV.

Patient will have cyanotic spells that are improved with squatting - Increasing the systemic resistance and lowering o2 demand. Increasing Systemic vascular resistance means high pressure in Left side of the heart. Leading to increased blood flow into right side and therefore increased blood to pulmonary arteries and lungs. Better oxygenation then occurs following this.

RV gives appearance of Boot shaped heart
There is also Systolic Murmur
Cyanotic spells
Improved with Squats

4: Things:
- Right outflow obstruction (PS / Atresia)
- VSD
- RV Hypertrophy
- Overiding aorta

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8
Q

Pulmonary Atresia

A

Very severe
Oligaemic Lung fields
There is little or no blood flow through the Pulmonary artery

MUST have other defects to be compatible with life:

PFO/ASD/VSD is essential to allow mixing between the left and right heart.

The blood then must had a PDA (patent Ductus arteriorsus) that allows the blood to then go to the lungs for oxygenation

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9
Q

Coarction vs AS

A

Radiofemoral delay?
If yes - Coarction
AS also has classic murmur

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10
Q

Continuous Murmur

A

PDA

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11
Q

Blood Reaction

A

Caused by HLA incompatibility if Crossmatched or O neg

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12
Q

Streptococcus Pharyngitis

A 
FeverPAIN Score
Fever - 1 
Pus - 1
Attenuates quickly - 1
Inflamed Tonsils - 1 
No Cough - 1

0 - 1 = no antibiotics

2- 3 = Delayed Antibiotics

4 = antibiotics if severe or 48 hour delayed antibiotics strategy

or Centor Score:

The Centor criteria are: score 1 point for each (maximum score of 4)

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

3 or 4 give antibiotics

Phenoxymethylpenicillin is the drug of choice- amox rash with EBV.
Give for 7 - 10 days

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13
Q

Keppra Side Effects

A 
Weight Changes / Anorexia
Abdominal Pains
Nausea
Diarrhoea 
Anxiety
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14
Q

Lamotrigine side effects

A 
Skin Rashes
Joint Pains
Sleep Disturbances
Blurred Vision 
Dizziness
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15
Q

Valproate side effects

A 
Weight GAIN
Thrombocytopenia 
Transient hair loss
Aggression / Behaviour Changes
Ataxia and Tremors
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16
Q

Phenytoin side effects

A 
Paraesthesia 
Gingival Hypertrophy 
Fatigue
Acne
Hirsutuism 
Peripheral neuropathy 
Stephens Johnson Syndrome
Blood disorders
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17
Q

Carbemazapine side effects

A 
Dry Mouth 
Fatigue
Hyponatraemia
Blood Disorders ( anaeamia )
Dermatitis
Gynaecomastia
Male Infertility 
Hepatitis
Restlessness
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18
Q

Menieres Disease?

A

Triad:
Hearing loss (fluctuant)
Tinitus
Vertigo

Also fullness

Comes in episodes of varying time

Prochlorperazine for acute treatment
Betahistine for prevention

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19
Q

BPPV

A

Vertigo on movement
Lasting seconds to minutes

JUST VERTIGO - no hearing loss, Tinitus or Fullness

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20
Q

Vestibular Neuritis

A

Also known as labrynthitis Viral infection leading to secondary vertigo
This is made worse by movement, get very sick (nausea and vomitting) and posturing

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21
Q

Cholesteatoma

A

This is usually asymptomatic at first

Foul smelling persistent discharge

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22
Q

Hirsutism

A

Definition:
Androgen Depedent Hair Growth in a woman

  • Poly cystic Ovary
  • Cushings
  • Adrenal Tumour
  • CAH
  • Obesity
  • Androgens / Steroids
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23
Q

Hypertrichosis

A 
This is androgen independent hair growth
Causes:
Porphyria Cunea Tarda 
Anorexia
Ciclosporin
Congenital causes
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24
Q

Penetrance

A 
Low = mild symtpoms despite abnormal genotype
High = Severe Symptoms despite mildly abnormaly genotype
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25
Q

Osteomylitis / Cellulitis in Sickle Cell

A

Non Typoid Salmonella

Is for some reason more common to get salmonella blood and bone infections in sickle and malaria

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26
Q

Osteomylitis types:

A

Blood bourne
Non blood bourne

  • Blood bourne is usually monomicrobial, found in children and vertebral oesteomylitis is the most common form.
    RF: blood stuff: - sickles cell, IVDU, IE
  • Non Blood bourne is likely polymicrobial and is when an adjacent soft tissue infection spreads to the bone. (Diabetic foot).
    RF: Diabetes, Pressure sores, Peripheral art disease (essentially poor healing)

Staph A is most common cause
Salmonella is most common in sickle cell patients

Fluclox (clinda if pen allergic) for 6 weeks
MRI is imaging of choice

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27
Q

Stye Treatment

A

This is a small bacterial infection of oil gland
Hot compress only
If associated conjunctivitis - for topical antibiotics

Chalazion occurs when a cyst forms
Most resolve
Some need surgical drainage

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28
Q

Osteomalacia

A

Vit D deficiency
This is Rickets when growing
It leads to de mineralisation of the bones and resorption of Calcium and phosphate.

Ix:

  • Low Vit D by definition
  • Raise ALP (Due to increased bone turnover/ de mineralisation)
  • Low CA and Low Phosphate in 30% of cases

Replace Ca and Vitamin D

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29
Q

Fibroids:

A

Benign smooth muscle tumours of the uterus
20% White women
50% Black Women

Asymptomatic
Menoorhagia
ABdominal Pain
Bloating
Urinary symptoms
Sub fertility 
Polycythaemia (can be from production of EPO)

symptomatic management with a levonorgestrel-releasing intrauterine system is recommended by CKS first-line
This can be done if its < 3cm and not changing the shape of the uterine cavity

TXA or COCP

GnRH agonists can reduce the size of the fibroid - these turn off the ovaries

Hysterectomy, myomectomy
Uterine artery emobilisation

Red degeneration is bleeding into the tumour that occurs in pregnancy

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30
Q

Gastroschisis

A

This tend to be a more mild condition that exomphalos
It is a small defect usually next to the ubilicus. It can have a normal Vaginal delivery but patient needs it surgically fixing within 4 hours of delivery

Not encased in a sac
Visible intestines

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31
Q

Exomphalos

A

Abdominal contents protrudes outside the abdominal wall but is covered by a sac of amniotic sac and peritoneum.
Associated with syndromic and cardiac/kidney malformations: Downs/ BW syndrome

Delivery by C Section
Allow the sac to granulate
At this point then repair - delayed repair to avoid abdominal compartment syndrome

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32
Q

Colchicine side effect

A

diarrhoea

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33
Q

Allopurinol indications for Gout?

A 
ULT is particularly recommended if:
>= 2 attacks in 12 months
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics

Allopurinol is first line
febuxostat if ineffective

Give Colchicine cover if starting allopurinol

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34
Q

Side effect of Gold

A

Proteinuria

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35
Q

Side effect of infliximab

A

Reactivation of TB

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36
Q

Side Effect of sulphasalazine

A

Oligospermia
Rashes
Heinz Body Anaemia
Interstitial Lung Disease

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37
Q

SE: Methotrexate

A

Myelosuppression
Liver Cirrhosis
Pneumonitis

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38
Q

SE: Hydroxychloroquine

A

Retinopathy

Corneal Deposits

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39
Q

SE: Penicillamine

A

Protienuria

Exacerbation of myasthenia gravis

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40
Q

SE: Entanercept

A

Reactivation of TB

Demylination

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41
Q

HRT Considerations:

A

Indications:

  • Vasomotor symptoms / headache / insomnia
  • Prevention of osteoperosis in early menopause (continued until 50)

Combined or oestrogen only
Continuous or cyclical

  • If have had hysterectomy then can have oestrogen only
    PROGESTERONE IS NEEDED TO PREVENT UTERINE CA therefore combined is required in most women
  • Continuous vs cyclical is to do with when LMP was

if < 1 year since LMP then needs to have cyclical

Can have continous if
LMP > 1 year ago
Have had Cyclical for > 1 year
LMP > 2 years ago (if under 40 aka early menopaus)

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42
Q

Vasomotor symptoms in menopause

A

HRT

Other options include
- Clonidine, SNRI, SSRIs (sertraline isn’t used)

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43
Q

Menorrhagia treatment?

A

Mirena coil is first line

Investigate with FBC

TV Us if symptoms of structural abnormality present (fibroids/ endometriosis i guess) = intermenstural bleeding, post coital bleeding, pain, pressure

If not for contraception (aka trying for a baby) mefanic acid 500mg TDS or TXA 1 g TDS on first day of the period

If requires contraception:

  • Mirena coil
  • COCP
  • Long acting progesterones
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44
Q

Breastfeeding drugs to avoid:

A 
ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
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45
Q

Breast Cancer Contraception

A

Only Safe contraception is IUD / Condoms

All hormone contraceptions are contraindicated

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46
Q

IM Ben Pen dosing in kids?

A

< 1 = 300mg
1-10 = 600mg
> 10 = 1200mg

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47
Q

Oral involvement with blistering of skin in elderly?

A

Pemiphigus Vulgaris

Bullous pemphigoid doesnt’ have blisters in the mouth

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48
Q

Antiphospholipid syndrome

A

Associated with SLE
Can be stand alone

Signs and symptoms:

  • Paradoxical APTT rise
  • Thrombocytopenia
  • Livedo Reticularis
  • VTE
  • Arterial Thrombosis
  • Recurrent misscariges
Treatment:
- Aspirin low dose
- Warfarin 
INR target 2-3 but if has a clot then 3-4 
THINK ABOUT EBONY's MUM
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49
Q

Retinoblastoma

A

Commonest in 1-2 years (peak at 18months)

Loss of red reflex
10% hereditary
Autosomal Dominant

Good Prognosis with varying treatment options dependent on the stage of disease

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50
Q

Levonelle

A

Used as 1 of the 3 emergency contraceptives
needs to be taken within 72 hours of the UPSI
Decreases effectiveness overtime
Progesterone
Should be doulbe dose in high BMI
1% vomit
if Vomit in 3 hours - repeat the dose

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51
Q

Ulipristal

Ellaone

A

Emergency contraceptive
30mg taken up to 120 hours after the UPSI
Can have multiple doses in a menstral cycle but should hold contraception and breastfeeding for 5 days following the dose

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52
Q

IUD

A

Emergency Contraceptive

Can be inserted up to 5 days following UPSI

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53
Q

Children under 3 months Meningitis treatment?

A 
IV Amoxicillin and Cefotaxime (cover for listeria)
Also if requried can give dex
Indications:
- Frankly purulent CSF
- WCC > 1000 on CSF
- Bacteria on Gramstain
- Raised Protein > 1 with Increased WCC
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54
Q

Corneal Abraisions analgesia

A

Don’t advise topical anaesthetic agents as can lead to bad outcome
Simple oral analgesics are advised

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55
Q

Granulum annulare?

A

Depressed centres hyperpigemented often found on the dorsum of the hand. ? Associated with DM

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56
Q

Brushfield Spots?

A

White spots in the peripheries of the iris associated with Downs syndrome

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57
Q

Coloboma

A

Defect causing a gap in lens, iris or retina, associated iwth patau syndrome

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58
Q

GORD in children

A

Really common
40% of infants regurg food
If just regurg then just treat with gaviscon and feeding techniques - sit up, small feeds, sleep on back etc.

However, if:

  • Stopping feeding
  • Distress
  • Faultering growth

Try gaviscon and then trial a PPI

Metoclopramide saved for specialist use

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59
Q

Ovarian Cysts

A

Physiological cysts

Benign Germ cell Cysts

Benign Epithelial Tumours

multiloculated cysts need to be biopsied to rule out malignancy

Phsyiological cysts:
Follicular - commonest type - regress after a few menstral cycles

Corpus luteum cysts: when Corp luteum doesn’t break down and can be filled with blood or fluid- can present as intraperitoneal bleeding

Benign Germcell Cysts:
Dermoid cysts:  - Mature cystic Teratomas
Can contain skin, hair or teeth
< 30 v common 
Bilateral in 20%
Asymptomatic unless torsion occurs

Benign epithelial cysts
Serous Cystadenoma - commonest benign epithelial tumour (20% bilateral)

Mucinous cystademoa- can become massive

Meigs syndrome is commonly associated with fibroma

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60
Q

Salivary Glands:

A

3 pairs
parotid (serous) - most tumours
submandibular (mixed) - most stones
sublingual (mucous)

Pleomorphic adenomas (benign, ‘mixed parotid tumour’, 80%)
middle age
slow growing, painless lump
superficial parotidectomy; risk = CN VII damage

Stones
recurrent unilateral pain & swelling on eating
may become infected → Ludwig's angina
80% are submandibular
plain x-rays; sialography
surgical removal

Other causes of enlargement
acute viral infection e.g. mumps
acute bacterial infection e.g. 2nd to dehydration diabetes
sicca syndrome and Sjogren’s (e.g. RA)

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61
Q

Ottawa Rules

A

These are rules used for the ankle injury ? need for X ray

Pain in the malleolar zone + any of the following: = X ray

  • Bony Tenderness at the lateral malleolar zone
  • Bony Tenderness at the medial malleolar zone
  • Inability to walk / weight bear immediately after injury
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62
Q

Capgras syndrome?

A

Capgras syndrome: the delusion that a friend or partner has been replaced by an identical-looking impostor.

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63
Q

Othello Syndrome?

A

Othello syndrome is the irrational belief that one’s partner is having an affair with no objective evidence.

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64
Q

De Clerambault Syndrome?

A

De clerambault syndrome is the delusional idea that a person whom they consider to be of higher social and/or professional standing is in love with her.

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65
Q

Cortard Syndrome?

A

Cotard syndrome is the delusional idea that one is dead.

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66
Q

Fregoli Syndrome?

A

Fregoli syndrome is the delusional idea that the various people that the patient meets are in fact the same person.

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67
Q

What is gliclazide?

A 
Sulfonylurea 
hypoglycemic agent
Stimulates the Beta cells to produce insulin
Common adverse effects:
- Hypoglycaemia 
- Weight Gain (just like insulin)

Rare:

  • SIADH and hyponatraemia
  • Marrow suppression
  • Cholestatic hepatotoxicity
  • Peripheral neuropathy

AVOID IN PREGNANCY AND BREASTFEEDING

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68
Q

Metformin

A 
biguanide that acts at the liver, not the pancreas
Therefore no weight gain or hypos
FIRST LINE IN Type 2 diabetes
Stops gluconeogeneiss 
Increases insulin sensitivity

Adverses effects:

  • Gastric upset
  • Reduced B12 absorption
  • Lactic acidosis

CKD don’t use if < 30 egfr and dose adjust if 30-45

Hold on day of contrast imaging and stop for 48 hours.

Careful re lactic acidosis in hypoxic event (aka hold if had MI, sepsis or hypoxia)

Used in PCOS to help ovulation
Also used in NAFLD

Continue in pre existing T2 diabetes in pregnancy, stop all other hypoglycaemics and start insulin

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69
Q

Parkinson’s Treatment?

A

Should be initiated by a movement specialist

If there are motor problems - Levodopa
If there are not many motor problems - any of the antiparkinson’s meds

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70
Q

Levodopa

A

Prodrug to Dopamine
Administered like this as can cross the blood brain barrier
Administered with Carbidopa (decarboxylase inhibitor)
This cannot cross the blood brain barrier
This allows Dopamine to be increased in the brain withouth increasing peripheral dopamine

Levodopa effectiveness wears off with time

On off effect
dyskinesia 
Dry Mouth
Postural drop, psychosis, drowsiness 
Don't stop this medication suddenly
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71
Q

Dyskinesia vs Dystonia

Tardive Dyskinesia?

A

Both occur in parkinsons especially in the later stages

Dyskinesia is the involuntary movements often described as rolling movement seen with Levodopa use. It is due to too much dopamine. This effects large mm groups - head + neck, Limbs, Trunk

Tardive Dyskinesia is a specific type of Dyskinesia seen in antipsychotic medication use. The main difference is these often effect the eyes, mouth, tongue.

Dystonia is involuntary prolonged muscle contraction causing abnormal posture and pain. This is seen in CP/Brain injuries as well as when PD meds effectiveness wears off.

Treated with antimuscarinics and benzos

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72
Q

Dopamine Receptor agonists and use in parkinsons?

A

Bromocriptine, Ropinorole, Cabergoline, apomorphine

These are ergot derived (fungus derived) meds used in parkinsons to increase dopamine.

Adverse effects:
Increased risk of pulmonary, cardiac and peritoneal fibrosis.
It is advised to get ECHO, CXR, Cr and ESR before starting

Also warn of impulse disorders like smoking, spending and gambling addictions

Get other things like day time sleeping and hallucinations.

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73
Q

MAO-B

A

Monoamine oxidase inhibitors
These stop the break down of dopamine
Selegiline

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74
Q

Amantadine

A

Used in parkinsons ? increases expression of dopamine receptors

Used in MS as well for fatigue
Can cause slurred speech

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75
Q

Treatment of tremor in drug induced parkinsons?

A

Procyclidine
Procyclidine has an atropine-like action on parasympathetic-innervated peripheral structures including smooth muscle.
Also used in antipsychotic use for acute dystonia

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76
Q

Acne Severity

A

Mild - open and closed comodomes
Moderate - pustules and papules
Severe- inflammation with scarring

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77
Q

Acne stepwise treatment?

A

Single Topical: BPO or retinoid

Combo Topical: BPO/Retinoid/Antibiotic

Oral Antibiotic: Tetracycline/Lymecycline/doxycycline
Erythromycin for pregnancy
Not minocycline as causes pigmentation

COCP in women - dianette is used for anti androgen properties

Oral isoretinoin: under specialist supervision
PREGNANCY IS CONTRAINDICATED

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78
Q

Commonest cause of headache in paeds?

A

Migraine
Equal sex distribution until puberty then F:M 3:1
Ibuprofen first line
Tryptan if > 12 - nasal spray only

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79
Q

Fibroids treatment if wanting to conceive

A

Myomectomy

Need to concel about pregnancy as may require a C section due to the increased risk of uterine rupture

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80
Q

Starting Allopurinol?

A

Offer after 1 episode of gout but suggest if:

  • > 2 episodes in 12 months
  • Tophi
  • Renal Disease
  • uric acid stones

Start with NSAID / Colchicine cover
Start at 100mg OD and titrate up until urate serum level is < 300

Febuxostat is the second line to allopurinol

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81
Q

Cardiotocography

A

Measures pressure changes in the uterus
Normal Fetal heart rate is 100-160

Baseline Brady - Increased Fetal vagal tone/ Maternal beta blocker use

Baseline Tachy - prem, maternal fever, infection

Loss of baseline variability < 5 beats / min = Prematurity or hypoxia

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82
Q

Types of Decelarations on the CTG

A

Early: These are decelerations in the HR that occur at the start and finish with the end of the contractions. These are usually benign

Late: These indicate fetal distress. When the deceleration in the HR occur after the onset of the contraction and doesn’t return to the baseline until after 30 seconds after the end of the contraction

Variable Decelerations - these are independent of contractions and may indicate cord compression

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83
Q

Guidance for alcohol and pregnancy?

A

Avoid in pregnancy completely

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84
Q

Antenatal care basics:

A

Nausea and vomiting - natural remedies like ginger and acupuncture are recommended by NICE

Vitamin D - encourage a minimum of 10 micrograms daily of Vit D Supplementation

Alcohol - women shouldn’t drink

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85
Q

Smoking Cessation

A

All patients should be offered this when undergoing smoking cessation

Options:
Varenicline or bupropion or NRT
Should have a target date when prescribing
Prescribe for 2-4 weeks after this date
Represcribe if evidence of ongoing trial to quit

Don’t re try NRT within 6 months of failure

NRT:
Headahce, N and V and Flu like symptoms are adverse effects of NRT
If high level of dependency - patch plus (gum, or something else)

Varenicline:
Varenicline is a nicotinic receptor partial agonist
Start 1 week before target stop date
Recommend course for 12 weeks
More effective than Bupropion 
Causes nausea and sleep distrubance
Avoid in self harm and depression
NOT IN PREGNANCY

Bupropion:
A Noradrenaline and dopamine reuptake inhibitor and nicotinic antagnoist
1 - 2 days before patient target stop date
Small risk of seziures
Contraindicated in epilepsy and PREGNANCY

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86
Q

Smoking cessation in pregnancy

A

Nice recommend CO detection because so hard to admit to smoking
If > 7 or admit to smoking, then offer cessation

CBT, Motivational interviewing and structured help should be first line
Second line is NRT

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87
Q

SIADH causes

A

Malignancy: Small Cell Lung, Pancreas and Prostate
Neuro: Storke, SAH, SDH, Meningitis/infection
Infection: TB, Pneumonia
Drugs: SSRIs, Sulfonylureas (gliclazide), Carbemazapine, Cyclophosphamide
Other: Porphyria, PEEP

Dilutional hyponatraemia - may have peripheral oedema

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88
Q

SIADH treatmnet

A

Try to correct slowly to avoid central pontine demylinolysis

Treat with fluid restriction

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89
Q

B3 Deficiency

A

Niacin deficiency

Pellegra: 4 Ds - Diarrhoea, dementia, Dermatitis and Death

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90
Q

B1 Deficiency

A

Thiamine
Beri Beri (Dry or wet)
Korsakoffs and Wernickes encephalopathy

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91
Q

B6 Deficiency

B6 Excess?

A

Pyridoxine deficiency
Peripheral neuropathy, Anaemia, Seizures

Remember is given in TB treatment for Isoniazid avoidance of peripheral neuropathy

HOWEVER, EXCESS OF B6 can also cause Peripheral Neuropathy WTF

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92
Q

B9 Deficiency

A

Folic Acid

NT defects, Megaloblastic Anaemia

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93
Q

B12 Deficiency

A

Cyanocobalamin - Peripheral neuropathy, Megaloblastic anaemia

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94
Q

Vitamin C Deficiency

A

Ascorbic acid

Scurvy - Gingervitis and bleeding

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95
Q

Vitamin D Deficiency

A

Ergocalciferol/ Cholecalciferol
Rickets in growing
Osteomalacia in adult

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96
Q

Vitamin A

A

Retinoids

Night Blindness

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97
Q

Risk of Breast Cancer?

A 
Increased by:
Early Menarche
Late Menopause
COCP
HRT

Decreased by
Multiple Pregnancy
Breast Feeding

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98
Q

Most common inherited clotting disorder?

A

Von Willebrand’s Disease

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99
Q

Von Willebrand’s Disease

A

Abnormal amount of von willebrand factor- mild disease
Abnormal von willebrand factor - severe disease

Types
type 1: partial reduction in vWF (80% of patients)
type 2*: abnormal form of vWF
type 3**: total lack of vWF (autosomal recessive)

Is autosomal dominant and most is asymptomatic.
May require DDAVP
Severe disease may require clotting factors

VWB factor has a role in platelet aggregation
this is similar to TTP pathology

Ix:
Investigation
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

Management
tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate

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100
Q

Erythema Multiforme

A

Target lesions
Used to be on a spectrum with SJS and TEN (now not)
However use this to remember similarities

Triggered reaction by infections or drugs

HSV
Mycoplasma
Streptococcus
Penicillin, sulphonamides, Carbemazapine, allopurinol, NSAIDs, COCP

Also seen in SLE, Sarcoid and Malignancy

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101
Q

Glaucoma?

A

This is an optic neuropathy caused by raised intraocular pressure. They are categorised into 2 categories dependent on if the iris is covering the trabecular meshwork:
Open angle: iris is clear of the meshwork
Closed Angle: Iris is covering the trabechular meshowrk

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102
Q

Open Angle Glaucoma

A

Iris is clear of the trabecular meshwork so there is aqueous outflow
Causes: Increasing age and genetics
Classically asymptomatic and is picked up on a routine check

Signs: - Raised IOP
- Visual Field Defect
PAthological Cupping of the disc
Most are managed with eye drops
These aim to lower the IOP to prevent progressive vision loss

First line: Lanoprost (prostaglandin analogue)

Second Line: Beta Blocker (timolol)
Carbonic Anhydrase inhibitor (Acetazolamide)
Sympathomimetic eyedrop (dilator)

Third line: Laser/surgery

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103
Q

Lanoprost mechanism of action

A

Increases outflow

Causes brown pigmentation of iris

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104
Q

Betablocker/Timolol MoA

A

Reduces aqueous formation

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105
Q

sympathomimetics (brimonidine- (alpha 2 agonist)

A

Reduces formation and increases drainage

Avoid in MAOI or TCA

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106
Q

Carbonic anhydrase inhibitors (acetazolamide)

A

Reduce aqueous formation

Toxicity

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107
Q

Miotics(pilocarpine, a muscarinic agonist)

A

Increase outflow

Constricted pupil, blurred vision and headache

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108
Q

Metastatic bone pain

A

Analgeisa
Then trial bisphosphonates
Then trial Radiotherapy

Dexamethasone can be given in metastatic spinal cord compression

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109
Q

Breast Cancer Referral?

A

2ww
> 30 with history of unexplained lump with or without pain
> 50 with unilateral nipple change

Consider 2ww if: - skin changes ? breast Ca
- > 30 with axilla lump

< 30 with lump = non urgent referral

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110
Q

2 Month immunisations?

A

infra hex 6 in 1
- Dip, Tet, Who, Pol, Hib, Hep

oral rota virus

Men B

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111
Q

3 Month immunisations?

A

Infrahex 6 in 1
- Dip, Tet, Who, Pol, Hep, Hib

Oral Rota virus

Pneumococcal

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112
Q

4 Month Immunisations?

A

Infrahex 6 in 1
Dip, Tet, Whop, Pol, Hep, Hib

Men B

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113
Q

12-13 Months

A

Hib/Men C
MMR
Pneumococcal
Men B

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114
Q

2- 8 years Vaccine

A

Flu Vaccine Annually

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115
Q

3-4 year Vaccine

A

Pre school vaccine 4 - in - 1

Dip, Tet, Whop, Pol

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116
Q

12- 13 years Vaccine

A

HPV vaccination

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117
Q

13-18 Years Vaccine

A

3 in 1 Teenage top up vaccine
Dip, Tet, Pol

Men ACWY

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118
Q

Berger’s Disease

A

Commonest cause of Glomerulonephritis worldwise
Macroscopic Haematuria in young person with an URTI

Associated conditions: 
Alcoholic cirrhosis
Coeliac Disease
Dermatitis Herpitformis
HSP

Mesangial Deposition of IgA immune complexes
Considerable overlap with HSP
Positive immunofluorescence for igA and C 3

Typical patient:
Young male with recurrent episodes
URTI
Very rare progression to renal failure

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119
Q

Post Strep GN vs Berger’s Diease (IgA Nephropathy)

A

Post Strep
Low Complement levels
Proteinuria > Haematuria
An interval between URTI and renal problems in post strep

Berger’s
- Haematuria
- 2 days post URTI
‘Young males

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120
Q

Rapidly progressive Glomerulonephritis

A

Term for rapid loss of renal function assciated with formation of epithelial crescents

  • Good Pastures Syndrome
  • Wegener’s Granulomatosis
  • SLE
  • Microscopic polyarteritis

PRESENTS AS NEPHRITIC SYNDROME
- red cell casts, proteinuria, hypertension, oliguria

Treated with immunosuppression and plasmapheresis

Anti coagulation

Type 1 - Anti-GBM antibody (Goodpasture Sydrome) - linear on immunofluorecence
Type 2 - Immune complexes (post strep, Lupus, IgA, HSP)
Granular on immunofluorecence
Type 3 - Pauci - Immune (ANCA positive)
No immunofluorecence

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121
Q

Developmental Milestones

3 Months

A

Little head lag on pulling up
Lying on abdomen, good head control
Held sitting lumbar curve

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122
Q

Developmental Milestones

6 Months

A 
Lying on abdomen arms extended 
Lying on back, lift and grasps feet
Pulls self to sitting
Held sitting, back straight
Rolls front to back
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123
Q

Developmental Milestones

8 months

A

Sits without support

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124
Q

Developmental Milestones

9 Months

A

Pulls to standing

Crawls

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125
Q

Developmental Milestones

12 months

A

Cruises

Walks with hand held

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126
Q

Developmental Milestones

13-15 months

A

Walks unsupported

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127
Q

Developmental Milestones

18 months

A

Squats to pick up a toy

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128
Q

Developmental Milestones

2 years

A

Runs

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129
Q

Developmental Milestones

3 years

A

Rides a trike using pedals

Walks up stairs without holding a rail

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130
Q

Developmental Milestones

4 years

A

hops on 1 leg

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131
Q

How many Tetanus jabs = lifelong immunity?

A

5

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132
Q

Gonorrhea Microbiology

A

Gram-negative diplococcus Neisseria gonorrhoeae

Treated with IM Ceftriaxone

Oral Cef and Azithromycin if IM is refused
Cipro if known to be sensitive

Key features of disseminated gonococcal infection
tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)

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133
Q

Chlamydia

A

Most common cause of STI in this country
NAAT testing

Tx: Doxy for 7 days
Azithromycin 1 dose (better compliance and pregnancy)

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134
Q

PCOS Bloods

A 
High Androgens (Testosterone) 
High LH
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135
Q

Guttae Psoriasis

A 
Common in young people following Strep infection
Tear drop papules
With scales 
Most resolve in 2 months 
UVB / Topical agents
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136
Q

Erythema Nodosum

A

symmetrical, erythematous, tender, nodules which heal without scarring

most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

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137
Q

Pyoderma Gangrenosum

A

initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders (Sarcoid) and myeloproliferative disorders

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138
Q

Necrobiosis lipoidica diabeticorum

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

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139
Q

Pretibial Myxoedema

A

symmetrical, erythematous lesions seen in Graves’ disease

shiny, orange peel skin

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140
Q

Breast feeding in Epislepsy

A

Safe with almost all Antiepileptics

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141
Q

Anti Epileptics in Pregnancy

A

Important to not have seizure > Risk to baby
Doulbe risk of malformation only

Try get to monotherapy
? Carbemazapine and Lamotrigine have better profile
Valproate causes NT defects
Phenytoin casues cleft lip

Essentially try get to 1 only

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142
Q

How is the ataxias inherited?

A

These are exception to the ‘structural - dominant’ rule

They are inherited in a recessive manner

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143
Q

How is hyperlipidaemia II and hypokalaemic periodic paralysis inheritied?

A

These are the exception to the ‘metrabolic rule’
Normally metabolic = recessive
These however are dominant

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144
Q

How is G6PD and Huntington’s inheritted?

A

These are an exception to the ‘metrabolic rule’

They are inherited X linked

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145
Q

Inducers?

A

SCRAP GP

Sulphonylureas
Carbemazapine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarb
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146
Q

Inhibitors?

A

SICK FACES. COM

Sodium Valproate
Isoniazid
Cemetidine
Ketoconazole
Fluconazole
Alcohol
Chloramphenicol
Erythromycin
Sulfonamides (trimethoprim)
Ciprofloxacin
Omeprazole
Metronidazole
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147
Q

Noonan Syndrome?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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148
Q

Fragile X

A

Large Head
Large balls

Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
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149
Q

William’s Syndrome?

A 
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
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150
Q

Pierre Robin syndrome

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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151
Q

Prader-Willi Syndrome?

A

Hypotonia
Hypogonadism
Obesity

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152
Q

Patau’s Syndrome? Trisomy 13

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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153
Q

Edward’s Syndrome? Trisomy 18

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

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154
Q

Barlow manoeuvre

A

attempt to dislocate the femoral heads

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155
Q

Ortolani manoeuvre

A

Relocate the femoral heads

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156
Q

Hip US?

A

Family 1st degree history (mum and dad?)
Multiple pregnancy
Breech presentation at 36 weeks

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157
Q

Common Peroneal nerve lesion?

A

The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula

The most characteristic feature of a common peroneal nerve lesion is foot drop.

Other features include:
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles

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158
Q

Polymorphic eruption of pregnancy

A

Polymorphic eruption of pregnancy

Kinda looks like cushings

pruritic condition associated with last trimester
lesions often first appear in abdominal striae
management depends on severity: emollients, mild potency topical steroids and oral steroids may be used

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159
Q

Pemphigoid gestinosis

A

Pemphigoid gestationis

More plaque and raised

pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required

160
Q

Third Nerve Palsy

A

Features
eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)

Bascially need to assess if there is pupil involvement and if it is painful
IF PAINFUL +/- pupil involvement = SURGICAL Causes:
- Posteroir communicating artery aneurysm
-
Causes if no pupil involvement = diabetes, SLE and GCA

161
Q

Fomepizole ? treatment

A

Used for ethylene Glycol and methanol poisoning

162
Q

TCA overdose?

A

Unable to haemodialise

Use Bicarbonate

163
Q

Lithium Overdose?

A

Fluids, HAemofiltration +/- bicarbonate but poor evidence

164
Q

Heparin overdose?

A

Protamine

165
Q

Cyanide poisoning?

A

Hydroxocobalamin - B12

166
Q

Organophosphate poisoning?

A

Atropine

167
Q

Beta Blocker

A

Atropine

Glucagon

168
Q

Janeway Lesions

A

Janeway lesions are painless, erythematous haemorhagic lesions seen on the palms and soles. They are associated with infective endocarditis

169
Q

Roth Spots

A

Roth spots are retinal haemorrhages. Although they can be seen in endocarditis they would be noted on fundoscopy.

170
Q

Osler’s Nodes

A

osler nodes are painful erythematous lesions caused by immune complex deposition

171
Q

BV diagnosis and treatment?

A

Overgrowth of normal flora of vagina
White fishy discharge

Bacterial vaginosis (BV) describes an overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

Oral metronidazole for 7 days
Safe in pregnancy

Clue cells
positive whiff test
pH > 4.5

172
Q

Holme’s Adie Pupil

A

Holmes-Adie pupil is a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.

Overview
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light

Holmes-Adie syndrome
association of Holmes-Adie pupil with absent ankle/knee reflexes

173
Q

Finasteride side effects?

A 
Adverse effects
impotence
decrease libido
ejaculation disorders
gynaecomastia and breast tenderness

Finasteride is an inhibitor of 5 alpha-reductase, an enzyme which metabolises testosterone into dihydrotestosterone.

IT is used in BPH And male pattern baldness

174
Q

Aphonia

A

Aphonia describes the inability to speak. Causes include:
recurrent laryngeal nerve palsy (e.g. Post-thyroidectomy)
psychogenic

Psychogenic is short lived

Polyps / laryngitis cause horseness

175
Q

Tylosis

A

Thickened hyperkeratosis in palms and soles of the feet

Associated with oesophageal cancers

176
Q

Acquired ichthyosis

A

? What rhys has - associated with lymphoma

dry, rough skin with prominent scaling that involves significant portions of the body.

177
Q

acquired hypertrichosis lanuginosa

A

acquired hypertrichosis lanuginosa is associated with lung and gi cancers
It is increased hair growth of long thin downy hair
BARE RARE

178
Q

Menigitis microbiology by age?
Neonatal - 3month
1 month - 6 years
> 6 years

A

Neonatal to 3 months
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes

1 month to 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae

Greater than 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
179
Q

Cancer patient that develops a DVT

A

Cancer patients with VTE - 6 months of a DOAC

180
Q

Digoxin

A

Cardiac Glycoside

Slows the heart rate, increases the heart contraction (ionotropy)

Decreases conduction through the AV node which slows the rate in AF and Atrial Flutter

Increases the force of cardiac muscle contraction via inhibition of Na/K/ATPase pump

Digoxin levels important due to narrow therapeutic range
take level 8 - 12 hours last dose

Toxicity:
N+V, unwell, Yellow vision
Bradycardia
Gynaecomastia

Precipitated by hypokalaemia, hypothermia, hypothyroid and hypomagnesia

  • Thiazides and loop diuretics (cause hypokalaemia therefore classic to cause toxicity)
  • Amiodarone also causes (hypothyroid)
  • Paradoxically spironolactone also causes toxicity

Treat toxicity with
Digibind
Correct arrythmias
Monitor the potassium

181
Q

Haemophilus influenzae

A

Gram negative

Most common IECOPD

182
Q

Influenza A followed by bacterial pneumonia?

A

Staph A

183
Q

Only risk factor for Haemorrhagic disease of the Newborn?

A

Exclusive Breast Feeding

184
Q

PEP in HIV

A

Can be used up to 72 hours
Not recommended if undetectable and sustained undetectable viral load < 200
(aka on treatment)

Depends on Viral load and incident to manage risk

The first-line regimen is Truvada and raltegravir
28 days

Follow-up HIV testing is recommended 8-12 weeks after exposure.

Anal receptive sex highest risk with ejaculation
1 in 65
Needle stick is 1 in 333

185
Q

PEP first line treatment in HIV?

A

Truvada and raltegravir

186
Q

Hyperemesis Gravidarum

A

Diagnostic criteria triad:
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

187
Q

Leukoplakia vs Candidiasis vs Lichen planus

A

Candidiasis is the first thing to rule out
Does it rub off - if so treat as candidiasis
Oral thrush is benign - consider if it is a sign of immunosupression
Nystatin suspesion or oral miconazole gel

Lichen planus next -
White lace like patern. Also seen on the palms and soles. It is 50% cases have oral involvement
Koebner phenomenon
On the body it is itchy papular raised rash, polygonal shape
Treat with steroid cream

Leukoplakia
This is a diagnosis of exclusion- aka you need to do a biopsy before diagnosis. Things to think about are Lichen planus and SCC.

This is pre malignant transformation of mucous membrane that leads to hard white spots in the mouth
1 % transform to SCC
Treatmnet is mainly surgical

188
Q

Drug Causes of Tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

189
Q

Miosis

A

Small pupil

190
Q

Mydriasis

A

Dilated Pupil

191
Q

Mydriasis Causes

A 
Causes of mydriasis (large pupil)
third nerve palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital

Drug causes of mydriasis
topical mydriatics: tropicamide, atropine
sympathomimetic drugs: amphetamines, cocaine
anticholinergic drugs: tricyclic antidepressants

Anisocoria may result in apparent mydriasis, due to the difference with the other pupil.

192
Q

Miosis causes

A 
Horners
Argile Roberson Pupil - Diabetes, Syphillis
Cluster Headache
MS 
Intracranial Haemorrhage 
Brain stem stroke 
Iris inflammation
193
Q

L3 Nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

194
Q

L4 Nerve Root Compression

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

195
Q

L5 Nerve Root Compression

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

196
Q

S1 Nerve Root Compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

197
Q

Tenderness over the distal fibular

Ottawa Negative`

A

Anterior talofibular ligament which inserts in the anterior part of the fibula.

198
Q

Painless Haematuria > 45

A

Bladder cancer until proven otherwise

199
Q

Emergency contraception in asthmatics

A

Avoid Ella One in severe asthma

200
Q

Alcohol guidelines for men and women

A

< 14 units / week
Spread out over > 3 days

Calculate units by:
Volume x % as a decimal / 10

1 unit is 10ml Ethanol

201
Q

Rectal Tumours surgical options?

A

Both abdominoperineal resections and low anterior resections are used to treat rectal malignancy.

Abdominoperineal resections
removal of the anus, rectum and section of sigmoid colon, are used for tumours located in the distal one third of the rectum.

Lower anterior resections:
Low anterior resection chosen for patients whose malignancy lies in the upper two thirds of their rectum. This surgery involves resection of the area of malignancy, followed by anastomosis. To attempt to reduce complication rates, a defunctioning ileostomy can be created, which results in the majority of bowel matter bypassing the newly formed anastomosis.

Points on Rectal surgery
Rectum is extraperitoneal when in situ
This means we can offer radiation - in contrast with treatments for colonic cancers

Patients with T1 and 2 /N0 disease on imaging do not require irradiation and should proceed straight to surgery.

T3 , N0 tumours may be offered short course radiotherapy prior to surgery.

Patients with T4 disease will typically have long course chemo radiotherapy.

In emergency: Patients presenting with large bowel obstruction from rectal cancer should not undergo resectional surgery without staging as primary treatment (very different from colonic cancer). This is because rectal surgery is more technically demanding, the anastomotic leak rate is higher and the danger of a positive resection margin in an unstaged patient is high. Therefore patients with obstructing rectal cancer should have a defunctioning loop colostomy.

202
Q

Contraceptives effectiveness times

A

Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

203
Q

MS treatment of Spasticity

A

Baclofen
Gabapentin are first line

Botox?

204
Q

Central Retinal Vein occlusion

A

Painless loss of vision
RF: increasing age
Glaucoma
Polycythemia

Retinal haemorrhages on fundoscopy
Swollen disc

205
Q

Central Retinal Artery Occlusion

A

This is caused by atherosclerosis or arteritis
Casues sudden loss of vision
RAPD
Cherry spot on a pale retina (no blood is in the retina)

206
Q

Vaginal Candidiasis

A

RF:
Diabetes, Pregnancy, Immunosupression, Drugs like steroids

Cottage cheese non offensive discharge
superficial dyspyrunia
itch

Tx:
Local or systemic
- Local = clotrimazole pessary 500mg PV STAT
- Systemic = itraconazole 200mg BD 1 day or Fluconazole 150mg Stat

If Pregnant then can only have local treatment

207
Q

Nitrofurantoin in pregnancy?

A

This is the first line for UTI in pregnancy
Trimethoprim should be avoided as is a Folate antagonist
Cipro should be avoided throughout pregnancy

Avoid close to term as can cause neonatal haemolysis
Advise to give Cef if UTI close to term

TREAT asymptomatic bacteriuria in pregnant women- this is thought to progress to Acute pyelonephritis so is beneficial to treat with Nitro full course

208
Q

Hepatocellular carcinoma

A 
RF:
Hep B 
Hep C 
Alcoholism
PBC

Basically any cirrhosis leads to increased risk. Hep B and C most common but Alcholism and Haemachromatosis also significant (these should all be offered screening if evidence of cirrhosis)

Alpha Fetoprotein is screening tool as well

209
Q

Femoroacetabular impingement

A

Anterior Groin pain in a young active male

Associated with snapping

210
Q

Toxoplasmosis retinitis

A

White focal retinitis with overlying vitreous inflammation

211
Q

CMV Retinitis

A

Pizza Pie - retinal spots with flame haemorrhages

212
Q

Vincristine Side effect?

A

Peripheral neuropathy

213
Q

Cyclophosphamide side effect?

A

Haemorrhagic cystitis
Myelosuppression
TCC

214
Q

Belomycin

A

Lung Fibrosis

215
Q

Doxyrubicin

A

Cardiomyopathy

216
Q

Methotrexate

A

Myelosuppresion

Liver and Lung Fibrosis

217
Q

Cytarabine

A

Ataxia

218
Q

cisplatin

A

ototoxicity
Peripheral neuropathy
Hypomagnesia

219
Q

Day and Night time continence?

A

3-4 years old

220
Q

Breast Fibroadenoma

A

Basics
Develop from a whole lobule
Mobile, firm breast lumps - a ‘breast mouse’
12% of all breast masses
Over a 2 year period up to 30% will get smaller
No increase in risk of malignancy
If >3cm surgical excision is usual,

221
Q

Low Dose Mirtazapine vs High Dose Mirtazapine?

A

Low dose- increased sleepiness
High dose - more alert
Appetite stimulant
Alpha 2 adrenergic receptor blocker = increased NT

This is useful in elderly people with insomnia and poor appetite

222
Q

Uterine Atony?

A

IV oxytocin - think this causes contraction (prostaglandins cause vasodilation)

Start with IV Oxytocin and supportive
Then IM Carboprost
Then surgical management 
First surgical maneouvre should be balloon tamponade 
Then other management

Hysterectomy is an emergency life saving procedure.

223
Q

Post Partum haemorrhage

A

Primary (<24hours)
This is 90% caused by Uterine Atony
Secondary (24hrs - 12 weeks)
Retained placental tissue or endometritis

224
Q

Neonatal blood spot screening test

A 
performed at 5-9 days
Previously known as the Guthrie test
The following conditions are currently screened for:
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
225
Q

Dupuytren’s Contracture

A 
Specific causes include:
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
226
Q

Drug Causes of Deafness

A

aminoglycosides (e.g. Gentamicin), furosemide, aspirin, Quinine, cytotoxic agents

227
Q

Quinine

A

Quinine may be given for nocturnal leg cramps or as an antimalarial. side effects of quinine include tinnitus, deafness, sweating, low platelets and increased sweating.

228
Q

Hashimotos thyroiditis?

A

Commonest cause of hypothyroid in UK
(iodine deficiency worldwide)

Autoimmune
Anti TPO and Anti Thyroglobulin antibodies
Goitre, non tender
Can have acute hyperthyroiditis

Associated with MALT lymphoma

229
Q

De Quervain’s Thyroiditis

A

Hyperthyroid

This is like a reactive thyroiditis
Following a viral illness
Get Hyper (painful goitre with high ESR)
Then Eu
Then Hypo 
Then recovery

Thyroid scintigraphy shows global reduced iodine uptake

Usually self limiting
NSAIDs for pain
Consider Steroids if severe
Treat Hypothyroid if doesn’t recover

230
Q

Drusen?

A

These are white/yellow spots in broch’s membrane that are seen in Dry Macular Degeneration
You also get macular pigmentation

Wet Macular Degeneration basically has exudate and neovascularity. Bleeds then cause rapid loss of vision

RF for ARMD - AGE and smoking (auntie Jean)

Vitmain ACE and Zinc improve slightly (moderate disease)

Anti VEGF for Wet
Also laser therapy for Wet

231
Q

Commonest cause of Hypothyroidism in the UK?

A

Hashimotos
Autoimmune
Anti TPO anti Thyroglobulin

232
Q

Trichomonas Vaginalis

A

TV is similar to BV
They are both treated with Metronidazole
They both cause pH > 4.5

TV also leads to:
Green frothy discharge
Strawberry Cervix

Men usually asymptomatic but can cause urethritis

233
Q

Hydroxychloroquine side effects?

A

Think about the eye
Retinopathy
Corneal Depositis

234
Q

Etanercept Side Effects?

A

Reactivation
Demylination

Re and De for E - tanercept

235
Q

Fibroadenosis (fibrocystic disease, benign mammary dysplasia)

A

Most common in middle-aged women

‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

236
Q

Mammary duct ectasia

A

Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

237
Q

Duct papilloma

A

Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge

238
Q

Fat necrosis

A

More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted

239
Q

Oligohydramnios

A 
oligohydramnios = <500ml at 32 weeks. 
or Amniotic Fluid index < 5
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
240
Q

Polyhydramnios

A

Amniotic fluid index > 24
Seen in 1% of pregnancies

Causes:
Multiple gestations, Oesophageal atresia, Batter syndrome, Maternal diabetes

241
Q

COCP Cancer Risk

A

Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

242
Q

COCP Cancer Risk

A

Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

243
Q

Group B Strep?

A

Streptococcus agalactiae - also known as group B streptococcus

This is the commonest cause of neonatal sepsis in brand new baby

244
Q

Secondary Ammenorrhea and Hepatitis

A

Think Autoimmune Hepatitis

245
Q

Toxin Vaccines

A

Toxoid (inactivated toxin)
tetanus
diphtheria
pertussis

246
Q

Inactivated Vaccines

A

Inactivated preparations
rabies
hepatitis A
influenza (intramuscular)

247
Q

Live Vaccines

A 
Live attenuated
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
248
Q

Live Vaccines

A 
Live attenuated
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
249
Q

Herpes Simplex keratitis

A

Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer.

Features
red, painful eye
photophobia
epiphora
visual acuity may be decreased
fluorescein staining may show an epithelial ulcer

Management
immediate referral to an ophthalmologist
topical aciclovir

250
Q

VZV in pregnancy

A

Greatest risk for foetus is before 20 weeks
Scarring of the skin, limb hypoplasia, microcephaly and eye defects

If there is a concern that there is VZV exposure in pregnancy then need to check the mother for VZV antibodies and get some IVIG in them asap if no previous exposure

251
Q

Congenital CMV

A

Antenatal cytomegalovirus infection can cause cerebral calcification, microcephaly and sensorineural deafness.

252
Q

Congenital Rubella

A

Antenatal rubella infections are associated with deafness, congenital cataracts and cardiac complications.

253
Q

Congenital Parvovirus

A

This causes hypdrops Fetalis and Death

254
Q

Hearing Loss 2 types

A

Conductive hearing loss = Air
Sensorineural hearing loss = Bone

Sensorineural essentially bypasses the malleus, incus and stapes bones. This means it must be a problem with the nerve if there is bone hearing loss.

If there is a problem with sensorineural - there will be reduced air and bone - as the problem is central.

If it is conductive hearing loss then air conduction will be seen only - as bone conduction can occur and use the normal nerves to continue hearing normally

On an audiogram any thing > 20dB is normal

If Bone and Air impaired = Sensorineural loss
If Only Air then = Conductive loss

255
Q

HPV VAccine

A

Boys and Girls 12-13

256
Q

HPV strains of importance?

A

6 & 11: causes genital warts

16 & 18: linked to a variety of cancers, most notably cervical cancer

257
Q

Hearing Loss 2 types

A

Conductive hearing loss = Air
Sensorineural hearing loss = Bone

Sensorineural essentially bypasses the malleus, incus and stapes bones. This means it must be a problem with the nerve if there is bone hearing loss.

If there is a problem with sensorineural - there will be reduced air and bone - as the problem is central.

If it is conductive hearing loss then air conduction will be seen only - as bone conduction can occur and use the normal nerves to continue hearing normally

On an audiogram any thing > 20dB is normal

If Bone and Air impaired = Sensorineural loss
If Only Air then = Conductive loss

You can get mixed hearing loss
If this happens you have essentially Sensorineural hearing loss (Bone and Air impaired) plus Conductive (air impaired)

This means you get both a drop in bone and air conduction hearing, however, air is lower.

258
Q

HbA1c abnormally high or low?

A

HbA1c is glycosylated haemoglobin
This is influenced by 2 factors:
Serum Glucose
And Average RBC lifespan

We cannot interpret HbA1c then as a reflection of average serum glucose if there is an abnormality in the blood leading to increased or decreased RBC lifespan

Haemolysis causes lower RBC lifespan and therefore leads to an unexpectidly low HbA1c:
- Sickle Cell
- Spherocytosis
G6PD Deficiency

There are other causes of increased RBC lifespan:

  • Solenectomy (reduced haemolysis)
  • Iron Def Anaemia
  • B12/Folate Deficiency
259
Q

HbA1c abnormally high or low?

A

HbA1c is glycosylated haemoglobin
This is influenced by 2 factors:
Serum Glucose
And Average RBC lifespan

We cannot interpret HbA1c then as a reflection of average serum glucose if there is an abnormality in the blood leading to increased or decreased RBC lifespan

Haemolysis causes lower RBC lifespan and therefore leads to an unexpectidly low HbA1c:
- Sickle Cell
- Spherocytosis
G6PD Deficiency

There are other causes of increased RBC lifespan:

  • Solenectomy (reduced haemolysis)
  • Iron Def Anaemia
  • B12/Folate Deficiency
260
Q

Average blood glucose from HbA1c?

A

((2*HbA1c) -4.5)/10

261
Q

Average blood glucose from HbA1c?

A

((2*HbA1c) -4.5)/10

262
Q

Gastric Ulcer Vs Duodenal Ulcer History?

A

Eating!
Gastric ulcer is made worse when eating (and relieved by fasting) - eating causes increased acid!

Duodenal Ulcer is made better by eating and worse by fasting

263
Q

Blepharitis treatment?

A

Reassurance
Warm Compress
Lid Hygiene

264
Q

Periorbital vs Orbital cellulitis

A

Need to differentiate between periorbital and orbital cellulitis.

Orbital cellulitis:
Infection involving fat and muscles POSTERIOR to orbital septum within the orbit but not involving the globe

THIS IS AN EMERGENCY
It is usually following a upper respiratory tract infection that spreads to the sinuses. Commonly the Ethmoid sinus!

Periorbital cellulitis is PRE Septal and is anterior to the orbital septum, usually resulting from superficial tissue infection like chalazion or insect bite.

The way to tell the difference is to establish pre or post septal.

Remember POST septal you have muscles: therefore Orbital cellulitis presents with: Opthalmaplegia, Painful eye movements, Proptosis, Visual disturbance, Reduced visual acuity

Investigations include full eye exam and CT with contrast to assess inflammation

IV antibiotics

Caused by upper respiratory bugs: Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

265
Q

Periorbital vs Orbital cellulitis

A

Need to differentiate between periorbital and orbital cellulitis.

Orbital cellulitis:
Infection involving fat and muscles POSTERIOR to orbital septum within the orbit but not involving the globe

THIS IS AN EMERGENCY
It is usually following a upper respiratory tract infection that spreads to the sinuses. Commonly the Ethmoid sinus!

Periorbital cellulitis is PRE Septal and is anterior to the orbital septum, usually resulting from superficial tissue infection like chalazion or insect bite.

The way to tell the difference is to establish pre or post septal.

Remember POST septal you have muscles: therefore Orbital cellulitis presents with: Opthalmaplegia, Painful eye movements, Proptosis, Visual disturbance, Reduced visual acuity

Investigations include full eye exam and CT with contrast to assess inflammation

IV antibiotics

Caused by upper respiratory bugs: Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

266
Q

Faecal occult blood screening

A

FIT is being offered to the unfit
faecal immunochemistry testing allows to find HUMAN as opposed to animal occult in stools
60-74 years old
offered it 2 yearly

IF abnormal result- given colonoscopy invite
40% have polyps on colonoscopy
10% have Ca

267
Q

Gestational Diabetes

A

5678

Fasting should be < 5.6

OGTT at 2 hours should be < 7.8

If Above either of these then they have gestational diabetes

If Fasting < 7 = Diet for 1 week then go onto metformin if target not met

However if > 7 fasting glucose OR > 6 with diabetic complications (Macrosomic or hydramnios) then start insulin.

268
Q

Cervical Cancer Screening

A

Essentially it depends on:
- HPV +ive or negative
and
- Normal or abnormal cytology

Now is HPV first
So if negative - go back to normal recall

If postivie for HPV
Cytology of samples is examined

If Abnormal - Colposcopy

If normal then repeat the test in 12 months

1st repeat test:

  • HPV negative = normal recall
  • HPV positive, normal cytology = 12 month return

2nd Repeat test
HPV negative = normal recall
HPV still positive (24 months) - COLPOSCOPY

If inadequate sample - repeat sample in 3 months
if 2 x inadequate = COLPOSCOPY

269
Q

Bartter’s syndrome

A

Inherited cause of hypokalaemia

NORMAL BLOOD PRESSURE

Defective Na+ K + 2Cl- cotrasnporter in the loop of Henle.

Unlike other causes of hypokalaemia that are associated with hypertension:

  • Conns
  • Cushings
  • Liddles
Features
usually presents in childhood, e.g. Failure to thrive
polyuria, polydipsia
hypokalaemia
normotension
weakness
270
Q

Bell’s Palsy

A

Facial nerve palsy (LMN)

lower motor neuron facial nerve palsy - forehead affected*
patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

Prednisolone
Eye Care

Rule out ramsey hunt - look for vesicles in inner ear

271
Q

Pneumothorax

A

Primary vs Secondary is the first decision

Primary - young no PMH
Secondary - Lung disease

Then size and symptoms are the next question

PRIMARY:
< 2cm and no symptoms = discharge

If > 2cm or symptomatic = Aspiration

If aspiration fails (> 2cm or still symptomatic) - Chest drain and 24 hour admission

Advised to stop smoking

SECONDARY:
If > 50 and either: > 2cm rim or Symptomatic = Chest Drain

if 1-2cm and asymptomatic and not over 50 = Aspiration

If aspiration fails (> 2cm or symptomatic) = Chest Drain

If < 1 cm - Admitt with oxygen for 24 hours

COMPLETELY AVOID SCUBADIVING unless bilateral pleuradhesis and follow up CT

272
Q

Hand Foot and Mouth Disease

A

Hand, foot and mouth disease is a self-limiting condition affecting children. It is caused by the intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71). It is very contagious and typically occurs in outbreaks at nursery

Vesicles on the Palms and Soles

Clinical features
mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet

Supportive treatment
Off school if ill but othwerise not a notifiable disease

273
Q

Prostate Cancer At risk Ethnicity?

A

Afro Carribean

274
Q

Gastric Cancer Risk Factors

A 
Associations
H. pylori infection
blood group A: gAstric cAncer
gastric adenomatous polyps
pernicious anaemia
smoking
diet: salty, spicy, nitrates
275
Q

Gastric Cancer Risk Factors

A 
Associations
H. pylori infection
blood group A: gAstric cAncer
gastric adenomatous polyps
pernicious anaemia
smoking
diet: salty, spicy, nitrates
276
Q

Commonest Cause of Travellers Diarrhoea?

A

E.Coli

277
Q

Gastroenteritis: Giardia

A

Prolonged Diarrhoea

Not Bloody

278
Q

Gastroenteritis: Shigella

A

Bloody diarrhoea

Vomitting and abdominal pain

279
Q

Gastroenteritis: Staph A

A

Short incubation

Vomitting +++

280
Q

Gastroenteritis: Campylobacter

A

Flu like prodrome

Can lead to GBS

281
Q

Bacillius cereus

A

Short acting

After rice

282
Q

Amoebiasis

A

Gradual onset bloody diarrhoea
lasting for several weeks
Hepatic abscesses

283
Q

Early Menopause Definition?

A

Menopausal symptoms and elevated gonadotrophins before the age of 40

284
Q

Causes of Macroglosia?

A 
Acromegaly
Hypothyroid
Hurler Syndrome
Amyloidosis
Duchenne muscular dystrophy

Downs is relative or apparent macroglosia (small mouth and hypotonia) so isn’t true macroglosia

285
Q

Commonest causes of croup?

A

Parainfluenza Viruses

Epidemiology
peak incidence at 6 months - 3 years
more common in autumn

Features
stridor
barking cough (worse at night)
fever
coryzal symptoms
0.15mg/kg single dose of dexamethasone
286
Q

TB Treatment

A

RIPE
Rifampicin (Red Urine/Body Secretions)
Isoniazid (Peripheral neuropathy + Agranulocytosis)

These are both given for total of 6 months

Pyrazinamide (hyperuraemia)
Ethambutol (Optic Neuritis)

  • We Give B6 (pyridoxine) to prevent peripheral neuropathy *

They all cause hepatitis give or take (RIP)
And a couple of them cause flu like and arthralgia symptoms

287
Q

Sulphonylureas side effects

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)

288
Q

Corneal Opacities?

A

Hydroxychloroquine and Gold
Also Amiodarone and indomethacin

Amiodarone, Metronidazole and Ethambutol cause optic neuritis

289
Q

Oligospermia and Interstitial Lung Disease?

A

Sulphasalazine

290
Q

Psuedomonas Gram stain?

A

Gram negative Rods

Very common cause of LRTI in bronchiectasis / Chronic Lung disease like CF

If well can wait for cultures and sensitivities but if unwell then start Taz - 14 day irradication
Alternatively Ciprofloxacin

Pseudomonas also causes Skin, Ottitis Externa (especially in diabetics) and Urinary infections

291
Q

Incubation periods for Causes of gastroenteritis?

A

Incubation period

6 SABC, 2 SEC, 3 SHC, 7 GIA

1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

292
Q

Stress incontinence management

A

Pelvic Floor Exercise
Surgery (mid urethral tape)
Duloxetine (SNRI) leads to stronger sphincter contraction

293
Q

Urge Incontinence / Overactive Bladder Managment

A

Bladder Retraining
Antimuscarinics (solifenacin, oxybutinin, tolteridone)
AVOID OXYBUTININ IN FRAIL WOMEN

3rd line is Mirabegron (B 3 Agonist)

294
Q

As in Ank Spond?

A 
Other features - the 'A's
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)
HLA B27 +ive in 90%
Men > Female 3:1
Average presentation 20-30 years old 
Schober's Test - shows reduced forward flexion
Lateral flexion reduced
Reduced chest expansion
295
Q

Skin Prick Test vs Skin Patch Test

A

Skin Prick: this is useful for allergy like food and pollen
Most commonly used and easiest to perform allergy testing
Droplet of allergen placed on skin then needle makes prick
Histamine vs control used and interpretted within 15 mins

Skin Patch: Useful for contact dermatitis
30-40 allergens placed on the back and irritants may also be tested for
Removed 2 days later
then interpretted 2 days after that

RAST: Radioallergenosorbent test
Blood test that looks at the IgE level to a specific antigen (e.g. egg protein). Then graded 1 - 6 on strength of reaction. This is useful in severe eczema where skin prick isnt possible

296
Q

Sweets Syndrome

A

Associated with AML

297
Q

Secondary Amenorrhea

A

Secondary amenorrhoea is defined as when menstruation has previously occurred but has now stopped for at least 6 months.

Regular Periods
Not what the pateitns determines to be their normal

298
Q

Primary Amenorrhea

A

Failure to establish period by 15 if otherwise normal secondary sexual characteristics are present

Failure to establish period by 13 if also in the abscence of all other secondary sexual characteristics

299
Q

Ambulatory BP treatment thresholds?

A

If < 80
135/85
+
CVD / End organ damange / Q risk over 10 %

Treat - if doesn’t have Q risk > 10% then ? watchful weight or consider treatment

If < 80
150/95
Treat regardless

300
Q

Breast Cyst?

A

Aspirate it

There is a small chance of breast cancer

301
Q

Pregnancy Physiological changes

A

For the cardiovascular system. Plasma volume increases which results in an increase heart rate, stroke volume and cardiac output. From a haematological point of view the plasma volume increased by up to 50% and the red blood cell volume increase by about 20-30%. Due to this discrepancy, the haematocrit can decrease due to the dilution effect.

302
Q

Section 2

A

Assessment up to 28 days against a patients will

Includes possibility of treatment against a patients will

303
Q

Section 3

A

Assessment and Treatment up to 6 months

304
Q

Section 4

A

72 hours assessment order for someone not in hospital

305
Q

Section 5 (2)

A

This is the one we use in hospital

Voluntary hospital patient can be detained by a doctor for 72 hours for assessment

306
Q

Section 5 (4)

A

This is the one a nurse would use in hospital

Voluntary hospital patient can be detained by a nurse for 6 hours until assessment

307
Q

Section 17a

A

Community Treatment Agreement

If patient breaks the supervised community treatment they can be recalled back to hospital

308
Q

Section 135

A

Police allowed to enter a home to get a patient to a place of safety (this is a court order)

309
Q

Section 136

A

Police have 24 hours to take patient from a public place to a place of safety (136 unit) 24 hours to arrange an assessment

310
Q

Replacing Folate and B12 deficiency

A

Start with B12 (as if b12 given second can get suabcute degeneration of the cord).

B12 before Folate so you are BFs.

311
Q

Commonest Cause of Childhood hypothyroidism?

A

Autoimmune

Others include irradiation and iodine deficiency

312
Q

Carcinoembryonic antigen

A

Colorectal Cancer

313
Q

Hashimoto’s Vs De Quervain’s Thyroiditis

A

If Goitre is painless = Hashimoto’s

If Dequervain’s - its very sore

314
Q

Types of Misscardige?

A

Missed: - Dead foetus in sac before 20 weeks without symptoms
Innevitable: - Dead Foetus in sac with pain/ symptoms of imminent expulsion
Incomplete: Retained products in the sac with some having been expelled
Threatened: Closed os with symptoms of bleeding +/- abdominal pain

315
Q

Ovarian cyst seen in US scan?

A

Repeat Scan in 12 weeks

If persists after 12 weeks then consider non urgent gynae referral

316
Q

POP Mechanism of Action?

A

Thickens Cervical Mucus

Apart from Desogestrel - this inhibits ovulation

317
Q

COCP Mechanism of Action?

A

Inhibits ovulation

318
Q

Injectable

A

Inhibits ovulation

and Causes increased cervical mucus

319
Q

IUD

A

Kills sperm

320
Q

Mirena Coil

A

Stop endometrial thickening (hence why people don’t get periods/ improve if heavy)
Also increases cervical mucus

321
Q

Optic Neuritis Drug Causes

A

Metronidazole
Ethambutol
Amiodarone

322
Q

Minocycline orally - not used in acne due to which side effect?

A

Pigmentation

Can also cause drug induced lupus

323
Q

Drug induced lupus

A 
Procainamide
Hydralazine
Isoniazid
Minocycline
Phenytoin
324
Q

Sick Euthyroid syndrome?

A

Repeat TFTsin 6 weeks

Basically everything is low
or
T3/4 is low and TSH normal

However, patient is well and has had recent illness

325
Q

Orbital Lymphoma

A

Consider if recurrent conjunctivitis that hasn’t improved with treatment
Indidious onset

326
Q

< 3/60

A

This is the level at which you are legally blind

327
Q

Mefloquine Antimalarial contraindications?

A

Nightmares/ Anxiety

Lots of neuropsych side effects mean any history of severe anxiety/depression/self harm is a contraindication

328
Q

Primary Hyperparathyroidism

A

Seen in elderly patients with unquenchable thirst
Found to have a high calcium and inappropriately normal or high PTH

Causes:
- Solitary adenoma (80%)
- Hyperplasia (15%)
- Multiple Adenomas (4%)
Carcinoma (1%)

Symptoms of hypercalacemia
Low Phosphate
Pepperport Skull
Definitive management is parathyroidectomy

329
Q

Sotos syndrome

A

Sotos syndrome is a rare genetic disorder characterised by excessive physical growth during the first 2 to 3 years of life

It is caused by a mutation in the NSD1 (Nuclear receptor-binding SET domain containing protein) gene and is inherited with in an autosomal dominant fashion

macrodolichocephaly, down-slanting palpebral fissures and a pointed chin. Patients have a normal life expectancy.

330
Q

UC managment

A

Mild -moderate flares

Proctotitis / Proctosimoiditis

Rectal mesalazine
Then change to oral
If no remission then change to oral and topical steroid
If still no joy - oral steroid

If more extensive disease
Topical and oral mesalazine
If no joy then change early to oral mesalazine and oral steroids

Severe Colitis:
Admission
IV steroids
If no improvement on 72 hrs can then have IV ciclosporin
Consider surgery after this
331
Q

HSV1 vs HSV2

A

HSV1 is oral cold sores

HSV2 is genital

332
Q

Expectant management of ectopic pregnancy

A

Expectant management of an ectopic pregnancy can only be performed for

1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining

333
Q

First line antibiotics for Severe Campylobacter infection

A

Clarithromycin

334
Q

Migraine prophylaxis

A

Toperamte or Propranolol

Avoid Topiramate if patient is pregnant as causes cleft palate

335
Q

Methotrexate interactions

A

Avoid Trimethoprim and Co trimoxazole

336
Q

Hyperhidrosis

A

Treatment:
Aluminium chloride is first line
Botox should also be considered

337
Q

Sulfasalazine Contraindication

A

Aspirin hypersensitivity

Remember Mesalazine (UC) and Sulfasalazine (RA) are both aminosalycilates, Similar to Salicylates like aspirin.

338
Q

Which Drugs cause hypercalcaemia?

A

Thiazide diruetics

339
Q

Commonest Reason for THR revision operation?

A

Aseptic Loosening

340
Q

Charcot’s Triad

A

RUQ pain
Fever
Jaundice

This is ascending cholangitis
IV antibiotics
ERCP

341
Q

Changing oral morphine to subcut?

A

Divide my 2

Basically oral dose goes to 1/2 dose when changing to subcut

342
Q

Doxazocin and incontinence?

A

Doxazocin may worsen stress incontinence by relaxing the bladder and urethra

343
Q

Cervical Excitation?

A

Ectopic Pregnancy

PID

344
Q

Recurrent Conjunctivitis in a new born

A

Nasolacrimal Duct Obstruction

This is really common and commonest cause of persistent eye watering in an infant.

This can be managed consertavitely
Lacrimal Massage
Hygiene
Chlorampenicol if it becomes infected

Refer to opthalmology when they are of 1 year of age and still having recurrence

345
Q

Club Foot (talipes equinovarus)

A

This is inverted and plantar flexed foot that is usually diagnosed on the newborn examination

If it is not passively correctable then this is diagnostic

Ponseti method has been favoured in recent years
Progressive casting soon after birth
Night time braces until 4 years old due to relapse prevention

346
Q

Men B vaccination

A

2 months
3 months
12 months

347
Q

Reversible long term consequences of Haemochromatosis ?

A

Cardiomyopathy
Bronze skin

Other non reversible include
DM
Arthropathy
Cirrhosis
Hypogonadotrophic hypogonadism (cirrhosis and pituitary dysfunction)
348
Q

Risks of HRT

A 
Increased VTE (oral only)
Increased Stroke (oral oestrogens)
Increased IHD
Increased Breast Ca 
Increased Ovarian Ca

Oestrogen only cannot be given to women with uterus as this increases Endometrial risk

Contraindications of HRT:

  • Breast Ca
  • Oestrogen sensitive Ca
  • Endometrial hyperplasia (untreated)
  • unexplained vaginal bleeding
349
Q

HRT management

A

Lifestyle first
Then can have HRT or non HRT management of ongoing symptoms

Vasomotor: Fluoxetine, Citalopram, Venfalazxine, Clonidine

Urinary Sx: Oestrogen creams

Cognitive: CBT antidepressants

HRT can be given but should be given as both progesterone and oestrogen if have a uterus

350
Q

Mitral Stenosis

A

Mid Diastolic Murmur
Associated with AF
Malar Flush on the cheeks
Dyspnoea

There is also haemoptysis thought to be due to rupture of the bronchial veins

351
Q

Antenatal clinic guidelines

A

10 visits if primary and uncomplicated
7 for sequential un complicated pregnancies
Don’t have to be seen by a consultant if uncomplicated
All women given HIV test
All women tested for smoking
Women Screened twice for anaemia

352
Q

Most common rotator cuff injury?

A

Supraspinatus

Abducts arm before deltoid (lower 15% of abduction)

353
Q

Infraspinatus

A

Rotates arm laterally

Arms right angles pain when pushing outwards

354
Q

Teres Minor

A

Rotates arm laterally

Adducts the arm

355
Q

Subscapularis

A

Adducts the arm

Rotates the arm medially

356
Q

Cystic Hygroma

A

These are usually evident at birth
Large Neck swellings in the newborn
They are fluctuant and 90% present before 2

357
Q

Branchial Cyst

A

Found between sternocleidomastoid muscule and the pharynx.

Usually present in early adult hood

358
Q

UKMEC Criteria?

A

UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method

UKMEC 2: advantages generally outweigh the disadvantages

UKMEC 3: disadvantages generally outweigh the advantages

UKMEC 4: represents an unacceptable health risk
ABSOLUTE CONTRAINDICATION

359
Q

COCP Absolute Contraindications?

A

more than 35 years old and smoking more than 15 cigarettes/day

migraine with aura

history of thromboembolic disease or thrombogenic mutation

history of stroke or ischaemic heart disease

breast feeding < 6 weeks post-partum

uncontrolled hypertension

current breast cancer

major surgery with prolonged immobilisation

360
Q

Dysmenorrhea Clasification

A

Primary and Secondary

Primary is no underlying pathology
This usually occurs within a couple of years of menarche (first period)
This is usually cyclical and occurs the day or a couple of hours before starting the period.
They are suprapubic cramping pain that may radiate to the back and down the thigh

Secondary is pathological
This often is NEW dysmenorrhea many years after menarche
This usually starts a few days before the start of a patients period
Causes include
Endometriosis
Adenomyosis
PID
Fibroids
IUD (copper)

This requires secondary referral to Gynae

361
Q

Which Contraceptive is associated with Weight Gain?

A

Depo Prova

362
Q

Premenstural Syndrome?

A 
Emotional and physical symptoms a woman experiences in the luteal phase of a normal menstural cycle 
Emotional symptoms include:
anxiety
stress
fatigue
mood swings

Physical symptoms
bloating
breast pain

Mild: Lifestyl
Moderate: COCP (Yasmin)
Severe: Consider SSRI

363
Q

Migraine with Aura Contraception

A 
COCP is contraindicated UKMEC 4
All other are UKMEC 2 
POP
Depot
Mirena Coil

However, IUD is the only ‘safe’ and recommended treatment. UKMEC 1

364
Q

Polyurethane ?

A

This is condom option in Latex allergy

365
Q

Barrier Contraception with Latex Allergy

A

Polyurethane condoms

366
Q

Endometrial Cancer Risk Factors

A

Essentially more periods you have the increased risk of Endometrial Ca

  • Nulliparity
  • Early Menarche
  • Late Menopause
Then there are some others
Unopposed oestrogen (oestrogen HRT is contraindicated in patients with a uterus for this reason)
Obesity
Tamoxifen
PCOS
HNPCC
367
Q

Endometrial Cancer Presentation

A

Patients present with post menopausal bleeding
75% are post menopause
Usually painless

368
Q

Management of Endometrial Ca

A

Any women with post menopausal bleeding > 55 - urgent referral

TVUS is gold standard

Then ureteroscopy with biopsys

Surgery is curative

Progesteroine may be offered if too frail

369
Q

Iliac fossa pain with cervical excitation but negative pregnancy test?

A

Torsion of an ovarian cyst

370
Q

Pre op COCP

A

this should ideally be stopped 4 weeks pre operatively if there is going to be a significant op with immobilisation (one of the contraindiations to the COCP)

Barrier or {Progesterone only can be offeredin the meantime

371
Q

Pregnancy Supplements recommended?

A

400micrograms Folic Acid
Vitamin D 10 micrograms

These are if fit and well
Obviously increase to 5mg Folic Acid in risk of NT defects like epilepsy etc/ DM

The Folic Acid in both cases should be continued until the 12th week
This is the time after which NT defects are much reduced

372
Q

Whooping Cough Vaccine in pregnancy

A

20 - 32 weeks

373
Q

> 75 with a fragility fracture

A

Skip DEXA and just start alendronic acid

374
Q

Drugs that cause photosensitivity

A 
Causes of drug-induced photosensitivity
thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas
375
Q

Genital Wart Treatment

A

Many/Cluster (colliflower) then podophyllum topically

If solitary: Cryotherapy

376
Q

HB s Ag positive

A

Means current infection either acute or chronic

377
Q

Anti HBs

A

Previous infection or immunisation

378
Q

HbeAg

A

Marker of infectivity

379
Q

Anti HBc

A

previous or current infection
IgM - acute
IgG - previous

380
Q

Influenza vaccination in children

A

This is a live vaccine (intranasal)
Starting at 2 then given yearly
It is live so immunosupression is a contraindication

381
Q

Addenbrokes Cognitive examination?

A

Test for Dementia

The domains tested are Memory, Attention, Fluency, Language and Visuospatial.

Less than 82 suggest Dementia

Alzhiemers shows a global pattern to deficit

82-88 = Mild cognitive impairement

382
Q

Clozapine adverse side effects?

A 
weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias

This is why you do ECGs baseline

383
Q

Urinary Retention caused by Drugs

A

The following drugs may cause urinary retention:

tricyclic antidepressants e.g. amitriptyline
anticholinergics
opioids
NSAIDs
disopyramide
384
Q

Phenytoin Adverse Effects

A

Acute

initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures

Chronic
common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
lymphadenopathy
dyskinesia
Hepatitis
Drug induced lupus

385
Q

Septic Arthritis screen in children?

A

Kocher’s criteria is used to assess the probability of septic arthritis in children using 4 parameters:

Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr

The probabilities are calculated thus:
0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis

386
Q

SSRI following Myocardial infarction?

A

Sertraline

This is the most researched

387
Q

Antipsychotics in the elderly

A

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:
increased risk of stroke
increased risk of venous thromboembolism

388
Q

Breast Feeding candida infection

A

Continue Breast Feeding

Treat with miconazole topical cream to the nipple and mouth of the baby

389
Q

Missing a POP time

A

Consider it a missed dose if > 3 hours aka usually take it at 0800 and took it at 1300.
If this is the case then take it asap, use condoms for 2 days and continue the cycle

Cerazette (desogestrel) is exception to this which is 12 hours

390
Q

Risk Factors for Ovarian ca

A

This is genetics / FH (BRCA 1 or 2)
Followed by increased times you have ovulated

This is why the COCP is protective
Other risk factors are early menarche, late menopause, nulliparity.
HRT (continues ovulation)
Obesity is another risk factor

391
Q

If no Rubella Antibodies at booking in pregnancy?

A

Advise to avoid rubella

Arrange for MMR post natally

392
Q

PSA when to repeat the test?

A

NICE advise that, as PSA levels may be increased, testing should not be done within at least:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

393
Q

Pupil reduces to objects (accommodation) but not to light

A

Argyl Robertson Pupil
Accommodation reflex present
Pupillary Reflex Absent

This is seen in DM
and highly specific to Neurosyphillis

These are small irregular pupils

394
Q

Cataracts complications

A

Blurring of vision shortly after surgery:
Cystoid macular oedema

Blurring years after:
Posterior capsule opacification

Cataracts cannot recurr after surgery as the lens has been removed.
Retinal Detachement can also occur

395
Q

Normal Intraoccular Pressure?

A

10-21

Optic Disc cupping is when cup to disc ratio is > 0.7

396
Q

Ekbom Syndrome?

A

Ekbom syndrome is also known as delusional parasitosis and is the belief that they are infected with parasites or have ‘bugs’ under their skin. This can vary from the classic psychosis symptoms in narcotic use where the user can ‘see’ bugs crawling under their skin or can be a patient who believes that they are infested with snakes.

397
Q

Management of Scabies?

A

Management
permethrin 5% is first-line
malathion 0.5% is second-line
give appropriate guidance on use (see below)
pruritus persists for up to 4-6 weeks post eradication

avoid close physical contact with others until treatment is complete
all household and close physical contacts should be treated at the same time, even if asymptomatic
launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.

MSRA (1 decks)

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