MSRA Flashcards

Question

Osteomylitis / Cellulitis in Sickle Cell

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

``` 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

Answer 9

Proteinuria

Answer 10

Reactivation of TB

Answer 11

Oligospermia Rashes Heinz Body Anaemia Interstitial Lung Disease

Answer 12

Myelosuppression Liver Cirrhosis Pneumonitis

Answer 13

Retinopathy | Corneal Deposits

Answer 14

Protienuria | Exacerbation of myasthenia gravis

Answer 15

Reactivation of TB | Demylination

Answer 16

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)

Answer 17

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

Answer 18

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

Answer 19

``` ciprofloxacin, tetracycline, chloramphenicol, sulphonamides lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone ```

Answer 20

Only Safe contraception is IUD / Condoms | All hormone contraceptions are contraindicated

Answer 21

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

Answer 22

Pemiphigus Vulgaris Bullous pemphigoid doesnt' have blisters in the mouth

Answer 23

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 ```

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

Emergency Contraceptive | Can be inserted up to 5 days following UPSI

Answer 28

``` 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 ```

Answer 29

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

Answer 30

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

Answer 31

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

Answer 32

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

Answer 33

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

Answer 34

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

Answer 35

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)

Answer 36

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

Answer 37

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

Answer 38

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

Answer 39

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.

Answer 40

Cotard syndrome is the delusional idea that one is dead.

Answer 41

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

Answer 42

``` 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

Answer 43

``` 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

Answer 44

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

Answer 45

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 ```

Answer 46

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

Answer 47

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.

Answer 48

Monoamine oxidase inhibitors These stop the break down of dopamine Selegiline

Answer 49

Used in parkinsons ? increases expression of dopamine receptors Used in MS as well for fatigue Can cause slurred speech

Answer 50

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

Answer 51

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

Answer 52

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

Answer 53

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

Answer 54

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

Answer 55

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

Answer 56

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

Answer 57

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

Answer 58

Avoid in pregnancy completely

Answer 59

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

Answer 60

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

Answer 61

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

Answer 62

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

Answer 63

Try to correct slowly to avoid central pontine demylinolysis Treat with fluid restriction

Answer 64

Niacin deficiency | Pellegra: 4 Ds - Diarrhoea, dementia, Dermatitis and Death

Answer 65

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

Answer 66

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

Answer 67

Folic Acid NT defects, Megaloblastic Anaemia

Answer 68

Cyanocobalamin - Peripheral neuropathy, Megaloblastic anaemia

Answer 69

Ascorbic acid | Scurvy - Gingervitis and bleeding

Answer 70

Ergocalciferol/ Cholecalciferol Rickets in growing Osteomalacia in adult

Answer 71

Retinoids | Night Blindness

Answer 72

``` Increased by: Early Menarche Late Menopause COCP HRT ``` Decreased by Multiple Pregnancy Breast Feeding

Answer 73

Von Willebrand's Disease

Answer 74

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

Answer 75

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

Answer 76

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

Answer 77

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

Answer 78

Increases outflow | Causes brown pigmentation of iris

Answer 79

Reduces aqueous formation

Answer 80

Reduces formation and increases drainage | Avoid in MAOI or TCA

Answer 81

Reduce aqueous formation | Toxicity

Answer 82

Increase outflow | Constricted pupil, blurred vision and headache

Answer 83

Analgeisa Then trial bisphosphonates Then trial Radiotherapy Dexamethasone can be given in metastatic spinal cord compression

Answer 84

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

Answer 85

infra hex 6 in 1 - Dip, Tet, Who, Pol, Hib, Hep oral rota virus Men B

Answer 86

Infrahex 6 in 1 - Dip, Tet, Who, Pol, Hep, Hib Oral Rota virus Pneumococcal

Answer 87

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

Answer 88

Hib/Men C MMR Pneumococcal Men B

Answer 89

Flu Vaccine Annually

Answer 90

Pre school vaccine 4 - in - 1 | Dip, Tet, Whop, Pol

Answer 91

HPV vaccination

Answer 92

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

Answer 93

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

Answer 94

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

Answer 95

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

Answer 96

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

Answer 97

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

Answer 98

Sits without support

Answer 99

Pulls to standing | Crawls

Answer 100

Cruises | Walks with hand held

Answer 101

Walks unsupported

Answer 102

Squats to pick up a toy

Answer 103

Rides a trike using pedals | Walks up stairs without holding a rail

Answer 104

hops on 1 leg

Answer 105

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)

Answer 106

Most common cause of STI in this country NAAT testing Tx: Doxy for 7 days Azithromycin 1 dose (better compliance and pregnancy)

Answer 107

``` High Androgens (Testosterone) High LH ```

Answer 108

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

Answer 109

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)

Answer 110

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

Answer 111

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

Answer 112

symmetrical, erythematous lesions seen in Graves' disease | shiny, orange peel skin

Answer 113

Safe with almost all Antiepileptics

Answer 114

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

Answer 115

These are exception to the 'structural - dominant' rule | They are inherited in a recessive manner

Answer 116

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

Answer 117

These are an exception to the 'metrabolic rule' | They are inherited X linked

Answer 118

SCRAP GP ``` Sulphonylureas Carbemazapine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarb ```

Answer 119

SICK FACES. COM ``` Sodium Valproate Isoniazid Cemetidine Ketoconazole Fluconazole Alcohol Chloramphenicol Erythromycin Sulfonamides (trimethoprim) Ciprofloxacin Omeprazole Metronidazole ```

Answer 120

Webbed neck Pectus excavatum Short stature Pulmonary stenosis

Answer 121

Large Head Large balls ``` Learning difficulties Macrocephaly Long face Large ears Macro-orchidism ```

Answer 122

``` Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis ```

Answer 123

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

Answer 124

Hypotonia Hypogonadism Obesity

Answer 125

Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions

Answer 126

Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers

Answer 127

attempt to dislocate the femoral heads

Answer 128

Relocate the femoral heads

Answer 129

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

Answer 130

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

Answer 131

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

Answer 132

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

Answer 133

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

Answer 134

Used for ethylene Glycol and methanol poisoning

Answer 135

Unable to haemodialise | Use Bicarbonate

Answer 136

Fluids, HAemofiltration +/- bicarbonate but poor evidence

Answer 137

Hydroxocobalamin - B12

Answer 138

Atropine | Glucagon

Answer 139

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

Answer 140

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

Answer 141

osler nodes are painful erythematous lesions caused by immune complex deposition

Answer 142

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

Answer 143

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

Answer 144

``` 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

Answer 145

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

Answer 146

Thickened hyperkeratosis in palms and soles of the feet | Associated with oesophageal cancers

Answer 147

? What rhys has - associated with lymphoma dry, rough skin with prominent scaling that involves significant portions of the body.

Answer 148

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

Answer 149

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) ```

Answer 150

Cancer patients with VTE - 6 months of a DOAC

Answer 151

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

Answer 152

Gram negative | Most common IECOPD

Answer 153

Exclusive Breast Feeding

Answer 154

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

Answer 155

Truvada and raltegravir

Answer 156

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

Answer 157

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

Answer 158

Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine

Answer 159

Small pupil

Answer 160

Dilated Pupil

Answer 161

``` 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.

Answer 162

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

Answer 163

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

Answer 164

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

Answer 165

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

Answer 166

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

Answer 167

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

Answer 168

Bladder cancer until proven otherwise

Answer 169

Avoid Ella One in severe asthma

Answer 170

< 14 units / week Spread out over > 3 days Calculate units by: Volume x % as a decimal / 10 1 unit is 10ml Ethanol

Answer 171

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.

Answer 172

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

Answer 173

Baclofen Gabapentin are first line Botox?

Answer 174

Painless loss of vision RF: increasing age Glaucoma Polycythemia Retinal haemorrhages on fundoscopy Swollen disc

Answer 175

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)

Answer 176

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

Answer 177

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

Answer 178

``` 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

Answer 179

Anterior Groin pain in a young active male | Associated with snapping

Answer 180

White focal retinitis with overlying vitreous inflammation

Answer 181

Pizza Pie - retinal spots with flame haemorrhages

Answer 182

Peripheral neuropathy

Answer 183

Haemorrhagic cystitis Myelosuppression TCC

Answer 184

Lung Fibrosis

Answer 185

Cardiomyopathy

Answer 186

Myelosuppresion | Liver and Lung Fibrosis

Answer 187

ototoxicity Peripheral neuropathy Hypomagnesia

Answer 188

3-4 years old

Answer 189

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,

Answer 190

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

Answer 191

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.

Answer 192

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

Answer 193

``` 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) ```

Answer 194

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

Answer 195

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

Answer 196

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.

Answer 197

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

Answer 198

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

Answer 199

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

Answer 200

Hashimotos Autoimmune Anti TPO anti Thyroglobulin

Answer 201

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

Answer 202

Think about the eye Retinopathy Corneal Depositis

Answer 203

Reactivation Demylination Re and De for E - tanercept

Answer 204

Most common in middle-aged women | 'Lumpy' breasts which may be painful. Symptoms may worsen prior to menstruation

Answer 205

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'

Answer 206

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

Answer 207

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

Answer 208

``` 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 ```

Answer 209

Amniotic fluid index > 24 Seen in 1% of pregnancies Causes: Multiple gestations, Oesophageal atresia, Batter syndrome, Maternal diabetes

Answer 210

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

Answer 211

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

Answer 212

Streptococcus agalactiae - also known as group B streptococcus This is the commonest cause of neonatal sepsis in brand new baby

Answer 213

Think Autoimmune Hepatitis

Answer 214

Toxoid (inactivated toxin) tetanus diphtheria pertussis

Answer 215

Inactivated preparations rabies hepatitis A influenza (intramuscular)

Answer 216

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

Answer 217

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

Answer 218

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

Answer 219

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

Answer 220

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

Answer 221

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

Answer 222

This causes hypdrops Fetalis and Death

Answer 223

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

Answer 224

Boys and Girls 12-13

Answer 225

6 & 11: causes genital warts 16 & 18: linked to a variety of cancers, most notably cervical cancer

Answer 226

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.

Answer 227

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

Answer 228

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

Answer 229

((2*HbA1c) -4.5)/10

Answer 230

((2*HbA1c) -4.5)/10

Answer 231

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

Answer 232

Reassurance Warm Compress Lid Hygiene

Answer 233

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.

Answer 234

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.

Answer 235

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

Answer 236

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.

Answer 237

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

Answer 238

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 ```

Answer 239

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

Answer 240

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

Answer 241

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

Answer 242

Afro Carribean

Answer 243

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

Answer 244

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

Answer 245

Prolonged Diarrhoea Not Bloody

Answer 246

Bloody diarrhoea | Vomitting and abdominal pain

Answer 247

Short incubation | Vomitting +++

Answer 248

Flu like prodrome | Can lead to GBS

Answer 249

Short acting | After rice

Answer 250

Gradual onset bloody diarrhoea lasting for several weeks Hepatic abscesses

Answer 251

Menopausal symptoms and elevated gonadotrophins before the age of 40

Answer 252

``` Acromegaly Hypothyroid Hurler Syndrome Amyloidosis Duchenne muscular dystrophy ``` Downs is relative or apparent macroglosia (small mouth and hypotonia) so isn't true macroglosia

Answer 253

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 ```

Answer 254

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

Answer 255

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

Answer 256

Hydroxychloroquine and Gold Also Amiodarone and indomethacin Amiodarone, Metronidazole and Ethambutol cause optic neuritis

Answer 257

Sulphasalazine

Answer 258

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

Answer 259

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

Answer 260

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

Answer 261

Bladder Retraining Antimuscarinics (solifenacin, oxybutinin, tolteridone) **AVOID OXYBUTININ IN FRAIL WOMEN** 3rd line is Mirabegron (B 3 Agonist)

Answer 262

``` 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 ```

Answer 263

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

Answer 264

Associated with AML

Answer 265

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

Answer 266

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

Answer 267

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

Answer 268

Aspirate it | There is a small chance of breast cancer

Answer 269

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.

Answer 270

Assessment up to 28 days against a patients will | Includes possibility of treatment against a patients will

Answer 271

Assessment and Treatment up to 6 months

Answer 272

72 hours assessment order for someone not in hospital

Answer 273

This is the one we use in hospital | Voluntary hospital patient can be detained by a doctor for 72 hours for assessment

Answer 274

This is the one a nurse would use in hospital | Voluntary hospital patient can be detained by a nurse for 6 hours until assessment

Answer 275

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

Answer 276

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

Answer 277

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

Answer 278

Start with B12 (as if b12 given second can get suabcute degeneration of the cord). B12 before Folate so you are BFs.

Answer 279

Autoimmune | Others include irradiation and iodine deficiency

Answer 280

Colorectal Cancer

Answer 281

If Goitre is painless = Hashimoto's | If Dequervain's - its very sore

Answer 282

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

Answer 283

Repeat Scan in 12 weeks | If persists after 12 weeks then consider non urgent gynae referral

Answer 284

Thickens Cervical Mucus Apart from Desogestrel - this inhibits ovulation

Answer 285

Inhibits ovulation

Answer 286

Inhibits ovulation | and Causes increased cervical mucus

Answer 287

Kills sperm

Answer 288

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

Answer 289

Metronidazole Ethambutol Amiodarone

Answer 290

Pigmentation | Can also cause drug induced lupus

Answer 291

``` Procainamide Hydralazine Isoniazid Minocycline Phenytoin ```

Answer 292

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

Answer 293

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

Answer 294

This is the level at which you are legally blind

Answer 295

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

Answer 296

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

Answer 297

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.

Answer 298

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 ```

Answer 299

HSV1 is oral cold sores | HSV2 is genital

Answer 300

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

Answer 301

Clarithromycin

Answer 302

Toperamte or Propranolol Avoid Topiramate if patient is pregnant as causes cleft palate

Answer 303

Avoid Trimethoprim and Co trimoxazole

Answer 304

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

Answer 305

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

Answer 306

Thiazide diruetics

Answer 307

Aseptic Loosening

Answer 308

RUQ pain Fever Jaundice This is ascending cholangitis IV antibiotics ERCP

Answer 309

Divide my 2 | Basically oral dose goes to 1/2 dose when changing to subcut

Answer 310

Doxazocin may worsen stress incontinence by relaxing the bladder and urethra

Answer 311

Ectopic Pregnancy | PID

Answer 312

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

Answer 313

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

Answer 314

2 months 3 months 12 months

Answer 315

Cardiomyopathy Bronze skin ``` Other non reversible include DM Arthropathy Cirrhosis Hypogonadotrophic hypogonadism (cirrhosis and pituitary dysfunction) ```

Answer 316

``` 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

Answer 317

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

Answer 318

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

Answer 319

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

Answer 320

Supraspinatus | Abducts arm before deltoid (lower 15% of abduction)

Answer 321

Rotates arm laterally | Arms right angles pain when pushing outwards

Answer 322

Rotates arm laterally | Adducts the arm

Answer 323

Adducts the arm | Rotates the arm medially

Answer 324

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

Answer 325

Found between sternocleidomastoid muscule and the pharynx. | Usually present in early adult hood

Answer 326

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

Answer 327

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

Answer 328

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

Answer 329

Depo Prova

Answer 330

``` 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

Answer 331

``` 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

Answer 332

This is condom option in Latex allergy

Answer 333

Polyurethane condoms

Answer 334

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 ```

Answer 335

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

Answer 336

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

Answer 337

Torsion of an ovarian cyst

Answer 338

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

Answer 339

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

Answer 340

20 - 32 weeks

Answer 341

Skip DEXA and just start alendronic acid

Answer 342

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

Answer 343

Many/Cluster (colliflower) then podophyllum topically If solitary: Cryotherapy

Answer 344

Means current infection either acute or chronic

Answer 345

Previous infection or immunisation

Answer 346

Marker of infectivity

Answer 347

previous or current infection IgM - acute IgG - previous

Answer 348

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

Answer 349

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

Answer 350

``` weight gain excessive salivation agranulocytosis neutropenia myocarditis arrhythmias ``` This is why you do ECGs baseline

Answer 351

The following drugs may cause urinary retention: ``` tricyclic antidepressants e.g. amitriptyline anticholinergics opioids NSAIDs disopyramide ```

Answer 352

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

Answer 353

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

Answer 354

Sertraline | This is the most researched

Answer 355

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

Answer 356

Continue Breast Feeding | Treat with miconazole topical cream to the nipple and mouth of the baby

Answer 357

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

Answer 358

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

Answer 359

Advise to avoid rubella | Arrange for MMR post natally

Answer 360

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

Answer 361

Argyl Robertson Pupil Accommodation reflex present Pupillary Reflex Absent This is seen in DM and highly specific to Neurosyphillis These are small irregular pupils

Answer 362

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

Answer 363

10-21 | Optic Disc cupping is when cup to disc ratio is > 0.7

Answer 364

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.

Answer 365

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.