MSRA pt 4 Flashcards
1
Q
What is a meibomian cyst?
A
A meibomian cyst (or chalazion) is a chronic, non-infectious, inflammatory granuloma caused by blockage of meibomian gland duct(s).
Meibomian cysts are the most common inflammatory lesions of the eyelids. They can occur at any age but are thought to be more common in adults (ages 30–50).
2
Q
What is the Wernickes and Korsakoffs symptom triad and what is the Wernicke’s COAT.
A
Wernickes and Korsakoffs syndrome triad; Confusion, Ataxia, Nystagmus
Wernicke’s COAT
Confusion
Oculomotor dysfunction
Ataxia
Thiamine is treatment
3
Q
What causes Wernicke’s syndrome
A
Thiamine Deficiency
4
Q
What is Korsakoffs psychosis and what are its features
A
Korsakoff’s psychosis CART (Cart them off - because it’s incurable at this stage) Chronic and irreversible
Confabulation
Anterograde and
Retrograde amnesia
Temperament altered
5
Q
What is the age of incidence of molluscum contagiosum, how long does it last, how does it present and how long does it last for
A
In children, lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur. It is self limiting spontaneously resolving within 18months
The lesions are usually characteristic, presenting as smooth-surfaced, firm, dome-shaped, flesh-coloured or pearly white papules with a central umbilication.
6
Q
What is the first line treatment for vestibular nausea?
A
BMJ best practice recommends use of cyclizine as a first-line treatment in disorders due to the vestibular system
7
Q
What are the facts of Levonorgestre to remember to consult?
A
Must be taken within 72hours, has reduced effectiveness the longer the delay, can start hormonal contraception straight after. If weight is over 70kg or BMI over 26 double dose to 3.0mg
8
Q
What are the facts of Ulipristal to remember to consult?
A
Must be taken with 120hours, other hormonal contraception must be started after 5days, caution in severe asthma,
9
Q
What is the emergency contraception to use if taking an Enzyme inducing drugs?
A
Copper Coil
10
Q
How does cow’s milk protein intoleramce/allergy present?
A
Cow’s milk protein intolerance/allergy (CMPI/CMPA) occurs in around 3-6% of all children and typically presents in the first 3 months of life in formula-fed infants, although rarely it is seen in exclusively breastfed infants.
11
Q
What come first in a Migraine, a headache or an aura?
A
An aura
12
Q
What is the imheritemce pattern of Androgen insensitive syndrome and how does it cause developmental delay?
A
X linked recessive characterised by end-organ resistance to testosterone
13
Q
At what pH does a pleural fluid tap indicate an infection and a need for a chest drain
A
<7.2
14
Q
How does prochlorperazine work?
A
Prochlorperazine is a dopamine blocker
15
Q
What is the 2 haematological complications of carbamazepine?
A
Carbamazepine, another antiepileptic drug, can cause aplastic anaemia or agranulocytosis in rare cases
16
Q
Is Carbimzazole teratogenic?
A
Yes
17
Q
Is Carbimzazole teratogenic?
A
Yes
18
Q
What is the commonest cause of headache inchildren
A
Migraines are the commonest cause of primary headaches in children
19
Q
What is the Antidote to antifreeze, phosphate poisoning and iron poisoning
A
Antidote to anti freeze is fomepizole
Antidote to phosphate stuff is atropine
Antidote to iron is desferrioxamine
20
Q
How do you investigate Enuresis in a child
A
Enuresis is diagnosed from 5years, rule out diabetes, constipation and uti and other stuff. Primary enuresis is phycological, secondary (dry for 6months) is normally always pathological.
21
Q
What is the difference of an IUD and a IUS
A
IUD is copper
IUS is progesterone
22
Q
What is the treatment for an outbreak of Genital herpes?
A
Give acyclovir
23
Q
What the commonest bacterial in a peritoneal.dialysis infection?
A
Staph epididermis is the commonest organism causing peritoneal dialysis infection
24
Q
What investigation do you order if you suspect multiple myeloma?
A
FBC
Urea & creatinine
Calcium
Immunoglobulins & serum electrophoresis
Serum-free light chains
25
What are the features of multiple myeloma?
Presentation is with anaemia, bone pain, skeletal destruction, pathologic fractures, or Bence Jones proteinuria and increased susceptibility to infection
26
What are the features of multiple myeloma?
Presentation is with anaemia, bone pain, skeletal destruction, pathologic fractures, or Bence Jones proteinuria and increased susceptibility to infection
27
What is cataplexy?
Cataplexy is the cause of sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened). Around two-thirds of patients with narcolepsy have cataplexy.
28
What is a hydrocele and what are their types?
A hydrocele describes the accumulation of fluid within the tunica vaginalis. They can be divided into communicating and non-communicating:
communicating: caused by patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum. Communicating hydroceles are common in newborn males (clinically apparent in 5-10%) and usually resolve within the first few months of life, these are repaired if they are still present 1-2 years.
non-communicating: caused by excessive fluid production within the tunica vaginalis - these need US
29
What are the causes of secondary hydrocele?
Hydroceles may develop secondary to:
epididymo-orchitis
testicular torsion
testicular tumours
30
What is Buerger's disease?
Buerger's disease, or thromboangiitis obliterans, is a condition characterised by progressive inflammation and thrombosis of the small and medium arteries in the hands and feet. It can present as acute ischaemia or chronic progressive ischaemic changes to the skin/tissues.
31
What is the features of carcinoid syndrome and what are the investigations?
Carcinoid syndrome- flushing, diarrhoea, bronchospasm, hypotension, and weight loss. The investigation for this is urinary 5-HIAA, as the tumour will secrete serotonin.
32
What is the 4th line anti HTN treatment?
Step 4 treatment in HTN managemant
NICE define step 4 as resistant hypertension and suggest either adding a 4th drug (as below) or seeking specialist advice
first, check for:
confirm elevated clinic BP with ABPM or HBPM
assess for postural hypotension.
discuss adherence
if potassium < 4.5 mmol/l add low-dose spironolactone
if potassium > 4.5 mmol/l add an alpha- or beta-blocke
33
What does polycythemia vera cause and what is it?
Polycythemia vera (PV) has been recognized as the main cause of primary erythrocytosis, it is a myeloproliferative neoplasm known to be associated with dysregulated signalling of the Janus associated kinases JAK1 and JAK2.
34
What is the classic clinical features of polycythemia vera?
pruritus is very common - exacerbated by a warm bath
35
What are the features of diabetes insipidus
polyuria
nocturia
polydipsia
confusion or coma if hypernatraemia - especially in cranial diabetes insipidus
growth failure in familial nephrogenic diabetes insipidus - more severe in boys than girls
36
What is diabetes insipidus and what are the different types?
This is the inability to produce a concentrated urine due to:
a deficiency of antidiuretic hormone (ADH) (cranial diabetes insipidus), or,
renal resistance to ADH (renal diabetes insipidus)
37
What are the investigations to diabetes insipidus and the results?
blood glucose, plasma calcium and potassium – hypercalcemia and hypokalemia can cause nephrogenic diabetes insipidus
serum sodium - may be raised
serum and urine osmolarity - plasma osmolality should be high and urine osmolality should be low. In cases of psychogenic polydipsia then generally the plasma osmolality is low
confirm existence of polyuria - more than 3.0 L urine in 24 hours
38
What is the treatment for diabetes insipidus
Desmopressin
39
What are the adverse effects of clozapine? SECOND AP
Seizures, sedation, salivation
Elevated lipids
Cardiac QT problems, myocarditis
Orthostatic hypotension
Neutropaenia, agranulocytosis
Dizziness
Anticholinergic
Prolactin
40
When should HIV PEP be started after exposure?
According to UK guidelines, HIV post-exposure prophylaxis (PEP) should be initiated as soon as possible after exposure but can be given up to 72 hours after the event. The sooner PEP is started, the more effective it is likely to be. However, it can still offer some protection if started within 72 hours of exposure.
41
What are the eye adverse effects of amiodarone?
Amiodarone can cause opacities on the cornea and optic neuritis. Metronidazole And ethambutol also cause optic neuritis
42
What is the time window for alteplase and thrombectomy for a stroke?
Alteplase and thrombectomy is within 4.5 hours
43
Describe both Wernickes and Brocas aphasia
Wernicke's aphasia is associated with lesions in the posterior superior temporal gyrus, it is sometimes termed fluent aphasia or receptive aphasia. Speech remains fluent but makes little sense and commonly includes nonsense or irrelevant words. Interestingly, the person does not realise they are using incorrect words.
Broca's aphasia is classically caused by lesions affecting the frontal lobe and is called non-fluent or expressive aphasia. Patients have difficulty speaking fluently, and their speech may be limited to a few words at a time. Speech is halting or effortful. Generally, there are able to understand speech well and maintain the ability to read.
44
When can IUD be inserted?
at any time during the menstrual cycle
immediately after first- or second-trimester abortion, or
at any time thereafter from 4 weeks post-partum, irrespective of the mode of delivery
45
What should be performed before inserting an IUD?
STI risk assessment
46
When should you screen for STIs?
When they have risk factors which include:
being sexually active and aged<25 years
having a new sexual partner in the last 3 months
having more than one sexual partner in the last year
having a regular sexual partner who has other sexual partners
a history of STIs
attending as a previous contact of STI
alcohol/substance abuse
47
If STI testing in women is indicated what are the methods
Chlamydia trachomatis testing should be performed as a minimum requirement. In most settings a single vulvovaginal or endocervical swab can be sent for combined C. trachomatis and Neisseria gonorrhoeae testing by nucleic acid amplification techniques
vulvovaginal swabs may be self-taken if preferred
syphilis and HIV testing should also be offered routinely
there is no indication to screen for other lower genital tract organisms in asymptomatic women considering IUC. If bacterial vaginosis or candidal infection is diagnosed or suspected the infection should be treated and the method inserted without delay
48
Can you use urine specimens for STI testing in women
No
49
Do you need to await STI screening results when inserting an IUD and would you wait to insert an IUD if there is a high chance of chlamydia?
in asymptomatic women attending for insertion of IUC there is no need to wait for STI screening results or to provide antibiotic prophylaxis providing the woman can be contacted and treated promptly in the event of a positive result
however antibiotic prophylaxis for chlamydia (and gonorrhoea if local prevalence or individual risk factors warrant) can be considered for women who require an emergency IUD and who are symptomatic or at high risk of STI (e.g. if their partner is known to be infected)
50
Do you need to delay IUD implantation if they are known to have GBS
no need to delay treatment or treat asymptomatic women who have been identified as having Group B streptococci
51
When can an IUD be fitted after the emergency contraceptive pill?
Within the first 5 days (120 hours) following first UPSI in a cycle or within 5 days from the earliest estimated day of ovulation, outside of this time a negative pregnancy test must be done no sooner than 3weeks
52
Can you get an ectopic pregnancy even with an IUD
Yes
53
How do you follow up an inserted IUD
Routine follow-up
at 3-6 weeks to check threads and exclude perforation
return if problems or time for removal; no further follow-up needed
At first follow-up visit exclude infection, perforation or expulsion
54
What are the features of club foot and how is it diagnosed on the newborn exam?
foot points downwards at the ankle (equinus) the heel is turned in (varus), the midfoot is deviated towards the midline (adductus), and the first metatarsal points downwards (plantar flexion)
deep creases may be present behind the heel or on the medial side of the foot. The deformity in club foot is not passively correctable by the examiner
55
How is club foot managed?
preferred treatment for clubfoot is the Ponseti method
detailed method of manipulation and casting without major surgical releases, and it is the treatment of choice of most orthopaedic surgeons worldwide
56
How common is club foot and what is it associated with meaning a full neurological review needs to be performed?
One of the most common birth deformities with an incidence of 1.2 per 1000 live births each year in the white population
Associated with most common associated conditions are spina bifida (4.4% of children with clubfoot), cerebral palsy (1.9%), and arthrogryposis (0.9%)
57
What is the commonest cause of leukaemia in adults
CLL
58
How quickly does CLL present and what is the rate of incidental presentation.
Approximately 70 - 80% of patients are diagnosed incidentally when they are found to have lymphocytosis
59
When do CLL symptoms present and what could this signify?
At the advanced stage
B symptoms are not common but if present it might indicate that CLL has transformed into an aggressive large B-cell lymphoma (Richter’s transformation)
60
When would you offer anticoagulation in AF/flutter
Offer anticoagulation with a direct-acting oral anticoagulant (DOAC) first-line if a person has AF and a CHA2DS2-VASc score of 2 or above, and consider a DOAC for a man with AF and a CHA2DS2-VASc score of 1, taking into account the risk of bleeding.
61
When do you not start rate control in AF patients?
A potentially reversible cause.
Heart failure thought to be primarily caused by AF.
New-onset AF within the past 48 hours.
A rhythm-control strategy is felt to be more suitable clinically — this will usually be a specialist decision. See the section on Admission or referral for more information.
62
What is the reversal for Dabigatran
Idarucizumab
63
What is the reversal for apixaban and rivaroxaban?
Andexanet alfa
64
What is the reversal to edoxaban?
There is none
65
What is used if warfarin overdose and bleeding?
Prothrombin complex
66
How common is open angle glaucoma in glaucomas, how does it occur, how does it initially present and how does it progress
accounts for more than 90% of cases of glaucoma, and it occurs when fluid in the eye is unable to drain properly
most people with open-angle glaucoma are initially asymptomatic
as the disease progresses, patients can develop problems with peripheral vision and, sometimes, central vision, causing difficulty with reading, walking, and driving
67
How does acute angle-closure glaucoma occur and how does it present?
due to acute obstruction of fluid drainage from the eye, leading to blurry vision, halos around lights, eye pain, nausea, vomiting, and rapid vision loss
this type of glaucoma requires emergency treatment to decrease intraocular pressure and prevent rapid onset of blindness
68
What are the eye signs of Horner's syndrome?
Midirasis
Ptosis
Anhydrosis
69
70
When do you medically cardiovert patients and which drugs do you use?
Less than 48hr onset
flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease
71
What is the commonest cause of meningitis in children?
Meningitis B is currently the most common cause of meningococcal disease in children the UK
72
What are the three scalp oedema that occur in neonates?
Caput Succedaneum
Cephalohaematoma
Subgaleal Haemorrhage
73
What is a caput succedaneum and how is it managed?
Birth trauma resulting in oedema that does crosses the cranial suture lines which is a benign self-resolving condition.
Treatment and management of caput succedaneum are observational. A majority of cases will self-resolve within forty-eight hours, and management includes observation and reassurance only.
74
What is a Cephalohematoma and how is it managed?
Cephalohematoma refers to hematoma associated with birth trauma (instrument-assisted delivery, prolonged delivery) that results in rupture of capillaries located inferior to the periosteum. The resulting hematoma is a firm fluctuant mass that does not cross cranial suture lines or midline. This mass size grows during the first day of life and is rarely associated with intracranial hemorrhage and infection, requiring monitoring for hyperbilirubinemia in the newborn. The swelling typically resolves itself between two weeks to six months.
75
What is subgaleal haemorrhage?
Subgaleal hemorrhage refers to hemorrhage associated with birth trauma located inferior to the epicranial aponeurosis that can present as edema on the scalp that crosses suture lines and then spreads diffusely. This condition is associated with a high mortality rate and is associated with seizures, skull fractures, and hypotonia. Subgaleal hemorrhage can result in hypovolemia, coagulopathy, and hyperbilirubinemia. Subgaleal hemorrhage is also associated with vacuum and forceps-assisted delivery. The subgaleal space is large, and the fluid collection has the potential to extend behind the orbits and back on the neck as well. In comparison to the edema found in caput succedaneum, both will cross midline as the fluid collection is above the cranial suture lines in both cases. However, subgaleal hemorrhage will be much more diffuse
76
What is diplopia and what is the difference between monocular and binocular double vision
Double vision
Monocular diplopia is double vision in one eye which persists after the other eye is covered. Image separation is slight, often described as 'ghosting.'
Binocular double vision may be caused by disorders affecting the eye muscles or other conditions such as brain tumours, diabetes, thyroid disease or severe head injury
77
What are the causes of monocular diplopia?
refractive error - the commonest problem - if looking through a pinhole abolishes the diplopia then spectacles should be worn
developing cataract - areas of differing refractive index cause splitting of the light beam and diplopia. Usually abates as the opacification increases
corneal scarring
78
Who should you refer to in a painful and painless diplopia
Painful - urgent ophthalmology
Painless - persistent symptoms or signs when seen, is anticoagulated or has had more than 1 event in 24 hours, consider admission to emergency department
79
What are the DVLA rule for driving with syncope?
Syncope
simple faint: no restriction
single episode, explained and treated: 1 month off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
80
What are the DVLA rules for driving with their first seizures?
Epilepsy/seizures - all patient must not drive and must inform the DVLA
first unprovoked/isolated seizure: 6 months off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. If these conditions are not met then this is increased to 12 months
81
What are the DVLA rules for driving with their established epilepsy or those with multiple unprovoked seizures?
may qualify for a driving licence if they have been free from any seizure for 12 months
if there have been no seizures for 5 years (with medication if necessary) a 'til 70 licence is usually restored
withdrawawl of epilepsy medication: should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose
82
What are the DVLA rules with strokes and TIA?
stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit
multiple TIAs over short period of times: 3 months off driving and inform DVLA
83
What are the rules for the DVLA after brain surgery?
craniotomy e.g. For meningioma: 1 year off driving*
pituitary tumour: craniotomy: 6 months; trans-sphenoidal surgery 'can drive when there is no debarring residual impairment likely to affect safe driving'
84
What are the rules for the DVLA with narcolepsy/cataplexy and chronic neurological conditions such as MS?
narcolepsy/cataplexy: cease driving on diagnosis, can restart once 'satisfactory control of symptoms'
chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, complete PK1 form (application for driving licence holders state of health)
85
What is the first line anti-epileptic medications for:
Generalised tonic-clonic seizures in male and female
Focal seizures in male and female
Absent seizures in male and female
Generalised tonic clonic seizures
Male: Sodium valproate / Female: Levetiracetam and lamotrigine
Focal seizures: Both Levetiracetam and Lamotrigine
Absent seizures: Ethosuximide
86
What are the different presentations of UC and Corhns
UC: Colitis which can result in ulcers and causes bloody diarrhoea more common, Abdominal pain in the left lower quadrant as it starts in the rectum, Tenesmus
Crohn's: Diarrhoea usually non-bloody, Weight loss more prominent, There is a tendency to form complications such as strictures, abscesses and fistulae affecting the upper gastrointestinal symptoms, mouth ulcers, perianal disease, Abdominal mass palpable in the right iliac fossa as the granulomatous inflammation most frequently affects the terminal ileum
87
Which IBD has a higher rate of colorectal cancer?
Risk of colorectal cancer high in UC than CD
88
What is the treatment for bullous and non-bullous impetigo
If the person has localized non-bullous impetigo and is not systemically unwell or at high risk of complications: hydrogen peroxide 1% cream
If the person has widespread non-bullous impetigo and is not systemically unwell or at high risk of complications: fusidic acid
If the person has localized or widespread non-bullous impetigo and is systemically unwell or at high risk of complications: flucloxacillin
Bullous impetigo: Flucloxacillin
89
What are the musculoskeletal side effects of steroids?
musculoskeletal
osteoporosis
proximal myopathy
avascular necrosis of the femoral head
90
What are the three cases where steroids need weaning?
the BNF suggests gradual withdrawal of systemic corticosteroids if patients have:
received more than 40mg prednisolone daily for more than one week
received more than 3 weeks of treatment
recently received repeated courses
91
What are the clinical features of subacute combined degeneration of the spinal cord are based on:
Paresthesia, impaired proprioception, loss of vibratory sensation, tactile sensation, and position discrimination due to demyelination of the dorsal columns
Spastic paresis due to demyelination of the lateral corticospinal tracts (axons of upper motor neurons)
Gait abnormalities (spinal ataxia) resulting from the damage of spinocerebellar tracts and dorsal columns
Long-term deficiency can lead to irreversible neurological damage.
Neuropsychiatric disease (e.g., reversible dementia, depression, paranoia) [8]
92
What are the side effects of ACE-I and what does it do to potassium?
Side-effects:
cough - occurs in around 15% of patients and may occur up to a year after starting treatment
angioedema: may occur up to a year after starting treatment
hyperkalaemia
first-dose hypotension: more common in patients taking diuretics
93
What is the acceptable change in potassium and kidney function when starting ACE-i
a rise in the creatinine and potassium may be expected after starting ACE inhibitors
acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l.
94
What are the toxic features of digoxin and lithium
Digoxin toxicity - nausea/vomiting, confusion, yellow-green vision
Lithium toxicity - coarse tremor, hyperreflexia, confusion
95
What is tamoxifen, how long is it taken for and what are its side effects?
Oestrogen receptor modulator, taken for 5years after surgery,
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer
96
What is the test for Cushing's syndrome?
Overnight dexamethasone suppression test
Cushing's syndrome
97
What are the different forms of Cushing's syndrome?
Iatrogenic
ACTH dependent (Cushing's disease -Pituitary adenoma, SCLC)
ACTH independent (adrenal adenoma)
98
Mutations of the BRCA2 gene increases the risk of which two cancers?
breast cancer
ovarian cancer
99
What is Erythema infectiosum otherwise known as?
Slapped cheek/Parvovirus
100
How do you differentiate between vitreous haemorrhage and vitreous detachment?
Vitreous haemorrhage
causes: diabetes, bleeding disorders, anticoagulants
features may include sudden visual loss, dark spots
Retinal detachment
features of vitreous detachment, which may precede retinal detachment, include flashes of light or floaters (see below)
101
At what age does premature ovarian insufficiency occur and how is it diagnosed?
- Premature ovarian insufficiency is transient or permanent loss of ovarian function before aged 40years, it is confirmed with both
o Diagnosis requires elevated gonadotrophins - FSH above 40 IU per litre together with raised LH and low oestradiol (less than 100 pmol per litre) on at least two occasions
o Amenorrhoea/oligorrhea for at least 4months
102
When should FSH be tested in ovulatory disorders (menopause)
FSH should only be performed on:
- Over 45s with atypical symptoms
- 40-45 with symptoms
- Less than 40 with suspected POI
103
Define primary amenorrhea
Primary amenorrhea
- Failure to establish first period if no secondary sexual characteristics at age 13/14
- Failure to establish first period if there are secondary sexual charactertistics at age 15/16
104
Where should the majority of anal fissures occur and if they are not found here what is the differential diagnosis to consider?
around 90% of anal fissures occur on the posterior midline.
if the fissures are found in alternative locations then other underlying causes should be considered e.g. Crohn's disease
105
What is the management of acute and chronic anal fissures?
Acute - stool softeners
Chronic (more than 6weeks) - GTN cream
106
What is the management after failure of the GTN cream to treat anal fissures?
After 8 weeks refer for surgery or botulin
107
How does Anastrozole work, when is it given and what are its side effects?
It is an aromatase inhibitor preventing the formation of oestrogen. This is important as aromatisation accounts for the majority of oestrogen production in postmenopausal women and therefore anastrozole is used for ER +ve breast cancer in this group.
Adverse effects
osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
108
When is Aspirin & dipyridamole taken life long
Aspirin (lifelong) & dipyridamole (lifelong), no other antiplatelets
ischaemic stroke (cannot take clopidogrel)
TIA (cannot take clopidogrel)
109
When is Aspirin taken lifelong, no other antiplatelets
peripheral arterial disease (cannot take clopidogrel)
110
What other findings are seen in polycystic kidney disease?
Young
recurrent UTIs, intermittent haematuria
liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly
berry aneurysms (8%): rupture can cause subarachnoid haemorrhage
cardiovascular system: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary
111
What is the step approach to managing asthma above 12years old
Anti-inflammatory reliever therapy - ICS/Formeterol
If severe (night time symptoms or exacerbations) MART low dose
MART mod dose
FeNO testing, if raised refer
If not raised LTRA or LAMA
Then refer
112
What eye presentation occurt in rheumatoid arthritis?
all of them except uveitis
113
What is the treatment of choice for prophylaxis of variceal haemorrhage?
Propranolol
114
What vessel adverse effects is most characteristically associated with antipsychotics along with EPSE and name the other SE
Increase risk of VTE and stroke
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin
may result in galactorrhoea
due to inhibition of the dopaminergic tuberoinfundibular pathway
impaired glucose tolerance
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold (greater with atypicals)
prolonged QT interval (particularly haloperidol)
115
Positive cANCA serology
Granulomatosis with polyangiitis
116
Positive pANCA serology
Churg-Strauss syndrome
117
What anti-plt do you take after a PCI?
Aspirin (lifelong) & prasugral or ticagrelor (12 months), no other antiplatelets
118
How should you manage poor T2DM control on metformin?
you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to 58 mmol/mol
119
ncludes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea)
53 mmol/mol (7.0%)
120
Which virus causes warts and verucas?
HPV
121
What is the treatment for warts?
Salicyclic acid, refer if on the face or immunosuppressed
122
What causes anogenital warts and how is it treated?
HPV 6 and 11, podophyllotoxin, if pregnant then refer.
123
What are the different grades for varicocele?
Grade I (small) — palpable only with Valsalva manoeuvre.
Grade II (moderate) — palpable without Valsalva manoeuvre.
Grade III (large) — visible through the scrotal skin.
124
How are varicoceles managed?
If an adolescent -
Subclinical or grade I varicocele — no treatment is necessary.
Provide advice and reassurance.
Grade II or III varicocele and symmetrical testes — observe with annual examinations.
The primary indication for surgery is testicular growth arrest.
Grade II or III and asymmetrical testes — refer to a urologist for possible surgery.
If an adult -
Sub-clinical or grade I varicocele — no treatment is necessary.
Offer semen analysis if fertility is a concern.
Grade II or III asymptomatic varicocele and normal semen parameters — consider observing with semen analysis every 1–2 years if clinically appropriate.
Grade II or III symptomatic varicocele, or with abnormal semen parameters — refer to a urologist for possible surgery.
125
How is lipodermatosclerosis managed?
Perform a ABPI, if between 0.8 and 1.3 arterial insufficiency is unlikely and give stockings, if between 0.8 and 0.5 then is likely to be mixes arterial and venous insufficiency.
Emollients and steroid cream for flares
126
What is the difference between vestibular neuritis and labrinthitis?
The labyrinth is inflamed causing vertigo and hearing loss.
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How is vestibular neuritis managed?
Short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine teoclate).
Refer to balance specialist.
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When is prochlorperazine CI?
Agranulocytosis.
A history of angle closure glaucoma.
Prostate hypertrophy.
Myasthenia gravis.
Heart failure.
Hypothyroidism.
Parkinson's disease.
History of jaundice.
Liver or renal dysfunction.
Phaeochromocytoma.
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How do you treat chronic severe urticaria?
Non sedating anti-histamines (cetirizine, fexofenadine, or loratadine) for 6weeks and 7days pred 40mg if severe
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What is chronic spontaneous urticaria and how is it managed?
urticaria that lasts for 6 weeks or longer, typically on most days of the week caused by odd things (heat, water) managed with daily antihistamine treatment for 3–6 months
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How are scabies close contact treated?
All members of their household, their sexual partners within the past month, and any other close personal contacts (even if asymptomatic) should also be treated with topical permethrin 5% cream.
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When is antibiotics given for acute sinusitis and whci hantibiotic is given?
If a person has had symptoms for around 10 days or more with no improvement or symptoms increase after 5 days. Pen V
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What is Superficial vein thrombosis
(SVT, also known as 'superficial thrombophlebitis' or 'superficial phlebitis') describes inflammation of the superficial vein system associated with venous thrombosis
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How is thrombophlebitis managed?
Urgent referral for doppler US, do not do a D-dimer
There is suspected SVT affecting the proximal long saphenous vein.
There is suspected SVT at the saphenofemoral junction at thigh level.
There is extensive SVT, for example measuring 5 cm or more, or affecting both the thigh and the calf.
The diagnosis is uncertain.
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What causes thrombophlebitis
Most cases of SVT are spontaneous
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Emollients are the first-line treatments during both acute flares and remissions of the condition.
The use of topical steroids should be considered for red, inflamed skin. The lowest potency and amount of topical corticosteroid necessary to control symptoms should be prescribed, depending on the severity of the flare.
If there is persistent, severe itch, or urticaria, a one-month trial of a non-sedating antihistamine should be considered.
If itching is severe and affecting sleep, a short course of a sedating antihistamine should be considered (if appropriate).
If there is severe, extensive eczema, a short course of oral corticosteroids should be considered.
If eczema is weeping, crusted, or there are pustules, with fever or malaise, secondary bacterial infection should be considered, and antibiotic treatment should be prescribed.
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What is severe eczema?
Severe — if there are widespread areas of dry skin, incessant itching, and redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation).
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What are the moderate potency steroid creams and for how long should they be given for in moderate eczema
betamethasone valerate 0.025% or clobetasone butyrate 0.05% - 48horus
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What is the treatment for restless leg syndrome?
A non-ergot dopamine agonist (pramipexole, ropinirole, or rotigotine),
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What are the causes for restless leg syndrome?
most commonly pregnancy, iron deficiency, or stage 5 chronic kidney disease), or the use of certain drugs (for example, some antidepressants, some antipsychotics, and lithium).
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When do you refer achilles tendinopathy?
Referral to physiotherapy should be made if symptoms of Achilles tendinopathy fail to improve within 7–10 days.
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When is GTN cream used to treat anal fissures?
For adults whose symptoms have persisted for 1 week or more without improvement considering a 6–8 week course of rectal glyceryl trinitrate (GTN) ointment.
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How do you treat balanitis?
Depending on the cause:
hydrocortisone 1% cream
imidazole cream (clotrimoxazole)
mupirocin 2% ointment
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When is bowel cancer screening done?
Every 2 years from 50-74
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When should bronchiectasis be suspected?
Persistent production of mucopurulent or purulent sputum, particularly with relevant associated risk factors for bronchiectasis.
A cough that persists for longer than 8 weeks, especially with sputum production or a history of an appropriate trigger.
Rheumatoid arthritis if they have symptoms of chronic productive cough or recurrent chest infections.
Chronic obstructive pulmonary disease (COPD) with frequent exacerbations (two or more annually) and/or a positive sputum culture for Pseudomonas aeruginosa whilst stable.
Inflammatory bowel disease and chronic productive cough.
COPD who do not smoke or who have frequent or prolonged exacerbations.
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What is the most important investigation for bronchiectasis?
High-resolution computed tomography (HRCT) (thin section scanning) is the most frequently used imaging test to establish the diagnosis of bronchiectasis.
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Which antibiotics do you give in bronchiectasis exacerbations for each bacteria?
Streptococcus pneumoniae Amoxicillin 500 mg three times daily
Haemophilus influenzae (beta-lactamase negative) Amoxicillin 500 mg three times daily
Haemophilus influenzae (beta-lactamase positive) Co-amoxiclav 625 mg three times daily
Moraxella catarrhalis Co-amoxiclav 625 mg three times daily
Staphylococcus aureus (MSSA) Flucloxacillin 500 mg four times daily
Staphylococcus aureus (MRSA)
Doxycycline 100 mg twice daily PLUS rifampicin (for adults weighing less than 50 kg, give rifampicin 450 mg once daily. For adults weighing more than 50 kg, give rifampicin 600 mg once daily) PLUS trimethoprim 200 mg twice daily
Coliforms (such as Klebsiella or enterobacter) Ciprofloxacin 500 or 750 mg twice daily I
Pseudomonas aeruginosa Ciprofloxacin 500 mg twice daily (or 750 mg twice daily in more severe infections)
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How is primary erythrocytosis managed?
Test for JAK2 mutation
Manage risk factors
Vensection and aspirin
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What is Gilbert's syndrome?
Gilbert's syndrome is an inherited (usually autosomal recessive) metabolic disorder characterized by a mild and intermittent elevation of unconjugated (indirect) bilirubin levels, due to defective conjugating enzymes in the liver.
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What is the treatment for head lice?
Wet combing or dimeticone 4% lotion
