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YEAR 3 NICE > nice > Flashcards

nice Flashcards

1
Q

16 is age can legally cosnent to any sexual acitivity

A

children under 13 cannot consetn to any sexual acitivty

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2
Q

Hiv often presents with a flu like illness in the first few weeks

A

person is highly infectious during primary HIV infection

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3
Q

pneumocystis jirovecci cna have

A

decreased exercise tolerance

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4
Q

kaposi sarcoma - most common tumour in people with hiv infection adn presents wth

A

dark purple or brown intradermal skin lesions that look like bruises but feel firmer

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5
Q

hyperlipidaemia is common in anti HIV meds

A

NAARt fot HIV can interact with statins and fibrates

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6
Q

all womrn with HIV should have

A

colposcopy - to assess risk of cervical cancer

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7
Q

copper coil is recommneded as the emergency contraception in a woman with a CD4 count less than 200

A

post exposure prophylaxis for HIv can be given up to 72 hrs after

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8
Q

give dexa scan to all woman diagnosed with POI and those with amenorrhoea for more than 6 months

A
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9
Q

causes of b12 def- colchicine (gout), metformin, nitrous oxide, PPI

A

causes of folate def- anticonvulsants, methotrexate and trimethroprim and nitrofurantoin

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10
Q

total b12 ( serum cobalamin) or active b12 (serum holotranscobalamin)

A

anti intrinsic factor antibody test should be considered in autoimmune gastriits

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11
Q

if there is neurological involvement for b12 def - initially have injections on alternate days

A

b12 and folate def- brown pigmentation of nail beds and skin creases

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12
Q

recreational nitrious ozide use can cause folate/b12 def

A

if got neurological symptoms with suspected b12 def. - do not hold treat while waiting for test results due to risk of sub acute combined degeneration of the cord

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13
Q

normal MCV does not exlude b12/f def as a nornal MCV is seen in 25% of cases

A

main cuase of foalte def is gluten induced enteropathy

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14
Q

if on carbamazepine it can reduce the conc of other drugs such as folic acid

A

serum ferritin most reliably correlates with total body iron stores

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15
Q

restless leg syndrome and cognitive dysfunction is common in

A

iron def

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16
Q

in premenopausal woman - can try diagnostic trial of iron treatmetn even if bloods are within an expected range

A

pencil cells can indicate iron def anaemia

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17
Q

offer FIT testing for iron def anemia in adults

A

diarrhoea is also an effect of iron supplements

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18
Q

absorption of iron is reduced if also taking calium rich foods, tannins (tea,coffee),

A

10 appointments for first time mum and 7 for if had kids before

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19
Q

preg women have how many ultrasounds scans

A

2 - dating scan between 11-15 weeks
fetal anomaly scan - around 20 weeks

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20
Q

blood pressure and urine sipstick should be offered at every pregnancy appointment

A

28 weeks - routine anti D prophylaxis to all neg woman

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21
Q

varcicose veins are common in pregnancy and often improve after pregnnacy

A

vaginal discharge is common in preg

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22
Q

BV has no itch or soreness

A

should do pH of the discharge in BV

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23
Q

all those with meningitis with non blanching rash or meningococcal septicaemia - should get benzylpenicillin at earliest possible stage

A

Brudzinkski’s sign - persons knees and hips flex when neck is flexed - meningitis

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24
Q

bulging fontanelle can be a sign of meningitis in babies

A

can get ear and postauricular ear pain in bells palsy

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25
Q

hyperacusis (noise sensitivity ) can be seen in bells palsy- as nerve to stapedius is affected

A

people with bells palsy can get a dry mouth due to loss of innervation to submandibular and sublingual glands

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26
Q

diazepam can aggravate

A

myasthenia gravis

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27
Q

mastitis can have a hard area of the breast which is often in a wedge shaped distribution

A

non lactional mastitis includes- periductal and granulomatous

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28
Q

deep burning, aching or shooting pain in the brest that is usually worse during or just after breastfeeding

A

infection of the mammary ducts

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29
Q

lumph behind the nipple in duct eectasia is just scar tissue or a dilated duct

A

in fat necrosis - the skin around the lump may look red or bruised

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30
Q

most common cuase of nipple plain

A

poor infant attachment

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31
Q

blanching of the nipple us due to poor breastfeeding technique

A

confirm a breast abscess with an US

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32
Q

is changing antipsychotic - reducess gradually voer 4 weeks

A

if totally stopping antipsychotic or history of manic relaps when stopping antipsychotic then discontinue over 3 months

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33
Q

ECG is mandatory for dose changes of haloperidol

A

oculocgyric crises - adverse effect of apiprazole

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34
Q

especially clozapien and olanzapine are known to cause weight gain

A

cardiomyopathy associated with quietiapien

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35
Q

most widely reported caridac conduction defect by antipsychotics is QT interval prolongation

A
  • try using apiprazole instead.
    ( tricyclic antideprssants, erythomucin or antiarrhythmics also shown to prolong the QT)
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36
Q

photosensitivity is common with chlopromazine

A

obesity is the seoncd biggest cause of cancer after smoking in the UK

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37
Q

cyclical breast pain has dull, heavy or aching and is usually bilateral

A

mammography ( breast screening) from age 50-70 and is every 3 years

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38
Q

in suspected brain cancer want to do an

A

MRI

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39
Q

peak incidence aged of cervical cancer is

A

30-34

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40
Q

radical trachelectomy involves removal of teh

A

cervix

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41
Q

external beam radiotherapy is considered first line to reduce recurrence of cervical cancer

A

if HPV remains positive at 24 months then the person should be. referred to colposcopy

42
Q

colposcopy - acetic acid abnormal areas turn white
iodine - normal tissue. stains dark brown

A

people with CIN are at a 2-5 times more likely than the general population to develop cervical cancer and they should have a test of cure after 6 months of treatment

43
Q

cin1- 1/3, 2-2/3 cin3 - full thickness of the surface layer is affected

A

vulvo vaginal swab is the sample of choice in women for chlamydia

44
Q

repeat testing should be offered to all people under 25 diagnosed with chlamydia 3-6 months after completion of treatment to check fo reinfection

A

lymphogranuloma venerum - tenesmus (feeling you need to poo) , blood rectal discharge, diarrhoea or altered bowel habitt

45
Q

azithrmoycin, amoxicillin or erythromycin for chlaymdia in preg

A

oestogen and progterone both inhibit LH and FSH hence why can be used in COC

46
Q

if taken ulipristal acetate - wait 5 days before starting COCP

A

ectopic pregnancy signs tend to appear 6-8 weeks after the last normal menstrual period

47
Q

vomiting and diarrhoe can be the presenting symptoms of abdominal bleeding

A

transvaginal US is diagnostic tool for ectopic pregnancy

48
Q

need to be able to have follow up if taking methotrexate for ectopic pregnnacy

A

women who took methotrexate for ectopic should wait at least 3 months before trying to conceive again

49
Q

side effects that are common with antiepileptics

A

sedation and dizziness when starting but usually resolves with time
suicidal thoughs - this applies to all antiepileptic drugs
oosteoporosis

50
Q

most common cause of secondary erythrocytosis

A

chronic lung disease

51
Q

apparent erythrocytosis is when there is an increase in haemotcrit and haemoglobin. with a normal red cell mass

A
  • most commonly occurs in people taking thiazide diuretics and those who are heavy smokers or heavy alcohol users
52
Q

erythrocytosis is an abnormally high haematocrit and haemoglobin and causes

A

increased blood viscocity

53
Q

increased red cell mass means

A

increase in the total number of red blood cells in the circulation

54
Q

FBC in suspected polyctthaemia should be repeated in a week to check the rise isnt transient

A

erythrocytosis headahce may be descreibes as fullness in the head and neck

55
Q

polycyhtameia vera may haeve tenderness or painful burbing sensation in hands or feet

A

what drug can reduce risk of thrombosis if got polyctahemia - hydroxycarbamide

56
Q

history of falls is the strongest rf for a fall

A

timed up and go test can be used to assess fall

57
Q

psychotropics eg antipsychotics, antidepressants, anti anxiety should be revviewed and discontinued if possible to reduce risk of falls

A

fibroids form whorled tumours in the myometrium

58
Q

fobroids aer a mixture of smooth muscle cells and fibroblasts

A

intramural fibroids can cause heavy menstrual bleeding and dysmennorhea by interfering with the constrciction of blood vessels durig menstruation

59
Q

sertraline is first lien for GAD

A

gonorrhoea is symptomatic in 90% of men and 50% of women

60
Q

NAAT is used for chlamydoa and gonorrhoea

A

gonorrhoea - ceftriaxone when dont know antibiotic suscpetibility and ciprofloxacin when do know

61
Q

gentamicin and azithrmycin if got allergy or needle phobia for gonorrhoea

A

ceftrizone if fine to give if got penicillin allergy

62
Q

men with symptmatic infection of gonorrhoea should tell all partners within preceding 2 weeks or most recent partner
everyone else should tell all partners withing the preceding 3 months

A

Us of the abdomen and pelvis in ovarian cancer if ca-125 is high

63
Q

cancer referral for haem is 2 week but 48hrs if children or young person

A

everything is reduced in leukemia - eg anaemia, reduced white cells, reduced platelets

64
Q

for myeloma should offer protein elctrophoreis and bence jones urine test within 48hrs

A

head injury is the commonest cause of death and diability in people aged 1-40

65
Q

Hypopituitarism is estimated to occur in 33-50% of all people following traumatic brain injury

A

bout of cluster headahce ususally lasts 2 weeks - 3months

66
Q

paroxysmal hemicrania - attacks are more frequent than cluster headache

A

do not prescribe sumatriptan if have history of ischaemic heart disease, uncontrolled hypertensionm prebious MI, previous TIA or stroke or severe hepatic impoariemtn

67
Q

triptans can cause dizziness and drowsiness - can affect driving

A

medication overuse headahce - occurs on 15 days or more per month

68
Q

in medication overuse headahce stop meds abruptly and for at least 1 month

A

tension headahces are non pulsating

69
Q

pericranial tenderness

A

tension headhace

70
Q

pain often spreads into arises from the neck in

A

tension headahce

71
Q

drug prophylaxis for tension headahce

A

amitripyline

72
Q

main risk of taking acei/arbs to fetus is during what trimesters

A

second adn third

73
Q

apirin should be taken from 12 weeks if preg mother got hypertension

A

albumin: creatinine ratio is down to quantify proteinuria in preg woman or protein:creatinine

74
Q

itch in pregnancy which doesn not present with a rash

A

obstretic cholestasis

75
Q

obstetric cholestasis generally poses no risk

A

intensely itchy rash in preg that starts on abdo and coalesce into plaques - Polymorphic eruption of pregnnacy

76
Q

polymorphic eruption of preg- no risk and symptoms usually resolve following delivery

A

pemphigoid gestationis - itch often precedes the rash

77
Q

obtetric cholestasis usually starts

A

abruptly in the 3rd trimester

78
Q

polymorphic eruption of pregnnacy - start on abdo and coalesce to plaques
atopic eruption - history of atopic exzema

A

pemphigoid gestationis - blister and itch precedes rash
obstructive cholestasis - itch that presents with NO RASH

79
Q

miscarriage is up to

A

24 weeks

80
Q

recurrent miscarraige is the loss of

A

3 or more pregnancies before 24 weeks gestation

81
Q

most common cause of spontaneous pregnancy loss in the first trimester is due to

A

chromosomal abnormalities

82
Q

TRANSVAGINAL us - diagnostic tool to assess location and viability of pregnancy - even in miscarriage. better than abdominal as it provides clearer piture of the womb, ovaries and surrounding areas

A

first line mx for miscarriage is expectant management

83
Q

menstruation expected to resume 4-8 weeks after a miscarriage

A

multiple myeloma is an incurable disease

84
Q

paraproteinaemia - proliferation of abnormal monoclonal immunoglbulin in the blood

A

immunofixation of serum and urine confirms the presence of a paraprotein

85
Q

to confirm plasma cells - need to do bone marrow biopsy with trephine biopsy

A

infection is a common cause of death in people with multiple myeloma

86
Q

perimenopause is until 12 months after last period

A

only a consultant neurologist should make the diagnosis of MS

87
Q

altered sensation radiating down the back and sometime into the limbs on neck flexion - Lhermittes symptom

A

loss of colour discriminantion is particualry with the colour reds in optic neuritis in MS

88
Q

transverse myelitis seen in MS can sometimes be described as a tight band sensation around the trunk

A

cerebellar symptoms can be in MS

89
Q

methylprednisolone is typically given for relapses of MS

A

febrile neutropenia is the most common complication of anticancer treatment and describes the presnece of a fever in a person with neutropenia

90
Q

septic shock- sepsis with hypotension despite fluid correction and inotropes AND hyperlactatemia with a serum lactate greater than 2

A

neutropenic sepsis - temp greater than 38 and or signs of sepsis in pt with low neutrophil count

91
Q

drugs such as steriods can mask a high temperature in neutropenic sepsis

A

piperacillin/tazobactam for neutropenic sepsis

91
Q

hypokinesia is poverty of movements so reduced facial expression or reduced arm swing

A

lead pipe rigidity - has constant resistnace felt
cogwheel- has regular intermittent relaxation of tension

92
Q

drug induced parkinsons presents with rapid onset symtoms, bilateral motor symptoms and threre is often no rigidity or resting tremor but there may be an action tremor

A

everyone with Parkinsons must notify the DVLA

93
Q

anti parkinsosn meds should not be stopped abruptly

A

ropinirole is a dopamine agonist

94
Q

nausea and vomiting can occur when starting anti parkisnons meds - reassures that it settles over time

A

septic shock- perisitant hypotension needing vasopressor to maintain MAP of 65 and serum lactate of greater than 2

95
Q

staph aureus, pseudomonas and e.coli are the most common cuases of shock

A

hypothermia and abscence of fever are more likely in older adults and in people with chronic alcohol abuse or immunosupression in terms of shock

96
Q

people after a stroke should be screened for hearing problems within the first 6 weeks

A

spasticity and contractures are common following a stroke

97
Q

continence problems can occur after a stroke

A
98
Q

clopidogrel - blocks P2Y12 receptos which inhibits teh binding of ADP

A

trichomoniasis is caused by a protozoan

99
Q

trichomoniasis - classic discharge is frothy and yellow-green with a fishy odour - strawberry appearnce of cervix

A

want to treat PID fairly quick as if got long term can increases risk of ectopic, infertility

100
Q

normal vaginal discharge becomes clearer, wetter before ovulation

A

YEAR 3 NICE (14 decks)

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