nice Flashcards
16 is age can legally cosnent to any sexual acitivity
children under 13 cannot consetn to any sexual acitivty
Hiv often presents with a flu like illness in the first few weeks
person is highly infectious during primary HIV infection
pneumocystis jirovecci cna have
decreased exercise tolerance
kaposi sarcoma - most common tumour in people with hiv infection adn presents wth
dark purple or brown intradermal skin lesions that look like bruises but feel firmer
hyperlipidaemia is common in anti HIV meds
NAARt fot HIV can interact with statins and fibrates
all womrn with HIV should have
colposcopy - to assess risk of cervical cancer
copper coil is recommneded as the emergency contraception in a woman with a CD4 count less than 200
post exposure prophylaxis for HIv can be given up to 72 hrs after
give dexa scan to all woman diagnosed with POI and those with amenorrhoea for more than 6 months
causes of b12 def- colchicine (gout), metformin, nitrous oxide, PPI
causes of folate def- anticonvulsants, methotrexate and trimethroprim and nitrofurantoin
total b12 ( serum cobalamin) or active b12 (serum holotranscobalamin)
anti intrinsic factor antibody test should be considered in autoimmune gastriits
if there is neurological involvement for b12 def - initially have injections on alternate days
b12 and folate def- brown pigmentation of nail beds and skin creases
recreational nitrious ozide use can cause folate/b12 def
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
normal MCV does not exlude b12/f def as a nornal MCV is seen in 25% of cases
main cuase of foalte def is gluten induced enteropathy
if on carbamazepine it can reduce the conc of other drugs such as folic acid
serum ferritin most reliably correlates with total body iron stores
restless leg syndrome and cognitive dysfunction is common in
iron def
in premenopausal woman - can try diagnostic trial of iron treatmetn even if bloods are within an expected range
pencil cells can indicate iron def anaemia
offer FIT testing for iron def anemia in adults
diarrhoea is also an effect of iron supplements
absorption of iron is reduced if also taking calium rich foods, tannins (tea,coffee),
10 appointments for first time mum and 7 for if had kids before
preg women have how many ultrasounds scans
2 - dating scan between 11-15 weeks
fetal anomaly scan - around 20 weeks
blood pressure and urine sipstick should be offered at every pregnancy appointment
28 weeks - routine anti D prophylaxis to all neg woman
varcicose veins are common in pregnancy and often improve after pregnnacy
vaginal discharge is common in preg
BV has no itch or soreness
should do pH of the discharge in BV
all those with meningitis with non blanching rash or meningococcal septicaemia - should get benzylpenicillin at earliest possible stage
Brudzinkski’s sign - persons knees and hips flex when neck is flexed - meningitis
bulging fontanelle can be a sign of meningitis in babies
can get ear and postauricular ear pain in bells palsy
hyperacusis (noise sensitivity ) can be seen in bells palsy- as nerve to stapedius is affected
people with bells palsy can get a dry mouth due to loss of innervation to submandibular and sublingual glands
diazepam can aggravate
myasthenia gravis
mastitis can have a hard area of the breast which is often in a wedge shaped distribution
non lactional mastitis includes- periductal and granulomatous
deep burning, aching or shooting pain in the brest that is usually worse during or just after breastfeeding
infection of the mammary ducts
lumph behind the nipple in duct eectasia is just scar tissue or a dilated duct
in fat necrosis - the skin around the lump may look red or bruised
most common cuase of nipple plain
poor infant attachment
blanching of the nipple us due to poor breastfeeding technique
confirm a breast abscess with an US
is changing antipsychotic - reducess gradually voer 4 weeks
if totally stopping antipsychotic or history of manic relaps when stopping antipsychotic then discontinue over 3 months
ECG is mandatory for dose changes of haloperidol
oculocgyric crises - adverse effect of apiprazole
especially clozapien and olanzapine are known to cause weight gain
cardiomyopathy associated with quietiapien
most widely reported caridac conduction defect by antipsychotics is QT interval prolongation
- try using apiprazole instead.
( tricyclic antideprssants, erythomucin or antiarrhythmics also shown to prolong the QT)
photosensitivity is common with chlopromazine
obesity is the seoncd biggest cause of cancer after smoking in the UK
cyclical breast pain has dull, heavy or aching and is usually bilateral
mammography ( breast screening) from age 50-70 and is every 3 years
in suspected brain cancer want to do an
MRI
peak incidence aged of cervical cancer is
30-34
radical trachelectomy involves removal of teh
cervix
external beam radiotherapy is considered first line to reduce recurrence of cervical cancer
if HPV remains positive at 24 months then the person should be. referred to colposcopy
colposcopy - acetic acid abnormal areas turn white
iodine - normal tissue. stains dark brown
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
cin1- 1/3, 2-2/3 cin3 - full thickness of the surface layer is affected
vulvo vaginal swab is the sample of choice in women for chlamydia
repeat testing should be offered to all people under 25 diagnosed with chlamydia 3-6 months after completion of treatment to check fo reinfection
lymphogranuloma venerum - tenesmus (feeling you need to poo) , blood rectal discharge, diarrhoea or altered bowel habitt
azithrmoycin, amoxicillin or erythromycin for chlaymdia in preg
oestogen and progterone both inhibit LH and FSH hence why can be used in COC
if taken ulipristal acetate - wait 5 days before starting COCP
ectopic pregnancy signs tend to appear 6-8 weeks after the last normal menstrual period
vomiting and diarrhoe can be the presenting symptoms of abdominal bleeding
transvaginal US is diagnostic tool for ectopic pregnancy
need to be able to have follow up if taking methotrexate for ectopic pregnnacy
women who took methotrexate for ectopic should wait at least 3 months before trying to conceive again
side effects that are common with antiepileptics
sedation and dizziness when starting but usually resolves with time
suicidal thoughs - this applies to all antiepileptic drugs
oosteoporosis
most common cause of secondary erythrocytosis
chronic lung disease
apparent erythrocytosis is when there is an increase in haemotcrit and haemoglobin. with a normal red cell mass
- most commonly occurs in people taking thiazide diuretics and those who are heavy smokers or heavy alcohol users
erythrocytosis is an abnormally high haematocrit and haemoglobin and causes
increased blood viscocity
increased red cell mass means
increase in the total number of red blood cells in the circulation
FBC in suspected polyctthaemia should be repeated in a week to check the rise isnt transient
erythrocytosis headahce may be descreibes as fullness in the head and neck
polycyhtameia vera may haeve tenderness or painful burbing sensation in hands or feet
what drug can reduce risk of thrombosis if got polyctahemia - hydroxycarbamide
history of falls is the strongest rf for a fall
timed up and go test can be used to assess fall
psychotropics eg antipsychotics, antidepressants, anti anxiety should be revviewed and discontinued if possible to reduce risk of falls
fibroids form whorled tumours in the myometrium
fobroids aer a mixture of smooth muscle cells and fibroblasts
intramural fibroids can cause heavy menstrual bleeding and dysmennorhea by interfering with the constrciction of blood vessels durig menstruation
sertraline is first lien for GAD
gonorrhoea is symptomatic in 90% of men and 50% of women
NAAT is used for chlamydoa and gonorrhoea
gonorrhoea - ceftriaxone when dont know antibiotic suscpetibility and ciprofloxacin when do know
gentamicin and azithrmycin if got allergy or needle phobia for gonorrhoea
ceftrizone if fine to give if got penicillin allergy
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
Us of the abdomen and pelvis in ovarian cancer if ca-125 is high
cancer referral for haem is 2 week but 48hrs if children or young person
everything is reduced in leukemia - eg anaemia, reduced white cells, reduced platelets
for myeloma should offer protein elctrophoreis and bence jones urine test within 48hrs
head injury is the commonest cause of death and diability in people aged 1-40
Hypopituitarism is estimated to occur in 33-50% of all people following traumatic brain injury
bout of cluster headahce ususally lasts 2 weeks - 3months
paroxysmal hemicrania - attacks are more frequent than cluster headache
do not prescribe sumatriptan if have history of ischaemic heart disease, uncontrolled hypertensionm prebious MI, previous TIA or stroke or severe hepatic impoariemtn
triptans can cause dizziness and drowsiness - can affect driving
medication overuse headahce - occurs on 15 days or more per month
in medication overuse headahce stop meds abruptly and for at least 1 month
tension headahces are non pulsating
pericranial tenderness
tension headhace
pain often spreads into arises from the neck in
tension headahce
drug prophylaxis for tension headahce
amitripyline
main risk of taking acei/arbs to fetus is during what trimesters
second adn third
apirin should be taken from 12 weeks if preg mother got hypertension
albumin: creatinine ratio is down to quantify proteinuria in preg woman or protein:creatinine
itch in pregnancy which doesn not present with a rash
obstretic cholestasis
obstetric cholestasis generally poses no risk
intensely itchy rash in preg that starts on abdo and coalesce into plaques - Polymorphic eruption of pregnnacy
polymorphic eruption of preg- no risk and symptoms usually resolve following delivery
pemphigoid gestationis - itch often precedes the rash
obtetric cholestasis usually starts
abruptly in the 3rd trimester
polymorphic eruption of pregnnacy - start on abdo and coalesce to plaques
atopic eruption - history of atopic exzema
pemphigoid gestationis - blister and itch precedes rash
obstructive cholestasis - itch that presents with NO RASH
miscarriage is up to
24 weeks
recurrent miscarraige is the loss of
3 or more pregnancies before 24 weeks gestation
most common cause of spontaneous pregnancy loss in the first trimester is due to
chromosomal abnormalities
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
first line mx for miscarriage is expectant management
menstruation expected to resume 4-8 weeks after a miscarriage
multiple myeloma is an incurable disease
paraproteinaemia - proliferation of abnormal monoclonal immunoglbulin in the blood
immunofixation of serum and urine confirms the presence of a paraprotein
to confirm plasma cells - need to do bone marrow biopsy with trephine biopsy
infection is a common cause of death in people with multiple myeloma
perimenopause is until 12 months after last period
only a consultant neurologist should make the diagnosis of MS
altered sensation radiating down the back and sometime into the limbs on neck flexion - Lhermittes symptom
loss of colour discriminantion is particualry with the colour reds in optic neuritis in MS
transverse myelitis seen in MS can sometimes be described as a tight band sensation around the trunk
cerebellar symptoms can be in MS
methylprednisolone is typically given for relapses of MS
febrile neutropenia is the most common complication of anticancer treatment and describes the presnece of a fever in a person with neutropenia
septic shock- sepsis with hypotension despite fluid correction and inotropes AND hyperlactatemia with a serum lactate greater than 2
neutropenic sepsis - temp greater than 38 and or signs of sepsis in pt with low neutrophil count
drugs such as steriods can mask a high temperature in neutropenic sepsis
piperacillin/tazobactam for neutropenic sepsis
hypokinesia is poverty of movements so reduced facial expression or reduced arm swing
lead pipe rigidity - has constant resistnace felt
cogwheel- has regular intermittent relaxation of tension
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
everyone with Parkinsons must notify the DVLA
anti parkinsosn meds should not be stopped abruptly
ropinirole is a dopamine agonist
nausea and vomiting can occur when starting anti parkisnons meds - reassures that it settles over time
septic shock- perisitant hypotension needing vasopressor to maintain MAP of 65 and serum lactate of greater than 2
staph aureus, pseudomonas and e.coli are the most common cuases of shock
hypothermia and abscence of fever are more likely in older adults and in people with chronic alcohol abuse or immunosupression in terms of shock
people after a stroke should be screened for hearing problems within the first 6 weeks
spasticity and contractures are common following a stroke
continence problems can occur after a stroke
clopidogrel - blocks P2Y12 receptos which inhibits teh binding of ADP
trichomoniasis is caused by a protozoan
trichomoniasis - classic discharge is frothy and yellow-green with a fishy odour - strawberry appearnce of cervix
want to treat PID fairly quick as if got long term can increases risk of ectopic, infertility
normal vaginal discharge becomes clearer, wetter before ovulation
