Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3rd Year > NICE Guidelines JMS > Flashcards

NICE Guidelines JMS Flashcards

1
Q

fibroadenoma indication for surgery

A

> 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

breast cyst treatment

A

Aspirate

If blood-stained, do a biopsy or excise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

sclerosis adenosis

A

biopsy + excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

fat necrosis investigation

A

biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

duct papilloma treatment

A

Microdochectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Beast cancer screening programme

A

anyone aged 47-73 is invited for 3 yearly mammogram

given to younger patients if they have a first degree relative with:

  • breast cancer <40
  • bilateral breast cancer <50
  • male breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 indications for wide local excision

A

small cancer large breast
DCIS <4cm
peripheral tumour
solitary lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

4 indications for mastectomy

A

Large cancer small breast
DCIS >4cm
central tumour
multifocal tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

indications for adjuvant radiotherapy in breast cancer

A
  • mastectomy with >4 lymph nodes involved

- after any wide local excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treatment for ER+ tumours pre-menopausal & post-menopausal

A

tamoxifen for 5 years

anastrozole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

contraindication for herceptin

A

History of heart disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

management of angina

A
  • aspirin, nitrate, statin for everyone
  • CCB (no verapamil with heart failure) or beta blocker
  • max dose
  • CCB and BB (not verapamil and BB so use modified release nifedipine)
  • PCI + other things like long acting nitrate, nicorandil (K activator)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

monitoring statins

A

LFTs at baseline, 3 month, 12 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

investigating heart failure

A
  • previous MI –> echo in 2 weeks

- no previous MI –> BNP. if normal, monitor. If elevated, echo in 6 weeks. If high, echo in 3 week.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

treating systolic heart failure

A

ACE or BB (pro or carv)
spironolactone, ARB, hydralazine/nitrate if black
cardiac resynchronisation/digoxin
others (furosemide + vaccines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hypertension management

A

ACEi or CCB
add other
add thiazide like (indapamine/chlorthalidone)
add spironolactone (if K >4.5 then add more thiazide)
alpha or BB
Centrally acting antihypertensives (methyldopa, monoxidine, clonidine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

primary prevention statins

A 
20mg
use if:
- >10% 10 yr risk 
- most type 1 diabetics
- CKD with eGFR <60
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

secondary prevention statins

A

80mg
use if:
- underlying IHD, PVD, Cerebrovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Non ST-elevation ACS

A 
M
O
N
A (aspirin 300, clop 300)
heparin 5 days
GRACE (>3% 6 month mortality then use tirofiban and PCI in 96 hours)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

STEMI

A 
M
O
N
A aspirin 300, ticag 180
B
A
S
H
PCI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

acute LV failure

A 
oxygen
diuretics
opiates
vasodilators
inotropic agents
CPAP
ultrafiltration
mechanical circulatory assistance (VAD, IAC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CHADSVASC

A 
CHF
HTN
A >75=2, >65=1
Diabetes
Stroke/TIA = 2
V = PVD, MI, IHD
Sc = female

0 = no treatment
1 in man = consider
1 in women = no treatment
=>2 = warfarin target INR 2.5 or NOAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

INR target first VTE

recurrent VTE

A
  1. 5

3. 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

foods to avoid on warfarin

A

sprouts, spinach, kale, brocolli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SVT
acute
prophylaxis

A

unstable –> DC cardio version

Stable
vagal manoeuvres
adenosine 6 12 12
DC cardio version

BB and ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HbA1c in diabetics

A

monitored every 6 months

target of 48mmol/mol (6.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

blood glucose targets

A

4-7

5-7 first thing in morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

insulin

A

Basal-bolus is first line (levemir and actrapid)

metformin can be used if BMI>25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

driving and diabetes

A

inform if >=2 hypos in 12 months. no need to say if not on something that can induce hypos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

T2DM first line treatment and target

A

metformin + lifestyle

48mmol/mol (6.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

when to add and what is T2DM second line treatment and target

A

if HbA1c >58mmol/mol (7.5%)
add one of any of the others apart from GLP-1 mimetic
53mmol/mol (7%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

third line treatment T2DM

A

a triple therapy
or insulin medium acting OD or BD (isophane)
or exanatide (GLP1 agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

thyrotoxicosis tremor control

A

propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

thyrotoxicosis first line drug

A

carbimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

main SE of carbimazole

A

agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

2nd line treatment for thyrotoxicosis

A

radioiodine treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

treatment of hypothyroidism

A

thyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

starting dose of thyroxine

A

50-100micrograms (25 if elderly or IHD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

how often do you measure TFTs after starting or changing dose of thyroxine

A

8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

therapeutic goal of thyroxine

A

normalisation of TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

diagnostic criteria of DKA

A

glucose >11 or known DM
ketones >3 or ++ on urine
pH <7.3
bicarb <15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

treatment of DKA

A

1000ml of saline in first hour (will need 5-8L over 24hrs)

IV insulin and when glucose gets <15 add dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

treatment of gastroparesis in diabetes

A

metoclopromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

BPPV diagnosis

A

clinical picture + positive Dix hallpike

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

BPPV treatment

A

epley
home Brandt-Daroff exercises
betahistine?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

menieres acute attack

A

buccal or IM prochlorperazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

prevention of menieres

A

betahistine

vestibular rehab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

driving and menieres

A

don’t until controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

PUD treatment

A

1st line = PPI + amox + clarithromycin (7day course)
retest for H.pylori 4 weeks later using C13 breath test
2nd line = PPI + BC + met + tetracycline
retest
repeat 2nd line
retest
refer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

criteria for emergency upper GI endoscopy

A 
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena/haematemesis
Swallowing difficulty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

management of diverticular disease - general

A

fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

management of diverticular disease - mild attacks

A

conservative with antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Severity classification of diverticulitis and management based on that

A 
Hinchey
1 = paraboloni abscess --> drain
2 = pelvic abscess --> drain
3 = purulent perforation --> Hartmanns or lap washout
4 = faeculent perforation --> Hartmanns
54
Q

CRC monitoring

A

carcinoembryonic antigen

55
Q

screening programme for CRC

A

60-74 (50-74 in scotland) is invited for faecal occult blood
if positive, get colonoscopy
of these, 5/10 are normal, 4/10 have polyps, 1/10 has cancer

56
Q

asymptomatic gallstone disease
in gallbladder
in CBD

A

no treatment

remove as will cause problems

57
Q

acute cholecystitis

A

Antibiotics + supportive therapy

resect 1 week later

58
Q

Upper GI bleeding

A 
Blatchford = bleeding risk stratification
Rockall = rebleed
59
Q

fissure in ano

A

GTN ointment or diltiazem cream
botulinum toxin
internal spinchterotomy

60
Q

haemorrhoids

A

lifestyle fibre and fluids

injection sclerotherapy/band ligation/HALO

61
Q

rectal cancer
high up
near dentate line

A

preop radiotherapy + surgery:
anterior resection
abdominoperineal resection of rectum

62
Q

acute pancreatitis grading

A 
Glasgow
PAO2 <8
Aage >55
Neutrophils WBC >15
Calcium 
Renal function urea
Enzymes LDH >600; AST >200
Albumin
Sugar >10

3 or more of the above means it is severe

63
Q

imaging of choice for chronic pancreatitis

A

CT pancreas with contrast

64
Q

Intestinal obstruction

A

Drip and suck
cyclizine or ondansetron can be used
NOT metoclopromide as it is prokinetic

65
Q

when to start antiepileptics

A

2 seizures >24 hours apart
1 seizure + >60% risk of another one
epilepsy syndrome in a child
risk of another seizure is unacceptable

66
Q

generalised tonic clonic

A

sodium valproate

67
Q

myoclonic

A

sodium valproate

68
Q

focal seizure

A

carbamazepine

69
Q

absence seizure

A

ethosuximide

70
Q

pregnancy

A

lamotrigine

71
Q

parkinsons

A 
motor? levodopa
No motor? 
- non-ergot derived dopamine agonists (bromocriptine, cabergiline, pergolide)
- MAO-B (seleginine)
- levodopa

2nd line
- COMT inhibitor (entacapone)

72
Q

drug induced parkinson’s

A

procyclidine (antimuscarinic)

73
Q

diagnosing MS

A

2 episodes in space and time

OR

1 episode that fulfils McDonald criteria

74
Q

acute MS

A

methypred

75
Q

chronic management of MS

A

1st line = beta interferon
2nd line = choose from:
- glatiramer = immune decoy/suppressant
- natalizumab = a4b1 preventing BBB crossing of WBC
- alemtuzumab = glycoprotein CD52
- fingolimod = sphingosine 1 phosphate stops leaving lymph nodes

76
Q

MS symptoms relief: residual volume bladder dysfunction

A

self catheterisation

77
Q

MS symptoms relief: bladder dysfunction with no residual

A

anticholinergics oxybutinin

78
Q

MS symptoms relief: oscilloscopia

A

gabapentin

79
Q

spasticity

A

baclofen or gabapentin

80
Q

fatigue

A

CBT or amantadine

81
Q

stroke diagnosis

A

ROSIER score >0

  • syncope = -1
  • seizure = -1
  • asymmetrical face/arm/leg = +1 each
  • speech/visual field disturbance = +1 each
82
Q

stroke investigation

A

CT head

swallowing assessment

83
Q

ischaemic stroke acute treatment

A

within 4.5 hours –> alteplase

300mg aspirin stat

84
Q

CI of thrombolysis

A 
>4.5 hours
brain cancer
recent stroke
seizure with stroke
active bleeding
pregnancy
varices
hypertension >200
85
Q

secondary prevention of stroke
in hospital
at home

A

intermittent pneumatic calf pump

statin if >3.5
clopidogrel 75mg for life (After 2 weeks) - if CI use aspirin and dipyridamole
BP control

86
Q

haemoragic stroke treatment

A

control BP to 100-120
reverse anticoagulation
call neurosurgeons

87
Q

alzheimers management

A

triple therapy of anticholinesterases (donepezil, galantamine, rivastigmine)

2nd line = memantine (NMDA antagonist)

88
Q

TIA (in past week)

A

300mg aspirin stat

send in to hospital

89
Q

delerium

A

haloperidol is first line sedative

90
Q

status epilepticus

A

rectal diazepam/IV loraz/buccal midaz
IV loraz
phenytoin
anaesthesia

91
Q

subarachnoid haemorage

A

ABCDE + neurosurgery review
After:
- nimodipine CCB (reduces deficits)
- stools softness, antitussives (reduces rebreeds)

92
Q

acute migraine

A

triptan

93
Q

migraine prophylaxis

A

2 or more over 1 month (60% effective)

1st = propranolol + topiromate
2nd = gabapentin + acupuncture (10 sesh/5-8wks)

menstrual = triptans

94
Q

renal stones imaging

A 
Initial = USS
Best = CTKUB no contrast
95
Q

medical management of urinary stones

A

IM/rectal diclofenac

tamsulosin + nifedipine

96
Q

indication for medical management of stones

A

<5mm and no obstruction

97
Q

indication for ECSL

A

5mm-2cm

98
Q

indication for percutaneous nephrolithotomy

A

> 2cm or complex shape (e.g. staghorn)

99
Q

indication for decompression with stent or percutanoues nephrostomy

A

hydronephrosis or pyrexia

100
Q

prevention of stones:
calcium
oxalate
urate

A

thiazides
cholestyramine
allopurinol/urinary alkalisation (bicarb(

101
Q

BPH

A

1st line = tamsulosin

2nd line = finasteride (takes 6 months)

102
Q

prostate cancer
T1/T2
T3/T4
Metastatic

A
  • brachy, radio, surgery
    • hormonal therapy
  • only hormonal therapy:

cyproterone acetate (prevents DHT/antiandrogen)
goserelin (GnRH analogue)
degarelix (gnRH antagonist)

103
Q

CKD management of anaemia

A

replenish iron stores

give EPO

104
Q

CKD and HTN

A

ACEi

when GFR <45, furosemide

105
Q

AKI diagnostic guidelines

A

<0.5ml/kg/hr for more than 6 hours
GFR 50% rise in 7 days
rise in creatinine >26 in 48 hours

106
Q

hyperkalaemia management

A

1st thing = calcium gluconate
others = insulin+dextrose, salbutamol
to get rid of K = resonium, dialysis

107
Q

diagnosing asthma

A

FeNO >40ppb

spirometer FEV1/FVC <70%
reversibility of FEV1 >12%

108
Q

chronic management of asthma

A 
SABA
\+ ICS
\+ LTRA
\+ LABA
\+ increase ICS in a MART
\+ increase ICS and add theophylline 
refer onwards

Move up if using SABA 3x or more a week

109
Q

COPD diagnosis

A

FEV1/FVC <70% and symptoms

110
Q

Management of COPD

A 
SABA or SAMA
Add LAMA or LABA (if FEV1 <50%, add ICS to LABA)
Add all three
theophylline 
mucolytics
111
Q

indications for home use oxygen

A 
ankle oedema
two ABGs with pO2 <7.3
FEV1 <30%
cyanosis
polycythaemia
raised JVP
Sats of less than 92% on room air
112
Q

investigating legionella

psittacosis

A

urinary antigen

sputum PCR

113
Q

Assessment of pneumonia

A 
Confusion <8/10 AMTS
Urea >7
RR >30
BP <90/60
<65
0-1 = home with 5 days of amox (3%)
2-3 = hospital with amox/clari 7 days (3-15%)
4-5 = ITU with tazocin (15%)
114
Q

recovery timeline for pneumonia

A

1 week = fever
4 weeks = chest pain + sputum
6 weeks = cough + breathlessness
6 months = fatigue

115
Q

acute asthma management

A 
Oxygen
Salbutamol back to back through oxygen neb
Hydrocortisone/ pred for at least 5 days
Ipratropium bromide just once
Magnesium
IV salbutamol
Escalate
116
Q

acute asthma severity

A

moderate = 50-75% peak flow

acute severe = 33-50% Peak flow, can’t complete sentences. RR>25, pulse >110.

life-threatening = <33% peak flow, <92% sats, cyanosis, silent chest, normal CO2

117
Q

COPD exacerbation when to give Abx

A

Anthsonian criteria. give Abx when 2 of:

  • increased sptutum
  • increased purulence
  • increased breathlessness
118
Q

target sats for COPD

A

88-92

if proven to not be CO2 retainer, 94-98

119
Q

indications for BIPAP with COPD

A

acidosis <7.35
type 2 respiratory failure
unresponsive to CPAP with cardiogenic pulmonary oedema
weaning from tracheal intubation

120
Q

pneumothorax management

A

primary
<2cm –> review in clinic
>2cm or breathless –> aspirate, wait, clinic or drain

secondary
1-2cm aspirate and then maybe drain
>2cm drain and admit

121
Q

Wells score

A

diagnosing PE

DVT = 3 points
PE most likely = 3 points
HR>100 = 1.5 points
surgery <3wks, immobilisation>3days = 1.5 points
previous DVT/PE = 1.5 points
haemolytic = 1 point
malignancy = 1 point

For PE
If <4 –> D-dimer and PERC
if >4 –> CTPA

For DVT
>=1 you doppler the leg
0 then you do D-dimer

If pregnant, allergic or CKD, V/Q scan instead of CTPA

122
Q

treating PE

A

massive with shock –> thombolysis

no shock:
5 days of LMWH
start warfarin within 24 hours
3 months if provoked, 6 months if unprovoked
INR 2.5 if first, 3.5 if recurrent

pregnant or cancer –> LMWH for 6 months

123
Q

post thrombotic syndrome treatment

A

compression stocking and elevation

no prophylaxis anymore

124
Q

treatment for peripheral artery disease

A

exercise training
80mg statin
clopidogreal (better than aspirin)

other: vasodilator, angioplasty, stent, bypass

125
Q

AAA surgery indications

A

> 5.5cm
1cm/year growth
pain
EVAR is surgery of choice

126
Q

venous ulcers treatment

A

4 layer compression banding

if fail to heal after 12 weeks, skin graft

127
Q

screening for osteoporosis

A

women >65, men >75 use FRAX
if low risk –> nothing
if high risk –> treat (alendronate and vita/Ca
if medium –> DEXA and recalculate

128
Q

rate control

A

atenolol
verapamil/diltiazem
digoxin (unless HF then first line)

129
Q

rhythm control

A

DC cardio version if there isn’t a reason they’re in AF
sotalol
amiodarone
flecanaide (is paroxysmal and normal heart)

130
Q

complete heart block

A

temporary pacing until surgery puts pacemaker in

atropine can be used until then.
0.5mg up to 6 times up to 3mg

3rd Year (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions