NME Flashcards
A patient presents with LUTS, what are voiding symptoms and what is the most likely cause?
Hesitancy, decreased flow, incomplete voiding, intermittent flow
Most likely caused by obstruction (prostate, stricture, retention)
A patient presents with LUTS, what are storage symptoms and what is the most likely cause?
Frequency, urgency, urge incontinence, nocturia
Most likely UTI (but could also be pregnancy, overactive bladder or tumor)
Name 4 red flags to ask about if a patient presents with LUTS?
Haematuria
Weight loss
Saddle anesthesia
Abdominal pain
On abdominal examination, what is suggested by a finding of: Palmar erythema?
Liver disease
On abdominal examination, what is suggested by a finding of: Dupuytren’s contracture
Alcohol excess
On abdominal examination, what is suggested by a finding of: Kolionychia (spoon nails)
Chronic iron deficiency
On abdominal examination, what is suggested by a finding of: Leukonychia
Hypoalbuminaemia
Liver failure
On abdominal examination, what is suggested by a finding of: Hepatic flap
Hepatic encephalopathy
Uremia
CO2 retention
On abdominal examination, what is suggested by a finding of: Petechiae
Low platelets
On abdominal examination, what is suggested by a finding of: Hair loss
IDA
Malnourishment
On abdominal examination, what is suggested by a finding of: Acanthosis nigricans
GI adenocarinoma
Obesity
On abdominal examination, what is suggested by a finding of: Xanthelasma
Hyperlipidaemia
On abdominal examination, what is suggested by a finding of: Angular stomatitis
IDA
B12 deficiency
On abdominal examination, what is suggested by a finding of: Mouth ulcers
Crohns
Coeliac
On abdominal examination, what is suggested by a finding of: Oral candidiasis
Immuniodeficiency
Steroid use
IDA
On abdominal examination, what is suggested by a finding of: Glossitis
IDA
B12 or folate deficiency
On abdominal examination, what is suggested by a finding of: Spider naevi
> 5 suggests chronic liver disease
On abdominal examination, what is suggested by a finding of: Gynaecomastia
Liver cirrhosis
Spironolactone/ digoxin
On abdominal examination, what is suggested by a finding of: Cullen’s sign (and what is it?)
Bruising around umblicus
Pancreatitis or ruptured AAA
On abdominal examination, what is suggested by a finding of: Grey turners sign (and what is it?)
Bruising in flanks
Pancreatitis or ruptured AAA
On abdominal examination, what is suggested by a finding of: Striae
Shows distension
On abdominal examination, what is suggested by a finding of: Caput medusa
Portal hypertension
Chronic liver disease
What is Murphy’s sign and how do you examine for it
Press at 9th costal margin, MC line
Ask patient to inspire
If they stop inspiration this is Murphy’s positive as pain from inflamed gallbladder has prevented further inspiration
What are the management options for a patient with diverticulosis? (3)
High fibre diet,
Bulk forming laxatives
Paracetamol for pain
What are the consequences of UC which a patient should be counselled on?(3)
2x risk o CRC
Risk of osteoporosis
25% lifetime surgery
What do you advise a patient with UC about colonoscopy follow up?
After 10 years have a colonoscopy every 1-3 years due to CRC risk
What do you advise a patient with Crohn’s about colonoscopy follow up?
One colonoscopy 10 years after diagnosis
How long does carbimazole take to work?
4-8 weeks
How long is a patient likely to take carbimazole?
12-18months
50% then cured
What checks are done when a patient is on carbimazole?
TFT’s monthly
What are the common side effects of carbimazole?
Headache, sickness, taste change
Should pass in a few weeks
What is the important SE you must council on for carbimazole?
Agranulocytosis
(Fever, rash, sore throat, mouth ulcers)
Check WCC immediately
How long does a patient take levothyroxine for?
Lifelong
How should levothyroxine be taken?
Before breakfast (Iron or calcium can affect absorption)
How should a patient on levothyroxine be monitored?
Check TFT’s after 1 month
What are the SE of levothyroxine?
Weight loss, diarrhoea, irritability, sweating etc
What should a patient on levothyroxine be counseled on regarding prescriptions?
Free for life
Name 3 bits of lifestyle advice for a patient with newly diagnosed diabetes?
Healthy diet
Lose weight
30mins exercise 3x/ week
Stop smoking/ control BP
What are the common SE’s of metformin? (4)
Nausea, diarrhoea, change in taste, lack of appetite
What is the rare but important SE of metformin?
Lactic acidosis
If very sick, very tired, very SOB let doctor know.
- Normally occurs when already unwell
- Alcohol can precipitate
What should a patient be warned about regarding hospital admissions with metformin?
Advise doctors (as can raise risk of AKI so is normally stopped)
Can’t have if having contrast
How should a patient be counselled to take their metformin?
Same time each day
Take after food
Swallow whole don’t break or chew
What should a patient do if they forget a dose of metformin?
Take next dose as normal
Don’t take two doses together
For a patient with newly diagnosed T2DM, how often should the HbA1c be checked?
3-monthly until stable
Then 6 monthly
Name 5 symptoms to council a patient on for a hypo?
Trembling, sweating, anxiety, tingling, blurred vision, confusion
What blood test should you do before starting a patient on metformin?
Kidney function
In a diabetic foot examination, what three pieces of equipment are needed?
Mono-filament
Tuning fork
Tendon hammer
What are the signs of PAD on inspection of the leg in a diabetic foot exam (3)?
Dry/shiny skin
Hair loss
What are the signs of venous disease in a peripheral vascular exam (2)?
Haemosiderin deposits
Eczema
What are the characteristics are arterial ulcers? (4)
Very painful
Deep and punched out appearance
With diabetes/ PAD
What are the characteristics of venous ulcers?(4)
Less pain
Large and shallow
Associated with venous disease
Name the components that should be checked in a lymph node examination.
Head and neck LN’s (Inspect and palpate)
Axiallary LN’s (Ant, medial, post, lateral, apical) - Gloves
Epitrochlear + popilteal LN’s
Inguinal (Horizontal and vertical chains)
Palpate for hepato or splenomegaly
