oddities Flashcards
What are the filling pressures like in heart failure
Normal or high
What symptoms does left heart failure lead to
Lung symptoms: pulmonary oedema, orthopnoea, paroxysmal nocturnal dysponea, fatigue
What symptoms does right heart failure lead to
Body symptoms: pedal oedema, raised JVP, ascites, hepatomegaly
Definitive treatment of heart failure
TAVI
Acute management of heart failure
High flow oxygen, IV GTN, IV furosemide, IV morphine
Who gets pneumococcal and influenza vaccines
COPD and HF
2nd line treatment for heart failure
Spironolactone
3rd line treatment for heart failure
Candesartan and hydralazine
Causes of dilated cardiomyopathy
Alcoholic or idiopathic
Treatment of hypertrophic cardiomyopathy
Amiodarone
Symptoms of cardiomyopathy
Dyspnoea, fatigue, pulmonary oedema and emboli
First line treatment of pericarditis
Cardiocentesis
Second line treatment of pericarditis
Ibuprofen, Omeprazole, Colchicine, Exercise restriction
Triad of signs of pericarditis
Low BP, Raised JVP, Muffled HS
Treatment of aortic aneurysm
Asprin, Ace Inhibitor, Beta blocker, Statin
Treatment of aortic dissection
ABCDE, labetalol and morphine before surgery
Treatment post aortic repair
HTN below 120, BB and ACEI
Lead V1-V4 artery and area
LAD, Anterior/ Septal
Leads 2,3,AVF artery and area
RCA, inferior
Leads V5,6 and 1, artery and area
Circumflex and lateral
Stage 2 hypertension values
160/100 or 150/95 at home
Angina ongoing treatment
GTN, Aspirin, BB, Statin
Advice about taking GTN
Expect pounding headache and light head
Take, 5 mins, take, 5 mins, take phone ambulance
Signs of VSD and AVSD
Systolic murmur and thrill
Cardinal sign of coarctation
Right arm hypertension
Cyanotic structural heart disease without shunts
Coarctation, congenital AS
Acyanotic structural heart disease without shunts
Pulmonary stenosis, tricuspid regurg
Treatment of structural heart disease
Surgery, IE prophylaxis
Regular broad complex tachycardia
VT
Give amiodarone
Regular narrow complex tachycardia
SVT
Vagal Manouveres
Adenosine
Wolf parkinson white ECG
Delta waves (slope on the Q)
Sustained ventricular tachycardia
VT/ ectopic lasting more than 30s
Non sustained ventricular tachycardia
VT/ ectopic lasting less than 30s
Digoxin antidote
Digoxin Immune Fab
AV node reentrant tachycardia
Often young people, most common SVT
Describe sarcoid features
Non caseating granulomas
Bilateral lymphadenopathy, fibrosis, fever,arthralgia
Young black woman
Diagnosis of sarcoid
Bronchoscopy and biopsy
Features of IPF
Clubbing, fibrosis
Diagnosis of IPF
High resolution chest CT
Treatment of IPF
IV prednisolone
Antifibrinolytic for IPF
Perfenidone
Active TB 1st investigation
CXR
Active TB diagnostic investigation
Sputum for NAAT
What do you give to treat isoniazid neuropathy
Pyridoxine
How long do you treat CNS TB for
12 months
Potts Disease
Spinal TB
Pulmonary Hypertension clinical findings
Loud Second Pulmonary HS
Treatment of H Influenza pneumonia
Amoxicillin
Treatment of S Aureus pneumonia
Flucloxacillin
Treatment of pulmonary hypertension
Diuretics, Calcium Channel Blockers, ?LTOT
Treatment of pseudomonas
Ciprofloxacin
Diagnosis of bronchiectasis
High resolution CT Chest
Treatment of bronchiectasis
Firstly: Exercise and Diet. Then chest Physio, nebulised saline and salbutamol
Exudative pleural effusion
High protein, Infection, Cancer, PE, Connective tissue disorders
Transudative pleural effusion
Low protein, cardiac, renal, liver failure, Meigs, hypoalbuminaemia, hypothyroid
Treatment of pleural effusion
Thoracocentesis then furosemide
Treatment of a secondary pneumothorax less than 1cm in size
Oxygen and observe
Treatment of a secondary pneumothorax in a patient over 50
Chest drain
Wegeners features
Nasal, lung and glomerulonephritis
Other name of wegeners
Granulomatosis with Polyangitis
Treatment of GPA/ Wegeners
IV prednisolone
Methotrexate
Folic acid
How do you diagnose goodpastures
Renal biopsy= cresenteric glomerulonephritis
Treatment of goodpastures
1- IV pred
Definitive- plasmaphoresis
Where can mesothelioma involve
Pleura, perineum, pericardium and testes
Describe pleuritic fluid in mesothelioma
Bloody and straw coloured
PE Wells score over 4
Skip D Dimer, go straight to CTPA
How long on a DOAC for a provoked PE (not cancer)
3 months
When and how do you use fibrinolysis in PE
Alteplase when they are haemodynamically unstable
How do you treat a meconium ileus
Constrast enema and lactulose
What is a gene modulator for CF
Ivacafter
What does the FBC of a COPD patient show
Secondary polycythaemia
How do you treat an infective exacerbation of COPD
Amoxicillin and Prednisolone
What virus can cause a COPD exacerbation
Rhinovirus
Which virus commonly causes tonsilitis
Adenovirus
Name 2 nasal decongestants used for sinusitis
Pseudoephidrine, oxymetalozine
Treatment of croup
Adrenaline nebulised, dexamethasone, oxygen, fluids
Treatment of epiglottitis
Intubation and IV fluids
Score used for common cold
CENTOR/McIsaac
What is needed for diagnosis of pneumonia
Chest XR
Pneumonia treatment in penicillin allergic patient
Cefuroxime
Post influenzae pneumonia cause
staph aureus
Gram negative hospital acquired pneumonia
E Coli
ITP, Encephalopathy, Pneumonia, Diagnose on serology
Mycoplasma Pneumonia
Hypernatraemia and Pneumonia
Legionella, diagnose with urinary antigen
Treatment of atypical pneumonia
Erythromycin
Features of adenocarcinoma
Non smokers, gynaecomastia, HPOA
What warrants a 2WW for lung cancer
40 + and haemoptysis
CXR suspicious of cancer
40 + and 2 symptoms suspicious of cancer
Asthma questions to ask in hisotry
Last 3 months
- nocturnal waking
- daily symptoms
- affecting ADLs
COPD questions to ask in history
Home Oxygen?
How Many Exacerbations?
How Many Rescue Packs?
How Many Admissions?
Diagnostic for cholecystitis when query sepsis
CT
What are 2 things that bile stones can be made of
90% cholesterol, 10% calcium bilirubinate
What type of cancer is oesophagea
Adenocarcinoma
Where does oesophageal cancer metastasise to
Lung and liver
Describe two distinct features of gastric cancer
Epigastric pain that doesn't radiate Tingling feet (from b12 deficiency)
Treatment of gastric cancer
Chemo and surgical resection
What type of cancer is pancreatic cancer
Ductal adenoma
Investigation for pancreatic cancer
CT and tumour markers
Where is the pain for pancreatic cancer
Epigastric/ RUQ/ LUQ but radiates to the back
What type of cancer is colorectal cancer
Adenocarcinoma
Bowel cancer screening
FIT/FOB testing for 60-74 year olds, once every 2 years
Diagnostic investigation for colorectal cancer
Colonoscopy
What imaging is used for staging colon cancer
CT
What imaging is used for staging rectal cancer
MRI
Treatment fo severe colon cancer
Radiotherapy
Treatment of mild rectal cancer
Transanal excision
First line treatment of an acute crohns flare
IV hydrocortisone
Second line treatment of acute crohns flare
Azathioprine
Third line treatment of acute crohns fare
Infliximab
Complications of crohns
Fistulae, abscesses, colon cancer
Extra GI features of crohns
Arthropathy, erythema nodosum, pyoderma gangrenosm. Uveitis and episcleritis
Treatment of a symptomatic hernia
Laparoscopic mesh repair
Chronic diarrhoea and malabsoprtion diagnosis and management
Giardiasis and metronidazole
What causes Guillain Barre Syndrome
Campylobacter
Whats the likely causative organism when the diarrhoea is bloody with abdominal pain
Shigella
Vomitting and diarrhoea within 6 hours of ingesting dodgy food
S Aureus
Which two bloods can rule out appendicitis
FBC and CRP
How do you treat appendicitis if theyre not for surgery
Antibiotics
Distinctive blood result of diverticulitis
Polymorphonuclear lymphocytosis
Treatment of diverticulitis
Increase fibre in diet, analgesia and antibiotics
Where is the pain in pancreatitis
LUQ
Invesigation for acute pancreatitis
Serum lipase
Investigation for chronic pancreatitis
Abdominal ultrasound
Symptoms of hereditary haemochromatosis
Bronze skin, hepatomegaly, diabetes, likely post menopausal if female
Diagnostic investigation for hereditary haemochromatosis
HFE gene testing
Treatment of hereditary haemochromatosis
Desferrioxamine
Diagnostic investigation for wilsons disease
24 hour urinary copper excretion
Treatment of wilsons disease
Zinc
Alpha 1 antitrypsin deficiency first linvestigation
Spirometry and LFTs
Alpa 1 antitrpysin deficiency diagnostic investigation
Plasma alpha 1 antitrpysin level
First treatment in Alpha 1 antitrpysin deficiency
Smoking cessation
Investigation for ascites
Ultrasound
Investigation for spontaneous bacterial peritonitis
Ascitic fluid- absolute neutrophil count
Symptoms of volvolus
Abdo pain and bilious vomiting
Investigation for volvolus
Upper GI contrast CT
Treatment of volvolus
Ladd procedure
Hep A first line investigation
Anti HAV antibody
Hep A diagnostic investigation
HAV RNA
First line treatment of Hep B
Interferon alpha
Long term treatment of Hep B
Tenofovir
Hep C first line investigation
Anti HCV antibody
Hep C diagnostic investigation
HCV RNA
Hep D first line investigation
Anti HDV antibody
Which of the Hepatitises are RNA
ACE
Hep E first line investigation
Anti HEV antibody
Hep E diagnostic investigation
HEV RNA
What should be calculated for alcoholic cirrhosis
Discriminant function (bilirubin and PTT)
Treatment of ascites
Spironolactone
Treatment of portal hypertension
Propanolol
Treatment to prevent hepatic encephalopathy
Lactulose
What causes UC flares
NSAIDs and stress
UC on biopsy
No granulomas or inflammation beyond submucosa, reduced goblet cells, crypt abscesses
What is mild UC flare
Less than 4 stools a day
Second line treatment of Acute Severe UC flare
IV Ciclosporin
Third line treatment of Acute Severe UC flare
Infliximab trial
PBC and PSC treatment
Ursodeoxycholic acid
PSC diagnosis
ERCP
New painless obstructive jaundice
Pancreatic cancer
Well person, new jaundice after new drug/ antibiotic
Acute drug induced liver injury
Bloods for coeliac
IgA TTG and serum IgA levels
Associated symptoms of coeliac
Dermatitis Herpetiformis Osteomalacia Enteropathy associated T cell lymphoma of small bowel Hyposplenism Anaemia
What does dermatitis herpetiformis look like
Cluster of itchy bumps, eczema like
Anaemia of B12, Folate and IDA after travel
Tropical sprue
Investigation for haemorrhoids
Anoscopic examination
First line treatment for haemorrhoids
Diet and lifestyle change
Second line treatment for haemorrhoids
Topical hydrocortisone
Third line treatment for haemorrhoids
Band ligation
Investigation for anal fistulae
MRI and ultrasound
Treatment of anal fistulae
Fistulotomy and drainage
Anal fissure symptoms
Tearing sensation, blood, defecation pain
Anal fissure treatment
Lifestyle, topical GTN
GORD treatment
8 week PPI and lifestyle measures
What do you give if nocturnal symptoms with GORD
Rantidine
When do you do an OGD in GORD
Over 55 Weight Loss More than 4 weeks OR Relapsing
What treatment does mallory weiss tear need
Resolves spontaneously
Diagnosis of mallory weiss tear
OGD
Plummer vinson syndrome
Glossitis, IDA and dysphagia
Boerhaave syndrome
Retrosternal chest pain, vomiting, surgical emphysema
Eradication of H Pylori
Amoxicillin (or metronidazole) + clarithromycin + omeprazole for 7 days
Treatment of varices
Blood, terlipressin, prophylactic ceftriaxone
Investigation of varices
OGD, NILS
Symptoms of scleroderma
CREST and fibrosis and renal
limited systemic sclerosis antibody
Anti centromere antibody
Diffuse systemic sclerosis antibody
Anti Scl 70/ antitopoisomerase
First line treatment of IBS
Lifestyle and FODMAP
2nd line treatment of IBS
Constipation: lactulose
Diarrhoea: loperamide
Requirements for IBS diagnosis
1 day a week for past 3 months with 2 of
- altered stool frequency
- altered stool form
- pain associated with defecation
Treatment for unstable patient with SBO Sx or AXR suggestive of SBO
CAT 1 laparatomy
Investigation for stable patient with SBO Sx or AXR suggestive fo SBO
CT with contrast
Features for surgery in small bowel obstruction
Bowel ischaemia
Closed loop obstruction
Obstructive lesion
Tympanic abdomen
Large bowel obstruction
Investigation for large bowel obstruction
AXR
Charcot Marie Tooth
Motor inherited neuropathy. Frequently sprained ankles. Foot abnormalities
Posterior spinal cord neuropathy
Romberg positive, sensory
Lateral spinal cord neuropahty
UMN signs (motor) and spastic
Describe alcohol neuropathy and treatment
Sensory then motor. Treatment is pabrinex
Important thing to do after giving prednisolone in GCA
Opthalmology review
Severe stabbing pain in one side of face
Trigeminal neuralgia
Treatment of parkinsons
Levodopa (dopaminergic) and Carbidopa (decarboxylase inhibitor)
Incontinence, dementia and ataxia
Symptoms of normal pressure hydrocephalus
Investigation for normal pressure hydrocephalus
MRI and CSF flow studies
Treatment of normal pressure hydrocephalus
Ventriculoperitoneal shunt
Diagnosis of huntingtons
CAG repeat testing (more than 40)
Treatment of huntingtons
Symptomatic- SSRI or haloperidol
DMARD in MS
Interferon beta
Acute treatment in MS
Methylprednisolone
Symptoms of MS
Foot drop, UMN, optic neuritis, Lhermittes electric shock down spine
Investigations for Myasthenia Gravis
Serum anticholinesterase receptor antibodies
Muscle Specific Tyrosine kinase antibodies
What imaging might you do in Myasthenia Gravis
CT chest looking for thymoma
Treatment for MND
Riluzole and supportive care
Investigations for meningitis
LP, blood cultures, bloods inc lactate
Who gets amoxicillin added on for meningitis
Over 50 or under 3 months
What do you treat meninigitis with
Cefuroxime (+amox) and IV dexamethasone
Treatment of fungal meningitis
Amphotericin B
Treatment of viral meningitis
Aciclovir (as likely HSV)
Treatment of CMV
Ganciclovir
Investigation of encephalitis
MRI
How long does a TIA last
Up to 24 hours
Investigation of TIA
ECG and bloods (FBC, clotting, U and E, glucose)
Whats the treatment of TIA
300mg aspirin
Long term clopidogrel and statin
16-30 year old with spinal cord compression
Trauma
30-50 year old with spinal cord compression
Disc disease
40 plus year old with spinal cord disease
Malignancy
Acute onset spinal symptoms
Trauma or disc herniation
Chronic onset spinal symptoms
Osteoporosis, osteomyelitis or malignancy
Treatment of spinal cord compression
Immobilisation and decompressive laminectomy
Treatment of spinal malignancy
Corticosteroids, surgery and radiotherapy
What tissue do most pancreatic cancers come from
Exocrine
Imaging for abscess
Ultrasound
Hayfever treatment
Daily oral antihistamine, daily nasal steroid
Who gets an erythematous rash with amoxicillin
Allergic, CLL and infectious mononucleosis
Most common brain tumour
Astrocytoma
Investigation for astrocytoma
MRI and surgical biopsy
Progression of astrocytoma
Pilocytic, diffuse, anaplastic, glioblastoma multiforme
Visible bony growth, brain tumour
Meningioma
Child, vomiting relieves headache
Medulloblastoma
Medulloblastoma imaging
CT and MRI
Treatment of medulloblastoma
Resection
Mild head injury GCS
13-15
Moderate head injury GCS
9-12
Severe head injury GCS
<9
Vision change caused by parietal lobe problem
Inferior vision
Vision change caused by temporal lobe problem
Superior vision
Vision change caused by pitiutary tumour
superior quadrant defect
Vision change caused by craniopharyngoma
Inferior quadrant defect
Treatment of brain bleeds
Phenytoin
Removal of anticoagulation
Treatment of subarrachnoid haemorrhage
ABCDE and nimodipine
2nd line epilepsy medication
Lamotrigine
How long does an epileptic need to be seizure free before they can drive
1 year
How long do you have to be seizure free after 1 seizure if not epileptic
6 months
3 things for Total anterior circulation stroke
Honomymous hemianopia, motor, cognition
1st line treatment of stroke
Alteplase within 4.5 hours
Contraindication for alteplase for stroke
Bleeding anywhere or neuro disease
Alternative to alteplase for stroke
Thrombectomy in 6 hours
Long term medications after stroke
Clopidogrel and statin
AF and stroke, anticoagulant choice
DOAC not clopidogrel
Imaging for stroke
Carotid artery doppler and CT head
Which artery causes locked in syndrome
Basilar artery
Acronym for features of migraine
POUNDing
Prophylaxis of Tension headache
Amitryptilline and acupuncture
Treatment of acute tension headache
NSAID and paracetamol
Treatment of acute migraine
Sumatriptan and ibuprofen
Prophylaxis of migraine
Propanolol
Symptoms of cluster headache
autonomic and one sided
How many counts as chronic tension headache
15 a month
Symptoms of migraine
Pounding, pulsatile, 4-72 hours, unilateral N and V, disabling
When do you operate on varicocele
More than 2cm, 20% volume or symptoms
Hydrocele description
Fluid collection which varies in size (operate if 2-21yrs old or infected)
What would you see on Ultrasound of a torsion testes
Whirlpool sign
Investigations for ED
Sexual health inventory for men
Glucose
Lipids
2 line treatment of ED
Intracavernous alprostadil suppository
3rd line treatment of ED
intraurethral alprostadil suppository
Investigation for renal colic
Non contrast KUB CT
Treatment of nephrolithiasis acutely
PR diclofenac and ondansetron
Treatment of urice acid renal stones
Allopurinol
Treatment of calcium renal stones
Indapamide
Treatment of oxalate renal stones
Calcium carbonate
Treatment of all renal stones
Pottasium citrate
BHcG is a tumour marker for which
Choriocarcinoma or seminoma
AFP is a tumour marker for which
Non seminoma
LDH is a tumour marker for which
Tumour burden
Investigation for testicular cancer
Ultrasound and tumour markers
Investigation for prostatic cancer
PR and PSA then TRUS (Transrectal US guided needle biopsy)
Treatment for prostate cancer when more than 10 years to live
Brachytherapy
Treatment for prostate cancer when high risk
Prostatectomy
Treatment for prostate cancer when metastatic
Androgen deprivation with lueprolin
third line treatment for BPH
Sildenafil
Non bothersome BPH treatment
Watchful waiting and behaviour management
What does BPH surgery choice depend on
TUIP, TURP or prostatectomy dependent on prostate volume
Nephrotic child treatment
MCD so give pred
Young adult nephrotic treatment
FSGN so ACE
Older person nephrotic treatment
IgA so ACE
Criteria for PCKD in under 30s
2 cysts
Criteria for PCKD in 30-60 year olds
2 cysts in each kidney
Criteria for PCKD in 60+ year olds
4 cysts in each kidney
Other considerations in PCKD
ECG and CT head as aneurysm and murmur risk
Pyelonephritis first investigations
MC and S of urine, blood culture and bloods (renal US)
Treatment of chlamydia
Azithromycin
Treatment for Gonorrhoea
Ceftriaxone and azithromycin
Causative organisms of prostatitis
E Coli
Treatment of prostatitis
Ciprofloxacin
Cystitis commonly caused by
E Coli
Cystitis treatment first line
3 days trimethoprim
Treatment of complicated cystitis
Ciprofloxacin
ECG changes in hypercalcaemia
Reduced QT interval
Osborn J waves
Arrythmias
Causes of hypocalcaemia
Parathyroidectomy
Vitamin D
Bisphosphonates
Hypocalcaemia ECG
Long QT
Arrythmias
Treatment of hypocalcaemia
IV calcium gluconate (then AdcalD3)
Name a vitamin D supplement
Colecalciferol
Diagnostic investigation of diabetes insipidus
Water deprivation test (wont concentrate urine)
Treatment of central diabetes insipidus
Desmopressin
Treatment of diabetes insipidus
Fluid intake
Treatment of SIADH
Fluid restriction
1st line investigation for conns
Serum aldosterone: renin ratio
Diagnostic investigation for conns
Fludrocortisone suppresion test
Treatment of Conns
Adrenalectomy or spironolactone
Acute treatment of addisons
IV hydrocortisone
Long term treatment of addisons
Hydrocortisone and fludrocortisone for life
Biochemistry in primary hyperparathyroidism
PTH high, calcium high, urine calcium low
Causes of primary hyperparathyroidism
Low calcium, parathyroidectomy, bisphophonates
Treatment of secondary hyperparathyroidism
Ergocalciferol
Signs of pseudohypoparathyroidism
Short 4th and 5th metacarpals, round face and short
Causes of hypoparathyroidism
Gland failure
Long term removal of pottasium from blood
Calcium resonium
Progress of ECG changes in hyperkalaemia
Peaked T waves, prolonged PR, flat P, wide QRS, sine wave, v fib, asystole
Upper limit of how much pottasium to give an hour
20mmol
ECG changes in hypokalaemia
ST depression, loss of T waves, long PR
Long acting insulin example
Insulin glargine
Education courses for diabetes
DAFNE- T1DM
DESMOND- T2DM
How long do you give 1L of fluid over in DKA
2,2,4,4,6
When do you escalate management of T2DM
When HbA1C still over 58
Treatment of increased sugar after meals in T2DM
Acarbose
MODY
Maturity onset diabetes of the young
Investigation for MODY
C peptide present
Treatment of MODY
Sulfonylurea
LADA
Latent autoimmune diabetes in adults
Treatment of LADA
Metformin, soon progresses to insulin
Diagnostic test for acromegaly
Oral glucose tolerance test
Treatment of acromegaly
Transphenoidal surgery
Ocreotide
Low ACTH in cushings syndrome suggests
Adrenal adenoma
Treatment of cushings disease
Pituitary MRI
Transphenoidal surgery
Renal cancer causes
Increased EPO and subsequent polycythaemia
Ovarian cancer causes
Hypoglycaemia
Medullary thyroid cancer causes
Increased calcitonin and subsequent hypocalcaemia
SCLC causes
SIADH
Lambert eaton
Cushings
Carcinoid tumours causes
serotonin syndrome
Squamous cancers cause
PTHrP relase and hypercalcaemia
Treatment of toxic multinodular goitre or toxic thyroid adenoma
Radioactive iodine
Investigation for thyrotoxicosis
Radioactive iodine uptake
Hypothyroid investigation
MRI incase pituitary adenoma
Tetracyclines example and side effect
Mirtazepine, weight gain
TCA side effects
Sedation, anticholingeric, cardiac arrythmias
SNRIs examples
Duloxetine, velafaxine
Examples of typical antipsychotics
Haloperidol
Chlorpromazine
Examples of atypical antipsychotics
Olanzapine, risperidone
Symptoms of anxiety (3 of which must be present most of the time)
Muscle tension, sleep disturbance, fatigue, restlessness, irritability, poor concentration
Methylphenidate side effect
Appetite suppression
Psychosis
Atoxemetine side effect
Liver dysfunction
Suicidality
Mild depression
2 core and 2 others
Moderate depression
2 core and 3 other
Severe depression
3 core and 4 others
Step wise medical management of depression
SSRI
TCA
SSRI and TCA
Define deliberate self harm
Self poisoning or injury, irrespective of apparent purpose of teh act
Tuberous sclerosis
Cognitive delary
Angiofibromas on cheeks
Ash leaf spots on spine
6 components of addiction
Tolerance Withdrawal Impaired control Continued use despite adverse consequences Compulsion to take Neglecting other activities
Section 2 of mental health act
Assess 28 days
Section 3 of mental health act
Treatment 6 months
Section 5.2 of mental health act
Doctors holding power, 72 hours
Conditions of mental capacity act
Assume they have capacity
Maximise their ability to make decisions
Unwise decisions doesnt mean you lack capacity
Anything done must be in best interests
Anything done must be least restrictive option
PD, isolated and restricted expression
Schizoid
PD, delusions and hates social interaction
Schizotypal
PD, social inhibition and extreme sensitivity
Avoidant
Cluster A personality disorder
Odd- paranoid, schizoid, schizotypal
Cluster B personality disorder
Dramatic- antisocial, borderline, narcissistic
Cluster C personality disorder
Anxious- avoidant, dependent, anankastic
Tool for autism diagnosis
CAST- childhood autism screening tool
Treatment of autism
Applied behaviour analysis
ASD preschool programme
Psychoeducation
Something to remember in the treatment of ADHD
Treat coexisting anxiety and depression first
Requirements for gender dysphoria diagnosis
Desire to live as other gender and seeking body transformation for 2 years
Taken steps regarding presentation to resemble other sex
Requirements for gender dysphoria treatment
Observe changed sex role officially for 1 year
Hormonal treatment for male to female
Estradiol valerate and goserelin
Hormonal treatmetn for female to male
Testosterone
schneiderian first rank symptoms
3rd person auditory hallucinations
Made acts/ feelings
Thought disorder
Delusional perception
Simple schizophrenia
Just negative symptoms
Hebephrenic schizophrenia
Thought disorder and flat affect
Catatonic schizophrenia
Immobile or agitated behaviour
Residual schizophrenia
Chronic negative symptoms
Bipolar definition
Two occasions where the patients moody and activity levels are significantly disturbed
Treatment of an eating disorder
Structural eating plan with electrolyte and vitamin supplementation. SSRI
Describe refeeding syndrome
If fed too quickly get low phosphate, pottassium and magnesium as glucose and insulin are increased meaning electrolytes are driven into cells
Differences between bulimia and anorexia
Bulimia= BMI over 18.5, parotid hypertrophy, slightly older
Treatment of syphilis
IM benzathine penicillin
Describe primary syphilis
Painless ulcer, local non tender lyphadenopathy
Features of tertiary syphylis
Tabes dorsalis, ascending aortic aneurysms, neurosyphilis
Name two female sexual disorders
Female sexual arousal disorder= less thoughts feeling sand responses
Female orgasmic disorder= absent, infrequent, reduced or delayed orgasm
Types of sexual therapy
CBT
Systemic
Integrative
Treatment of peyronies
Watchful wait and traction
Treatment of chlamydia
Doxycycline 7 days
Treatment of gonorrhoea
IM ceftriaxone 1g
Genital warts
Small fleshy protrubrences, HPV. Topical podophyllum or cryotherapy
Gential herpes
Painful ulcers. HSV2. Aciclovir, saline bathing and analgesia (c-section)
Chancroid
Painful ulcers and unilateral painful lymphadenopathy. Haemophilus ducreyi. Azithromycin
Lymphogranuloma venereum
Painless pustule. Painful lymphadenopathy. Proctocolitis. Chlamydia trachomatis. Doxycycline
Trichomonas Vaginalis
Offensive green frothy discharge, strawberry cervix. Microscopy of wet mount. Metronidazole
Bacterial vaginosis
Fishy. Garderella Vaginalis. Metronidazole
Thrush
Cottage cheese. Candida albicans. Fluconazole
First line treatment of OA
Topical diclofenac
Second line treatment of OA
Paracetamol
X Ray signs of RA
Loss of joint space
periarticular Erosions
Soft tissue swelling
Soft bones (osteopenia)
1st line treatment for RA
Methotrexate and NSAIDs
pred for flares
2nd line treatement for RA
Etanercept
Treatment of RA in pregnancy
Pred
Treatment of spondyloarthritis
NSAIDs and physio
Treatment of GCA when there are eye signs
IV methylpred
1st line treatment of psoariatic arthritis
NSAIDs
2nd line treatment of psoariatic arthritis
Methotrexate
Investigations for psoariatic arthritis
Bloods and XR
Presentation of JIA
Knee pain in child, more than 6 weeks
Imaging of JIA
US
1st line treatment of JIA
NSAIDs and MDT
2nd line treatment of JIA
Methotrexate
Investigations for reactive arthritis
Fluid analysis and microscopy
NAAT and stool cultures
Treatment of acute reactive arthritis
First NSAIDs Second pred
Treatment of chronic reactive arthritis
Sulfasalazine
What are you doing to the fluid in septic arthritis
MC and S
Polarising microscopy
WCC
Treatment of septic arthritis
Abx
Refer to surgeons
Second line treatment of osteoporosis
Denosumab
FRAX
Osteoporosis, BMD, FHx, PMHs, corticosteroids, obesty
Smoking, alcohol,
RA (not OA)
Pagets on XR
Lytic lesions
Diagnosis of pagets
Bone biopsy
Diagnosis of osteomalacia
Iliac crest biopsy
Treatment of osteomalacia
Adcal D3
Treatment of vitamin D deficiency
Colecalciferol for 8 weeks
First line treatment of gout flare
Naproxen
Second line treatment of gout flare
Prednisolone
Third line treatment of gout flare
Colchicine
Pseudogout findings on XR
Chondrocalcinosis
1st line treatment of pseudogout
Intraarticular dexamethasone
Treatment of disc disease
Ibuprofen and physio
How would herniated disc present
Dermatomal symptoms
Which disease is better when lying down
Spinal stenosis
Degenerative disc/ compression fracture imaging
First XR then MRI
Undisplaced fracture treatment
Splint
Closed displaced fracture treatment
Open reduction, internal fixation
Treatment of osteomyelitis
IV Flucloxacillin
Treatment of femoral closed stable and undisplaced fracture
Intramedullary nailing
Humerus fracture, closed, stable and undisplaced
Elevate and ice
First line treatment of fibromyalgia
amitryptilline
Imaging of PMR
US
Treatment of polymyalgia rheumatica
Prednisolone
SS = Crest BUT ALSO
Renal, fibrosis and carpal tunnel
Treatment of raynauds
Iloprost or sildenafil
Antibodies in antiphospholipid
Lupus anticoagulant
Anti cardiolipin
Anti beta 2 glycoprotein 1
Treatment of antiphospholipid syndrome
Dalteparin acutely
Warfarin long term
Antibodies in poly/dermatomyositis
Anti Jo
Anti Mi2
Treatment of poly/dermatomyositis
Prednisolone
1st line treatment of lupus
Hydroxycholoroquine and suncream
Name some social interventions
Statutory benefits, care package, supported housing, cultural advocacy, psychoeducation, employment support, arts based and exercise based groups, safeguarding, educational support package, social integration package
Rapid tranquilisation in psych
Firstly oral/ deescalation then
IM Lorazepam/ haloperidol + promethazine (to avoid SE)
Which drugs can cause NMS
Metoclopramide, antipsychotics
Treatment of serotonin syndrome and NMS
Stop meds
Investigations for NMS and serotonin syndrome
Creatinine kinase and WCC
Common SE of lithium
Nausea, dry mouth, fine tremor, metallic taste, thisty
Signs of lithium toxicity
Polyuria, worse tremor, drowsy, confused
Investigation of lithium toxicity
Lithium level
Lithium toxicity treatmetn
Supportive care
What to tell a patient when theyre starting on lithium
Regular blood tests, avoid dehydration, dont suddenly change your salt intake, take care with NSAIDs, Diuretics, SSRIs, epilepsy, antibiotics
Drug reaction which happens straight after administration of antipsychotics
Acute dystonic reaction
Treatment of acute dystonic reaction
Medical emergency- procyclidine IM
Symptoms of acute dystonic reaction
Mouth held open, dysarthria, oculogyric crisis, neck spasm
Treatment of extrapyramidal SE from antipsychotics
IM Procyclidine
Side effects of clozapine
Neutropenia
Toxic megacolon
Country where hepatitis B is endemic
Pakistan
Specific name of drug used to treat hep C
Ledipasvir
Diagnosis of malaria
3 thick and thin films 24 hours apart
Treatment of malaria if no complications
Chloroquine
Complications of malaria
Acidotic
Renal impairment
Seizures
DIC
Treatment of complication. malaria
IV artesunate
Prophylaxis of malaria
Chloroquine and doxycycline
Ongoing monitoring of malaria
12 hourly blood films for parasitaemia, FBC and clotting
Peripheral stigmata of IE and where they are found
Janeaway lesions on palms
Oslers nodes on finger pulps
Roth spots on fundoscopy
Splinter haemorrhages in nail beds
Criteria for IE
Duke criteria
Investigation of IE
3 blood cultures 30 minutes apart
Which organism would cause an IE from UTI
Enterococcus
Complications of infective endocarditis
Heart failure
Pericarditis
Arrythmias
Renal failure
Treatment of strep IE
6 weeks IV ben pen
Treatment of staph IE
6 weeks IV fluclox
Treatment of MRSA IE
6 weeks vancomycin
Name of drug used for prep and pep
Truvada
Antibiotic given as prophylaxis in AIDS
Cotrimoxazole
Antibiotic given to treat PCP
Cotrimoxazole
Whatre you looking for on TB sputum culture
Acid fast bacilli
Bloody diarrhoea without feer
E coli
Most common cause of gastroenteritis and comes from meat
Campulobacter
What do you want to do to the stool in infective diarrhoea
Microscopy, culture and sensitivities
C Difficile toxin testing
Microscopy for ova, cysts and parasites
Treatmetn of travellers diarrhoea
Rehydration
Loperamide
Azithromycin
Treatment of meningitis is over 65 or immunocompromised
Add in amoxicillin to cover for listeria
Order of investigations/ treatments in meningitis
- Blood culture
- LP
- IV Abx
What do you give to household contacts of meningitis
Rifampicin or ciprofloxacin
How do you test for Mycoplasma or Chlamydia pneumonia
Sputum
Which antibiotic for cover of atypical pneumonias
Clarithromycin
Pen Allergic pneumonia treatment
PO doxycycline
IV teicoplanin
When does it class as hospital acquired pneumonia
Been in hospital more than 48 hours
Cellulitis but well treatment
PO flucox (clinda if pen allergic)
Treatment of strep cellulitis if unwell
IV ben pen
Treatment of MRSA cellulitis if unwell
IV teicoplanin
Treatment of necrotising fasciitis
Early aggressive debridement and IV Abx
Age defined as elderly
85
- 80+ frail
- 75+ parkinsons
Malnutrition requirements
BMI under 18.5
BMI under 20 and 5 percent weight loss in 6m
10 percent weight loss in 6m
Considerations in MUST
BMI
Weight loss
Acute disease effect i.e. NBM
What to do if low risk MUST
Repeat weekly
What to do if medium risk MUST
Observe diet for 3 days
What to do if high risk MUST
Refer to dietician
Investigations to do after a fall
Lying and standing BP ECG Bloods inc glucose Urinalysis CT head
Does gylcaemic control have to get tighter with age
No can get looser, as less time for complications to occur
What drug does trimethoprim interact with
Methotrexate
What drug does clarithromycin interact with
Warfarin
Treatment of Dementia
Rivastigmine and Donepezil
Treatment of BPSD
Haloperidol
Risperidone
What changes are happening in alzheimers
Atrophy and beta amyloid plaques
Alzheimers history
Progressive, recent events forgotten first, word finding difficulties
What medication would you use in gestational diabetes once diet and exercise failed
Insulin
Diagnosis of post natal depression
Edinburgh post natal depression score
1st line treatment of post natal depression
Self help and CBT
First line treatment of dysfunctional uterine bleeding when not requiring fertility
Endometrial ablation
BP in pregnancy which requires medication
Labetalol at 160/110
Treatment of hyperemesis gravidarum without fluid depletion
Pyridoxine, supportive care
Treatment of hyperemesis gravidarum with fluid depletion
IVI
Metaclopramide
Hypothalamic cause of amenorrhoea
Low GNRH, anorexia, psych
Pituitary cause of amenorrhoea
High prolactin, endocrine or sheehans
What is sheehans syndrome
Pituitary necrosis after large obstetric bleed
Ovarian causes of amenorrhoea
PCOS, turners
Adrenal causes of amenorrhoea
Congenital adrenal hyperplasia
Investigation of CAH
17 hydroxyprogesterone
Tract causes of amenorrhoea
Vaginal septum, Ashermanns syndrome
What is ashermanns syndrome
Adhesions after surgical miscarriage
1st line treatment of amenorrhoea
COCP
1st line treatment of amenorrhoea if desires fertility
Clomifene
3 symptoms of PID
Uterine tenderness
Cervical motion tenderness
Adnexal tenderness
Treatment of PID
Ceftriaxone and doxycycline
Symptoms of lichen sclerosis
Itchy external genitalia (non hairy areas)
Treatment of lichen sclerosis
Clobetasone topical, avoid perfumes
Does thrush smell
No, just looks like cottage cheese
1st line treatment of thrush
Clotrimazole topical
2nd line treatment of thrush
Oral fluconazole
Diagnosis of prolapse
Clinical
Treatment of prolapse
1st supportive and pelvic floor exercises
2nd surgery
Ovarian torsion symptoms
Severe pain and palpable adnexal mass
Investigation of ovarian torsion
TVUS and doppler flow
Treatment of ovarian torsion
Surgery- detorsion or salpingoophrectomy
investigation of uterine fibroids
TVUS then endometrial biopsy
Treatment of uterine fibroids
Mifepristone (antihormonal)
Surgery for fibroids
Myomectomy
Investigation of ovarian cysts
TVUS, if ?Ca then CA125 and CT
Investigation of male infertility
Sperm studies
Treatment of male infertility
Treat cause and assisted reproduction
Female infertility treatment
- diet and exercise
- clomifene and counselling
- ovarian drilling
Placenta praevia investigations
TVUS, repeat at 32 and 36. Delivery at 36
Placental abruption and more than 37 weeks pregnant
Induction
Pulsations over the os
Vasa praevia
Severe abdo pain between contractions
Uterine rupture, c section
Endometrial cancer 1st line investigation
TVUS
Diagnostic investigation for endometrial ancer
Endometrial biopsy and hysteroscopy
1st line investigation for ovarian cancer
TVUS
1st line investigation for cervical cancer
Speculum examination
Diagnostic investigation for cervical cancer
Colposcopy and biopsy
Steps of surgery in cervical cancer
Cone biopsy
Trachelectomy
Hysterectomy
Diagnosis of ovarian cancer
Histopathology after surgery
Treatment of threatened or complete miscarriage
Paracetamol and counselling
Treatment of inevitable, incomplete or missed miscarriage
Evacuation
Misoprostol
Investigation of miscarriage
TVUS
Serum BHcG
Grapelike discharge from vagina, increased uterine size and increased blood pressure
Hydratiform mole/ molar pregnancy
Treatment of hydratiform mole
Dilation and cutellage
Endometriosis treatment if family desired
Clomifene and IVF
Treatment of PCOS
- Weight loss
- Metformin
- COCP
- Clomifene
- anti androgens- spironolactone, finasteride
First line treatment of menorrhagia
IUS, levonorgestrol
2nd line treatment of menorrhagia
Tranexamic acid if wants kids
COCOP if doesnt
Third line treatment of menorrhagia
Depot progestogen
First line treatment of dysmenorrhoea
NSAID, waterbottle, stop smoking
Second line treatment of dysmenorrhoea
COCP
What counts as premature labour
24-37 weeks
When to induce delivery in premature labour
Over 34 weeks
1st line treatment of prolonged labour
Vaginal prostaglandins
2nd line treatment of prolonged labour
Amniotomy and syntocin
Causes of primary PPH
Tone (uterine atony)
Tissue (retained placenta)
Trauma (instrumental, episiotomy)
Thrombin (vascular, coagulopathies)
What counts as secondary PPH
More than 24 hours
Less than 12 weeks
Treatment of secodnary PPH
IV Abx and misoprostol
Where does MM metastasise to
Liver Lung Lymph
What is acral MM
On palms and soles
What is lentigo maligna
Large premalignant lesion on face
Treatment of MM <1mm thick
excision with 0.5cm margin
Treatment of MM >1mm thick
excision with sentinel lymph node biopsy
Diagnosis of skin cancers
Biopsy
Treatment of BCC
Mohs excision, radiotherapy if untreatable
Treatment of SCC
Surgical excision, radiotherapy if untreatable
Causes of pigmentation under nail
MM or trauma
Diagnsois of fungal infections
Skin scrapings/ nail clippings
Preciptants of fungal infections
Immunosuppressants, moisture
Treatment of fungal infections
1st- topical terbinafine
2nd- oral fluconazole
Molluscum contagiosum
Small firm papules with umbilication
Areas of body contact, genitals in adults
Adults= curettage and cry
Children= conservative
What causes itch
Renal (urea) Cholestatic (bile salts) Haem (PCV, basophils and mast cells) Endocrine Malignant (carcinoid)
Scabies
Linera burrows in webspaces
Treatment of scabies
Topical permethin and antihistamines, treat whole family
Primary prevention of premalignant and malignant skin lesions
Sun cream
Avoid sun
Avoid tanning
Cover areas
Treatment of actinic keratosis
Cryotherapy, fluoracil and emolients
Treatment of seborrheic keratosis
Cryotherapy and topical beclometasone
Treatment of Bowens disease
Fluoracil and cryotherapy
Treatment of keratoacanthoma
Excision biopsy +- radiotherapy
Compound naevus
Dome shaped papule
Dermal naevi
Flat patch
Junctional naevi
Flat patch with sticky up bit
Dysplastic naevi
ABCDE features
First line treatment of acne
Topical retinoid- tretinoin
Second line treatments of acne
Topical benzoyl peroxide, topical clindamycin, COCP
Treatment of allopecia
Dermovate, cosmetic camouflage, patient support
Investigation for allopecia
Positive hair pull test
1st line treatment of psoarisis
Dermovate and calcitriol
Ranking of steroids
Hydrocortisone Eumovate Betnovate Dermovate Oral
What happens if you use steroids near eyes
Cataracts
Glaucoma
Eczema + widespread blistering rash
Eczema herpeticum
Aciclovir
1st line treatment of eczema
Topical hydrocortisone and emolient
2nd line treatment. of eczema
Eumovate and cetirizine
3rd line treatment of eczema
Betnovate and chlorphenamine
4th line treatment of eczema
Dermovate and tacrolimus
Erythema multiforme
Target lesions
Herpes and mycoplasma pneumonia
Cutaneous T cell lymphoma
Atrophy, telangectasia, pigmentation
Sezory cells on biopsy
Pityriasis rosea
Herald patch
Thumb sign
Pityriasis vesicolor
patches of discoloured skin
Not itchy
harmless
Macule
Flat area of altered colour- less than 1.5cm
Patch
Flat area of altered colour- more than 1.5cm
Papule
Solid rasied palpable lesion less than 0.5cm
Nodule
Solid raised palpable lesion more than 0.5cm
Vesicle
Raised clear fluid filled lesion less than 0.5cm
Bulla
Raised clear fluid filled lesion more than 0.5cm
Pustule
Pus containing lesion less than 0.5cm
Abscess
Localised accumulation of pus
Wheal
Oedematous papule or plaque caused by dermal oedema
Causes of conductive hearing loss
otitis externa
Obstruction
Cholesteatoma
Causes of sensory neural hearing loss
Presbycusis
Post bacterial meningitis
Acoustic neuroma
Alport syndrome
Hearing loss and renal
Positive sign of dix hallpike if its BPV
Rotary nystagmus
Maintenance exercises for BPPV
Brandt daroff
Treatment of menieres disease
1- low salt diet and acetazolamide
2. Promethazine
How to prevent menieres disease
Beta histine
What else do you have to consider in management. of menieres
Have to inform DVLA
Vestibular neuronitis symptoms
URTI and then vertigo
Vestibular neuronitis treatment
Prochlorperazine
Viral labrynthitis symptoms
URTI, vertigo, hearing loss and tinnitus
Treatment of viral labrynthitis
Chrochlorperazine
Referral of unilateral nasal polyps
2ww
Referral of bilateral nasal polyps
Routine NET referal
Treatment of nasal polyps
Flexible endoscopic sinus surgery and polypectomy
Infectious mononucleosis causative organism
EBV
Infectious mononucleosis symptoms
sheet of pus on tonsils
Treatment of infectious mononucleosis
Conservative
No contact sports for 8 weeks
What shouldnt you give in infectious mononucleosis and what will happen
Maculopapular rash if give amoxicillin
First investigation for cholesteatoma
Audiogram and otoscopy
What will otoscopy find in cholesteatoma
Attic crust
Diagnostic for cholesteatoma
CT scan of petrous temporal bones
Symptoms of acoustic neuroma
Unilateral sensorineural hearing loss, dizziness and numbness
Investigation for acoustic neuroma
Gadolinium enhanced MRI
What could bilateral acoustic neuroma suggest
Neurofibromatosis type 2
Treatment of TMJ dysfunction
Joint rest
Treatment of bells palsy
Pred and eye protection
Treatment of Ramsay Hunt
Aciclovir and pred
Sinusitis less than 10 days
Viral
Sinusitis more than 10 days
Bacterial (S. pneumoniae, H influenzae)
1st line investigation for sinusitis
Nasal speculum examination
Diagnostic investigation for sinusitis
Nasal endoscopy
Treatment of sinusitis
Co amoxiclav if bacterial
Nasal saline irrigation
Intranasal budesonide
What causes mumps
RNA paramyxovirus
Investigation for mumps
Salivary Mumps IgM
Gingitivits
Gum disease
Sialadenitis
Staph Aureus
Gland swelling
Airway support and coamoxiclav
DeGeorge syndrome
mastoiditis and pneumonia
Otoscopy and tympanometry to distinguish ear infections
Normal in otitis externa
1st line treatment of mastoiditis
- IV antibiotics
2. mastoidectomy and grommets
Complications of mastoiditis
Abscess, 6th or 7th nerve palsy
Cause of acute otitis media
Normally viral (RSV or parainfluenza) Bacterial: S.pneumoniae, H.influenza, Moraxella
Treatment of acute otitis media
Regular analgesia
Back up prescription of amoxicillin
Treatment of acute otitis media if no improvement in 2 weeks
Myringometry and drainage
What does ear granulation tissue suggest
Otitis externa malignant
symptoms of otitis externa
Tragal tenderness, otalgia, ear canal inflammation
Treatment of bacterial otitis externa
Topical ciprofloxacin
Treatment of fungal otitis externa
Topical acetic acid
Treatment of malignant otitis externa
Oral and topical clindamycin
Bacteria that cause otitis externa
Pseudomonas and S Aureus
Advice to someone with otitis externa
Avoid swimming
Describe OM with effusion
Glue ear, more than 3 months, conductive hearing loss, not infection. Bulging grey tympanic membrane
Treatment of OM with effusion
Conservative, hearing aids, grommets
Cerebral perfusion pressure calculation
MAP - intracranial pressure
Which med is used when someone has been on opioids and needs a step down
Dihydrocodiene
Why do you give adrenaline with lidocaine
Causes vasoconstriction so acts for longer locally
Stepwise SE of anaesthetic
Numb tongue Lightheaded Visual/auditory disturbance Muscle twitching Unconscious Seizures
4 components of anaesthesia
Lack of consciousness
Analgesia
Amnesia
Muscle relaxant
Bloods for a DVT
FBC U and E LFT Clotting ?D dimer
Symptoms of fat embolus
Petechial rash Drowsiness Oliguria PE symptoms Fleck like shadows on CXR
Treatment of fat emboli
High flow oxygen and stabilise fracture
Treatment of severe vomiting in acute abdomen
NG
Things that are in both a DVT and a PE Wells score
Cancer, immobilisation, previous DVT/PE, alternative diagnosis less/more likely
Things just in a DVT Wells score
Entire leg swollen
Swelling more than 3cm
Unilateral pitting oedema
Superficial oedema
Things just in a PE Wells score
DVT Sx
Tachycardia
Haemoptysis
Antidote to benzodiazepines
Flumazenil
GCS Motor 1
None
GCS Motor 2
Extension
GCS Motor 3
Flexion
GCS Motor 4
Withdraws
GCS Motor 5
Localised
GCS Motor 6
Follows commands
Treatmetn of bradycardia
ABCDE
ECG
500mcg Atropine (then repeat or adrenaline)
Treatment of unstable tachycardia
Shock x3 then amiodarone
Symptoms of second degree burns
Blistering
Treatment of sunburn/ scald
Showers and cold presses
Analgesia
Adequate oral intake
Apply emolients
Causes of post op fever
Wind- respiratory Water- uti Walk- dvt/pe Wound- infection Wonder- drugs?
When to increase flow when giving oxygen
Not at target sats or RR over 30
How much water do you need to give a day
30ml/kg
How much K, Na, Cl do you need to give a day
1ml/kg
What can you see on mallampati 4
Hard palate
What can you see on mallampati 3
Soft palate and uvula base
What can you see on mallampati 2
Soft palate, uvula, fauces
What can you see on mallampati 1
Soft palate, uvula, fauces, pharyngeal pillars
How do you manage COCP around surgery
Stop 4 weeks before, bridging POP, start 2 weeks after
Which drugs do you keep going through operations
Beta blockers and steroids
What would you give in massive blood loss
Warm NaCl
4 units warm O-
tranexamic acid
What would you give to treat low Hb
Red cells
What would you give to treat high APTT and high PT
Fresh frozen plasma
How would you treat low platelets
Platelets
What would you give to treat low fibrinogen
Cryoprecipitate
What do you do if someone is unable to maintain their airway despite airway adjuncts in an emergency setting
Rapid sequence induction
How do you treat open pneumothorax
Simple adhesive dressing
What imaging in trauma if the patient is unstable
CXR
What imaging in trauma if the patient is stable
CT
What imaging in trauma if its a child
CXR or US
How do you treat pelvic fracture after high energy trauma
Pelvic binder
What should you give if someone has been involved in major trauma
Tranexamic acid
What should you give if someone on warfarin has undergone trauma
Prothrombin complex
Investigations for acute heart failure
CXR, ECG, BNP, Troponin
Dose of salbutamol given in acute asthma
5mg
Dose of prednisolone given in acute asthma
30mg
4 symptoms of horners syndrome
Miosis
Ptosis
Enopthalmos
Anhydrosis
What causes Horners syndrome
Loss of sympathetic nerve supply to the eye
What does papilloedema look like
Swollen optic disc on fundoscopy
Bilateral grittiness and discomfort around eye margins
Blepharitis, hot compresses twice dialy
Outer eye lid gland infection- tender
Stye, hot compresses and analgesia
Inner eye lid gland infection- non tender
Chalazion, hot compresses and eye hygeine
Name an antiVEGF
Afibercept
Investigation for diabetic retinopathy
Fundus photographs
Progression of findings in Diabetic retinopathy
Microaneurysms Blot haemorrhages In every quadrant Hard exudates Cotton wool spots Neovascularisation
Acute closed angle glaucoma
Sight threatening
IV azetazolamide
Symptoms of acute closed angle glaucoma
Sudden pain
Halos around lights
Nausea and vomitting
Headache
Diagnosis of acute closed angle glaucoma
Gonioscopy
Open angle glaucoma
Optic disc cupping on fundoscopy
Open angle glaucoma symptoms
Peripheral vision loss and patches of missing vision
Treatment of open angle glaucoma
Latanoprost (prostaglandin antagonist)
Timolol
What does severe pain, reduced acuity, semidilated pupil and hazy cornea suggest
Glaucoma
Small fixed pupil, ciliary flush, photphobia, HLAB27, hypopyon
Anterior uveitis, prednisolone eye drops
Severe pain especially on movements and tenderness of eye, Rheumatoid
Scleritis, prednisolone eye drops
Purulent discharge from the eye
Conjunctivitis, chloramphenicol eye drops
What is keratitis and who gets it
Inflammation of the cornea, people who wear contact lenses
investgation for keratitis
Corneal scraping
Dendritic pattern keratitis
Herpes, aciclovir
Eye signs after trauma/ coughing
Subconjunctival haemorrhage
Eye signs post eye surgery
Endopthalmos
Faded colour vision, glare, halos around lights
Cataracts
Investigation of cataracts
Silt lamp examination of anterior chamber
1st investigation of age related macular degeneration
Amsler grid
Age related macular degeneration on fundoscopy
Drusen, neovascularisation
Diagnostic of ARMD
Optical coherence tomography
Treamtnet of ARMD
Observe, anti VEGF
Investigation for CRVO and CRAO
Fluorescin angiogram
Treamtent of CRVO and CRAO
Supportive
Dense shadow starts peripherally and progresses to centre, straight lines appear curved, central vision loss
Retinal detachment
Define health
A state of complete physical, mental and social wellbeing, not merely the absence of disease
What are the three domains of public health
Health protection
Health improvement
Improving services
Define health protection
Measures to control infectious disease risk and environmental hazards e.g. notifiable diseases, contact tracing for STI
Define health improvement
Social interventions aimed at preventing disease, promoting health and reducing inequality e.g. 5 a day campaign, screening
Define improving services
Organisation and delivery of safe, high quality service e.g. auditing and implementing reccomendations
Categories of determinants of health
Genetic
Lifestyle
Environmental
Health care
Genetic determinants of health
Age
Gender
Ethnicity
Lifestyle determinants of health
Smoking status
Wealth
Employment
Environmental determinants of health
Housing
Socioeconomic status
Access to education
Health care determinants. ofhealth
Economic factors
Access
Quality
What is the inverse care law
The availability of medical or social care tends to vary inversely with the need of the population served
Define equality
Equal shares
Define equity
What is fair and just
Define horizontal equity
Equal treatment for equal need
Define vertical equity
Unequal treatment for unequal need
Describe a health needs assessment
Needs assessment, planning, implementation, evaluation
Review health issues affecting a population which leads to agreed priorities and resource allocation which will improve health and reduce inequalities
3 types of health needs assessments
Epidemiological
Comparative
Corporate
Epidemiological health needs assment
Looks at current service and population served and suggests improvements
Comparative health needs assessment
Compares services received by one population with another
Corporate health needs assessment
Considers the views of key stake holders
Define need
The ability to benefit from an intervention
Define supply
What is provided
Define demand
What people ask for
Define felt need
Individual perceptions of deviations from normal health
Define expressed need
Seeking help to overcome variation in normal health
Define normative need
Professional defines intervention for expressed need
Define comparative need
Comparison between severity, interventions and cost
Describe maslows heirachy of need
Physiological Safety Love Esteem Self actualisation
What are three approaches to resource allocation
Egalitarian
Maximising
Libertarian
Describe a egalitarian approach
Provide all care that is necessary and required to everyone
Describe a maximising approach
Based solely on consequence
Describe a libertarian approach
Each individual is responsible for own health
6 things. tolook for when assessing the quality of a service
Access, Appropriate, Acceptible
Equity, efficient, effective
Define health behaviour
Behaviour aimed at preventing disease
Define illness behaviour
Behaviour aimed at seeking remedy
What are the steps of the transtheoretical model
PC PAM
Precontemplation, contemplation, planning, action, maintenance (relapse)
What are steps of the theory of planned behaviours
Attitudes, subjective norms and percieved behaviour control affect intention which affects behaviour
What does intention to behaviour depend on
P PAIR
Prepatory action, percieved control, anticipated regret, implementation intentions, relevance to self
What is the health belief model
Percieved susceptibility Percieved severity Health motivation Percieved benefits Percieved barriers All affect likelihood of action
What are absolute rights
Never acceptable
Article 3- right to protection
Article 4- prohibition of slavery
Article 7- protection from retrospective criminal penalties
What is diversity
Appreciating the differences between people and treating peoples values, beliefs, cultures and lifestyles with respect
Kahneman and Tversky
Intuitive- understand instantly without conscious reasoning
Analytical- measured and calculated
Define screening
Identifying apparently well individuals who have (or are at risk of having) a particular disease
Screening criteria categories
Wilson and junger
Disease, test outcome
Wilson and junger screening criteria- disease
Important
Natural history known
Early treatment better than late
Wilson and junger screening criteria- test
Acceptable to the population
Facilities available
Simple, safe, precise
Wilson and junger screening criteria- outcomes
Ongoing feasbility
Treatment available
Cost benefit analysis
Randomised control trial advantages
Infer causality, less bias
RCT diasadvantages
time consuming, expensive, not always ethical
Describe cohort study
Longitudinal prospective, records exposures and conditions in a population as they develop
Describe case control
Retrospective observational, comparing experiences of those with and without the disease
Cross sectional study
Snapshot of those with and without the disease looking at associations at a particular time
Factors to assess causality
Biological plausibility Temporal relationship Dose response Strength of association Specificity Consistency Coherence with existing themes Reversibility
Define confounders
Risk factors other than those being studied which influence the outcome
Define bias
Systematic error that results in a deviation from the true effect of an exposure on an outcome
Give three types of bias
Selection
Information (measurement, observer, recall, reporting)
Publication
4 questions for medical negligence
1) Was there a duty of care
2) Was there a breach in that duty
3) Was the patient harmed
4) Was the harm due to the breach in care
Bolam rule
Would a reasonable doctor do the same
Bolitho rule
Would that be reasonable
Types of error
Fixation and loss of perspective Communcation breakdown Poor team working Playing the odds Bravado Ignorance Mis triage Lack of skill System error Sloth
Swiss cheese error model
Shows how several latent failures of failed or absent defenses lead to active failure
The three bucket model
Error involves interaction between
Self
Context
Task
Never events
Serious, largely preventable patient safety incidents that should not occur if available, preventative measures have been implemented.
- wrong route chemo
- wrong site surgery
- escape of a mental health patient
Consequences of never events
Financial penalty
CQC visit
Reputation loss
Define domestic abuse
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those who are 16 and over who are/have been intimate partners or family members irrespective of gender or sexuality
Types of domestic abuse
Psychological Physical Sexual Financial Emotional
Which tool is used to assess risk in domestic abuse
DASH tool
What is an IDVA
Independent advocate to help domestic abuse victim access help
What. isa domestic homicide review
Review after someone dies from domestic abuse
wHAT. ISA marac
MultiAgency Risk Assessment Conference- MDT meeting about domestic abuse
Risk factors to think about in breast cancer
Early menarche Late menopause Children Breast feeding HRT
Most common type of breast cancer
Invasive ductal carcinoma
Breast cancer screening
50-70 every 3 years
Treatment for oestrogen or progesterone receptor positive breast cancers
Tamoxifen
Whats another name for herceptin
Tastuzumab
Mammogram shows calcification
Ductal carcinoma in situ
Mammogram shows irregular spiculated mass
Breast ancer
Where does breast cancer metastasise to
LLB: liver lung brain
What drug would you give to a post menopausal woman with breast ancer
Anastrozole, letrozole= aromatase inhibitors
What is stage 4 breast cancer and what should you give
Metastatic, bisphophonates
Lump behind nipple and clear/ blood stained discharge
Duct papilloma
Menopause age, areola lump, milky thick nipple discharge
Duct ectasia
Pagets disease
Nipple eczema, indicates underlying breast cancer
Treatment of non cyclical mastalgia
NSAID, check for cardiac/MSK pain
Treatment of cyclical mastalgia
Proper bra
Short term tamoxifen
Mastitis and breast feeding
Peripheral breast.
Flucloxacillin and keep breast feeding
Mastitis and not breast feeding
Central breast
Flucloxacillin and metronidazole
G6PD on peripheral blood film
Blister and bite cells, Heinz bodies
Treatment of G6PD
Folic acid
Avoid fava beans
Blood transfusion
Symptoms of hereditary spherocytosis
Pallor
Jaundice
Splenomegaly
Treatment of hereditary spherocytosis
Splenectomy
Vaccinations
Blood transfusions
Describe patients with ITP
Low platelets
Not ill
Bleeding
Purpura
How do you treat ITP
Prednisolone and IVIG
Whats the difference between ITP and TTP and DIC
ITP doesnt have schistocytes and theyre not ill
Treatment of TTP
Plasma exchange
Signs of TTP
Schistocytes on blood film but other clotting fine or raised
Signs of DIC
Schistocytes on blood film and abnormal clotting, thrombin excess
Investigations for acute leukaemias
- Peripheral blood film
Gold= bone marrow biopsy
Investigations for chronic leukaemias
- Peripheral blood film
Gold= flow cytometry
Symptoms of leukaemia
SOB
Fatigue
Splenomegaly
Lymphadenopathy
Age groups for leukaemias acronyms
ALL CeLLmates have CoMmon AMbitions under 5, over 45 over 55 over 65 over 75
ALL
Most common in children.
Downs syndrome
CLL
Most common in adults
Warm haemolytic anaemia, Richters transformation into lymphoma, smudge and smear cells
AML
Auer rods and blasts
Can come from myeloproliferative disorder
CML
Philadelphia chromosome
Painless lymphadenopathy and mediastinal mass
Hodgkins lymphoma
Diagnosis of lymphoma
Excisional lymph node biopsy
Treatment of hodgkins
ABVD
Scan for lymphoma staging
CT PET
Symptoms. of non hodgkins lymphoma
Lymphadenopathy, splenomegaly, B symptoms (night sweats, weight loss, fever, amalaise)
Treatment of non hodgkins lymphoma
RCHOP
Treatment of hyeprcalcaemia
Saline
IV Pamidronate
ECG in hypercalcaemia
Short QT
When to suspect myeloma
Over 60 and bone/ back pain
Myeloma diagnostic investigation
Serum/ urine electrophoresis for light chains/ bence jones protein
Treatment of myeloma
Stem cell transplant or Thalidomide
Dexamethasone
Consequences of myeloma
Calcium Renal Anaemia Bone pain Bleeding infection
Fibroadenosis
Multiple breast lumps and pain prior to menstruation or menopause
Symptoms of PCV
Red cheeks
Headaches
Raised haematocrit and haemoglobin
Treatment of PCV
- Hydroxycarbamide
2. Phlebotomy
Treatment of DVT if pregnant
LMWH
DIC treatment
Fresh frozen plasma
What are the clotting studies results in haemophilia
Increase APTT but normal bleeding time
What are the findings in antiphospholipid investigations
Lupus anticoagulant antibodies
Increased APTT
Treatment of von willebrands disease
Mild: tranexamic acid
More severe: desmopressin
Treatment of B12 anaemia
Hydroxocabalamin
Hypersegmented polymorphonuclear and megalocytes
B12 and folate
Treamtent of raised ICP
IV mannitol and prednisolone
Signs of raised ICP
High BP
Low pulse
Low resp rate
Symptoms of SVC obstruction
Oedema of the face and upper extremities
Investigations. of SVC obstruction
- CXR
2. CT
Imaging of SBO
CT
Imaging of LBO
AXR
Investigation of seizures
Video telemetry and EEG
Which anticonvulsant if elderly
Lamotrigine
Side effects of chemotherapy
Mucosal irritation Myelosuppresion Infertility Mouth ulcers Alopecia
ECOG 0
Fully active
ECOG 1
Light work
ECOG 2
Ambulatory
ECOG 3
Limited self care
ECOG 4
Disabled
ECOG 5
Dead
Duodenal atresia investigation and finding
Abdominal XR= double bubble
Treatment of GORD in child
Upright positioning
Feed thickeners
Fundoplication
Small bowel biopsy findings in Coeliac
Villous atrophy
Crypt Hyperplasia
Increased intraepithelial lymphocytes
Fanconi
Thirsty and weeing lots
Damage to PCT
Electrolyte losses
Scan to look for renal scarring
DMSA
Rate of chest compressions in child
100-120
Fluid used for replacement in children
0.9% saline + 5% dextrose + 10mmol KCl
Amount of fluid to give to rehydrate child stat
10ml/kg
Perthes
4-8 year old
AVN of femoral head
Slipped upper femoral epiphysis
10-15 years old
Displacement of femoral head posterio-inferiorly
Developemntal dysplasia of hip
Neonate girl
Treatment of intermittent/ exercise induced asthma
Salbutamol
How do you assess severity of asthma in an under 5
Same as over 5 just without peak flow
