OSCE questions Flashcards
What colour would you expect ascitic fluid to be? and if there was infection what colour would you expect?
Clear/ Straw coloured for ascites
Cloudy for SBP
What does the WWC have to be over for diagnosis of SBP?
> 250 Microliters
What must the SAAG be in order for an exudate to be diagnosed?
<11g/L or 1.1g/dL
Name some causes of Transudate for ascites:
Cirrhosis
Bud chari syndrome
Extreme malnutrition
Alcohol hepatitis
Name some causes of exudate for ascites:
Malignancy
Infection
Inflammatory
pancreatitis
What biochemical results would you expect to see in bacterial meningitis?
High neutrophil count >100 cells per microliter
High protein >50mg/dL
Low glucose <40% serum
What biochemical results would you expect to see in viral meningitis and what pathogens are commonly attributed to the condition?
High Lymphocyte count >50-1000 cells
High protein >50mg/dL
Normal glucose
Enterovirus HSV2 VZV HIV Mumps
What is the biochemical finding seen in the CSF following a subarachnoid bleed, and how long till it shows?
Xanthochromia
12 hours
What is your immediate management of a subarachnoid bleed?
Fluid resuscitation
Ted X stockings
Nimodipine
Analgesia
Neurosurgical:
- clipping
- coils
- stenting
What are the radiological findings of O/A and RA
O/A:
- reduced joint space
- Subchondral sclerosis
- Osteophytes
- subchondral cyst
RA:
- reduced joint space
- Joint erosion
- osteoporosis
- soft tissue swelling
Surgical intervention for acute critical limb ischemia:
angioplasty/ stenting
surgical by- pass
- femoral popliteal bypass
- aorto- iliac bypass
What is the long term management of someone with limb ischemia?
Aspirin
Anti-hypertensives - avoiding Beta blockers
Statins
Fibrates
Lifestyle changes:
- smoking
- diabetes control
- activity levels
What are the treatment options for RA?
First line:
NSAIDs
Bridging:
- steroids
2nd Line:
DMARDs
Biological agents:
- Infliximab
- Tocilizumab
- Rituximab
what are the antibodies screened for in MG?
ACh receptor auto-antibodies
muscle specific kinase receptor antibodies
low density lipoprotein receptor related antibodies
What is the treatment of MG?
Pyridostigmine
Immunosuppressive
rituximab
thyectomy
if there is a MG crisis:
- ventilation
- immunoglobulins
- Plasma exchange - filtration
What is the biggest risk factor for a stroke?
Hypertension
What is the immediate treatment following a stroke?
Admission to stroke unit.
- Alteplase - within 4.5 hours of stroke
+
Aspirin
what is the subsequent treatment of stroke?
2 weeks aspirin 300mg
then switch to: Clopidogrel \+ Simvastatin \+ anti HTN \+ Life style changes - stop smoking \+ Physiotherapy
What are the different types of stroke a person can have?
TACS:
- contra - lateral hemiparesis
- contra-lateral homonymous hemianopia
- Higher cerebral dysfunction
PACS:
- 2/3 or higher dysfunction
PCS:
- Cranial nerve palsy
- Pupil disorders
- Cerebellar dysfunction
- isolated homonymous hemianopia
Lacunar:
- pure sensory
- pure motor
- ataxia hemiparesis
What are the main types of MS:
Relapsing remitting
Secondary progressive
Primary Progressive
Name Some symptoms of MS:
Weakness Optic neuritis Scanning speech clumsiness Painful shocks bowel/ bladder dysfunction depression fatigue
Uhthoff’s phenomenon
- worse after hot shower
Diagnostic criteria for MS and investigations:
> 2 attacks of demyelination disseminated by time and space
MRI - t2 weighted
LP - Oligoclonal IgG bands
Visual Evoked Responses
Treatment of MS:
Relapse:
- Methylprednisolone
+
- PPI
1st line:
- Interferon beta
- glatiramer acetate
2nd line:
- Fingolimod
- natalizumab
What is the pathological feature behind migraines?
Trigeminovascular system
Management of migraines:
Avoid triggers
High dose Aspirin
Triptans
Anti-emetics
Prophylaxis
- propranolol
- amitriptyline
Name some causes of cushing’s syndrome:
Cushing’s disease - adenoma in the pituitary gland
Adrenal adenoma
Iatrogenic
Paraneoplastic effect
- small cell
What are the diagnostic tests for cushing’s?
- late night cortisol salivary sample.
- Dexamethasone suppression test:
first low dose of 1mg
- no effect if cushing syndrome
this then leads onto the second dose which is:
High dose of 8mg.
- if cushing’s disease it will suppress CRH and ACTH reducing cortisol
- if adenoma will reduce ACTH but not cortisol
- if paraneoplastic neither will be reduced.
What is the treatment of cushing’s syndrome?
Removal of tumour:
- transsphenoidal approach
- removal of adrenal
- cancer removal
Ketoconazole can also be used
What diagnostic tests can be done to diagnosis Pheochromocytoma?
and how is it treated?
24 hour adrenaline measurement
plasma free metadrenalines
Urinary analysis of:
- adrenaline
- Metaadrenaline
- Metanoradrenaline
Treatment:
Alpha blockers
Beta blockers
Removal of tumour - adrenalectomy
What is the treatment of hyperthyroidism?
1st line:
Carbimazole
- prevents thyroperoxidase
Block and replace or titrate
2nd line:
Propylthiouracil
- blocks 5’ iodinase
beta blockers
- propranolol - non cardioselective
Thyroid storm:
- beta blockers
- antiarrhythmic drugs
- fluid resuscitation
What treatments are available for acromegaly?
Transsphenoidal removal of tumour
Dopamine agonists
- bromocriptine
somatostatin agonists
- octreotide
What investigations should be done into adrenal insufficiency?
Diagnostic:
- Short synacthen test
Blood osmolality
- hyponatremia
Hyperkalemia
What is the treatment of adrenal insufficiency?
Hydrocortisone
- start when even suspected.
Fludrocortisone
Emergency ID tag
Steroid card
Addisonian Crisis:
- IV hydrocortisone
- IV fluids
- Glucose
- Electrolyte management
What are the two major causes of hyperaldosteronism, and how can they be biochemically differentiated?
and what is the management?
Primary:
- adenoma
Secondary:
- renal artery stenosis
Primary:
- low renin, high aldosteronism
Secondary:
- High renin, high aldosteronism
Management:
- Spironolactone
- Eplerenone
Surgery
- removal of tumour
- angioplasty of tumour
List some sign of peritonitis:
Guarding
Absent bowel sounds
Pyrexial
Extreme tenderness
Name some causes of abdominal distention:
Ascites
Constipation
Fat
Pregnancy
Name some causes of hepatomegaly:
Alcoholic liver disease Fatty liver disease Right sided heart failure Hepatocellular carcinoma Lymphoma Leukemia
Name some causes of splenomegaly:
Haematological disorders:
- leukemia
- Myeloproliferative disorders
- haemolytic anaemias
Infections:
- mononucleosis
- TB
Portal Hypertension
Name some causes that will cause a drastic rise in the ALT and AST:
Hep A
Hep E
Toxins
Ischemia
List some symptoms of aortic stenosis, and what pulse would you expect to feel?
Breathlessness
Syncope/ presyncope
angina
dizziness
Narrow Pulse pressure
Low volume
slow rising
List some causes of finger clubbing:
Carcinoma of the bronchus Interstitial lung disease fibrosing alveolitis cyanotic congenital heart infective endocarditis IBD - ulcerative colitis idiopathic familial Liver cirrhosis
Name the dermatomal patterns of the upper limb at distal ends:
C4 - top shoulder C5 - regimental area C6 - tip of thumb C7 - middle finger C8 - little finger T1 - inside of forearm
What stain can be used for haemochromatosis of the liver?
Prussian blue
How is Hep B managed?
Interferon alpha
Nucleotide analogues
Fibroscan
Lifestyle advice
- stop smoking
- stop drinking
What is a useful biochemical marker for assessing if someone has had an upper G.I bleed?
Urea
- rising rapidly
What scoring system can be used to establish whether someone has had an upper G.I bleed? and what does it include?
and what scoring system is used once endoscopy has been done to determine likely hood of survival and rebleed?
Glasgow Blatchford Score:
- Hb
- rise in urea
- drop in blood pressure
- HR
- melena
- Syncope
Rockall score
What investigations would you want to do when considering DKA?
Plasma glucose ABG Plasma Ketones Urinalysis - ketones - glucose U&Es
What is your initial treatment of DKA?
Fluids Insulin Glucose K+ Bicarb treat underlying infection
Orthopedically if someone presents with a shorten externally rotated limb, what is the pathology?
Broken Hip
Following an infection, how long does Gullia Barre syndrome take to present, what investigations can be done and what is the medical management?
~4 weeks post infection
Diagnosis is Brighton’s criteria
- bilateral flaccid weakness
- loss of reflexes
- LP studies
EMG studies
LP - raised protein
Treatment:
- IV immunoglobulins
- Plasma exchange
- Supportive care - ventilation
What are the symptoms of coeliac disease? and what antibodies tested for in coeliac disease?
Diarrhea failure to thrive Fatigue Weight loss Mouth Ulcer Anaemia Dermatitis Herpetiformis
tTG
Endomysial Antibodies
Anti - Deamidated gliadin peptide antibodies
- endoscopy biopsy
Treatment:
- Gluten free diet
What symptoms would you expect to see with leukaemia and what investigations would you carry out?
Fatigue Fever Anaemia Night sweats Bruising - petechiae Purpuric Rash Abnormal bleeding - epistaxis, bleeding gums Gum hypertrophy recurrent infections Abdominal pain - hepatosplenomegaly Lymphadenopathy Headaches - if CNS involvement
FBC Blood film LDH Bone marrow aspirate LP - if CNS involvement
What is the defective gene in CML and how is it treated?
BCR ABL - 9:22 chromosome.
Imatinib
What tests could you order in suspected inflammatory arthritis?
Rh factor
Anti CCP
HLA B27 testing
ESR levels
What are the symptoms of Multiple Myeloma?
Bone Pain
Hypercalcemia symptoms - mood, stomach pain, Kidney Stones
Renal dysfunction
- bence jones protein
Anamia
Infections
What investigations should be ordered in suspected myeloma? and how is the diagnosis made?
Urine electrophoresis - bence jones proteins
Serum free light chain assay
Serum Immunoglobulins
Serum electrophoresis
Bone marrow biopsy
What is the treatment for Hodgkin’s lymphoma?
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine
(ABVD)
What is the diagnostic criteria for nephrotic syndrome?
and what investigations would you want to order?
> 3.5g protein loss
<30g of albumin serum
oedema
Pro-coagulable
hyperlipidaemia
Investigations:
- urine analysis
- protein- creatinine ratio
- U&Es
- FBC
- Serology
- Imaging
What nephritic syndrome occurs weeks after the infection?
Post strep glomerulonephritis
Common Drug interaction to be aware off:
Metformin and Cimetindine
Warfarin and Aspirin
ACE inh and Metaformin
ACE and K+ sparing diuretics
Gentamicin and Loop diuretics
Statins and Macrolides
Thiazides and PPIs
What abnormality is being looked for in cervical screening? What is used to analyse the smear and what is the next step if there is an abnormality seen?
Dyskaryosis
- koilocytes
Colposcopy - with 5% acetic acid
What is the margins for melanoma removal?
<1mm= 1cm margin >1mm = 2cm margin
Name a specific chemotherapy agent used for melanomas:
Vemurafenib
What investigations would one want to do for suspected endocarditis? and what Antibiotic regimen for infective endocarditis:
Echocardigram
3 sets of blood cultures
CRP and FBC
Native valve:
- flucloxacillin
- gentamicin
- amoxicillin
- 4 weeks
Prosthetic:
- vancomycin
- gentamicin
- 5 weeks
Viridans:
- Benzylpenicillin
- Gentamicin
What is your long term management following an M.I?
Beta Blockers Aspirin Statins ACE inhib Ticagrelor \+/- Eplerenone (diabetics and Heart failure)
Lifestyle changes - smoking
Management of NSTEMI?
Aspirin
Heparin
Clopidogrel
Investigations and treatment of meningitis:
CT if signs of:
- raised ICP
- neurological deficits
- Papilloedema
- seizure
- over 60
Lumbar Puncture.
Blood cultures
Throat swaps
S.Pneumonia
- Ceftriaxone - 10-14 days
- dexamethasone - 4 days
N. Meningitidis:
- ceftriaxone - 7 days
- dexamethasone - 4 days
Listeria monocytogenes - Ceftriaxone - 21 days \+ Amoxicillin - 21 days \+ Dexamethasone
Ciprofloxacin to family and friends `
Management of heart failure:
Beta blockers + ACE inhib \+ Mineralocorticoid \+ Sacubitril and Valsartan \+ ICD or Ivabradine \+ Digoxin
What is an important investigation into heart failure?
Presence of natriuretic peptides
List some features of severe and life threatening asthma:
Severe: PEF - 33-50% tachy >110 Tachy >25 inability to complete sentences
Life threatening: PEF <33% Stats 92% silent chest reduced GCS Normal PaCO2 arrhythmia
Management of asthma attack:
Oxygen - >94%
Nebulised: salbutamol and Ipratropium
Steroids - prednisolone
+/- antibiotics
IV magnesium
+
Senior help
ICU
+
IV salbutamol
What investigations would be done into a women presenting with postmenopausal bleeding?
FBC - establish anaemia
Trans-vaginal ultrasound
Biopsy of endometrium
*postmenopausal bleeding is endometrial cancer until proven otherwise.
What is needed when checking a prescription:
Name, DOB of patient and address. Black Ink Capital letters Drug, dose and instructions No short hand for micrograms, units or nano-litres Minimum dosing interval Signature of doctor GMC No. Address of practice
Check for:
- unnecessary decimals (3mg vs 3.0mg)
List some AIDS defining illnesses:
Kaposi Sarcoma Pneumocystis Jiroveci Pneumonia Burkitt's lymphoma TB Candidiasis of esophagus
How is AIDS monitored?
and how is AIDs treated?
CD4 levels
Viral Load
HAART - high active antiretroviral treatment
Prophylaxis cotrimoxazole - PCP
Frequent Cervical smears
What investigations are carried out for TB?
Culture stains with Ziehl Neelsen staining
Mantoux test / PDD test
What can be put into place when an adult is seen to lack capacity?
Adults with Incapacity Act 2000 - benefit of the adult - minimum intervention - present past wishes Consultation with adult
What can be used to address the use of contraceptives in children under the age of 16?
Fraser guidelines
What are the DVLA restrictions around certain diseases:
Diabetes:
car: inform
Lorry: banned until checked
Seizure:
car: 6 months
Lorry: 5 years
Stroke:
Car: 1 month
Lorry: 1 year
M.I
Car: 1 week
Lorry: 6 weeks
Hypoglycaemic:
>1 episode in 12 months. Must notify DVLA
How long does endoscopy take and what are the complications?
~10mins. Allow 2 hours mins. Day procedure - go home after 30mins
Complications:
- sedation
- bleeding
- sore throat
- damage to crown or teeth
- aspirate pneumonia
- perforation
What are the typical pathogens associated with CAP Pneumonia?
S. Pneumonia
H. Influenza
Moraxella Catarrhalis
Atypicals:
Legionella Pneumophila
Mycoplasma Pneumonia
Chlamydia Psittaci
What are HAP pathogens?
S. Aureus
E. Coli
Pseudomonas
Outline CURB65 and name the antibiotics given:
Confusion Urea >7 Respiratory >30 Blood pressure <90 65 years old
CURB <2 = PO amoxicillin
CURB >3 = IV Clarithromycin + IV co-amoxiclav
Outline your management of exacerbation of COPD:
Cultures Chest x-ray ABG FBC CRP
Treatment:
- oxygen - 88-92%
- Nebulised salbutamol
- Antibiotics - amoxicillin (+IV + clarithromycin)
- Low dose steroids
What would your typical investigations be for COPD in a non- exacerbation setting?
Spirometry
- reversibility - 15% change/ <400ml of change
- FEV1/ FVC ratio <0.7
Chest x-ray
Sputum
FBC - polycythemia?
What investigations would you do when asthma is suspected?
PEAK Flow
Histamine Provocation test - >20% drop
Scratch test
What factors may exacerbate Myasthenia gravis?
Gentamicin, opiates, Beta blockers
What laboratory investigations would you want to do in someone presenting with abdominal pain?
**consider Pregnancy test
FBC
CRP
Amylase
In diarrhea what investigations would you like to complete?
Stool cultures
faecal calprotectin
C. Diff toxins
consider sigmoidoscopy
List four organisms that cause bloody diarrhea:
E. Coli 0157
Campylobacter
Shigella
Salmonella
Name some causes of diarrhea that won’t cause bloody stool:
Cholera
Enterotoxigenic E. Coli
Viral infection - norovirus
Enterotoxins of Staph aureus
In a patient with non-mechanical causes of back pain, what investigations would you want to consider?
Imaging - MRI
Calcium levels
ALP
Anti - CCP and Rh factor
Name an aromatase inhibitor:
Letrozole
Name a Oestrogen receptor blocker used in breast cancer and what may it cause?
Tamoxifen
endometrial hyperplasia - increasing risk of endometrial cancer
How would you manage a patient with an STI?
Accurate diagnosis Treat disease and prevent complications Bring back to test for cure Advise to contract partners Screen for other STIs Education on safe sex
What is the investigation for gonorrhea and what is the treatment?
Nucleic acid amplification test - NAAT
- throat and genitals
- mid flow sample
- swap (females)
Ceftriaxone
+
Azithromycin
- to cover for chlamydia as well
What is the organism that causes syphilis, name some complications of it and what is the treatment?
Treponema Pallidum
CNS
Cardiovascular
VIsual
Dark Field Microscopy for diagnosis
Treatment:
- Penicillin injection
What is the most common type of renal cancer? and where is a common spread of this too?
and how does it present?
Renal Cell carcinoma
Cannon ball metastasis to the lungs
Haematuria - frank Hydrocele flank pain palpable mass fever
Most common cause of bladder cancer? and name a surgical management of it:
Transitional
transurethral resection of bladder tumour (TURBT)
What are the investigations into prostate cancer?
What are the management options for prostate cancer?
Rectal Examination
PSA levels
Transrectal ultrasound guided biopsy
Watch and weight Radiotherapy - directly to the prostate LHRH antagonist Anti - androgens orchiectomy
What antibodies are involved in Hashimoto’s disease?
and what are the causes of hypothyroidism?
Anti - thyroperoxidase
Anti - perioxidase antibodies
Autoimmune Thyroiditis Severe Iodine deficiency thyroidectomy Drug induced - amiodarone
List some common side effects of Anti TB drugs:
Rifapamcin - red tears
Isoniazide - hepatitis
Pyramide - Hepatits
ethambutol - Optic neuritis
Name some gait types:
Antalgic gait - painful gait
Apraxic gait - unable to lift legs
Ataxic gait - uncoordinated, wide base
Spastic gait - restricted knee movement
Myopathic - waddling, belly leaning out
What is it called when you can see free gas either side of the bowel, allowing both walls of the bowel to be seen?
Riglers sign
What is thumb printing on the bowel suggestive off?
Inflammation - oedema.
How does a caecal and sigmoidal volvulus present radiographically?
Caecal - Embryo sign
Sigmoidal - Coffee bean
What investigation do you want to carry out in the evidence of an Upper G.I bleed?
and what is your management?
FBC - anaemia U & Es - urea for upper G.I bleed Cross Match / Group and Save ABG - lactate LFTs Erect chest x-ray
ABCDE approach - fluid resuscitation - Blood transfusion <7 urea - Oxygen - Assess risk (Glasgow Blatchford) - endoscopy - banding, clipping, adrenaline, haemostatic powders \+ Terlipressin \+ Tazocin
**stop NSAIDS & Anticoagulants
What is the definition of AKI? what is your initial investigations and what is your management?
Decline of renal excretory function over hours to days recognised by an increase in creatinine and urea.
Stage 1: 1.5 - 2 x base line
Stage 2: 2 - 3 x base line
Stage 3: >3 x base line
Investigations:
- urinalysis - blood, nitrites, protein: creatinine ratio
- ultrasound of kidneys
- U&Es
- ECG - tall T waves and wide QRS complex
- Immunocomplex screen
Management:
- stop ACE and NSAIDs
- IV fluids
- Removal of obstruction
- treatment of infection
- Manage hyperkalemia: Calcium gluconate, Salbutamol, IV Insulin, calcium resonate
*consider Renal replacement therapy
What investigation would you carry out for a suspected UTI/ Pyelonephritis and what is your management?
Urinalysis - nitrates, blood, glucose, wwc
Urine cultures - midstream - send in specific container
FBC - white cells
CRP
U & Es
Management:
- don’t treat unless symptomatic
- nitrofurantoin/ trimethoprim - men and non- pregnant women
- removal of catheter
- ciprofloxacin - upper UTI in men and non - pregnant women
- gentamicin - signs of sepsis
*pregnant women and children always treated even if asymptomatic
What is indications for renal replacement therapy?
Refractory Hyperkalemia >6.5
Refractory Pulmonary oedema
Refractory acidosis
encephalopathy - uraemia
What test is done to establish diagnosis of Diabetes insipidus?
and what is your treatment?
water deprivation test - 8 hours.
followed by synthetic ADH - urine measure for osmolality
Desmopressin
Management of CKD:
Control blood pressure - ACE inhibitors recommended Darbepoetin - synthetic EPO Phosphate binders Vit D supplements Bisphosphonates Renal replacement
In a patient with suspected rhabdomyolysis, what is your investigations and management?
Creatine Kinase
U&Es - AKI
ECG - Hyperkalemia
urinalysis
management:
IV fluids
Mannitol
What are the types of dialysis present?
Haemodialysis Continuous ambulatory peritoneal dialysis Automated Dialysis - weight gain - bacterial peritonitis - abdominal sclerosis
What is Q - SOFA:
Define Septic Shock:
<15 GCS
>22 breaths
<100mmHg
2/3 for positive
Persistent low blood pressure (MAP <65) with a lactate >18mg/dL despite adequate vasopressors
When is pyelonephritis actually diagnosed?
Fever + Bacteriuria
or
Loin Pain + Bacteriuria
What antibodies are associated with hyperthyroidism Grave’s disease? and what can be some triggers for it?
TSH receptor antibodies
Anti - perioxidase antibodies
pregnancy
amiodarone
HLA DR3 - type 1 DM, celiac disease, Autoimmune hep
In parkinson’s disease what investigations do you want to order and what is the treatment options?
DAT- SPECT MRI Scan
Bloods - copper, thyroid (rule out)
MRI - rule out vascular
Treatment:
- L-Dopa
- dopamine agonists - pramipexole/ bromicide
- MAO - Inhibitors
- Decarboxylase inhibitor
Deep brain stimulation
What is the investigations into a sinister looking mole?
and what is the most common mutation?
Dermoscopy
Biopsy - ideally removal of the entire mole in doing so.
Sentinel node biopsy
BRAF
How would you differentiate between Acute Cholecystitis and Ascending cholangitis?
How do you diagnosis this?
Acute cholecystitis:
- RUQ pain
- Fever
- Leukocytosis
Investigation:
- LFTs
- US of gallbladder
NIL by mouth Fluids Analgesia \+/- Antibiotics Elective cholecystectomy
Ascending Cholangitis:
- RUQ pain
- Fever
- Jaundice
- Rigors
Investigations:
- FBC - infection
- LFTs
- MRCP
- ERCP
Management:
- Sepsis 6 management
- ERCP to clear the CBD
What are your investigations when someone presents with suspected gallstones, cholecystitis or cholangitis?
LFTs
Ultrasound
MRCP
ERCP - indicated if obstruction in the common bile duct
What are your investigations and management of acute pancreatitis?
Amylase (3x normal is diagnostic) CT Scan Ultrasound of Gallbladder for stones MRCP ERCP - when able
Modified Glasgow Score - predicting severity. >3 suggests ICU intervention
Management: - IV fluid - Analgesics - Anti - emetics - Urinary output - measure organ dysfunction - organ Support \+/- Antibiotics
48 hours start eating
Further Management:
- ERCP
- Cholecystectomy
- Alcohol removal
What investigations do you want to do in suspected appendicitis?
Pregnancy test
Ultrasound
FBC - WWC
CT Scan
What is your investigation and management of SJS and TEN?
Investigations:
- Skin biopsy
- U & Es - assess hypovolemia
- ABG - mucosal involvement
- Blood cultures - assess for infection
Management:
Remove causing agent/ Drug
IV fluids
- measure fluid output
Ophthalmology examination
Admit to ITU for burns
Protective dressings/ Bedding
Prophylactic antibiotics
IV immunoglobulins
What is your management of psoriasis?
Patient advice - not infectious etc
1st Line: Emolients Vitamin D analogue Tar Corticosteroids
2nd Line:
Narrow Band UVB
Retinoid cream
Methotrexate
Severe:
Ciclosporin
PUVA
Ustekinumab
List some drugs that cause postural hypotension:
Ca2+ blockers ACE inhibitor Nitrates (sildenafil) Alpha -1 blockers Tricyclics Antipsychotics Beta blockers
What sign can be conducted to assess for SJS and TEN?
Nikolsky’s sign - exfoliation of the epidermis on gentle rubbing
Medication that can cause a fall:
Diabetic medication - hypoglycemia
Postural hypotension medication
Benzodiazepines - lowered GCS
What investigations would be useful to do when a patient has had a fall?
Standing/ sitting blood pressure ECG - arrhythmias Echo - valvular disease Blood glucose CT head - neuro
What further investigations would you want to do into someone presenting with hypertension?
ECG Lipid profile Renin: Aldosteronism U & Es Uroanalisis - end organ damage
What investigations would you want to do in hypothyroidism?
Thyroid function tests
Anti peroxidase/ thyroglobulin antibodies
Glucose levels - associated type 1 DM
Investigations into hyperthyroidism?
TFTs
Auto antibodies
Ultrasound
ECG
What investigations would you want to carry out on someone with anaemia?
FBC Blood film TIBC Ferritin levels MVC Reticulocyte count ECG
How do you manage AF?
Rate control - 1st Line: atenolol, verapamil 2nd Line: Digoxin
**HF only atenolol and Digoxin
Rhythm control - Flecainide Amiodarone
*Amiodarone only for HF
Anti-coagulation - >48 hrs consider 6 weeks course of anti - coagulation
What scoring system is used to assess whether someone needs to be anti-coagulated?
CHAD2DS2VASc score
How does LVH appear on ECG?
S in V1 + R in V6 = >35mm / 7 large squares
R in aVL = >11mm
If FBC and Blood film have been done for anaemia, what other investigations would you want to consider?
B12
Folate
Ferritin levels
U & Es
What additional assessments can be done into depression? and what is your management?
MMS
Thyroid levels
FBC
**always assess risk
Management:
- SSRIs - Citalopram, fluoxetine
- Counseling
- CBT
- review 2 weeks
What investigations would you want to order in someone with palpitations?
ECG TFTs CXR U & Es - for electrolyte imbalances Troponins - if chest pain
What are some risk factors for melanoma?
Previous skin cancer Sun burn Previous lived abroad Immunosuppression >5 atypical Naevi Family history Parkinson's disease
What is the strongest predictor of the outcome of melanoma?
Breslow’s thickness
What further investigations should be offered following a skin examination?
Dermoscopy
Skin biopsy - diagnostic excision of lesion for melanomas
Skin Scrapings
