Brainscape's Knowledge GenomeTM

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


See full index

Year 6 Written > PACES > Flashcards

PACES Flashcards

1
Q

IBS Mx

A

Conservative: Trial probiotics, FODMAP
Medical: Loperamide for diarrhoea, antispasmodics (hyoscine bromide) for cramps

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

GORD Ix

A
  • H pylori (stool antigen)
  • Oesophageal pH via manometry
  • OGD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

H Pylori eradication

A

PPI plus 2 antibiotics i.e. amoxicillin and clarithromycin) for 7 days

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

PUD surgical mx

A

resection if severe

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

GE mx

A

Cons: oral rehydr salts (IV fluids if needed), isolate to prevent spread until 48h after syx resolve,
Med: abx in severe cases/ depending on org

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

Systems r/v to ask for CP

A
  • SOB
  • Dizziness
  • Palp
  • Tingling/numbness
  • Reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CVD Ix (bloods)

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

Stable angina mx

A

Med:
1. GTN
2. BB or CCB
(if both - then must be dihydropiridine CCB e.g., nifedipine) - ! decreasing the heart’s workload and oxygen demand

2ndry prev: Aspirin, ACEi, statin
Surg: PCI or CABG

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

Dizzy spell px ddx

A
  • Arrhythmia, e.g., AF
  • Valve disease, e.g., Aortic stenosis
  • HF
  • Anxiety/panic attack
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dizzy spell px ix

A

Bedside: Lying standing BP
Bloods: U&Es, NTproBNP

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

AF Mx

A

Cons: cardio ref / hosp admission if tachy++
Med:
- Rate control: B-blocker, CCB, or digoxin (sedentary lifestyle)
all pt rate control unless asyx/new onset within 48h/reversible cause/
- Rhythm control: Fleicanide, or amiodarone (structural heart disease)
- Long term anticoag w DOAC (or warfarin) according to CHADVASC

(For paroxysmal AF: Consider pill in the pocket strategy i.e. flecainide/ amiodarone.)

Surg: ablation trx

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

How does AF cause stroke?

A

Normally, blood flows into the heart, and gets fully pumped out every time the heart beats. But in AF, blood can pool inside the heart. A clot can form in the blood and then travel up to the brain, causing a stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why DOAC over warfarin

A

wider therapeutic window, rapid onset of action, stable and predictable

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

Testicular torsion ddx

A
  • Epididymoorchitis
  • Hydrocoele or haematocoele
  • Incarcerated hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TT Mx if orchidopexy fails

A
  • Orchidectomy (removing the affected testicle) if surgery is delayed or necrosis occurs
  • Follow-up for fertility issues and hormonal consequences, whether viable or non-viable testicle and offer counselling
  • Psychotherapy as required
  • Consider implantation of a prosthesis if an orchidectomy is performed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

TT pathophysiology and RF

A

Testis rotates around its own axis, causing twisting of the blood vessels that supply it. This leads to ischaemia (lack of blood flow) and subsequent damage to the testicular tissue

RF: trauma, undescended testis, prior intermittent torsion

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

GRACE score

A

Estimates admission-6 month mortality for patients with acute coronary syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MI complx

A
  • Death
  • Heart failure
  • Valve disease
  • Embolism
  • Recurrence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Raised troponin causes

A
  • MI
  • Aortic dissection
  • PE
  • HF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

STEMI (/NSTEMI) mx

A
  • Loading dose antiplatelet: aspirin and clop 300mg

2ndry prevention
- DAPT
- ACEi
- BB (or CCB)
- Statin

  • Cardiac rehab programme
  • ECHO post MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lumps in neck ddx

A
  • Lymphoma
  • Lymphadenopathy
  • Infx mononucleosis/glandular fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lymphoma ix

A

Bloods
- HIV test
- EBV monospot
Imaging/special
- Excisional lymph node biopsy
- Bone marrow aspirate (if B syx)
- PET (staging)

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

Classification for lymphoma

A

Lugano

Limited
Stage I: one node or group of adjacent nodes
stage II: two or more nodal groups, same side of diaphragm

Advanced
stage III: nodes on both sides of the diaphragm
stage IV: diffuse or disseminated involvement

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

Addison Ix

A

Bedside: lying standing BP
Bloods: iron studies, glucose, TFTs, renin/aldosterone
TSH/Prolactin /FSH / LH ( assess hypothalamic-pituitary axis)

screening test: 9am cortisol level (usually high, but low in Addisons)
confirmatory dx: short synACTHen test (will see that cortisol still doesn’t rise:()

Imaging/special tests: CT adrenals

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

steroids SEs

A
  • Cushings
  • Weight gain
  • Thinning of skin
  • Immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Drowsy + T1 Diabetes hx Ddx

A
  • DKA
  • HHS
  • Dehydration
  • Rule out infx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Diabetic emergency mx

A

Cons
- Frequent monitoring
- DVT prophylaxis
- Diabetics team/endo r/v
- Consider HDU if severely unwell
- Consider NG tube for drowsy/vomiting pts

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

Blood glucose targel levels!

A

Before meals
4-7mmol/L
2h after meals
5-10mmol/L

HbA1C
1) 48mmol/L for dx of diabetes
2) 48mmol/L target if no trx
3) 53mmol/L target if on trx

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

DKA dx criteria

A

Blood glucose >= 11mmol/L
Ketones
pH <7.3

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

Types of insulin

A
  • Rapid acting (15 mins): humalog
  • Short acting (30 mins): humulin R
  • Intermediate acting (2-4h): humulin N
  • Long acting (several hours): lantus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Acromeglay ddx

A

Pseudo-acromegaly
(looks like it but w/o incr GH)
Causes: obesity, insulin resistance, hypothyroidism

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

Acromegaly ix

A

Bedside: BM/HbA1c, ECG
Bloods: IGF-1 (insulin-like growth factor 1), oral glucose tolerance test, prolactin, triglycerides, GHRH, cortisol/estradiol/testost
Imaging: ECHO, MRI brain/hypothal, CT scan (to check for lung/pancreas/adrenal/ovarian tumours in ectopic production)

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

Acromegaly mx

A

Definitive:
- Pit adenoma: trans-sphenoidal pituitary tumour removal
- Ectopic: ca removal
- Familial cause, e.g., MEN 1: genetic counselling

Meds to suppress GH:
- Somatostatin analogue, e.g., octreotide
- Dopamine agonist, e.g., bromocriptine + cabergoline

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

Pathophys of acromegaly

A

Pituitary gland releases too much GH -> signals liver to produce insulin-like growth factor I (IGF-I) -> causes bones and body tissue to grow.

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

Acoustic neuroma (vestibular schwannoma)

A

benign tumour on vestibular nerve

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

Acoustic neuroma ix and mx

A

Ix
- Audiometry to assess hearing loss (sensorineural)
- MRI or CT head to establish dx

Mx
- ENT referral

Conservative: monitor growth if no syx

  • Radiotherapy to reduce/stop tumour growth
  • Microsurg to remove tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Crohn’s mx

A

(!quit smoking)
Induce: PO pred / IV hydro
Maintain: azathioprine

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

UC mx

A

Induce: if mild- mod, PO/PR mesalazine; if severe, IV hydro
Maintain: mesalazine (Aminosalicylates)

Surg: panproctocolectomy

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

NY HF classification

A

1 - no syx/ no limitation ADL
2 - mild syx / slight limitation
3 - only comf at rest / sig limitation
4 - syx at rest / severe limitation

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

Qs for hepatobiliary

A
  • Jaundice
  • Pale stool
  • Dark urine
  • Itchiness
  • IVDU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Ix for hepatobiliary

A

Bloods:
- Iron studies (haemochromatosis)
- Viral hep screen
- Antibodies: Anti-smooth muscle (AI hep), Anti-mitochondiral (PBC), p-ANCA(PSC)
- HIV
- STI

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

Viral hep (B and C) mx

A
  • Hep ref
  • Analgesia: paracetamol
  • Itch: chlorphenamine
  • minimise transmission - pt education
  • consider GUM referral
  • contacts for hep vax

Antivirals - hepB:interferon alpha, hepC: ribavirin

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

AI hep mx

A
  • Steroids
  • Azathioprine (immuno suppr)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Child Pugh score

A

Cirrhosis severity and mortality (BR, albumin, INR, ascites, encephalopathy)

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

Thyrotoxicosis mx

A
  • Supportive care: O2, fluids, electr repl
  • Anti-thyorid meds: PTU
  • Steroids: prednisolone (reduce inflamm and lower thyroid levels)
  • v severe: plasmapheresis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Cushings Ix

A

Cushings syndrome
1. 24h urinary cortisol OR overnight (low dose) 1mg dexamethasone suppression test OR salivary cortisol
2. If +ve, perform 2nd test from above -> positive = confirmed

(dexamethasone is basc acting on same Rs as cortisol, so we should get -ve feedback and thus low cortisol)

Cushings disease
Serum midnight ACTH -> normal/high
^High dose dexamethasone suppression test
- If suppressed -> cushing’s disease -> pituitary MRI
- If not suppressed -> ectopic ACTH -> CT TAP

Serum midnight ACTH -> low
^ACTH independent cause -> CT TAP ?adrenal carcinoma

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

Cushings mx

A

Syndrome
- Identify + treat underlying cause
- Syx mx: HTN, high blood sugar, osteop

Disease
- First line: transsphenoidal surgery to remove pit tumour ± adjuvant radiation
- Medication: Ketoconazole - lower cortisol // neoadjuvant

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

Lung ca mx

A
  • SCLC: chemo, e.g., cisplatin
  • NSCLC: immunotherapy, e.g., tyrosine-kinase inhib
  • SVCO: IV dexameth -> radiotherapy or SVC stenting

Surgical
Lobectomy + adjuvant chemo & radio (more for NSCLC which is more localised)

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

HF Ix to ask

A

BNP and ECHO !!

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

COPD cons mx

A
  • Vaccinations incl pneumococcal, influenza and COVID
  • Pulm rehab
  • Personalised self-mx plan
  • Good inhaler technique
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Bronchitis and emphysema

A

Bronchitis is inflammation of the bronchi in the lungs that causes coughing.
Emphysema is damage to alveoli

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

Combo inhaler therapy asthma

A

MART - combo of corticosteroid preventer and long acting bronchodilator

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

1)ILD caused by asbestosis/silicosis
2) ILD caused by exposure to hay/dust/birds

A

1) Pneumoconiosis
2) Hypersensitivity pneumonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Mx ILD

A

Cons
- Vacc: pneumococcal, influenza + COVID
- Physio + pulm rehab
- Advanced care planning
Med
- IPF: anti-fibrotics, e.g., pirfenidone
- Hypersens pneumonitis: avoid antigen, PO gluococorticoids
- Advanced: LTOT

Surg
- Lung transpl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

1)AS associations
2)AS Mx

A

1) Uveitis, IBD
2) Regular:NSAIDs
Steroids during flares -> biologics: anti-NF (e.g., infliximab)
Surg: may be required to fix spine deform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Extra articular manifestations RA

A
  • Rheumatoid nodules
  • Secondary sjogrens (dry eyes, dry mouth)
  • Carpal tunnel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Gout !blood test

A

Serum urate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

PMR v polymyalgia v fibromyalgia

A

PMR - inflamm disease; bilat pain and stiffness of shoulders, hips, neck; clinical + raised ESR & CRP
PM - inflamm disease; proximal muscle weakness; clinical + CK, lactate dehydrog raised, muscle biopsy
FM - chronic pain disorder widespread MSK pain and tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

PMR mx

A

Cons: NSAIDs, PT+OT, rheum
Med: Steroids + PPI, osteoprophylaxis (bisphos, Ca, vit D), consider steroid-sparing/immunosuppressants (MTX + folate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

SLE mx

A

1st line (non severe): hydroxychloroquine
(±NSAIDs&Corticosteroids&immunosuppr, e.g., MTX, biologics, e.g., rituximab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Pathophys SLE

A

In SLE, the immune system produces antibodies that target and attack various parts of the body, including the skin, joints, kidneys, lungs, and other organs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

SLE Complx + related diseases

A
  • Kidney disease
  • CVD
  • Pulm disease
  • Infx
  • Osteopor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Rhabdo and Ix

A

Occurs when damaged muscle tissue releases its proteins and electrolytes (K+, Na, Ca) into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death.

Ix:
- Urine myoglobin
- CK, ABG (met acidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Rhabdo mx

A
  • IV fluids
  • Correct complx, e.g., hyperK or arrhythmia
  • Consider withholding nephrotoxic drugs
  • Consider IV mannitol (impr eGFR and oedema surrounding muscle and nerves)
  • Consider haemodialysis if renal function doesnt improve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Cluster headache mx

A

High flow O2 + triptans

prophy - verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Stroke mx

A

! Refer to acute stroke unit

Ischaemic
- 300mg STAT dose PO aspirin
- Thrombectomy (6h) / thrombolysis (4.5h)

Haemorrhagic
- Neurosurgeon referral
- Reverse if on warfarin
- Monitor BP and gradually lower as necessary to prevent further bleed
- TED stockings

(2ndry prevention incl clopidogrel 75mg daily)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Pathophys MG

A

Autoimmune disease of the neuromuscular junction (NMJ) caused by antibodies that attack components of the postsynaptic membrane, impair neuromuscular transmission, and lead to weakness and fatigue of skeletal muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

MG Complx

A
  • Myasthenic crisis (worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation)
  • Dysphagia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

MG mx

A
  • Pt education and support
  • Ref to specialist neuromusc services
  • Reg monitoring syx
  • Syx mx: AChesterase inhib - pyridostigmine
  • Immunomodulatory mx: corticosteroids/azathioprine/rituximab - pt w mod-severe/don’t respond adequately to syx trx

! Thymectomy should be considered for all pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Seizure meds

A

Generalised tonic clonic & absence & atonic & myotonic: sodium valproate

focal: carbamaz/lamotr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Triggers for epileptic seizures

A
  • Lack of sleep
  • Missed meds
  • Stress
  • Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

MS ddx and ix

A

Ddx
- Vit B12 deficiency
- GBS

Ix
- Vit b12
- MRI brain/spinal cord (demyelinating lesions)
- LP (oligoclonal bands in MS, elevated in GBS
- Nerve conduction studies (slow in GBS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

MS mx

A
  • Relapsing-remitting: immunomodulator - interferon beta
  • Primary progressive: anti CD20 MAB
  • Neuropathic pain: amitryptiline
  • Spasticity: baclofen
  • Psychotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

MS eye condition assoc

A

Optic neuritis (50%) - inflamm of optic N
- Pain worse w eye movement
- Vision loss one eye
- Loss vision colour
- FLashing lights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Mx hx Qs

A
  • Fatigue
  • low mood
  • Vertigo
  • Vision
  • Bowel/bladder
  • Speech issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

BCC types

A

Nodular, superficial spreading, sclerosing, pigmented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

BCC and SCC Ix and Mx

A

1) Dermoscopy, excisional biopsy + histology ± CT/MRI for spread
2) Surgical excision and closure / radiotherapy / 5-fluorouracil / cryotherapy / curettage and ekectodesiccation / Moh’s micrographic surgery!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Acne patho

A

Combo of: excess sebum production + follicular plugging with sebum and keratinocytes + colonisation of follicles by cutibacterium acnes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Acne mx

A

Topical:
1. Mild-mod: Retinoids
2. Severe: retinoids + benzoyl peroxide + PO abx
PO (not resp to topical)
3. Mod-sev: PO abx
4. Sev/scarring: isotetrinoin

*referral to derm if severe/scarring or no response to initial treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Eczema steroids weak to strong

A
  • Hydrocortisone
  • Eumovate
  • Betnovate
  • Dermovate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Eczema patho

A

people with eczema suffer from the condition due to a lack of filaggrin. Filaggrin is a protein responsible for building a strong, protective skin barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Cellulitis patho

A

skin is disrupted and microorganisms invade the subcutaneous tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Psoriasis mx

A

Topical steroids / vit D analogue / phototherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Psoriasis v eczema

A

Psoriasis - scalp, elbow, knees, lower back; thick, scaly silver/white patches
Eczema - backs of knees, inside elbows, face; red, itchy, inflamed skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Types of psoriasis

A
  • Plaque (most common)
  • Scalp
  • Nail
  • Guttate
  • Pustular (dangerous)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

How does cholecystitis cause shoulder pain?

A

when GB inflamed and swollen, irritates your phrenic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

murphys sign

A

Acute chole, elicit by asking pt hold deep breath while palpating R subcostal area-> pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

SBO (adhesions) ddx

A
  • Bowel perf
  • Bowel isch
  • Diverticular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Gen surg mx on admission

A
  • NBM
  • IV fluids ± NG tube
  • electrolyte repl
  • Analgesia
  • VTE
90
Q

Paralytic ileus/ pseudo obstr

A

normal coordinated movements of the muscles of the digestive system become impaired, resulting in a blockage of the intestines

due to surgery, injury, infection

91
Q

Rovsings sign

A

Appendicitis - pain referred to RLQ when LLQ palpated

92
Q

Acute pancreatitis mx

A

Mild
- Admission + monitor
- NBM
- IV fluids + correct elec disturb
- Analgesia

Mod-severe
as above +
- Nutr support via NG
- Abx if infx susp/confirm

93
Q

Pancreatitis causes

A

I - idiopathic
G - gallstones
E - ethanol
(T)
(S)
M - mumps

94
Q

Peritonitis v guarding

A

Severe abdo pain that worsens w any motion

voluntary or invol tensing of abdo muscles

95
Q

Diverticulitis presentation

A
  • Melaena
  • Vomiting
  • LL abdo pain, worsen by eating
  • ±pyrexia/shivering
96
Q

Diverticulitis mx

A

Cons:
1) home ± abx if syx + safety net
2) admit if
- Pain not managed w paracetamol
- Poor hydration
- Syx >48h
cons: NBM + IV fluids + analgesia ± NG if vom
medical: PO Co-amox 5 days if uncompl // IV if severe acute
surg: ref + surg if complx (perf, abscess, sepsis)

97
Q

Most common site diverticulum

A

sigmoid colon

98
Q

Tender, swollen testicle ddx

A
  • Epidiymo-orchitis
  • Trauma
  • Cellulitis
  • Test torsion
99
Q

Chlamydia and gonorrhea testing

A

NAAT - nucleic acid amplification testing

100
Q

Epididymo-orchitis / epididymitis mx and complx

A

Mx
- Admit if acutely unwell
- Abx depending on pathogen: STI - doxy, E coli - cipro
- Bed rest + scrotal elevation + analgesia
- Abstain sex intercourse + reduce physical activity

Complx
- Chronic epididymitis
- Abscess
- Infertility
- Sepsis

101
Q

Stress incont v urge incont mx

A

1) lifestyle: avoid caff/excessive fluid + weight loss + pelvic floor exercise

Stress
2) 3/12 pelvic floor exercise if ineffective - surgery: colposuspension, urethral bulking agent, tension free vaginal tape
3) duloxetine

Urge
2) BLadder training
3) meds: oxybutynin (anti musc), or mirabegron
4) surg/procedures: botulinum toxin A inj, sacral nerve stim

102
Q

Prostate ca ddx and ix

A

ddx
- Prostatitis
- UTI
- bladder ca (typically haematuria)

ix
- Pt voiding diary
- PSA
- Transrectal US-guided biopsy (confirms dx and Gleason grading)

103
Q

prostate ca mx

A

Depending on Gleason score + staging
- Asyx/unsuitable: watchful waiting - annual PSA and mx urinary syx
- Low risk + localised: active surveillance - 6 monthly PSA + annual DRE + yearly MRI
- Intermed/high risk: radical prostatectomy or radiotherapy
- Mets: hormone therapy

104
Q

BPH ddx & ix

A
  • Prostate ca (less likely w/o FLAWS, but should excl)
  • Prostatitis
  • UTI

Ix
! clinical dx

105
Q

IPSS score

A

International prostate syx score
- Screen/track syx/suggest mx for syx of BPH

106
Q

What are LUT symptoms?

A

range of urinary symptoms that can affect the bladder, prostate gland, urethra (LUT)

Obstructive syx
- hesitancy
- weak stream
- straining
- incomplete emptying

Irritative syx
- Urinary urgency
- frequency
- nocturia
- urinary incont

107
Q

Tamsulosin SE

A
  • Orthostatic HTN
  • Sexual dysf - decr libido, ED, ejac disord
108
Q

BPH mx

A

Cons: physical acitivity, less fluid before med, mod consump alc and caff + intermit self cath if BPH causing frequent retention, UTI or renal failure

Med: alpha blocker, e.g., tamsulosin or 5-alpha reductase inhib, e.g., finasteride

Surg: transurethral resection of the prostate (TURP)

*TURP syndrome: HTN + brady + mental status change (too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream)

109
Q

1 AAA screening
2 AAA mx
3 ruptured AAA mx

A

1) M 65 USS screening ± F 70 w/ RFs
<3cm bye bye, 3-4.4 yearly, 4.5-5.4cm 3-monthly

2)
Cons: contact DVLA if >6, stop driving is >6.5cm
Med: mx RFs
Surg: refer to vasc if >3cm; urgent if >5.5cm vie
EVAR (endovascular aneurysm repair) or laporotomy

3) Ruptured AAA
- Emerg surg (not to be delayed by diagnostic imaging)
- Lower BP than usual

110
Q

DVT mx

A

DOAC (apixaban)
Provoked: 3 months
Unprovoked: up to 6 months
(LMWH/UFH if low renal function)

111
Q

signs of aortoiliac involvement in intermittent claudicationt

A

erectile dysfunction and pain in thighs

112
Q

Intermittent claudication/ Peripheral vascular disease ddx

A
  • Neurogenic claudication (due to spinal canal stenosis)
  • MSK cause
  • ?DVT
113
Q

Ix to look at presence of pulses + ABPI values

A

1) Doppler US
2) 0.5-0.9 peripheral artery disease, <0.5 critical limb ischaemia

114
Q

Mx peripheral vascular disease

A

Lifestyle
- Alc <14 units/week
- Exercise programme

Med (2ndry prev CVD)
- Antiplatelet
- Statin
- Good control DM and HTN

Surg/proced
- Interventional - angioplasty + stenting
- Bypass surg (last resort)

115
Q

Types of breast ca

A
  • Invasive (most common)
  • Invasive lobular
  • Paget’s disease of the breast
  • DCIS
  • LCIS
116
Q

Breast ca mx

A
  • Surgery: breast-conservative + adjuv radio/chemo, OR mastectomy
  • Chemo
  • Radio
  • Hormonal: if ER+ -> tamoxifen (premen), or aromatase inhib (postmen)
  • Targeted: if HER2 +ve -> herceptin
117
Q

BPPV ddx, Ix and Mx

A

Ddx
- Acute vestibular labyrinthitis
- Vestibular neuritis
- Meniere’s

Ix
- Dix- hallpike (syx of vertigo and rotational nystagmus when head tilted to opposite side of diseased ear)

Mx
- Consider DVLA/occup risk
- Limit syx by moving head slowly
- Vestibular rehab, e.g., Brandt-Daroff exercises ±physio input
- Epley manoeuvre

118
Q

1 Acute vestibular labyrinthitis/ viral labyrinthitis v
2 vestibular neuritis v
3 meniere’s disease v
4 osteosclerosis

A

1 - Inner ear problem usually caused by viral infx -> vertigo/ hearing loss/tinnitus

2 - Inflamm of vestibular nerve -> no hearing loss/tinnitus

3 - Inner ear problem due to accum fluid -> recurrent episodes of vertigo, tinnitus and hearing loss + syx pressure/fullness

4 - Abnormal bone growth in middle ear -> cond hearing loss

119
Q

BPPV pathophys, cause and RF

A

BPPV occurs when small crystals of calcium carbonate, shift in the inner ear and/or fall into another area within the balance canals

Cause: inner ear infx (labyrinthitis), fever, head injury, whiplash injury

RF: Concussions, meniere’s, DM, HTN

120
Q

Neck lump ddx and ix

A

Ddx
- Tumour
- Goitre
- Skin abscess / cyst
- Lymphadenopathy

Ix
- Blood film
- HIV
- Monospot/EBV test
- TFT
- USS (soft tissue sarcoma)
- CT

121
Q

Head and neck ca mx

A

Cons: SALT, dietitician input, psychosocial support
2ndry prev: smoking/alc/fruit/veg/reduce red meat + fried food / reg dentist/ vax against HPV

122
Q

Types of lympadenopathy

A
  • Reactive
  • Infected
  • Inflamm
  • Malignant
123
Q

Sore throat ddx

A
  • Tonsillitis (most commonly due to group A strep/strep pyogenes)
  • Pharyngitis/laryngitis
  • Infx mono/glandular
124
Q

Tonsillitis mx

A

Cons: avoid spread, analgesia, safety net
Med:
- ABx: if CENTOR >= 3 or FeverPAIN >=4; if not delayed abx
Surg
- ENT ref if recurrent >7/year or 5/year for 2 years or 3/year for 3 years

125
Q

FeverPAIN

A

Fever past 24h
Purulent tonsils
Attend rapidly within3 days
Inflamm tonsils severely
No cough or coryza

126
Q

TOnsillitis complx

A
  • Otitis media
  • Quinsy (peritonsillar abscess)
  • OSA
127
Q

Otitis externa complx

A
  • Abscess
  • Stenosis ear canal
  • Perf tymp membr
128
Q

Otitis media ±effusion

A

Cons
- watch & wait, usually resolves 3-7 days
- Analgesia
- Valsalva manouevre
Med
- Admit if syst unwell
- Immed abx if syst unwell/immunosupp
- Delayed prescr after 3 days if syx dont impr
Surg
- ENT ref if complx -> tympanocentesis or grommet fitting

129
Q

Common pathogenic causes and complx of otitis media

A

Pathogens: strep pnum, RSV
- Facial N palsy
- Mastoiditis
- Acute labyrinthitis

130
Q

Meniere’s Ix and Mx

A

Ix
- Audiometry (low freq sensorineural hearing loss)
- MRI (excl vestibular schwannoma)

Mx
- Decr salt and caffeine intake
- DVLA
- Vestibular suppressants for acute eps (prochlorperazine)

131
Q

Achilles tendinopathy mx

A
  • Rest + immobil
  • Ice
  • Analgesia (NSAIDs)
  • Elevation
  • 6-12 weeks to heal
  • Night splints to hold foot in neutral position
  • VTE prophylaxis
  • Physio input

If ruptured
- Period of non weight bearing
- Brace or plaster cast
- Surgical r/v

132
Q

Carpal tunnel, RFs, and mx

A

Compression of median n in risk

RFs: overweight, preg, activities repeatedly bend wrist, prev wrist injury

Cons
- Rest
- Minimise activities which exacercbate
- Wrist splint
- Trial NSAIDs ± PPI cover
- physio
- ergonomic changes

Med
- Steroid inj (syx relief)

Surg
- Carpal tunnel decompr surgery
- Sonographically guided carpal tunnel release

133
Q

Shoulder pain Ddx and Ix

A
  • Rotator cuff tear (USS)
  • Rotator cuff rupture (USS)
  • Adhesive capsulitis (frozen shoulder)
  • OA (XR)
  • #
134
Q

Rotator cuff inj mx

A

Cons
- Rest
- Analgesia
- Ice
- Adapt activities
- Physio

Surg
- Depends on degree of damage lol

135
Q

Compartment syndrome
ddx, cause and mx

A

increase in pressure inside a muscle, which restricts blood flow and causes pain

ddx
- #
- Haematoma
- RHabdo

cause
- #
- badly bruised muscle
- constricting bandages

mx
- urgent ortho referral for fasciotomy
(relieve Pa within compartment and restore blood flow -> prevent tissue necrosis) within 6h
- Analgesia
- oral hydr
- remove any external dressings
- elevate leg to heart level

136
Q

ACL tear ddx, ix, mx

A

ddx
- #
- Patellar disloc
- meniscal tear

ix
- MRI
- arthroscopy (gold standard to visualise ligaments)

Mx
- ortho ref
Cons
- Rest, ice, compression, elevation, rehab
- analgsia: NSAID
- crutches/knee brace
-physio
Surg
- Ligament reconstruction (arthroscopic surgery) in complete rupture where no local healing detectable

137
Q

Fall/collapse ix

A
  • Primary survey
  • Lying/standing BP
  • ECG
  • Urine dip
138
Q

NOF # mx

A

Cons
- analgesia
- VTE prophylaxis
- PT/OT input
- prophyl abx if open wound
- falls assessment (age, presenting w/ fall, meds or med conditions that incr risk fall, hx falls, etc)
- r/v meds

Surg
Intracapsular
- Displaced: THR or hemiarthroplasty
- Undisplaced: dynamic hip screw

Extracapsular
- Intertrochanter: dynamic hip screw
- Subtrochanter: intramedullary nail

139
Q

Meds that increase risk of falls in elderly

A
  • HTN meds
  • Benzodiazepines
  • Antidepressants
  • Antipsychotics
  • Opioids
  • NSAIDs
140
Q

Garden classification

A

For subcapital femoral neck #, predicts development of osteonecrosis

141
Q

HTN dx value and stages + targets

A

Dx: >140/90 (clinic), or 135/85 (home)

Stage 1: >140/90, or >135/85
Stage 2: >160/100, or >150/95
Stage 3: >180/120

<80 y/o: <140 S, <90 D
>80 y/o: <150 S, <90 D

142
Q

HTN end organ damage ix

A
  • Kidney: dipstick -> proteinuria, haematuria // Urine albumin:creatinine ratio // U&Es
  • Eye: fundoscopy -> hypertensive retinopathy
  • Bloods: glucose, lipid profile
143
Q

Osteoporosis RF

A
  • Incr age
  • F
  • Low BMI
  • Long term steroids
  • Alcoh
    -Smoking
144
Q

FRAX assess

A

Risk of fragility # over next 10 years

145
Q

CIs of LP

A
  • Local skin ifx
  • Spinal cord compr
  • Papilloedema/other signs of raised ICP
146
Q

Adhesive capsulitis (frozen shoulder) and mx

A

fibrosis and thickening of the joint capsule and adherence to the humeral head

onset to recovery 12-42 months, most pts recover but normal ROM may not return

!diabetes pts at higher risk

Mx
Cons
- Continue using arm but dont exacerbate pain
- Physio -> active/passive exercise and stretching
- Analgesia ± TENS (transcutaneous electr N stim) for pain mx
- Pain clinic/ortho if signif disab + poor pain control

Med
- Intra-articular steroid injections

Surg
- Arthroscopy to remove adhesions

147
Q

Phases of adhesive capsulitis

A

Freezing/inflamed -> frozen/stiff -> thawing

148
Q

Cauda equina ddx, ix and mx

A

Ddx
- Prolapsed lumbar disc
- Conus medullaris
- Peripheral neurop

Ix
- ER MRI to confirm/exclude

Mx
- Hosp admission
- Neurosurg input -> lumbar decompr surg
- VTE proph
- Abx if infx cause

149
Q

Conus medullaris v cauda equina

A

Vertebral level
CM: most distal end of spinal cord - CNS (L1-2)
CE: collection of N roots - PNS (L2-S5)

Impacted n roots
CM: sacral
CE: lumbosacral

Symmetry of signs
CM: symmetrical
CE: asymmetrical

Involvement of lower extr, bowel, urin
CM: less extr, but more bowel + urin
CE: more

Reflexes
CM: Increased
CE: decreased

150
Q

Spinal stenosis, syx, rf, ix, mx

A

Narrowing of spinal canal -> compr of spinal n, or sometimes spinal cord.

syx: back pain + leg pain ± numbness, mostly when walking

rf:
- Narrow spinal canal
- F
- >= 50 yo
- Prev inj/spinal surg

ix: MRI

mx:
1. Cons
- Physio: impr spiinal mobility, strength
- Pain mx
- Overal fitness ++, ± weight loss
2. Med
- Spinal injections
- Nerve root block
3. Surg
- Decompression

(*types: lateral, central and foraminal stenosis)

151
Q

Acute prostatitis presentation and ddx

A

Most commonly due to ascending urethral infx

  • Groin pain, worse on opening bowels
  • Dysuria, incr freq, slow stream
  • Feverish
    (can be caused by STIs huh)

Ddx
- UTI
- Urinary tract stones
- Prostatic abscess

152
Q

Acute prostatitis mx and complx

A

Cons
- Analgesia

Med
- Admission if acutely ill/septic
- Abx if <6/12 hx
- Alpha blockers, e.g., tamsulosin, to relax smooth muscle and improve syx

Surg
- Suprapubic cath (if urin reten)
- Transrectal aspiration under US guidance for abscess

Complx
- Abscess
- Epididymitis
- Sepsis

153
Q

Haemorrhoids

A

Swollen vein/group of veins around anorectal region
(*Thrombosed -> when blood clots develop -> pain & itch + -> bleed if ulcerated)

154
Q

Haemorrhoids mx

A
  • Topical trx to reduce swelling/pain - anusol
  • Constip: incr fibre + fluid intake
  • Non-surg: rubber band ligation (cut off blood supply), bipolar diathermy
  • Surg: haemorrhoidectomy, haemorrhoidal artery ligation
155
Q

Lateral epicondylitis (tennis elbow) ddx, ix, mx

A

Ddx
- Olecranon bursitis
- Elbow arthritis

Ix
- Clinical dx
- XR if unclear

Mx
- Self limiting (most good progn)
- Rest
- Modify activities that exacerbate syx
- NSAIDs
- Apply heat/ice
- Physio
- Orthotics - elbow braces
Med: ± steroid inj short term relief
Surg: release/repair damaged tendons

156
Q

MM ddx, ix, mx

A

Ddx
- Monoclonal gammopathy of undetermined significance (MGUS)
- Bone metastases
- CLL

Ix
- Urine electrophoresis (Bence Jones protein)
- Bone profile (ca)
- Serum protein electrophoresis (shows which type of myeloma proteins raised)
- Blood film (rule out leukaemia)
- XR (lytic bone lesions)

Mx
Cons: analgesia, hydration, emotional/psych support
Med: trx guided by haem and onc specialists
- Non chemo regime: combo of dexamethasone and immunomodulatory agent
- Conven chemo: as above + chemo, e.g., cyclophosphamide
- Cement inj in #/lesions to improve spine stab
- Stem cell transpl
- Treat any complx myeloma

157
Q

MM complx

A
  • infection
  • renal failure
  • spinal cord/nerve root compression
  • neuropathy
158
Q

MM v MGUS v smouldering myeloma

A

MM: malignant cancer of plasma cells that produce abnormal M protein, which can cause bone pain, anaemia, kidney damage, and other symptoms

all related to the abnormal growth of plasma cells in the bone marrow, but differ in terms of severity and risk of progression to multiple myeloma

MGUS: benign condition presence of small amount of abnormal monoclonal protein (M protein) in blood without any symptoms or organ damage. MGUS does not require treatment and does not progress to multiple myeloma in most cases.

SM: higher level of M protein and abnormal plasma cells in the bone marrow than MGUS, but no symptoms or organ damage. Smoldering myeloma has a higher risk of progression

159
Q

Leukaemia, presentation, ddx, ix

A

Ca of particular line of stem cells in bone marrow - myeloid v lymphoid

Prx
- Bruising/petechiae
- FLAWS
- pallor
- hepatosplenomgaly

Ddx
- HSP
- ITP
- Meningococcal septicaemia

Ix
- Blood film!
- Bone marrow biopsy

160
Q

HSP

A

Henoch-Schönlein purpura (HSP) is an IgA mediated vasculitis, tends to occur post-infection with the most common trigger being group A streptococci (URTI or GI)

purpura on legs, buttocks, arms
(self limiting)

161
Q

ITP

A

Purpura + low platelets following viral illness

(self limiting)

162
Q

AML (acute myeloid leukaemia)

A

Most common acute adult leukaemia. It can be the result of a transformation from a myeloproliferative disorder (e.g., PCV or myelofibrosis). Associated with Auer rods + blast cells ++.

163
Q

CML (chronic myeloid leukaemia)

A

Has three phases: 1) chronic - 5yr and asyx, 2) accelerated and 3) blast. Associated with the Philadelphia chromosome.

164
Q

CLL (chronic lymphocytic leukaemia)

A

Most common leukaemia in adults overall. Associated with warm haemolytic anaemia, CLL can undergo Richter’s transformation into high grade lymphoma. Blood film shows smudge / smear cells.

165
Q

Chemo complx

A
  • Failure
  • Infx due to immunodef
  • Infertility
  • TLS
166
Q

TLS

A

Release of uric acid from cells being destroyed by chemo -> forms crystals in interstitial tissue and tubules of kidneys -> AKI

mx: allopurinol

167
Q

Causes clubbing

A

Cardiac
- Congenital heart disease
- Infective endocarditis

Respiratory
- Lung ca
- Bronchiectasis
- Pulm fibrosis / ILD

GI
- IBD
- Coeliac

168
Q

CV exam spiele

A
169
Q

Resp exam spiele

A
170
Q

ILD -> pulm fibrosis causes by areas of lung

A
171
Q

Abdo spiele

A
172
Q

Ddx abdo pain

A
173
Q

UMN v LMN

A
174
Q

Upper limb spiele

A
175
Q

LL spiele

A
176
Q

Hip exam spiele

A
177
Q

Knee exam spiele

A
178
Q

Mc Murray’s test

A
179
Q

OA Knee XR spiele

A
180
Q

OA mx

A
181
Q

Knee joint repl

A
182
Q

Hands and wrist spiele

A
183
Q

Breast spiele

A
184
Q

Vascular spiele

A

I performed a vascular exam on this x year old pt.
The patient appeared comfortable at rest.
On examination, there were no signs associated with vascular disease. CRT was <2s both in upper and lower limbs. All pulses were palpable throughout the body. Buergers test was negative.

185
Q

Breast signs

A
186
Q

Breast path

A
187
Q

HL and NHL ix and mx

A
188
Q

HIV patho

A

Once inside the body, HIV gets inside certain types of white blood cell called CD4. These cells are part of the body’s defenses against infection.Without treatment the virus gradually damages the immune system. Eventually people become susceptible to unusual infections that would not normally trouble someone with a healthy immune system.

189
Q

E.g.s of AIDs defining illnesses

A
  • Bacterial infx - multiple or recurrent
  • Kaposi sarcoma
  • Pneumocystis jirovecii pneumonia
190
Q

Mx new HIV dx

A

General mx new HIV dx

  • ART
    • START study - better health outcomes when starting early
    • Normal life expectancy
    • Undetectable = untransmittable
      • <50 copies/ml undetectable viral load
  • Contact tracing & PEP
  • Charities offering support
  • Once stable
    • Monitor 2x/year: in-depth annual r/v and six-monthly viral load, hepatitis and syphilis test
191
Q

Febrile neutropenia

A

Duet to pt’s decreased ability to mount an inflamm response

  • most common life-threatening complication of cancer therapy - onc emergency
  • Prompt empirical abx trx
192
Q

IBD + preg mx

A
  • 5 mg of folic acid per day + Ca + vit D supplementation ± nutritional support if not gaining weight early in preg
    • Meds such as sulfalazine interfere folic acid metab
    • Latter 2 to prevent bone loss
193
Q

Types of AF

A
  • Paroxysmal: occurs intermittently and stops on its own within 7 days
  • Persistent: lasts longer than 7 days
  • Long-standing: lasts longer than a year
194
Q

*Fluttering chest syx w no pain (±tachy, SOB, dizziness/lightheadedness) ddx

A
  • AFib
  • SVT
  • Premature ventricular contractions
195
Q

How is acromegaly linked to heart problems?

A

Acromegaly is a condition that results from excess growth hormone (GH) secretion by the pituitary gland. This excess GH can cause abnormal growth of body tissue, including the heart.

One of the most common cardiac problems associated with acromegaly is hypertrophic cardiomyopathy, which is a thickening of the heart muscle. This occurs most commonly at the septum, which can cause reduced, or even obstruction, of blood flow out of heart.

You can also get stiffness of the ventricle due to cellular changes that happen in cardiac muscle when it thickens - ventricle can’t relax normally and fill with blood → less blood at end of filling → less blood pumpled to rest of body

196
Q

Causes of end stage renal disease

A
  • Diabetes
  • HTN
  • PKD
  • SLE
  • Kidney stone
  • Chronic pyelonephritis
197
Q

ADPKD (autosomal dominant polycystic kidney disease) and cause

A

Fluid filled cysts develop → gradually enlarge + damage kidney → reduced kidney function over time

Cause: mutation of PKD1 or PKD2 gene which produce proteins that are important for kidney function.

198
Q

ADPKD syx and mx

A

Syx

  • Abdo pain
  • Back pain
  • Haematuria
  • HTN

Mx

  • Refer to nephrology
  • Monitor kidney function
    • Creatinine
    • eGFR
    • urine dip for protein
  • Mx HTN
    • ACEi/ARBs
  • Mx pain
  • Genetic counselling
199
Q

(Charcot triad) - dx features of cholangitis

A
  • Jaundice
  • RUQ
  • Fever
200
Q

Peripheral arterial disease subtypes

A

1) Intermittent claudication ->
2) critical limb ischaemia
3) acute limb ischaemia

201
Q

Intermittent claudication

A

syx of ischaemia during exertion
- crampy/achy pain which resolves on rest

202
Q

Acute limb ischaemia

A

rapid onset limb ischaemia due to thrombus (/clot) blocking supply to distal limb!
- 6Ps!
- emergency trx needed

203
Q

Critical limb ischaemia

A

end stage disease (chronic) - inadequate blood supply at rest
- Pain at rest
- Muscle wasting
- Hair loss
- Non-healing ulcers
- small, deep, well-defined borders
- More peripherally, e.g., toes
- painful
- Gangrene

204
Q

Atherosclerosis

A

Lipid deposits in artery walls → atheromatous plaques → stiffening (which causes HTN and increased strain on heart) + stenosis (reduced blood flow) + plaque rupture (thrombus)

205
Q

End results atherosclerosis

A
  • Angina
  • MI
  • TIA / stroke
  • Peripheral artery disease
  • Chronic mesenteric ischaemia
206
Q

Intermittent claudication mx

A

Lifestyle changes
- stop smoking
- exercise training programme
- treatment of medical conditions
Medical:
- Atorvastatin 80mg
- clopidrogel 75mg
- naftidrofuryl oxalate (peripheral vaso-dilator)
Surgical
- Angioplasty and stenting
- Inserting catheter through arterial system under xray guidance → balloon inflated at area of stenosis to create space in the lumen → stent to keep artery open
- Endarterectomy
- cutting vessel open and removing atheromatous plaque
- Bypass surgery
- Using graft to bypass blockage

207
Q

Mx critical limb ischaemia

A
  • Urgent referral to vasc team
  • Analgesia to manage pain
  • Urgent revascularisation
    • Endovascular angioplasty and stenting
    • Endardectomy
    • Bypass surgery
  • Amputation
    • If unable to restore blood supply
208
Q

Mx acute limb ischaemia

A
  • Urgent referral to oncall vasc team
  • Endovascular thrombolysis
    • Inserting catheter and applying thrombolysis directly to clot
  • Endovascular thrombectomy
    • Inserting catheter and removing thrombus via aspiration/mechanical device
  • Surgical thrombectomy
    • Cutting open vessel and removing thrombus
  • Endarterectomy
  • Bypass surgery
  • Amputation

How do you unblock an artery? - Fogarty catheter

209
Q

Venous disease and classification

A

Veins bring blood back to the heart, in venous disease veins become diseased or abnormal so we essentially have a drainage issue.

Venous disease can be classified via CEAP classes (Clinical manifestation, etiology, anatomic distr, and pathophysiology), the following is the C bit:

C0 - no signs of venous disease

C1- telangiectasia/spider vei

C2 - varicose veins

C3 - oedema

C4 - skin changes, e.g., pigmentation

C5 - healed venous leg ulcer

C6 - active venous leg ulcer

210
Q

Venous ulcers

A
  • Larger, more superficial
  • Irregular border
  • Affect midcalf down to ankle
  • Less pain
  • ±Haemosiderin staining
  • ±venous eczema
211
Q

Venous disease ix and mx

A

Investigations: duplex USS (look at the speed of blood flow, and structure of the leg veins)

Management (venous ulcer)

  • Conservative: ulcer clinic for compression banding, analgesia, patient education - self-care, including regular exercise, maintaining a healthy weight, keeping limb raised where poss
  • Medical: corticosteroids for itching, abx for infx
212
Q

ILD v PF

A

ILD are a group of lung conditions which cause inflamm and scarring

PF is what the scarring itself is called

213
Q

Parkinson plus syndromes and some features

A
  • Multisystem atrophy
    (LSBP -> shy drager syndrome)
  • Progressive supranuclear palsy
    (eye movements -> nystagmus)
  • Corticobasal degeneration
214
Q

Causes aortic stenosis

A

-Degenerative: age-related calcific
- Infx: Rhfever, IE
-Structural: HOCM

215
Q

Aortic stenosis: Signs of severity

A

-Narrow pulse pressure / slow-rising pulse
-Delayed closure of A2 or reversed splitting of 2nd HS
-Absent 2nd HS
-Heaving apex beat
-Features of congestive cardiac failure
-Symptomatic

216
Q

Aortic stenosis: Indications for surgery

A

-Symptomatic
-CCF
-Mean transvalvular pressure grdient -> Pa before and after valve
>40mmHg; valve area <1cm^2; or jet velocity
>4m/s
-Concomitant CABG

217
Q

Surg options for aortic stenosis

A

-Open surg
-TAVI
:) No bypass / large scars
:( ^ risk stroke vs open
-Balloon valvuloplasty

218
Q

Metallic v bio valve

A

TAVI usually inserted via temporal artery and up into aorta
Metallic:
-Lasts >20-30 yrs
- ☑ Warfarian life long -> younger pt
- ☑ hyperpanothyr

Bio:
- Lasts 10-15 yrs -> More likely replacement
- Not typically needing warfarin -> older pt
- ☑ Kidney disease

219
Q

Warfarin targets (examples)

A

Aortic bioprosthetic -> Nil (aspirin) -> n/a
}Much lower rates thromboembolic events
Mitral bioprosthetic -> 2.5 (2-3) -> 3 months (then aspirin)

Aortic mechanical -> 3 (2.5-3.5) -> Life-long !Mech. valve ALWAYS warfarin

Mitral mechanical -> 3.5 (3-4) -> Life-long

INR target mitral > aortic as mitral valve at greater risk thromboemb. event

220
Q

CABh most commonly used

A

Internal thoracic (mammary) ARTERY currently most commonly used

221
Q

Coronary artery bypass grafting: Medication post-CABG

A

1:-Dual anti-platelets (aspirin + -c-l-o-p-i-d-o-g-r-e-l-) -> ticagrelor -> more common
- For 12 months
- Then aspirin alone
- +/- Specialist opinion [NICE]
2:-Cardio-selective beta-blocker (e.g. bisoprolol)
3:-ACE-inhibitor (or angiotensin receptor blocker) -e.g. ramipril

222
Q

Causes of mitral regurg:

A

-Degen: M1
-Infx: RhF, IE
-Autoimm: SLE
-Structural: conn. tiss dis, e.g. Marfans

Year 6 Written (26 decks)

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