pack 1 Flashcards
Hydroxychloroquine adverse side effect
Retinopathy - can result in severe and permanent visual loss
therefore need to monitor visual acuity
Hypercalcaemia:
bones, stones, groans, moans
- Painful bones
- Renal stones
- Abdo GI nausea, vomiting, constipation
- Psychosis, memory loss, lethargy
Hypocalcaemia:
CATS go numb
Convulsions
Arrhythmias
Tetany
Spasms (trousseau’s and chvostek’s sign) and stridor
Numbness in the fingers
Which has mucosal involvement i.e. mouth/vulva:
- bullous pemphigoid
- pemphigus vulgaris
pemphigus vulgaris
- Itchy, tense blisters
- Blisters heal without scarring
- No mucosal involvement
Bullous pemphigoid
5 causes of massive splenomegaly
- myelofibrosis
- CML
- visceral leishmaniasis (kala-azar)
- malaria
- Gaucer’s syndrome
philadelphia chromosome t(9:22) BCR-ABL gene, is present in patients with what ?
Chronic myeloid leukaemia CML
First line treatment for chronic myeloid leukaemia
Imatinib
(tyrosine kinase inhibitor)
second line: hydroxyurea, IFN-a, allogenic bone marrow transplant
Head injury with a lucid interval, what haemorrhage
Extradural haemorrhage
Convex/lens-shaped haemorrhage on CT
Extradural haemorrhage
Concave/crescent moon shaped haemorrhage on CT
Subdural haemorrhage
- Bone-spicule pigmentation on fundoscopy
- Worsening tunnel vision
- Night blindness
Retinitis pigmentosa
Diagnostic test for glandular fever/Epstein Barr virus
Monospot test
Sore throat
Pyrexia
Cervical lymphadenopathy
classic triad of what infection
Epstein barr virus HHV4
Glandular fever, infectious mononucleosis
classical triad of renal cell carcinoma
haematuria
loin pain
abdominal mass
The Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in…
Bradycardia
Hypertension
Wide pulse pressure
Acute and PAINFUL swelling to the thyroid gland with raised TSH
Subacute (De Quervain’s) thyroiditis
- likely preceded by viral infection
- initially hyperthyroid, then hypothyroid, then euthyroid
Grave’s disease autoimmune disease has what antibodies
TSH receptor antibodies
- goitre is PAINLESS
- proptosis, pretibial myxoedema, hyperthyroid picture
what is the most common well-differentiated thyroid cancer
papillary carcinoma
triad of Behcets disease
oral ulcers
genital ulcers
uveitis
+ venous thromboembolism
Lymphogranuloma venereum (LGV) is caused by what pathogen
chlamydia trachomatis
- small painless pustule that forms an ulcer
- painful inguinal lymphadenopathy
- proctocolitis
what is treatment for Lymphogranuloma venereum (LGV) - caused by chlamydia
- small painless pustule that forms an ulcer
- painful inguinal lymphadenopathy
- proctocolitis
Doxycycline
A 23-year-old man presents with an ulcer on the coronal sulcus of the penis. The ulcer is not causing him any discomfort. On examination an ulcer with an erythematous border and a clean base is found. What STI is the cause?
Syphilis
Treatment of provoked PE vs unprovoked PE
Provoked = 3 months of DOAC e.g. apixaban
Unprovoked = 6 months
first line treatment for scabies
permethrin
what is a normal ankle-brachial pressure index value (ABPI)
0.9-1.2
<0.9 = arterial disease >1.3 = disease with calcification
what autoantibody has the highest specificity for rheumatoid arthritis
anti-CCP
Management of venous ulceration
- Compression bandage
2. Oral pentoxifylline
treatment for gonnorrhoea
IM ceftriaxone
treatment for chlamydia
oral doxycycline
treatment for BV and trichomonas
oral metronidazole
4 main features of PTSD
- Avoidance
- Hyperarousal/vigilance
- Emotional numbing
- Flashbacks/nightmares
COPD patients if they are non-smokers, optimised all other therapy and have any of:
- frequent exacerbations with sputum
- prolonged exacerbations
- hospitalisations from exacerbations
can have what medication for prophylaxis?
azithromycin
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced <70%
What is the cause
Obstructive disease e.g. COPD, asthma
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased >70%
What is the cause
Restrictive disease e.g. fibrosis
Background retinopathy features
- microaneurysms (dots)
- blot haemorrhages
- hard exudates
- Cotton wool spots (soft exudates)
- > 3 blot haemorrhages
- Cluster haemorrhages
Pre-proliferative retinopathy
treat with laser photocoagulation
- Retinal neovascularisation
- Vitreous haemorrhage
- Fibrous tissue forming
Proliferative retinopathy
- Hard exudates
- Background changes on macula
Maculopathy
Adrenaline IM dose for anaphylaxis
500 micrograms (0.5mg)
0.5ml 1:1000
can be repeated every 5 mins
coeliac disease genes
HLA-DQ2
HLA-DQ8
coeliac disease auto-antibodies
IgG anti-endomysial
IgG anti-gliadin
IgA tissue transglutaminase
Central retinal artery occlusion causes sudden unilateral visual loss. It is due to …
- thromboembolism (from atherosclerosis); or
2. arteritis e.g. temporal arteritis
Afferent pupillary defect
Cherry red spot on pale retina
Unilateral sudden visual loss
What is the diagnosis
Central retinal artery occlusion
Acute management of SVT (haemodynamically stable)
- Vagal manoeuvres
- IV adenosine 6mg -> 12mg -> 12mg
- Electrical cardio version
n.b adenosine is contraindicated in asthmatics so verapamil is used
Most common type of peptic ulcer and epigastric pain relieved by eating
Duodenal ulcer
Most common cause of travellers diarrhoea
E coli
what antibiotic can cause long QT interval
erythromycin
what medication exacerbates plaque psoriasis
beta-blockers lithium antimalarials NSAIDs ACE inhibitors infliximab
what antibiotics should be avoided in patients on methotrexaate
trimethoprim
co-trimoxazole
fluctuating reduction in visual acuity, especially at night, with druse - small accumulations of extracellular material between Bruch’s membrane and retinal pigment epithelium of the eye.
What is the diagnosis
DRY age-related macular degeneration
wet = has choroidal neovascularisation
Presbyopia
lack of eye accommodation with age, cannot focus on close objects
Ankylosing spondylitis features - the six ‘A’s
- apical fibrosis
- anterior uvetitis
- aortic regurg
- achilles tendonitis
- AV node block
- amyloidosis
What is the genotype positive in 90% of ankylosing spondylitis patients
HLA-B27
what is 1st line management for ankylosing spondylitis
Exercise regimes
NSAIDs e.g. meloxicam
If these don’t work then adalimumab
post-herpetic neuralgia treatment
amitriptyline
or gabapentin
1st and 2nd line treatment for c diff
- vancomycin
2. fidaxomicin if the above does not work
what section allows treatment up to 6 months
Section 3
section 2 = 28 days
72 hour assessment order section for a patient NOT in hospital
section 4
police mental health act order at home vs in public
section 135 - home
section 136 - public
what section allows treatment up to 28 days
section 2
section 3 = 6 months
haematoma between the dura and arachnoid
subdural haematoma
- concave shaped
Palpating under the right costal margin causes her to catch her breath with cholecystitis is what sign
Murphy’s sign
Ascending cholangitis triad
- fever
- RUQ pain
- jaundice
Constipation in children first line medication
movicol
Primary pneumothorax treatment if:
(a) <2cm /no SOB
(b) >2cm
(a) Discharge or aspiration
(b) Chest drain
Secondary pneumothorax treatment if:
(a) <2cm
(b) >2cm/SOB/ older than 50
(a) Aspiration - or chest drain if fails
(b) Chest drain
toxoplasmosis treatment in:
(a) immunocompromised
(b) normal immune system
(a) pyrimethamine
(b) no treatment needed
what diabetic meds bind to ATP-dependent potassium channels on pancreatic b-cells to increase insulin release?
sulfonylureas
e.g. gliclazide
oral hypoglycaemic drug.
treatment for minimal change glomerulonephritis
prednisolone steroids
if steroids doesn’t work, biopsy is indicated
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, what is the next step
admitted immediately for CT imaging to exclude a haemorrhage
The partial horner’s syndrome is actually a fairly common sign seen in what headaches
cluster headaches
horner’s syndrome signs
ptosis - drooping eyelid
miosis - small pupil
anhidrosis
Most common complication of measles is…
otitis media
+/- pneumonia
The most common complication of measles is otitis media.
What are 4 late complications of measles infection:
- keratoconjunctivitis
- encephalitis
- subacute sclerosing panencephalitis
- pneumonia
what is the antibiotic treatment for salmonella
ciprofloxacin
what pathogen is the most common cause of discitis
staph aureus
what is gold standard test for degenerative cervical myelopathy
MRI spine
XRAY CANNOT DIAGNOSE IT
Sudden painless loss of vision
Severe retinal haemorrhages on fundoscopy
What is the diagnosis
Central retinal VEIN occlusion
Otitis externa can be caused by bacteria (staph aureus, pseudomonas), dermatitis and swimming. It has an itchy discharge ear with red, swollen, eczema canal on otoscopy.
What is the treatment for this
- Topical antibiotic
- With topical steroid
malignant otitis externa is more common in elderly diabetics
Malignant otitis externa is the extension of infection into the bony ear canal. What group of patients is it most common in?
elderly diabetics
usually needs IV Abx
huntington’s disease is a defect in what gene on what Chr
Huntingtin gene on Chr 4
Pneumocystis jiroveci penumonia treatment
co-trimoxazole
in severe cases = IV pentamidine
parkinson’s disease - if motor symptoms are affecting patient’s life the most, what treatment
L-dopa
parkinson’s disease - if motor symptoms are NOT affecting patient’s life, what treatment
- dopamine agonist (non-ergot derived) e.g. cabergoline, bromocriptine
- or levodopa
- or MAO-B inhibitor e.g. selegiline
Obese, young female with headaches / blurred vision
idiopathic intracranial hypertension
Obese, young female with headaches and blurred vision has benign idiopathic intracranial hypertension.
What is management
- Weight loss program
- Azetazolamide if abnormal visual findings
- Topiramate
- Lumbar puncture
- Surgery - optic nerve sheath decompression, shunts to reduce intracranial pressure
In the UK, men are offered abdominal aneurysm screening at what age with what method …
single abdominal ultrasound at 65 years
trigeminal neuralgia treatment
carbamazepine
Guillain-Barre syndrome is classically triggered by which infection
Campylobacter jejuni
Which pathogen is the most common cause of viral meningitis in adults
Coxsackie virus
Miller Fisher syndrome is a variant of Guillain-Barre syndrome (but it is descending paralysis rather than ascending). What is the triad
Opthalmoplegia
Areflexia
Ataxia
Miller Fisher syndrome is a variant of GBS (but it is descending paralysis rather than ascending) with ophthalmoplegia, areflexia and ataxia.
What antibodies are seen in Miller Fisher syndrome?
Anti-GQ1b antibodies
What 3 criteria exist for urgent endoscopy 2 week cancer wait cancer referral?
- Dysphagia
- Upper abdo mass that feels like stomach cancer
- > 55yo with weight loss AND pain, reflux or dyspepsia.
The most common organism causing infective exacerbations of COPD is
Haemophilus influenzae
rifampicin side effects
hepatitis
orange secretions
liver inducer
isoniazid side effects
peripheral neuropathy
hepatitis
agranulocytosis
liver enzyme inhibitor
pyrazinamide side effects
hyperuricaemia - gout
arthralgia
myalgia
hepatitis
ethambutol side effects
optic neuritis
renal impairment
haematoma between the dura and the skull
epidural haematoma
- convex shape
How to differentiate between Erythema multiform major and Steven Johnson’s syndrome?
- Erythema multiform major has target lesions, usually after INFECTION e.g. herpes
- Steven Johnson’s syndrome usually follows DRUG reaction with blistering.
Difference between Steven Johnson’s Syndrome and Toxic Epidermal Necrolysis
SJS is <10% surface area involvement
TEN >30% involvement
areas of darkened and thickened skin in the axillary creases in obese person
Acanthosis nigricans
usually associated with Cushing’s syndrome, PCOS, steroids, insulin
Hepatocellular carcinoma most common causes:
(a) worldwide
(b) in Europe
(a) hep B
(b) hep C
Koebner phenomenon (new skin lesions at site of trauma) and polygonal white-line (wickham’s striae) shaped rashes are seen with what skin lesion
Lichen planus
usually on palms, soles, genitalia, flexor surfaces of arms
The standard HbA1c target in type 2 diabetes mellitus if on metformin/no meds is
48mmol/mol
it is 53 if taking sulfonylurea e.g. gliclazide
Treatment of lichen planus
Topical steroids
Oral lichen plants - benzydamine mouthwash or spray
Transferrin (aka TIBC) levels and transferrin saturation levels in iron deficiency anaemia are usually…?
Transferrin (TIBC) = high
Transferrin saturation levels = low
Carpal tunnel syndrome is the entrapment of which nerve
Median nerve
- thenar muscle wasting
- parasthesia
- pain at night
- weakness of LOAF muscles
cutaneous form of T-cell lymphoma that can present like eczema or psoriasis
Mycosis fungoides
Loss of foot dorsiflexion + sensory loss dorsum of the foot, positive sciatic nerve stretch test - what nerve root is affected
L5
What is this patient’s audiogram results below suggestive of?
- Bilateral impairment
- High-frequency hearing loss
- Downward-sloping pure tone thresholds
presbyacusis
Otoscopy would show a greasy, pearly-white lump in the ‘attic’ of the tympanic membrane. An audiogram will show a conductive hearing loss with an ‘air-bone gap’ suggests what diagnosis?
Cholesteatoma
After acute ischaemic stroke, aspirin 300mg should be given, and then switched to..
75mg clopidogrel lifelong
if clopidogrel contraindicated, then aspirin 75mg and MR dipyridamole can be used.
This patient is presenting with flashers and floaters which are associated with…
retinal/vitreous detachment
- retinal = starts peripherally, goes centrally, straight lines appear curved
- vitreous - peripherally
Ischaemic optic neuropathy is also known as
amaurosis fugax
- pale swollen optic disc
- cotton wool spots
- curtain coming down
- treat with aspirin 300mg
What is step-up management of acne
- Single topical retinoids/benzoyl peroxide
- Combination topical therapy (Abx, BP, retinoid)
- Oral Abx with topical retinoid/benzoyl peroxide
- COCP in women as an alternative to oral Abx
- Oral retinoids
Sudden onset sensorineural hearing loss (SSNHL) is caused by what in 80% of cases
acoustic neuroma
Hearing loss
Vertigo
Tinnitus
ABSENT corneal reflex
Are important signs of…?
Acoustic neuroma
- with sudden onset sensorineural hearing loss
Associated with neurofibromatosis type 2
What two chromosomes do neurofibromatosis type 1 and type 2 affect?
NF1 - Chr 17
NF2 - Chr 22
What is the diagnosis with the signs of:
- cafe-au lait spots
- CUTANEOUS neurofibromas
- Lisch nodules - iris hamartomas
Neurofibromatosis 1
Chr 17
These are a/w phaeochromocytomas and optic gliomas
What is the diagnosis with the signs of:
- sensorineural hearing loss
- bilateral acoustic neuroma (vestibular schwanoma)
- meningiomas
- cataracts
- ependynomas
Neurofibromatosis 2
Chr 22
What topical agent may be used on a long-term basis for psoriasis?
Calcipotriol
