PassMed Flashcards
1
Q
Erythema nodosum presentation
A
- can develop after a flu like illness
- tender, nodular lesions on the limbs
- assoc w pregnancy
2
Q
erythema multiforme
A
ed patches on the hands before progressing to target lesions.
3
Q
Polymorphic eruption of pregnancy
A
- occurs in late pregnancy
- intensly itchy rash - vesicles, papules and plaques
- starts on abdomen, in stretch matks
4
Q
pemphigold gestationis
A
- autoimmune blistering in pregnancy
- Lesions often start around the umbilicus before spreading to other parts of the body
- tends to affect mucous membranes
5
Q
pomphylx
A
dyshidrotic eczema, primarily affects hands and feet causing itchy vesicles (seen more in pregnancy but is basically just eczema)
6
Q
Erythroderma - mjst monitor for
A
Inpatient treatment for erythroderma must be monitored for complications like dehydration, infection and high-output heart failure (SOB)
7
Q
scabies Tx
A
Permethrin 2x doses 1 week apart for the patient and all household contacts
8
Q
how is shingles diagnosed
A
clinical
9
Q
who starts retinoids
A
topical can be started by GP, oral by dermatology only
10
Q
what causes ecxema herpeticum
A
Eczema herpeticum is a primary infection of the skin caused by herpes simplex virus (HSV) and uncommonly coxsackievirus
11
Q
levido retocularis =
A
discolouration of the skin resulting from reduced blood flow through the arterioles that supply the cutaneous capillaries, commonly affecting the lower limbs.
12
Q
what is levido reticularis linked to
A
- SLE
- antiphospholipid
- polyartertis nodosa
13
Q
Four Ds of pellagra
A
Four D’s of pellagra (vitamin B3 deficiency):
Diarrhoea
Dermatitis
Dementia
Death
14
Q
What can cause pellagra
A
Isoniazid, an anti-TB medication, may induce pellagra
15
Q
first line for urticaria
A
Non-sedating antihistamines are first-line for acute urticaria - oral certizine
16
Q
troublesome sleep with urtiaria
A
- add sedating SH like chlorphenamine used at night alongside daytime non sedating
17
Q
Tx for severe or resistant urticaria
A
pred
18
Q
Nikolskys sign
A
Stevens-Johnson syndrome exhibits Nikolsky sign in erythematous areas - blisters and erosions appear when the skin is rubbed gently
19
Q
new onset purpura in a kid ->
A
Children with new-onset purpura should be referred immediately for investigations to exclude ALL and meningococcal disease
20
Q
LT Tx for psoriasis
A
Calcipotriol
21
Q
Tx of choice in scabies
A
permethrin
22
Q
Molloscum contagiosum Mx
A
reassurance
23
Q
First line in rosecea for mild papules and pustules
A
topical ivermectin
24
Q
Koeber phenomenom
A
- lesions develop at sites of skin trauma
- seen in chronic plaque psoriasis
25
Auspitz sign
pinpoint bleeding that occurs when psoriatic scales are scraped off,
26
Roseacea: severe papules and/or pustues
combination of topical ivermectin + oral doxycycline is first-line for patients with severe papules and/or pustules
27
EN is a
paniculitis, inflammation of subcutaneous fat (painful bruises on shins)
28
HHT criteria
- 3/4 = definitive diagnosis
- epistaxis : spontaneous, recurrent nosebleeds
- telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
- visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
- family history: a first-degree relative with HHT
29
HHT inheritance
auto dom
30
dermato[hyte nail infections Tx
oral terbinafine (unless VERY mild then use topical amorolfine)
31
common comps of seb derm
Otitis externa and blepharitis are common complications of seborrhoeic dermatitis
32
Bullous pemphigold vs pemphigus vulgaris
- no mucosal involvement: bullous pemphigoid
- mucosal involvement: pemphigus vulgaris
33
Ab used in acne in pregnancy
erythromycin
34
break bwteeen steroids in psorasis
aim for 4 week break
35
first line for seb derm
topical ketoconazole
36
cause of seb derm
Malassezia furfur
37
what is assoc w seb derm
HIV AND PARKINSONS DISEASE
38
scalp seb derm first line
- ketoconazole shampoo
- OTC zinc pyithione like head anc shouldrrs can be used if person doesnt want this
39
when should a pt be refered to derm for acne
- 2x treatments including oral agent
40
what is the safest C with migraine w aura
Copper IUD
41
RF for ectopic
- PID, surgery (damage to tubes)
- prev ectopic
- endometriosis
- IUCD
42
Baby fundal growth rates (normal)
> before 24 weeks: 2cm per week
> after 24 weeks: 1cm per week
43
what signs of twin to twin transfusion should we warn the mum of
The Royal College of Obstetricians and Gynaecologists advises that mothers should be specifically asked to report any sudden increases in the size of their abdomen and/or any breathlessness, which may be the result of polyhydramnios affecting the recipient twin.
44
what can be used as the progesterone comp of HRT
mirena IUS for 4 yrs
45
Threatened miscarroahe =
painless vaginal bleeding typically around 6-9 weeks
46
Missed miscarriae =
light vaginal bleeding and symptoms of pregnancy disappear
47
Inevitable miscarriage
complete or incomplete depending or whether all fetal and placental tissue has been expelled.
48
complete miscarriage=
- little bleeding
49
incomplete miscarriahe
- heavy bleeding and crampy, lower abdo pain.
50
Ectopic pregnancy
- Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later.
- Shoulder tip pain and cervical excitation may be present
51
hyatidiform mole =
- Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis.
- The uterus may be large for dates and serum hCG is very high
52
Placental abtuption =
- constant lower abdo pain
- shock
- tense woody uterus
- fetal heart may be distressed
53
placental pravia
- vg bleeding no pain
- non tender uterus
- normal lie and pres
54
Vasa pravia
- rupture of membranes followed by immediate vg bleeding
- fetal bradycaria classically seen
55
WHAT SHOULD YOU NOT DO FOR PLACENTAL PRAVIA
VAGINAL EXAM IT CAN CAUSE HAEMORRHAGE
56
Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone →
androgen insensitivity
57
Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency →?
fibroids
58
Hep B and BF
SAFE
59
Ix for urinary incont
- bladder diaries 3 days
- vg exam to exclude prolapse
- then urodynamic studies if diary inconculsibe
60
MCUG is used for
vesicoureteral reflux
61
Which of these is a contraindication for using epidural anaesthesia during labour?
Coaglopathy
62
Expectant management of an ectopic pregnancy can only be performed for
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
63
Ectopic sites
- Ampulla - AMPle space - most common
- Isthmus - IS bad - most likely to rupture
64
PID increases risk of
ectopic
65
surgical ectopic Mx
All ectopic pregnancies >35 mm in size or with a serum B-hCG >5,000IU/L should be managed surgically
66
which surgery tends to be doen for ectopic
laparasocpic salpingectomy/otomy
67
SE of GnRH agonists
Loss of bone mineral density - they induce pseudomenopause
68
High risk of pre-eclampsia: mx
take low dose aspirin from 12 weeks to term of pregnancy
69
Autoimmune conditions & pre-ec
Women with autoimmune conditions such as SLE or antiphospholipid syndrome are at high risk of pre-eclampsia (and should receive 75 mg of aspirin daily)
70
The three features of Meig's syndrome are:
- a benign ovarian tumour
- ascites
- pleural effusion
71
Most common cause of pruitus vulvae
contact derm (from condoms)
72
normal lab findings in pregnancy
Reduced urea, reduced creatinine, increased urinary protein loss
73
EC - copper IUD insertion time
The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later
74
Pregnancy anaemia cut offs
T1: < 110
T2/T3: < 105
PP: <100
75
first degree perineal tears
- superficial damage with no muscle involvement
- do not require any repair
76
Second degree tear
- injury to the perineal muscle, but not involving the anal sphincter
- require suturing on the ward by a suitably experienced midwife or clinician
77
third degree tear
- injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
- repair in theatre
78
4th degree tear
- injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
- require repair in theatre
79
Erbs palsy
- damage to BP usually from shoulder dystocia
- adduction and internal rotation of arm with pronation of forearm
80
waiters tip =
erbs palsy
81
Klumpkes palsy =
ccurs due to damage of the lower brachial plexus and commonly affects the nerves innervating the muscles of the hand.
82
PROM what should be given
- oral erthryomycin
- anetnatal steroids
- IV Mg SULFTE
83
Preterm prelabour rupture of the membranes: IV magnesium sulphate FOR
fetal neuroprotection if < 30 weeks
84
basic cord prolapse managamen
- patient on all 4s
- cord should not be pushed back into uterus (vasospasm)
- presenting part should be pushed pack into uterus
- do a C section
85
Medical Tx for cord prolapse
- tocolytics may be used to reduce uterine contractions
retrofilling the bladder with 500-700ml of saline may be helpful as it gently elevates the presenting part
86
Investigating PPROM
When investigating suspected PPROM, if there is no fluid in the posterior vaginal vault then testing the fluid for PAMG-1 (e.g. AmniSure) or IGF binding protein-1 may be helpful
87
what is most commin after a surgiucal TOP
infection
88
If fetal movements have not yet been felt by ?weeks, referral should be made to a maternal fetal medicine unit
24
89
Which cancer does PCOS inc risk of
Endometrial
90
Hyperemesis Tx
1) Antihistamines like cyclizine or promethazine
1) oral prochlorperazine
2) ondansteron or metoclopramide or domperidone
91
initial Ix for incont
In patients with urinary incontinence, make sure to rule out a UTI and diabetes mellitus
92
Mx of atypical endometrial hyperplasia
A total hysterectomy with bilateral salpingo-oophorectomy, in addition, is advisable for all postmenopausal women with atypical endometrial hyperplasia, due to the risk of malignant progression
93
mx of weight loss >10% in first week
If a breastfed baby loses > 10% of birth weight in the first week of life then referral to a midwife-led breastfeeding clinic may be appropriate
94
Woman on ARB/ ACEi who becomes pregnant
If a pregnant woman takes an ACE inhibitor or angiotensin II receptor blocker (ARB) for pre-existing hypertension this should be stopped immediately and alternative antihypertensives started (e.g. labetalol) whilst awaiting specialist review
95
best type of HRT for VTE risk
Transdermal - no increased risk
96
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity,
, medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)
97
Pueperal psychosis =
, medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)
98
Management of placental abruption when the fetus is alive, <36 weeks and not showing signs of distress
steroids and monitor closely
99
FGM < 18
report to police
100
HRT: unopposed oestrogen increases risk
endometrial ca
101
First line for menorrhagia
Mirena
102
Pregnant women with blood pressure ≥ 160/110 mmHg
admit to local maternity unit for obs and consideration of medication
103
ovarian cysts in early pregnany
physiological (Corpus luteum) - leave them alone
104
snow storm appearance on US
hyatidiform mole (moles burrow in the snow
105
Complete hyatidiform mole
complete -> completely from partner, no fetal parts
106
incomplete hyatidiform mole
Incomplete hydatidiform mole occurs due to two sets of paternal chromosomes and one set of maternal chromosomes. There are often foetal parts present and snowstorm appearance is not seen on ultrasound.
107
how is pre-ec managed
Pre-eclampsia is defined as new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction
108
preferred method of induction with Bishop < 6
Vaginal prostaglandin or oral misoprostol
109
Bishop scoring
- A score of less than 5 = cervix not ready - do not induce!
- A score of 5-7 = cervix ready - induce with a PGE2 pessary.
- A score of more than 7 = cervix ready - induce with artificial rupture of membranes (+/- syntocinon infusion as required)
110
Ix for placental pravia
TVUS
111
which contraception causes weight gain
depO
112
Cat 1 C section
- an immediate threat to the life of the mother or baby
- examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
- delivery of the baby should occur within 30 minutes of making the decision
113
Cat 2 C section
maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision
114
cat 3 c section
delivery req but mum and baby stable
115
cat 4 c section
elective
116
when can u do an ECV for breach/ transverse lie
if amniotic sac has not ruptured
117
? is the medication of choice in suppressing lactation when breastfeeding cessation is indicated
cabergoline
118
AFOL pres
- . malaise, fatigue, nausea
- jaundice, mild pyrexia, hepatitic LFTs, raised WBC, coagulopathy and steatosis on imaging.
119
obestetric cholestasis
severe itching - hands and feet, at night
120
> can be used more than once in the same cycle
levonoresgtrogel and uipristal
121
Bladder still palpable after urination, think
retention with urinary overflow - overflow incont
122
how do most patients with endomerial cancer present
stage 1 disease, amenable to surgery alone
123
Thromboprophylaxis oin prwgnancy
LMWH antenatally + 6 weeks postanatal
124
Withdrawal bleed on the pill
no medical infication, can forgo
125
Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus →
adenomyosis
126
boggy uterus ->
adeno
127
The thyrotoxicosis phase of postpartum thyroiditis is generally managed with
propranolol alone
128
Tx for Mg sulphate toxicity
calc gluconate
129
Magnesium sulphate - monitor
reflexes and RR
130
COCP and smoking
absolutely contraindicated in women over 35 smoking 15 cigarettes or more a day
131
Molar pregnancy blood findings
- High bHCG
- low TSH
- high thyroxine
132
Why is thyroxine high in molar preg
HCG similar to TSH so stimulates thyroxine production
133
NICE recommend arranging emergency secondary care assessment for any woman in whom
pre-ec suspected
134
pre-ec with mild/ moderate HTN after 37 weeks ->
IV Mg sulphate & immediate deliery
135
Raised FSH/LH in primary amenorrhoea ->
consider gonadal dysgenesis (e.g. Turner's syndrome)
136
RF for placental abruption
ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
137
SFH normal range
weeks +/- 2cm
138
Examples of contraceptives that are unaffected by EIDs are:
- Copper intrauterine device - preferred
- Progesterone injection (Depo-provera)
- Mirena intrauterine system
139
antidiabetic safe to BF on
metformin
140
Placental praevis is not
painful
141
when does anti-D need to be given for rhesus negative women
Rhesus negative woman - anti-D at 28 + 34 weeks
142
Missed POP witin 48 hrs of starting
If unprotected sex occurred after a missed POP and within 48 hours of restarting the POP emergency contraception is needed
143
High chance from combined/ quadruple screening
- less risk: non invasive prenatal screening
- amniocentesis: higher risk of miscarriage
144
Mirena is licensed for
- 8 yrs
- but in women over 45 is licenced until 55
145
Gastric sleeve - CI contraception
Patients who have had a gastric sleeve/bypass/duodenal switch cannot have oral contraception ever again due to lack of efficacy, including emergency contraception
146
First line for PPH (medical)
- oxytocin
- alt: ergometrine, carboprost and misoprostol
147
1st stage of labour
1st stage of labour: from the onset of true labour to when the cervix is fully dilated
148
Safest Cfor BC
iud
149
Current breast cancer is a contraindication for
hormonal cont
150
POP most common SE
Progestogen-only pill: irregular vaginal bleeding is the most common adverse effect
151
Post-partum, women only require contraception
21 days from giving birth
152
starting POP PP
at any time, implant can also be started at any time PP
153
Positive antiphospholipid antibodies (e.g. in SLE) is UKMEC ? for the COCP
4 - UNACCEPTABLE HEALTH TISK
154
How long after UPSI can each EC be used
Levon - 72 hrs
Ulipristal - 120 hrs
IUD - 120 hrs or 5 days after ovulation
155
which cancers does COCP inc risk of
Breast and cervical - the CANCERS WE SCREEN FOR
156
COCP - protective against
Ovarian and endometrial
157
MM of missed miscarriage
- Mifepristone orally (mi first)
- Then misoprostol 48 hrs later
158
misoprostol mech
prostaglandin analogue, binds to myometrial cells → strong myometrial contractions → expulsion of products of conception
159
IUD insertion times PP
The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks
160
Second screen for anaemia and atypical red cell autoab
28 weeks
161
Nuchal scan
11-13+6 weeks
162
Urine culture for asymptomatic bacturia
8-12 weeks (booking)
163
UKMEC 4 for COCP
- >35 years old and smoker of > 15 cigarettes per day
- migraine with aura
- Personal history of deep vein thrombosis or pulmonary embolism
- Personal history of stroke or ischaemic heart disease
- Uncontrolled hypertension
- Breast cancer
- Recent major surgery with prolonged immobilisation
- Breast feeding and < 6 weeks postpartum
164
ukmec 3 for COCP
- > 35 years old and smoker of < 15 cigarettes per day
- BMI > 35
- Migraine with no aura
- Family history of deep vein thrombosis or pulmonary embolism in first degree relative < 45 years old
- Controlled hypertension
- Immobility e.g. Wheelchair use
- Breast feeding and 6 weeks to 6 months postpartum
165
If two pills are missed, between days 8-14 of the cycle,
If two pills are missed, between days 8-14 of the cycle, no emergency contraception is required, as long as the previous 7 days of COCP have been taken correctly
166
Which contraception gives biggest delay in return of fertility
depo - up to 12 months
167
C - return of fertility on stopping
- IUS: immediate
- COCP: within a month
- Depo - several months
168
Stopping COCP before surgery
- stop 4 weeks before surgery
- switch to POP
169
IUD - standard mechanism
decreases sperm motilkity and survival
170
caution of Ulipristal
severe asthma
171
Tx of choice for stage 1 and 2 endometrial cancer
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
172
Patients with features of acute life-threatening asthma who fail to respond to treatment, should be
sent to ICU - intubation and ventilation
173
The first line investigation for adults with suspected asthma is to
measure eosinophil count or FENO
174
PEFR in acute asthma - categories
> Moderate: 50-75% of best/pred
> Severe: 33-50%
> life threatening < 33%
175
In a mild-moderate flare of ulcerative colitis extending past the left-sided colon
oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far
176
C diff sigmoidoscopy findings
yellow plaques
177
Tx for all pts with suspected hepatic encepahlopathy
lactulose
178
Kantors string sign
- terminal ileum looks like a string
- seen in Crohns
179
Variceal bleeding not stopped by telipressin and endoscopic band ligation
1) insert A Sengstaken-Blakemore tube
2) TIPS
180
what is associated w H pylori
duodenal ulcer most commonly but also gastric adeno
181
Bile-acid malabsorption may be treated with
> common after a cholecsyetecomt
- can be treated w Cholestyramine
182
Most common extra colonic cancer from HNPCC
endometrial cancer
183
Lynch syndrome cancers mneumonic
Mr Lynch is a CEO
Colon cancer
Endometrial cancer - most common extra colonic
Ovarian cancer
Pancreatic in men
184
Management of constipation
1) Bulk forming laxative e.g. isphalga husk
2) osmotic laxative like macrogol
185
lifestyle advice for constipation
- increase fibre
- increase fluid intake
- ensure adequate activity levels
186
which type of hernias are more common in women
femoral, more common in multiparous women
187
Femoral hernias
- inferolateral to pubic tibercle
188
Comps of hernias
- incarceration - hernia tissue cannot be reduced
- strangulation - surgical emergency (tender and non reducible)
- bowel obst - surg emergency
189
which hernias carry higher risk of strangulation
femoral
190
Mx of a femoral hernia
- must surgically repair - high risk of strangulation - laparascopic or laparatoy
- laparatomy in an emergency
- do not use hernia suppory belts -> risk of strangulation
191
intussepction
- 2x as common in boys
- severe abdo pain, draws knees up & pale
- red currant jelly blood stained stool
- sausage shape mass in RUQ
192
Ix of int
US - may show target like mass
193
Mx of intussepction
- redution by air insufflation
- if this fails or peritonitis -> surgery
194
most common type of panc cancer
adenocarcinomas which occur at the head
195
RF for panc cancer
- smoking
- diabetes
- chronic panc
- HNPCC
- BRAC-2
- KRAS gene mutatuion
196
Features of panc cancer
- painless jaundice
- pale stools, dark urine
- cholestatic liver function
- ado masseses: hepatomegaly from mets or GB (ourvoisiers law)
- anorexia, WL
- new diabetes
- steattorhoea from loss of exocrine function
197
pain in panc cancer
epigastric may radiate to bacl often worse whe lying flat pr eating
198
Trousseau's syndrome
Migratory thrombophlebitis - more common with PC than other cancers
199
Ix for panc cancer
High res CT - double duct sign
200
Mx of panc cancer
- Whippes for resectable lesions at the head of the panc
- adj chemo
- ERCP with stenting for palliation
201
SE of whipples
dumping syndrome, PUD
202
Ruptured AAA
- Immediate vascular review
- haem unstable pts -> take straigjt to theatre (clinical diagnosis)
- haem stable: CT angiogram if diagnostic doubt
203
intestinal obst features
- History of malignancy/previous operations
Vomiting
- Not opened bowels recently
'- Tinkling' bowel sounds
204
Urinary retention
- History of prostate problems
Dullness to percussion around suprapubic area
205
Ovarian cancer
- Older female
- Pelvic pain
- Urinary symptoms e.g. urgency
- Raised CA125
- Early satiety, bloating
206
BC features
- breast lump: typically painless. Classically described as fixed, hard
- breast skin changes
- bloody nipple discharge
- inverted nipple
- axillary mass
207
fibroadenoma basics
- breast mouse
- no inc risk of malignancy
- if >3cm surgical excision
208
Mx of nipple candidasis
> micronazole cream for mum
- nystatin suspension for the baby
209
Mx of mastitis
> ab if:
- syst unwell
- nipple fissure present
- no improvement after 12-24 hrs of infective milk removal
- culture indicates infection
- cont BF
- flucloxacillin
210
Raynaurds disease of the nipple
- pain is often intermittent and present during and immediately after feeding
- blanching of the nipple -> cyanosis or erthyema
211
Mx of raynaurs disease of he nipple
- minimise cold exposure
- heat packs
- stop smoking
212
Poor infant weight gain
> if loss of more than > 10% in first week of life-> midwife led breastfeedinf clinic
213
cylical mastalgia
- It varies in intensity according to the phase of the menstrual cycle
- advise to wear a supportive bra
- tx: standard oral and topical analgesia
214
when should mastalgia be referred
- after 3m no response to cons Tx
- or affecting sleep
- bromocriptine and danazol
215
ab tx of mastalgia
Flucloxacilin 10-14 days
216
inguinal hernia
- more common in men
- superior and medial to PT
- mild discomfory, strangulation rare
217
direct vs indirect infuinal hernias
- indirect: hernia through inguinal canal
- direct: through posterior wall of ing canal
218
mx of inguinal hernia
- the clinical consensus is currently to treat medically fit patients even if they are asymptomatic
- if unfit for surgery: hernia truss
219
which surgical technique is done for hernias
- mesh repair
- unilateral: open approacch
- bilaeral and recurrent: laparascopic
220
nerve damage after hernia repair
- the ilioinguinal nerve is the most commonly injured and may lead to numbness or tingling over the superomedial thigh, base of penis, or anterior scrotum/labia
221
infertility post hernia repair
damage to vas defernes
222
mx of variceal bleeding
Mx: telipressin (or ocreotide used less) & IV ab must be given b4 endoscopy
Prevention: Propanolol
223
Methods of stopping bleeding in a variceal haemorrhage
- endoscopic band ligation during endoscopy
- Sengstaken Blakemore tube if uncont haemorrhage
- TIPSS if all measures fail
224
What does TIPSS do
- connects the hepatic vein to the portal vein
- exacerbation of hepatic encephalopathy is a common complication
225
Prophylaxis of variceal haem
- propanolol
- EVL
- TIPSS if other methods unsuccessful
226
RF for anal fissues
- constipation
inflammatory bowel disease
sexually transmitted infections e.g. HIV, syphilis, herpes
227
where do 90% of anal fissues occur
posterior midline. if the fissures are found in alternative locations then other underlying causes should be considered e.g. Crohn's disease
228
Mx of acute anal fissure
- soften stool - dietary, bulk -> lactulose
- lubricants b4 defecation
229
Mx of chronic anal fissure
- topical GTN first line
- if not effective after 8 weeks: refer for sphincterotomy or botox
230
most common side effect of IUS within first 6 months
irregular bleeding - warn pts
231
AIN
Acute interstitial nephritis causes an 'allergic' type picture consisting usually of raised urinary WCC and eosinophils, alongside impaired renal function
232
UGIB from gastric ulcer that bleeds despite repeated endoscopic therapy
ref to gen surg
233
most common histological subtype of RCC
Clear cell carcinoma - A complicated cystic mass arising from the parenchyma of the left kidney is seen on a CT scan of the abdomen. The mass contains solid and liquid components, and is septated.
234
Alport syndrome
- microscopic haem
- bilateral SN deadness
- progressive renal failure
235
White 'curdy' vaginal discharge with pH <4.5 is likely to be
candidiasis
236
major dose limiting SE of Mg salts
diarrhoea
237
lichen planus
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over surface. Oral involvement common
238
Lichen slerosus
tchy white spots typically seen on the vulva of elderly women
239
Mx of PID
stat IM ceftriaxone followed by 14 days of oral doxycycline + oral metronidazole is the preferred first-line treatment
240
IgA nephropathy classically presents as
Visible haematuria following recent URTI
241
Mx of vaginal thrush
- oral fluconazole single dose
- if pregnant: local tx eg. clomitrazole pessary - oral Tx CI
242
PSC and PBC -> cancer
PSC: cholangiocarcinoma
PBC: HCC
243
HERNIAS MNEUMONIC
MILF
244
Negative fluid balance chart sx
- tachy
- hypotension
- oliguria
- sunken eyes reduced skin turgor
245
risk of strangulation with inguinal hernias
< 5%
246
high AAA rupture risk
- symptomatic, aortic diameter >=5.5cm or rapidly enlarging (>1cm/year)
- refer within 2 weeks to vascular surgery for EVAR
247
Deranged coagulation in sepsis ->
DIC
248
Bilious vomiting on the first day is likely due to
INTEST ATERSIA
249
cea
raised in CRC
250
HAEMATURIA AFTER VIRAL ILLNESS
- igA: 1-2 days
- post strep GMN: 1-2 weeks
251
initial topical Tx for anal fissure - acute
lidocaine
252
Expectant management of an ectopic pregnancy can only be performed for
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
253
key intv in ascites LT
restrict SALT and alc
254
hallmark finding of NEC on AXR
pneumatosis intestibalis - intramural gas
255
raised ESR + osteoporosis ->
MM
256
Findings of kartageners
- dextrocardia
- bronchiectasis - tram track
- subferility
257
anti GBM disease ->
haemoptysis + AKI/proteinuria/haematuria
258
blood stained discharge is most likely caused by
papilloma
259
renal colic Sx + shock (tachy and hypotension) ->
RUPTURED AAA -> URGENT VASCULAR REVIEW
260
What should be doen for an inguinal hernia
routine surgical refer even if asymp
261
acutely tender blue black lum on anal margin ->
thrombosed haemorrhoid - SIG pain is what differentiates it from an external haemorrhoid
262
Increased serum calcium and ALP along with increasing pain at rest ->
mets bone cancer
263
periductal mastitis
- infection inthe breast common in smokers
- Tx w co-amox
264
Cardiovascular risk factors + post-prandial pain → ?
chronic mesenteric ischaemia
265
features of intestinal angina
- post prandial abdo pain
- sig WL
- epigastric bruit
266
gold stanard for bladder cancer diagnosis
cytoscopy
267
PPI and endoscopy
- withold for 2 weeks b4
- do prescribe it acutely until after endoscopy if there is evidence of recent non variceal haemorrhage
268
Bleeding ulcer despite repeated endoscopic Tx
laparotomy + surgerical exp
269
Henoch-Schonlein purpura classically presents with
abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs
270
Bowel obst soon after surgery ->
paralytic ileus
271
hyperacute transplant rejection
- within 24-48 hr
- caused by pre-existing antibodies against ABO/HLA
272
risk of which cancer is inc following renal transplant
scc
273
Sterile pyuria and white cell casts in the setting of rash and fever should raise the suspicion of
AIN which is commonly due to ab therapy
274
abs CI for depo injection
current BC
275
mem nephropathy
- freq w malignancy
- subepithelial spikes seen on microscopy
276
muddy brown cell casts
ATN
277
ACUTE PANC CAUSES
HYPOCAL
278
? is an indication that kidney disease is chronic and not acute
HYPOCAL
279
Ongoing loin pain, haematuria, pyrexia of unknown origin → ?
rcc
280
appendicitis
- neutrophil predominant leucocytosisis
- pain on standing on one leg
- pain on hip extension (psoas sign)
281
mesenteric adenitis
- abdo pain following viral infection (v similar to appendicitis)
- appendicitis if no preceding viral infection
- consv mx
282
haematuria ref
> younger pts under 40 -> nephrology normally
> > 40 - urology
283
A newborn baby boy presents with gross abdominal distension. He is diagnosed with cystic fibrosis and his abdominal x ray shows distended coils of small bowel, but no fluid levels.
meconium ileus
284
CA15-3
bc
285
ca19-9
panc
286
AFP
hcc
287
Unresolving left varicocele ->
renal cell cancer
288
A 41-year-old man with cerebral palsy is admitted with abdominal pain and diarrhoea. His carers report him passing 5-6 watery stools per day for the past four days. On examination he has a mass in the left side of the abdomen.
constipation causing overflow
289
hepatic adhesions =
fitz Hugh curitis (PID) - complication of PID which leads to inflammation of the liver capsule forming Glisson capsule
290
COCP - cancer
Protective against what we screen for: breast and cervical
Increases risk of ovarian and endometrial
291
constipation in kids Mx
Macrogols like Movicol 1st line & advice on fluid and diet
292
surgery time for a femoral hernia
surgery within 2 weeks - urgently due to strangulation risk
293
aortic dissection sx
- tearing back pain (chest pain in type A, back pain in type B)
- pulse deficity
- neurological symptoms!!! such as limb ischaemia or paraplegia
294
Sister Mary Joseph nodule
- periumbilical LN
- sign of mets to periumbilical LN - SMALL HARD SWELLING NEXT TO UMBILICUS, OFTEN WITH UMBILICAL PROTRUSION
- classically from gastric cancer
295
HIV and nephrotic syndrome =
focal segmental
296
tx of bladder cancer - carinoma in situ
transurethral resection of superifical lesions
297
mx of invasive bladder caner
radical cystectomy
298
most likely cause of blood stained discharge
ductal papilloma
299
most common type of BC
invasive ductal (no special type)
300
sx of inflammatory BC
progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3.
301
Mx of RCC
> T1 (less than 7cm): partial nephrectomy
> T2 or above (greater than 7cm) -> radical nephrectomy
302
bloody diarrhoea, tenesumus and painful diarrhoea after radiotherapy for PC
proctitis - common comp - leads to rectal inflammation and presents similar to UC
303
ectopics always almost occur
in T1 (before 12 weeks)
304
why is neoadjuvant chemo used in BC
to try to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy
305
Vaginal discharge following recent ab exposure ->
thrush
306
RCC mx
usually resistant to chemo and radio - nephrectomy is the usual tx
307
All patients with suspected upper GI bleed require
endoscopy witin 24 hrs of admission
308
panc psuedocyst formation
Pancreatic pseudocysts result from the organisation of a peripancreatic fluid collection and typically occur 2-4 weeks after acute pancreatitis
309
cause of new onset AF following GI surgery
- anastamotic leak
- presents 5-7 days following surgery
- fleculent material in the wound drain
310
RCC can cause
liver dysfunction in particular cholestasis and hepatosplenomegaly Stauffer syndrome
311
what does TIPS connect
hepatic vein and portal vein
312
memory loss seen after ECT
retrograde amnesia
313
most common cause of LBO
CRC
314
Top 2 cancers of HNPCC
1) CRC
2) endometrial
315
sjogerns increases risk of
lymphoid malignancies
316
screening for 65 yo man
AAA
317
in what context do trans women get breast screening
taking feminising hormones for 2 years
318
what are preg women tested for at booking
- HIV, syphilis and hepatitis B
- sickle cell & thalassemia
319
how does perianal abscess present
severe pain in the perianal region, and may have spiking temperatures
320
ongoing jaundice and pain following lap chole
Gallstones may be present in the CBD causing ongoing jaundice and pain after cholecystectomy
321
Using SSRI in OCD vs depression
When treating OCD, compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response
322
number 1 cause of massive GI bleeding on kids
Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
323
anal fissure mx summary
- Acute anal fissure (< 1 week): soften stool, dietary fibre, analgesia and topical anaesthetic cream
- if this fails/ chronic: GTN spray
- if after 8 weeks still having symptoms: refer for sphincterotomy or botox
324
mx of intussepction
air insufflation
325
Features of renal cell carcinoma:
- classical triad: haematuria, loin pain, - abdominal mass
- pyrexia of unknown origin
- left varicocele (due to occlusion of left testicular vein)
- endocrine effects: may secrete
- erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
326
features of chlamydia
- asymptomatic in around 70% of women and 50% of men
- women: cervicitis (discharge, bleeding), dysuria
- men: urethral discharge, dysuria
327
rectal intusussception
- obstructed defecation
- can occur after childbirth
- barium enema tends to be normal, defecating proctogram required
328
causes of bilous vomiting
- NEC
- malrotation
- meconium ileus
- duodenal atresia
329
Imaging for breast lumps
- even if it benign and no red flags we should still image
- US for under 35
- mammogram for over 35
330
Most patients presenting with symptomatic renal cell carcinoma have
stage 4 disease (metastatic)
331
urinary retention can be precipitated by
UTI
332
Memb GN - what can be seen
- low total thyroxine levels
- cause of NS
- associated with autommine conditions like SLE
333
Poor prognosis in liver cirrhoisis
ascites development - sig increases mortality
334
Child Pugh classification
- ABCDE
- Albumin
- Bilirubin
- Clotting (prothrombin)
- Distended abdo
- Encephalopathy
335
An obese woman presents with an irregular lump on the lateral aspect of her right breast associated with skin tethering. Biopsy excludes a malignant cause.
fat necrosis
336
PSA levels may also be raised by:
- benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 6 weeks after treatment)
- ejaculation (ideally not in the previous 48 hours)
- vigorous exercise (ideally not in the previous 48 hours)
- urinary retention
i- nstrumentation of the urinary tract
337
in a teenager with primary amenorrhea who experiences regular painful cycles what is the leading diff
imperforate hymen - obstruction to menstrual flow
338
. A 19-year-old lady is admitted with lower abdominal pain. On examination she is diffusely tender. A laparoscopy is performed and at operation multiple fine adhesions are noted between the liver and abdominal wall. Her appendix is normal
PID
339
Membranous glomerulonephritis
- BM thickening
- subepithelial spikes - look like an M
- PLA2 positive
340
DS increases risk of
hypothyroidism
341
indications for surgical management of an ectopi
All ectopic pregnancies >35 mm in size or with a serum B-hCG >5,000IU/L should be managed surgically
342
most common SE of metoclop
diarrhoea - prokinetic
343
Charcot's cholangitis triad
fever jaundice RUQ pain
344
gallstone problem exp
NO Jaundice
1.) Biliary colic - pain only, NO fever
2.) Acute cholecystitis - pain and fever
WITH Jaundice (obstruction is at common bile duct)
3.) Choledocholithiasis - pain + jaundice, NO fever
4.) Acute cholangitis - pain + jaundice + fever
345
target sign on US
Intusseption. Also sausage shaped mass on XR
346
Scoring system for whether a patient needs to be admitted for a GI bleed
Glasgow Blatchford
347
blatchford vs rockall
Blatchford Before endoscopy
Rockall Requires endoscopy
348
Brown-green nipple discharge is most commonly associated with
duct ectasia
349
2WWW criteria - bladdr cancer
A patient >= 60 years of age with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test should be referred using the suspected cancer pathway (within 2 weeks) to exclude bladder cancer
350
tamoxifen uses increases risk of
endometrial cancer
351
Deterioration in patient with hepatitis B - ?
HCC
352
What is not seen in HSP
thrombocytopenia
353
local gonorrhoea comps
- urethral stricture
- epididymitis
- saplingitis
354
raised bHCG and AFP
non seminomatous test cancre
355
calcific foci on the pancreas ->
chronic pancreatitus
356
CD can cause an abdo mass
palpable in the RIF
357
WHAT CAN BE USED TO CONFIRM HIRSCHSPRUNGS
RECTAL BIOPSY
358
Gallstone ileus
mechanical small bowel obstruction which occurs due a gallstone obstruction most often in the ileum
359
finings of gallstone ileus
with two key radiological findings: pneumobilia and a calcified opacity in the distal ileum.
360
hep A pres
Hepatitis A presents with flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
361
most common cause of PID
chlamydia
362
leadpipe colon
- UC
- loss of haustral markings in distal bowel
363
scrotal swelling in a child which is not possible to palpate a normal cord above
indirect inguinal hernia
364
lower back pain worse on hip extension + fever
psoas abscess
365
Mittelschmerz pain
- suprapubic discomfort + normal inflammatory markers
- tends to occur 2 weeks after last period, mid cycle
366
what to exclude before IUD insertion
PID - absolute CI
367
Coffee bean sign
sigmoid volvulus
368
uncontrollable massive variceal haemorrhage ->
sengtaken blakemore tube
369
endoscopy cannot be done in the case of
massive bleeding
370
Lateral anal fissure?
look for other causes e.g. IBF
371
Earliest symptom of SCC
back pain
372
solitary rectal ulcer syndrome
- assoc w const and straining - chronic
- indurated area on exam
373
miscarriage vs ectopic
- miscarriage: mild suprapubic pain
374
urogenital prolapse sx
heavy dragging sensation in the suprapubic region
375
galacticele
- benign milk filled cyst occurs during lactation or shortly after sopping BF
- well circumscribed lesion on US, aspiriation of white fluid
376
Chorioamnionitis
- You should think chorioamnionitis in women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia
-
377
Mx of chorioamnionitis
- IV ab
- Immediate delivery, consider C section
378
constipation + vomiting + raised amylase
SBO - amylase can rise in SBO
379
Free fluid under D
PERFORATION
380
xr features of NEC
- dilated bowel loops (often asymmetrical in distribution)
- bowel wall oedema
- pneumatosis intestinalis (intramural gas)
- portal venous gas
- pneumoperitoneum resulting from perforation
- air both inside and outside of the bowel wall (Rigler sign)
- air outlining the falciform ligament (football sign)
381
CRVO
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
382
Key fining suggestive of aortic dissection on CT angio
false lumen
383
Plummer vinson syndrome
- dysphagia (loss of post-cricoid webs)
- glossitis
- IDA
384
chellitis
IDA
385
Acute flares of RA Mx
IM steroids e.g. IM methylpred
386
diarrhoea ->
normal anion gap met acidosis (loss of bicarb)
387
low PTH but high PTHrP ->
In hypercalcaemia secondary to malignancy, PTH is low, although PTHrP may be raised
388
Tx of extrinsic allergic alveolitis
avoid triggers
389
horizontal vs vertical nystagmus
Horizontal nystagmus = peripheral cause (goes in direction of ears)
Vertical nystagmus = central cause (goes in direction of brain)
390
SE of EPO
Bone aches, flu-like symptoms and skin rashes
391
Scrotal swelling than can be palpated as separate from the body of the testicle
epididymal cyst
392
bag of worms swelling in scrotum
varicocele
393
transilluminating scroyal swelling
hydrocele
394
time ou stage of WHO surg checklist
before first skin incision is made
395
stages of surg checklist
Before induction = sign in
Before first incision = time out
Before patient leaves = sign out
396
TEN RF
- penicillins
- quinolones
- NSAIDs
- steroids
- sulfonamides
397
isoniazid and P450
inhibitor.
398
CI to LP
unreactive pupils, seizure, raised ICP, meningococal rash
399
Glaucoma features
severe pain, haloes, 'semi-dilated' pupil
400
uveitis =
small, fixed oval pupil, ciliary flush
401
what can interact w SSRI -> serotonin syndrome
St Johns Wort
402
restarting hormonal contraception after levonorgesterl
restart immediately
403
restarting hormonal contraception afer ulipristal
5 days
404
if there is an ankle injury with NV compromise,
X-rays should not be taken of obvious ankle injuries if neurovascular compromise is present - immediate reduction / stabilisation instead
405
what is assoc w psoriatic arthropathy
nail pitting and onchylysis
406
DKA initial Mx
isotonic saline should be used initially eveb if severely acidotic - 1L 0.9% sodium chloride
407
When should COCP be stopped before surgery
- 4 weeks
- no need to stop if only using LA
408
risk of peripheral neuropathy with isoniazid can be reduced by co-prescribing
pyroxidine
409
retinal detachment =
Retinal detachment is a cause of sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally
410
UTI in pregnant woman
- treat asymptomatic bacturia
- long course - 7 days
- use nitrofurantoin unless close to term - neonatal haemolysis
411
Ab choice for UTI in preg
- T1: Nitro
- T3: trimethoprim
412
which rate of growth would make u refer a AAA
- > 1cm/ year or a size of more than 5.5cm
- refer to vascular to be seen within 2 weeks
413
When should we do a FIT test
- Patients aged < 50 years with rectal bleeding and either of the following unexplained symptoms should have a FIT test first to determine the need for urgent colorectal cancer pathway referral
- abdominal pain
- weight loss
414
CT findings of diverticulitis
- mural thickening of the colon
- presence of pericolic fat stranding
415
Deep ulcer on toe/heel → ?
- arterial ulcer
416
Features of an arterial ulcer
- lack of blood flow -> thin skin, hair loss, cool peripheries
- absent/ dimished pulses
- pain worse at rest and when elevated - VERY PAINFUL
417
neuropathic ulcer
- usually over pressure points or from a minor injury
- PAINLESS
418
Pressure ulcer
- develop at a site of friction or pressure
- usually over bony prominences in immobile pts
419
venous ulcer
- shallow, poorly defined edges
- usually over medial malleoli
- features of venous insufficiency:oedema, brown pigmentation, lipodermatosclerosis, eczema
420
Painless ulcers
Neuropathic and venous
421
Mx of venus ulcers
4 layer compression banding after exclusion of arterial disease or surgery
422
where do arterial ulcers occur
- heels and toes
- deep punched out appearance
423
mx of neuropathic ulcer
cushioned shoes to reduce callous formation
424
pyoderma gangernosum
- Associated with inflammatory bowel disease/RA
- Can occur at stoma sites
- Erythematous nodules or pustules which ulcerate
425
axillary node clearance->
lymphodema
426
Ix for a right hemicolectomy
Caecal, ascending or proximal transverse colon cancer
427
Ix for a left hemicolectomy
distal 2/3rds of the transverse colon and descending colon tumours.
- rectum is left intanct so patient does not have a perm stoma
428
which type of stomas are spouted
ileostomy
429
retractile testis
A testis that appears in warm conditions or which can be brought down on clinical examination and does not immediately retract
430
Rosvings sign
- appendicitis
- palpation of LIF -> pain in RIF
431
SE of anastazole
osteoporosis - do DEXA b4 starting
432
Blood products in AAA
- cross match 6 units
433
Parkland formula for burns
Volume of fluid = total body surface area of the burn % x weight (Kg) x 4ml = amount to give over 24 hrs
434
In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →
end colostomy
435
surgery for rectal tumours
- anterior resection
- unless in low rectal tumouts
436
Low rectal tumours
- APER - used for low rectal tumouts close to or involving the anal sphincter
437
Hartmanns procedure
- makes an end colostomy w/o anastamosis
- emergency situations like obstruction or perforation
438
common SE of TPN especially if given peripherally
thrombophlebitis
439
thrombophelbitis sx
pain redness swelling at cannula site, mild fever
440
PVD Mx
- smoking cessation, WL
- exercise training before starting Tx
- severe PAD: angioplasty or bypass
441
AMA Mx
- immediate laparatomy, non viable bowel resection
442
prostatitis
- bleeding at the end of micturition
- fevers
- pus
443
Secondary prevention of CVD with PAD
Clopidogrel 75mg + Statin 80mg
444
primary prevention statin dose
20mg. 80mg is secondary prevention
445
caecal tumour mx
righrt hemi
446
why is an ileostomy spouted
to prevent skin from coming into contact w ezymes in the small intestines
447
duct ectasia =
Duct ectasia: non-malignant breast disease with thick green nipple discharge, occurring with breast involution
448
Imaging for PAD
- duplex US first line
- do MRA b4 any interventions
449
