Passmed 2 Flashcards
1
Q
mx of varicose veins
A
- leg elevation
- WL
- compressions stockings
2
Q
Referral to SC for varicose veins
A
-significant/troublesome lower limb symptoms e.g. pain, discomfort or swelling
- previous bleeding from varicose veins
- skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)
- superficial thrombophlebitis
- an active or healed venous leg ulcer
3
Q
Low rectal tumours Mx
A
- anterior resection UNLESS its within 2cm of dentate line = APER
4
Q
sig comp of TPN
A
- reefeding syndrome
- must monitor for hypophosphataemia
5
Q
ER+ BC Mx
A
- Tamoxifen if pre-men
- Anastrazole if post -men (Ancient)
6
Q
Mx of an anal fistula
A
- simple: fistulotomy
- deep fistula: seton drain
7
Q
Hyatid cysts
A
- endemic to middle east
- caused by tapeworm Echinococcus granulosus
- Type 1 HSN
8
Q
Ix for a hyatid cyst
A
- CT is best to differentiate between hyatid and ameobic cysts
- US often first line
9
Q
Mx of a hyatid cyst
A
Surgery. Perc aspiration is CI
10
Q
Which nerve is at risk of injiry in a total HR
A
- Sciatic
- foot drop
11
Q
Hemangioma =
A
- hyperechoic lesion with normal AFP
12
Q
Spondylothesis
A
- young athletic that presents with sudden pain
13
Q
AS is strongly associated with
A
UC
14
Q
Most common type of renal cancer
A
Adeno, clear cell (adeno -> EPO)
15
Q
renal pelvis cancer
A
Transitional cell cancer
16
Q
Mx of node positive BC
A
FEC-D chemo
17
Q
Mx of node negative BC
A
FEC
18
Q
What should you do before referring for CRC
A
FIT
19
Q
Bc Screening
A
Mammography ever 3 years aged 50-70
20
Q
Anastrazole MAO
A
reduced peripheral synthesis of oestrogen
21
Q
RF for embolic ALI
A
af
22
Q
Mx of minimal intraabdominal bleeding without haem compromise
A
- consv mx with analgesia and freq obs
- does not require a laparotamy
23
Q
First line Mx of SBO
A
First-line medical management of small bowel obstruction involves IV fluids and gastric decompression, or ‘drip-and-suck’
24
Q
BC referral criteria
A
- aged 30 and over and have an unexplained breast lump with or without pain or
- aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
25
when to consider referring for BC
- with skin changes that suggest breast cancer or
- aged 30 and over with an unexplained lump in the axilla
26
BC - non urgent referral for
people under 30 with an unexplained breast lump or w/o pain
27
type of stoma with an anterior resection of the rectum
loop ileostomy
28
Mx of a transverse colon cancer
left hemi with colo-colon anastamosis
29
A 23-year-old man presents with intermittent symptoms of altered sensation in his arm and discomfort when he uses his hands. He works as an electrician and his symptoms are worst when he is fitting light fixtures.
cervical rib
30
what must be given b4 appendicetomy
Prophylactic IV ab
31
most common site of ischaemic colitis
- splenic flexure - watershed area
32
thumbprinting on XR
ischaemic colitis
33
mx of an unruptured sigmoid volvulus
decompression via rigid sigmoidoscopy and flatus tube insertion
34
Mx of abdominal wound dehiscence
- coverage of wound with saline impregnanted gauze
- IV ceftriazone and metronidazole
35
? → ?large bowel obstruction
Abdominal distension, absence of passing flatus or stool, late onset/no vomiting → ?large bowel obstruction
36
what should be given with fluids for managing a SBO
potassium
37
mx of superficial thrombophelbitis
- compression stockings
- NSAIDs
38
FIT testing should be offered first-line to help exclude colorectal cancer for patients aged ≥ 50 years with any of the following:
- rectal bleeding
- abdo pain
- WL
39
Severe, sudden abdominal pain + out-of-keeping physical exam findings + AF → ?
AMI
40
Marjolins ulcer =
squamous cell carcinoma occurring at sites of chronic inflammation or previous injury.
41
strongest Rf for anal cancer
HPV 16
42
Ix for acute mesenteric ischaemia
High res CT angiogram without contrast
43
wide local excision vs masectomy
wide local excision is more breast conserving - used for smaller tumours
44
Mucinous carcinoma
grey gelatinous surface
45
Pagets disease vs nipple eczema
Pagets: affects nipple first then spreads to areaolar region
Nipple eczema: tends to affect areolar region
46
comedo necrosis =
DCIS
47
Halo sign on mammography =
breast cyst
48
? can be used to defunction the colon to protect an anastomosis
loop ileostomy
49
Left lower quadrant pain, low-grade fever in elderly patient →
diverticulitis
50
Ix for a thoracotomy
Indications for thoracotomy in haemothorax include >1.5L blood initially or losses of >200ml per hour for >2 hours
51
Hb serology
- HbA → antigen means has an infection right now
- HbS → S for safe i.e. vaccinated
- HbC → C for caught the infection previously
52
symptoms of an anal fistula
- offensive discharge from anus
- usually occur following prev ano-rectal sepsis
53
imaging for appendicitis
- US first line (espec in females to exclude ovarian pathology)
- diagnostic laparscopy if very certain of Dx - eg. thin male patient
54
Dukes criteria for CRC
- (A) cancer lives in the mucosa, it
- (B)reaks into the walls, - (C)omes down the lymph nodes to travel to - (D)istant metastases
55
Mx of a caecal volvulus
- viable bowel: right hemicolectomy with primary ileocolic anastamosis
- non viable bowel (isch/ perf): right hemicolectomy + stoma (e.g. end ileostomy with mucous fistula).
56
isograft =
Identical twin- twin donations are usually genetically identical and are therefore isografts.
57
autograft
Transplantation of organs or tissues from one part of the body to another in the same individual
58
xenograft
Tissue transplanted from another species
59
allograft
Transplant of tissue from genetically non identical donor from the same species
60
mx of a congenital inguinal hernia
refer to paeds surgery
61
Sign of peforation
Rigler's sign (double wall sign) is an indication of pneumoperitoneum secondary to a perforation
62
Free air under D
- sign of perf but does not always occur
- only seen on an erect XR not a subpine
63
How much of the Pd fluid volume should be given in the first 8 hrs
- calculates the fluid given in 24 hrs
- give half of this in 8h
64
What should be done first in suspected ALI
Handheld arterial doppler, then do ABPI if doppler pulses present
65
3 month surveillance for AAA when
4.5-5.4cm is a medium aneurysm and requires 3-monthly ultrasound assessment
66
AAA < 4.5cm
12m US
67
aorta with <3cm
normal, no further action
68
shock - IV fluids not improving BP
neurogenic
69
Patients aged ≥ 60 years with anaemia ->
Patients aged ≥ 60 years with anaemia (even in the absence of iron deficiency) should have a FIT test first to determine need for urgent colorectal cancer pathway referral
70
person in major accident who was lucid and then dies suddently
aortic transection - widened mediastium on XR
71
Haemopericardium Sx
- cardiac tamponade after trauma
- raised JVP, muffled heart sounds, paradoxical pulse
72
claudication affecting femoral vessels
- femoral: calf pain
- iliac: buttock pain
73
what should be done for BC before primary surgery
- axillary US before operation even no axillary lymphadenopathy
74
In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →
end colostomy
75
SE of tamoxifen
- menstrual disturbance: vaginal bleeding, amenorrhoea
- hot flushes
- venous thromboembolism
- endometrial cance
76
Grading of internal haemorrhoids
- Grade I Do not prolapse out of the anal canal
- Grade II Prolapse on defecation but reduce spontaneously
- Grade III Can be manually reduced
- Grade IV Cannot be reduced
77
Tx for HER2+ BC
trastuzumab - herceptin
78
richters hernia
- can present with strangulation even without sx of obstruction
- causes a meyabolic acidosis
- presents with a firm mass
79
cullens sign
- severe peri umbilical bruising
- usually with acute panc
80
Boas sign
- hyperasthesia beneath right scapula
- with acute cholecystitis
81
Rosvings sign
- appenidicits
- LIF palpation -> RIF pai
82
Boas and Murphys sign
- cholesystitis
83
Grey turners vs cullens
Grey-Turners, 2 words, 2 flanks bruised
Cullens, 1 word, 1 peri-umbilical area bruised
84
what should be done in BC if there is clinically palpable lymphadenopathy
In patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery
85
what MUST be done in a young woman with abdo pathology
urine HCG
86
shock + warm peripheries
neurogenic, septic or anaphylactic (Distributive shock)
87
biologic used to manage complex perianal crohns
infliximab
88
Ix for imatinib
- TKI
- used in gastro stromal tumours & CML
89
Painful ulcer + low ABPI
Arterial
90
painless ulcer + normal ABPI
neuropathic
91
definitive Ix for SBO
abdo CT
92
Recurrent episodes of natal cleft pain with discharge → ?
- Pilonidal disease
- Managed with pilondial cystectomy when incision and drainage has failed
93
Mx of pilondial disease
- asymptomatic: consv, focus on hygiene
- symptomatic: acute: incision and drainage
- if chronic/recurrent then surgery
94
Mx of sigmoid volvulus with peritonitis
- skip the flexible sigmoidoscopy
- go straight to urgent laparotomy
95
The risk of transfusion associated lung injury is greatest with
plasma components
96
ALI pres
6 P's: pale, pulseless, pain, paralysis, paraesthesia, perishingly cold
97
Diverticulitis flare Mx
- oral ab at home
- no improvement within 72 hrs: admit for IV ceftriaxone + metronidazole
98
intial imaging for a bowel perf
erect CXR
99
Rectal varices should be considered in patients with
Portal HTN and lower GI bleeding
100
how can RCC present?
- renal vein thrombosis
- polycythemia
- EPO production
- ACTH and renin production
- left varicocele
101
what can carotid endartecteromy damage
- ipsilateral hypoglossal nerve
- tongue deviates to the side of the lesion
102
what should be routinely doen following breast conserving surgery
RADIOTHETAPUY
103
Applying pressure over the deep inguinal ring can control a
indirect hernia
104
sigmoid volvulus vs caecal volvulus
- sigmoid: LBO, coffee bean
- caecal: SBO
105
Deceleration injury + persistsent hypotension ->
aortic rupture
106
widened mediastinum =
aortic rupture/ dossection
107
signs of chronic venous insufficiency
- haemosiderin deposition
- lipodermatosclerosis - champagne bottle legs
- eczema
108
creamy/green/cheese like nipple discharge in PM
- mammary duct ectasia
- reassure is theTx, surgery if bothersome Tx
109
Lidocaine + adrenaline preparations should not be used for
- minor surgery involving end-arterial areas like the fingers, toes, penis, nose and ears
- adrenaline causes vasoconstriction -> digital ischaemia
110
SBO vs LBO on xr
- SBO: lines all the way across - plicae circularis
- haustra visible - halfway across
111
ECG findings of hyperkal
- tall tended t waves
- loss of P waves
- broad QRS
- sinusodial wave pattern
112
Acute pilonidal abscess →
ncision and drainage, allowing the wound to close by secondary intention
113
what is recommende following a wide local excision
whole breast radiotherapy, reduces reoccurence by 2/3
114
Fever, pain, peritonitis 5-7 days post colorectal surgery → ?
anastamotic leak
115
PAD with CLI Mx
- angioplasty if < 10cm stenosis
- bypass if > 10cm
116
what is a hartmanns proedure
sigmoid colectomy and formation of end stoma
117
intial fluids for burns
hartmanns
118
haemorrhagic vs neurogenic shock
- haemorrhagic: cold peripheries
- neurogenic: warm
119
Ix for anal fistula
pelvic MRI
120
Backpain and haem instability ->
rule out AAA
121
Type of incision for a breech baby emergency c section
Pfannenstiel's
122
snowstorm sign on US of axillary LN
Shows extracapsular implant rupture
123
AAA screening programme
single abdo
124
RTAs involving passengers wearing seatbelts incorrectly can result in
carotid artery lacertations
125
tumour marker for medullary thyroid cancer
calcitonin (medulla of bone)
126
papilary thyroid cancer marker
thyroglobulin
127
CLI pres
presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia
128
features of CLI
- rest pain in foot for more than 2 weeks
- ulceration
- gangrene
129
Patients with long saphenous vein superficial thrombophlebitis should have
venous US of legs to exclue DVT
130
Open vs laparscopic hernia repair
- open: unilateral
- lap: recurrent or bilateral
131
what can be done for LN mets in BC where the patienr refuses axillary node clearance
axillary radiotherapy
132
definitive Tx of AMI
LAPAROTOMY
133
Most common type of rectal cancer
adeno
134
pilar cyst =
- foul smelling cheesy material
- surrounded by outer part of a hair follicle
135
what not to do when awaiting hernia surgery
attempts to manually reduce it
136
Mx of haemorrhoids
- soften stools - fibre and fluid
- topical LA and steroids to help symptoms
- injection sclerotherapy
- surgery for large symp unresponsive to Tx
137
Cardiovascular risk factors + post-prandial pain → ?
chronic mesenteric ischaemia
138
angiodysplasia
- massive bleeding
- more commonly affect R colon
- usually no other Sx
139
Rectal cancer on the anal verge →
Abdomino-perineal excision of rectum
140
bubbly urine =
enterovesicular fistula, freq a result of CRC
141
Baretts oesophagus ->
adenocarcinoma of oesophagus
142
weak pulses, pain only relieed by dangling legs over the side of the bed
CLI
143
Congenital hernias Mx
- inguinal: repair ASAP (get them IN for surgery)
- umbilical: manage conservatively
144
initial Mx of ALI
analgesia, IV heparin and vascular review
145
Right-sided tenderness on PR exam, think
appenidicity
146
first line in diverticulitis
CT with contrast is the first-line imaging for suspected diverticulitis
147
first line Mx for BC
- surgery - if less than 4cm then wide local excision
- followed by radiotherapy and hormonal therapy
148
where are diverticula more commonly seen
sigmoid colon
149
mx of advanced colorectal cancer who present with bowel obstruction
Palliative bowel stent
150
method of checking that an anastamosis has healed and not leaking
Gastrogafin enema
151
DVLA and AAA
- DVLA Notified: 6.0-6.4cm
- Driving not allowed: 6.5cm+ (until successful treatment)
152
Flail chest =
multiple rib F#
153
comps of enteral feeding
- diarrhoea
- aspiration
- hyperglyc & refeeding
154
Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended.
psoas stretch sign
155
Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended.
murphys sign
156
way of checking if a bladder suture line has healed
cystogram
157
mx of neurogenic shock
vasopressors
158
indications for a splenectomy
- uncontrollable splenic bleeding
- hilar vasc injuries
- devascularised spleen
159
Gastric volvulus- triad of
triad of vomiting, pain and failed attempts to pass an NG tube
160
FAST scans can be used to assess the
presence of fluid in abdomen and thorax
161
hiatus hernia Mx
- lifestyle advice and PPI
- Surgery is Ix for a rolling hernia (As opposed to a sliding)
162
which analgesic should be avoided following renal transplant
NSAID - nephrotoxic
163
A sinusoidal ECG pattern is indicative of
SEVERE HYPERKALAEMIA - > 9mmol
164
achalasia increases risk of
- SCC
- friable mass in oesophagus
165
Pharyngeal pouch ->
hallitosis & difficulty intubating
166
Diverticulitis symptoms + pneumaturia or faecaluria → ?
?colovesical fistula
167
ABPI in CLI
0.3 and undder
168
sunset foot
- hyperaemia in pts w severe vasc disease
- APBI usuallya round 0.5
169
useful antiemetic in SBO
IM cyclizine
170
what is CI in bowel obst
metoclopramide
171
most common cause of bloody discharge in a young woman
intraductal papilloma
172
radiologic finding of SBO
Valvulae conniventes
173
vertigo and pain after eating following a gastric bypass -.~
dumping syndrome
174
BRCA inheritance
- 50/50 chance of siblings and children to a carrier to also haeve it
- AUTOSOMAL DOMINANT
175
lynch syndrome vs FAP
- lynch: little polyps
- FAP: many polyps
176
screening test for AKPD
US
177
Peripheral curtain over vision + spider webs + flashing lights in vision think
retinal detachment
178
post-thrombotic syndrome
- following DVT
- leg heaviness, aching, pruritis, and oedema that improves with elevation (such as overnight)
179
Which drug class increases risk of achilles tendon rupture
ciprofloxacin (quinolone)
180
first line in hypercal
IV fluids
181
prevention of tumour lysis syndrome
- allopurinol
- rubricase
182
Mx of a hydrocele in a baby
reassure, surg repair if it does not resolve by 1-2 yrs
183
Excess parathyroid hormone results in
Excess parathyroid hormone results in Excess phosphate Excretion. (The rule of E's)
184
what should be ruled out b4 diagnosing anxiety
Thyroid disease
185
Antidepressants should be continued for at least ? after remission of symptoms to decrease risk of relapse
6 months
186
strawberry cervix ->
Trichomonas vaginalis
187
All patients > 65 with ? must have a CT scan
loss of consciousness or amnesia - CT within 8 hrs
188
CT head within 1 hr
- GCS < 13 on initial assessment
- GCS < 15 at 2 hours post-injury
- suspected open or depressed skull fracture
- any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign).
- post-traumatic seizure.
- focal neurological deficit.
- more than 1 episode of vomiting
189
CT head within 8 hrs:
- age 65 years or older
- any history of bleeding or clotting disorders including anticogulants
- dangerous mechanism of injury
- more than 30 mins of retrograde amnesia of events immediately b4 the event
190
pt on warfarin who have sustained a head injury
if no other CT indications, perform within 8 hrs
191
Elderly, alcoholic, head injury, insidiuous onset symptom -
subdural haematoma - rupture of bridging veins
192
extradural haematoma ->
rupture of MMA
193
Mx of chronic subdural bleeds
- burr hole evacuation
194
hypodense cresenteric bleed on CT
Chronic subdural haematoma - hypodense = dark so blood is old
195
recurrent falls + fluctuating consciousness
- subdural haem
196
Goserelin MAO
GHRH agonist
197
diagnosis of chronic pancreatitis
- can be diagnosed w/o imaging
- if pain is charateristic and amylase 3x normal
- initiate fluid resus
198
For a young patient who has always had difficulty achieving an erection, referral
to urology is required
199
Ix for testicular cancer
- US first line
- then measure tumour markers
200
Renal stone Mx
- watchful waiting if < 5mm and asymptomatic
- 5-10mm shockwave lithotripsy
- 10-20 mm shockwave lithotripsy OR ureteroscopy
- > 20 mm percutaneous nephrolithotomy
201
ureteric stone Mx
- shockwave lithotripsy +/- alpha blockers>< 10mm
- 10-20 mm ureteroscopy
202
If subarachnoid haemorrhage is suspected but a CT head done > 6 hours after symptom onset is normal
a lumbar puncture should be done to confirm or exclude the diagnosis 12 hours post symptom onset
203
preventing stone formation in a pt with hypercal
hydrochlorthiazine - thiazide diuretic acan be used
204
CI to circumscision
hypospadius
205
preventing vasospasm in aneurysmal SAH
Nimodipine
206
What is a CI to lapascopic repair of a BO
Acute intestinal obstruction with dilated bowel loops is a contraindication to laparoscopic surgery
207
how can rhabdo cause AKI
due to ATN
208
Preferred diagnostic test for CP
CT - can see calcification
209
high pressure chronic urinary retention
- if impaired renal function
- or if there is hydronephrosis
210
painless distended bladder with no hydronephrosis/ renal impairment
low pressure urinary retention
211
Consider bariatric surgery as a first-line option for adults
BMI > 50
212
Gastric MALT lymphoma ->
eradicate H pylori
213
most common cause of cholangitis
E coli
214
?calcaemia causes pancreaitisi
- Hypercalcaemia causes
- hypocalcaemia is the result
215
panc causes mneumonic
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps (other viruses include Coxsackie B)
- Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
- Scorpion venom
- Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
- ERCP
- Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
216
staghorn calculi are made of
struvite
217
extradural haematoma is commonly caused by
- fracture of the pterion
- this is close to the MMA -> extradural
218
Mx of an OAB
muscarnic antagonist
219
lucid interval after a fall ->
extradural
220
Mx of acute urinary tract obst
- of hydronephrosis do a nephrostomy
221
Wilms tumour
- usually a mass + haematuria and pyrexia
- early metastasis to lungs
- Tx is nephrectomy
222
which disease increases risk of gallstones
CD
223
Soft, non-tender swelling on one side of the scrotum that transilluminates →
Hydrocele
224
Dx of a hydrocele
US
225
Mx of hydrocele
- infantile: repaired if does not resolve within 1-2 yrs
- adults: US, conservative approach
226
Blown pupil after head injury
- sign of CN3 compression
- most likely cause is an extradural haemorrhage
- transtenorial herniation causes this
227
Asymptomatic renal stones < 5mm are generally managed
with watchful waiting and follow up imaging
228
Mx of TT
urgent bilateral orchidoplexy - fix both testes to prevent torsion of the other
229
extra vs subdural haematomas
- extra: limited by suture lines
- subural: cross suture lines
230
hCG is associated with
testicular seminomas
231
Ix for men with ED
- testosterone
- CVD, hypogonadism, HBA1C, lipids
- if testosterone is abn repeat and add FSH and LH
232
Normal CT in a suspected SAH
If subarachnoid haemorrhage is suspected but a CT head done within 6 hours of symptom onset is normal, do not do an LP, consider an alternative diagnosis instead
233
Post obstructive diuresis
- can occur following Tx of BO
- measure U&Es to find cause
234
measuring exocrine function in CP
faecal elastase
235
Mx of a varicocele
- stage 1: reassure
- stage 2: asymp & normal semen: semen analysis every 1-2 yrs
- grade 2/3: symptoms + abn semen -> surgery
236
Avoid performing a prostate specific antigen test within ? of a UTI or prostatitis
6 weeks
237
LFTs with biliary colic
- Normal ALP and GGT
- normal AST and ALT
- normal CRP
238
Central tearing CP + prolonged vomiting + surgical emphysema ->
Boerhaves synrome - oesophageal rupture
239
Following a cholecystectomy, pain, fever and bilious drainage from a surgical drain are suggestive of
a bile leak
240
SAH - CT
- if CT head is done within 6 hours of symptom onset and is normal, DO NOT DO A LP
- If CT > 6 hrs after and is normal, do a LP 12 hrs after symptoms onset
241
drugs causing ED
SSRI and BB
242
First line for suspected prostate cancer
mutliparametric MRI
243
Imaging in acute vs chronic panc
- acute: US abdo
- Chronic: CT pancreas
244
best test for acute panc
- lipase espec for late presentations
245
RF for testicular cancer
- infertility - strongest
- cryptochidism
- mumps
- Fhx
- klinefelters
246
imaging of choice for suspected renal colic
NC CT-KUB
247
Mx of renal colic
- Diclofenac (IM) 1st
- 2nd: if NSAIDS CI'/ not enough: IV paracetamol
248
Infection with what predisposes to staghorn calculi
proteus mirabalis
249
Non-seminoma germ cell testicular tumours (e.g. teratomas) are associated
with raised hCG and AFP
250
Mx of a foreign body aspiration
- imaging: plain XR
- Mx: endoscopy
251
what are varicoceles assoc w
male infertillity
252
Infants with hydrocephalus will present with
increased head circumferences, a bulging fontanelle and sunsetting of the eyes - impaired upwards gaze
253
most common form of PC
adeno
254
reynolds pentad =
Charcot's triad plus hypotension and confusion
255
Cushings triad
- HTN
- widened pulse pressure
- resp changes
- bradycardia
256
Absolute CI to laparscopic surgery
- haem instability/ shock
- raised ICP
- acute intestinal obstruction with - dilated bowel loops (e.g. > 4 cm)
uncorrected coagulopathy
257
Patients with obstructive urinary calculi and signs of infection require
Urgent renal decompression and IV antibiotics due to the risk of sepsis
258
Investigations for suspected epididymo-orchitis are guided by age:
- sexually active younger adults: NAAT for STIs
- older adults with a low-risk sexual history: MSSU
259
Comp of radiotherapy for PC
- proctitis
- increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer
260
Patients with intracranial bleeds, who become unresponsive should receive an urgent
CT scan to check for hydrocephalus
261
testing for diabetes in CP
Annual HBA1C
262
Mx of priapism
- 1) exercise, ice packs, ejaculation
- 2) aspiration of blood from corpus cavernosa followed by irrigation with normal saline
- 3) phenylephrine intracavernosal injection
263
Mx of cerebral oedema
IV mannitol
264
most sensitive scan for DAI
MRI
265
Mx of epididymo-orchitis - junknown organism
single dose ceftriaxone + 10-14 days of doxy
266
what can cause ongoing jaundice following cholecystectomy
gallstones in CBD
267
what is damaged in a subdural bleed
bridging veins between cortex and venous sinuses
268
Ix for OAB
Urodyanmic studies to measure bladder voiding
269
Schisotosoma haematobium infection increases risk of
Sq cell carcinoma of the bladder (smoking and schistosome are RF)
270
Gastrectomy can result in
B12 def
271
Balinitis Xeortica
- assoc with phimosis - male equiv of LS
- (tight irretractable foreskin)
272
drugs causing panc
- mesalazine
- bendroflumethazide
- furosemide
- steroids
- COCP
- amoxicillin
273
which type of testicular cancer has a better prognosis
seminomas
274
e.g. of antimuscarinics used for OAB
- oxybutynin
- tolterodine
- darifenacin
275
biliary colic vs acute cholecystitis
ACl: systemically unwell
- no jaundice in both
276
What needs to be checked after a SAH
- U&Es
- hyponatreamia common
277
Acute prostatitis in a young man should prompt testing
for STI
278
What must be prescribed with goserelin in PC
cyproterone acetate or flutamide DUE TO RISK OF TUMOUR FLARE - start this 3 days b4 goserelin
279
prehns sign
In testicular torsion the elevation of the testis does not ease pain compared to epididymitis (Prehn's sign)
280
Urinary problems in a man with a history of gonorrhoea may be due to a
urethral stricture
281
orchidectomy vs orchiplexy
- orchidectomy: complete removal of the testis, done if infarcted and non viable
- orchiplexy: surgical fixation of the testis
282
CI of NSAID
Recent GI bleed, CKD
283
Scoring of severe pancreatitis - Glasgow e.g.
- hypoxia
- age > 55
- hypocalcaemia
- hyperglycaemia
- neutrophilia
- elevated LDH amd AST
284
most common cause of epididymyo-orchitis in older men
- low STI risk: E coli
- high STI risk/ younger men: Gonorrhoea and Chlamydia
285
RUQ pain with raised inflammatory markers in a patient with a history of gallstones points to
acute cholecystitis or cholangitis rather than biliary colic
286
Mx of subarachnoid haemorrhage intercranial aneursym
coil by interventional neuroradiologist
287
subdural haematomas can present ?after the initial injury
sev weeks
288
what is a common consq of SAH
SIADH -> hyponatreamia
289
Highest rates of PC in
- afro-carbbean men
290
DAI present
- occurs when the head is rapidly accelerated or decelerated -> multiple haemorrhages and diffuse axonal damage to the white matter
-
291
airway Mx in the case of major trauma
- do a jaw thrust because we don't know if there is a C spine injury
- Head tilt chin lift should not be done
292
? is a common complication from intraventricular haemorrhages
hydrocephalus
293
which type of renal stones are radio-lucent
- cystine stones: semi-opaque
- urate + xanthine stones: radio-lucent
294
? is characteristic of testicular torsion
In acute testicular pain, a unilateral swollen and retracted testicle, with loss of the cremasteric reflex, is characteristic of testicular torsion
295
uncal herniation eye sign
dilated pupil from oculomotor compression
296
Criteria for BS death
- Fixed pupils which do not respond to sharp changes in the intensity of incident light
- No corneal reflex
- Absent oculo-vestibular reflexes - no eye movements following the slow injection of at least 50ml of ice-cold water into each ear in turn (the caloric test)
- No response to supraorbital pressure
- No cough reflex to bronchial stimulation or gagging response to pharyngeal stimulation
- No observed respiratory effort in response to disconnection of the ventilator for long enough (typically 5 minutes)
297
what is not tested in BS death
no response to sound
298
BPH Tx
- tamsulosin first like: A1 antagonist
- Finasteride can be added 2nd line: 5-AR inhibitor
- finasteride takes 6months to work
299
Scrotal swelling you can't get above:
inguinal hernia
300
Medical indications for circumcision
- phimosis
- recurrent balanitis
- balanitis xerotica obliterans
- paraphimosi
301
hydrocele features
- not separate to the testis
- transilluminate
- tend to be less tense when the pt is supine
302
Factors favouring an organic cause of ED
- Gradual onset of Sx
- lack of tumescence - erection
- normal libido
303
Mx of perthes under 6
- consv: good prognosis
- older: surgery
304
prada willi inheritance
imprinting - loss of a functioning copy results in prader-willi, the father didn't give a copy, and the mother turned their copy off.
305
jaundice within fist 24 hrs is
always pathological!
306
Congenital CMV manifests with
- Heating loss
- low birth weight
- petechial rash
- microcephaly
- seizures
307
dermoid cysts=
- may develop a sites of embryonic fusion
- usually have hair follicles
308
desmoid cysts =
- large infilytrative masses, benign tumours of CT
309
sebacous cyst =
sually have a punctum and contain a cheesy material.
310
epidermoid cyst =
keratin plugs
311
Nenonatal death
within first month of life (28 days)
312
Miscarriage =
death in utero before 24 weeks
313
pueperal death =
maternal death within 6 weeks of babies birth
314
TOF signs
- cyanosis/ collapse in first month
- hypercyanotic spells
- Ejection systolic murmur at left sternal edge
315
what is lost in SUFE
- internal rotation of the leg in flexion
- suFI -> problem with Flexed + Internal rotation
316
Mx of SUFE
internal fixation: typically a single cannulated screw placed in the centre of the epiphysis
317
Ebsteins pearl
- white coloured nodule at the roof of neonates mouth
- often mistaken for neonatal teeth
318
when should APGAR scores be done
1 & 5 mins (if low then repeat at 10 min)
319
PS ABG
. Hypochloremic, hypokalaemic metabolic alkalosis
320
MCUG vs DMSA
- MCUG for Reflux
- DMSA for renal scarring
321
Neonatal hypoglycaemia Mx
- - Capillary blood glucose of < 1mmol/L should be started on an IV dextrose, regardless of whether they are symptomatic or not.
- Capillary blood glucose of > 1mmol/L with symptoms (e.g.: jittery, hypotonic and irregular respirations) also for IV dextrose
- if hypoglycaemia but asymptomatic: feed normally and monitor
322
rubella school exclusion
5 days
323
SF school exclusion
24 hrs after ab
324
HFM school exclusion
no exclusion
325
? should be given to all children who have an asthma attack
Steroids
326
most common cause of stridor in a neonate
- laryngomalacia
- congenital abn of the larynx
327
damage in CP
Spastic cerebral palsy results from damage to upper motor neurons in periventricular white matter
328
Ix for mecckles
- technetium scan if stable
- mesenteric arteriography in more severe cases
329
where does hypospadius most freq occur
distal ventral surface
330
what determines degree of severeity in TOF
- severity of right ventricular outflow tract obstruction (pulmonary stenosis) determines the degree of cyanosis and clinical severity
331
Dyskinetic cerebral palsy
- athetoid movements and oro-motor problems
- affects BG & substantia nigra
332
toddler with diarrhoea, undigested food in stool, no FTT
toddlers diarrhoea
333
use of what during pregnancy can lead to a cleft palate in the baby
antiepileptics
334
Osglood Schlatter disease
- inflammation of tibial tuberosity
- v common in young active kids
- supportive Mx
335
croup vs bronchiolitis vs epiglotittis cause
- crouP: parainfluenza virus
- epiglotiitis: HiB
- bronch: HSV
336
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers
Edwards = trisomy 18
337
CF diet
High calorie and high fat with pancreatic enzyme supplementation for every meal
338
Term infant with clinical significant PDA →
Transcatheter PDA closure (not ibuprofen/ indomethacin)
339
Mx of eczema in kids
- simple emollients
- topical steroids
- wet wrapping
340
what is assoc w more severe episodes of bronchiolitis
bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
341
first line medical Mx of ADHD
methylphenidate (drug therapy is given as a last resort and ONLY IN > 5)
342
Contraindication to lumbar puncture
- Raised ICP signs:
- focal neurological signs
- papilloedema
- significant bulging of the fontanelle
- disseminated intravascular coagulation
- signs of cerebral herniation
- meningococcal septicaaemia
343
Nec fas Sx
- rapidly evolving rash along with significant pains out of proportion to the rash
- caused by B-haemolytic Group A strep
- comp of chickenpox
344
Mx of a viral induced wheeze
- SABA first line
- 2: oral monteleukast or inhaled steroid
345
rescue therapy for recurrent febrile seizures
benzos - buccal midazolam or rectal diazepam
346
partial seizures occuring at night ->
benign rolandic
347
generalised myoclonic seizures in the morning or following sleep deprivation
juvenile myoclonic
348
Newborns with a positive heel prick for CF testing ->
Newborns with a positive heel prick for CF, i.e. they have a raised immunoreactive trypsinogen (IRT) result, get a sweat test, which will be high if they have CF
349
most common comp of measles
otitis media
350
most common cause of death with measles
pneumonia
351
SF
- notifiable disease
- treat wirh 10 days of penicillin
352
Prostaglandin E1
should be given to maintain a patent ductus arteriosus in cyanotic congenital heart diseases
353
the 5 T's for cyanotic congenital heart diseases (CHD):
- Tetralogy of fallot
- Transposition of great vessels (TGA)
- Tricuspid atresia
- Total anomalous pulmonary venous return
- Truncus arteriosus
354
A child with whooping cough should be excluded from school for
- 48 hrs after starting ab.
- 21 day after symptom onset if no ab
355
All breech babies at or after 36 weeks gestation require
USS for DDH at 6 weeks
356
unilateral descended testis
- review at 3 months
- if persistent refer, baby should ideally see a surgeon before 6 months
357
bilateral undescended testis ->
urgent review by senior paediatrician within 24 hours
358
multiple bruises at different stages of healing ->
contact safeguarding lead
359
Mx of genu valgum
Knock knees (genu valgum) are are a usual variant and usually resolve by the age of 8 years
360
acute limp Mx
Urgent assessment should be arranged for a child < 3 years presenting with an acute limp
361
mx of meningitis < 3 months
IV cefotaxime and IV amoxicillin
362
what should not be given for kids under 3 months with meningitis
steroids
363
when should a bone marrow biopsy be done for ITP
- splenomegaly
- bone pain
- diffuse lymphadenopathy
364
red flags criteria in fever
- Pale/mottled/ashen/blue
- * No response to social cues
* Appears ill to a healthcare professional
* Does not wake or if roused does not stay awake
* Weak, high-pitched or continuous cry
- grunting
- tachypnoea: RR > 60
- moderate or severe: chest indrawing
- reduced turgor
- * Age <3 months, temperature >=38°C
* Non-blanching rash
* Bulging fontanelle
* Neck stiffness
* Status epilepticus
* Focal neurological signs
* Focal seizures
365
Criteria for immediate CT in kids
- Loss of consciousness lasting more than 5 minutes (witnessed)
- Amnesia (antegrade or retrograde) lasting more than 5 minutes
- Abnormal drowsiness
- Three or more discrete episodes of vomiting
- Clinical suspicion of non-accidental injury
- Post-traumatic seizure but no history of epilepsy
- GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department
- Suspicion of open or depressed skull injury or tense fontanelle
- Any sign of basal skull fracture (haemotympanum, panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
- Focal neurological deficit
- If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
- Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)
366
moderate or severe ? is a red flag in paeds with a fever
intercostal recession
367
SE of methylphenidate
stunted growth
368
triad of transient synovitis
hip pain, limp and recent infective illness
369
mitochondiral disease
- Affected males cannot pass it onto their children
- Affected females will pass it onto all of their children
- All individuals who inherit the affected mitochondria, will have the disease
370
Plagiocephaly
- skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a 'parrallelogram' appearance
- reassure
371
Mx of whooping cough
- oral azithromycin for 21 days
- notifiable disease to PHE
372
What is the most common presentation of neonatal sepsis
resp distress & grunting
373
salmon pink rash + joint pains
- JIA (systemic onset) a.k.a Stills disease
-
374
when does infantile colic tend to resolve
6 months
375
Children under the age of 5 years who have nocturnal enuresis can be managed
reassurance and advice
376
progressive hip pain, limp and stiffness in a young boy ->
Perthes
377
Bruising at birth can lead to
elevated bilirubin levels (due to hemolysis)
378
why should we not give ibuprofen for CP
INCREASED RISK OF NEC FASH WITH NSAIDS
379
what is true of x linked inheritance
female child of a heterozygous female carrier has a 50% of being a carrier
380
amber signs under NICE traffic light
- Nasal flaring
Lung crackles on auscultation
Not responding normally to social cues
Reduced nappy wetting
Dry mucous membranes
Pallor reported by parent or carer
381
red signs under NICE traffic light
- Moderate or severe chest wall recession
Does not wake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting
382
PDA - how is the drug given
ibuprofen/indomethacin is given to the neonate in the postnatal period, not to the mother in the antenatal period
383
RR of ??? is red flah
A respiratory rate of >60 per minute (at any age) is a red flag according to the NICE paediatric traffic light system
384
Williams syndrome
- Elfin facies
- stabismus
- broad forehead and short stature
- very friendly and social
385
features of ITP
- brusing
- petechial or purpuric rash
- usually following viral illness
- epistaxis or gingival bleeding
386
FBC in ITP
- shows isolated thrombocytopenia
- blood film
387
Mx of ITP
- usually none
- advised to avoid activities that can lead to trauma
- if v low platelet count or sig bleeding: steroids, Iv immunoglobulins
388
Outcomes in congenital diagphramtic hernia are dependene ton 2 factors
1) Liver position - herniation of the liver into the chest is bad
(2) Lung-to-head ratio - ratio > 1 is better
389
Parallel aorta and pulmonary trunk on echocardiography is indicative of
TGA - give prostaglandin E1 to maontain the duct
390
causes of snoring in kids
- obesity
- nasal problems: polyps, deviated - septum, hypertrophic nasal turbinates
- recurrent tonsillitis
- Down's syndrome
- hypothyroidism
391
RF for meconium aspiration
- post term delivery !!
- maternal HTN, pre-eclampsia, chorioamniotis, smoking
392
Mx of nocturnal eneusiris
- reducing fluids b4 bed
- reward system
- eneurisis alarm
- desmopressin
393
Mx of umbilical hernias
- Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age.
- If small and asymptomatic peform elective repair at 4-5 years of age
394
downs syndrome is strongly linked with
alzheimers and ALL
395
A boy is noted to have a webbed neck and pectus excavatum =
NOONAN
396
An infant is found to have small eyes and polydactyly =
Patau
397
A 7-year-old boy with learning difficulties and macrocephaly
fragile x
398
CMPI - what can the mother do if BF
- eliminate diary from her diet
- calcium supplementation to prevent deficiency
399
Measles Sx
characterised by prodromal symptoms, Koplik spots. maculopapular rash starting behind the ears and conjunctivitis
400
where should adrenaline be injected
anterolateral aspect of middle third of the thigh
401
In acute asthma, the BTS guidelines only recommend ABGs for patients with
O2 sats < 92%
402
memory loss in depression
- global rather than STM
- called pseudodementia
403
if a patient on amlodepine develops ankle swelling
switch to another anti-HTN such as indapemide
404
HUS
- caused by E coli 0157: h7
- presents with AKI, haemolytic anaemia and thrombocytopenia
- bloody diarrhoea
405
when is ECV done at its earliest
- 36 weeks
- 37 if multiparous
406
most common malignancy of acanthosis nigricans
GI adenocarcinoma
407
To diagnose tumour lysis syndrome, you require
either increased serum creatinine, a cardiac arrhythmia or a seizure to have occurred
408
Type 1 vs type 2 hepatorenal syndrome
- Type 1: renal failure within 2 weeks, usually after an acute event like an UGIB
- type 2: gradual decline in renal function, associated with refractoty ascites
409
bilateral conductive hearing loss ->
otosclerosis
410
Qfracture score > 10% ->
arrange DEXA
411
What type of injury most commonly causes axillary nerve injury
anterior shoulder dislocation
412
The following drugs may cause urinary retention:
- tricyclic antidepressants e.g. amitriptyline
- anticholinergics e.g. antipsychotics, antihistamines
- opioids
- NSAIDs
- disopyramide
413
key SE of prostaglandin analogue for glaucoma
yelash length, iris pigmentation and periocular pigmentation
414
what does cyroprecipiate contain
- factor 8
- fibrinogen
- VWF
- factor 13
415
COCP and surgery
stop 4 weeks before, retsart 2 weeks after
416
Ix for cancer history + new back pain
MRI spine
417
A pyogenic granuloma may mimic amelanotic melanoma but can be differentiated based on
history of trauma
418
breakthrough dose =
1/6th daily morphine dose
419
digoxin - toxicity
Toxicity can occur in patients with digoxin levels in the therapeutic range - narrow therapeutic window
420
digoxin and ionotropy
positive inotropy - increases cardiac contractility
421
key RF for an oesophageal adeno
- smoking and alcohol
422
? should not be used in a patient with epilepsy as it reduces seizure threshold
bupropion
423
? is a risk factor for small bowel bacterial overgrowth syndrome
scleroderma
424
Dysphagia, aspiration pneumonia, halitosis → ?
pharyngeal pouch
425
When using an inhaler, for a second dose you should wait
for 30s before repeating
426
? is the most frequent and most severe manifestation of chronic Chagas' disease
cardiomyopathy. Urgently do an echo
427
focal seizures with impaired awareness
- emotional disturbance and automatisms
- followed by post-ictal state
428
Reduced visual acuity after exercise =
Uthoffs phenomenon - seen in MS
429
Optic neuritis can be a feature of
MS. Do an MRI
430
Chiari malformations are often associated with ?due to disturbed cerebrospinal fluid flow at the foramen magnum
synringomyelia
431
tetrad of NMS
hyperthermia, muscle rigidity, autonomic instability, altered mental status
432
Contralateral homonymous hemianopia with macular sparing and visual agnosia -
posterior cerebral artery
433
how to differentiate between true and pseudoseizure
prolactin
434
Causes of WE
- alcohol
- anorexia nervosa
- stomach cancer
435
? is the first-line treatment in patients with early status epilepticus
IV lorazapam
436
