Passmed Corrections Flashcards
1st line medication management for STRESS incontinence
Duloxetine (is an SNRI)
- If asked for conservative Mx: Pelvic floor Muscle Training
Urinary Incontinence causes:
- Urge(overactive bladder due to detrusor overactivity)
- Stress incontinence- leaking small amounts by cough/sneeze
3.Mixed incontinence (urge and stress) - Overflow incontinence: due to bladder outlet obstruction
- Functional Incontinence
Urge Incontinence Management:
- Bladder retraining (1st line)
- antimuscarinics- Oxybutynin- avoid in older women (immediate release)
Menopause contraception until when:
is needed until 12 months after last period if MORE than 50 years and for 24 months if LESS than 50 years
Glucocorticoid(steroid like prednisolone) treatment: what can it cause in a blood result?
Can induce Neutrophilia (increased neutrophil count)
Characteristics of Mania vs. Schizophrenia
Mania:
- Flight of ideas(there are links to change in topic)
Schizophrenia:
-Knight’s move thinking (no links in conversation)
Thought disorders: types and presentations
- Circumstantiality: tangent that eventually returns back to original point
- Tangentiality: does not return back to topic
-Neologism: New word formation/combining of 2 words
-Clang association: words are related by their similar sound/rhyme - Word Salad: completely incoherent speech(nonsense sentences)
- Knight’s Move thinking: unexpected and illogical leaps from one idea to another= feature of schizophrenia
-Perseveration: repetition of ideas/words DESPITE attempt to change topic. - Echolalia: repetition of someone ELSE’S speech, including the question that was asked.
Tuberculosis:
Latent TB: on CXR, can see a calcified Ghon complex(calcified nodule)
Features of Rheumatoid Arthritis:
Juxta-Articular osteoporosis/osteopenia-loss of bone density(early feature of R.A)
- Other features: chronic history of swelling and pain in small joints of hand, soft tissue swelling, periarticular erosions, subluxation
X-Ray changes of Osteoarthritis:
-Subchondral sclerosis
-Subchrondral cysts
-Osteophytes
Conditions that can be diagnosed prenatally by amniocentesis:
- Alpha1 Antitrypsin deficiency (is located on chromosome 14)
-Meniere’s Disease presentation:
- Recurrent episodes of vertigo, fluctuating sensorineural hearing loss and sensation of fullness/pressure in affected ear, nystagmus
Neonates: transient hypoglycaemia in first hours after birth is normal
neonatal hypoglycaemia is less than 2.6mmol/l
- if asymptomatic=encourage normal feeding and monitor blood glucose
-symptomatic/low blood glucose: admit to neonatal unit, IV infusion of 10% dextrose
Ankylosing Spondylitis(Inflammatory Arthritis) features:
-Pain improves with exercise
- pain is worse in the morning
- is associated with HLA-B27 gene
- O/E: Schober’s test: reduced forward flexion
Adding progestogen HRT increases risk of which cancer?
Breast cancer
Adding oestrogen only HRT increases risk of which cancer?
Endometrial cancer- Unopposed oestrogen increases risk
Smoking cessation medication in pregnant women:
Nicotine replacement patch therapy
- NB: Bupropion(is contraindicated in pregnancy, breastfeeding and epilepsy) and Varenicline are contraindicated
Dorzolamide(used in the management of Primary Open Angle Glaucoma) drug class:
- Carbonic Anhydrase Inhibitor: works by reducing aqueous humour in eye and therefore reducing intraocular pressure- used in glaucoma
Prophylaxis medical management for oesophageal bleeding:
Propanolol: (a non-selective beta blocker can be used- as it reduces portal venous blood flow)
Polymyalgia Rheumatica:
- O/E: no true weakness of limb girdles in this condition; any weakness of muscles is due to myalgia.
Features: rapid onset less than 1 month, patient is more than 60 yrs old.
Treatment: - Prednisolone 15mg/once daily (steroids typically help)
Ddx: could be frozen shoulder- but this is usually unilateral
Rotator Cuff Injury:
- Typically Unilateral, presents with pain on abduction of arm(painful arc)
Febrile seizures considered medication:
-Buccal Midazolam or Rectal Diazepam
Vision disorder classical presentation:
- Central field vision loss: Age-related Macular Degeneration
- Peripheral visual field loss: Primary open-angle Glaucoma
Age-related Macular degeneration:
- Risk factors: advancing age, smoking
- 2 types: Dry and Wet
-Fundoscopy: show presence of Drusen
Advanced life support guidelines:
-Don’t give atropine in asystole/pulseless electrical activity- only give this for patients with shockable rhythms.
reversible causes of cardiac arrest:
Reversible causes of cardiac arrest:
The 4 Hs:
Hypoxia
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
Hypothermia
4 T’s:
Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade – cardiac
Toxins
Tetralogy of Fallot Presentation:
-may experience episodic tet (hypercyanotic spells)
shaken baby syndrome triad:
encephalopthy, SUBdural haematoma, retinal haemorrhage
neonates resp distress syndrome:
if can hear tinkling sounds in a resp exam= think diaphragmatic hernia. Manage by: intubation and ventilation
in suspected Lyme disease for Asymptomatic patients:
no need to do anything, just reassure patient and give safety-netting advice.
- is caused by spirochaete Borrelia Burgdoferi
- can be diagnosed clinically if erythema migrans(bulls eye ring) is present
- give doxycycline for early symptomatic disease(upto 30 days ish)
PTSD:
flashbacks, nightmares
mx: CBT or if medical: Venlafaxine(SNRI)/SSRI
Alcohol(ethanol) why it increases polyuria:
Ethanol inhibits ADH secretion
NSTEMI management:
NSTEMI (managed conservatively) antiplatelet choice
- Aspirin, plus either:
- Ticagrelor, if not high bleeding risk
- Clopidogrel, if high bleeding risk
= Would perform Coronary Angiography if clinically unstable patient/or do one in 72 hours if GRACE score more than 3%
For potential Tonsillitis/throat infection, use which criteria?
Centor criteria= to assess likelihood of bacterial/viral infection and if no points scored on: fever, tonsillar exudate, tender cervical adenopathy, cough=then no need for abx: simple analgesia and rest.
NICE does not recommend taking throat swabs
Bowen’s Disease Mx:
Is a type of squamous cell carcinoma in-situ affecting the epidermis.
- presents with red, scaly crusted patch on sun-exposed areas of the body.
Mx: 1st line with topical 5-fluorouracil
Haemochromatosis blood test results:
- Raised Transferritin saturation, Raised ferritin, Low total iron binding capacity
Stable Angina 1st line Investigation:
- CT coronary angiography
Presentation: Persistent productive cough +/- haemoptysis in a young person with a history of resp problems and no foreign travels+finger clubbing=??
Bronchiectasis
patients with AAA(Abdominal Aortic Anerysm) Mx:
- With symptoms= immediately refer to vascular surgery so can do emergency repair
Presenting symptoms: - severe, central abdominal pain radiating to the back
-patients may be shocked
-pulsatile mass in abdomen
can only send for a CT scan to confirm diagnosis if patient is stable.
Acute mx. of kidney stone (renal colic):
- IM Diclofenac, 2nd line IV paracetamol
- Presenting features: severe sudden onset loin to groin pain with nausea
Obstructive Sleep Apnoea Mx:
1st line: CPAP (for moderate/severe) after weight loss
Diagnostic test: Sleep Studies
Also inform DVLA if it is causing daytime sleepiness
Diabetic Neuropathy Mx (think neuropathic pain):
1st Line:
- Amitriptyline
- Duloxetine
- Gabapentin
- Pregabalin
Drug toxicity management:
-Opiate(pain): Naloxone
-Benzodiazepine: Flumazenil
-Paracetamol overdose: N-acetyl cysteine, (if ingested less than 1 hour ago, activated charcoal)
- Salicylate(aspirin) and Tricyclic Antidepressants(amitriptyline): IV Bicarbonate, haemodialysis
- Warfarin: Vitamin K
- Heparin: Protamine Sulphate
-Carbon Monoxide: 100% oxygen
-Cyanide: Hydroxycobalamin
Association of T2DM: (Axilla)
Acanthosis Nigricans: is caused by insulin resistance, (sometimes description as: Hyperpigmentation and Hyperkeratosis in the axilla and groin regions.
Most dangerous presentation of breech:
- Footling presentation
Unilateral glue ear in an adult Management:
- Need to do 2 week wait referral as needs evaluation for a posterior nasal space tumour.
- Presentation of glue ear:
SSRIs: benefit with PMS and periods?
either continuously or during luteal phase helps PMS.
Cotton wool spots on eye slit lamp means what?
Retinal infarction, and presents in diabetic retinopathy
Vitiligo: Dermatological condition association?
- is an autoimmune condition associated with other autoimmune conditions and alopecia areata
- Koebner phenomenon: trauma may precipitate more reactions.
Umbilical cord prolapse is a medical emergency, management?
- Get patient on all 4’s.
Congenital Cytomegalovirus presentation in neonates?
Presents with:
- Hearing Loss
- Low birth weight
- Petechial rash
- Microcephaly
- Seizures
Otitis Externa management:
Topical Antibiotics+topical steroid
- Presents as: external auditory canal infection
- infection is often caused by: Staph aureus, Pseudomonas Aeruginosa
- recent swimming is also a trigger
Sialadenitis? (salivary glands)
- Is inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.
Missed pill rule:
- If taken COCP in first 7 days of cycle, then if missed a pill a day ago and then resumed to take 2 more pills= Means no emergency contraception will be required.
Side effect of long term anti-psychotics?
Can lead to the development of diabetes and glucose dysregulation.
Other common side effects of typical antipsychotics (Extra-pyramidal side effects)=
-Parkinsonism
-Acute Dystonia
-akathisia
-tardive dyskinesia
Definitive management for acute angle-closure glaucoma?
- Laser iridotomy
- is an emergency and needs a ophthal referral
Postnatal depression screening tool?
Edinburgh Scale
Management: of primary haemorrhage(bleeding) within hours after tonsillectomy?
- Requires immediate return to theatre
- if question is phrased like= IV tranexamic acid
When can a copped IUD be fitted into the menstrual cycle?
Anytime in the cycle, as the IUD is not hormonally linked.
missed miscarraige is also known as?
delayed miscarraige
Surfactant disease in newborn (Respiratory Distress) is a common risk factor in?
- Maternal Diabetes Mellitus
Hyperthyroidism (Grave’s disease) mx?
Normally Carbimazole but if not in option:
- GP can start: Propanolol for symptom control
- specialist can start: Propylthiouracil to bring thyroid levels under control.
Acute angle-closure glaucoma DEFINITIVE mx?
Laser peripheral iridotomy
NB: 1st line) Latanoprost eye drops
Associations of: Acute angle closure glaucoma AND Primary open-angle glaucoma
-Acute angle: Hypermetropia (long-sightedness)
-Primary open angle: Myopia (near-sightedness)
Main risk factor for retinal detachment?
- Myopia
Mx. of OESTROGEN receptor positive breast cancer in pre-menopausal women?
Tamoxifen
- Although examples of aromatase inhibitors is: Anastrozole and letrozole: reduces peripheral oestrogen, however could cause Osteoporosis.
For asthma diagnosis in children:
- Even if spirometry is negative, still need to check Fractional exhaled nitric oxide testing (FeNO) to confirm asthma diagnosis.
Pulmonary Fibrosis investigation required for definitively diagnosing the condition?
- CT (high resolution): also hear Bilateral Fine Crepitations and finger clubbing can be seen.
- Spirometry: classically shows a restrictive picture (ratio increased FEV1/FVC: decreased)
- Poor prognosis, life expectancy is around 3-4 years.
Most common organism: in young adults with septic arthritis?
Neisseria Gonorrhoeae
Renal colic: acute management based on guidelines?
- IM Diclofenac (NSAID)
- Imaging: Non contrast CT kidney, ureter and bladder.
Example of a nephrotoxic disease that needs to be stopped if patient has a AKI?
Ibuprofen
New-onset AF management: if Pharmacological cardioversion is agreed
- If evidence of structural/ischaemic heart disease: give Flecainide or Amiodarone
- If yes: evidence of structural heart disease= Amiodarone
Rate control medication for AF:
- Atenolol (beta blockers)
- Digoxin therapy: only if patient is presenting with non-paraoxysmal AF+sedentary
What medications should patients be prescribed for a STEMI= that needs Fibrinolysis?
- Alteplase
AND - Fondaparinux (is an antithrombin drug)
how to manage: IRREGULAR broad complex tachycardia?
- this is a rare condition: therefore= seek specialist cardio input
What is typically spared in Motor neuron Disease?
- Ophthalmoplegia: eye movements (as extraocular eye muscles are preserved)
What would point towards a diagnosis of Motor Neuron Disease?
- Fasciculations
- Asymmetric limb weakness is most common presentation of ALS (amyotrophic lateral sclerosis)
- wasting of small muscle hands
NB: doesn’t affect eye muscles, has no cerebellar signs
Osteomalacia blood results?
- Low calcium
- low vitamin d
- low phosphate
- usually high alkaline phosphatase
In Diabetes when should you add another medication to monotherapy?
- If Hba1c rises to more than 58mmol/mol
- Hba1c should be checked every 3-6 months until stable, then 6 monthly
Diabetes and then get MI: what to prescribe?
D for diabetes
D for Dapagliflozin
Presentation of Ileus (post-operative= same as bowel obstruction)?
- Abdominal pain
- Bloating
- Vomiting
(following bowel surgery)
Optic Neuritis mx?
- IM corticosteroids (high dose steroids) + MRI of brain and orbit of eye
Presentation of Optic Neuritis?
- Subacute unilateral vision loss
- Eye pain worse on movements
Anterior Uveitis Mx?
- Steroid and Cycloplegic eyedrops
Eczema Herpeticum: most likely diagnosis?
- Very severe emergency presentation: is a painful red rash, occurs when HSV(Herpes Simplex Virus) infects an area that is infected by eczema
- is a life-threatening condition and should be admitted for IV aciclovir
Side effects of beta blockers?
Sleep disturbances: Insomnia
A woman at moderate or high risk of pre-eclampsia should take ?
Aspirin 75-150mg daily from 12 weeks gestation until the birth
Associated condition to think of: Mitral stenosis and what condition?
Rheumatic fever (past history)
Mitral Stenosis murmur: loud S1, opening snap.
