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passmed corrections march Flashcards

1
Q

exomphalos vs gastroschisis

A

exomphalos (omphalocele) - abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum. c section indicated to prevent sac rupture. staged repair over 6-12 months

gastroschisis- not covered in peritoneum. vaginal delivery can be attempted. go to theatre straight after delivery within 4 hours

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2
Q

reactive arthritis
management and cause

A

conjunctivitis, urethritis, arthritis ‘Can’t see, pee or climb a tree’
often post STI (chlamydia) or dysentry (shigella) doesnt include bacteria in synovial fluid just more WBCs

treat symptomatically with NSAIDs
or sulfazalazine or methrotrexate for persistent

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3
Q

imaging for TIA if needed

A

MRI brain with diffusion-weighted imaging is the preferred modality in patients with suspected TIA who require brain imaging
(most dont)

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4
Q

monitoring for magnesium sulphate

A

urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment. also restrict fluid

treat with calcium gluconate if resp depression suspected

treatment should continue for 24 hours after last seizure or delivery

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5
Q

complications of hysterectomy

A

enterocoele and vaginal vault prolapse. Urinary retention may occur acutely following hysterectomy, but it is not usually a chronic complication.

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6
Q

features of autonomic neuropathy

A
  1. Postural hypotension
  2. Loss of respiratory arrhythmia
  3. Erectile dysfunction
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7
Q

mesenteric adenitis

A

inflamed mesenteric lymph nodes. It is often preceeded by a viral infection. It is self limiting

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8
Q

when to refer for no foetal movements- in weeks

A

24 weeks Generally women can feel their babies move around 18-20 weeks

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9
Q

espectatnt managment of ectopic can only be done if (5things)

A

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

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10
Q

cerebellar signs

A

DANISH

Dysdyadochokinesia, dysmetria, appear drunk
Ataxia
Nystagmus
Intention tremor
Slurred staccato speech, Scanning dysarthria
Hypotonia

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11
Q

why does aortic dissection cause neurological deficits

A

compression of surrounding areas
or propagation of the intimal tear to branch arteries

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12
Q

causative organisms of IE
dental, IVDU, prosthetic valve surgery,

A

dental- Streptococcus mitis and Streptococcus sanguinis
IVDU- Staphylococcus aureus
prsthetic valve- Staphylococcus epidermidis

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13
Q

Key features of disseminated gonococcal infection

A

tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)

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14
Q

threadworms name

A

Enterobius vermicularis

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15
Q

UKMEC 3 contraindications to COCP

A
  • more than 35 years old and smoking less than 15 cigarettes/day
  • BMI > 35 kg/m^2*
  • family history of thromboembolic disease in first degree relatives < 45 years
  • controlled hypertension
  • immobility e.g. wheel chair use
  • carrier of known gene mutations -associated with breast cancer (e.g. BRCA1/BRCA2)
  • current gallbladder disease
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16
Q

UKMEC 4 conditions contraindications to COCP

A
  • more than 35 years old and smoking more than 15 cigarettes/day
  • migraine with aura
  • history of thromboembolic disease or thrombogenic mutation
  • history of stroke or ischaemic heart disease
  • breast feeding < 6 weeks post-partum
  • uncontrolled hypertension
  • current breast cancer
  • major surgery with prolonged immobilisation
  • positive antiphospholipid antibodies (e.g. in SLE)

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity

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17
Q

raised ICP headache inv

A

non contrast CT head to rule out space occupying lesion
LP contraindicated due to risk of brain herniating into foramen magnum
cough, valsalva (trying to breathe out with nose and mouth blocked), sneeze or exercise assoc

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18
Q

contraindications for statins

A

macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course
pregnancy

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19
Q

in males with fragility fracture check what

A

testosterone levels, SHBG, FSH, LH

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20
Q

when to get echocardiogram for kawasaki

A

at diagnosis, 1-2 weeks and 6-8 weeks

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21
Q

treatment for scarlet fever

A

oral pen V for 10 days, azithromycin if allergy

children can return to school 24 hours after commencing antibiotics

notifiable disease

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22
Q

complications of scarlet fever

A

otitis media
acute glomerulonephritis
rheumatic fever

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23
Q

bone marrow failure features

A

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

24
Q

de quervains tenosynovitis affects what tendons

A

extensor pollicis brevis and abductor pollicis longus tendons

EPB and APL

25
lower left sternal edge murmurs in an adult could be
tricuspid valve pathology, a VSD or HOCM
26
RILE
right side murmur louder in inspiration (tricuspid, pulmonary) rinspiration like scooby doo left side murmur louder in expiration (mitral, aortic)
27
main difference in rheumatoid and psoriatic arthritis
An asymmetrical presentation suggests psoriatic arthritis rather than rheumatoid
28
Lateral medullary syndrome or wallenburgs
- PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner's if brainstem features are present on the left side, the left posterior inferior cerebellar eg left sided horners and right sided numbness
29
atrial septal defect and ventricular septal defect sounds
ASD = A Split Double VSD = Very Systolic = Pansystolic
30
management of bradycardia
ABCDE- oxygen and Iv access observe if haemodynaimcally stable and no risk of asystole if needing management- atropine (IV 500mcg) up to 3mg transcutaneous pacing isoprenaline/adrenaline infusion titrated to response consideration by experts of transvenous pacing if there is no response to the above measures.
31
Enuresis becomes an issue at what age
by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract' primary (the child has never achieved continence) or secondary (the child has been dry for at least 6 months before) enuresis alarm first line but reward charts if nae keen. desmopressin if gan fae a sleepover
32
management for whooping cough
under 6 months- admit macrolide if onset of the cough is within the previous 21 days of inf (no point if after cus its probs eradicating itself by then) household contacts should be offered antibiotic prophylaxis back to school 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics ) Notifiable Women who are between 16-32 weeks pregnant will be offered the vaccine.
33
stress incontinence if exercises dont work give what
duloxetine
34
urge incontinece if exercises dont work give what
Antimuscarinic (oxybutynin) and beta-3 agonist (mirabegron)
35
vit b12 IM injections regime
no neurological features: 3 injections per week for 2 weeks followed by 3 monthly treatment of vitamin B12 injections more frequent doses are given for patients with neurological features folic acid supplementation may also be required
36
what scores do you used for upper GI bleed
glasgow blatchford 0-23 before endocopy to see if can be treated as outpaptient then rockall 0-11 after to see percentage risk of rebleeding and mortality
37
wilsons disease wtf is it
genetic problem on ATP7B gene autosomal recessive disorder characterised by excessive copper deposition in the tissues neuro and liver issues penicillamine is treatment check for Kayser-Fleischer rings would have reduced serum copper and caeruloplasmin and more in urine
38
signet ring cells are seen in
gastric cancer
39
synthetic function of the liver works on
coagulation factors- check APTT gluconeogenesis and glycogen storage- can lead to hypoglycaemia Albumin- The liver produces albumin, Hypoalbuminaemia in ALF can lead to oedema and ascites. Enzymes- Liver enzymes ALP and transaminases (AST and ALT) are released into circulation during hepatocyte injury. converts ammonia to urea- hyperammonaemia, contributing to hepatic encephalopathy.
40
severity of UC mild, mod, severe criteria
mild: < 4 stools/day, only a small amount of blood moderate: 4-6 stools/day, varying amounts of blood, no systemic upset severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
41
hep B serology way to remember
HBsAg = ongoing infection, either acute or chronic if present > 6 months anti-HBc = caught, i.e. negative if immunized (includes IgG and IgM)
42
ascites abdominal pain fever what is
Spontanrous bacterial peritonitis paracentesis: neutrophil count > 250 cells/ul the most common organism found on ascitic fluid culture is E. coli IV cefotaxime prophylaxis if fluid protein <15g/l
43
main risk factor for cholangiocarcinoma
Primary sclerosing cholangitis (can ahve raised CA 19-9 levels)
44
COPD management
SABA asthmatic features then LABA + ICS if not then LAMA + LABA if patients remain breathless or have exacerbations offer triple therapy i.e. LAMA + LABA + ICS if taking SAMA switch to SABA
45
criteria for antibiotic prophylaxis in COPD
azithromycin prophylaxis is recommended in select patients patients should not smoke, have optimised standard treatments and continue to have exacerbations
46
asthma guidlines
step 1 Low-dose ICS/formoterol combination inhaler used as needed (as-needed AIR therapy) (MART) step 2 low dose MART regularly step 3 mod dose MART regularly step 4 check the fractional exhaled nitric oxide (FeNO) level if available, and the blood eosinophil count. if neither are raised then trial LTRA or LAMA in addition to mod MART if raised then refer to resp specialist
47
managment of angina
aspirin statin bblocker (or CCB) GTN
48
what is charcots triad for
ascending cholangitis
49
wtf is Roseola infantum
6th disease age 6 month-2y human herpes virus 6 (HHV6) 3 day fever then rash with no fever febrile convulsions often occur Nagayama spots: papular enanthem on the uvula and soft palate diarrhoea and cough also seen
50
reversible Hs for cardiac arrest
Hypoxia Hypovolaemia Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders Hypothermia
51
reversible Ts for cardiac arrest
Thrombosis (coronary or pulmonary) Tension pneumothorax Tamponade - cardiac Toxins
52
ALS guidelines
chest compressions 30:2 a single shock for VF/pulseless VT followed by 2 minutes of CPR or if witnessed cardiac arrest then 3 shocks then CPR adrenaline 1 mg for non-shockable rhythms during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock repeat adrenaline 1mg every 3-5 minutes amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered. a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been given
53
diagnostic threshold for GDM
fasting glucose is >= 5.6 mmol/L 2-hour glucose is >= 7.8 mmol/L 5678
54
external rotation affected more than internal rotation or abduction
adhesive capsulitis
55
major bleed on warfarin management
eg variceal or intracranial bleed irrespective of the patient's INR levels, all patients on warfarin who have major bleeding are advised to stop warfarin and are administered intravenous vitamin K 5mg and PCC. restart warfarin when INR < 5.0 in minor bleeed or no bleed give less vit K if minor or no
56
upper lobe fibrosis causes
C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis eveyrthing else upper
57
wtf is Alport syndrome
genetic condition with deficiency in collagen type IV glomerulonepjritis, end-stage kidney disease, and hearing loss, and it is managed using ACE inhibitors and haemodialysis. if kidney disease then vit D cant be activated so bone issues all ports affected: eyes, ears, urinary (renal)

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