Passmed Year 4 Flashcards
What symptoms would suggest a lacunar stroke?
Pure motor / sensory / cerebellar symptoms
Symptoms of total anterior circulation stroke
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Symptom of partial anterior circulation stroke
2 of:
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Symptoms of posterior circulation stroke
1 of:
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
common causes of acute interstitial nephritis
Drugs (eg NSAIDs or abx) are more common
Systemic inflammatory conditions eg SLE
Management of acute interstitial nephritis
Stop offending agent
Steroids or dialysis if severe
Symptoms of acute interstitial nephritis
rash, fever and eosinophilia
White cells and white cell casts in urine
Mild renal impairment
HTN
Anti platelets in patients with ACS who are taking oral anticoagulant
Aspirin and clopidogrel
Anti platelets in patients with ACS who aren’t already on anticoagulants
Aspirin and prasugrel
Symptoms of HOCM
Asymptomatic Exertional dyspnoea Angina Syncope Sudden death
What cancer is CA15-3 a marker of?
Breast
Management of pregnant women colonised with group B strep
Prophylactic abx in Labour
Indication for pregnant women having intrapartum abx prophylaxis against group B strep
Previous baby with group B strep
Preterm Labour
Pyrexia in Labour
What is a hyatidiform mole?
A pregnancy which becomes cancerous early in development
Symptoms of hyatidiform mole
Painless PV bleeding in early pregnancy
Uterus is large for date
Hyperemesis
Symptoms of thyrotoxicosis
Diagnosis of hyatidiform mole
Ultrasound is highly suggestive (resembles bunch of grapes)
Histopathological examination is diagnostic
What is asherman syndrome?
Scar tissue adhesions form in the uterus following surgery leading to amenorrhoea
Aetiology of imperforate hymen
Congenital (no hole in hymen from birth)
Management of hydrocele
In neonates it may close spontaneously within a few months
If not then surgery
Whooping cough treatment
Abx (azithromicin) if presenting in first 21 days
Whooping cough prophylaxis
Household contacts
Symptoms of neuroleptic malignant syndrome
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
When does neuroleptic malignant syndrome usually present?
Soon after starting antipsychotics
Causes of jaundice in first 24 hours
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
Management of polycythemia Vera
Aspirin
Venesection
Chemo
Complications of polycythemia Vera
Thrombotic events
Myelofibrosis
Acute leukaemia
Symptoms of pityriasis rosea
herald patch (usually on trunk) followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a 'fir-tree' appearance
Age affected by pityriasis rosea
Young adults
Management of pityriasis rosea
None needed
Prognosis in pityriasis rosea
Good, typically clears up spontaneously in 6-12 weeks
Symptoms of Lyme disease
Bulls eye rash headache lethargy fever arthralgia
Late features of Lyme disease
cardiovascular (heart block, peri/myocarditis)
neurological (facial nerve palsy, radicular pain, meningitis)
Management of Lyme disease
Abx
Management of thrush
Oral or pessary antifungals
Management of thrush in pregnancy
Antifungal pessary
Management of recurrent thrush
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
Normal resp rate in neonates
30-60
Normal heart rate in neonates
100-160
Management of PDA
indomethacin or ibuprofen
given to the neonate
(inhibits prostaglandin synthesis and closes the connection in the majority of cases)
if associated with another congenital heart defect amenable to surgery then prostaglandin E1 is useful to keep the duct open until after surgical repair
What differentiates gestational hypertension from pre-eclampsia?
Gestational hypertension has no proteinuria
NICE criteria for immediate CT head
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
NICE criteria for CT head within 8 hours
age 65 years or older
any history of bleeding or clotting disorders
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury
Site to avoid when cannulating diabetic patient
Foot (risk of foot ulcers)
Causes of oligohydramnios
premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia
Treatment of takotsubo cardiomyopathy
Supportive
Prognosis of takotsubo cardiomyopathy
Good (most patients recover with supportive treatment)
Pathophysiology of takotsubo cardiomyopathy
Transient apical ballooning of the heart triggered by stress
What is dermatofibroma?
Benign lesion.
Firm elevated nodules.
Usually history of trauma.
Lesion consists of histiocytes, blood vessels and fibrotic changes
What is pyogenic granuloma?
Overgrowth of blood vessels.
Red nodules.
Usually follow trauma.
May mimic amelanotic melanoma
Site to avoid when cannulating diabetic patient
Foot (risk of foot ulcers)
Causes of oligohydramnios
premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia
Treatment of takotsubo cardiomyopathy
Supportive
Prognosis of takotsubo cardiomyopathy
Good (most patients recover with supportive treatment)
Pathophysiology of takotsubo cardiomyopathy
Transient apical ballooning of the heart triggered by stress
What is dermatofibroma?
Benign lesion.
Firm elevated nodules.
Usually history of trauma.
Lesion consists of histiocytes, blood vessels and fibrotic changes
What is pyogenic granuloma?
Overgrowth of blood vessels.
Red nodules.
Usually follow trauma.
May mimic amelanotic melanoma
Appearance of CSF fluid in viral meningitis
Clear / cloudy
Appearance of CSF fluid in TB meningitis
Slightly cloudy
CSF glucose in Bacterial meningitis
Low (less than half plasma level)
CSF glucose in viral meningitis
Normal (60-80% plasma level)
CSF glucose in TB meningitis
Low (less than half of the plasma glucose level)
CSF glucose in fungal meningitis
Low (less than half of the plasma level)
CSF protein in bacterial meningitis
High
CSF protein in viral meningitis
Normal
CSF protein in tuberculosis meningitis
High
CSF protein in fungal meningitis
High
CSF white cells in bacterial meningitis
High polymorphs
CSF white cells in viral meningitis
High lymphocytes
CSF white cells in TB meningitis
High lymphocytes
CSF white cells in fungal meningitis
High lymphocytes
Management of proximal scaphoid fractures
Surgical fixation
Management of undisplaced distal scaphoid fracture
Splint or cast for 6 weeks
Initial management of scaphoid fracture
Immobilise with splint
Orthopaedic follow up with repeat imaging in 7-10 days
How often is adrenaline given in CPR
Every 3-5 mins
First line medication and route for medical miscarriage
Misoprostol pessary
How long may an expectant miscarriage be trialed for?
14 days
Medications in meningitis in child under 3 months
Antibiotics
Steroids contraindicated
How long after exposure to text for HIV
4 weeks
Management of initial negative HIV test
Repeat at 12 weeks after exposure
Investigation for full thickness oesophageal tear
CT contrast swallow
What is Boerhaaves syndrome
Spontaneous oesophageal rupture due to vomiting
Symptoms of oesophageal rupture
Sudden chest pain
Vomiting
Surgical emphysema
Management of oesophageal rupture
Surgery
Symptoms of narcolepsy
Excessive daytime sleepiness. Cataplexy. Sleep paralysis and hallucinations
Investigation of narcolepsy
Multiple sleep latency EEG
Management of narcolepsy
Daytime stimulants
Is there a vaccine for Hep A?
Yes
Most common site of necrotising fasciitis
Perineum
Symptoms of necrotising fasciitis
Acute onset pain swelling and redness with pain out of keeping with physical features. Fever and tachycardia later
Causes of neonatal hypoglycaemia
Transient hypoglycaemia is normal.
preterm birth (< 37 weeks) maternal diabetes mellitus IUGR hypothermia neonatal sepsis inborn errors of metabolism Beckwith-Wiedemann syndrome
Management of asymptomatic neonatal hypoglycaemia
Encourage feeding. Monitor BMs
Management of symptomatic neonatal hypoglycaemia
Dextrose infusion
Definition of incarcerated hernia
Can’t be reduced
Definition of strangulated hernia
Lost blood supply
What differentiates patients with incarcerated and strangulated hernias
Patient will be systemically unwell in strangulated hernia
Management of femoral hernia
Surgical repair
Typical history of cervical rib
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.
Conditions caused by high altitude
Acute mountain sickness
High altitude pulmonary oedema
High altitude cerebral oedema
Prevention and management of acute mountain sickness
Ascend slowly
Acetazolamide is preventative
Treated with descent
Symptoms of acute mountain sickness
Headache
Nausea
Fatigue
Treatment of high altitude cerebral oedema
Descent
Dexamethasone
Treatment of high altitude pulmonary oedema
Descent
Oxygen
Nifedipine or dexamethasone
Management of suspected DVT with negative USS but raised D dimer
Repeat USS in 1 week
Management of immunosuppressive drugs patient who has been in contact with chickenpox
Check if they have varicella antibodies
If negative, give varicella immunoglobulins
What pneumonia is associated with erythema multiforme
Mycoplasma pneumonia
Is minimal change disease nephrotic or nephritic?
Nephrotic
Is membranous glomerulonephritis nephrotic or nephritic?
Nephrotic
Is focal segmental glomerulosclerosis nephrotic or nephritic?
Nephrotic
Management of membranous glomerulonephritis
ACE inhibitor
Immunosuppression
Consider anticoagulants
What is a first degree burn?
Red and painful. Epidermis is burned
What is a second degree burn?
Pink or white. Painful. Blistered. Dermis is burned
What is a third degree burn?
White / brown / black. Not painful. Full thickness
What cancer does pernicious anaemia increase risk of?
Gastric
Management of hip dislocation
Reduction under GA in 4 hours to reduce risk of AVN
First line in superficial vein thrombosis
Compression stockings
Where is small cell lung cancer usually found?
Centrally
What is lambert eaton syndrome?
Associated with SCLC
antibodies to voltage gated calcium channels causing myasthenic like syndrome
What cancer is lambert Eaton syndrome associated with?
Small cell lung cancer
Treatment of lung cancer
Usually Chemo and radiotherapy. Surgery if very early
Palliative of late
Complications of PBC
Liver cirrhosis
Liver cancer
Management of child under 3 presenting with acute limp
A&E assessment (high risk of septic arthritis)
History and typical patient in transient synovitis
Acute limp
Accompanies viral infection
Child well
Most common in boys 2-12
Management of dyspepsia not responding to high dose PPI
Test for H pylori (and treat if present)
What is calcitonin a tumour marker for?
Medullary thyroid cancer
Treatment of scabies in close contacts
2 doses permethrin a week apart
Symptoms of Bartholin’s cyst
Soft painful labial lump
Signs in ALS motor neurone disease
UMN and LMN
Signs in primary lateral sclerosis motor neurone disease
UMN
Signs in progressive muscular atrophy motor neurone disease
LMN affecting diatal muscles first
Symptoms of progressive bulbar palsy motor neurone disease
palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
When to start treatment in subclinical hypothyroidism
Symptomatic patients. Younger patients. Very high TSH
What is balanitis xerotica oliberans?
Tight foreskin due to lichen sclerosus
What is paraphimosis?
Foreskin can’t be returned to it’s original position after being retracted
What is phimosis?
Tight foreskin means it can’t be retracted
What is balanitis?
Inflammation of the head of the penis
First line investigation in suspected primary hyperaldosteronism
Serum aldosterone to renin ratio
Features of primary hyperaldosteronism
Hypertension
Hypokalaemia (can cause muscle weakness)
Alkalosis
Patau syndrome features
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Edwards syndrome features
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
Fragile X syndrome features
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
Noonan syndrome features
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Prader Willi syndrome features
Hypotonia
Hypogonadism
Obesity
Organophosphate poisoning symptoms
Parasympathetic e.g. pupil constriction, sweating, incontinence, hypotension, bradycardia
Opioid toxicity symptoms
Pupil constriction, constipation, respiratory depression
Cataract symtpoms
Gradual onset blurred vision and reduced colour vision with halos around lights
Surgical procedure in cataracts
Lens replacement with artificial lens
Vitreous haemorrhage symptoms
Sudden onset unilateral vision loss after trauma. Often associated with a red hue
Causes of optic neuritis
multiple sclerosis: the commonest associated disease
diabetes
syphilis
Symptoms of optic neuritis
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma
Management of optic neuritis
High dose steroids
Murmurs on which side of the heart are loudest on expiration?
Left
Murmurs on which side of the heart are loudest on inspiration?
Right
Indications for induction of labour
prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
diabetic mother > 38 weeks
pre-eclampsia
rhesus incompatibility
What is the main complication of induction of labour?
Uterine hyperstimulation
Consequences of uterine hyperstimulation
Foetal hypoxia
Rarely it can cause uterine rupture
Management of uterine hyperstimulation
Remove vaginal prostaglandins
Stop oxytocin infusion
Terbutaline
Management of tachycardia with adverse features (shock, syncope, MI, heart failure)
DC cardioversion
Management of regular broad complex tachycardia
Amiodarone
Management of regular narrow complex tachycardia
Vagal manoeuvres followed by adenosine if unsuccessful
Features of chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Features of Osgood-Schlatter disease
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Features of osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
Features of patellar subluxation
Medial knee pain due to lateral subluxation of the patella
Knee may give way
Features of patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Risk factors for pharyngeal pouch
Males
Older age
Pharyngeal pouch features
dysphagia regurgitation aspiration neck swelling which gurgles on palpation halitosis
Pharangeal pouch management
Surgery
Symptoms of necrotising enterocolitis
Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.
Key investigation in necrotising enterocolitis
Abdo X-ray
AXR in necrotising enterocolitis
dilated bowel loops
bowel wall oedema
Gas in the peritoneum, bowel walls or portal vein
Test prior to BCG vaccine in patients over 6 years
Tuberculin skin test
Diagnosis of boerhaave’s syndrome
CT contrast swallow
Symptoms of roseola infantum
3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever
Classic rash in roseola infantum
Non itchy maculopapular rash starting on the trunk and limbs
First line management of suspected PE in stable patient
Rivaroxaban
First line management of unstable suspected PE
Alteplase
Investigation of reduced foetal movement
Doppler to confirm heartbeat. Ultrasound if it can’t be detected. 20 minute CTG
What is meralgia parasthetica?
tingling, numbness and burning pain in the outer part of the thigh, caused by compression of the lateral cutaneous nerve often in obese people
What is Steven-Johnson syndrome?
painful erythematous macules evolving to target lesions, with severe mucosal ulceration of at least 2 surfaces (e.g. skin, mouth, urethra).
First line for diagnosis of small bowel bacterial overgrowth syndrome
Hydrogen breath test
What is hairy leukoplacia?
an EBV-associated lesion on the side of the tongue, and is considered indicative of HIV
What is oral lichen planus?
a chronic infection that affects mucosal membranes in the mouth. It appears as white lacy patches, open sores, or red swollen patches. It doesn’t tend to affect the tongue. It is generally very itchy for patients and they may be advised to take antihistamines to provide relief.
When is a tetanus booster needed in a wound?
Tetanus vaccine status incomplete or unknown
Last dose over 10 years ago in tetanus prone wound
Management of childhood inguinal hernia
Urgent surgery
Management of necrotising fasciitis
Surgical debridement and IV abx
Total iron binding capacity in iron deficiency anaemia
High
Management of obstetric cholestasis
induction of labour at 37-38 weeks
ursodeoxycholic acid
vitamin K supplementation
What is psittacosis?
Respiratory illness spread by birds
Dengue fever treatment
Symptomatic
First line treatment for ITP in adults
Oral prednisolone
Uterine fibroids symptoms
may be asymptomatic
menorrhagia (may result in iron-deficiency anaemia)
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility
Management of asymptomatic uterine fibroids
Monitor
Management of symptomatic uterine fibroids
Contraception / NSAIDs / TXA to manage menorrhagia
Short term - GnRH agonists
Surgery - myomectomy / endometrial ablation / hysterectomy / uterine artery embolisation
Pathogen in scarlet fever
Group A strep e.g. strep pyogenes
Scarlet fever symptoms
fever: typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat 'strawberry' tongue rash (sandpaper like fine pinhead rash starting on torso)
Scarlet fever management
abx
Age associated with croup
6 months to 3 years
Croup symptoms
stridor
barking cough (worse at night)
fever
coryzal symptoms
Management of croup
Oral dexamethasone
Supportive (usually at home)
Admit if severely unwell or comorbidities
What is Cushing’s disease
ACTH secreting pituitary adenoma
What is filgrastim?
A granulocyte-colony stimulating factor used in neutropaenia
Cause of neonatal bilious vomiting with double bubble sign on X-ray
Duodenal atresia
Treatment of Perthe’s disease
Rest and physio. Surgery if severe (more common in older children)
Treatment of slipped upper femoral epiphysis
Bed rest. Surgery if severe
Causes of lobar collapse
Lung cancer, asthma, foreign body
Symptoms of branchial cyst
Asymptomatic neck lump
Most common cause of traveller’s diarrhoea
E coli
Symptoms of Shigella diarrhoea
Bloody diarrhoea
Abdo pain and vomiting
Symptoms of campylobacter diarrhoea
A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
Management of new onset AF <48 hours
Cardioversion (electrical / amiodarone / flecainide)
Management of new AF onset >48 hours
Anticoagulate then cardioversion (electrical)
Can breastfeeding continue in mastitis?
Yes
Treatment of lactational mastitis
abx if systemic illness, nipple fissure, cultures positive, not resolving in 24-48 hrs
Presentation of fat necrosis
It tends to present with a firm, round lump in the breast tissue, often following trauma
Symptoms of primary ciliary dyskinesia
Recurrent chest infections
Recurrent sinusitis
Subfertility
What drug is added to induce remission in UC if mesalazine unsuccessful?
Oral steroids
Indications for high dose folic acid in pregnancy
Maternal or paternal family history of neural tube defects Anti-epileptics Coeliac Diabetes BMI over 30
Management of pregnant woman with group B strep
BenPen in labour
Target HbA1c in patients with only lifestyle advice or metformin
48
Target HbA1c in patients on two drugs
53
Symptoms of dengue fever
retro-orbital headache, elevated fever, rash (usually maculopapular) and thrombocytopenia after returning from a trip abroad. May develop into haemorrhagic fever
Ebola symptoms
The first symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding
Symptom of thrombosed haemorrhoid
acutely painful and tender blue-black lump originating from the anal margin (and bleeding if it bursts)
Management of thrombosed haemorrhoid
Analgesia, stool softeners and ice pack. If presenting within 72 hours consider surgical excision
Test for BPPV
Dix-Hallpike test
First line for induction of labour
Vaginal prostaglandins
Symptoms of lymphogranuloma venereum
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
Lesions in Kaposi’s sarcoma
Raised purple lesions
First and second line in paediatric constipation
Movicol paediatric plain then add senna if ineffective
Symptoms of measles
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Symptoms of mumps
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Symptoms of rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Symptoms of erythema infectiosum
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
What virus causes erythema infectiosum?
Parvovirus
What is erythema infectiosum also known as?
Slapped cheek disease
Symptoms of scarlet fever
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Symptoms of hand foot and mouth disease
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
How long before vasectomy is effective?
Do semen analysis at 16-20 weeks to check for no sperm
Which renal condition is associated with an “allergic” type picture?
Acute interstitial nephritis
Nerve conduction studies in motor neurone disease
Normal
Uterine fibroids symptoms
Symptoms of fibroids include: Menorrhagia Pain (with torsion) Subfertility As fibroids get larger they cause symptoms due to their size such as: dysuria, hydronephrosis, constipation and sciatica.
Uterine fibroids treatment
First line treatment is often tranexamic acid, NSAIDs or progesterones as they are used in menorrhagia, but surgery is usually required for troublesome fibroids.
Management of auricular haematoma
Urgent ENT referral
Consequence of rapid treatment of hyponatraemia
Osmotic demyelination syndrome
Symptoms of vestibular neuronitis
acute, severe vertigo, nausea, vomiting and ataxia
How to differentiate vestibular neuronitis from labyrinthitis
Vestibular neuronitis won’t have hearing loss
Treatment of vestibular neuronitis
Vestibular rehabilitation exercises and anti-emetics
Treatment of asymptomatic fungal nail infections
Topical anti fungal for 6-12 months
Treatment of symptomatic fungal nail infections
Oral anti-fungal
Bone profile in oseteogenesis imperfecta
Normal
Aetiology of osteogenesis imperfecta
Autosomal dominant
Antibodies in systemic sclerosis
ANA / anti-Scl 70
Treatment of lichen planus
Topical steroids
Management of ankle fractures
Prompt reduction then typically surgical repair in younger patients or conservative in older patients
What is transposition of the great arteries?
aorta leaves the right ventricle
pulmonary trunk leaves the left ventricle
Signs in transposition of great arteries
Cyanosis, tachypnoea, load S2, prominent right ventricular impulse
Management of transposition of great arteries
Supportive then surgery
Management of otitis externa
Topical antibiotic and steroid
Emergency treatment of severe croup
Oxygen and nebulised adrenaline
Reactive arthritis symptoms
Urethritis + arthritis + conjunctivitis
Reactive arthritis treatment
Symptomatic : NSAIDs, analgesia, intra-articular steroids
Lead poisoning symptoms
abdominal pain peripheral neuropathy (mainly motor) fatigue constipation
What is the time window from symptom onset for thrombolysis in stroke?
4.5 hours
What is the time window from symptom onset for thrombolysis in stroke?
6 hours
How long for IUD to be effective contraception
Immediately
How long for IUS to be effective contraception
7 days
Adverse effect of IUD
Periods longer, heavier, more painful
What is mittelschmertz?
Mid cycle pelvic pain due to fluid released in ovulation. Systemically well and pain resolves
First line in acute pericarditis
NSAID and colchicine
Aetiology of osteopetrosis
Recessive
Management of thyroxine in pregnancy
Increase dose (typically by up to 50% in first 4-6 weeks
What is galactocele?
Painless breast lump after stopping breast feeding due to milk build up
Symptoms of allergic btonchopulmonary aspergillosis
bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)
Symptoms of allergic btonchopulmonary aspergillosis
bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)
Management of type B aortic dissection
Control BP then supportive
Indication for abx in mastitis
Systemically unwell
Fissure
Symptoms for over a day
Bacteria on culture
Symptoms of breast engorgement
Bilateral breast pain worse before feed. May be red. May have difficulty feeding. Typically a few days after birth
Symptoms of breast engorgement
Bilateral breast pain worse before feed. May be red. May have difficulty feeding. Typically a few days after birth
Management of breast engorgement
Hand expression
Complications of breast engorgement
Blocked ducts
Mastitis
Difficulty feeding
Symptoms of raynauds disease of the nipple
Breast pain and cyanosis or redness during or after feeding
Management of Raynaud’s disease of the nipple
Heat packs
Stop smoking
Reduce caffeine
Most common cause of erythema multiforme
HSV
VSD murmur
Pansystolic murmur in lower left sternal border
Coarctation of aorta murmur
Crescendo-decrescendo murmur in the upper left sternal border
PDA murmur
Diastolic machinery murmur in the upper left sternal border
Pulmonary stenosis murmur
Pulmonary stenosis Ejection systolic murmur in the upper left sternal border
Causes of HUS
classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7 (‘verotoxigenic’, ‘enterohaemorrhagic’). This is the most common cause in children, accounting for over 90% of cases
pneumococcal infection
HIV
rare: systemic lupus erythematosus, drugs, cancer
Features of HUS
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
Investigations in HUS
full blood count: anaemia, thrombocytopaenia, fragmented blood film U&E: acute kidney injury stool culture looking for evidence of STEC infection PCR for Shiga toxins
Management of HUS
Mostly supportive
Management of contacts of person with measles
Unvaccinated contacts offered MMR
Encephalitis symptoms
fever, headache, psychiatric symptoms, seizures, vomiting
focal features e.g. aphasia
CSF in encephalitis
lymphocytosis, raised protein
ALS guideline pulseless electrical activity
Non-shockable. Give IV adrenaline
What heart rhythms are shockable
VF / Pulseless VT
What heart rhythms are non-shcokable
Asystole, Pulseless electrical activity
Cardiac arrest causes
Hypoxia Hypovolaemia Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders Hypothermia Thrombosis (coronary or pulmonary) Tension pneumothorax Tamponade – cardiac Toxins
What is a Whipple’s procedure?
Removal of pancreas and duodenum
Investigation of carcinoid syndrome
Urinary serotonin
Bells palsy treatment
Oral prednisolone and artificial tears
What is Bells palsy?
acute, unilateral, idiopathic, facial nerve paralysis
Risk factors for Bells palsy
20-40 or pregnant
Bells palsy symptoms
Unilateral facial weakness (including forehead). Patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
Bells palsy prognosis
Mostly resolves in a few months
What do seborrheic keratoses look like?
They are typically described as well-circumscribed plaques or papules with a ‘stuck on’ appearance, and most commonly affect the torso or face. The colour of the lesions can vary, but they are most commonly grey-brown or black.
Management of seborrhoeic keratoses
Reassuarnace
Prognosis in seborrhoeic keratoses
Good, they are benign
What is erythema ab igne
Erythema ab igne is a skin disorder caused by over exposure to infrared radiation. Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia.
What is an osteoma?
Benign bone growth, often on skull
What is osteochondroma?
Cartilage covered bone tumour most common in young males
What is osteosarcoma?
Most common primary bone tumour seen mainly in children and teens in the metaphysis
What is Ewing’s sarcoma?
Bone tumour seen in children and teens
What is chondrosarcoma?
Malignant tumour of cartilage most commonly seem in middle age in the axial skeleton
Hirsutism management
Healthy weight
Cosmetic e.g. waxing
Consider COCP
Investigation of reduced foetal movements
Initially handhold doppler. If heartbeat is found then CTG. If no heartbeat is found then USS
Presentation of cephalohaematoma
Swelling on head a few hours after birth that doesn’t cross suture lines
Management of typical endometrial hyperplasia
Progesterone and watch and wait
Management of atypical endometrial hyperplasia
Hysterectomy and bilateral salpingo-opherectomy
High PTH, high calcium, low phosphate
Primary Hyperparathyroidism
High PTH, low calcium and phosphate
Osteomalacia
High PTH, normal calcium, low phosphate
CKD
Vestibular neuronitis symptoms
recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus
Treatment of severe hyponatraemia
Hypertonic saline
Where to check pulse in paediatric BLS
Femoral or brachial
Primary hyperparathyroidism treatment
Surgery
Management of suspected DVT but doppler negative
Stop anticoagulant and repeat scan in 7 days
Wells score cut off in DVT and actions
2 or more DVT likely start anticoagulation (DOAC) and arrange doppler USS
1 or less DVT unlikely do D-dimer
Uterine fibroids symptoms
may be asymptomatic
menorrhagia
may result in iron-deficiency anaemia
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility
Uterine fibroids age range
Pre-menopausal
Amoebiasis treatment
abx
Bacteria that causes pneumonia following influenza
Staph aureus
Which fingers are affected by cubital tunnel syndrome?
4th and 5th
Cubital tunnel syndrome management
Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases
Pernicious anaemia management
B12 replacement
Myocarditis symptoms
usually young patient with an acute history
chest pain
dyspnoea
arrhythmias
Myocarditis causes
Infection / autoimmune / other
Myocarditis investigations
bloods ↑ inflammatory markers in 99% ↑ cardiac enzymes ↑ BNP ECG tachycardia arrhythmias ST/T wave changes including ST-segment elevation and T wave inversion
Myocarditis treatment
Treat underlying cause (e.g. abx)
Supportive
Myocarditis complications
Arrhythmias, heart failure
Torsades de pointes management
Magnesium sulphate
Anticoagulation after stroke (first and second line)
Clopidogrel first line
Aspirin and dipyridamole second line
Apixaban if AF
Symptoms of posterior dislocation
The affected leg is shortened, adducted, and internally rotated
Management of hip dislocation
ABCDE
Analgesia
Reduction within 4 hours (under general anaesthetic)
Physio
Complications of hip dislocation
Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments
Management of cord prolapse
Push presenting part back in vagina
Patient on all fours
Tocolytics to stop contractions
Caesarean delivery
Treatment of deQuervains thyroiditis
Self resolving. NSAIDs if thyroid pain
Management of extrinsic allergic alveolitis
Avoid trigger
Mild croup treatment
Stat dose dexamethasone
Severe croup treatment
Nebulised adrenaline
Croup symptoms
stridor
barking cough (worse at night)
fever
coryzal symptoms
Acute TB test gold standard
Sputum culture
Treatment of rosacea
Topical metronidazole
Oral doxycycline
Management of slipped capital femoral epiphysis
Surgical fixation
PSC antibodies
pANCA
PSC investigation
ERCP / MRCP
pANCA
Pericarditis treatement
NSAIDs and colchicine
Treat underlying cause
What is significant postural hypotension?
Drop more than 20 systolic
Drop to below 90 systolic
Drop more than 10 diastolic with symptoms
Medication for severe postural hypotension not responding to conservative measures
Fludrocortisone
What is Takayasu’s arteritis?
Takayasu’s arteritis is a large vessel vasculitis. It typically causes occlusion of the aorta and questions commonly refer to an absent limb pulse. It is more common in females and Asian people
Symptoms of Takayasu’s arteritis
systemic features of a vasculitis e.g. malaise, headache
unequal blood pressure in the upper limbs
carotid bruit
intermittent claudication
aortic regurgitation (around 20%)
Aetiology of otoscelrosis
Autosomal dominant
Otosclerosis age of onset
20-40
Reflux nephropathy investigation
Micturating cystourethrogram
Drug for prophylaxis of hepatic encephalopathy
Rifaximin
Management of sudden onset sensorineural hearing loss
ENT referral
Steroids
Investigate cause
Biliary atresia symptoms
Jaundice
Hepatomegaly with splenomegaly
Abnormal growth
What is Guttate psoriasis?
Psoriasis with small plaques over the body 2-4 weeks after an infection
Guttate psoriasis prognosis
Clears in a couple of months
Necrotising enterocolitis symptoms
feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis
necrotising enterocolitis treatment
Gut rest with total parenteral nutrition
Surgery for perforation
PDA management
Indomethacin or ibuprofen
Rhabdomyolysis management
IV fluids
What nerve is used for corneal reflex
V1
Jaw jerk reflex nerve
V3
BPH first line
alpha agonist e.g. tamsulosin
What hormones are in the implant?
Progesterone
Implant effect on periods
Heavy
Epidydimal cyst examination findings
separate from the body of the testicle
found posterior to the testicle
Epidydimal cyst diagnosis
Confirmed on USS
Epidydimal cyst treatment
Management is usually supportive but surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts
Keratoacanthoma appearance
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
Keratoacanthoma management
Usually regress within 3 months
Remove if suspicious for BCC / SCC
Cervical myelopathy investigation
MRI spine
Cervical myelopathy treatment
Decompressive surgery
What is MODY?
development of type 2 diabetes mellitus in patients < 25 years old
Treatment of MODY
As per type 2 DM
Aetiology of MODY
Genetic
Management of Bowen’s disease
Topical 5-flurouracil
Surgery
Cryotherapy
Sarcoidosis symptoms
erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia, dyspnoea, non-productive cough, malaise, weight loss, skin rash hypercalcaemia
What is pituitary apoplexy?
Haemorrhage or infarction of pituitary adenoma
Pituitary apoplexy symptoms
sudden onset headache similar to that seen in subarachnoid haemorrhage
vomiting
neck stiffness
visual field defects: classically bitemporal superior quadrantic defect
extraocular nerve palsies
features of pituitary insufficiency
e.g. hypotension/hyponatraemia secondary to hypoadrenalism
Seen in person with pituitary pathology
Pituitary apoplexy treatement
urgent steroid replacement due to loss of ACTH
careful fluid balance
surgery
Restless leg syndrome management
simple measures: walking, stretching, massaging affected limbs
treat any iron deficiency
dopamine agonists are first-line treatment (e.g. Pramipexole, ropinirole)
How long should a second febrile convulsion be before ambulance called?
5 mins
Malrotation symptoms
Distended abdomen
Bilious vomiting
Malrotation investigation
Upper GI contrast study and USS
Malrotation treatment
Surgery
Drug induced lupus antibodies
Anti-histone antibodies
Clubfoot management
Splinting and progressive casting
First line investigation in stable angina
CT coronary angiogram
What is mesothelioma
Cancer of pleura caused by asbestos exposure
What is an aspergilloma?
An aspergilloma is a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis)
Anticoagulants used in patients who will have PCI
Aspirin and prasugrel
Normal pressure hydrocephalus symptoms
dementia, ataxia and urinary incontinence
Toxic shock syndrome symptoms
fever
hypotension
diffuse rash
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
Toxic shock syndrome management
removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics
Acromioclavicular degeneration symptoms
popping, swelling, clicking or grindings and a positive scarf test
Subacromial impingement symptoms
pain on overhead activities and demonstrate a painful arc of abduction on examination - worse between 90 and 120 degrees. There may also be popping, snapping or grinding.
Rotator cuff tear symptoms
weakness as well as pain and there may be muscle wasting and tenderness on palpation. There may be a painful arc of movement and weakness of the affected muscle.
Frozen shoulder risk factors
Diabetes
Frozen shoulder symptoms
external rotation is affected more than internal rotation or abduction
both active and passive movement is affected
patients typically have a painful freezing phase, an adhesive phase and a recovery phase
bilateral in up to 20% of patients
the episode typically lasts between 6 months and 2 years
Frozen shoulder treatment
NSAIDs, physio, steroid injections
Pharyngeal pouch treatment
Surgery
Gingival hyperplasia causes
phenytoin, ciclosporin, calcium channel blockers and AML
Idiopathic intercranial hypertension risk factors
obesity
female sex
pregnancy
drugs (COCP, steroids, tetracyclines, vitamin A, lithium)
Idiopathic intercranial hypertension symptoms
headache blurred vision papilloedema (usually present) enlarged blind spot sixth nerve palsy may be present
Idiopathic intercranial hypertension treatment
weight loss diuretics e.g. acetazolamide topiramate repeated lumbar puncture surgery: optic nerve sheath decompression (prevent damage to the optic nerve) or shunting
Patellar fracture management
Non-displaced and extensor function in tact: Knee brace
Displaced or extensor function impaired: Surgery
Toxic epidermal necrosis causes
Usually drug reaction
Toxic epidermal necrosis treatment
Supportive including fluids
Steroids
Immunoglobulin
How long after emergency contraception before restarting hormonal contraception?
5 days
Nasal septal haematoma symptoms
the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea
bilateral, red swelling arising from the nasal septum
Nasal septal haematoma treatment
Drainage
IV abx
What is sick euthyroid syndrome?
Low T4 in acute illness
FSGS age group
Typically young adults
FSGS management
Steroids and consider immunosuppression
What symptom suggests mastoiditis as a complication of otitis media?
Post auricular swelling
Umbilical hernia management
Often resolve spontaneously
If large or symptomatic repair aged 2-3
If asymptomatic repair aged 5
Management of oesophageal dysplasia seen on endoscopy
Endoscopic resection or ablation
What condition causes slapped cheek rash?
Erythema infectiosum
When to consider surgery in aortic stenosis
Symptomatic
Facial nerve lesion symtpoms
flaccid paralysis of the upper and lower face, loss of taste, hyperacusis and loss of corneal reflex
Trigeminal nerve lesion symptoms
trigeminal distribution pain, loss of corneal reflex, loss of facial sensation, paralysis of mastication muscles and deviation of the jaw to the weak side
Lichen sclerosus management
Topical steroids and emollients
Pityriasis versicolour symptoms
most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus
Pityrisasis versicolour treatment
Topical antifungals
Management of anti-phospholipid syndrome
Prophylactic aspirin if no history of VTE
Warfarin if history of VTE
Androgen insensitivity syndrome presentation
Genotypically male. Phenotypically female.
Primary amenorrhoea
Often have inguinal hernias due to undescended testes
Hand foot and mouth disease treatment
Symptomatic as it is self limiting
S1 lesion symptoms
Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test
L3 compression symptoms
sensory loss over the anterior aspect of the thigh, weakness of the quadriceps with a reduction in the knee reflex on the affected side. Finally, pain can be elicited in the anterior thigh when performing the femoral stretch test
L4 compression symptoms
weakness of the quadriceps, a reduced knee reflex and a positive femoral stretch test. Reduced sensation over anterior knee
L5 compression symptoms
sensory loss on the dorsum aspect of the foot with weakness of the foot and big toe dorsiflexion. L5 nerve compressions will also result in a positive sciatic nerve stretch test but the reflexes are normally unaffected.
Prolapsed disc management
similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises
if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
Hypospadias management
Surgery at 12 months
Genital warts management
topical podophyllum or cryotherapy are commonly used as first-line treatments depending on the location and type of lesion. Multiple, non-keratinised warts are generally best treated with topical agents whereas solitary, keratinised warts respond better to cryotherapy
imiquimod is a topical cream which is generally used second line
Small bowel bacterial overgrowth syndrome risk factors
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
Small bowel bacterial overgrowth syndrome investigations
hydrogen breath test
small bowel aspiration and culture: this is used less often as invasive
clinicians may sometimes give a course of antibiotics as a diagnostic trial
Small bowel bacterial overgrowth syndrome management
correction of underlying disorder
antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance
Small bowel bacterial overgrowth syndrome symptoms
Similar to IBS
Cluster headache prophlyaxis
Verapamil
PMS treatment
Conservative. COCP. SSRIs if severe
Slipped capitol femoral epiphysis symptoms
hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
bilateral slip in 20% of cases
Slipped capitol femoral epiphysis management
Internal fixation surgery
Newborn BLS
Dry baby
Assess tone, HR and RR
If not breathing, 5 rescue breaths
If still not breathing, CPR at 3:1 ratio
Bartholin’s cyst age
Reproductive age
Gonorrhoea treatment
Single dose IM ceftriaxone
Asymptomatic bacteriuria in catheterised patient treatment
None
Postnatal depression screening scale
Edinburgh depression scale
Neuroleptic malignant syndrome blood tests
Raised CK
May have leukocytosis
May have hyperkalaemia due to muscle damage
Neuroleptic malignant syndrome management
stop antipsychotic
IV fluids to prevent renal failure
dantrolene may be useful in selected cases
bromocriptine may also be used
What rash has a herald patch?
Pityriasis rosea
Pityriasis rosea treatment
Self limiting
Does warfarin affect PT or APTT?
PT
Alcoholic hepatitis management
Steroids in a flare
First line to maintain remission in Chrons
Azathioprine or mercaptopurine
Stevens johnsons syndrome symptoms
Flu like prodrome
Rapid onset painful red blistering rash
Stevens johnsons syndrome treatment
Stop drug
Admit for IV fluids
What is syringomyelia?
Syringomyelia (‘syrinx’ for short) describes a collection of cerebrospinal fluid within the spinal cord that gradually expands over time
Syringomyelia symptoms
Slowly progressive neurological symptoms:
loss of temperature sensation in upper limbs
spastic weakness (predominantly of the lower limbs)
neuropathic pain
upgoing plantars
autonomic features e.g. Horner’s syndrome or bladder and bowel dysfunction
Syringomyelia diagnosis
MRI
Bells palsy management
Prednisolone and eye care
Epidermoid cyst symptoms
Common and affect face and trunk
They have a central punctum, they may contain small quantities of sebum
The cyst lining is either normal epidermis (epidermoid cyst) or outer root sheath of hair follicle (pilar cyst)
Dermatofibroma symptoms
Solitary dermal nodules
Usually affect extremities of young adults
Lesions feel larger than they appear visually
Histologically they consist of proliferating fibroblasts merging with sparsely cellular dermal tissues
Pheochromocytoma first line investigation
Plasma and urine metanephrines
Acromegaly first line investigation
Serum IGF-1
What is pompholyx eczema?
Blistering eczema of hands and feet triggered by warm temperatures
Mesenteric adenitis treatment
Self limiting
What is mesenteric adenitis?
Mesenteric adenitis is inflamed lymph nodes within the mesentery. It can cause similar symptoms to appendicitis and can be difficult to distinguish between the two. It often follows a recent viral infection and needs no treatment
Meniere’s disease treatment
ENT referral. Prochlorperazine in acute attack. Antihistamine and vestibular rehabilitation as prophylaxis
Meniere’s disease symptoms
recurrent episodes of vertigo, tinnitus hearing loss lasting minutes to hours
Anti phospholipid syndrome antibodies
Anti-phospholipid syndrome antibodies are lupus anticoagulant (LA) and anti-cardiolipin antibodies (aCL)
Entamoeba hystolytica symptoms
dysentery, liver abscesses, colonic abscesses, or inflammatory masses in the colon
Amoebiasis treatment
Metronidazole
Acute intermittent porphyria symtpoms
abdominal, neurological and psychiatric symptoms
Acute intermittent porphyria demographic
Young females
Acute intermittent prophyria investigation finding
Urine turns dark red when left
Acute intermittent porphyria management
Haematin / haem arginate in a flare. Avoid triggers
Shaken baby syndrome symptoms
Retinal haemorrhages, subdural haematoma and encephalopathy
What is Osgood Schlatter disease also known as?
Tibial epophysitis
Osgood Schlatter disease symptoms
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Vestibular schwannoma symptoms
vertigo, hearing loss, tinnitus and an absent corneal reflex
What is atopic eruption of pregnancy
Common itchy eczematous skin condition in pregnancy
What is polymorphic eruption of pregnancy?
Itchy rash in last trimester. Treated with emollients or topical steroids
What is pemphigoid gestationis
Vesicular rash in second half of pregnancy
Acute anal fissure management
Laxatives, analgesia, lubricants
Chronic anal fissure management
Laxatives, analgesia, lubricants, topical GTN, surgery considered second line
Postpartum thyroiditis treatment
Propranolol
Strawberry naevus presentation
erythematous, raised and multilobed tumours often on face, scalp or back that develops quickly in the month after birth then regresses in a few years
Unilateral nasal polyp management
Urgent ENT referral
When can someone fly after pneumothorax?
1 week after CXR shows it has cleared
When can someone dive after pneumothorax?
Ideally never
What is malignant hyperthermia?
Hyperthermia and muscle rigidity after general anaesthetic
Malignant hyperthermia treatment
Supportive and dantrolene
What vaccine should people with coeliac get?
Pneumococcal
Pyoderma gangrenosum treatment
Steroids
Management of displaced intracapsular hip fracture
Internal fixation if fit or hemiarthroplasty if unfit
Hyperhidrosis treatment
Topical aluminium chloride first line. Botox second line. Surgery third line
Iliopsoas abscess symptoms
Fever
Back/flank pain
Limp
Weight loss
Iliopsoas abscess investigation
CT
Iliopsoas abscess treatment
Antibiotic and drainage
Joint aspiration in RA
Yellow with high WBCs
No bugs or crystals
NF1 symptoms
Cafe au lait spots
Some tumours
NF2 symptoms
Schwannomas
Von Hippel Lindau symptoms
Cysts and benign tumours
Are antibiotics given prior to surgery in appendicitis?
Yes
Pagets disease of the bone treatment
Bisphosphonates
SSRI discontinuation syndrome symptoms
Mood change, restlessness, insomnia, sweating, GI symptoms
Paediatric inguinal hernia management
Surgery
How to distinguish viral labyrinthitis from vestibular neuronitis
Labyrinthitis has hearing loss
What is a sequestration crisis?
A sequestration crisis is when blood pools in organs due to sickling occurring, and this can cause worsening of anaemia due to loss of blood in the vasculature
Tuberous sclerosis symptoms
Depigmented skin lesions Roughened skin lesions Developmental delay Epilepsy Cysts
What does low haptoglabin indicate?
Intravascular haemolysis
Medication for bile acid malabsorption
Cholestyramine
Autoimmune hepatitis antibodies
Anti-smooth muscle or ANA
Guttate psoriasis symptoms
‘Tear drop’, scaly papules on the trunk and limbs
Guttate psoriasis management
Most cases resolve spontaneously within 2-3 months
Topical agents as per psoriasis
Pityriasis rosea symptoms
Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.
May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance
Pityriasis rosea management
Self limiting
When to increase frequency of AAA screening
Over 3 cms
Treatment of threadworms
Single dose mebendazole
CXR in transient tachypnoea of the newborn
Hyperinflation
Fluid in horizontal fissure
What is a hartmans procedure?
Sigmoid Colectomy and stoma formation
Chronic pancreatitis first line imaging
CT abdo (look for calcification)
Most common lymphoma
Diffuse large B cell lymphoma
What subtype of melanoma is more aggressive?
Nodular
Pheochromocytoma management
Alpha blocker e.g. phenoxybenzamine
Then beta blocker e.g. propranolol
Then surgery
Paediatric umbilical hernia managment
Watch and wait
Umbilical granuloma symptom
small, red growth of tissue is seen in the centre of the umbilicus in first week of life. May leak fluid
Umbilical granuloma management
Salt. Cautery with silver nitrate
What is omplailitis?
Infection of umbilicus
Polyarteritis nodosa symptoms
Systemic vasculitic symptoms
Drug induced lupus antibodies
Anti-histone
Chagas disease complications
Cardiomyopathy, GI issues
Chagas disease management
Anti-fungal. Monitor for complications e.g. echo
Screening for diabetic nephropathy
Urine albumin creatinine ratio yearly
Most common cause of bitemporal hemianopia with predominately the lower quadrants being affected
Craniopharyngioma
Hypospadias management
Surgery at 12 months
Forms of systemic sclerosis
Limited cutaneous: Mostly on digits. May have CREST syndrome.
Diffuse cutaneous: Mostly on trunk. May have other organ involvement.
Scleroderma: Tightening of skin without organ involvement.
What can CLL transform to?
Lymphoma
Ramsey Hunt syndrome symptoms
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
Ramsey Hunt syndrome treatment
Steroids and acyclovir
Mild rosacea first line
Topical metronidazole
What is Charcot joint?
A badly disrupted joint due to loss of sensation
Symptoms of Charcot joint
Red swollen warm slightly painful joint often in daibetics
Unilateral undescended testicles referral and management
Refer at 3 months. Surgery at 1 year
Bilateral undescended testes referral and management
Refer immediately for endocrine and genetic tests
Haemochromatosis iron studies
Transferrin high
Ferritin high
TIBC low
Leishmaniasis symptoms
Skin lesions or mouth / nasal ulcers.
May have systemic symptoms
What virus causes aplastic crisis in sickle cell?
Parvovirus
Acute bronchitis symptoms
Cough (usually non-productive initially then productive)
Rhinorrhoea and sore throat
May have low grade fever
May have wheeze
Acute bronchitis treatment
Symptomatic. Abx if systemically unwell
Newborns to mothers with lupus are at increased risk of what?
Arrhythmias
Toxoplasmosis symptoms
Usually asymptomatic in immunocompetent people. May have low grade malaise symptoms
Haemochromatosis inheritance
Autosomal recessive
Latent autoimmune diabetes of adulthood presentation
Slow onset type 1 diabetes symptoms
Scalp psoriasis first line
Topical steroids
Post thrombotic syndrome management
Compression stockings
Management of bradycardia if atropine fails
Transcutaneous pacing
Duct ectasia symptoms
Nipple retraction and milky discharge
First line in ITP
Steroids
What does India ink stain for?
Cryptococcus
Pagets age
More common in older age
First line for multiple genital warts
Topical podophyllum
Guttate psoriasis treatment
As per normal
Management of immunosuppressed patients exposed to chickenpox
Immunoglobulin if no antibodies
Management of whooping cough
Abx is presenting within 21 days
Notify public health
Abx for household contacts
Meralgia paraesthetica age
30s - 40s
Which lung cancer is associated with gynaecomastia?
Adenocarcinoma
What is Lemierre’s syndrome?
Lemierre’s syndrome presents with thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection
Chronic subdural haematoma management
If asymptomatic, conservative
If symptomatic, burr holes
Primary hyperparathyroidism most common cause
Solitary adenoma
Primary hyperparathyroidism treatment
Total parathyroidectomy. If asymptomatic and Ca not too high and older patient may do nothing
Ramsey Hunt treatment
Oral acyclovir and steroids
Thyroglossal cyst age
Teen or young adult
Cystic hygroma age
Newborn or babies
Branchial cyst age
Young adults
Acute intermittent porphyria age
Young adults
Acute intermittent porphyria symptoms
Abdo pain
Neuropsychiatric
Red urine
Acute intermittent porphyria management
Avoid triggers
Haem arginate in a flair
Subacute combined degeneration of the cord symptoms
Loss of vibration and proprioception
UMN and LMN signs (e.g. brisk knee reflexes, absent ankle reflexes)
Medical miscarriage drug
Vaginal misoprostol
Tetralogy of fallot murmur
ejection systolic
Gestation to offer external cephalic version
36 weeks
How to check thrombolysis has worked in STEMI
repeat ECG in 60-90 minutes and transferring for urgent PCI if ST-elevation has not resolved
lichen planus management
Topical steroids
Hypercalcaemia ECG
Short QT
What is Argyle Robertson pupil?
Small fixed pupil
No light reflex
Accommodation reflex in tact
Gestational diabetes management at diagnosis
If BM less than 7, lifestyle and diet advice and then metformin if BM still high in 2 weeks
If BM over 7, start insulin
Otitis media bacteria
Haemophilus influenzae
Average age of orbital cellulitis
Children
Orbital cellulitis management
IV abx
Blepharitis management
Hot compresses and lid hygiene
Management of non-retractable foreskin
Watch and wait until 2 years as often resolves
After 2 years consider surgery
What do muddy brown casts indiate?
ATN
What do white cell casts indicate?
Acute interstitial nephritis
Angle closure glaucoma management
Eyedrops of pilocarpine, beta blockers and alpha blockers
IV acetazolamide
Laser ididotomy
Open angle glaucoma symptoms
peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping
Scalp seborrheic dermatitis management
OTC shampoos e.g. head and shoulders
Topical ketoconazole
Topical steroids if severe
Face seborrheic dermatitis management
Topical ketoconazole
Topical steroids
Hereditary haemorrhagic telangectasia symptoms
epistaxis
telangiectases (multiple at characteristic sites e.g. lips, oral cavity, fingers, nose)
visceral lesions with or without bleeding (e.g. GI telangiectasia, pulmonary AVM, hepatic AVM, cerebral AVM, spinal AVM
family history
Management of dysplasia on endoscopy
Endoscopic treatment
What is Kartagener syndrome also known as?
Primary ciliary dyskinesia
FSGS age
Young adults
UTI treatment near delivery
Amoxicillin
Internuclear ophthalmoplegia symptoms
impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side
Internuclear ophthalmoplegia cuases
MS
Vascular
Leprosy symptoms
Patches of pale skin
Sensory loss
What type of vision is a risk factor for angle closure glaucoma?
Hypermetropia (long sighted)
Trigeminal neuralgia first line
Carbemazepine
CRAO symptoms
Painless vision loss
CRAO on ophthalmoscopy
Pale retina with cherry red spot
CRVO symptoms
Painless vision loss
CRVO on ophthalmoscopy
Retinal haemorrhages
Vitreous detachment symptoms
Flashers and floaters
Vision loss starting peripheral and moving centrally
Vitreous haemorrhage symptoms
Dark spots over vision
Hypocalcaemia ECG
long QT
Eczema herpeticum treatment
IV antivirals
What is thoracic outlet syndrome?
a disorder involving compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet. TOS can be neurogenic or vascular; the former accounts for 90% of the cases
Thoracic outlet syndrome demographic
Young thin women
Neurogenic thoracic outlet syndrome symptoms
painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
sensory symptoms such as numbness and tingling may be present
if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling
Vascular thoracic outlet syndrome symptoms
subclavian vein compression leads to painful diffuse arm swelling with distended veins
subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene
Thoracic outlet syndrome investigations
chest and cervical spine plain radiographs to check for any obvious osseous abnormalities e.g. cervical ribs, exclude malignant tumours or other differentials e.g. cervical spine degenerative changes
other imaging modalities may be helpful e.g. CT or MRI to rule out cervical root lesions
venography or angiography may be helpful in vascular TOS
Thoracic outlet syndrome management
conservative management with education, rehabilitation, physiotherapy, or taping is typically the first-line management for neurogenic TOS
surgical decompression is warranted where conservative management has failed
in vascular TOS, surgical treatment may be preferred
What sort of childhood neck lump is multiloculated and heterogenous on imaging?
Dermoid cyst
What is thromboangiitis obliterans also known as?
Buerger disease
Buerger disease symptoms
extremity ischaemia (intermittent claudication and / or ischaemic ulcers)
superficial thrombophlebitis
Raynaud’s phenomenon
Leptospirosis risk factors
sewage workers, farmers, vets or people who work in an abattoir
Leptospirosis symptoms
flu-like symptoms subconjunctival redness / haemorrhage acute kidney injury hepatitis aseptic meningitis
Leptospirosis management
Abx
What is Li-Fraumenni syndrome?
Autosomal dominant
High incidence of malignancies particularly sarcomas and leukaemias
What is Gardeners syndrome?
FAP variant
Interstitial cystitis symptoms
lower urinary tract symptoms and suprapubic pain
Interstitial cystitis investigation
Bladder cystography. Will see red area, small blood vessels and granulomas which may bleed
Termination of pregnancy options
less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions
less than 13 weeks: surgical dilation and suction of uterine contents
more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
What suggests Korsakoff syndrome rather then Wernicke’s encaphalopathy?
Anterograde / retrograde amnesia and confabulation
What is hyphaema?
Blood in anterior chamber
Management of hyphaema
Strict bed rest
Management of BP over 180/120
Admit for same day assessment if signs of organ failure (retinal haemorrhage, papilloedema, confusion, chest pain, heart failure, AKI)
If not investigate for organ failure and review in 1 week
Medication to offer with CBT in moderate - severe OCD
SSRI
Management of bleeding a few hours after tonsillectomy
Theatre
Management of bleeding a few days after tonsillectomy
Abx
Hip dislocation management
Reduction under anaesthetic within 4 hours
What is enteropathic arthritis?
Asymmetric seronegative arthritis associated with IBD
First line in open angle glaucoma
Prostaglandin analogue eye drop eg lantoprost
What is Kallman syndrome?
Hypogonadotropic hypogonadism
LH and FSH in Kallman syndrome
Low / inappropriately normal
De Quervain’s tenosynovitis management
analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required
Cervical degenerative myelopathy management
Decompressive surgery
Mammary duct ectasia risk factors
Perimenopausal
Smoker
Mammary duct ectasia findings on mammogram
Microcalcifications
