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Passmed Year 4 Flashcards

1
Q

What symptoms would suggest a lacunar stroke?

A

Pure motor / sensory / cerebellar symptoms

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2
Q

Symptoms of total anterior circulation stroke

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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3
Q

Symptom of partial anterior circulation stroke

A

2 of:

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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4
Q

Symptoms of posterior circulation stroke

A

1 of:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
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5
Q

common causes of acute interstitial nephritis

A

Drugs (eg NSAIDs or abx) are more common

Systemic inflammatory conditions eg SLE

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6
Q

Management of acute interstitial nephritis

A

Stop offending agent

Steroids or dialysis if severe

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7
Q

Symptoms of acute interstitial nephritis

A

rash, fever and eosinophilia
White cells and white cell casts in urine
Mild renal impairment
HTN

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8
Q

Anti platelets in patients with ACS who are taking oral anticoagulant

A

Aspirin and clopidogrel

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9
Q

Anti platelets in patients with ACS who aren’t already on anticoagulants

A

Aspirin and prasugrel

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10
Q

Symptoms of HOCM

A 
Asymptomatic 
Exertional dyspnoea
Angina
Syncope
Sudden death
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11
Q

What cancer is CA15-3 a marker of?

A

Breast

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12
Q

Management of pregnant women colonised with group B strep

A

Prophylactic abx in Labour

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13
Q

Indication for pregnant women having intrapartum abx prophylaxis against group B strep

A

Previous baby with group B strep
Preterm Labour
Pyrexia in Labour

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14
Q

What is a hyatidiform mole?

A

A pregnancy which becomes cancerous early in development

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15
Q

Symptoms of hyatidiform mole

A

Painless PV bleeding in early pregnancy
Uterus is large for date
Hyperemesis
Symptoms of thyrotoxicosis

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16
Q

Diagnosis of hyatidiform mole

A

Ultrasound is highly suggestive (resembles bunch of grapes)

Histopathological examination is diagnostic

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17
Q

What is asherman syndrome?

A

Scar tissue adhesions form in the uterus following surgery leading to amenorrhoea

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18
Q

Aetiology of imperforate hymen

A

Congenital (no hole in hymen from birth)

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19
Q

Management of hydrocele

A

In neonates it may close spontaneously within a few months

If not then surgery

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20
Q

Whooping cough treatment

A

Abx (azithromicin) if presenting in first 21 days

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21
Q

Whooping cough prophylaxis

A

Household contacts

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22
Q

Symptoms of neuroleptic malignant syndrome

A

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

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23
Q

When does neuroleptic malignant syndrome usually present?

A

Soon after starting antipsychotics

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24
Q

Causes of jaundice in first 24 hours

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

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25
Management of polycythemia Vera
Aspirin Venesection Chemo
26
Complications of polycythemia Vera
Thrombotic events Myelofibrosis Acute leukaemia
27
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 ```
28
Age affected by pityriasis rosea
Young adults
29
Management of pityriasis rosea
None needed
30
Prognosis in pityriasis rosea
Good, typically clears up spontaneously in 6-12 weeks
31
Symptoms of Lyme disease
``` Bulls eye rash headache lethargy fever arthralgia ```
32
Late features of Lyme disease
cardiovascular (heart block, peri/myocarditis) | neurological (facial nerve palsy, radicular pain, meningitis)
33
Management of Lyme disease
Abx
34
Management of thrush
Oral or pessary antifungals
35
Management of thrush in pregnancy
Antifungal pessary
36
Management of recurrent thrush
induction: oral fluconazole every 3 days for 3 doses maintenance: oral fluconazole weekly for 6 months
37
Normal resp rate in neonates
30-60
38
Normal heart rate in neonates
100-160
39
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
40
What differentiates gestational hypertension from pre-eclampsia?
Gestational hypertension has no proteinuria
41
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
42
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
43
Site to avoid when cannulating diabetic patient
Foot (risk of foot ulcers)
44
Causes of oligohydramnios
``` premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia ```
45
Treatment of takotsubo cardiomyopathy
Supportive
46
Prognosis of takotsubo cardiomyopathy
Good (most patients recover with supportive treatment)
47
Pathophysiology of takotsubo cardiomyopathy
Transient apical ballooning of the heart triggered by stress
48
What is dermatofibroma?
Benign lesion. Firm elevated nodules. Usually history of trauma. Lesion consists of histiocytes, blood vessels and fibrotic changes
49
What is pyogenic granuloma?
Overgrowth of blood vessels. Red nodules. Usually follow trauma. May mimic amelanotic melanoma
50
Site to avoid when cannulating diabetic patient
Foot (risk of foot ulcers)
51
Causes of oligohydramnios
``` premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia ```
52
Treatment of takotsubo cardiomyopathy
Supportive
53
Prognosis of takotsubo cardiomyopathy
Good (most patients recover with supportive treatment)
54
Pathophysiology of takotsubo cardiomyopathy
Transient apical ballooning of the heart triggered by stress
55
What is dermatofibroma?
Benign lesion. Firm elevated nodules. Usually history of trauma. Lesion consists of histiocytes, blood vessels and fibrotic changes
56
What is pyogenic granuloma?
Overgrowth of blood vessels. Red nodules. Usually follow trauma. May mimic amelanotic melanoma
57
Appearance of CSF fluid in viral meningitis
Clear / cloudy
58
Appearance of CSF fluid in TB meningitis
Slightly cloudy
59
CSF glucose in Bacterial meningitis
Low (less than half plasma level)
60
CSF glucose in viral meningitis
Normal (60-80% plasma level)
61
CSF glucose in TB meningitis
Low (less than half of the plasma glucose level)
62
CSF glucose in fungal meningitis
Low (less than half of the plasma level)
63
CSF protein in bacterial meningitis
High
64
CSF protein in viral meningitis
Normal
65
CSF protein in tuberculosis meningitis
High
66
CSF protein in fungal meningitis
High
67
CSF white cells in bacterial meningitis
High polymorphs
68
CSF white cells in viral meningitis
High lymphocytes
69
CSF white cells in TB meningitis
High lymphocytes
70
CSF white cells in fungal meningitis
High lymphocytes
71
Management of proximal scaphoid fractures
Surgical fixation
72
Management of undisplaced distal scaphoid fracture
Splint or cast for 6 weeks
73
Initial management of scaphoid fracture
Immobilise with splint | Orthopaedic follow up with repeat imaging in 7-10 days
74
How often is adrenaline given in CPR
Every 3-5 mins
75
First line medication and route for medical miscarriage
Misoprostol pessary
76
How long may an expectant miscarriage be trialed for?
14 days
77
Medications in meningitis in child under 3 months
Antibiotics | Steroids contraindicated
78
How long after exposure to text for HIV
4 weeks
79
Management of initial negative HIV test
Repeat at 12 weeks after exposure
80
Investigation for full thickness oesophageal tear
CT contrast swallow
81
What is Boerhaaves syndrome
Spontaneous oesophageal rupture due to vomiting
82
Symptoms of oesophageal rupture
Sudden chest pain Vomiting Surgical emphysema
83
Management of oesophageal rupture
Surgery
84
Symptoms of narcolepsy
Excessive daytime sleepiness. Cataplexy. Sleep paralysis and hallucinations
85
Investigation of narcolepsy
Multiple sleep latency EEG
86
Management of narcolepsy
Daytime stimulants
87
Is there a vaccine for Hep A?
Yes
88
Most common site of necrotising fasciitis
Perineum
89
Symptoms of necrotising fasciitis
Acute onset pain swelling and redness with pain out of keeping with physical features. Fever and tachycardia later
90
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 ```
91
Management of asymptomatic neonatal hypoglycaemia
Encourage feeding. Monitor BMs
92
Management of symptomatic neonatal hypoglycaemia
Dextrose infusion
93
Definition of incarcerated hernia
Can’t be reduced
94
Definition of strangulated hernia
Lost blood supply
95
What differentiates patients with incarcerated and strangulated hernias
Patient will be systemically unwell in strangulated hernia
96
Management of femoral hernia
Surgical repair
97
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.
98
Conditions caused by high altitude
Acute mountain sickness High altitude pulmonary oedema High altitude cerebral oedema
99
Prevention and management of acute mountain sickness
Ascend slowly Acetazolamide is preventative Treated with descent
100
Symptoms of acute mountain sickness
Headache Nausea Fatigue
101
Treatment of high altitude cerebral oedema
Descent | Dexamethasone
102
Treatment of high altitude pulmonary oedema
Descent Oxygen Nifedipine or dexamethasone
103
Management of suspected DVT with negative USS but raised D dimer
Repeat USS in 1 week
104
Management of immunosuppressive drugs patient who has been in contact with chickenpox
Check if they have varicella antibodies | If negative, give varicella immunoglobulins
105
What pneumonia is associated with erythema multiforme
Mycoplasma pneumonia
106
Is minimal change disease nephrotic or nephritic?
Nephrotic
107
Is membranous glomerulonephritis nephrotic or nephritic?
Nephrotic
108
Is focal segmental glomerulosclerosis nephrotic or nephritic?
Nephrotic
109
Management of membranous glomerulonephritis
ACE inhibitor Immunosuppression Consider anticoagulants
110
What is a first degree burn?
Red and painful. Epidermis is burned
111
What is a second degree burn?
Pink or white. Painful. Blistered. Dermis is burned
112
What is a third degree burn?
White / brown / black. Not painful. Full thickness
113
What cancer does pernicious anaemia increase risk of?
Gastric
114
Management of hip dislocation
Reduction under GA in 4 hours to reduce risk of AVN
115
First line in superficial vein thrombosis
Compression stockings
116
Where is small cell lung cancer usually found?
Centrally
117
What is lambert eaton syndrome?
Associated with SCLC | antibodies to voltage gated calcium channels causing myasthenic like syndrome
118
What cancer is lambert Eaton syndrome associated with?
Small cell lung cancer
119
Treatment of lung cancer
Usually Chemo and radiotherapy. Surgery if very early | Palliative of late
120
Complications of PBC
Liver cirrhosis | Liver cancer
121
Management of child under 3 presenting with acute limp
A&E assessment (high risk of septic arthritis)
122
History and typical patient in transient synovitis
Acute limp Accompanies viral infection Child well Most common in boys 2-12
123
Management of dyspepsia not responding to high dose PPI
Test for H pylori (and treat if present)
124
What is calcitonin a tumour marker for?
Medullary thyroid cancer
125
Treatment of scabies in close contacts
2 doses permethrin a week apart
126
Symptoms of Bartholin's cyst
Soft painful labial lump
127
Signs in ALS motor neurone disease
UMN and LMN
128
Signs in primary lateral sclerosis motor neurone disease
UMN
129
Signs in progressive muscular atrophy motor neurone disease
LMN affecting diatal muscles first
130
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
131
When to start treatment in subclinical hypothyroidism
Symptomatic patients. Younger patients. Very high TSH
132
What is balanitis xerotica oliberans?
Tight foreskin due to lichen sclerosus
133
What is paraphimosis?
Foreskin can't be returned to it's original position after being retracted
134
What is phimosis?
Tight foreskin means it can't be retracted
135
What is balanitis?
Inflammation of the head of the penis
136
First line investigation in suspected primary hyperaldosteronism
Serum aldosterone to renin ratio
137
Features of primary hyperaldosteronism
Hypertension Hypokalaemia (can cause muscle weakness) Alkalosis
138
Patau syndrome features
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions
139
Edwards syndrome features
Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers
140
Fragile X syndrome features
``` Learning difficulties Macrocephaly Long face Large ears Macro-orchidism ```
141
Noonan syndrome features
Webbed neck Pectus excavatum Short stature Pulmonary stenosis
142
Prader Willi syndrome features
Hypotonia Hypogonadism Obesity
143
Organophosphate poisoning symptoms
Parasympathetic e.g. pupil constriction, sweating, incontinence, hypotension, bradycardia
144
Opioid toxicity symptoms
Pupil constriction, constipation, respiratory depression
145
Cataract symtpoms
Gradual onset blurred vision and reduced colour vision with halos around lights
146
Surgical procedure in cataracts
Lens replacement with artificial lens
147
Vitreous haemorrhage symptoms
Sudden onset unilateral vision loss after trauma. Often associated with a red hue
148
Causes of optic neuritis
multiple sclerosis: the commonest associated disease diabetes syphilis
149
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
150
Management of optic neuritis
High dose steroids
151
Murmurs on which side of the heart are loudest on expiration?
Left
152
Murmurs on which side of the heart are loudest on inspiration?
Right
153
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
154
What is the main complication of induction of labour?
Uterine hyperstimulation
155
Consequences of uterine hyperstimulation
Foetal hypoxia | Rarely it can cause uterine rupture
156
Management of uterine hyperstimulation
Remove vaginal prostaglandins Stop oxytocin infusion Terbutaline
157
Management of tachycardia with adverse features (shock, syncope, MI, heart failure)
DC cardioversion
158
Management of regular broad complex tachycardia
Amiodarone
159
Management of regular narrow complex tachycardia
Vagal manoeuvres followed by adenosine if unsuccessful
160
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
161
Features of Osgood-Schlatter disease
Seen in sporty teenagers | Pain, tenderness and swelling over the tibial tubercle
162
Features of osteochondritis dissecans
Pain after exercise | Intermittent swelling and locking
163
Features of patellar subluxation
Medial knee pain due to lateral subluxation of the patella | Knee may give way
164
Features of patellar tendonitis
More common in athletic teenage boys Chronic anterior knee pain that worsens after running Tender below the patella on examination
165
Risk factors for pharyngeal pouch
Males | Older age
166
Pharyngeal pouch features
``` dysphagia regurgitation aspiration neck swelling which gurgles on palpation halitosis ```
167
Pharangeal pouch management
Surgery
168
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.
169
Key investigation in necrotising enterocolitis
Abdo X-ray
170
AXR in necrotising enterocolitis
dilated bowel loops bowel wall oedema Gas in the peritoneum, bowel walls or portal vein
171
Test prior to BCG vaccine in patients over 6 years
Tuberculin skin test
172
Diagnosis of boerhaave's syndrome
CT contrast swallow
173
Symptoms of roseola infantum
3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever
174
Classic rash in roseola infantum
Non itchy maculopapular rash starting on the trunk and limbs
175
First line management of suspected PE in stable patient
Rivaroxaban
176
First line management of unstable suspected PE
Alteplase
177
Investigation of reduced foetal movement
Doppler to confirm heartbeat. Ultrasound if it can't be detected. 20 minute CTG
178
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
179
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).
180
First line for diagnosis of small bowel bacterial overgrowth syndrome
Hydrogen breath test
181
What is hairy leukoplacia?
an EBV-associated lesion on the side of the tongue, and is considered indicative of HIV
182
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.
183
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
184
Management of childhood inguinal hernia
Urgent surgery
185
Management of necrotising fasciitis
Surgical debridement and IV abx
186
Total iron binding capacity in iron deficiency anaemia
High
187
Management of obstetric cholestasis
induction of labour at 37-38 weeks ursodeoxycholic acid vitamin K supplementation
188
What is psittacosis?
Respiratory illness spread by birds
189
Dengue fever treatment
Symptomatic
190
First line treatment for ITP in adults
Oral prednisolone
191
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
192
Management of asymptomatic uterine fibroids
Monitor
193
Management of symptomatic uterine fibroids
Contraception / NSAIDs / TXA to manage menorrhagia Short term - GnRH agonists Surgery - myomectomy / endometrial ablation / hysterectomy / uterine artery embolisation
194
Pathogen in scarlet fever
Group A strep e.g. strep pyogenes
195
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) ```
196
Scarlet fever management
abx
197
Age associated with croup
6 months to 3 years
198
Croup symptoms
stridor barking cough (worse at night) fever coryzal symptoms
199
Management of croup
Oral dexamethasone Supportive (usually at home) Admit if severely unwell or comorbidities
200
What is Cushing's disease
ACTH secreting pituitary adenoma
201
What is filgrastim?
A granulocyte-colony stimulating factor used in neutropaenia
202
Cause of neonatal bilious vomiting with double bubble sign on X-ray
Duodenal atresia
203
Treatment of Perthe's disease
Rest and physio. Surgery if severe (more common in older children)
204
Treatment of slipped upper femoral epiphysis
Bed rest. Surgery if severe
205
Causes of lobar collapse
Lung cancer, asthma, foreign body
206
Symptoms of branchial cyst
Asymptomatic neck lump
207
Most common cause of traveller's diarrhoea
E coli
208
Symptoms of Shigella diarrhoea
Bloody diarrhoea | Abdo pain and vomiting
209
Symptoms of campylobacter diarrhoea
A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
210
Management of new onset AF <48 hours
Cardioversion (electrical / amiodarone / flecainide)
211
Management of new AF onset >48 hours
Anticoagulate then cardioversion (electrical)
212
Can breastfeeding continue in mastitis?
Yes
213
Treatment of lactational mastitis
abx if systemic illness, nipple fissure, cultures positive, not resolving in 24-48 hrs
214
Presentation of fat necrosis
It tends to present with a firm, round lump in the breast tissue, often following trauma
215
Symptoms of primary ciliary dyskinesia
Recurrent chest infections Recurrent sinusitis Subfertility
216
What drug is added to induce remission in UC if mesalazine unsuccessful?
Oral steroids
217
Indications for high dose folic acid in pregnancy
``` Maternal or paternal family history of neural tube defects Anti-epileptics Coeliac Diabetes BMI over 30 ```
218
Management of pregnant woman with group B strep
BenPen in labour
219
Target HbA1c in patients with only lifestyle advice or metformin
48
220
Target HbA1c in patients on two drugs
53
221
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
222
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
223
Symptom of thrombosed haemorrhoid
acutely painful and tender blue-black lump originating from the anal margin (and bleeding if it bursts)
224
Management of thrombosed haemorrhoid
Analgesia, stool softeners and ice pack. If presenting within 72 hours consider surgical excision
225
Test for BPPV
Dix-Hallpike test
226
First line for induction of labour
Vaginal prostaglandins
227
Symptoms of lymphogranuloma venereum
stage 1: small painless pustule which later forms an ulcer stage 2: painful inguinal lymphadenopathy stage 3: proctocolitis
228
Lesions in Kaposi's sarcoma
Raised purple lesions
229
First and second line in paediatric constipation
Movicol paediatric plain then add senna if ineffective
230
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
231
Symptoms of mumps
Fever, malaise, muscular pain | Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
232
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
233
Symptoms of erythema infectiosum
Lethargy, fever, headache | 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
234
What virus causes erythema infectiosum?
Parvovirus
235
What is erythema infectiosum also known as?
Slapped cheek disease
236
Symptoms of scarlet fever
Fever, malaise, tonsillitis 'Strawberry' tongue Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
237
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
238
How long before vasectomy is effective?
Do semen analysis at 16-20 weeks to check for no sperm
239
Which renal condition is associated with an "allergic" type picture?
Acute interstitial nephritis
240
Nerve conduction studies in motor neurone disease
Normal
241
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. ```
242
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.
243
Management of auricular haematoma
Urgent ENT referral
244
Consequence of rapid treatment of hyponatraemia
Osmotic demyelination syndrome
245
Symptoms of vestibular neuronitis
acute, severe vertigo, nausea, vomiting and ataxia
246
How to differentiate vestibular neuronitis from labyrinthitis
Vestibular neuronitis won't have hearing loss
247
Treatment of vestibular neuronitis
Vestibular rehabilitation exercises and anti-emetics
248
Treatment of asymptomatic fungal nail infections
Topical anti fungal for 6-12 months
249
Treatment of symptomatic fungal nail infections
Oral anti-fungal
250
Bone profile in oseteogenesis imperfecta
Normal
251
Aetiology of osteogenesis imperfecta
Autosomal dominant
252
Antibodies in systemic sclerosis
ANA / anti-Scl 70
253
Treatment of lichen planus
Topical steroids
254
Management of ankle fractures
Prompt reduction then typically surgical repair in younger patients or conservative in older patients
255
What is transposition of the great arteries?
aorta leaves the right ventricle | pulmonary trunk leaves the left ventricle
256
Signs in transposition of great arteries
Cyanosis, tachypnoea, load S2, prominent right ventricular impulse
257
Management of transposition of great arteries
Supportive then surgery
258
Management of otitis externa
Topical antibiotic and steroid
259
Emergency treatment of severe croup
Oxygen and nebulised adrenaline
260
Reactive arthritis symptoms
Urethritis + arthritis + conjunctivitis
261
Reactive arthritis treatment
Symptomatic : NSAIDs, analgesia, intra-articular steroids
262
Lead poisoning symptoms
``` abdominal pain peripheral neuropathy (mainly motor) fatigue constipation ```
263
What is the time window from symptom onset for thrombolysis in stroke?
4.5 hours
264
What is the time window from symptom onset for thrombolysis in stroke?
6 hours
265
How long for IUD to be effective contraception
Immediately
266
How long for IUS to be effective contraception
7 days
267
Adverse effect of IUD
Periods longer, heavier, more painful
268
What is mittelschmertz?
Mid cycle pelvic pain due to fluid released in ovulation. Systemically well and pain resolves
269
First line in acute pericarditis
NSAID and colchicine
270
Aetiology of osteopetrosis
Recessive
271
Management of thyroxine in pregnancy
Increase dose (typically by up to 50% in first 4-6 weeks
272
What is galactocele?
Painless breast lump after stopping breast feeding due to milk build up
273
Symptoms of allergic btonchopulmonary aspergillosis
bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma bronchiectasis (proximal)
274
Symptoms of allergic btonchopulmonary aspergillosis
bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma bronchiectasis (proximal)
275
Management of type B aortic dissection
Control BP then supportive
276
Indication for abx in mastitis
Systemically unwell Fissure Symptoms for over a day Bacteria on culture
277
Symptoms of breast engorgement
Bilateral breast pain worse before feed. May be red. May have difficulty feeding. Typically a few days after birth
278
Symptoms of breast engorgement
Bilateral breast pain worse before feed. May be red. May have difficulty feeding. Typically a few days after birth
279
Management of breast engorgement
Hand expression
280
Complications of breast engorgement
Blocked ducts Mastitis Difficulty feeding
281
Symptoms of raynauds disease of the nipple
Breast pain and cyanosis or redness during or after feeding
282
Management of Raynaud’s disease of the nipple
Heat packs Stop smoking Reduce caffeine
283
Most common cause of erythema multiforme
HSV
284
VSD murmur
Pansystolic murmur in lower left sternal border
285
Coarctation of aorta murmur
Crescendo-decrescendo murmur in the upper left sternal border
286
PDA murmur
Diastolic machinery murmur in the upper left sternal border
287
Pulmonary stenosis murmur
Pulmonary stenosis Ejection systolic murmur in the upper left sternal border
288
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
289
Features of HUS
acute kidney injury microangiopathic haemolytic anaemia thrombocytopenia
290
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 ```
291
Management of HUS
Mostly supportive
292
Management of contacts of person with measles
Unvaccinated contacts offered MMR
293
Encephalitis symptoms
fever, headache, psychiatric symptoms, seizures, vomiting | focal features e.g. aphasia
294
CSF in encephalitis
lymphocytosis, raised protein
295
ALS guideline pulseless electrical activity
Non-shockable. Give IV adrenaline
296
What heart rhythms are shockable
VF / Pulseless VT
297
What heart rhythms are non-shcokable
Asystole, Pulseless electrical activity
298
Cardiac arrest causes
``` Hypoxia Hypovolaemia Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders Hypothermia Thrombosis (coronary or pulmonary) Tension pneumothorax Tamponade – cardiac Toxins ```
299
What is a Whipple's procedure?
Removal of pancreas and duodenum
300
Investigation of carcinoid syndrome
Urinary serotonin
301
Bells palsy treatment
Oral prednisolone and artificial tears
302
What is Bells palsy?
acute, unilateral, idiopathic, facial nerve paralysis
303
Risk factors for Bells palsy
20-40 or pregnant
304
Bells palsy symptoms
Unilateral facial weakness (including forehead). Patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
305
Bells palsy prognosis
Mostly resolves in a few months
306
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.
307
Management of seborrhoeic keratoses
Reassuarnace
308
Prognosis in seborrhoeic keratoses
Good, they are benign
309
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.
310
What is an osteoma?
Benign bone growth, often on skull
311
What is osteochondroma?
Cartilage covered bone tumour most common in young males
312
What is osteosarcoma?
Most common primary bone tumour seen mainly in children and teens in the metaphysis
313
What is Ewing's sarcoma?
Bone tumour seen in children and teens
314
What is chondrosarcoma?
Malignant tumour of cartilage most commonly seem in middle age in the axial skeleton
315
Hirsutism management
Healthy weight Cosmetic e.g. waxing Consider COCP
316
Investigation of reduced foetal movements
Initially handhold doppler. If heartbeat is found then CTG. If no heartbeat is found then USS
317
Presentation of cephalohaematoma
Swelling on head a few hours after birth that doesn't cross suture lines
318
Management of typical endometrial hyperplasia
Progesterone and watch and wait
319
Management of atypical endometrial hyperplasia
Hysterectomy and bilateral salpingo-opherectomy
320
High PTH, high calcium, low phosphate
Primary Hyperparathyroidism
321
High PTH, low calcium and phosphate
Osteomalacia
322
High PTH, normal calcium, low phosphate
CKD
323
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
324
Treatment of severe hyponatraemia
Hypertonic saline
325
Where to check pulse in paediatric BLS
Femoral or brachial
326
Primary hyperparathyroidism treatment
Surgery
327
Management of suspected DVT but doppler negative
Stop anticoagulant and repeat scan in 7 days
328
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
329
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
330
Uterine fibroids age range
Pre-menopausal
331
Amoebiasis treatment
abx
332
Bacteria that causes pneumonia following influenza
Staph aureus
333
Which fingers are affected by cubital tunnel syndrome?
4th and 5th
334
Cubital tunnel syndrome management
Avoid aggravating activity Physiotherapy Steroid injections Surgery in resistant cases
335
Pernicious anaemia management
B12 replacement
336
Myocarditis symptoms
usually young patient with an acute history chest pain dyspnoea arrhythmias
337
Myocarditis causes
Infection / autoimmune / other
338
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 ```
339
Myocarditis treatment
Treat underlying cause (e.g. abx) | Supportive
340
Myocarditis complications
Arrhythmias, heart failure
341
Torsades de pointes management
Magnesium sulphate
342
Anticoagulation after stroke (first and second line)
Clopidogrel first line Aspirin and dipyridamole second line Apixaban if AF
343
Symptoms of posterior dislocation
The affected leg is shortened, adducted, and internally rotated
344
Management of hip dislocation
ABCDE Analgesia Reduction within 4 hours (under general anaesthetic) Physio
345
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
346
Management of cord prolapse
Push presenting part back in vagina Patient on all fours Tocolytics to stop contractions Caesarean delivery
347
Treatment of deQuervains thyroiditis
Self resolving. NSAIDs if thyroid pain
348
Management of extrinsic allergic alveolitis
Avoid trigger
349
Mild croup treatment
Stat dose dexamethasone
350
Severe croup treatment
Nebulised adrenaline
351
Croup symptoms
stridor barking cough (worse at night) fever coryzal symptoms
352
Acute TB test gold standard
Sputum culture
353
Treatment of rosacea
Topical metronidazole | Oral doxycycline
354
Management of slipped capital femoral epiphysis
Surgical fixation
355
PSC antibodies
pANCA
356
PSC investigation
ERCP / MRCP | pANCA
357
Pericarditis treatement
NSAIDs and colchicine | Treat underlying cause
358
What is significant postural hypotension?
Drop more than 20 systolic Drop to below 90 systolic Drop more than 10 diastolic with symptoms
359
Medication for severe postural hypotension not responding to conservative measures
Fludrocortisone
360
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
361
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%)
362
Aetiology of otoscelrosis
Autosomal dominant
363
Otosclerosis age of onset
20-40
364
Reflux nephropathy investigation
Micturating cystourethrogram
365
Drug for prophylaxis of hepatic encephalopathy
Rifaximin
366
Management of sudden onset sensorineural hearing loss
ENT referral Steroids Investigate cause
367
Biliary atresia symptoms
Jaundice Hepatomegaly with splenomegaly Abnormal growth
368
What is Guttate psoriasis?
Psoriasis with small plaques over the body 2-4 weeks after an infection
369
Guttate psoriasis prognosis
Clears in a couple of months
370
Necrotising enterocolitis symptoms
feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis
371
necrotising enterocolitis treatment
Gut rest with total parenteral nutrition | Surgery for perforation
372
PDA management
Indomethacin or ibuprofen
373
Rhabdomyolysis management
IV fluids
374
What nerve is used for corneal reflex
V1
375
Jaw jerk reflex nerve
V3
376
BPH first line
alpha agonist e.g. tamsulosin
377
What hormones are in the implant?
Progesterone
378
Implant effect on periods
Heavy
379
Epidydimal cyst examination findings
separate from the body of the testicle | found posterior to the testicle
380
Epidydimal cyst diagnosis
Confirmed on USS
381
Epidydimal cyst treatment
Management is usually supportive but surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts
382
Keratoacanthoma appearance
initially a smooth dome-shaped papule | rapidly grows to become a crater centrally-filled with keratin
383
Keratoacanthoma management
Usually regress within 3 months | Remove if suspicious for BCC / SCC
384
Cervical myelopathy investigation
MRI spine
385
Cervical myelopathy treatment
Decompressive surgery
386
What is MODY?
development of type 2 diabetes mellitus in patients < 25 years old
387
Treatment of MODY
As per type 2 DM
388
Aetiology of MODY
Genetic
389
Management of Bowen's disease
Topical 5-flurouracil Surgery Cryotherapy
390
Sarcoidosis symptoms
erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia, dyspnoea, non-productive cough, malaise, weight loss, skin rash hypercalcaemia
391
What is pituitary apoplexy?
Haemorrhage or infarction of pituitary adenoma
392
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
393
Pituitary apoplexy treatement
urgent steroid replacement due to loss of ACTH careful fluid balance surgery
394
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)
395
How long should a second febrile convulsion be before ambulance called?
5 mins
396
Malrotation symptoms
Distended abdomen | Bilious vomiting
397
Malrotation investigation
Upper GI contrast study and USS
398
Malrotation treatment
Surgery
399
Drug induced lupus antibodies
Anti-histone antibodies
400
Clubfoot management
Splinting and progressive casting
401
First line investigation in stable angina
CT coronary angiogram
402
What is mesothelioma
Cancer of pleura caused by asbestos exposure
403
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)
404
Anticoagulants used in patients who will have PCI
Aspirin and prasugrel
405
Normal pressure hydrocephalus symptoms
dementia, ataxia and urinary incontinence
406
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)
407
Toxic shock syndrome management
removal of infection focus (e.g. retained tampon) IV fluids IV antibiotics
408
Acromioclavicular degeneration symptoms
popping, swelling, clicking or grindings and a positive scarf test
409
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.
410
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.
411
Frozen shoulder risk factors
Diabetes
412
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
413
Frozen shoulder treatment
NSAIDs, physio, steroid injections
414
Pharyngeal pouch treatment
Surgery
415
Gingival hyperplasia causes
phenytoin, ciclosporin, calcium channel blockers and AML
416
Idiopathic intercranial hypertension risk factors
obesity female sex pregnancy drugs (COCP, steroids, tetracyclines, vitamin A, lithium)
417
Idiopathic intercranial hypertension symptoms
``` headache blurred vision papilloedema (usually present) enlarged blind spot sixth nerve palsy may be present ```
418
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 ```
419
Patellar fracture management
Non-displaced and extensor function in tact: Knee brace | Displaced or extensor function impaired: Surgery
420
Toxic epidermal necrosis causes
Usually drug reaction
421
Toxic epidermal necrosis treatment
Supportive including fluids Steroids Immunoglobulin
422
How long after emergency contraception before restarting hormonal contraception?
5 days
423
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
424
Nasal septal haematoma treatment
Drainage | IV abx
425
What is sick euthyroid syndrome?
Low T4 in acute illness
426
FSGS age group
Typically young adults
427
FSGS management
Steroids and consider immunosuppression
428
What symptom suggests mastoiditis as a complication of otitis media?
Post auricular swelling
429
Umbilical hernia management
Often resolve spontaneously If large or symptomatic repair aged 2-3 If asymptomatic repair aged 5
430
Management of oesophageal dysplasia seen on endoscopy
Endoscopic resection or ablation
431
What condition causes slapped cheek rash?
Erythema infectiosum
432
When to consider surgery in aortic stenosis
Symptomatic
433
Facial nerve lesion symtpoms
flaccid paralysis of the upper and lower face, loss of taste, hyperacusis and loss of corneal reflex
434
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
435
Lichen sclerosus management
Topical steroids and emollients
436
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
437
Pityrisasis versicolour treatment
Topical antifungals
438
Management of anti-phospholipid syndrome
Prophylactic aspirin if no history of VTE | Warfarin if history of VTE
439
Androgen insensitivity syndrome presentation
Genotypically male. Phenotypically female. Primary amenorrhoea Often have inguinal hernias due to undescended testes
440
Hand foot and mouth disease treatment
Symptomatic as it is self limiting
441
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
442
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
443
L4 compression symptoms
weakness of the quadriceps, a reduced knee reflex and a positive femoral stretch test. Reduced sensation over anterior knee
444
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.
445
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
446
Hypospadias management
Surgery at 12 months
447
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
448
Small bowel bacterial overgrowth syndrome risk factors
neonates with congenital gastrointestinal abnormalities scleroderma diabetes mellitus
449
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
450
Small bowel bacterial overgrowth syndrome management
correction of underlying disorder | antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance
451
Small bowel bacterial overgrowth syndrome symptoms
Similar to IBS
452
Cluster headache prophlyaxis
Verapamil
453
PMS treatment
Conservative. COCP. SSRIs if severe
454
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
455
Slipped capitol femoral epiphysis management
Internal fixation surgery
456
Newborn BLS
Dry baby Assess tone, HR and RR If not breathing, 5 rescue breaths If still not breathing, CPR at 3:1 ratio
457
Bartholin's cyst age
Reproductive age
458
Gonorrhoea treatment
Single dose IM ceftriaxone
459
Asymptomatic bacteriuria in catheterised patient treatment
None
460
Postnatal depression screening scale
Edinburgh depression scale
461
Neuroleptic malignant syndrome blood tests
Raised CK May have leukocytosis May have hyperkalaemia due to muscle damage
462
Neuroleptic malignant syndrome management
stop antipsychotic IV fluids to prevent renal failure dantrolene may be useful in selected cases bromocriptine may also be used
463
What rash has a herald patch?
Pityriasis rosea
464
Pityriasis rosea treatment
Self limiting
465
Does warfarin affect PT or APTT?
PT
466
Alcoholic hepatitis management
Steroids in a flare
467
First line to maintain remission in Chrons
Azathioprine or mercaptopurine
468
Stevens johnsons syndrome symptoms
Flu like prodrome | Rapid onset painful red blistering rash
469
Stevens johnsons syndrome treatment
Stop drug | Admit for IV fluids
470
What is syringomyelia?
Syringomyelia (‘syrinx’ for short) describes a collection of cerebrospinal fluid within the spinal cord that gradually expands over time
471
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
472
Syringomyelia diagnosis
MRI
473
Bells palsy management
Prednisolone and eye care
474
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)
475
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
476
Pheochromocytoma first line investigation
Plasma and urine metanephrines
477
Acromegaly first line investigation
Serum IGF-1
478
What is pompholyx eczema?
Blistering eczema of hands and feet triggered by warm temperatures
479
Mesenteric adenitis treatment
Self limiting
480
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
481
Meniere's disease treatment
ENT referral. Prochlorperazine in acute attack. Antihistamine and vestibular rehabilitation as prophylaxis
482
Meniere's disease symptoms
recurrent episodes of vertigo, tinnitus hearing loss lasting minutes to hours
483
Anti phospholipid syndrome antibodies
Anti-phospholipid syndrome antibodies are lupus anticoagulant (LA) and anti-cardiolipin antibodies (aCL)
484
Entamoeba hystolytica symptoms
dysentery, liver abscesses, colonic abscesses, or inflammatory masses in the colon
485
Amoebiasis treatment
Metronidazole
486
Acute intermittent porphyria symtpoms
abdominal, neurological and psychiatric symptoms
487
Acute intermittent porphyria demographic
Young females
488
Acute intermittent prophyria investigation finding
Urine turns dark red when left
489
Acute intermittent porphyria management
Haematin / haem arginate in a flare. Avoid triggers
490
Shaken baby syndrome symptoms
Retinal haemorrhages, subdural haematoma and encephalopathy
491
What is Osgood Schlatter disease also known as?
Tibial epophysitis
492
Osgood Schlatter disease symptoms
Seen in sporty teenagers | Pain, tenderness and swelling over the tibial tubercle
493
Vestibular schwannoma symptoms
vertigo, hearing loss, tinnitus and an absent corneal reflex
494
What is atopic eruption of pregnancy
Common itchy eczematous skin condition in pregnancy
495
What is polymorphic eruption of pregnancy?
Itchy rash in last trimester. Treated with emollients or topical steroids
496
What is pemphigoid gestationis
Vesicular rash in second half of pregnancy
497
Acute anal fissure management
Laxatives, analgesia, lubricants
498
Chronic anal fissure management
Laxatives, analgesia, lubricants, topical GTN, surgery considered second line
499
Postpartum thyroiditis treatment
Propranolol
500
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
501
Unilateral nasal polyp management
Urgent ENT referral
502
When can someone fly after pneumothorax?
1 week after CXR shows it has cleared
503
When can someone dive after pneumothorax?
Ideally never
504
What is malignant hyperthermia?
Hyperthermia and muscle rigidity after general anaesthetic
505
Malignant hyperthermia treatment
Supportive and dantrolene
506
What vaccine should people with coeliac get?
Pneumococcal
507
Pyoderma gangrenosum treatment
Steroids
508
Management of displaced intracapsular hip fracture
Internal fixation if fit or hemiarthroplasty if unfit
509
Hyperhidrosis treatment
Topical aluminium chloride first line. Botox second line. Surgery third line
510
Iliopsoas abscess symptoms
Fever Back/flank pain Limp Weight loss
511
Iliopsoas abscess investigation
CT
512
Iliopsoas abscess treatment
Antibiotic and drainage
513
Joint aspiration in RA
Yellow with high WBCs | No bugs or crystals
514
NF1 symptoms
Cafe au lait spots | Some tumours
515
NF2 symptoms
Schwannomas
516
Von Hippel Lindau symptoms
Cysts and benign tumours
517
Are antibiotics given prior to surgery in appendicitis?
Yes
518
Pagets disease of the bone treatment
Bisphosphonates
519
SSRI discontinuation syndrome symptoms
Mood change, restlessness, insomnia, sweating, GI symptoms
520
Paediatric inguinal hernia management
Surgery
521
How to distinguish viral labyrinthitis from vestibular neuronitis
Labyrinthitis has hearing loss
522
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
523
Tuberous sclerosis symptoms
``` Depigmented skin lesions Roughened skin lesions Developmental delay Epilepsy Cysts ```
524
What does low haptoglabin indicate?
Intravascular haemolysis
525
Medication for bile acid malabsorption
Cholestyramine
526
Autoimmune hepatitis antibodies
Anti-smooth muscle or ANA
527
Guttate psoriasis symptoms
'Tear drop', scaly papules on the trunk and limbs
528
Guttate psoriasis management
Most cases resolve spontaneously within 2-3 months | Topical agents as per psoriasis
529
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
530
Pityriasis rosea management
Self limiting
531
When to increase frequency of AAA screening
Over 3 cms
532
Treatment of threadworms
Single dose mebendazole
533
CXR in transient tachypnoea of the newborn
Hyperinflation | Fluid in horizontal fissure
534
What is a hartmans procedure?
Sigmoid Colectomy and stoma formation
535
Chronic pancreatitis first line imaging
CT abdo (look for calcification)
536
Most common lymphoma
Diffuse large B cell lymphoma
537
What subtype of melanoma is more aggressive?
Nodular
538
Pheochromocytoma management
Alpha blocker e.g. phenoxybenzamine Then beta blocker e.g. propranolol Then surgery
539
Paediatric umbilical hernia managment
Watch and wait
540
Umbilical granuloma symptom
small, red growth of tissue is seen in the centre of the umbilicus in first week of life. May leak fluid
541
Umbilical granuloma management
Salt. Cautery with silver nitrate
542
What is omplailitis?
Infection of umbilicus
543
Polyarteritis nodosa symptoms
Systemic vasculitic symptoms
544
Drug induced lupus antibodies
Anti-histone
545
Chagas disease complications
Cardiomyopathy, GI issues
546
Chagas disease management
Anti-fungal. Monitor for complications e.g. echo
547
Screening for diabetic nephropathy
Urine albumin creatinine ratio yearly
548
Most common cause of bitemporal hemianopia with predominately the lower quadrants being affected
Craniopharyngioma
549
Hypospadias management
Surgery at 12 months
550
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.
551
What can CLL transform to?
Lymphoma
552
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
553
Ramsey Hunt syndrome treatment
Steroids and acyclovir
554
Mild rosacea first line
Topical metronidazole
555
What is Charcot joint?
A badly disrupted joint due to loss of sensation
556
Symptoms of Charcot joint
Red swollen warm slightly painful joint often in daibetics
557
Unilateral undescended testicles referral and management
Refer at 3 months. Surgery at 1 year
558
Bilateral undescended testes referral and management
Refer immediately for endocrine and genetic tests
559
Haemochromatosis iron studies
Transferrin high Ferritin high TIBC low
560
Leishmaniasis symptoms
Skin lesions or mouth / nasal ulcers. | May have systemic symptoms
561
What virus causes aplastic crisis in sickle cell?
Parvovirus
562
Acute bronchitis symptoms
Cough (usually non-productive initially then productive) Rhinorrhoea and sore throat May have low grade fever May have wheeze
563
Acute bronchitis treatment
Symptomatic. Abx if systemically unwell
564
Newborns to mothers with lupus are at increased risk of what?
Arrhythmias
565
Toxoplasmosis symptoms
Usually asymptomatic in immunocompetent people. May have low grade malaise symptoms
566
Haemochromatosis inheritance
Autosomal recessive
567
Latent autoimmune diabetes of adulthood presentation
Slow onset type 1 diabetes symptoms
568
Scalp psoriasis first line
Topical steroids
569
Post thrombotic syndrome management
Compression stockings
570
Management of bradycardia if atropine fails
Transcutaneous pacing
571
Duct ectasia symptoms
Nipple retraction and milky discharge
572
First line in ITP
Steroids
573
What does India ink stain for?
Cryptococcus
574
Pagets age
More common in older age
575
First line for multiple genital warts
Topical podophyllum
576
Guttate psoriasis treatment
As per normal
577
Management of immunosuppressed patients exposed to chickenpox
Immunoglobulin if no antibodies
578
Management of whooping cough
Abx is presenting within 21 days Notify public health Abx for household contacts
579
Meralgia paraesthetica age
30s - 40s
580
Which lung cancer is associated with gynaecomastia?
Adenocarcinoma
581
What is Lemierre's syndrome?
Lemierre's syndrome presents with thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection
582
Chronic subdural haematoma management
If asymptomatic, conservative | If symptomatic, burr holes
583
Primary hyperparathyroidism most common cause
Solitary adenoma
584
Primary hyperparathyroidism treatment
Total parathyroidectomy. If asymptomatic and Ca not too high and older patient may do nothing
585
Ramsey Hunt treatment
Oral acyclovir and steroids
586
Thyroglossal cyst age
Teen or young adult
587
Cystic hygroma age
Newborn or babies
588
Branchial cyst age
Young adults
589
Acute intermittent porphyria age
Young adults
590
Acute intermittent porphyria symptoms
Abdo pain Neuropsychiatric Red urine
591
Acute intermittent porphyria management
Avoid triggers | Haem arginate in a flair
592
Subacute combined degeneration of the cord symptoms
Loss of vibration and proprioception | UMN and LMN signs (e.g. brisk knee reflexes, absent ankle reflexes)
593
Medical miscarriage drug
Vaginal misoprostol
594
Tetralogy of fallot murmur
ejection systolic
595
Gestation to offer external cephalic version
36 weeks
596
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
597
lichen planus management
Topical steroids
598
Hypercalcaemia ECG
Short QT
599
What is Argyle Robertson pupil?
Small fixed pupil No light reflex Accommodation reflex in tact
600
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
601
Otitis media bacteria
Haemophilus influenzae
602
Average age of orbital cellulitis
Children
603
Orbital cellulitis management
IV abx
604
Blepharitis management
Hot compresses and lid hygiene
605
Management of non-retractable foreskin
Watch and wait until 2 years as often resolves | After 2 years consider surgery
606
What do muddy brown casts indiate?
ATN
607
What do white cell casts indicate?
Acute interstitial nephritis
608
Angle closure glaucoma management
Eyedrops of pilocarpine, beta blockers and alpha blockers IV acetazolamide Laser ididotomy
609
Open angle glaucoma symptoms
peripheral visual field loss - nasal scotomas progressing to 'tunnel vision' decreased visual acuity optic disc cupping
610
Scalp seborrheic dermatitis management
OTC shampoos e.g. head and shoulders Topical ketoconazole Topical steroids if severe
611
Face seborrheic dermatitis management
Topical ketoconazole | Topical steroids
612
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
613
Management of dysplasia on endoscopy
Endoscopic treatment
614
What is Kartagener syndrome also known as?
Primary ciliary dyskinesia
615
FSGS age
Young adults
616
UTI treatment near delivery
Amoxicillin
617
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
618
Internuclear ophthalmoplegia cuases
MS | Vascular
619
Leprosy symptoms
Patches of pale skin | Sensory loss
620
What type of vision is a risk factor for angle closure glaucoma?
Hypermetropia (long sighted)
621
Trigeminal neuralgia first line
Carbemazepine
622
CRAO symptoms
Painless vision loss
623
CRAO on ophthalmoscopy
Pale retina with cherry red spot
624
CRVO symptoms
Painless vision loss
625
CRVO on ophthalmoscopy
Retinal haemorrhages
626
Vitreous detachment symptoms
Flashers and floaters | Vision loss starting peripheral and moving centrally
627
Vitreous haemorrhage symptoms
Dark spots over vision
628
Hypocalcaemia ECG
long QT
629
Eczema herpeticum treatment
IV antivirals
630
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
631
Thoracic outlet syndrome demographic
Young thin women
632
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
633
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
634
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
635
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
636
What sort of childhood neck lump is multiloculated and heterogenous on imaging?
Dermoid cyst
637
What is thromboangiitis obliterans also known as?
Buerger disease
638
Buerger disease symptoms
extremity ischaemia (intermittent claudication and / or ischaemic ulcers) superficial thrombophlebitis Raynaud's phenomenon
639
Leptospirosis risk factors
sewage workers, farmers, vets or people who work in an abattoir
640
Leptospirosis symptoms
``` flu-like symptoms subconjunctival redness / haemorrhage acute kidney injury hepatitis aseptic meningitis ```
641
Leptospirosis management
Abx
642
What is Li-Fraumenni syndrome?
Autosomal dominant | High incidence of malignancies particularly sarcomas and leukaemias
643
What is Gardeners syndrome?
FAP variant
644
Interstitial cystitis symptoms
lower urinary tract symptoms and suprapubic pain
645
Interstitial cystitis investigation
Bladder cystography. Will see red area, small blood vessels and granulomas which may bleed
646
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')
647
What suggests Korsakoff syndrome rather then Wernicke's encaphalopathy?
Anterograde / retrograde amnesia and confabulation
648
What is hyphaema?
Blood in anterior chamber
649
Management of hyphaema
Strict bed rest
650
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
651
Medication to offer with CBT in moderate - severe OCD
SSRI
652
Management of bleeding a few hours after tonsillectomy
Theatre
653
Management of bleeding a few days after tonsillectomy
Abx
654
Hip dislocation management
Reduction under anaesthetic within 4 hours
655
What is enteropathic arthritis?
Asymmetric seronegative arthritis associated with IBD
656
First line in open angle glaucoma
Prostaglandin analogue eye drop eg lantoprost
657
What is Kallman syndrome?
Hypogonadotropic hypogonadism
658
LH and FSH in Kallman syndrome
Low / inappropriately normal
659
De Quervain's tenosynovitis management
analgesia steroid injection immobilisation with a thumb splint (spica) may be effective surgical treatment is sometimes required
660
Cervical degenerative myelopathy management
Decompressive surgery
661
Mammary duct ectasia risk factors
Perimenopausal | Smoker
662
Mammary duct ectasia findings on mammogram
Microcalcifications

Progress Tests (17 decks)

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