PassMedicine Flashcards
Urinary incontinence + gait abnormality + dementia =
normal pressure hydrocephalus
This condition presents with dementia as well as psychiatric symptoms, the most common of which are hallucinations.
Lewy body dementia
is a Parkinson’s plus condition. Thus, the condition shares many of the core features of Parkinson’s disease (tremor, rigidity, bradykinesia) as well as additional symptoms
Multiple system atrophy
cardinal features of Parkinson’s disease
(tremor, rigidity and bradykinesia)
Newly diagnosed patient of black African or African–Caribbean origin with hypertension - add a
calcium channel blocker
have reduced efficacy in black patients and are therefore not used first-line
ACE inhibitors
typically causes an early diastolic murmur
Aortic regurgitation
most common valvular defect after infective endocarditis
aortic regurgitation
Intensity of the murmur is increased by the handgrip maneuver
Collapsing pulse
Wide pulse pressure
Aortic regurgitation
is a murmur that occurs with a patent ductus arteriosus, which is a type of congenital heart defect where the ductus arteriosus does not close after birth.
continuous machine-like murmur
An ejection systolic murmur is heard with
aortic stenosis
A low-pitched diastolic murmur, sometimes called a rumbling murmur, is caused by
mitral stenosis
A pansystolic murmur, or holosystolic murmur, is a murmur present throughout all of systole and is typical for
mitral regurgitation
This may cause a small volume pulse, a fourth heart sound and a thrill.
pansystolic murmur, or holosystolic murmur, mitral regurgitation
Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with
dexamethasone
can reduce cerebral oedema, and therefore, reduce intracranial pressure, help alleviate symptoms of headaches and improve associated neurological deficits.
Dexamethasone
would not improve the raised intracranial pressure, and can take up to 72 hours to reach peak serum concentrations.
Fentanyl patch
is preferable to topiramate in women of childbearing age (i.e. the majority of women with migraine)
Propranolol
propranolol is preferable to topiramate, as the latter may be
teratogenic
it can reduce the effectiveness of hormonal contraceptives
topiramate
is a medication which can be used to prevent predictable menstrual migraine.
Frovatriptan
is considered a first-line option for migraine prophylaxis, but it can be teratogenic and it can reduce the effectiveness of hormonal contraceptives
Topiramate
is a medication which can be used to prevent predictable menstrual migraine
Zolmitriptan
are used in the acute treatment of migraine
5-HT receptor agonists
First line management of acute pericarditis involves
combination of NSAID and colchicine
This might be a suitable choice if NSAIDs or colchicine were contraindicated or have failed or when there is a specific indication such as an autoimmune disease.
Prednisolone
Over-replacement with thyroxine increases the risk for
osteoporosis
reduced bone mineral density and osteoporosis
Over-replacement with thyroxine
is seen in thyrotoxicosis associated with Graves’ disease, due to the autoantibody-mediated activation of orbital fibroblasts.
Exophthalmos (proptosis)
is more commonly associated with hyperglycaemia, rather than hypoglycaemia.
Thyrotoxicosis
is a cause of high-output heart failure
Severe anaemia
as it causes cardiac stress through tachycardia and increased stroke volume.
high-output heart failure
This occurs when blood accumulates in the myocardium, usually following trauma.
Cardiac tamponade
It typically presents with Beck’s triad and requires immediate pericardiocentesis.
Cardiac tamponade
It does typically affect patients in this age group but is a genetic condition causing the heart muscle to be thicker, and is a cause of sudden death in young people. It is not related to severe anaemia.
Hypertrophic cardiomyopathy
is an inflammation of the heart muscle which can cause heart failure
Myocarditis
is an inflammation of the pericardium
Pericarditis
Discontinue SAMA (switch to SABA) if commencing LAMA
COPD
Serial peak flow measurements at work and at home are used to detect
occupational asthma
The onset of cough and wheeze after starting a new job coupled with the improvement of symptoms whilst on holiday suggests a diagnosis of
occupational asthma
A baker is a high-risk profession for occupational
asthma
Schistosomiasis is treated with
praziquantel
which commonly causes a ‘swimmer’s itch’, particularly in patients who return from Africa
schistosomiasis
This usually causes an itchy rash to form commonly on the legs due to swimming in infected water.
schistosomiasis
is commonly used in the management of cellulitis.
Flucloxacillin
can be used for the management of nematodes.
Thiabendazole
is a parasitic flatworm infection
Schistosomiasis, or bilharzia
Definitive diagnosis of sickle cell disease is by
haemoglobin electrophoresis
This patient is presenting with a history of thrombotic crises, typical of
sickle cell anemia
the sickle-shaped red blood cells occlude the vessels causing
momentary ischemia
The treatment is supportive, with analgesia and abundant fluids.
sickle-shaped red blood cells occlude the vessels causing momentary ischemia.
Serum-free light chain assay is used to diagnose
multiple myeloma
is a contraindication to statin therapy
Pregnancy
Thymomas are commonly associated with
myasthenia gravis
Lambert-Eaton myasthenic syndrome is commonly associated with
small-cell lung cancer
is a life-threatening medical emergency that requires immediate treatment with pericardiocentesis
Cardiac tamponade
triad consists of muffled heart sounds, raised JVP and hypotension.
Beck’s triad
Cardiac tamponade is an emergency and requires immediate
pericardiocentesis to drain the blood in the pericardium.
is a procedure used to aspirate air from the pleural cavity in patients with a tension pneumothorax.
Thoracocentesis
It is important to remember that strokes can be caused by
hypercoagulable states and hyperviscosity
which usually also presents with bone marrow infiltration, splenomegaly and sometimes lymphadenopathy.
Waldenstrom’s macroglobulinaemia
Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of
myasthenia gravis
are used to treat myasthenic crisis where there is respiratory muscle weakness
Plasmapheresis and IV immunoglobulin
Immunosuppressive agents such as prednisolone can be used to treat relapses however it may take months of treatment to achieve remission.
myasthenia gravis
would be considered if the disease is not easily controlled by pyridostigmine or there was evidence of a thymoma to prevent local invasion.
Thymectomy
Posterior MI typically present on ECG with
tall R waves V1-2
usually occurs due to an occlusion of the posterior descending artery (posterior interventricular artery).
Posterior myocardial infarction
In 80% of people, this artery branches from the right coronary artery.
posterior descending artery (posterior interventricular artery)
In this case there is a high risk wound and symptoms so tetanus ___________would be advised alongside a muscle relaxant such as diazepam, and ventilatory support if needed.
immunuglobulin
Wounds burns needing surgery delayed more than 6 hours
Wounds contaminated with soil
Compound fractures
Wounds containing foreign bodies
Wounds/burns in people with systemic sepsis
High risk wounds
Signs of right-sided heart failure are
raised JVP, ankle oedema and hepatomegaly
describes the hypertrophy of the right ventricle and right heart failure that are caused by pulmonary arterial hypertension.
Cor pulmonale
hypoxia induces pulmonary vasoconstriction, eventually causing
pulmonary hypertension
Shortness of breath on exertion, orthopnoea and paroxysmal nocturnal dyspnoea are more indicative of
left-sided heart failure
Chest pain on exertion is indicative of angina due to
coronary artery disease.
is a sign of right-sided heart failure
Hepatomegaly
sign may be seen in pancreatic cancer
The ‘double duct’
New onset diabetes (HbA1C of 7.3%) in someone of this age should ring alarm bells for
pancreatic cancer and prompt referral.
A raised serum lipase and painless jaundice also add to the case.
pancreatic cancer and prompt referral.
this is seen on brain imaging and can indicate progressive supranuclear palsy (PSP)
Hummingbird sign
Pulmonary stenosis is louder on
inspiration
causes an ejection systolic murmur that is louder on inspiration.
Pulmonary stenosis
An ejection systolic murmur that is louder on expiration is characteristic of
aortic stenosis
A holo-systolic murmur that is louder on expiration is indicative of
mitral regurgitation.
A holo-systolic murmur that is louder on inspiration is indicative of
tricuspid regurgitation
Late systolic murmurs indicate
mitral valve prolapse and coarctation of the aorta
A mid-systolic click is caused by
prolapse of the mitral valve
is the gold standard test for diagnosing venous sinus thrombosis
MR Venogram
slow-onset severe headache, diplopia, nausea and seizures. These are all features of
increased intracranial pressure
past medical history of antiphospholipid syndrome coupled with pregnancy, which induces a
hypercoagulable state, lead to a diagnosis of venous sinus thrombosis.
is defined as a thrombotic obstruction of the cerebral veins and/or dural sinuses.
Venous sinus thrombosis
MR venogram is a form of MRI which is used to diagnose this condition
Venous sinus thrombosis
This is the investigation of choice to diagnose meningitis, which would present with fever, photophobia and neck stiffness
Lumbar puncture - CSF sent for cell counts and gram stain
This is the investigation of choice to diagnose a subdural haematoma when a CT head is negative
Lumbar puncture with CSF sent for xanthochromia
severe, sudden onset thunderclap headache, photophobia and neck stiffness
subdural haematoma
is normal in around 70% of patients affected by venous sinus thrombosis.
Non-contrast CT head scan
describes patients with ischaemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia
Unstable angina
This patient is presenting with chest pain accompanied by deeply inverted T waves in V2-3 and a 0.5mm ST depression in the same leads.
unstable angina
would present with a sharp, tearing pain in the anterior chest or back.
Aortic dissection
It is a type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck.
Ludwig’s angina
presents with chest pain and ST-segment depression
Non-ST elevation myocardial infarction
needs an ST elevation greater than 1.5 mm in V2-3 in women to be diagnosed and elevated troponin levels.
ST elevation myocardial infarction
classically presents as visible haematuria following a recent URTI
IgA nephropathy
episodes of macroscopic haematuria, typically associated with a recent respiratory tract infection and mild proteinuria.
IgA nephropathy
which is caused by immune complex (IgG, IgM, and C3) deposition in the glomeruli.
post-streptococcal glomerulonephritis
This happens more slowly, typically 7-14 days following a group A beta-hemolytic Streptococcus infection and causes proteinuria.
post-streptococcal glomerulonephritis
is an X-linked dominant disease. It presents with microscopic haematuria, bilateral sensorineural deafness, and lenticonus.
Alport’s syndrome
can present as nephrotic syndrome, haematuria, or proteinuria.
Membranoproliferative glomerulonephritis
disease is very common in children, but nearly always presents as nephrotic syndrome.
Minimal change
causes renal failure by tubular cell necrosis
Myoglobinuria
The history and a very high serum creatine kinase give a diagnosis of
rhabdomyolysis
can cause a restrictive lung defect on spirometry
Kyphoscoliosis (e.g. ankylosing spondylitis)
a normal chest examination along with a normal chest x-ray make clinically significant ILD unlikely
Pulmonary fibrosis
The x-ray may show emphysema, flattened hemidiaphragms and hyperinflation. In obstructive lung disease, the FEV1/FVC ratio is < 0.7.
COPD
should be stopped in AKI as may worsen renal function
ACE inhibitors
is a 5α-reductase inhibitor and treats benign prostatic hyperplasia (BPH) by blocking dihydrotestosterone synthesis.
Finasteride
‘Unprovoked’ pulmonary embolisms are typically treated for
6 months
is used to suppress nausea and vomiting with intracranial tumours
Dexamethasone
can reduce the oedema of CNS tumor can relieve nausea and vomiting.
Dexamethasone
is commonly prescribed in malignant nausea, it is not the best drug for nausea secondary to brain tumours because it does not directly treat the cause of nausea.
histamine H1-receptor antagonist (antihistamine)cyclizine
helps to reduce labyrinth disorders related symptoms.
Prochlorperazine
is analogous to chlorpromazine; both of these agents antagonize dopaminergic D2 receptors in various pathways of the central nervous system.
Prochlorperazine
the antiemetic action of ____________is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone in the central nervous system, it will not reduce the oedema of the tumour which causes the symptoms
metoclopramide
is a type of benzodiazepine which will reduce his agitation
Lorazepam
should be urgently referred for assessment by specialist spinal services (neurosurgery or orthopaedic spinal surgery)
degenerative cervical myelopathy
degenerative cervical myelopathy
Cervical decompressive surgery
SGLT-2 inhibitors have been linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
Dapagliflozin
is an SGLT-2 inhibitor used in type 2 diabetes. It acts to inhibit sodium glucose co-transporter 2 in the proximal convoluted tubule which reduces glucose reabsorption and increases urinary glucose excretion.
Dapaglifozin
Ileocaecal resection may result in
vitamin B12 deficiency
is absorbed in the terminal ileum, therefore resection of the terminal ileum as part of ileocaecal resection would reduce
vitamin B12
would cause anaemia and glossitis
Iron deficiency
Cortisol: suppressed
ACTH: suppressed
High-dose dexamethasone suppression test with a pituitary adenoma
Suppressed ACTH and cortisol on high-dose dexamethasone suppression
Cushing’s disease (pituitary adenoma)
Suppressed ACTH but unsuppressed cortisol on high-dose dexamethasone
adrenal adenomas
Unsuppressed ACTH and cortisol on high-dose dexamethasone suppression
Ectopic ACTH syndrome
following possible exposure give immunglobulin + vaccination
Rabies
there will be an abnormally large drop in BP during inspiration, known as pulsus paradoxus
In cardiac tamponade
drop in blood pressure on inspiration
pulsus paradoxus
The symptoms three months ago were likely due to optic neuritis, a common presenting feature of ___________.
multiple sclerosis
The combination of low platelet counts and raised FDP in this setting make ________ the most likely diagnosis.
Disseminated intravascular coagulation
is most commonly caused by cavernous sinus tumours.
Cavernous sinus syndrome
the nasopharyngeal malignancy has locally invaded the left cavernous sinus
Cavernous sinus syndrome
Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner’s syndrome.
Cavernous sinus syndrome
Measure of disease activity in rheumatoid arthritis
DAS28
Helps estimate the risk of a patient having a deep vein thrombosis
Wells score
Mini-mental state examination - used to assess cognitive impairment
MMSE
Used in the assessment of suspected obstructive sleep apnoea
Epworth Sleepiness Scale
Indicates prognosis in prostate cancer
Gleason score
is the second most common association of HNPCC after colorectal cancer
Endometrial cancer
are ‘critical’ medicines which should not be stopped on acute admissions and must be delivered on time
Levodopa and other antiparkinsons drugs
presents with the triad of sudden onset abdominal pain, ascites, and tender hepatomegaly
Budd-Chiari syndrome
Gallstones are likely to cause a greater increase in
ALP
causes a rise in bilirubin after an acute stress on the body eg: illness or fasting.
Gilbert’s syndrome
DVT investigation: if the scan is negative, but the D-dimer is positive
→ stop anticoagulation and repeat scan in 1 week
Sexual dysfunction is an important side effect of
thiazide-like diuretics such as indapamide
Due to it’s action as an insulin secretagogue, it can cause hypoglycaemia.
Gliclazide
Hypsarrhythmia on EEG suggests
infantile spasms (West’s syndrome)
typically present with tonic-clonic movements and a loss of consciousness, with a history of fever, most commonly between the ages of 6 months and 3 years.
Febrile seizures
typically presents in adolescence with infrequent generalised seizures.
Juvenile myoclonic epilepsy
Nasogastric tubes are safe to use if
pH <5.5 on aspirate
develops in around 10% of primary sclerosing cholangitis patients
Cholangiocarcinoma
is the most common cause of an exudative pleural effusion
Pneumonia
protein level >35 and the LDH >200 point
exudative effusion
can immediately be ruled out as they are both transudative.
heart failure and renal failure
ITP - give oral
prednisolone
is the first-line treatment for immune thrombocytopenic purpura (ITP) which is defined as an isolated low platelet count
Oral prednisolone
3 sets of blood cultures are recommended in the investigation of
infective endocarditis
is used for symptomatic bradycardia if atropine fails
External pacing
typically presents with haematuria, proteinuria/oedema, hypertension and oliguria
Post-streptococcal glomerulonephritis
periorbital oedema, oliguria, proteinuria and haematuria after impetigo.
Post-streptococcal glomerulonephritis
profuse diarrhoea due to infection with Escherichia coli O157
Haemolytic uraemic syndrome
presents similarly and also occurs after an upper respiratory tract infection, but has a shorter latency period (1-2 days following the infection)
IgA nephropathy
It could result in dark (‘cola coloured’) urine due to myoglobinuria
Rhabdomyolysis
infection is a common cause for non-specific urethritis (dysuria +/- urethral discharge)
Chlamydia trachomatis
most common symptom of Crohn’s disease in children?
Abdominal pain
COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features →
add a LABA + ICS
is used first-line to prevent angina attacks
A beta-blocker or a calcium channel blocker
Newly diagnosed patient with hypertension who has a background of type 2 diabetes mellitus - add
an ACE inhibitor or an angiotensin receptor blocker regardless of age
Motor (6 points) Verbal (5 points) Eye opening (4 points). Can remember as ‘654…MoVE’
GCS
A sudden anemia and a low reticulocute count indicates parvovirus
sickle cell anaemia
It is important to remember that strokes can be caused by
hypercoagulable states and hyperviscosity
UTI in a pregnant woman in the third trimester - use
amoxicillin or cefalexin
is the recommended treatment for symptomatic UTI in pregnant women near term
Cefalexin
is the treatment of choice for some sexually transmitted infections such as Chlamydia in pregnant women
Azithromycin
postural hypotension may be seen in Parkinson’s disease the ataxic gait point towards a diagnosis of
multiple system atrophy
is associated with faecal-oral spread, commonly affecting shellfish and pork products. Blood results show elevated bilirubin and significant transaminitis.
Hepatitis E
Pneumocystis jiroveci penumonia is treated with
co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
are the investigation of choice in genital herpes
Nucleic acid amplification tests (NAAT)
Optic neuritis can be a feature of
multiple sclerosis
should first be investigated with a Holter monitor after initial bloods/ECG
Palpitations
should first be investigated with a Holter monitor after initial bloods/ECG
Palpitations
are best visualized by MRI of the cerebellopontine angle
Acoustic neuromas
Regular opioid medication can lead to
medication overuse headaches
In life-threatening Clostridium difficile infection treatment is with
ORAL vancomycin and IV metronidazole
are generally used first-line in the management of patients with warm autoimmune haemolytic anaemia
Steroids (+/- rituximab)
Lying/standing blood pressure is a very important investigation in the elderly who present with
falls
often presents with raised CK and leukocytosis
Neuroleptic malignant syndrome
accounts for the majority of lung cancer cases in non-smokers
Adenocarcinoma
is an X linked disorder affecting red cell enzymes.
Glucose-6-phosphate dehydrogenase deficiency
PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin
H. pylori eradication:
is associated with Takayasu’s arteritis
Renal artery stenosis
Patients with a suspected pulmonary embolism should be initially managed with a
direct oral anticoagulant (DOAC)
There is no need for prophylactic antibiotics for Lyme disease in
asymptomatic patients bitten by a tick
causes peripheral neuropathy
Isoniazid
are first-line in benign prostatic hyperplasia if the patient has troublesome symptoms
Alpha-1 antagonists
pseudopolyps seen on endoscopy
Ulcerative colitis
should be prescribed in all patients with suspected hepatic encephalopathy
Lactulose
Obese, young female with headaches / blurred vision think
idiopathic intracranial hypertension
painless bright red vaginal bleeding
Placenta praevia
Right upper quadrant tenderness and bilious fluid in the intra-abdominal drain would suggest
bile leak following the cholecystectomy
Patients with GORD being considered for fundoplication surgery require
oesophageal pH and manometry studies
disease is a cause of hypoglycaemia
Addison’s
A grossly elevated APTT may be caused by
heparin therapy, haemophilia or antiphospholipid syndrome
include flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
Stereotypical features of Legionella
Poorly controlled hypertension, already taking an ACE inhibitor - add
a calcium channel blocker or a thiazide-like diuretic
Guidelines continue to recommend the use of IM diclofenac in the acute management of
renal colic
Pneumonia caused by Streptococcus pneumoniae is associated with
cold sores
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity, medical treatment can be tried
(e.g. IUS, tranexamic acid, COCP etc)
is the persistent belief in the presence of an underlying serious disease, e.g. cancer
Illness anxiety disorder (hypochondriasis)
Isolated fever in well patient in first 24 hours following surgery?
Think physiological reaction to operation
should be stopped in AKI as may worsen renal function
Angiotensin II receptor antagonists
must be temporarily stopped when a macrolide antibiotic is started
Statins
Adult with asthma not controlled by a SABA -
add a low-dose ICS
This is a common cause of itch in the third trimester of pregnancy
intrahepatic cholestasis of pregnancy
a high ALP and GGT, with a lesser rise in ALT
cholestatic picture of liver function tests (LFTs)
are now the first-line test for acromegaly
Serum IGF-1 levels
is at risk with duodenal ulcers on the posterior wall
Gastroduodenal artery
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
should be offered to women with a previous baby with early- or late-onset GBS disease
Maternal intravenous antibiotic prophylaxis
can cause orange tears/urine
Rifampicin
congenital adrenal hyperplasia is most common cause in newborns
Ambiguous genetalia
most commonly affects neonates in the first 30 days of life and is most commonly bilious
Malrotation
Pregnant women who have a first degree relative with diabetes should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at
24-28 weeks
is a dislocation of the distal radioulnar joint with an associated fracture of the radius
A Galeazzi fracture
test is the most reliable test to confirm ovulation
Day 21 progesterone
Patients with raised ICP may exhibit Cushing’s triad:
widening pulse pressure
bradycardia
irregular breathing
To detect a subarachnoid haemorrhage the LP should be done at least
12 hours after the start of the headache
is used in non-falciparum malaria to destroy liver hypnozoites and prevent relapse
Primaquine
purpura classically presents with abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs
Henoch-Schonlein purpura
A young woman complains of feeling lonely. She has stopped seeing her old friends as she is worried about not being liked or criticised -
avoidant personality disorder
if both parents are carriers (heterozygote) there is a 25% chance of having an affected (homozygote) child
autosomal recessive conditions
Prolactin release is persistently inhibited by
dopamine
External rotation (on both active and passive movement) is classically impaired in
adhesive capsulitis
Small cell lung carcinoma secreting ACTH can cause
Cushing’s syndrome
Chest x-ray in transient tachypnoea of the newborn may show
hyperinflation and fluid in the horizontal fissure
is the most effective form of emergency contraception and is not affected by BMI
The copper intra-uterine device
The presence of proximal muscle weakness with dermatological signs should raise suspicion of
dermatomyositis
Careful speculum examination to look for pooling of amniotic fluid in the posterior vaginal vault is the first-line investigation for
preterm prelabour rupture of the membranes
is the most common metabolic complication in patients with cancer
Hypercalcaemia
maternal fever, tachycardia and neutrophilia (note that the normal range is elevated during pregnancy).
Chorioamnionitis
classically presents as visible haematuria following a recent URTI
IgA nephropathy
inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle
Furosemide
Bisphosphonates can cause a variety of
oesophageal problems
in infants use a two-thumb encircling technique for chest compression
Paediatric BLS
is associated with bilateral vestibular schwannomas
Neurofibromatosis type 2
Investigation for diabetes insipidus
water deprivation test
this is 7 days before the end of the lady’s regular cycle when progesterone levels should be tested.
Day 28
Haemoarthroses are a common feature of
haemophilia
can present several weeks after the initial head injury
Subdural haematomas
Urinary incontinence in a man with a history of gonorrhoea may be due to a
urinary stricture
is a risk factor for hyperemesis gravidarum
Multiple pregnancy
Lip smacking + post-ictal dysphasia are localising features of a
temporal lobe seizure
The most appropriate treatment of a patient with signs and symptoms consistent with _______________ is urgent, same day referral for assessment by an opthalmologist
anterior uveitis
once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery
Surgery / diabetes
In an infant, the appropriate places to check for a pulse are the brachial and femoral arteries
Paediatric BLS
are known to exacerbate plaque psoriasis
Beta-blockers
Ligamentous injuries of the knee joint are best confirmed through
magnetic resonance imaging (MRI)
Isoniazid inhibits the
P450 system
classically associated with a pansystolic murmur
Ventricular septal defect
is the investigation of choice for intussusception
Ultrasound
Pneumonia caused by Streptococcus pneumoniae is associated with
cold sores
A complication of epidural anesthesia is a
epidural haematoma
is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
Meckels diverticulum
Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training
is associated with a history of recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation
Borderline (emotionally unstable) personality disorder
is a contraindication for injectable progesterone contraceptives
Current breast cancer
is a key investigation for a suspected perforated peptic ulcer
An erect chest x-ray
are seen in SSRI discontinuation syndrome
Gastrointestinal side-effects such as diarrhoea
presents with the triad of sudden onset abdominal pain, ascites, and tender hepatomegaly
Budd-Chiari syndrome
Gottron’s papules, roughened red papules over the knuckles mainly, are seen in
dermatomyositis
direct oral anticoagulant (DOAC) should be offered first-line for reducing stroke risk in
atrial fibrillation (AF)
may also present with shoulder pain and upper limb neurological signs due to local extension of the tumour
As well as Horner’s syndrome, Pancoast tumours
Patients who have received an organ transplant are at risk of
skin cancer (particularly squamous cell carcinoma) due to long-term use of immunosuppressants
Liver transplantation criteria in paracetamol overdose
pH < 7.3 more than 24 hours after ingestion
The standard HbA1c target in type 2 diabetes mellitus is
48 mmol/mol
demonstrated by severe itching, jaundice, obstructive LFTs, normal WBC and no evidence of coagulopathy.
cholestasis of pregnancy
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity, medical treatment can be tried (e.g.
IUS, tranexamic acid, COCP etc)
is associated with ‘tear drop’ poikilocytes on blood film
Myelofibrosis
is a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction.
Cholesteatoma
are ANA positive, therefore it is a useful rule out test
Over 99% of patients with SLE
An itchy rash affecting the face and scalp distribution is commonly caused by
seborrhoeic dermatitis
if both parents are carriers (heterozygote) there is a 50% chance of having a carrier (heterozygote) child
For autosomal recessive conditions
may be diagnosed in patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others
Paranoid personality disorder
is the most common hereditary sensorimotor neuropathy
Charcot-Marie-Tooth Disease
is the most suitable management option for epistaxis where the bleed site is difficult to localise
Anterior packing
COPD symptoms in a young person - think
alpha-1 antitrypsin (A1AT) deficiency
is a complication of acute pancreatitis
Acute respiratory distress syndrome
Human bites, like animal bites, should be treated with
co-amoxiclav
typically involves loss of motor or sensory function. May be caused by stress
Conversion disorder
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
HRT: unopposed oestrogen increases risk of
endometrial cancer
hyperpigmentation of the palmar creases
Addison’s disease
is the imaging of choice in suspected renal colic
Non-contrast CT-KUB
should be continued during an acute attack in patients presenting with an acute flare of gout who are already established on treatment
Allopurinol
Pneumocystis jiroveci penumonia is treated with
co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
Newly diagnosed patient with hypertension (< 55 years) - add an
ACE inhibitor or an angiotensin receptor blocker
Gestational diabetes can be diagnosed by either a:
fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L
fibrinolysis should be offered within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes
STEMI management
is a safer opioid to use in patients with moderate to end-stage renal failure
Oxycodone
Behcet’s syndrome is associated with
erythema nodosum
should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.
Vesicovaginal fistulae
Use of the contraceptive pill should be ceased before an operation to prevent a
pulmonary embolism
Coeliac disease increases the risk of developing enteropathy-associated
T cell lymphoma
are recommended for superficial thrombophlebitis
Compression stockings
The main ECG abnormality seen with hypercalcaemia is
shortening of the QT interval
Diagnosis of a mesothelioma is made on histology, following a
thoracoscopy
is the investigation of choice for suspected aortic dissection (depending on stability of patient)
CT angiography
normally presents within 5-10 days post-operatively. The shortness of breath makes a diagnosis of
Venous thromboembolism
ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation
Budd–Chiari syndrome
X-ray changes of osteoarthritis (LOSS)
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts
Chickenpox exposure in pregnancy - first step is to
check antibodies
If 2 pills missed in week 3, finish the pills in the current pack and start new pack immediately, omitting pill-free interval
COCP
is used in patent ductus arteriosus to promote duct closure
Indomethacin or ibuprofen
neuroimaging findings: ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement
Normal pressure hydrocephalus
HBsAg negative, anti-HBs positive, IgG anti-HBc negative -
previous immunisation
A protein found on the surface of the hepatitis B virus and only positive in active infection.
HBsAg - hepatitis B surface antigen
hepatitis B surface antibody. Individuals produce anti-HBs following natural infection or vaccination. Therefore, positive anti-HBs indicates immunity but does not differentiate between previous infection or previous vaccination.
Anti-HBs (sometimes written HBsAb)
These are antibodies produced against the hepatitis B core antigen. The vaccine does not contain core antigen, only exposure to the hepatitis B virus gives positive anti-HBc. IgM antibodies indicate current infection (high titre indicates acute infection, low titre indicates chronic infection), while IgG antibodies indicate a previous infection.
Anti-HBc (HBcAb) - hepatitis B core antibody.
HBsAg positive
anti-HBs negative
IgG anti-HBc negative
IgM anti-HBc positive (high titre)
Acute infection:
HBsAg positive
anti-HBs negative
IgG anti-HBc negative
IgM anti-HBc positive (low titre)
Chronic infection:
HBsAg negative
anti-HBs positive
IgG anti-HBc positive
IgM anti-HBc negative
Immune due to natural infection:
HBsAg negative
anti-HBs negative
IgG anti-HBc negative
IgM anti-HBc negative
No immunity or infection:
is the most common inherited clotting disorder
Von Willebrand’s disease
should be used for children with pneumonia if mycoplasma is suspected
A macrolide e.g. erythromicin
is a risk factor for hyperemesis gravidarum
Multiple pregnancy
Elderly, alcoholic, head injury, insidiuous onset symptom -
subdural haematoma
Passage of meconium after 48 hours is a red flag
Hirschsprung’s disease
Red or black lump, oozes or bleeds, sun-exposed skin
Nodular melanoma
Endotracheal intubation may be necessary to protect the airway in
acute epiglottitis
Trophoblastic disease is a risk factor for
hyperemesis gravidarum
An effective treatment for borderline personality disorder is
dialectical behaviour therapy (DBT)
Any person on anticoagulants with a head injury must receive a
CT head within 8 hours
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years
Premature ovarian insufficiency
Membranous nephropathy is frequently associated with
malignancy
should be used as the first-line treatment in opioid detoxification
Methadone or buprenorphine
ulcers usually occur around the medial malleolus (gaiter region)
Venous
are first-line treatment for prolactinomas, even if there are significant neurological complications
Dopamine agonists (e.g. cabergoline, bromocriptine)
slapped-cheek syndrome, also known as erythema infectiosum.
parvovirus b19
Dysphagia, aspiration pneumonia, halitosis → ?
pharyngeal pouch
syndrome produces pain on passive stretch
Compartment
A common endocrine complication of small cell lung cancer is
SIADH
As well as xanthochromia, CSF findings consistent with subarachnoid haemorrhage include a
normal or raised opening pressure
Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?
osteomalacia
Benzylpenicillin is the antibiotic of choice for ________prophylaxis
GBS
Patients are at increased risk of bladder, colon, and rectal cancer following radiotherapy for
prostate cancer
Bilious vomiting on the first day is likely due to
intestinal atresia
Bilateral idiopathic adrenal hyperplasia is the most common cause of
primary hyperaldosteronism
Unstable angina or NSTEMI?
Elevation in troponin points towards NSTEMI
if the patient is conscious and able to swallow the first-line treatment is a fast-acting carbohydrate by mouth i.e.. glucose liquids, tablets or gels
Hypoglycaemia treatment
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller → ?
dengue
Corticosteroids may cause
proximal myopathy
If a hernia cannot be reduced it is referred to as
an incarcerated hernia
The low-dose (overnight) dexamethasone suppression test is the best test to diagnosis
Cushing’s syndrome
Use of the contraceptive pill should be ceased before an operation to prevent a
pulmonary embolism
Haemolytic uraemic syndrome - classically caused by
E coli 0157:H7
is a common cause of bacterial otitis media
Haemophilus influenzae
should be considered if a bradycardia doesn’t respond to drugs or transcutaneous pacing
Transvenous pacing
is elevated in biliary atresia
Conjugated bilirubin
Neutrophil predominant leucocytosis is present in 80–90% of people with
appendicitis
can cause AKI due to acute tubular necrosis
Rhabdomyolysis
raises the possibility of Ramsey-Hunt syndrome but this is actually quite common in Bell’s palsy
The pain around the ear
T2DM with abnormal LFTs - ?
non-alcoholic fatty liver disease
Confusion, ataxia, nystagmus + ophthalmoplegia are features of
Wernicke’s encephalopathy
is an important side effect of amiodarone
Thyroid dysfunction
A child aged 6-11 years should be administered adrenaline at a dose of 300 micrograms (0.3ml), repeated every 5 minutes if necessary
Anaphylaxis
The AST/ALT ratio in alcoholic hepatitis is
2:1
extend beyond the limits of the incision.
Keloid scars
if the fasting plasma glucose is < 7 mmol/l a trial of diet and exercise should be offered for 1-2 weeks
Gestational diabetes
hydrocortisone + fludrocortisone
Addison’s disease management
can cause fluid retention and is therefore contraindicated in patients with heart failure.
Pioglitazone
A tension pneumothorax should not be investigated if suspected but should be immediately
decompressed with a needle
is the mainstay for acute PR bleeds if patient is haemodynamically stable
Supportive management
Rapid correction of hyponatraemia can cause
osmotic demyelination syndrome
Trichomonas vaginalis + bacterial vaginosis are associated with a pH
> 4.5
are first line for lower back pain
NSAIDS
acute treatment: subcutaneous sumatriptan + 100% O2
Cluster headache
is a risk factor for developing adhesive capsulitis
Diabetes mellitus
may present with upper quadrant abdo pain
Lower lobe pneumonia
is a restrictive lung condition. Therefore spirometry results will commonly show a normal or slightly reduced FEV1 and a reduced FVC
Pneumoconiosis
Carbamazepine is a P450 enzyme
inductor
The standard target time for thrombectomy in acute ischaemic stroke is
6 hours
Multiple painful genital ulcers, sexually active -
genital herpes
acute alcohol intake is not associated with an increased risk of developing hepatotoxicity and may actually be protective
Paracetamol overdose
The main ECG abnormality seen with hypercalcaemia is
shortening of the QT interval
Complications of thyroid surgery - damage to parathyroid glands can result in
hypocalcaemia
Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil =
Horner’s
is a highly specific test for SLE
Anti-dsDNA
stroke causes leg weakness but not face weakness or speech impairment
Anterior cerebral artery
rule out thyroid disease
Anxiety
is recommend for patients with an acute ischaemic stroke who present within 4.5 hours
A combination of thrombolysis AND thrombectomy
Trichomonas vaginalis + bacterial vaginosis are associated with a pH
> 4.5
The sudden fall in haemoglobin without an appropriate reticulocytosis is typical of an
aplastic crisis, usually secondary to parvovirus infection
Organophosphate insecticide
atropine
helps to distinguish pseudogout from gout
Chondrocalcinosis
In life-threatening Clostridium difficile infection treatment is with
ORAL vancomycin and IV metronidazole
In women at risk of neural tube defects, folic acid should be started
before conception
Investigating suspected PE: if the CTPA is negative then consider a
proximal leg vein ultrasound scan if DVT is suspected
symptoms suggests idiopathic Parkinson’s
Asymmetrical
Dominant hemisphere middle cerebral artery strokes cause
aphasia
is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects
Metoclopramide
is a good first line anti-emetic for intracranial causes of nausea and vomiting
Cyclizine
is used for long-term prophylaxis of cluster headaches
Verapamil
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
Combined oral contraceptive pill
toxicity - avoid beta-blockers
Cocaine
levels can indicate an upper GI bleed versus lower GI bleed
High urea
cancer may present with cholestatic LFTs
Pancreatic
Tracheal deviation, resonant to percussion and absent breath sounds in the context of respiratory distress and shock - think a
tension pneumothorax
Hormonal contraception can be started immediately after using levonorgestrel (Levonelle) for
emergency contraception
fever, jaundice and right upper quadrant pain
Charcot’s cholangitis triad:
Gastrointestinal side-effects such as diarrhoea and bloating are a common side effect with
metformin
Otoacoustic emission test is used to screen newborns for
hearing problems
is a risk factor for developmental dysplasia of the hip
Breech presentation
Fever on alternating days, think
malaria
although surgery is definitive management, patients must be medically managed before surgery using alpha blocker then beta blocker
Phaeochromocytoma
in breastfeeding must be avoided
Lithium
can present with sweating, tremor, confusion and hyperreflexia
Serotonin syndrome
is the screening test for adult polycystic kidney disease
Ultrasound
Activated protein C resistance (Factor V Leiden) is the most common inherited
thrombophilia
HNPCC/Lynch syndrome is a strong risk factor for
endometrial cancer
A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination -
ventricular septal defect
HOCM may present with
exertional dyspnoea
Pernicious anaemia predisposes to
gastric carcinoma
Diabetes treated with SGLT-2 inhibitors are at particular risk of
necrotising fasciitis
The most common causes of arrest in children are
respiratory
malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure
Osteosarcoma
The short synacthen test is the best test to diagnose
Addison’s disease
classically presents with abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs
Henoch-Schonlein purpura
is characterised by a sandpaper rash
Scarlet fever
presents with flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
Hepatitis A
is a common complication in subarachnoid haemorrhages
Hyponatraemia
it can develop up to 4 weeks after precipitating infection and can run a relapsing-remitting course over several months
Reactive arthritis
are associated with a significant increase in mortality in dementia patients
Antipsychotics
may cause precipitation of digoxin toxicity
Thiazides
are the investigations of choice in primary sclerosing cholangitis
ERCP/MRCP
is a cause of autoimmune haemolytic anaemia
SLE
Poorly controlled hypertension, already taking an ACE inhibitor and a thiazide diuretic -
add a calcium channel blocker
expectant management is not suitable if evidence of infection or increased risk of haemorrhage
Miscarriage
Agranulocytosis/neutropenia is a life-threatening side effect of
clozapine - monitor FBC
Visual loss, eye pain and red desaturation are all classical symptoms of
Optic neuritis
is the most common cause of stridor in infants.
Laryngomalacia
A prostaglandin analogue should be used first-line in patients with a history of asthma.
glaucoma
increases the risk of lactic acidosis - suspend during intercurrent illness eg. diarrhoea and vomiting
Metformin
infection can cause rose spots on the abdomen
Salmonella typhi
can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics
Tardive kinesia
Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training
are first-line in benign prostatic hyperplasia if the patient has troublesome symptoms
Alpha-1 antagonists
Consider fibromuscular dysplasia in young female patients who develop AKI after the initiation of an
ACE inhibitor
1st line of treatment for blepharitis is
hot compresses
Ferritin and transferrin saturation are used to monitor treatment in
haemochromatosis
High-resolution CT scanning is the diagnostic investigation of choice for
pancreatic cancer
can be used within an hour of an aspirin overdose
Activated charcoal
The first-line investigation of a testicular mass is an
ultrasound
Non-contrast CT head scan is the first line radiological investigation for
suspected stroke
Sudden death, unusual collapse in young person - ?
HOCM
Coal workers’ pneumoconiosis typically causes
upper zone fibrosis
Prophylactic IV antibiotics are given prior to
appendicectomy
Complete heart block following a MI? -
right coronary artery lesion
is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic
Erythromycin
demonstrated by jaundice, mild pyrexia, hepatitic LFTs, raised WBC, coagulopathy and steatosis on imaging.
acute fatty liver of pregnancy
is a common complication in subarachnoid haemorrhages
Hyponatraemia
Juxta-articular osteoporosis/osteopenia is an early x-ray feature of
rheumatoid arthritis
Patients with a suspected pulmonary embolism should be initially managed with a
direct oral anticoagulant (DOAC)
Patients with tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive
up to 3 synchronised DC shocks
Hypertension in diabetics - ACE inhibitors/A2RBs are first-line regardless of
age
The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and
an absent corneal reflex
Hypothermia, hyporeflexia, bradycardia and seizures, think
myxoedemic coma
An elective laparoscopic cholecystectomy is the treatment of choice for
biliary colic
presents with the 6 P’s: pale, pulseless, pain, paralysis, paraesthesia, perishingly cold
Acute limb-threatening ischaemia
DPP-4 inhibitors increase levels of incretins such as GLP-1 and GIP
Sitagliptin
in elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation in a patient with chest wall trauma
Consider cardiac tamponade
side effects of antipsychotics include dysglycaemia, dyslipidaemia, and diabetes mellitus
Metabolic
release serotonin, so will cause a raised urinary 5-HIAA
Carcinoid tumours
Disproportionate microcytic anaemia - think
beta-thalassaemia trait
is a good first line anti-emetic for intracranial causes of nausea and vomiting
Cyclizine
- radioactive iodine is the treatment of choice
Toxic multinodular goitre
increases the risk of developing enteropathy-associated T cell lymphoma
Coeliac disease
is associated with erythema multiforme
Mycoplasma
in diabetics - ACE inhibitors/A2RBs are first-line regardless of age
Hypertension
Scrotal swelling you can’t get above:
inguinal hernia
is the only test recommended for H. pylori post-eradication therapy
Urea breath test
The presence of pain distinguishes scleritis from
episcleritis
Liver transplantation criteria in paracetamol overdose
pH < 7.3 more than 24 hours after ingestion
is the investigation of choice for suspected aortic dissection (depending on stability of patient)
CT angiography
are the commonest extra-renal manifestation of ADPKD
Liver cysts
must be taken within 72 hours of UPSI
Levonorgestrel
Patients with intracranial bleeds, who become unresponsive should receive an urgent CT scan to check for
hydrocephalus
has a longer half-life than amylase when investigating suspected acute pancreatitis and may be useful for late presentations > 24 hours
Serum lipase
absolutely contraindicated in women over 35 smoking 15 cigarettes or more a day
combined hormonal contraception
More than 90% of colorectal cancers are
adenocarcinomas
- carbamazepine is first-line
Trigeminal neuralgia
Somatisation = Symptoms hypoChondria = Cancer
Unexplained symptoms
accelerations present, variability >5bpm, no decelerations, HR 110-160
Normal CTG
In patients with non-alcoholic fatty liver disease, enhanced liver fibrosis (ELF) testing is recommended to aid diagnosis of
liver fibrosis
In a young woman taking COCP, cervical ectropions are a common finding in the context of
post-coital bleeding
An isolated rise in bilirubin in response to physiological stress is typical of
Gilbert’s syndrome
is a risk factor for embolic acute limb ischaemia
Atrial fibrillation
are associated with drug-induced lupus
Antihistone antibodies
ECT is indicated in life-threatening major depressive disorder, where
catatonia in present
You cannot interpret TTG level in coeliac disease without looking at the
IgA level
are first-line in patients with benign prostatic hyperplasia
Alpha-1 antagonists
Myelodysplasia may progress to
acute myeloid leukaemia
tumours are the most common cause of brain metastases
Lung primary
In Cushing’s disease, cortisol is not suppressed by low-dose dexamethasone but is suppressed by
high-dose dexamethasone
needs to be excluded in all adults presenting with painless jaundice.
Pancreatic cancer
Lambert-Eaton syndrome or myasthenia gravis?
Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise
should be used to treat acute gout if NSAIDs are contraindicated for example a peptic ulcer.
Colchicine
Most common clinical sign in a PE
tachypnoea (96%)
A total hysterectomy with bilateral salpingo-oophorectomy, in addition, is advisable for all postmenopausal women with
atypical endometrial hyperplasia, due to the risk of malignant progression
is far the most likely cause of primary post-partum haemorrhage.
An atonic uterus
For an SVT, the Resus Council recommend escalating adenosine doses of
6mg → 12mg → 18 mg
are ANA positive, therefore it is a useful rule out test
Over 99% of patients with SLE
Target saturations in COPD are
94-98% if CO2 is normal on ABG
An asymmetrical presentation suggests psoriatic arthritis rather than
rheumatoid
Aspirin is a common cause of
urticaria
Patients with focal seizures may experience
post-ictal weakness (Todd’s paresis)
intrauterine system (Mirena) is first-line
Menorrhagia
Moderate-severe aortic stenosis is a contraindication to
ACE-i
CSF lymphocytosis combined with a glucose greater than half the serum level points towards a
viral meningitis
Migraine
acute:
triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
Normal laboratory findings in pregnancy:
Reduced urea, reduced creatinine, increased urinary protein loss
