Passmedicine gap deck Flashcards
How soon after sex should levonorgestrel be taken
72 hours post UPSI
- single dose of levonorgestrel 1.5mg
when should dose of levonorgestrel be doubled
BMI >26 or weight over 70kg
dose should also be doubled if taking enzyme-inducing drugs (although a copper IUD as emergency contraception is preferable in this situation)
when should levornogestrel be repeated
if vomiting occurs within 3 hours then the dose should be repeated
can you take levonorgestrel multiple times in a menstrual cycle
yes
can you start hormonal contraception post levornogestrel
hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception
MOA ellaOne
selective progesterone receptor modulator
The primary mode of action is thought to be inhibition of ovulation
time frame post UPSI of EllaOne
120 hours
Ella One and other contraception
Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
caution of ellaone
severe asthma
can you use ellaone multiple times in the same cycle
yes
when should you insert IUD copper
must be inserted within 5 days of UPSI, or
if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date
breastfeeding and ellaone
breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel
MOA IUD
may inhibit fertilisation or implantation
what is somatisation disorder
This condition involves multiple physical symptoms that have been present for at least two years, and the patient refuses to accept reassurance or negative test results. The chronic nature of her symptoms (abdominal pain, headaches, joint pain) and the fact that extensive investigations have returned normal results align well with somatisation disorder. Given the chronicity and multiplicity of her unexplained physical symptoms, along with significant distress and impact on functioning, somatisation disorder is the most appropriate diagnosis.
2WW for oesophageal and stomach cancer
All patients who’ve got dysphagia
All patients who’ve got an upper abdominal mass consistent with stomach cancer
Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia
non urgent upper GI referral
Patients with haematemesis
Patients aged >= 55 years who’ve got:
treatment-resistant dyspepsia or
upper abdominal pain with low haemoglobin levels or
raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain
managing patients who do not meet referral criteria
- Review medications for possible causes of dyspepsia
- Lifestyle advice
- Trial of full-dose proton pump inhibitor for one month OR a ‘test and treat’ approach for H. pylori
if symptoms persist after either of the above approaches then the alternative approach should be tried
testing for h.pylori and test of cure
initial diagnosis: NICE recommend using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology ‘where its performance has been locally validated’
test of cure:
there is no need to check for H. pylori eradication if symptoms have resolved following test and treat
however, if repeat testing is required then a carbon-13 urea breath test should be used
scarlet fever is caused by
Group A haemolytic streptococci (usually Streptococcus pyogenes)
presentation and incubation of scarlet fever
Scarlet fever is spread via the respiratory route by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing).
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash
fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
it is often described as having a rough ‘sandpaper’ texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes
diagnosis of scarlet fever and mx
a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results
oral penicillin V for 10 days
patients who have a penicillin allergy should be given azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease
scarlet fever complications
otitis media: the most common complication
rheumatic fever: typically occurs 20 days after infection
acute glomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
mx of patient on anticoag w/ TIA sx
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging to exclude a haemorrhage
mx of TIA
patients with TIA or minor ischaemic stroke should be given antiplatelet therapy provided there is neither a contraindication nor a high risk of bleeding
for patients within 24 hours of onset of TIA or minor ischaemic stroke and with a low risk of bleeding, the following DAPT regimes should be considered:
clopidogrel (initial dose 300 mg followed by 75 mg od) + aspirin (initial dose 300 mg followed by 75 mg od for 21 days) followed by monotherapy with clopidogrel 75 mg od
ticagrelor + clopidogrel is an alternative
if not appropriate for DAPT:
clopidogrel 300 mg loading dose followed by 75 mg od should be given
proton pump inhibitor therapy should be considered for DAPT
triptan contraindications
patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease
undescended testis management
Unilateral undescended testis
referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
mx of prostatitis
ciprofloxacin
Management of NSTEMI
fondaparinux should be offered to patients who are not at a high risk of bleeding and who are not having angiography immediately
if immediate angiography is planned or a patients creatinine is > 265 µmol/L then unfractionated heparin should be given
what does the GRACE score take into consideration
age
heart rate, blood pressure
cardiac (Killip class) and renal function (serum creatinine)
cardiac arrest on presentation
ECG findings
troponin levels
Which patients with NSTEMI/unstable angina should have coronary angiography (with follow-on PCI if necessary)?
immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3% i.e. those at intermediate, high or highest risk
coronary angiography should also be considered for patients if ischaemia is subsequently experienced after admission
Percutaneous coronary intervention for patients with NSTEMI/unstable angina
unfractionated heparin should be given regardless of whether the patient has had fondaparinux or not
further antiplatelet (‘dual antiplatelet therapy’, i.e. aspirin + another drug) prior to PCI
if the patient is not taking an oral anticoagulant: prasugrel or ticagrelor
if taking an oral anticoagulant: clopidogrel
A 74-year-old man with symptomatic aortic stenosis is reviewed in the cardiology clinic. He is otherwise fit and well and keen for intervention if possible. What type of intervention is he most likely to be offered?
Bioprosthetic aortic valve replacement. This patient with symptomatic aortic stenosis who is fit for surgery would most likely be offered a bioprosthetic aortic valve replacement. According to UK guidelines, this intervention is recommended for patients aged >65 years or younger patients not wishing to take lifelong anticoagulation. Bioprosthetic valves have the advantage of not requiring long-term anticoagulation, unlike mechanical valves, and are generally preferred in older patients due to their better hemodynamic properties and lower risk of thromboembolic complications.
when do you need to refer molloscum to specialties
Molluscum contagiosum with eyelid or ocular involvement and red eye requires urgent ophthalmology review
what can cause myasthenic crisis
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
is azathioprine safe in pregnancy
yes
what to do if on clopidogrel 75mg post stroke and want to change
clopidogrel 75 mg daily should be the standard antithrombotic treatment;
aspirin 75 mg daily should be used for those who are unable to tolerate clopidogrel;
port wine stains
Port wine stains are vascular birthmarks that tend to be unilateral. They are deep red or purple in colour. Unlike other vascular birthmarks such as salmon patches and strawberry haemangiomas, they do not spontaneously resolve, and in fact often darken and become raised over time. Treatment is with cosmetic camouflage or laser therapy (multiple sessions are required).
what causes hand foot and mouth disease
coxsackie or enterovirus
first line for delirium in agitated palliative patients
oral haloperidol
pregnancy and antiepileptics
aim for monotherapy
there is no indication to monitor antiepileptic drug levels
sodium valproate: associated with neural tube defects - DO NOT USE IN PREGNANCY
carbamazepine: often considered the least teratogenic of the older antiepileptics
phenytoin: associated with cleft palate
lamotrigine: studies to date suggest the rate of congenital malformations may be low.
The dose of lamotrigine may need to be increased in pregnancy
breast feeding and antiepileptics
Breast feeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates
It is advised that pregnant women taking phenytoin are given vitamin K in the last month of pregnancy to prevent clotting disorders in the newborn
mx of CURB 65 patients
0: low risk (less than 1% mortality risk)
NICE recommend that treatment at home should be considered (alongside clinical judgement)
1 or 2: intermediate risk (1-10% mortality risk)
NICE recommend that ‘ hospital assessment should be considered (particularly for people with a score of 2)’
3 or 4: high risk (more than 10% mortality risk)
NICE recommend urgent admission to hospital
mx of CAP
Management of low-severity community acquired pneumonia
amoxicillin is first-line
if penicillin allergic then use a macrolide or tetracycline
NICE now recommend a 5 day course of antibiotics for patients with low severity community acquired pneumonia
Management of moderate and high-severity community acquired pneumonia
dual antibiotic therapy is recommended with amoxicillin and a macrolide
a 7-10 day course is recommended
NICE recommend considering a beta-lactamase stable penicillin such as co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia
things that hinder discharge with a CAP
NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings:
temperature higher than 37.5°C
respiratory rate 24 breaths per minute or more
heart rate over 100 beats per minute
systolic blood pressure 90 mmHg or less
oxygen saturation under 90% on room air
abnormal mental status
inability to eat without assistance.
They also recommend delaying discharge if the temperature is higher than 37.5°C.
when should you have a CXR post pneumonia
CXR @ 6 weeks
when can a child crawl
9 months old
which diabetic meds can cause cholestasis
gliclazide
murmur and signs in aortic regurg
early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
criteria for USS for DDH
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
what type of fever in bronchiolitis
low grade
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
mx of keloid scar
The most appropriate management for this patient with a keloid scar is to refer for intralesional triamcinolone. Intralesional corticosteroids, such as triamcinolone, are the first-line treatment for keloids according to UK guidelines. They work by reducing inflammation, collagen synthesis, and fibroblast proliferation, ultimately leading to a reduction in the size and appearance of the keloid. Multiple injections may be required at 4-6 week intervals.
COCP UKMEC 3
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
COCP UKMEC 4
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
how long does finasteride treatment of BPH take to be effective
may take 6 months before results are seen
what is spider naevi associated with
liver disease
pregnancy
combined oral contraceptive pill
COCP MOA
Inhibits ovulation
Progestogen-only pill (excluding desogestrel) MOA
Thickens cervical mucus
Desogestrel-only pill MOA
Primary: Inhibits ovulation
Also: thickens cervical mucus
Injectable contraceptive (medroxyprogesterone acetate) MOA
Primary: Inhibits ovulation
Also: thickens cervical mucus
Implantable contraceptive (etonogestrel) MOA
Primary: Inhibits ovulation
Also: thickens cervical mucus
Intrauterine contraceptive device MOA
Decreases sperm motility and survival
Intrauterine system (levonorgestrel)
Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
methods of emergency contraception and mechanism of action
Levonorgestrel Inhibits ovulation
Ulipristal Inhibits ovulation
Intrauterine contraceptive device Primary: Toxic to sperm and ovum
Also: Inhibits implantation
T1DM HbA1C targets
In type 1 diabetics, a general HbA1c target of 48 mmol/mol (6.5%) should be used
holmes adie pupil facts
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light
association of Holmes-Adie pupil with absent ankle/knee reflexes
meningitis in neonatal to 3 months
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes
meningitis bacteria in 1 month to 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
meningitis in >6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
eczema herpeticum
caused by superimposed herpes simplex 1
management of prophylaxis of oesophageal bleeding
propanolol (NSBB)
blood test deranged in APS
prolonged APTT and low platelets
s.aureus incubation time
short - severe vomiting, no diarrhoea
management of small fibroadenomas that have no concerning features
<3cm on imaging –> first line is watchful waiting without biopsy
when do you give oral abx in acute COPD
if there is purulent sputum / signs of pneumonia
glaucoma ocular pressure
normal IOP –> normal tension glaucoma
mumps school avoidance guidelines
kept off school for 5 days from the onset of the swollen glands
red flags paeds
child <3 months with a fever >38 –> ED
RR > 60
moderate or severe chest indrawing
chickenpox exposure in pregnancy:
antivirals or VZIG (if available) should be given at 7-14 days post exposure if not immediately
maintatining remission in crohns
azathioprine / mercatopurine
section 4
GPs can use section 4 of MHA (alongside an AMHP or NR) to transfer a patietn for an emergency psychiatric assessment
APKD screening
USS abdo
alcohol withdrawal
symptoms 6-12 hours
seizures 36 hours
DT 72 hours
most common cause of cushings syndrome
pituitary adenoma
most common headache in children
migrainesi
what to do if starting SGLT-2 as initial therapy for T2DM
ensure metformin is uptitrated first
most common cardiac defect downs
AVSD
APER vs high anterior resection
APER removes anal canal –> therefore if there is anal verge involvement need an APER > resection
Latent TB management
3 months of isoniazid (with pyridoxine) and rifampicin OR
6 months of isoniazid with pyridoxine
inducing remission for UC that extends past the left side
oral aminosalicylate and rectal
opthamia neonatorum
infection of the newborn eye
chlamydia and neisseria
refer for same day assessment
children with squint
refer to opthalmology
bow legs in child <3
normal variant and usually resolves by the age of 4
what will the kidney be like in diabetic nephrologist
bilaterally enlarged kidneys
most common cause of orbital cellulitis in children
ethmoidal cellulitis
decreasing vision over months with metamorphosia and central scotoma
wet age related macular
lyme disease rash
eyrthema migrans
is hyperacusis seen in bells palsy
yes
what wosense plaque psoriasis
beta blockers
dermatophyte nail infection
oral terbinafine
live attenuated vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
difference between MCUG and DMSA
MCUG for reflux
when can women have pertussis vaciner
16-32 weeksw
hearing test in school entry
pure tone audiometry
lfts testing statin
lfts at baseline, 3, 12 months
pagets disease of bone presents with
bowing of legs
managed with nbisphosohonates
what should you avoid in HOCM
ramipril
children under the age of five with enuresis
reassurance and advice
A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face
rubella
A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted
Rubella
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
Lacunar stroke
unilateral motor disturbance affecting the face, arm or leg or all 3.
complete one sided sensory loss.
ataxia hemiparesis.
management of PBC
ursodeoxychlocic acid
what precipitates gout
furosemide
patients having cocaine induced MI should be given what as part of acute management
diazepam
actinic keratosis management
topical fluoracil
is digoxin monitored
no
monitoring of haemochromatosis
ferritin and transferrin saturation
diclofenac and cardiovascular disease
CI
most common site affected in UC
rectum
BV tx alternative to metronidazole
topical clindamycin
when in thrombolysis indicated
if a stroke is confirmed occlusive proximal
most common symptoms of posterior circulation stroke
dizziness
If a patient with AF has a stroke or TIA, the anticoagulant choice…
he anticoagulant of choice should be warfarin or a direct thrombin or factor Xa inhibitor
which PD meds causes hallucinations
ropinirole
calcium level in rhabdomyolysis
calcium is usually low
medical cardioversion if evidence of structural heart disease
amiodarone
what do you need to monitor when on magnesium sulfate
monitor reflexes and respiratory rate
what can ramipril do to BNP
cause it to be low
RAST test
Determines the amount of IgE that reacts specifically with suspected or known allergens, for example IgE to egg protein. Results are given in grades from 0 (negative) to 6 (strongly positive)
Useful for food allergies, inhaled allergens (e.g. Pollen) and wasp/bee venom
Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines
review of sertraline
<25 - review in 1 week
>25 - review in 2 weeks time
difference betwween polymorphic eruption of pregnancy and pemphigoid
Polymorphic eruption of pregnancy is not associated with blistering
what is GABA
inhibitory neurotransmitter
benzos increase GAB A
treatment of chronic rhinosinusitis
nasal irrigation with saline solution
PCV
there is overproduction of platelets, neutrophils and Hb
what to avoid in BPH
amitriptyline –> risk of urinary retention
level of PSA post prostastectomy
should be less than 0.2 = undetectable
what should you avoid with SSRIs
patients prescribed warfarin
radial tunnel syndrome
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
management of labial adhesions if recurrent UTIs
oestrogen cream
when do you take progesterone levels in women
7 days before next expected period
what to do if you pick up a simple ovarian cyst on the scan
repeat USS in 12 weeks time
rhesus negative women when do you give first dose of anti D
28 weeks
FAST questionnaire
4 item questionnaire
minimum score = 0, maximum score = 16
the score for hazardous drinking is 3 or more
with relation to the first question 1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits
if the answer to the first question is ‘never’ then the patient is not misusing alcohol
if the response to the first question is ‘Weekly’ or ‘Daily or almost daily’ then the patient is a hazardous, harmful or dependent drinker. Over 50% of people will be classified using just this one question
skin manifestations of tuberous sclerosis
adenoma sebaceum
severity of COPD scores
is blepharitis associated with acne rosacea
yes
when is meningitis B vaccine given
2 months, 4 months, 12-13 months
what causes angular chelitis in anorexia
zinc deficiency
does gliclazide cause weight gain/loss
causes weight gain - This occurs due to increased insulin levels leading to increased glucose uptake and storage as glycogen or fat.
difference between PVD, RD, vitreous haemorrhage
PVD: Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
RD: Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
VH: Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
MMR vaccine contraindication
allergy to neomycin
gap between most recent live attenuated virus and MMR vaccine
4 weeks
what does newborn blood spot screening test for
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
isoniazid side effects
b6 deficiency causing peripheral neuropathy
which antimalarial is taken weekly
mefloquin
doxycycline s/e
photosensitivity
webers syndrome
Weber’s syndrome is a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
investigations for sarcoidosis
serum ACE, sputum culture and CXR
what investigation do you do pre-herceptin
echo as it is cardiotoxic
which conditions do not require school exclusion
Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
scarlet fever exclusion
24 hours after commencing antibiotics
Whooping cough exclusion
2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
measles school exclusion
4 days from rash onset
rubella school exclusion
5 days rash onset
chickenpox school exclusion
all lesions crusted over
mumps exclusion
5 days from onset of swollen glands
impetigo exclusion
until lesions are crusted and healed / 48 hours post commencement of abx treatment
scabies exclusion
until treated
infleunza excluion
until recovered
blurring of vision years post cataract suregry
posterior cataract opacificationc
caput succadenum vs cephalohaematoma
caput secadaneum is scalp oedema that crosses suture lines
cephalohaematoma does not cross suture lines
post MI SSRI choice
setraline
hypolcaemia and cataracts
hypocalcaemia is a risk factor for cataracts
suspected laryngeal cancer guidelines
A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
persistent unexplained hoarseness or
An unexplained lump in the neck.
ENT referral ear ache
Unexplained, unilateral ear ache for more than 4 weeks with unremarkable otoscopy should be referred under the 2 week wait
difference between labrynthitis and vestibular neuronitis
there is hearing loss with labrynthitis
constipation in IBS what drug
ispaghula husk
migraine anti sickness
metoclopramide
somatisation disorder
multiple physical symptoms for at least 2 years, patient refuses to accept reassurance or negative test results
triptans and SSRIs
increase risk of serotonin syndrome
FIT testing programme
Faecal immunochemical tests (FIT) are used to screen for colorectal cancer. Screening kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland. If the results of these are abnormal then the patient is offered a colonoscopy.
PSA timings
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
TIA rules driving
can start driving if symptom free after 1 month - no need to inform the DVLA
CFS - how long should you have symptoms for
3 months
difference between erysipelas and nec fasc
erysipelas only affects the upper dermis
VZV babies look lije
scarring of the skin, limb hypoplasia, microcephaly and eye defect
rubella in babies symptons
congenital cataracts, sensorineural deafness and pulmonary artery stenosisr
rules for acei
he BNF recommends the angiotensin-converting enzyme inhibitors should only be stopped if the creatinine increases by 30% or eGFR falls by 25% or greater.
AKI stages
osgood schlatter disease
This condition is a common cause of knee pain in growing adolescents, typically aged between 10 and 15 years old. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). The symptoms usually include pain and swelling over the tibial tubercle, which can be exacerbated by physical activity such as hockey. The condition tends to resolve itself with time, once the child has stopped growing.
painful diabetic neuropathy tx
duloxetine
first line otitis externa management
topical corticosteroid and aminoglycoside
keratoderma blennorhagica
seen in reactive arthritis
management of invaive diarrhoea (causes bloody diarrhoea and fever)
ciprofloxacin
what medication can cause TEN and other complications that it can cause and mx
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
can cause AKI on bloods
mx: IVIG / supportive care
which contraception types are not affected by enzyme inducing drugs
copper IUD
progesterone injection
mirena
incubation period of b.cereus
6-15 hours
varenciclone drug class
nicotinic receptor partial agonist
what is the best measurement to assess for response to treatment for hashimotos
TSH
mechanism of action of bupropion
norepinephrine and dopamine reuptake inhibitor and nitotinic antagonist
side effects of colchicine
diarrhoea
what is a risk factor for respiratory distress syndrome
maternal diabetes mellitus
tamsulosin side effects
dizziness and postural Hypotension
when do you avoid amitriptyline. what can you use alternatively
if there is BPH –> can cause urinary retention
pregablin
patients on allopurinol already
they should take it at the same dose during acute episodes, but new patients should not be started on allupurinol until an acute attack has settled
what are traditional POPs and the rules with these
micronor
noriday
nogeston
femulen
if less than 3 hours late no action required, continue as normal
if more than 3 hours late
take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
what criteria in salicylate overdose –> haemodialysis
pulmonary oedema and metabolic acidosis
what is used in managing tremor in drug induced parkinsonism
procyclidine
focal seizure drug management
lamotrigine / levetiracetam
generalised TC seizures management
males: sodium valproate
females: lamotrigine or levetiracetam
girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children or women who are unable to have children may be offered sodium valproate first-line
absence seizures management
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
myoclonic seizures management
males: sodium valproate
females: levetiracetam
tonic or atonic seizures management
males: sodium valproate
females: lamotrigine
primary open angle glaucoma visual loss
unilateral peripheral visual loss
patient who has an extensive stroke with right sided hemiplegia what side will the homonymous hemianopia be
right sided
femeroacetabular impingement
caused by anterior groin pain
one of the most common causes of persistent hip pain in active young adults
pain worse on prolonged sitting and assocaited with snapping, clicking or locking of the hip
management of menieres
referaral to ENT
when can children combine two words by
2 years old
parkland fluid resuscitation formula
Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
50% given in first 8 hours
50% given in next 16 hours
ensure it is crystalloid only = hartmanns/ringers lactate
management of first episode genital herpes during third trimester
managed with daily suppressive oral aciclovir 400mg until delviery
C/S
how to remember where brocas and wenickes areas are
Spoken word is heard at the ear. This passes to Wernicke’s area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca’s area. The Broca’s area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).
what would you see on bloods in hyposplenis m
target cells and howell jolly bodies
management of otitis externa depending of severity
Mild - mild cases (mild discomfort and/or pruritus; no deafness or discharge), consider prescribing topical acetic acid 2% spray.
More severe - 7 days of a topical abx with or without topical steroid
degenerative cervical myelopathy symptoms
Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
Often they are incorrectly diagnosed with carpal tunnel syndrome
itching in scabies
can persist for 4 weeks post infection
haemolytic uraemic syndrome treatment
supportive measurement
when is downs syndrome screening done
11-13+6 weeks
measles symptoms
koplik spots, macpap rash behind the ears and conjunctivitis
causes of cranial diabetes insipidus
idiopathic
post head injury
pituitary surgery
craniopharyngiomas
infiltrative
histiocytosis X
sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
haemochromatosis
causes of nephrogenic DI
genetic:
more common form affects the vasopression (ADH) receptor
less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes
hypercalcaemia
hypokalaemia
lithium
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis
invesigations for diabetes insipidus
high plasma osmolality, low urine osmolality
a urine osmolality of >700 mOsm/kg excludes diabetes insipidus
water deprivation test
management of diabetes insipidus
nephrogenic diabetes insipidus
thiazides
low salt/protein diet
central diabetes insipidus can be treated with desmopressin
trinucloetide repeat disorders
Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy
shaken baby syndrome type of haemorrhage
subdural
dental abscess abx
amoxicillin
what precipitates dupuytrens
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
azathioprine adverse affects
bone marrow depression - consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer
shadow in red reflect
cataract
sildenafill side effects
headaches
positive straight leg test means
sciatic nerve irritation
what to do next in endometriosis if analgesia doesnt work
COCP and progesterone
how long can nexplanon stay in situ
3 years
tetanus rules with exposure
if a patient had 5 doses of tetanus with the last dose <10 years ago they do not require a booster vaccine nor immunoglobulins
what to avoid NSAIDs with
warfarin
first line for trigeminal neuralgia
carbamazepine
difference between VWD and haemophilia A
haemophilia A APTT is a lot more prolonged
PET management
Delivery should not be offered to women before 34 weeks unless:
severe hypertension remains refractory to treatment
maternal or fetal indications develop as specified in the consultant plan
At 34 weeks delivery should be offered to women with pre-eclampsia once a course of corticosteroids has been completed.
transient tachypnoea of the newborn
there are no CXR changes
management of chickenpox in pregancy
You should ask pregnant women exposed to chickenpox if they have had the infection before. If they say no or are unsure, varicella antibodies should be checked. If it is confirmed they are not immune, varicella immunoglobulin should be considered. It can be given at any point in pregnancy and is effective up to 10 days after exposure.
what should you investigate prior to anti-tuberculous therapy
LFTs
what is a risk of combining sodium valrpoate and lamotrigine
steven johnsons syndrome
what causes xanthelasma
hypercholesterolaemia
when would you do a renal biopsy in minimal change disease
if the response to steroids is poor
CI to the pneumococcal vaccine
current febrile illness
MMR vaccination if missed
give MMR with repeat dose in 3 months
glue ear
Also known as otitis media with effusion
peaks at 2 years of age
hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
secondary problems such as speech and language delay, behavioural or balance problems may also be seen
antifreeze antidote
fomepizole
what to do after a 5 year period on bisphosphonates
After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true:
Age >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score <-2.5 after treatment
If any of the high risk criteria apply, treatment should be continued indefinitely, or until the criteria no longer apply. If they are in the low risk group however, treatment may be discontinued and re-assessed after two years, or if a further fracture occurs.
what to do if the person does not have any of the high risk criteria
The best option would therefore be to re-scan her now, and consider a two year break if her T score is >-2.5
what is used to prevent migraine
propanolon
what is used to prevent cluster headaches
verapamil
retinitis pifmentosa
night blindness and tunnel vision
first line seborrhoeic dermatitis
topical ketoconazole
what is seborrhoeic dermatitis associated with
HIV and PD
COCP cancer risks
increased risk of breast and cervical. protective against ovarian and endometrial
thiazides side effect
hypercalcaemia
high risk factor for PET in pregnancy
hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension
moderate risk factors for PET
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy
who should take aspirin 75-150mg daily from 12 weeks gestation until birth
1 or more high risk factor
2 or more moderate risk factors
Wells score for DVT
if 2 or more you would do a leg USS
side effects of TB drugs
Ethabutol - eye
isoniazid - i cant feel my feet
pyrazinamide - uric acid
rimpicins - P450 inducer
red/orange
criteria of anti-D
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
management of impetigo
hydrogen peroxide, fusidic acid
extensive -oral fluclox
transient tachypnoea of the newborn vs RDS on CXR
hyperinflation and fluid in the horizontal fissure
ground glass
iodine uptake findings
graves disease - increased homogenous uptake
subacute thyroiditis - faint diffuse uptake
no uptake - subacute thyroiditis
single hot nodule with the rest of the gland suppressed - toxic adenoma
raised AFP and BHCG
non seminomatous testicular cancer
as a raised AFP excludes a seminoma
kallmans syndrome bloods
LH and FSH low - normal but testosterone is low
what are the causes of scarring alopecia
lichen planus
what are causes of non scarring alopecia
trauma/burns, radiotherapy, lichen planus, discoid lupus, tine acpaitis
what size fibroadenoma would you excise
you would surgically excise if >3cm
what is the most common ocular manifestation of rhuematoid arthritis
keratoconjunctivitis sicca
optic neuritis
central scotoma
RAPD
decreased colour vision and pain on momevement
croup age group
6 months - 3 years old
types of conjunctivitis
herpes simplex - there will be cold sores or fluorescein uptake showing dendritic ulcers
bacteiral conjunctivitis - purulent discharge
adenoviral - this is the most common infectious type
L3 nerve root compression symptoms
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression symptoms
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression symptoms
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression symptoms
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Management of prolapsed disc
similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises
NICE recommend using the same drugs as for back pain without sciatica symptoms i.e. first-line is NSAIDs +/- proton pump inhibitors rather than using neuropathic analgesia (e.g. duloxetine)
if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
organophosphate poisoning symptoms
DUMBELS
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.
management of glue ear
children should be observed for 6-12 weeks as symptoms are self-limiting and referral should be reserved if sx persist beyond this point
However, referral should be earlier if:
Symptoms are significantly affecting hearing, development or education
Immediate referral in children with Downs syndrome or cleft palate
causes of mydriasis
third nerve palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital
first line in priapism in a child
cavernosal blood gas
when should you refer for infertility
early referral
Female Male
Age above 35 Previous surgery on genitalia
Amenorrhoea Previous STI
Previous pelvic surgery Varicocele
Previous STI Significant systemic illness
Abnormal genital examination Abnormal genital examination
PHQ-9 interpretation
‘less severe’ depression: encompasses what was previously termed subthreshold and mild depression
a PHQ-9 score of < 16
‘more severe’ depression: encompasses what was previously termed moderate and severe depression
a PHQ-9 score of ≥ 16
what is internuclear opthalmoplegia
Internuclear ophthalmoplegia (INO) occurs due to a lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement.
first rank sx of schizophrenia
auditory hallucinations
thought disorders
passivity phenomena
delusional perceptions
when can you get gestational HTN
> 20 weeks
what are the bloods like in beta thalassaemia trait
there is a mild hypochromic microcytic anaemia
and the HBA2 is raised
what happens if you are outside the window of the oral rotavirus vaccine
it should not be given after 15 weeks
