past paper learnings Flashcards
haemolytic uraemic syndrome
- rf
- presentation
- tx
kids
exposure to farm animals
- AKI
- normocytic anaemia - microangiopathic haemolytic anaemia
- thrombocytopenia
often diarrhea (inc bloody)
abdo pain
fever
vom
supportive tx
glandular fever (infectious mononucleoisis)
- pathogen (normally)
- tx
- what happens when treated with amoxicillin
EBV
rest, avoid contact sports/ alcohol
rash! widespread, itchy, maculopapular, pruritic rash
allergic reaction vs anaphylaxis
anaphylaxis is like whole body stuff, like shock
immunisation schedule
- 8w/ 2m
- 12w/ 3m
- 16w/ 4m
- 1y
- 3y4m
- 12-13y
- 14y
- extra one?
8w = 6 in 1 (DTaP, IPV, Hib, Hep B), Men B, Rotavirus.
- 12w = 6 in 1 (DTaP, IPV, Hib, Hep B), PCV, Rotavirus.
- 16w = 6 in 1 (DTaP, IPV, Hib, Hep B), Men B.
- 1y = Hib/Men C, PCV, MMR, Men B.
- 3y 4m = ‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio), MMR.
- 12-13y = HPV.
- 14y = 3 in 1 (Tetanus, diphtheria, polio). Men ACWY.
Influenza vaccine is also offered to all children of primary school age and those in Y7. It is also
offered from 6m to those at high risk.
6 in 1
4 in 1
3 in 1
whats in them and when are they
6 in 1
diptheria, tetanus, polio, Hib, hepB, whooping cough, polio
2m, 3m, 4m,
4 in 1
tetanus, diptheria, whooping, polio
3y4m
3 in 1
tetanus, diptheria, polio
12-13y
congential adrenal hyperplasia
- what is it
- features
- presents when
too little cortisol and aldosterone
so less K excreted and less sodium reabsorbed
hyperkalemia
hyponatraemia
metabolic acidosis
when older - early puberty for boys, and under/unusally developed genetalia for girls
often 1-3w old
Roseola Infantum
- cause
- symptoms
- tx
HHV-6 (human herpes) (or7)
fever (sometimes febrile convulsions)
THEN
maculopapular rash
“Nagayama” spots on uvula/ roof of mouth
supportive
where does chemo not go
CNS (brain blood barrier)
testes
what does penicillamine do
chelates copper in wilsons disease
patient demographic way to distinguish haemophilia a/b and von willebrand disease
haemophilia a/b is x linked recessive so only boys
willebrand = woman too
both bleeding disorders
haemophilia a
- defiency of what
haemophilia b
- deficiency of what
A- clotting factor VIII
B = clotting factor IX
investigation to diagnose
- hodgkin lymphoma
- Leukaemia
- hodgkin lymphoma - PET scan
- Leukaemia - blood film
lymphomas: common when
- hodg and non hodg
what are the b symptoms
other symptoms
hodg- teenagers
non hodg - children
unexplained weight loss
unexplained fever
drenching sweats - esp at night
fatigue
prurits
enlarged lymph nodes
developmental dysplasia of hip risk factors
breech
heavy baby
oligohydraminos
prematurity
female
duodenal atresia x ray sign
double bubble
assoc with downs
ankastic personality disorder
personality with set rules and ideals that the person believes everyone should
follow
cheese effect
- with what drug - egs
- results in what
MAOi - phenlezine, Isocarboxazid, selegiline, tranylcypromine
HTN
acute tx in bipolar
- manic episode
- depressive episode
long term managmenet
atypical antipsychotic
SSRI+ atypical - fluoxetine and olanzapine
lithium (if no work - valporate)
lithium tremor
lithium in range - fine tremor
lithium toxicity - coarse tremor
lithium toxicity
sx
tx
normally 1.5 and above:
coarse tremor
ataxia
slurred speech
vomitting
seizure
polyuria
hyperreflexia
fluids
alcohol detox drugs
Chlordiazepoxide (a benzo)
thiamine
delerium tremens tx
IV Pabrinex (vit b..) and high dose Benzodiazepine
serotonin syndrome sx
triad of neuromuscular excitability, autonomic dysfunction (hypo or hypertension), and
altered mental state
neuromuscular excitation
- hyperreflexia
- myoclonus
- rigidity
autonomic nervous system excitation
- hyperthermia
- sweating
- flushed skin
- BP change/ HR change
altered mental state
- confusion
- agitation
neuroleptic malignant syndrome
a change in mental state,
rigidity, (causes raised creatinine kinase)
fever, (raised wbc)
autonomic dysfunction
metabolic acidosis
odd U/E + LFTs
fibroid degeneration
- when
- sx
- tx
pregnancy - it grows with the oestreogen, then degenerates when blood supply isnt enough
“red degeneration”
pain
vomitting
fever
conservative
PID like symptoms following recent coil insertion. you leave in and treat with broad-spectrum abx. when would you take the coil out though?
72h no improvement
UTI meds in pregnancy
trimeth - bad for 1st trim
nitro - bad for 3rd trim
cephalosporin fine throughout
fibroids
- 1st line
- other meds
- other options
mirena coil
COCP (not near surgery though)
mefanamic acid
transexamic acid
oral / injectable progesterone
surgery - take GnRH agonists before to shrink + reduce chance of bleed
- myomectomy
- endometrial ablation
- uterine artery embolisation
- hysterectomy
bHCG
- normal
- ectopic
- miscarriage
- downs
over 48h:
- normal : doubles
- ectopic : rises but not doubles
- miscarriage : falls
- Downs: raised
chlamidya tx
Doxycycline 100mg PO BD for 7 days
riluzole for?
ALS (MND) - prolongs life by few months
bacterial meningitis most common cause
- neonates
- children
neonates: group b strep
children: haem inf, neis men, strep pnuem.
what is given to close contacts of bacterial meningitis
what is given to patitent
Oral ciprofloxacin
IV cefotaxime
foot drop nerve
L5
postural hypotension criteria
systolic drop >20mmHg when going from sitting/lying to standing. Patient should be lying or sitting still for 5 minutes and then their baseline measured. Get them to stand and measure their BP at 1 minute and 3 minutes. If there is a drop >20mmHg at either 1 min or 3 mins then they have postural (orthostatic) hypotension.
pericarditis first line
NSAIDs
what reverses heparin (e.g active bleed starts)
too much warfarin?
reverse DOAC?
protamine
vit K
Beriplex
rehydration after DKA
1. alert, no vom
2. unconc, vom
- PO fluids + SC insulin (0.1units/kg/hr)
- IV fluids (0.9% NaCl 10ml/kg) + SC insulin (0.1units/kg/hr)
over 48h to prevent cerebral oedema
DKA blood results
- creatine
- na
- k
- glucose
- pH
- ketones
- bicarb
- creatine = mildly raised (dehydration)
- na = normal/ mildly raised (dehydration)
- k = high (acidosis, low insulin)
- glucose = high
- pH = acidosis
- ketones = high
- bicarb = low (used up by bicarb)
JIA tx
- monoarticular
- polyarticular
- screening
- monoarticular: steroid injections
- polyarticular : methotrexate (steroid injections in interim)
- screen eyes for anterior uvieits every 3m
JIA is assoc with what disease
JIA effect on puberty?
anterior uveitis
can be delayed
stephen johnson syndrome
- causes
- features
- tx
medication
- Allopurinol
- Lamotrigine
- Penicillin
- Phenytoin
viral
- mumps
- flu
- HSV
- EBV
- flu-like symptoms
- followed by a red/purple target-like rash that spreads and forms blisters. The affected skin eventually dies and peels off.
- The mucous membranes of the mouth, throat, eyes and genital tract may also become blistered and ulcerated
fluids
analgesia
opthalmology
treat 2’ infections
CSF
- what makes it turbid
- what affects glucose
- what affects protein
what is the appearance of
- bacterial meningitis
- viral meningitis
- encephalitis
- TB meningitis
turbid - wbc/ rbc (bacterial)
glucose - low = bacterial/ fungal
protein - raised = bacterial
Bacterial meningitis - turbid appearance, raised polymorphs, raised protein, low glucose
Viral meningitis/ encephalitis - clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose
TB meningiti- turbid/clear appearance, raised lymphocytes, raised protein, low glucose
wilms tumour
- when
- features
5-10y
abdominal mass and painless haematuria.
what are these are
Procyclidine
Protamine sulphate
Pyridostigmine
tertrabenazine
Procyclidine - dystonia
Protamine sulphate - heparin reversal
Pyridostigmine - MG
tertrabenazine - tardive dyskinesia
opiate overdose
- symptoms
- tx
- rhinorhea - watery nose/ eyes
- drowsy
- needle tracks
- methadone
- Buprenorphine
Clomipramine
- class
- good for
TCA
OCD
- used after at least one SSRI
clozapine monitoring
- what for
- when
- WBC (neutropaenia and agranulocytosis)
- 1 blood test / week for 18w, then fortnightly until 1y, then monthly (if all fine, otherwise may stay more highly monitored)
factor v leiden
- increase or decrease in clotting
increase
how small is too small to manage a suspected miscarriage (rather than expectant)
<7mm
repeat US in 7days
although most are managed by waiting to see if miscarries spontaneously. only after 7-14d would you consider medical/surgical mx
source of vaginal cancer mostly =
metastatic / 2’ from the cervix or endometrium.
next step of asymptomatic suspected UTI in preg screening
repeat culture (may be contaminated) and treat with sensitive abx from culture
definition of oligo and polyhydraminos
oligo - <5cm
poly >24cm
what is the most important treatable cause of recurrent miscarriage
And so what to look out for
antiphospholipid syndrome
which is assoc with SLE - joint pain, (nail fold capillaries)
small cell carcinoma of lung can secrete what?
ADH/ ACTH
so can cause cushings/ SIADH
AKI stages
- in terms of creatinine compared to baseline
- in terms of urine output
1: 1-1.9x
2: 2-2.9x
3: 3+x
urine output <0.5ml/h for
1: 6h
2: 12h
3: 24h // anuria for 12+h
CKD stages
Stage 1: > 90 mL/min/ 1.73m
Stage 2: 60-89 mL/min/ 1.73m
Stage 3A: 45-59 mL/min/ 1.73m
Stage 3B: 30-44 mL/min/ 1.73m
Stage 4: 15-29 mL/min/ 1.73m
Stage 5/ESRF: <15mL/min/ 1.73m
COPD treatment
also: what are these
bromide -
salbutamol -
beclamethsone -
Tiotropium -
salmeterol-
work out if steroid- responsive:
- steroid responsive = FEV1 variation, atopic asthmatic features
- non-steroid responsive = no FEV1 variation, no atopic/ asthmatic features
steroid responsive:
● Step 1: SABA or SAMA
● Step 2: SABA + LABA + ICS (if they were originally on SAMA, discontinue and start SABA)
● Step 3: SABA + LABA + ICS + LAMA
non-steroid responsive:
● Step 1: SABA or SAMA
● Step 2: SABA + LABA + LAMA (if they were originally on SAMA, discontinue and start SABA)
bromide - SAMA
salbutamol - SABA
beclamethsone - ICS
Tiotropium - LAMA
salmeterol - LABA
nephrotic syndrome
- triad
- features
- cause
proteinuria
oedema
hypoalbuminaemia
swelling- facial, eyes, ankles, groin
2-5y
hyperlipidaemia (increase in cholesterol)
hypercoagulable (decrease in antithrombin)
prone to infection (decrease in immunoglob)
hypovolemia (due to oedema)
hypocalcaemia (loss of vit D)
mostly minimal change glopmerulonephritis
(can also be secondary to allergens, henloch-shein purpura, infections and SLE)
henloch shein purpura
- cause
- features
- tx
cause= valsculitis of small vessels
rash
- trunk spared!
- buttocks, limbs- extensor
- symetrical
- uritcarial –> mac pap + purpuric, palpable
- may have localised oedema
joint pain
abdo pain
ig nepropathy - haematuria, renal failure
treatment = supportive + treat joint pain. maybe steroids/ Immuunosup
mostly self-limiting
monitor BP and urine re kidneys
ranitidine is a what
H2 receptor antagonost
antacid - reduce acid production and stomach content volume
omeprazole is a what
proton pump inhibitor
what is a D2 receptor antagonist +e.g.
enhances gastric emptying
- e.g. domperidone
Antiemetic/ anti reflux
is someone is resistant to treatment for GORD, what is the surgery called
Nissed fundoplication
tonsilitis medication (if FeverpAIN is high enough)
Phenoxymethylpenicillin
(NB: if tonsilitis is caused by glandular fever, amoxicillin causes widespread rash)
port wine stain
strawberry stain
port wine - present from birth - naevus flammeus
strawberry - develops after birth <1m - cavernous haemangioma
- milia
- mongolian blue spots
- erythema toxicum
- milia - white spots on nose/ cheeks
- mongolian blue spots - lower back /bum (look like bruises)
- erythema toxicum - (neonatal urticaria) is a common rash appearing at 2-3 days of age, consisting of white pinpoint papules at the §centre of an erythematous base, concentrated on the trunk
immune thrombocytopenia tx
prednisolone to increase platelet numbers
but normally self-resolves so no tx needed
splenectomy for life-threatening bleeds
advice to avoid contact sports/ bleeding triggers
otitis media tx
amoxicillin 5d
(clarith if allergic)
— if under 2 and bilateral – otherwise, watch and wait
B1
B2
B9
B12
(vitamins)
B1 - thiamine
B2 - riboflavin
B9 - folate
B12 - Cobalamin
when to use methadone vs naloxone
also naltrexone? benzos?
methadone (+ naltrexone) - opioid dependance
naloxone - opioid toxicity / OD
benzos also used?
activated charcoal
use for poisoning / paracetemol overdose as reduces absorption - but need to get it in quick
cocaine withdrawal
Symptoms
first 24 h - most intense
- increased hunger
- fatigue
- anxiety
- irritable
- reduced motivation
next 10 weeks - above but less intense
next 6 months - milder above but - low mood
fetal hydrops = ?
causes
Fetal hydrops is the abnormal accumulation of serous fluid in 2+ fetal compartments
due to fetal anaemia
immune
- rhesus incompat
non immune
● Severe anaemia – congenital parvovirus B19 infection, alpha thalassaemia major (not beta), massive materno-feto haemorrhage
● Cardiac abnormalities
● Chromosomal – Trisomy 13, 18, 21, or Turners
● Infection – toxoplasmosis, rubella, CMV, varicella
● Twin- Twin transfusion syndrome (in the recipient twin)
● Chorioangioma
uterine leiomyoma =?
are they tender on palpation?
fibroid silly!
nontender (unlike adenomyosis, endometriosis
most common cause of childhood squint
tx
hypermetropia (long-sighted –> excessive accomodation)
treated q successfully with convex lenses
ADHD
1st and 2nd line
1st - Methylphenidate
2nd - Lisdexamfetamine
3rd - Dexamfetamine (if benefited from lisdexam .. but could not tolerate it)
age of asthma/ viral induced wheeze / bronchitis
asthma = 4/5y +
viral induced wheeze = 2- 4/5y
bronchiolitis= <1y
viral induced wheeze tx
1) SABA - nebulised salbutamol
2) LTRA, (ICS)
what should be monitored in lithium
TFTs
U/E
eGFR
lithium can cause hypo and hyperthyroidism, hyperPTH (calcium), kidney issues ..
Haematocolpos = ?
accumulation of blood like cos of imperforate hymen
what do bat wing opacities represent?
alveolar oedema
what does AUDIT score do
assesses alcohol abuse
when are triptans a no no
SSRI
coronary artery disease
status epilepticus tx in hospital
IV benzo. eg IV lorazepam
- can repeat dose if ineffective after 10-20mins
- if not in hosp - PR diazepam or buccal midazolam
ongoing–> phenytoin
still ongoing –> general anaesthetic
normal pressure hydrocephalus symtpoms
gait
incontinence
dementia
hyperthyroidism tx
symptoms – propanolol
disease course – carbimazole
ulcerative collitis
- flare up
- remission
hydrocortisone
messalazine
prednisolone
acromegaly inv
OGTT
(not growth hormone as it is pulsatile)
Atrial fib vs atrial flut
rhythym
AF = irregularly irreg
flut = regularly irreg
effects and mode of action of
-acomprosate
- disulferide
- naltrexone
acomprosate - alleviates cravings - enhances GABA
disulferide - makes feel ill after alcohol - build up of acetaldeyde
naltrexone - reduces pleasure of drinking - opiate antagonist
what s/e of mitrazapine can be used to advantage
sedation (insomnia) - take at night
weight gain (low appetite / weight loss)
(SNRI)
ECT absolute and relative contraindications
absolute
- raised ICP
relative
- pregnancy
- cerebral tumour
- cerebral aneurysm
- phreatochroma
- recent MI /stroke
- active bleeding
- liver disease
- retinal detachment
ECT s/e
Short-term side-effects
- headache
- nausea
- short term memory impairment
- memory loss of events prior to ECT
- cardiac arrhythmia
Long-term side-effects
- some patients report impaired memory
first line delerium tx (pharmacological ) inc dose and route
haloperidol 0.5 mg PO / IM
(lorazepam can be used too, but not first line, can be added)
prem ROM –> what Abx
erythromycin PO
unless fever/ previous group B strep –> benzylpenicillin
genital warts features
itch
no pain
bleed
discharge - pH
BV and TV has pH >4.5
all else <4.5 - acidic
cauda equina tx
high dose dexamethason (decompresses)
consider surgical decompression (above in the meantime)
consider inv into cancer as a cause
how to take bisphosphonate (alendronic acid)
sat/ stood upright for 30 mins
empty stomach (eg 30 mins before breakfast)
alcoholic liver disease LFTs
↑AST +↑ALT with an AST/ALT ratio of 2:1
- ↑AST +↑ALT with an AST/ALT ratio of 2:1
- ↑AST +↑ALT with an AST/ALT ratio of 1:2
- isolated ↑ALT
- predominate ↑ALT
- isolated ↑Bilirubin
- alcohlic liver disease
- viral hepatitis or possibly non-alcoholic fatty liver diseasey in alcoholic patients
- breakdown of bone e.g bony metastases
- cholestatic
- gillberts
indapamide =?
thiazide like diuretic
febrile seizure - normal vs concerning
- length
- further seizure
- type
up to 15 min fine, longer = concerning.
further seizure within 24 h = concerning
further seizures more than 5min = concerning
tonic clonic fine, focial = concerning
idiopathic ICP tx
Acetazolamide to reduce eye pressure
then shunts etc later
65y+ and on long term steroids …. they should start a ?
alendronic acid = bisphosphonate (regardless of DEXA)
rhabdomyolysis features
dark brown urine following long lie (eg fell and wasnt found)
meningitis + mengicocal rash = what organism?
neiseria meningitis = causative organism
ebstein anomaly
- cause
-effect
lithium
low tricuspid valve insertion
impetigo tx
- hydrogen peroxide 1% cream
- topical fusidic acid
- oral flucoxacillin (eryth if allergic)
initial LOC with clinical improvement then sudden
deterioration
extradural
