Past papers Flashcards
Difference between ABPA and EAA
ABPA- IgE, BE on CXR
EAA- IgG, mild fever, bad when in place where exposed
Tx of serotonin syndrome
Benzos
Severe- cyproheptadine or chlorpromazine
Late signs of mesenteric ischaemia
High lactate, acidosis and
peritonism develop at a late stage when there is established bowel wall necrosis
When is a hernia likely to be strangulated
If it is very tender
No bowel motions
Initial ix of SCD
Blood film
Blood supply to legs and buttock
Internal- buttock
External leg
So if claudication in both- stenosis in common iliac
If low fibrinogen, WBC, RBC, plt what is dx
DIC from PML RARA
15:17
If calf pain on exertion, pulse not findable what is the mx
Exercise programme since on claudication
Tx of GBS
IVIG
25 yo with long standing cough, haemoptysis with rings on CXR
CF- not cancer since unlikely under 40
Sx of vesicular reflux
Extensive renal scarring can cause renal insufficiency,
end-stage renal disease, renin-mediated hypertension
Renal USS showed dilated calyces and
cortical thinning bilaterally
Increased tone, hypertensive, tachycardia and dilated pupils dx
Serotonin toxicity
TCA OD sx and tx
Long QRS
Dilated pupils
Arrythmias and seizures
Sodium bicarbonate
BB OD sx
BB have poor CNS penetration and causes bradycardia and hypotension; it would not
cause CNS depression
Common arrhythmia after CBAG
AF
Sx of candiasis on men
Diabetic
Balanitis
Itchy white discharge
Levels of diabetic retinopathy
Background (mild NPDR)- 1 or more micro aneurysm
Mod- cotton wool, haemorrhages, hard exudate
Severe- (pre proliferative)- blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
Proliferative- new vessels on disc or elsewhere
CURB65 meaning and management
AMTS <8
Urea >7
R >30
B <90/60
>65
0/1- can discharge
2- can admit to ward
>3- HDU/ICU
Large vs SBO on presentation
Small- early vomitting
Large- if recurrent- think volvulus, early gross abdominal distention
Pain tx for sickle cell crisis
Fluids
IV morphine
Exchange transfusion if not working
When to use each type of test for significance in study
T test - normal distribution
Paired- if part of same group- i.e same group before and after treatment
Unpaired- comparing different groups
Mann–Whitney U-test- not normal distribution
Cohort study vs case control study
Case control- start with outcome- i.e disease and look back at factors
Cohort- prospective and retrospective
Start with exposure and either follow over time (pros) or look to see if developed disease (retro)
Specificity and sensitivity formula
Spec= TN/ without disease so TN/TN+FP
Sens= TP/with disease so TP/TP+FN
NPV and PPV formula
NPV= TN/TN+FN
PPV= TP/TP+FP
Determine accuracy of test to get it right/wrong
Takes into account prevalence
Ingested foreign body Ix
Lateral soft tissue X ray
Pseudomonas tx
Cipro or gent
Monitoring GBS respiratory function
FVC
Hoarsness and laryngeal involvement ix
Larygoscope
Toxoplasmosis on MRI
usually single or multiple ring-enhancing lesions, mass effect may be seen
Conductive hearing loss and haematuria
GPA
Tx of trigeminal neuralgia
Carbamazepine
When to refer for breast cancer
aged 30 and over and have an unexplained breast lump with or without pain or
aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
Carpal tunnel Ix
EMG
Tx of rhabdo
Fluids
NSTEMI treatment algorithm
Aspirin on admission
GRACE score- If >3%
CA within 72 hours with possible PCI
ONLY give fondaparinux if not immediate PCI
<3% give ticagrelor
Tx of aortic stenosis
Only replace valve if
>40mmHg pressure
or symptamatic- SAD
If old or cormobid- TAVI
Younger- replace
Ventricular aneurysm vs free wall rupture vs papillary rupture sx post MI
HF symptoms, persistent ST elevation- Aneurysm
Muffled HS, hypotensive- free wall rupture
Early mitral regurg on auscultation- papillary rupture
When each type of bacteria causes IE
IVDU- staph
After valve replacement- staph epidermis
Other dentist- strep viridian’s
Which drugs inhibit CYP450
Increase drugs
Acute alcohol
Allopurinol
Azole
Ciprofloxacin
Disulifram
Erythromycin
Valproate
3rd line drugs for HF
Ivabradine
Hydralazine- Black afro
sacubitril-valsartan- ACE washout period
When to give ICD or resync therapy for HF
ICD- <35%, max meds, good QoL
Resync- Wide QRS
NYHA classification for HF
1- no sx
2- mild on physical- ordinary physical cause SOB
3- mod on physical no on rest- not normal things cause SOB
4- severe- even at rest
What antihypertensive should you not give to poorly controlled DM
Thiazides- reduce glucose tolerance
When to give drugs in ALS
VF/pVT- adrenaline and amiodarone- 3
Adrenaline- non shockable
NSTEMI vs inferior MI
NSTEMI- St depression and T wave inversion
Inf- ST depression in anterior leads, Tall R waves
What precipitates digoxin toxicity
Hypokalaemia
Amiodarone
Tx of SVT in asthmatics
Verapamil
How MI can present in DM an elderly
Silent
Sweating
SoB
Tx of orthostatic hypotension
Fludrocortisone
Tx algorithm of CVA
<4.5 hour- thrombolysis - then 24hrs later- aspirin for 2weeks
If over- 300mg aspirin for 2 weeks
After if AF anticoagulant if CHAD, or clopidogrel 75mg
Scorings for strokes
ROSIER- if stroke or mimic
NIHSS- severity
Barthel- ADLs
Tx of MG, GBS and MS
MG- pyridostigmine, prednisilone- if crisis IVIG
GBS- IVIG
MS- methylprednisolone IM
What drugs precipitate MG
Antibiotics- gent and macrolides
BB
Lithium
Phenytoin
Difference in sx between lesions in cerebellum
Vermis- gait ataxia
Hemi- peripheral
Sagittal vs cavernous thrombosis
Sagittal- peri orbital swelling, proptosis
Cavernous- CN palsies- V1,2 3, 4,6
Feeding in stroke/ MND
PEG
Can try NG first- but if long term disability with unsafe swallow- PEG
Driving restrictions in neuro conditions
First seizure- 6 months
TIA- 1 month
Epilepsy- can drive if seizure free for 1 year
Cant drive if meds withdrawn for 6 months
Pupil up and out and problems looking downstairs
4th CN palsy
SE of phenytoin
Peripheral neuropathy
Hypertrophic gums
Enaemia aplastic
No calcium- hypo
Isolated raised protein in LP
GBS
PE treatment algorithm
Well score
If >4- CTPA - longer than 4 hours- AC
IF CTPA neg- doppler if indicated
<4- D dimer - “
If D dimer neg- alternative
If +- CTPA
Effusion Ix and tx
Lights- 0.5 protein, 0.6 LDH, or LDH 2/3 ULN
(PE is exudative_
If turbid or pH <7.2 chest drain
COPD antibiotic therapy
Prophylaxis- azithromycin- >3 exacerbations in year- use if sputum purulent - ECG
If IE- amox, doxy or clarithro
Asthmatic features of COPD
Eosinophillia
Previous diagnosis of asthma or atopy
Diurnal variation of PEF
Variation in FEV over time
Step down of asthma
Reduce steroid by 25-50%
Insertion of needles or drains into chest
Lower border between ribs
SO for chest drain- just above 6th
Aspiration- just above 3rd
Referral for lung cancer
Haemoptysis >40 - unlikely if below 40
Chest X ray demonstrating
Silicosis X ray
Egg shell calcification of hilar
Upper lobe fibrosis
Dx of mycoplasma vs legionella
Myco- serology
Legionella- urinary antigen
Treatment order of RhA
2 DMARDs then biologics
Sulphalazine, hydroxycarbamide, meth
DAS >5.1 adding
<2.6 reducing
Tx of SLE, sjorgrens, diffuse scleroderma
SLE- maintain with hydroxycarbamide, pred and cyclo for fairs, ACEi for renal
If preg- azathiptine or HC
Sjogrens- HC
Scleroderma- ACEi for renal
When to give bisphosphoantes
start bisphosphonates if:
1) aged >75 y/o and fracture, a DEXA scan may not be required
2) <75 y/o than do DEXA first, <-2.5 = bisphosphonates
3) high-risk FRAX
Pagets
If patient on steroids:
2) aged > 65 no need DEXA
2) aged <65 do DEXA first
- if T score less than 1.5 -> give alendronate
- If T score more than 1.5 ->repeat scan 1-3 yearly
What supplements should be give with BP
Vit D and calcium- only calcium if diet inadequate
Must correct these before BP
APLS sx ix and tx
Livedo reticularis- Lacey
VTE
Miscarriage
Anticardiolipin, Lupus anticoagulant
Tx- low dose aspirin no VTE
warfarin- VTE
Fever, pink rash, hypotensive, arthralgia tx
Stills
NSAIDs 1weeks- then steroids
RhA pre op check
Lateral and AP neck X ray
Tx of OA
Paracetamol
Topical NSAIDs- hands and knees
Then Oral NSAIDs with PPI or Weak opioid
RF of pseudo gout
Acromegaly
Hyperparathyroid
Haemachromatosis
Hypothyroid
Wilsosn
Symptoms of AS
Anterior uveitis
Aortic regurg
Apical fibrosis
Achilles tendonitis
Squaring
Supraspinatous calc
Syndesmophytes
Sx and cause of avascular necrosis
Asymp then pain
In long bones- femur
Chemo
Steroids
Adhesive capsulitis vs subacromial bursitis vs rotator cuff tear
Adhesive- >40, DM, no trauma, limited external rotation
SB- impingement- painful arc at 60-120- no weakness, activity
Tear- pain <60- weakness- associated with activity, trauma/sporting
Septic arthritis blood and aspirate
50% have negative gram stain
So if high WCC and signs- treat with IV ABx
WBC 10,000/mm3 and may be as high as 100,000/mm3. Neutrophil levels are >90%
SLE bloods
Low plt
Low FBC
Low WCC
Low complement
Female
Roots vs peripheral neuropathy signs of upper limbs
If peripheral- sensation will be located to hand only
If root- will be forearm
Radial head fracture
FOOSH
Impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination
Herniated disc Sx
Pain unilaterally
Sudden pain in back
Straight leg raise +- sciatic nerve- L4- S3
UC remission tx
Rectal AS
Then in 4 weeks and no remission and oral then steroids
If had severe or >2 in a year- mercaptopurinol or azathioprine
SBP dx and tx
Neuts >250
Tx- tazoscin
Prophylaxis- propanolol and cipro
Spiro for ascites, may drain if tense ascites
Stain for haemachromatosis
Pearls
What should you do to prepare for H pylori testing
Breath test- ABx 4 weeks, PPI 2 weeks
Endoscopy- PPI 2 weeks
Tx of Peutz, FAP and HNPCC
Peutz- endoscopy 2-3 yrs
FAP- usually >100 polyps, any polyp- resection
HNPCC- scanty polyp
Colonoscopy 1-2 yrs from 25 , can have prophylactic surgery
Can cause endometrial cancer
Crohsn vs UC on pathology
UC- Crypt abscess and pseudopolyps
Crohns- goblet increase and granuloma
Pyoderma gangrenosa description and symptoms
Initially features:
usually starts quite suddenly
small pustule, red bump or blood-blister
later features:
the skin then breaks down resulting in an ulcer which is often painful
the edge of the ulcer is often described as purple, violaceous and undermined.
the ulcer itself may be deep and necrotic
may be accompanied by
systemic symptoms
fever
myalgia
Cause of pruritus
IDA
Lymphoma
Polycythaemia
PBC vs PSC tx
PSC- observation
PBC- ursodeoxy
NG tube placement
pH <5.5 in right place
If not- CXR
Paracetamol OD tx
<1 hours- charcoal
> 1 measure at 4
If >150mg/kg in 8 hours
Or if staggered or unknown timing
or >24 hrs with symptoms
NAC
If pH <7.3 at 24 hours- liver transplant
Venous vs arterial vs neuropathic vs pyoderma sx
Venous- irregular, eczema, haemosiderin, painless, medial malleolus, shallow, foul smelling
Arterial- painful, punched out, toes
Neuropathic- bottom of foot
Pyoderma- irregular, painful, prev trauma, purple border, deep and necrotic
Sx and Tx of intermittent claudication, critical limb ischaemia and acute limb ischaemia
IC- only pain when walking
Exercise programme
Quit smoking
Clopidogrel and statin
Critical- >2 weeks, pain at rest, ulcers
Urgent referral
>10cm- bypass/ endarectomy
<10cm- angioplasty
Acute- Ps, doppler ABPI, IV heparin- immediate referral
Thrombolysis or endarectomy
Tx of scaphoid fracture
Suspected fracture- futuro splint imaging 7 days
Proximal pole- fixation
Dispaced- fix
Undisplaced- cast
Tx of VT
If pulseless- shock
If pulse- unstable- shock
Stable- amiodarone- then if not working- sync shock
Ottawa rules for ankle
Pain and one of posterior malleolus <6cm from base, inability to weight bare
Insulin regime when DKA
FRII - 0.1 U/Kg
Continue long acting, stop short
Acne rosacea sx and tx
Pustules- over nose and forehead which is worsened by sunlight
topical Ivermectin- moderate pustle
Ivermectin and doxy- severe
More Telangectasia- laser
More flushing- bromidine
Sign for retrocaecal appendicitis
Psoas sign
Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended
Imaging of acoustic neuroma
MR imaging with contrast of internal acoustic meatus
Tx of SBO
NG tube and fluids
If fails to work- surgical
Bacterial vs viral meningitis sx
Bacterial- high pressure, high fever, hours to develop
Viral- normal pressire, days to develop
Coxsackie
If shocked and JVP is high what tx do you give
Adrenaline
Tx of venous ulcer
Stockings
TLS biochemistry and treatment
High P, K and creatinine, low Ca
High risk- high tumour turnover- IV rasburicase or allopurinol
Low risk- PO allopurinol
Plt and RBC transfusion indications
Plt- <10, <30 and bleeding, <50 procedure, <100 for eyes
RBC- <70 or <80 ACS
G6PD presentation and triggers
Males !
Jaundiced
Malarials, sulpha, nitro
Tx of DAT + HA
Steroids and rituximab
When to treat suspected neutropenic sepsis
If obvious risk
RR >25 and temp >38- IB Abx
PKD vs Hereditary sphere vs G6PD vs Thala vs AIHA presentation
PKD- burr cells or ehcinocytes
G6PD- males after triggers, Heinz
AIHA- CLL, CLE, mycoplasma causes- speherocytes and DAT +
Thala- Sig lower MCV, high A2, basophilic stiplling
HS- spherocytes, Northern European
DKA dx, tx and resolution
Dx
pH <7.3
Glucose >11
Ketones >3
Treat with fluid, 0.1U fixed of rapid insulin
Add potassium when in range 3.5-5.5
Add dextrose when <14
Resolution
When >7.3
Ketones <0.6
Bicarb >15
If acidosis and ketones not resolved in 24 hours- refer to endo
Drugs affecting TSH and T4
Ferrous and Caglu- decreases resorption of levo
Should take 4 hours apart
Amiodarone- causes hyper/hypo
If hypo- continue and take thyroxine
If hyper- stop amiodarone and take carbimazole if goitre or steroids if no goitre
Treatment of Graves
Proponalol and Carbimazole
When to give hypertonic solution
When Na <120
Tx of SIADH
Fluid restrict
Demeclocycline
Tx of subclinical hypothyroid
> 10 3m apart- 6m trial levo
5.5-10 and symptomatic- trial
When to increase insulin rate in DKA
If glucose isn’t falling by 3/hr
If ketone aren’t falling by 0.5 per hour
Problems occurring with fluid resuscitations
If hyponatraemic- increase Na too fast- demyelination- central pontine myelinosis
If hypernatraemic- decrease Na too fast- cerebral oedema
ACAG vs anterior uveitis vs scleritis vs keratitis vs retinal detachment vs ischamic sx vs optic neurtiis and tx
ACAG- hazy cornea, painful, large pupil - IV acet, timolol and pilo, UR
AU- small irregular pupil, causative condition, photophobia, reduced acuity - UR
Scleritis- painful, vessels don’t move- no reduction in sacuoty, causing condition- Referral urgent
Keratitis- red eye, painful, gritty- UR
Ischamia- curtain coming down_- UR
ON- pain when moving- red desats- UR
Differentiating between types of hypopituitism
Apoplexy- pain like SAH
Macroadenoma- can often be unnoticed
May cause change in viison
Painful legs, red eyes, pyrexia
Leptospirosis
Blood film of coeliac disease
Siderocytes
Howell Jolly
Post thrombotic syndrome - sx
Pain, oedema, dermatitis, ulceration, abnormal skin pigmentatio
When can you extend thrombectomy fort stroke to 24 hours
If advanced scanning shows salvageable brain tissue
Infection from cats
Bartonella- systemic symptoms
How papiloedema is described and when it presents
Blurring of optic margins
Venous engorgment
Causes
SOL
HTN
IIH
Ix and treatment of varicose veins
Doppler USS- retrograde flow
Treat with compression stockings
Only referral if significant symptoms, venous ulcer
If pt denies eppley manoeuvres what can you do
Exercises at home
Brandt-Daroff exercises
Verbal part of GCS
1- none
2- sounds
3- words
4- confused
5- normal
Ix of wet ARDM
Fluroscein angiography If neovasculism is suspected
Driving after MI
4 weeks
6 weeks if lorry off inform DVLA
Virus causing nasopharyngeal cancer and tonsillar cancer
NPG- EBV
Tonsillar- HPV
If have fasting glucose of 8.1 what next
Should do OGTT
When to surgically removed bowel in UC
Dysplastic changes
Severe flair- resistant to tx
When to intubate
<8
High carboxyHb tx
High flow O2
Pa O2 will be normal
Analgesia of SCD
Fluids- caused by dehydration
IV morphine
Of fails- exchange
Urine sodium in DI and PP
DI- high urine sodium
PP-low urine sodium
Endoscopy for vocal cords, cant maintain strong grip what improves sx
Pyridostigmine- since checking weak vocal cords
Hyperthyroid hand changes
Oncholysis
acropachy
Morphine to SC
/2
When to stop statins
CK 5 ULN
or with macrolide
or LFT 3 UMN
If Lower GI bleeding what Ix should you do
Flexible sigmoidoscopy- if normal
Colonoscopy
2cm smooth non-tender swelling fixed to underlying structures on L wrist
Ganglion
When to refer to the coroner
o Unexpected or sudden deaths
o Not seen within 14 days before death
o Death occurs within 24 hours of hospital admission
o Accidents, injuries and suicide
o Industrial injury or disease (e.g. asbestosis)
o Deaths occurring as a result of ill treatment, starvation or neglect
o Death occurred during an operation or before recovery from the effect of an anaesthetic
o Poisoning, including taking illicit drugs
Test for femoral nerve irritation
Femoral strach test
Lay pronated
Extend hip behind- + if pain- radiculopathy in L2-4
Chlamydia exposure what do you do
Test and treat without results
Tx of otitis externa in diabetics
Cipro to cover psuedo
DEXA scan t and z score meaning
T score- compared to young healthy
Z- compared to same age
Most likely cause a brain mets
Lung
Cause of juxta articular oesteopaenia
RA
Medial vs lateral epicondylitis
Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended
Medial epicondylitis is commonly referred to as ‘golfer’s’ elbow. The pain is aggravated by wrist flexion and pronation
Results of syphillis testing
Treponum HA test (specific)
Venerum test/rapid plasma reagin (non specific)
If specific + and non - successful treatment
If specific - and non + false positive (SLE, pregnancy, HIV)
If on bisphosphonates for 5 years what should you do
Treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
Continue if
- >75y/o
- on steroids
- prev hip/vertebral fracture
- high risk FRAC
- T score <2.5 still
Tx of ascites
Fluid restrict if sodium <125
Spironolactone otherwise
Low sodium diet
When is liraglutide used
person has a BMI of at least 35 kg/m²
prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)
Mx of hiatus hernia
Lifestyle and PPI- sliding
If paraoesophgeal- rolling- surgery if others fail
Tx of vestibular neuritis
Short course of prochlorperazine
Rehab exercises if chronic
Boehavves dx
Contrast swallow
Diarrhoea and hypoglycaemia dx
Cholera
Tx of constipation in IBS
Bulk forming laxatives
Ispaghula husk
Anti nausea in migraines
Metoclopramide
Unilateral lymph node enlargement with eosinophillic nuclei
Reed sternberg
Hodgkin
Nuclei can also be called mirror image
Prevention of second TIA
Clopidogrel and aspirin
What drug causes hypomagnesia
Cisplatin
Vaccine after Hep B infection
Pneumococcal
Tx of sebhorreic dermatitis
Topical ketoconazolr
Menieres vs acoustic
Meniere- tinnitus and fullness
Acoustic- corneal reflex
If BPh but have urge and incontinence what tx
Oxybutynin for overreactive bladder
Tx of nasal polyps
Unilateral large- referral
Bilateral- inhaled CS
Asthmatic with 4.9 K and one 3 HTB meds what do you give
A blocker
Rapid progressing GLN examples and findings on biopsy
GPA, eGPA, Goodpastures
Crescenteric
Central Retinal artery occlusion vs Anterior ischemic optic neuropathy on fundoscopy
CRAO- cherry red spot with pale retina
AION- Engorged pale optic disc with blurred margins
What drugs used in surgery are those With MG resistant to
Suxamethonium
Most common heriditary cause of thrombosis
Factor C resistance- Factor V Leiden
Acute abdo pain and acidotic
DKA
Not paracetamol as doesn’t acutely cause acidosis
Homonymous hemianopia with macular sparing lesion location
Occipital cortex
Tx of acute flare up in RhA
IM pred
Mx of acute panc
Aggressive early fluid resuscitations (since fluid in 3rd space)
Bisferens pulse cause
HOCM
Whole body convulsion with no awareness loss
Psychogenic
Unilateral blurry vision and halos surrounding light sources
Cataracts
How tranexamic acid should be given in major haemorrhage
Rapid bolus followed by slow infusion
If scan is negative and d dimer is positive what do you do
Stop DOAC and repeat scan in 1 week
Latent TB features and tx
Ghon focus- bacteria may be in granuloma
Isoniazid with rifampicin for 3 months or I for 6m
What can compartment syndrome do to renal function
Cause rhabdo and cause AKI
Bennets and potts fracture
bennets- fracture of base of thumb, usually in fights
Potts- bimalleolar
Testicular cancer sx (non genital related)
gynaecomastia
If giving a HF patient >2 bags of transfusion what else should you give them
Furosemide STAT
If HIV + what should you do
Start HAART and test again in 12 w
Coeliacs can be deficient in
B12, iron and folate
What medication should be stopped in C diff
Opioids
How to detect acute kidney graft failure
Asymptomatic
picked up by a rising creatinine, pyuria and proteinuria
Testing in chronic pancreatitis
Annual Hba1c- since DM will likely develop
Painful knee shortly after chlamydia infection synovial fluid
High WCC but sterile
Reactive arthritis
If PE suspected and CTPA negative what next
Doppler of leg
If OP and CKD 5 what do you give
Denosumab
Thiazide vs furosemide effect on calcium
Thiazide- increases
Loop- decrease
Important investigation after aminosalicylate
FBC- for agranulocytosis
Osteolytic and sclerotic lesions
Pagets
If long wait for CTPA what do you do
DOAC and wait
Only D dimer if <4
When to use sync CV
Unstable pulse VT
Unstable tachys
Acne in pregnancy
Erythromycin if not responding to BPO
How to prepare for colonoscopy
Laxatices day before surgery
What can happen if you give a lot of insulin in HHS
Myelinosis
Aspirin in AKI
Can be continued
Seb dermatitis vs tine capitus
Tinea- hair loss
Seb dermatitis vs tine capitus
Tinea- hair loss
When should you wait bare after surgery for hip fracture
As soon as tolerabel
Yellow fever features
Illness
Recovery for 48 hours
Deterioration- jaundice and haematemesis
Congenital adrenal hyperplasia sx
Since defifiecnt in enzymes making cortisol and aldosterone
Increase in test- early menarche, hirsutism
Addisons features
Shingles analgesia
After NSAIDs, para and neuropathic pain
Can give prednisilone in first2 weeks as long as on acilovir
Pus in anterior chamber of eye tx
Steorids and cyclo (atropine, tropicamdie)
Since anteiror uveitis
When to use Escharotomy
Indicated in circumferential full thickness burns to the torso or limbs.
Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involve
Tx of herpes
10d valaciclovir
Labyrunthitis vs neuronitis
Labyrinth- hearign loss
What precipitates Pompholyx eczema
Warmth
Eczema on palms and soles
Cause of OM in sickle cell pts
Salmonella
Sudden change in cognition and control mx
Urgent imaging
AKI stages
1- 1.5-1.9- 0.5 for >6 hrs
2- 2-2.9- 0.5 for >12hrs
3- >3 - 0.3 for >24 hours
Tx of hyperthyroid in pregnancy
Propylthiouracil
Cause of keratitis
Contact lens- acanthaboea (water exposure) , pseudomonas
Non- staph
Acute SNL hearing loss mx
Urgent ENT referral
High dose steroids
Audiometry and Brain MRI
Drug indued Lupus
HIP
Hydralazine
Isoniazid
Phenytoin
Posterior communicating artery vs cavernous sinus thrombosis
CVT- proptosis, 3rd nerve palsy, absent corneal reflex
PCA- 3rd nerve palsy
BMI ASA
30-40 2
40+ 3
Thumbprinting on x ray
Mesenteric ischamiea
Unilateral vs bilateraal papiloedema
Unilateral- optic nerve tumour
Bilateral- HTN, IIH, tumour
Drug in MND that offers survival benefit
Riluzole
Prophylaxis of gout
Allopurinol but also colchicine when starting allopurinol as prophylaxis
Myeloma investigations
Serum protein electrophoresis
whole body MRI
Gingivitis mx
Simple- dentist
Systemic- refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine mouth wash
simple analgesia
Ix of GBS
LP and NCS
AI hepatitis AB
Anti smooth muscle or ANA 1
Anti LK 2
Refractory anaphylaixs
Resistant to 2 doses on adrenaline
Antibodies in drug induced lupus
Anti histone
ECG of pericarditis and tx
PR depression and widespread ST
Colchicine and NSAIDs
Minimal displaced malleolar fracture below talar dome mx
Weight baring with controlled ankle motion boot
CI to lung surgery for cancer
SVCO
Malignant pleura
FEV <1.5
Vocal cord paralysis
Brain death testing
Fixed unresponsive pupils
No cornea reflex
No response to supraorbital pressure
No cough reflex
No resp effort if disconnected
2 separate doctors test on seperate occasions
When to give oral 5ASA in UC if mild disease
If disease is affecting ascending colon as enema will not reach that far
If history of nausea after surgery what drug is useful
Propofol since AE effect
Biopsy of membranous vs GPA vs minimal vs FSG
Membranous- subepithelial spikes, BM thickening
GPA- crescenteric, along BM linear
Minimal- not seem, seem on EM
FSG- only some changes, not all- collagen sclerosis
NSTEMI conservative management
Aspirin plus clopidogrel if high risk bleed
Ticagrelor if low risk
Treating Hep B exposure
Test their Anti Hbs Abs
If low- non responder- give vaccine an dIG
If high- vaccine
Diagnosis of IBD in severe flare
Flexible sigmoidoscopy since colonoscopy is CI
Long vs short saphenous location
Long- medial
Short- lateral
Presbycusis findings
Bilateral high frequency- SN loss
Tx of thyrotoxic storm
Propanolol
CM/PTU
HC
When to treat K with insulin
If changes or >6
Which medication falsely lowers GFR
Trimethorpeim
Bullous pemphigoid and Pemphigus vulgaris AB attack what
Epidermal BM- bulls
Caherin- PV
Acne progression treatment
Add oral lymecycline in addition to treatment
Topical adapelene with topical benzoyl peroxide and oral lymecycline
Mx of BB OD
Glucagon
Diabetic renal biopsy
Nodular glomerulsclerosis
Tx of enteral feeding with hyperglycaemia
Insulin
Tx of non infective exacerbation of COPD
Pred 5 d
Dysuria with negative urine dip next ix
STI check
How to calculate NNT
1/CER (Control Event Rate) – EER (Experimental Event Rate)
In %
So if CER is 12% and EER is 20%
NNT= 1/20-12
RRR and ARR
RRR= 1- (EER/CER)
ARR=CER-EER
AB for GPA and eGPA
GPA- cANCA or proteinase
eGPA- pANCA or MPO
Tx of TIA with AF
Aspirin 300mg
Then AC
Tx of cavernous sinus thrombosis
LMWH
When cant you use colchicine
<50 gfr
Tx of MRSA on IE
Vanc and rifampicin
Add gent if prosthetic HV
Tests for Herceptoin
ECG- can cause cardiomyopathy
Hep C with pro thrombotic state and oedema ix
Urien dip and PCR
For membranous GLN
Tx of hypocalcaemia
<2 or symptomatic give IV
ECG
Ix for reduced GCS with DKA
CT head for oedema
Tx of steroid induced diabetes
Sulphonylurea
Mx of Barrets
PPI and endoscopy 3-5 yrs
If dysplasia- resection
How should you ix coeliac
Measure TTG and IgA
If IgA deficiency measure IgG TTG
Mx of mesenteric ischaemia
Peritonitic- laparotomy
Not- CT agnio
Max dose of AC and getting thrombosis what do you do
Switch to another
Filter only for those who cant tolerate AC
Relative risk
Relative risk =risk exposed to drug%/ risk not exposed%
Tx of IgA nephropahty
ACEi
Retinal detachment vs central retinal O
Retinal- curtain cowning over
Retinal- stroke RF
Tx of septic arthritis in prosthetic limb resistant to ABx
Surgical washout
Tx to stop smoking
varenicline OR bupropion
V- nicotin partial agonist
B- norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
Pregant can use if CBT fail s
Lump only present on standing
Varicocele
What can donezepil cause
3rd degree Hb
Dressler syndrome tx
Aspirin/ NSAIDs
Leprosy sx and mx
Hypopigmented skin
Sensation
Dapson and rifampicin
Tumour of parotid gland
Pleiomorphic adenoma
Continual pneumonia sx and smokes mx
2ww referral
ABx before abdo surgery
IV coamox
Present to GP with acute chole mx
Admission
Ix of CLL
Immunophenotyping
Flow cytometry
Infections in splenectomy
Step pneum
H influ
N menig
Active form of VIt D
Calcitriol
OA vs fracture
Cant weight bare or SLR in fracture
When to use oxycodone vs afentanil
Oxycodone 30-60
afentanil <30
What are those on chemo more prone to MSK
Gout
What AB is present in UC
pANCA
Where does Pagets affect the most
skull, spine/pelvis, and long bones
Mx of open fractures
Debridement- within 12hrs for high energy and 24 for not
External fixation for soft tissue swelling- severe
Good if lots of soft tissue swelling
Test for hypermobility
Beighton score
Buckle vs greenstick fracture
Buckle-bulge due to compression
GS- fracture due to bend
Imaging for avascular necrosis
MRI is best
Ix for man with osteoporosis
Testosterone
Tx of shock after spinal damage
Vasopressors- neurogenic shock
Inheritance of BRCA1 gene
AD- so 50% chance children or siblings have it
Neo adjuvant chemo in breast uses
To down size tumour- WLE instead of mastectomy
If varicocele what mx
Urgent referral
Torsion of spermatic cord vs appendage
Cord- no reflex
Appendage- partial reflex
Halo sign in breast
Cyst
When to refer varicose veins to secondary care
Superficial vein thrombosis.
A venous leg ulcer
Skin changes
Tx of intermittent torsion
Prophylactic emergency fixation
swollen, hyperaemic optic disc with peripapillary splinter haemorrhages.
Non artertic optic neuropathy
Diabetes
Absent gag reflex pathology
Medulla
Mx of feeding in oesophageal cancer
Gastroscopy
Since radio can cause painful swallowing
Tx of collapsed lung due to atelectasis
Chest physio
Then bronchoscopy
Superior vs inferior homonymous hemianopia lesions
Superior- temporal, inferior radiation
Inferior- Parietal, superior
Tx of TTP
Plasma exchange
Low vs high radial nerve damage
Low- no sensory loss
High- wrist and tricep and sensory loss
Odds ratio
OR=AD/BC
odds of exposed/odds of unexposed
FLushing after treatment with NAC
Stop
Restart slower +/- chlorampenine
Dx of pneumococcal pneumonia
Urinary antigen
Pneumonia with poor air conditioning
Legionella
Pneumonia with CF
Pseuodomonas
Glucose in CSF to serum ratio in viral/bacterial meningitis
Viral- >0.6
Bacterial- <0.4
Sx after radiation of prostate cancer
Radiation proctitis
Diarrhoea, tenesmus
Tx of Pemberton sign + NHL
Dexamethasone- means obstructing SVC
If hyper echoic lesions on liver CT what next ix
Colonoscopy- since undetectable sometimes on CT
What should you give as breakthrough pain mx and other meds with it
Immediate release morphine 1/6
Senna regularly and as required Anti emetic
Lisfranc injury
Dislocation of the base of the second metatarsal and the medial cuneiform in the midfoot.
The injury usually occurs due to a direct force, such as a sudden rotation of the joint during such as changing direction or a forced plantar flexion
Displaced fracture mx before surgery next day
Closed reduction and plaster slab
Sx and mx of CRPS
Excessive pain 4-6 weeks after injury
Tx with amitryptilin e
BRAC 2 cancer
Prostate and breast in men
Smith vs galazzi
Smith- in distal
Galeazzi- shaft
Obstructive bowel AE and chemo
Cyclizine for obstruction
Ondan- chemo
Mx of acute vs chronic osteomyelitis
Chronic- await MSC results
Surgical debridement
Treatment of VRE and of staph epididermis
VRE- linezolid
Staph- remvoal of central line and vanc
Positive tournique test meaning
Petechiae show up on skin with BP cuff
Dengue virus
Pyogenic vs hydatid vs amoebic
CT to differentiate
Pyogenic- E coli in adults
Tx drainage (typically percutaneous) and antibiotics
amoxicillin + ciprofloxacin + metronidazole
if penicillin allergic: ciprofloxacin + clindamycin
Hydatid- asymptomatic- pain, surgery
Daughter cyst
Amoebic cyst- diarrhoea, cyst
Metronidazole
Entamoeba histolytica
If diabetic and bloating after meals what tx
Metoclopramide
Surgery for IE
Prolonged PR
Recurrent
HF
Tx of green faeces
cholestyramine
Increases absoprtion of bile
Pneumonia and crusty lip
Strep pneumonia assocaited with cold sores
