PasTest Learning Flashcards
kidney stones scan
urgent non contrast CTKUB unless pregnant or child
idiopathic pulmonary fibrosis mx
pirfenidone or nintedanib
downregulate growth factors
need FVC between 50-80%
stopped if FVC down by 10% in 10 months / disease progression
cerebellar signs / lateralises where
Dysdiadokinesia / dysmetria.
Ataxia.
Nystagmus.
Intention tremor.
Speech - slurred or scanning.
Hypotonia
lateralises same side as lesion
renal artery stenosis assess, signs
renal arteriography
malignant hypertension older person, worsening renal function, flash pulmonary oedema
MI dvla rules
1 week if you had angioplasty, it was successful and you don’t need any more surgery
4 weeks if you had angioplasty after a heart attack but it wasn’t successful
4 weeks if you had a heart attack but didn’t have angioplasty
6 weeks if bus driver
driving and HTN
if >180/110, malignant htn then can’t drive til treated
seizures and dvla
licence taken away, must be fit free for 12 months to reapply
reapply after 6 months fit free if due to medication change only
if one off non epileptic seizure then can restart driving after 6 months fit free
TIA and dvla
stop driving for 1 months with no further symptoms and only restart with doctor permission
dvla and angina
can drive if stable not if unstable
AAA and dlva
if >6.5cm AAA can’t drive
operations and dvla
must tell if can’t drive 3 months after op
diabetes and dvla
need to know if on insulin for more than 3 months
stroke and dvla
only tell them if having issues per doctor 1 month+ after stroke
fainting and dvla
can drive if no other issues and one off + doctor doesn’t think will affect your driving
if got arrhythmia syndrome + fainting can’t drive / also if had assoc cardiac arrest can’t drive
professional dilemmas tips
always choose the option that addresses the problem most directly first
confronting others always worsens the position relative to other similar options
these conditions may worsen during pregnancy
herpes infection, acne rosacea, SLE
internal inflammatory conditions + things like hidradenitis improve
inv to discriminate on causes of hypoglycaemia
low sugar with normal or high insulin = insulinoma
sugar-lowering drugs = C peptide
low insulin no ketones = anti insulin receptor Ab from cancer
insulin low, ketones high = alcohol, pituitary or adrenal failure
post prandial low sugar = either post gastric surgery or t2dm, do proglonged glucose tolerance test
non bilious projectile vomiting 3rd or 4th week of life with hypokalaemic metabolic alkalosis
pyloric stensosis (hypertrophy of circular pyloric muscle)
mx pyloromyotomy
very soon after birth, bile stained vomiting, abdo distension, not passing meconium after first few bowel movements
congenital duodenal atresia (1 third assoc with Down’s)
mx duodenojejunostomy
first few days of life, bilious vomiting, abdo distension, no meconium
Hirshsprung’s - no nerve ganglion cells in hindgut, no peristalsis, diagnose with biopsy. mx with surgical ‘pull-through’ operation
preterm, bilious vomiting, distended, bloody stools
Necrotising enterocolitis
can get pneumatosis intestinalis on the x ray (gas in gut wall)
mx bowel rest and IVI, abx
early after birth choking, coughing, cyanosis on feeding, recurrent LRTI
tracheoesophageal fistula or oesophageal fistula
athetosis
involuntary writhing movement
common with cerebral palsy
chorea
jerky fleeting movement
assoc with:
Huntingdon’s, certain drugs like phenytoin / L dopa, hyperthyroid, SLE, stroke
hemiballismus
violent swinging unilateral movement
brain infarct
rheumatic fever
Fever
Arthritis (painful, tender joints), most commonly in the knees, ankles, elbows, and wrists
Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
Fatigue (tiredness)
Chorea (jerky, uncontrollable body movements)
happens if scarlet fever/ strep throat or skin infection not treated appropriately
myoclonus
sudden jerking of single muscle group
epilepsy or benign essential
tics
repetitive twitching of face / hands
gilles de la tourette syndrome
multiple tics, barking, grunting
akathisia
restlessness of legs
assoc antipyschotics
3-6 weeks since start
dystonia
torticollis - spasming neck twisting (crick neck)
opisthotonus - stretching back with shoulders/heels only on bed
assoc antipsych within first 4 weeks
tardive dyskinesia
chewing, grimaces
choreoathetosis -(writhing rapid piano playing movements of fingers/toes)
12+weeks after treatment
RAST test
when looking for specific allergen
e.g. latex IgE
abnormal ears, shortened philtrum, micrognathia, hypertelorism, poor growth, recurrent infections, aortic arch abnormality, cleft palate
digeorge syndrome
deletion small bit chrom22
22q11 deletion syndrome
no or poor thymus and have assoc cardiac defects
pulsus alternans
strong and weak beat occurring alternately
causes: when taking BP, LVF, toxic myocarditis, paroxysmal tachycardias
pulsus paradoxus
abnormally large decrease in systolic BP and pulse during inspiration (>20mmhg)
seen in cardiac tamponade, severe COPD
plateau pulse
slow upstroke
found in aortic stenosis
pulsus bisferiens
two aortic waveforms per cycle
assoc AS, hypertrophic CM, AR
collapsing pulse
rapid upstroke and descent
assoc aortic regurg
pulsus bigeminus
two beats close together with longer pause
lots of causes incl PVCs
chondromalacia patellae
teenager anterior knee pain worse walking downstairs and after prolonged sitting
+Ve shrug test (compress patella while quads tight = pain)
inferior patellar pain, bony lump at tibial tuberosity, sporty teenage boy
self resolving as grow up , due to overuse of underdeveloped patellar ligament
osgood schlatter disease
osteochondritis dissecans
sporty teenager with vague pains made worse by activity with possible swelling, locking / catching and giving way
separation of subchorndral bone articular cartilage from bone surface
dx on imaging
patellar subluxation
knee giving way laterally with things like running/ jumping
anterior pain even when sitting, can be stiff and swollen too
knee brace
remember this with kid knee pain
always examine hip too, may be referred
pregnant UTI
can have nitro, NOT trimethoprim
diabetes insipidus
cranial - decreased ADH secretion
as below but responds to exogenous ADH
nephro - decreased ability to respond to ADH at the kidney
low urine osmolality + high volume dilute, high plasma osmolality
SIADH
low sodium, low osmolality
often have lung ca too
chronic reflux nephropathy
disease of childhood
occurs after recurrent backflow
often presents just as recurrent childhood UTIs, mostly aim to prevent infection and usually grow out of it
keratitis
impaired vision and ulcer near visual axis
iritis
= anterior uveitis
small distorted pupil with red eye
acute glaucoma
severe pain, severe visual impairment, red eye , vomiting
red eye red flags
acute extreme pain, acute visual loss, periorbital cellulitis not responding to abx
acute closed angle glaucoma
episodes blurred vision, headache, eye pain, nausea,, haloes around lights
acute painful red eye
needs urgent ophthal mx
signs on fundoscopy closed angle glaucoma
optic disc atrophy
optic disc cupping >21 mmhg IOP
blood vessels emerging from optic disk have breaks
lose nasal and superior fields first
mx glaucoma oopen angle
prostaglandin analogue
- latanoprost
then beta blocker - timolol
then carbonic anhydrase inhibitor - brinzolamide
can add trabeculoplasaty if nec
mx closed angle glaucoma
lie pt flat, pilocarpine eydrops, acetazolamide oral tablet or dorzolamide drops
after acute attack then mx with laser peripheral iridotomy
t2dm present
metabolic syndrome, acanthosis nigricans, if v severe polydips,polyuria
dx t2dm
dx >48 hba1c x2
x1 if sympomatic
fasting gluc >7 abnormal
mx t2dm
3-6 monthly monitoring hba1c
dietician, aim 5-10% weight loss if high BMI
annual eye, BP, diabetic foot, kidney screen
drugs:
1. metformin
2. add ‘gliptin (pioglitazone) or SU (gliclazide) or SGLT2inhibitor (‘flozins)
3. metformin, gliptin, gliclazide
4. GLP1 mimetic (trulicity/dulglutide) / add insulin
common diabetic meds SEs
metformin - diarrhoea, metallic taste, lactic acidosis in those with organ failures
SU/gliclazide - hypoglycaemia, weight gain
‘flozins /SGLT2i - DKA, hypos, UTIs
gliptins / PGs - GI disturbance, headache, rarely pancreatitis
burns survey
% body area burned and depth, pre injury weight, FBC, U+E, glucose
osteomalacia
generalised aches proximal myopathy, RFs for vti D deficiency
Looser zones (linear areas of low density on x ray)
low calcium, low normal phosphate, high ALP
brodie abscess
intraosseus subacute pyogenic OM, usually in children and staph bateria
lytic lesion surrounded by reactive sclerotic zone
chronic dull aching pain
paget disease
bone / joint pain worse at night and feels warm
peripheral neuropathy
usually pelvis spine or skull
old
can get hearing probs
mx with bisphosphonates
high calcium, normal phos, high ALP
child, nauseous, testicular pain, point tenderness upper pole, small point of blue discolouration to scrotal skin
torted hydatid of morgagni
still likely to have exploratory surg to r/out torsion given sx
woody hard irregular area in testis palpation normal AFP
seminoma
teratoma have high AFP
spermatocoele
can occur post vasectomy due to sperm collecting
usually expectant mx but can be excised
multiple target lesions with concentric colours
erythema multiforme
often due to herpes simplex
erythema migrans
lyme disease
2 weeks after bullseye lesion
stevens johnson syndrome
rare severe skin reaction to meds
often abx
red rash and prodromal illness
skin lost in sheets
headache worse in morning, visual disturbance, dizziness, pulsatile tinnitus
idiopathic intracranial HTN
unclear cause
can get enlarged blind spot and reduced visual field due to papilloedema
acutely - steroids, LPs, diuretics
surgical shunts , weight loss
ethmoidal sinusitis
needs ethmoid sinus drainage
then cef abx
indication mastectomy
DCIS, tumour incl nipple, multifocal tumour, large tumour in small breast
lumpectomy indication breast
well circumscribed in single quadrant, no local spread
cytology reporting
c1 not enough cells
c2 good sample not malign
c3 probably benign, repeat
c4 largely malignant
c5 all cells are malignant
when amniocentesis
after week 15
nocturnal enuresis
common, grow out of it
enuresis alarm at first
can use short term desmopressin if needed
diagnostic criteria migrain
5 headache attacks lasting 4-72 hrs
at least two of: unilateral, throbbing, worsened by movement, severe
many don’t get auras
AML genotype
philadelphia chromosome
t9:22
weight loss, middle aged, high WCC, anaemia, high platelets
URTI then get haematuria
IgA nepropathy / Bergers disease
usually resolves although can progress
cast nephropathy
assoc with light chain deposits in kidney from m myeloma
minimal change disease
nephrotic picture (oedema, proteinuria) in a child
dx with biopsy (clear)
mx with steroids
alport syndrome
inherited
nephrotic with ear + eye issues too
hard exudates in retina
htn and diabetes
lipoproteinleakingfrom blood vessels, ringed white deposits
soft exudates in retinan
cotton wool spots - due to infarcted retina, assoc with ischaemia
healthy old man, longer term leg pain with no injury, high ALP, all else normal
paget’s
bony met sources
prostate, breast, kidney, thyroid, lung
hypercalc, renal fail, anaemia, bone pain
myeloma
levetiracetam associations
GI symtpoms, reflux, anorexia, anxiety
phenytoin SEs
gingival hypertrophy, acne, hirsuitism, aplastic anaemia
sodium valproate SEs
weight gain, low plts, tremor
carbamazepine SEs
dry mouth, low sodium, blood disorders, gynaecomastia, male inferitility
cyp450 inducers
PCBRAS (lower effective dose of a medication metabolised this way like warfarin)
phenytoin
carbamazepine
barbz
rifampicin
alcohol chronic
sulphonylureas /gliclazide
cyp450 inhibitors
SICKFACES.COM
sodium valproate
isoniazid
cimetidine
ketoconazole
fluconazole
alcohol acute
chloramphenicol
erythromycin/clari
sulfonamide (trimethroprim)
cipro
omeprazole
metronidazole
cyp450 common substrates
Statins
Theophylline
Phenytoin
Warfarin
Selective serotonin reuptake inhibitors (SSRI): sertraline, citalopram, fluoxetine
Amitriptyline
Codeine
Caffeine
child, gradually inc hip pain, reduced ROM, sclerotic femoral head on x ray
avascular necrosis of the hip
5 day unilat child limp, ROM restricted, normal inv, recovers after 3 days
transient synovitis
cryptococcal meningitis
HIV +ve
india ink stain +v
amphotericin mx
htn mx summary
black or >55 yrs:
- CCB
- add ACEx / ARB
- add thiazide or spironolactone instead if K+ <4.5
<55 yrs non black pts:
- ACEx or ARB
- add CCB
- add thiazide or spironolactone instead if K+ <4.5
dx htn
clinic bp 140/90 + and HBPM of 135/85+
also check bloods, ECG, urine acr and modify metabolic RFs
contralateral hemiparesis, ipsilateral facial palsy, abducens palsy
lesion of the pons
insertion sites of CNs to help identify brain lesion origins
skull base - I, II
midbrain - III, IV, V
pons - VI, VII, V
cerebellopontine angle - VIII
medulla - IV to XII
itchy rash reaction = what
IgE mediated therefore skin prick test or RAST
skin patch is for contact based llergies
ovarian hyperstimulation syndrome
after clomiphene or hormones to prep for egg collection
abdo fluid build up, nausea, dehydration, effusions
risk factors breast ca
high BMI, early menarche, older
2-5 day incubation, reheated takeaway meal , abdo cramps and diarrhoea
campylobacter jejuni
self limiting
rarely need abx
food poisoning short incubation <18 hrs
clostridium perfringens if longer
if very short with reheated rice thinkk b cereus
meniere’s
fluctuant hearing loss
vertigo
tinnitus
aural fullness
normal eardrums
bppv
vertigo minutes to seconds, head movements,nausea
cholesteatoma
recurrent ear discharge, foul
conductive hearing loss
retracted eardrum with crusting
usually comes on after long term recurrent ear inf
mx is surgical
age related macular degen
big inc after 70
straight lines look wavy
blurry central vision
poor vision in low light levels
peripheral vision preserved
can progress to ‘wet’ from dry which means blood vessels form that damage the macula
central retinal artery occlusion
cherry red spot
acute persistent painless loss of vision
metabolic risk factors
central retinal vein occlusion
subacute variable visual loss
pain, eye redness, photophobia
retinal haemorrhages, dilated torturous vessels, macular oedema, optic disc oedema
retinal detachment
floaters, flashing lights, field loss, loss of visual acuity
shadow in peripheral fields
very urgent mx needed
childhood vax schedule
8 weeks
- 6 in 1
- menB
-rotavirus
12 weeks
- 6 in 1
- pneumococcal
- rotavirus
16 weeks
- 6 in1
- menB
1 year old
-Hib, menC
- MMR
-pneumococcal, menB booster
3 yrs 4 months
- MMR booster
- some of 6 in1 booster
12, 13 yrs
- HPV
14,15 yrs
- menACWY
- DTP booster
when to give child ORS or IVI
ORS:
2+ vomits or 5+ diarrhoea eps in 24 hrs
can’t tolerate fluids
<1 yr old
IVI
can’t tolerate NG fluids
in shock
not improving on ORS
possible rare side effect cipro
achilles tendon rpture
pt on long term dialysis with widespread joint pains and stiffness
dialysis amyloidosis
female with groin lump no cough impulse, not reduced on lying down, transilluminates
hydrocoele of canal of Nuck
tender groin lump in a woman, no cough impulse, reduced below and lateral to pubic tubercle
femoral hernia
man with bluish lump in groin with palpable cough impulse, disappears lying down
saphena varix
lobulated consistency lump
lipoma
child motor milestones (head control, rolling, sit, crawl, stand, walk, run, hop)
3 months - head control
6 months - rolls over
9 months - sits, crawls
12 months - stands
18 months - walks
2 years - runs, can climb stairs 2 foot per step
3-4 years - stand one foot
5 years - skip /hop
fine motor and vision milestones
3 months - fix and follow, reach
6 month - co ordination, transfers
9-12 months - pincer grips
18 months - uses spoon
2 years - scribbles, lines
3-4 years - builds bridge with bricks
5 years - full drawings
hearing and language milestones
3 months - cries, laughs, vocalises
6 months - localises sounds, babbles
9 months - inappt sounds
12 months - babbles, simple commands, says mama dada
18 months - uses words
2 years - 2 word phrases
3-4 years - short sentences
5 years - fluency
social milestones
3 month - laughs
6 months - alert interactive, startles
9 months - stranger anxiety
12 months - waves bye, responsive
18 months - stranger shyness tantrums
2 years - knows identity, parallel play
3-4 years - interactive
5 years - dressing
fragile x syndrome
FMR1 ribonuceloprotein issue
X linked dominant
developmental delay
learning disability
long narrow face, large ears, large testicles , hyperactivity
hard to detect usually presents post puberty
klinefelter syndrome
47 XXY
infertility, tall lanky male
small testicles
gynaecomastia
turner syndrome
45 X0
short webbed neck
low set ears
low hairline
short stature
absent menarche
trisomy 18 / edward syndrome
cardiac defects, oesophageal atresia,, intellectual disability, microcephaly, micrognathia
neonatal hypotonia, apnoea, seizures
commonly have VSD
would be detected at neonatal screening
management of tachyarrhythmias summary
adverse features - shock, ischaemia, syncope, HF -> synchronised DC shock x 3 and then amiodarone 300 then 900mg
otherwise:
narrow QRS:
regular = vagal manoeuvres then 6/12/12mg adenosine
if no sinus achieved - likely atrial flutter, give beta blocker
irregular = likely AF, give beta blocker or diltiazem
broad QRS:
regular: if VT or uncertain, 300mg amiodarone over 60 mins, then 900mg over 24 hrs
if SVT with BBB then treat as SVT
irregular: need expert help, consider amiodarone
Hutchinson’s sign
shingles to tip of nose (i.e. V1 ophthalmic branch of trigeminal nerve, risk of corneal ulceration , nee urgent treatment)
arm dermatomes sensation
C5 outer shoulder / deltoid
C6 thumb, radial side forearm
C7 - heaven, index + middle finger
C8 - ring and little finger
T1 - ulnar side forearm
T2 - inner shoulder, triceps
spinothalamic tract does
pain and temp
dorsal column does
light touch and vibration and proprioception
myotomes upper limb
C5 shoulder abduction
C6 elbow flexion
C7 elbow,wrist,finger extension
C8 finger flexion
T1 finger abduction, thumb abduction
lower limb dermatomes
L1 asis and area surrounding groin
L2 upper outer thigh
L3 knee and inner thigh
L4 medial ankle
L5 foot
S1 lateral ankle and outer foot
S2 genitals
S3 groin around genitals
myotomes lower limb
L2/L3 - hip flexion
L4/L5 - hip extension
L3/L4 - knee extension
L5/S1 - knee flexion
S1/S2 - ankle plantarflexion
syringobulbia
fluid filled cyst within spinal cord extending into the brainstem (below this level is called syringomyelia)
causes CN palsies and dissociated sensory loss
UMN signs below lesion
LMN signs at lesion levlel
MND signs
combined UMN/LMN signs in the same body regions
usually starts with limb symptoms and progresses to slurring / poor speech
MS signs
only UMN signs
average age 30
usually presents with optic neuritis or isolated limb tingling /weakness
upper motor neurone signs
normal muscle bulk
mild weakness
increased tone
brisk reflexes
upgoing plantars
lesion has to be in central nervous system / brain
lower motor neurone signs
atrophic muscle
severe weakness, worse distally
fasciculations
reduced tone
reduced reflexes
downgoing plantars
peripheral nervous system only
paracetamol overdose
if staggered overdose, start NAC immediately
or if likely over 150mg/kg as high risk toxicity then
otherwise a/w bloods
mx of angina
GTNspray
beta blocker +/- CCB first line
can then consider adding long acting nitrate etc if not tolerating those
life threatening asthma exacerbation
PEFR <33% normal
sats <92%
silent chest
cyanosis
clinical shock
severe asthma exacerbation
can’t talk in full sentences
PEFT 33-55%
RR >25
HR >110
accessory muscles
sats >92%
moderate asthma exacerbation
talk in full sentences
PEFR 50-75%
RR <25
HR <110
chronic asthma mx
- SABA
- add low dose ICS
- add LABA (switch to MART/combination inhaler)
- increase ICS
- add LTRA
- specialist opinion
acute asthma hosp mx
high flow o2
neb salbutamol, ipratropium
steroids oral or IV
add abx if likely infection
if no improvement can try magnesium, IV salb, aminophylline
indications to refer asthma pt to ITU
deteriorating PEFT
worsening hypoxia
rising CO2
decreasing pH
exhaustion
reduced GCS
Pierre Robin syndrome
not inherited
micrognathia, glossoptosis(tongue pushed back)
freq resp infections as neonate
cleft palate
single palmar crease, protruding tongue, brachiocephaly, prominent epicanthal folds, upward slanting palpebral fissures
Down’s syndrome appearance
Noonan’s syndrome
autosomal dominant
low set ears, micrognathia
short webbed neck, delayed puberty in males
commonly get pulmonary stenosis and pectus excavatum as well as bleeding defects
fever pain score
1 point each
fever over 38
purulence
<3 days of symptoms
inflamed tonsils
no cough coryza
thyroglossal cyst
midline cystic lump near hyoid bone moving up or down when swallow or protrude tongue
mx : ENT do Sistrunk’s procedure
branchial cyst
painless, slow-growing, smooth fluctuant swelling in lateral neck
ENT - give abx and excise
cystic hygroma
neonatal abnormality
seen on antenatal USS
usually in axillae
sclerotherapy or surgical removal
ranula
clear/bluish cyst at floor of mouth
excision incl sublingual gland
laryngocoele
air filled cyst that can bulge internally into the larynx
intermittent neck swelling that becomes palpable after valsalva manoeuvre
mx surgical excision
mx of unknown neck lump
red flag 2ww if - 45yrs+ and unexplained neck lump or persistent and unexplained and younger than that
otherwise urgent USS if unexplained enlarging lump
aortic stenosis
ejection systolic murmur loudest over aortic valve
crescendo decrescendo
radiates to carotids
if no radiation may be aortic sclerosis
mitral regurg
pansystolic murmur loudest over mitral area, radiates axilla, displaced apex beat
can develop post MI due to ischaemic papillary dysfunction
aortic regurg
decrescendo early diastolic murmur loudest at left sternal edge
assoc with marfan’s
collapsing pulse
severe AR = austin flint murmur
clinical signs assoc:
- corrigan’s sign (visible distension + collapse of neck carotids)
- de musset’s (head bobbing with heartbeat)
-quincke’s sign (pulsations seen in nailbed with light compression)
-traube’s sign (pistol shot sound when steth placed over femoral artery)
-muller’s sign (uvula pulsations seen with beats)
mitral stenosis
low pitching rumbling mid diastolic murmur
assoc with AF
malar flush a sign
triscuspid regurg
pansystolic murmur
assoc with inf endocarditis and righ ventriular dilatation
congenital cause is Ebstein anomaly
clinical signs:
right sided HF signs
v waves visible in jugular
visible hepatic pulsation
pulmonary stenosis
ejection systolic
mostly congenital assoc
pulmonary regurg
usually due to pulmonary HTN
early decrescendo murmur
Graham Steel murmur if assoc with mitral stenosis
tricuspid stenosis
mostly assoc with rheumatic fever
mid diastolic murmur rarely audible
raised JVP, RVF signs
hypocalcaemia signs
tingling, muscle aches / spasms, tetany, seizures
common thyroid surgery complication
parathyroid injury and therefore low calcium
behcet disease
arthritis iritis recurrent oral and genital ulcers
raised inflamm markers
positive pathergy test (latent papule at site of needle insertion)
nikolsky sign
differentiates intra vs subepidermal blisters
hallmark sign of pemphigus, TEN or staph scalded skin syndrome
auspitz sign
small bleeding points after removing scales
psoriasis
koebner phenomenon
new plaques / vitiligo or lichen planus in sites of trauma
sebaceous cyst
small non tender smooth mobile lump, can’t move skin over the top
lipoma
soft doughy, mobile on palpation, skin moves freely over
o/e thyroid malignancy
would move with swallowing and be hard, firm and non tender
midline and skin moves over
marjolin’s ulcer
consider if poorly healing ulcer
this is a type of SCC in a venous ulcer
likely injury falling onto shoulder tip
acromioclavicular dislocation
marked downwards shoulder displacement causes
FOOSH injuries
young - posterior displacement of radial epiphysis, greenstick # or supracondylar # of humerus
teen - # clavicle
young adult - scaphoid # or humeral #
elderly - colle’s distal radius # or humeral #
risk of humeral #
injury to radial nerve in spiral groove causing wrist drop and sensory loss at base of thumb
causes posterior shoulder dislocation
seizures or electrocution
anterior shoulder dislocation
presents with panful shoulder held in external rotation
risk to axillary nerve - injury would cause decreased sensation over deltoid + weakness of this muscle
sialolithiasis
salivary gland stones
hard lump under tongue, worse and more swollen on eating
give NSAIDs and refer ENT (+ abx if signs of infection)
I.E. signs
fevers chills malaise night sweats arthralgia
heart murmurs, splinter haem, Janeway lesions, Osler nodes, Roth spots
LUTS with normal prostate male
alpha blocker like doxazosin (can add oxybutynin if further mx needed)
give finasteride 5a reductase inhibitor to men with enlarged prostates or raised PSA
testing for chlamydia in PID
NAAT
also symptoms incl deep dyspareunia, lower abdo/adnexal tenderness
radial nere injury
numb posterior arm and dorsum hand
wrist drop
absent triceps and supinator reflex
meidannerve injury
numb lateral hand
weak pronation and flexion
weak 1-3rd fingers
hand of benediction whenflexing fingers
ulnar nerve injury
numb hypothenar area and medial fingers
weak flexion
claw hand on extension
cluster headache mx
nasal triptan
short burst oxygen therapy
after specialist input
verapamil prophylaxis
continuous murmur in baby radiating to the back
breathless sweaty FTT
patent ductus arteriosus
cyanosed newborn baby with oligaemic lung fields
pulmonary atresia
3 month old baby with cyanotic episodes and short systolic murmur at upper left ternal edge, boot shaped heart (RVH), oligaemic lung fields
tetralogy of fallot
overriding aorta
VSD
right ventricular hypertrophy
right ventricular outflow tract obstruction
CLL mx
if 17p deletion or TP53 delection then = acalabrutinib
otherwise bendamustine + rituximab
hodgkin’s vs non hodgkin’s lymphoma
Despite the many differences between these two types of lymphatic cancer, both have similar symptoms, such as:
Enlarged lymph nodes in the armpits, neck or groin
Fever and/or night sweats
Unexplained weight loss
Severe itching
Ongoing fatigue
key differences:
Hodgkin = younger patient, starts in neck / upper body, pain in LN after alcohol
first line mx for CML
imatinib (tyrosine kinase inhibitor)
ALL mx
steroids + one of many types of chemotherapy agent
unless got philadelphia chromosome then add in imatinib TK inhibitor
if younger and not responding may try CAR-T therapy
fatigue, fever, pallor, abnormal bruising, abnormal bleeding, raised LN, HSM
leukaemia
ALL
2-4 year old child
acute proliferation of blast cells, usually B cell lineage
30% of children have t 15:17 translocation
30% of adult sufferers have PHiladelphia t 9:22 translocation
assoc with Downs
CLL
chronic B cell proliferation
usually >55 yrs old
assoc rarely with warm AI haemolytic anaemia
can transform into high grade lymphoma (Richter’s transformation)
smear or smudge cells on blood film
CML
chronic/accelerated and blast phases
chronic can last 5 years and pt asympto
blast phase >30% blast cells in blood
typical change is philadelphia t 9:22
AML
most common adult leukaemia
can come from transformation of myeloprofilerative disorder (MF or PRV)
blood film = lots of blast cells and auer rods
tumour lysis syndrome
cause - uric acid release by tumour cell destruction
crystals form in kidney interstitium
cause AKI
mx with allopurinol or rasburicase
must mx other electrolytes too
atenolol and verapamil don’t give together why
severe risk of asystole and hypotension
dx uncomplicated vasovagal syncope
no features suggesting alternative diagnosis
3Ps
posture
provoking factors
prodromal symptoms of faint
epilepsy indicator symptoms needing 2ww neuro referral for EEG
tongue biting
transientLOC withhead turning
no memoryof abnormal behaviour duringLOC
unusualposturing
prolonged limb jerking(brief seizure-like activity can happen with a faint)
confusion afterwards
prodromal deja vu
incontinence
diagnose bacterial vaginosis
vaginal pH >4.5
fishy odour and discharge
transient global amnesia
usually >50
triggers can include cold/hot water, sex, heavy exercise
no neuro impairment except anterograde memory
diagnosis of exclusion
must be witnessed
usually don’t recognise others around them but know who they are
no neuro signs no LOC
no epilepsy
resolves in 24 hrs
no recent head injury
unlikely to recur
cerebral venous thrombosis
headache, focal neuro, ICH, assoc prothrombotic statae
need cerebral angiography
asympto carotid dissection incidental finding
if no prev ischaeimic issues can mx with antiplatelets / anticoags and f/up surveillance
blurred vision, conjunctival injection, dendritic ulceration to the cornea, otherwise well
herpes simplex virus keratitis
what is trachoma
cause of preventable infectious blindness in developing world
chlamydia causes
chronic keratoconjunctivitis
sudden ocular pain, halos around lights, vomiting, fixed and mid dilated pupil
acute closed angle glaucoma
diverse elbow / ankle / joint pain, hx of risky sex,, tendon swelling, vesiculopustular skin rash and unwell with fever
gonococcal arthritis
mononeuritis multiplex
multiple individual peripheral nerves affected in diverse areas
assoc AI disorders and diabetes
median neuropathy signs
carpal tunnel syndrome
can be caused by pregnancy low thyroid RA or occupational
thenar wasting, sensory loss + weakness
tinel + phalen’s positive
cubital tunnel syndrome
ulnar neuropathy
weak and wasted hypothenar
pain at elbow
tingling medial hand + ring/little finger
froment’s sign - can’t pinch and hold onto paper
meralgia paresthetica
compression of lateral femoral cutaneous nerve
numbness + tingling of lateral thigh
increased by walking and relieved by sitting
normal strength and tone
femoral neuropathy
can come on due to surgery, hip dislocation or retroperitoneal haematoma
poor knee extension + hip flexion
sensory loss around anterior leg
reduced patellar reflex
sciatic neuropathy
ankle jerk diminished
muscle weakness around ankle
sensory loss entire foot
usually assoc with hip arhthroplasty, prolonged lithotomy position etc
peroneal neuropathy
compressed at lateral border by the knee
foot drop and foot eversion
sensory loss to dorsum of foot
more common age teratoma vs seminoma
seminoma 35-45 years
tertatoma 20-30 years
palpable separate smooth lump at back of testicle
epididymal cyst
painless scrotal swelling below and anterior to testes which will transilluminate
hydrocoele
left sided painless testicular swelling
classically ‘bag of worms’ feeling within spermatic cord above testis
will disappear on lying down
veins increase on standing
may have cough impulse
assoc with infertility
if RIGHT sided needs urgent specialist referral (v rare)
2ww colorectal criteria
40+ with wt loss/abdo pain
50+ unexplained rectal bleeding
60+ with IDA / change bowel habit
+ve FIT test
psoriasis can increase risk of what
all metabolic syndrome stuff incl CVD
congenital abnormality associations with drugs (Set 1)
lithium Ebstein’s anomaly - heart defect
thalidomide - phocomelia (malformed limbs)
warfarin - can cause foetal bleeding or foetal warfarin syndrome (nasal hypoplasia, calcified femur/vertebrae, brachydactyly)
warfarin safe in breastfeeding btw
carbamazepine - spina bifida + macrocephaly
congenital abnormality associations with drugs (Set 2)
ACEx - 2nd trim onwards - IUGR, renal tubular aplasia
vitamin A - ear malformations
abx safe vs unsafe in pregnancy
SAFE:
penicillins
erythromycin
cephalosporins (cefs)
AVOID:
1st trim: streptomycin, trimethoprim (folate interference)
3rd trim: tetracyclines
hyperacute graft rejection mechanism
class 1 HLA ab activation, granulocyte adhesion and thrombosis
acute rejection then involves donor MHC 1 reacting with host CD8
phenytoin SEs
gingival hypertrophy and tenderness
child urinary symptoms
if constant incl dribbling etc then OAB - can use oxybutynin if over 5
otherwise treat as noct enuresis
mx of pt with symptomatic carotid artery stensosi
if <50% manage RFs and give aspirin
if greater than that do endartectomy
female <30 with breast lump + no suspicious featuers
refer routinely to breast surgery
breast clinic 2ww referral when
30+ with new lump in breast or axillae
any age with skin / nipple changes or sx suspicious of ca
cold agglutinins and raised antibody titres + pneumonia
mycoplasma
clari
marjolin’s ulcer
non healing sores increasing at site of scars, pus, easy bleeding, lots of granulation
type of scc
bipap indications
COPD with resp acidosis
hypercapnic resp failure secondary to chest wall deformity or neuromusc disease
weaning from treacheal intubation
obstructive sleep apneoa mx
CPAP and weight loss
use epworth scale
kawasaki disease mx
treated with single infusion IVIG and then higher dose aspirin for 2 weeks before lower dose until echo done at 6-8 weeks (can get coronary artery aneurysm complication - if clear, stop mx)
NB oral steroids are used if fever persists >36 hrs after IVIG
psoriasis indications for referral
immediate:
erythroderma (>90% skin coverage)
severely worsening / unwell pt
generalised pustular
routine if:
>10% body area coverage
psych distress
poor response to mx
psoriasis mx generic
- lifestyle advice / emollient
- topical steroids up to 8 weeks +/- OD vit D analogue
- stop steroids, try 8-12 weeks BD vit D analogue
- if still not working, add potent topical steroids (as had 4 week break) or coal tar preparation for next 4 weeks
- can try dithranol
- referral
sickle cell genetics
single gene disorder on chromosome eleven
beta globin chain issue
decreased libido, infertility, gynaecomastia, LD, normal lifespan
klinefelter’s 47XXY or 48XXXY
most common inherited cause of LD in men, sex linked, macro orchidism
fragile x syndrome
weak right triceps + brachioradialis, absent triceps jerk, normal sensation otherwise
radial nerve injury (usually get wrist drop too if Q not being stupid)
worth noting don’t always have altered sensation
amiodarone SEs
slate grey complexion, avoid sunlight
can get thyroid disorder either way
or pulmonary fibrosis
monitor with CXR and TFTs
perorbital area swollen and red, eye red and proptosed, conjunctiva chemosed, restricted eye movements, evidence of RAPD, swollen optic disc
orbital cellulitis
commonly caused by ethmoidal sinusitis which requires surgical drainage
give taz to adults and co amox to kids
OA mx
weight loss if overweight
physio / muscle strengthening
topical NSAIDs then
oral NSAIDs + PPI
joint injection with steroids
if sig impact, refer ortho
harsh systolic murmur, not changing with inspiration, biventricular hypertrophy
VSD
early peaking systolic murmur worse on valsalva and reduced on squatting, assoc with jerky pulse
LVH on ECG
HOCM
pain on resisted supination / elbow issue
lateral epicondylitis
pain on resisted palmar flexion with elbow issue
medial epicondylitis
sudden unilateral painless loss of vision, CVD risk factors, fundoscopy shows cherry red spot and pale retina
central retinal artery occlusion
hypertensive retinopathy
copper wiring - vessels appear copper colours
AV nipping - veins appeared indented
dot,blot,flame haemorrhages
cotton wool spots - retinal ischaemia
papilloedema
optic disc cupping
glaucoma
age related macular degen
drusen
if wet version, vessels grow into the macula
diabetic retinopathy basic stages with details
- background diabetic retinopathy (microaneursyms, dot+blot haemorrhages)
- pre proliferative (+ cotton wool spots)
- proliferative (+new vessels at optic disc or elsewhere)
- advanced diabetic ret (all of above + complications e.g. vitreous bleeds, raised IOP, detachment)
mx proliferative diabetic ret
panretinal photocoagulation (you see clusters of burn marks on the retina)
stages hypertensive retinopathy
- grade 1 - arteriolar narrowing
- AV nipping
- retinal bleeds, hard exudates, cotton wool spots
- optic disc swelling + symptoms of malignant HTN
central retinal vein occlusion fundoscopy
retinal hypoxia leads to extravasation of bloods - widespread bleeds, tortuous veins, cotton wools spots, disc swelling
unexplained syncope with normal inv - DLVA
don’t drive 6 months / they must inform
scarlet fever
strep throat + strawberry tongue, papular rash etc
child - tingling of lips / tongue, interference with speech / drooling / twitching of face / mouth
often begins during sleep or on waking
benign rolandic epilepsy
10-16 yrs old, generalised epilepsy with myoclonic jerks, some GCS impairment
juvenile myoclonic epilepsy
temporal lobe epilepsy
partial or focal seizures. affects speech / taste / memory -> deja vu, GI disturbance, olfactory hallucinations
repeated vocalisations, automatism / lip smacking
imaging choice for osteolytic lesions in multiple myeloma
whole body low dose CT
DPP4 inhibitor
sitagliptin
sulphonylurea
gliclazide
hard exudates vs soft exudates
hard exudate = yellow deposits of lipoprotein leaking out of blood vessels (hence diabetes/HTN disease)
soft exudate = cotton wool, in infarcted retina with swollen nerve fibres
rare causes of stridor
vascular ring - 2 week old child, worse when crying, barium swallow shows filling defect (rare)
low grade fever, hoarse cough + stridor = acute laryngotracheobronchitis AKA croup
young child with stridor assoc with painless hand / feet / lip swelling - rare condition, angioneurotic oedema
farm worker with headache, fever, myalgia, petechial rash, jaundice, fever, raised urea + liver damage
weil’s disease / leptospirosis -doxy
farm / dairy ingestion, joint pain, fever, fatigue, systemic symptoms
brucellosis - doxy
firm red papules to the hands, handle sheep
orf
acute febrile illness, risk of rodent exposure - fever / rash/ polyarthirits
rat bite fever
borfelia burgdorferi
lyme disease
bullseye rash
painless multiple scaly rash pale on dark skin, dark on pale skin
pit versicolor
painful swollen limb, tingling, febrile, dusky skin
nec fasciitis
45+ inc irregular periods, irriatble, tearful
perimenopausal
clear non offensive vaginal discharge / occasional spotting post cocp
cervical ectropion
macrocytosis, raised LFTs, mild hypothyroid
alc excess
pernicious anaemia
abs vs instrinsic factor which is needed to absorb b12
can get peripheral neuropathy and subacute combined degen of spinal cord
moa common haem drugs
heparin - potentiates antithrombin III
aspirin - blocks thromboxane
clopi - blocks platelet ADP receptors which then stops glycoprotein activation
drug related low potassium
loop diuretics, thiazides, alcohol xs, insulin, beta agonists
drug related high potass
spironolactone, ACEx, ARB, nsaids, ciclosporins, beta blockers
circumcorneal redness, blurred vision, photophobia, small pupil
anterior uveitis /iritis
e histolytica complications
liver abscess
diarrhoea
dev country poor sewage barrier
floaty stools etc
returning traveller 2 weeks ago, constipation progressing to bloody diarrhoea, gradually increasing fever, fatigue, rose spots
typhoid fever (salmonella typhi)
HIV diarrhoea
cyryptosporidium
urethritis, seronegative arthritis, conjunctivitis
reactive arthritis (common triggers can be post chlamydia or food poisoning)
assoc with HLA B27
fat sausage fingers / dactylitis, nail pitting, oncholysis
psoriatic arthritis
bronchial carcinoid tumour
neuroendo lung tumour
weight gain, high BP, hirsuitism
headache, confusion, seizure, blackout, dark urine + a cancer hx
SIADH
(right handed pt)
contralateral hemiplegia, left hemisphere neglect, dysarthria, left side homonyous hemianopia
non dominant MCA infarct
headache, fever, eye pain, cranial nerve defects, seizures (assoc with cellulitis)
carvenous sinus thrombosis
ipsilateral facial weakness, contralateral trunk weakness, dysphagia / dysarthria, vertigo, nystagmus
PICA stroke
kawasaki
5+ day high fever, bilateral conjunctival injection, polymorphous rash, strawb tongue, cracked tongue, oedema / erythema to hands + feet, cervical LNs
blood test scarl fever
anti streptolysin antibodies
fever, rash, cough, blanching erythematous rash, white/grey lesions to buccal mucosa
measles
koplik spots
discrete rose pink macpap rash, itchy in adults, large palatal petichae (forcheimer sign)
rubella
teratogenic in preg women sadly
parvo b19
slapped cheek syndrome
circumoral pallor
red cheeks
otitis externa with discharge/ unwell /hearing loss
topical abx/steroid
just acetic acid if no severe signs
cataracts pathophys
lens opacification
replace lens
nephritic syndrome
proteinuria, haematuria, HTN
Goodpasture’s / hypersensitivity angiitis
haemoptysis + haematuria
anti GBM abs
prove with linear immunofluorescence / crescent moon appearance to glomeruli
nephrotic triad
hypoalb
high prot
oedema
CKD stages
1 >90ml/min
2 60-90
3a 45-60
3b 30-45
4 15-30
5 <15
hyperkalaemia typical ECG
tall tented T waves, broad QRS, prolonged PR, flattened P waves
hypokalaemia typical ECG
prolonged PR interval, prominent U waves, T wave inversion, ST depression
hypercalcaemia typical ECG
shortened QT interval
severe = J waves
hypocalcaemia typical ECG
prolonged QT interval
carotid dissection
important cause of stroke in under 40s
string sign on doppler
palm/sole rash + septic arth
gonococcalarth
severe hyperemesis, first trim pre eclampsia, vaginal bleeding
hydatiform mole
v high bHCG
scotomas
glaucoma - arcuate scotoma
toxic neuropathy - centrocaecal scotoma
ret pigmentosa - ring scotoma
macula / AMD - central scotoma
assessing MS
MRI with contrast
polymyositis assoc
assoc malignancy in older pt 20% of time
marked weakness + tenderness
PMR criteria
bilateral shoulder/neck stiffness
onset <2 weeks
ESR >40
morning stiffness >1 hr
65+
bilat upper limb tendernes
intracapsular hip # locations
subcapital
transcervical
basicervical
femoral nail
femoral shaft
DHS
intertrochanteric or peritrochanteric #
cannulated screw hip # type
undisplaced subcapital #
hemiarth or THR preferred
displaced intracapsular hip #
hemiarth or THR
hip # classification
Garden class
1 - undisplaced, incomplete #
2- undisplaced, complete #
3 - partly displaced,complete#
4- displaced, complete #
summary of weird drowsy child scenarios
colicky abdo pain, vomiting, papilloedema - lead poisoning
severe vom and GI bleeding then drowsy and cvs compromise - iron toxicity
sudden onset drowsiness in 2 week old infant - raised PT - may be intracerebral bleed due to inadequate vit K
normal lumbar puncture in drowsy baby with EEG slow waves in temporal lobe - herpes simplex encephalitis
neuro signs / drowsy baby with african ethnicity - may be cerebral infarct assoc with SCD
older pt, excess painkiller hx, normocytic anaemia, raised creat
analgesic nephropathy
E nodosum
painful, red, bruised looking nodules to anterior leg surface
colles #
dorsal displacement of distal radius
smith #
volar displacement of distal radius
bennett #
of base of metacarpal of thumb
painful swollen thenar eminence, can’t move thumb
turner’s assoc with
aortic coarctation
clear CSF
raised WCC
mildly raised protein
normal CSF to plasma glucose ratio
viral meningitis
turbid CSF
raised WCC (++ neutrophils)
raised protein
very low CSF to plasma glucose ratio
bacterial meningitis
RA features on x ray
periarticular osteoporosis
narrowed joint space
juxta-articular bony erosions
sublux
deformity
periarticular soft tissue swelling
RA features in the hand o/e
swan neck deformity
ulnar deviation of MCP joints
boutonniere deformity of thumb
bouchard’s nodes in isolation
OA signs on x ray
subchondral cysts
osteophytes
narrowed joint space
subchondral sclerosis
heberdon’s DIP nodes
bouchard’s PIP nodes
mx shingles if immunocomp
if post transplant or on chemotherapy etc
need IV mx and admission
toddler with progressive ataxia, dysarthria, optic atrophy, absent lower limb reflexes, LVH
freidreich’s ataxia
charcot marie tooth
auto dominant
progressive sensorimotor neuropathy
presents with slowly progressive distal weakness + sensory loss
hungtindon’s presentation
chromosome 4 issue
chronic progressive personality / behaviour change, chorea, FH
unpasteurised milk
brucellosis context clue
metro doxy SEs warning
metro - no alcohol
doxy - no sun
Multiple endocrine neoplasia 1 (MEN1)
parathyroid tumours, pituitary tumours, pancreas tumours
this and MEN 2a present with hypercalc / hyperparaT
MEN2a /2b
both assoc with phaeos and medullary thyroid ca
difference is type 2b assoc with marfanoid appearance + neuromas too
subacute meningism, progressive headache, RF for HIV
fungal meningitis
target range CD4 count HIV
aim above 350 cells per mm cubed
conjunctivitis in preg lady
topical fusidic acid eye drops not chloramphenicol as pregnant
bullous pemphigoid vs pemphigus vulgaris
pemphigus vulgaris = thin walled flaccid blisters that rupture easily, intraepidermal splitting
bullous pemphigoid = subepiderminal splitting
postprandial pain, fear of eating, weight loss, vascular RF hx
chronic mesenteric ischaemia
absence seizure mx
ethosuximide
can have valproate if male
guidelines for ACE/ARB bloods monitoring
if eGFR/creat drop of less than 25% then can continue and rpt test to check stable
if more than that drop, stop drugs
guidelines for stopping antidepressants
if first episode of depression, ideally take treatment for at least 6 months before weaning down
if recurrence, for 12 months
common metastasis sites for: osteosarcoma, colorectal + breast ca
osteosarcoma - to lung
colorectal - to liver
breast - to bone
older pt, blood in urine, raised calcium level, varicocoele
renal cell adenocarinoma (classically have palpable mass, haematuria, flank pain)
wilm’s tumour
nephroblastoma
one of most common childhood malignancy, found in kids aged 3-4 yrs
ACEx and renal artery stenosis
they worsen the kidney function if have renal artery stenosis
acute interstitial nephritis vs acute tubular necrosis
AIN = hypersensitivity reaction to a drug usually, will have eosinophilia, systemic symptoms, treat by withdrawing the drug
ATN = toxic insult to tubular cells, ‘muddy brown casts’, either nephrotoxic or ischaemic cause
knee pain for a few weeks with limited hip joint movement in 6 year old
perthes aka avascular necrosis of femoral epiphysis
obese teenager with limp and groin pain with leg discrepancy
SUFE
typical vs atypical antipsychotics and EPSEs
more common with typicals i.e. haloperidol
what type of signs with MS
upper motor neurone signs
furosemide side effect
ototoxicity (may get ringing in ears etc)
contraind LP
raised ICP signs
haemodynamically unstable
purpura
seizures until stabilised
plt <100 or on anticoag
infected LP site
resp compromise
drug choice for cmv mx if mx needed
ganciclovir
drug of choice for nephrogenic DI (i.e. not respsonding to ADH)
chrlorothiazide
possible SE from statin
peripheral neuropath
mx asymptomatic renal stones
lithotripsy if <1.5cm in size and normal kidneys
normal kidney, larger stone >1.5cm
perc nephrolithotomy
symptomatic kidney stone with poor kidney func
nephrectomy
kidney stones (small) not responding to ESWL
ureterorenoscopy and holmium laser
ground glass kidney stone mx
cystine calculi
alkaline diuresis mx
dry mouth, gritty eyes, joint aches
sjogren’s
schirmer tear test dx
polyarteritis nodosa
mid vessel vasculitis
middle aged men
fever, wt loss, malaise followed by severe organ sequelae assoc with infaractions
hypertensive retinopathy emergency mx (Swollen discs)
iv labetalol
ottowa ankle rules
criteria for ankle x ray
pain in malleolar area +
- tenderness at posterior tip or medial or lateral malleolous
- unable to weight bear
fever, meningism,rash, foreign country
typhus
hydrophobia and neuropsych issues
rabies
breech position, DDH, monitoring
US scan of hips by 6 weeks to assess
mx of uterine atony
bimanual compression
then IV oxytocin/ergometrine
then intrauterine carboprost
then rectal misoprostol
then balloon tamponade / ligation of uterine arteries / hysterectomy
child around 13 months / weaning age with cutaneous and GI symptoms
CMPA
IgE mediated if urticarial rash and more immediate reaction, otherwise non IgE
dermatomyositis
myalgia, purple eyelids, orbital oedema, Gottron’s papules of the knuckles, retinopathy
biltaeral ptosis, difficulties letting go of grip, <40 presentation, FH
myotonia dystrophica (Auto dominant)
wasted mastication muscles, swan neck, ptsosis, can’t let go
unilateral conductive haring loss, fh, pinkish tympanic membrane, younger pt
otosclerosis
normal Rinne WEber findings
+ve rinnes both ears (air>bone conduction)
Weber heard equally both ears
conductive hearing loss findings test
negative rinne a.k.a. bone cond>air conduction
Weber’s lateralises to bad ear
sensineural hearing loss Rinne Weber
+ve rinne’s
weber’s lateralises to the unaffected ear
post natal urinary incontinence and watery vaginal d/c after assisted delibery
possible cystovaginal fistula
anti smooth muscle antibodies assoc
AI hepatitis
ITP defining feature
isolated low platelets
postviral autoimm complic
tetralogy of fallot tetrad
overriding aorta
VSD
RVH
right vent outflow tract obstruction
boot shaped heart
oligaemic lung fields
cyantoic congential heart defects
tetralogy
transposition of arteries
tricuspid atresia
pulmonary atresia
acyanotic congenital heart defects
VSD
ASD
PDA
coarctation
down and out eye nerve lesion
third nerve (oculomotor)
expressive dysphasia, personality change, disinhib, anosmia, grasp reflex, incontinence
frontal lobe lesion
visuospatial,language loss, sensory change
parietal lobe lesion
dominant hemisphere lesoin
dysphasia, apraxia, left right disorientation
non dominant hemisphere lesion
contralateral neglect
prosopognosia
memory /verbal changes, personality change, receptive dysphasia
temporal lobe lesion
homonymous hemianopia
occipital lobe lesion
ipsilateral deafness, nystagmus, corneal reflex reduced, ipsilateral cerebellar signs, nerve palsies 7/5
cerebellopontine angle lesion
unequal pupils, eye muscle paralysis, amnesia, sleepiness
midbrain lesion
fever, AKI, cerebral dysfuction, low platelets, microangiopathic haemolytic anaemia
TTP
rare
small and distorted pupil
anterior uveitis /iritis
solitary fleshy vascular lesion, rapidly growing and easy bleeding
commonly on fingers and hands
pyogenic granuloma
benign
mx endometrioma
chocolate cyst
need gnrh analogue pre surgical resection
hypersensitivity reactions categorise
acid
allergic - type 1 - immediate
cytotoxic - type2 - ab mediated
immune complex deposition - type3
delayed / cell mediated - type 4 - e.g. graft rejections
itchy rash on nipple
paget’s disease of nipple, assoc breastc a
common long term drug monitoring blood test frequency
amiodarone - TFT/LFT/U+E 6monthly
azathioprine - FBC, LFT 3 monthly
lithium - U+E, TFT, plasma levels, 6 monthly
methotrexate - FBC, U+E, LFT 3 monthly
clozapine monitoring
weekly FBC until week 18 after initiation
then monitor 6 monthly alongside lipids, glucose
yearly health monitoring
MCA strokes
contralateral hemiparesis/sensory loss + contralateral homo heminanopia
left hemisphere typically dominant
dominant MCA stroke - added aphasia
non dominant - added hemineglect
lacunar stroke
pure hemiparesis alone
pure hemisensory loss
and others
infected nasal swab / tampon / more rarely infected wound with fever / rash / low BP / diarrhoea / skin changes
toxic shock syndrome
microcytic anaemia with normal MCHC and raised HbA2
beta thalassaemia
hba2 decides thisover alpha
holmes adie syndrome
absent knee and ankle jerks with dilated unreactive pupil
young females, unknown cause
miosis, ptosis, reduced sweating to forehead of same side
horner syndrome
assoc lung ca
post MI meds
ACE inhib, dual antiplatelet, beta blocker, statin
pericarditis
nsaids until asympto then 3 months colchicine
gonorrhoea, chlamydmia mx
gonorrhoea - im cef
chlamydia - doxy or azithro if preg
wells score dvt likely
2+ points
summary transfusion reactions
febrile - most common, small temp rise minute afterwards - supportive
haemolytic reaction - ABO incompat - v bad, IV fluids, diuretics
allergic reaction - urticaria - antihistmaines, continue
TRALI - ARDS type reaction, stop tranfusion, treat airway
TACO - SOB (fluid overload), slow down rate and give diuretics
anitcholinergic syndrome signs
flushingk dry skin, mydriasis, loss of accommodation, fever, sinus tachy, constipation
give activated charcoal, gastric lavage
give physostigmine if tachydysrhythmia
treating hirsuitism in pcos
COCP with cyproterone acetate
pcos trying for baby
clomiphene (stimulates ovulation)
risk of OHSS
dka mx
fluid resus first then VRII
common cancers that met to bone
BPKLT
breast prostate kidney lung thyroid
conn’s and mx
HTN, hypokalaemia, hypernatraemia
mx with spironolactone
types of thyroid cancers
papillary - local spread only
follicular - more aggressive and invades lungs
anaplastic - very very aggressive and invades trachea / oesophageal areas
medullary - produces calcitonin
MS signs
intention tremor
nstyagmus
slurred speech
uthoff phenom (worsening neuro func with high temp)
lhermitte sign (elec shock bending neck forward)
ataxia
monitoring GBS
may affect resp muscles so need to monitor FVC in case you need intubation
mx ivig plasmapharesis
bitemporal heminanopia lesion location
optic chiasm / pituitary
homonymous hemianopia lesionlocation
contralateral optic tract
homonymous quandrantanopia lesion location
contralateral optic radiation temporal lobe
homonymous heminaopia with macular sparing lesion location
contralateral occipital cortex
Ab vs desmosome
pemphigus vulgaris
ab vs skin basement membrane
bullous pemphgoid
difficulty reading, distorted straight lines
age releated macular degen
atypical pneumonia sx in farmer, usually abroad, contact with ticks / animals
think q fever
ddx hyponatraemia
true = low sodium, low serum osmolality
hypovolaemic - GI loss, diuretics, burns/skin losses
euvolaemic - SIADH, low thyroid, low adrenals
hypervolaemic - HF, liver failure, renal failure, nephrotic syndrome
NB - if urinary sodium >20, cause is some form of renal loss, if urine osmolality very high 500+ only SIADH
ethambutol
may cause optic neuritis
most common causes nephrotic syndrome
minimal change (most common in kids)
membranous nephropathy
amyloid
lupus
diabetic nephropathy
focal segmental glomerulosclerosis
most common cause nephritic syndrome
IgA nephropathy (post viral reaction - days after)
HSP (IgA vasculitis - may precede IgA neprho)
post strep glomerulonephritis (weeks after)
granulomatosis with polyangitis (saddle nose)
Goodpasture’s (anti GBM abs)
haemolytic uraemic syndrome (post E coli infection)
high unconjugated bilirubin
means pre hepatic cause aka haemolytic
if high conjugated = hepatic or posthepatic
monteggia vs galeazzi fractures
monteggia - ulnar # with dislocated proximal radial head
galeazzi =radial # with dislocated distal ulnar
pterygium vs pinguecula
pterygium - fleshy triangular mass extending over cornea
pinguecula - small yellow blob not over cornea
both due to irritated conjunctiva
leukoplaki
white lesions to mucosa that can’t be brushed off, assoc with alc,smoking
may need biopsy as assoc scc
NB if towards edges of tongue, assoc EBV in immunocomp patient
pit rosea
herald patch then xmas tree lesions, due to one of hhv viruses
burn body % calcs
head - 9%
upper limb - 9% each
trunk - 36%
genitalia - 1%
lower limb - 18% each
de quervain’s thyroiditis (subacute thyroiditis)
viral illness then hyperthyroid with neck/jaw pain + fever
then progresses to hypothyroid
grave’s vs hashmoto’s thyroiditis
grave’s has anti TSH abs but frequently has anti TPO as well
more likely grave’s if got the eye symptoms too
