Pelvic mass Flashcards

Question

PCOS Hirsutism and acne Tx - ?? --> ?? and what else?? Infertility Tx - ? ---> (? > ?) Amenorrhoea tx? -TVUSS - Endomet thickness (THICK = ?action ... due to ? ) (NORM = ?hormonals )

Answer 1

Hirsutism and acne - Dianette/COCP --> -Eflornithine + -Flutamide/Finasteride/Spiro Infertility - WL --> (CLOMIFENE #refer > metformin) Amenorrhoea: - Cyclical Prog = Medroxyprog = NOT contracep dose !!! - COCP (not @fatso/UKMEC3-4) - Levonorgest-iuS= fat+need contracep -TVUSS - Endomet thickness (THICK = refer ?hyperplasia/cancer) (NORM = MMC mirena / medroxy-prog cyc-prog / cocp)

Answer 2

CA125 - Ovarian Cancer/Cysts, - Periods, - Endometriosis ``` Ovarian cancer types: MOST COMMON CAUSE OF OVARAN: -CANCER = SEROUS cancer -BENIGN tumour < 25y = DERMOID Teratoma -ENLARAGEment @reproductive age = FOLLICULAR cyst ``` -Epithelium - sero / mucinous --> (@rupt = pseudomyx peritonei) MUCIN IN ABDO!!!!! BLUERGH ``` -Germ-cell ChorioTropho/ Embryonic/ Terotoma-dermoid/ YolkSac/ Dysgerminoma ``` -Sex-cord = Granulosa / Thecoma / Leydig-Sertoli Type of Ovarian Cyst -Follicular > Corpus luteum Complex cyst = cancer = REFER Ovarian teratoma --> Psych dx, memory dx, encephalitis, seizures, dyskinesias, autonomic dx, language dx = Anti-NMDA

Answer 3

________________HRT* _____________Cycli ¦ Contin Predictible______ Y ¦ N bleed_____i.e.@peri-mp ¦ i.e.@mp LBP _________<1yr ¦ >1yr / >2yr @POF *HRT = Endomet? (Y = O+P* / N = O) O+P*(P=protect against Endo cancer) __________ Vasomotor syx tx? - Clonidine - NH - SSRI - NH - SNRI - NH - HRT = hormonal Atophic vag - top oest ± Lubricants and moisturisers

Answer 4

@MP - Bleed Stopped: LMB-age ¦ contraception until... - --<50 ¦ 2yr AFTER LMB - -->50 ¦ 1yr AFTER LMB @STILL bleed >40yr ____Age ¦ COCP/Combo ¦ Depot ---<50 ¦ cont till 50 --->50 ¦ NH/ius-pop-implant @STILL bleed >40yr ____Age ¦ IuS/POP//Implant ---<50 ¦ cont till 55 --->50 ¦ cont till 55/check bleed pattern -> FSH: - check if stop b4 55 - >30 = cont ius-pop-implant for 1 year

Answer 5

``` Pros: OCP Cancer: OOOvarian, EEEndo, COLORECTAL Periods: heavy=fibroids / pain-endomet ``` Cons: BV BBBreast/CCCervical* VTE *(Ectropion) (ECTZ column cells - Cold Coag) __________________ ``` Cons of HRT: BEVi Breast (prog increases this) Endomet (prog reduces this) VTE / IHD (Transdermal HRT reduces this) iNC Fibroid size __________________ ``` Ovarian Failure - MP Premature ovarian failure = MP syx + high FSH/LH < 40yrs ------ 1% women. menopause = 12 months of amenorrhoea AFTER the LMB Avg age women MP = 51

Answer 6

``` PRIMARY: CMFT Anorexia B444* puberty!!! #PRE-pubertal CAH/5alphaReduct, Malformation, Feminisation-AndInsensSynd, Turner + genetic dx ``` *GnRH release will be delayed, hence PRIMARY - otherwise Anorexia generally = SECONDARY SECONDARY: SHeePGOAT Stress HCG - preggers Excess Exercise Prolactin Gonadotrophins - MP/POF;Asherman;PID;Sheehan Oestradiol - MP/POF Androgen - PCOS TFT ________________________________ Infertility in men? ``` V - HF/LF/RN I - orchitis (STI/mumps) Neoplasm D - saulfasal/infliximab I - Trauma/Surg/WARM BALLS C - Cryptoorchid Ai Thyroid dx T - Trauma/Surg/WARM BALLS E: DM / HYPERTHERMIA _______ ``` pros: Ov/Endo cancer prevent Colo cancer prevent Periods lighten(fibroid)/pain ease (endometriosis) cons: breast/ cervical cancer VTE

Answer 7

Asherman's syndrome

Answer 8

Missed miscarriage -TVUS = no fetal heart.

Answer 9

Primary Dysmenorrhoea Nsaid/paracetamol Cocp/pop Gnrh agonists/surg ________________ primary AMENorrhoea (failure to START menses by the age of 16 years) _________________ POF = MP syx + high FSH/LH < 40yrs ------ 1% women. ___________________ Primary Infertility = couples who HAVE NEVER conceived.

Answer 10

Secondary DYSSSmenorrhoea REFER TO GYNAE ASAP!!! UNDERLYING PATHOLOGY C-CHAF: - Cancer-Cavity dx(PID/IuD/Polyp) , - Histolog dx, - Adenomyosis, - Fibroid, - Endometriosis) REMEMBER menorrhagia=CHAF/Dysmen=Endometriosis but for this condition it all could cause Dysmenorrhoea so Ix for both 🤷🏽‍♂️🤦🏽‍♂️ ________________ Secondary AMENorrhoea = bleeding PREVIOUSLY occurred - - > now stopped for at least 666666666666666 months ________________ Secondary Infertility in couples who HAVE PREVIOUSLY conceived.

Answer 11

MFOL - Menstruation d1-5 - Follicular - Endomet PROLIF phase - Ovulation d14 - Luteal - Endomet SECRETORY phase Follicles: primordial, primary, secondary, tertiary Physiologic changes @preggers -rises: everything else -drops: Hb + BP ______________ 1. MENSTRUATION d1-4 - > mucus = THICK + forms a PLUG @EXT OS 2. FOLLICULAR phase (endomet prolif phase) d5-13 a. -FSH peak = follicle development - - > -oestradiol peak = body temp falls - - > -LH peak - - > ovulation b. mucus = clear, acellular, low viscosity, 'stretchy' spinnbarkeit just b4 ovulation 3. OVULATION d14 -Tertiary follicle - - > corpus LAD #Luteum, Albicans, Degraded. 4. LUTEAL phase (Endomet SECRETORY phase) a. Corpus Luteum secrete Prog -> Body temp RISES after ovulation b. If fertilisation NOT occur, corpus luteum degenerate and prog lvl fall) d15-28" ___________________ Oestrgoen secreted -> so body TEMP FALL B4 Ovulation Prog secreted by the Corpus Luteum -> so body TEMP RISE After Ovulation

Answer 12

Vulval carcinoma = commonly @labium MAJORA. ULCERATED Melanomas = usually PIGMENTED. VIN = WHITE/PLAQUE-like NOTTTTT ulcerate

Answer 13

``` Abortion/Miscarriage >12w TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic Evac after miscarriage ``` - I AM DE Acne Rosacea tx = 8-12 weeks mild/mod - ltd pap/pust = -TOP: Ivermectin / Azelaic/Metro @preg/BFeed mod/severe - ext pap/pust ± plaques -PO Doxy / Erythro @preg/BFeed ______ ``` Pityriasis versicolor Ix: skin scraping MCS @preg/BFeed = give Ketoncon Preg/BFeed CI: Selenium / Flucon/Itracon Tx: ASKIF ```

Answer 14

``` Abortion/Miscarriage >12w TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic Evac after miscarriage ``` A. 8-12 wks - - Booking - overlap w/ Down's nuchal scan ``` B. 11-13 -Down's + Nuchal scan -overlap w/ booking __________ C. 28 wks - 1st dose of anti-D prophylaxis @RhNEG - 2nd Anemia/AlloAB test @28w ``` ``` 34 wks: 2nd dose of anti-D prophylaxis @RhNEG __________ D. 36 wks: -BFeed / Blues -ECV ?Presentation legit -Vit K ``` ``` @viral load < 50 @ w36: VAG > C-section - IF c-section, then b4 c-section: IV zidovudine After birth: < 50: PO zidovudine @neonate > 50: Triple ART @neonate ________ ``` Mother: - BabyBond - Reduce BreastCancer / PPH-risk Kid: i-AIRD - Infections - Allergy/ IBD / RA / DM 1 ``` MMR CI Live vaccine <4w Ig tx / 3m Preg avoid @MMR<4w Preg avoid @MMR<4w IC Neomycin allergy ``` Influenza vacc = egg allergy?

Answer 15

Bradycardia < 100 -Beta-blocker / vagal tone Tachycardia > 100 -Infection / Prematurity ___________ Early Decel -head compression #normal Late Decel -asphyxia/placent insuff #hypoxia -> DO FETAL BLOOD SAMPLING -> ?c-section ___________ Variable decel -cord comp Loss of baseline variablity -Prematurity / Hypoxia

Answer 16

SGA: small for gest age = <10th centile Down's babies generally smaller - have own chart Macrosomia - hypoglyc / obstructed labour /disticia iuGR - CVD / DM iuGR -> 'stressed' generally -> cortisol release -> lung MATuration -> LESS RDS @iuGR small mum = small baby _______ Antidepressants in preg/BFeeding? - Sertraline + Fluoxetine @preg - Sertraline @BFeed OTC->HCG: OTC preg test positive @day 10 serum HCG detected by day 11 G=total pregnancies ``` P: x- births >24w + y=pregnancies <24w losses _______ ``` Preg -> BELL'S palsy

Answer 17

Penile fracture Which layer damaged? -tunica albuginea Urethral dx most likely @ -both corporsa cavernosum Ix @urethral injury? --Retrograde/Asc urethrogram -> SPC Ix for the actual dick? - caverno-sography - MRI ``` Tx: -Hematoma evac -Fix T.Albuginea + Urethra -SPC ________ ``` Bladder rupture: - Tx = Conservative Foley urinary catheter - LAPARATOMY @intraperitoneal __________ Phimosis: if dont clean under foreskin, 2 issues? - stones @pre-putial sac - penile cancer Conservative Med: Steriods Surg: Circumcision ______ Bulbar rupture --Retrograde/Asc urethrogram -> SPC Membranous rupture --Retrograde/Asc urethrogram -> SPC __________ Bladder/urethral rupture - IVUrogram or Cystogram - intraperitoneal = LAPARATOMY - extraperitoneal = Conservative + Foley Catheter

Answer 18

Tight white ring + phimosis @foreskin tip -BXO-LSclerosis Flat-pap #ulcerate @foreskin = SqCC Red-velvet plaque = EoQ SqCC-IS Orange/ red/ pinpoint = Zoon's balanitis Reactive Arthiritis -> red plaque , ragged white border = Circinate balanitis ________ BPH tx: Conservative: - Alco/Caffeine/Fizzy drinks - Constipation - Ex/diet - Sweeteners/Smoke stop Med: - alpha-blocker Tamsulosin = post hypoTN - 5alphaReduct-i = Finasteride - Finasteride take 6 months before results Surg: TURP -> TURP syndrome #glycine #HYPOnatraemia __________ -Non-semi=Choriocarc.Embryonic.Teratoma.Yolk-sac #germ -Seminoma #germ -Non-germ=Leydig-Lymohoma.Sertoli-Sarcoma _______________ ........(NSemi......Semi)....NGerm AFP/ hcg: high ..................... Age: .....(20-30......40).......50 Prognosis:............good) GERM: AFP 60% ; LDH 40% -hcg 20% @seminomatous ``` FHx Undesc Crypto-Orchid Kleinfelter Infertility TIN --> size/shape/texture change = 2WW + USS TESTES !!! ```

Answer 19

``` When to USS testicle? Hematocele @non-trauma -if < x3 V contralat = chill Hx of pain/ persistent/ trauma Hydrocele = 20-35 Uncertain ddx Testicle = ETvTesticle ? _________ ``` ``` Varicocele - Refer: -Sudden pain -Not drain @supine -R-sided varicocele -TGA = low volume _________ ``` ``` When 2 refer for Urology: -Torsion -AEOrchitis -StrangHernia -Hematocele TRAUMA _________ Dx = Hydrocele ``` For CONGEN hydrocele: -Reassure < 2yrs -when 2 refer for paeds: Hydrocele @SCord /Abdo-Scrotal Hernia Hernia = Inguinal /Strang For non-CONGEN hydrocele: -Surg/Sclero/Asp __________ Varicoceles - how 2 manage: G1/subclin -Reassure, Analgesia, Infertile 33.3%, Supportive underwear -@G2/3 Symmetrical - Annual exam Asymm = Urology ref Syx OR Abnormal semen = Urology ref Asyx AND Normal semen = Semen analysis __________ ``` Congenital inguinal hernia – paediatric surgery ASAP incarceration risk <6w - surg <2d <6m - surg <2w <6y - surg <2m _____________ ``` ``` Infanta UMBILICAL hernia No tx - resolve <3yrs -Assoc with HypoT !!! If Syx/ Large = Surg @2-3yr -If Asyx+Small = ?Surg @4-5yr ```

Answer 20

yellow/green -strawberry cervix -smelly Dx? Trichomoniasis Tx? Metro ``` Chlamydia= Doxy /Azithro 7d//////2d, respectively Refer for: -GUM -Repeat infection @25/+ y/o = high p(re-infection) -Avoid sex after ABx end/Azithro +7d -STD screen/ Safe sex -Sex-abuse < 18yrs ``` Gonorrhoea=Ceftriax IM /Cipro - Asyx = NAAT 2/+w after ABx end - Syx = C+S 3/+d after ABx end Syx men = C+T: - all partners < 2w - most recent partner if >2w The rest i.e. Asyx men /Women - C+T all partners <3m _______ PID: Mycoplasma genitalium -moxifloxacin / ceftriax -> Azithro Gon high risk = Ceftriax+Doxy+Metro Gon low risk = Ceftriax/Oflox

Answer 21

EOrchitis 3 causes: - E.coli - (anal sex/ catheter) -> Cipro - STD - (Age <35) -> Ceft+Doxy /Cipro - Mumps - (supportive) - MSU/dipstix --f/u2w-> ``` f/u = ?ABx change + Refer @UTI/ STI/ Fail ___________ UTI tx? -Cath change @7/+d -ABx/Analgesia -MSU/ Dipstix -Preg = Tx NOW; ANC @GBS-agalactae ``` Refer: - S+F dx - Atyp org - Recurrence/Persistence - CATHETER - Atyp org - S+F dx -TwoWW@ 45/+ + vHU 45/+ + vHU + (UTI + Tx fail) 60/+ nvHU + - dysuria / inc WCC - recurrent/persistence ``` IC/ Urology dx @prostatitis = REFER -Acute = cipro+CS --f/u=2d-> C+S result d/w @f/u -ABx accordingly -GUM @STD ``` Chronic = -Lactulose @pain-poo, Alpha-blocker, CBT/ADep, Trimeth ________ 45/+ + vHU: -w/ UTI + Tx fail -w/out UTI ________ Cx UTI — UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure) -Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC) Recurrent = Relapse/Reinfeciton -UTI 2/+ / 6 m -UTI 3/+ /12m - Relapse — same strain infection - Reinfection — different strain infection

Answer 22

AStenosis -S4=HOCM/HTN/ASten Asyx = OBSERVE Asyx >40/50mmHg + LV sys dx = SURG Syx = valve replacement -> balloon valvuloplasty Ax Aortic stenosis: <65 - bicuspid aortic valve #TURNER >65 - calcification Rheumatic Fever ________________ ``` For bioprosthetic valve for OLDER Inc risk of calcification >65 get aortic one >70 get mitral one Long term AC not needed, give aspirin ``` For mechanical valve for YOUNGER Inc risk of thrombosis Give warfarin + aspirin if IHD. ____________ S1 = AV valves mitral/tricuspid closing soft @Regurg loud @MS ``` S2 = Aortic/pul closing soft @ASten Loud @ -HTN, Hyperdymamic states, -ASD-PulHtn ``` Wide s2- delay RV empty -(PS; PAH{MRegurg severe}; RBBB) Paradox s2 -WPW-b, AS/LBBB, RVPacing, PDA Fixed s2 - ASD S4 = atria contract against STIFF ventricle HOCM/HTN ASten ``` S3 = diastolic filling of ventricle Const pericarditis - pericard knock, X+Y, X ✔️; Dilated CM, MRegug NORMAL<30y ____________ ``` 1st and 2nd degree: K+low; IHD; myocarditis; Beta-blockers; Athletes; Digoxin 3rd degree complete block: iHD, Fibrosis; AS; Surg/Trauma; Congen ____________ Pericardial rub - pericarditis Pleural rub - pneumonia/PE Pericardial knock - C. Pericarditis ____________ LBBB=CM, HTN, AS, IHD RBBB=PE, ASD, Normal ___________ RAD vs LAD A(R>S @ V1) - WWPW - B (S>>>R + Tinvert)+ VT AAAArm switch/dextrocardia RRRRVH - LVH Lat (circumflex) - MMMMI - Inf (RCA) TTTTall thin = RAD Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular) ``` p176 ECG John Hampton book _______ LVH: R>25mm @V5+6 Inverted T @ V5+6, 1, VL LBBB+LAD ``` RVH: R tall @ V1 Inverted T @ V1+2, RBBB+RAD Bifid/Broad P-mitrale +/- AF = LAH -MS -> LAH Peaked P-pulmonale #RAH -TS>RVH(PS/PAH) As per John Hampton p112 ____________ Tamponade/ Severe asthma: - PAH, AR/ASD, High Left EDV AS _________ AR/PDA/ Incr requirement LVF _________ HOCM/Aortic valve Dx HOCM _________ J = hypothermia HyperCalcemia Widespread ST elevate = pericarditis _________ PR depression = most sensitive for pericarditis!!!!! pericardial knock = constr pericard _______. - Collapsing pulse = AR/PDA/ Incr requirement - Wide Pulse Pressure = AR/PDA/3rd HB - Narrow Pulse Pressure = ASten - slow rising pulse = ASten

Answer 23

Catheter UTI = TANP 7d -do NOT treat Asyx bacteria @catheterised pts Recurrent UTI = TANC (TN>AC) proph SD @: - expose2trigger - ON Preg: - Asyx BU == NAC 7d - UTI @preg = NAC 7d Bog-standard UTI w/ no catheter/preg -man = NT 7d -woman = NT-PF 3d _________ ``` Kids: 1. UTI < 3m = Refer asap + ABx + C+S ``` 2. UTI > 3m = dipstick -> - nitrite POS AND leukocyte POS = ABx - nitrite POS + leukocyte NEG = ABx - nitrite NEG + leukocyte POS = UrineMCS --@infants and toddlers, sample = Clean Catch Urine -fail-> Suprapubic Kids >3m Upper-UTI #fever + flank-pain - Pyeloneph = Cefalexin/ Co-amox Kids >3m Lower-UTI - TANC (TN>AC) - Even recurrent = -TANC (TN>AC) /6m-r/v Kids < 3m U or L-UTI = Refer asap + ABx + C+S _______ ``` USS-KUB @: Flow dx / Mass Atyp org Sepsis Tx fail Recurrence, USS-KUB@: - acute infection if < 6m/o @recurrent - <6w if > 6m/o @recurrent ``` Acute infection @Recurrent /Atyp< 3y --4-6m-> DMSA #parenchymal dx For reflux = MCUG ______ Recurrence: x2 (L-UTI + U-UTI) x1 (L-UTI + U-UTI) AND x1 (L-UTI) Recurrent = Relapse/Reinfeciton - UTI 2/+ /6 m - UTI 3/+ /12 m - Relapse — same strain infection - Reinfection — different strain infection

Answer 24

Ear wax imapction Perf Tymp Memb ______ AOM: earache/TUGGING/rubbing/crying/restlessness ear reveals a BULGING tympanic membrane -H.Flu !!! OME (glue ear) — @otoscope = effusion and air fluid levels/bubbles w/ normal/RETRACTED tympanic membrane landmarks #conductive hearing loss. speech and language delay, behavioural or balance problems CSOM — 2 WEEKS!!!! persistent inflammation and PERF of the tympanic membrane with discharge Myringitis-bullous -mycoplasma -erythema/injection of tymp memb _________ Otitis Externa 1. -Otomise -> -Fluclox/Erythro 2. -REFER + Cipro @malig otitis ext -> 3. Tx fail = ?dermatitis/?fungal -top c.sted/top a.fungal Viral conjunctivitis _________ Cholesteatoma -pars FLACCIDA Tympanosclerosis _________ Allergic Rhinitis

Answer 25

AOM: MUSIC FBI PUNK Admit @ - Mastoiditis/Meningitis - Unwell systemically#<3m >38deg - Sinus Thrombosis - IC Abscess - CN 7 paralysis ABx @: - Fail tx / 4/+ days - Bilat @<2yr - IC - Perf /Discharge - Unwell - Kidney liver heart etc dx Tx: Analgesia + Amox/Clari- > worsen but NO MUSIC = Co-Amox ______ Sinusitis <10d Syx - NO ABx Sinusitis >10d Syx: -nasal c.sted ABx only @ Cx: - Systemic dx - Peri-orbital/orbital cellulitis - Ophthalmoplegia - Sub-periosteal abscess - Meningitis Tx = PMP-V -> Co-Amox/ Doxy @allergy __________ 1. Fever > 38/ 3-14y 2. Purulent exudate Admit <3d 4. No cough/Coryza Inflamed tonsils 6. C.LNopathy FeverPAIN 4/5 = PMP-V Centor 3/4 = PMP-V ________ ``` -Persistent OME IN BETWEEN episodes due to EUSTACHAIN BLOCKAGE -Persistent C.LNopathy -Epistaxis Tx = 2ww NPCancer!! ``` ``` If recurrent AOM @... -Unexplained -Adult -Downs/Cleft #Craniofacial dx --> Refer __________ ``` OME: ASAP refer @Downs/Cleft / Cholesteatoma/ Hearing-loss WW <12w (± Auto-inflation @older kids): -2 PTAudio+Tympano-metries 12w apart - OM -> perf = Amox - Hearing-aid(/Surg* @Down's/Cleft) @BILAT -OME - Auto-inflation: CI @URTI/pain - Myringotomy + grommet ± Addenoidectomy* Grommets usually stop functioning after 10m CSOM >2w = ENT -Cleaning, ABx, Top c.steds Cholesteatoma = ENT -CT + Audiology

Answer 26

Sinusitis <10d Syx - NO ABx Sinusitis >10d Syx: -nasal c.sted ABx only @ Cx: - Systemic dx - Peri-orbital/orbital cellulitis - Ophthalmoplegia - Sub-periosteal abscess - Meningitis Tx = PMP-V -> Co-Amox/ Doxy @allergy __________ 1. Fever > 38/ 3-14y 2. Purulent exudate Admit <3d 4. No cough/Coryza Inflamed tonsils 6. C.LNopathy FeverPAIN 4/5 = PMP-V Centor 3/4 = PMP-V ________ ``` Allergic Rhinitis: Mild-Mod: AHist > MastCellStab 1. AHist: - a. Intranasal Azelastine > - b. Oral AHist > ``` 2. MastCellStab-NaCromoGlic Mod-Severe/ Mild fail: -Intranasal Csted Chronic Bilat rhino-sinusitis? -saline nasal douches -Chronic UNILAT rhino-sinusitis = 2WW!!! ________ -PERENNIAL all year - house dust mites -seasonal hay-fever - spring/summer* -Occupational ________ 1. House dust mites - all the time/ALLyear #PERENNIAL 2. Pollens:* - Tree = spring - Grass = early summer - Weed = spring/summer/autumn 3. Occupational

Answer 27

Bastards: ``` Acoustic neuroma: #NF2 CN 5 7 8 affected -corneal reflex dx V1 -facial nerve palsy - CN4 -sensorineural vertigo tinnitus CN8 ``` MRI cerebello-pont angle -> Surg ________ Most common salivary gland tumour - parotid 80% I--> most common paroid tumour = Pleomorphic Adenoma > Warthin's tumour __________ ``` Recurrent unilat pain/swelling @EATING -submandible = Wharton -@face-side = Stenson @parotid -infected = Ludwig angina - ivdu floor of mouth dx ___________ ``` Tonsilar SCC is associated with HPV infection Audiogram: -if ONE ear low than other AND -Bone > Air Dx = MIXED hearing loss Presbycusis - Sensori A>B - HIGH-freq -B/L Otoscloersis - Conductive B>A - LOW-frew -B/L Low libido + ED -> Psycho-Somatic ED Ix -morning Testost > FSH/LH/Prolactin Normal libido + ED -> Organic cause... need to Ix (usualy vascular dx) B P P V = Vertical nystag Vestib = horizontal nysag -Still going on -> Vestib REHAB exercises!!!! Aspirin + NSAIDs taken in HIGH doses can cause tinnitus ``` UTI 4w Biopsy 6w Ex 48hr Ejac 48hr DRE 7d ``` Perf Tym Memb -NO infectoin -hx of barotrauma WW 6-8 weeks Post-tonsillectomy haemorrhages should be assessed by ENT Primary haemorrhage WITHIN HOURS hours after tonsillectomy = immediate RETURN 2 theatre Haemorrhage 5-10 days AFTER tonsillectomy = Wound infection -Tx = ABx AOM pathogen = H. Flu Branchial cyst: - benign, lateral, UNI-lateral neck mass - acellular CHOLESTEROL crystals Top decongestants for prolonged periods = TachyPhylaxis Prostate Cancer: RT risk = COLOrectal cancer Fluid AROUND testicle #CANNOT FEEL testes -TRANSILLUMINATES Dx = HYDROCELE

Answer 28

A 31-year-old woman is diagnosed with a primary herpes infection at 35+2 weeks gestation. She does not have any other medical problems. She has had a normal pregnancy up to this point. A Caesarean section is planned for delivery at 39 weeks. What treatment should be initiated? - Oral Aciclovir 400 mg tds until DELIVERY - c-section The oral contraceptive pill is associated with drug-induced cholestasis Helicobacter pylori infection is also associated with duodenal ulceration > gastric ADENOcarcinoma + atrophic gastritis + MALT lymphoma Hoover's sign differentiates between organic and non-organic lower leg weakness Parkinsons disease should only be diagnosed, and management initiated, by a specialist with expertise in movement disorders - Don’t just start levodopa - Refer URGENTLY In sickle-cell, acute painful vaso-occlusive THROMBOTIC crises should be diagnosed clinically #dactylitis #peripheries in pain – infarcts of bone etc - Oxygen, Hydration, Analgesia - HOHuria = PREVENTION of crises Eosinophilia is a feature of ALLERGIC bronchopulmonary aspergillosis Look at isoelectric lead -> find lead perp to isoelectric lead -> find direction of that perp lead - If positive = LAD - If negative = RAD - If neither = normal A 22-year-old man is referred to urology with possible urinary retention. He is passing huge amounts of urine. Post void bladder ultrasound is normal. - Craniopharyngioma -> Diabetes insipidus - Bitemporal hemianopia.

Answer 29

HYPERthyroidism = oligomennorhoea, or amennorhoea, whereas HYPOthyroidism = menorrhagia - patient has proximal muscle weakness (difficulty getting out of chair and combing hair) consistent with myopathy - This type of myopathy can be due to drugs (glucocorticoids), connective tissue disease (e.g. polymyositis), neuromuscular (e.g. myasthenia gravis) disease or endocrine (e.g. hypo or hyperthyroidism). Myelodysplastic syndrome -> leading to ANT Myelofibrosis neutropaenia, WITHOUT anaemia/TCP -> @early disease: spleen compensate for RBC + Plts production. @dx progression: spleen production tapers off = RBC + Plts numbers begin to fall ``` _____Hb WCC Plt | Philadel JAK2 Hb high high high - JAK2 WCC low high high - 9,22 Plts ASP + HOHuria FibroBlasts low = HSM/Teardrop/Bone -PRV / CML / ET / MyeloFib ``` Polycythemia - RBC mass: -low = Relative: Acute=Dehydration Chronic=HTN/Alco/Obesity/ ``` -high = Absolute Pri = PRV* 2ndry = Altitude/ COPD/ EPO-OSAS ``` *(Abnormal bleed, SMeg, HTN/Hyperviscos, Itch @shower/ Plethoric) ULTx @: - Two/+ attacks/yr // Tophi/joints - Urate stones - RF GFR <60 - Proph @cytotoxics/diuretics/pyrazinamide the British Society of Rheumatology Guidelines = advocate offering ULT to all patients after their FIRST BASTARD attack of gout -Offer allopurinol TWO weeks AFTER attack with colchicine cover ``` Hyperacute transplant rejection -minutes to hours -is caused by pre-existing ABs against ABO or HLA antigens ``` Acute graft failure (< 6 months) = mismatched HLA - Cell-mediated (cytotoxic T cells) - Tx = steroids + immunosup Chronic graft failure (> 6 months) = both AB + cell-mediated mechanisms -> fibrosis to the transplanted kidney #chronic allograft nephropathy -get recurrence of original renal disease (MCGN* > IgA > FSGS) -MesangioCap/MembProlif GN ``` S-SSI-S G=Stop+Steds A=Stop+Saline D=Stop+IVIg N=Stop+Slow+Paracetamol ``` Acute GvH stop + steds --PAINful MacPap Rash Mandem w/ Ai PMH + join pain + RhF neg = ?HLA-B27 dx 25-year-old male attends his GP with myalgia and flu-like symptoms. - Toxo IgM + IgG positive - NOT immunocomp = DON’T TREAT - Immunocomp = Pyrimethamine and sulphadiazine Sunlight is a common trigger for cold sores ``` Erb's palsy = fell (waiters TIP)-> pronated + medially rotated = brachial trunks C5-6 -ERB'S HAS 4 LETTERS but just add one FFS... ``` ``` Klumpke's paralysis = slip, hung on -> weakness of the hand intrinsic muscles + Horner’s = brachial trunks C8-T1 -KULMPKE'S HAS 8 LETTERS ``` Confabulation/Apathy-AmnesiaRetro/Psychosis are features of Korsakoff's psychosis ``` Which RTA dyou get renal stones in?! Type 1 renal tubular acidosis (distal) complication – RENAL stones Congen URO dx RHEUM dx Amphoterocin Painkillers – NSAID ``` Fever on alternating days, think MALARIA - headache, myalgia, HMeg - history of foreign travel Acute hepatitis B - anorexia, nausea and - RUQ pain + tender HMeg - fever Typhoid fever classically presents with 4 phases. - ROSE spot rash + Constipation - BRADYcardia - dry cough, fever, EPISTAXIS and malaise - Ix = CULTURES Dengue fever (high ALT/ low Plts) - Febrile phase - critical phase (abdo pain, vomiting and incr RR) - recovery phase. Viral haemorrhagic fever can also present with fever and non-specific flu-like symptoms. However, it does not typically cause hepatomegaly and does not cause this pattern of fever. Most neurologists now start antiepileptics following a SECOND epileptic seizure. Following a FIRST seizure, anti-epileptic drug treatment should only be started before specialist review in exceptional circumstances including: SDSU 1. SEIZURE activity observed on EEG 2. Presence of a neurological DEFICIT 3. Presence of a STRUCTURAL brain abnormality 4. Patient, parent or carer considers the risk of a further seizure to be UNACCEPTABLE - prescribe LORAZEPAM to use in the event of status epilepticus. Positron Emission Tomography (PET) demonstrates Glucose uptake dissecting aneurysm of the ascending aorta which originates at the aortic valve -Aortic root replacement Mandem when strokes his face/shaves/brushes care - gets tingling pain - He's < 40 years of age - Sensory changes - Deafness ear problems - Skin / Oral LESIONS = ?spread perineurally - Pain @OPHTHALMIC V1 division of the trigeminal (socket, forehead, nose) - Optic neuritis / FHx of MS ---Tx? NOT carbemazapine straight away.. URGENT REFERRAL for specialist assessment rather than treatment. Has had several episodes where she becomes suddenly tearful --> -period of unresponsiveness: -wanders the house = unaware of what she is doing -sleeps for around 2 hours Patients may display AUTOMATISM during a COMPLEX FOCAL SEIZURE #TEMPORAL lobe Anterior MI -> Complete heart block Tx = pacing inferior MI -> Complete heart block NOT an indication for pacing Nasal mupirocin + chlorhexidine for the skin CT = ANT CIRC ischaemic stroke + LIMITED (I.E. not completely fucked !!) infarct CORE - thrombectomy in acute ischaemic stroke, - extended target time of 6-24 hours - CTperf/MRd-w =?SAVE brain tissue

Answer 30

IV iron should be used in patients who are found to have iron deficiency anaemia prior to surgery where - oral iron either can't be tolerated or the - time interval is too short Growth hormone is recommended in the treatment of Turner's syndrome Right heart failure is associated with a firm, smooth, tender and PULSATILE liver edge Paraneoplastics: - Small cell: Kulchitksy cells = SAL* - Squamous = PTHrP - Adeno = GynaecomAstiA - Large = hcg * SIADH, ACTH, Lambert-Eaton Lung cancer in NOn-smoker - AdeNO Lung cancer in SSSmoker - SSSquamous HYPERACUTE rejection is caused by pre-existing antibodies against ABO or HLA antigens -minutes to hours Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises. Beta-blockers reduce hypoglycaemic awareness Beta-blockers may cause insomnia Bile-acid malabsorption may be treated with cholestyramine Aortic regurgitation typically causes an early diastolic murmur A late diastolic murmur is associated with mitral stenosis. Charcot-Marie-Tooth disease (hereditary sensorimotor neuropathy type I) is an autosomal dominant ``` NOT FUCKING RHEUMATOID ARTHITIR SYOU FUCKONG PIECE OF FUCKING SHI !!!!!!!!!!! Upper zone -PMF-coal/beryliosis HSRpneumonitisAKAExtAllAlveolitis, AnkSpond, RTherapy !!!!!!!!!!!!!! , TB ``` Mid Zone - Sarcoid - Silicosis-EGGSHELL/Caplan@RA - Histoplasmosis Lower Zone - IdiopathPF - Asbestosis - Amiodarone/Bleomycin/MTX/Nitro Arnold-Chiari malformation can cause - non-comm hydrocephalus #OBSTRUCTIVE - assoc w/ Syringomyelia Status epilepticus: rule out hypoxia and hypoglycaemia before thinking of other causes: LLPR but fucking choose BM man orlistat = Pancreatic lipase inhibitor MTX 6m AFTER tx #preg CN3 palsy: Motor(down+out, ptosis), PSymp(dilated), ?vertical nystagmus -isch, CavSinThrom, UncalHerniate/trans-tentorial, MidbrainWeber, PComAneurysm COCP use + FHx of VTE + Severe HEADACHE = more insidiously than a 'thunderclap headache', with ?subtle neurology -MR Venogram is the gold standard test for diagnosing venous sinus thrombosis Cavernous sinus syndrome Ax = Cavernous sinus tumours, OR NPC = locally invades cavernous sinus. -> Corneal Reflex Absent, Horner, Opthalmoplegia Pain, Proptosis #mass-effect -CN 3 Opthalmoplegia (ptosis/diplopia) -CN 4 Opthalmoplegia -CN 5- (V1=Corneal Reflex Absent, V2=low max sens) -CN 6 Opthalmoplegia + ICA (thrombosis) + Symp trunk (Horner's) CN3 palsy: Motor(down+out, ptosis), PSymp(dilated), ?vertical nystagmus -isch, CavSinThrom, UncalHerniate/trans-tentorial, MidbrainWeber, PComAneurysm PAINFUL third nerve palsy = posterior communicating artery aneurysm Ulcerative colitis - the rectum is the most common site affected -Diverticu = sigmoid most affected (dont get mixed up !!!) low-grade temperature.extensive painful ulceration of his mouth and gums. 37.4ºC submandibular lymphadenopathy. -HSV 1 !!! Sudden weight loss is associated with non-alcoholic fatty liver disease - MANDEM got roux-en-y, gastric bypass, lost 30kg. Suddenly got jaundice - Acute on chronic NAFLD !!! IgA nephropathy develops 1-2 days after URTI PSGN develops 1-2 weeks after URTI.

Answer 31

Intention tremor @ cerebellar dx Dysmetria - over/undershooting @ MS/ALS ET v Parkinsons = NICE recommend 123I‑FP‑CIT SPECT Levo/carbi - Motor improve/cx increase - ADLs improve - Adverse rxns decrease (hallucinations/impulse/sleep) - Time inc = effectiveness decrease Ropinirole/CabergolineCardiacFibrosis - hallucinations/impulse/sleep Mandem = NA 154 serum osmo >300 urine osmo < 600 Ax? - Binge alco/ DM/ MDMA/ Polydipsia/ SIADH -Tx: BINGE ALCO = suppress ADH @post-pit -> polyuria Beta thalassaemia long term tx? - Life-long blood transfusions - desferrioxamine chelation -> prevent iron overload Corticosteroids are used in the management of severe ALCOHOLIC hepatitis Alco+Met Acidosis+NORMAL BMs Alcoholic ketoacidosis is managed with an infusion of SALINE + Thiamine __________________ *PRAD: Pyrexia, Rigidity (high CK), Autonomic syx, Delirium - ORP PRAD - ORP 1. SeRAPIDtotonin Serotonin Syndrome - CyproPhetadine/Chlorpromazine ``` 2. NMS: Anti-pSLOOOOOOOOWcotic Stop APsych/Start Parkinson-meds, IVF, -Dantrolene/?DopAgonists - bromocriptine __________________ ``` SSRI Discontinuation Syx Paroxetine = HIGHER incidence of DISCONTINUATION syx than other SSRI ______________________ SSRI Discontinuation Syx Paroxetine = HIGHER incidence of DISCONTINUATION syx than other SSRI ______________________ ``` Aortic dissection BICUSPID aortic valve MarfanEhlers/Turner's and Noonan -Preg/syph -> Chest pain radiate 2 back THORACIC AORTIC DISSECTion -Aortic Root Valve Replacement __________ ``` DVT 1/- 2/+ ; PE 4/- 5/+ 1/- = Dimer (POS = PLSDoppler <4hr / PLS <24hr + Tx DOAC ; NEG = d/c) ``` 2/+ = PLSDoppler <4hr POS = Tx DOAC ; NEG = Dimer (Pos dimer = Repeat PLS <6-8d + Tx DOAC ; Neg dimer = d/c) Pos Repeat PLS = Tx DOAC Neg Repeat PLS = d/c ``` 30-d mortality - ?OP tx? = PESI SUSPECT PE? - PERC criteria to r/o PE - ALL the criteria must be ABSENT to have NEG PERC to rule-out PE - this should be done when you think there is a LOW PRE-TEST probability of PE, but want more REASSURANCE that it isn't the diagnosis - this low probability is defined as < 15% Pearly penile papules are not a cause for concern and do not require intervention Bone pain + Deformity (OM / Paget..) -> X-rayX-ray generalised osteopenia, erosion of the terminal phalyngeal tufts (acro-osteolysis) and sub-periosteal resorption of bone particularly the radial aspects of 2nd + 3rd middle phalanges. -Hyperparathyroidism. STEPWISE progression of symptoms in dementia - think vascular dementia

Answer 32

The investigation of choice for narcolepsy is multiple sleep latency EEG I and aVL, and slightly in V5+V6 LEFT circumflex Over the past seven days pt has received TPN + adequate Calcium replacement. DESPITE THIS, she remained HYPOcalcaemic. Patients with malabsorption may develop MAGNESIUM deficiency Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart Gilbert's syndrome is a benign condition causing a mild rise in bilirubin - NO treatment needed - Streptococcus viridans - classically linked to poor dental hygiene or following a dental procedure 2 - Streptococcus bovis - most commonly linked with colorectal cancer 3 - Coxiella burnetti - causes Q fever, an infection caught most commonly from farm animals. So, consider in any farmer or abattoir worker. 5 - Staphylococcus epidermis - most commonly associated with patients who have undergone previous PROSTETIC VALVE surgery / Peritoneal Dialysis Farmer, fever, transaminitis ?Q fever -Coxiella Fever + - Headache + Photophobia + neck stiffness. #meningitis - seizure -> Recovers within 2 minutes + more tired than before #encephalitis - altered mental status #encephalitis Dx: Encephalitis = IV (Aciclovir + ABx) -meningitis = enterovirus; -encephalitis = HSV1 Hypodense collection #chronic around the convexity of the brain #subdural that is not limited to suture lines dysphagia + glossitis + iron-def anaemia -Plummer Vinson Conjunct Pallor Angular cheilosis + Atrophic glossitis koilonychia spoon-nails -Iron Def Anemia Neuro shit Angular cheilosis + Glossitis (red smooth + shiny tongue, ? ulcers) Lemon skin -B12 def CT confirms numerous bilateral calculi. Investigations urgently? -U+E #OBSTRUCTION BASTARD Arteriovenous fistulas are the preferred method of access for haemodialysis A 17-year-old girl presents with a six week history of nausea and abdominal discomfort. Routine blood tests reveal the following. ALP 262 high AF !!! -Preg V PBC? -PREGGERS!!!! Pbc = middle aged IgM etc sputum appears red and jelly-like. KLEBSIELLA pneumonia-> commonly due to aspiration Complete heart block following a MI? - right coronary artery lesion = AVN The concurrent use of MTX + Trimeth containing antibiotics may cause bone marrow suppression -> pancytopaenia Azo + Allopurinol = Myelo too... Acute toxoplasmosis in the immunocompetent pt can mimic acute EBV (low-grade fever, generalised LNopathy, prominent cervical lymph nodes, malaise) -should be suspected with NEGATIVE EBV serology. -VCA neg – EBNA neg i.e. EBG antigens For thrombectomy in acute ischaemic stroke, an extended target time of 6-24 hours may be considered if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume A 28-year-old man develops nausea and a severe headache whilst trekking in Nepal. Within the next hour he becomes ataxic and confused. A diagnosis of high altitude cerebral oedema is suspected. Other than descent and oxygen, what is the most important treatment? - Acetazolamide is used more in the PREVENTION of high altitude cerebral oedema, - Dexamethasone used in TREATMENT of cerebral oedema Octreotide + cyprophetadine@diarrhoea - Octreotide is a somatostatin analogue used to treat the symptoms of carcinoid syndrome - urine 5hiaa/ plasma chromogranin Whilst using an inhaler, you should ideally hold your breath for 10 seconds AFTER PRESSING down on the canister When using an inhaler, for a second dose you should wait for approximately 30 seconds B4 REPEATING

Answer 33

Isolated TCP + Rash in a WELL pt --> ITP MAHA + AKI + TCP#Rash = TTP Amniocentesis Alpha1-antitrypsin deficiency can be diagnosed prenatally. - Chorionic villus sampling is usually performed between 11 to 14 weeks gestation - amniocentesis @15 to 20 weeks gestation ``` PCP: • co-trimoxazole • IV pentamidine @ severe cases • aerosolized pentamidine is an alternative Tx for PCP but is LESS effective with a risk of Pneumothorax • steroids if hypoxic ``` Neurogenic Thoracic Outlet Syndrome -muscle wasting @hands, - numbness + tingling, - ?autonomic syx Arterial Thoracic Outlet Syndrome - least common subtype of thoracic outlet syndrome - pain, cold sensitivities + poor circulation @hands + extremeties Subdural haemorrhage is caused by damage to bridging veins between cortex + venous sinuses In trauma, to test if the fluid draining from the nose or ear is CSF, check for glucose 35M pain occurs AFTER he has walked for 10 mins -relieved when he sits -toes turn white, then blue and red during the COLD #Raynaud -smoking 3 - 4 PACKS of cigs/ day for 10yrs i.e. Raynaud's + extremity ischaemia + SMOKING = Buerger's Thromboangiitis obliterans Dx -medium vessel vasculitis SLE + proteinuria = consider lupus nephritis LP --> A low pressure headache - Tx: Caffeine and fluids Consider the use of pain management clinics in resistant diabetic neuropathy ``` If MSCC is suspected, high-dose oral Dexamethasone should be given ASAP WHILST AWAITINGGGG Whole spine MRI ``` Isoniazid can cause drug-induced lupus -iTEACH ``` Woman with bone metastases- most likely to originate in the breast In order of frequency: Breast Bronchus Brostate Bridney Bryroid ``` The Levine Scale: •Grade 4 = palpable THRILL •Grade 5 - palpable THRILL + steth EDGE •Grade 6 – heard WITHOUT STETH Dominant hemisphere MCA strokes cause aphasia stopping of anti-epileptic drugs (AED) is most correct? - If seizure free for > 2 years, + - AEDs being stopped over 2-3 months 'high-stepping' gait - he tends to excessively flex his knees to ensure the feet 'clear' the ground when walking. Dx: Peripheral neuropathy -high-stepping gait develops to compensate for foot drop Atorvastatin 20mg is a high-intensity statin and should be started as primary prevention against cardiovascular disease HNPCC is endometrial cancer + pancreatic cancer Overnight dexamethasone suppression testing was performed, which revealed no change in cortisol levels i.e. FUCKING SYNDROME !!! high urinary cortisol + LOW ACTH i.e. sutin suppressing pituitary (pituitary isn’t obvs making any XS ACTH so cant be pit adenoma bastard). Likely Adrenal Adenoma making loads of cortisol -> suppress ACTH @pit #CT-Abdo suspected stroke. unable to speak BUT able to follow instructions - do not know the handedness of the patient - Percentage of right (90% )and left (60%) handed individuals - making the LEFT BRAIN always > most likely affected side - MCA on dominant side supplies both Wernicke's (sup Temp Gyrus) + Broca's (inf Frontal Gyrus) areas - which are responsible for understanding and production of speech. Insulin DM1: MTRM - multiple daily Basal-Bolus -fail-> cont SC ins @12/+ yr - twice daily Detemir basal - RA analog b4 meals - metformin @BMI 25/+ 3. Insulin DM2: INDGP NPH=SA @HbA1c 75/+ Detemir/Glargine Pre-mixed w/ SA analogue man TChol of 6.2 Q-risk score to be 23%. 10 cigarettes a day His father died of a heart attack aged 50. Tx: Atorva 20 or Atorva 80? -ATORVA 20 !!!!!! HES NOT HIMSELF HAD A FUCKING MI -If non-HDL NOT drop by 40%/+ -> Titrate up provided GFR > 30

Answer 34

Chondrocalcinosis helps to distinguish pseudogout from gout Acromegaly can develop POS BIREFRINGENT -RHOMBOID - PseudoGout HyperParathyroidism is a risk factor for Pseudogout - whereas HYPOcalcaemia = cataracts Gout = needle-shape NEG birefringent CT scan was performed 1.5cm nodule – adrenal gland = a lipid rich core -Benign Incidental Adenoma TXA = IV bolus followed by slow infusion upper 2/3 oesophagus – SqCC lower 1/3 = adenoCC The incubation period of Ebola virus is 2-21 days CKD-mineral bone disease = Correct hyperPHOSPHataemia first -start with Dietary changes before (eduction in foods like chocolate, nuts, shellfish and cola) BEFORE STARTING... -starting a phosphate binder = Sevelamer and Lanthanum Patient with CKD taking calcium-based binders (Calcium acetate) can have problems -> -Hypercalcaemia + Vascular calcification There is no need for prophylactic antibiotics for Lyme disease in asymptomatic patients bitten by a tick ``` Pt a/w swelling of face arms trunk. PMH: this happened b4. No allergy/anaphylaxis signs or history. Serum C4 = LOW AF. Dx: Hereditary angioedema: Tx: IV C1-inhibitor concentrate / FFP ``` MS: high dose steroids can be used in the management of acute relapse If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI, urgent coronary artery bypass graft (CABG) is recommended TRALI is the specific name given for ARDS occurring within 6 hours of a transfusion. ARDS can only be diagnosed in the ABSENCE of a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised) Pulmonary capillary wedge pressure NOT raised = ARDS Pulmonary capillary wedge pressure raised = Pul Oed #cardiac In suspected spinal epidural abscess, a full spine MRI is required to search for skip lesions Intramuscular vitamin B12 -> start oral folic acid when vitamin B12 levels are NORMAL to avoid precipitating subacute combined degeneration of the cord. ``` 74M viral gastroenteritis 1 week ago -3 days of D+V -Sx settled -Ongoing nausea. -Vision = more blurry + felt dizzy -> falls HR 54/min + irregular pulse BP 119/68 mmHg PMH: IHD, HTN, AF and T2DM. -ECG: ST depression + T-invert bradycardia -Digoxin ``` Kaposi's sarcoma - caused by HHV-8 (human herpes virus 8) -Red man syndrome: stop, resolve, slower Stop vancomycin infusion until symptoms resolve re-starting a slower rate Hypothermia/K low or high/Alco is a cause of Torsades de pointes pseudohypertrophy calf muscles use his arms to help stand up from the floor #Gower-Sign Becker's muscular dystrophy is a less severe form of dystrophinopathy that presents at a later age 71F presents with 2w SOB and haemoptysis O/E: reveals a loud S1 = diastolic murmur + new-onset AF Mitral Stenosis -> raised left atrial pressure --> rupture of Bronchial Veins --> Haemoptysis i -It aint gna be AR cos AR has S3 sound remember!!!! Woman on warfarin has INR < 2 i.e. sub-therapeutic - inc warf dose - cover LMWH in meantime i.e. short-acting - monitor INR - LMWH discontinued when has adequate INR Reduction in GCS + vomiting > 1 are sinister signs in headache: urgent CT head is indicated ECG is performed that shows a - bradycardia with - intermittently non-conducted P waves - no sign of PR elongation / shortening of the waves that are conducted - Mobitz II is an indication for a pacemaker Oxycodone > morphine in palliative patients with mild-moderate renal impairment IV infusion of phosphate polyfusor is commonly used to treat acute hypophosphataemia in adults @refeed syndrome Indications for corticosteroid treatment for sarcoidosis are: - Systemic Dx - HYPERcalcaemia - NOT BHL alone emergency splenectomy. takes PMP-V on a daily basis. Which organism is he particularly susceptible to? Since he already on PMP-V, then strep pneu is covered. So H.Flu would be risky!!! ``` Temporarily lost GCS 20 secs -states feeling lightheaded this AM. -shake her limbs for a few secs -NOT bite her tongue/incontinence -she came around, she was PALE, -took few minutes B4 she felt orientated again. -This was the FIRST TIME this has happened Dx: Vasovagal syncope ``` - SHORT post-ictal period in comparison to a tonic-clonic seizure. - Syncopal episodes = rapid recovery + short post-ictal period - Seizures are associated with a far greater post-ictal period Psychogenic Pseudoseizures FACTOrs: - FHx epilepsy/Females - ALONE = don't occur - CRYING after seizure - Thrusting pelvic - Onset = GRADUAL Favour true epilep seizures: - Tongue biting - PROLACTIN __________ There is NO role for ABx in the Tx of HUS unless indicated by preceding diarrhoeal infection - Only supportive treatment e.g. fluids and dialysis as required ``` Trimethoprim --> HANDA ROTS RTA4 !!! = leading to -HyperKALaemia and -increased Creatinine -decreased urine output, and -swelling in both of her legs ``` ``` CCD: remember.... low Aldost: -Heparin -ACE/ARB -NSAID -DM Renin -Addison ``` Resistance - Obst Uropathy - TMP-SMX - Spiro/Amiloride

Answer 35

Colchicine = diarrhoea Patients don't typically tend to get Cryptococcal infection with a CD4 count that high, you would start to suspect it in the <300 range Nerve conduction studies can help in the diagnosis of Guillain-Barre syndrome -plasmapharesis, IVIg, Nerve Conduction studies, DVT proph FFS CORNEAL involvement in Grave's disease indicates severe eye pathology ``` Child Pugh: A - albumin B - bilirubin C - clotting D - distention (ascites) E - encephalopathy -ALT/AST IS SHIT !!!! ``` Lymphoma + Alcohol = painful node = HODGKINs --MIRROR image nuclei = Reed Sternberg Stains inhibit HMG-CoA = DECR chol SYNTH Phaeo = alpha block + beta block (propranlol/ labetalol) - CHOOSE NON-CARDIO SELECTIVE BB = propr #periph - cardio selective eg atenolol/ bisop NOT legit @Phaeo Gram + Catalase + Coag + = ? Gram + Catalase + Coag NEG = ? Gram + Catalase NEG = ? HOCM = sudden cardiac death from vent arrythmia AIHA Hemolysis Ix? = Direct Coombs + LOW Haptoglobin Rhesus hemolytic dx of NEWBORN = INdirect Coombs Lipophilic statins = Simva/ Atorva -> Prox-myopathy #CK-high Hydrophilic = Rosouva/ Prava/ Fluva give when lipophilic fucks muscles up SUDDEN SYNCOPE Pt = bradycardia + ... -loads of Ps + and few QRS = don't match up = 3rd HB -WIDE + DEEEEEP inverted T waves = Stokes-Adams attacks Lung cancer surgery CI - FEV < 1.5 L - Exudate MALIG pleural effusion - Vocal Cord paralysis - SVCO Acoustic neuroma = PROGressive SVT Menieres = Intermittent attacks of SVT + aural fullness Parkinon's TRAPS = -Asymmetric, pill-rolling @rest, -IMPROVE with voluntary MOVEMENT (Rememer Back 2 the Future guy ice skating?!) Tremor = WORSENS as reaches out to examiner's finger -Intention tremor = cerebellar dx ``` past-pointing - pointing BEYOND the finger @finger-nose test = cerebellar dx #Dysmetria ``` Tremor = worsens @OUTstetched arms = essential tremor -BIlateral + WORSEN with action Low plts + high Fibrin Degradation Products = DIC COPD = XS O2 lose hypoxic drive -> retain co2 -> -Resp Acid + Met Compensation for ABG Acidosis questions, if BE is high and CO2 is high i.e. 'mixed' -> - look at pH - then CO2 (in keeping @resp, norm/NOT in keeping @met) - THEN bicarb (low in acid, high in alk) Glomerulonephritis + VTE = AT3 loss from piss!! #VTE Orthostatic HTN = 20/10 drop after 3 fucking minutes Carotid Sinus HSR -> - Vent pause > 3s - SystBP drop by 50mmHg/+ Unilat headache + meningism (bend head back) + NO fever = SAH -Preload high - Regurg/VSD Overload -meds (Nsaid/Pioglit/Steds) -IVF -Pump failure - CM/CPericard; IHD/Ionotrope neg (CCB/AntiArrythmicFlecanide) Arrhythmia -Afterload high - Stenosis (any valve) HTN(periph/pul-corpulmonale) -High output - Preg/Anemia/Thyrotoxicosis

Answer 36

Acute Mesenteric Ischaemia -emboli @Endocard/Cancer --> block SMA LACTATE FIRST CT --> URGENT Surg ____________________ Isch. Colitis -cocaine mucosal OED/HAEMORRH --> - AXR = THUMBPRINTING --> SUPPORTIVE Tx ______ Beta-blockers/ CCB-RL such as bisoprolol are common precipitants of myasthenic crises. Beta-blockers reduce hypoglycaemic awareness -and autonomic neuropathy Beta-blockers may cause insomnia suspected neoplastic spinal cord compression should have an urgent MRI of the WHOLE Spine maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour -40 mmol bag over 4hrs IVDU + DESCending paralysis + diplopia + bulbar palsy = Clostridium botulinum Phenytoin infusion = cardiac monitoring is required due to the pro-arrhythmogenic effects IgA @ breast milk iAIRED Kaposi's sarcoma @kids = with only generalised lymphadenopathy #lymphoma Coeliac disease is associated with - iron, -folate , -vitamin B12 deficiency - normocytic = micro + macro #Asplenia Swallowing of saliva is often more difficult @globus pharyngis -solids + liquids are fine though Lung cancer = chemo/RT #immune-checkpoint inhibitor. Nivolumab for SOLID tumours Headache triggered by coughing -> legit? NO #investigate further -@suspected head cancer = Standard Struct MRI @hypothermia --> cardiac arrest - defibrillation is SHIT - only 3 shocks should be administered - b4 the patient is rewarmed to 30 degrees Progressively worsening headache with higher cognitive function impaired = URGENT imaging required -----Standard Struct MRI -@suspected head cancer Disproportionate MICROCYTIC Anemia = thallaemia I.e. MCV of like 60 Hyaline casts @urine = furosemide Corticosteroids are used in the management of severe ALCOHOLIC hepatitis Alcoholic ketoacidosis is managed with an infusion of SALINE + Thiamine COPD: -LTOT improve survival -Becky = Improve: QoL, FEV1 / Reduces freq exac _________ Short attacks with stereotyped movement + QUICK RECOVERY = focal aware seizures Focal seizures + impaired awareness -impaired consciousness AND post-ictal state Focal dystonia would involve rigidity + writhing Relapse-Remit Secondary progressive MS -usually have relapse-remit anyway.. ``` MS = -Worsening symptoms -NO periods of remission -Elderly population PRImary progressive ``` ``` severe headache -nausea -difficulty in finding the right words. -cocp -FHx: mother had an unprovoked DVT in her 30s Dx: Venous Sinus Thrombosis Ix: MR Venogram ``` The interossei are supplied by the ulnar nerve. Vision worse going down stairs? Think 4th nerve palsy -TROCHLEAR!!!!

Answer 37

The EIA = Acute IgM to syphilis - it may be NEGATIVE in reinfection. The T-pallidum particle agglutination (TPPA) test is a specific test for syphilis and often remains POSITIVE in patients who have been PREVIOUSLY infected. The rapid plasma reagin (RPR) - useful to monitor disease activity and reinfection. - 1 in 2 means it needs to be diluted twice, - 1 in 32 means it needs to be diluted 32 times (meaning disease activity is higher in the latter). - A rise by x 4 or more in a previously infected patient = no treatment response/ reinfection. Following treatment for syphilis: TPHA remains positive, VDRL becomes negative ___________ SAICA - Admit / Follow-up -BEST -MAST BP ECG SpO2 Tryptase Medic-alert ACH Skin Prick Teach Ant Lat Thigh ``` Keeping them in 24hrs: Biphasic ED access difficult Asthma severe Night/ Eve/ Unable 2 respond Continuing absoprtion Onset = slow/severe ________________________ ``` ____________MAP=CO.SVR HR PAP Hypovol______low . low..................low Cardiogen___ _low . low Anaphyl/Sepsis_low...........low..........low Neurogen_____low . low.low -Distributive = anaphl/seps/neurogenic ``` ____________MAP=CO.SVR HR PAP Hypovol______low . low.........high.low Cardiogen___ _low . low.........high Anaphyl/Sepsis_low...........low.high..low Neurogen_____low . low.low ``` ______Fe . TFsats . Ferritin . TIBC ..Fe.......low . low .........................high .ChrDx.low . low ........high.........low .HChr...high . high ......high.........low Sidero.high . high ......high.........low ``` Syx + IlioFem DVT -Cath Directed Thrombolysis Funct status legit low p(bleed) LE >1 yr Sx < 14d ``` 30-d mortality suitability of OP tx -use of the Pulmonary Embolism Severity Index (PESI) score SUSPECT PE? -PERC criteria to r/o PE -ALL the criteria must be ABSENT to have NEG PERC to rule-out PE -this should be done when you think there is a LOW PRE-TEST probability of PE, but want more REASSURANCE that it isn't the diagnosis -this low probability is defined as < 15% ________ COPD: 2. LABA + ARave: Asthma/Resp2steds (atopy/ variable diurnal/FEV/ eosinophilia --> ``` Y=Becky --(Sx-lowQol/1severe/2mod exac/yr)-> N=LAMA--> _______________ STAMM DR MACROLIDE* 250mg x3/wk -Non-smoker -Optimum-meds -Sputum+Exac ``` ``` Before *Macrolide: -Sputum/TB C+S -CT-Thorax/Chest-physio _______________ Roflumilast -Exac 2+/yr -FEV<50% -COPD/Bronchitis _______________ 1sev/2mod exac/yr Sputum+Exac @Macrolide Exac-2+/yr @Roflumilast _______________ SpO2 < 92 PolyCythemia / PeriphOed FEV< 30% JVP high Cyanosis ``` SBOT @ severe = evidence of resp2prevTx -dont smoke = FUCKING explosion ``` LTOT @Pao2: ABG-x2/3w-apart <7.3 + stable 7.3-8.0 + ... -P.Cythemia -P.HTN-pul -P.Oed-periph -PNoct Hypoxia _______________ ``` Surg: SOB+CT Bulla 1/3HT = Bullectomy Transplant: FEV1<50+lowQoL NON-smoker FINISH -ChestPhysio LungVolRed consider**: FEV1<50+lowQoL NON-smoker FINISH -ChestPhysio -140m6minWalk after ** ''consider'' --> 'actually do' LungVolRed @: -Plethysmography = HyperInflation -CT = Emphysema __________ Adults - Kids: Ix for asthma? 1 - 3-FeNO >40 / >35 @ 5-16yrs ppb 2 - 1-Spiro FEV/FVC < 70 obstr 3 - 2-BD Inc 12% *FEV* @ 200ml SABA/Becky 4 - 4-PEFR inc 20% *VARIABILITY* in 2-4w @BD monitoring 5 - 5-Methacholine Histamine Test PC20 @8mg/ml FEV drop CC50M: @control=reduce maintenance after 3m check: BP BM-hba1c BMD; Chol Cataracts @Steds 50+ = Syx/HDsteds/1exac requiring PO steds/year --> MACROLIDE 500mg x3/wk 6-12m - ECG-QTc = 0m 1m - LFT 0m 1m 6m ``` StopSteds=reduce by 25-50%/3m __________ Pneumothorax -Age >50 + smoking Hx -Lung dx @O/E or CXR Y = 2ndary N = 1rimary ``` -N i.e. (Air Rim<2cm AIR no SOB)=d/c+OPD r/v -> 1. Stop smoke 2. Pluorodesis offer 3. Fly >2w/>1w AFTER drain AND no residual air @trauma/spont __________________ CCF: ICD @QRS<150 - LBBB+NYC 3/- CRT @QRS 120-150 + LBBB+NYC 2/+ CRT @QRS 120-150 - LBBB+NYC 4 ``` Surgery: CPT a. CResync b. Partial Ventriculectomy @non-IHD= -Chagas/CMyopathy/Valve-dx -Aim=reduce:EDV->LVstrain-> optimiseLVFunction c. Transplant ```

Answer 38

The most common causes of VIRAL meningitis in Adults are ENTEROviruses -Coxsackie B virus (CMV/Cryptococc/Arbovirus/Mumps/EnterooooooCoxsackie) Herpes simplex virus is the commonest cause of viral ENCEPHALITIS in the adult population -iv aciclovir = cross B-B barrier ``` Insulin -> sliding scale Li 4 days b4 AC = 5 days b4 COCP 1m ____ K spare = day of surgery Oral hypoglyc = nbm + sliding scale PRILs = day of surgery -Spiro + Rampiril = day of surgery ``` HIV needlestick PEP= Refer to Emergency Department + oral antiRETROviral therapy for 4 weeks The Creatine Kinase (CK-MB) remains elevated for 3 to 4 days following infarction. Troponin remains elevated for 10 days. This makes CK-MB useful for detecting re-infarction in the window of 4 to 10 days after the initial insult HBsssssssAg: acute/chronic>6m dx --- ALTTTT@ ACTIVE #CARRIER/INFECTIOUS HBsAg Anti-HBc: prev/current --- IgM @ ACUTE -> IgG CHRONIC HBV-DNA: acute/chronic>6m (high lvls assoc with HCC) HBeeeeAg infectivity marker --> anti HBeeeee @ resolving anti-HBsss POS only -IMMUNE - vaccine anti-HBsss POS, anti-HBccc/eee POS -IMMUNE prev hep B anti-HBc only: Resolved/Acute resolving/Chronic low level / False positive BITHE > 100 Booster at 5 years 10 - 100 - 1 more vaccine dose + test @immunocomp < 10 Non-responder -testing SCDE + HBIg @fail + 3 doses again Over-replacement with thyroxine = HYPERThyr increases the risk for osteoporosis Baclofen and gabapentin are first-line for spasticity in multiple sclerosis Diplopia is not common in Parkinson's disease and may suggest an alternative cause of parkinsonism such as progressive supranuclear palsy Miliary TB is due to the spread of the bacteria through pulmonary venous system -gain entry into the pulmonary venous system via damaged alveolar squamous epithelium -> gain access to the lymphatic system using macrophages. Patients with focal seizures may experience post-ictal weakness (Todd's paresis) If there is clubbing with hyperthyroidism, think Graves' disease ACROPACHY __________ - BMI < 18.5; - unintentional WL > 10% @last 3-6 months; or - BMI < 20 + unintentional WL > 5% @last 3-6 months NAFLD = WL 10% / 6m (any faster = worsen fibrosis) WL 5% pre-preg Weight, Electrolyte dx, Dehydration __________ ``` Mandem had accident -> Cord injury @above T6 -> HTN + Bradycardia + ... -Flushed + Sweating #Red ABOVE shoulders -PALE BELOW shoulders Ax of HTN = Autonomic Dysreflexia ``` Mandem in accident -HTN and Bradycardia -flushed above shoulders, pale below Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level Faecal impaction / urinary retention are the most common triggers of autonomic dysreflexia Stroke is a life-threatening event associated with autonomic dysreflexia Patients with a GCS below 8 should be considered for both i) review by an anaesthetist and ii) intubation and ventilation Coagulase-negative Staphylococcus is the most common cause of peritonitis secondary to PERITONEAL dialysis - Staphylococcus epidermis ``` Multiple myeloma + Paget's disease are typically associated with osteoLYTIC lesions - Mets =Sclerotic _______ Pregnant: - Raised ALP = NORMAL ``` Acute fatty liver of pregnancy = - jaundice, N+V, headache, and hypoGLYCaemia - ALT would typically be raised Obstetric cholestasis = pruritis + raised bilirubin _________ NICE = contrast-enhanced CT coronary angiogram for someone presenting with -non-cardiac chest pain + -resting ECG shows ischaemia = Q wave abnormality, ST-T wave changes NEVER EVER CHOOSE EXERCISE ECG FOR ANYTHING FFS Fever, weight loss, malaise, headache. - palpable-purpura - HUria -jaundice..... - no URT/LRT/lung dx... - ---Polyarteritis Nodosa = Hep B

Answer 39

HbA1c is not recommended in the diagnosis of type 1 diabetes -do FPG @DM1 to confirm DM2 + HTN. What ANTI-HTN? ARB or ACEi? -ACEi DM2 + HTN + Black. What ANTI-HTN? - ARB or ACEi? - ARB!!!!!!!! - losartan Teen, STD = MCS show obligate intracellular bacterium. Dx? -Chlamydia Gram Neg Intracellular Bact Systemic Sclerosis + HTN + Age > 55 + MAHA @severeSS. Tx - ACE/CCB? -ACEi Alpha1-antitrypsin deficiency can be diagnosed prenatally Mandem in accident -HTN and Bradycardia -flushed above shoulders, pale below Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level Light microscopy = ground-glass hepatocytes = CHRONIC hepatitis B infection Bisphosphonates and denosumab can be used to prevent pathological fractures in bone metastases. If the eGFR < 30, denosumab is preferred RAPD = CN2 diplopia when asked to look laterally = CN6 -LR6 SO4 R3 occupation asthma is suspected. Most appropriate diagnostic investigation? -Serial peak flow measurements @work + home 1 pack year is defined as 20 cigs/day for 1 year Mandem got CP SOBOE Syncope, narrow pulse pressure, slow rising pulse. How to tx Syx? -Furosemide Nitrates are contraindicated in aortic stenosis Swabs for chlamydia and gonorrhoea in women should be taken from the vulvo-vaginal area (introitus) pt a/w abdo pain/constipation + neuropsych syx + Anaemia -O/E: blue lines @gum margin. legs become WEAK in the past few days. ?Basophilic stippling #NOiron -Lead poisoning is often occupational ventilation -> Sudden deterioration -suggests TPx Myelodysplasia into AML CLL = Richter into NHL Prophylactic IV antibiotics are given prior to appendicectomy Hydroxychloroquine can be safely used during pregnancy in Rheumatoid Arthritis Nictonic Replacement Therapy can be safely used during pregnancy in Smoking Cessation Bupropion = NorAdr + Dopamine reuptake inhibitor, and Nicotinic BLOCKER (Blocker... Bupropion) VareNICline = NICtonic agonist Men who have sex with men should be offered immunisation against hepatitis A -ECG shows new widening QRS complexes and a -NOTCHED morphology of the QRS complexes in the lateral leads = LBBB RSR complex = RBBB CKD-mineral bone disease = Correct hyperPHOSPHataemia first -start with dietary changes before (eduction in foods like chocolate, nuts, shellfish and cola) BEFORE STARTING... -starting a phosphate binder = Sevelamer and lanthanum ``` High phosphate levels in CKD 'drags' calcium from the bones, resulting in osteomalacia -Tx = Bisphosphonates (but not under GFR< 30) ``` Patient with CKD taking calcium-based binders (Calcium acetate) can have problems -> hypercalcaemia + vascular calcification Metastatic bone pain: -bisphosphonates, analgesia, or RT Metastatic Spinal Cord Compression -Dexamethasone bumetanide = LOOPS Ascending loop of Henle

Answer 40

``` RCC -Paraneo: EPO Polycythemia, PTHrH HyperCalcemia, ACTH cushings syndrome ``` -RCC+cholestasis/HSM -paraneoplastic hepatic dysfunction syndrome AKA Stauffer syndrome #increased IL-6 Tx: -Partial/Total nephrectomy -IFN-alpha, IL2 reduce tumour size + mets -TyK = Sunitinib/sorafenib > superior efficacy IFN-alpha __________ ``` TCP - Inc p(bact infect) = ROOM TEMP: <10 + no (bleed/surg / TCP dx) <30 + bleed <50 + surg <100 + CNS-bleed/procedure ``` No major hamorrhage: - PT/APTT >1.5 / Surg - ----Fibrinogen = clot/plasma prots - Fibrinogen <1.5 / Surg 1.0 - ----Cryo = f8+13 / fibrinogen + vWF - WARFARIN Stop warfarin Vit K IV @minor bleed >5 Vit K PO @NO bleed >8 Restart @< 5.0 No bleed + 5-8 = withhold dose, reduce dose -bleed @ therapeutic lvl? Ix cause..?renal/gastro dx ``` Major Haemorrhage MHP - PTC warfarin reversal emergency - <1 hr -Stop warf / PTC + vit K / FFP @unavail - @HI / ICH ___________ ``` ``` Bone pain (all 3 bone dx - OM/OPet/Paget) Deformity (all 3 bone dx - OM/OPet/Paget) + HSM - (JUST Petrosis) -OMRicKIDS Tx: Ca+Vit D -OPetrosis:Tx: BMT, alpha-IFN, EPO -Pagets:Tx: Bisphosphonates ___________ ``` Bone pain+Deformity: -OMRicKIDS Myopathy/Myalgia ``` RicKIDS - apophysis NOT fused Vit D resistance OsteoDystrophy LF Tumour ``` X-ray sign? - LOOSERs Pseudo# Tx: Ca+Vit D ______________ ``` Bone pain, Deformity + HSM: -OPetrosis: OC dx -> bone expands = BM narrow -> ExtraMedHematopoeisis HSM Tx? BMT, alpha-IFN, EPO ______________ ``` Pagets: XS OB/C activity -> Pain+deformity Tx: Bisphosphonates ______ Ca/VitD , PO4, PTH, ALP: OM low low high high OPet low/high ALP Paget high ALP Pri PTH = OFC high low high high 2ndry PTH = CKD / PseudoHypoPTH -low high high high 3rtiary PTH = CKD - high low high high

Answer 41

Cluster headache = SBOT + SubCut sumatriptan --@Migraine = Intranasal sumatriptan can be used DKA can present with an 'unrecordable' BM + confusion + abdominal pain coarctation of the aorta = assoc w/ Bicuspid aortic valve Hodgkin's lymphoma: signs of poor prognosis: B-symptoms, increasing age, male sex, stage IV disease and lymphocyte depleted subtype does not undergo angioplasty DVLA advice post MI - cannot drive for 4 weeks Raised ALP + normal LFT's = raise suspicion of malignancy #bone cancer/ metastases British National Formulary recommends giving the vaccine at least 2 weeks B4 Elective splenectomy ``` Jacksonian march (clonic movements travelling proximally) indicates Frontal LOBE epilepsy ``` HCC + nausea W/OUT vomiting -jaundice ascites bloated + BNO 2 days, but PASSING WIND -Dx = Functional BO -> metoclopramide CKD + potassium > 6mmol/L should prompt Cessation of ACE inhibitors (once other agents that promote hyperkalemia have been stopped) Carvedilol + Bisoprolol have been shown to reduce mortality in stable heart failure Beck’s triad of falling BP, rising JVP and muffled heart sound. What is the most appropriate diagnostic test for this man's condition? -Echocardiogram _______ Small + Delayed puberty: Turner/Noonan/Prader/GH def Normal/Tall + Delayed puberty: Kline/Kallowman/AIS GIRL + Amenorrhoea = Turner 45 XO -High FSH/LH KlineFortySeven 47 XXY -High FSH /LH + Low testosterone KlineFelHerTits = Pri Hypogonadism KallowwwmanOSMIA Xr - FSH/LH lowwwww + low Testost - Hypogonadotrophic(low FSH/LH) hypogonadism(low Testost) Low FSH/LH + High Testost -Testost secreting tumour AIS: -High FSH/LH + norm/high Testost XLr so MALE, bastard!! -> overall RESISTANCE to testosterone -Male karyotype (46XY) -External female PHENOtype i.e. Man with External female genitalia -breasts may develop at puberty, #testost -> oestradiol -NO internal female organs, -testicles IN ABDOMEN #groin swelling -If not identified at birth, it can present with primary amenorrhoea. ---ANDROGEN INSENSITIVITY SYNDROME ______________ Syringomyelia classically presents with cape-like loss of pain and temperature sensation due to compression of the SPINOTHALAMIC tract fibres decussating in the ANTERIOR white COMISSURE of the spine COCP use + FHx of VTE + Severe headache = more insidiously than a 'thunderclap headache', with ?subtle neurology -MR Venogram is the gold standard test for diagnosing venous sinus thrombosis CLL is associated with warm AIHA A right coronary infarct supplies the AV node so can cause arrhythmias after infarction Oral glucocorticoids are the treatment of choice for allergic bronchopulmonary aspergillosis sudden onset hypotension, fever and dyspnoea is suggestive of ABO-incompatibility Acute haemolytic transfusion reaction. Bacterial contamination of blood products can result in a transfusion reaction, which typically develops over HOURS An INR >1.3 is a relative contraindication for chest drain insertion Clostridium difficile antigen positivity only shows exposure to the bacteria, rather than current infection - Reassure and continue monitoring bowel motions Lupus pernio = sarcoidosis - raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril Pubic lice infestation = MALATHION The SPLENIC FLEXURE is the most likely area to be affected by ischaemic colitis Diagnosis of a mesothelioma is made on HISTOLOGY, following a THORACOSCOPY If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either PO Azo/MCP = to maintain remission Pseudogout - weakly positively birefringent RHOMBOID-shaped crystals When managing patients with COPD, once the pCO2 is known to be NORMAL the target oxygen saturations should be 94-98%. -if dont know + COPD = assume 88-92 for now until CO2 known absolute contraindication to thrombolysis? -Known intracranial neoplasm (VINDICATE) Chondrocalcinosis helps to distinguish pseudogout from gout The osteoporosis guidelines state if a postmenopausal woman has a fracture she should be put on bisphosphonates (there is no need for a DEXA scan). Hepatocellular carcinoma • hepatitis B most common cause worldwide • hepatitis C most common cause in Europe Cisplatin is associated with hypomagnesaemia Nephrotic syndrome is associated with a hypercoagulable state due to loss of AT3 via the kidneys Restless leg syndrome - management includes - simple measures, - Tx Fe def, - Ropinirole > Benzo/gabapentin The pneumococcal vaccine should be offered to patients with chronic hepatitis Sickle cell patients should receive the pneumococcal polysaccharide vaccine every 5 years Which of the following combinations of vaccinations are routinely offered to pregnant women in the UK? Influenza and pertussis pt w/ T2DM + BPH = burning pain in his feet. Tx? - DAG (if URINARY RETENTION, then NO AMITRIPTYLINE, BASTARD) In a patient with suspected anaemia of chronic disease secondary to CKD, Fe status should be checked prior to commencing EPO Statin: LFTs at 0m, 3 months and 12 months Spinal cord compression - BACK PAIN is the earliest and most common symptom High calcium, PROTEIN in urine, old person #back-pain -> fucking - MM DM 1 check other Ai dx -Thyroid + Coeliac/Addison Pernicious

Answer 42

PAINFUL ulcers -Herpes painful nodes (oral aciclovir / @preg=oral ciclovir till delivery -> c-section) -Behcet - uveitis VTE and painful ulcer -Chancroid-HDucreyi= painFUL Unilat Ing NODE sharply defined, ragged, undermined border. ______________ PAINLESS ulcers -Syphilis=painLESS Ing node - HPV 1+2=plantar, 4=common, 6+11-anus; - solitary-cryo, multiple-podophyllum -LGC: LymphoGranulomaChlamydia= painFUL Ing nodes, ProctoColitis B/C/D -DGiK: Donovanosis Granuloma Inguinale Klebsiella -Azith Cipro Gent __________ Which 2 beta blockers = shown to reduce mortality in stable HF? Bisop / Cardev AKI w/ UNKNOWN pathology? FUCKING USS THEM !!!! Patients with an uncertain tetanus vaccination history should be given a BOOSTER vaccine + Tet Ig, unless the wound is very minor and < 6 hours old Testing for HIV in Asyx pts should be done at 4 weeks after possible exposure ``` HIV needlestick PEP= Refer to Emergency Department + oral antiretroviral therapy < 72hrs for 4 weeks ``` Neg Antibody test after 3 months = UNlikely HIV infection gonorrhoea + scared of needles = oral cefixime + oral azithromycin #refuses IM ceftriaxone ___________ Deep peroneal nerve-failed: - fooooot EEEEEEVersion (i.e. inversion FINE!!!) - sensory loss in 1st web space - dorsiflexion / toe extension Superficial peroneal nerve-failed: -Ankle EEEEEVersion (i.e. inversion FINE!!!) - sensory loss @ANT-LAT lower leg + foot-DORSUM (NOTTTTTT the 1ST web space). L5 nerve root --> sciatic --> CPeron = S/D @lat thigh, lower leg, foot-dorsum, 1ST WEB SPACE - foot INversion + EVersion BOTH fucked - hip abduction - pain and sensory loss - Common peroneal fucked too (as above) S1 nerve root dx -weak PLANTARflex + low sensation @LAT malleolus

Answer 43

TCA use + dementia = worsening cognitive impairment Hypertonic is usually indicated in patients with SEVERE hyponatraemia (< 120 mmol/L) GTN SEs = '3 H's' 1. Headache 2. Hypotensive 3. HR increase What criteria should be used to determine whether patients who are having an excerbation of COPD require antibiotics? -Purulent sputum OR clinical signs of pneumonia ST elevation -MI / Pericarditis / brugada ST dep -isch, CVD, VH (left or right), Digoxin T-invert -isch/old, Brugada, VH (left or right), Digoxin ``` short PR interval (<120ms), wide QRS complex (>120ms) upsloping delta wave. -WPW -PR 120-200ms; QRS <120ms ``` - low k+ high sodium; high BP; high renin = RAS / other 2ndary dx - low k+ high sodium; high BP; low renin = Conn’s/Cushings >80 with >150/90 clinic + ABPM < 145/85 = lifestyle >80 with >150/90 clinic + ABPM > 145/85 = lifestyle + consider tx Recurrent infections (due to hypogammaglobulinaemia) are a complication of CLL Bog standard UTI MEN 7 FUCKING DAYS!!!!!!!!!!!!!!!! -women = 3 Acoustic neuroma Syx progressively getting worse -Stroke e.g. VertebroBasilar Insuff / POCS = sudden onset @old person+RFs Vision worse going down stairs? Think 4th nerve palsy -TROCHLEAR!!!! BHL = sarcoid / TB Breast lump + firn NON-tender (so not abscess or cyst) -stopped BF recently -USS = well-circumscribed lesion -> white fluid Dx = Galactocele

Answer 44

Bradycardia < 100 -Beta-blocker / vagal tone Tachycardia > 100 -Infection / Prematurity ___________ Early Decel -head compression #normal Late Decel -asphyxia/placent insuff #hypoxia -> DO FETAL BLOOD SAMPLING -> ?c-section ___________ Variable decel -cord comp ``` Loss of baseline variablity -Prematurity / Hypoxia __________ -Anti D @Rh neg ATE ME: Abortion TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic ``` Miscarriage >12w Evac after miscarriage ___________ A. 8-12 wks - - Booking - overlap w/ Down's nuchal scan ``` B. 11-13 -Down's + Nuchal scan -overlap w/ booking __________ C. 28 wks - 1st dose of anti-D prophylaxis @RhNEG - 2nd Anemia/AlloAB test @28w ``` ``` 34 wks: 2nd dose of anti-D prophylaxis @RhNEG __________ D. 36 wks: -BFeed / Blues -ECV ?Presentation legit -Vit K ``` ``` @viral load < 50 @ w36: VAG > C-section - IF c-section, then b4 c-section: IV zidovudine After birth: < 50: PO zidovudine @neonate > 50: Triple ART @neonate ________ ``` Mother: - BabyBond - Reduce BreastCancer / PPH-risk Kid: i-AIRD - Infections - Allergy/ IBD / RA / DM 1

Answer 45

The definition of a TIA is now TISSUE-based #imaging -NOT Syx DURATION RELATED!! Hyperventilation -> reduce CO2 -> vasoCONSTRICTion of the cerebral arteries -> reduced ICP Sweating, Pallor and N+V -> transient LOC -Suggestive of REFLEX syncope AKA neurally mediated syncope The 'double duct' sign may be seen in PANCREATIC cancer COCP use + FHx of VTE + Severe HEADACHE = more insidiously than a 'thunderclap headache', with ?subtle neurology -MR Venogram is the gold standard test for diagnosing venous sinus thrombosis Cavernous sinus syndrome Ax = Cavernous sinus tumours, OR NPC = locally invades cavernous sinus. -> Corneal Reflex Absent, Horner, Opthalmoplegia Pain, Proptosis #mass-effect -CN 3 Opthalmoplegia (ptosis/diplopia) -CN 4 Opthalmoplegia -CN 5- (V1=Corneal Reflex Absent, V2=low max sens) -CN 6 Opthalmoplegia + ICA (thrombosis) + Symp trunk (Horner's) CN3 palsy: Motor(down+out, ptosis), PSymp(dilated), ?vertical nystagmus -isch, CavSinThrom, UncalHerniate/trans-tentorial, MidbrainWeber, PComAneurysm PAINFUL third nerve palsy = posterior communicating artery aneurysm Rectal diazepam 10 mg Syncope. QRS duration is 110 ms, PR interval is 180ms and corrected QT interval is 500ms.what is the cause for the abnormality seen on the ECG? -Hypo-Mg/Ca/Kal (ssri/tca, abx-macrolide, Li low MgCaK, Typs) Behcet's syndrome is associated with erythema nodosum Haloperidol is contraindicated in patients with Parkinson's disease Anti-psychotics should be avoided in delirious patients with a background of Parkinson's disease xanthelasma secondary to hyperCHOLesterolaemia. 'Young' stroke blood tests include thrombophilia and autoimmune screening -performed in those <55 with no obvious cause of a stroke Which one of the following is the most common symptom of Crohn's disease in children? Abdominal pain T2DM blood pressure targets are the SAME as non-T2DM. If < 80 years: Pepper pot = multiple *tiny* well-defined lucencies in the calvaria caused by resorption of trabecular bone (looks like sand) #hyperparathyroidism Raindrop = multiple, well-defined lytic lesions (punched out lesions) of *various size* scattered throughout the skull #MM STEMI: Aspirin + ticagrelor + IV heparin + immediate percutaneous coronary intervention IV magnesium sulfate is used to treat torsades de pointes Hypertension is the commonest association for aortic dissection diarrhoea + hypoglycaemia = Cholera Atrial fibrillation + NO struct heart dx - cardioversion: amiodarone + flecainide Atrial fibrillation + struct heart dx - cardioversion: amiodarone (AAAmiodarone @FFFUCKED Heart - AF) ___________ most common form of brain tumours – metastases solid tumours = central necrosis + contrast enhancing rim; B-BBarrier dx -> vasogenic oedema. -most common PRIMARY brain tumours – GLIOBLASTOMA #poor prognosis tumour arising from falx cerebri -> pushing on the brain. - Well-defined border between the tumour + brain - Meningiomas develop from the DURA mater She should be offered the flu vaccination during flu season (October to January) What shown to confer a survival benefit in motor neuron disease? Riluzole Sulfonylureas (e.g. gliclazide) are the optimal treatment in HNF1A-MODY Acute Hemolytic Rxn – do Coombs test to confirm!!! _____________ Pleomorphic tumour cells border necrotic areas = Glioblast Spindle cellspsammoma bodies = Meningioma Rosenthal fibres (corkscrew eosinophilic - Pilocytic astrocytoma - most common PRI brain tumour in kids fried egg appearance = OOOligodendroma perivascular pseudorosettes = Ependymoma foam cells and high vascularity = HemangioBlastoma

Answer 46

T1/2 = Ectopic / Miscarriage-Molar preg T3 = Praevia / Abruption _________________ Complete HyDatiDiForm Mole (MOLAR) Tx = EVAC -> CONTRACEP 12m COMPLETE=46 XX/XY -EMPTY egg + 1 sperm --> DNA duplicates --> ALL 23x2 male genes -Honeycomb/Grapes/SNOWstorm @USS PARTIAL=69 XXX/XXXY - haploid egg (23) + 2 sperm (23x2) - partial fetal parts Around 2-3% = develop choriocarcinoma ___________ Accreta - delayed labour #3rdstage - prev c-sec/praevia/PID 3-types = chorionic villi:- - invade PPerimetrium #PPercreta - IInvade myometrium #IIncreta - AAttach* 2 myometrium #AAccreta *-instead of decidua basalis #accreta Tx: hysterectomy w/ placenta left in-situ ___________ P.Abruption - PainFUL PV bleed -OUT OF KEEPING w/ visible loss - feta heart fucked + DIC/Pre-Ecl ____________ 1. NO fetal distress + <36w - observe+steroids - ?adjust delivery threshold 2. NO fetal distress + >36w - vag delivery 3. Fetal distress - tx? -immediate c-section _____________ P.Praevia - PainLESS PV bleed - IN PROPORTION to visible loss - Lie = abnormal Ix? - what to avoid?! -TV-USS - avoid PV exam till praevia excluded!! LLP @W-16-20 = Rescan @w34 -34 + G1/2 = TVUSS/2w -37 = high-presenting-part/abnormal life = C-SECTION 1. If low-lying placenta at 16-20 week scan - rescan at 34 weeks 2. If still present at 34 weeks and grade 1/2 then - scan every 2 weeks 3. If high presenting part at 37 weeks then - C-section 4. If abnormal lie at 37 weeks then -C-section _______________ Vasa praevia -ROM - >PVbleed + BradyBaby

Answer 47

``` -BOE-CAB Bimanual uterine compression Oxytocin - stim ut contract Ergotamine( -5HT/Alpha-adr/Dop=vasc SM constrict -> reduce Uterus BF = less bleed) ``` Carboprost Atony = Balloon tamponade B-lynch UA/Iliac ligation/TAH ________________________ Premature labour: Admit Tocolytics and Steds After W20, S-F height i= -g.WEEKS +/- 2cm _______ Oligohydramnios < 500ml @ T3 AFI < 5th centile Ax: Renal agenesis / ACEi IUGR PROM/Pre-Ecl/Post-term>42w ``` Shoulder dystocia: MESZ McRoberts' - flexion and abduct Episiotomy, Symphysiotomy, Zavanelli / Rubin Wood's Corkscrew ___________ ``` MIFEProgRecepBlocker ONLY USED IN Abortion BASTARD MISCARRIAGE: WMVE ``` WW < 2w (d/c with f/u in ? week) Med/Surg Mx @: -Haemorrhage (late T1/blood dx) -Infection -Prev preg dx ``` MED: Vag MMMisoProstaGlandin - > Ut Contract -Moebius Synd= Cranial Nerve dx ``` SURG: OP: VVVacuum Asp Suction Curettage IP: Theatre EEEEEvacuation _____________ ABORTION: MMSE ``` < 9 w: MM 0hrs: MifeProg-ReceptorBlocker - Moebius Synd= Cranial Nerve dx 48 hours: MisoProstaGlandin= stim ut contract < 13 w: DS Surg dilation + Suction >15-24 weeks: DE Surg dilation and Evac medical abortion = 'mini-labour' >24 - ILLEGAL MURDERRRRRRRRR

Answer 48

Thoracic ADiss: Stanford/DeBakey A / 1+2) Asc = SURG + Labetall B)/3 Desc i.e. distal to L Subcl = TLC = Labetalol + BP 100-110 maintain Diabetes sick-day rules for insulin: -normal dose BUT more frequent checking MI #transmural -> PR dep / Saddle ST elevation: - Pericarditis @first 48 hours following MI - Dressler's syndrome @2-6 weeks following a MI t - Tx = NSAIDs + Colchicine Pt w/ stroke + already on AC -EMERGENCY ED imaging !!! Adrenaline dose @ >12y=0.5mg, 6-12yr=0.3mg, 6m-6yr=0.15mg, <6m=0.15mg - Cardiac arrest = 1mg Coeliac/Hyplori -> haem cancers: - coeliac = Enteropathy T-cell Lymphoma - pylori - MALT lymphoma #erad tx Orthostatic HTN = 20/10 drop after 3 fucking minutes Carotid Sinus HSR -> - Vent pause >3s - SystBP drop by 50mmHg/+ Chondrocalcinosis helps to distinguish pseudogout from gout Acromegaly can develop POS BIREFRINGENT -RHOMBOID - PseudoGout HyperParathyroidism is a risk factor for Pseudogout - #Calcium PyroPhosphate - whereas HYPOcalcaemia = cataracts Gout = needle-shape NEG birefringent Mandem = AF + chadsvasc 0: - no AC - do Echo!!!! exclude valvular dx - -remember pulse, ecg, echo 2 excl valve dx Factor V leiden = AKA Activated Prot C RESISSSSSSSSSSSSSSSSTANCE -aProtC –x10 more Slowly INactivates--> f5a Oropharyngeal infection + Internal Jug Vein Thrombophlebitis -> Lemiere Syndrome

Answer 49

Mandem takes MTX + wants a baby - >6m AFTER stopping tx Atypical Lymphocytes = EBV! Paget bones = Skull, Spine, Pelvis, Long bones 1ml of insulin syringe = 100 inuslin units? Venous cutdown of ankle veins - Long Saphenous -ant to medial malleolus OSAS can lead to what CV dx? HTN !!! ThromboProph Tx? -APLS + NO prev VTE = Aspirin lifelong -APLS + Prev VTE = Warf lifelong -APLS + pregnancy: Aspirin + LMWH(stop after w34) - APLS + Prev VTE WHILST on AC = - --Warf lifelong + Aspirin lifelong - --LMWH @Preg + Aspirin lifelong -APLS + ArtTE = Warf LIFElong - INR 2-3 @initial/ ArtTE - INR 3-4 @recurrent ArtTE = Art ThromboEmbolism Warfarin - NOT legit in pregnancy but - legit for breastfeeding - @APLS + PREG ± prev VTEs = Asp + LMWH - -@APLS + prev VTEs = Warf - --@APLS + VTEs whilst ON AC= Asp + Warf Type 2 Nec Fasc organism = GAS Pyogenes -Type 1 = post-surg + aerobes/anaerobes + DM Acute RA flare tx = IM MethylPred Osteogenesis imperfecta childhood with bone fractures and deformities BLUE sclera + hearing/visual problems Osteo Imperfecta = ALL BONE PROFILE BLOODS FKN NORMAL!!!!! Px: - Age >50 + Sig Smoke Hx - Lung dx O/E or CXR Leptospirosis Ix = Serology - lepto = serology - sally = cultures - legion = urinary antigens - mycoplasma/s.pneu - serum antigens Pt with chest infection + TNFi use for rheum dx -> ABx failed -> ITU -Bronchoscopy + BAL = Invasive Aspergillosis Away: TPx, Hernia, Effusion, Mass Towards: Collpase, Hypoplasia, Pneumonectomy AF questions + ?cardioversion -> look at ? !!!! - IF HD unstable THEN legit - offer rate or rhythm control if the onset of the arrhythmia is < than 48 hours, - and start rate control if it is > than 48 hours or is uncertain -> 3wk AC elec>pharm cardiovert -Urticarial Rashes/Fever -U+E fucked AND -High Urine: WCC, IgE, Eosinophils Dx = Acute Interstitial Nephritis #Penicillins

Answer 50

Ruptured AAA - ?blood products? -6 units CROSSMATCH RBC >80 with ABPM >145/85 -St1 HTN = lifestyle changes + ?Tx HepatoRenal Syndrome - develops < 2 weeks - Type 1 - develops >2 weeks - Type 2 ``` Mandem had accident -> Cord injury @above T6 -> HTN + Bradycardia + ... -Flushed + Sweating #Red ABOVE shoulders -PALE BELOW shoulders Ax of HTN = Autonomic Dysreflexia ``` Mandem in accident -HTN and Bradycardia -flushed above shoulders, pale below Autonomic dysreflexia can only occur if the spinal cord injury occurs above the T6 level Faecal impaction / urinary retention are the most common triggers of autonomic dysreflexia SB bacterial overgrowth syndrome = RIFAXIMIN Mandem w/ cancer -> Chemo -> U+E: - hyperrrKALaemia, -hyperrrPHOSPHataemia - HIGH creatine - Seizure/arrythmia -LOWW Calcium TLS - Allopurinol #Tumour lysis syndrome Absent corneal reflex, CN7 palsy, SVT #CN578 -Acoustic Neuroma _________ Cauda Equina Spinal Cord Compression Cancer + NEW back pain = MRI whole spine #spinal-mets _________ Stroke disability score prediction -BARTHEL index

Answer 51

Cerazette > 12 hrs late The rest > 3 hrs late ``` POP miss = 2UP TC -2d condom + -UPSI < 2-3 days = Emerg contracept -Preg Test -take last pill (even if taking 2 pills) -cont pills OD _____________________ COCP: pros = -ovarian/endomet cancer protect -colo cancer protect -periods = lighten (fibroid) / less pain (endmetr) ``` cons = - breast/ cervical cancer - vte POP cons: i-WOAH 1. Irreg periods, 2. Weight gain, Obesity, Acne, Headache Depot cons: DOB - delayed return 2 fertility - obesity - BMD low ``` Cons of HRT: BEVi Breast (prog increases this) Endomet (prog reduces this) VTE / IHD (Transdermal HRT reduces this) iNC Fibroid size ``` Tamoxifen cons? LEV LF/Hypertriglyc, Endomet dx, VTE ______________________ yLARC - Implant > Depot / IuS / POP = Low BMD!! _____________ BC past = 3, current = 4 -Barrier/Copper only yLARC - Implant > Depot / IuS / POP = Low BMD Contracept UNaffected by Enzyme-Ind Drugs? E I D: IuS - Depot IuD - Depot Obesity - POP _________ Contraceptive mechanisms: Inhibit ovulation > Thicken cervical mucus < Endomet proliferation Inhibit ovulation > Thicken cervical mucus - Depot/Implant/POP Endomet proflif > Thicken cervical mucus - IuS Inhibit ovulation: - Levonorgestrel / Ella1Ullipristal (CI: BF 1wk wait, Asthma) / COCP _______________________ Cu-IuD - Sperm motility / Implantation / TOXIC Latex allergy - PolyUreThane yLARC - Implant > Depot / IuS / POP = Low BMD!! Depot - weight gain / delayed return 2 fertility ____________ Post-pill amenorrhoea - periods return about 6m Depot IuS/D Contraceptions that work: Now - IuD 2d - POP 7d - COCP / Depot / IuS Implant -How long it lasts Nex = 3yrs Mirena = 5yrs Copper iuD = 10yrs Contraception for obese ppl? -POP Sterilisation failure rate: Female - 1/200 Male - 1/2000 _________ 1. Levenorgestrel - < 3d UPSI 2. IuD - < 5d UPSI / AFTER ovulation / FATSOs - IuD > EllaOneUllipristal!!!!! 3. EllaOneUllipristal - < 5d UPSI EllaOneUllipristal BFeed 1 week WAIT CI = Asthma < 21d PP - - > UPSI - - > Not need emerg contra if EMERGENCY Contrapception - Cu-iuD most effective <3d <5d generally - Cu-iuD not affected by BMI Levonelle (double the standard 1.5 mg dose) -i.e. 3mg levonorgestrel BMI >26 / weight > 70kg Ella1 = CI asthma / BF wait 1 week Cu-iuD = not recommended in patients with distortion of the uterine cavity e.g. fibroids. seeking emergency contraception -UPSI = 80 hours ago (i.e. between 3-5 days) -On day 20 of her menstrual cycle. -Took ellaOne ulipristal was prescribed to this patient 10 days ago for a similar episode (i.e. in same cycle). Which of the following is a suitable method of emergency contraception in this case? -Can give Ella1Ullipristal TWICE in a cycle -Can give CuiUD too <5d/ after d14/ FATsos ``` Woman vomits < 3 hours of taking Levonorgestrel OR Ella1Ullipristal, prescribe a SECOND dose of emergency hormonal contraception ASAP _______________ ________________ ``` Age > 35 + Smoke stop< 1yr/<15perday --> >15/day BMI > 35 BRCA/Prev BC --> Current BC Clots VTE FDR (< 45/immobile) --> VTE Current/Past/Dx Controlled HTN/>140/90 --> Uncontrolled >160/100 / VASC dx Current GB dx --> major surg IMMOBILE = switch to POP ``` UKMEC 4 BMI -slva -carl -BFeed < 6w pp = cos it reduces milk -Migraine w/ aura = stroke -IHD / LF / Stroke -vasc dc/APLS -----Cx / AF / L-RVFail _________________ ``` ``` BFeed < 6w PP = 4 PP < 21d + VTE RFs = Y(4) N(3) PP >21d + VTE RFs = 3 PP 2d - 4w = 3 @ IuS/D ___________ ``` POP UKMEC 3 + 4 - Stroke/IHD/BC past/LF = 3 - BC current = 4

Answer 52

GDM - booking appt: - Prev 1. macrosomia 4.5kg /+ 2. GDM -> selfBM/OGTT @booking - -ifNormal--> OGTT @w24-28 -Urine BM ++ / + x2 ``` -BMI >30 + Birth <40+6w recommended + Anesthetic r/v @obesity/auto neuropathy + steds/tocolysis @fetal lung mat -BAME/GDM FDR ``` --> do 2hr-OGTT: FPG 5.6/+ OR OGTT 7.8/+ -GDM ANC + HbA1c <1wk / 1-2wks FPG 6.1-6.9 = 1. Lifestyle d/e -2wk/fail-> 2. Metformin a. --cant tol-> Insulin alone b. --CAN tol but BM control fail-> + Insulin c. -Insulin --can't tol/fail-> Gliben (?discontinued) FPG 7.0/+ // PolyHydramnios/Macrosomia+6.1-6.9 = INSULIN ± Metformin + d/e measure: -Fasting + Post Meal-1hr @DM2/GDM NOTTTTTT@multiple daily injections -Fasting, Pre + Post Meal-1hr, Bedtime @DM1 / DM2/GDM @multiple daily injections ``` cap BM target: -Fasting 5.3, AND -1hr Post Meal 7.8 -2hr Post Meal 6.4 Hba1c 48/+ = HRisk _____________ ``` ``` Pre-Existing DM @preg 1a. Renal Assx: Creat > 120 Urine A:C >30 --> >220 #VTEproph TProt >0.5g/d -> 5g/d #VTEproph ``` 1b. Retinal Assx: 16, 28 digital image w/ mydriasis w/ procainimide @1stANC--DiabRetinopath--> w16-20 --> w28 2. Anomaly scan @w20 + 4-chamber heart view = 28 w28-36 / USS/4wk 3. WL @BMI >28/+ ``` 4. Birth @37 - 38+6w recommended Anaesthetic r/v @obesity/auto neuropath Steds/Tocolysis @fetal-lung-mat -FPG @6w post-natal check (6-13 w PP) ```

Answer 53

Paroxysmal HemiCrania -Indomethacin __________ Conduction aphasia - Arcuate Fasciculus - Fluent + Sense + Comp NORM - Repetition fucked Wernicke Receptive - SUP Temp gyrus - Fluent + NO Sense + Comp FUCKED - Repetition NORM ``` Broca Expressive -INF Frontal gyrus -NON-Fluent + Sense + Comp NORM -Repetition fucked ______ ``` Dexa @Oed from tumour Mannitol @Raised ICP Nimodipine @SAH to reduce vasospasm ______ Gait ataxia = cerebellar vermis lesions -Vermillion Gate Cerebellar hemisphere = finger-nose past-pointing ataxia -hemisPhere=PastPoint Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington's) Parietal lobe - sensory symptoms, dyslexia, dysgraphia Frontal lobe - motor symptoms, expressive aphasia #BrocaInfFrontGyrus, disinhibition ________ suspected stroke. unable to speak BUT able to follow instructions - do not know the handedness of the patient - percentage of RIGHT-HANDED > Left-Handed handed - therefore dominant LEFTTT hemisphere is 90% and 60% respectively, - making the left always the most likely affected side - MCA on dominant side supplies both Wernicke's (sup Temp Gyrus) and Broca's (inf Frontal Gyrus) areas - which are responsible for understanding and production of speech.

Answer 54

Sarcoidosis can cause a false negative Mantoux test - Causes of false-negative Mantoux test - Sarcoid - ImmunoComp - Lymphoma - Old ppl - -Fever/Low Alb-Hb ``` 0-12m, HR area, Contacts of smear + , Unvacc (35/-) / (36/+ + HCW) Mantoux/ IFN/ Tuberculin NEG ``` ``` <5mm = UNvaccinated >5mm = past TB / BCG >15mm = current TB infection ``` Impaired hypoglycaemia awareness occurs due to neuropathy of parts of the autonomous nervous system Thyrotoxic storm is treated with beta blockers + PTU + hydrocortisone Glucocorticoid treatment can induce neutrophilia Stroke is a life-threatening event associated with autonomic dysreflexia An ICD can be inserted to reduce the risk of sudden cardiac death in HOCM ``` classically worse on standing + IMPROVE when lying flat CHILLING --> Low CSF headaches = Spontaneous Intracranial Hypoootension (not necessarily post-LP) ``` Yellow fever is present in Kenya but you would expect more significant jaundice and bleeding 1/3 of patients have infrequent relapses and 1/3 of patients have frequent relapses a majority (2/3) will have later recurrent episodes #MCD HSP = full recovery !!! DEXA scans: the Z score is adjusted for age, gender and ethnic factors Headache linked to Valsalva manoeuvres = e.g. coughing or lying down etc raised ICP until proven otherwise so LP is contraindicated Persistent ST elevation following recent MI, NO chest pain ?pitting oedema to both ankles + slight distension of the neck veins. -LV Aneurysm Sickle cell patients should receive the pneumococcal polysaccharide vaccine every 5 years In the UK the commonest cause is autoimmunity. Worldwide, however, the most common cause is infection (typically tuberculosis). Severe sepsis may result in neutropenia Steroids may result in neutrophilia Dysplasia on biopsy in Barrett's oesophagus requires an endoscopic intervention In the treatment of anaphylaxis, you can repeat adrenaline every 5 minutes Barrett's oesophagus: High dose PPI + endoscopic surveillance. -The metaplastic mucosa needs to be monitored on a regular basis to check for dysplasia/ malignancy ``` deranged LFTs + secondary amenorrhoea @young female strongly suggest autoimmune hepatitis ``` Tetracyclines can cause black hairy tongue Localised disease is an indication for surgery in bronchiectasis SMALL CELL lung cancer is associated with LAMBERT EATON syndrome, a rare paraneoplastic syndrome, which features autonomic symptoms, limb-girdle weakness (manifesting as a WADDLING gait), and hyporeflexia. Old person painful frontal headaches -pale oedematous optic disc Dx: Temp Arteritis + AION *Domperidone does NOT cross the blood-brain barrier and therefore does NOT cause EPSEs ! A low dose dexamethasone suppression test showed a lack of appropriate suppression of plasma cortisol. However, cortisol was suppressed during a high dose dexamethasone suppression test. Plasma ACTH was elevated. A pituitary MRI was normal. - What is the most likely diagnosis? - Cushing's disease (i.e. still frickn PIT ADENOMA BUT @Pit MRI = TOO SMALL TO BE PICKED UP !!!!!!!!!!!) MTX + Trimeth = MyeloSup Azathioprine + Allopurinol = MyeloSup amiodarone Is a common cause of thrombophlebitis HENCE should ideally be given into CENTRAL veins IV adenosine needs to be infused via a large-calibre vein or central route Pseudo Pelger-Huet cells arise in CML #9,22 If a pleural effusion is drained too quickly, a rare but important complication that can develop is REPO: Re-Expansion Pul Oedema Budd-Chiari syndrome presents with the triad of sudden onset abdominal pain, ascites, and tender hepatomegaly BG: Polycythaemia vera Specific lifestyle changes to manage premenstrual syndrome include - 2-3 hourly - small balanced meals - rich in complex carbohydrates

Answer 55

Syringomyelia is associated with the Arnold-Chiari malformation Non-contrast CT for stroke BASTARD!!!! Klebsiella can cause empyema formation shaft of the humerus = radial nerve dx Supracondylar fracture of humerus = ulnar nerve damage. Proximal humerus Fracture = axillary nerve damage. 3 month history of numbness and paraesthesia in his feet. On examination there is widespread numbness of both feet which does not fit a dermatomal distribution. A recent gamma-glutamyl transpeptidase (gamma GT) is 4 times the upper limit of normal. -What is the most likely diagnosis? -Alcoholic peripheral neuropathy Pulmonary rehabilitation is recommended to start early in the course of COPD, as soon as patients start feeling shortness of breath with regular activity The AST/ALT ratio in alcoholic hepatitis is 2:1 number of features in keeping with a diagnosis of ARDS - ACUTE onset within the past day, on the background of a known risk factor (e.g. pneumonia) - B/L pulmonary oedema (crackles, x-ray changes) - CRACKLES heard (in collapse/atelectasis, don't get crackles) - DESPITE oxygen therapy = hypoxia Central pontine myelinolysis is a complication of correcting hyponatraemia too rapidly COPD: - LTOT/Stop Smoking = improve survival - Becky = Improve: QoL, FEV1 / Reduces freq exac Stopping smoking is the most effective intervention -to slow FEV1 decrease in COPD -to improve survival Septic arthritis - most common organism: Staphylococcus aureus Patients with sickle cell disease are at increased risk of Salmonella spp septic arthritis. Dermatomyositis is associated with ANA Another clue is the fact that the patient is a retired sushi-chef and is likely to have consumed a fair quantity of fish which is known to be high in nitrosamines - a known carcinogen #oesophageal cancer 4-year-old son to you the GP. She says her son has not been growing relative to his peers in school. -Axillary freckles are indicative of neurofibromatosis 1 Opioids should be stopped in Clostridium difficile infections A positive femoral nerve stretch test may indicate referred lumbar spine pain as a cause of hip pain productive cough = worsening / 6 months. IVDU + multiple episodes of pneumonia in the past. O/E conjunctival pallor and bilateral wheezing -lots of eosiniphils -Sputum CS: Eosinophils and fungal hyphae Dx = ABPA --Tx=Steds Reactive arthritis is not typically acute - it can develop up to 4 weeks after precipitating infection and can run a relapsing-remitting course over several months -Oral prednisolone is the correct answer. Haemodialysis is the most common form of renal replacement therapy. The usual first line option for INDEPENDENT patients for renal replacement is a form of peritoneal dialysis. Haemofiltration is only used in the acute setting, often only being available in critical care departments for very sick patients. Farmer, fever, transaminitis ?Q fever - Coxiella Levodopa and other antiparkinsons drugs are 'critical' medicines which should not be stopped on acute admissions and must be delivered on time -Acute withdrawal of levodopa can precipitate neuroleptic malignant syndrome.

Answer 56

First-line treatment for ITP is oral prednisolone Hepatitis E is spread by the faecal-oral route and is most commonly spread by undercooked pork The neurologist decides to initiate treatment that will provide initial symptomatic relief. Pyridostigmine ong-acting acetylcholinesterase inhibitor emporarily improving symptoms of myasthenia gravis C8 is the ONLY cervical nerve root that comes out BELOW the vertebra A HIV test should be offered to all patients with TB The postural hypotension and ataxia makes the Parkinson's plus disorder progressive multi-system atrophy the most likely diagnosis. Warfarin may rarely cause skin necrosis The pneumococcal vaccine should be offered to patients with chronic hepatitis Sickle cell patients should receive the pneumococcal polysaccharide vaccine every 5 years Which of the following combinations of vaccinations are routinely offered to pregnant women in the UK? Influenza and pertussis In infective endocarditis, - Mitral valve is most commonly affected - IVDUs get Tricuspid regurg Seizures are characteristically provoked by hyperventilation Pt w/ myasthenia gravis is due for an elective abdominal hysterectomy. Which commonly used anaesthetic agent would she most likely be resistant to? -Suxamethonium PMH: rheumatoid arthritis, is -scheduled to have a laparoscopic cholecystectomy. What imaging should be performed pre-operatively? -Ant + Post + Lateral c-spine radiographs -Atlanto-Axial subluxation is a rare complication of rheumatoid arthritis, but important as it can lead to cervical cord compression. -goes to surgery in a C-spine collar and the neck is NOT HyperExtended on intubation. Penicillamine can cause MEMBRANOUS glomerulonephropathy in patients with Wilson's disease Which is the best assessment tool for differentiating between stroke and stroke mimics? ROSIER If a pituitary incidentaloma is found within the sellar, laboratory investigation must be done to determine if it is functional or non-functional Hypoglycaemia is commonly mistaken for being ‘drunk’ and so blood glucose measurement should always be part of initial assessment. low HbA1c = Hemolysis / RF / WL high HbA1c = Haematinics/ Splenectomy Ask her GP to repeat thyroid function tests (TFTs) in 6 weeks Sick euthyroid is common in unwell, elderly patients and often needs no treatment Syringomyelia - wasting SMALL muscle hands - Pain + Temp FUCKED - ARNOLD CHIARI Frontotemporal dementia is associated with motor neurone disease ``` The KETOGENIC diet is a -high fat, -low carbohydrate, -controlled protein diet. It is an established treatment for children with epilepsy = hard to control + unresponsive to antiepileptic meds ``` FODMAP diet - This is used in treating irritable bowel syndrome (IBS) Herpes + Preg = Oral aciclovir until delivery and delivery by caesarean section

Answer 57

Fibroadenoma -W+W < 3cm -Surgical excision @ >3cm _____________ Fibroadenosis -FibroadenoSISSSSSS - SISters !!! (fibrocystic disease, benign mammary dysplasia) _______________ Breast cancer Ductal No Special Type> Lobular > DCIS > LobCIS ___________ Paget's disease of the breast - intraductal carcinoma _________ FROM USMLE BOOK 2019 p635 -NLM TLS Nipple, LACTIFerous duct_Major duct = Paget, Abscess, Mastitis, IntraDuct-Papilloma=bloody TERMinal duct_LOBular unit = Cancers - DCIS etc Stroma = Fibroadenoma/Phyllodes tumour _______________ Aphonia = inability to speak. - Ax: 1. Recurrent Laryngeal Nerve palsy (TT/Tumour) 2. PSYCHOgenic

Answer 58

Mammary duct ectasia -Dilatation of the LARGE breast ducts __________ Duct papilloma - NOT malignant or premalignant _________ Fat necrosis Rare and may mimic breast cancer so further investigation is always WARRANTED!!!!!! __________ Breast abscess -LACTATING women -Fluclox + I+D ________ Breast cyst -HALO sign @ mammograms Excision > I+D Needs excision to remove shell - breast cancer risk !!! __________ PERIDUCTAL mastitis -ABx, I+Drain ___________ Lactational mastitis -FLUCLOX and Cont BFeeding -S Aureus ________ T1 <2cm T2 2-5cm T3 >5cm T4a skin T4b CW T4c skin + CW T4d INFLAMM FEC-D chemo = for node +ve, and that FEC chemo = for node -ve that requires chemo ______________ Hospital. Refer @ 160/110 / ProtUria [2/+] ______________ Intrahepatic cholestasis of preg increased risk of PREMATURITY Induce @ 37w + USDA + Vit K

Answer 59

W1-3 patch ; W4 = patch free = bleed ``` W1-2 patch delay <2d TC W1-2 patch delay >2d 7UP TC -7d Barrier -UPSI @ >2d delay/last 5 days = EMERG CONTRACEP -Preg test -Take off patch -Change ASAP ``` @W3-end, patch removal DELAY? -Take off patch -Change patch @next cycle start even if withdrawal bleeding @W4 patch-FREE week END, delay new patch application? 7UPTC If combined patch started after day 5?? -7UPTC ________ ________ If COCP started after day 5 - -7UPTC ____________________ ``` Pill-free week end --> take COCP --> miss 9/+ days: 7UP TC -7d condom -UPSI @/after pill-free week - EMERG contra -Preg test -take last pill (even if taking 2 pills) -cont COCP OD _________________ ``` COCP methods: Tricycling 3 weeks 1 week off -W1-3 pills ; W4 = pill free = bleed No pill-free week ________ If 1 COCP missed: TC - take last pill (even if taking 2 pills) - cont COCPs OD If 2 or more COCPs missed 7UPTC: - 7d condom - UPSI @/after pill-free-week --> EMERG contracep - Preg test - take last pill (even if taking 2 pills) - cont COCPs OD @week 1: 7UP TC @week 2: chill @week 3: omit pill-free week ____________________ Ectropion/Polyps/Cancer - COCP UNDERdosing = breakthrough bleed, Depot, IuD, POP

Answer 60

If 2 or more COCPs missed generally: - 7d condom + - take last pill (even if taking 2 pills) - cont COCPs OD @week 1: - UPSI during/after pill-free-week --> EMERG contracep - Preg test @week 2: chill @week 3: omit pill-free week ____________________ ``` 7 Concsecutive COCPs missed: RCP -Restart COCP as new user -7d condom + -preg test ____________________ ```

Answer 61

``` 1 of: CKD HTN pre-existing AImmune DM ``` 2 of: FFM 10 35 40 FHx/First/multiple 10yr interval / BMI 35/+ 40/+yrs ______________ Refer @ - 160/110 / ProtUria [2+] - A:CR >8 / P:CR >30 = significant --> Refer obst HELP syndrome - IV MgSO4 Preggers/PP<4w = HENPS -Dx: Pre-Eclampsia -> Tx: 999 ___________ @ Pre-Eclampsia HR: 1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40) 2. @booking 8-12w - Asp 75mg W12 --> birth @ HR Pre-Ecl 3. Refer @ (dipstix/BP @each ANC) - 160/110 / ProtUria [2+] -A:CR >8 / P:CR >30 = significant --> Refer obst __________ Dipstix/BP @ each ANC If dipstix prot 1/+ --> Renal Assx: A:CR >8 / P:CR >30 = Significant --> Refer obst Refer @ 160/110/ ProtUria [2/+]

Answer 62

gHTN ----- >20 weeks w/ >140/90 ``` Pre-Eclampsia : ----- >20 weeks w/ >140/90 and ----- 1/+: ProtUria OR Organ dx (Neuro/ LF/RF/ UtPlacent dx/ TCP) ---HbA1c/HUria-uACR/U+E-Fundoscope-ECG ``` Eclampsia: as above + seizures --> Magnesium sulphate CaGluconate @ MgSO4 induced respiratory depression? ____________________ Ix: Dipstix/BP @ each ANC @ Pre-Eclampsia HR: 1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40) 2. @booking 8-12w - Asp 75mg W12 --> birth @ HR Pre-Ecl 3. Refer @: - 160/110 / ProtUria [2+] -A:CR >8 / P:CR >30 = significant --> Refer obst _____________ ACE/ARB/ THIAZIDEEEEEEEEEE Stop anti-HTN tx if BP < 110/70/ Syx @low BP chronic HTN >140/90 + NOT taking aHTN tx = LNM<135/85 --labetalol > nifedipine > methyldopa --> Target < 135/85 METHYLDOPA during preg stopped < 2 days of birth cos of DEPRESSION physiological DROP in BP @EARLY pregnancy?? Ix: Dipstix/BP @ each ANC @ Pre-Eclampsia HR: 1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40) - PRE-EXISTING PART OF CHAD mnemonic 2. @booking 8-12w - Asp 75mg W12 --> birth @ HR Pre-Ecl 3. Refer @: - 160/110 / ProtUria [2+] -A:CR >8 / P:CR >30 = significant --> Refer obst _____________ Physiologic changes @preggers - rises: everything else - drops: Hb + BP

Answer 63

1. probable UTI --> MSU --> f/u 1wk + Cephalex/ Amoxi/ Pivmecillinam 2. @PP: had pre-Ecl + NOT had anti-HTN tx = BP check 3–5d after birth 3. @PP: had pre-Ecl + HAD anti-HTN tx = - BP check/1-2d after birth - for 2 weeks 4. @PP BP > 150/100 start anti-HTN tx ``` Remember @preg = LNM<135/85 POSTnatal period: - not BREASTfeed = normal HTN tx - BREASTfeed 1. A/C* 2. A+C 3. A+C±B** ``` * SALANA = SA/LA = Nifed/Amlod * *+/- atenolol/labetalol ``` gHTN/chrHTN = BP check: check -day 1 -day 2 -days 3–5 (x1) ``` R/V BP meds @ 2wks postnatally Postnatal review 6-8 weeks chronic HTN >140/90 + NOT taking aHTN tx = LNM<135/85*** ---Target BP Postnatally: 140/90 ***labetalol > nifedipine > methyldopa --> Target < 135/85 _________ _________ _________ St 1: 140/90 -ABPM-> 135/85 St 2: 160/100 -ABPM-> 150/95 St 3: 180/120 ________ 180/120/+ w/ PapOed/RetHaem/LT syx* *Confusion/ChestPain-CCF/AKI ``` NO = -CVD RF - Lipid profile/Q10 -Lifestyle -EODx Assx = HUria/HbA1c, Urine ACR/U+E, Fundoscopy, ECG: Y = Tx-ABPM N = BP 7d repeat ``` YES = 1. 999 Malig Acc HTN 2. Suspected Phaemo: - 1. Rest, Atenolol, Nitroprusside/Labetalol, DBP drop <100/12-24hrs ``` - 2. Suspected Phaemo: HA/HTN, Anxiety, Sweat + pHoresis, pALlor/pALp, pOst HypoTN ________ ``` 160/110 / 2/+ PUria = refer @preg -@PPartum BP > 150/100 start anti-HTN tx = E/NAm ENAtLab 160/100 -ABPM-> 150/95 = St 2 160/90 = Isol Syst HTN 150/90 -ABPM-> 145/85 St 1 >80y 140/90 = gHTN/PreEcl 140/90 -ABPM-> 135/85 St 1 <80y 140/90 CKD + ACR <70 130/80 CKD + ACR >70 130/80 DM = AlbuminUria + 2/+ WTHG ___________________ BP tx when? 1. <40 = 2ndary cause find* 2. <60 + Q10/- 3. <80 + - CVD established - DM - EODx - Renal dx - Q10/+ = 20mg Atorva 4. >80 >150/90 ``` *Ix: CVD - Coarc/RAS Renal dx = LUMP* Eye dx Keith Wagner ECG Endo - Thyroid/Acromeg/GFR** dx Drugs ``` ``` * Lump - RCC Urine: PUria/AlbUria = DM / HUria = g.nephritis Mass = obst uropathy/RCC @loin Pyelo ``` ``` **G(Ald:Renin/synACTHen) F(DexaSuppTest) R Catechol (urine metaneph/CT-AP/meta-IBG) _____________ ``` Age<55/DM Age>55/Black 1. ACE/ARB C/D @ccb-CI e.g.CCF 2. A+C > A+D 3. A+C+D 4. K 4.5/- = Spiro / 4.51/+ = alpha/beta-block 5. Refer specialist

Answer 64

Vit D 10 micrograms once a day Folic acid 400 micrograms OD NTD pmh/fhx/prevpreg BMI 30/+, Coeliac, DM, Epilepsy, Thalassaemia INTRApartrum IV BenPenG ______ ``` V - Aspirin/Amiodarone I - chloramphen/Quinolone/Sulfonamide/Tetras/Fungals - selenium, flucon, itracon N - MTX/Cytotoxics D - LITHIUM/BENZOs I - LITHIUM/BENZOs C - LITHIUM/BENZOs A - MTX/Carbimazole TE - SUs ``` ``` Post-term = beyond 42 w --> INDUCE > WW -High Risk of Meconium Asp -High Risk of Oligohydramnios _______ ``` Labetalol Deliver < 48hrs Target DIASTOLIC bp = 80-100 _________________ Puerperal pyrexia - admit IVAbx -Post-partum period = <6wks __________________ Continue breast feeding + Tx BOTH: - Mum - Miconazole cream - Baby - Nystatin _________ ``` Polymorphic - emollients, top/PO steroids -Pruritic -3rd trimester -ABDO Striae --> spread -ACE ___________ ``` PemphigOOOOOid gestation - PO steds O looks like fkn belly-button!!! -and blisters too!!! _________ RACE Reassure - Blues < 1 wk ADMIT - Psychosis < 2-3 wks CBT + Sertraline/Parox V Fluox - PND < 4-12 wks - Sertraline + Fluoxetine @preg - Sertraline @BFeed Edinburgh Scale is a screening tool for postnatal depression ________ < 36 w turn spontaneously AFTER 36 w = ECV C-section/Vaginal delivery Summary: W36 spont -> ECV -> C-sec/Vag

Answer 65

1. sBEL: Fetal Varicella -small brain eyes limbs LIKE A CHICKEN-(pox) lol -disabilities/microophthalmia/hypoplasia _______ 3. CMV SEEEE-MV=Sensorineural - ganciclovir ________________ 4. Toxo -HydroCEPH ?erythema multiforme -spiramycin -pyrimethamine + sulfadiazine _______ 5. Rubella -ears, eyes, heart - PDA _________ ``` sensorineural = cmv + rubella brain calc = cmv + toxo chorioret = -cmv(white+red) + -toxo(white overlying vitreous) + -rubella(salt+pepper) __________ ``` Keep away from anyone w/ rubella Advise risks MMR PoooooST-NATALLY Reassure her. No further action check varicella ABs + VZIG > 20 w = ORAL Aciclovir <24hr of rash < 20 w = ?consider ORAL aciclovir

Answer 66

-Ticag = stops adenosine clearance -> incr adenosine --> SOB sx -Sub ticag for clopi ________ iNITIAL Tx? MONAsp 300mg + ... eligible for PCI: - -> DAPT: Asp + already on AC? - Y = Asp+ Clop - N = Asp + Prasugrel / Ticag or Clopi @75/+ + HR bleed ``` For the poor fuckers NOT eligible for reperfusion therapy --> DAPT: Asp + HR bleed? Y = Asp ± Clopi N = Asp + Ticag ``` ``` Can PCI be done < 2hr when Fibrinolysis COULD have been given? - Y = Angio + PCI = DES @Syx <12hr #AspThrombus-Radial>Fem #Syx >12hr = consider Angio + PCI @ContIsch/CardioShock ``` - N = Fibrinolysis#tPA + UFH/LMWH #AT ECG < 60-90 mins -> ?STEMI improve 50% NO = failed thrombolysis -> Refer for Angio + PCI GPi bailout @PCI via - Radial = UFH (ruff ruff like a dog... ) - Femoral = Bivilarudin STEMI + Multivessel dx + Cardiogen shock = -Culprit Vessel Revasc STEMI + Multivessel dx + NO Cardiogen shock = -COMPLETE Vessel Revasc B4 d/c: -LVF testing in all NSTEMI/STEMI #Echo (look at pictures on 18/1/21 for written notes)

Answer 67

NSTEMI: ``` MONAsp 300mg Fonda \ UFH @ @angio \ Creat >265 ASAP --> ``` GRACE 6m mortality - Bloods: Trop I or T / FBC U+E BM - Hx / Ex - ECG Angio ± PCI + UFH @cardiac cath lab = DES @ 1)-HD UNSTABLE 2)-Stable AND GRACE 1.5 - 3% #Low Risk AND Isch exp/demonstrate @testing 3)-Stable AND GRACE >3% #Inter/High Risk < 72hr ``` GRACE 1.5 - 3% #Low Risk For the poor fuckers NOT eligible for reperfusion therapy --> DAPT: Asp + HR bleed? Y = Asp ± Clopi N = Asp + Ticag ``` GRACE >3% #Inter/High Risk - DAPT: Asp + already on AC? - Y = Asp+ Clop - N = Asp + Prasugrel / Ticag B4 d/c: - isch testing if conservative tx @NSTEMI - LVF testing in all NSTEMI/STEMI #Echo

Answer 68

WMVE: Expectant management (d/c with f/u in 1 week) is generally the 1st line management for miscarriages except if: -Haemorrhage HR (late T1 i.e. w13ish 39/3 / bleed dx) -infection -PMH: prev fucked preg PROLONGED labour --> later woman continuous dribbling incontinence -VESICO-VAG fistula #prolonged-labour -Ix = Urinary dye studies > IV urogram/pyelogram __________ -Cerv cancer + St IA tumour + Gold standard tx = TAH ± Node clearance -Cerv cancer + St IA tumour + MAINTAIN FERTILITY = Cone biopsy + Neg margins Cervi Cancer + stage IB /+ = -RT + Chemo __________ Endomet Cancer Ix = TVUSS, Pipelle, Hystero+Sample TVUSS -> Pipelle biopsy –inconclusive--> Hysteroscopy + directed sampling (dilation + curettage) Endomet Cancer Tx @ localised disease = TAH + B/L Sooph –Hrisk--> post-op RT Endomet Cancer Tx @Frail elderly women + NOT suitable for surg = ---Progestogen tx Endometrial biopsy for PMB __________ Ovarian Cancer Tx? All stages = LaparoTOMY tumour excision Stagaes 2-4 = Chemo __________ Endometriosis is a risk factor for ectopic pregnancy Which of the following risks is most common following a Termination of Pregnancy? -Infection positive pregnancy test + abdo/ pelvic or cervical motion tenderness Tx = Immediate Assx -The Nexplanon prog-only implant can be inserted at any time ALTHOUGH contraception = NOT needed B4 day 21 postpartum. -The POP can be started on or after day 21 postpartum. -Mirena + Copper iuD can be used from 4w postpartum. ``` TRANS-Female (i.e. genetically a man) In relationship with another woman -Has regular UPSI. -In the process of gender reassignment. -No surgery on meat’n’2veg. What is the most appropriate form of contraception to advise? -Barrier = condoms ``` GMC) state that we should report all known cases of FGM in under-18s to the POLICE FGM 1234: Clitoris ± Labia ± Narrowed vag ± Procedures Which of the following ovarian tumours assoc w/ Endometrial HyperPlasia? -Granulosa cell tumours Atyp HyperPlasia of the endometrium is classified as a ? condition Rokitansky's protuberance = Teratoma (dermoid cyst) #Germ-cell unknown location @uss I.E they can’t see shit + hCG levels >1500 = ectopic - HCG 1. <1500 2. >1500 HBeat 1. -none 2. -visible 1. <35mm / Unruptured 2. >35mm / Ruptured 1. WW2d / MTX 2. Salpingectomy/Salpingostomy ___________ -How long it lasts Nexplanon = 3yrs Mirena = 5yrs CuID = 10yrs ``` suspicion of ovarian cancer but there is an abdo-pelvic mass/Ascites, CA125 and TVUSS can be BYPASSED and the patient directly REFERED to gynaecology ```

Answer 69

POP use. As a general guide: • 20% = amenorrhoeic • 40% will have Regular bleeding • 40% will have Erratic bleeding Suspected/PMH breast cancer/ BRCA - copper coil = safest diagnosed with a simple UTI -> prescribed a 3d Trimeth - Returns 2 weeks later = new onset VAG D/C - The patients vaginal discharge is most likely caused by a FUNGAL infection #reccent ABx Tx Lactational amenorrhoea is a reliable method of contraception as long as - AMENORRHOEIC - baby <6 months AND - breastfeeding (> 85% breast milk feeds) ``` If BFeed < 85% + UPSI After PP day 21= Preg Test + Contraception _____________ concerned as her daughter has NOT STARTED periods although suffers from NO pain. O/E: the daughter LOOKS WELL. Ddx? - Constitutional delay ``` ``` concerned as her daughter has NOT STARTED periods although suffers from NO pain. O/E: the daughter looks FUCKED (no uterus + hypoplastic upper vag). Ddx? - Mullergan Agenesis ``` ``` concerned as her daughter has NOT STARTED periods although suffers CYLICAL PAIN. O/E: the daughter LOOKS WELL. Ddx? -Imperforate hymen _____________ ``` salpinGECTomy is offered to women who has a tubal ectopic UNLESSSS they have other RFs for infertility eg. Contralat tube dx ---Otherwise, salpinGOSTomy is offered as an alternative. COMPLETE hydatidiform mole = 46 XX/XY -NO foetal parts present + snowstorm seen INCOMPLETE hydatidiform mole = 96 XXX/XXY - foetal parts present and - snowstorm NOT seen The best imaging technique for diagnosing ADENOMYOSIS is MRI _____________ Pregnant women who are > 6 weeks gestation + vag bleeding = Preg Assx Unit < 6 weeks gestation + vaginal bleeding + no pain = managed expectantly ------return if -bleeding continues / pain -repeat a urine pregnancy test after 7–10d ----negative pregnancy test means MISCARRIAGE Risk malignancy index (RMI) prognosis in ovarian cancer is based on US findings, menopausal status and CA125 levels ``` Good Medical Practice (2013) if YOU have a CONSCIENTIOUS OBJECTION to a particular procedure You must tell them about -their right to SEE ANOTHER DOC -make sure they HAVE ENOUGH INFO to exercise that right ``` Mirena = Initially IRREG bleeding --> light menses / amenorrhoea Young/FAT + First/Multiple preg assoc with HyperEmesis Pearl Failure Index of the COCP = 0.2: ``` 2 = become PREG _______________ = ONE year 1000 women using this form of contraception ``` ``` PMH of endometriosis + SUDDEN pain acute abdomen + FLUID in pelvis = ---RUPTURED endometrioma ``` ruptured ectopic pregnancy = Resuscitate and arrange for emergency LaparOTOMY If a SEMEN Sample is abnormal, REPEAT TEST should be arranged, ideally 3 months later ``` To confirm ovulation #MSC-GIST Take the serum mid-luteal prog level 7 days BEFORE expected next period e.g. 28d cycle: 28-7 = d21, USUALLY e.g. 35d cycle = 35-7 = d28 !!! (its not just d21, its Duration - 7 !!!) ``` Incontinence: 1-bladder diaries 3d –inconclusive--> urodynamic studies 2-vag exam exclude prolapse 3-dipstix/culture 4-Then ACES -> stress(Kegel ABDE dulox) / urge(BOMB)

Answer 70

FOLLICULAR > Corpus luteum -The Nexplanon prog-only implant can be inserted at any time ALTHOUGH contraception = NOT needed B4 day 21 postpartum. ``` -The POP can be started on or after day 21 postpartum #short-term contracep ``` -Mirena + Copper iuD can be used from 4w postpartum. UNNNaffected EID: IuS IuD Depot GnRH/hCG due to IVF tx ---Ovarian Hyperstim Cervical screening in PREGNANY delayed until 3 months post-partum unless missed screening / prev abnormal smears HIV positive = ANNUAL cervical cytology ``` Women who have been treated for CIN 2 should be offered -cervical screening at 6 months + -HPV TOC ``` The treatment for vaginal vault prolapse is sacro-colpo-plexy Most common site of ectopic pregnancy is in the ampulla of fallopian tube -most dangerous @isthmus #RUPTURE TOP: -A positive test < 4 weeks = NORMAL -A positive test > 4 weeks = INCOMPlete abortion / persistent Trophoblast Common Cx following Myomectomy = Adhesions HRT: adding a progestogen INCreases the risk of BREAST cancer adding a progestogen DECreases the risk of ENDOMET cancer ``` She is currently taking -carbamazepine for epilepsy #EID -BMI is 39 kg/m² -She has no other PMH Which of the following would be the most suitable contraceptive to offer her? ---ius iud Depot = NOT affected by EID ``` A diagnosis of hyperemesis gravidarum is made. What other treatment should this patient receive? ABCDE – IVF, electrolye correct + IV Vit B/C pabrinex 48-year-old want contraception -LMB 9 months ago -convinced that she has 'gone through the menopause'. Most suitable form of contraception is: COCP/Mirena/HRT/Barrier ? Taking into account AGE (ukmec 3 @35/+) has to be …? -The intrauterine system (IUS) hyperemesis = Reassure @preg <20w Ovarian cancers which are stage 2-4, are treated primarily by tumour excision + CHEMO Atrophic vaginitis is a diagnosis of exclusion, and can only be made after RULE SHIT OUT 1ST A transvaginal ultrasound shows an endometrial thickness of 15mm. A transvaginal ultrasound shows an endometrial thickness of 15mm. What would be the next appropriate line of investigation? -Endometrial biopsy at hysteroscopy Stop the pill 4 weeks before surgery and restart 2 weeks after surgery vaginal hysterectomy with antero-posterior repair. Which of the following is a long-term complication of this procedure? Vaginal vault PROLAPSE infected miscarriage --> progressing to septic shock Tx = evacuate the pregnancy ASAP ``` Heavy menstrual bleeding + Severe period pain -everything pretty much normal o/e Mx? ----MENORRHAGIA IPS!!! ---Ix = FBC/Clot, Hysterscope @SMF/Polyp/Endomet, USS tv/ta @fibroid, USS-TV @adenomyosis ---This bitch got menorrhagia AND dysmenorrhoea = TVUSS !!!!!! _________ ``` EMERGENCY Contrapception @FATSO Cu-iuD most effective <3d <5d generally Cu-iuD not affected by BMI Levonelle (double the standard 1.5 mg dose) -i.e. 3mg levonorgestrel BMI >26 / weight > 70kg Ella1 = CI asthma / BF wait 1 week Cu-iuD = not recommended in patients with distortion of the uterine cavity e.g. fibroids. seeking emergency contraception -UPSI = 80 hours ago (i.e. between 3-5 days) -On day 20 of her menstrual cycle. -Took ellaOne ulipristal was prescribed to this patient 10 days ago for a similar episode (i.e. in same cycle). Which of the following is a suitable method of emergency contraception in this case? -Can give Ella1Ullipristal TWICE in a cycle -Can give CuiUD too <5d/ after d14/ FATsos Woman vomits < 3 hours of taking Levonorgestrel OR Ella1Ullipristal, prescribe a SECOND dose of emergency hormonal contraception ASAP _________ Transdermal HRT does not appear to increase the risk of VTE ?? PCOS) increases the long-term risk of which of the following conditions? -Endometrial cancer ``` For people with -unexplained/ male factor INFERTILITY -mild ENDOMETRIOSIS who are having regular UPSI x2-3/wk Don’t offer IuInsemm yet Wait up to 2 years in total for these ppl ```