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General Finals & SBA Review > Postits > Flashcards

Postits Flashcards

1
Q

Colonic angiodysplasia is…
What does it cause?
Who gets it?

A

Vascular malformation
Causes PR bleeding
Often in elderly
Usually asymptomatic

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2
Q

Prerequisites for good bone healing (3)

A 
Patient condition (nutrients, age, comorbidities)
Minimal fracture gap 
Minimal movement in the break
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3
Q

Wolffs law regarding bone

A

Bone will adapt to forces applied to it (remodel)

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4
Q

How long until a fracture fully heals?

A

6 months typically

Dependent on other factors may take less time or more time

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5
Q

Which bones tend to heal faster?

A

Generally upper limbs heal faster

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6
Q

Fracture management

A

ABCDE

Reduce = bring the bone back together in an acceptable alignment 
Rest = hold the fracture in that position to prevent distortion of movement 
Rehabilitate = get function back and avoid stiffness
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7
Q

What are the 4 Rs of fracture?

A

Resuscitate
Reduce
Rest
Rehabilitate

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8
Q

What’s the big risk of immobility?

A

VTE

Need VTE prophylaxis!

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9
Q

Conservative fracture management

A

Conservative (for minor fractures)

  1. Rest, ice, elevation
  2. Plaster cast/fibreglass or splint
  3. Traction (weights to keep them in a particular position)
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10
Q

Surgical fracture management

A

Intramedullary nail
ORIF

External fixation = mono/biplanar, multiplanar

Arthroplasty = hemiarthroplasty, or total

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11
Q

Bronchopneumonia shows what on X-ray?

A

WIDESPREAD consolidation

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12
Q

Peripheral consolidation on X-ray =>

A

COVID

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13
Q

Line along femur that should cross femoral epiphysis =

A

Klein’s line

Relevant in SUFE

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14
Q

Line that should be smooth in pelvis, regarding hip fracture

A

Shenton’s line

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15
Q

X-ray view for SUFE

A

Frogs legs view

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16
Q

Features of Perthe’s disease on X-ray

A

Avascular necrosis of the femoral head
Flattening of the femoral head
Widening or reduction in joint space
Appearance of fragmentation

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17
Q

Difference between golfer’s elbow and tennis elbow

A

Golfer’s elbow is inside elbow pain (medial)

Tennis elbow is outside (lateral)

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18
Q

Management of tennis and golfers elbow

A

Rest
Ice
Brace
Reduce activity

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19
Q

Symptoms of tennis and golfers elbow

A

Stabbing, burning pain

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20
Q

Structure for presentation

A 
HERID
History 
Examination
Recommended tests 
Investigations 
Differential diagnoses
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21
Q

DDx of abdominal pain, think in categories

A

Viscera = appendicitis, renal colic, pyelonephritis, testicular torsion
Vascular = mesenteric ischaemia, AAA
Gynae = ectopic, ovarian cyst, saplingitis, PID
Other causes = DKA, referred pain from pneumonia

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22
Q

Neonatal cause of abdominal pain and red current stool, very upset

A

Intussception

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23
Q

Presentation of obstruction

A

Colicky pain
Not passed any stool or flatus
Pain may become constant

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24
Q

Presentation of inflammatory abdominal pain

A

More constant pain than an obstruction

More likely going to pick it up elsewhere

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25
Q

How do you screen for IBD?

A

Faecal calprotectin
Sign of inflammation in the bowel
If it isn’t present, can pretty much rule out IBD

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26
Q

Signs of peritonism

A

Rigid abdomen

Lying very still

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27
Q

Where does foregut pain refer to?

A

Epigastric/upper abdomen

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28
Q

Where does midgut pain refer to?

A

Umbilicus/central abdomen

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29
Q

Where might the pain from salpingitis present?

A

LIF, RIF

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30
Q

Supra pubic/ LIF pain in elderly most likely

A

Diverticulitis

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31
Q

Sign of appendicitis on urine dip

A

Raised leukocytes

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32
Q

Normal lactate level

A

Less than 1

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33
Q

Immediate manage of bowel perforation

A 
Escalate to senior 
NBM 
Sepsis 6 
Analgesia 
Theatre
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34
Q

What can increase risk of bowel obstruction?

A

Previous surgery -> adhesions

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35
Q

Immediate management of volvulus

A 
Escalate 
NBM 
Drip and suck
Consider sliding scale 
CT abdomen
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36
Q

PEARL in ABCDE is?

A

Pupils even and responsive to light

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37
Q

Haustra of small bowel are called

A

Valvulae conniventes

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38
Q

What separates intracellular and extra cellular fluid components?

A

Cell membrane

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39
Q

Examples of crystalloid fluid

A

Sodium chloride
Hartmanns
Dextrose

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40
Q

Signs of fluid overload

A

Raised JVP

Oedema (peripheral or pulmonary)

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41
Q

Signs of dehydration

A

Dry mucous membranes
Reduced skin turgor
Urine output
Tachycardia

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42
Q

Loss of fluid can be due to

A 
Vomiting 
Urine 
Diuretics 
Stoma 
Bleeding 
3rd spacing
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43
Q

How much potassium can you prescribe /hr

A

10mmol

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44
Q

How much glucose / hr?

A

50-100g / 24hr

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45
Q

Jobes test is also known as the …. test

A

Empty can test

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46
Q

Which muscle does the Jobes test assess?

A

Supra-spinatous

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47
Q

If Jobe’s test is positive, what does this indicate?

A

Shoulder impingement

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48
Q

Erythasma is…

A

Rash under the armpits and in the groin

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49
Q

Lichun planus is…

A

Superficial infection
See Wickham’s striae
Purple

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50
Q

Pityriasis versicolour is caused by…

A

Fungus

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51
Q

Pempholyx is…

A

Rash in the family of eczema
Tiny pustules along fingers and on feet
Resolves after a few weeks

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52
Q

Hidradenitis suppurativa is…

A

Issue with sebaceous glands

Results in chronic, recurring abscesses in armpit

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53
Q

Follicular pyoderma is…

A

Staph infection

Small yellow pustules

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54
Q

Bullous pemphigoid is

A

AI condition involving deep skin

Get tense blisters

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55
Q

What does insulin do to ketone production?

A

Switches it off!

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56
Q

If osteopaenia in CKD, which drug might you give?

A

Alfacalcidol
Active vit D
Cant activate with shit kidneys so can’t give cholecalferol

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57
Q

Patients reliant on steroids, what should you do with their dose when admitted with infection?

A

Double the dose

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58
Q

Hyperkalaemia management

A 
C BIG K DROP
Calcium gluconate
Beta agonist
Insulin
Glucose
Dialysis/diuretics
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59
Q

Signs of aortic dissection

A

Widened mediastinum on x-ray
Severe, tearing pain
Low BP
Cold and clammy

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60
Q

Causes of radio-radial delay

A

Coarctation of the aorta

Cervical rib interrupting blood flow

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61
Q

What do we use to screen for colorectal cancer?

A

FIT test

Faecal immuno testing

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62
Q

Risk factors of colorectal cancer

A 
Diet
Neoplasticism polyps 
Alcohol
Smoking 
Genetic predisposition = FAP
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63
Q

Presentation of colorectal cancer

A

Left sided => bleeding and altered bowel habit and mass
Right sided => weight loss, anaemia (iron deficiency microcytic), abdominal pain

Complications = haemorrhage, fistula, perforation

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64
Q

Bowel cancer markers

A

CEA (used to monitor after operation)

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65
Q

Where do colorectal cancers often spread to?

A

The liver

Make sure to do a CT abdo pelvis

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66
Q

Dukes stage A

A

Tumour confined to the bowel but not extending beyond it

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67
Q

Dukes D is …

A

Invasion of the bowel wall

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68
Q

Dukes C is…

A

Lymph node involvement

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69
Q

When do you do a right hemicolectomy?

A

Caecal tumours
Ascending tumours

You then attach the small intestine to the remaining colon

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70
Q

Left hemicolectomy procedure

A

Remove bit of bowel and then connect colon to colon

Anastomoses isn’t very good

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71
Q

What is Hartmanns procedure?

A

Removal of some colon with the formation of a stoma and end anorectal stump that can be joined up later

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72
Q

Indications for drain insertion

A

To eliminate dead space
Stop build up of fluid, pus, blood, bile, serous exudate
Seen decision making in gynae surgery, try to avoid by making sure there is no internal bleeding

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73
Q

Types of drains

A

Open
Closed
Active
Passive

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74
Q

Passive drainage post op most likely uses which drain?

A

Robinsons drain

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75
Q

Drain for drainage of bile, sits in the hepatobiliary tree

A

Pigtail drain

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76
Q

Assessment of drain involves…

A

Drain site, any ooze or erythema
Fluid output, what’s coming out of it
Any blockages
Assess infection risk and when it needs to be removed

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77
Q

Symptoms of anterior uveitis

A 
Blurred vision
Small pupil
Red eye 
Lacrimation
Photophobia 
Eye pain

Remember HLA-B27

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78
Q

Management of hepatic encephalopathy

A 
Oral lactulose (helps reduce ammonia load by affecting gut absorption)
Rifiximin is another choice if refractory to lactulose
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79
Q

Signs of hepatic encephalopathy

A 
Confusion 
Coma
Disruption of sleep cycle 
Liver flap
Altered GCS
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80
Q

RUQ pain radiating to shoulder tip

A

Cholecystitis
Subphrenic collection
Perforated duodenal ulcer

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81
Q

RUQ -> back

A

Biliary colic/cholecystitis

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82
Q

Central -> back pain

A

Pancreatitis/aorta

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83
Q

Any woman of childbearing age is having an X before proven otherwise?

A

Ectopic

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84
Q

3 categories of jaundice

A

Pre hepatic
Hepatic
Post hepatic

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85
Q

Which drug do you give alongside aspirin in NSTEMI?

A

Ticagrelor

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86
Q

First line treatment for Dresser’s syndrome

A

Aspirin

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87
Q

Symptoms of poly myalgia rheumatica

A

Stiffness in morning around shoulders

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88
Q

Treatment of polymyalgia rheumatica

A

Prednisolone

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89
Q

CO poisoning causes a rise in what?

A

Carboxyhaemoglobin

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90
Q

Unprovoked DVT, what do you need to do after acute management?

A

CT to check for malignancy

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91
Q

Scaling skin over wounds =>

A

Psoriasis

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92
Q

What improves cranial diabetes insipidus?

A

Desmopressin

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93
Q

Symptoms of prolactinoma

A

Irregular period
Galactorrhoea
Decreased libido

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94
Q

First-line medical management of prolactinoma

A

Cabergoline

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95
Q

Which tube protects from aspiration?

A

Tracheal tube

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96
Q

Causes of hepatomegaly

A

Heart failure
Haemochromatosis
Liver abscess
Hepatocellular carcinoma

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97
Q

Hepatomegaly, what levels do you want to check?

A

LFTs

Ferritin

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98
Q

Hepatomegaly and raised ferritin =>

A

Haemochromatosis

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99
Q

What type of headache can spinal anaesthetic cause?

A

Low-pressure headache

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100
Q

How long do you need to fast for before surgery?

A

6hr solids

2hr fluids

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101
Q

The antibody in rheumatoid arthritis

A

Anti-CCP

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102
Q

Cocaine-induced ACS =>

A

Coronary artery spasm

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103
Q

Drug to give in coronary artery spasm? Think ruptured berry aneurysm

A

Nifedipine

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104
Q

Malaria blood test

A

Thick and thin blood films

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105
Q

Symptoms of malaria

A

Confusion
Drowsiness
High fever

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106
Q

Cause of malaria

A

Plasmodium falciparum

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107
Q

4 Hs of hepatomegaly

A

Heart failure
Hepatic abscess
Hepatocellular carcinoma
Haemochromatosis

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108
Q

What is the treatment for severe hydronephrosis (say, due to a stone)

A

Nephrostomy

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109
Q

What does a nephrostomy do?

A

Drains the fluid from the kidney

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110
Q

What do you give in severe, sinus bradycardia?

A

Atropine

It poisons the vagus nerve, reducing parasympathetic activity and raising heart rate

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111
Q

Way to remember that atropine speeds up heart rate

A

Atro is agro

It poisons the vagus nerve

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112
Q

Treatment for acute gout

A

Naproxen = NSAID

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113
Q

Conductive hearing loss, Rinne test will show what

A

Louder on the pinna, because lost ability to conduct sound through air

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114
Q

Most likely, spreading cellulitis

A

Strep pyogenes

Can spread because it breaks down the cell matrix using streptokinase

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115
Q

Symptoms of superficial thrombophlebitis

A

Swollen, hard cord in the distribution of the long saphenous vein

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116
Q

How do you check if a superficial thrombophlebitis is a DVT?

A

USS

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117
Q

What drug can you give for superficial thrombophlebitis?

A

Naproxen

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118
Q

How long does it take for a superficial thrombophlebitis to settle?

A

6 weeks

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119
Q

Diabetic undergoing surgery, what do you do before?

A

Stop sulphonyureas and gliciazide

Make them 1st on the list to minimise fasting times (in case there are delays!)

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120
Q

Which part of the leg does the common fibular nerve innervate?

A

Anterior leg

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121
Q

Damage to the common peroneal nerve results in what sign?

A

Foot drop

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122
Q

Twitching in the arm for approx 2 mins then weak after => what type of seizure?

A

Partial seizure

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123
Q

Which lymph nodes do the abdominal organs drain to?

A

Para-aortic lymph nodes

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124
Q

Treatment of symptomatic cholecystitis

A

Laparoscopic cholecystectomy

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125
Q

The drug you can give in obstetric cholestasis (the main Sx of which is itching)

A

Ursodeoxycholic acid

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126
Q

Signs of cerebellar stroke

A

Prominent headache
Ataxia (because balance centre)
N+V (because balance centre!)

127
Q

ABPI >0.5

Venous ulcer Mx

A

Compression stockings

128
Q

Localise to pain = what GCS scoring

A

5/6

129
Q

Symptoms of acute, closed angle glaucoma

A

Hazy cornea
Blurred vision
Halos around lights
Sudden, red painful eye

130
Q

Red-eye, small pupil, painful =>

A

Anterior uveitis

131
Q

Recurrent candida can be seen in which endocrine condition?

A

Diabetes mellitus (because pissing out sugar)

132
Q

Time cut off for alteplase in ischaemic stroke

A

<4.5hr

133
Q

DIC platelet level on FBC

A

LOW

134
Q

Which drug can you give to reduce tumour size?

A

Dexamethasone

135
Q

How can you reverse warfarin?

A

Vitamin K IV and prothrombin complex concentrate

136
Q

Features of nephrotic syndrome

A

Ankle oedema

Low albumin

137
Q

Ix for nephrotic syndrome

A

Renal biopsy

138
Q

Which vasopressor can be given peripherally

A

Metraminol

139
Q

Complications of chest drain

A

Insertion related = damage to nearby structures, pneumothorax, subcutaneous emphysema
Infection
Placement, e.g. it’s got kinked

140
Q

When do you do hemiarthroplasty?

A

Poor baseline

May be demented or unable to walk

141
Q

When might you use an intramedulary nail?

A

Good baseline, young, Garden 1/2

142
Q

When might you do a total hip replacement?

A

Good functional baseline
Young
Displaced fracture, can’t fix it with a nail

143
Q

Example of an inotrope

A

Digoxin

Dopamine

144
Q

Examples of vasopressors

A

Metraminol

Adrenaline

145
Q

2 medications for a medical abortion

A

Mifepristine (clinic) + Misoprostal (home)

146
Q

Which oesophageal condition can cause dysphagia and can be visualised and removed via endoscope

A

Oesophageal candidiasis

147
Q

Mx of anterior uveitis

A

Topical steroids

148
Q

Cyst that moves with the tongue

A

Thyroglossal cyst

149
Q

What does the Lachmann test test for

A

Pull the knee forwads, see if there is an ACL injury

150
Q

Features to classify and present a fracture

A 
Which bone
Which part
Type of fracture 
Simple/open
Displacement (relative to PROXIMAL fragment)
Rotation
Shortening 
Bone quality
151
Q

Questions to ask if you are thinking of hepatitis

A

Sexual history
Abdominal Sx
Cirrhosis

152
Q

Typical pabrinex prescription

A

2 pairs

3x daily

153
Q

Markers for acute pancreatitis

A

Amylase

Lipase!

154
Q

Pancreatic cancer, red lines on legs, what’s the condition?

A

Migratory thrombophlebitis

155
Q

What does cholestyramine do?

A

Bings to bile acids

Reduces itching

156
Q

What can overdose of aspirin cause?

A

Reyes syndrome

157
Q

Why do you do an echocardiogram in Kawasaki?

A

Coronary artery aneursym

158
Q

Features of Scarlet fever

A

Group A strep
Sandpaper rash
Fever

159
Q

Kawasaki disease Mx

A

High dose aspirin

IV Ig

160
Q

Cut off for abortion (not due to risk to mother)

A

24 weeks

161
Q

Mx of acute flare in UC

A

IV hydrocortisone

162
Q

Long standing rash
Lymphadenopathy
Peeling hands and feet

A

Kawasaki

163
Q

Additional questions to ask in abortion Hx

A 
Contraception
Normal Hx aswell
Sexual Hx
Ectopic stuff
SH
164
Q

Mx of acute- severe asthma

A

Nebulised salbutamol
Ipratropium bromide
Oral prednisolone
(IV if refractory)

165
Q

When might you use amiodarone?

A

Anti-arrhythmic drug

166
Q

How does eclampsia cause seizures?

A

You are leaky everywhere
The abdominal pain is fluid causing the liver capsule to stretch
Cerebral oedema causes the seizures

167
Q

What neurological assessment should you do in eclampsia?

A

Clonus
Looking for UMN signs
Reflexes

168
Q

Drug for pre-eclampsia

A

Labetalol

169
Q

Blood pressure cut off for pre-eclampsia

A

140

170
Q

Urinary tests for pre-eclampsia

A

Protein

PCR 30< (confirms pre-eclampsia)

171
Q

Mx of large pneumothorax or secondary

A

Chest drain

172
Q

Which types of jaundice cause itching?

A

Hepatic and post hepatic

173
Q

In a woman, what test should you always consider doing?

A

Pregnancy test

174
Q

When should you not use a nasopharyngeal tube?

A

Basal skull fracture

175
Q

Features of Colles fracture

A

FOOSH
Osteoporosis RF
Dorsal displacement of the distal radius

176
Q

Important things to check with arm fractures

A

Neurovascular involvement

177
Q

Which bone is the radius?

A

Thumb side forearm bone

178
Q

Mneumonic for suicide risk

A 
HIRMS 
Hope
Intention
Risk
MSE 
Support network
179
Q

Whats an important place to ask about regarding paediatrics?

A

How school is going

180
Q

Causes of epigastric pain in categories

A 
Gastric = ulcer, gastritis
Pancreas = pancreatitis
Intestinal = appendicitis, obstruction, colitis 
Biliary = gallstones, cholecystitis, ascending cholangitis
181
Q

Drug to treat oesophageal candidiasis

A

Nystatin

182
Q

Risk factors of breast cancer

A 
2 first degree relatives or 1 young close relative with breast cancer or if they had bilateral cancer or a male affected in the family 
Ovarian cancer 
Jewish ancestry
Increased age 
BRCA mutation
183
Q

Things that decrease breast cancer risk

A

Pregnancy
Breastfeeding
Use of oral contraceptives

184
Q

Chance of detecting a cancer with screening and follow up tests

A

1%

185
Q

Which radiograph do you use for younger people for screening for breast cancer?

A

USS

186
Q

Popcorn calcification is a feature of which breast mass?

A

Calcified fibroadenoma

187
Q

Micro calcifications in the ducts on breast mammogram =>

A

Breast carcinoma

188
Q

Causes of high stoma output

A

New stoma
Short bowel syndrome
Sepsis
Prokinetics

189
Q

Risk factors of AAA surgery (categorise)

A

Immediate = blood loss, anaesthetic issues
Intermediate = sepsis
Long term = DVT

190
Q

Which diagnosis do you always have to remember when reporting flank pain?

A

AAA!

191
Q

What is shock?

A

Inability to perfuse body’s tissues

192
Q

Hypovolaemic shock, which 4 compartments do you need to check for loss of blood?

A

Chest
Abdo
Long bones
On the floor

193
Q

Type of scan you can do quickly to determine if there is free fluid/bleeding?

A

FAST scan

194
Q

Signs of hypovolaemic shock

A 
Hypotension 
Tachycardia 
Pallor 
Weak thready pulse 
Pallor 
Reduced urine output
195
Q

What medications can you give to improve hypovolaemic shock?

A

Fluids

Vasopressors (but can cause peripheral tissue ischaemia because pushing all the fluid centrally)

196
Q

Average age of menopause

A

51

197
Q

Drug for breast cancer, oestrogen sensitive in post-menopausal women

A

Anastrozole

198
Q

FNA or core needle biopsy for histology sample?

A

Core needle biopsy

199
Q

Fast growing, smooth lump in breast in elderly

A

Phyllodes tumour

200
Q

Painful breast in lactating woman, no mass just tenderness. Fever.

A

Peuperal mastitis

Local inflammation due to ascending infection through crack in nipple

201
Q

HER2 positive drug treatment for breast cancer

A

Trastuzumab (herceptin)

202
Q

Pulmonary oedema, tense swelling in legs, breathless, having chemotherapy for breast cancer, what’s the likely drug culprit?

A

Herceptin

Cardiotoxic

203
Q

Triad of acute liver failure

A

New onset jaundice
Coagulopathy (INR >1.5)
Encephalopathy

204
Q

Causes of vitamin B12 deficiency

A

Pernicious anaemia
Zollinger Ellison syndrome
Terminal ileum resection
Chronic severe gastritis

205
Q

Long term management of pernicious anaemia

A

Cobalamin

206
Q

What is Whipple’s disease?

A

Rare, systemic disease caused by tropheryma whipplei
Diarrhoea
Abdo pain
Joint pain

Diagnosed with bowel biopsy -> presence of acid-schifff macrophages

207
Q

Treatment of hepatic encephalopathy

A

Oral lactulose

Reduced ammonia production

208
Q

Painful ascites and unwell implies

A

Spontaneous bacterial peritonitis

209
Q

Treatment of cholera

A

Effective rehydration

Potentially doxycycline

210
Q

Long term UC management (distal rectal disease)

A

Mesalazine suppository

211
Q

Triad of nephrotic syndrome, with values

A

Hypoalbuminaemia (<30g)
Proteinuria (3.5g25hr)
Oedema

212
Q

Mx of child with nephrotic syndrome

A

Refer to renal

Prednisolone treatment

213
Q

What is the only acceptable form of contraception in women with active breast cancer?

A

IUD

214
Q

Woman doing lots of planks at the gym, now got a painful lump on her elbow, not tender to touch

A

Olecranon bursitis

215
Q

Mx of olecranon bursitis

A

Ice
Rest
Anti-inflammatories

216
Q

At what time in the cycle does ovulation occur

A

Halfway

Say day 14 of 28

217
Q

Symptoms of coeliac disease

A 
Loose smelly stools
Bloating 
Abdo pain
Hx/FH of autoimmune disease
Failure to thrive
218
Q

Gene linked with coeliac disease

A

HLA DQ2

219
Q

Complications of coeliac disease

A

Osteoporosis

MALT

220
Q

Why shouldn’t you use an IUD in active chlamydia infection?

A

Can result in an ascending infection (PID)

221
Q

Drug treatment for benign prostatic hyperplasia

A

Tamsulosin

222
Q

Antibiotic for cellulitis in penicillin allergic

A

Cephalosporin e.g. clindamycin

223
Q

48 years old, last period 12 months ago, contraception advice

A

IUD for 1 year

Need 2 years of no periods if under 50yo

224
Q

Hx of breast cancer, which contraceptive to prescribe

A

IUD

225
Q

Someone has forgotten to take their POP for 4 hours, what do you advise?

A

Take the pill, continue as normal, condoms for 2 days

226
Q

Patient on methotrexate, encountered patient with chickenpox 2 days ago, what do you do?

A

Give VZIG

227
Q

Key differences between GPA, Churg-strauss and Goodpastures disease

A

GPA: URT involvement (epistaxis)
Churg-Strauss: More of an asthma picture with sinusitis
Good pastures: More respiratory (pulmonary haemorrhage + haematuria)

228
Q

Causes of proximal myopathy

A 
PEACH PODS 
Polymyositis
Endocrine
Alcohol
Carcinoma
HIV

Osteomalacia
Drugs (statins)
Steroids and sarcoidosis

229
Q

Features of polymyositis

A

Proximal muscle weakness with no pain or stiffness or skin involvement

230
Q

Which marker is raised in polymyositis

A

CK

231
Q

Dermatomyositis and polymyositis turn your muscles to CLAA mneumonic for blood tests to order stands for…

A

CK
Lactate dehydrogenase
ALT
AST

232
Q

Best NSAID to use in GI bleed (should be avoiding, but in case they really need it)

A

Celocoxib
These are COX-2 inhibitors
DONT use in IHD

233
Q

Which medication, used in rheumatoid arthritis alongside methotrexate can cause loss of colour vision

A

Hydroxychlorquine

Stop it immediately at the first signs of damage

234
Q

Mx of temporal arteritis

A

1mg/kg oral prednisolone for 4 weeks then slowly taper off for 6 months

235
Q

Why do you taper steroids very slowly in temporal arteritis?

A

High risk of recurrence

236
Q

What type of vaccine is contraindicated in methotrexate Mx?

A

Live vaccines

e.g. yellow fever

237
Q

Features of chronic fatigue syndrome

A

Persistent disabling fatigue
May have on and off flu symptoms
Tired all the time, lots of naps
May have muscle aches (difficult to determine between this and fibromyalgia often)

238
Q

Pyoderma gangrenosum is associated with…

A

IBD (usually UC)

239
Q

Complications of septic arthritis

A

Immediate: Sepsis, loss of limb, osteomyelitis

Long term: Arthritis, removal of replacement joint

240
Q

Triad of Felty’s syndrome

A

Rheumatoid arthritis
Enlarged spleen
Neutropaenia (can lead to infection!)

241
Q

SANTA features of Felty’s syndrome

A 
Splenomegaly
Arthritis 
Neutropaenia 
Thrombocytopaenia
Anaemia
242
Q

Scoring system for hypermobility

A

Beighton

243
Q

X-ray features of psoriatic arthritis

A

Loss of joint space
Pencil in cup deformity
Bone erosions
Arthritis mutilans

244
Q

Mx of psoriatic arthritis

A

Treatment is conservative at first with local steroid injections and NSAIDs, but most require regular immunosuppression with methotrexate, and increasingly novel biologics

245
Q

Pain in ankle
Recent chemotherapy
Chronic kidney disease
DDx?

A

GOUT
Septic arthritis
Trauma
Pseudogout

246
Q

What is an obturator hernia?

A

Abdominal contents herniate through the obturator canal (the hole in the pelvis)
On PR may feel a mass in the upper lateral region
Symptoms of bowel obstruction
Parasthesia down the medial thigh because the obturator nerve is impacted

247
Q

Most common site of occlusion in mesenteric ischaemia

A

Superior mesenteric artery

248
Q

Acute rectal bleeding, with no pain DDx

A 
Meckel's
Ischaemic colitis (due to tissue necrosis)
249
Q

Alcohol is a risk factor to developing which type of oesophageal cancer?

A

SCC?

250
Q

What is malignant hyperthermia?

A

Hyperthermia triggered by anaesthetics
Often caused by an autosomal dominant mutation in ryanodine receptor 1
Patient may have a very rigid abdomen

251
Q

How much of the bodies surface area does each leg count for?

A

18%

252
Q

Complications of venous ulcers

A

Immobility
Osteomyelitis
Infection and sepsis

253
Q

Mx of venous ulcers

A 
Lifestyle advice
Keep ulcer clean
Encourage mobility
Weight reduction
Leg elevation at rest
Emollient treatment of the leg

Compression bandaging - aimed at improving venous return from the leg
Patients must have an ABPI to exclude co-commitment arterial disease as bandaging will worsen arterial supply to the leg.

Surgery – not usually necessary
Debridement
Skin grafting

254
Q

Flatulence related to fatty meals
Indigestion
Abdominal pain
Long-standing

A

Chronic cholecystitis

255
Q

How long do you give nitrofurantoin for in pregnancy?

A

7 days

256
Q

Management of intussception

A

Rectal air insufflation or contrast enema (only to be performed if child is stable)

Operative reduction indicated if:
Failure of non-operative management
Peritonitis or perforation is present
Haemodynamically unstable

257
Q

Painless scrotal lump, can still palpate testis, transilluminates

A

Epididymal cyst

258
Q

Fluid requirement in cardiac disease

A

25ml/kg/day

259
Q

Drug treatment of delirium

A

Low dose haloperidol

260
Q

Myasthenic crisis, what do you want to measure?

A

FVC with spirometry

261
Q

What might the PR interval being prolonged indicate in infective endocarditis?

A

It’s a poor prognostic marker
Indicates greater mortality
This is because it’s associated with an aortic root abscess

262
Q

What is Waterhouse-Freidrichson syndrome?

A

Waterhouse-Friderichsen’s syndrome is caused by a severe bacterial infection which results in disseminated intravascular coagulation and subsequent adrenal haemorrhage and failure.

263
Q

Investigations for bladder cancer

A

Urine dip
Flexible cytoscopy
Histological sampling
CT urogram

264
Q

Features of pseudobulbar palsy

A 
UMN signs 
Dysphagia
Difficulty with speech 
Small stuff tongue
Exaggerated gag reflex
265
Q

Features of bulbar palsy

A

LMN signs
Absent gag reflex
Floppy tongue because hypotonia

266
Q

Features of femoral nerve damage

A

Loss of sensation to front of thigh and medial leg

Absent knee jerk

267
Q

Operation for a Achalasia

A

Heller myotomy

268
Q

Whenever the patient doesn’t eat for a while they get dizzy and agitated. Gained a lot of weight recently. Ix and Dx

A

C peptide levels

Insulinoma

269
Q

What is a myxoedema coma?

A

Extremely low levels of thyroxine

Low BP low HR and temperature

270
Q

Jaundiced gentleman with distended abdomen and prominent abdominal veins. Most likely cause =

A

Alcoholic liver disease

271
Q

Rx for hypospadias

A

Surgical correction

272
Q

Features of a Monteggia fracture

A

Ulna fracture

Radial displacement

273
Q

Features of Galazzi fracture

A

Radial fracture

Ulna displacement

274
Q

Features of bowel obstruction

A 
Abdominal pain 
Vomiting 
Not passing stool
Tinkly bowel sounds 
Distended abdomen
275
Q

What is proctalgia fugax?

A

Stabbing anal pain

276
Q

Features of a pantaloon hernia

A

2 parts

Straddles the inferior epigastric artery

277
Q

If unconscious what type of breathing tube is needed?

A

Endotracheal tube
The others are for partially conscious/impaired consciousness.
If unconscious they will not be able to maintain their airway!
Get an endotracheal tube down

278
Q

What Ix for a psoas abscess?

A

Abdominal MRI

279
Q

Ix for ectopic

A

B-Hcg

TVUSS

280
Q

Sx of ectopic

A

Amennorhoea
Abdominal pain
Spotting
Shoulder tip pain

281
Q

Sudden onset knee pain and swelling
Pt complains of the knee ‘locking’
Dx & Mx

A

Osteochondritis dissecans
A fragment of bone is stuck in the knee, ouch
Need key hole surgery to remove it

282
Q

What is the pathophysiology of Osgood Schlatter disease?

A

Repeated rubbing of the patella tendon across the knee growth plate
That’s why you see it in young athletes!

283
Q

What is chondromalacia patellae?

A

Chronic overuse of knee leads to damage and inflammation to the underside of the patella (the cartilage)
It becomes rough and painful to move across the cartilage

In short, damage to the cartilage underneath the patella

284
Q

Which 3 components to breast lump triple assessment

A 
Examination 
Scan (USS in young women, mammography for older)
FNA/core biopsy 
Core biopsy for histology 
FNA for cytology
285
Q

What is Cushing’s disease?

A

ACTH secreting tumour in the pituitary

286
Q

Pt up who had Cushing’s syndrome had their adrenals removed, but now they have darkening skin and high BP
Dx?

A

Nelsons syndrome
The original cause for their Cushing’s was an ACTH secreting tumour
Now that the negative feedback is gone, it has grown loads and is making loads of ACTH hence the tanning (like Addison’s disease)

287
Q

Symptoms of Conn’s syndrome

A 
Excessive thirst.
Fatigue.
Frequent urination.
Headache.
Muscle cramps.
Visual disturbances.
Weakness or tingling

All caused by excess aldosterone

288
Q

Surgical procedure for rectal tumours

A

Abdominoperineal resection

289
Q

Mx of colorectal cancer

A 
MDT
Staging 
Radiotherapy 
Chemotherapy 
Surgery and potential stoma
290
Q

Features of an incarcerated hernia

A

Painless and persistent

291
Q

Features of a strangulated hernia

A

Twisted around blood supply
Painful
May have signs of bowel obstruction

292
Q

Fleshy, rubbery lesions, often on torso

When you touch them they tingle

A

Neurofibromas

293
Q

Which type of neurofibromatosis is more related to cutaneous issues?

A

1

Treeman is number 1!

294
Q

Which movements are performed by each of the arm nerves

A 
Radial = extend at wrist
Median = scout sign 
Ulna = abduct fingers
295
Q

Which nerve does a humeral fracture often damage?

A

Radial nerve

296
Q

What is the difference between a radial nerve injury and a posterior interosseous nerve injury?

A

Both cause wrist drop
No sensation loss in posterior interosseous injury
Still have sensation on back of thumb and scaphoid. Wouldn’t in radial injury.

297
Q

What is a pleomorphic adenoma?

A

Hard lump on jaw angle
Painless
NO FACIAL NERVE INVOLVEMENT

298
Q

What is the pathology and presentation of an acoustic neuroma?

A

Benign tumour of the Schwann cells of the vestibular cochlear nerve
May have facial nerve involvement
Sensorineural hearing loss and facial tingling

299
Q

Which type of hearing loss do you get in otosclerosis?

A

Conductive hearing loss

Because the stapes (middle ear) is fixed

300
Q

Features of splenic injury

A

Elevated left diaphragm
LUQP
Guarding

301
Q

Which bacteria are encapsulated?

A

Meningococcus

Pneumococcus

302
Q

Symptoms of salivary gland calculus

A

Swelling and pain on eating

303
Q

Management of SUFE

A

Surgery with screw, potentially the other side as well

304
Q

Features of incisional hernia

A

Late complication of abdominal surgery

Usually managed conservatively if stable

305
Q

What Ix should you consider for ulcers?

A

USS Doppler
Need a skilled operator but can determine if there is a deep vein issue that may benefit from surgery (can often really benefit)

306
Q

What is erysipelas?

A

Superficial streptococcal infection

307
Q

Mx of erysipelas

A

IV antibiotics to avoid cellulitis and sepsis

308
Q

What is paronychia?

A

Infection of the nail

309
Q

Mx of paronychia

A

Antiseptic cream

If gets big, need to cut and drain it (seen in A&E)

310
Q

What should you do for a Dupytrens that is interrupting function?

A

Operate

311
Q

Causes of Dupytrens contracture

A

Liver disease
Anti epileptics
Peyronie disease

312
Q

How long do upper limb fractures take to heal?

A

6-8weeks

313
Q

Factors that affect healing

A 
Body habitus
Blood supply
Drugs 
Diabetes 
Steroid use

General Finals & SBA Review (8 decks)

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