Prev exam qs Flashcards
DDx for vulvovaginal pruritis
Candidiasis
Contact dermatitis
lichen sclerosis
lichen planus
How can a pt with haem malignancy present ?
1. lymphoma
2. leukaemia
3. myeloma
- Lymphadenopathy
- pancytopaenia
- CRABS, fatigue
Acutely painful hip joint ddx?
- Septic arthritis
- transient arthritis
- slipped femoral epiphysis
- trauma- fracture
Pt with back pain and weight loss: what Ix would you do?
MRI spine
Bilious vomiting in a neonate with downs syndrome?
Duodenal atresia
AXR shows double bubble sign, contrast study may confirm
mx: Duodenoduodenostomy
Genital herpes in pregnancy: what ix would you do?
Swab of one of the lesions- check for HSV and PCR to distinguish 1 or 2.
HIV test
NAAT swabs- chlamydia and gonorrhea
High vaginal charcoal swab- other infections
Rash in an adult differentials
purpura
- DIC
- ITP
- Sepsis
- Vasculitis
Maculopapular
- VZV
-kawasaki
How to manage gestational HTN?
Labetalol(not asthma)
Nifedipine
3rd line: hydralazine
Need to be referred to Obstetrician led clinic to have regular follow ups and closer monitoring
Should measure their BP at home
acute behavioural disturbance in psychotic pt: what can you prescribe?
Benzodiazepine
How to treat vaginal discharge in these conditions:
Chlamydia
Gonorrhoea
Candida
BV
Trichomoniasis
Cervical ectropian
Chlamydia- doxycycline 7 days, if pregnant then azithromycin
Gonorrhoea- one IM dose of ceftriaxone
Candida- one dose of fluconazole or clotrimazole pessary
BV- metronidazole 5 days
Trichomoniasis- metronidazole 5 days
Cervical ectropian- physiological but if causing issues can do ablative treatment ‘cold coagulation’
Child with UTI Ix:
Urine dip and microscopy
<6m- USS within 6 weeks
atypical or recurrent- USS during infection
DMSA
MCUG <6months
Osteoporosis tx:
Lifestyle changes- healthy, balanced diet, moderation of alcohol consumption and avoidance of smoking
regular weight-bearing and muscle strengthening exercise
Vit D and calcium supplementation
Bisphosphonates- alendronate (PO-once a week) OR zolendronate (IV once a year)
2nd line-Denosumab
Epistaxis management
- Pinch soft part of nose and tilt torso forward and open mouth (for at least 20 mins0
- If you can visualise the bleed can cauterise- local anaesthetic spray and silver nitrate stick for 3-10 seconds
- If can’t visualise the bleed can use anterior tamponade
What is the DSM-5 criteria for ASD
Persistent deficits in social communication and social interaction across multiple contexts features such as
- problems with social reciprocity
- abnormal social approach
- failure of back and forth conversation
-Impaired non verbal communication
- reduced understanding and use of gestures
- Deficits in developing, maintaining, and understanding relationships
Restricted, repetitive patterns of behavior, interests, or activities
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior
Conditions co morbid with ASD
Epilepsy
Tuberous sclerosis
Dyspraxia
Visual or hearing impairment
Anxiety
ADHD
Fragile X
What are poor prognostic features of ASD
No communicative speech by Agę 5
IQ less than 50
Behavioural strategies for child constipation
Scheduled toileting
Bowel habit diary- track frequency and consistency of stool
Use of encouragement or reward systems - star charts for visiting toilet
Address underlying psychological or social problems
What are behavioural signs of physical abuse in elderly ?
- quiet and withdrawn
Being aggressive or angry for no obvious reason
Appearing depressed
Fear/not wanting to be left alone or with particular people
Being usually light hearted and insisting nothings wrong
What actions to take to reduce risk of re feeding syndrome
Assessment and replacement of electrolytes
Reintroduce food slowly
Replace B vitamins
Features of anorexia nervosa
Fear of gaining weight - extreme
Emaciated- BMI <17.5 or less 15% of expected
Endocrine disturbances- amenorrhoea
Distorted body image
Deliberate loss of weight- reduced energy intake, fasting, restrictive eating
For at least
Clinical features of anorexia other than low body weight
- lanugo hair
- swelling of parotid sand submandibular gland
- dry skin
- thinning of hair
- hypothermia
- bradycardia
- hypotension
- loss of muscle mass
- peripheral oedema
Differentials for low body weight and loss of weight
Anorexia nervosa
Thyrotoxucosis
T1DM
Addison’s d
Physical complications of chronic anorexia nervosa
Heart failure
Bradycardia /arrythmias
Mitral valve prolapse
Osteoporosis
Infertility
Anaemia
Wernickes encephalopathy
Psychological Management of anorexia nervosa
Individual eating disorder focussed CBT
MANTRA
Specialist supportive clinical management
Symptoms of giant cell arteritis
Unilateral throbbing headache over temporal region
Malaise
Jaw Claudication
Tenderness over temples
Fever
Cough
Sore throat
Vision loss
Weight loss
What can steroids increase the risk of developing
- diabetes M
- osteoporosis
- myopathy/muscle weakness
- mood changes
Increased risk of infection
Weight gain
Hypertension
Pathophysiology of GCA causing vision loss
Vasculitis affecting the ophthalmic artery which leads to narrowing and reduction of blood flow to the optic nerve
Name some dopamine agonists
Ropinirole
Pramipexole
Rotigotine
Apomorphine
Name a MAOB inhibitor ? MOA? ADRs?
Rasagaline, selegiline
inhibition of the enzyme monoamine oxidase, which is involved in the breakdown of monoamines, such as dopamine, within the in pre-synaptic neurone
Abdo pain, angina pectoris, arthralgia, arthritis, conjunctivitis
Otitis media with effusion sxs
Otalgia
Hearing loss
Constant or seasonal symptoms
Nasal obstruction secondary to rhinitis
Associated eczema or asthma
What features of the Dix hall pike give you a positive finding for Bppv?
transient vertigo
Geotropic torsional nystagmus
which often follows a latent period
lasts 20-40 seconds.
Explain the underlying mechanism of BPPV
otoconia (loose debris composed of calcium carbonate) within the semilunar canals of the inner ear. Attacks are triggered by head movements the otoconia roll up angainst the cupula of the posterior semilunar canal. This sends a message to the brain that the head is rotating which contradicts the messages from the eyes causing vertigo
Breast cancer poor prognostic factors
Large tumour size
Axillary lymph node
High S phase
ER neg
Her2 pos
BRCA1/2 pos
African American ethnicity
age <35
Pt post gastrectomy advice for postoperative nutrition
Small meals with increased protein and carbs - reduces N+V, diarrhoea and bowel dumping syn
Vitamin B12 injections - loss of production of intrinsic factor
Calcium supplements - reduction in absorption
Features of lichenification
Induration
Hyperpigmentation
Skin thickening
Ill defined margins
Exaggerated skin lines
Cutaneous side effects of topical steroids
Skin thinning
Skin depigmentation
Telangiectasia
Striae
Acne
Excessive hair growth
Perioral dermatitis
What are the risks to mum and baby when pt has T1/2DM?
What can you offer women with T2DM that want to get pregnant?
-individualised dietary advice
- (BMI) above 27 kg/m2, offer advice on how to lose weight
- folic acid (5 mg/day) until 12 weeks of gestation
- monthly measurement of HbA1c levels (keep below 48 mmol/mol (6.5%))
- blood glucose meters for self-monitoring
- metformin can be used as an adjunct or alternative to insulin- stop all other hypoglycaemic agents-> insulin
- retinal assessment and renal assessment- preg can worsen retinopathy and nephropathy
What medication should be stopped before/during preg?
Oral hypoglycaemic agents other than metformin
ACEi and ARBs
Statins
What should women at risk of gestational hypertension and pre-eclampsia be given after 12 weeks ?
Risk factors for hypertensive disease in preg
75-150mg aspirin from 12 weeks-birth
Management for PPH: non medical or surgical
Call for help
Lie woman down flat
Catheterisation
Rubbing the uterus/Bimanual compression of the uterus
IV fluids/Blood transfusion/FFP
Oxygen
Management for PPH: medical
IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH
Management for PPH: surgical
intrauterine balloon tamponade
B-Lynch suture
ligation of the uterine arteries
hysterectomy
what can cause painless loss of vision in 1 eye ?
CRA/V occlusion
retinal detachment
Vitreous haemorrhage
Optic neuritis
papilloedema
GCA
acute closed angle glaucoma
what Inx and assessments would you do for painless loss of vision in 1 eye
Visual acuity (Snellen Chart) (0.5 mark), Visual field testing (0.5 mark), Fundoscopy (0.5 mark), Pupillary light reflexes (0.5 mark), Colour Vision with Ishihara colour chart
how to manage a CRV occlusion
most conservatively
macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents
retinal
neovascularization - laser photocoagulation
If someone in undergoing chemo for ALL what other tx will you give ?
Antiemetics – side effects of chemotherapy drugs often include nausea and vomiting.
Antibiotics – chemotherapy causes immunosuppression and increased susceptibility to infections.
Blood transfusion – chemotherapy can lower the number of red cells and platelets and impact the bone marrow’s ability to produce new cells.
NG feeding/nutrition support – reduced appetite and ensuring that the patient is strong enough to withstand treatment.
sxs of subarachnoid haem other than thunderclap headache
Depressed consciousness/ loss of consciousness
Neck stiffness/ muscle aches/ meningismus
Ptosis/ eyelid drooping,
Photophobia
Nausea/vomiting
Seizures
Vision changes (diplopia), vision loss
Agitation/ behavioural change
Focal neurological deficits
Short and long term side effects of subarachnoid haem
rebleed
acute/Chronic hydrocephalus
Neuropsychiatric problems (mood/ memory / concentration problems)
Increased intracranial pressure/ brain herniation
Cerebral infarct
Seizures/ epilepsy
vasospasm
Death
Emotional issues (depression, anxiety ,PTSD)
how to manage a subarachnoid haemorrhage
ABCDE resus and stabilize the patient
Monitoring neurological status and examination at least every hour. BP, continuous ECG,
Temperature
Consider nimodipine
Provide analgesia. Consider antiemetic + stool softener +anti-convulsant
Stop ramipril. VTE prevention
Urgent discussion with senior and referral to neurosurgeons/ specialist neurosciences centre
Neurosurgery (endovascular coiling, clipping)
HER2 receptor positive tumour
breast cancer
what treatment post operatively will you give
Trastuzumab (herceptin)
what is hutchinsons sign ?
vesicular rash extends to the tip or side of the nose. This is a strong predictor of nasociliary nerve involvement and so potential ocular involvement and complications such as keratitis
Waterlow Score is used to predict the risk of developing pressure ulcers. what are the factors used to calculate it?
Gender
Age group
BMI
Skin type
Mobility
Continence
Recent weight loss
Appetite
Tissue malnutrition
Neurological deficit
Major surgery or trauma
Medication
How to treat acne rosacea?
BID
Brimonidine - if only flushing
Ivermectin (topical) or top metronidazole
Doxycycline - mod-severe pap/pustules or rhinophyma
Refer if tx not improved sxs or have rhinophyma
what is postural hypotension defined as
drop in systolic bp >20mmhg 3 mins after standing
What causes normocytic normochromic anaemia
-chronic infection
-malignant disease
-renal failure
-acute blood loss
-pregnancy
signs of anaemia
pallor
koilonychia
tachycardia
tachypnoea
microcytic anaemia questions?
any excessive bleeding from anywhere?
any weight loss?
any blood in stool?
excessive mentrual blood loss?
any diets that reduce food intake?
investigations for anaemia
FBC- Hb, MCV, reticulocytes
Blood film- for any signs of malignancy or anisopoikilocytosis
serum ferritin
Total iron-binding capacity (TIBC)/transferrin- high TIBC reflects low iron stores
but transferrin saturation will however be low
what can cause b12 deficiency
Reduced intake- diet
reduced absorption- Crohns, UC, ileal resection
drugs- nitrous oxide and metformin
pernicious anaemia
PERNICIOUS ANAEMIA
PATHOPHYSIOLOGY AND TESTS?
-autoimmune disorder affecting the gastric mucosa
-antibodies to intrinsic factor +/- gastric parietal cells
IF binds to vitamin B12 in the small intestine, allowing the epithelial cells of the ileum to absorb the complex
vitamin B12 is important in both the production of blood cells and the myelination of nerves → megaloblastic anaemia and neuropathy
Tests:
anti intrinsic factor antibodies
anti gastric parietal cell antibodies
triad in miller fischer varient of GBS?
progressive proximal weakness and a triad of ophthalmoplegia, areflexia and ataxi
