Psych Flashcards

Question

Factors favouring pseudoseizures Factors favouring true epileptic seizures __________ Delirium > Dementia __________ ALS and polio are UMN or LMN conditions?? Which has worst prognosis? -PseudoBulbar or PROGressive Palsy? __________ ``` Stiff spastic tongue Donald Duck Speech Brisk Jaw Jerk i.e. HyperReflexia -get the BSC syx!!! ________ ``` ``` Palsy of the -Tongue -Chewing muscles -Swallowing and -Facial muscles due to loss of function of Brainstem Motor Nuclei -get WATFR syx!!! ```

Answer 1

Pseudoseizures FACTOrs: - FHx epilepsy/Females - ALONE = don't occur - CRYING after seizure - Thrusting pelvic - Onset = GRADUAL Favour true epilep seizures: - Tongue biting - PROLACTIN __________ -Emotions = fear, agitation -Fluct Syx = worse @night, normal periods -GCS impaired -Hallucinations/Illusions/Delusions #perception __________ ALS = UMN + LMN + Norm Sensory/Bowel-Bladder Polio are LLLLLLLMN conditions WORST Prognosis = PROGressive bulbar palsy _________ PseudoBulbar Palsy _______ PROGressive bulbar palsy -WORST Prognosis

Answer 2

re-experiencing e.g. flashbacks, nightmares avoidance e.g. avoiding people or situations hyperarousal e.g.hypervigilance, sleep problems -PTSD !!! 1. EU-BPD - SAIMA AFI's girl - Emotionally Unstable Borderline PD - Psychotherapy -mood stabilisers/anti-psych 2. Anankastic - OC PD - DIFF to OCD where: anxiety-inducing and involuntary thoughts --> unwanted/unhealthy acts/behaviours ________________________ 3. Avoidant 4. Paranoid - like you, you PRICK ________________________ 5. Schizoid - like House MD 6. a) Diff beteen delusional and 'ideas of reference'? delusions = NO insight IoRef = HAS insight b) SCHIZOTYPAL

Answer 3

Thought dx Auditory hallucinations Passivity phenomenon Delusional perception ________ ``` 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 4

Mood - how they FEEL Affect - how they APPEAR - emotional state Antipsychotic Ix: - FBC/U+E/LFT - BMI/BM/BP - CVD: lipids/ECG/QRisk Suidice = social classes 1 + 5 ________ ``` 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 5

Depression > Dementia ________ Antipsychotic Ix: - FBC/U+E/LFT - BMI/BM/BP - CVD: lipids/ECG/QRisk Suidice = social classes 1 + 5 ________ Duod - Iron Jej - Folate Term Ileum - B12 ___________ TICS MATCH RALPH FBD 1. Microcytic: - Thalassaemia, Iron Def, ChrDx, Sidero 2. Normocytic: - Marrow dx - Acute blood loss - Thyroid LOW - ChrDx early / CKD - Hemolytic ``` 3. Macrocytic: Non-megalo -Myelo-prolif/dysp/mm -Reticulocytosis -Alco XS - GGT CDT high MCV -LF -Preg -HypoT ``` Megalo: -Folate, B12, Drugs (allop/phenyt/OHcarbimide) P450 inducers = INR low - Phenytoin - Carbemazapine - Barbituates - Rifampicin - Alco - SUs ``` P450 inhibitors - INR HIGH -PPI/grapefruit -LF -Allopurinol -NSAID -Cranberry -DISULFIRAM -Erythromycin -Valproate -Isoniazid -Cipro/Ketocon -Ethanol -Sulfonamides __________ ```

Answer 6

Things you get wrong in the heart shit: Salicylates - Bicarb/dialysis Lithium* tremor HYPERreflexia ataxia - IVF/dialysis TCA - Bicarb Ax Aortic stenosis: <65 - BICUSPID aortic valve #TURNER For BIOprosthetic valve for OLDER Inc risk of CALCification >65 get aortic one >70 get mitral one S2 = Loud @ - HTN, Hyperdymamic states, - ASD-PulHtn Paradox s2 -WPW-b, AS/LBBB, RVPacing, PDA 3rd degree complete block: iHD, Fibrosis; AS; Surg/Trauma; Congen RBBB=PE, ASD, Normal RAD vs LAD Lat (circumflex) - MMMMI - Inf (RCA)TTTTall thin = RAD Peaked P-pulmonale #RAH -TS >RVH(PS/PAH) Pulses paradoxes? PAH Tamponade/ Severe asthma: - PAH, AR/ASD, High Left EDV _________ Organophosphates - atropine Heparin - protamine sulfate Ethylene glycol - Fomepizole/ Ethanol / Dialysis Methanol - Fomepizole>Ethanol / Dialysis Salicylates - Bicarb/dialysis Lithium* tremor HYPERreflexia ataxia - IVF/dialysis TCA - Bicarb Cyanide - OH-cobalamin Digoxin - Dig-specific Antibodies Lead/Arsenic*- dimercaperol / edetate ________ 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 7

Alcohol withdrawal symptoms: <12 hours seizures: 36 hours delirium tremens: 72 hours Thaimine Vit B1111111111 Ber1 Ber1 1. Delirium Tremens - CLT < 72hrs! 2. Wernicke NOAC 3. Korsakoff KAM 4. Alco withdrawal ________ MRI scans = detect diffuse axonal injury + cancer Repeat CT = useful to see if the contusions INC in size. CT angio = useful @SAH patient when looking for Ax. CT w/ contrast = useful for tumours or possible abscesses ________ Dexa @Oed from tumour Mannitol @Raised ICP#subdural/extradural Nimodipine @SAH to reduce vasospasm

Answer 8

Schizophrenia types: Paranoid Hebe-Phrenic -short-LIVED hallucinations -affect changes PROMINENT __________ Catatonic - Stopping of voluntary movement or - staying still in an unusual position = catatonia Undifferentiated __________ Residual --NEGATIVE features Simple _________ Pre-morbid social withdrawal is a poor prognostic Family history poor prognostic lower IQ poor prognosis Gradual onset poor prognosis Tetra-benazine = tardive dyskinesia Propranolol = akathisia Procyclidine benztropine = acute dystonia Lorazepam = calm psychotic episode

Answer 9

Monoplegia - 1 limb Hemiplegia - Unilat 2 limbs Quadriplegic - 4 limbs -Paraplegia - Bilat LOWER limbs ACA MCA PCA* L>UL ; UL>L < -- HemiParesis ........Aphasia -- > Agnosia ........Sensory ....HomoHAnopia -- > Mac-Sparing *PCA - Weber Midbrain -Same CN3, opp HemiParesis -Agnosia -Macular sparing HomoHNopia ________________ Amaurosis fugax - Retinal/Ophthalmic Artery Locked in syndrome - Basilar Artery ____________ Pontine bleed - Absent < -- > horizontal eye-move - Miosis - Paralysis=Quadriplegia AICA: Lat Pont - Same FACE: PD/PT (paralysis/deaf // pain/temp) - Opp limb - Nystagmus - Ataxia PICA: Lat Med Wallenburg - same as above EXCEPT - paralysis and deafness ______________ Anterior Circulation Stroke: 3=TotalACS 2=PartialACS - Unilat sensory/motor FAL - Cog dx - VisuoSpatial/Dysphasia - HomoHNopia ``` LacACS Assoc w/ HTN 1 of: -Sensory -AtaxicHemiParesis -Motor PURELY _________ ``` 4-6-4 H: CN4 vertical nystagmus CN3 Ptosis, Dilated, Vertical nystagmus CN6 horizontal nystagmus Nystagmus: Central v Periph: central is: - B/L - Assoc sens/motor dx - Direction = multi / purely uni or rotatory ``` Brainstem Death: Coma unknown Ax Reversible ax excluded Sedation X Electrolytes fine ``` ``` Bronchial stim -> no cough Response to sound/Supra-Orb Pressure Occ-Vestib Reflex absent Corneal Reflex absent Disconnect ventilator 5-mins -> no resp support ________ ``` -Emotions = fear, agitation -Fluct Syx = worse @night, normal periods -GCS impaired -Hallucinations/Illusions/Delusions #perception __________ Bell's Palsy present < 72hr - PREDNISOLONE -keep the eye: lubricated, tape @night, sunglasses @day REFER @Worsening of existing/new neuro findings REFER @Limb paresis, facial paraesthesia, other cranial nerve involvement, postural imbalance #UMN dx - BSC ``` REFER @ Gradual onset of symptoms, persistent facial paralysis > 6 months, pain in the distribution of the facial nerve, head or neck lesion suggestive of cancer, history of head and neck cancer, hearing loss on the affected side #cancer ``` Systemic/ severe local infection / Trauma. _____________ Hutchinson Sign = HZO = ACICLOVIR Taste ant 2/3 Hyperacusis Eye - lacrimation -> ulcer/dry Ipsi upper AND lower facial muscles LMN: LOW Weak, atrophy, tone, fascic, reflexes UMN: Babinski (FAN OUT #UPgoing), Spastic, Clasp knife _____________

Answer 10

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 11

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 12

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 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 Most common ovarian tumour <25 reproductive age = Teratoma Dermoid 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 ``` When start PP? Nexplanon = ANY time (but not needed <21) POP > 21d Mirena >4w CuiD > 4w ``` ``` 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 13

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 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 14

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 vaginal hysterectomy with antero-posterior repair. Which of the following is a long-term complication of this procedure? Vaginal vault PROLAPSE 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 ```

Answer 15

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 _________ 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 -NOT affected by EID: 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 ``` PP contraception timing: Nexplanon ANY TIME but not needed < 21d POP after d 21 Mirena > 4w CuiuD > 4w ``` 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 16

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 _______ 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 17

``` -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 18

Codeine to PO morphine /10 PO morphine = to... SC moprhine /2 OXYCOD PO /2 SC diamorphine/3 IV moprhine /3 OXYCOD SC /4 Alcohol units = %.mls / 1000 -make a toAST with alcohol > ALT. 2>1 _________ Monoplegia - 1 limb Hemiplegia - Unilat 2 limbs Quadriplegic - 4 limbs -Paraplegia - Bilat LOWER limbs ACA MCA PCA* L>UL ; UL>L < -- HemiParesis ........Aphasia -- > Agnosia ........Sensory ....HomoHAnopia -- > Mac-Sparing *PCA - Weber Midbrain -Same CN3, opp HemiParesis -Agnosia -Macular sparing HomoHNopia ________________ Amaurosis fugax - Retinal/Ophthalmic Artery Locked in syndrome - Basilar Artery ____________ Pontine bleed: PAMP - Absent < -- > horizontal eye-move - Miosis - Paralysis=Quadriplegia AICA: Lat Pont - Same FACE: PD/PT - ------(paralysis/deaf // pain/temp) - Opp limb - Nystagmus - Ataxia PICA: Lat Med Wallenburg - Same FACE: PD/PT (pain/temp) - Opp limb - Nystagmus - Ataxia ______________ Anterior Circulation Stroke: 3=TotalACS 2=PartialACS -UCH - Unilat sensory/motor FAL - Cog dx - VisuoSpatial/Dysphasia - HomoHNopia ``` LacACS = L-SAMP 1 of: -Sensory -AtaxicHemiParesis -Motor PURELY + HTN ``` POstCS _________ 4-6-4 H: CN4 vertical nystagmus CN3 Ptosis, Dilated, Vertical nystagmus CN6 horizontal nystagmus Nystagmus: Central v Periph: central is: - B/L - Assoc sens/motor dx - Direction = multi / purely uni or rotatory ``` Brainstem Death: Coma unknown Ax Reversible ax excluded Sedation X Electrolytes fine ``` ``` Bronchial stim -> no cough Response to sound/Supra-Orb Pressure Occ-Vestib Reflex absent Corneal Reflex absent Disconnect ventilator 5-mins -> no resp support _______ ``` -Emotions = fear, agitation -Fluct Syx = worse @night, normal periods -GCS impaired -Hallucinations/Illusions/Delusions #perception _________ Paroxysmal HemiCrania -Indomethacin __________ MCA lesions (dominant side - i.e. most ppl are right-handed so left-sided MCA fucked): 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 Cerebellar hemisphere = finger-nose ataxia Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington's) Parietal lobe - sensory symptoms, dyslexia, dysgraphia Frontal lobe - motor symptoms, expressive aphasia, disinhibition

Answer 19

Amoebiasis entamoeba histolytica - fecal-oral - FRJ+Aask+bloodydiarrhoea+irregUSS margins USS->CT Metronidazole ______ Coxsackie/Polio/Rhino - Picorna MeaslesMumps - ParaMyxo CroupParaInflu - ParaMyxo Influenza - OrthoMyxo Viral warts - HPV Papova-Virus Hepatits - Hepad-virus HIV - retro -receiving anal sex ________ 1. Tuberculoid 2. Lepromatous Tx: -Dapsone + Rifampin @tuberculoid form; - +CloFaziMine @lepromatous _________ Rocky Mountain Ricketsia -spotted fever Palms and soles rash @: - CoxsackieA (hand, foot, mouth) - Rocky Mountain Ricketsia - Syphilis 2° (you drive CARS using your palms and soles). Rickettsii on the wRists, Typhus on the Trunk. ________ 1. Histo - similar 2 leishmaniasis TWICE daily SPIKEs 2. Coccidio ________ 3. Blasto 4. ParaCoccidio ____________ ____________ ____________ Leptospirosis - Doxy+Penicillin - CK high = myalgia Leptospirosis Ix = Serology _______ Balkan Nephropathy _______ ``` Leishmaniasis=Kala Azar 7-21d -Similar to Histoplasmosis: --SMeg-ANT + MidZoneConsolidation ________ ?Strongyloides -rash @plantar + bum __________ ``` Yellow fever 2 - 14 days -Worse Better Worse #Councilman-bodies -Viral haemorrhagic fever ________ Dengue -hemorrhagic manifestations -4-10d _______ Typhoid - culture -SplenoMegaly+BRADYYYYcardia RRickettsii on the wRRists, TTyphus on the TTrunk. _______ a. Disseminated gonorrhoea infection b. Fitzhugh Curtis ________ Meningitis, Arthritis, E.Multiforme = coccidiomycosis (-remember causes of E.Multiforme = HSV, Mycoplasma-Strep-Toxo-Coccidio-SOAP) Lyme disease ELISA blood serology E.Migrans+No other dx? - Doxy / Amoxi - Ceftriaxone disseminated ``` NO E.Migrans -Syx+TickBiteHx? Test antibodies = ELISA serum + = Abx - = Repeat+Refer ________ ``` Bartonella - catch scratch dx ________ <6 hrs ABC -Aureus/Bacillus/C.perfringens <48 hrs -Sally/E.coli 48-72 hrs -Shiggy/Campy > 7 days YAG Yersinia/AmoebiasisAnchhovy/Giardiasis All blood except -ABC+Giardiasis+TravellersDiarrhoeaEcoli ``` diarrhoea + HypoGlycaemia = CHOLERA _________CD4 < 350 Burkitt EBV NHL High Grade SHEFCOT 1. Shingles 2. HSV 3. EBV HAIRY Leukoplakia UNscrapable EBV->CNS lymphoma -single-ring-enhancing lesions @MRI -Thallium SPECT POS 4. Fungal-CoTrimox/Atovaquone/Pentamadine/Sted @hypoxia ``` CD4 < 200 Diarrhoea Kaposi - Crypto Cocc-Meningitis / Sporid-Diarrhiea - Oesophageal Candidiasis - Toxo = brain abscess, MULT ring-enhancing lesions, Thallium SPECT neg - PyriMethAmine+SulfaDiaZine

Answer 20

``` RIGHT EYE__LEFT EYE 4 4 6-------6 3-dilated 3-dilated ptosis ptosis ``` 4-Trochlear 3-Occulumotor 6-Abducens ____________ Ptosis Miosis +/- Anhydrosis - head face arms = central = stroke/syringomyelia - face = pre-gang = pancoast / Cervical rib - nothing at all = post-gang = ICA dissection ``` Diplopia Double Vision DIRECTION: #H ^ ^ | < - - - - > | v v ``` 4 6 4 * 4 vertical * 6 horizontal * 4 vertical CranioPharyngioma = -Inf Bitemp HAnopia Pituitary tumour = -Sup Bitemp HAnopia ____________ LR6 SO4 R3 = -Lr - SO - 3R 6 4 Nerve Tract Radiation: 1. RON - right MonoOccularVisionLoss - chiasm-> (right chiasm = right NasalHAnopia) 2. ROT #LeftHomoHAnopia - LGN-> 3. SIñOR Pi-Ts: - RsOR @Pi = LiQA - RiOR @Ts #Meyer = LsQA - Rs+iOR = PiTs = #LeftHomoHAnopia ``` SIñOR Pi-Ts: S OR @PI-qa - Parietal-InfQA I OR @TS-qa - Temp-SupQA Post Cerebal Art Occluded = Macular SPARING _______ ``` Med #MS #Stroke INO - InterNuclear Ophthalmoplegia Long Fasciculus: So.. normally when you trying to look LEFT for example... contralat LR6 ABDucts @left eye + ipsilat MR ADDucts @right eye ``` but in INO.. contralat LR6 ABDucts @left eye + ipsilat MR3 ADDucts=FAILS @right eye --> ``` contra LR6 works overtime to stim ipsi MR3 --> contra LR6 nystagmus

Answer 21

Subdural old alcoholic brain atrophy --> fragile bridging veins damaged BRIDGING veins between cortex and venous sinuses HYPERDENSE bright - acute Hypodense dark - chronic slow Similar so LEWYBODY dementia - fluctuating GCS!! _____________ Extra/Epidural haemorrhage -lucid interval -middle meningeal artery _______________ ``` Subarachnoid -Circle of Willis vessels = basilar and ACA -LP > 12 hours = Xanthocrhomia Tx: -NIMODIPINE = reduce vasospam -Coiling by IR! _____________ _____________ ``` 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

Answer 22

IntraVentrivular haemorrhage Risk of risk of obstructive hydrocephalus _________ Hydrocephalus - Communicating non-obstructive - meningitis -> low CSF reabsorption @arachnoid granulations - Non-communicating = obstructive - tumours/hemorrhage _________ inc head circumferences (splaying of the skull plates allowed by unfused sutures), Pressure on the TECTAL PLATE/SUP COLLICUS --> Sunsetting ________ Normal pressure hence NO SIGN OF RAISED ICP (eg Papilloedema)

Answer 23

Exudate: RIM -Rheum dx/Infection/Infarction/Malignancy Transudate = HM -HF, LF, RF / HypoT -Miegs / Malabsorption ________ Absence = 3Hz @EEG _____________ Motor FRONTAL lobe - Head/leg movements - ictal weakness - Posturing - Jacksonian-march ``` Non-motor: -Temporal Hallucinations, Epigastric-rising, Automatisms-LIPSMACKING/PUCKING, Deja-vu/Dysphasia ``` -Parietal lobe (sensory) = Paraesthesia -Occipital lobe (visual) = Floaters/flashes _____________ Focal: Carbamaz Lamotrigine VLOG Valproate, Levetiracetam, Oxycarbamaz, Gabapentin Focal epilepsy #partial - aware = simple - impaired-aware = complex Absence = 3Hz @EEG: Valproate Ethosux Lamotrigine T-C GEN: Valproate Carbamaz Lamotrigine Atonic: Valproate Lamotrigine Myoclonic: Valproate Lamotrigine Valproate MOST teratogenic = NTDs as well as carbemazapine Infantile ---------> Lennox Gustaut - hyps-arrythmia - slow-spike - poor prog <8m - < 5yr * West 'Infantile' Nile Spasm Benign Rolandic Epilepsy < 12yr -EEG: centrotemporal spikes ``` Juvenile Janz Myoclonic Epilepsy -AM: seizure/absence - > random fkn myoclonus _________ _________ ``` Relapse-Remit 2° prog 1° prog ``` Mcdonald criteria Oligoclonal Antibodies CSF - IgG PeriVent Plaques high T2 signals @MRI Evoked Potentials - delayed but preserved Dawson FLAIR fingers = 90° to CCallosum ``` Lifestyle : diet/ex/Smoke ``` Glatiramer Azo MethylPred MITOX AMANTADINE ``` ``` Baclofen botox IFN B Natalizumab/Alemtizumab/FingoLiMod SSRI __________ ``` 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 ```

Answer 24

Raised ICP ___________ ``` Hypoglossal - Tongue TOWARDS Accessory - shoulder droop + cant turn to opp side V3 jaw TOWARDS Vagus - uvula AWAY!!!!! _______ ``` Migraine!!!! Ibuprofen first line!!! Triptan >12yrs _______ Pupillary Reflex #symp: Retina -CN2-> PTN or Hypothal ``` PTN -> EdW -CN3-> Ciliary Ganglion -ShortC.nerves-> Sphincter pupillae ``` ``` Retina -CN2-> Hypothal -> CilioSpinal Budge (C8-T2) -> Sup cerv.gang -ICAplexus, CavSinus, orbit = long Cil Nerve-> Pup Dilator __________ ``` 5 normal 4 resistance 3 gravity 2 some 1 flicker 0 none Alert 15 Voice 12 Pain 8 Unresponsive 3 _______ ``` 2(Na+K) + BM + Urea = calc osmo (Na + K) - (Cl - HCO3) = anion gap 1-2mmol/kg of Na/day 1mmol/kg of K and H2O/day 50-100g/day of Gluc ``` Paeds maintenance: 1st 10kg = 100ml/kg/d 2nd 10kg = 50ml/kg/d Remainder = 20ml/kg/d ``` SV=EDV-ESV CO=SVxHR PP=SBP-DBP EF=SV/EDV MAP=COxSVR ```

Answer 25

``` Fred is your SPACKER FRATaxin bro, always: - staggering (Ataxia #SpinoCerebellar tract) -falling (DC-ML) cos of prop/vib -(CST - spastic paralysis) ``` but has a - sweet (DM) - big heart (Hypertroph CM) - funny eyes = nystagmus/pes cavus ``` AR = metabolic except ataxias AD = structural except Gilbert, HL2 ``` Die from CARDIO MYOPATHY ____________ Myotonic dystrophy -Autosomal Dom __________ Duchenne - XLr -high CK (suggest to do MUSCLE BIOPSY=absent dystrophin) Facio-Scapulo-Humeral Musc Dystrophy

Answer 26

ICP monitoring @GCS 3-8 w/ normal/abnormal CT scan. Gingko leaf @CXR = Subcut emphtsema Air under diaphragm = perf Dexa @Oed from tumour Mannitol @Raised ICP Nimodipine @SAH to reduce vasospasm SIADH Minimum of cerebral perfusion pressure of: - 40-70 mmHg in KIDS - 70mmHg in ADULTS. Hutchinson Pupil ``` Pupil dilated: -Unilateral = CN3 dx #TransTentHerniation #Hutchinson Pupil Holmes-Adie Pupil+absent knee reflexes Marcus Gunn RAPD ``` -Bilateral = CN3 dx bilat Constricted: -Unilateral = Symp dx ``` -Bilateral = Argyll-Robertson = DM/Syph #prostitues-pupil Opiates, Pontine dx ________ ``` Dys-Dia-Dhocho-Kinesis HemiBallismus Chorea ________ __________ alexia, acalculia, finger agnosia RIGHT-LEFT disorientation -Gerstman's hemichorea: involuntary, irregular, non-rhythmic movements of one side of the body hemiBALLismus: involuntary, flinging, violent movements of one side of the body PONV - Ondan5HT3/Ginger @Medulla ______________ ICP high Motion-labrynthine / MECH Bowel Obst Preg -AntiHist > DopBlock RT/Cancer = DopBlock _______________ Ondan5HT=CYTOTOXICS=DopBlock - Nabilone=cannabinoid - Rolapitant-NK1 blocker Opiod - OCD -Ondan5HT/Antihis/DopBlocker -ChemoreceptorTrigger zone - CT-zone ________________ OCDMPH: Ondan5HTron - 5HeroTotinin3 blocker -medulla CycliZINE - antihistaMINE -ZINES - promethazine NOT prochlorperazine FOR HIGH ICP!!!!!!!!!!! DopBlockr: Domp MetocloProkinetic Prochlorperazine Haloperidol - METABOLIC stuff ?highCa/RF Funct - metoclop / Mech - Cyclizine

Answer 27

Von Hippel-Lindau ________ Marco Tropical Scam in Pak: Marcus-Gunn RAPD - AION - RVO/RAO-central - CRVO/CRAO - Optic Neuritis: MS/DM/Syph TTTunnel Vision: - Ret pigmentosa - Optic Atrophy @TTTabesDorsalisSyph - POAG-ACAG - ICP high i.e. pappilooedema - ChorioRet-CMV/Toxo ``` Scotoma: -CRVO -ARMD -Migraine - scintillating _____________ ``` ``` Hypopyon: -Post-op endophthalmitis, -Ant uveitis, -Keratitis _________________ ``` - Intermittent squint in NEWborn <3 months = NORMAL - underdeveloped eye muscles - >3m ?start worrying #refer Concomitant: Convergent In > Divergent Out Paralytic: muscle paralysis Ix: Corneal light reflection Cover test Tx: Refer - eye patch @ >3months ________ Aciclovir: Top @HSV Keratitis PO @HZO _______ DM Amyotrophy

Answer 28

1. PBC - AMA/SMA IgM 2. Autoimmune hepatitis ANA/SMA LKM1kids 3. PSC 4. PBC liver transplant @: - Bili >100 - Recurrent cholangitis - Refractory itching - Ascities ``` 5. Kolestyramine for ITCH Usda #FIRST-LINE BASTARD!!!!! Transplant ADEK MONITOR AFP LFT USS Stop Smoke ``` 6. PBC: HCC PSC: Cholangiocarcinoma/Colorectal/UCC ___________ -FBC - check for hemolysis -UCB + CB in 1-3 months __________ ``` Wilson - AR Ix? MRI, Slit lamp, Copper: serum/ceruloplasmin LOW Copper: 24hr urine HIGH ``` ``` Tx: Penicllamine Avoid Cu foods Screen kids Transplant/Trientine/TetraThio.. _________________ ``` HChr - AR ``` Ix: HFE/C28Y/H63D/Pearl stain Image: MRI, Xray Tx: VeneSection -> ferritin/TF sats <50% Desferioxamine _____________ ``` ``` Alpha-1 antitrypsin = ACoDominant!!! Ix: PiSS>PiZZ Slow>V.slow COPD Ix and LFTs ``` Tx: IV alpha 1 antitrypsin ``` Bead sign? MRCP PSC Pearl sign? HChr PAS +? Alpha-1 antitrypsin Piecemeal necrosis? Autoimmune hep Porcelain? Cholecystitis - cancer risk ```

Answer 29

Haemorrhoid Fissure -?PMH: crohns ``` Solitary rectal ulcer Histology: -mucosal thickening -lamina propria replaced w/ collagen and SM (fibromuscular obliteration) ``` Chronic fissure > 6/52: triad Perinanal Hematoma Proctitis Causes: Crohn's, UC, C.difficile ___________ Ano rectal abscess Ano -rectal abscess --> Anal fistula Goodsalls rule determines location Rectal prolapse = childbirth and rectal intussceception. = int/external _________ Rectal=Adeno Anal cancer=Squamous __________ __________ Mallory-Weiss Tear Hiatus Hernia -What should NOT be associated with dysphagia or haematemesis? UnCx hiatus ORBS: Oesopghageal Rupture Boerhaave Syndome -Complete disruption of the oesophageal wall in absence of per-existing pathology. Oesophagitis Dieulafoy Lesion - can be HDunstable Diffuse erosive gastritis - can be HDunstable Pharyngeal Pouch - ZENKER DIVERTIC -herniation between thyropharyngeus and cricopharyngeus muscles #Killian's Dehiscence - BSwallow MGravis Oesophag Candidiasis ____________ Squamous cell carcinoma of the oesophagus Adenocarcinoma of the oesophagus - GAS Upper 2/3 Oesophagus = Squamous Lower 1/3 Oesophagus = Adenocarcinoma ___________ Achalasia: MCS BED CaMP - Manometry Contrast Swallow = dilated tapered oesophagus - BalloonEndoDilation – > CardioMyotomy+PPI Peptic stricture Dysmotility disorder - 1. Oesophageal spasm - coodination messed 2. Nutcracker - all @same time

Answer 30

5. APLS: - Cardiolipin/Coagulant - gp12b Clots, Livido-Retic, Obstetric cx - miscarriage TCP/APTT high paradoxical 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 _________ WPW = AL BRt A - left sided RAD = dom R wave @ V1 B - right sided LAD = no dom R wave @ V1 ``` Assoc: MESH MVP, Ebstein anomaly, Secundum ASD, HOCM/ HyperT ``` Tx: radioFreq ablation of acc pathway FAPS Avoid sotalol @AF cos it - prolongs refractory period @AVN -> - inc transmission rate through acc pathway -> - Inc vent rate = VF

Answer 31

RIPE-RMFA -RNA polym, Mycolic acid, FA, Arab-transferase Rifamp = stop RNA polym -> stop mRNA synth -flu-like / orange secretions Isonoazid (+ Pyridox) = Mycolic Acid synth stop - B3Pellagra=Dementia/Diarrhoea/Dermatitis - Agranulocytosis - Neuropathy=GBS - SL3-histone Pyridox = stop FA synth Gout/Arthralgia Ethambutol - Eye dx #OpticNeuritis -stop arab-transferase ________ Latent TB screening: - New NHS employees - IC / Immigrants - Contact w/ pul/laryngeal TB pt - CXR=TB scarring/Untx fibrotic changes -> Mantoux/IGRA -> -RIpyridox 3m @34/-/high LFTs -Ipyridox 6m @IC _______ Active TB: Ix: - CXR - 3-sputum-MCS ``` Tx: -2m RIpPE -> 4m RIp #6m-RIp #10m @TB-men -DOT @Homeless/Non-compliant/Prisoner _________ ``` _______ Mantoux POS = Assx 4 active / Tx 4 latent #IFN #IGRA ``` Mantoux NEG = IFN -IFN POS = follow Mantoux POS -IFN NEG = BCG @ 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 ___________ Parasaitemia = 999+PHE: >2% - severe/cx -IV Artesunate > Quinine >10% - exchange transfusion <2% non-severe/UnCx: -ACT* > Atovaquone-proguanil Doxy-Quinine ACT = AL-ArM: - ArteMether+Lume - ARteSunate+Mefloquine Non-falciparum -oral ACT / Chloroquine -Tx vivax/ovale -> dormant HYPNOZOITES @Liver? Primaquine-G6PD beware Avoid what drugs with following: - HA - chloroquine - Seizures - Chloroquine/Mefloquine - Psych dx - Mefloquine - GI dx - proguanil - Folate dx - proguanil

Answer 32

5-15% 30-45% ______________ HNPCC Lynch - MSH2 gene - Gastric/SBowel - ENDOMET/Bladder FAP - Dom -Gardener Syndrome get OSTEOMAS!!! _________ ``` Peutz -Jeghers - Dom -STK11 (LKB1) -GI / Panc cancers -Gynae cancer (except Endomet) -Testicular cancers __________ ``` Cowden dx - Dom £10-bet - P-TEN -Breast, Endomet, Thyroid _________ Duodenal atresia -Duodenoduodenostomy Jej/ileal atresia Meconium ileus -surg Decomp / resection @serosal dx ______________ Malrotation with volvulus -Ladds procedure NEC Necrotizing Enterocolitis

Answer 33

``` uRinalysis uO uSs kub u+E --> ``` -NORM = Pre-Renal -Prot ± Blood = Intrinsic* -Blood = Post-Renal Waxy = CKD / Fatty = nephrotic RBC casts: g.nephritis/HTN nephropathy ``` Instrinsic --> WCC casts? -Y = Nephritis Pyelo AIN-acute interstitial nephritis -Omep/Penicillin-Quinolones-Rifamp/Spiro-Amiloride Transplant ``` ``` -N = ATN tub cells die -> can't retain Na/H20 -> urine osmo low / urine Na high -urine Na classically >30!! = FC fail + low gravity ``` -OPP happens in pre-renal dx #COlow, HYPOvol, Drugs ____________ AR= Loop - Barter - AscLoopHenle/NKCC --HypoNat/Kal AR = Thiazide/Gitelman = Prox DCT/NaCl channel - -HyperGlyc/Lipidemia/Uricemia/Calcaemia-Calciuria - -HypoNat/Kal/Mg AD = LiDDle: Met Alk HypoKal HypoChlor fucked ENaC @lumen Inc ENaC activity -> Inc Na -> 3Na/2K+ pump basally: * -3Na enter blood -> H20 follow = HTN -2K+ enter cell -> relatively NEG lumen -> --2K= leave cell -> enter lumen = HYPOkal --inc H-ATPase activity --inc H+ secretion --inc:HCO3-/Cl- : HCO3- enter blood #MET-ALK, Cl- enter cell -> enter lumen -> mop up H+ 3Na in; 2K+ and 1H+ exit = charge balanced _________ PCT: HCO3-* BM, AA, Na (ANP/AT2) PO4- (PTH) *Old tetras/Wilson's/Acetazolamide/Mannitol RTA 2 = NAMA = low K+ -HCO3- absorption dec i.e. inc secretion -> -N.A.MET ACID ____________ ``` CCD: Congen URO dx RHEUM dx Amphoterocin Painkillers - NSAID --> ``` ``` RTA 1 = NAMA = low K+ -low H-ATPase pump activity -low H+ secretion -low :HCO3-/Cl- : less HCO3- enter blood #MET-acid, Cl- enter cell -> enter lumen -> mop up H+ ``` Cx of RTA 1 ? -renal stones !!! _____________ CCD=Ald low/Resistance Ald low: Heparin/ACE-ARBs/NSAID/DM renin low/Addisons Resistance: Obst Uropathy, TMP-SMX, Spiro/Amiloride

Answer 34

PNEUMONIA @LOWER FKN LOBE -lower lobe pneumonia = felt as upper quadrant abdo pain ___________ Juvenile polyps - hamartomas ___________ Tietze - costal cartilage swelling Costochondritis - NO swelling __________ Oesophageal spasm -barium: cork-screw oesophagus 1. diff oesophageal spasm UNcoordination @several points Dysphagia 2. nutracker oesophagus - COOrdinated contraction Forceful = pain PPI, Iso Mononit #LAN Nifed #CCB Dilation balloon/Myotomy

Answer 35

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 Steriods 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 36

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 37

NSTEMI + no C.Enzymes = U.Angina NSTEMI + C.Enzymes = NSTEMI CA SpaZm = PrinZmetal - Tx = DHP Amlodipine @lying = decibitus __________ RBBB = No axis deviation Left ant fascic block = LAD Left posterior fascic block = RAD RBBB + left ant fascic block = LAD #bifascicular RBBB + left post fascic block = RAD #bifascicular ``` Trifascicular block (incomplete) -Bifasicular + 1st/2nd degree heart block ``` Trifascicular block (Complete) -Bifasicular + 3rd degree Heart block __________ COSA Coved/Convex STEMI + T-invert - BRUGADA DIG TOXICITY ST dep + R high = Posterior MI COMPLETE HB 3rd -Stoke Adam = deep AF T inversion ________ ST elevation = MI/ Pericarditis/ Brugada ``` ST dep = ischemia Conduction dx VHypert* Digox ``` ``` T invert = ischemia/old Brugada VHypert* Digoxin ``` *(+ tall R = RVH(V1-3), LVH(V5-6, 2,3,avL)) ________________ - PERICARD dx = worse @insp/ying; improve @lean-forward - PR Depression = MOST specific for PPPeRRRicarditis!! - NSAID+++++Colchicine BOTH!!!! Trop T peak most sensitive - max accurate at 12 hrsssssss! HypoKal - PRUQT HIGH: PR, U QT Low: ST/T HyperKal - QRST HIGH: QRS, T-wave Low: P Sinus tachy, RBBB, RAD-strain - Resp Alk = PEEEEEEEEE RBBB+RAD = ASD secundum dx -EMBOLUS SHOOT OFF -> STROKE!!!!!! RBBB+LAD = ASD primum dx -prime lad ____________ ``` short PR interval (<120-200ms), wide QRS complex (>120ms) upsloping delta wave. -WPW -normal PR interval = 120-200ms QRS < 120ms ___________ ___________ ``` 1. Cholestyramine=Gallstones + Constipation 2. -Cholestyramine Bind 2 bile @GI -> prev absorption -> shit out bile, HENCE... -bile acid level drops -> chol convert 2 bile acid -> chol reduce!! -CHOLESTYRAMINE=CONSTIPATION 3. Dyslipidaemia=lowHDL highLDL - Nicotinic Acid - FLUSHING!!! 4. insp-> low SV-> BPdrop>12 PAH AR / ASD High Left EDV Tam-PulsParadox-onade CPericardKnock-Kussmaul 5. MI / MR!!!! > AR / CCF ``` 6. StAMP Stress test CI: ARrhythmias/ADiss/ASten MI / HF / PE Peri/Myocarditis ``` 7. Limb <5mm Chest <10mm Distance incr: CCoPPd* Infiltrative Metabolic MyxoedHypoT COPD/CPericardiKnock Obesity Pericard/myocarditis

Answer 38

XLr G6PD Oxidative RBC stress: - Mehndi - ABx=Sulfa/Quinine/Quionlone-cipro/sulfasal - FavaBeans - Heinz/Bite cells - INTRAvasc - AFRICAAAAAAA AD hereDitary Spherocytosis Retic LOW + Hb LOW -ParvoAplasticHemolysis Retic HIGH=Sequester ________ Reefeding syndrome _______ Vasc/Plt dx Coag dx __________ __________ - 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 Patients with a GCS below 8 should be considered for both i) review by an anaesthetist and ii) intubation and ventilation

Answer 39

Irradiated blood products = AVOID -transfusion-associated GvH dx Philadelphia chr - 9,22 - CML=Imatinib RAI - CLL SmudgeSmear --RichterTransform-> NHL-Bcell Reed Sternberg - Hodgkin*, EBV, Localised Auer Rods - AML APML15,17 Ann Harbor Lymphoma: 1node, 2nodes, 2sideDiaphragm, Extranodal Multiple nodes, B>T cells, Extranodal = NHL ``` Hodgkin: Nodular - Women+Lacunar cells Mixed - Eosinophil/RS cells HIGH Lymphocytic -Predom=BEST -Deplete=WORST ``` ``` NHL - High > Low: High: B-cell diffuse=chest nodes/HIV/nonMalt Burkitt=EBV/Malaria/StarrySky/C-myc T-cell=Tokyo/hTlv ``` ``` Low: MALT-pylori / Mantle 11,14 LC/LPC waldenstroM-Macroglob-IgM Follicular 14,18 Skin/SezaryMycosis ``` ``` XS prolif Bone-Marrow Plasma-Cells, Heavy>light chain, Bence-Jones LIGHT @URINE MGUS=no CRABIE MM=*CRABIgG>AEsrrouleaxy WaldenstromMacroglob=IgM-LC/LPC LowGradeNHL ``` ``` *Ca URB RF-dialysis ANT Bone-Cytokines release-> oClast -> -RAINDROP* LyticLesions IgG>A ESRouleax clump/Clots ``` *PepperPot = fucking HyperParaThyroidism !!!!!!!!!!!!!!!! Raindrop = MM !!! _________ MAT - TTP - large vWF multimers SKEW - ITP - Gp2b3a ABs ``` O-anti A+B -Recieve FFP -Give ABO A - antiB ANti-D @ Rh neg ``` ``` Desmopressin @ Haemophila -A8 Xr -B9 Xr XMAS -C10 Ar ``` vWDx + TXA - 1 AD - 2 AD - 3 Ar Thalassemia+SCDx= AR - Pigmented gallstones Assoc w/ with sickle cell - bilirubin and Hemolysis etc occurs

Answer 40

1. Allergens: - Avian bird poo=Bird/PigeonFancier - Fungal=Farmer/Malt/Mushroom 2. Inhaled organic dust-->HSR: - Type 3 I-C = Acute - Type 4 cell-mediated = Chronic 3. Extrinsic Allergic Alveolitis AKA HSR pneumonitis -Later: SOBOE, WL, T1RF, corpulmonlae, fibrosis 4. Tx = Avoid allergy + Steroids ________ Bakers lung = Occ Asthma _________ MesoTheliOma -But ACTUALLY Asbestosis -> LUNG CANCER >Mestothelioma!!!!!!!!!!!!!!!!!!! ________ Central = BronchoScopy biopsy -Squamous (get clubbing) Peripheral = CT > USS guided biopsy -Adeno/Large UNdx after Bronch / CT/USS biopsy= ThoracoScopy CT shows large LNs -> check status B4 surg = MediastinoScopy 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

Answer 41

Strep Pneu - HSV Staph -Influenza Legionella Klebsiella Pseudomonas Mycoplasma PCP -Ix: BAL / Biopsy -Tx: CoTrimox, Atovaquone, Pentamadine, STEDS @hypoxia __________ ``` Lung abscess -Anaerobes -Bronchiectasis STINKY too!!! -Clinda _______ ``` Asp Pneumonia - RLL + Recent intubation - FB can get stuck here too

Answer 42

Thoracotomy: in haemothorax include >1.5L blood initially, OR >200ml/hr >2hr loss ......... FEV FVC FEV/FVC Obst <80 <70 Rest <80 <80 >70 Exudate > ? Transudate < ? 25-30 = Light's criteria Pleura : Serum Prot : Prot >0.5 LDH : LDH >0.6 pH < 7.2 / GramMCS/Cloudy PF-LDH > 2/3 UL serum / >200 ``` Low TLCO/DLCO: Pefo + CO-low, Pneumonia, COPD -Scoliosis/Kyphosis -NMwall dx -AnkSpond -Pneumonectomy #KCo ``` ``` High TLCO/DLCO: -Hemorrhage -Asthma -L->R shunt -Polycythemia -Ex/Male ___________ ``` Exudate: RIM -Rheum dx/Infection/Infarction/Malignancy Transudate = HM - HF, LF, RF / HypoT - Miegs / Malabsorption prIck-->RAST @food/pollen -IrrItant? Pr1ck=1gE=T1HSR p4tch test @ Allergy = T4HSR _________ ``` _____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) ________________________ ____________MAP=CO.SVR HR PAP Hypovol______low . low..................low Cardiogen___ _low . low Anaphyl/Sepsis_low...........low..........low Neurogen_____low . low.low ``` ____________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

Answer 43

Congenital inguinal hernia – paediatric surgery ASAP incarceration risk <6w - surg <2d <6m - surg <2w <6y - surg <2m probability of strangulation = 3% Direct V Indirect Ing Hernia -Direct = weakness @posterior wall of the inguinal canal -Indirect = persistent PVaginalis _____________ ``` Infanta UMBILICAL hernia No tx - resolve <3yrs -Syx and large = 2-3yrs -Asyx and small = 4-5yrs __________________ ``` epidural analgesia helps to accelerate the return of NORMAL bowel function after abdominal surgery Juvenile polyp hamartomas Fissure FPG - -?PMH: crohns fever + severe pain = Intersphincteric Abscess > fissure Solitary Rectal Ulcer - excl cancer #biopsy Haemorrhoids FP BDISH -No pain - unless thrombosed Rectal prolapse/intususception Chronic fissure > 6/52: triad Perinanal Hematoma Proctitis Causes: Crohn's, UC, C.difficile Ano-rectal abscess --> Fistuale Goodsall rule determines location ___________ ______________ 1 node, 2 node, b/l diaphragm, extranodal MWND: Mucosa, Wall, Node met, Distant mets A-P resection @low-rectun/anus - Anterior Resection @mid-rectum + above - High Ant Resection @sigmoid Hartmanns at @Perf ______________ FAST SCAN Diverticula most commonly at SIGMOID Thoracotomy: in haemothorax include >1.5L blood initially, OR >200ml/hr >2hr loss Subcut emphysema!! Not fkn Perf 🤦🏽‍♂️😶 SIGMOID at oldie, psychos, Parkinsons, Chagas 4-BSA-kg 8+16hrs mls.% / 1000 Spout SMALL Bowel stoma cos of enzymes!!! - Richters hernia = Strang Syx w/out Obst - SPIGELIAN HERNIA!! LLVH tense red TPN derranges LFTs!!!!! -retroperitoneal FIBROSIS Gastric MALT lymphoma - eradicate H. pylori!!! colovesical fistula - CT!!!! Bowel obstruction Ix - definitive = CT!!!!! -Abdo = initial GASTROGRAFIN

Answer 44

1. Conservative 2. Laparotomy with conservation 3. Resection ______________ PEG BEST LONG TERM!!! ____________ Hyatid Echinococcus Cysts #Eosino #Daughter - CT abdomen!!!! - MEBENDAZOLE -> ?Resection + HyperTonic swabs - Perc Asp is contraindicated Liver hemangioma Liver abscess AMOEBIC cyst = Asp anchovy paste + poorly defined boundary = METRONIDAZOLE Liver cell adenoma -OCP 30-50 y/o B12 def -Subacute Combined Degen of Spinal Cord cos #NO INTRINSIC FACTOR Urinary 5HiAA - H.pylori + Carcinoid --> Coronary-itis - TR/PS Spine epithelial defect + HIRSUTISM = pilonidal sinus ______________ Boas = shoulder/scapula excitation @cholecystitis Cullen @panc = umbilicus; Grey-Turner = flank Blumberg@appendicits = rebound tenderness Rovsing @appendicitis = touch LIF = pain RIF Claybrook@PERF -heart/breath sound @abdo = PERF SBO Ax - ACHI: adhesions/cancer/hernia/ibd-crohns LBO Ax - cancer _______________ ACUTE Cholecystitis -AUSS, AMG+Lap Chole <1wk - lap chole @syx gallstones #day-case #elective - CYSTIC DUCT!!! - Asyx NOT need op - not well for lap chole = Cholecystostomy - USDA @radio-lucent <1.5cm + funct GB @cystography -CBD stones = lap chole + CBD clearance via: ERCP or @lap chole -if ERCP fail = temporary stenting ``` cholecystectomy 6 months ago -> since the operation = experienced -chronic diarrhoea #float in the toilet Tx = CHOLESYTRAMINE - help absorb bile salts ``` PMH: rheumatoid arthritis, is -scheduled to have a laparoscopic cholecystectomy. What imaging should be performed pre-operatively? -Ant + Post + Lateral c-spine radiographs -Atlantoaxial 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. Isolated hyperbilirubibemia Ix? = - FBC - check for hemolysis - UCB + CB in 1-3 months Lidocaine max dose? With Adren? 3mg/kg, 7mg/kg w/ adrenaline ______ Foregut- Oesoph -> U.Duod AoVater -Coeliac T12 Midgut- L.Duod -> prox 2/3 TC -SMA L1 Hindgut- distal 1/3 TC -> anal canal above pectinate line - Ligament of Treitz = upper GI v lower GI D-J jct - IMA L3

Answer 45

``` 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/+] __________ __________ __________ 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 46

-Bodily sensation CONTROLLED by ext influence = passivity phenomenon -Object is perceived --> Sudden Intense Delusional Insight into the objects meaning -------Delusional perception wakes up and less often when he is falling asleep he is 'PARALYSED' and UNABLE 2 MOVE. 'hallucinations' such as seeing another person in the room -Dx = Sleep paralysis Clozapine -reduces SEIZURE threshold -Smoking CESSATION can cause a rise in clozapine blood levels -constipation/intestinal obstruction -If clozapine doses are missed > 48 hours the dose will need to be restarted AGAIN SLOWLY Stopping of voluntary movement or staying still in an unusual position = catatonia narcissistic personality disorder have a heightened impression of self-importanceunlimited abilities to succeed, become powerful lack empathy and will happily take advantage of others to achieve their own need. -NARCISITIC PD Chronic insomnia may be diagnosed after 3 months Tetra-benazine = tardive dyskinesia Propranolol = akathisia Procyclidine benztropine = acute dystonia Lorazepam = calm psychotic episode Which of the following features is needed to make a diagnosis of a personality disorder? Over 18 years of age CT head scan should be considered in elderly patients with new sudden onset psychosis to rule out an organic cause for their presentation EUBPD = dialectical behaviour therapy (DBT) Clinical Institute Withdrawal Assessment for Alcohol (CIWA) = alcohol withdrawal severity Chlordiazepoxide is used in the treatment of delirium tremens Pseudohallucinations are more common after bereavement and do not imply psychosis --HAS INSIGHT OCD = marked/severe functional impairment e.g. loses job etc = refer + iapt/CBT + ssri-clomi GAD: Persistent, ‘free-floating’ anxiety, with associated features. Treatment with SSRIs + CBT is key. Panic disorder: a panic disorder is more associated with RANDOM panic attacks, on a background of no anxiety usually. lower back pain, constipation, headaches, low mood, and difficulty concentrating. i.e. bones stones moans psychic groans #hypercalcemia = Lithium ``` Circadian rhythm disturbance is a feature of schizophrenia #INSOMNIA ``` wife died WITHIN LAST < 6 months. reports being tearful 'picking fights' he has on occasion described HEAR HIS WIFE talking to him and on one occasion he prepared a meal for her. -NORMAL grief reaction People can hear voices it's perfectly normal. Train of thought = voice in your head. CONFUSION about source of voice = what makes it a hallucination wife died >6m ago SUDDENLY…. i.e. fkn ages ago bro reports being tearful 'picking fights' he has on occasion described hearing his wife talking to him and on one occasion he prepared a meal for her. -ATYPICAL grief reaction #delayed/prolonged M1 O2D2 G3 S4 (PTSD also 4 too!!) D24

Answer 47

Lithium = NEPHROgenic DInsipidus ; HypoT, Ebstein Check levels -12 hours after the last dose - -> -7 days after dose change Cotard syndrome is associated with severe depression patient is in a public place and threatening violent behaviour. The police should be contacted to be brought in + assessed hypomania = Delusions of grandeur - 4d + no Hosp/Funct dx/Psych dx Copro-praxia = involuntary performing of obscene or forbidden gestures e.g. inappropriate touching ''Coppring a feel... he he he " Echopraxia = imitation of the movements of OTHERS Pali-lalia automatic repetition of one's OWN words Folie à deux - shared hallucinations/delusions between individuals De Clerambault AKA Erotomania Delusional disorder presence of delusion (of a FAMOUS person being in love with them) with ABSENCE of other psychotic symptoms ---like that girl in love with joey #Drake Ramoray Melanosis Coli = Purging behaviours in bulimia are not only vomiting, can be use of LAXATIVES or Diuretics or Exercising SSRI: TIC Cont 6m after remission -> reduce dose over 4 week period Mania = Refer urgent @DMSA !!! danger mania severe-depression adv st8ments Illness anxiety disorder AKA CHONDRIASIS=CANCER !!! A 14-year-old patient presents to her GP complaining of unexpected weight gain and tiredness. She has been in contact with mental health services recently for treatment of anorexia nervosa. -Dx = HypoThyroidism Anorexia can cause HypoThyroidism in some individuals Antisocial personality disorders more often affects men -steal 'because they can' -do not see why they should obey the rules of society -enjoyed hurting their younger siblings -killed the family pet ANTISOCIAL PD – ?DialecticalBT ``` Patients with poor oral compliance to antipsychotics should be considered for once MONTHLY IM antipsychotic depot injections ``` Paroxtene = Discont Synd -PURSM + GI dx GRADUAL onset schizophrenia is a poor prognostic indicator fluoxetine when used in the T3 -Persistent pulmonary hypertension hypomania describes decreased / increased function for 4 days or MORE ffs !!!! but NO FHP !!!!!

Answer 48

TCA -Opp of SLUDS: Blurred vision + dry mouth These antimuscarinic side-effects are more common with IMIPRAMINE than other types of -OVERFLOW incontinence !!!!!!!! Selective serotonin reuptake inhibitor = Sertraline/Citalopram SNRI = Venlafaxine Serotonin and Noradrenaline reuptake inhibitor ``` clozapine olanzapine: higher risk of dyslipidemia and obesity risperidone quetiapine amisulpride aripiprazole ``` Clozapine -reduces SEIZURE threshold -Smoking CESSATION can cause a rise in clozapine blood levels -constipation/intestinal obstruction -If clozapine doses are missed > 48 hours the dose will need to be restarted AGAIN SLOWLY ECT – -cardiac arrhythmias are a short term side effect -AntiDEPRESSANT medication should be REDUCED NOT STOPPED when pt = about to commence ECT treatment -ECT = Retrograde amnesia #memory impairment Aripiprazole has the MOST TOLERABLE side effect profile of the atypical antispsychotics, particularly for prolactin elevation Mirtazapine = Specific Serotonergic + NorAdr antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors -useful side effects (sedation + increased appetite) -i.e. useful for those who can’t sleep + low BMI Antipsychotics in the elderly - increased risk of STROKE + VTE Zopiclone increases the risk of falls in elderly patients Avoid TCA/MAOi in people using brimonidine alpha ag @ACAG -FOVL / iNFLAMM-Itch / TCA-MAOi SSRIs and MAOis (phenelzine) should never be combined as there is a risk of serotonin syndrome Triptans/MAOi/Ecstasy should be avoided in patients taking a SSRI Citaloproam = the most likely SSRI to lead to long-QT + Torsades de pointes SSRI @preg = Sertaline/Fluox-parox --still cause CONGEN Heart dx TCA = antimusc = opposite of SLUDS -OVERFLOW incontinence !!!!!!!! Pt on Long-term atypical ANTIPSYCHOTICS -gets polyuria, polydipsia etc can lead to the development of Glucose dysregulation and DIABETES Schizophrenia = Cognitive behavioural therapy Alcohol withdrawal symptoms: <12 hours seizures: 36 hours delirium tremens: 72 hours

Answer 49

IV fluids should be given in 2nd degree aka Partial thickness Superficial or more that cover 15% BSA Superficial dermal burns covering >3% TBSA in ADULTS must be referred to secondary care In KIDS, IVF are recommended when burns cover 10% body surface area. Pityriasis rosea often follows a VIRAL infection. Streptococcal throat infection tends to trigger GUTTATE psoriasis Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures Horner's syndrome – (ptosis miosis ±anhydrosis) ANHYDROSIS determines site of lesion: •head, arm, trunk = central lesion: stroke, syringomyelia •JUST face = pre-ganglionic lesion: Pancoast's, cervical rib •ABSENT = post-ganglionic lesion: carotid artery _________ patient reports NO new findings on history including normal vision. Fundoscopy = abnormality in both eyes. -What abnormality is most likely in this patient: Cotton wool spots / Retinal neovascularisation? Cotton wool spots = NORMAL vision patient reports NEW VISUAL LOSS findings. Fundoscopy = abnormality in both eyes. -What abnormality is most likely in this patient? Cotton wool spots / Retinal neovascularisation Retinal neovascularisation = FUCKED vision _________ POAG = Disc Haemorrhages/Pallor = Atrophy Optic disc = SWOLLEN = CRVO / Papilloedema Paton’s Concentric Radial RETinal lines = CASCADE from optic disc = Papilledema Papilloedema = BLURRED Optic disc margin = LOSS of optic CUP + LOSS of venous PULSATION Increased ARTERIAL REFLEX = feature of HTN retinopathy. ``` The use of antivirals for shingles may reduce the incidence of POST HERPETIC NEURALGIA particularly in older people Antivirals will NOT affect the virulence of the patient, ``` ``` Those with a POS FHx of glaucoma should be screened ANNUALLY from aged 40 years ```

Answer 50

- LONG-sighted #HyperMetropia = ACAG - Short-sighted #Myopia = POAG Afro-Caribbean origin = skin type VI Fitzpatrick --never burns/tans In diabetic retinopathy, cotton wool spots represent areas of retinal INFARCTION - Pre-capillary arteriolar occlusion ``` Erysipelas is a bacterial infection caused by Streptococcus PYOGENES - GAS FLUCLOXACILLIN ---It is differentiated from cellulitis due to its raised and well defined BORDER. # s.aureus=cellulitis ``` Bilateral gritty eye -WORSE @MORNING BLEPHARITIS -WORSEN @THROUGHOUT day = Dry eyes Lund and Browder chart is the most accurate way to asses the burns area Lund > Wallace 9 Cataracts are not an acute problem so carry no urgency. Cataract removal operations should NEVER be rationed on the basis of visual acuity I.E. SEND THAT DAMN referral ROUTINELY The most common dermatosis in pregnancy is atopic eruption of pregnancy SUP-VL: - CANNOT SEE see retina @fundoscope = Vitreous haemorrhage #vitreous is full of blood. - severe retinal haemorrhages @fundoscope = CRVO HZO = ADMIT -> PO Aciclovir HZO -> Ant Uveitis #CORNEAL involvement pemphigOLD = no mucous membranes -Anti-HEMI-DESmosome pemphiGUS - nikolsy sign -Anti-desmoGLEIN (anti-desmosome) ***GUS GUIL(ein)-FOY *** LOL

Answer 51

Lipomas = >5cm = USS ?sarcoma MACROprolactinomas >1cm = TS surg B/L adrenal hyperplasia = Spiro @Hyperldosternosim centre, spider naevi • liver disease • pregnancy • cocp skin rash under her new wrist watch. An allergy to nickel is suspected. - PATCH test = HSR 4 builder presents with sore and itchy skin on his hands and wrists. He has noticed it gets better when he is not in work and wonders if it is something he is coming into contact with at work causing the irritation -Skin Patch - Type 4 hypersensitivity (Delayed Th1 Cell-mediated) This history suggests a delayed reaction to an irritant at work (Allergic contact dermatitis) so is likely to require a longer period of exposure to elicit a reaction, so needs patch testing female who has JUST started work as a cleaner presents with a rash on her hands. On examination there is a generalised erythematous rash on the dorsum of both hands. There is no evidence of scaling or vesicles. What is the most likely diagnosis? - Irritant contact dermatitis 1. Cataract - halos in cataract + ACAG ffs Actinic keratoses may develop on ANY sun-exposed area -Bowen's isolated and well demarcated.

Answer 52

alopecia areata = screen for other Ai dx TAPD: thyroid addisons pernicious dm ``` Blunt ocular trauma + hyphema (blood @ant chamber) --> high-risk of raised IOP #intraocular pressure-Glaucoma ``` erythema nodosum Mx -No active treatment, arrange routine follow-up Anterior uveitis TOP steroid + TOP cycloplegic (mydriatic) drops ARMD Ix = Fluorescein angiography Inpatient treatment for erythroderma must be monitored for complications like dehydration, infection and high-output CCF P.Ganrenosum = PPU Dx Unrelated = -RAIM: RA AML IBD MyeloProflif 2. Dry Eye WMD ALI If pt use > 6 drops/day --> consider PRESERVATIVE-free drops -cos preservatives = FURTHER damage cornea/conjunctiva-epith @mod-severe, PRESERVATIVE TOXICITYpotential = is higher due to MORE frequent dosing and REDUCED tear secretion. -@severe: PUNCTAL plugs @tear ducts --> increase tear film 8-year-old girl noticed a small growth on the sole of her foot for the last 3 months that has become painful. O/E small, firm, hyperkeratotic growth + tiny overlying black dots. -Salicylic acid Wallace 9 rule - Whole UPPER limbs FRONT+BACK = 9 - Chest/abdo/lower limb FRONT = 9 Pyoderma gangrenosum = -RA AML IBD MyeloProflif

Answer 53

Hyphaema = Red ``` -Blunt ocular trauma + Hyphema --> high-risk of raised IOP #intraocular pressure-Glaucoma ``` Hypopyon = pus _______ Ramus MAXILLARY fracture ______ Comminuted MAXillary fracture ---Blowout ______ Depressed zygomatic fracture - --CHEEK - --BINOCULAR vision