Quick drug treatments

Question 1

Hypothyroid

Answer 1

levothyroxine

ideally taken 30-60 minutes before breakfast/caffeine

1.6microgram/kg
25-50 microgram in elderly /cardiac

Question 2

Hyperthyroid

Answer 2

Carbimazole

15-40mg initially
decreased to 5-15mg maintenance

beware sore throat/infection
stop taking and seek medical attention (agranulocytosis)

Question 3

Skin lesion and renal transplant?

Answer 3

Squamous cell carcinoma

Question 4

Rolled edges, pearly appearance, central ulceration

Answer 4

BCC

Question 5

most important diagnostic factor in melanoma

Answer 5

breslow thickness

Question 6

features of Kawasaki disease?

Answer 6

Persistant high fever
strawberry tongue
cracked lips
maculopapularrash on hands and feet

Question 7

Management of Kawasaki disease?

Answer 7

High dose aspirin

Question 8

What hormone is raised in Cushings?

Answer 8

Cortisol

Question 9

Symptoms of bushings syndrome?

Answer 9

Central obesity
Moon face
Striae
Hypertension
hyperglycaemia
osteoporosis

Question 10

Causes of cushings?

Answer 10

Exogenous steroids
Pituitary adenoma (stimates ACTH) = Cushing disease

Question 11

Diagnosis of bushings?

Answer 11

dexamethasone suppression test

Question 12

Raised AST and ALT suggests

which is more sensitive?

Answer 12

Liver damage

ALT

Question 13

Is AST or ALT more raised in alcoholic liver?

Answer 13

AST

Question 14

Raised ALP & GGT suggests

Answer 14

cholestatic picture

Question 15

3 main causes of pancreatitis

Answer 15

gallstones
alcohol
post ERCP

Question 16

What does I GET SMASHED refer to?

Answer 16

Causes of pancreatitis

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion
Hyperlipidaemia
ERCP
Drugs (furosemide)

Question 17

Investigations for pancreatitis

Answer 17

Bloods:
FBC
U&E
LFT
Amylase
Calcium

ABG

USS to look for gallstones

Question 18

Management of acute pancreatitis?

Answer 18

Admit

IV fluids
Find gallstones/manage cause

Question 19

Features of chronic pancreatitis

Answer 19

Less severe than acute - epigastric pain, low grade fever

Loss of endocrine function of pancreas - diabetes

steatorrhoea

Question 20

Management of chronic pancreatitis

Answer 20

Abstinance from alcohol

analgesia

treat deficiencies - insulin & creon

ERCP & stunting if obstruction or strictures

Question 21

DD for generalised abdo pain?

Answer 21

BO
Peritonitis
Ruptured AAA
Ischaemic colitis

Question 22

DD for RUQ pain

Answer 22

Biliary colic
acute cholecystitis
acute chiolagitis

Question 23

Charcots triad consists of?

what condition is it associated with?

Answer 23

RUQ pain
Fever
Jaundice

Acute cholangitis

Question 24

Lower abdominal pain in woman

Answer 24

Rule out pregnancy or ectopic.

apendicitis

Question 25

Patients with no uterus needing hrt

Answer 25

Oestrogen only

Question 26

Uterus plus mirena IUS requiring HRT

Answer 26

Oestrogen only

Question 27

Patient with uterus wanting HRT (post menopausal)

Answer 27

continuous combined HRT

(combined pill/patch)

(cont estradiol patch/gel/oill and progestogen tablet/IUS

Question 28

Pt with uterus wanting HRT <1 year since LMP

Answer 28

Sequential HRT

2 weeks just oestrogen
2 weeks combined (allows withdrawal bleed)

Question 29

Contraindications to HRT

Answer 29

Breast cancer (current/past)

Previous idiopathic or current venous thromboembolism , unless the woman is already on anticoagulant treatment.

Active or recent angina or myocardial infarction.

Active liver disease with abnormal liver function tests.

Question 30

Important points to cover in miscarriage station

Answer 30

LMP - gestation
Bleeding - amount/clots/tissue

cramping

signs of infection - fever, pain, shoulder tip pain

past obstetric history

past gynae history - surgery/STI

social history

Question 31

Examinations to consider in ?misscariage

Answer 31

Abdominal - acute abdo

Speculum

bimanual (ectopic)

Question 32

Investigations in suspected miscarriage?

Answer 32

serial beta HCG

FBC, Cross match, group and save if significant bleeding

rhesus D status

TVUS

Question 33

Management of miscarriage

What must you do?

Answer 33

Expectant

Medical - misoprostol (preg test 3 weeks later)

Surgical

SAFETY NET - infection of retained products

Question 34

Risk of recurrence of miscarriage

Answer 34

After 1 there is no increased risk of recurrence

after 2 there is 25%increased risk

Question 35

Structure for gynae history

Answer 35

PC

HPC
SOCRATES
colour/quantity/smell of discharge

fever/abdo pain/shoulder tip pain/dyspareunia/urinary/bowel symptoms

To give a better idea of what’s going on I’d like to ask some more personal questions about your menstrual history:
Age of menarche
LMP - regularity
contraception
+/- barrier

Current pregnancy:
gestation? singleton or multiple?
previous pregnancies/miscarriages/ToP
symptoms?

ICE

I’d now like to ask about your sexual history:
partner
casual/long term
STD/smear history

PMH
DH
FH
SH

ICE

Question 36

Hypertension history red flags

Answer 36

Headaches
visual disturbance
N&V
chest pain

Haematuria
peripheral oedema

Question 37

Investigations for hypertension review

Answer 37

BP
Urinalysis
HbA1c
lipid profile

Question 38

CKD symptoms

Answer 38

General symptoms: such as fatigue, nausea and vomiting, cramps, insomnia, restless legs, taste disturbance, bone pain, and pruritus

Abnormal urine output: such as polyuria, oliguria, or nocturia

Fluid overload: may present as dyspnoea and orthopnoea
Sexual dysfunction

Severe uraemia may also cause hiccups, pericarditis, coma and seizures