Random Flashcards
What causes brwon sequard syndrome
Injury to back -> one side of spinal cord damaged -> hemisection
What is brown sequard syndrome
Unilateral spastic paresis
Loss proprioception/vibration sensation with loss pain and temp opp side
Carpal tunnel syndrome management
6 weeks wrist splint and steroid injections
Severe - wrist decompression surgery
Idiopathic intracranial HPTN symptoms
Diffuse headaches
Pulsatile tinnitus
Blurred vision
Bilateral papilloedema
When treat a person under 80 with stage 1 HPTN
Diabetic (ACEi)
Renal disease
QRISK2 >10%
Established coronary vascular disease or end organ damage
Mild falre of UC
Fewer than four stools daily with or wothout blood
No systemic disturbance
Normal ESR and CRP
Moderate flare of UC
4-6 stools a day w minimal systemic disturbance
Severe flare of UC
> 6 stools a day containing blood
Evidence of systemic disturbance eg
Fever
Tachycardia
Abdo tenderness, distension, reduced bowel sounds
Anaemia
Hypoalbuminaemia
Admit to hospital
NIV key indications
COPD w reps acidosis pH 7.35-7.35
T2 resp failure secondary to chest wall deformity, Neuromuscular disease or obstructive sleep apnoea
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation
What glaucomas are myopia vs hypermetropia ass with
Hypermetropia - acute angle closure glaucoma
Myopia 0 primary open angle glaucoma
Risk factors for primary open angle glaucoma
increasing age
affects < 1’5 in individuals under 55 years of age
but up to 10% over the age of 80 years
genetics
first degree relatives of an open-angle glaucoma patient have a 16% chance of developing the disease
Afro Caribbean ethnicity
myopia
hypertension
diabetes mellitus
corticosteroids
Fundoscopy signs POAG
- Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
- Optic disc pallor - indicating optic atrophy
- Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
- Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
Investigations for POAG
automated perimetry to assess visual field
slit lamp examination with pupil dilatation to assess optic nerve and fundus for a baseline
applanation tonometry to measure IOP
central corneal thickness measurement
gonioscopy to assess peripheral anterior chamber configuration and depth
Assess risk of future visual impairment, using risk factors such as IOP, central corneal thickness (CCT), family history, life expectancy
What are glaucomas
optic neuropathies ass w raised intraocular pressure
open - iris clear of trabecular meshwork
Closed - iris blocking meshwork
First line investigation sus cauda equina
Urgent MRI spine (within 6 hours)
What does concurrent leg pain, new neurological deficit and back pain suggestive of
Spinal nerve impingement in spine
What symptoms are suggestive of cauda equina
Urinary symptoms with saddle anaesthesia and abnormal rectal examination
Complications of cauda equina
New incontinence and paralysis of lower limbs, irreversible within hours
Causes of cauda equina
the most common cause is a central disc prolapse
this typically occurs at L4/5 or L5/S1
other causes include:
tumours: primary or metastatic
infection: abscess, discitis
trauma
haematoma
What does erythema migrans suggest
Bulls eye shaped rash concentric red rings - lyme disease
Features of erythema migrans
Bulls eye shaped rash concentric red rings
painless
1-4 weeks after initial bite
Complications of lyme disease
MSK, neuro, cardio
Arthritis, encephalitis, nerve palsies, arrhythmias
What to prescribe for cauda equina syndrome
Doxycycline if erythema migrans present and treatment initiated based on presence alone
Treatment if disseminated lyme disease
IV ceftriaxone
When have to test for antibodies before prescribing antibiotics in lyme disease
Symptoms suggestive (tick bite, fever, joint pain) but no erythema migrans
Post op delirium
Post operative ileus
Intestinal handling in srugery
Anticholinergics
Parkinsons
5 Ws of fever post surgery
Wind, water, walking, wound, wonder about drugs
Features of PCOS
Raised FSH to LH ratio
Normal or increased testosterone
Normal to low SHBG
1-2 dyas after surgery post op fever
Lungs, atelectasis, PE, aspiration
3-5 days post op fever
UTI, Catherter UTI
4-76 dyas post op fever
veins, DVT, immobility, PE
5-7 days post op
infections - superficial, deep, woiuinnd
Adverse drug reactions
Augemented - known side effect
B - bizarre 0 not predicted from known, immune mediated
C - chronic - long term
D - delayed - years after stop eg osteo
E - end of treatement eg withdrawal
Diagnosing PCOS
Oligo or anovulation
Fetaures or biochemical hyperandrogensim
Polycystic ovaries
Which hip condition is hyperactivity and shprt stature ass with
Perthes
What ROM have with a SUFE
Normal - limited internal rotation
Xray w SUFE
Ice cream falling off cone
Southwick angle for severity
Displaced and inferolaterally falling femoral head
Perthes disease
Flattened femoral head -> fragment if untreated
Rest and physio
Treat SUFE
Rest - avoid avascular necrosis
Mayneed to pin if severe
What symptoms is long term use of olanzapine most likely to have
Polyuria and dypsia - diabetes from atypical antipsychotic s
hat is priaprism
RProlonged erection of the penis
What do after a LETZ as follow up
Cervical smear in 6 months
hat should Hb levels be in pregnancy
first trimester Hb less than 110 g/l
second/third trimester Hb less than 105 g/l
postpartum Hb less than 100 g/l
Lithium side effects
Difficuty concentrating, headaches, low mood, constipation
Features ass with increased risk of miscarriage
Increased maternal age
Smoking in pregnancy
Consuming alcohol
Recreational drug use
High caffeine intake
Obesity
Infections and food poisoning
Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes
Medicines, such as ibuprofen, methotrexate and retinoids
Unusual shape or structure of womb
Cervical incompetence
How to treat antidopaminergic side effects
Procyclidine
Antidopaminergic side effects
Worsning pain and stiff arms
Tremor
Increased agitation, limited responsiveness
How to treat tardive dyskinesia
Tetrabenazune or valproate
How to treat NMS
Dantrolene
How to treat akathesia
Porpanolol or cyproheptadine
Monitoring for APs
Cholesterol
HbA1c
What do before commence Antipsychs
ECG
baseline bloods
What stage of labour arragnge C section for breech when discovered
Before fully dilated - C section
After - all fours
Double bubble on xray paeds
Duoenal atresia (presents similarly to intussusception)
How to diagnose premature ovarian insufficiency
two sets of FSH levels raised - second after 4-6 weeks
When should babies be able to sit up on own
7-8 month old
Refer to paeds after one year
Can u have aspirin in breastfeeding
NO
Tranpositinon of great arteries present
Cyanosis immediately after birth
loud S2 _ RV impulse
Egg on string X ray
What is alprostdil infusion
PGE2 inhibitor
Features of temporal seizure
focal seizsures - aware in episode, minutes post ictal
smakcing lips
aura - stomach upset
Medial is most common origin
Jacksonian march where originates
Frontal lobe
parietal lobe seizure
paraestehsia
1st line for vaginal candidiasis
Clotrimazole pessary
Oral fluconazole one dose
Treatment for a intussception - draw legs up to abdomen and mass, pallor, vomitting, crying
Reduction via air insufflation
US intussception
Target sign
What is ramsteads pylorotomy a treatment for
Pyloric stensosis
Which inctontinence is duloxetine for
Stress
How can acute lymphoblastic leukaemia present
Haemorrhagic/thrombotic complications due to DIC
What do when admit for bronchiolitis
Supportive management only
What do to manage
What CP can be caused by noenatal jaundice
Dyskinetic CP - kenicterus 0 basal ganglia eso effected by bilirubin
hat suspect in raised FSH and LH and primary amenorrhea
Gonadal dysgenesis/Turners syndrome
What is the most common complication of Roseola infantum
Febrile convulsions
hen repeat a smear if HPV + and cytology is normal
12 months
AntiCCP vs Rf
Anti-CCP much more specific for RA
Bpth present in around 70% of RA
Hydatiform mole on US
mole appears as a solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as ‘snow-storm’ appearanc
Hydatiform mole on US
mole appears as a solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as ‘snow-storm’ appearanc
Within 1 hour CT head injury
GCS<12 initial or <15 3hrs post
Open/depressed skull
Basal skull sign
Post traumatic seizure
What CCB is contraindicated in heart failyre
Verapamil
Graves disease most common ab
thyroid receptor antibodies
Treatment for mennieres
Prochlorperazine - 1st line to help in nausea in acute attacks
Betahistine to prevent attacks long term
BPPV diagnose and treat
Dix halpike test
Epley manouvre treat
Mennieres symptoms
Fullness/tinnitus in ear
Longer attacks
What is features of acuta ngle closure glaucoman
Acute painful red eye
Haloes in bright lights
More dilated
Hypermetropia risk factor
BCC presentation
Pearly rolled edge
Telangiectasia
Raised
SCC presentation
Flatter
Ulcers
white on it
What do if woman less than 6 weeks pregnant presents with bleeding
expectant managemnet
Infantile spasms
classically characterised by repeated flexion of head/arms/trunk followed by extension of arms
Investigations if reduced foetal movements with vs without HB
with - CTG for 20 mins
WIthout - US scan
Chromosome pattern of androgen insensitivity syndrome
46XY
Male genotype, female phenotype
What is considered reduced foetal movement
RCOG considers less than 10 movements within 2 hours (in pregnancies past 28 weeks gestation)
Investigations for reduced foetal movements
If past 28 weeks gestation:
Initially, handheld Doppler should be used to confirm fetal heartbeat.
If no fetal heartbeat detectable, immediate ultrasound should be offered.
If fetal heartbeat present, CTG should be used for at least 20 minutes to monitor fetal heart rate which can assist in excluding fetal compromise.
If concern remains, despite normal CTG, urgent (within 24 hours) ultrasound can be used. Ultrasound assessment should include abdominal circumference or estimated fetal weight (to exclude SGA), and amniotic fluid volume measurement
If between 24 and 28 weeks gestation, a handheld Doppler should be used to confirm presence of fetal heartbeat.
If below 24 weeks gestation, and fetal movements have previously been felt, a handheld Doppler should be used.
If fetal movements have not yet been felt by 24 weeks, onward referral should be made to a maternal fetal medicine unit
What is the only suitable UPSI after 5 days of ovulation
Offer to fit IUD
How many times do you repeat smear if HPV positive and normal cytology before colposcopy
3
Age ranges for smears
25 - every 3 years
50 - every 5 years
Stop over 64
Salmon pink rash and sore joints
JIA/Stills disease
HIV positive when offered HPV smear
Annually
reatment for whooping cough
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
Presentation of tetralogty of fallot
Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge
Target BP in pregnancy
135/85
blood pressure falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
after this time the blood pressure usually increases to pre-pregnancy levels by term
HPTN in pregnancy
systolic > 140 mmHg or diastolic > 90 mmHg
or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic
Most common cause of PPH
Uterine atony
When do urgent delivery after foetal blood smaple
Foetal acidosis
What do it late decelerations on ECG
Foetal blood sampling - pathological sign
Biggest risk factor for Bella’s palsy
Pregnancy
What diuretic causes hypercalcemia
Thiazide like
What diuretic causes hypercalcemia
Thiazide like
What two conditions cause 90% of hypercalcemia?
Primary hyperparathytoidism
Malignancy - PTHrP secreting tumour, bone mets, myeloma (increased osteoclast activity)
What’s the most appropriate medical
Management for PE with hypotension
Alteplase - thrombolysis
Alteplase MOA
Recombinant tissue plasminogen activator - activates plasminogen -> plasmin
More aggressive than anticoagulant, higher bleeding risk
PE no haemodynamic instability treatment
DOAC first line
LMWH if unavailable or unsuitable
Management of major bleed on warfarin
Stop warfarin
IV vitamin K 5mg
Prothrombin complex concentrate
Above regardless of INR immediately
Repeat dose vit K in 24 hours if INR still high
Management of INR >8 vs 5-8 and minor bleed warfarin
Stop warfarin
IV vit K 1-3mg
if INR>8 repeat in 24 hours if INR still too high
For both Restart warfarin when INR <5
When use oral vit K warfarin reversal
INR >8 but no bleeding
Otherwise same management as >8 and minor bleeding
When withold warfarin
When INR 5-8
Withold 1 or 2 doses and reduce subsequent maintenance dose
What condition could present as painful red bumps on legs, non productive cough and recent joint pains, bilateral hilar lymphadenopathy
Sarcoidosis
First line treatment for broad complex tachycardia dw no adverse effects
IV amiodarone
MOA of amiodarone
Improves cardiac polarisation and depolarisation by blocking potassium channels
Helps in broad complex tachy - heart struggling to pump
What tahcycardia is adenosine used in
SVTs w narrow complexes
MOA adenosine
Stimulates A1recptors on cardiac cells inducing adenosine sensitive potassium channels and cAMP production -> prolonged conduction through AV node -> AV blockade -> sinus rhythm
What is atropine used for
Bradycardias
What does atropine act on
The vagus nerve
Remove PNS input on heart
When can alpha anti trypsin 1 deficiency be diagnosed and where is it made
Prenatal
Liver
First line forCML
Imatinib
Neuropathic pain medical management
Amitruptilline, duloxetine, gabapentin or pregabalin first line
If doesn’t work swap to another
Tramadol as rescue medication
Topical capsaicin if localised
What would urinary incontinence, gait instability and new dementia suggest in an elderly patient?
Normal pressure hydrocephalus
Wet wobbly and wacky
What can contribute to normal pressure hydrocephalus and what does it look like on imaging
Meningitis
Subarachnoid haemorrhage
Head injury
Looks like hydrocephalus with ventriculomegy +/- ducal enlargement
Management of normal pressure hydrocephalus
Ventriculoperitone shunt
10% she complications eg seizures, infection, haemorrhage
Why don’t cardiovert AF if >48 hours and when can you
May have a clot build up and DC cardioversion could dislodge and cause a stroke
Can cardiovert for long term after been on anti coagulation for 3 weeks
What does acute management of AF depend on
How acute it is
<48 hours = rate off rhythm control
>48 hours or uncertain = rate control beta blocker, CCB, digoxin
Who should rate control not be first line in for AF?
Reversible cause
Heart failure from AF
New onset <48 hours
Atrial flutter who can have ablation
Rhythm control better from clinical judgement
Does catheter ablation reduce risk of stroke in AF?
No - still need to CHAVASC HASBLED to decide if need to anticoagulste
Anticoagulation in catheter ablation
4 weeks prior
CHADVASC HASBLED
0 = 2 months of anticoagulstion
>1 = life long anticoagulant
Complications of catheter ablation
Cardiac tamponade
Stroke
Pulmonary vein stenosis
NSTEMI low GRACE score management low vs high bleeding risk
Low = ticagrelor (+apsirin + fondaparinux)
High = clopidogrel (+ above)
What is atelactasis
Post op complication where basal alveolar collapse -> respiratory difficulty due to AWs blocked w bronchial secretions
Features and treatment of atelectasis
Hypoxaemia and Dyspnoea up to 72 hours post op
Treat w chest physiotherapy and breathing exercises to clear secretions
c-ANCA vs p-ANCA
c-ANCA PR3 - grnaulomatosis with polyangitis - proteinase
p-ANCA - microscopic polyangitis
Histology in rapidly progressive glomerulinephritis
Crescenteric glomerulonephritis
What difference is there in results between secondary and tertiary hyperparathyroidsim?
Low to normal phosphate in tertiary
High in secondary
Sinus vs fistula
Fistula = abnormal passage between two epithelial surfaces
Sinus = blind channel lined with granulation tissue
What GI condition causes severe epigastric pain relieved on leaning forwards
Pancreatitis
Drugs causing pancreatitis
Azathipprine
Mesalazine
Didanosine
Bendeoflumethiazide
Furosemide
Pentamidine
Steroids
Sodium valproate
Typical presentation of primary hyperthyroidism
Tired
Polyuria
High calcium normal PTH
Low mood
Causes of primary hyperparathyroidisl form most to least likely
Solitary parathyroid adenoma (85%)
Hyperplasia 10%
Multiple adenoma 4%
Carcinoma 1%
How to remember hyperparathyroidsim symptoms
Bones, stones, abdo moans and psychic groans
Features of hyperparathryodism
Polydypsia, polyuria
Depression
Anorexia, nausea, constipation
Peptic ulcer
Pancreatitis
Connect pain/fracture
Renal stones
HPTN
