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Medicine Year 4 > Random finals revision > Flashcards

Random finals revision Flashcards

1
Q

What is alcohol-induced lymph node pain a sign of?

A

Hodgkin’s lymphoma

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2
Q

How many days in advance of surgery should warfarin be stopped?

A

5 days before

check INR day before procedure to ensure <1.5

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3
Q

What nerve roots are damaged in Erb’s palsy and what is the resultant deformity?

A

C5 & 6

Internal rotation of humerus

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4
Q

What medications can predispose to tendon rupture?

A

Quinolone antibiotics e.g. ciprofloxacin

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5
Q

What is a Pavlik harness used for?

A

Development dysplasia of the hip (DDH)

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6
Q

What are the muscles of the rotator cuff?

A 
SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
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7
Q

What is the principal clinical sign of adhesive capsulitis?

A

AKA frozen shoulder

Loss of external rotation

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8
Q

Osteogenesis imperfecta is a defect of ..?

A

Type 1 collagen

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9
Q

What is the inheritance pattern of osteogenesis imperfecta?

A

Autosomal dominant

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10
Q

Duchenne muscular dystrophy is a defect of which gene?

A

Dystrophin gene (involved in calcium transport)

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11
Q

How is diagnosis of Duchenne muscular dystrophy confirmed?

A

Raised serum creatinine phosphokinase / abnormalities of muscle biopsy

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12
Q

What is the emergency management of a tension pneumothorax?

A

Needle decompression with a large bore needle in the 2nd intercostal space, mid-clavicular line (–> chest drain)

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13
Q

What is the minimal acceptable urine output?

A

0.5ml / kg / hour

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14
Q

Initial antibiotic management of open fractures?

A

IV flucloxacillin, gentamicin and metronidazole

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15
Q

First line management of achilles tendon rupture?

A

Equinus cast (a plaster of Paris cast where foot is held in plantar flexion)

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16
Q

What is the gold standard test to confirm diagnosis of coeliac disease.

A

Upper GI endoscopy for small bowel biopsy. Must be done whilst on gluten-containing diet.

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17
Q

Gold standard investigation for acute RUQ / RIF pain?

A

Ultrasound

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18
Q

Gold standard investigation in pregnant woman with ?appendicitis

A

MRI

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19
Q

What are the two causes of peptic ulcer disease?

A

H. pylori infection (duodenal > gastric) and NSAID use (gastric > duodenal)

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20
Q

What diagnosis is suggested by the combination of peptic ulcer disease and diarrhoea?

A

Zollinger-Ellison syndrome (gastrin-producing neuroendocrine tumour). Can be associated with MEN-type 1

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21
Q

What is the gold standard investigation for diagnosing peptic ulcer disease?

A

Endoscopy with biopsy samples collected for rapid urease testing or histology

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22
Q

What is the recommended pathway for any patient > 55 years presenting with weight loss and dyspepsia

A

Urgent upper GI endoscopy within 2 weeks

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23
Q

Where can duodenal ulcers penetrate to?

A

Posteriorly into the pancreas

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24
Q

What investigation should be done if a patient’s H. pylori status is uncertain after endoscopy?

A

Carbon-13 urea breath test or stool antigen test

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25
Q

First line investigation for suspected Zollinger-Ellison syndrome?

A

Fasting serum gastrin

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26
Q

What is the H.pylori eradication therapy?

A

PPI + amoxicillin + metronidazole for 7 days

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27
Q

What are the 3 tumour types seen in MEN-type 1?

A

3 P’s

  • Pituitary adenoma
  • Parathyroid hyperplasia
  • Pancreatic tumours
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28
Q

Pheochromocytoma is a typical feature of what syndrome?

A

Multiple endocrine neoplasia type 2 (A+B)

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29
Q

What is the main side effect of TNFalpha inhibitors?

A

May reactivate latent TB

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30
Q

When are TNF alpha inhibitors indicated in rheumatoid arthritis? e.g. etanercept, infliximab

A

Inadequate response to at least 2 DMARDs (including methotrexate)

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31
Q

What are the adverse effects of methotrexate use?

A

Myelosuppression and liver cirrhosis

Monitor FBCs and LFTs

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32
Q

First line treatment for acute anal fissure?

A

Bulk forming laxative

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33
Q

First line treatment for chronic anal fissure?

A

Topical GTN

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34
Q

What is the recommended management for an inguinal hernia in an infant under 1 years old?

A

Refer for urgent surgery (due to risk of strangulation)

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35
Q

What is the recommended management for an inguinal hernia in a child over 1 years old?

A

Refer for routine surgery

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36
Q

Gold standard investigation for ?renal stones

A

Non-contrast CT-KUB

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37
Q

Management of renal stones <5mm?

A

Expectant management, should pass within 4 weeks

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38
Q

Management of renal stones <2cm?

A

Shockwave lithotripsy

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39
Q

Management of renal stones <2cm in pregnant woman?

A

Ureteroscopy (as lithotripsy is contraindicated)

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40
Q

What disease is associated with anti-scl-70 antibodies?

A

Diffuse cutaneous systemic sclerosis

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41
Q

What disease is associated with anti-centromere antibodies?

A

Limited cutaneous systemic sclerosis

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42
Q

Classic presentation of ascending cholangitis?

A

Fever, jaundice and RUQ pain (Charcot’s triad)

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43
Q

What is the most common cause of ascending cholangitis?

A

E.coli infection

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44
Q

What is the management of ascending cholangitis

A

IV antibiotics (piperacillin / tazobactam) with ERCP after 24-48 hours to relieve any obstruction

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45
Q

What drugs are used to prevent pathological fracture in bone metastases?

A

Biphosphonates and desunomab

Latter is preferred if eGFR <30

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46
Q

What is the first line management for ‘provoked’ PE?

A

3 months of DOAC e.g. apixiban / rivaroxaban

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47
Q

What is the first line management for ‘unprovoked’ PE?

A

6 months of DOAC e.g. apixiban / rivaroxaban

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48
Q

What is the mechanism of action of thiazide-like diuretics e.g. bendroflumothiazide, indapamide

A

Block the thiazide-sensitive NaCl symporter, inhibiting sodium reabsorption in the DISTAL CONVOLUTED TUBULE

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49
Q

When should patient with aortic stenosis receive valvular replacement?

A

If symptomatic OR aortic valve gradient > 40 mmHg

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50
Q

Common adverse effects of thiazide diuretics?

A

Dehydration, postural hypotension, gout. electrolyte abnormalities (hyponatraemia, hypokalaemia, hypercalcaemia), sexual dysfunction, worsen glucose tolerance

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51
Q

What condition can cause widespread ST elevation?

A

Pericarditis

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52
Q

What diagnosis is suggested by sudden onset chest pain with focal neurological deficit?

A

Aortic dissection

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53
Q

Gold standard investigation for suspected acute pericarditis?

A

Transthoracic echocardiography

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54
Q

Key feature of pericarditis chest pain?

A

Relieved by sitting forward

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55
Q

First line management for pericarditis?

A

Colchicine +/- NSAIDs

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56
Q

Most common cause of pericarditis?

A

Viral infection (coxsackie virus)

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57
Q

What is the most common cause of secondary hypertension?

A

Primary hyperaldosteronism (Subtype = Conn’s syndrome)

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58
Q

First line management for stable angina?

A

All patient given aspirin + statin
GTN spray for acute attacks
Either beta blocker or calcium channel blocker. If not tolerated, try the other one. If still symptomatic, try combination.

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59
Q

What are the main presenting features of hypercalcaemia?

A

Stones - kidney or biliary stones
Bones - bony pain
Groans - abdominal pain
Thrones - constipation / frequent urination
Tones - muscle weakness / hyporeflexia
Psychiatric moans - confusion, depression, anxiety

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60
Q

What inheritance pattern is seen in hypertrophic obstructive cardiomyopathy (HOCM)?

A

Autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins

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61
Q

Management of hypertrophic obstructive cardiomyopathy?

A 
ABCDE
Amiodarone
Beta blocker or verapamil for symptoms
Cardioverter defibrillator (ICD)
Dual chamber pacemaker
Endocarditis prophylaxis
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62
Q

What is coarctation of the aorta?

A

congenital narrowing of the descending aorta

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63
Q

First line investigation for stable angina?

A

CT coronary angiogram (with contrast) to assess blood flow through the coronary arteries and to look for any narrowing or blockages in the arteries.

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64
Q

What type of heart disease can chronic alcoholism cause?

A

Dilated cardiomyopathy

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65
Q

What is the mechanism of action of loop diuretics e.g. furosemide, bumetanide?

A

Block the Na-K-Cl cotransport (NKCC) in the THICK ASCENDING LIMB OF THE LOOP OF HENLE resulting in reduced absorption of NaCl

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66
Q

What electrolyte dysfunctions are caused by thiazide / thiazide like diuretics?

A

Hypokalaemia, hyponatraemia, hypercalcaemia, hypomagnesaemia

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67
Q

What electrolyte dysfunctions are caused by loop diuretics?

A

4 HYPOS. lOOp

Hypokalaemia, hyponatraemia, hypocalcaemia, hypomagnesaemia

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68
Q

What foods should be avoided in patients taking warfarin?

A

Broccoli, spinach, kale and sprouts (rich in vitamin K)

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69
Q

First line management of torsades de pointes?

A

IV magnesium sulphate

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70
Q

Secondary management of MI?

A

He had an MI, now he DABS

DABS
Dual anti platelet therapy (aspirin + prasugrel/ticagrelor/clopidogrel*)
ACE inhibitor
Beta blocker
Statin

*Stop 2nd anti platelet after 12 months

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71
Q

What are the 3 drugs used for rate control in AF?

A

BDD

Beta blockers (1st line)
Dilitiazem (1st line)
Digoxin (2nd line)

Monotherapy then dual therapy

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72
Q

When should a rhythm control method be used in AF rather than a rate control?

A

Co-existent heart failure, first onset AF or obvious reversible cause (e.g. pneumonia)

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73
Q

What drugs are used in rhythm control in AF?

A

Flecainide
Amiodarone
Adenosine ?

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74
Q

Which area of myocardial infarct can result in arrhythmias?

A

Inferior MI (leads II, III, aVF) supplies the right coronary artery which provides blood supply to the AV node. Therefore an inferior MI can result in arrhythmias

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75
Q

What should be suspected when a patient experiences a sudden deterioration of renal function following commencement of ACE inhibitor therapy?

A

Bilateral renal artery stenosis

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76
Q

What causes acute heart failure with a systolic murmur post-MI?

A

Ventricular septal defect (rupture of the interventricular septum)
OR
Acute mitral regurgitation secondary to ischaemia/rupture of papillary muscle

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77
Q

Acute management of supraventricular tachycardias?

A

1st line - vagal manoeuvres e.g. carotid sinus massage

2nd line - IV adenosine (6mg -> 12 mg)

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78
Q

What is seen on histology in coeliac disease?

A

Histology will show presence of intra-epithelial lymphocytes, villous atrophy, and crypt hyperplasia.

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79
Q

Most common symptom of Crohn’s in children?

A

Abdominal pain

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80
Q

Most common symptom of Crohn’s in adults?

A

Diarrhoea (bloody diarrhoea suggest colitis, either Crohn’s or ulcerative)

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81
Q

What medications should all patients with peripheral arterial disease be started on?

A

Atorvastatin and clopidogrel

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82
Q

What is the management for an asymptomatic AAA of 4.3cm?

A 
Annual ultrasound (3-4.4cm)
\+ statin and aspirin therapy
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83
Q

Management of superficial thrombophlebitis?

A

Referral for ultrasound scan
Oral NSAIDs and compression stockings
Consider prophylactic LMWH

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84
Q

What is the screening programme for abdominal aortic aneurysms?

A

A single abdominal ultrasound for men age 65

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85
Q

What is the most common site of venous ulcers?

A

Medial malleolus

Gaiter region

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86
Q

Which type of leg ulcer is associated with a brown pigmentation?

A

Venous ulcer

Brown pigmentation = hemosiderin deposition

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87
Q

What type of ulcer is small, deep and has a well-defined border?

A

Arterial ulcer

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88
Q

What does an ABPI of 0.6 suggest?

A

Moderate

> 0.9 normal
0.8-0.9 mild
0.5-0.8 moderate
< 0.5 severe

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89
Q

What are the two main causes of neuropathic ulcers?

A

Diabetes mellitus and vitamin B12 deficiency

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90
Q

What is the most common cause of vitamin b12 deficiency?

A

Pernicious anaemia - an autoimmune disorder affecting the gastric mucosa

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91
Q

What is the pathophysiology of pernicious anaemia?

A

Autoimmune disorder

Autoantibodies to intrinsic factor +/- gastric parietal cells

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92
Q

What is the function of vitamin B12?

A

Used in the production of blood cells and the myelination of nerves (therefore deficiency causes megaloblastic anaemia and neuropathy)

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93
Q

Where is the most common site for a neuropathic ulcer?

A

Plantar surface of metatarsal head

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94
Q

What initial investigation is indicated in suspected chronic limb ischaemia?

A

Doppler ultrasound (followed by CT angiography)

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95
Q

What medications should be started following a diagnosis of intermittent claudication?

A

Atorvastatin 80mg

Clopidogrel 75mg

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96
Q

What is the definition of critical limb ischaemia?

A

Ischaemic rest pain > 2 weeks requiring opiate analgesia OR presence of ischaemic lesions/gangrene OR ABPI <0.5

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97
Q

What are the 6 P’s of acute limb ischaemia?

A 
Pain
Pallor
Pulselessness
Paraesthesia
Perishingly cold
Paralysis
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98
Q

What are the two causes of acute limb ischaemia?

A

Embolism (80%) - proximal source

Thrombus (20%) - atherosclerosis

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99
Q

How to differentiate clinically between embolic and thrombotic cause of acute limb ischaemia?

A

Embolic aetiology - sudden onset, no history of claudication, obvious source of embolus (AF, recent MI), normal contralateral limb with intact pulses

Thrombotic aetiology - pre-existing claudication with sudden deterioration, no obvious source of emboli, reduced/absent pulses in contralateral limb, evidence of widespread vascular disease (MI, stroke, TIA)

Embolic typically more severe as no time for compensation!

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100
Q

What medication should all patients presenting with acute limb ischaemia be given?

A

Heparin (bolus dose followed by infusion)

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101
Q

Which stage of acute limb ischaemia is described (Rutherford classification)

Sensory loss of foot with rest pain, mild muscle weakness, inaudible arterial doppler and audible venous doppler

A

Stage IIb

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102
Q

Which stage of acute limb ischaemia is described (Rutherford classification)

No sensory loss or muscle weakness, audible arterial doppler and audible venous doppler

A

Stage I

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103
Q

Which stage of acute limb ischaemia is described (Rutherford classification)

Sensory loss of toes, no muscle weakness, inaudible arterial doppler, audible venous doppler

A

Stage IIa

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104
Q

Which stage of acute limb ischaemia is described (Rutherford classification)

Profound sensory loss, paralysis of limb, inaudible arterial doppler, unaudible venous doppler

A

Stage III

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105
Q

What are the 4 features used in the Rutherford classification of acute limb ischaemia?

A

Sensory loss, muscle weakness, arterial doppler signal and venous doppler signal

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106
Q

What are the surgical options for AAA repair?

A

Open repair or endovascular repair

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107
Q

What is the classic triad of symptoms seen in AAA rupture?

A

Back/flank pain, pulsatile abdominal mass and hypotension

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108
Q

What are the indications for repair of an AAA?

A

> 5.5 cm
Expanding at > 1cm/year
Symptomatic in otherwise fit patient

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109
Q

Which type of stroke is suggested by isolated hemisensory loss?

A

Lacunar infarct (LACS)

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110
Q

What investigations should be done in a ‘young’ person with a stroke?

A

Autoimmune and thrombophilia screen

This can include tests such as antinuclear antibodies (ANA), antiphospholipid antibodies (APL), Anticardiolipin antibodies (ACL), Lupus anticoagulant (LA), coagulation factors, erythrocyte sedimentation rate (ESR), homocysteine and syphilis serology.

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111
Q

What medications are given for secondary prevention of stroke?

A

Clopidogrel (first line anti platelet)

2nd line = aspirin +MR dipyridamole

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112
Q

What are the time thresholds for ischaemic stroke management?

A

4.5 hours for thrombolysis (alteplase)
6 hours for mechanical thrombectomy (can be extended to 24 hours if evidence of salvageable tissue on CT perfusion / diffusion weighted MRI)

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113
Q

What is the blood supply of Wernicke’s and Korsakoff’s areas of the cortex?

A

Middle cerebral artery on dominant side (L>R)

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114
Q

What is the recommended anti platelet regimen following a stroke?

A

Aspirin 300mg for 14 days, then clopidogrel 75mg long term

2nd line = aspirin + dipyridamole dual therapy long term

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115
Q

What is the first line investigation for suspected primary hyperaldosteronism?

A

Plasma aldosterone/renin ratio (showing high aldosterone levels and low renin levels)

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116
Q

Side effects of SGLT2 inhibitors e.g. dapagliflozin?

A

Increased glucose secretion in urine results urinary and genital infection (contraindicated in recurrent thrush)

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117
Q

What are the 2 types of pleural effusion?

A

Transudate (<30g/L protein) and exudate (>30g/L protein)

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118
Q

Most common cause of pleural effusion with <30g/L protein?

A

<30g/L = transudate

Most common cause of transudate pleural effusion is heart failure

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119
Q

Most common cause of pleural effusion with >30g/L protein?

A

> 30g/L = exudate

Most common cause of exudate pleural effusion is infection, specifically pneumonia

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120
Q

What are the classic examination findings of a pleural effusion?

A

Dullness to percussion, reduced breath sounds and reduced chest expansion

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121
Q

What electrolyte abnormality is associated with SSRIs?

A

Hyponatraemia

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122
Q

First line treatment for immune thrombocytopenia purpura (ITP)?

A

Prednisolone

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123
Q

What is the management for a patient presenting with pheochromocytoma?

A

A then B
Alpha blockers e.g. phenoxybenzamine followed by
Beta blockers e.g. propanolol

Surgery is the definitive management

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124
Q

What oral antibiotic is used for a mycoplasma pneumonia?

A

Macrolides e.g. erythromycin

erythroMYCin for MYCoplasma

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125
Q

What does an increased serum urea (>10 times upper limit of normal) but a normal creatinine suggest?

A

An upper GI bleed

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126
Q

Can ureteric or gallbladder stones be seen on plain X-ray?

A

ureteric - >90%

gallbladder - <10%

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127
Q

What are steroid hormones derived from?

A

cholesterol

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128
Q

What is the most common congenital heart defect?

A

ventricular septal defect

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129
Q

x

A

x

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130
Q

When is VSD usually diagnosed?

A

6-8 weeks

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131
Q

When is PDA usually diagnosed?

A

3-5 days

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132
Q

x

A

x

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133
Q

6 year old boy with intermittent groin pain for last few months, has now developed painless limp

A

Legg-Calves-Perthes disease (AKA idiopathic avascular necrosis of proximal femoral epiphysis)

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134
Q

First line investigation for suspected Perthes disease?

A

X-ray

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135
Q

Management of Perthes disease?

A

Usually conservative management (NSAIDs, PT, brace) but may require surgery (osteotomy) if >50% femoral head damaged

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136
Q

14 year old overweight boy presents with hip pain and limp

A

Slipped upper femoral epiphysis (SUFE)

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137
Q

First line investigation for suspected SUFE?

A

X-ray

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138
Q

Management of SUFE?

A

Surgery

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139
Q

9 year old boy presents with painful hip and a limp over. last few days, he has recently been off school with a cold

A

Transient synovitis

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140
Q

First line investigation for suspected transient synovitis?

A

FBC/inflammatory markers: will be raised

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141
Q

First line investigations for suspected subarachnoid haemorrhage?

A

CT head, if negative perform lumbar puncture to look for xanthochromia (at least 12 hours after onset).

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142
Q

Most common cause of non-traumatic SAH?

A

Intracranial aneurysm

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143
Q

First line management of SAH?

A

Give NIMODIPINE as soon as diagnosis is confirmed to prevent delayed cerebral ischaemia and improve outcomes

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144
Q

what is the investigation of choice for any concerning headache?

A

MRI with contrast.

CT without contrast done to rule out intracranial haemorrhage OR if MRI contraindicated

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145
Q

What are the spinal nerve roots responsible for the knee reflex?

A

L3 and L4

4 and 3 for the knee

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146
Q

What are the spinal nerve roots responsible for the achilles reflex?

A

S1 and S2

1 and 2 feet

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147
Q

What is the dermatomal distribution of L5

A

down the back of the leg and dorsum of foot including big toe

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148
Q

What is the dermatomal distribution of S1

A

down the back of the leg and lateral aspect of foot

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149
Q

What is the dermatomal distribution of C6

A

along lateral aspect of arm to the thumb and index finger (six shooter)

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150
Q

What is the most common compressive radiculopathy?

A

L5 nerve root compressed by L4 disc

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151
Q

What nerve roots are responsible for micturition reflex?

A

S2,3,4 (keeps the pee off the floor)

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152
Q

What can cause a ‘cape-like’ distribution of sensory loss over the neck and shoulders?

A

Syringomyelia of cervical region

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153
Q

Upper motor neurone pathology of the upper extremities causes spasticity in the FLEXORS OR EXTENSORS?

A

FLEXORS

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154
Q

Upper motor neurone pathology of the lower extremities causes spasticity in the FLEXORS OR EXTENSORS?

A

EXTENSORS

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155
Q

Is atrophy a UMN or LMN sign?

A

Lower motor neurone

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156
Q

Is decreased tone a UMN or LMN sign?

A

Lower motor neurone

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157
Q

Is increased tone a UMN or LMN sign?

A

Upper motor neurone

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158
Q

Are fasciculations present in UMN or LMN pathology?

A

Lower motor neurone

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159
Q

Are increased muscle stretch reflexes a UMN or LMN sign?

A

UMN

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160
Q

What are characteristics of an essential tremor?

A

Symmetrical high frequency tremor involving arms, legs, face, voice, neck and tongue. Action tremor (worsened by intentional movement) / postural tremor (worsened with sustained muscle tone).

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161
Q

What are characteristics of a Parkinson’s tremor?

A

Asymmetrical low frequency tremor present at rest. Involving hands, legs, chin.

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162
Q

What may be seen on autopsy of a patient with Parkinson’s disease?

A

Lewy bodies (eosinophilic sphere-shaped inclusions in the cytoplasm) along with degeneration of the dopaminergic neurons of the substantial nigra.

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163
Q

What are the classic triad of symptoms seen in Parkinson’s disease?

A

Resting tremor, bradykinesia and cogwheel rigidity

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164
Q

What two medications can contribute to hypothyroidism?

A

Amiodarone and lithium

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165
Q

What three drugs should be given in a thyrotoxic storm?

A

Hydrocortisone, propranolol and propylthiouracil

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166
Q

What drugs should be given in a myxoedemic coma?

A

thyroxine and hydrocortisone

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167
Q

What is the syndrome that causes rapid enlargement of an ACTH-producting pituitary adenoma secondary to bilateral adrenalectomy for Cushing’s disease?

A

Nelson’s syndrome - causes hyperpigmentation and local effects (bitemporal hemianopia, nerve palsies)

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168
Q

What are the three parts of triple assessment of a breast lump?

A

Clinical assessment (history and examination), imaging (ultrasounds and mammography) and histology (fine needle or core)

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169
Q

What is recommended referral for unexplained breast lump in a woman under 30?

A

Routine referral

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170
Q

What is recommended referral for unexplained breast lump in a woman over 30?

A

Urgent 2 week suspected cancer referral

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171
Q

What is recommended referral for unexplained lump in axilla in a woman over 30?

A

Urgent 2 week suspected cancer referral

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172
Q

What is recommended referral for unilateral nipple changes in a woman over 50?

A

Urgent 2 week suspected cancer referral

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173
Q

What is recommended referral for skin changes suggestive of breast cancer in woman under 30?

A

Urgent 2 week suspected cancer referral (for any age)

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174
Q

What should be done when a man presents with unexplained gynaecomastia?

A

Testicular examination - around 2% of patients with gynaecomastia will have testicular cancer

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175
Q

How do intraductal papillomas of the breast present?

A

Most commonly present with watery or blood stained nipple discharge

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176
Q

Initial management of an intraductal papilloma?

A

Triple assessment (history+exam, imaging and histology). Intraductal papillomas require complete surgical excision.

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177
Q

Most common cause of infective lactational mastitis?

A

Staphylococcus aureus

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178
Q

Management of lactational mastitis?

A

IF obstructive - conservative management with continued breastfeeding, breast massage, heat packs and painkillers

If conservative management fails or infection suspected - first line antibiotic management = flucloxacillin. 2nd line = erythromycin. Fluconazole given if fungal infection suspected. Milk sample can be sent for C+S

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179
Q

Advice for patient with mastitis who is breastfeeding?

A

Advised to continue breastfeeding - flow of milk will help to clear the infection and the milk is safe for the baby. alternative is to express milk.

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180
Q

Breastfeeding patient presents with infective mastitis and is given 7 day course of flucloxacillin. She then returns with a cracked sore nipple. What do you do?

A

Recurrent mastitis post-antibiotic therapy is likely fungal.
Also associated with oral candidiasis and nappy rash in the infant. Both mother and baby need treated.

  • Topical miconazole 2% applied to each nipple after each breastfeed.
  • Oral miconazole gel or nystatin for the baby
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181
Q

Management of non-lactational mastitis?

A

Requires BROAD SPECTRUM antibiotics
1st line - co-amoxiclav
2nd line - erythromycin + metronidazole

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182
Q

Management of a breast abscess?

A

Referral to the on-call surgical team

plus antibiotics, ultrasound scan, drainage/aspiration and c+s of aspirated fluid

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183
Q

What is the current UK breast cancer screening program?

A

Mammogram every 3 years for woman ages 50-70

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184
Q

What patients are seen as ‘high risk’ and advised to have yearly mammogram?

A
  1. A first-degree relative with breast cancer under 40 years
  2. A first-degree male relative with breast cancer
  3. A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
  4. Two first-degree relatives with breast cancer
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185
Q

What medications can be given to prevent breast cancer in women who are considered high risk AKA chemoprevention?

A

Tamoxifen (premenopausal)

Anastrozole (postmenopausal)

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186
Q

What imaging modality should be used to assess a breast lump?

A

Under 30 - ultrasound

Over 30 - mammogram

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187
Q

What are the three receptor types seen in breast cancer?

A

oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor (HER2)

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188
Q

What breast cancer type do the NICE guidelines suggest doing gene expression profiling on?

A

ER positive

PR and HER2 negative

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189
Q

Where does breast cancer commonly metastasise to?

A

2Ls and 2Bs

Lung, liver, bone and brain

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190
Q

What is the inheritance pattern of BRCA1 and BRCA2 mutations?

A

Autosomal dominant - children and siblings have 50% risk of having gene mutation

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191
Q

First line investigation in suspected bacterial meningitis?

A

Lumbar puncture

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192
Q

3 common types of bacterial meningitis?

A

Pneumococcal (strep. pneumoniae) gram +VE
Meningococcal (Neisseria meningitidis) gram -VE
Hib (haemophilus influenza type B) gram -VE

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193
Q

What is the disadvantage of using PPIs long term?

A

Increased risk of osteoporosis and fractures

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194
Q

What is the most common cause of ambiguous genitalia in the newborn?

A

Congenital adrenal hyperplasia (95% due to 21-hydroxylase deficiency)

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195
Q

What is the best location for total parenteral nutrition insertion?

A

TPN should be administered via a central vein (not peripheral as it is strongly phlebitic)

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196
Q

Most common complication of bacterial meningitis?

A

Hearing loss - 1 in 3 survivors will develop hearing loss

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197
Q

What causes a subdural haemorrhage?

A

Rupture of the bridging veins in the outermost meningeal layer (bleed between dura and arachnoid mater)

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198
Q

What does a subdural haemorrhage look like on CT?

A

Crescent shaped and not limited by cranial sutures

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199
Q

What type of patient gets a subdural haemorrhage?

A

usually elderly / alcoholic patients (atrophy in brain makes vessels more likely to rupture)

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200
Q

What causes an extradural haemorrhage?

A

Usually caused by rupture of the middle meningeal artery in the tempero-parietal region (bleed between the skull and dura mater)

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201
Q

What fracture is associated with an extradural haemorrhage?

A

Temporal bone fracture

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202
Q

What does an extradural haemorrhage look like on CT?

A

Bi-convex shaped and limited by cranial sutures

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203
Q

What type of patient gets an extradural haemorrhage?

A

Usually young patient with history of head trauma - classically hx of ongoing headache, improving neurological signs/conscious level then a rapid decline as bleed gets big enough to compress intracranial contents

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204
Q

What are the two main causes of subarachnoid haemorrhage?

A

Trauma and ruptured cerebral aneurysm

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205
Q

First line management of SAH?

A

Nimodipine

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206
Q

What is seen on investigations for MS?

A

MRI - lesions

LP - oligoclonal bands in CSF

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207
Q

Which type of tremor improves with alcohol?

A

Essential tremor

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208
Q

First and second line management of tonic-clonic seizures?

A

1st line - sodium valproate

2nd line - carbamazepine or lamotrigine

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209
Q

First and second line management of focal seizures?

A

1st line - carbamazepine or lamotrigine

2nd line - sodium valproate

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210
Q

Where do focal seizures start

A

Temporal lobes

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211
Q

First line management of absence seizures?

A

Ethosuximide or sodium valproate

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212
Q

Mechanism of action of sodium valproate?

A

Increases activity of GABA which has a relaxing effect o the brain

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213
Q

Side effects of sodium valproate

A

Very teratogenic - avoid in females

Liver damage/hepatitis, hair loss, tremor

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214
Q

Definition of status epilepticus

A

seizures lasting > 5 minutes or > 3 seizures in 1 hour

215
Q

1st line management of status epilepticus in the hospital

A

IV lorazepam (repeat once after 10 minutes if doesn’t work) then try IV phenobarbital /phenytoin

If other benzodiazepines have been given in community, remember to give max of 2 doses of benzodiazepines before then trying phenobarbital / phenytoin

216
Q

1st line management of status epilepticus in the community

A

Buccal midazolam / rectal diazepam

217
Q

1st line management of trigeminal neuralgia?

A

Carbamazepine

218
Q

What are the functions of the facial nerve (CN VII)?

A

Motor - muscles of facial expression, stapedius of inner ear, neck muscles
Sensory - taste from anterior 2/3rd of tongue
Parasympathetic - submandibular and sublingual salivary glands, lacrimal gland

219
Q

How do you differentiate between an upper or lower motor neurone facial nerve palsy?

A

UMN facial nerve palsy - unilateral weakness NOT INCLUDING FOREHEAD

LMN facial nerve palsy - unilateral weakness INCLUDING FOREHEAD

220
Q

What are the causes of an UMN facial nerve palsy

A

Stroke or tumour

221
Q

What are the causes of a LMN facial nerve palsy

A

Bell’s palsy, Ramsay-Hunt syndrome

222
Q

How long does a Bell’s palsy last for

A

Majority of patients will resolve within weeks to months

1/3rd will have residual weakness

223
Q

Management of a Bell’s palsy

A

Prednisolone if presenting within 72 hours
Lubricating eye drops / tape for sleeping. Refer to ophthalmology if eye becomes painful (exposure keratopathy)

Refer to ENT if no improvement after 3 weeks of steroids

224
Q

Management of a sore eye associated with bell’s palsy

A

Refer to ophthalmology - exposure keratopathy

225
Q

Presentation of Ramsay-hunt syndrome?

A

Unilateral LMN facial nerve palsy and a painful vesicular rash in ear canal/pinna/around ear on affected side. Rash may involve anterior 2/3rds of tongue and hard palate

226
Q

Management of Ramsay-hunt syndrome

A

Prednisolone and aciclovir (ideally within 72 hours)

227
Q

What are some features of a headache that are concerning and prompt further investigation?

A

Constant, nocturnal, worse on waking, worse when bending forward / coughing / sneezing, associated vomiting

228
Q

Whereabouts in the brain do acoustic neuromas occur?

A

AKA vestibular schwannomas

Occur around the cerebellopontine angle

229
Q

What does bilateral acoustic neuromas suggest?

A

Neurofibromatosis type 2

230
Q

When would you refer someone with Bell’s palsy to ENT?

A

If no improvement after 3 weeks of steroids.

231
Q

What is the definitive management of an extradural haematoma?

A

Craniotomy and hematoma evacuation

232
Q

Why does an extradural haemorrhae cause a fixed dilated pupil?

A

compression of the parasympathetic fibres of CN III

233
Q

What should be prescribed for a Parkinson’s patient who is declared nil-by-mouth?

A

Dopamine agonist patch (to prevent acute dystonia, co-careldopa can only be given orally)

234
Q

Which Parkinson’s medications are most likely to cause impulse control disorders?

A

Dopamine agonist therapy e.g. bromocriptine, cabergoline

But can happen with any dopamine increasing drug

235
Q

Pathophysiology of myasthenia gravis?

A

Autoantibodies against acetylcholine receptors

236
Q

Presentation of myasthenia gravis?

A

Muscle fatiguability, extra ocular muscle weakness (diplopia), proximal muscle weakness, ptosis, dysphagia

237
Q

What tumour type is associated with myasthenia gravis?

A

15% will develop a thymoma

50-70% will have thymic hyperplasia

238
Q

Diagnostic investigation of myasthenia gravis?

A

Single fibre electromyography (sensitive test)

239
Q

First line management of myasthenia gravis?

A

Long-acting acetylcholinesterase inhibitors e.g. pyridostigmine
Immunosuppression e.g. prednisolone
CT scan to look for thymoma, thymectomy if found

240
Q

Migraine prophylaxis?

A

Topiramate OR propranolol

241
Q

Migraine acute attack?

A

triptan + NSAIDs or paracetamol

242
Q

When is prophylaxis indicated for migraine?

A

2 or more attacks per month causing disability

243
Q

What is the typical EEG finding of absence seizures?

A

Bilateral, symmetrical 3Hz oscillations during a seizure episode

244
Q

How to differentiate between a true seizure and a pseudo seizure?

A

raised serum prolactin level

245
Q

characteristic feature of cluster headaches?

A

unilateral extremely painful headache, occurring several times a day for weeks (“cluster”) followed by an episode free period for 1-2 years

246
Q

first line management for acute cluster headache?

A

SC triptan and oxygen

247
Q

first line management for cluster headache prophylaxis

A

verapamil

248
Q

what type of aphasia is Broca’s aphasia?

A

expressive aphasia - broken speech

249
Q

what type of aphasia is Wernicke’s aphasia?

A

receptive aphasia - fluent speech but can’t understand (what?)

250
Q

which area of a stroke causes Broca’s aphasia

A

superior division of left MCA

251
Q

which area of a stroke causes Wernicke’s aphasia

A

inferior division of left MCA

252
Q

features of a third nerve palsy

A

eye ‘down and out’, ptosis and dilated pupil

253
Q

how can you differentiate between a CN III palsy and Horner’s syndrome?

A

CN III palsy= ptosis + dilated pupil

Horner’s = ptosis + constricted pupil

254
Q

Antiemetic of choice in Parkinson’s

A

domperidone (doesn’t cross bbb)

255
Q

muscle weakness following an infection suggests…

A

Guillan-barre syndrome

256
Q

Which infection is most associated with triggering Guillain barre syndrome?

A

campylobacter jejuni (gastroenteritis)

257
Q

what electrolyte abnormality is associated with SAH?

A

hyponatraemia secondary to SIADH

258
Q

what is the inheritance pattern

of Huntington’s disease

A

autosomal dominant

259
Q

what type of disease is huntington’s disease

A

genetic (AD) trinucleotide repeat disorder

260
Q

what gene is affected in Huntington’s disease and what is the resultant mutation?

A

HTT gene on chromosome 4 resulting in repeat expansion of CAG

261
Q

Managaement of Lambert-eaton syndrome?

A

CXR of SLCL

Amifampridine to increase ACh

262
Q

What is the usual age of onset of Huntington’s disease

A

age 30-50 but becomes more severe and earlier in age throughout generations

263
Q

what is the life expectance of a patient with huntingtons disease

A

usually 10-15 years after first symptoms. cause of death is usually infection. (e.g. pneumonia)

264
Q

what is Charcot-Marie-Tooth disease?

A

a hereditary disease affecting peripheral motor and sensory nerves

265
Q

what is the inheritance pattern of Charcot Marie tooth disease?

A

autosomal dominant

266
Q

what is the usual age of onset of Charcot-Marie-Tooth disease?

A

Usually < 10 years old

267
Q

most common type of pituitary adenoma

A

prolactinoma

268
Q

symptoms of prolactinoma in men

A

impotence, loss of libido, galactorrhea

269
Q

symptoms of prolactinoma in women

A

amenorrhoea, infertility, galactorrhea, osteoporosis

270
Q

management of symptomatic prolactinoma

A

dopamine agonists e.g. bromocriptine, cabergoline

271
Q

diagnostic investigation for suspected prolactinoma

A

MRI

272
Q

what should be done to a patients insulin regimen when in DKA

A

stop short acting insuline

start on a fixed rate insulin infusion and continue long acting insulin

273
Q

how to differentiate between nephrogenic and cranial diabetes insipidus?

A

water deprivation / desmopressin test

nephrogenic DI: low urine osmolality after fluid deprivation, low urine osmolality after desmopressin

cranial DI: low urine osmolality after fluid deprivation, high urine osmolality after desmopressin

274
Q

Examples of X-linked recessive conditions?

A

Duchenne muscular dystrophy, haemophilia A

275
Q

What are the chances of a child inheriting an X-linked condition if the father is unaffected and the mother is a carrier?

A

Son - 50% affected, 50% unaffected

Daughter - 50% carrier, 50% unaffected

276
Q

Examples of autosomal recessive conditions?

A

Cystic fibrosis, sickle cell anaemia

277
Q

What are the chances of a child inheriting an autosomal recessive condition if the parents are both carriers?

A

25% affected, 50% carriers, 25% unaffected

Gender is not a factor

278
Q

Examples of autosomal dominant conditions?

A

Huntingtons, Marfans, neurofibromatosis

279
Q

What are the chances of a child inheriting an autosomal dominant condition if one parent is affected?

A

50% affected, 50% unaffected
Gender is not a factor
There is no carrier status

280
Q

What should pregnant women avoid to reduce risk of toxoplasmosis

A

Cat litter, unpasteurised milk, soil, raw meat

281
Q

Why should pregnant women avoid pate and soft cheese?

A

Risk of listeria

282
Q

Why should pregnant women avoid shark, tuna, swordfish etc.?

A

High levels of mercury - teratogenic

283
Q

Why should pregnant women avoid eating liver?

A

High in vitamin A - teratogenic

284
Q

What features are associated with fetal alcohol syndrome?

A

microcephaly, IUGR/ short stature, ADHD, learning disability, kidney defects, heart defects, limb anomalies, facial deformity (smooth fulcrum, low set ears)

> 5 units/day is a risk of FAS

285
Q

What is the maximum amount of units which is safe to drink in pregnancy

A

No number of units are considered safe in pregnancy

286
Q

What is the maximum amount of caffeine recommended in pregnancy

A

less than 200 ug / day

roughly 1-2 cups of tea/coffee/coke

287
Q

What blood tests do ALL pregnant women get at booking?

A

Hb, blood type and antibodies, sickle cell and thalassaemia, HIV, syphilis and Hep B

288
Q

What blood tests do ALL pregnant women get at 28 weeks?

A

Repeat Hb and antibodies

Glucose only if high risk

289
Q

Which women are considered ‘high risk’ for GD and get their glucose level checked?

A

BMI > 30
Ethnicity which is high risk for diabetes
FHx of diabetes
PMHx of gestational diabetes and/or previous macrosomic baby

290
Q

What tests are done for the 1st trimester screening of downs syndrome? what results indicate a higher risk?

A

Offered at 11-14 weeks

USS - Nuchal translucency
Bloods - bHCG and PAPP-A

NT - high
bHCG - high
PAPP-A low

291
Q

What tests are done for the 2nd trimester screening of downs syndrome? what results indicate a higher risk?

A

Offered at 14-20 weeks

Bloods - AFP, oestradiol, inhibin, bHCG

AFP - low
oestradiol - low
bHCG - high
inhibin - high

292
Q

When is a pregnant woman offered CVS/amniocentesis for trisomy diagnosis?

A

when the risk is greater than 1/150

293
Q

When is CVS used rather than amniocentesis?

A

CVS (chorionic villus sampling) is used earlier in pregnancy (under 15 weeks). Amniocentesis is used later in pregnancy when there is enough amniotic fluid to safely take a sample.

294
Q

What antihypertensives are safe to use in pregnancy?

A

Labetalol, nifedipine, methyl-dopa, doxazosin

295
Q

What anti-epileptics are safe to use in pregnancy?

A

Lamotrigine, carbamazepine, levetiracetam

296
Q

Is methotrexate safe to use in pregnancy?

A

NO!
Teratogenic, can cause miscarriage and congenital abnormalities. Both mother and father must stop for 6 months prior to conception!

297
Q

What drugs are safe to use for RA in pregnancy?

A

Hydroxychloroquine (usually first line)

Sulfasalazine is also safe to use. Corticosteroids can be used for flare ups.

298
Q

Are NSAIDs safe for use in pregnancy?

A

Should generally be avoided - especially in third trimester as they can cause premature closure of the ductus arteriosus and delay labour

299
Q

How do babies present that are in withdrawal due to maternal opiate use?

A

Present at 3-72 hours with irritability, tachypnoea, high temperatures and poor feeding

300
Q

How would you manage a pregnant woman exposed to chickenpox who is unsure if she has had it before?

A

Check IgG levels for VSV.
If positive, she is immune and safe.
If negative - treat with IV varicella immunoglobulins within 10 days of exposure.

If presenting with rash within 24 hours and > 20 weeks gestation - treat with oral aciclovir

301
Q

When is a pregnant women given anti-D Injection?

A

(If rhesus negative)
Routinely at 28 weeks and again at birth if the baby is rhesus positive
Any sensitising event (within 72 hours)

302
Q

What can be considered a ‘sensitising event’ in regards to rhesus status?

A 
Miscarriage > 12 weeks
Abdominal trauma
Amniocentesis
ECV
Any antepartum haemorrhage
303
Q

What blood test can be done to check how much fetal blood has entered the maternal circulation in a sensitising event? When is it done?

A

Kleihauer test. Any sensitising event after 20 weeks

Add acid to blood sample, maternal blood will be destroyed and fetal blood will remain

304
Q

Are dichorionic diamniotic (DCDA) twins identical or fraternal twins?

A

They can be either!
1/3rd of identical twins are DCDA
All fraternal twins are DCDA

305
Q

Are monochorionic diamniotic (MCDA) twins identical or fraternal twins?

A

Identical twins - around 2/3rds of identical twins are MCDA

306
Q

Are monochorionic mono amniotic (MCMA) twins identical or fraternal twins?

A

Identical twins - only 4% of identical twin pregancies

307
Q

What type of pregnancy is suggested by the ‘lambda’ sign on ultrasound?

A

Dichorionic twin pregnancy (separate placentas)

308
Q

What type of pregnancy is suggested by the ‘T’ sign on ultrasound?

A

Monochorionic twin pregnancy (shared placenta)

309
Q

When should monoamniotic twins (MCMA) be delivered?

A

Planned C-section at 32-34 weeks

310
Q

What do nitrites on a urine dipstick suggest?

A

Nitrites are produced by gram negative bacteria e.g. E.coli. The bacteria break down nitrates (a normal byproduct in urine) to nitrites.

311
Q

What is the most common cause of urinary tract infection?

A

E.coli

312
Q

How do you manage UTI in pregnancy ?

A

7 days of antibiotics

Nitrofurantoin (should be avoided in 3rd trimester), amoxicillin or cefalexin

313
Q

When are pregnant women screened for anaemia

A

At booking and at 28 weeks

314
Q

What can cause a microcytic anaemia in pregnancy

A

iron deficiency

315
Q

what can cause a normocytic anaemia in pregnancy

A

physiological anaemia associated with increase in plasma volume

316
Q

what can cause a macrocytic anaemia in pregnancy

A

b12 or folate deficiency

317
Q

How would you manage iron deficiency anaemia in pregnancy

A

Iron replacement - ferrous sulphate 200mg three times daily

318
Q

How would you manage b12 deficiency anaemia in pregnancy

A

Test for pernicious anaemia (intrinsic factor antibodies)
B12 replacement; either
IM hydroxocobalamin injection
Oral cyanocobalamin tablets

319
Q

What is used for VTE prophylaxis in pregnant women

A

LMWH e.g. dalteparin, enoxaparin, tinzaparin

320
Q

when is VTE prophylaxis started in pregnancy

A

if 3 risk factors - 28 weeks

if 4 or more risk factors - booking

321
Q

what are the cut offs for gestational diabetes

A

fasting glucose > 5.6
2 hour glucose > 7.8

5-6-7-8

322
Q

what is the management of gestational diabetes

A

if fasting glucose < 7 - trial of diet and exercise for 1-2 weeks then metformin then insulin

fasting glucose > 7 - insulin +/- metformin

fasting glucose > 6 with macrosomia - insulin +/- metformin

323
Q

what is an alternative to insulin/metformin in gestational diabetes

A

Glibenclamide - a sulfonylurea

324
Q

how is pre-existing type 2 diabetes managed in pregnancy

A

Managed with metformin and insulin. All other oral diabetic medications should be stopped.

Retinopathy screening at booking and 28 weeks.

Planned delivery at 37-39 weeks.

325
Q

what does itching of the palms and soles of the feet in late pregnancy suggest?

A

Obstetric cholestasis

Other symptoms include fatigue, dark urine, pale greasy stools, jaundice.

there is no rash!! if there is a rash, think of an alternative diagnosis

326
Q

How would you investigate itching in late pregnancy?

A

LFTs (deranged) and bile acids (raised)

327
Q

What LFT raises physiologically in pregnancy?

A

ALP - produced by the placenta

328
Q

Management of obstetric cholestasis?

A

Ursodeoxycholic acid

329
Q

What causes skin blistering around the umbilicus which spreads to other parts of the body in pregnancy?

A

pemphigoid gestationis

330
Q

What are the three causes of antepartum haemorrhage

A

Placenta praevia, vasa praevia and placental abruption

331
Q

What is first line for induction of labour?

A

membrane sweep then vaginal prostaglandins

332
Q

At what gestation would you consider external cephalic version in a breech fetus?

A

36 weeks in nulliparous, 37 weeks in multiparous

Successful in 60%

333
Q

How to differentiate clinically between placenta praevia and placental abruption

A

placenta praevia - painless vaginal bleeding

placental abruption - painful vaginal bleeding

334
Q

How does placental abruption prseent

A

Vaginal bleeding (may only be small amounts due to bleed concealed behind placenta)
Constant pain
Tender, tense uterus “woody”
Maternal shock

335
Q

Management of placental abruption

A

If CTG / maternal vital signs normal ->
<36 weeks - admit and give IV corticosteroids for lung development.
> 36 weeks - delivery vaginally

If fetal distress/maternal shock - emergency C section

336
Q

1st line investigation for suspected preterm prelabour rupture of membranes

A

sterile speculum examination to look for pooling of amniotic fluid in the posterior vaginal vault

337
Q

Management of preterm prelabour rupture of membranes (PPROM)?

A

admission, regular obs to look for chorioamnionitis, oral erythromycin for 10 days, corticosteroids

consider delivery if >34 weeks

338
Q

1st line management of nausea and vomiting in pregnancy

A

promethazine (antihistamine)

339
Q

what is active management of the third stage of labour

A

10 IU oxytocin given IM to reduce risk of PPH
Given after delivery of anterior shoulder

Delayed cord clamping (between 1 and 5 minutes)
Controlled cord traction

340
Q

Investigations for reduced fetal movements > 28 weeks?

A

handheld doppler
If no fetal heartbeat heard - immediate ultrasound
If fetal heartbeat heard - 20 minutes of CTG

341
Q

how does epiglottitis present?

A

tripod posturing, mouth open, drooling, stridor, muffled voice

MEDICAL EMERGENCY - do not examine throat

342
Q

what causes acute epiglottitis

A

Haemophilus influenza B

343
Q

what is the management of acute epiglottitis?

A

immediate senior involvement (paeds, ENT, anaesthetics)
oxygen
IV ceftriaxone and dexamethasone

344
Q

what is the recommended management for vasa praevia when it is identified early?

A

corticosteroids from 32 weeks to mature fetal lungs

elective c-section from 34-36 weeks

345
Q

what is tocolysis?

A

drugs used to suppress or delay contractions/labour

346
Q

describe the process of external cephalic version

A

Mothers are given tocolysis with IV terbutaline (a beta agonist) which reduces the contractility of the uterus, making it easier for the baby to turn.

A kleihauer test is used to determine the dose of anti-D required after ECV

347
Q

what are the three symptoms that pregnant women should report if they occur?

A

reduced fetal movements, abdominal pain, vaginal bleeding

348
Q

what are the three major causes of cardiac arrest in pregnancy?

A

Obstetric haemorrhage
Pulmonary embolism
Sepsis (leading to metabolic acidosis and septic shock)

349
Q

what position should pregnant women be placed in to maximise cardiac output

A

left lateral position

moves uterus away from IVC and reduces compression

350
Q

what is the most common cause of bronchiolitis

A

RSV - respiratory synctial virus

351
Q

what age group gets bronchiolitis

A

Infants under 1, especially under 6 months

352
Q

what causes whooping cough

A

Bortadella pertussis - gram negative bacteria

353
Q

how does whooping cough present?

A

initially with mild coryzal symptoms, then after a week coughing fits usually start - classically with a loud inspiratory ‘whoop’

354
Q

first line investigation for whooping cough?

A

nasopharyngeal / nasal swab for PCR or culture if within 2-3 weeks

if after 2 weeks, patient can be tested for anti-pertussis toxin immunoglobulin G in oral fluid (children) or blood (adults)

355
Q

management of whooping cough

A

notifiable disease - inform public health
azithromycin
prophylactic antibiotics for close contacts if vulnerable (pregnant women, unvaccinated children, healthcare worker)

can last 8 weeks or longer
AKA ‘100 day cough’

356
Q

how does laryngomalacia present

A

occurs in infants, peaking at 6 months

presents with inspiratory stridor which is intermittent and worse when upset / feeding / lying on back

357
Q

management of laryngomalacia

A

supportive management - infants will usually grow out of it

358
Q

presentation of croup

A

usually age 6m - 5y

barking cough, increased work of breathing, hoarse voice, stridor

359
Q

causes of croup

A 
parainfluenza virus (main cause)
 RSV, influenza, adenovirus
360
Q

management of croup

A 
oral dexamethasone (single dose)
add nebuliser adrenaline if severe
361
Q

most common cause of bronchiolitis

A

RSV

362
Q

most common cause of croup

A

parainfluenza

363
Q

cause of epiglottitis

A

haemophilus influenza B

364
Q

cause of scarlet fever

A

group a strep toxins (e.g. strep pyogenes)

365
Q

cause of whooping cough

A

bordetella pertussis

366
Q

cause of slapped cheek syndrome

A

Parvovirus B19

367
Q

abdominal pain in 5 year old child with recent viral infection?

A

mesenteric adenitis

368
Q

what causes a continuous ‘machinery’ murmur in babies?

A

PDA

369
Q

how to treat PDA in babies?

A

indomethacin or ibuprofen to close PDA - inhibits prostaglandin synthesis

prostanaglandin E can be used to keep the PDA open until surgery (if associated with another heart defect)

370
Q

when can children return to school after having impetigo?

A

when all lesions are crusted over OR 48 hours after starting treatment

371
Q

how to differentiate between gastroschisis and exomphalos (omphalocele) and what are their management plans?

A

gastroschisis - paraumbilical abdominal wall defect where abdominal contents are outside of body WITHOUT peritoneal covering. vaginal surgery can be attempted. immediate surgery within 4 hours of birth.

exomphalos - anterior abdominal wall defect of umbilicus with abdominal contents outside of body COVERED with amniotic sac of peritoneum. C-section indicated due to risk of sac rupture. can have gradual staged repair over 6-12 months.

372
Q

what is the peak incidence of acute lymphoblastic leukaemia

A

age 2-5 years
slightly more boys than girls
most common childhood malignancy

373
Q

first line medical management of ADHD in children?

A

1st line - methylphenidate

2nd line - dexamfetamine

374
Q

projectile non-bilious vomiting in 6 week old infant

A

pyloric stenosis
Ix test feed or USS
Tx pyloromyotomy (surgery)

375
Q

bilious vomit, bouts of crying and pulling legs up in 7 day old infant

A

malrotation with volvulus
Ix upper GI contrast / USS
Tx laparotomy “ladds procedure”

376
Q

colicky pain, sausage shaped mass, red jelly stool in 6 month old infant

A

intussusception
Ix USS
Tx reduce with air inflation or surgery

377
Q

failure to pass meconium and abdominal distension could be?

A

Hirschprung’s disease
Ix AXR, rectal biopsy diagnostic
Tx initially rectal washout, definitively anal pull through

OR

Meconium ileus (high link to CF)
Ix AXR, PR contrast studies - may be therapeutic
Tx PR contrast studies, NG nacetylcysteine or surgery

378
Q

what is one of the only indications for the use of aspirin in children

A

kawasaki disease

379
Q

what are the three points of referral for developmental delay

A

if not smiling by 10 weeks
if not sitting unsupported by 12 months
if not walking by 18 months

380
Q

what is the first sign of puberty in males

A

testicular growth

381
Q

what is the first sign of puberty in females

A

breast development

382
Q

what is the most important test to do on a baby with jaundice lasting > 14 days

A

conjugated / unconjugated bilirubin

a raised conjugated bilirubin suggests biliary atresia which is a surgical emergency

383
Q

what heart defect presents with cyanotic heart disease in the first 1-2 days of life

A

Transposition of the great arteries (TGA)

cyanotic heart disease presenting at 1-2 months is tetralogy of Fallot

384
Q

what heart defect presents with cyanotic heart disease age 1-2 months

A

tetralogy of Fallot (TOF)

cyanotic heart disease presenting at 1-2 days of life is TGA

385
Q

should the combined oral contraceptive pile stopped before surgery?

A

yes stop 4 weeks before surgery

386
Q

what is the most common primary malignant bone tumour

A

osteosarcoma - malignant tumour producing bone

387
Q

what is the usual age group and location of osteosarcoma?

A

usually seen in children and adolescents

60% involving bones around knee

388
Q

what is the usual age group and location of chondrosarcoma?

A

usually middle age (~45)
common in pelvis / proximal femur
often large and slow growing (less aggressive than osteosarcoma)

389
Q

what is the most common type of hip dislocation and the resultant deformity?

A

posterior hip location (90%)

shortened, adducted, internally rotated

390
Q

what is reactive arthritis?

A

one of the hla b27 associated seronegative spondyloarthropathies
previously known as Reiter’s syndrome (triad of conjunctivitis, urethritis and arthritis following STI or diarrhoeal illness “can’t see can’t pee can’t climb a tree”)

391
Q

what disease is described by a ‘pencil in cup’ appearance on x-ray?

A

psoriatic arthritis

392
Q

what is the most common cause of septic arthritis?

A

overall - staph. aureus

sexually active young adults - Neisseria gonorrhoea

393
Q

first line investigation for suspected septic arthritis?

A

synovial fluid sampling

THEN blood culture - ideally prior to Abx

394
Q

management of septic arthritis

A

IV flucloxacillin

6-12 weeks of Abx

395
Q

what is the most common cardiac manifestation of SLE?

A

pericarditis

396
Q

what is the diagnostic investigation for multiple myeloma?

A

plasma / urine electrophoresis (Not fully true)

397
Q

what kind of deafness is caused by pagets disease

A

conductive deafness!!

398
Q

what antibodies may be seen in rheumatoid arthritis

A

rheumatoid factor and anti-CCP antibodies (latter is more specific and therefore the preferred test)

399
Q

what antibodies may be seen in SLE?

A

ANA (+ve in >90% - sensitive but not specific)
anti-dsDNA (specific, varies with disease activity)
Anti-SM (specific, low sensitivity)
c3/c4 levels (low when disease active)

400
Q

what investigations should be done in SLE?

A

antibodies
FBC (showing anaemia, leukopenia and thrombocytopenia)
urinalysis to look for signs of glomerulonephritis
CT chest to look for ILD
MRI to look for cerebral vasculitis
Echo to look for pericardial effusion / pericarditis

401
Q

management of SLE?

A

skin/arthralgia - hydroxychloroquine (DMARD), NSAIDs and topical steroids

inflammatory arthritis/organ involvement - immunosuppression e.g. azathioprine

severe organ disease - iv steroids and cyclophosphamide

402
Q

what antibodies are best used to monitor SLE?

A

anti-dsDNA and complement levels (C3/4)

403
Q

what antibodies are associated with systemic sclerosis?

A

ANA antibodies (not specific)

limited SS (CREST syndrome) - anti-centromere antibodies
diffuse SS - anti-scl-70 antibodoes
404
Q

what antibodies are associated with anti-phospholipid syndrome?

A

lupus anticoagulant, anti-cardiolipin antibodies anti-beta-2-glycoprotein antibodies

405
Q

management of anti-phospholipid syndrome

A

episode of thrombosis - long term warfarin
recurrent pregnancy loss - LMWH + aspirin during pregnancy

incidental antibody finding with no episode of thrombosis do not require anticoagulation

406
Q

first line investigation for suspected gout

A

sample of synovial fluid - shows needle shaped uric acid crystals which are negatively birefringent

(pseudo gout will show calcium pyrophosphate crystals which are POSITIVELY birefringent)

407
Q

management of gout

A

acute attack - NSAIDS, colchicine

prophylaxis - allopurinol

408
Q

what disease is commonly seen in association with polymyalgia rheumatica

A

giant cell arteritis

409
Q

investigation for suspected PMR

A

no diagnostic investigation
commonly raised CRP / ESR
respond dramatically to prednisolone

410
Q

presentation of giant cell arteritis

A

visual disturbance, headache, jaw claudication. scalp tenderness (often on combing hair)

411
Q

what disease is suggested by jaw claudication

A

giant cell arteritis - occurs as result of ischaemia of maxillary artery

412
Q

investigation of choice for suspected GCA

A

temporal artery biopsy (100% specificity but low sensitivity due to patchy involvement)

413
Q

management of GCA

A

prednisolone

414
Q

what antibodies are associated with sjogrens syndrome?

A

anti-Ro and anti-La antibodies

415
Q

what investigations should be done in suspected polymyositis / dermatomyositis?

A

inflammatory markers - raised
creatinine kinase - raised to 10x upper limit
antibodies - ANA, anti-Jo, anti-SRP

416
Q

clinical features of polymyositis and dermatomyositis

A

polymyositis - proximal muscle weakness (insidious onset)
dermatomyositis - as above with gottrons lesions (scaly plaques over knuckles, elbows), photosensitive erythematous rash over neck, shoulders, chest and a ‘heliotrope’ rash (purple rash over face)

417
Q

what is polymyositis and dermatomyositis associated with?

A

malignancy - paraneoplastic syndrome in 25%

418
Q

how to differentiate between sciatic nerve pain and lower back pain

A

sciatic nerve pain will go beyond knee

positive sciatic nerve stretch test

419
Q

first line management of suspected cauda equine syndrome

A

urgent MRI to detect level of prolapse followed by surgery (urgent discectomy)

420
Q

what causes carpal tunnel syndrome

A

median nerve compression in the carpal tunnel

421
Q

what causes cubital tunnel syndrome

A

ulnar nerve compression in the cubital tunnel

422
Q

what age should an infant be able to sit unassisted

A

6-8 months

423
Q

what age should a baby be able to hold its own head up without lag?

A

2-3 months

424
Q

what age should an infant be able to stand

A

9-12 months

425
Q

at what age should an infant develop a pincer grip?

A

12 months

426
Q

at what age should a child be saying double syllables “rehleh” “gada”

A

6 months

427
Q

at what age should an infant be able to say mama and dada

A

9 months

428
Q

what is the investigation of choice for DDH

A

under 6 months - USS

over 6 months - Xray

429
Q

what is the principal clinical sign of SUFE

A

loss of internal rotation of the hip

430
Q

what is an important potential complication of scaphoid fractures

A

avascular necrosis of the scaphoid due to retrograde blood supply via dorsal carpal branch (branch of radial artery)

431
Q

presentation of a meniscal tear

A

pain localised to the medial (most common) or lateral joint line. swelling occurs the following day, the pt then complains of pain and ‘locking’

432
Q

presentation of ACL tear

A

a ‘pop’ usually felt or heard, deep pain in joint, swelling from haemarthrosis occurs within the hour

433
Q

what examination technique can be used to identify meniscal tears?

A

Steinmanns test - rotation of the tibia

test is positive if lateral pain is elicited on medial rotation or medial pain on lateral rotation

434
Q

what is more common, medial meniscal tear or lateral meniscal tear

A

medial (10x more common)

435
Q

management of acute meniscal tears

A

supportive management. 90% unsuitable for surgery.

if persistent pain at 3 months, can consider arthroscopic partial menisectomy

436
Q

rotatory instability (giving way on turning) is the principal presenting clinical complaint of which knee injury?

A

ACL rupture

437
Q

prognosis after an ACL rupture?

A

1/3 compensate well and can manage ADLs and sports
1/3 manage by avoiding certain movements but can’t do high impact sports
1/3 will do poorly with frequent giving way with ADLs

438
Q

what patients are good candidates for ACL reconstruction surgery?

A

40% of pts

professional sportsmen and those who have frequent giving way with ADLs

439
Q

management of acute MCL tear?

A

hinged knee brace

440
Q

management of acute LCL tear

A

usually surgical

441
Q

what injury is associated with LCL tear?

A

common peroneal nerve injury

442
Q

what age group tends to get:
quadriceps tendon rupture
patellar tendon rupture

A

quadriceps - >40s

patellar - <40s

443
Q

what way does the patella usually dislocate

A

laterally

444
Q

what tendons should you AVOID steroid injection due to risk of rupture

A

Extensor mechanism of knee

Achilles

445
Q

what nerve injury is associated with Colles fracture?

A

median nerve compression (carpal tunnel syndrome)

446
Q

what is a Colles fracture

A

fracture of distal radius resulting in a dorsal displacement of the radius (dinner fork deformity)
more common than smiths

447
Q

what is a smiths fracture

A

fracture of distal radius resulting in a ventral displacement of the radius (garden spade deformity)
less common than Colles

448
Q

what nerve injury is associated with anterior shoulder dislocation?

A

axillary nerve palsy

449
Q

what nerve injury is associated with a humeral shaft fracture?

A

radial nerve palsy (in spiral groove)

450
Q

what nerve injury is associated with supracondylar fracture of the elbow?

A

anterior interosseus branch of median nerve

451
Q

what nerve injury is associated with posterior dislocation of the hip?

A

sciatic nerve injury

452
Q

how to differentiate between polymyalgia rheumatic and polymyositis?

A

creatinine kinase

CK will be very high in polymyositis but normal in PMR

453
Q

most common cays of peritonitis secondary to peritoneal dialysis?

A

staph. epidermidis

other causes: staph. aureus

454
Q

recommended pain relief for renal colic

A

diclofenac (usually IM)

455
Q

management of epididymo-orchitis of unknown cause?

A

single dose of ceftriaxone plus 10-14 days of dexamethasone

456
Q

what are the 4 main causes of liver cirrhosis?

A

AFLD, NAFLD, hep B and hep C

457
Q

what should patients with liver cirrhosis be screened for and how often?

A

hepatocellular carcinoma
MELD score, USS and afp every 6 months

also endoscopy every 3 years for varices

458
Q

what diet is recommended for patients with liver cirrhosis

A

high protein low sodium

459
Q

what drug is used for stable varices

A

propranolol

460
Q

management of bleeding varices

A 
vasopressin analogue (terlipressin) to cause vasoconstriction
vitamin k and FFP for coagulopathy
461
Q

1st line antibiotics for ascitic peritonitis

A

iv cefotaxime

462
Q

management of hepatic encephalopathy

A

clear the ammonia

laxatives - lactulose
antibiotics - rifaximin (poorly excreted so stays in GI tract)

463
Q

blood test results for haemophilia?

A

prolonged aptt

464
Q

what is deficient in x-linked recessive disorder haemophilia A?

A

factor VIII

465
Q

what is deficient in x-linked recessive disorder haemophilia B?

A

factor IX

466
Q

what drug is used for medical management of an unruptured ectopic pregnancy?

A

methotrexate

467
Q

investigation of choice for suspected pyloric stenosis?

A

ultrasound scan (+/- test feed)

468
Q

management of haemochromatosis?

A

weekly venesection

469
Q

management of Wilson’s disease

A

copper chelation with penicillamine or trientene

470
Q

first line investigation for suspected haemochromatosis?

A

serum ferritin (raised, not reliable), serum transferrin (raised, more reliable)

471
Q

first line investigation for suspected Wilson’s disease

A

serum caeuruloplasmin level

472
Q

what is the inheritance pattern of haemochromatosis and Wilsons disease

A

autosomal recessive

473
Q

management of acute uncomplicated diverticulitis in primary care?

A 
oral co-amoxiclav for 5 days
clear liquids (avoid solid foods) until symptoms improve, usually 2-3 days
analgesia (avoid NSAIDs or opioids)
474
Q

what are the three arteries that supply the abdominal organs

A

foregut - stomach, first part of duodenum, biliary system, liver, pancreas, spleen - COELIAC ARTERY

midgut - distal duodenum to first half of transverse colon - SUPERIOR MESENTERIC ARTERY

handgun - second half of transverse colon to rectum - INFERIOR MESENTERIC ARTERY

475
Q

presentation of chronic mesenteric ischaemia

A

‘abdominal angina’

central colicky abdominal pain, starts 30 minutes after eating and lasts 1-2 hours
weight loss due to food avoidance
abdominal bruit

476
Q

diagnostic investigation for chronic mesenteric ischaemia?

A

ct angiogram

477
Q

what are gallstones usually made of?

A

cholesterol

478
Q

medical management of BPH?

A

immediate symptomatic management - tamsulosin (alpha blocker)
reduce size of prostate - finasteride (5-alpha reductase inhibitor), may take up to 6 months to work

479
Q

common side effect of tamsulosin?

A

postural hypotension

480
Q

common side effects of finasteride?

A

sexual dysfunction due to reduced testosterone

481
Q

what part of the prostate usually enlarges in BPH

A

transitional zone

482
Q

what part of the prostate usually enlarges in prostate cancer?

A

peripheral zone

483
Q

what side do varicoceles usually occur?

A

left side (90%)

484
Q

what is the triad of symptoms seen in renal cell carcinoma?

A

Haematuria, flank pain, palpable mass

485
Q

what features are seen in haemolytic anaemia

A

normocytic anaemia, splenomegaly and jaundice

486
Q

what type of inheritance is seen in hereditary spherocytosis and hereditary eliptocytosis?

A

autosomal dominant

487
Q

management of hereditary spherocytosis / elliptocytosis

A

folate supplementation and splenectomy

488
Q

inheritance pattern of G6PD deficiency

A

x linked recessive

489
Q

common triggers of g6pd deficiency crisis

A

broad beans, infections, anti-malarials, some diabetic drugs

490
Q

key finding on blood film of g6pd deficicency

A

Heinz Bodies

491
Q

management of autoimmune haemolytic anaemia

A

blood transfusions, prednisolone, Rituximab (MAB against B cells) and splenectomy

492
Q

two types of autoimmune haemolytic anaemia

A

warm type - occurs at or above normal temp (most common, usually idiopathic)
cold type - occurs below normal temp (less common, associated with other conditions)

493
Q

inheritance pattern of thalassaemia and sickle cell disease

A

autosomal recessive

494
Q

what type of anaemia is seen in thalassaemia

A

microcytic anaemia

495
Q

what are some key features of thalassaemia

A 
signs and symptoms of anaemia
jaundice
gallstones
splenomegaly
pronounced forehead and cheekbones 
increased fracture risk
increased absorption of iron (iron overload presents similarly to haemochromatosis)
496
Q

how is thalassaemia diagnosed

A

FBC - microcytic anaemia
Hb electrophoresis - diagnoses the globin abnormality
DNA testing

497
Q

what type of haemoglobin is seen in sickle cell disease

A

HbS - crescent shaped

usually HbF is replaced by HbA at around 6 weeks of life

498
Q

what is sickle cell trait

A

when someone has only one copy of the sickle cell gene - usually asymptomatic

499
Q

when is sickle cell disease screened for

A

newborn screening heel prick test

pregnant women are checked for carrier status

500
Q

what are the age groups affected by the 4 main types of leukaemia?

A

ALL - <5yo and >45yo
CLL >55yo
CML >65yo
AML >75yo

ALL CeLL mates have CoMmon AMbitions

501
Q

when to refer a child/young adult with suspected leukaemia directly to hospital?

A

any child/young adult with petechiae or hepatosplenomegaly should be referred to hospital IMMEDIATELY

502
Q

initial investigation for suspected leukaemia in adults

A

urgent FBC within 48 hours

503
Q

what is seen on blood film in ALL?

A

blast cells

504
Q

what is seen on blood film in CLL?

A

smudge/smear cells

505
Q

what are the three stages of CML?

A

chronic phase (5 years)
accelerated phase
blast phase

506
Q

what is seen on blood film in AML?

A

blast cells with auer rods

507
Q

4 features of multiple myeloma

A

CRAB

calcium (raised)
renal failure
anaemia (normocytic normochromic)
bone lesions/pain

508
Q

prophylaxis for cluster headaches?

A

verapamil 1st line

other options: lithium, prednisolone

509
Q

management of acute cluster headache

A

oxygen and subcut triptan

510
Q

how to monitor standard heparin

A

aptt

511
Q

how to monitor LMWH

A

anti-factor Xa

512
Q

what subtypes of HPV are cancerous and would require referral for colposcopy

A

HPV 16, 18 and 33

513
Q

what subtypes of HPV are associated with genital warts?

A

HPV 6 and 11

514
Q

what 3 things are increased in the pathophysiology of DKA

A

increased lipolysis, glycogenolysis, gluconeogenesis

515
Q

what virus is associated with oropharyngeal cancer

A

HPV

516
Q

damage to what part of the brain causes dressing apraxia

A

parietal lobe

517
Q

degenerative osteoarthritis of the spine is called…

A

spondylosis

518
Q

stress fracture defect in the pars interarticularis of the vertebrae is called…

A

spondylolysis

519
Q

most common location of spondylolysis

A

L4/L5

520
Q

displacement of one vertebra over the vertebral body below it is called…

A

spondylolisthesis

521
Q

most common location of spondylolisthesis

A

L5/S1

522
Q

what ligament is commonly injured in inversion injuries of the ankle

A

anterior talofibular ligament

523
Q

what congenital anomalies are associated with a type 1 diabetic pregnancy

A

neural tube defects and cardiac abnormalities

524
Q

what protozoa is known to chronically infect HIV patients, presenting with diarrhoea

A

cryptosporidium parvum

525
Q

painful red eye worse at night..?

A

glaucoma

526
Q

first line investigation for suspected penetrating injury of the eye?

A

CT scan of orbits

527
Q

convergent squint with horizontal diplopia when looking to the left..?

A

left 6th nerve palsy

528
Q

top 2 differentials for a soft compressible groin lump with a cough impulse that disappears when lying flat

A

femoral hernia and saphena-varix

529
Q

what is the most common groin hernia

A

indirect inguinal hernia

530
Q

what groin hernia is much more common in men that women

A

direct inguinal hernia

531
Q

what groin hernia occurs in children

A

indirect inguinal hernia

532
Q

what groin hernia is more common in women than men

A

femoral hernia (differential: saphena-varix)

533
Q

most common urinary tract neoplasm associated with painless haematuria

A

transitional cell carcinoma of the urothelium

534
Q

how to diagnose bladder cancer

A

flexible cystoscopy

Medicine Year 4 (2 decks)

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