Revision Flashcards
What are the three parts of a health economic evaluation
Structure process outcome
Health needs assessment
epidemiological, comparative corporate
healthcare economic efficacy
cost per natural unit gained
maxwell’s dimensions of quality
effectiveness, acceptability, efficiency, access, equity and relevance
remission in crohns
Azathioprine
Post viral gastro-enteritis complication
lactose intolerance
Cushing’s test
overnight low dose dexamethasone test
toddler, undigested food, normal centiles
Toddler’s diarrhoea
Rapid sequence induction muscle relaxant
Suxamethonium
primary post-partum haemorrhage most likely cause
atonic uterus
atonic uterus tx
syntometrine
Newborn hearing screening
otoacoustic emission
Skin cancer in immunosuppressed
Squamous cell carcinoma
known or suspected lung cancer next inv
contrast-enhanced CT scan of the chest, liver and adrenals.
Prophylaxis with abx for bites
A human bite that has drawn blood or broken the skin in a high-risk individual
A cat bite that has drawn blood or appears to be deep
A dog bite that has caused considerable tissue damage or is contaminated
Pulsus parodoxus sign of?
cardiac tamponade
Drug before beta blocker in pheochromocytoma
Phenoxybenzamine or other non-selective alpha blocker
Dermatitis herpetiformis
Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
Features
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
Diagnosis
skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
Management
gluten-free diet
dapsone
Length of VTE prophylaxis following VT
provoked (e.g. recent surgery): 3 months
unprovoked: 6 months
Duchenne muscular dystrophy diagnosis
Was muscle biopsy, now genetic testing
acute haemolytic reaction
fever, abdominal pain, tachycardia, tachypnoea and hypotension
Incontinence management
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training
urge incontinence management
Bladder retraining
Antimuscarinics such as oxybutynin
Mirabegron - beta 3 agonist if concerned about anticholinergic effects
stress incontinence
Pelvic floor muscle training
Surgery
Duloxetine
nipple candidiasis
miconazole cream for the mother and nystatin suspension for the baby
Statin monitoring
LFTs at baseline, 3 months and 12 months
Pityriasis versicolor
superficial cutaneous fungal infection
patches may be hypopigmented, pink or brown (hence versicolor)
ketoconazole shampoo
leptospirosis
rat urine. renal failure.
lower back pain, fever, myalgia, fatigue, jaundice and a subconjunctival haemorrhage
Carcinoid syndrome
flushing (often earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
Carcinoid syndrome management
urinary 5-HIAA
plasma chromogranin A y
somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help
Wilson’s disease test
Ceruloplasmin
Leriche syndrome
- Claudication of the buttocks and thighs
- Atrophy of the musculature of the legs
- Impotence (due to paralysis of the L1 nerve)
Beck’s triad
Pericarditis - hypotension, raised JVP, muffled ehart sounds
Dressler’s syndrome
Post MI pericarditis
Most common pericarditis
Coxsackievirus B
Peripheral Arterial Disease features
Pain Pallor Pulseless Paralysis Paraesthesia (abnormal sensation or “pins and needles”) Perishing cold
Compartment syndrome features
P – Pain “disproportionate” to the underlying injury, worsened by passive stretching of the muscles
P – Paresthesia
P – Pale
P – Pressure (high)
P – Paralysis (a late and worrying feature)
Compartment syndrome test
Needle manometry
Drug to avoid with lithium
NSAIDS
Diuretics
Define status epilepticus
A seizure lasting 30 mins or more (although treat as status even if over 5 mins)
Immediate bedside test for status epilepticus
BM
A and E management of status epilepticus
Lorazepam IV
Other anti-epileptics in status epilepticus
Phenytoin, Phenobarbitol or diazepam
Seizure in alcoholic what treatment to give
Thiamine, and glucose if you can
Causes of seizure
Alcoholic withdrawal Infection Cancer Brain haemorrhage Febrile convulsions Hyponatraemia Epilepsy
Addison’s treatment
Hydrocortisone, Glucose, Fluids - may need hyperkalaemia
CAP with erythema multiforme organism
Mycoplasma pneumoniae
Status epilepticus management in the community
Status Epilepticus Management:
Oh My Lord Phone the Anaesthetist O - O2 M - Buccal Midazolam or Rectal Diazepam L - IV Lorazepam P - IV Phenytoin A - Rapid induction of Anaesthesia
double duct sign indicates?
Pancreatic cancer
Wernicke’s encephalopathy
Confusion, ataxia, nystagmus + ophthalmoplegia
toxic multinodular goitre nuclear scintigraphy
patchy uptake
Graves disease scintigraphy
diffuse enlargement of both thyroid lobes, with uniform uptake throughout
most common cause of hyperthyroidism.
Graves disease
psoas sign
positive in appendicitis
Hyperacute transplant rejection mechanism
Hyperacute transplant rejection is caused by pre-existing antibodies against ABO or HLA antigens
life-threatening Clostridium difficile infection treatment
ORAL vancomycin and IV metronidazole
Polycythaemia blood sign
isolated rise in haemoglobin
Autonomic dysreflexia spinal cord level
T6 level and above
C. difficile treatment if not responsive to vanc
oral fidaxomicin
acute ischaemic stroke who present within 4.5 hour mx
thrombolysis AND thrombectomy
Malignant hyperthermia treatment
IV dantrolene therapy
Cause of pneumaturia
enterovesical fistula
AAA surgical intervention criteria
Surgery is only indicated in those who are symptomatic, or asymptomatic with an AAA larger than 4cm which has grown by more than 1 cm in 1 year, or asymptomatic and 5.5 cm or larger. Surgery is also indicated for a ruptured AAA. He does not meet any of these criteria.
Parsonage - Turner syndrome description
This is a peripheral neuropathy that may complicate viral illnesses and usually resolves spontaneously.
Migraine tx
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
EGFR change referral guidelines
NICE guidelines suggest referring to a nephrologist from primary care if eGFR falls below 30 or progressively by > 15 in a year
Essential tremor features
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)
Essential tremor tx
propranolol is first-line
primidone is sometimes used
Bile-acid malabsorption tx
cholestyramine
iliopsoas abscess presentation
Back pain, loin radiation, fevers
Polymyositis common presentation
Raised CKs and malignancy
