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Revision Topics Flashcards

1
Q

Age of premature menopause

A

< 40

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2
Q

Who should be offered a DEXA scan to screen for osteoporosis

A

All post-menopausal women > 65

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3
Q

Conservative management of menopause

A

Vaginal estrogen creams

Reduce risk of osteoporosis by smoking cessation and vitamin D

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4
Q

What are the 2 main health problems caused by menopause

A

Osteoporosis

Cardiovascular disease

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5
Q

Indications for HRT

A

Menopausal symptoms
Premature menopause until age 51, even if asymptomatic
Women < 60 at risk of osteoporotic fracture who aren’t suitable for other treatments

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6
Q

Risks of HRT

A

Endometrial cancer if unopposed
Breast cancer
Thrombotic disease - DVT, PE, stroke, CHD

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7
Q

Main contraindications to HRT

A 
If still have uterus can't have unopposed
Undiagnosed vaginal bleeding
Breast/endometrial cancer
Untreated endometrial hyperplasia
VTE
Untreated HTN
MI, angina, coronary artery disease
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8
Q

What medications can be used for hot flushes associated with menopause that aren’t HRT

A

SSRIs - Paroxetine
Clonidine
Gabapentin

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9
Q

Actions of parathyroid hormone in response to low Ca

A

Increased osteoclast activity
Increased renal Ca reabsorption and PO4 excretion
Increased vitamin D levels

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10
Q

Overall effect of PTH on serum Ca and PO4

A

Increases serum Ca

Decreases serum PO4

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11
Q

Causes of primary hyperparathyroidism

A

Solitary adenoma
Parathyroid gland hyperplasia
Parathyroid gland cancer

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12
Q

Chronic renal failure commonly causes which type of hyperparathyroidism

A

Tertiary hyperparathyroidism

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13
Q

A paraneoplastic syndrome commonly from SCLC that causes high Ca

A

Parathyroid hormone related protein

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14
Q

Symptoms of high parathyroid hormone

A 
Pruritus
Bone pain/fractures/osteopenia
High BP
Ca deposits in skin
Sx of high calcium - weak, tired, low mood, polyuria, polydipsia, renal stones
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15
Q

Medication used to lower PTH levels

A

Cinacalcet

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16
Q

Angiotensinogen comes from which organ

A

Liver

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17
Q

Angiotensin converting enzyme comes from which organ

A

Lung

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18
Q

Symptoms of hypocalcaemia

A 
Cramps
Perioral numbness
Muscle spasm
Chvostek sign
Confusion
Seizures
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19
Q

Actions of angiotensin II

A

Vasoconstriction

Aldosterone release from the adrenal cortex (Na retention)

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20
Q

Typical presentation of erythema multiforme

A

Target lesions
Initially back of hands/feet then spread to torso
Upper limbs > lower limbs
Mild pruritus

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21
Q

Main precipitating factor for erythema multiforme

A

Herpes simplex virus

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22
Q

At what percentage of body surface area affected does Stevens-Johnson syndrome become Toxic Epidermal Necrosis

A

When > 30% of the skin is affected

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23
Q

What is the name of the sign when mild lateral pressure separates the epidermis

A

Nikolsky’s sign

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24
Q

Percentage body area needed to be affected in erythroderma

A

90+ %

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25
Q

Classical presentation of squamous cell carcinoma

A

Painless, non-healing, bleeding ulcer
Everted edges
Floor of ulcer resembles granulation tissue and bleeds easily

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26
Q

Is SCC or BCC more common

A

BCC

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27
Q

Risk factors for squamous cell carcinoma

A 
Sun
Skin type
Radiation
Chronic immunosuppression
Actinic keratosis
Bowen's disease
Chemical carcinogens
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28
Q

What is a Marjolin’s ulcer

A

An aggressive form of SCC that typically develops from areas of chronically damaged skin such as ulcers (e.g., pressure ulcers, osteomyelitis) and scars (e.g., burn scars)

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29
Q

What is Bowen’s disease

A

Squamous cell carcinoma in situ

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30
Q

What infection is Bowen’s disease associated with

A

HPV 16 and 18

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31
Q

Keratin pearls are a histological finding of which skin disease

A

Squamous cell carcinoma

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32
Q

What is Keratoacanthoma and how do they characteristically look

A

A benign skin tumour
Common in the elderly
Rapid growth on sun exposed areas
Round erythematous nodule with a central crater

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33
Q

What is Moh’s microsurgery used for

A

Skin cancers - removes them later by layer so best method for ensuring its all removed whilst also ensuring uninvolved skin is spared

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34
Q

What is the most common type of skin cacner

A

BCC

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35
Q

Risk factors for basal cell carcinoma

A 
Sun exposure
Skin type
Gorlin syndrome
Arsenic exposure
Radiation
Chronic immunosuppression
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36
Q

What is Gorlin syndrome

A

A genetic condition that puts you at risk for multiple BCCs and other tumours

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37
Q

Topical chemotherapy for some skin cancers

A

Imiquimod

5-FU

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38
Q

Risk factors for melanoma

A 
UV
Skin type
Numerous nevi
Immunosuppression 
Xeroderma pigmentosum
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39
Q

Clinical features of melanoma

A

Pruritic, bleeding
Asymmetry
Irregular border with indistinct margins
Colour change of various pigmentation within the same lesion
Diameter >6mm
Evolving in regards to size, shape or colour

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40
Q

Types of melanoma

A 
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Amelanotic
Uveal
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41
Q

What is the most common type of melanoma

A

Superficial spreading

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42
Q

Describe lentigo maligna

A

A type of melanoma common in the elderly on sun exposed areas
Large and irregularly shaped patch with irregular pigmentation and slow horizontal growth

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43
Q

Describe Acral lentiginous

A

A type of melanoma common in dark skinned ethnicities
Irregularly shaped brown/black nodule that may ulcerated
Affects the palms/soles/nailbed/mucous membranes

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44
Q

Biopsy of choice in suspected skin cancers

A

Full thickness excisional biopsy with safety margins

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45
Q

What system is used to stage melanomas based on thickness/depth

A

Breslow scale

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46
Q

2 pre-cancerous skin lesions that can develop into SCC

A

Actinic keratosis

Leukoplakia

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47
Q

Describe a typical actinic keratosis

A

Sun exposed area

Small lesion with rough surface, sandpaper like texture. Grow and become erythematous and scaly

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48
Q

Treatment options for actinic keratosis

A 
Cryotherapy
Topical Imiquimod or 5-FU
Phototherapy
Curettage
Excision
SUN SCREEN
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49
Q

Difference between hypertrophic and keloid scars

A

Hypertrophic don’t grow beyond the boundaries of the original lesion whereas keloid scars do

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50
Q

Typical appearance of seborrheic keratosis

A 
Darkly pigmented plaques or papules
Sharply demarctaed
Soft, greasy, wax like texture
Stuck on appearance
May be itchy/bleed/increase in number over time
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51
Q

Slowly growing skin coloured/brown nodule mainly on lower legs, sometimes related to bites/skin trauma
Pinching the lesion produces a central dimple (Fitzpatrick’s sign)

A

Dermatofibroma

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52
Q

What are the 3 main types of nevus

A

Junctional
Compound
Intradermal

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53
Q

Describe a junctional nevus

A

Flat, well demarcated brownish macule

Growing at the dermal-epidermal junction

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54
Q

Describe a compound nevus

A

Elevated lesion

Arising from a junctional nevus

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55
Q

Describe an intradermal nevus

A

Elevated lesion that may be hard/fibrotic and grow hair

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56
Q

Causes of acanthosis nigricans

A 
T2DM
PCOS
Cushing's
Steroids
Oral contraceptives
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57
Q

What is a solar lentigo

A

Benign skin lesion

Flat brown macules or patches induced by sun exposure - usually on the cheeks and backs of hands

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58
Q

Delirium tremens typically occurs how many days after alcohol cessation

A

3 days

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59
Q

Typical triad of symptoms in Wernicke’s encephalopathy

A

Mental status change/confusion
Gait ataxia
Occulomotor dysfunction/nystagmus

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60
Q

Which vitamin is Thiamine

A

B1

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61
Q

What is the main feature of Korsakoff syndrome

A

Loss of short term memory and confabulation as a result

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62
Q

Symptoms of polymyalgia rheumatica

A

Morning stiffness of proximal limb muscles
Lerthargy, depression, anorexia, low grade fever
Symptoms of GCA

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63
Q

What is polyarteritis nodosa

A

A medium vessel vasculitis

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64
Q

Who gets polyarteritis nodosa

A

Middle aged men with Hep B infection

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65
Q

Typical angiography description of polyarteritis nodosa

A

‘Beading’ appearance - numerous microaneurysms

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66
Q

What is the life-threatening complication of Kawasaki disease and how do you check for it

A

Coronary artery aneurysm

Echocardiogram

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67
Q

6 Key features of Kawasaki disease

A 
High grade fever for >5 days
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles of feet which later peel
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68
Q

Management of Kawasaki disease

A

High dose Aspirin
IV immunoglobulins
Echocardiogram

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69
Q

What is Scarlet fever

A

A reaction to toxins produced by group A strep (usually strep pyogenes)

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70
Q

Organism that can result in scarlet fever

A

Group A Streptococci - usually Strep Pyogenes

71
Q

Typical features of Scarlet fever

A

Fever 1-2 days
Malaise, headache, nausea, vomiting
Sore throat/strep throat
Strawberry tongue
Fine punctate erythematous rash that spares the palms and soles, rough sandpaper texture, later desquamation around fingers/toes
Flushed appearance with circumoral pallor

72
Q

Treatment for Scarlet fever

A

Oral Penicillin V for 10 days

73
Q

What is the most common complication of scarlet fever

A

Otitis media

74
Q

Rheumatic fever usually occurs how long after what infection

A

2-6 weeks after Streptococcus Pyogenes infection

75
Q

Major criteria for Rheumatic fever

A 
Erythema marginatum (ring shaped)
Sydenham's chorea
Polyarthritis
Pancarditis
Subcutaneous nodules
76
Q

Minor criteria for Rheumatic fever

A

Raised CRP/ESR
Pyrexia
Arthralgia
Prolonged PR interval

77
Q

Causes of osteomalacia

A

Vitamin D deficiency
Renal failure
Anticonvulsants
Liver cirrhosis

78
Q

Pagets disease - are Ca, PO4, ALP high, normal or low

A

Normal Ca and PO4

Raised ALP in isolation

79
Q

Treatment for Pagets disease

A

Bisphosphonates

80
Q

First line treatment for dysfunctional uterine bleeding

A

Progesterone only contraception (usually coil)

81
Q

Treatment options for dysfunctional uterine bleeding/menorrhagia

A

Progesterone only contraception (coil) or combined contraception
NSAIDs - Mefanamic acid
Antifibrinolytics - Tranexamic acid
D+C if want future children
GnRH analogues if want future children
Endometrial ablation/resection/hysterectomy if they don’t want more children

82
Q

3 main types of fibroids

A

Intramural
Subserosal
Submucosal

83
Q

Which medications can shrink fibroids

A 
GnRH analogues (injection)
Ulipristal acetate
84
Q

Surgical treatment of fibroids in someone who wants future children

A

Myomectomy

Hysteroscopic resection

85
Q

A differential for menorrhagia caused by endometrium growing into the myometrium

A

Adenomyosis

86
Q

Treatment for myasthenia gravis

A

Pyridostigmine (cholinesterase inhibitor)

87
Q

In myasthenia gravis, what are antibodies directed against

A

ACh receptors

88
Q

Myasthenia gravis can be associated with a benign tumour of ?

A

Thymus gland (Thymoma)

89
Q

Features of myasthenia gravis

A

Sx worsen with muscle use and improve with rest
Eye muscle weakness - ptosis, diplopia, blurred vision
Bulbar muscles - slurred speech, chewing/swallowing difficulties
Proximal limb weakness
Respiratory muscle weakness

90
Q

Diagnosis of myasthenia gravis

A

EMG
ACh receptor antibody screen
Tensilon/Edrophonium test

91
Q

In Lambert Eaton syndrome what are antibodies directed against

A

Voltage gated Ca channels

92
Q

Management of myasthenic crisis

A

Plasmapheresis
IV immunoglobulin
Airway management

93
Q

Monoclonal proteins found in Multiple Myeloma

A

IgG > IgA > Bence Jones

94
Q

Abnormal production of monoclonal IgM suggests which plasma cell dyscrasia

A

Waldenstrom’s macroglobulinaemia

95
Q

Multiple myeloma a) best initial test b) confirmatory test

A

a) serum protein electrophoresis

b) bone marrow biopsy

96
Q

Diagnosis of organ damage in multiple myeloma

A

Hypercalcaemia
Renal insufficiency
Anaemia
Bone lesions on MRI

97
Q

Diagnostic criteria for multiple myeloma

A

10+ % of clonal bone marrow plasma cells in biopsy plus at least one of;

  • Organ damage - Ca, Renal, Anaemia, Bone lesions
  • 60+ % clonal plasma cells in bone marrow
  • Serum free light chain ration 100+
  • > 1 focal lesion on MRI
98
Q

Rouleaux formation on blood smear indicates which disease

A

Multiple Myeloma

99
Q

Treatment of multiple myeloma

A

Chemotherapy
Stem cell transplant
Immunotherapy
Bisphosphonates, blood transfusion, EPO

100
Q

What is the most common plasma cell dyscrasia

A

MGUS (monoclonal gammopathy of undetermined significance)

101
Q

What is MGUS

A

Monoclonal gammopathy of undetermined significance
Monoclonal immunoglobulins in serum WITHOUT CLINICAL SYMPTOMS
< 10% plasma cells in marrow
No evidence of organ damage
Watch and wait as usually precedes multiple myeloma

102
Q

Organism that cause croup

A

Parainfluenza virus

103
Q

Organism that causes bronchiolitis

A

RSV

104
Q

Organism that causes epiglottitis

A

HiB

105
Q

Organism that causes whooping cough

A

Bordetella pertussis

106
Q

Organisms that cause bacterial tracheitis

A

Staph aureus

Group A beta-haemolytic strep

107
Q

Treatment of croup

A

Stat steroids

108
Q

Management of whooping cough

A

Antibiotics

Admit if < 6 months old

109
Q

Management of epiglottitis

A

Call anaesthetics and ENT

IV Cefotaxime

110
Q

Management of bacterial tracheitis

A

Emergency airway management

Cefotaxime and Flucloxacillin

111
Q

Stepwise management of chronic asthma in children

A 
SABA
\+ Steroid
If < 5 + Motelukast
If > 5 + LABA
Refer, add PO prednisolone if >5
112
Q

Children below what age should really be using a spacer with their inhaler

A

< 8 years old

113
Q

Treatment of severe asthma in a child

A
  1. Sit up, high flow 100% oxygen
  2. Salbutamol 5mg nebulised in 4ml saline with Ipratropium bromide 0.25mg
  3. Hydrocortisone 100mg IV or Prednisolone soluble tablets (1-2mg/kg max 40)
  4. Consider one IV magnesium sulphate dose 40mg/kg over 2omins
  5. Aminophylline 5mg/kg IV over 20mins then IV infusion. Give with ondansetron to prevent vomiting
  6. Nebulisers continuously until improving then reduce frequency. Give Ipratropium 8hrly if needed
  7. Consider starting CPAP in the ED. If refractory or exhausted take to ITU
114
Q

Primary biliary cholangitis features

A 
Raised ALP
Fatigue
Pruritus
Pressure point hyperpigmentation
Xanthelasma, Xanthomata
Clubbing, hepatosplenomegaly
May progress to liver failure
115
Q

Diseases associated with primary biliary cholangitis

A

Sjogrens
RA
Systemic sclerosis
Thyroid disease

116
Q

Primary biliary cholangitis significantly increases the risk of which cancer

A

Hepatocellular cancer (20 X)

117
Q

Antibodies associated with primary biliary cholangitis

A

Anti-mitochondrial antibodies - M2 subtype are highly specific
Smooth muscle antibodies

118
Q

Management of primary biliary cholangitis

A

Cholestyramine for pruritus
Ursodeoxycholic acid
Fat soluble vitamin supplementation
Liver transplant

119
Q

Diseases associated with primary sclerosing cholangitis

A

Ulcerative colitis
Crohn’s
HIV

120
Q

Features of primary sclerosing cholangitis

A

Cholestasis –> jaundice and pruritus
RUQ pain
Fatigue

121
Q

Standard diagnostic investigation for primary sclerosing cholangitis and the characteristic finding

A

ERCP or MRCP

‘Beaded’ appearance of biliary strictures

122
Q

Management of primary sclerosing cholangitis

A

Cholestyramine for pruritus
Ursodeoxycholic acid
Liver transplant

123
Q

What features would make you consider encephalitis rather than meningitis

A

Altered mental status
Seizures
Focal neurological findings (weakness, visual disturbance, aphasia, cerebellar finding, behaviour change)

124
Q

What type of organism usually causes encephalitis

A

Virus

HSV, Japanese encephalitis

125
Q 
Vertigo:
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing loss
A

Viral labyrinthitis

126
Q

Vertigo:
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss

A

Vestibular neuritis

127
Q

Vertigo:
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds

A

BPPV (benign paroxysmal positional vertigo)

128
Q 
Vertigo:
Vertigo
Hearing loss
Tinnitus
Sensation of pressure/fullness
A

Meniere’s disease

129
Q

Vertigo:
Elderly patient
Dizziness on neck extension

A

Vertebrobasilar ischaemia

130
Q 
Vertigo:
Hearing loss
Vertigo
Tinnitus
Absent corneal reflex
Signs of neurofibromatosis type 2
A

Acoustic neuroma

131
Q

How can you explain what PSA is to a patient

A

A protein made by the prostate gland

132
Q

Who is eligible for PSA testing if asymptomatic and ask for it

A

Men age 50+

133
Q

Things to avoid in the lead up to a PSA test

A

Don’t ejaculate 48hrs before
Don’t exercise 48hrs before
Also can’t have it if you have a UTI or have had a prostate biopsy in the past 6 weeks

134
Q

What are the 4 H’s and 4T’s for reversible causes of cardiac arrest

A
  1. Hypoxia
  2. Hypovolaemia
  3. Hyperkalaemia/Hypokalaemia/Hypoglycaemia/Hypocalcaemia/Acidaemia
  4. Hypothermia
  5. Thrombosis – coronary or pulmonary
  6. Tension pneumothorax
  7. Tamponade
  8. Toxins
135
Q

What are the ‘shockable’ rhythms of cardiac arrest

A

Ventricular fibrillation

Ventricular tachycardia

136
Q

What are the ‘non-shockable’ rhythms of cardiac arrest

A

Asystole

Pulseless electrical activity (other than TV)

137
Q

Management of shockable rhythms

A

Compressions (30:2) and five first shock straight away
Shock every 2 minutes (every 5 cycles of CPR)
With the third shock give 1mg IV Adrenaline and IV Amiodarone
Give Adrenaline after every other shock
Consider Amiodarone again after 5th shock

138
Q

Management of non-shockable rhythms

A

Chest compressions 30:2
Give 1mg IV Adrenaline straight away
Give further Adrenaline every 5 cycles of CPR

139
Q

What 2 substances can cause pupil dilation in overdose

A

Benzodiazepines

Tricyclic antidepressants

140
Q

ECG changes in tricyclic antidepressant overdose

A

Sinus tachycardia
Broad QRS
Long QT interval

141
Q

Reversal of warfarin

A

Vitamin K

Prothrombin complex

142
Q

Reversal of heparin

A

Protamine sulphate

143
Q

What do you give if someone has taken too many beta blockers and is bradycardic

A

Atropine

144
Q

Typical features of measles

A 
Erythematous maculopapular rash
Palms and soles spared
Desquamation days later
Prodromal illness - cough, coryza, conjunctivitis
Koplik spots
Fever, malaise, lymphadenopathy
145
Q

Typical features of scarlet fever

A 
Erythematous maculopapular rash
Fine, rough, feels like sandpaper
Linear petechiae in groin/joint folds
Desquamation weeks later
Sudden onset high fever
Red flushed face with perioral pallor
Strawberry tongue
Recent strep throat infection/tonsillopharyngitis
146
Q

Typical features of rubella

A

Pink maculopapular rash
Only lasts 3 days
Mild systemic disease
Red petechiae on soft palate

147
Q

Typical features of slapped cheek

A 
Maculopapular confluent rash that eventually becomes lace-like
Initially red, flushed cheeks
Mild systemic disease
Arthritis
Pruritus worse in sunlight
148
Q

Presentation of HSP

A 
Usually 3 days after a cough
Purpuric rash on legs, buttocks
Abdo pain 
Nephritis + haematuria 
High BP
149
Q

Presentation of HUS

A

Usually 5-10 days after bloody diarrhoea in children
Low platelets
Microangiopathic haemolytic anaemia
Decreased renal function

150
Q

5 key features of TTP

A 
Microangiopathic haemolytic anaemia
Low platelets
AKI
Neuro sx
Fever
151
Q

Secondary causes of ITP

A 
Lymphoma
Leukaemia
SLE
HIV
HCV
152
Q

Key features of Kawasaki disease

A

Fever >5 days
Bilateral conjunctival injection
Change in mucous membranes/strawberry tongue
Change in extremities - erythema and then desquamation of hands
Polymorphous rash
Cervical lymphadenopathy

153
Q

Hungtington disease inheritance pattern

A

Autosomal dominant

154
Q

Typical features of Huntington disease

A

Age 30-50
Initially - chorea, oculomotor disorders, hyper-reflexia, autonomic dysfunction
Later - hypokinetic, akinetic, dysarthria, dysphagia, dementia, depression, aggression

155
Q

Neck lumps:
Midline, painless, firm
Elevates on swallowing and tongue protrusion

A

Thyroglossal duct cyst

156
Q

Neck lumps:
Lateral to midline, anterior to sternocleidomastoid
Painless, firm
Doesn’t move on swallowing

A

Branchial cleft cyst

157
Q

Neck lumps:
Posterior triangle
Transilluminates
Soft, compressible, painless

A

Cystic hygroma

158
Q

Antiplatelet medication

A

Aspirin
Clopidogrel
Ticagrelor

159
Q

Bilateral conjunctival injection
Change in mucous membranes/strawberry tongue
Change in extremities - erythema and then desquamation of hands
Polymorphous rash
Cervical lymphadenopathy

A

Kawasaki disease

160
Q 
Microangiopathic haemolytic anaemia
Low platelets
AKI
Neuro sx
Fever
A

TTP

161
Q

Usually 5-10 days after bloody diarrhoea in children
Low platelets
Microangiopathic haemolytic anaemia
Decreased renal function

A

HUS

162
Q 
Usually 3 days after a cough
Purpuric rash on legs, buttocks
Abdo pain 
Nephritis + haematuria 
High BP
A

HSP

163
Q 
Maculopapular confluent rash that eventually becomes lace-like
Initially red, flushed cheeks
Mild systemic disease
Arthritis
Pruritus worse in sunlight
A

Slapped cheek/Parvovirus

164
Q

Pink maculopapular rash
Only lasts 3 days
Mild systemic disease
Red petechiae on soft palate

A

Rubella

165
Q 
Erythematous maculopapular rash
Fine, rough, feels like sandpaper
Linear petechiae in groin/joint folds
Desquamation weeks later
Sudden onset high fever
Red flushed face with perioral pallor
Strawberry tongue
Recent strep throat infection/tonsillopharyngitis
A

Scarlet Fever

166
Q 
Erythematous maculopapular rash
Palms and soles spared
Desquamation days later
Prodromal illness - cough, coryza, conjunctivitis
Koplik spots
Fever, malaise, lymphadenopathy
A

Measles

167
Q

Well score for:

a) DVT likely
b) PE likely

A

a) 2+

b) >4

168
Q

Difference in calf circumference of ?cm indicates DVT

A

> 3cm

169
Q

CTPA findings that are pathognomonic for PE

A

Wedge shaped infarction with pleural effusion

170
Q

Medication to treat hyperprolactinaemia

A

Cabergoline or Bromocriptine (dopamine agonist)

171
Q

What is the common cause of aplastic crisis in sickle cell disease

A

Parvovirus B19

172
Q

Dactylitis is a finding of which blood disease

A

Sickle cell

173
Q

Medication for sickle cell that can reduce number of crises

A

Hydroxyurea

174
Q

Skull XR finding in myeloma

A

‘Raindrop’ appearance

Finals (32 decks)

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