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1
Q

What meds are people put on post-STEMI?

A
  • Atorvastatin
  • Aspirin
  • Another antiplatelet-> clopidogrel or ticagrelor for 12 months
  • ACE-i-> ramipril
  • Atenolol or other beta-blocker
  • GTN spray
  • Aldosterone antagonist-> if clinical HF
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2
Q

STEMI management?

A
  • PCI-> present within 12 hours + available within 2 hours of presentation
  • Thrombolysis-> if within 12 hours but PCI not available within 2 hours
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3
Q

What cardiac enzymes can rise during damage?

A
  • Tropinin
  • LDH
  • CK
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4
Q

Pathway for asthma management?

A
  • SABA
  • SABA + ICS
  • SABA + ICS + LABA
  • SABA + ICS + LRTA
  • Consider MART regimes
  • May add LAMA or theophylline later
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5
Q

Physiological measurement of COPD control/severity?

A

FEV1

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6
Q

Stages of CKD?

A 
1-> >90
2-> 60-89
3a-> 45-59
3b-> 30-44
4-> 15-29
5-> <15
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7
Q

Causes of CKD?

A
  • Hypertension
  • Glomerulonephritis
  • Renovascular disease
  • Pyelonephritis
  • Polycystic kidney disease
  • Obstructive uropathy
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8
Q

Why do renal USS in CKD?

A
  • Exclude obstruction
  • Assess renal size
  • Exclude PCKD
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9
Q

Blood tests in CKD?

A
  • U+Es
  • Calcium
  • Phosphate
  • ALP
  • PTH
  • FBC
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10
Q

Signs of CKD on examination?

A
  • Pallor
  • Uraemic tinge
  • Purpura
  • Bruising
  • Brown nail discolouration
  • Excoriation
  • Peripheral oedema
  • HTN
  • Pericardial rub
  • Pleural effusions
  • Proximal myopathy
  • AV fistula
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11
Q

Complications of peritoneal dialysis?

A
  • Bacterial peritonitis
  • Local infection at catheter site
  • Constipation
  • Failure
  • Sclerosing peritonitis
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12
Q

Why do people on immunosuppression need dermatology input?

A

Increased risk of SCC

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13
Q

X-ray findings in rheumatoid arthritis?

A
  • Loss of joint space
  • Soft tissue swelling
  • Juxta-articular osteopaenia
  • Bony erosions
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14
Q

Extra-articular complications of RA?

A
  • Scleritis
  • Episcleritis
  • Scleromalacia
  • Lymphadenopathy
  • Pleural effusion
  • Pulmonary fibrosis
  • Pericardial effusion
  • Rheumatoid nodules-> elbow, pleura
  • Amyloidosis
  • Vasculitis
  • Anaemia
  • Felty’s syndrome-> splenomegaly
  • Peripheral neuropathy
  • Raynaud’s phenomenon
  • Carpal tunnel
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15
Q

What is Felty’s syndrome?

A

RA + splenomegaly

+ neutropenia

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16
Q

How do NSAIDs work?

A

COX2 inhibitors-> reduce prostaglandin synthesis + reduce inflammation

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17
Q

What are some signs of acromegaly?

A
  • Bitemporal hemianopia
  • Excess sweating
  • Enlarged facial features
  • HTN
  • Headache
  • Prognathism
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18
Q

Role of OGTT in acromegaly?

A
  • Normal-> rapid blood glucose increase should suppress GH secretion
  • In acromegaly-> doesn’t
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19
Q

Tests of choice in acromegaly?

A
  • Serum IGF-1

- OGTT

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20
Q

What else needs to be screened for in acromegaly?

A

Diabetes-> GH is anti-insulin so can cause insulin resistance + DM

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21
Q

What might FBC in hypothyroidism show?

A

Macrocytic anaemia

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22
Q

Causes of hypothyroidism?

A
  • Autoimmune
  • Iodine deficiency
  • Cancer
  • Infection
  • Hypopituitarism
  • Amiodarone
  • Radiotherapy
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23
Q

Signs of hypothyroidism?

A
  • Goitre
  • Dry/thinning hair
  • Bradycardia
  • Dry skin
  • Loss of lateral third of eyebrows
  • Ataxia
  • Mental slowness
  • Carpal tunnel
  • Oedema
  • Peaches and cream complexion
  • Slow relaxing relfexes
  • Peripheral neuropathy
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24
Q

Where does the thyroid originate from?

A

Foramen caecum

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25
What might white patches on the hands in hypothyroidism indicate?
Vitiligo
26
What are some signs of lymphoma?
- Lump-> painless, rubbery, pain induced by alcohol - Enlarged nodes at other side - Splenomegaly - Hepatomegaly
27
Why might SVC obstruction occur in lymphoma?
Mediastinal lymph node enlargement
28
What are some signs of iron deficiency anaemia?
- Tachypnoea - Tachycardia - Pale conjunctiva - Ejection systolic murmur - Angular chelosis - Koilionychia - Atrophic glossitis
29
Chronic diarrhoea differentials in younger people?
- IBD - IBS - Infective-> protozoa/parasites - Coeliac - Cancer - Medications - Chronic pancreatitis - Thyrotoxicosis
30
Tests for IBD?
- FBC-> anaemia, raised WCC - CRP - Albumin - Vitamin B12 - Stool MC&S - Coeliac screen - Amylase - TFTs - Sigmoidoscopy + biopsy - Colonoscopy - Barium enema - Capsule endoscopy
31
Histological features of Crohn's?
- Granulomas - Transmural inflammation - Lymphocytic infiltration
32
Endoscopic appearance and distribution of Crohn's?
- Skip lesions-> not continuous - Mouth to anus - Commonly terminal ileum - Cobblestone appearance
33
Endoscopic appearance and distribution of ulcerative colitis?
- Only large bowel-> mostly rectum - Uniform inflammation - Thin walls + vascular pattern
34
Extraintestinal features of Crohn's?
- Erythema nodosum - Pyoderma gangrenosum - Iritis - Conjunctivitis - Episcleritis - Large-joint arthritis - Ankylosing spondylitis - Aphthous ulcers
35
Complications of Crohn's?
- Perianal fistulae - Perianal abscess - Enteric fistulae - Perforated bowel - Small bowel obstruction - Colon carcinoma - Malnutrition
36
How does infliximab help in Crohn's?
Monoclonal antibody against TNF-> used to establish inflammation + granuloma formation
37
Why might Hb be unaffected in upper GI bleed?
No haemodilution-> fall might not happen till later after bleed
38
What blood test abnormality might be apparent in upper GI bleed?
Urea raised out of proportion to creatinine
39
Where might portosystemic anastamoses occur in liver cirrhosis?
- Superior rectal vein-> haemorrhoids | - Paraumbilical vein-> caput medusae
40
Treatment of oesophageal varices?
- Banding - Adrenaline - Sclerotherapy - Argon plasma coagulation
41
What conditions are associated with berry aneurysms?
- PCKD - Ehler-Danlos - Coarctation of aorta
42
Symptoms and signs of SAH?
- Thunderclap headache - Vomiting - Collapse - Seizures - Coma - Visual disturbance - Photophobia - Focal neurology due to haematoma
43
What is Kernig's sign?
- Hip and knee bent to 90 degrees - Pain when straighten knee-> positive - Suggests meningeal irritation
44
What is Brudzinski's test?
- Lie flat on back - Lift head and neck off bed - Positive-> involuntary hip and knee flexion - Suggests meningitis
45
Appearance of extradural haematoma on CT?
- Lens-shaped or biconvex (eat the lemon) | - Can't cross sutures
46
Appearance of subdural haematoma on CT?
- Crescent shaped | - Not limited by suture lines ie can cross
47
Pathophysiology of pain in appendicitis?
- Visceral peritoneum supplied by T10 dermatome-> generalised pain - Parietal supply-> somatic + specific (RIF)
48
Complications of appendicitis?
- Appendix mass - Abscess - Perforation and peritonitis - Sepsis
49
What is a diverticulum?
Outpouching of colonic mucosa through the muscle wall
50
Complications of diverticulitis?
Perforation, bleeding, abscess, strictures, fistulas
51
Causes of urinary retention?
- UTI - BPH - Constipation - Meds-> anticholinergics, opiates, antidepressants - Pelvic nerve damage - Post-anaesthesia - Alcohol
52
What is important to assess in urinary retention?
Lower limb neuro + PR-> cauda equina symptoms
53
What does post-catheterisation care involve?
- Residual volume measurement - Take specimen for CSU - Retract foreskin over glans
54
What is the difference in symptoms between acute and chronic urinary retention?
- Acute-> painful | - Chronic-> painless and higher volume (1.5L+)
55
How does tamsulosin work?
Alpha-1 receptor antagonist-> relax prostatic smooth muscle
56
How does finasteride work?
Anti-androgen 5-alpha reductase inhibitor-> inhibits conversion of testosterone to dihydrotestosterone (more potent androgen in prostatic tissue)
57
Risk factors for bladder cancer?
- Smoking - Aromatic amines-> paint and dye workers - Chronic cystitis - Schistosomiasis-> SCC - Pelvic radiotherapy - Cyclophosphamide
58
How is T1 TCC of the bladder treated?
- TURBT | - Intravesical agents-> BCG, mitomycin C
59
Where do bladder tumours metastasise to?
- Local-> uterus, rectum, pelvic side wall - Lymphatics-> iliac, para-aortic - Other-> liver, lungs, bone
60
What are some risk factors for developing septic arthritis?
- Intra-articular injections - RA - DM - Immunosuppression - Penetrating injury - Infection elsewhere eg gonococcal
61
Common organism in septic arthritis in a metal prosthesis?
Staphylococcus epidermis
62
Where does the supraspinatus attach to the humerus?
Greater tuberosity
63
What most commonly causes epistaxis?
Trauma
64
Why should FBC be done in epistaxis?
- Hb drop | - Low platelets-> may be cause of epistaxis
65
Blood tests in epistaxis?
- FBC - LFTs-> clotting factors etc - Group and save-> may need transfusion - INR if on warfarin
66
Management of epistaxis?
- Cauterisation - Packing - Balloon/foley catheter - Ligation or embolisation of artery
67
Medical term for painful swallowing?
Odynophagia
68
Symptoms of tonsillitis?
- Odynophagia - Fever - Anorexia - Headache - Ear pain - Change to voice - Abdominal pain
69
What lymph node is often affected in tonsillitis?
Jugulodigastric
70
Why is amoxicillin contraindicated in tonsillitis?
Causes maculopapular rash if diagnosis is actually glandular fever
71
Definition of an arterial aneurysm?
Swelling of more than 150% of original diameter due to weakness in wall
72
What is the number needed to screen?
Number of patients needed to be screened to prevent one access death/morbidity
73
What can cause AAA?
- Connective tissue disease-> Ehler Danlos, Marfans - Atheromatous degeneration - Mycotic aneurysms from infection
74
Surgery complications in AAA repair?
- Bleeding - Infection - DVT/PE - MI - Spinal ischaemia - Renal failure - Mesenteric ischaemia - Distal thrombus-> limb ischaemia - Death
75
Disadvantages of EVAR?
- Long term follow up needed - Not suitable for every type of aneurysm - High reintervention rate
76
Investigations for AAA?
- FBC - Cross match - Amylase - U+E - ECG - Abdominal CT with contrast if stable
77
What is trash foot?
- Cholesterol embolism - From vascular surgery-> atheromatous debris shed during surgery + lodges in distal vessels - Local ischaemia-> mottled skin + darkened segments
78
What are the four layers of an arterial vessel?
- Intima - Tunica media - Tunica externa - Adventitia
79
What serum immunoglobulin is often raised in severe eczema?
IgE
80
What are some of the different types of psoriasis?
- Plaque - Flexural - Guttate - Pustular - Erythrodermic
81
Treatment options for psoriasis?
- Emollients - Topical steroids - Vitamin D analogues - Coal tar - Topical calcineurin inhibitors eg tacrolimis - Phototherapy - Ciclosporin
82
What causes conjunctivitis?
Allergy or infection
83
What causes neonatal conjunctivitis?
Gonorrhoea or chlamydia
84
What are the signs of diabetic retinopathy (proliferative)?
- Microaneurysms - Flame haemorrhages - Hard exudates - Engorged tortuous veins - Cotton wool spots-> ischaemic nerve fibres - Neovascularisation
85
How is proliferative diabetic retinopathy treated?
Panretinal photocoagulation
86
What eye conditions are diabetics at risk of getting?
- Diabetic retinopathy - Cataracts - Glaucoma - Vitreous haemorrhage - Retinal detachment - Ocular motor nerve palsies - Infections
87
Risk factors for placenta praevia?
- Previous C section - Twin/multiple pregnancy - High parity - Older women
88
Causes of antepartum haemorrhage?
- Placenta previa - Placental abruption - Uterine rupture - Vasa previa - Cervical polyp - Cervical cancer
89
What foetal lie and presentation is usually present in placental abruption?
Normal-> longitudinal + cephalic
90
What are some risk factors for placental abruption?
- IUGR - Previous abruption - Maternal smoking - Pre-eclampsia - HTN - Multiple pregnancy
91
What would clotting studies after major abruption show?
- Afibrinogenaemia-> placental damage causes thromboplastin release into circulation - Causes DIC-> clotting factors used up
92
Symptoms of ectopic pregnancy?
- Severe unilateral abdominal pain - Amenorrhoea - Adenexal mass - PV bleed - Shoulder tip pain
93
Risk factors for ectopic pregnancy?
- Previous ectopic - IUD - Previous PID - Tubal surgery - Endometriosis
94
Medical management of ectopic?
Methotrexate
95
Risk factors for hyperemesis gravidarum?
- 1st pregnancy - Young age - Multiple pregnancy - Molar pregnancy - Hyperthyroidism - Previous motion sickness
96
Definition of orthostatic hypotension?
Drop in systolic by >20mmHg or drop in diastolic by >10mmHg within 1st 10 minutes of standing
97
Causes of postural hypotension?
- Hypertensive meds-> ACE-is, diuretics - Excess alcohol - Hypovolaemia-> dehydration, diarrhoea, haemorrhage, Addison's - Primary autonomic failure-> Parkinson's, multiple system atrophy - Secondary autonomic failure-> diabetic neuropathy
98
Management options for postural hypotension?
- Education on symptoms and taking action - High salt diet - Bed tilt - Full length compression hosiery - Fludrocortisone - Midodrine
99
Definition of delirium?
Syndrome of clouded consciousness, disorientation, perceptual impairment and changes in affect and behaviour
100
What tool can be used to differentiate dementia from delirium?
Confusion Assessment Method (CAM)
101
How do penicillins work?
Inhibit cell wall synthesis
102
How do bacteria develop resistance against penicillin-based antibiotics?
Beta-lactamase production-> break down beta-lactam ring
103
Why are other antibiotics often added to penicillin-based ones in treatment regimes?
These are beta-lactamase inhibitors-> reduce resistance
104
What should be done before starting lithium?
- U+Es - TFTs - ECG
105
Symptoms of lithium toxicity?
- Coarse tremor - N+V - Diarrhoea - Confusion - Lethargy - Polyuria - Seizures
106
What are the key features of depression?
Low mood + anhedonia + lack of energy-> for 2+ weeks
107
What are some limitations to the Hospital Anxiety and Depression Score (HADS)?
- Variation of scores between different populations and cultures - Only validated in hospitals not general population
108
What are the features of atypical depression?
- Weight increase - Increased appetite - Hypersomnolence-> daytime sleepiness - Mood improves with positive events - Catanonia-> leaden limbs - Social impairment
109
What might CXR show in bronchiolitis?
Hyperinflation
110
Differentials for stridor in children?
- Croup - Epiglottitis - Anaphylaxis
111
What organisms cause croup?
- Parainfluenza - RSV - Influenza
112
What can be used in severe croup?
Nebulised adrenaline
113
What can trigger an angina attack?
- Cold/windy weather - Emotion-> anxiety, excitement - Lying down - Vivid dreams-> nocturnal
114
Blood tests in angina?
- FBC-> anaemia - TFTs-> thyrotoxicosis - Lipid profile - Glucose-> random, fasting etc - U+Es-> if considering ACEi
115
How does aspirin work?
- Irreversibly inhibits COX-> prevents thromboxane production - Shifts balance of PGI2:TxA2 towards inhibiting platelet aggregation
116
How to raise someone's K+?
K+ replacement-> oral or add to fluids
117
3 most likely organisms to cause CAP?
- Strep pneumoniae - H.influenzae - Mycoplasma pneumoniae
118
At what CURB65 score should someone be admitted to hospital with CAP?
Score of two or more
119
Why should statins be stopped when clarithromycin is started?
Interacts-> risk of myositis increased
120
Where does hydroxylation of vitamin D occur?
Liver + kidney
121
What is bone disease in renal failure called?
Renal osteodystrophy
122
What blood results would you expect in tertiary hyperparathyroidism?
- Calcium-> high - PTH-> high - Prolonged secondary-> PT glands act autonomously
123
Pre-renal causes of AKI?
- Hypovolaemia - Sepsis - Renal artery stenosis - ACE-is - NSAIDs - Congestive cardiac failure - Cirrhosis
124
Renal causes of AKI?
- Acute tubular necrosis - Nephrotoxins-> drugs, contrast - Myeloma - Rhabdomyolysis - Vasculitis - Glomerulonephritis - Haemolytic uraemia syndrome - Malignant hypertension - TTP - Cholesterol emboli - Acute tubulointerstitial nephritis - Pre-eclampsia
125
Complications of AKI?
- Pulmonary oedema - Hyperkalaemia - Haemorrhage
126
Indications for dialysis in AKI?
- Acidaemia - Electrolytes-> refractory hyperkalaemia - Intoxication/ingestions - Overload-> CCF - Uraemia-> encephalopathy, pericarditis
127
Causes of gout attacks?
- Alcohol - High purine diet-> meat and shellfish - Trauma - Infection - Surgery - Dehydration
128
Signs of gout on X-ray?
- Normal joint space - Soft tissue swelling - Periarticular joint erosions
129
Sign of pseudogout on X-ray?
Chondrocalcinosis-> calcification within joints
130
What joints are usually affected in pseudogout?
- Knee - Hips - Wrist
131
What drugs can be used in hyperthyroidism?
- Carbimazole | - Propythiouracil
132
What are the symptoms of diabetes insipidus?
- Weight loss - Polyuria - Polydipsia - Hypernatraemia - Absence of glucosuria
133
What causes diabetes insipidus?
Lack of (cranial) or lack of response to (nephrogenic) ADH
134
How does the water deprivation test for diabetes insipidus work?
- Starve of fluid - Normal-> concentrated urine + reduced UO - DI-> still low osmolality + increased UO
135
What is Sheehan's syndrome?
Pituitary infarction-> happens after PPH
136
Drugs used in sickle cell disease?
- Hydroxyurea (hydroxycarbamide) - Penicillin - Folic acid
137
What can bring on sickle cell crisis?
- Infection - Dehydration - Cold weather - Hypoxia
138
Commonest immunoglobulin expressed in myeloma?
IgG
139
Symptoms of multiple myeloma?
- Abdominal pain - Confusion - Renal stone symptoms - Weight loss - Recurrent infections - Tiredness - Bruising easily
140
Why are patients with myeloma prone to infections?
Bone marrow infiltration-> immunoparesis secondary to overexpression of 1 Ig and underexpression of others
141
Acute complications of myeloma?
- Hypercalcaemia - AKI - SCC - Hyperviscosity
142
Risk factors for peptic ulcer disease?
- Smoking - Physiological stress - H.pylori - SSRIs - NSAIDs - Hypercalcaemia - Chronic renal failure
143
How does the urease breath test work?
- H.pylori produces urease-> breaks down urea into ammonia + CO2 - Radio isotope of carbon (C13 or C14) in form of urea ingested - If urease present-> breaks down urea + radioisotope measured
144
What is Zollinger-Ellison syndrome?
- Abnormally high gastrin levels-> atypical ulcers | - Usually from pancreatic gastrinoma
145
How long are antibiotics given in H.pylori?
2 weeks
146
What is the gold standard test for proving reflux?
Oesophageal pH manometry
147
How does Nissen fundoplication help in GORD?
Augments high pressure zone-> gives strength to gastrooesophageal junction
148
Side effects of Nissen fundoplication?
- Dysphagia from compression of GOJ - Dumping syndrome - Achalasia
149
Commonest cause of cerebral infarct?
Carotid artery embolism-> endarterectomy
150
What is Todd's palsy?
Temporary weakness after a seizure-> usually in affected limbs and after focal seizures
151
What airway adjunct can be used in seizures?
Nasopharyngeal airway
152
What is a hernia?
Protrusion of a structure through the wall of a cavity in which it's usually contained
153
How are femoral and inguinal hernias differentiated in relation to the pubic tubercle?
- Femoral-> inferior + lateral | - Inguinal-> superior + medial
154
How are indirect and direct hernias differentiated (in relation to the inferior epigastric vessels)?
- Indirect-> lateral to vessels | - Direct-> medial to vessels
155
Risk factors for inguinal hernias?
- Premature - Male - Chronic cough - Constipation - Obesity - Heavy lifting - Physical activity-> sports
156
What is the difference between an obstructed and a strangulated hernia?
- Obstructed-> GI contents can't pass through | - Strangulated-> ischaemia of portion of bowel affected
157
Complications of inguinal herniotomy surgery?
- Infection of wound site - Recurrence - Mesh infection - Hydrocele - Intestinal damage - Bladder damage - Spermatic cord damage - Testicular infarction (secondary to blood vessel damage)
158
What line divides internal and external haemorrhoids?
Dentate line
159
What is sensitivity (of a test)?
- Number of people with the disease who test positive | - True +ves / true positives + false negatives
160
What is specificity (of a test)?
- Ability of a test to rule out a diagnosis/condition - Number of people without the disease who test negative - True negatives / true negatives and false positives
161
What should be done if testicular torsion is suspected?
Surgical exploration-> very limited time before necrosis of testicle
162
What does whirlpool sign on US/CT indicate?
Ovarian torsion
163
What are the layers of the testicle?
- Skin - Dartos fascia - External spermatic fascia - Cremaster muscle - Internal spermatic fascia-> tunica vaginalis - Tunica albuginea
164
When is nasopharyngeal airway contraindicated?
Suspected basal skull fracture
165
What would dull percussion of lung after stab wound indicate?
Massive haemothorax
166
How is massive haemothorax managed?
Wide bore chest drain
167
What is the definition of Barrett's oesophagus?
Metaplasia of squamous to columnar epithelium in the lower oesophagus
168
What does difficulty swallowing solids but not liquids indicate?
More likely a stricture (benign or malignant)-> if fluids difficult, would likely be motility disorder
169
Risk factors for oesophageal cancer?
- Smoking - Alcohol - Obesity - Achalasia - Barrett's oesophagus - Coeliac - Older age - Male - Family history
170
Why is left recurrent laryngeal palsy more common than on the right?
Longer course-> more risk of damage
171
Which laryngeal muscle isn't supplied by the recurrent laryngeal nerve?
Cricothyroid
172
What nerve supplies the cricothyroid muscle?
Superior laryngeal nerve
173
What can cause recurrent laryngeal nerve palsy?
- Tumour-> thyroid, larynx - Surgery - Idiopathic - Bulbar or pseudobulbar palsy
174
Symptoms of vocal cord palsy?
- Hoarse voice - Cough - SOB - Vocal fatigue
175
6P's of critical limb ischaemia?
- Pulseless - Paraesthesia - Pallor - Pain - Perishing cold - Paralysis
176
What causes critical limb ischaemia?
- Thrombosis - Embolism - Aortic dissection - Trauma - Iatrogenic - Intra-arterial drugs
177
When should limb salvage surgery be done in critical limb ischaemia and why?
- Within 6 hours | - Irreversible tissue ischaemia can occur within this time
178
How does heparin prevent blood clots?
Activates anti-thrombin III-> inactivates thrombin + factor Xa-> prevents clotting cascade from activating-> anticoagulant
179
Side effects/complications of heparin infusion?
- Frequent APTT monitoring + dose adjustment - Increased haemorrhage risk - Heparin-induced thrombocytopaenia - Long term-> osteoporosis
180
What is intermittent claudication a sign of?
Peripheral vascular disease
181
What could intermittent claudication + impotence + buttock pain be a sign of?
Internal iliac artery stenosis
182
Diagnostic investigations for intermittent claudication?
- US doppler - ABPI - CT/MRI angiogram
183
What is the pathway between the common femoral artery and the aorta?
Common femoral-> external iliac-> common iliac-> aorta
184
What is the diagnosis- Ashkenazi Jewish man, blisters erupting all over body (especially mouth), easily burst?
Pemphigus vulgaris
185
Tests in pemphigus vulgaris?
- Biopsy | - Autoantibodies screen
186
What causes pemphigus vulgaris?
Drug-induced or autoimmune
187
What is Nikolsky's sign?
Rub skin-> skin layers separate
188
How is pemphigus vulgaris treated?
Immunosuppression or high dose steroids
189
What are the types of melanoma?
- Superficial spreading - Nodular - Acral lentiginous - Letingo maligna
190
What is used to assess severity/prognosis of a melanoma?
Breslow thickness-> superficial to deep
191
Where can malignant melanoma occur?
- Skin - Choroid of eye - CNS - GI tract
192
How is hypertensive retinopathy classified?
Grade 1-4
193
What are some signs of severe hypertensive retinopathy?
- Silver wiring-> arteriolar constriction - AV nipping - Cotton wool spots - Exudates - Flame haemorrhages - Papilloedema
194
What are the findings in grade 2 hypertensive retinopathy?
- Silver wiring | - AV nipping
195
Differentials for loss of vision?
- Cataracts - Maculopathy - Retinal disease - Presbyopia - Optic neuritis - Vitreous haemorrhage - GCA - TIA - Retinal vein occlusion - Central retinal artery occlusion - Optic atrophy - Macular degeneration
196
Risk factors for cataracts?
- Older age - Diabetes - Eye trauma - Uveitis - Long term steroids - Smoking - Alcohol - Congenital - Myotonic dystrophy - Radiotherapy
197
Surgical treatment for cataracts?
Phacoemulsification
198
Complications of cataracts surgery?
- Early-> posterior capsule rupture | - Late-> posterior capsule opacification
199
What blood tests are routinely offered in pregnancy?
- FBC + Hb - Blood group + rhesus status - Rubella - Syphilis serology - Blood glucose - HIV - Hep B - Hb electrophoresis-> sickle cell
200
Why are sexual infections screened for in some pregnancies?
- Risk of prematurity - Vertical transmission - Neonatal conjunctivitis
201
What will a triple test for Down's syndrome show if positive?
- hCG-> increased - AFP-> decreased - Unconjugated oestriol-> decreased
202
Risk factors for gestational diabetes?
- Previous GDM - Previous macrosomia - Previous stillbirth - 1st degree relative with diagetes - Obesity - Race-> Asian, black Caribbean
203
Risks of diabetes in pregnancy?
- Congenital abnormalities - Premature labour - Foetal lung immaturity - Increased birth weight - Polyhydramnios - Shoulder dystocia - Birth trauma - Sudden foetal death
204
How is miscarriage managed medically?
Mifepristone + misoprostol
205
What are some complications of surgical evacuation of miscarriage?
- Cervix injury - Uterus perforation - Asherman's syndrome-> scarring of endometrium - Anaesthetic risks - Bleeding - Infection
206
What can cause recurrent miscarriage?
- Antiphospholipid syndrome - Infection - Cervical incompetence - Parental chromosome abnormality - Uterine abnormality-> large fibroids, bicornuate
207
What can be offered before hysterectomy in dysfunctional bleeding?
- Mirena coil | - Endometrial ablation
208
What can be used in Alzheimer's and how do they work?
- Anticholinergics-> donepezil or rivastigmine | - Inhibit acetylcholinesterase-> less ach broken down-> more available at synapse
209
What drugs might precipitate urinary incontinence?
- Diuretics | - Sedatives-> opiates, antipsychotics
210
Risk factors for stress incontinence?
- Childbirth - Multiparity - Pregnancy - Obesity - Chronic cough-> may be exacerbated by drugs (eg ACEis) - Chronic constipation
211
How does duloxetine help in stress incontinence?
- SNRI-> inhibits reuptake of noradrenaline at synapse - Increased NA available - Increases urethral sphincter tone
212
Complications of chronic alcohol abuse?
- Fatty liver - Hepatitis - Cirrhosis - Cognitive dysfunction - Seizures - Ataxia - Peripheral neuropathy - Hypertension - Strokes - Cardiomyopathy - Peptic ulcers - Pancreatitis - Oesophageal varices
213
How does disulfiram work?
- Blocks acetaldehyde dehydrogenase-> acetaldehyde not broken down - Builds up when ingest alcohol-> vomiting, tachycardia, headache, SOB - Aversion
214
Is bile present in vomit in pyloric stenosis?
No-> stenosis causes obstruction too high for bile to be present
215
Where is pylorus palpated during feeds in pyloric stenosis?
Lateral border or rectus in RUQ
216
What are the four sections of the stomach?
- Cardia - Fundus - Body - Pylorus
217
What are the risk factors for SUFE?
- Male - Age 10-15 - Obesity - Trauma - Chemo/radiotherapy - Hormone deficiency (eg GH)
218
What cartilage makes up the epiphyseal plate?
Hyaline cartilage
219
What is the normal length of a QRS complex?
<0.12s ie 2 small squares
220
What is a capture beat?
Normal QRS between VT complexes
221
What drugs may be used during cardiac arrest?
- Amiodarone - Adrenaline - Oxygen - Lidocaine
222
What ECG pattern might be seen due to digoxin use?
- Reverse tick pattern - ST depression - T wave inversion in V5-V6
223
What drugs are used to treat TB and how long for?
- Rifampicin (6 months) - Isoniazid (6 months) - Pyrazinamide (2 months) - Ethambutol (2 months)
224
Why are 4 different drugs used to treat TB?
To combat multi-drug resistance
225
What can cause erythema nodosum?
- Idiopathic - Crohn's - UC - Sarcoidosis - TB - Drugs-> OCP, sulphonamides - Streptococcal infection - Chlamydia - Leprosy
226
What organisms commonly colonise the lungs of people with CF?
- Pseudomonas aeruiginosa - Strep pneumoniae - H. influenzae
227
What can cause bronchiectasis?
- Idiopathic - CF - TB - Post-infective - Post-obstruction-> tumour, foreign body - Allergic aspergillosis - RA - UC - A1 antitrypsin deficiency - Congenital - Immunodeficiency
228
What is the diagnosis- elderly man, confused, fallen, raised U+Es, blood in urine, AKI?
Rhabdomyolysis due to prolonged immobility-> acute tubular necrosis
229
What blood test will be raised in rhabdomyolysis?
Creatinine kinase
230
What might be seen on urine microscopy in rhabdomyolysis?
Urinary myoglobin-> muddy brown/granular casts
231
What can cause rhabdomyolysis?
- Statins - Prolonged immobility - XS exercise - Crush injury - Burns - Seizures - Neuroleptic malignant syndrome
232
ECG changes in hyperkalaemia?
- Tall tented T waves - Flattened P waves - Prolonged PR interval - Widened QRS
233
What blood tests should be done in rapidly progressive glomerulonephritis?
- ANCA | - Anti-GBM
234
How might a diagnosis of Wegener's granulomatosis be confirmed?
Renal biopsy
235
What immunological blood tests might be positive in SLE?
- Anti-DsDNA - ANA - Antiphospholipid antibodies - Anti-Sm - RF
236
What skin changes might be present in SLE?
- Malar rash on face - Discoid rash - Photosensitive rash - Vasculitis rash
237
What are some features of SLE?
- CVD - Increased infections - Thrombocytopaenia - Pericarditis - Lupus nephritis - Arthralgia - Myalgia
238
How is SLE managed?
- NSAIDs - Steroids - Hydroxychloroquine - MTX - Azathioprine - Monoclonal antibodies
239
What can repeated episodes of hypoglycaemia lead to?
Lack of hypoglycaemia awareness
240
How can hypoglycaemia be prevented?
- Regular finger prick monitoring - Never miss a meal - Emergency supply of glucose in pocket - Adjust insulin appropriately in response to change in diet/activity/illness
241
What can cause hypoglycaemia in non-diabetic patients?
- Liver failure - Addison's - Insulin secreting tumours - Pituitary insufficiency
242
How does the oral glucose tolerance test work?
- Fast overnight - Give drink with 75g glucose - BMs before + 120 mins after - Diagnosis-> if >11.1mmol/L - Fasting blood glucose-> >7mmol/L - Don't drink coffee or smoke during fast
243
What can cause splenomegaly?
- Lymphoma - Malaria - Mononucleosis - Haemolytic anaemia - Myelofibrosis - Liver cirrhosis with portal HTN - Amyloidosis
244
How can acute and chronic leukaemia be differentiated on a blood film?
- Acute-> white cells in blast stage (immature) | - Chronic-> white cells mature + full spectrum of lineage
245
Main information for ALL?
- Most common in kids | - Associated with Down's
246
Main information for CLL?
- Most common leukaemia in adults overall - Associated with warm haemolytic anaemia - Ritcher's transformation into lymphoma - Smudge/smear cells
247
Main information for CML?
- 3 phases including asymptomatic chronic phase | - Philadelphia chromosome
248
Main information for AML?
- Most common acute adult leukaemia - Can be result of transformation from myeloproliferative disorder - Auer rods
249
What causes bone pain in haematological malignancy?
Bone marrow infiltration
250
What supportive treatment is needed pre-stem cell transplant?
- Blood transfusions-> anaemia symptoms - Platelet transfusions-> prevent haemorrhage - Prophylactic antibiotics - Counselling about treatment
251
What is the tumour marker sometimes present in pancreatic cancer?
CA19-9
252
What does having antibodies to hepatitis B core antigen (anti-HBC) signify?
Past infection
253
What does HBsAg (surface antigen) signify?
Active infection
254
What does HBeAg (E antigen) signify?
Viral replication-> high infectivity
255
What does HBcAb (core antibodies) signify?
Past or current infection
256
What does HBsAb (surface antibody) signify?
Vaccination or past or current infection
257
What does HBV DNA signify?
Direct count of viral load
258
What does bitemporal hemianopia with no endocrine symptoms signify?
Non-functional pituitary adenoma
259
Damage to what can lead to homonymous hemianopia?
- Optic radiations | - Occipital lobe
260
What sensations are conveyed by the spinothalamic tracts?
Pain, temperature, light touch
261
What sensations are conveyed by the dorsal columns?
Proprioception, vibration, deep touch
262
Where does the dorsal column decussate?
Medulla
263
How does Brown Sequard present?
- Ipsilateral spastic paralysis + loss of vibration and proprioception - Contralateral loss of pain and temperature
264
What modalities are conveyed by the corticospinal tracts?
Motor neurones
265
What is the gold standard for imaging in acute mesenteric ischaemia?
Angiography
266
What is the function of the red pulp of the spleen?
Filter and destroy faulty RBCs
267
What is the function of the white pulp of the spleen?
Lymphoid tissue + part of immune system
268
Indications for splenectomy?
- Splenic rupture - Neoplasia - Cysts - Abscess
269
What are patients at risk of post-splenectomy?
Encapsulated bacteria infection
270
What do patients require post-splenectomy?
- Antibiotic prophylaxis | - Vaccinations-> PCV, meningococcal, influenza
271
What are Howell-Jolly bodies?
- RBCs present post-splenectomy | - Nuclear remnant still seen
272
How does small bowel obstruction present differently to large bowel?
- Less abdominal distention | - Pain higher up in abdomen
273
What is in bile?
- Cholesterol - Bile salts - Bile pigment - Phospholipids - Water
274
What are the different types of gallstone?
- Cholesterol - Bile pigments - Mixed
275
What are the four lobes of the liver?
- Right - Left - Caudate - Quadrate
276
What ligament divides the anterior of the liver into the two anterior lobes?
Falciform ligament
277
Where do secondary liver cancers typically originate from?
- GI tract - Uterus - Lung - Breast
278
Tumour marker for HC cancer?
AFP
279
How do renal masses present?
- Moves up and down with respiration - Mass palpable on bimanual palpation - Can get above it
280
Risk factors for renal cell cancer?
- Increased age - Male - Smoking - Obesity - Hypertension - Long term dialysis - Hereditary papillary RCC - Von Hippel-Lindau syndrome
281
What is the gold standard investigation for renal colic?
CT-KUB
282
Where is the ureter narrowed and more prone to obstruction with stone?
- Pelvic-ureteric junction - Vesico-ureteric junction - Renal pelvis
283
Emergency intervention in pyelonephritis?
Percutaneous nephrostomy-> relief of obstruction
284
What is 'triple diagnosis'?
Physical, psychological and social
285
What management is indicated in kids <1 year with hydrocele?
Conservatively-> spontaneously resolves
286
What causes hydrocele?
Fluid in tunica vaginalis as derived from processus vaginalis (connected to embryonic peritoneum)
287
Risks associated with TURP?
- Retrograde ejaculation - Bladder neck stenosis - Haematospermia - TURP syndrome
288
What is TURP syndrome?
- Irrigation fluid from op enters IV space via prostatic bed - Expands IV space - Fluid overload and hyponatraemia
289
How does oxybutynin work?
Anticholinergic-> reduces spasmodic activity of detrusor
290
What can cause recurrent UTI in men?
- Urethral stricture - Prostatic enlargement - Indwelling catheter - Neuropathic bladder - Urinary tract surgery - Colovesical fistula - Immunosuppression
291
What organisms frequently cause UTI?
- E.coli - Klebsiella - Enterococcus - Staph saprophyticus
292
What can cause urethral stricture?
- Pelvic trauma - Perineal trauma - Urethral instrumentation - Foreign body - Gonorrhoea - Chlamydia - Long term catheter - Lichen sclerosis
293
How does urethral stricture present?
- LUTS - Divergent stream - Chronic retention - Overflow incontinence
294
Investigations for urethral stricture?
- Cystoscopy - Urinalysis - U+Es - Urodynamic testing - Endoluminal US
295
Complications of urethral stricture?
- Calculus formation - Chronic infection + prostatitis - Epididymitis - Renal impairment - Bladder diverticula
296
How does bladder diverticulum occur?
- Chronic increase in intravesical pressure - Bladder mucosa pushes through muscle layer - Chronic colonisation pseudomonas or E.coli
297
What is the unhappy triad?
Tear in ACL + medial collateral ligament + medial meniscus-> tight adherence
298
What imaging can be used to visualise meniscal tears?
Knee MRI
299
Where is an autograft taken from for ACL reconstruction?
Patella, hamstring or quadriceps tendon
300
What is the arterial supply to the head of the femur?
- Intramedullary vessels - Artery of ligamentum teres - Cervical vessels in joint capsule retinaculum
301
What is fractured in a Colle's fracture?
Distal radius (metaphysis)-> dorsal displacement + angulation
302
What is a Smith's fracture?
Distal radius-> volar displacement + angulation
303
What is a Bier's block?
Tourniquet applied + LA injected IV
304
How long does it take for a Colle's fracture to heal?
6-8 weeks
305
What classification system is used for open fractures?
Gustilo and Anderson classification
306
Complications of open fracture?
- Wound infection - Tetanus - Osteomyelitis - Nerve damage - Vascular damage - Malunion - Non-union - Compartment syndrome - Sepsis - DVT - Death
307
Where does the spinal cord terminate in adults?
L2/L3
308
Where does the spinal cord terminate in newborns?
L4/L5
309
What can cause cauda equina syndrome?
- Slipped intervertebral disc - Malignancy - Fracture - Haematoma
310
Who is more likely to develop OA?
Females
311
What can cause unilateral facial weakness?
- Bell's palsy - Ramsey Hunt syndrome - TIA - Hemiplegic migraine - Tumours - MS - Parotid tumour - Acoustic neuroma - Cerebellopontine angle lesions - GBS
312
What are the branches of the facial nerve?
- Temporal - Zygomatic - Buccal - Marginal mandibular - Cervical
313
Causes of vertigo?
- BPPV - Meniere's - Vestibular neuronitis - Acoustic neuroma - MS - Cholesteatoma - Trauma - Drugs-> gentamicin, diuretics, metronidazole
314
What bacteria causes otitis media?
- Strep pneumoniae - H.influenzae - Moraxella catarrhalis
315
What are the two portions of the eardrum called?
Pars flaccida + pars tensa
316
Main differential for vestibular schwannoma (acoustic neuroma)?
Meningioma
317
What are paranasal sinuses?
Air filled cavities in facial bones with connection to nasal cavity
318
What are the four paranasal sinuses?
- Sphenoid - Maxillary - Frontal - Ethmoidal
319
What epithelium lines the paranasal sinuses?
Ciliated and pseudostratified columnar epithelium
320
What causes maxillary sinusitis?
- Mostly bacterial infection (post-viral) - Dental rool infection - Diving/swimming in infected water - Trauma - Cancer
321
What percentage of salivary gland tumours are in the parotids?
80%
322
What is the commonest tumour of the parotid gland?
Pleomorphic adenoma
323
What criteria make up the ABCD2 score?
- Age - Blood pressure - Character of symptoms-> weakness (2) or speech without weakness (1) - Diabetes - Duration of symptoms-> >60 mins (2), 10-59 mins (1)
324
What are the risks of carotid endarterectomy?
- Can cause stroke/TIA - MI - Wound haematoma - Death
325
What structures are at risk of damage during carotid endarterectomy?
- Hypoglossal nerve - Vagus nerve - Ansa cervicalis - Internal jugular vein - Superficial cervical lymph nodes
326
What is an ulcer?
Abnormal break in epithelial surface
327
What is primary intention healing?
Wound edges approximated + healing of epidermis + dermis occur without penetration + epithelialisation of entire dermis-> small scars
328
What is secondary intention healing?
Wound open + allowed to granulate from bottom up-> scar large + takes longer to heal
329
What can be done for someone with recurrent DVTs?
IVC filter-> via femoral/jugular vein + traps clots (before gets to chest)
330
What are some indications for limb amputation?
- Major trauma - Venous disease - Gangrene - Lower limb primary malignant tumour - Gas gangrene - Uncontrolled sepsis - Necrotising fasciitis - Severely deformed joints (neuropathy) - Failed orthopaedic surgery
331
What should be considered during amputation surgery?
- Adequate blood supply to stump (healing) - Retain as many working joints as possible - Site between large joints-> prosthesis fitting
332
Muscles in lower leg?
- Gastrocnemius - Tibialis anterior - Peronei longus - Soleus
333
Complications of amputation?
- Wound infection - Stump ischaemia + non-healing - Failure to mobilise - Pressure sores - Cardiac events or CVAs
334
Stages of wound healing?
- Haemostasis-> platelets migrate + form platelet plugs - Inflammation-> release inflammatory cytokines, recruit macrophages + fibroblasts, extracellular matrix - Proliferation-> angiogenesis from endothelial cells + collagen production from fibroblasts - Remodelling-> collagen synthesis + destruction levels, scarring (myofibroblasts + surface re-epithelialises)
335
What conditions can cause varicose veins?
- DVT - Pregnancy - Pelvic tumours - Ovarian mass - AV malformation
336
Risk factors for varicose veins?
- Obesity - Prolonged standing - Pregnancy - COCP - Family history
337
Skin changes in venous disease/varicose veins?
- Eczema - Ulcers-> medial malleolus - Oedema - Haemosiderin staining - Lipodermatosclerosis
338
Where is the saphenovenous junction?
5cm below + medial to femoral pulse
339
Complications of varicose veins?
- Bleeding - Pain - Ulcers - Superficial phlebitis - Psychological
340
What should be done for a life threatening wound?
- Direct pressure - Elevation - Surgical advice
341
What is the femoral triangle?
- Inguinal ligament (superior) - Medial border to adductor longus (medial) - Medial border of sartorius (lateral)
342
What is in the femoral triangle?
Femoral artery, vein, nerve and lymphatics
343
Signs of vascular injury on exam?
- Profuse bleed - Absent/reduced distal pulses - Expanding/pulsatile mass - Audible thrill over mass
344
Investigation for major artery laceration repair?
On table arteriogram
345
What is Bowen's disease?
SCC in situ
346
Differentials for SCC?
- BCC - Malignant melanoma - Keratoacanthoma - Pyogenic granuloma - Solar keratosis - Warts
347
What sites of SCC have the worst prognosis?
Ear and lip
348
Appearance of shingles?
- Vesicular - Crusting - Erythematous - Swollen plaques - Dermatomal
349
Common chronic complication of shingles?
Post-herpatic neuralgia
350
Grades of pressure sores?
I-> non blanching erythema over intact skin II-> partial thickness skin loss III-> full thickness skin loss + into SC fat IV-> destruction including muscle, bone or supporting tissue
351
Differentials for white atrophic area around anogenital area?
- Lichen sclerosus - Scleroderma - Vitiligo - SCC - Bowen's disease - Lichen planus - Vulval intraepithelial neoplasia
352
How is lichen sclerosus managed?
- Topical steroids - Topical emollients - Lubricants
353
Complications of lichen sclerosus?
- SCC - Constipation - Dyspareunia - Vulvodynia - Uropathy - Scarring
354
How is BCC managed?
Moh's micrographic surgery-> removed in layers + histologically analyse
355
Advice to give to people with acne?
- Will likely grow out of it around age 20 - Wash face with soap and water twice daily - Not to do with health
356
Side effects of isotretinoin?
- Depression - Teratogenicity - Dry skin + lips - Migraine
357
Upper limit of normal for intraocular pressure?
21mmHg
358
What is gonioscopy?
- Measured iridocorneal angle | - Helps distinguish between open + closed angle glaucoma
359
What's important to check in open angle glaucoma?
Optic disk-> check for cupping
360
Risk factors for open-angle glaucoma?
- Older age - Family history - Myopia - Race-> black - Intraocular HTN
361
How is open-angle glaucoma managed?
- Latanoprost (prostaglandin analogue) - Timolol (beta-blocker) - Pilocarpine (sympathomimetics) - Azetazolamide (carbonic anhydrase inhibitor) - Trabeculotomy
362
How does latanoprost work?
- Prostaglandin analogue | - Increase uveoscleral outflow
363
How does timolol work?
- Beta blocker | - Reduces aqueous humour production
364
How does azetazolomide work?
- Carbonic anhydrase inhibitor | - Reduce aqueous humour production
365
How does pilocarpine work?
- Sympathomimetic - Reduce aqueous fluid production - Increase uveoscleral outflow
366
Symptoms of macular degeneration?
- Central visual field loss - Reduced acuity - Crooked/wavy appearance to straight lines - Wet-> acute
367
Features on fundoscopy of macular degeneration?
- Reduced acuity - Scotoma (central vision loss) - Drusen on fundoscopy - Wet-> choroidal neovascularisation, leaky vessels
368
Treatment for wet macular degeneration?
- Anti-VEGF (intravitreal) - Photodynamic therapy - Laser photocoagulation
369
General advice for patients with macular degeneration?
- Inform DVLA - Stop smoking - Green veg - Won't cause complete blindness
370
Causes of painless loss of vision?
- Retinal detachment - Vitreous haemorrhage - Central retinal artery occlusion - Retinal vein occlusion - CVA
371
Symptoms of retinal detachment?
- Visual field loss - Flashes - Floaters - Acuity loss
372
Is hypermetropia or myopia a risk factor for retinal detachment?
Myopia-> retina thinned as stretched over large area
373
How is retinal detachment managed?
- Vitrectomy + replacement - Cryotherapy - Laser therapy - Scleral buckle
374
Risk factors for acute closed angle glaucoma?
- Family history - Female - Hypermetropia - Older age
375
Examination findings in acute closed-angle glaucoma?
- Decreased acuity - Hazy cornea - Large fixed dilated pupil - Increased intraocular pressure - Circumcorneal injection (red)
376
Why is acuity decreased in acute closed angle glaucoma?
Corneal oedema
377
Why are the symptoms of acute closed-angle glaucoma improved during sleep?
Pupil constricts-> pulls peripheral iris out of angle
378
What should you examine when central retinal artery occlusion is suspected?
- BP - Carotids for bruit - Murmurs - Pulse for AF
379
Classical finding on fundoscopy for central retinal artery occlusion?
- Pale retina | - Cherry red spot
380
What is Hutchinson's sign in shingles?
- Shingles on end of nose - Nasocillary nerve affected - Likely corneal involvement-> loss of sensation means vulnerable to abrasion
381
What should be tested in ophthalmic shingles?
Corneal sensation-> may be affected + vulnerable to ulceration
382
When does puerperal psychosis present?
3-5 days (always <2 weeks)
383
How likely is puerperal psychosis to recur?
50% chance in next pregnancy
384
Risk factors for post-partum depression?
- Previous history - Previous depression or bipolar - Lack of social support - Marital/partner relationship problems - Recent stressful events
385
What medical problem should be considered in people presenting with post-partum depression?
Post-partum thyroiditis
386
What causes baby blues?
- Psychosocial | - Hormones
387
Risk factors for pre-eclampsia?
- Nulliparity - Multiple gestation - Previous history - Family history - Diabetes - Pre-existing HTN - Older age - Obesity - Antiphospholipid syndrome - AI disease
388
How is magnesium sulphate toxicity monitored?
Reflexes checked
389
Signs of chorioamnionitis?
- Mum-> pyrexia, tachycardia, hypotension, discharge, tenderness - Foetus-> tachycardia
390
Components of Bishop score?
- Cervical dilatation - Position of cervix - Effacement of cervix - Consistency of cervix - Station of foetal head
391
Why is left DVT more common than right DVT in pregnancy?
Gravid uterus puts more pressure on left iliac vein-> slower venous return
392
What blood tests should be done in suspected obstetric cholecystitis?
- LFTs | - Bile acids
393
How should obstetric cholestasis be managed?
- Ursodeoxycholic acid - topical emollients - antihistamines - induction of labour
394
Risk factors for shoulder dystocia?
- Previous dystocia - High maternal BMI - Large foetus - Diabetes - Prolonged 1st or 2nd stage of labour - Oxytocin augmentation - Secondary arrest
395
Manoeuvres in shoulder dystocia?
- McRoberts-> hyperflexion of maternal legs | - Suprapubic pressure
396
Components of APGAR score?
- Appearance - Pulse rate - Grimace reflex - Activity (tone) - Respiratory effort
397
Risk factors/causes of cord prolapse?
- Abnormal lie - Polyhydramnios - Prematurity - Foetal abnormalities - Abnormal placentation - Artificial rupture of membranes - Breech - Unengaged presenting part
398
What should be done during cord prolapse?
- Pressure off cord by lifting baby's head | - Emergency C section
399
Why might pregnant people have anaemia?
Normal + physiological
400
What can cause ejection systolic murmur in pregnancy?
Hyperdynamic circulation-> normal
401
How do pregnant people increase their oxygen intake?
Increase tidal volume
402
What are some contraindications to foetal blood sampling?
- Maternal infection - Foetal blood disorder - Prematurity - Abnormal presentation
403
What should happen if someone is shown to have dyskaryosis on smear?
Colposcopy referal
404
What is ectropion?
Endocervical columnar epithelium (not normal squamous) outside of external os
405
What is CIN?
Premalignant-> abnormally dividing cells don't invade below basement membrane
406
What does LLETZ stand for?
Large loop excision of the transition zone
407
What is a dermoid cyst?
Derived from primitive germ cells-> can differentiate into any body tissue + low risk of malignancy
408
Where is endometriosis likely to occur?
- Ovary - Rectovaginal pouch - Uterosacral ligament - Pelvic peritoneum - Umbilicus - Lower abdominal scars - Lung
409
Risk factors for endometriosos?
- AGe - IUD use long term - Smoking - Family history
410
Symptoms of endometriosis?
- Dysmenorrhoea - Chronic pelvic pain - Cyclical + radiate to legs - Dyspareunia - Dysuria - Pain on defecation - Rectal bleeding - Diarrhoea - Haematuria
411
What is adenomyosis?
Endometrial tissue in myometrium
412
Treatments for endometriosis?
- Analgesia eg NSAIDs - COCP - POP - Mirena coil - GnRH agonists - Laparoscopy + excision/ablation of deposits - Hysterectomy + bilateral salpingo-oophorectomy
413
Blood tests for ovulatory function?
- LH - FSH - Oestradiol - 21 day progesterone - Prolactin
414
Tests for tubal patency?
Hysterosalpingogram
415
Symptoms of PCOS?
- Hirsuitism - Weight gain - Acne - Amenorrhoea - Infertility - Diabetes symptoms
416
treatment for PID?
IV ceftriaxone + doxycycline +/- metronidazole
417
Contraindications to IUD?
- Pregnancy - STI - Cancers-> ovary, endometrium, cervical
418
What can cause post-menopausal bleeding?
- Endometrial cancer - Endometrial hyperplasia - Polyps - Fibroids - Cancers-> vagina, cervix, ovary - Trauma - Infection
419
What is red degeneration of fibroids?
- Ischaemia, infarction and necrosis of fibroid - Usually larger + during late pregnancy - Severe abdo pain + low grade fever
420
Initial radiological investigation for post-menopausal bleeding?
TVUS of pelvis
421
Treatment of endometrial cancers confined to uterus + cervix?
- Chemo - Hormone-> medroxyprogesterone acetate - Radiotherapy
422
Where do endometrial cancers metastasise to?
- Liver - Bone - Inguinal LNs - Vagina - Peritoneum - Lung
423
How does warfarin work?
- Inhibits reductase enzyme responsible for regeneration of active vitamin K - Inhibits production of vitamin K dependent clotting factors-> 2, 7, 9, 10 - Vitamin K antagonist
424
Contraindications to thrombolysis?
- Age <18 or >80 - Haemorrhagic stroke - SAH - Active bleeding - Major surgery within 14 days - GI bleed in last 21 days - Thrombocytopaenia - Pregnancy - Systolic BP >185 - Previous intracranial haemorrhage - Neurosurgery in last 3 months - Recent LP - Hypoglycaemia
425
Myeloma screen components?
- Urine Bence-Jones protein | - Serum electrophoresis
426
Abnormality on X-rays in myeloma?
Lytic lesions
427
How is spinal cord compression managed?
- Surgery | - Radiotherapy
428
How is hypercalcaemia managed?
- IV fluids | - IV bisphosphonates
429
Palliative care symptoms and management options?
- Pain-> morphine - Agitation-> midazolam - Respiratory secretions-> glycopyrronium bromide - Nausea-> cyclizine - Dyspnoea-> morphine
430
Risk factors for schizophrenia?
- Family history - Male - Obstetric/prenatal events (eg low birth weight) - Perinatal infection - Cannabis use - Asian or African - Poor social situation
431
What is a delusion?
- False held believe with strong conviction despite evidence against it - Not in keeping with person's social + cultural background
432
Negative symptoms of schizophrenia?
- Apathy - Reduced speech - Blunted affect - Social withdrawal
433
What are acute dystonic reactions?
- Secondary to antipsychotics | - Dopamine form substantia nigra blocked-> Parkinsonism occurs
434
What affect does dopamine have on prolactin?
Inhibits prolactin release
435
What BMI supports a diagnosis of anorexia?
<17.5
436
What can be done if someone presents within 1 hour of paracetamol overdose?
- Activated charcoal-> large surface area to absorb poison + stop absorption - Gastric lavage
437
How does NAC work?
- NAPQI metabolite detoxified by conjugation with glutathione - Overdose-> glutathione reserves depleted - NAC-> gives liver enough glutathione to break NAPQI into form that can be excreted
438
What blood tests should be done after paracetamol OD treatment?
- Clotting studies - LFTs - U+Es - ABG for blood pH
439
Worrying features of self harm that put patient at high likelihood of completed suicide?
- Intention of attempt was death - Current psych illness - Poor social resources - Previous attempts - Social isolation - Male - Unemployed - Over 50
440
What detox programmes are available for opioid addiction?
- Methadone - Psych-> group therapy etc - Rapid detox with naltrexone
441
How does CBT work in anxiety?
- Identifying situations that provoke anxiety - Recognition that thoughts are causing panic attacks and aren't correct - Alter negative cognitions - Coping mechanisms to deal with situations
442
How does graded exposure therapy work in GAD/OCD?
- Therapist evaluates unpleasant effects of stimuli - Exposes patient at increased levels - Calms patient down with coping mechanisms - Allow patient to function in unpleasant situation
443
What might cause jaundice in first 24 hours of life?
- Always abnormal - Rhesus haemolytic disease - ABO incompatibility - Hereditary sphenocytosis - G6PD deficiency - Haematomas - Toxoplasmosis - Syphilis - Rubela - CMV - Herpes - Hepatitis
444
Investigations for neonatal jaundice (<24 hours of life)?
- FBC - Bilirubin - Blood group - Direct Coomb's - Blood film - TORCH screen - Urine-reducing substances - Urine dip + microscopy
445
What should be suspected when baby has prolonged jaundice + pale stools + raised conjugated bilirubin?
Biliary atresia
446
Causes of acyanotic heart disease?
- ASD - VSD - PDA - Coarctation of aorta
447
Causes of cyanotic heart disease?
- Teralogy of Fallot - Transposition of great arteries - Tricuspid atresia - Pulmonary atresia
448
What is Eisenmenger's syndrome?
Left to right shunt-> pulmonary HTN + shunt reversal-> cyanotic heart defect
449
What are the risk factors of infant respiratory distress syndrome?
- Prematurity - Maternal diabetes - C-section - Male - Hypothermia - Family history
450
What cells produce surfactant in the lungs?
Type II pneumocytes
451
CXR findings in infant respiratory distress syndrome?
Diffuse granular or ground glass shadowing
452
What is a complex febrile seizure?
- Lasts 15+ mins - Recurrence within 24 hours - Incomplete recovery within 1 hour - Focal neurology
453
What is cerebral palsy?
Chronic disorder of movement and posture due to non-progressive brain abnormalities occurring before the brain is fully developed
454
What are the different types of cerebral palsy?
- Spastic - Athetoid - Ataxic - Mixed
455
Signs and symptoms of cerebral palsy?
- Delayed milestones - FTT - Epilepsy - Urinary incontinence - Constipation - Drooling - Sleep disturbance - Contractures
456
What medications can help with muscle spasm in cerebral palsy?
- Baclofen - Diazepam - Dantrolene
457
X-ray findings in intussussception?
- Target sign - RUQ opacity - Dilated gas filled proximal bowel - Absence of gas in distal bowel - Fluid levels - Perforation
458
Indications for laparotomy in intissusseption?
- Perforation - Peritonitis - Prolonged - Failed enema - High likelihood of pathological cause
459
How do statins work?
Inhibits HMG-CoA reductase (rate limiting step in cholesterol synthesis)
460
Signs of hypercholesterolaemia on examination?
- Xanthelasmata - Tendon xanthoma - Corneal arcus - Other xanthomatas
461
What can cause AF?
- Pneumonia - MI - PE - Hyperthyroidism - Alcohol XS - Heart failure - Endocarditis
462
What is cardioversion (for AF)?
- Medical-> amiodarone, flecainide - Electrical-> DC cardioversion - Ablation
463
Complications of AF?
- Stroke - TIA - Heart failure - Systemic emboli - Falls
464
What organism usually causes infective endocarditis?
Streptococcus viridans-> 50-80%
465
Why is urine dipstick done in infective endocarditis?
Check for microscopic haematuria
466
What are Roth spots?
- Boat shaped retinal haemorrhage with pale centre | - In infective endocarditis
467
What criteria is used to diagnose infective endocarditis?
Duke criteria
468
Signs of aortic regurgitation?
- Early diastolic murmur - Austin-Flint murmur - Collapsing pulse - Wide pulse pressure - Displaced apex beat - Corrigan's sign-> carotid pulsation
469
How are blood cultures taken in infective endocarditis?
Three sets from different sites three different times
470
Risk factors for infective endocarditis?
- IVDU - Rheumatic heart disease - Prosthetic valves - PDA - VSD - Coarctation - MV disease - Aortic valve disease
471
How can infective endocarditis be prevented in IVDUs?
- Education on needle use and sterile techniques | - Prophylactic antibiotics before invasive procedures
472
Investigations for PE?
- Well's score - D-dimer - CTPA - V/Q perfusion scan
473
How does SVC compression present?
- Worsening SOB - Severe headache - Swelling in arms + legs - Dilated neck veins (non-pulsatile) - Positive Pemberton's test - Known malignancy or lymphoma
474
What is Pemberton's test?
- Raise arms above head - JVP raises, SOB/stridor, cyanosis in face - Indicates SVC compression
475
How does pulmonary fibrosis show on CXR?
- Reduced lung volume - Reticulonodular shadowing (worse in lower zones) - Honeycomb lung (advanced)
476
What respiratory diseases can cause clubbing?
- Pulmonary fibrosis - Bronchiectasis - Chronic abscess - Chronic empyema - Lung cancer - Mesothelioma - Cryptogenic organising pneumonia
477
What questionnaire can be used to assess obstructive sleep apnoea?
Epworth sleepiness scale/score
478
CXR findings in cor pulmonale?
- Dilatation of right atrium - Enlarged RV - Prominent pulmonary arteries
479
ECG changes in cor pulmonale?
- Right axis deviation - P pulmonale - Dominant R wave in V1 - Inverted T waves in chest leads
480
What can cause bilateral hilar lymphadenopathy?
- Lung cancer - Lymphoma - TB - Mycoplasma - Extrinsic allergic alveolitis
481
What is seen on biopsy in sarcoidosis?
Non-caseating granulomas
482
Extra-pulmonary signs of sarcoidosis?
- Erythema nodosum - Ocular-> anterior uveitis, posterior uveitis - Arthralgia - Neuropathy - CN palsy - Cardiomyopathy - Ventricular dysrythmias - Lymphadenopathy - Hepatosplenomegaly - Hypercalcaemia
483
Why should pleural tap (for effusion) be done above the rib?
Avoid neurovascular bundle (immediately beneath ribs)
484
If pleural fluid has high protein content, is it exudate or transudate?
Exudate
485
If pleural fluid has high LDH content, is it exudate or transudate?
Exudate
486
What lab tests should be performed on pleural fluid?
- Protein - LDH - MC & S - Cytology - Glucose - Amylase - PH - Ziehl-Neelsen staining
487
What is pleurodesis?
- Done in malignant pleural effusion - Drain effusion then plug gap - Can use talc, bleomycin, tetracycline
488
What is nephrotic syndrome?
- Proteinuria (>3g/24 hours) - Hypoalbuminaemia (<30g/L) - Oedema
489
Most common nephrotic syndrome in kids?
Minimal change disease
490
Most common nephrotic syndrome in adults?
Membranous nephropathy
491
Complications of nephrotic syndrome and their management?
- Increased infections-> antibiotics when suspected, PCV - Thromboembolism risk-> anticoagulation, avoid prolonged bed rest - Hyperlipidaemia-> statins
492
Dietary advice in nephrotic syndrome?
Normal protein level + low salt diet
493
What is the risk of correcting chronic hyponatraemia too quickly?
Central pontine myelinolysis
494
How does ADH work?
- Recruits aquaporin 2 channels to apical membrane of principal cells of collecting duct - Makes it water permeable-> reduced secretion and increases water retention
495
What does SIADH cause (in terms of blood and urine osmolality)?
- Euvolaemic hyponatraemia | - Increased urine osmolality-> more concentrated
496
What is used to treat SIADH?
- Strict fluid restriction | - Demeclocycline
497
Risk factors for UTI?
- Female - Pregnancy - Diabetes - Renal calculi - Long term catheter - Immunosuppression - Post-menopause - Sexually active - Spermicide - Incontinence - Poor hygiene
498
Contraindications to renal biopsy?
- Abnormal coagulation - Single functioning kidney - Systolic BP >160 - Diastolic BP >90 - CKD with small kidneys
499
Complications of renal biopsy?
- Macroscopic haematuria - Haematuria needing blood transfusion, angiography or nephrectomy - Pain - Haematoma - AV aneurysm formation - Infection - Death
500
What is heliotrope?
- Purple discolouration to eyelids | - In dermatomyositis
501
What are Gottron's papules?
- Rough, red papules over knuckles | - In dermatomyositis
502
What autoantibodies are associated with dermatomyositis?
- RF - ANA - Anti-Jo-1 - Anti-Mi-2
503
What can cause Raynaud's phenomenon?
- Raynaud's disease - SLE - RA - Dermatomyositis - Polymyositis - Ehler Danlos - Beta blockers - Polycythemia rubra vera - Occupation - MGUS - Hypothyroid - Atherosclerosis - Buerger's disease
504
What are the features of CREST syndrome (limited cutaneous systemic sclerosis)?
- Calcinosis - Raynaud's - Oeseophageal dysmotility - Sclerodactyly - Telangiectasia
505
Radiograph findings in ankylosing spondylitis?
Bamboo spine-> - calcification of intervertebral ligaments - fusion of spinal facet joints - formation of bridging syndesmophytes
506
Eye problem common in ankylosing spondylitis?
Anterior uveitis
507
Common lung finding in ankylosing spondylitis?
Fine inspiratory creps-> pulmonary fibrosis
508
Common heart sound in ankylosing spondylitis?
Aortic regurgitation-> early diastolic murmur
509
What is arthritis mutilans?
- Periarticular osteolysis and shortening of bones | - Severe form of psoriatic arthritis
510
What usually triggers reactive arthritis?
- STI | - Gastroenteritis
511
What is Reiter's syndrome?
Arthritis + urethritis + conjunctivitis
512
What are examples of ANCA +ve small vessel vasculitis?
- Wegener's granulomatosis - Microscopic polyangiitis - Churg-Strauss syndrome
513
What are examples of ANCA -ve small vessel vasculitis?
- HSP - Goodpasture's disease - Cryoglobulinaemia
514
What are examples of medium vessel vasculitis?
- Kawasaki disease | - Polyarteritis nodosa
515
What are examples of large vessel vasculitis?
- Temporal arteritis (GCA) | - Takayasu's arteritis
516
What systemic diseases can cause vasculitis?
-RA -SLE -IBD -Scleroderma -Bechet's -Hep B+C Polymyositis -Dermatomyositis -Infective endocarditis
517
What can cause mononeuritis multiplex (2+ peripheral nerves)?
- RA - Diabetes - HIV/AIDS - Sarcoidosis - Polyarteritis nodosa - Leprosy - Wegener's granulomatosis
518
What bedside test can confirm DKA?
Urine dipstick-> urinary ketones
519
What are some features of Addison's disease (primary adrenal insufficiency)?
- Fatigue - Nausea - Abdominal cramps - Reduced libido - Bronze hyperpigmentation - Hypotension
520
What causes bronze hyperpigmentation in adrenal insufficiency?
ACTH stimulates melanocytes to produce melanin
521
What blood results would you expect in Addisonian crisis?
- Hypotensive - Hyperkalaemic - Hypoglycaemic - Hyponatraemia
522
What test is diagnostic for Addison's disease?
Synacthen test -Give artificial ACTH -Measure cortisol at 30 + 60 minutes -Failure to rise less than double the baseline-> Addison's -Long test-> no cortisol response as adrenals don't work (Addison's) or eventually rise (adrenal atrophy ie secondary)
523
What U+E test results will be apparent in Addison's?
- Hyponatraemia | - Hyperkalaemia
524
What is prescribed in Addison's disease?
- Glucocorticoids-> hydrocortisone | - Mineralocorticoids-> fludrocortisone
525
Imaging for prolactinoma?
MRI head
526
What treatments can be used in prolactinoma?
- Dopamine agonists-> cabergoline or bromocriptine - Radiotherapy - Surgery
527
Blood results for primary hyperparathyroidism?
- PTH high - Calcium high - Phosphate low
528
Bloods for secondary hyperparathyroidism?
- PTH high - Calcium low/normal - Phosphate high/normal
529
Bloods for tertiary hyperparathyroidism?
- PTH high - Calcium high - Phosphate high
530
Complications of parathyroid gland resection?
- Hypoparathyroidism | - Laryngeal nerve palsy
531
What does vitamin D do to calcium?
Needed to absorb calcium in the gut
532
What sensory modality is lost first in diabetic neuropathy?
Vibration
533
What might be seen on diabetic foot exam?
- Blunted sensation - Charcot's joints (deformity) - Painless ulcers - High arched foot - Toe clawing - Diminished reflexes
534
What types of neuropathy occur in diabetics?
- Symmetrical polyneuropathy - Autonomic neuropathy - Diabetic amyotrophy - Mononeuropathy - Mononeuritis multiplex - Acute painful neuropathy
535
What is the diagnosis- diabetic with neuropathy presenting with intractable vomiting?
Autonomic gastroparesis
536
What type of transfusion reaction might be happening- 15 minutes in, temperature of 38.4, BP drop?
- Acute haemolytic reaction | - Bacterial contamination
537
Early complications of blood transfusion?
- Acute haemolytic reaction - Bacterial contamination - Allergic reaction - Anaphylaxis - Transfusion related acute lung injury - Fluid overload - Non-haemolytic febrile transfusion reaction
538
Late complications of blood transfusion?
- Iron overload - Graft versus host disease - Post transfusion purpura - Infection
539
What is a massive blood transfusion?
Entire blood volume (or 10 units) transfused within 24 hours
540
What might cause megaloblastic macrocytic anaemia?
- B12 deficiency - Folate deficiency - Cytotoxic drugs
541
What might cause normoblastic macrocytic anaemia?
- Alcohol - Liver disease - Hypothyroidism - Pregnancy - Reticulocytosis
542
How is pernicious anaemia diagnosed?
- FBC - Parietal cell antibody serology - Intrinsic factor antibody serology - Schilling test
543
Signs of thalassaemia?
- Hypochronic microcytic anaemia - Hepatosplenomegaly - Frontal bossing - Jaw enlargement - Dental malocclusion - Flow murmur - Pallor - Tachycardia
544
How is beta-thalassaemia major managed?
- Blood transfusions - Iron chelation therapy-> desferrioxamine - Genetic counselling
545
What can cause acute presentations of limb pain after minor injury in Haemophilia A?
Compartment syndrome
546
What causes joint deformity in haemophilia A?
Spontaneous bleeds into joints
547
What clotting factor is affected in haemophilia A?
Factor VIII
548
What would clotting studies look like in Haemophilia A?
- INR normal | - APTT raised
549
Why might someone be diagnosed with haemophilia A at an older age?
Acquired disease
550
Hereditary causes of liver cirrhosis?
- Haemochromatosis - Wilson's disease - Alpha-1-antitrypsin deficiency
551
Acquired causes of liver cirrhosis?
- Chronic alcohol abuse - Chronic viral hepatitis - Autoimmune hepatitis - Primary biliary cirrhosis - Venous obstruction - Idiopathic
552
How is the synthetic function of the liver tested for?
- Albumin | - INT or PT
553
How is ascites managed?
- Fluid restriction - Low sodium diet - Diuretics - Abdominal paracentesis-> drainage - Albumin infusion
554
What lab tests should be done for ascitic fluid?
- WCC - MC&S - Cytology - Albumin - LDH - Glucose
555
Why are laxatives given in hepatic encephalopathy?
Increase bowel transit-> reduce number of nitrogen producing bacteria in gut (contributes to encephalopathy)
556
How does coeliac disease present?
- Abdominal pain - Weight loss - N+V - Diarrhoea - Steatorrhoea - Fatigue - Iron deficiency anaemia - Osteomalacia - FTT - Infertility - IgA deficiency - Dermatitis herpetiformis
557
Why might anti-EMA antibodies be negative in coeliac disease?
Severe malabsorption-> IgA deficiency (+other proteins)
558
Histological features of coeliac disease?
- Villous atrophy - Increased intraepithelial lymphocytes - Hypoplasia of small bowel architecture - Proliferation of crypts of Lieberkuhn
559
Cancers associated with coeliac disease?
- GI T-cell lymphoma - Enteropathy associated T-cell lymphoma (EATL) - NHL - Gastric - Oesophageal - Small bowel
560
Where do colorectal cancers usually metastasise to?
- Lymphatics - Local invasion - Liver - Lung - Bone
561
What organisms commonly cause meningitis in young adults?
- Neisseria meningitidis | - Streptococcus pneumoniae
562
Why might CT head be done before LP in meningitis?
To rule out raised intracranial pressure
563
Which muscles does the median nerve supply?
LLOAF - Lateral lumbricals (2) - Opponens pollicis - Abductor pollicis brevis - Flexor pollicis brevis
564
What are some risk factors for carpal tunnel syndrome?
- Pregnancy - Repetitive activity - Menopause - OCP - Obesity - Trauma - Diabetes - Hypothyroidism - RA - Acromegaly - Amyloidosis - Dialysis - Local compression-> lipoma, ganglion
565
Management options for Parkinson's?
- Levodopa + co-careldopa etc - Bromocriptine or cabergoline-> dopamine agnonists - Selegiline or rasagiline-> monoamine oxidase-B inhibitors - Entacapone-> COMT inhibitors
566
What can be used to medically manage raised intracranial pressure?
- IV mannitol | - Dexamethasone
567
What is Beck's triad?
- Falling BP + rising JVP + muffled heart sound | - Indicates cardiac tamponade
568
How is tension pneumothorax managed?
- Wide bore cannula | - 2nd IC space, midclavicular line, affected side
569
What can cause pneumothorax?
- Idiopathic - Trauma - Asthma - COPD - Lung cancer - Pneumonia - Lung abscess - TB - Sarcoidosis - Barotrauma - CF - Connective tissue disorders - Iatrogenic-> mechanical ventilation, CVP line insertion
570
How long does it take for PTX to resorb?
1.25% of radiographic lung volume per day
571
How long should patients refrain from flying after pneumothorax?
1 month after symptoms + PTX resolved
572
Signs on examination in PCKD?
- HTN - Palpable kidneys (large + irregular) - Hepatomegaly - Mitral valve prolapse-> late diastolic murmur
573
Complications of PCKD?
- Berry aneurysms - Chronic renal failure - HTN - Renal calculi - Cyst infection - Chronic pain - Hepatic cysts - Haematuria
574
What is Cushing's disease?
Hypersecretion of ACTH from pituitary adenoma
575
What images should be requested in someone with Cushing's syndrome?
- MRI brain - CT abdo - CXR
576
How is Cushing's syndrome investigated?
- Dexamethasone suppression test | - 24 hour urinary cortisol
577
Why might someone with acute epigastric pain need a CXR?
Check for pneumoperitoneum
578
What are some components of the Glasgow score for pancreatitis?
- pO2 <8kPa - Age 55+ - Neutrophils (WBCs >15) - Corrected calcium <2 - Urea >16 - Enzymes (LDH >600 or AST/ALT >200) - Albumin <35g/L - Glucose >10mmol
579
What is Cullen's sign?
Bruising around umbilicus-> intra-abdominal bleeding in pancreatitis
580
What is Grey Turner's sign?
Bruising along flanks-> intra-abdominal bleeding in pancreatitis
581
What tumour is associated with myasthenia gravis?
Thymoma
582
What investigations can aid diagnosis of myasthenia gravis?
- Acetylcholine receptor antibody - Anti-MuSK - Tensilon test - Neurophysiology studies - Muscle biopsy - CT/MRI for thymoma
583
Treatment options for myasthenia gravis?
- Acetylcholinesterase inhibitors-> neostigmine, pyridostigmine - Immunosuppression-> prednisolone, azathioprine, ciclosporin - Plasmapheresis - IV Igs - Thymectomy
584
What can cause a midline neck mass?
- Thyroglossal cyst - Dermoid cyst - Chondroma - Thymus mass
585
How do thyroglossal cysts arise?
- Thyroid develops at foramen caecum - Migrate to base of neck - Connect to tongue by thyroglossal duct - Cysts can arise anywhere on pathway
586
What medical management can be given in PPH?
- Ergometrine - Oxytocin - Carboprost - Haemabate
587
What is a cystocele?
A prolapse of the anterior vaginal wall containing bladder
588
What is a rectocele?
Prolapse of rectum into the posterior vaginal wall
589
What investigation should be done in incontinence with prolapse?
Urodynamic studies
590
What medical treatments can be used in urge incontinence?
Antimuscarinics-> oxybutynin, solifenacin, tolterodine
591
What proportion of Caucasians are carriers of cystic fibrosis?
1 in 25
592
What are some pulmonary complications of cystic fibrosis?
- Recurrent chest infections - PTX - Bronchiectasis - Pulmonary HTN - Aspergillus - Nasal polyps
593
What are some GI complications of cystic fibrosis?
- Cirrhosis - Pancreatitis - Intestinal blockage-> constipation, obstruction, intussusception - Reflux - Meconium ileus
594
What are the possibly modalities of sustaining burns?
- Thermal injury - Electricity - Chemicals - Radiation
595
How can the extent of burns be assessed?
- Wallace rule of nines | - Lund and Browder chart
596
What are the features of superficial burns?
- Pain - Blisters - Erythema - Brisk capillary refill
597
What are the features of full-thickness burns?
- Painless - No blisters - White/grey/black - Absent cap refill
598
What is the Parkland formula (ie how much IV Hartmann's to give to someone with burns over 24 hours)?
4 x body weight (kg) x body surface area affected (%)
599
How is administration of fluid divided over 24 hours in burns treatment?
- 1/2 given over 8 hours | - 1/2 given over 16 hours

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