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Stuff Flashcards

1
Q

What is Increased Intracranial Pressure (IICP)?

A

A condition where there is an increase in pressure within the skull.

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2
Q

What are the symptoms of IICP compared to shock?

A

Symptoms of IICP are opposite of shock.

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3
Q

What is the effect of IICP on systolic blood pressure?

A

Increased systolic blood pressure (↑ Systolic B/P).

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4
Q

What is Cushing’s triad?

A

A clinical syndrome characterized by hypertension, bradycardia, and irregular respirations.

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5
Q

What are the components of Cushing’s triad?

A

Pulse, respirations, and blood pressure.

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6
Q

What happens to blood pressure in shock?

A

Blood pressure decreases (B/P).

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7
Q

What happens to pulse and respirations in shock?

A

Increased pulse (↑ Pulse) and increased respirations (↑ Respirations).

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8
Q

What are likely features suggesting that a patient might be having Trichomoniasis?

A
  1. Greenish vaginal discharge
  2. History of a new relationship

Note that a HVS from the posterior fornix should be sent for laboratory testing.

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9
Q

What is Moniiasis?

A

Moniliasis is a medical term for a yeast infection, also known as candidiasis:

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10
Q

What features may suggest Moniiasis in a patient?

A
  1. Unresponsiveness to drug Rx with antibiotics.
  2. Vulval swelling.
  3. Itching (pruritus vulvae)
  4. Vulval tenderness
  5. White cheesy discharge
  6. Superficial dyspareunia
    7.? Dysuria

Note that symptoms tend to be exacerbated premenstrually and remit during menstruation.

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11
Q

What other features can make you suspect candidiasis in a patient?

A
  1. Curdy vaginal discharge
  2. Presence of Mycelia on microscopy
  3. Low PH (<4.5)
  4. Immunosuppression eg. DM
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12
Q

What features may make you suspect bacterial vaginosis in a patient?

A
  1. Foul smelling vaginal discharge
  2. Presence of clue cells on microscopy
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13
Q

What are the most common organisms involved in B. Vaginosis?

A
  1. Gardnerella vaginalis
  2. Prevotella spp.
  3. Mycoplasma hominis
  4. Mobiluncus spp
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14
Q

What are the risk factors for B. vaginosis?

A
  1. Sexual activity
  2. New sexual partner
  3. Other STIs
  4. Women of Afro Caribbean descent
  5. Presence of Copper IUD
  6. Vaginal douching
  7. Bubble baths
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15
Q

What are protective factors for B. Vaginosis

A
  1. COCP
  2. Condone use
  3. Circumcised partner
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16
Q

Discuss Amsel’s criteria and it’s components

A

Is used to diagnose B. Vaginosis, and require at least 3 of the following for diagnosis.

  1. Homogeneous discharge
  2. Microscopy showing vaginal epithelial cells coated with a large number of bacilli (clue cells)
  3. Vaginal PH >4.5
  4. Fishy odour on adding 10% potassium hydroxide to vaginal fluid.
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17
Q

What features could make you suspect Cervical erosion (cervical ectropion) in a patient?

A
  1. Use of COCP
  2. Whitish vaginal discharge
  3. Pinkish outer cervix
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18
Q

What features could make you suspect Genital herpes simplex in a woman?

A
  1. Several painful ulcers in the vagina and perineum
  2. Vaginal discharge
  3. Others: fever, malaise, weight loss, and lymphadenopathy.

Investigation: PCR testing of Ulcer scraping or vesicle fluid aspirate.

Rx: Acyclovir 400mg orally TDS for 7-10 days.

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19
Q

What features may suggest Toxic Shock syndrome in a patient?

A
  1. If in her periods, she is probably using tampons which is a RF.
  2. FS vaginal discharge
  3. Fever (39)
  4. Borderline BP or Frank hypotension
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20
Q

What features could make you suspect chronic PID?

A
  1. Previous hx of PID
  2. Dyspareunia
  3. Lower abdominal pain
  4. Absence of active symptoms like fever and vaginal discharge
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21
Q

What single most appropriate management would you consider in a woman with lupus anticoagulant, anticardiolipin and ahistory of recurrent miscarriages?

A

With features such as Recurrent St miscarriages and positive anticardiolipin antibodies, likely diagnosis is Anti-Phospholipid syndrome

For women with APS who have had >/-3 pregnancy loss, administration of LMW heparin combined with low dose aspirin is recommended throughout pregnancy..

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22
Q

What is Gestational Hypertension?

A
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23
Q

What is the Presentation and management of Functional incontinence?

A
  1. Presentation: patient is unable to reach the toilet in time, due to poor mobility or unfamiliar surroundings.

Management: 1. Assess for Cognitive impairment
2. Follow a prompted and timed toileting programme

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24
Q

What is the Presentation and management of Stress incontinence?

A

Presentation:
1. involuntary leakage of urine on effort or exertion, or on sneezing, or coughing.
2. Incompetent sphincter may be associated with genitourinary prolapse.

Management:
1. First line: pelvic floor exercises for 3 months
2. Second line: Duloxetine.
3. Surgery if all fails.

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25
Q

What is the Presentation and management of Urge incontinence?

A

Presentation:
1. Involuntary during leakage following urgency of micturiction
2. Sudden and compelling desire to urinate that cannot be deferred.
3. Detrusor instability or hyperlexia leading to involuntary Detrusor contraction.
4. Idiopathic or secondary to neurological problems.

Management:
1. First line is bladder training for 6months
2. Second line: Anticholinergic drugs eg. Oxybutinin (avoid in the elderly), tolterodine, propiverine which relax urinary smooth muscle.

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26
Q

What is the first line treatment for detrusor instability?

A

Bladder training.

It involves pelvic muscle exercises, scheduled avoiding intervals with stepped increases and suppression of urge with distraction or relaxation techniques.

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27
Q

What is the most effective measure for those with stress incontinence and BMI of 30kg/m2 or greater?

A

Weight loss

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28
Q

What are the possible associations of Premature Ovarian Syndrome?

A
  1. Mumps
  2. Tuberculosis
  3. Malaria
  4. Chicken pox
  5. Cytomegalovirus
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29
Q

What are the investigations for Premature Ovarian Insufficiency?

A
  1. FSH: 2 samples, >4 weeks apart. Two raised levels (more than 40IU/l) are diagnostic.
  2. Low estradiol (usually <50pmol/l)
  3. TFT and Prolactin levels to exclude alternative pathology.
  4. A dual energy X-ray absorptiometry (DXA) bone scan to be undertaken at diagnosis and then every two years to assess bone mineral density.
  5. Antimullerian hormone could reflect reduced ovarian reserve.
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30
Q

What is the first line investigation for Perimenopausal bleed (PMB) ?

A

TVUS, as endometrial cancer is one of the most important causes of PMB.

31
Q

What is osteoporosis?

A

A progressive systemic skeletal disease characterised by reduced bone mass and micro-architectural deterioration of bone tissue.

It is the end result of an imbalance in the normal process of bone remodeling by osteoclast and osteoclast.

32
Q

About Osteoporosis, what happens during normal ageing?

A

Bone breakdown by osteoclasts increases and is not balanced by new bone formation by osteoblasts., resulting in changes in bone composition (BMD), architecture, size, and geometry..

33
Q

What are the risk factors of osteoporosis?

A
  1. Endocrine dx: DM, Hyperthyroidism, Hyperparathyroidism
  2. GI dx: Malabsorption from Coeliac dx, Crohn’s dx, UC, and chronic pancreatitis.
  3. CKD
  4. CLD
  5. COPD
  6. Menopause
  7. Immobility
  8. BMI <18.5
34
Q

What are the features of atrophic vaginitis?

A
  1. Postmenopausal
  2. Recurrent cystitis
  3. Dyspareunia

Rx: Topical Oestrogen cream

35
Q

What is a recurrent miscarriage?

A

The patient has lost 3 or more pregnancies..

36
Q

What are the investigations for consideration in Hyperthyroidism.?

A
  1. TFT: TSH can exclude primary thyrotoxicosis. Confirm diagnosis with T4. If TSH is suppressed but free T4 levels are normal, then T3 level may be needed (elevated in 5% of patients)
  2. Auto antibodies: seen most commonly in graves dx.
  3. Antimicrosomal Abs: against thyroid peroxidase.
  4. Antityroglobulin Abs:
  5. TSH-receptor Abs:
  6. Thyroid USS
  7. Thyroid uptake scans: to locate hot (overactivity) and cold (no activity) spots.
  8. Inflammatory markers: I thyroid iris, CRP and ESR are often raised..
37
Q

What is subclinical hypothyroidism?

A
  1. TSH is suppressed below normal reference range
  2. FT4 and FT3 are normal.
38
Q

How may drugs such as haloperidol contribute to infertility?

A

Haloperidol is a Dopamine D2 receptor antagonist. All dopamine receptor antagonists stimulate production of prolactin from pituitary. Hyperprolactinaemia causes irregular or no ovulation, probably leading to infertility..

39
Q

What are the features of endometriosis?

A
  1. Hx of abdominal pain that worsens during menstruation
  2. Difficulty breathing, haemoptysis and chest pain during menstruation
  3. Sub/infertility
  4. Tender or enlarged uterus on examination
40
Q

What is the choice of management for ectopic pregnancy when patient is haemodynamically unstable..?

A

Laparatomy

41
Q

What features makes pancreatitis likely in a patient?

A
  1. Upper Abdominal pain (severe).
  2. Vomiting
  3. Patient leans forward as this position relieves the pain..
  4. Generalised abdominal tenderness..
42
Q

An acute, severe abdominal pain radiating to the groin is most likely?

A

Ureteric colic

43
Q

How do patients with urinary tract stone present?

A

Stones can be in the kidney, renal pelvis, or ureter, causing dilatation, stretching and spasm of the ureter

  1. Pain starts in the loin about the level of the costovertebral angle (sometimes lower) and moves to the groin, with tenderness of the loin or renal angle, sometimes with haematuria.
  2. If the stone is high and distends the renal capsule, then pain will be in the flank but as it moves down pain will move anteriorly and down towards the groin.
  3. A stone that is moving is often more painful than a stone that is static.
  4. The pain radiates down to the testes, scrotum, labia or anterior thigh..
  5. Other symptoms: fever, rigor, dysuria, haematuria, urinary retention and nausea or vomiting.
44
Q

What are the investigations for renal/ureteric colic?

A
  1. Urine dipstick
  2. Non-enhanced CT scanning is the imaging modality of choice.
  3. USS to differentiate radio opaque from radioluscent stones.
  4. Plain Xray KUB- useful in watching the passage of radio opaque stones (75% of stones are calcium, so radio opaque).
45
Q

What features may make you suspect endometrial cancer in a patient?

A
  1. Post Menopausal Bleed
  2. Endometrial thickness of more than 5mm on TVUS..

Endometrial biopsy for definitive diagnosis in post menstrual bleeding.

Hysteroscopy and biopsy are preferred diagnostic technique to diagnose polyps.

46
Q

Management of EC

A
  1. Laparoscopic total hysterectomy with bilateral salpingo-oophorectomy.
  2. Adjuvant radiotherapy (if low grade dx with deep myometrial invasion or high-grade superficial invasion)
  3. High dose progesterone (palliation).
47
Q

Risk factors for EC.

A
  1. Prolonged periods of unopposed Oestrogen
  2. Nulliparity
  3. Late menopause
  4. Obesity raises Oestrogen levels
  5. PCOS
  6. Endometrial Hyperplasia
  7. Breast Ca
  8. Genetic predisposition
  9. DM T2
48
Q

What can you say about Cervical Ectropion?

A

CE occurs when the columnar epithelium of the endocervix is displayed beyond the os. The cervix enlarges under the influence of Oestrogen and as a result, the endocervical canal is everted.

Features:
1. Use of COCP
2. Contact bleeding

49
Q

The choice of contraception in patients with personal or family (FDR) hx of DVT is?

A

POP

50
Q

What is the treatment of choice in Vaginal Candidiasis?

A

Topical Clotrimazole

51
Q

One possible cause of post Menopausal bleeding after cervical blood cytology and endometrial sampling have been deemed normal is?

A

STI

52
Q

What features might make you suspect Imperforate Hymen in a patient?

A
  1. Primary amenorrhoea
  2. Cyclical abdominal pain
  3. Presence of secondary sexual characteristics.
53
Q

What features might make you suspect Imperforate Hymen in a patient?

A
  1. Primary amenorrhoea
  2. Cyclical abdominal pain
  3. Presence of secondary sexual characteristics.
54
Q

What’s the appropriate advice to give to someone diagnosed with glandular fever regarding contact sport?

A

Avoid contact sport for 4 weeks..

55
Q

What’s the typical presentation of Girdiasis?

A

Ongoing/persistent diarrhoea + Bloating + Flatulence + Lethargy + Steatorrhoea + Unintentional weight loss +/- Recent Travel..

*No presence of bllod or mucus in stool.

56
Q

What is the appropriate investigation to check for lyme’s disease?

A

Blood test for serology

57
Q

About STI and their features

A
58
Q

What anti malaria medication is associated with photosensitivity?

A

Doxycycline

59
Q

What anti malaria medication should be avoided in patients with depression?

A

Mefloquine

60
Q

What anti malaria medication is taken weekly?

A

Mefloquine

61
Q

What would a preceeding influenza infection predispose to?

A

Staph Aureus pneumonia

62
Q

What is the difference between the appearance of Chancroid and Herpes Simplex ulcers?

A
63
Q

About features and treatments of various STIs

A
64
Q

About features and treatments of various STIs

A
65
Q

What’s the recommended action for patients found positive for MRSA?

A
66
Q

What is the role of dexamethsone in the Rx of bacteria meningitis?

A
67
Q

Most common cause of pneumonia in alcoholics?

A

Klebsiella pneumoniae.

Classic radiographic presentation to includes consolidation, often with abscess or cavity formation, typically in the upper lobes.

68
Q

Strawberry cervix is an association with?

A

Trichomonas vaginalis..

The term refers to the appearance of the cervix during speculum examination: red and inflamed with pinpoint haemorrhage, often resembling a straw berry.

*may cause urethritis in men.

69
Q

Current standard protocol for diagnosis of HIV?

A

Combination test (HIV p24 antigen + HIV Antibody test)

  1. P24 antigen becomes positive within a week.
  2. HIV Antibody test develops 4-6 weeks post exposure.
70
Q

What vaccination do the following qualify for?

  1. Post splenectomy
  2. COPD
  3. Chronic Hepatitis C
A

Post splenectomy:
Pneumococal - 5yrs

COPD:
Annual influenza + one off pneumococcal.

Chronic hepatitis C :
One off pneumococal.

71
Q

Classic features of Behcet dx

A

Triad of oral ulcers, genital ulcers, and uveitis.

DVT might also be present.

72
Q

Stereotypical hx of Mycoplasma pneumonia

A
  1. Worsening flu-like symptoms
  2. Dry cough
  3. Erythema multiforme
73
Q

Features of Organophosphate poisoning

A

D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.

74
Q
A

DrFeelGood (3 decks)

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