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AKT > Surgery, Ortho, Rheum > Flashcards

Surgery, Ortho, Rheum Flashcards

1
Q

When to refer microscopic haematuria

A

with dysuria OR raised WCC on bloods

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2
Q

Red flags for lower back pain (5)

A

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

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3
Q

BPH Mx

A

1st - alpha 1 antagonist (tamsulosin, alfuzosin)
2nd - 5 alpha reductase (finasteride)

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4
Q

Reasons to refer for breast review if patient’s first or second degree relative has the following… (>5)

A

age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in < 45 years
paternal history of breast cancer (two or more relatives on the father’s side of the family)

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5
Q

Fragility fracture primary care Mx

A

<75 needs DEXA for FRAX assessment
>75 - start oral bisphosphonate

Ca/ Vit D shoulder be corrected prior to starting bisphosphonates

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6
Q

Features associated with Ankylosing Spondylitis (6)

A

Apical fibrosis
Aortic regurgitation
AV node block
Amyloidosis
Anterior uveitis
Achilles Tendonitis

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7
Q

Groups that are advised to take vitamin D supplementation (4)

A

ALL pregnant and breastfeeding women
Children 6 months to 5 years
>65 yo
People not exposed to sunlight eg housebound, head coverings

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8
Q

Rheumatoid arthritis Ix

A

1st - rheumatoid factor
2nd - anti CCP
3rd - X ray

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9
Q

Lateral epicondylitis (tennis elbow) significant movement test

A

resisted wrist extension with the elbow extended

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10
Q

hydroxychloroquine (for SLE) side effect

A

severe retinopathy - monitor visual acuity annually

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11
Q

minimum steroid intake a patient should be offered osteoporosis prophylaxis

A

Equivalent of prednisolone 7.5 mg or more each day for 3 months
If this is presumed then to start prophylaxis straight away rather than wait 3 months eg Tx for PMR

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12
Q

Bone protection for patients taking corticosteroids age limits

A

< 65 yrs: DEXA scan first
>= 65 yrs: start alendronate

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13
Q

Mammary duct ectasia Fx

A

tender breast lump
+/- green discharge
most common around menopause

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14
Q

Fibroadenosis (fibrocystic disease, benign mammary dysplasia) Fx

A

Lumpy breasts
may be painful
may worsen around menstruation

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15
Q

Denosumab main side effect

A

atypical femoral fractures

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16
Q

Breast clinic referral
USC
Routine

A

USC (2WW) - >30yo + unexplained breast lump OR >50 + unilateral nipple change

Routine - <30 + unexplained breast lump

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17
Q

Obesity Bariatric referral cut off for BMI

A

with risk factors > 35 kg/m^2
no risk factors: > 40 kg/m^2

Risk = T2DM, HTN

If BMI >50 = consider surgery as first line

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18
Q

Diffuse cutaneous systemic sclerosis antibody

A

anti-scl-70

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19
Q

Limited cutaneous systemic sclerosis antibody

A

anti-centromere antibody

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20
Q

Carpal tunnel Mx

A

1st - wrist splint +/- steroid injection
2nd - wrist splint + physiotherapy
3rd - Surgery

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21
Q

Methotrexate and trimethoprim together can lead to

A

bone marrow suppression and severe pancytopenia

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22
Q

Maximum safest dose of Lidocaine (local anaesthetic) at 1%

A

3mg/kg

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23
Q

Medial epicondylitis (golfers elbow) is aggravated by what movement

A

wrist flexion and pronation

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24
Q

DEXA scan
T score
Z score

A

T score - bone mass of young population
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis

Z score - adjusted for age, gender, ethnicity
Z scores tend to be used in children, men below 50 and premenopausal women.

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25
Q

Breast Duct Papilloma

A

blood stained nipple discharge
if large, may present with a mass

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26
Q

Anal fissure Mx

A

1st - stool softeners - eg high fibre diet, ispaghula husk (bulk forming)
2nd - lubricants, topical anaesthetics
3rd - Topical GTN (first line for chronic anal fissures)
4th - if GTN not effective after 8 weeks for referral

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27
Q

Sulfasalazine is contraindicated with what medications

A

Co trimoxazole
Aspirin

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28
Q

Congenital hernias Mx
inguinal
umbilical

A

inguinal: repair ASAP
umbilical: manage conservatively

29
Q

Lactational mastitis Mx

A

(first 24 hours) - self care, express milk
1st - Flucloxacillin
2nd - Co-Amox

30
Q

Varicose veins Mx

A

Graduated compression stockings (after ABPI to check for arterial insufficiency first)

31
Q

Reasons for referral for varicose veins (5)

A

significant lower limb symptoms e.g. pain, discomfort or swelling
bleeding from varicose veins
skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)
superficial thrombophlebitis
an active or healed venous leg ulcer

32
Q

Meralgia paraesthetica Fx

A

compression of lateral cutaneous femoral nerve (outer upper thigh paraesthesia, with no motor loss)
consequence of rapid weight gain
Ix - pelvic compression test

33
Q

Peripheral artery disease Mx

A

Clopidogrel and statin (Atorva 80mg)

34
Q

Prostatitis Mx

A

Ciprofloxacin (quinolone) 14 days
2nd line - Trimethoprim 14 days

35
Q

Interpretation of ABPI
> 1.2
1.0 - 1.2
0.9 - 1.0
< 0.9
< 0.5

A

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
1.0 - 1.2: normal
0.9 - 1.0: acceptable
< 0.9: likely PAD.
< 0.5 indicate severe disease which should be referred urgently

Compression bandaging only if ABPI >0.8

36
Q

Ottawa rules for X rays for ankle and foot injury (3)

A

lateral malleolar zone tenderness (posterior tip)
medial malleolar zone tenderness (posterior tip)
inability to walk four weight-bearing steps immediately after the injury and in the emergency department

37
Q

Non specific lower back pain Mx

A

1st - NSAID
2nd - benzo (if muscle spasm)

38
Q

Sjogrens syndrome antibody

A

anti-Ro
anti-La
Rheumatoid factor

39
Q

Osteoporosis Mx WITH fragility fracture

A

> 75 - start bisphosphonates (without DEXA)
<75 - DEXA scan then FRAX score

Ca/ Vit D should be corrected prior to starting bisphosphonates

40
Q

Acute gout Mx

A

1st - NSAID
2nd - colchicine
3rd - oral steroid

41
Q

Bone disorders lab values
Primary hyperPTH
CKD
Pagets
Osteomalacia

A

Primary hyperPTH - all high, Phos low

CKD - all high, Ca low

Pagets - all normal, ALP high

Osteomalacia - ALP/ PTH high, Ca, Phos low.

42
Q

Rheumatoid arthritis antibody

A

Anti CCP

43
Q

Methotrexate adverse effects (4)

A

Mucositis
Myelosuppression
Pneumonitis
Pulmonary/ Liver fibrosis

Contraindicated in pregnancy. Men should without Methotrexate >6 months if trying to concieve

44
Q

Osteogenesis imperfecta Fx

A

AKA “brittle bone disease”
Autosomal dominant
Fractures from minor trauma
blue sclera
deafness secondary to otosclerosis

45
Q

Breast Duct papilloma Fx

A

blood stained nipple discharge
no lump or skin changes

46
Q

Breast mammary duct ectasia Fx

A

tender lump around areola
green nipple discharge

47
Q

Behcets syndrome Fx

A

Oral ulcers
Genital ulcer
Anterior uveitis
Thrombophlebitis/ DVTs

48
Q

Colchicine common SE

A

Diarrhoea

49
Q

New onset synovitis Mx

A

Urgent Rheum refer

50
Q

Osteoarthritis Mx in primary care

A

1st- Top NSAID
2nd - PO NSAID + PPI
3rd - steroid injection (weak opiates not recommended)

51
Q

Gottron’s papules are roughened red papules over the extensor surfaces and are seen in dermatomyositis

Heberden’s and Bouchard’s nodes are seen in osteoarthritis. Aschoff nodules are pathognomonic of rheumatic fever whilst Muehrcke’s lines are white, transverse lines of the fingernail seen in hypoalbuminaemia

A

Gottron’s papules are roughened red papules over the extensor surfaces and are seen in dermatomyositis

Heberden’s and Bouchard’s nodes are seen in osteoarthritis. Aschoff nodules are pathognomonic of rheumatic fever whilst Muehrcke’s lines are white, transverse lines of the fingernail seen in hypoalbuminaemia

52
Q

Vit D supplements need what monitoring

A

Calcium
If hypercalcaemia - should consider hyperparathyroidism

53
Q

Methotrexate blood monitoring

A

FBC, UE, LFT

54
Q

Sulfasalazine SE

A

Oligospermia
Rash
Interstitial lung disease

55
Q

Dermatomyositis Fx

A

symmetrical, proximal muscle weakness
Skin lesions - maculopapular rash over shoulders/ back, photosensitive, Gottrons papules (rough red papules on extensors of fingers)
Associated with connective tissue disorders and malignancy (ovarian, breast, lung)

56
Q

Bowel screening UK age criteria

A

Between 60-74
every 2 years
Men and women

57
Q

Aromatase inhibitors (e.g. anastrozole) SE

A

osteoporosis

58
Q

Female Breast screening age criteria

A

50-70 yr old
every 3 years

59
Q

Erectile dysfunction initial bloods

A

1st - Testosterone, fasting glucose, lipids

If testosterone low then - repeat testosterone, FSH, LH, prolactin

If abnormal for Endocrine

60
Q

Erectile dysfunction Mx

A

1st - Sildenafil or Tadalafil
2nd - (if PDE-5i contraindicated or not wanted eg Stroke/ MI in past 6 months) - vacuum erection device

61
Q

Causes of dupytrens contracture (5)

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

62
Q

Bowel Ca screening age criteria

A

60-74 yr old
every 2 years
can self refer after 74

63
Q

Anorectal disorders
haemorrhoids
anal fissure
anal fistula
Pruritis ani
rectal ulcer

A

Haemorrhoids - Post defecatory (painless) rectal bleeding on wiping/ in pan

Anal fissure - Most common cause of painful rectal bleeding. Examination is painful, should be delayed until healed.

Anal fistula - usually secondary to ano rectal abscess. painful rectal bleeding

Pruritis ani - Children (worms), Adults (haemorrhoids)

Rectal ulcer - Rectal bleeding - Hx of constipation and straining

64
Q

Antiphospholipid syndrome biochemistry

A

(paradoxically) prolonged APTT + low platelets

65
Q

intraarticular knee fracture X ray findings

A

fat fluid level

66
Q

Glucosamine contraindicated with what allergy

A

shellfish

67
Q

Rheumatoid arthritis is associated with what conditions

A

Hypertension
IHD
osteoporosis
depression

68
Q

Ottawa Knee rules

A

Age 55 years or older
Isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
Tenderness of the head of the fibula
Inability to flex the knee to 90°
Inability to weight bear both immediately and during the consultation for four steps (inability to transfer weight twice onto each lower limb regardless of limping)

AKT (21 decks)

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