Topics I'm not good at Flashcards
1
Q
T12-L1 give rise to which nerve?
A
T12-L1 give rise to iliohypogastric nerve.
2
Q
L1-2 give rise to which nerve?
A
L1-2 give rise to genitofemoral nerve.
3
Q
L2-4 give rise to which nerve?
A
L2-4 give rise to femoral nerve.
4
Q
S2-4 give rise to which nerve?
A
S2-4 give rise to pudendal nerve.
5
Q
L4-5, S1-3 give rise to which nerve
A
Sciatic nerve
6
Q
Hypertensive retinopathy stages
A
I: Arteriolar narrowing and tortuosity. Silver wiring
II: AV nipping
III: Cotton-wool exudates
Flame and blot haemorrhages - ‘macular star’
IV: Papilloedema
7
Q
Patau syndrome
A
Triosomy 13
P - Palate (cleft)
A - A-lot-of-fingers (polydactyly)
T - Tiny mouth (micrognathia)
A - Angry scalp lesions
U - Uveas are small (small eyes)
8
Q
Edward’s syndrome
A
Trisomy 18
E - ears (low)
D - Dinky mouth
D - Dodgy feet (rockers)
Y - Fingers overlap (make a y shape)
9
Q
Fragile X
A
X linked
Learning difficulties & ADHD & Autism
Macrocephaly
Long face
Large ears
Macro-orchidism
Seizures
10
Q
Noonan syndrome
A
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
11
Q
Pierre-Robin syndrome*
A
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
12
Q
Prader Willi Syndrome
A
Hypotonia
Hypogonadism
Obesity
13
Q
William’s syndrome
A
Deletion on Chromosome 7
Short stature
Learning difficulties & ADHD
Friendly, extrovert personality
Starbrust iris
Wide mouth and big smile
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
14
Q
Cri du chat syndrome
A
Chromosome 5p
Characteristic cry due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
15
Q
Meniscal tear
A
Gives way & locks
Worse on straightening leg
Tender on joint line
16
Q
Episcleritis
A
Diffuse redness
NO Pain
Blanches with eye drops
17
Q
Scleritis
A
Redness, painful ++, pain worse on eye movement, reduced visual acuity
Rheumatoid
18
Q
GET SMASHED
A
Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs: azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, sodium valproate
19
Q
cephalohaematoma
A
Does not crosses suture lines
bleeding between the periosteum and the skull
2-3 days after delivery
Resolves
20
Q
Caput succedaneum
A
Crosses suture lines
Few hours after delivery
Takes months to improve
Oedema of presenting part
21
Q
Erythema infectiosum
A
5th disease or slapped cheek
Parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
No school exclusion
pancytopaenia, aplastic crisis, hydrops fetalis
22
Q
Measles
A
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
23
Q
Mumps
A
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
24
Q
Rubella
A
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
25
Scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
'Strawberry' tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
26
Hand, foot and mouth disease
coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
27
Angina management
1. Beta blocker/ CCB
- CCB monotherapy: verapamil/ diltizaem
- if combo with B-b: amlodipine, modified-release nifedipine
2. Add other of step 1
3. a long-acting nitrate/ ivabradine/ nicorandil/ ranolazine
28
Erythema nodosum causes - SORE SHINS
SORE SHINS
Streptococci
OCP
Rickettsia
Eponymous (Bechets)
Sulfonamides
Hansen’s disease (leprosy)
IBD
NHL
Sarcoidosis
29
Ankylosing spondylitis features - the 'A's
Anterior uveitis
Apical fibrosis
Aortic regurgitation
AV node block
Achilles tendonitis
Amyloidosis
30
Erythema multiforme
Target lesions
HSV (commonest cause)
Idiopathic
Mycoplasma
Streptococcus
Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapine
SLE
Sarcoidosis
Malignancy
31
Anion gap
NA + K - bicarb - Cl
Normal is between 12-17
32
Plasma osmolality
2Na + Urea + Glucose
Normal between 285-295
33
Bloody diarrhoea causes
SEECSY
Salmonella
E coli
Entamoeba
Campylobacter
Shigella
Yersinia
34
Side effect of Methotrexate
Myelosuppression
Liver cirrhosis
Pneumonitis
35
Side effect of Sulfasalazine
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
36
Side effect of Leflunomide
Liver impairment
Interstitial lung disease
Hypertension
37
Side effect of Hydroxychloroquine
Retinopathy
Corneal deposits
38
Side effect of Prednisolone
Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts
39
Side effect of Gold
Proteinuria
40
Side effect of Penicillamine
Proteinuria
Exacerbation of myasthenia gravis
41
Side effect of Etanercept
Demyelination
Reactivation of tuberculosis
42
Side effect of Infliximab
Reactivation of tuberculosis
43
Side effect of Adalimumab
Reactivation of tuberculosis
44
Side effect of Rituximab
Infusion reactions are common
45
Side effect of NSAIDs (e.g. naproxen, ibuprofen)
Bronchospasm in asthmatics
Dyspepsia/peptic ulceration
46
-
=i
47
Splenectomy vaccines/ Abx
Pneumococcal
HIB
Meningococcal
Influenza (annual)
Oral phenoxymethylpenicillin prophylaxis
48
Complications post MI
DARTHVADER
Death
Arrtyhymia
Rupture
Tamponade
Heart failure
Valvular disease
Aneurysm
Dressler's syndrome
Recurrence
Cardiogenic shock
49
Acute mitral regurgitation
More common with infero-posterior infarction
ischaemia or papillary muscle rupture.
Acute hypotension and pulmonary oedema may occur.
early-to-mid systolic murmur.
Vasodilator therapy but often require emergency surgical repair.
50
Bradyarrhythmias
AV block post inferior MI
51
Cardiogenic shock
If EF reduces too much due to ischaemia -> cardiogenic shock. Or after left ventricular free wall rupture as listed below. Inotropic support and/or an intra-aortic balloon pump.
52
Left ventricular aneurysm
Persistent ST elevation and left ventricular failure
Thrombus within the aneurysm increasing the risk of stroke- therefore anticoagulated
53
Left ventricular free wall rupture
in 3% of MIs and occurs around 1-2 weeks after. acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy
54
Pericarditis
Pericarditis in the first 48 hours following a transmural MI is common (c. 10% of patients). The pain is typical for pericarditis (worse on lying flat etc), a pericardial rub may be heard and a pericardial effusion may be demonstrated with an echocardiogram.
55
Dressler's syndrome
2-6 weeks following a MI
autoimmune reaction against antigenic proteins formed as the myocardium recovers
fever, pleuritic pain, pericardial effusion and a raised ESR
NSAIDs
56
Tachyarrhythmias
VF and VT. VF -> Death
57
Ventricular septal defect
| post MI
first week
around 1-2% of patients.
acute heart failure
pan-systolic murmur.
An echocardiogram excludes acute MR which presents in a similar fashion.
Urgent surgical correction needed.
58
C diff treatment
1. PO Vancomycin 10 days
2. Retreatment: fidaxomicin
3. PO Vanc +- IV Met
59
PID
Cef 1g IM
PO Doxy 10mg BD 14 days
PO Metro 400mg BD 14 days
60
Most common cause septic arthritis
Staph Aureus
61
Serotonin syndrome
Alternated mental status
NM hyperactivity - profound shivering, tremor, teeth grinding, hyperreflexia
Autonomic instability: Tachy, fever, high BP, D&V
62
Neuroleptic malignant syndrome
Treating with dopamine antagonists or withdrawal of dopamine agoinsts
Hyperthermia, muscle rigidity, altered mental status, sympathetic nervous system lability, hypermetabolism, high CK
63
Reed Sternberg cells
Hogkin's Lymphoma
64
Philadelphia chromosome
CML
65
Corneal abrasion
Chloramphenicol
66
Herpes Simplex Keratitis
topical aciclovir
67
Conjunctivitis
Clean with cooled boiled water
Chloramphenicol drops
68
Chlamydia
1. PO Doxy 7 days
2. if doxycycline contraindicated : azithromycin (1g stat, then 500mg OD for 2 days)
3. if pregnant then azithromycin, erythromycin or amoxicillin
69
--
--
70
Trichomonas
PO metronidazole 5-7 days
or one-off dose of 2g metronidazole
71
Gonorrhoea
1. single dose of IM ceftriaxone 1g
2. PO stat dose of cefixime 400mg + azithromycin 2g
72
Bacterial vaginosis
PO metronidazole 5-7 days or single oral dose of metronidazole 2g
Topical clindamycin can also be used
73
Scleroderma
Systemic: anti scl-70anti-topoisomerase
Limited (CREST): Anti-nuclear and anti-centromere
74
Cushing's syndrome: Investigations
1. overnight (low-dose) dexamethasone suppression/
24 hr urinary free cortisol/ bedtime salivary cortisol
2. High-dose dexamethasone suppression test
75
steeple sign x ray
croup
76
thumbprint sign xray
epiglottis
77
When to use ondansetron?
5HT3 antagonist
Post op & cytotoxic drug related (chemo)
78
Domperidone, procholerperazine, haloperidol, metoclopramide
Dopamine antagonist
Neoplastic disease, radiation sickness, opioids, cytotoxic and general anaestehtic
Note metoclopramide is prokinetic - so useful in GI disease
79
Cyclizine, promethazine, meclizine
Antihistamines H1
Motion sickness, morning sickness pregnancy, opidoids
80
Henoch Shloen Purpura HSP presentation
Recent illness
Palpable rash
Abdo pain/ bloody diarrhoea
Joint pain
Glomerlunephritis: urine dip for blood/ protein
81
Niacin deficiency
B3
Pellagra:
dermatitis
diarrhoea
dementia
82
Retinoid deficiency
Vitamin A
Night blindness
83
Thiamine deficiency
B1
Beriberi
polyneuropathy, Wernicke-Korsakoff syndrome
heart failure
84
Pyridoxine deficiency
B6
Anaemia, irritability, seizures
85
Biotin deficiency
B7
Dermatitis, seborrhoea
86
Folic acid deficiency
B9 Megaloblastic anaemia, deficiency during pregnancy - neural tube defects
87
Cyanocobalamin deficiency
Megaloblastic anaemia, peripheral neuropathy
88
Ascorbic acid deficiency
Vitamin C
Scurvy
gingivitis
bleeding
89
Tocopherol, tocotrienol deficiency
Vitamin E
Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
90
Naphthoquinone deficiency
Vitamin K
Haemorrhagic disease of the newborn, bleeding diathesis
91
Lachman test
ACL rupture
92
ACL rupture
high twisting force applied to a bent knee
loud crack, pain and RAPID joint swelling (haemoarthrosis)
93
PCL rupture
hyperextension injuries
Tibia lies back on the femur
Paradoxical anterior draw test
94
Rupture of medial collateral ligament
leg forced into valgus via force outside the leg
Knee unstable when put into valgus position
95
Menisceal tear
Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to 'unlock' the knee
Recurrent episodes of pain and effusions are common, often following minor trauma
96
Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
97
Osgood-Schlatter disease
(tibial apophysitis)
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
98
Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
99
Patellar subluxation
Medial knee pain due to lateral subluxation of the patella
Knee may give way
100
Patellar tendonitis
athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
101
Drug causes constriction of pupils
Miosis
Pilocarpine (muscarinc agonist)
Prostaglandin
Opioids
Organophosphate insecticide
102
Drug causes dilation of pupils
Mydriasis
Anticholinergics: atropine, tropicamide, cyclopentikate
Sympathomimetics: adrenaline, phenylephrine
103
Rotavirus
Most common diarrhoeal in children
Watery with vomiting +- fever, abdo pain
104
Causes of bleeding in 1st trimester
Miscarriage
Ectopic
Hydatidiform mole
105
Causes of bleeding in 2nd trimester
Miscarriage
Placental abruption
Hydatidiform mole
106
Causes of bleeding in 3rd trimester
Bloody show
Placental abruption
Placenta praevia
Vasa praevia
107
Anti D indications
TOP: surgical or medical
If miscarriage is followed by medical or surgical evac
Spontaneous complete miscarriage >12 weeks
Transplacental haemorrhage risk (CVS, amino, ECV, APH), abdo trauma, intrauterine death
Ectopic pregnnacy
Treatened miscarriage >12 weeks
108
Beck's triad
Cardiac tamponade
Distended neck veins
Hypotension
Muffled heart sounds
109
Haemophillia A
Factor 8
APTT
110
Haemophillia B
Factor 9
APTT
111
Von Willebrand disease
Reduced VWF - important for platelet function and stablising factor 8
112
APTT test
Intrinsic and common pathway
Factor 1,2,5,8,9,10,11,12
113
PT
Extrinsic and common pathway
Factor 1,2,5,7,10
Vitamin K deficiency
INR
114
Stork mark
Pink, flat, irregular, back of neck, not thickened
115
Port wine stain
Persist through life
Superficial and deep dilated capillaries
Pulse laser
116
Primary sclerosing cholangitis
Chronic inflammation and fibrosis of intra and extraheptic bile duct
IBD - esp UC
Male 30-40 years
ALP +, bilirubin +. ALT and ALP + after some time
MRCP beading of bile ducts
Antibodies are not specific: pANCA, ANA, anti-SMA
Risk of acute cholangitis, cholangiocarcinoma, colorectal cancer,
117
Primary biliary cirrhosis
Destruction of intraheptic bile canaliculi -> bile leak
Osteoporosis, sicca
30-65 years
Middle ages woman, fatigue, itching, jaundice, RUQ discomfort
AMA, high ALP
Tc: Ursodeoxycholic acid, cholestyramine
Risk of CVD, ADEK Vitamin deficiency, Hypothyroid, CTD
118
T2DM Dx
HbA1c > 48
Fasting glucose > 7
Random glucose or OGGT > 11.1
Twice if asymptomatic, once if symptomatic
119
Autosomal dominant
Structural
Exception: Gilbert's, hyperlipidaemia type II
120
Autosomal recessive
Metabolic/ Enzyme defects
Exception: Ataxia telangeiectsia and Friedrich's ataxia are AR
121
Live vaccines
MY BOOTII :
MMR
Yellow fever
BCG
Oral polio,
Oral rotavirus,
Typhoid,
Intranasal influenza
122
azathioprine
TMPT
Bone marrow suppression, hepatotoxic
Interacts with:
Allopurinol
Febuxostat
Warfarin
Clozapine
ACEi
Aminosalicylates
Methotrexate
123
Threatened miscarriage
Minimal Pain
Less bleeding Compared to peroid
Closed cervix
Uterus for dates
Heart visualised
124
Inevitable miscarriage
Pain +
More bleeding Compared to peroid
Open cervix
Uterus for dates
Heart may or may not
125
Complete miscarriage
No pain
Less bleeding Compared to peroid
Closing cervix
Uterus for dates
Empty on US
126
Incomplete miscarriage
May or may not have pain
Lots of bleeding
Open cervix
Small for dates
Retained products/ no fetal heart
127
Missed miscarriage
No pain
Minimal bleeding
Closed cervix
Uterus small for age
No fetal heart
128
RA Xray features
SPADES
Soft tissue swelling
Peri-articular osteoporosis
Absent osteophytes
Deformity
Erosions (late feature)
Subluxation (late feature)
129
OA X ray features
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
130
Haemochromatosis
DM
Cirrhosis
Skin pigmentation
131
Addison's disease
Hyponatremia and hyperkalemia
Too little aldosterone
132
cyp P450 inhibitors
SICKFACES.COM-G
sodium valproate
isoniazid
cimetidine
ketoconzole
fluconazole
acute alcohol+amiodarone
cipro+chloramphenicol
erythromycin
suflonamides
cranberry juice
omeprazole
metronidazole
grapefruit juice
133
cyp P450 inducers
BS CRAP GPS
barbiturates
st johns wort
carbamazpine
rifamicin
alcohol(chronic)
phenytoin
grisefulvin
phenobarbital
sulfonylureas.
134
Whirl pool sign
ovarian torsion
135
Acromegaly - test
IGF1/ OGTT. No suppression of GH in OGTT
136
Addison’s disease - test
Short Synacthen test. No production of cortisol
137
Cushing’s - test
dexamethasone suppression test. Suppressed cortisol if Cushing’s disease (pituitary adenoma)
Unsuppressed if Cushing’s syndrome/ ectopic
138
Conn’s - test
Renin: Aldosterone ratio. Low renin - primary. High renin - secondary cause.
139
SIADH - tests
all other tests negative. High urine sodium and osmolality
140
Diabetes insidious - test
water deprivation/ desmpressin test. Concentrates after water deprivation - polydipsia. Concentrates after desmopressin - craniogenic. Does not concentrate - neprhogenic DI
141
How to remember Broca/ Wernicke's
Spoken word is heard at the ear. This passes to Wernicke's area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca's area. The Broca's area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).
142
Broca's aphasia
difficult to find and say the right words, although they probably know exactly what they want to say.
Severely reduced speech, often limited to short utterances of <4 words.
Limited vocabulary.
Clumsy formation of sounds.
Difficulty writing (but the ability to read and understand speech).
143
Wernicke's aphasia
Able to speak well & use long sentences, but might not make sense. They may not know that what they're saying is wrong, so may get frustrated when people don’t understand them.
Impaired reading and writing.
An inability to grasp the meaning of spoken words (producing connected speech is not affected).
An inability to produce sentences that hang together.
The intrusion of irrelevant words in severe cases.
144
Gout
Gout = negatively infringement, monosodium urate, needle shape
145
Pseudogout
Pseudogout = positively infringement, rhomboid, calcium pyrophosphate,
146
Bronchiolitis -
RSV, 3-6 months, corzyal/ dry cough, SOB, wheeze, fine inspiratory crackles, feeding difficulty. Humidified oxygen
147
Croup -
parainfluenza, 6 months to 2 years, barking cough, stridor, dexamethasone, nebulised adrenaline/ budesonide, steeple on X ray
148
Epiglottitis -
HIB (haemophilus influenza type B), fever, sore throat, drooling, stridor, muffled voice. Thumb sign. DO not distress child - anaesthetics. Ceftriaxone & steroids.
149
Whooping cough -
Bortedella Pertussis, mild cough -> more severe in 2nd week, PCR testing, anti-pertussis toxin immunoglobulin G if longer than 2 weeks. Supportive care. First 21 days azithromycin, erythromycin and clarithromycin. Contacts are given prophylactic antibiotics
150
Laryngomalacia
- inspiratory stridor, 6 months, worse during infection, resolves with age
151
Cystic Fibrosis
AR, transmembrane conductance regulatory gene on chromosome 7, sweat test > 60mmol/L chloride,
Colonised by: staph aureus (long term fluxlco for this) and pseudomonas (nebulised tobramycin. PO ciprofloxacin). Vaccinations including pneumococcal, influenza and varicella
152
Drugs that cause gynaecomastia
DISCKO
-Digoxin
-Isoniazid
-Spironolactone (most common)
-Cimetidine
-Ketoconazole
-Oestrogen/anti testosterone/hormones Goserelin, Buserelin
153
Cardiac resynchronisation therapy indications
left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms.
154
Implantable cardiac defibrillator (ICD) indications
previous sustained ventricular tachycardia, ejection fraction <35% and symptoms no worse than class III of of the New York Heart Association functional classification.
155
Genetic causes of long QT syndrome
LQT1 / LQT2 (potassium channel mutation); LQT3 (sodium channel mutation)
Jervell and Lange-Nielsen syndrome (associated with deafness)
Romano-Ward syndrome
156
Electrolyte causes of long QT syndrome
Hypocalcaemia
Hypomagnesaemia
Hypokalaemia
157
Drug causes of long QT syndrome
Antiarrhythmics (e.g. amiodarone, sotalol)
Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)
Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)
158
anterior cerebral artery infarct
contralateral hemiparesis and sensory loss (lower extremities affected more than upper).
159
posterior cerebral artery infarct
contralateral homonymous hemianopia with macular sparing.
160
posterior inferior cerebellar artery infarct
ipsilateral facial pain and temperature loss, and contralateral limb/torso pain and temperature loss
may also be ataxia and nystagmus present.
161
middle cerebral artery infarct
contralateral hemiparesis and sensory loss (upper extremity more than lower)
contralateral homonymous hemianopia and aphasia
162
total anterior circulation infarct
TACI, c. 15%: involves middle and anterior cerebral arteries
all 3 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
163
Partial anterior circulation infarcts
PACI, c. 25%
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of :
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
164
Lacunar infarct
LACI, c. 25%
involves perforating arteries around the internal capsule, thalamus and basal ganglia
1 of:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
165
Posterior circulation infarcts
POCI, c. 25% involves vertebrobasilar arteries
1 of:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
166
Lateral medullary syndrome
posterior inferior cerebellar artery aka Wallenberg's syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
contralateral: limb sensory loss
167
Weber's syndrome
ipsilateral III palsy
contralateral weakness
168
Colles’
distal radius dorsal displacement
169
Smith fracture -
distal radius volar displacement
170
Bennet fracture -
base of metacarpal of thumb. Thenar pain swelling and inability to move thumb
171
Gatekeeper thumb -
subluxation of MCP of thumb with abduction
172
Budd Chiari syndrome -
occlusion of hepatic vein - severe epigastric pain, ascites, hepatomegaly. VTE
173
Weils disease
spirochetes, contaminated water, acute hepatic failure
174
HELLP syndrome
haemolysis with elevated LFT, and low platelet. Severe form of pre eclampsia.
175
HOCM
Systolic murmur worse on Valsalva and squatting, jerky pulse
176
VSD
VSD - biventricular hypertrophy
177
Primary biliary cholangitis -
The M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
178
Down's syndrome: Trisomy 21
Combined test - 11-14 weeks: >6mm Nuchal thickness, high BHCG, low PAPPA
Triple test - 14-16 weeks: high BHCG, low AFP, low oestriol
Quadruple test - 14-20 weeks: adds in inhibin A high
Aminocentesis if risk is greater than 1:150
CVS can be done before 15 weeks. Aminocenetesis is later, but safer
Hypotonia, small head, short
Reccurent otitis media
Hypothyroid
ASD. AVD. TOF
Hearing - conductive loss, glue ear
Eye problems
179
Meniere's disease: Acute and chronic treatment
Acute: Prochlorperazine or cinnarizine
Chronic/ prevention: betahistine
180
Commonest type of epilepsy in childhood
Benign Rolandic
181
Osler Weber Rendu Syndome
HHT - Hereditary Hemorrhagic Telangiectasia
1. Telangiectasia
2. Nose bleeds
3. FH
182
acute limb ischaemia
Pain
Pallor
Pulseless
Paralysis
Paraesthesia (abnormal sensation or “pins and needles”)
Perishing cold
183
MEN1
High calcium and renal stones = hyperparathyroid
Parathyroid adenoma
Pituitary adenoma
Zollinger-Ellison or hyperinsulinaemia - hypos
High prolactin - amenorrhoea
XS Growth hormone - acromegaly
Mass effect from pituary gland tumour
184
MEN2
2A:
Medullary thyroid cancer
Phaeochromocytoma - HTN, sweating, diarrhoea
Parathyroid adenoma with hyper parathroidism
2B
MTC, phaeo, Marfanoid, mucosal instetinal ganlioneuromatosis
185
186
Bacterial meningitis > 3 months old
NHS - most common is strep
Neisseria meningitidis
Haemophilus Type B (HIB)
Streptococcus pneumoniae
187
Bacterial meningitis < 1 months old
GBS (Strep agalctiae)
E coli
Streptococcus pneumoniae
Listeria
GESL
188
Hyperkalaemia ECG change
Tented T waves
P wave flatenning
PR prolonged
QRS widens
Sine wave
189
Goodpasture's syndrome
Pulmonary haemorrhage
Glomuleonephritis
anti GBM
CXR shows parenchymal consolidation from autoantibody induced inflammatory lesions
190
Wegener's granulomatosis
Granulomatosis with polyangiitis
URTI: nose bleeds, sinusitis
LRTI: Haemopytsis
Glomerulonephritis - pauci immune
Saddle nose
cANCA
191
Churg-Strauss syndrome
eosinophilic granulomatosis with polyangiitis (EGPA)
pANCA
Eosinophils
Asthma
Sinusitis
192
Hypocalcaemia ECG change
QT long
193
Hypercalcaemia ECG change
Short QT
J wave -positive deflection at QRS joint to ST point
194
Hypokalaemia ECG change
U waves
small or absent T waves
prolonged PR interval
ST depression
195
Hypothermia ECG changes
bradycardia
'J' wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias
196
Smoking cessation drugs
Bupropion and varenicline
197
Bupropion
Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist
1-2 weeks before target date
Small seizure risk
Contraindicated in epilepsy, pregnancy & breast feeding
Caution in: eating disorder
198
Varenicline
Nicotinic receptor partial agonist
1 week before target date
12 week treatment course
More effective than bupropion
Nausea side effect
Use in caution: depression/ self harm
Contraindicated: pregnancy and breast feeding
199
Brown Sequard Syndrome
Ipsilateral loss of proprioception and motor
Contralateral loss of pain and temperature
Due to hemisection of spinal cord - penetrating injury ot lateral compression
200
Central cord syndrome
Motor impairment much worse in upper compared to lower
Bladder dysfunction and urinary retnetion
Hyperextension injury in those with underlying cervical disease
201
Anterior cord syndrome
Bilateral loss of motor, pain and temp below the injusy
Intact vibrtation and proprioception
Hyperflexion injury/ disrupted anterior spinal arterty
202
neonatal jaundice causes:
Increased production of bilirubin or reduced clearance:
203
neonatal jaundice causes:Increased production of bilirubin:
Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
G6PD deficiency
204
neonatal jaundice causes:Decreased clearance of bilirubin:
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome
205
Egg allergy
no influenza vaccine
tickbourne encephalitis vaccine
or yellow fever vaccine
206
Wolf Parkinson White
Short PR
Prolonged QRS
Delta wave
207
Urge incontinence
Overactive muscle
Bladder retraining
Anticholinergic: oxybutynin, tolterdione, darifenacine
B3 agonist: mirabegron (not used in uncontrolled hypertension)
Botox
208
Stress incontinence
Laughing or coughing
Pelvic floor training
Surgery: Tape
Duloxietene SNRI
209
Paroxysmal nocturnal haemoglobinuria
Dark urine in AM
Acquired haemolytic anaemia
Thromboses in large vessels
Reduced new blood - pancytopenia/ aplastic anaemia
210
Genital ulcers
Painless
- Ulcer: Syhphilis (single) or Klebsiella
- Pustule: Lymphogranuloma venereum (LGV) - Chlamydia trachomati. Tx: Doxy. Lymph nodes & rectal Sx
Painful
- Ulcer: Chancroid (Haemophilus ducreyi, unilateral lymph nodes)
- Vesicles: HSV2 (Herpes)
211
TB drug side effects
RIPE
All: Hepatitis
Rifampacin - uRine orange
Isoniazid - peripheral neuropathy. Give B6 (Pyridoxine)
Pyrazinamide - High urea
Ethamutol - Eyes
212
Tx for generalised tonic clonic
Sodium valproate
Women that can have children: Lamotrigine or Levetiracetam (Keppra)
213
Tx for partial/ focal
Lamotrigine or Keppra
2nd line: carbamazepine
214
Myoclonic
Sodium valproate
Women that can have children: Levetiracetam (Keppra)
juvenile myoclonic epilepsy
215
Tonic and atonic
Sodium Valproate
Women that can have children: Lamotrigine
Atonic - drop attacks. Lennox-Gastaut syndrome.
216
Abscence
Ethosuximide
217
Infantile Spasms
West syndrome.
rare (1 in 4000) disorder
starting in infancy at around 6 months of age.
clusters of full body spasms.
poor prognosis: 1/3 die by age 25, however 1/3 are seizure free.
Prednisolone
Vigabatrin
218
Sodium Valproate side effect
Increases GABA
Used for most seizures if male - except focal/ absence
Teratogenic, so patients need careful advice about contraception
Liver damage and hepatitis
Hair loss
Tremor
Bone marrow suppression
Weight gain
p450 inhibitor
219
Carbamazepine side effect
Agranulocytosis
Aplastic anaemia
Hyponatraemia
Induces the P450 system
220
Phenytonin side effect
Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)
Gingival hyperplasia
P450 inducer
221
Ethosuximide side effect
Absence
CCB
Night terrors
Rashes
222
Lamotrigene side effect
Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes.
Leukopenia
OCP can reduce efficacy
223
Levetiracetam side effect
Depression
Behavouiral/ Psych issues
224
Which vaccine cannot be given if missed?
Rotavirus cannot be given after 24 weeks as risk of intussecuption
225
Trendelenburg Test
Hip drop of the unaffected side (the leg you are standing on has weakness in hip abductors: gluteus medius & minimus)
Causes:
Superior Gluteal Nerve Palsy
Weakness of gluteus medius
Hip instability and subluxation
Hip OA
Initially post THR
Lower back pain
Legg-Calvé-Perthes Disease
Congenital hip dislocation
226
Trendelenburg Gait
occurs when a patient has paralysis/paresis of the hip abductors.
Hip tilts downwards on non weight bearing side
227
Ottawa Knee Rules
1. > 55
2. Isolated tenderness of patella
3. Tenderness at head of fibula
4. Unable to flex to 90 degree
5. Unable to weight bear after and in ED for 4 steps
228
Polymorphic eruption of pregnancy PUPP
Very itchy
Last trimester
Abdominal straie
Umbilical sparing
Emollients
Resolves with delivery
Does not recurr on next pregnancy
229
Pemphigoid gestionis
Uncommon
Itchy, bullous eruption
Gets more severe with other pregnancy
Starts in peri umbilical region
Topical steroids/ oral steroids
230
Absolute contraindications to thrombolysis
- Prev intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected SAH
- Stroke / TBI in preceding 3 months
- LP in preceding 7 days
- GI haemorrhage in preceding 3 weeks
- Active bleeding
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg
231
Relative contraindications to thrombolysis
- Pregnancy
- Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in the preceding 2 weeks
232
Thrombolysis for acute ischaemic stroke?
alteplase or tenecteplase
if within 4.5 hours of onset of stroke symptoms &
haemorrhage definitively excluded
regardless of age or stroke severity, who were last known to be well more than 4.5 hours earlier: treatment can be started between 4.5 and 9 hours of known onset, or within 9 hours of the midpoint of sleep when they have woken with symptoms,
AND
evidence from CT/MR perfusion (core-perfusion mismatch) or MRI (DWI-FLAIR mismatch) of potential to salvage brain tissue
BP should be lowered to 185/110 mmHg before thrombolysis.
233
Pre stroke requirement for thrombectomy for acute ischaemic stroke?
pre-stroke functional status: <3 modified Rankin scale and >5 NIHSS
234
Who thrombectomy for acute ischaemic stroke?
Offer thrombectomy ASAP and within 6 hours of SX, together with intravenous thrombolysis (if within 4.5 hours), to:
- acute ischaemic stroke AND
- confirmed proximal anterior circulation occlusion ON CTA ON MRA
Offer thrombectomy ASAP to between 6 hours and 24 hours previously (including wake-up strokes):
- proximal anterior circulation occulsion on CT or MRA AND
- potential to salvage brain tissue
Consider thrombectomy together with intravenous thrombolysis (if within 4.5 hours) ASAP last known to be well up to 24 hours previously (including wake-up strokes):
acute ischaemic stroke & confirmed proximal posterior circulation occlusion (that is, basilar or posterior cerebral artery) on scan and
- potential to salvage brain tissue
235
Secondary prevention post stroke
300mg aspirin for 14 days
Clopi (rather than aspirin)
If clopi not tolerated then aspirin
Carotid artery stenosis
AF
Cholesterol
Smoking
BP control
236
TIA medications
1. 300mg aspirin stat & clopidogrel 300mg
2. aspirin (75 mg per day for 21 days) & clopidogrel 75 mg once daily 3. clopi after to continue
OR
1. 300mg aspirin stat & ticagrelor 180mg
2. Ticagrelor (90 mg BD plus aspirin (75 mg OD for 30 days)
3. antiplatelet monotherapy with ticagrelor 90 mg BD or clopidogrel 75 mg OD
237
Antiplatelets: summary of latest guidance
238
nbm before surgery
food 6 hours
clear liquids 2 hours
239
Bacterial vaginosis
overgrowth of anaerobic - gardenlis vaginalis
clue cells
ph >4.5
less lactic acid
240
Post AF ablation do you continue anticoagulation?
Patients who've had a catheter ablation for atrial fibrillation still require long-term anticoagulation as per their CHA2DS2-VASc score
241
CTG finding Baseline bradycardia
< 100
Increased fetal vagal tone, maternal beta-blocker use
242
CTG finding baseline tachycardia
> 160
Maternal pyrexia, chorioamnionitis, hypoxia, prematurity
243
CTG finding loss of baseline variability
< 5/ min
Prematurity, hypoxia
244
CTG finding
Early deceleration
Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction OK - innocuous feature and indicates head compression
245
CTG finding Late deceleration
BAD
Indicates fetal distress e.g. asphyxia or placental insufficiency
Deceleration HR which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction
246
Variable decelerations CTG finding
Independent of contractions
Cord compression !
247
What to do with warfarin
Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
248
What to do with warfarin
INR > 8.0
Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
249
What to do with warfarin
INR > 8.0
No bleeding
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
250
What to do with warfarin
INR 5.0-8.0
Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
251
What to do with warfarin
INR 5.0-8.0
No bleeding
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
252
The most common organism causing infective exacerbations of COPD is...
Haemophilus influenzae
253
acromegaly medical management
octreotide - somatostatin analogue
2nd line bromocriptine
254
Lower-than-expected levels of HbA1c
due to reduced red blood cell lifespan
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
255
Sickle-cell anaemia
due to increased red blood cell lifespan
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
256
Breast feeding - what to avoid
B- bromocriptine, benzodiazepine
R- Radioactive drugs, rizatriptan
E- ergometrine
A- aspirin, amiodarone, alcohol, atropine
S- sulphinamide, sulphonylurea
T- tetracycline,( iso)tretinoin
M - methotrexate
L - lithium
C - carbimazole
C - ciprofloxacin
C - chloramphenicol
257
Incubation periods of diarrhoeal illnesses
Incubation period
1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
258
targets in T1DM
HbA1c: 48
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
259
targets in t2DM
Lifestyle/ Metformin 48
Any drug causing hypo 53
On one drug, but HbA1c increased to 58, aim 53
260
Holmes-Adie pupil
ADIE:
Accommodates doesn't constrict
Dilated pupil
Ipsilateral (unilateral)
Extraocular symptoms- absent reflexes
