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MBBS Y5 > Y4 zero to finals mix > Flashcards

Y4 zero to finals mix Flashcards

1
Q

Gram positive cocci

A

Staphylococcus StreptococcusEnterococcus

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2
Q

Gram positive rods

A

Corny mike’s list of basic cars

CorneybacteriaMycobacteriaListeria BacillusNocardia
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3
Q

Gram positive anaerobes

A 
CLAPClostridiumLactobaccilus Actinomyces Propionibacterium
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4
Q

Abx inhibit cell wall synthesis

A

With beta-lactam ring (penicillin, carbapenem, cephalosporin)Without beta-lactam ring(Vancomycin, teicoplanin)

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5
Q

Abx inhibiting folic acid metabolism

A

Sulfamethoxazole and Trimethoprim block formation of folic acid Co-trimoxazole is a combination of the two

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6
Q

Abx inhibit protein synthesis (target ribosome)

A

Macrolides (erythromycin, clarithromycin, azithromycin)ClindamycinTetracyclinesChloramphenicol

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7
Q

Unusual chest infection organisms

A 
Moraxella catarrhalis (in immunicompromised with chronic Lung disease)
Pseudomonas auerginosa (CF)
Staphylococcus aureus (CF)
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8
Q

Most common UTI bacteria

A

E. coli| Gram -ve, anaerobic, rod shaped

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9
Q

Chest infection 1st line

A

Amoxicillin

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10
Q

UTI 1st line

A

Trimethoprim| Nitrofurantoin

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11
Q

UTI in pregnancy

A

7d abx 1st Nitrofurantoin (do not give in 3rd trimester - haemolytic anaemia)2nd amoxicillintrimethoprim (do not give in 1st or anti-epileptics as has ANTI FOLATE effect)

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12
Q

Cellulitis and golden crust?

A

Staph aureus infection

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13
Q

Cellulitis tx 1st line

A

Flucloxacillin

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14
Q

Centor criteria

A

<3 not bacterial tonsilitisFever >38*CTonsillar exudatesAbsence of coughTender lymph nodes

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15
Q

Bacterial tobsilitis 1st line

A

Penicilin V /phenoxymethylpenicillin 10days

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16
Q

Otitis media 1st line

A

Amoxicilin| But (erythronycin, clarithromycin if penicillin Allergy)

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17
Q

Sinusitis management

A

Pencilin V/ phenoxymethylpenicillin 5daysNo improvement after 10 days: 2 weeks of high dose steroid nasal sprayNo improvement after 10 days + likely bacterial cause: Abx

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18
Q

Septic arthritis tx

A

1st flucloxacillin + rifampicin| 2nd vancomycin + rifampicin (joint replacement or penicillin allergy)

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19
Q

Influenza treatment

A

Oral oseltamivir 75mg 2x day for 5 days Or Inhaled zanamivir 10mg 2x day for 5 days(Treatment must start within 48h of symptoms) Same drugs but 1x day for 10 days in PEP

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20
Q

Gram negative diplococcus

A

Gonorrhoea| Neisseria meningitidis

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21
Q

Bacterial meningitis in adults

A

Neisseria meningitidis, strep pneumoniaeNeonates: group B strep

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22
Q

Lumbar puncture in babies

A

<1 month with fever 1-3 month fever and unwell <1 year unexplained fever and serious ilness

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23
Q

Kernig’s test

A

Pt on back, flexing hip and straightening knee - meninges stretch and -> resistance or pain

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24
Q

Brudzinski’s test

A

Pt flat on the back, chin to chest -> if meningitis then pt flexes hips

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25
Q

Community meningitis 1st line

A

Benzylpeniclinin IM/IV stat300mg <1y600mg 1-9y1200mg >10y

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26
Q

Meningitis hospital tx

A

<3m cefotaxime + amoxicillin>3m ceftriaxone+ Dexamethasone to prevent hearing loss and neuro damage 4x/4 days

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27
Q

Lumbar puncture results

A

Bacterial - cloudyViral / normal - clear Bacteria release proteins and use up glucose Viruses don’t use glucose and release little protein Neutrophils released for bacteria and lymphocytes released for virusesHigh WBC for both

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28
Q

TB staining

A

Ziehl Neelsen stain turns bacteria bright red and background blueTB grows acid-fast bacilli (rod shaped)

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29
Q

BCG vaccine

A

Intradermal infection of life attenuated TB- works against complicated TB- not as effective for pulmonary TB

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30
Q

Mantoux test

A

Injecting tuberculin into intradermal space| Check after 72h, >5mm is positive (previous vaccination, latent, or active TB)

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31
Q

Interferon gamma release assays

A

Confirms latent TB disease

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32
Q

Pts at risk of TB reactivation (w latent TB) tx

A

Isoniazid and rifampicin 3m| Isoniazid 6m

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33
Q

Acute TB tx

A

Rifampicin 6mIsoniazid 6mPyrazinamide 2mEthambutol 2m

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34
Q

Isoniazid side effects and tx

A

Peripheral neuropathy| - Pyridoxine (B6)

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35
Q

Rifampicin se

A

Red discolourstion of urnie and tears| Induces p450 so reduces effect of contraceptive pill

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36
Q

Pyrazinamide se

A

Hyperuricaemia (high uric acid and gout)

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37
Q

Ethambutol se

A

Colour blindness and reduced visual acuity

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38
Q

PCP in hiv

A

Co-trimoxazole prophylaxis in CD4 <200

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39
Q

PEP

A

<72h| Truvada (emtricitabine/ tenofovir) and Raltegravir 28days

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40
Q

Uncomplicated malaria treatment

A

MalaroneQuinine sulphateDoxycycline

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41
Q

IV tx for complicated malaria

A

Artesunate and quinine dihydrochloride

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42
Q

Antimalarials

A

Malarone (2d/during/1week)Mefloquine (2w/during/4week) - psychotic episodes and seizuresDoxycycline (2w/during/4week) - Abx so thrush, diarrhoea

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43
Q

OA risk factors

A 
Obesity AgeTraumaFemaleFamily history
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44
Q

OA X-ray

A

Loss of joint spaceOsteophytesSubarticular sclerosisSubchondral cysts

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45
Q

OA symptoms

A

Pain and stiffness worsened by activity

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46
Q

OA signs

A

Haberdens nodes DIPBouchards nodes PIPSquaring of the thumb

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47
Q

OA management

A

Weight loss, physioParacetamol + topical NSAIDAdd oral NSAID + PPIAdd codeine / morphine

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48
Q

RA genetics

A

HLA DR4 - RF positive pt| HLA DR1 - often present in RA

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49
Q

Antibodies in RA

A

RF| anti CCP

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50
Q

RA presentation

A 
Symmetrical polyarthritis MCP and PIP jointsAtlantoaxial subluxationPain, swelling, stiffnessPain worse after rest, improves with activity
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51
Q

Signs in the hands RA

A 
Boggy feelingZ shaped thumbSwan beck deformityBoutonnières deformity (flexor digitorum superficialis works)Ulnar deviation
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52
Q

Felty’s syndrome

A

RA, neutropenia, splenomegaly

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53
Q

DAS 28

A

Disease activity score Swollen jointsTender jointsESR/CRP result

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54
Q

RA DMARDs

A

1st mono: methotrexate, leflunomide, sulfasalazine, hydroxychloroquine2nd: 2 drugs3rd: methotrexate + biological therapy (TNF inhibitor - adalimumab, infliximab, etanercept)4rd: methotrexate + rituximab

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55
Q

Methotrexate SEs

A

Pulmonary fibrosis

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56
Q

Leflunomide se

A

Hypertension and peripheral neuropathy

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57
Q

Sulfasalazine se

A

Male infertility (reduced sperm count)

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58
Q

Hydroxychloroquine se

A

Nightmares and reduced visual acuity

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59
Q

Anti TNF se

A

Reactivation of TB and hep B

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60
Q

Rituximab

A

Night sweats and thrombocytopenia

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61
Q

Psoriatic arthritis signs

A 
Nail pittingPsoriasis plaques on skinOnycholysis- nail separates from nail bedDactylitis ConjunctivitisPencil in cup appearance
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62
Q

Chlamydia vs| Gonorrhoea ->

A

Chlamydia -> Reactive arthritis| Gonorrhoea -> gonococcal septic arthritis

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63
Q

Reactive arthritis

A

Conjunctivitis, arthritis, balanitis

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64
Q

Seronegative spondyliarthropathy

A

HLA B27 geneAnkylosing spondylitisReactive arthritisPsoriatic arthritis

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65
Q

AS features

A

Sacroiliac and vertebral pain and stiffnessVertebral fracturesPain worse at night Morning stiffness, gets better throughout the dayStiffness worse with rest and better with movement

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66
Q

AS associations

A 
AnaemiaAnterior uveitis Aortitis Heart block Pulmonary fibrosis
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67
Q

X ray changes in AS

A 
Bamboo spine Squaring of vertebral bodiesSubchondral sclerosisFusion of joints Syndesmophytes
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68
Q

AS treatment

A

Nsaids 2-4weeks then change if no improvementSteroidsAnti TNF (etanercept)Monoclonal antibody against TNF (infliximab, adalimumab)

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69
Q

SLE signs

A

Photosensitive malar rash| Worse with sunlight

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70
Q

SLE investigations

A

C3 and C4 decreased in active diseaseCRP and ESR raised in active inflammationIncreased PCR in lupus nephritis

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71
Q

SLE antibodies

A

ANA| anti ds DNA (increased with disease activity)

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72
Q

Anti Smith

A

specific to SLE

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73
Q

Sensitivity

A

How many/% ill people had positive result

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74
Q

Specificity

A

What % of healthy people had negative result

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75
Q

Anti centromere

A

Limited cutaneous systemic sclerosis

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76
Q

Anti Ro and Anti La

A

Sjorgen’s syndrome

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77
Q

Anti Scl 70

A

Systemic sclerosis

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78
Q

Anti Jo 1

A

Polymyositis

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79
Q

SLE treatment

A

NSAIDsSteroids (prednisolone) Hydroxychloroquine (mild SLE 1st line)Biological therapies: rituximab, belimumab

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80
Q

Systemic sclerosis

A

Hardening of the skin| Fibrotic connective tissue disease

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81
Q

Limited cutaneous systemic sclerosis antibodies

A

Anti Scl 70| Anti centromere

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82
Q

Limited cutaneous systemic sclerosis features

A 
CalcinosisRaynuaurd phenomenonEsophageal dysmotilitySclerodactylyTelangectasia
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83
Q

Diffuse cutaneous systemic sclerosis antibodies

A

Anti Scl 70

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84
Q

Diffuse cutaneous systemic sclerosis symptoms

A

CREST+ CV problems+ lung problems + kidney problems

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85
Q

Polymyalgia rheumatica

A 
2 weeks ofBilateral shoulder pain, pelvic girdle painWorse with movementWakes up from sleepAt least 45min stiffness in the morning
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86
Q

Polymyalgia rheumatica tx

A 
15mg prednisolone /dayUntil symptoms settle (3-4 weeks)Then 12.5mg for 3 weeks10mg for 4-6 weeksReduce by 1mg every 4-8 weeks
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87
Q

Giant cell arteritis risk

A

Vision loss

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88
Q

Temporal artery biopsy findings in giant cell arteritis

A

Multinucleated giant cells| Also investigations: raised ESR, CRP, hypoechoic halo on duplex ultrasound

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89
Q

Giant cell arteritis tx

A

40-60mg prednisolone/day| also 75mg aspirin daily

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90
Q

Polymyositis and /dermatomyositis+ diagnosis+tx

A

Chronic muscle inflammation /+ skin involvementRaised CKCorticosteroids

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91
Q

DermatoMyositis signs

A

Gottron lesions (knuckle hardening)Photosensitive rash on the back and neckCalcium deposits in subcut tissue

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92
Q

Polymyositis antibodies

A

Anti Jo 1

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93
Q

Dermatomyositis antibodies

A

Anti Mi 2| ANA

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94
Q

Antiphospholipid syndrome antibodies

A

Lupus anticoagulantAnticardioliptin antibodiesAnti beta 2 glycoprotein I antibodies

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95
Q

Libmann-Sacks endocarditis

A

Non bacterial endocarditis with vegetations on mitral valve, SLE and antiphospholipid association

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96
Q

Livedo reticularis

A

Purple lace like rash with mottled appearance to the skin

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97
Q

Sjorgen’s Syndrome

A

Autoimmune condition affecting exocrine glands| -dry mucous membranes, dry mouth, eyes, vagina

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98
Q

Secondary Sjorgen’s

A

When condition is related to SLE or rheumatoid arthritis

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99
Q

Sjorgen’s antibodies

A

Anti Ro| Anti La

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100
Q

Schirmer test

A

Tears should travel 15mm in healthy adult| 10mm is significant

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101
Q

Sjorgen’s syndrome tx

A

Artificial saliva, tearsVaginal lubricantsHydroxychloroquine stops disease progression

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102
Q

Vasculitis markers

A

ESR and CRP raised| Anti neutrophil cytoplasmic antibody ANCA

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103
Q

pANCA

A

peri Nuclear anti-neutrophil cytoplasmicAnti-PR3Microscopic polyangitis, churg-Strauss

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104
Q

cANCA

A

Wegener’s granulomatosis

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105
Q

Vasculitis treatment

A

Steroids,| Immunosuppressants (cyclophosphamide, methrotrexate, azathioprine)

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106
Q

Henoch Schonlein Purpura

A 
IgA Vasculitis Purpuric rash in lower limbs and buttocks- purpura- joint pain- abdominal pain- renal involvement
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107
Q

Wegener’s polyangitis

A

Respiratory track and kidney involvement EpistaxisHearing loss and sinusitisSaddle shaped nose due to perforated septum

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108
Q

Kawasaki disease (medium vessel Vasculitis)

A 
CRASH AND BURNConjunctivitisRashAdenopathy /LymphadenopathyStrawberry tongueHands and feet skin peeling
Fever >5d
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109
Q

Kawasaki disease complication

A

Coronary artery aneurysm

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110
Q

Behcet disease gene

A

HLA B51 (prognostic of severe disease)

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111
Q

Behcet disease features

A

Oral and genital ulcers + skin inflammation, uveitis, muscle stiffness, GI ulceration, veins - Budd chiari syndrome, DVT, pulmonary artery aneurysm)

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112
Q

Pathergy test

A

For Behcet disease Tests for skin hypersensitivity Skin subcut abrasion, reviewed 24-48h later, >5mm weal is positive

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113
Q

Behçet’s disease tx

A

Colchicine for inflammationImmunosuppressant azathioprineTopical (bethamethasone) and systemic (prednisolone) steroids

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114
Q

Gout aspirate features

A

No bacteriaNeedle shaped crystalsNegative birefringent Monosodium urate

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115
Q

Gout X ray

A

Sclerotic boarders with overhanging edges| Punched out erosions

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116
Q

Gouty throphi

A

Subcut deposits of uric acid

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117
Q

Gout mx

A

Acute: NSAID, colchicine, steroid

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118
Q

Colchicine se

A

Diarrhoea -given in pts who can’t use NSAID

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119
Q

Gout prophylaxis

A

Allopurinol, reduces uric acid levels

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120
Q

Pseudogout

A

Calcium pyrophosphate crystals / chondrocalcinosis

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121
Q

Pseudogout joint aspirate

A

No bacteria Calcium pyrophospahte crystalsRhomboid shapedPositive birefringent

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122
Q

Pseudogout on X ray

A

Chondrocalcinosis

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123
Q

Pseudogout tx

A

NSAID, colchicine, steroids| +- joint washout

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124
Q

Risk factors for osteoporosis

A 
Old ageFemaleLow BMILow activity/ mobilityAlcohol and smokingRheumatoid arthritisLong term corticosteroid usePost menopause (oestrogen is protective)
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125
Q

FRAX tool

A

Prediction of fragility fracture in 10years| Age, BMI, smoking, alcohol, co-morbidities, family history

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126
Q

Osteoporosis tx

A

Bisphosphonates (upright, empty stomach, 30 min before eating)- alendronate 75mg/week- risedronate 35mg/week- zolendronic acid 5mg/ year IV

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127
Q

Osteomalacia

A

Defect in bone mineralisation due to insufficient vit D| If in children before growth plate close - rickets

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128
Q

Osteomalacia pathology

A

Low vit Dcauses low Ca and PO42* hyperparathyroidismReabsorption of Ca from bones (causing soft bones)

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129
Q

Investigation for vit D

A

<25 - vit D deficiency 25-50 insufficient >75 optimal

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130
Q

Osteomalacia tx

A

Vit D 50. 000 1x weekly (6w)20. 000 2x weekly (7w)4. 000 daily (10w)Maintenance 800 daily

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131
Q

Paget’s disease

A

Excessive bone turnover (formation and reabsorption due to increased osteoblast and osteoclast activity)Forms high density sclerotic and low density lytic patches.

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132
Q

Paget’s disease biochemistry

A

Raised ALPNormal Ca Normal PO4

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133
Q

Paget’s X ray

A

Cotton wool skull| V shaped defect in long bones

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134
Q

Paget’s disease treatment

A

Bisphosphonates + vit D and Ca supplementation on bisphosphonates NSAIDs for pain

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135
Q

ABCD2 score

A 
48h risk of stroke post TIAAge >60 (1)BP >140/90 (1)Clinical features - dysphasia (1), +weakness (2)Durstion >60min (2), 10-60min (1)Diabetes (1)
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136
Q

Stroke management

A

Aspirin 300mg/ day for 2 weeks| Thrombolysis with alteplase within 4.5h (after CT)

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137
Q

TIA mx

A

Aspirin 300mg + secondsry prevention:Clopidogrel 75mg 1x or dypiridamole 200mg 2xAtorvastatin 80mg

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138
Q

Crescendo TIA follow up

A

Within 24h specialist assessment| ABCD2 >3 24h assessment, otherwise 1 week assessment

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139
Q

GCS

A

Eyes: none, Pain, speech, spontVerbal: None, sounds, words, confused, orientalnedMotor: none, Extends, abnormal flexion, flexion, localises Pain, obeys commands

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140
Q

Subdural haemorrhage location

A

Bridging veins| Between dura and arachnoid

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141
Q

Subdural haemorrhage on CT

A

crescent shape| Crosses cranial sutures

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142
Q

Subdural haemorrhage risk factors

A

Elderly and alcoholic

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143
Q

Extradural haemorrhage location

A

Middle menigeal artery Temporal/parietal regionAssoc w fx of temporal bone

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144
Q

Extradural haemorrhage CT

A

Biconvex| Does not cross cranial sutures

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145
Q

Extradural haemorrhage hx

A

Young ptOngoing headache Period of improvement and rapid decline in consciousness

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146
Q

Subarachnoid haemorrhage location

A

Pia matter and arachnoid membrane

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147
Q

Subarachnoid haemorrhage vessel

A

Cerebral aneurysm rupture

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148
Q

Subarachnoid haemorrhage hx

A 
Occipital headache (strenous activity)Thunderclap headacheNeck stiffnessPhotophobiaHit on the back of head
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149
Q

Subarachnoid headache associations

A 
Cocaine useSickle cell anaemiaAlcoholSmokingHTN
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150
Q

Ix in subarachnoid haemorrhage

A

CT hyperattenuation| CSF red cell count and xantochromia

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151
Q

Subarachnoid haemorrhage mx

A

Coiling or clipping of the aneurysm Nimodipine for vasospasmLumbar puncture and shunt to treat hydrocephalus

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152
Q

CN VI palsy in MS

A

Internuclear ophthalmoplegia| Conjugate lateral gaze disorder

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153
Q

MS lumbar puncture

A

Oligoclonal bands

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154
Q

Optic neuritis features

A

Central scotomaPainReduced colour visionRAPD

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155
Q

MS relapse treatment

A

Methylprednisolone 500mg PO 1x for 5 days| Or 1g IV daily 3-5d

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156
Q

Lower motor neurone disease

A

Muscle wastingReduced toneFasciculationsReduced reflexes

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157
Q

Upper motor neurone disease

A

Increased toneBrisk reflexesUpgoing plantars

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158
Q

Management of motor neurone disease

A

Riluzole

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159
Q

Parkinson’s triad

A

Resting tremorRigidityBradykinesia

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160
Q

Parkinson’s features

A 
Ansomnia Shuffling gait Hypomimia Asymmetrical tremor 4-6hzWorse at restImproves with movementNo change with alcohol
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161
Q

Levodopa

A

Synthetic dopamine

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162
Q

Peripheral decarboxylase inhibitors

A

Benserazide| Carbidopa

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163
Q

Too high dopamine se

A

Dskinesia (excessive motor activity)

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164
Q

Dystonia

A

Abnormal postures and exaggerated movements

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165
Q

Chorea

A

Abnormal involuntary movements (jerking and random)

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166
Q

Athetosis

A

Involuntary twisting in hands feet fingers

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167
Q

COMT inhibitor

A

Inhibits levodopa metabolism in body and brain| Slows levodopa breakdown

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168
Q

Dopamine agonists

A

SE pulmonary fibrosisBromocryptinePergolideCarbergoline

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169
Q

MAO B Inhibitors

A

Block enzyme breaking down dopamine neurotransmitterSelegiline Rasagiline

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170
Q

Benign essential tremor tx

A

Propanolol (non selective beta blocker)| Primidone (anti epileptic)

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171
Q

Tonic clinic seizure

A 
Prolonged post ictalLoss of consciousness ConfusedDrowsyIncontinence
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172
Q

Focal seizures characteristics

A

Hearing speech memoryDeja vu Autopilot (strange things, don’t remember)Hallucinations

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173
Q

Focal seizure location

A

Temporal

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174
Q

Infantile spasms

A

West syndrome full body spasmsTx prednisolone and vigabatrin

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175
Q

Seizure treatment

A

(Everything but focal)Sodium valproate Lamotrigine/carbamazepineFocal Lamotrigine/carbamazepineSodium valproate/levetiracetam

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176
Q

Absence Seizure tx

A

Sodium valproate or Ethosuximide

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177
Q

Carbamazepine se

A 
AgranulocytosisP450 inducer (eg cocp)
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178
Q

Phenytoin se

A

Folate and vit D deficiency Osteomalacia Megaloblastic anaemia

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179
Q

Status epileptic is mx in community

A

Buccal midazolam| Rectal diazepam

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180
Q

Status epilepticus mx in hospital

A 
O2Check blood glucose IV accessIV lorazepam 4mg (repeat after 10min)IV phenobarbital or phenytoin
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181
Q

Trigeminal neuralgia tx

A

Carbamazepine

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182
Q

Neuropathic pain tx

A 
(1 at a time, if doesn’t work switch, try all 4)AmitryptylineDuloxetineGabapentinPregabalin
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183
Q

Bell’s palsy tx

A

Prednisolone (start within 72h)50mg for 10days60mg for 5 days and 5days reducing regime (10a day)

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184
Q

Ramsay Hunt Syndrome

A

Herpes zoster virus| 72h prednisolone, acyclovir

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185
Q

Bilateral acoustic neuromas association

A

Neurofibromatosis type 2

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186
Q

Acoustic neuroma symptoms

A

Hearing lossTinnitus Balance problems

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187
Q

Bromocriptine

A

Block prolactin secreting tumours

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188
Q

Somatostatin analogue (ocreotide)

A

Block growth hormone secreting tumours

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189
Q

Huntingtons genetics

A 
ADOn chromosome 4Trinuckeotide repeat disorder mutation in HTT geneAnticipation
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190
Q

What is anticipation

A

Successive generation have more repeats of the gene- earlier onset age- increased severity of disease

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191
Q

Drugs to manage huntingtons symptoms

A

Antipsychotic (olanzapine)Benzodiazepines (diazepam)Dopamine depleting (tetrabenazine)

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192
Q

Myasthenia gravis antibodies

A

Acetylcholine receptor antibodies 85%Muscle specific kinase antibodies 10% (make up the receptor)LRP4 abs (5%)

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193
Q

Edrophonium test

A

IV 10mg of endrophonium chloride / neostigmineStops breakdown of acetylcholine and relieves weaknessAtropine 0.6mg IV to reverse

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194
Q

Myasthenia gravis treatment

A

Acetylcholinedterase inhibitors (neostigmine, pyridostigmine)Or monoclonal:Rituximab, eculizumab

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195
Q

Myasthenic crisis tx

A

IVIG| Plasma exchange

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196
Q

Lambert Eaton associations

A

Small cell lung cancerProximal muscles affectedDiplopia, ptosis, dysphagia

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197
Q

Lambert Eaton treatment

A

Amifampridine - allows more Ach to be released in junction synapses

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198
Q

Charcot Marie tooth genetics

A

AD

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199
Q

Charcot Marie tooth characteristics

A 
High foot arch/ pes cavusInverted champagne bottle legsLoss of ankle dorsiflexionWeak handsReduced muscle tone Peripheral neuropathy
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200
Q

Gillian barre triggers

A

NAME?

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201
Q

Gullain barre ix

A

CSF raised protein| Nerve conduction reduced

202
Q

NF1 genetics

A

AD| chromosome 17

203
Q

NF1 diagnostic criteria

A 
Cafe au lait (6 spots >15mm)Relative with NF1Axillary/inguinal frecklesBony dysplasia, bowing of bonesIris hamartomasNeurofibromatomasGlioma of optic nerve
204
Q

NF2

A

Chromosome 22 AD —> leads to development of Schwannomas and acoustic neuromas

205
Q

NF 2 associations

A

Bilateral acoustic neuromas

206
Q

Tuberous sclerosis genetics

A

TSC1 gene chromosome 9 - hamartinTSC2 gene chromosome 16 - tuberinHamartin and tuberin control cell growth

207
Q

Skin signs of tuberous sclerosis

A 
Ash leaf spotsShagreen patches AngiofibromasCafe au laitPoliosis+ epilepsy and developmental delay
208
Q

Migraine acute and long term management

A

Acute: paracetamol, sumatriptan 50mg, nsaid, metoclopramide for vomitingLong: propanolol, topiramate (teratogenic, cleft lip and palate), amitriptyline

209
Q

Migraine around menstruation tx

A

NSAIDs Or FrovatriptanZolmitriptan

210
Q

Cluster headache acute and long term mx

A

Acute: high flow O2, sumatriptan 6mg subcut| Long term: veramapil, lithium, prednisolone

211
Q

Glaucoma

A

Optic nerve damage due to rise in intraocular pressure

212
Q

IOP

A

10-21mmHg| Start treatment in >24mmHg

213
Q

Risk factor for glaucoma

A

Black ethnicAgeMyopia/ near sight

214
Q

Glaucoma tx

A

LatanoprostTimolol DorzolamideBrimonidine

215
Q

Latanoprost

A

Prostaglandin analogue eye dropsIncrease uveoscleral outflowEyelash growthEyelid and iris pigmentation

216
Q

Timolol

A

B blocker| Reduce aqueous humour production

217
Q

Dorzolamide

A

carbonic anhydrase inhibitor| Reduce aqueous humour production

218
Q

Brimonidine

A

Sympathomimetic| Reduce aqueous fluid production and increase uveoscleral flow

219
Q

Medications precipitating close/acute angle glaucoma

A

Noradrenalin OxybutyninSolifenacinAmitryptyline

220
Q

Close angle glaucoma immediate management

A

Lie on the backPilocarpine eye drop (pupil contatriction)Acetazolamide PO 500mg (carbonic anhydrase, reduces aqueous humour production)

221
Q

Close angle glaucoma 2* care

A 
PilocarpineAcetazolamide Hyperosmotics (mannitol, glycerol)Timolol DorzolamideBrimonidine
222
Q

Age Related Macular Degeneration presentation

A 
Reduced visual acuity Wavy appearance of straight linesWorsening of central vision -drusen -scotoma-amsler grid
223
Q

Dry AMD tx

A

LifestyleStop smokingControl BP

224
Q

Wet AMD

A

anti VEGF injected into vitreous chamber (ranibizumab, bevacizumab, pegaptanib)

225
Q

Diabetic retinopathy pathophysiology

A

Blot haemorrhage Hard exudatesCotton wool spots

226
Q

Micro aneurysm

A

Small bulges in blood vessels due to weakness

227
Q

Venous beading

A

Walls of vessels no longer straight, string of beads or sausages

228
Q

Cotton wool spots

A

Nerve fibre damage - white fluffy patches

229
Q

Retinopathy management

A

Laser photocoagulation| Anti VEGF ranibizumab, bevacizumab

230
Q

Silver wiring/ copper wiring

A

Walls of arterioles are thickened and sclerosed

231
Q

Av Nicking

A

Arterioles compress veins when they cross over

232
Q

Cataract

A

Lens of the eye becomes cloudy and opaque

233
Q

Cataracts presentation

A

Worsening visionChange in colour vision (colours more brown/yellow)Starburts around lights Loss of red reflex

234
Q

Dilated pupil

A

Horner adieRaised icp 3rd nerve palsy Anticholinergics

235
Q

Constricted pupil

A

Horner syndromeArgyll Robertson pupilOpiateNicotine

236
Q

3rd CN palsy (oculomotor)

A

PtosisDilated pupilDown and out

237
Q

Horner syndrome

A

PtosisMiosis Anhidrosis + enophthalmos/ sunken eye

238
Q

Anhidrosis - pre ganglionic

239
Q

Anhidrosis central

A 
- Face arm trunkSyringomyeliaStrokeMSSwelling (tumour)
240
Q

Post ganglionic Anhidrosis

A

No AnhidrosisCarotid aneurysmCarotid artery dissectionCavernous sinus thrombosis

241
Q

Holmes Aldie pupil

A

dilated pupil, slow to react to light, slow dilatation

242
Q

Holmes aldie syndrome

A

Holmes aldie pupil| Ankle and knee reflexes absent

243
Q

Test for Horner syndrome

A

Cocaine (stops noradrenaline reuptake) - normal dilates, affected no reaction Adrenaline eye drop - will dilate affected pupil but no reaction in normal

244
Q

Hordeolum externum

A

stye| Gland of zeis/ moll infection at base of eyelashes

245
Q

Hordeolum internum

A

Meibomian glands infection, pointing inwards towards the eyeball

246
Q

Chalazion

A

Mebomian gland blockage and swellingHot compress and analgesiaChloramphenicol if acutely inflamed

247
Q

Trichiasis

A

Inward growth of eyelashes

248
Q

Preorbital cellulitis

A

Infection of eyelid and skin in front of the ortbital septum

249
Q

Orbital cellulitis

A

Infection around the eyeball involving tissues behind the orbital septum- pain on movememt- proptosis- reduced vision- abnormal pupil reactions

250
Q

Episcleritis vs scleritis

A

Episcleritis painless| Scleritis painful

251
Q

Conjunctivitis mx

A

Cool water eye cleaning| Chloramphenicol and fusidic acid drops

252
Q

Neonatal conjunctivitis

A

Gonococcal infection

253
Q

Anterior uveitis genetics

A

HLA B27Ankylosing spondylitisIBDreactive arthritis

254
Q

Anterior uveitis mx

A

Steroid (oral topical Iv)Immunosuppressants (dmard and TNF inhibitor) Cycloplegic-mydriatic - dilate pupil to reduce pain (cyclopentolate, atropine)

255
Q

Corneal abrasion in contact lenses

A

Pseudomonas infection

256
Q

Corneal abrasion complication

A

Herpes keratitis (antiviral treatment)

257
Q

Corneal abrasion /herpes keratitis diagnosis

A

Fluorescein stain - ulcer /abrasion

258
Q

Keratitis

A

Inflammation of the cornea

259
Q

Bacterial keratitis causes

A

Pseudomonas or staphylococcus

260
Q

Viral keratitis

A

Herpes simplex keratitis

261
Q

Herpes keratitis fluorescein

A

Dendritic corneal ulcer

262
Q

Herpes keratitis tx

A

Acyclovir (topical or oral)| Ganciclovir eye gel

263
Q

Sensorineural hearing loss caused by drugs

A 
Loop diuretics (furosemide)Aminoglucoside antibiotics (gentamicin)Chemotherapy drugs (cisplatin)
264
Q

Causes of prebyscusis

A 
(Sensorineural hearing loss)Loss of hair cells in cochleaLoss of neurons in cochleaReduced endolymphAtrophy of stria
265
Q

Sensorineural hearing loss tx

A

Cochlear implants

266
Q

Sudden sensorineural hearing loss

A

Over 72h| Loss of 30 decibels in 3 consecutive frequencies

267
Q

Sudden sensorineural hearing loss tx

A

Steroids (oral, intratympanic)

268
Q

Eustachian tube dysfunction mx

A

Valsava manouvre (blow closed nose)Decongestant nasal spraySurgery (grommet, ballon dilatation)

269
Q

Otosclerosis

A

Remodelling of small bones of middle ear - bone hardeningAD patternOnset <40yoConductive hearing loss

270
Q

Hearing loss at low frequencies

A

Otosclerosis

271
Q

Conductive hearing loss mx in otosclerosis

A

Hearing aids| Surgery - stapedectomy or stapedotomy

272
Q

Bacterial cause of otitis media

A

Step pneumoniaeOther: Hem influenzaMoraxella catarrhalisStaphylococcus aureus

273
Q

Otitis media tx

A

Amoxicillin 5-7dClarithromycin (in penicillin allergic)Erythromycin (in pregnant and allergic to penicillin)

274
Q

Otitis externa bacterial causes

A

Pseudomonas auerginosa| Staph aureus

275
Q

Otitis externa hearing loss

A

Conductive

276
Q

Pseudomonas auerginosa

A

Gram -ve aerobic rod shaped bacteria Colonises in lungs in CFTx with aminoglycosides (gentamicin), quinolones (ciprofloxacin)

277
Q

Otitis externa tx

A 
Mild: acetic acid 2%Moderate: topical abx + steroid - neomycin, dexamethasone, acetic acid-neomycin and bethamethasone- gentamicin and hydrocortisone- ciprofloxacin and dexamethasoneSevere: oral abx flucloxacillin or clarithromycin
278
Q

Ototoxic drugs

A

Aminoglycosides (gentamicin and neomycin) Toxic if get past tympanic membraneMust exclude perforated tympanic membrane

279
Q

Fungal otitis externa tx

A

Clotrimazole ear drops

280
Q

Malignant otitis externa findings

A

Granulation tissue

281
Q

Malignant otitis externa tx

A

AdmissionImaging IV abx

282
Q

Methods of removing ear wax

A

Ear drops (olive oil, sodium bicarbonate 5%)Ear irrigation Microsuction

283
Q

Primary tinnitus

A

Occurs with sensorineural hearing loss

284
Q

BPPV

A

Calcium carbonate crystals displaced into aemicircular canals

285
Q

Labirynthitis vs vestibular neuronitis

A

Labirynthitis causes hearing loss

286
Q

Posterior circulation infarction symptoms

A

VertigoAtaxia DiplopiaCN or limb symptoms

287
Q

Cerebellar examination

A 
DysdiadochokinesiaAtaxic gaitNystagmus Intention tremor SpeechHeel to shin
288
Q

Head impulse test

A

Shaking head left or right Asking pt to keep looking at doctors noseIf saccades, PERIPHERAL vertigo

289
Q

Nystagmus test

A

Quick look right to left (repeat)Unilateral horizontal: PERIPHERAL causeBilateral vertical: CENTRAL cause

290
Q

Central vertigo treatment

A

Referral, CT MRI

291
Q

Peripheral vertigo tx

A

Prochlorperazine| Antihistamine

292
Q

Meniere disease Tx

A

Betahistine

293
Q

Vestibular migraine tx

A

Triptans| Propanolol/ topiramate/ amitryptyline long term

294
Q

BPPV symptoms

A

Vertigo attacks 20-60 secasymptomatic in betweenOver several weeksNo tinnitus or hearing loss

295
Q

Vestibular neuronitis

A

Vestibular nerve inflammation

296
Q

Inner ear parts

A

Semicircular canalsVestibuleCochlea

297
Q

Semicircular canals role

A

Detect head rotation

298
Q

Otolith organs role

A

Detect gravity and linear acceleration

299
Q

Labirynthitis LOSS of hearing| Neuronitis NO loss of hearing

A

Tinnitus and hearing loss - Labirynthitis or Menieres disease Nausea and balance - vestibular neuronitis

300
Q

Vestibular neuritis and Labirynthitis treatment

A

Prochlorperazine| Antihistamines (cyclizine, promethazine)

301
Q

Meningitis complication

A

Hearing loss

302
Q

Meniere disease triad

A 
Hearing lossVertigoTinnitus- unilateral- symptoms 20min-couple hours- low frequency sensorineural hearing loss
303
Q

Cholesteatoma

A

Squamous epithelial cells abnormal collection in middle ear

304
Q

Choelsteatoma presentstion

A

Foul discharge| Unilateral conductive hearing loss

305
Q

Nosebleed management

A

Nasal packing (tampons or inflatable packs)Nasal cautery with silver nitrateThen 4x day for 10 days - naseptin nasal cream (chlorhexidine, neomycin)

306
Q

Naseptin components and contraindication

A

Chlorhexidine and neomycin| Cd: peanut or soya allergy

307
Q

Acute sinusitis

A

If symptoms not impoving after 10dHigh dose nasal spray 14d (momethasone 200mcg 2x daily)Delayed abx prescription if not improved after 7d (phenoxymethylpenicilline)

308
Q

Nasal polyps unilateral

A

Concern for malignancy, specialist referral

309
Q

Samter’S triad

A

Nasal polyps, asthma, aspirin intolerance/allergy

310
Q

Nasal polyps apperance

A

Pale grey/yellow growth on mucosal wall

311
Q

Apnoea assessment

A

Epworth sleepiness scale

312
Q

Tonsilits bacterial cause and tx

A

Group A step (streptococcus pyogenes) - penicillin V / phenoxymethylpenicillin

Or strep pneumoniaOther causes: Haemophilius ibfluenza Moraxella catarhhalis Staphylococcus aureus
313
Q

Centor criteria - probability of bacterial tonsilitis

A 
3 or more (40-60%) Fever 38*CTonsilar exudatesAbsence of coughLymphadenopathy
314
Q

FeverPAIN score

A

4-5 score (62-65%) - Fever in previous 24h - Pus on tonsilitis - Attend within 3 days of symptoms - Inflamed tobsils (severely inflamed) - No cough or coryza

315
Q

When to prescirbe abx?

A

Centor >= 3| FeverPAIN >= 4

316
Q

Tonsilitis tx

A

Penicillin V 10 day Course Or Clarithromycin for penicillin allergy

317
Q

Peritonsillar abscess cause

A

Strep pyogenes (group A Strep) Staph aureusHaemophilius influenzae

318
Q

Quinsy treatment

A

Co amoxiclav| Incision and drainage

319
Q

Tonsilectomy indications

A

7 tonsilitis in 1y5 tonsilitis in 2y3 tonsilitis in 3y

320
Q

Post tonsilectomy bleeding management

A

Hydrogen peroxide gargleAdrenalin soaked swabRe - surgery

321
Q

Thyroid lump

A

Moves with swallowing

322
Q

Thyroglossal cyst

A

Movement when sticking tongue out

323
Q

Bronchial cyst

A

Transluminates with light| Anterior triangle

324
Q

EBV and abx

A

Maculopapular rash in response to amoxicilin and cefalosporin

325
Q

Hodgkin lymphoma node biopsy

A

Reed Sternberg cell

326
Q

Thyroglossal cyst

A

MobileNon tenderSoftFluctuant

327
Q

Lipoma

A

MobileSoftPainlessNo skin change

328
Q

Branchial cyst

A 
RoundSoftCystic swellingTransluminate with lightAnterior to SCM
329
Q

Glossitis causes

A

Iron deficiencyB12, folate deficiencyCoeliac disease

330
Q

Oral candidiasis treatment

A

Miconazole gelNystatin suspensionFluconazole tablets

331
Q

Leuko and erythroplakia

A

Leuko - white patchesErythro - red lesionsPrecancerous changes, increasing risk of squamous cell carcinoma

332
Q

Aphthous ulcers treatment

A

Topical:Choline salicylateBenzydamineLidocaineTopical corticosteroids - severe:Hydrocortisone buccal tabletsBethamethasone soluble tabletsBeclomethasone inhaler spray

333
Q

VTE prophylaxis in hip/knee

A

LMWH 28d post hip, 14d post knee replacement| Or aspirin, rivaroxaban, stockings

334
Q

Prostethic joint infection organizm

A

Staphylococcus aureus

335
Q

Children fracture types

A

Salter Harris ONLY in childrenGreenstickBuckle fracture

336
Q

Cancers that metastasise to the bone

A 
PoRTaBLeProstateRenalThyroidBreastLung
337
Q

FRAX tool

A

Measures pt’s risk of fragility fracture over 10 years

338
Q

Tx for preventing fragility fractures

A

Calcium and vit D| Bisphosphonates (alendronic Acid) - alternstive with monoclonal ab Denosumab-

339
Q

Bisphosphonates side effects

A

Osteonecrosis of jaw or external auditory canalReflux and oesophageal erosionAtypical fractures

340
Q

Non displaced intra capsular fx tx

A

Internal fixation

341
Q

Displaced intra capsular fx tx

A

Hemiarthroplasty - elderly, co morbidities, mobility issues| Total hip replacement - young, walk independently

342
Q

Extra capsular fx

A

Intertrochanteric fx| Subtrochanteric fx

343
Q

Intertrochanteric fx tx

A

Dynamic hip screw

344
Q

Subtrochanteric fx tx

A

Intramedullary nail

345
Q

Hip fx presentation

A

Shortened, abducted, externally rotated leg

346
Q

Disruption of Shenton line

347
Q

Acute limb ischaemia

A

PULSELESS limb

348
Q

Acute compartment syndrome

A 
Pain - disproportionate, worsened by passive movememt ParaesthesiaPaleHigh pressureParalysis
349
Q

Osteomyelitis

A

Inflammation of bone and bone marrow due to bacterial infection

350
Q

Most common cause of osteomyelitis

A

Staph aureus

351
Q

Acute osteomyelitis treatment

A

6 weeks of flucloxacillin with rifampicin/fusidic acid added for first 2 weeksClindamycin if penicillin allergy Vancomycin or teicoplanin if MRSA

352
Q

Most common bone cancer

A

Osteosarcoma

353
Q

Kaposi sarcoma cause

354
Q

Most common sarcoma metastasis

355
Q

Sciatic nerve roots

A

L4 - S3Exits pelvis through greater sciatic foramenThen divided into tibial and common peroneal nerve

356
Q

Thomas test

A

Flexibility of hip flexors (eg iliopsoas muscle group)

357
Q

Long term back ache tx

A

Duloxetine| Amitryptyline

358
Q

Cauda equina

A

Compression of cauda equina nerve roots L3-S5

359
Q

Cervical cancer Red flag

360
Q

Primary amenorrhoea

A

Not starting period by 13yo when no other pubertal development Not starting period by 15yo when there are other signs of puberty

361
Q

Normal puberty dates/events

A

Girls 8-14 with Breast buds then pubic hair| Boys 9-15

362
Q

Hypogonadotrophic hypogonadism

A

LH and FSH deficiency so no stimulation for ovaries to produce sex hormones

363
Q

Causes of hypogonadotrophic hypogonadism

A 
HypopituitarismCFDelay in growth and developmentGrowth hormone deficiencyHypothyroidismCushing HyperprolactinemiaKallman syndrome
364
Q

Kallman syndrome

A

Hypogonadotrophic hypogonadism| Ansomnia

365
Q

Hypergonadotrophic hypogonadism

A

Gonads fail to respond to gonadotropins (LH FSH)

366
Q

Hypergonadotrophic hypogonadism

A

Previous gonads damage (torsion, cancer, mumps)Congenital absence of ovariesTurner syndrome XO

367
Q

Congenital adrenal hyperplasia symptoms

A 
FEMALE with:TallFacial hairPrimary ammenorhoeaDeep voiceEarly puberty
368
Q

Androgen insensitivity syndrome

A

MalesMale sexual characteristics do not developResults in female phenotype, female external genitalia, absent uterus/vagina/fallopian tubes/ovaries

369
Q

GH deficiency screening

A

ILGF low = low GH

370
Q

Hypogonadotrophic hypogonadism tx

A

(Eg hypopituitarism or Kallman syndrome) Treat with pulsatile GnRH (induce menstruation and ovulation)Replacement sex hormones (cocp - induce menstruation)

371
Q

Secondary amenorrhoea

A

No menstruation >3m if previous regular periods| No menstruation 6-12m if previous irregular

372
Q

Pituitary causes of secondary amenorrhoea

A 
Pituitary tumour (prolactinoma)Pituitary failure (Sheehan syndrome)
373
Q

Drugs to reduce prolactin production

A

Bromocriptine| Cabergoline

374
Q

Dopamine agonists (cabergoline bromocriptine)

A

Treat hyperprolactinemjaParkinson’sAcromegaly

375
Q

Primary ovarian failure bloods

376
Q

PCOS bloods

A

High LH| High LH:FSH ratio

377
Q

Raised testosterone conditions

A

PCOSAndrogen insensitivity syndrome Congenital adrenal hyperplasia

378
Q

Reducing osteoporosis risk in pts with amenorrhoea

A

Vit D and Calcium| Hormone replacement therapy

379
Q

PMS

A

Symptoms during luteal phase| These are progesterone induced

380
Q

PMS mx

A

Healthy lifestyleCOCP (drospirenone)SSRI CBT

381
Q

Physical symptoms of PMS tx

A

Brest swellingWater retention Bloating - spironolactone

382
Q

Cyclical breast pain tx

A

Danazole, tamoxifen

383
Q

Menorrhagia

A

Heavy menstrual bleeding (>80ml)

384
Q

Menorrhagia mx (no contraception)

A

Tranexamic acid - if no pain (antifibrynolytic reduced bleed)Mefenamic acid - pain (NSAID reduce bleed and pain)

385
Q

Menirrhagia mx contraception

A

Mirena coil IUSCOCPCyclical oral progestogens (norethistone 5mg 3x daily days 5-26)

386
Q

Fibroid

A

Benign tumour of uterus smooth muscle They grow in response to oestrogen

387
Q

Fibroid types

A

IntramuralSubmucosalSubserosalPedunculated

388
Q

Fibroids <3cm mx

A

IUS mirenaNSAID/ tranexamic acidCOCPCyclical legal progestogens

389
Q

Surgical options for fibroids <3cm

A

Endometrial ablationResection during hysteroscopyHysterectomy

390
Q

Fibroids >3cm mx

A 
Referral to GynaeNSAID/ tranexamic acidMirena coil IUSCOCPcyclical progestagen
Uterine artery embolisationMyomectomyHysterectomy
391
Q

How to reduce fibroid size?

A

GnRH agonist before surgery Goserelin (Zoladex)Leuprorelin (Prostap)Induce ovulation-like state

392
Q

Uterine artery embolisation

A

Blockage of arterial supply to fibroids causes them to shrink

393
Q

Malignant change of fibroid

A

Leiomyosarcoma

394
Q

Red degeneration

A

Ischaemia and necrosis if fibroid due to disrupted blood supply (occurs in larger fibroids >5cm)Fibroid enlarges quickly in 2nd and 3rd trimester and outgrows it’s blood supply so it dies

395
Q

Red degeneration hx

A 
Severe abdominal painLow grade fever Tachycardia Vomiting +history of fibroidsTx: test fluid analgesia
396
Q

Endometriosis

A

Ectopic endometrial tissue outside the uterus

397
Q

Endometrioma

A

Lump of endometrial tissue outside uterus - in ovaries these are called chocolate cysts - within the myometrium: adenomyosis

398
Q

Risk factors for adenomyosis

A

Multiparous| Later reproductive years

399
Q

Adenomyosis symptoms

A

DysmenorrheaMenorhhoagiaDyspareunia

400
Q

Gold standard ix for endometriosis and adenomyosis

A

Endometriosis - laparoscopy| Adenomyosis - hysterectomy with histological examination

401
Q

Adenomyosis tx

A

Same as endometriosis and heavy menstrual bleeding

402
Q

Premature menopause

A

Before age of 40Result of premature ovarian insufficiency - lack of ovarian follicular function - Low oestrogen and progesterone - LH and FSH High

403
Q

Lack of oestrogen risks

A 
Osteoporosis Pelvic organ prolapseUrinary incontinenceCVDStroke
404
Q

Symptoms of lack of oestrogen

A 
Hot flashesLow moodPMSirregular and heavy/light periodLow libidoJoint painsVaginal dryness
405
Q

When can menopause be diagnosed?

A

12 months with no periods in women >45yo

406
Q

When to do FSH blood tests?

A

<40 yo with suspected menopause| 40-45yo with symptoms or change in menstruation

407
Q

Contraception and menopause

A

For 2 years after LMP of <50yo| For 1 year after LMP >50yo

408
Q

Depo - Provera (progesterone depot injection) SE

A

Weight gainReduced bone density / osteoporosisUNSUITABLE in >45yo

409
Q

Progesterone with low risk of DVT

A

Norethisterone| Levonorgestrel

410
Q

Primenopausal symptoms management

A

HRTTibolone (steroid hormone, continuous combined HRT)Clonidine (agonist of alpha-adrenergic and imidazoline receptors)Testosterone for low libidoVaginal oestrogen or moisturiser

411
Q

Premature ovarian insufficiency

A

Menopause <40yo| Hypergonadotrophic hypogonadism

412
Q

Diagnosis of premature ovarian insufficiency

A

FSH raised >25/30 on 2 samples with 4 weeks apart

413
Q

HRT under 50yo

A

Does not increase risk of breast cancer| Increased risk of VTE, but this is reduced by transdermal patch

414
Q

Why progesterone must be added to contraception?

A

Must be given to women with uterus as it prevents endometrial hyperplasia secondary to unopposed oestrogen

415
Q

Continuous or cyclical HRT

A

if still have periods must go on cyclical HRT with cyclical progesterone and regular breakthrough bleedsIf no periods for >12months go on continuous combined HRT

416
Q

Non hormonal menopause tx

A 
Lifestyle changesCBT SSRI Clonidine (agonist of alpha adrenergic) Venlafaxine (SNRI) Gabapentin
417
Q

Clonidine

A

Lowers BP and HRAlpha 2 adrenergic receptor agonistsUsed to prevent vasomotor symptoms SE dry mouth, headaches, dizziness, fatigue

418
Q

Alternative remedies for menopause

A 
Black cohosh - cause liver damageDong quai - causes bleeding disordersRed clover - oestrogenic side effectsPrimrose oil - clotting disorders and seizuresGinseng- mood and sleep benefit
419
Q

HRT risks (worse in older women and longer use)

A

Breast cancerVTEStrokeCoronary artery disease

420
Q

HRT risks that do not apply

A

To women <50yoNo risk of endometrial cancer if no uterusNo risk of breast cancer and CVD if oestrogen-only HRT

421
Q

Choosing HRT formulation

A

1) local or systemic symptoms (topical or systemic tx)2) uterus - combined HRT, no uterus - continuous oestrogen only HRT3) perimenopausal - cyclical HRT, postmenopausal- continuous HRT

422
Q

Cyclical progesterone use

A

10-14 days per month

423
Q

Continuous progesterone HRT

A

When no period in 24months <50yo or 12 months >50yo

424
Q

Progestogens definition

A

Chemicals that target progesterone receptors

425
Q

Progesterone

A

Hormone naturally produced in the body

426
Q

Progestin

A

Synthetic progesterone

427
Q

Progestogen classes

A

C19 peogestogen derived from testosterone (norethisterone, levonorgestrel, desogestrel) - help with reduced libidoC21 progestogen derived from progesterone (dydrogesterone, medroxyprogesterone) - help with mood and acne

428
Q

Best way of delivering oestrogen in HRT?

A

Patches, reduced VTE risk

429
Q

Best way of providing progesterone in HRT?

A

Intrauterine deviceAdded benefit of contraception and treating heavy periodNo progestogenic side effects or risk of breast cancer or CVD

430
Q

Tibolone

A

Synthetic steroid Oestrogen and progesterone receptorsContinuous combined HRTHelp with reduced libido

431
Q

HRT and surgery

A

Stop 4 weeks before major surgery| HRT and oestrogen contraceptive

432
Q

Oestrogen SE

A

BloatingBreast swelling HeadacheLeg cramps

433
Q

Progesterone se

A 
Mood swings BloatingFluid retentionAcneWeight gain
434
Q

Rotterdam criteria for PCOS

A

Anovulation Hyperandrogenism (hirsuitisn or acne)PCOS

435
Q

Drugs causing hirsuitism

A 
PhenytoinCyclosporinCorticosteroidsTestosteroneAnabolic steroids
436
Q

Pelvic ultrasound in PCOS

A

String of pearls - 12 or more follicles in the ovary| Ovary >10cm3

437
Q

Impaired fasting glucose

438
Q

Impaired glucose tolerance (at OGGT 2h)

439
Q

Diabetes OGTY 2h

440
Q

Drugs to induce fertility/ovulation

A

Clomifene| Metformin/letrozole

441
Q

Hirsuitism mx

A

COCP Co-Cyprindol (treats hirsuitism and acne)| Topical eflornithine

442
Q

Acne mx

A 
Topical adapalene (retinoid)Topical abs (Clindamycin with benzoyl peroxide)Tetracycline Abx oral
443
Q

Reducing risk of ovarian cancer (factors)

A

Late menarcheEarly menopausePregnancy COCP

444
Q

Risk of malignancy index (whether ovarian mass is malignant)

A

Menopausal statusUSCA125

445
Q

Ovarian cyst Simple 5-7cm

A

Routine gynaecology referral and annual screen

446
Q

Meig syndrome

A

Women (older) with pleural effusion and ovarian massOvarian fibromyalgiaPleural effusionAscites

447
Q

When is ovarian torsion more likely to occur?

A

Pregnancy| Benign tumour

448
Q

Ovarian torsion imaging

A

Whirlpool sign

449
Q

Asherman syndrome

A

Adhesions formed in the uterus due to damage- post dilatation and curettage- uterine surgery- endometritis

450
Q

Asherman syndrome presentation

A

Secondary amenorrhoeaLight periodsDysmenorrhoea

451
Q

Gold standard ix for Asherman syndrome

A

Hysteroscopy and dissection of adhesions

452
Q

Cervical ectropion

A

Columnar epithelium of endocervix extends to the ectocervix

453
Q

Ectroption presentstion

A

Due to high oestrogen / COCPincreased vaginal dischargeVaginal bleedingDyspareunia(Boarder between columnar epithelium and squamous epithelium)

454
Q

Ectropion tx

A

Cauterisation with silver nitrate| Cold coagulation during colposcopy

455
Q

Rectocele

A

Defect in posterior vaginal wall, rectum prolapses into the vagina

456
Q

Cystocele

A

Defect in anterior vaginal wall, bladder prolapses backwards into the vagina If urethra prolapses as well: cystourethrocele

457
Q

Uterine prolapse grades POP-Q

A

Grade 0: normal 1: lowest part >1cm above introitus2: lowest part within 1cm of introitus3: lowest part >1cm below introitus4: full descent with eversion of vagina

458
Q

most common cervical cancer

A

squamous cell carcinoma| Adenocarcinoma

459
Q

hpv cancer strains

A

type 16, 18| HPV inhibits tumour supressor genes

460
Q

risk factors for cervical cancer

A 
smokingHIVCOCPincreased number of pregnanciesearly sexual activitynot using condoms increased number of sexual partners
461
Q

CIN - grading for level of dysplasia

A

diagnosed at colposcopyCIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer,CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, ]CIN III: severe dysplasia, progress to cancer

462
Q

cervical screening programme

A

Every three years aged 25 – 49| Every five years aged 50 – 64

463
Q

exceptions from screening programme

A
  • HIV are screened annually- >65 may request a smear if they have not had one since aged 50- previous CIN - immunocompromised- Pregnant women due a routine smear should wait until 12 weeks post-partum
464
Q

IUD device and smear result

A

Actinomyces-like organisms are often discovered in women with an intrauterine device (coil)

465
Q

inadequate sample

A

repeat the smear after at least three months

466
Q

HPV negative

A

continue routine screening

467
Q

HPV positive with normal cytology –

A

repeat the HPV test after 12 months

468
Q

HPV positive with abnormal cytology –

A

refer for colposcopy

469
Q

acetic acid in colposcopy

A

appear white / acetowhite - CIN and cervical cancer

470
Q

Schiller’s iodine test

A

healthy cells brown, abrnoaml areas do not stain

471
Q

cervical cancer staging

A

Stage 1: Confined to the cervixStage 2: Invades the uterus or upper 2/3 of the vaginaStage 3: Invades the pelvic wall or lower 1/3 of the vaginaStage 4: Invades the bladder, rectum or beyond the pelvis

472
Q

cervical cancer management

A

1A: LLETZ or cone biopsyStage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapyStage 2B – 4A: Chemotherapy and radiotherapyStage 4B: surgery, radiotherapy, chemotherapy and palliative care

473
Q

Pelvic exenteration

A

removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum.(for cervical cancer)

474
Q

HPV vaccine

A

Gardasil strains 6, 11- genital wartsstrains 16, 18- cervical cancer

475
Q

most common endometrial cancer and risk factors

A

Adenocarcinoma (oestrogent dependent cancer)- obesity- diabetes

476
Q

endometrial hyperplsia treatment

A

IUS| continuous oral progestogen (medroxyprogesterone or levonorgestrel)

477
Q

Risk facotrs for endometrial cancer

A 
(unopposed estrogen)Increased ageEarlier onset of menstruationLate menopauseOestrogen only hormone replacement No pregnanciesObesityPolycystic ovarian syndromeTamoxifen
478
Q

tamoxifen

A

Tamoxifen has an anti-oestrogenic effect on breast tissue, but an oestrogenic effect on the endometrium

479
Q

protective factors for endometrial cancer

A

Combined contraceptive pillMirena coilIncreased pregnanciesCigarette smoking

480
Q

tx for endometrial cancer

A

radical hysterectomyradio/chemoprogesterone to slow progression of cancer

481
Q

most common ovarian cancer

A

Epithelial cell tumours (serous tumour most common)

482
Q

germ cell tumours blood results

A

alpha fetoprotein and hCG raised

483
Q

krukenberg tumour

A

metastatis from GI to ovary,| signet ring on histology

484
Q

risk factors for ovarian cancer

A 
BRCA 1 2obesitysmokingincreased number of ovulationrecurrent use of clomifeneearly periodslate menopauseno pregnancies
485
Q

protective facotrs for ovarian cancer

A

COCPbreastfeedingpregnancy

486
Q

ovarian mass on obturator nerve

A

reffered hip or groin pain

487
Q

ovarian cancer symptromes

A

ascitespelvic massabdominal mass

488
Q

Ix for ovarian cancer

A

CA125 (>35IU/ml is significant)| pelvic ultrasound

489
Q

risk of malignancy index

A

menopausal statusUS findigsCA125

490
Q

germ cell tumour markers

A

raised:alfa fetoproteinhCG

491
Q

ovarnian cancer staging

A

Stage 1: Confined to the ovaryStage 2: Spread past the ovary but inside the pelvisStage 3: Spread past the pelvis but inside the abdomenStage 4: Spread outside the abdomen (distant metastasis)

492
Q

vulval cancer most common

A

squamous cell carcinoma

493
Q

risk factors for vulval cancer

A

> 75yoimmunosurpressionHPVlichen sclerosus

494
Q

frequent location of vulval cancer

A

labia majora| ulceration, bleeding, irregular mass

495
Q

Mx in vulval cancer

A

wide local excisiongroin lymph node dissectionchemoradio

496
Q

BV bacteria

A 
anaerobic bacteria due to loss of lactobacilli- Gardnerella vaginalis (most common)- Mycoplasma hominis- Prevotella species
497
Q

BV 4

A

clue cells on microscopypH >4.5fishy smellgrey-white discharge

498
Q

mx of BV

A

Metronidazole PO - DO NOT DRINK alcohol, causes N&V, flushing, shock, angiodemaClindamycin

499
Q

Candidiasis

A

candida albicansthick white dischargevulval and vaginal itching, irritation, discomfort+- erythrema, dyspareunia, dysuria

500
Q

Risk factors for candidasis

A

oestrogen increase (pregnancy)poorly controlled diabetesimmunosuppressionborad-spectrrum abx

MBBS Y5 (27 decks)

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