Year 4 Passmed Incorrect Qs 4 Flashcards
Erectile dysfunction
Factors favouring an organic cause (3)
Factors favouring a psychogenic causes (7)
ORGANIC
Gradual onset of symptoms
Lack of tumescence
Normal libido
PSYCHOGENIC
- Sudden onset of symptoms
- Decreased libido
- Good quality spontaneous or self-stimulated erections
- Major life events
- Problems or changes in a relationship
- Previous psychological problems
- History of premature ejaculation
Talk me through stepwise COPD management
- SABA or SAMA
2a. If atopy LABA + ICS (B for Bloody asthma!)
2b. No atopy LABA + LAMA
- LAMA + LABA + ICS
Urinary problems in a male with previous Gonorrhoea think what?
urinary stricture
STEM: muddy brown casts in the urine =
Acute tubular necrosis
Management of lactational mastitis?
First line-
If it doesn’t resolve in… -
1)
2)
First line- Conservative, encourage continue breast feeding, analgaeisia, ensure good positioning when breastfeeding.
If doesn’t resolve in 12-24hrs- Antibiotics
1) oral flucloxacillin (500mg four times a day for 14 days) or erythromycin if penicillin allergic.
2) Second-line choice is co-amoxiclav.
What is Ludwig’s Angina
Why so life threatening?
Rare infection of the floor of the mouth and soft tissues of the neck- usually after tooth extraction
Can cause rapid deterioration with airway compromise within minutes and requires urgent airway management and aggressive surgical treatment therefore 999 emergency call
Premenstrual syndrome
What is it?
Emotional symptoms (4)
Physical symptoms (2)
PMS describes the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle- only occurs in the presence of ovulatory menstrual cycles - it doesn’t occur prior to puberty, during pregnancy or after the menopause.
Emotional symptoms include:
anxiety
stress
fatigue
mood swings
Physical symptoms
bloating
breast pain
Management of PMS Premenstrual sydrome
Mild
Mod
Severe
Mild- Lifestyle, sleep exercise, ref freq meals 2-3 hrly complex carbs
Mod- COCP
Severe- SSRI continually or in luteal phase
Difference between strangulated and incarcerated inguinal hernias
Incarcerated- they are irreducible, but no pain or any other symptoms are present (predisposes them to become strangulated)
Strangulated- where the blood supply to the herniated tissue becomes compromised risking ischaemia and necrosis, leading to pain
ENT How do you differentiate clinically between Viral labyrinthitis, Vestibular neuronitis, Meniere’s disease and BPPV
Viral labyrinthitis
- post-viral
- sudden onset horizontal nystagmus
- hearing affected and tinnitus
- nausea, vomiting
- vertigo
Vestibular neuronitis
- Also post-viral
- Also horizontal nystagmus
- Also N+V and vertigo
- BUT no hearing affected or tinnitus
Meniere’s disease
- More chronic and reoccuring than acute
- Again classic 3 of vertigo, tinnitus and hearing loss though
- STEM fullness feeling in ear
BPPV
- vertigo brought on by movement
- v short episodes
- no hearing disturbances or tinnitus or nystagmus
STEM Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes
silicosis
Slipped Upper Femoral Epiphysis
What moments are restricted?
Surgical management?
- Int rotation of leg in flexion
- Internal fixation- typically a single cannulated screw placed in the centre of the epiphysis
What is the genetic inheritance pattern on sickle cell?
Sickle cell disease is an autosomal recessive condition
Paeds suspected meningitis what Abx used in >3 monthns and <3 months?
What if recent travel outside of uk?
< 3 months- ceftriaxone + amoxacillin (listeria)
> 3 months ceftriaxone (IV 3rd gen cephlasporin)
addition of vancomycin to the 3rd generation cephalosporin is indicated when there has been recent travel outside of the UK.
6 month old baby presenting with bilious vomiting associated with signs of obstruction (distended abdomen and absent bowel sounds), what are you thinking?
intestinal malrotation
Causes of oligohydramnios (think later too) 5
- premature rupture of membranes
- Potter sequence
bilateral renal agenesis + pulmonary hypoplasia - intrauterine growth restriction
- post-term gestation
- pre-eclampsia
COPD meds- Name the class of medication
pratropium bromide-
formoterol-
tiotropium-
salbutamol-
budesonide-
theophylline-
Ipratropium bromide- SAMA (antagonist)
formoterol- LABA
tiotropium- LAMA
salbutamol- SABA
budesonide- ICS
theophylline- LAMA?
The causes of upper lobe fibrosis can be remembered with the mnemonic ‘CHARTS’
Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis
Paraneoplastic syndromes of
Adenocarcinoma (2)
Squamous Cell (4)
Small Cell (3)
Adenocarcinoma (2)
-Hypertrophic pulmonary osteoarthropathy
- Gynaecomastia
Squamous Cell (4)
- Hypercalcaemia from inc PTHrP
- Hyperthryoidism due to ectopic TSH
- Clubbing
- Hypertrophic pulmonary osteoarthropathy
Small Cell (3)
- ACTH ectopic - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
- Lambert-eton syndrome
- SIADH
% and Stages of FEV1/FVC and predicted FEV1 for COPD
Mild
Mod
Severe
V. Severe
Mild- < 0.7 and >80% Pred
Mod - < 0.7 and 50-79% Pred
Severe- < 0.7 and 30-49% Pred
V. Severe- < 0.7 and <30% Pred
What is the antibiotic of choice for prophylactic use in COPD?
What is criteria for prophylactic antibiotic prescription?
250mg azithromycin three times per week if
‘A’ to ‘A’void infections
CRITERIA:
- The patient no longer smokes.
- Has optimised non-pharmacological management & inhaled therapies.
- Referred to pulmonary rehab (if appropriate).
- * 4 acute exacerbations in the last year (producing sputum), requiring hospital admission at least once.
4 steps of Obstructive Sleep Apnoea Management?
Management
1) Lifestyle- weight loss
2) continuous positive airway pressure (CPAP) is first line for moderate or severe OSAHS
‘C’ for ‘C’losed airways
3) intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
4) the DVLA should be informed if OSAHS is causing excessive daytime sleepiness
limited evidence to support use of pharmacological agents
what pH of an NG tube aspirate is safe to use?
pH < 5.5
What should lead to escalation to intensive care team in acute asthma management?
A normal PaCO2- indicates exhaustion and should, therefore, be classified as life-threatening
What is Kartagener’s syndrome?
STEM *Assoc with what condition?
What would you see in CXR? (3)
2 Complications with this syndrome?
aka primary ciliary dyskinesia- Pathogenesis=
dynein arm defect results in immotile cilia
Assoc. with dextrocardia (heart on right side)
CXR:
1) dextrocardia or complete situs inversus
2) bronchiectasis- tram track opacities
3) Hyperinflation?
Complications
1) recurrent sinusitis
2) subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
Is a PE induced pleural effusion transudative or exudative?
Exudative (Protein >30g/L)
The 4T’s for common causes of anterior mediastinal masses?
T- Teratoma
T- Terrible lymphadenopathy
T- Thyroid mass
T- Thymic Mass eg Thyoma (mass of Thymus)
What are the differences in doing plural aspiration and chest drain in pleural effusion management?
Plural Aspiration- used to determine underlying cause of effusion
Chest drain- Used as symptomatic relief to drain the fluid off and should only be used first over aspiration if increasing oxygen requirements
SIADH what do you see in the blood?
Is fluid statis hypo, eu or hypervolaemic?
Urine osmolality inc, dec or -
Serum osmolality inc, dec, or -
Urine sodium
Hyponatraemia due to excessive water retention and dilution affect
Euvolaemic
Urine osmolality increases (urine more concentrated)
Serum osmolality decrease (Serum more dilute)
Urine sodium increases as expel more
