YSKT compile AS Flashcards
Patient has a fall and fractures hip. Cardiac problems, the fall was due to an MI, how do you manage?
Hemiarthroplasty, Dynamic hip screw, intramedullary device
57 year old male trips on pavement falls onto outstretched arm. X ray shows midshaft humeral fracture and osteolytic lesion on head of humerus. Fracture was opened and fixed. How would you describe this?
Pathological fracture due to mets
Pelvic X ray of osteoarthritis acetabulum, what do you do?
Total hip replacements
Patient has a fall and fractures hip - Extracapsular fracture (non special type). Cardiac problems, the fall was due to an MI, how do you manage?
Dynamic hip screw
Patient has a fall and fractures hip - Extracapsular fracture (reverse oblique, transverse or sub trochanteric). Cardiac problems, the fall was due to an MI, how do you manage?
Intramedullary device
Age <70 Patient has a fall and fractures hip - Displaced intracapsular fracture. Cardiac problems, the fall was due to an MI, how do you manage?
Internal fixation (if possible), hip arthroplasty if not
Osteopenia vs Osteoporosis
Male vs female Age (Younger = penia)
Patient has anatomical snuffbox tenderness and bait scaphoid fracture but no obvious signs on x ray. How do you manage?
Cast and return for x ray in 2-3 weeks
Parathyroid blood results: Raised calcium Raised PTH Low phosphate High ALP Serum Ca:Cr clearance >0.01
Primary hyperparathyroidism
Parathyroid blood results: Low/normal calcium High PTH High phosphate Low Vit D High ALP
Secondary hyperparathyroidism (gland hyperplasia)
Parathyroid blood results: Raised calcium Very raised PTH decreased or normal phosphate Normal/low Vit D High ALP
Tertiary hyperparathyroidism
Parathyroid blood results: High/normal calcium Normal/low PTH High phosphate Normal Vit D High ALP
Familial hypocalciuric hypercalcemia
Jaundice in first 24 hours - cause? Mother is O+ve?
ABO incompatibility
Jaundice in first 24 hours - cause? Mediterranean/African Americans/ Middle Eastern Male infant
G6PD deficiency
Jaundice in first 24 hours - cause, FH and spherocytic blood film
Spherocytosis
Jaundice in first 24 hours - Mother was infected during pregnancy Treat?
Growth restriction Hepatosplenomegaly TTP (Congenital infections) Exchange transfusion
Parathyroid blood results: High Calcium Normal/low PTH Low phosphate High ALP
Parathyroid malignancy
Child presents with bruising, high lymphocytes
ALL
Child presents with bruising, high lymphocytes Reddish purple dots on the ankles and feet (petechia)
Immune Thrombocytic Purpura
Child with purpuric rash Bloody diarrhoea and abdo pain Rash on buttocks, legs and feet
Henloch Schonlein purpura
Child with purpuric rash + splenomegaly
ALL
Back pain with irregular prostate, and urinary symptoms
Prostate cancer
Solid mass on liver imaging, diabetes, women taking estrogen-containing oral contraceptive medication - 4cm, vascular?
Hepatic adenoma
Alcoholic patient with solid mass on liver imaging - 4cm, vascular?
Hepatocellular carcinoma
Cancer patient presents acutely with cord compression?
1) Steroids - Dexamethasone 2) MRI spine and review
Round opacification of paediatric XR
Pneumonia
Paediatric non accidental injury
Bruising on back Mid-shaft transverse femoral fracture
APGAR score 0-3 management?
ABCDE on baby High flow O2 Adrenaline Compressions Monitor glucose
Renal artery stenosis imaging?
Angiography
How to prevent diabetic nephropathy progression in long term diabetic?
ACE-i to stop progression according to BMJ BP Keep BP below 130/80
Patient presents 38 weeks pregnant - bp 140/90 and protein ++ Diagnosis? Management?
Pre-eclampsia Deliver the baby
Patient presents 35 weeks pregnant - bp 140/90 Diagnosis? Management?
Gestational hypertension B-blockers - labetalol
When to give oxytocin in 3rd stage of labor?
10iu of oxytocin as anterior shoulder of baby is out and then double clamp cord -in delay of clamping cord= higher haematocrit levels in neonates
What is the gold standard investigation for endometriosis ?
Laproscopy
How do you prevent diabetic proliferative retinopathy?
Laser treatment
What is the scoring system ABCD2 used for?
TIA Age: >/= 60 =1 BP: >/= 140/90=1 Clinical features: -unilateral weakenss= 2 -speech impairment without weakenss= 1 Duration: >/= 60min= 2 10-59min: 1 Diabetes= 1
What is the management of ABCD2 score >4?
carotid imaging within 24hrs of initial assessment -CT/ MRI
What is the management of ABCD2 score 0-3?
Need other indication for hospital observation
6wks pregnant woman with light bleeding, HCG 650, and TVU showing no fetus?
miscarriage
6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing no fetus, intrauterine mass with small cystic spaces (honeycomb)?
Hyaditiform mole (complete)
6wks pregnant woman with vaginal bleeding, shoulder tip pain, abdominal pain, bHCG >1500
Ectopic pregnancy
6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing fetal tissue?
Hydatidiform mole (incomplete)
What are varicose ulcer signs?
Lipodermatosclerosis, swollen, achy legs, shallow red sore with irregular edges
What is the management of aspiration pneumonia in post stroke + swallowing problem patient?
SALT referral Metronidazole
BPH + LUTS management?
tamsulosin + finasteride
Patient jaundice, fever, RUQ pain?
Ascending cholangitis (Charcot’s triad)
What is the ix for 51yr-old woman, 14 months amenorrhoea, hot flushes?
menopause- none
What is the ix for 42yr-old woman, 14 months amenorrhoea, hot flushes?
FSH
33 year old comes for random test - has +ve RF but no sx?
Doesn’t have RA
33 year old comes for random test - has +ve RF, +ve anti-CCP, but no sx
RA
33 year old comes for random test - has +ve ANCA, CRP, ESR
Most likely connective tissue disorder
SLE with Antiphospholipid syndrome, what do you need to warn them about ?
Miscarriage
Patient comes in with fever with new heart murmur? Treatment?
Infective endocarditis Flucloxacillin + Gentamicin
What’s Duke criteria used for and what does it consist of?
Infective endocarditis Major: +ve blood culture evidence in ECHO Minor: predisposition (IVDU, previous heart) fever microbiology vascular phenomenon (janeaway lesions, etc)
Patient been on sertraline for 18 months, not getting on with it, what is the next management?
Switch to other SSRI (fluoxetine)
Patient with migraines, experiencing them 2x a week, stressed with new job - what would you start?
Acute: triptan + NSAID/paracetamol Prophylaxis: propanolol
Pt with severe unilateral headache, especially around one eye, lacrimation ?
Cluster headache
What is the immediate and prophylaxis management of cluster headache?
Acute: 100% O2 + subcut triptan Prophylaxis: verapamil
Patient with Phalen’s sign, thenar wasting, weakness of thumb?
Carpal tunnel
Cyclist comes in with hypothenar wasting, tingling of fourth and fifth finger?
Guyon’s canal syndrome; ulnar nerve entrapment
Presentation in anorexic patient that requires hospitalisation?
BMI <13 or >1kg/ week amenorrhoea abnormally low potassium abnormally low temperature infection of any kind HR <40bpm
Bulimia vs AN?
Bulimia= normal BMI -more impulsive than AN -weight fluctuation -parotid hypertrophy (sialadenosis)
What is the presentation of patient with Bipolar that stopped taking medication?
anxiety, mania, headaches, pressured speech, irritability, depression
Section 2 Used for? Recommendation? Apply? Duration?
Used for assessment Two Section 12 doctors or One section 12 patient’s GP Apply by nearest relative or AMHP (health professional) 28 days –> Discharged or convert to S3 (Patients can appeal in first 14 days)
Section 3 Used for? Recommendation? Apply? Condition? Duration?
Used for treatment Two Section 12 doctors or One section 12 patient’s GP Apply by nearest relative or AMHP (health professional) Appropriate treatment available of condition or protect public Duration is 6 months –> Elongate or discharge (Patients can appeal once every 6 months)
Section 4 Recommendation? Apply? Condition? Duration?
Emergency admission by any doctor Apply by nearest relative or AMHP (health professional) Mental disorder Duration 72 hours –> Discharge, convert to S2/3, Elongate (can’t appeal)
Section 5(2) Recommendation? Apply? Condition? Duration?
Emergency of detention of information patient Doctor in charge of patient No application Mental disorder Duration 72 hours –> Discharge, convert to S2/3, Elongate (can’t appeal)
Section 5(4) Recommendation? Apply? Condition? Duration?
Emergency of detention of information patient Nurse in charge of patient No application Mental disorder Duration 4 hours –> Discharge, convert to S5(2), Elongate (can’t appeal)
Section 136 Recommendation? Apply? Condition? Duration?
From public place police powers to remove to place of safety (A&E, police station) someone who appears to be suffering from a mental disorder 72 hrs requested by AMHP and granted by magistrate
Section 35
remand for hospital for assessment
Section 36
remand to hospital for treatment
section 48/49
transfer of a remanded prisoner from prison to hospital
section 37
hospital order
section 37/41
hospital order with restriction order
section 47/49
transfer of a sentenced prisoner to hospital for treatment
Section 17a
supervised community treatment -compulsory treatment for community patients -apply to patients under section 3 -last for 6 mths
Patient with post op, PE and calf swelling. What is the best IX?
CTPA
8 year-old that need emergency appendectomy, comes with patient. Can child consent? If not, who can?
Child cannot consent because Gillick non-competent; grandparents do not have parental decision making Can act on patient’s best interest (Beneficence)
2-3 week history of feeling tired/ill, in last few days suddenly urine output drops, haematuria, proteinuria, bp is normal: what is cause?
post-strep glomerulonephritis
3 day history of feeling tired/ill, in last few days suddenly urine output drops, proteinuria, bp is normal: what is cause?
membranous
What are the symptoms of avoidant PD?
AFRAID Avoids social contact Fears Criticism Restricted lifestlye Apprehensive Inferiority Doesn’t involve unless sure of acceptance
What are the symptoms of dependent PD?
SUFFER Subordinate Undemanding Feels hopeless when alone Fears abandonment Encourages others to make decisions Reassurance needed
What are Cluster A PD?
paranoid, schizoid, schizotypal
What are Cluster B PD?
antisocial, borderline, histrionic, narcissistic
What are Cluster C PD?
avoidant, OCD, dependent
What are the symptoms of paranoid PD?
SUSPECT Sensitive Unforgiving Suspicious Possessive and jealous Excessive self-importance Conspiracy theories Tenacious sense of rights
Squamous cell carcinoma arises from?
Arises from actinic keratosis (pre-cancer)
Rx for VZV in pregnant woman?
IVIG immediately
Ulnar neuropathy first line Ix/
EMG/NCS
What are the developmental milestones for 2.5 yrs old?
use 250 words walk, run, turn doorknob, selfish and self-centered
Chinese guy with conductive hearing loss?
nasopharyngeal carcinoma
What are the croup ddx?
epiglottis foreign body peritonsilar abscess
What is the acute management of mild/moderate asthma?
nebulise salbutamol
What is the presentation of opiate/ heroin withdrawal?
sweating, muscle aches, sleep problems, runny nose, irritability -later: dilated pupils, vomiting, diarrhoea, abdo pain, tachy/brady, cramping goose bumps
Which feature of CTG implies fetal hypoxia?
late deceleration
What are the presentations for acoustic neuroma?
vertigo, unilateral hearing loss, tinnitus, absent corneal reflex, facial palsy MRI of CPA
What are the common symptoms peripheral vascular disease in diabetics?
Venous ulcer
Patient comes in with ear pain, itch and discharge. Otoscopy shows red, swollen canal. What is the management?
Otitis externa Hydrocortisone Rx: topical antifungal (clotrimazole)
DVLA laws for stroke patient?
6months
DVLA laws for epilepsy?
12 months since last seizure
11yr-old girl with 3mths hx of abdo distention, weightloss, no blood or mucus in stool, mouth ulcers and dermatitis herpetiformis?
Coeliac
11yr-old girl with 3mths hx of abdo distention, loose, watery stools after drinking milk?
Lactose intolerance
11yr-old girl with 3mths hx of bloody diarrhoea, urgency to defacate, tenesmus?
UC
11yr-old girl with 3mths hx of recurrent diarrhoea, abdo pain, delayed puberty, and malnutrition?
Crohn’s
Patient comes in with generalised weakness, leg cramps and nausea?
HHS (hyperosmolar hyperglycaemic state)
What does endomysial and anti-gliadin indicate?
Coeliacs
What are the signs for Parkinson’s disease?
TRAPD Tremor Rigidity Postural instability bradykinesia
What are the signs of community acquired pneumonia?
increased vocal fremitus
Sudden chest pain Increased JVP SOB Low BP Tachypnea Discomfort relieved by sitting or leaning forward
Cardiac tamponade
What are the signs of community acquired pneumonia?
Increased vocal fremitus
What are the signs of Hospital acquired pneumonia
Decreased vocal resonance
How does gout present in a 60 old year old hypertensive who has had it for 2 years?
Cyclical flares of joint pain, swelling and erythema 12 hours - several days (Predisposed by diuretics)
Treatment for glaucoma?
Medical - pilocarpine Surgical - Iridoplasty
Treat oligomenorrhoea in patient with BMI 30 with PCOS who desires fertility after advising weight loss?
Metformin
Meningitis CSF - Clear Normal pressure Lymphocytes mostly Normal glucose High protein PCR-assay
Viral
Meningitis CSF - Cloudy Pressure increase Neutrophils Decreased glucose High protein Gram stain culture
Bacterial
Meningitis CSF - Opaque High pressure Mostly neutrophils Decreased glucose High protein Acid fast bacillus stain PCR
TB
Meningitis CSF - Clear High pressure High lymphocytes Decreased glucose Moderately high protein India ink stain
Cryptococcal
MS patient on low dose baclofen, not experiencing side effects. How would you treat her pain?
Increase baclofen
Bilateral conjunctivitis + itchy eyes
Topical antihistamines
Patient is delirious with diagnosis 80. Squamous cell lung cancer with liver mets diagnosed?
Hepatic encephalopathy
Patient in Ventricular Tachycardia arrests?
DC cardiovert Stable – pharmacological cardioversion with Amiodarone, Lidocaine, Procainamide
Patient has fit, seen to have jerking movements, loses continence and bites tongue - what is it?
Generalised tonic clonic seizure
Endometrial cancer, what type of cancer is it?
Adenocarcinoma
Patient with weight loss, dysphagia and occult blood - next investigation?
Upper OGD
Dyskaryosis
Multi nucleation Increased cytoplasm:nucleic ratio
Patient presents, after vomiting for past few days, with a little bleed - cause?
Mallory Weis tear
Dyskaryosis
Multi nucleation Increased cytoplasm:nucleic ratio Irregular chromatin distribution Hyperchromasia
Hep B Immune marker to indicate Hepatitis division/multiplying
HbsAg
COPD on Salbutamol and comes into clinic, breathless, FEV <40% (acute) - management?
Salbutomal and Ipratropium Nebulised and Prednisolone
COPD on Salbutamol and comes into clinic, breathless, FEV <40% (chronic) - management?
Oral pred ICS
Psoriasis question, gentleman doesn’t want to take anything oral, which of options has good evidence?
Topical corticosteroid
Baby with asymmetrical gluteal creases, what investigation do you do?
Ultrasound Developmental dysplasia of the hip
Baby with asymmetrical gluteal creases, what investigation do you do?
Ultrasound and then hip XR Developmental dysplasia of the hip
Psoriasis question, gentleman doesn’t want to take anything oral, which of options has good evidence?
Topical corticosteroid (mild) Phototherapy (moderate to severe)
Patient had depression, had core symptoms + extras - 6 in total - Management?
Antidepressant (Sertraline) + CBT
Girl with primary nocturnal enuresis - First line management?
Behavioural
Progressive hip pain (over weeks), Limp, stiffness and reduced range of movement in 7 year old, trendelenburg +ve - Diagnosis?
Perthes disease
What symptom most likely to be found in meningococcal septicaemia?
Non-blanching rash
Patient post stroke, has IT job and 5th floor flat with lift. Has quite a few problems. - what would you do?
Full OT assessment and home visit before discharge
Patient wanted contraception. When is it advised to start?
First day of period
Melanoma - key factor for prognosis?
Thickness (depth)
Patient with hx of macular degeneration was agitated and delirious but was not a threat to anyone - how would you manage?
Reassurance patients Reduce noise and distraction (Side room)
XR of colles fracture
Horizontal across radius
Imaging ACL tear
MRI
Patient with osteoarthritis - mild sx and managed with analgesia. How would you manage?
Physiotherapy
Open fracture of tibia - how do you manage?
Abx & dress
MS relapse management ?
IV methylprednisolone
Woman BMI>40 and previous macrosomic baby - when do you test for GDM in pregnancy?
28 weeks
Epistaxis management after pressure attempted, what next?
Packing (children/not well tolerated) Cauterise sphenopalatine
Acne treatment causing blue patch?
Minocycline
CT show calcification in alcoholic patient?
Chronic pancreatitis
Teenager RTA with bruising on the chest and hypovolaemia. Resp exam is ok - first step?
Cannula Bloods - FBC, U&Es, crossmatch, clotting Fluid resus
Child with red rash on Flexor aspects of elbows and on wrist
Atopic eczema
NSTEMI with normal troponin
Unstable angina
2 week of haematuria post URTI
Post Strep Glomerulonephritis
Peripheral artery disease management
Quit smoking Atorvastatin Clopidogrel Endovascular revascularisation
ADHD - what would aid in the diagnosis?
Report from the teacher
Most common cause pyelonephritis
E.Coli
Painful eye movements, Swollen fingers + eosophageal
Myasthenia gravis
Contraception for adolescents
Gillick competencies Under 16s having sex call police Recommend the use of condoms both as a contraceptive, and to prevent sexually transmitted infections (STIs).
Cause of Intermenstrual bleeding in woman with COCP
Missed COCP pill Alternative remedies taken Clotting drugs Tamoxifen Cervical pathology, vaginal or uterine causes Smear tests
Everything normal pretty much and endometrial tissue is 5mm in woman with bleeding
Dysfunctional uterine bleeding
Rheumatoid arthritis lung changes
Both restrictive and obstructive (fibrosis)
Endometriosis symptom most indicative
Deep dyspareunia
Most common cause of Pelvic Inflammatory Disease
Chlamydia Gonorrhoea
What to do before inducing labor
Cervical sweep
Haematuria 1 year ago, then painless haematuria
Renal cell carcinoma
Painless jaundice ddx
Pancreatic cancer
Necrotizing enterocolitis biggest risk factor
Preterm
Commonest cause of preterm babies
Pregnancy with multiple babies Hx of preterm labour/birth Infection Diabetes/HTN
Subfertility, cycles 35-48 days, causes of why she can’t get pregnant?
Smoking
Kid wanted to sleep but couldn’t due to rash
Eczema (itching at night)
Wife has manic symptoms on a background of depression, currently on SSRI, what do you do?
Bipolar Stop SSRI, swap to Lithium
Management of PTSD
Watchful waiting for mild symptoms Trauma focussed CBT Severe - Eye movement desensitisation and reprocessing (Paroxetine if drugs being used)
Management of OCD
CBT SSRI
Diagnosis of asthma
Reversibility
18m old child, can’t walk, crawls. Alert to strangers - where is delay?
Gross motor delay
Fraser guidlines
- He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment 2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them 3. He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment 4. His/her physical or mental health is likely to suffer unless he/she received the advice or treatment 5. The advice or treatment is in the young person’s best interests.
What is the most common injury with anterior dislocation of shoulder?
Axillary nerve and artery 95% Presentation in examination: humeral head visible, flattened deltoid
What are the causes of anterior shoulder dislocation?
falling in outstretched arm
RTA patient with open book fracture pelvis, scaphoid fracture. stable but absent bowel sounds?
ABCDE and then CT TAP Internal fixation
Management for Open comminuted fracture of tibia?
wash out in theatre and give abx immobilise, IV ABx, tetanus vaccine (everyone gets, if not fully immunised–> 3 vaccines and 2 boosters 10 years apart), debride and lavage, fixation if indicated
Management of Cervical spine fracture, developed neurological symptoms?
immobilise + analgesia and immediate neurosurgical referral + IV methlyprednisolone
Management of Cervical spine fracture with pain?
NSAID and Follow Up can add temporary opioid
Sensory lost on medial 1 and a half finger, where is the lesion?
cubital tunnel syndrome
Pronounced claw hand and motor symptoms, normal back of hand sensation?
guyon’s canal syndrome
Man, smoker, alcohol drinker, lost weight. Picture of a lesion at the back of the throat?
Squamous cell
Numbness half face, post nasal drip and other signs, when is the investigation is most appropriate: Nasal endoscopy? CT? MRI?
Considering CSF leakage OR cancer CT Scan is good for identifying breaks in bones/skull or if cancer has spread to bone. MRI is better to see the type and size of the cancer
Sensorineural hearing loss (unilateral), tinnitus, headache, CN palsies (trigeminal/facial/vestibulocochlear nerve), vertigo (late sign), signs of raised ICP Diagnosis? Investigation?
Acoustic neuroma (vestibuloschwannoma) MRI brain - gadollinium enhanced
Complications of cataract surgery?
Posterior capsule opacity (PCO) Intraocular lens dislocation. Eye inflammation. Light sensitivity. Photopsia (perceived flashes of light) Macular edema (swelling of the central retina) Ptosis (droopy eyelid) Ocular hypertension (elevated eye pressure)
Diabetic proliferative retinopathy and macular oedema in one eye. How best to manage?
Anti-vegf injection +/- panretinal photocoagulation (if significant then photocoag first then, intravitreol anti vegf, macular laser)
Patient has anterior uveitis. What medication is contraindicated?
Pilocarpine - irritates ocular surface
Patient with renal transplant, lesion on lip - diagnosis?
Immunosuppression due to the transplant -> increased risk of SCC.
Prodromal fever and malaise. Lesions start on the head, then spread to trunk and peripheries. Lesions as papules → Vesicles → Pustules → Crusting Diagnosis? Treatment?
Analgesia and go home
Occasional barking cough and no audible stridor at rest. No or mild suprasternal and/or intercostal recession. The child is happy and is prepared to eat, drink, and play.
Mild croup
Frequent barking cough and easily audible stridor at rest. Suprasternal and sternal wall retraction at rest. No or little distress or agitation. The child can be placated and is interested in its surroundings
Moderate croup
Management of croup
Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity - prednisolone is an alternative if dexamethasone is not available - Advise paracetemol or ibuprofen for fever/pain Emergency treatment ● high-flow oxygen ● nebulised adrenaline
Frequent barking cough with prominent inspiratory (and occasionally, expiratory) stridor at rest. Marked sternal wall retractions. Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia). Tachycardia occurs with more severe obstructive symptoms and hypoxaemia.
Severe croup
Acute asthma, already on salbumatol nebs and steroid, no improvement, what do you give next?
- Oxygen (if <94%) 2. Salbutamol - also consider IV 3. Ipratropium bromide 4. Oral steroids = prednisolone 3-5 days 5. Aminophylline/theophylline (OSHIMT) Magnesium sulphate IV is an adjuvent that can be given if no response after step 4.
Asthma not well controlled, told about a wheeze and other signs. What would you like to know next?
Peak flow
Downs, healthy at birth no cardiac signs. Parents have been told of complications. What do you do next?
Echo
Down syndrome with failure to thrive
Coeliac disease
Down syndrome conditions risk
- An abdominal x-ray is indicated in infants with DS, as they may be born with a GI defect such as duodenal or anal stenosis, or duodenal or anal atresia (30%). - Hearing screen and thyroid tests are required in all newborns in general. - Vision should be examined in the newborn period because some infants with DS are born with ophthalmic problems. - Haemoglobin for anemia - Dental due to caries - Obstructive sleep apnea
Malaysian girl, persistent jaundice (>2 weeks), yellow/brown urine, pale stools, hepatosplenomegaly after 3rd/4th week. High conjugate bilirubin Diagnosis?
Biliary atresia (rare) → absence of bile ducts. (Immediate Kasai procedure hepatoportoenterostomy → Drain bile) Ddx - neonatal hepatitis
Causes of prolonged jaundice in newborns
Biliary atresia Hyperthyroid Galactossemia UTI Breast milk jaundice (unconjugated bilirubin) CMV/Toxoplasmosis
Has had 2 vasoocclusive crises in a Sickle Cell Disease patient. Also takes penicillin, spleen enlargement with abdo pain + circulatory collapse. What treatment is best?
Splenectomy
Patient has vasoocclusive crisis in a SCD patient. Also takes penicillin, 1cm palpable spleen. What treatment is best?
Hydroxyurea (prevent future crisis) Acutely - NSAIDs, antihistamine
Child misbehaving at home, but fine at school. What meds will help?
Nothing ADHD is worse in school
Newborn sob, grunting, 6 hours after birth. Normal delivery, was fine before. What is likely cause?
Acute respiratory distress syndrome
Menorrhagia treatment - 1st line? 2nd line?
1st line: Mirena Coil (IUS) 2nd line: Tranexamic Acid (or if want kid)
41 week gestation, unremarkable pregnancy, 2cm dilated, station 0, cervix position anterior, soft consistency, almost fully effaced. What do you do?
Membrane sweep Intravaginal prostaglandins Breaking of waters (amniotomy with amnihook) Oxytocin
41 week gestation, unremarkable pregnancy, 2cm dilated, station 0, cervix position anterior, soft consistency, almost fully effaced. What do you do?
Membrane sweep Intravaginal prostaglandins If doesn’t work: Do CTG monitoring Breaking of waters (amniotomy with amnihook) Oxytocin
What is Bishop score used for and what does each mean?
Assess the necessity of induction in prolonged pregnancy (>12days after EDD or 41 (+3)) <5= induction 5-9= ARM >9= spontaneous labour Call PEDS C: consistent P: position E: effacement D: dilatation S: station
Indications for induction of labour?
-prolonged pregnancy (>12 days EDD) -prelabour premature rupture of the membranes without labour starting -DM mother >38weeks -Rh incompatibility
What are CI for induction of labour?
-acute fetal compromise -abnormal lie -placenta praevia -pelvic mass/deformity -cephalopelvic disproportion
What medication for induction of dead fetus?
Misoprostal
Lady positive pregnancy test (7weeks) , LIF pain and bleeding, what is most appropriate investigation?
TVUS
Lady positive pregnancy test (<5 weeks) , LIF pain and bleeding, what is most appropriate investigation?
quantitative serial b-HCG
Patient has pcos. What investigative ratio is most suggestive of diagnosis?
testosterone/ SHBG –> baseline test for evaluation of hyperandrogenism
What is the best ix to rule out causes of oligomenorrhoea/ amenorrhoea in PCOS?
LH/FSH ratio
Risk factors for gestational diabetes screening?
BMI >30 previous macrosomic baby previous GDM 1st degree relative with DM ethnicity of high DM prevalence (South Asia, black carribean, middle eastern)
Treatment for pregnancy induced HTN?
labetalol Methyldopa for asthmatic
What week gestation for GDM screening?
booking appointment (8-10wk) and 24-8 weeks
Secondary PPh, what initial investigation will show retained placenta?
TVUS–> will show endometrial thickness >10mm
Lady has progressive weakness, subdued deep tendon reflexes and normal tone, had URTI a week ago?
Guillain-Barre syndrome
What is the management of Guillain-Barre syndrome?
IVIg or plasma exchange
35 yr-old female with eye pain and vision problems, numbness and pain on limbs, headache and coordination problems?
Multiple Sclerosis
What is the management for MS relapse?
IV methylprednisolone 3 days
What is the management for relapsing-remitting MS?
beta interferon (glatiramer, teriflunomide)
Lady has self harm, fight with boyfriend, history of child abuse. How do you treat?
DBT
Pregnant women with Mania and presenting to A&E?
Olanzapine IM Stop depression
Guy arrested carrying knives, said paert of religious beliefs. Is ‘aloof’, what is likely diagnosis?
Schizotypal
Schizotypal characteristics
●Indifference to praise and criticism ●Preference for solitary activities ●Lack of interest in sexual interactions ●Lack of desire for companionship ●Emotional coldness ●Few interests ●Few friends or confidants other than family
Schizoid characteristics
●Ideas of reference (differ from delusions in that some insight is retained) ●Odd beliefs and magical thinking ●Unusual perceptual disturbances ●Paranoid ideation and suspiciousness ●Odd, eccentric behaviour ●Lack of close friends other than family members ●Inappropriate affect ●Odd speech without being incoherent
Lady is mad depressed, feels dead inside, her organs are rotting. What do you give?
Cotard syndrome fluoxetine + olanzapine
62, increasingly withdrawn, few words used, finding it difficult to name things. Mmse 28/30. What was likely cause?
Primary progressive aphasia the language capabilities slowly and progressively become impaired. (Caused by alzheimers)
Which following features would suggest Lewy body dementia?
In LWB, get visual hallucinations, parkinsonism and fluctuating cognition. Do a DaTSCAN
Schizophrenic guy, police bring in under 136
MHA assessment and admit
COPD, on salbutamol and ipratropium. FEV1 was 40%. What do start?
LABA + ICS combination inhaler (Seretide - salmeterol + fluticasone
Man has Pancoast tumour, miosis, ptosis, clubbing, chest pain. What sign indicates extra-thoracic growth?
Thoracic outlet syndrome causes pain, in horner’s shouldn’t normally have pain. Pain characteristically is around the shoulder/scapula, but can also move to arm/hand if brachial plexus is affected.
Crohn’s - Drugs used to induce remission?
1st line: Steroids (use mesalazine if can’t use steroids) Adjunct: Azathioprine/mercaptopurine
Crohn’s - Drugs used to maintain remission?
- Azathioprine (1st line) - Methotrexate (2nd line)
UC - Drugs used to induce remission?
1st line: Aminosalycate (Mesalazine) 2nd line: Steroids (pred)
UC - Drugs used to maintain remission?
1st line: oral Aminosalicyates – Mesalazine 2nd line: Azothioprine / Mercaptopurine
Young lady with polydipsia and urea. Had DKA – which fluids do you give?
0.9% NaCl 1L – over 1st hour, 0.9% NaCl 1L – over next 2 hours, etc
DKA – once patient has been put on saline, what else do you give?
(Potassium if <3.5 then add potassium chloride to NaCl) Insulin
Man with nocturnal back pain, high ESR. Obvious myeloma – what do you do next?
1st Ix: Serum/Urine electrophoresis - to identify paraprotein / light chain urinary excretion Confirm with BM aspirate Imaging (in order of preference) - MRI, CT, skeletal survey (X-Rays)
Patient with Graves – Whats the treatment? Side effects?
Carbimazole SE: Rashes, pruiritus. Serious SE: Agranulocytosis
DM Type 1 nephropathy – patient has high hba1c and high protein in urine. What do you do?
Increase insulin
Mitral valve replacement and low arterial BP, distended neck veins, muffled heart sounds. Next step?
(Beck’s triad) Refer to CT surgeon immediately for pericardiocentesis.
Infective endocarditis antibiotics: Non prosthetic? Prosthetic? MRSA? Staph Aureus?
Non prosthetic: Amoxicillin + Gentamicin (>1wk) [<1wk is flucox and gentamicin] Prosthetic: Vancomycin, Rifampicin + Gentamicin MRSA: Vancomycin + Gentamicin
Hospital acquired pneumonia: Most common causes - Gram stain?
Pseudomonas aeruginosa primarily … gram -ve bacilli Staph aureus … gram +ve cocci also common cause of HAP
Hospital acquired pneumonia: Treatment before MC&S in mind and severe?
If mild – Doxycycline PO + Metronidazole PO If severe or can’t take oral – Benzylpenicillin IV + gentamycin IV
Patient with RUQ pain, hepatomegaly, jaundice, distension/ascites, early satiety, weight loss/cachexia, hepatic encephalopathy –which biochemical marker do you use?
HCC Alpha fetoprotein
Treatment of IgA nephropathy - Whats the other name for it?
Berger’s disease Most common GN Management: 1.Conservative if mild 2.Supportive therapy – ACE-I to control BP (<140/90) 3.If risk of high progression (persisting proteinuria + preserved renal function) – Prednisolone 4.If RPGN/AKI involved – Immunosuppression -> Prednisolone + Azathioprine
Lady with recurrent UTI and scarring. Reflux nephropathy - chronic pyelonephritis + vesico-ureteric reflux: Presentation? Investigations?
Dysuria Frequency Pyrexia Urinary incontinence at night 1.MCUG: contrast is used to see the reflux of urine during voiding 2.IVU: show scarring with thin cortex overlying a distorted calyx. Clubbing of calyx: normal cupping of calyx is reversed. 3.DMSA scan: show renal scarring due to reflux.
XRay of rheumatoid
Early x-ray findings ● loss of joint space ● juxta-articular osteoporosis ● soft-tissue swelling Late x-ray findings ● Periarticular erosions ● Subluxation
Pt with frank haematuria. He had this before and took Abx and it went away. But now it has returned. Smokes 30 ciggs a day since he was born. Bladder cancer, UTI
UTI (Be aware Penicillin can cause haematuria)
Patient with raynauds and anticentromere - Diagnosis?
Limited cutaneous systemic sclerosis Scleroderma affects face and distal limbs predominately – hardening of the connective tissue.
CREST syndrome What does it stand for?
Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
Scleroderma affects trunk and proximal limbs predominately Associated with scl-70 antibodies Hypertension, lung fibrosis and renal involvement seen
Diffuse cutaneous systemic sclerosis
Patient with rheumatoid + steroid use and methotrexate with swollen elbow for past 1 week. She felt hot (but didn’t tell us there was fever) - Ddx? Microscopy?
Gout, Septic arthritis (but its not cause 1 wk hx) Long needle-shaped crystals which are negatively birefringent under polarised light.
Short term management of Gout
- NSAIDs- diclofenac or indomethacin 50mg/8h for up to 8 days (strong NSAIDs) 2. Colchicine 0.5mg/6h until pain resolves. Also use if NSAIDs are contraindicated
Long term management of Gout
Long term therapy – Allopurinol. Do not start within 1 month of an attack, and NSAIDs/ Colchicine given for 4 weeks before and after starting allopurinol. 2nd line is Probenecid.
Neuro rehab: purpose of rehab
Re-learn lost functionality Reduce symptoms and improve the wellbeing of people with diseases
Patient has really high BP, low platelets and a bruise after an injection. Which of these is a relative contraindication to heparin?
Elderly Low platelets / thrombocytopenia are absolute CI to heparin, recent cerebral haemorrhage, severe hypertension; peptic ulcer; after major trauma or recent surgery to eye or nervous system; acute bacterial endocarditis
Paediatric epilepsy - protocol for status epilepticus
Time 0 mins (1st step) - Seizure starts Check ABC, high flow O2 if available Check blood glucose 5 mins (2nd step) - Midazolam 0.5 mg/kg buccally Or Lorazepam 0.1 mg/kg if intravenous access established 15 mins (3rd step) Lorazepam 0.1 mg/kg intravenously 25 mins (4th step) Phenytoin 20 mg/kg by intravenous infusion over 20 mins or (if on regular phenytoin) Phenobarbital 20 mg/kg (if known heart block or already on phenytoin)intravenously over 5 mins 45 mins (5th step) Rapid sequence induction of anaesthesia using thiopental sodium 4 mg/kg intravenously
Venous leg ulcer management
Compression bandaging (4 layer), moisturiser, oral pentoxifylline (reduces platelet aggregation and inflammation)
When do you give anti-D to non-sensitised Rh-ve mothers? When would you give ASAP?
28 and 34 weeks ● delivery of a Rh +ve infant, whether live or stillborn ● any termination of pregnancy ● miscarriage if gestation is > 12 weeks ● ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required) ● external cephalic version ● antepartum haemorrhage ● amniocentesis, chorionic villus sampling, fetal blood sampling
6 week child with congenital dysplasia -
Most unstable hips spontaneously stabilise by 3-6 weeks Pavlik harness – if child <5 months If older than – surgery
How does the COCP protect against PID?
Thickens cervical mucus – making it difficult for both sperm and bacteria to enter.
Pt with rh arthritis, on methotrexate with 6 month hx of SOB. Both fev1 and FVC reduced with ratio @ 86%. Diagnosis? Cause?
Pulmonary fibrosis Methotrexate
Patient with painful ankle and negatively birifringent crystals – what is dx?
Gout
80 year old patient with hip fracture and normal bloods (pretty much). What management (if needed) should you initiate for osteoporosis? Treatment?
Assess risk by FRAX Oral alendronate (biphosphonate) All patients starting steroids for >3 months should have an osteoporosis assessment *All patients age >65 starting steroids should be commenced on Adcal D3 + alendronate*
Patient with muscle weakness, difficulty combing hair (i.e. raising arm) with raised ESR and raised CK and Anti-Jo1 antibody, positive rheumatoid factor. Diagnosis?
Polymyositis Symmetrical, proximal muscle weakness Elevated skeletal muscle enzyme levels Symmetrical, proximal muscle weakness with insidious onset Muscles usually painles
70 year old patient with muscle aching, difficulty combing hair (i.e. raising arm) with raised ESR and normal CK and EMG normal. Diagnosis? Treatment?
Polymyalgia rheumatica Prednisolone
Patient with psoriasis – tried emollients and wants to avoid oral meds. What next?
1st line mod-severe = narrow band UVB. (Phototherapy)
Pt diagnosed with open angle glaucoma. Which piece of advice should patient be given?
Pt’s eyesight is irreversible Damage to the optic nerve is likely to be prevented or delayed. Sadly treatment cannot restore any sight that has already been lost.
Patient with sensorineural hearing loss, tinnitus, vertigo and aural fullness. Diagnosis?
Menieres
The patient gets dizzy every time he turns his head. Presents with left lateral gaze and nystagmus Diagnosis? Investigation? Treatment?
Benign paroxysmal positional vertigo Dix-halpike Epley
Patient with sensorineural unilateral hearing loss, vertigo and on MRI found to have an abnormal lesion leaving the internal auditory meatus. Diagnosis?
Acoustic neuroma aka vestibular schwannoma, arising from vestibular nerve
Pt with nose bleed which has now become bilateral with blood leakage into the mouth. Bleeding hasn’t stopped after holding onto nose. Next step?
Topical anaesthetic and cotton wool soaked in vasoconstrictor (oxymetazoline) Then cauterise with silver nitrate sticks
Pt with STEMI – Immediate management?
Morphine + metoclopramide Oxygen GTN – sublinhual/IV Aspirin 300mg Ticagrelor Anticoag – enoxaparin/abciximab
CHA2DS2-VASc score
C Congestive heart failure (or Left ventricular systolic dysfunction) - 1 H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) - 1 A2 Age ≥75 years - 2 D Diabetes Mellitus - 1 S2 Prior Stroke or TIA or thromboembolism - 2 V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) - 1 A Age 65–74 years - 1 Sc Sex category (i.e. female sex) - 1
Patient with past mitral valve replacement presenting with new pan systolic murmur and fever. What is most important investigation?
Blood cultures
Patient diagnosed with angina but also has asthma. Already on aspirin – what is the first drug pt should be put on?
Verapamil
Wells criteria - What is it for?
Pulmonary embolism clinical signs and symptoms of DVT = 3 an alternative diagnosis is less likely than PE = 3 heart rate more than 100 = 1.5 immobilisation for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5 previous objectively diagnosed PE or DVT = 1.5 haemoptysis = 1 malignancy (on treatment, treatment in last 6 months or palliative) = 1
Pt with TB signs – what type of stain should be done on sputum?
Ziehl Nielsen
Pt with weakness and dizziness alongside changing colour in palmar creases. What is best test? Top differential?
SynACTH. Addison’s – palmar crease pigmentation, weakness, abdo pain. Short synacthen test is best diagnostic + 1st line in diagnosing
Pt with T2 diabetes and keeps having hypos. What is the cause?
Glimeperide (Insulin/sulfonylureas (gliclazide and glimepiride)
Patient with t2 diabetes mellitus (on metformin) with high cholesterol, high BMI (31) and poor glucose control. How should the pt control their cholesterol?
Statin
Patient with 3 month history with bowel troubles and campylobacter infection prior to this. Abdo pain relieved by defacation. Altered stool passage (straining, urgency, incomplete evacuation) abdominal bloating (more common in women than men), distension, tension or hardness symptoms made worse by eating and passage of mucus Normal bloods, no fever and negative stool. What is most likely dx?
IBS
Patient with signs consistent with encephalopathy (liver failure) on the background of alcoholic cirrhosis and being alcohol independent. What is the first step in Mx?
20 degree head tilt, A-E, lactulose, treat sepsis, +/- Abx (rifaxilline), +/- Mannitol
Patient with signs consistent with encephalopathy (liver failure) on the background of alcoholic cirrhosis and being alcohol independent. What is the first step in Mx?
Lactulose Phosphate enemas Stop diuretics if low potassium
Pt with melaena, altered bowel habit and weight loss, no lesions anywhere on body. What is Dx?
Colon cancer
Pt had surgery 3 days prior and has dropped in renal output with increased creatinine. He was on amox, met and gent. What is the most immediate step in management?
Stop gent
Pt had surgery 3 days prior and has dropped in renal output with increased creatinine. He was on amox, met and gent. What is the most immediate step in management?
Stop gent
Pt with 2 weeks hx of frank haematuria and varicoceale. What is most likely Dx?
Renal cell carcinoma
Pt with PET and has HELLP. 39 weeks pregnant, what is the best step in Rx?
Delivery + IV Dexamethasone MgSO4 If hypertensive: IV Labetolol
HELLP?
Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) . It’s a serious but rare pregnancy complication.
Pt with light bleeding and crampy pain @ 7 weeks. Has a closed OS but on USS there is something which looks like a gestational sac?
Threatened miscarriage - presents with a closed cervical OS, normal uterus size, mild / light bleeding.
Pt with light bleeding and lower abdominal pain @ 9 weeks gestation. What is definitive investigation to find out whats happening?
TV USS
Patient stage 1 and needs augmentation. What is best way?
Oxytocin
Patient stage 3 and wanted to naturally deliver placenta. What is the best way to ensure she does not loose any extra blood?
Syntometrine - is a combination of oxytocin + ergometrine. Carboprost Used in combination for delivery of placenta and prevention of PPH.
Woman with late decelerations on CTG, what next?
Do another foetal investigation - foetal blood sampling with pH. Late decelerations = deceleration starts at peak of uterine contraction, recovers after. Requires foetal blood sampling with pH. If acidotic -> Emergency c section.
Lady trying to conceive with low progesterone, oligomenorrhoea, normal fsh and LH, normal TSH. What is the cause?
Premature menopause
Pt with signs of endometriosis and a 4mm endometrioma on USS. What is the best way to manage? Investigation?
COCP TVUS
Pt with signs of endometriosis and a 4mm endometrioma on USS. What is the best way to manage? Investigation?
COCP GnRH analogues - reduce the size Laprascopic laser to reduce complications TVUS
RLQ pain sudden onset and constant pain, N+V, increased CRP, but normal WBC.
Ovaian torsion
Child born at term and starts to seize. Weight is 4.8kg, what is the first investigation that should be done?
Glucose and electrolytes
Baby (8 months) with crying episodes where baby brings legs to tummy. Mother opened nappy to find red current stool
Intersussception
Indian baby who was bought in with mum looking pale. Hb done and found to be low. Baby is 1 years old and is on cows milk. What is the reason for anaemia?
Low iron in cows milk.
New born baby and tests done. Levels of immunoreactive trypsin were found to be high. What does this point to?
Cystic fibrosis
Child with seizure going on for 20 minutes. Has been given lorazepam, what should you give him now?
Lorazepam 0.1 mg/kg intravenously Benzo
Child with seizure going on for 20 minutes. Has been given lorazepam, what should you give him now?
Lorazepam 0.1 mg/kg intravenously (Benzo)
Pt has migraine which are getting more frequent. What is the best prophylactic measure?
Propanolol - Beta Blocker.
Women presents with mixture of distal sensory and motor signs after having gastroenteritis 1 week ago. What is the worst thing you want to rule out first? Triggered by?
Guillain Barre syndrome Immune mediated demyelination often triggered by Campylobacter jejuni.
Pt with sensory and motor signs peripherally. Vitamin?
Vitamin B12 (Vitamin E)
Pt with right sided stroke with legs>arms and vision loss. What blood supply is affected?
ACA
Pt comes in with left sided weakness which lasts for 60 minutes. Treatment?
If 0-3 = Specialist assessment within 1 week of symptom onset +/- brain imaging 4 or more = Aspirin 300mg immediately, specialist assessment within 24 hours, address RFs
Pt with stroke that occurred 1 hr ago. What is the best Rx?
tpA intravenous
GCS
Eyes Spontaneous To sound To pressure None Verbal Orientated Confused Words Sounds None Motor Obey commands Localising Normal flexion Abnormal flexion Extension None
Patient with constant worries going out. Diagnosis?
Agorophobia
Patient with normal weight but having a problem binge eating. Patient uses laxatives to vomit after feeling bad. Diagnosis?
Bulimia
Patient with low TSH, normal t3 and t4, oligomenorrhoea, low FSH and LH, and exercises a lot. What is the most likely Dx?
Levothyroxine misuse
Patient with schizophrenia with high BMI and cholesterol. What medication should the pt be started on?
Amisulpiride, *Aripiprazole*, Ziprasidone - least weight gain
Pt started on clozapine and is told to come back on a weekly basis for Ix. Why?
Agranulocytosis
Patient with varicose veins with a single bleeding episode from vein. What should you do after seeing the patient in the clinic? Ix?
Refer pt to vascular team Duplex
Patient with gangrenous toe and ulcer under foot with leg pain at rest. What is the next step?
Revascularisation (critical limb ischaemia)
Patient with acute ischaemic limb. No pulses past femoral pulse and cold limp up till below knee. What is Rx?
Thrombolise from femoral down 6Ps: pain, pallor, perishingly cold, pulseless, paralysis, parasethesia
How to reduce risk of kidney stones?
● high fluid intake Reduce high purine foods such as red meat, organ meats, shell fish ● low animal protein, low salt diet ● thiazides diuretics (increase distal tubular calcium resorption)
Antibodies for SLE - Most sensitive? Most specific?
Anti-nuclear antibodies (ANA) are autoantibodies to the nuclei of your cells. dsDNA and anti-smith antibodies
COPD ladder
Vaccinations - influenza and pneumococcal Rehab Step 1: Inhaled therapy (SABA or SAMA) (Salbutamol + Ipratropium) Step 2: Without asthmatic features - LABA (Salmeterol) + LAMA (Tiotropium) Step 2: With asthmatic features - LABA + ICS (Budesonide/Beclomethasone) Step 3: If still breathless then LAMA + LABA + ICS
Newborn baby from C-Section having difficulty breathing, cyanosis, CXR shows hyperinflated lungs and fluid in horizontal fissure
Transient tachypneoa of the new born–> usually gets better in 1-2 days
Newborn baby from mother with polyhydramnios, having difficulty breathing, difficulty swallowing secretions
Esophageal atresia
Acute management of depression with psychosis?
antipsychotics- olanzapine/ haloperidol
Management of schizophrenia
Atypical antipsychotics (Respiradone, olanzapine, quetiapine, apriprazole)
Cerebral oedema - CT scan
Ventricle disappears
chronic pelvic pain dysmenorrhoea - pain often starts days before bleeding deep dyspareunia subfertility tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen
Endometriosis
Treatment of compartment syndrome with trauma
Fasciotomy Amputation (With rhabdo –> hydration and bicarb)
Investigating for retained products of miscarriage?
USS
Investigating for retained products of pregnancy?
USS (TVS)
Male have sexual tendency towards underage girl what would indicate that she not is at immediate risk?
Been less than 6 months of these tendencies
What is the management of alcohol withdrawal?
chlordiazapoxide 300mg
What are the side effects of oxybutynin?
anti-cholinergic -dry mouth, dizziness, drowsiness, blurred vision, dry eyes, N&V, constipation, diarrhea, weakness, runny nose
SZ vs schizotypal disorder?
retained insight in schizotypal -odd beliefs and magical thinking, odd, eccentric behaviour
Signs of physical abuse (non-accidental injury) including bruises, burns, fractures?
Bruises: -symm. bruised eyes -mouth, eyes, soft tissues on face -finger marks on legs, arms, chest -linear buttock or back -uncommon sites: chest, stomach, genitalia, neck Burns, scalds -cigarettes -backs of hands, soles of feet -glove and stocking distribution Human bite mark Fractures: -long bones (arms, legs, ribs) -multiple fractures in various bones -fractures of different ages
What is rehabilitation?
the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.
Treatment of woman who comes in contact with check pox unsure if chicken pox in childhood.
Treat with IVIG
Parameters in acute asthma
Moderate - PEFR - 50-75% Speech normal Resp <25 Pulse <110 Severe - PEFR - 33-50% Can’t complete sentences RR > 25 Pulse >110 Life-threatening - PEFR - < 33% O2 SATS < 92% Silent chest Cyanosis Feeble resp effort Pulse <80 HTN Exhaustion
HbsAg - positive Anti-Hbc - positive IgM anti-Hbc - negative anti HbS - negative
Chronic hepatitis
High lipid, which drug to treat dyslipidemia?
Atorvastatin
Woman trying to conceive for 18m periods 28-70 day cycle, partner ok, no past hx, all blood result normal except for low 21day progesterone
Early menopause
Placenta retained
Placenta oxytocin or ergometrine injection into the umbilical vein with 20 IU of oxytocin in 20 ml of saline is recommended, followed by proximal clamping of the cord
Patient with stroke symptoms, regain movement after 45min - management?
Alteplase then start aspirin 300mg 24 hours later.
Spasticity on 5mg bd baclofen. Management?
increase baclofen (100mg/d is maximum)
Indications for CT head in children?
-LOC -vomiting, headache -post traumatic seizure (no hx epilepsy) - GCS < 14 - suspected fracture - any signs of fracture - focal deficits
Glasgow scale - Which parameter indicates worse outcome?
P - PO2 <8 A - age >55 N - WCC >15 C - Calcium <2 R - renal urea >16 E - AST >200 A - Albumin <32 S - Sugar >10 (3 or more is pancreatitis)
Definition of Privacy
Privacy refers to freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual Dignity is being worthy of respect
Diabetic drug that causes hypoglycemia
Insulin, sulfonylureas (Glucoside)
What is Akathisia?
Restlessness
2y old know only few words, but understands clearly, no motor delay what is the next step?
• assessment → audiological, neurodevelopmental and SALT • medical treatment → correction of hearing loss, correct cleft lip/palate • social → support at school
7y year old still bedwetting, father has history of bedwetting until 8. Nothing in the hx about previous treatment What is the next treatment?
Lifestyle Eneursis alarm
2nd degree prolapse management?
Asymp - lifestyle and pelvic floor Symp - pessary
Patient presented with stroke within 1hr- which treatment provide best possible outcome?
Thrombolysis
Dialysis patient 3day/week complains of tingling sensation, low power reflex, had diarrhea 2 weeks ago, which condition needs to be exclude?
Guillain Barre
Melena and microcytic hypochromic anemia in older guy?
Anemia of chronic disease (cancer)
Stroke affecting vision weakness in arm>leg – which territory is affected?
MCA
Neonate premature at 30 with intermittent apnea, what is the management options include Corticosteroid, diuretics, and caffeine?
Caffeine
Psychotic symptoms with suicidal ideation want to leave a&e, which law would you use?
Mental health act
what does anti tissue transglutaminase indicate?
Coeliac
Raynaud’s, positive Scl-70, DsDNA negative?
Systemic sclerosis (diffuse cutaneous)
Patient with NSTEMI, what to do?
O2 Nitrates Metoclopramide Aspirin + Clopidogrel/Ticagrelol LMWH B-blocker - diltiazam/verapamil (Tirofiban in high risk patients)
RTA broken nose, abnormal chest movement, weirdly displaced leg, leg bleeding management?
C-spine/ airway/ chest drain
Lady with gallstones, presenting with acute pancreatitis because of gallstones, after stabilization, how would you manage?
Cholecystectomy
Cystic fibrosis on xray
Consolidation, hyperinflation, dilatation
USS shows echogenicity (more dense) and hepatomegaly, ALT>AST
NAFLD
Lady with lower abdominal pain, painful VE in fornices, pyrexial
PID
Third stage of labour management
Oxytocin/Syntocinon and then Ergometrine Immediate cord clamping
Man couldn’t close eye, facial and unilateral hearing loss - Investigation?
MRI Cerebellopontine angle
Haematuria, smoker, ct found multiple lesions in lungs and renal kidney lesion - Diagnosis?
RCC
Treatment of small cell lung cancer
multidrug platinum-based chemotherapy limited-stage SCLC then offer thoracic irradiation concurrently with the first or second cycle of chemotherapy or after completion of chemotherap
UTI kid why do USS?
To show dilated calyces
Difficulty having kids, trying 14 months, hubby fine, periods every 2-3 months. Normal testosterone and SHBG, FSH:LH ratio raised, normal progesterone and prolactin - Diagnosis?
PCOS
Endometriosis - lady wants to have kids in future -management?
Laparoscopic ovarian cystectomy with excision Can do laparoscopic surgery if severe disease if >3cm
Treatment of thyrotoxicosis
Propylthiouracil
55 year old new onset gastritis - treatment?
Test for H Pylori
Migraine prophlyaxis patient previous depression
Venlafaxine (SNRIs)/Amitryptilline Duloxetine Milnacipran
60 year old Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal - Management?
Temporal arteritis
Migraine prophlyaxis patient previous depression
Venlafaxine (SNRIs) Duloxetine Milnacipran
Trichomonas vaginalis treatment?
Metronidazole
Pregnancy induced hypertension why given labetalol?
Prevent superimposed pre-eclampsia
Baby born 6 hours at term, fed well 45mls, developed grunting and subcostal recession - Diagnosis?
Transient tachypnoea of newborn
Baby born developed grunting and subcostal recession - Diagnosis?
RDS
Guy had cataract surgery came back 3 days later with eye pain
endopthalmitis
Stroke guy, why can’t he drive?
if stroke or TIA: 1 month off driving may not need to inform DVLA if no residual neruological deficit if multiple TIA over short period times: 3 months off driving and inform DVLA
Carpal tunnel definitive sign
Phalen’s test/Tinnels
Girl fell over, incontinent of urine, biting of tongue etc. - Investigation before leaving hospital?
EEG
Old lady saw spiders, incontinent, not looking after herself for last few days - Differentials?
Delirium tremens Lewy body dementia
Features of parkinson plus
Vertical gaze palsy +- falls Impotence/Incontinence Visual hallucinations Interfering activity by affected limb (Alien limb syndrome) Diabetic/HTN patient who falls
Glaucoma - lady used to wear glasses, had vomitted. Definitive test?
Gonioscopy (slit lamp examination)
Indication to below the knee amputation.
If all other methods have failed/Unsuitable for revascularisation
14 year boy comes in asking for contraception to have sex with 15year old.
Both are below age of 16 and above age 13 Underage sexual activity should always be seen as a possible indicator of child sexual exploitation.
1st rank symptoms of schizo
Auditory hallucinations, somatic hallucinations, thought withdrawal or inserting, broadcasting, delusional perception, delusions of control
Insomnia Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances and seizures
Diazepam/Benzo withdrawal
Depression Anxiety Fatigue Decreased conc Cravings (increased appetite) Excess sleep Vivid dreams CRASH - suicide ideation, N&V, formication
Cocaine withdrawal
Diarrheoa Lacrimation Vomiting Rhinorrhea Dysphoria Nausea Fevers Sweating Insomnia Agitation and aches Dilated pupils
Heroine withdrawal
Boy with developmental delay….thick calves - Diagnosis?
Duchenne’s
Melanoma - what’s the most prognostic factor?
Breslow
Endometrial cancer. Risk factor?
Obesity >50 yrs Endometrial hyperplasia Unopposed oestrogen (early menarchy, late menopause, HRT) Tamoxifen FH
Shoulder dystopia. Most likely cause to get shoulder dystocia?
Macrosomic baby
Respiratory Distress Syndrome. After giving surfactant. Next treatment?
Another surfactant dose
Cholesystitis treatment
IV co-amoxiclav lap chole
Hep B treatment
Pegylated INF-a - tenofovir and entecavir
Cholangiocarcinoma investigations? Tumour markers?
CT abdo CA 19-9
Increased prolactin Increased GH Normal/low LH+FSH Normal/low testosterone+estradiol
Pituitary adenoma
IgA nephropathy diagnosis
Renal biopsy - diffuse mesangial IgA deposition Urine analysis MC&S U&Es eGFR Renal USS CT KUB (normal) C3 and c4 complement (normal)
Acamprosate use
Acts on NMDA and GABAa Reduces Cravings and risk of relapse
Disulfiram use
Inhibits acetaldehyde dehydrogenase - leading to accumulation
Epistaxis Telangiectasis Visceral lesions FHx (first degree)
3 or more - hereditary haemorrhagic telangiectasia
How to aid women with External cephalic version?
Tocolytic (Terbutaline) in primiparous women
Why do you give Anti D?
Stop mother making antibody Prevent maternal sensitisation
Spirometry asthma vs COPD; FEV1/FVC
COPD <70% Asthma <80%
Osteoarthritis drug management
LA Diclofenac (with omeprazole) Steroid injection (methylpred)
Cystocele first line management
Bladder training, Kegel exercises
Large Bowel obstruction treatment.
Drip and suck - nasogastric decompression plus fluid resus
First line management of angina
Exercise Diet Nitrates Antiplatelet therapy
Small Bowel obstruction treatment.
Drip and suck - nasogastric decompression plus fluid resus
Diabetic with hyperlipidaemia and high cholesterol and raised Hba1c. How to control cholesterol levels?
Atorvastatin 80 mg
Rheumatoid features - most likely RA?
Swan neck deformity Boutonnieres deformity *Ulnar deviation* Nodules on elbow (Morning stiffness)
Blood results showing HELLP syndrome.
Total Bili >1,2 LDH >600 GGT >70 Platelets <100,000
Mechanism of Baclofen
Muscle relaxant and antispastic inhibiting both monosynaptic and polysynaptic reflexes at the spinal level
18 month of a child has respiratory distress that came on suddenly. Biphasic wheeze + afebrile. Investigations? Asthma emergency management?
SABA and PEFR Inhaled SABA, ICS, abx if needed, O2
Management of Primary 8mm pneumothorax?
Aspiration
Causes of Akathesia
SSRIs, CCBs, anti-emetics (metoclopramide), anti-vertigo
Biggest risk factor for completed suicide?
Age >65 Postnatal status Personal/FHx of depression Steroids IFN male
Treatment for PTSD
Trauma focussed CBT FOR EXAMPLE eye movement desensitisation and processing
Pt with proximal myopathy-ish symptoms - and low Na and high K. Diagnosis?
Addisons
Child with UTI. You do a USS. Parent asks why you chose to do USS?
vesicoureteric reflux
Lady with pregnancy-induced HTN with bp at 146/something. Why do you control her bp?
To prevent superimposed pet
Pt with FHx of hypertension or PET, but has DM and is obese. What is most likely risk factor of her getting pet/what makes you want to investigate further?
First baby Hx of pre-eclampsia FHx of pre-eclampsia BMI>30 Maternal age >35
Tests before starting Vit D and alendronate?
Serum 25-hydroxy VitD (D1) Serum ALP Serum calcium Fasting phosphorus PTH
Pitting in nails and swelling in 3 DIP joints and dactylitis - Diagnosis?
Psoriatic arthritis (Hx of psoriasis is common)
Where do you place grommet?
Anterior inferior
Patient presents with one red eye that are: pain or photophobia no itching poorly reactive pupil irregularity of the pupil Diagnosis?
Anterior uveitis
Loss of deterioration of central vision (can be sudden or gradual) Flashes of light
Retinal detachment
Patient comes in with periorbital pain, loss of visual acuity with scotoma (blind spot), loss of color vision, and rapid afferent pupillary defect. Diagnosis?
Optic neuritis
Patient with weight loss and UC. Primary sclerosing cholangitis or cholangiocarcinoma?
Primary sclerosing cholangitis
Started someone on ACEi, he had a small creatinine rise what do you do?
Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% Treat with NaCl fluid
Bone pain with fragility fractures, depression and renal stones
Primary hyperparathyroidism
Placenta praevia (placenta is low) - when do you do elective C section?
37-38 weeks
Long term MI management?
Aspirin, B blockers (bisoprolol, metoprolol), Statin (atorvastatin)
Most likely cause of PPH?
Atonic uterus
Trichomonas vaginalis microscopy
Motile trophozoites in vaginal discharge smears.
Lady had a loss of sensation up to umbilicus and bad cough and significant pack years
Chest xray and thoraco-lumbar MRI
Paeds pneumonia - management?
Penicillin V or amoxycillin (In pneumonia associated with influenza, co-amoxiclav is recommended)
CURB-65 - Score 3 management?
- Confusion (abbreviated Mental Test Score <=8) (1 point) - Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) - Respiratory Rate > 30 per minute (1 point) - Blood Pressure: diastolic < 60 or systeolic < 90 mmHg (1 point) - Age >= 65 years (1 point)
CURB-65 - Score 3 management?
- Confusion (abbreviated Mental Test Score <=8) (1 point) - Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) - Respiratory Rate > 30 per minute (1 point) - Blood Pressure: diastolic < 60 or systeolic < 90 mmHg (1 point) - Age >= 65 years (1 point) Admit and Ben Pen IV and doxycycline PO
CXR with ground glass appearance
Respiratory distress syndrome
Infected bile duct obstruction (ascending cholangitis) - management?
IV abx (tazobactam or piperacillin) + ERCP
Presents frequently to healthcare Intense but unstable relationships Persistent feelings of boredom and emptiness with uncertainty Unstable mood - Anger, low tolerance of stress Impulsive (and damaging behaviour) Diagnosis?
Emotionally unstable personality disorder
Characteristic cystic fibrosis features?
Failure to pass meconium (meconium ileus), Failure to thrive, voracious apetite
Coryzal symptoms Dry cough Increasing breathlessness Wheezing Fine inspiratory crackles Feeding difficult
Bronchiolitis (Respiratory syncytial virus)
Goserelin - What is it? Mechanism of action?
GNRH receptor agonist Inhibition of pituitary gonadotropin secretion
Anti-d – why don’t you give it before 12 weeks?
Blood transferred during that time is not significant
Kid hits her head bad and vomits 2 times what do you do?
Skull XR if suspected fracture 3 or more for CT MRI
Man has replaced hip and is hallucinating and has long QT - Drug that’s causing it? lorazepam, risperidone, tamazepam, quetiapine and benzo, haloperidol
Haloperidol
Man had AF and raised amylase(very slightly)
Mesenteric ischaemia
Reasons for referral to psychiatry
superficial self-harm
What to check before starting COCP?
Blood pressure
Failure to pass meconium – does a pr exam and lots of faeces come out. Investigations?
Meconium plug syndrome CF blood sample Rectal suction biopsy Contrast enema
Bronchiolitis, a premature baby born 24 weeks, what do you give the baby?
Oxygen
How to diagnose Hirschsprung’s? First line?
Rectal biopsy Plain abdo XR Contrast enema
How to diagnose Hirschsprung’s? First line? Screening tool?
Rectal biopsy Plain abdo XR Contrast enema (most valuable)
B-hcG of 650 in 5-week pregnant woman, can pick up heartbeat but can’t see anything on USS, what is this?
Pregnancy of unknown location
Type of miscarriage? pain; bleeding > bleeding equivalent to menstruation; cervix = open; uterine size = dates; ultrasound Fetal heart may/may not be visualised
Inevitable miscarriage
Type of miscarriage? no pain; bleeding < bleeding equivalent to menstruation; cervix = closing; uterine size = dates; ultrasound = empty uterus
Complete miscarriage
Type of miscarriage? minimal pain; bleeding < bleeding equivalent to menstruation; cervix closed; uterine size = dates; ultrasound = Fetal Heart visualised
Threatened miscarriage
Type of miscarriage? pain +/-; bleeding >>bleeding equivalent to menstruation; cervix = open; uterine size = or < dates; ultrasound = retained products/no fetal heart
Incomplete miscarriage
Type of miscarriage? no pain; bleeding = minimal brown; cervix = closed; uterine size = small; ultrasound = no fetal heart
Missed miscarriage
woman with monochromic (one placenta) diamniotic twins (diagnosed at 1st US scan) suddenly gets intense abdo pain and is large for dates. What is cause?
Twin to twin transfusion polhydro
Causes of menorrhagia, no intermenstrual bleed, multiparous, abdo exam normal, didn’t want to have bimanual?
Fibroids
Causes of menorrhagia
PID Dysfunctional uterine bleeding Fibroids Anovulatory cycles Hypothyroid IUD
Depression admission criteria
Severe agitation Psychotic Suicidal Catatonia
Management of stone that couldn’t be ERCP?
Emergency CBD exploration + Abx
Paeds clavicle fracture, macrosomic 4-week old baby, CXR of chest showed clavicle fracture /w callus, examination (for other signs of abuse) was unremarkable?
If in ED then send to GP Fracture clinic - if it doesn’t heal in 6 weeks
Best schizophrenia prognosis
Paranoid
Acute heart failure management
O2 therapy Loop diuretics - furosemide GTN spray
Side effects of respiridone
Depression Anaemia Anxiety Abnormal appetite Chest discomfort/Cough Conjunctivitis
ENT what is associated with polyps & post nasal drip
asthma & aspirin allergy
ENT what is associated with polyps & post nasal drip
asthma, hay fever & aspirin allergy
Hypothyroid in children treatment
Levothyroxine
Afebrile paed with wheeze and expiratory crackles 9 weeks old with recession
exacerbation of asthma
Surveillance for 4.8cm aaa
3 monthly
Diabetic brought into hospital hypernatremic, what will be given to him next?
NaCl Insulin IV (Glucose if low)
Labour, mention of repeated late decelerations over last 40 mins, what do u do next?
Fetal blood sampling
Skier - knee swelling that is delayed by one day
Meniscal tear
Guy who leans on the table gets ulnar neuropathy, where is lesion?
Cubital canal
Treatment of mastitis
Continue breastfeeding The first-line antibiotic is flucloxacillin for 10-14 days (Staph aureus)
Simple humeral fracture presented 5 days after fracture, what next?
immobilisation collar and cuff
CURB-65 - Score 0 management?
Community care Doxycycline PO 200mg STAT then 100mg OD
Treatment of viral meningitis
Ceftriaxone IV and acyclovir If immunocompromised or >55 add amoxicillin
Simple pain management already on nsaids, what next?:
Weak opioids - codiene, dyhydracodeine, tramadol Strong opioids - diamorphine, fentanyl
What more likely to cause endometrial cancer?
Obesity Nulliparity Early menarche Late menopause Unopposed estrogen
HRT contraindications
Breast cancer Estrogen sensitive cancer Undiagnosed vaginal bleedings Endometrial hyperplasia
Schizo acute dystonia treatment?
Procyclidine Hydrochloride
Pt has ptosis slightly weak medial eye movement, whats caused this?
Subarachnoid haemorrhage
Test before starting azathioprine?
Thiopurine methyltransferase (TPMT)
Red painful eye with normal visual acuity - what to do next?
Look at the surface of the eye Snellen chart Inspection of lid and brow Inspection of the ocular surface and subtarsal surface, pupillary reactions
Given vancomycin antibiotic for chest infection then gets erythroderma, what is cause?
drug reaction
Tia abcd2 calculation & management, if u worked it out he had a score of 6?
Admission + MRI
Prostate symmetrically enlarged smooth on exam, raised PSA (1.0 over normal range), what do u do next?
Repeat PSA in 6 months
Parkinsons off symptom management
Levodopa + Entacapone
Risk factors for suicide
male Hx of self harm Alcohol or drug misuse Hx of mental illness Hx of chronic disease Advancing age Unemployment or social isolation/living alone Being unmarried, divorced or widowed
Paeds urticaria management, the boy forgot his blue inhaler?
IM adrenaline
Neonate that’s grunting and 92 sats after 20hr premature rupture of membrane labour, what do you do next?
O2/CPAP or Intubate, surfactant
After operation become hypertensive, <38C temp ?normal sats, what is the cause of fever
Atelectasis
What antibiotics do u give in pyelonephritis
Co amox +- IV gent
Repeat key differentiating thing between stress & urge?
Nocturia
What is oxybutinin?
Antimuscarinic
Guy that wants to stop getting depressed, how do u treat him, hes tried to OD on pills in the past
CBT
Boy who had delayed puberty, said father also was delayed.
Constitutional delay
GCA management
Steroids
Vascular surgery man is awaiting angioplasty for intermittent claudication revascularisation, what do u give him in mean time?
Statin
Kid has hypovolemic shock weighed 12kg: how much fluid do you give them?
20ml/kg bolus over 10 mins.
Treatment of dysmenorrhagia
Mefanamic acid COCP
55 year old new onset gastritis
1) Refer to urgent endoscopy
Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal
MRI because SAH
Migraine lady had really severe headache, neck stiffness, CT normal, photophobia
LP because meningitis
Antepartum haemorrhage: 8 weeks pregnant investigation
Pregnancy test FBC Rhesus Serum BHCG TVUS
Urinary retention and pain in back of legs where was the lesion?
S234
Presentation of posterior humeral fracture
Wrist extension (wrist drop) Radial nerve fracture Loss of sensation in dorsal aspect of 1st+2nd
Guy fell from climbing frame, snapping sound heard and had haematoma on sole of foot. He can’t stand on the toes or push off. Diagnosis?
Achilles tendon rupture
Giant cell arteritis treatment
High dose prednisolone Emergency opthamology review (if confirmed give aspirin additionally) (Allergic/relapsing then give methotrexate)
Mechanism of urticaria due to IgE
Mast cell degranulation
Cause of urticaria due to autoimmunity
Complement Phagocytes Immune deficiency (HIV)
Guy had something that looked like psoriasis after coming back from Africa, what do you give?
Seborrheic dermatitis ketoconazole (steroid for flareups)
Guy had hep c and hep b - management?
Treat hep c interferon alfa and ribavirin.
Guy couldn’t find the right words for things, what is this?
Anomic aphasia
Cervical screening – why do you not screen people under 25?
high false positive rate
Alcoholic man with chronic pancreatitis?
Creon
she was feeling hot then cold and yawning and dilated pupils
Opioid withdrawal
lifetime prevalence of schizophrenia
1%
Guy had AKI after surgery - what do you assess?
saline bolus 250ml
Primary ovarian failure presentation
Low progesterone High LH
What further test do you need to do to make sure lp is safe?
CT only done if contraindications
Lady spontaneously changed from speaking English to fluent polish and was delusional shouting that Lady gaga wanted to kill her, whats the diagnosis?
transient psychosis
Lady is bleeding after birth 4500 ml of blood what radiological intervention would you do?
intrauterine balloon
Q of a guy who hit his head and had symptoms the next day in a rugby match?
CT scan
Mechanism of action of COCP?
Suppress the secretion of gonadotropins (follicle stimulating hormone, FSH and luteinizing hormone, LH) through negative feedback inhibition.
What is amount of blood loss is considered post partum haemorrhage?
Over 500 mL
Sickle cell disease with chest syndrome - management?
O2 (sats >94%)+ incentive spirometry+ fluids+analgesia (sc morphine 0.1mg/kg)
ACL tear bare co-morbidities (T2DM un-controllable, CABG) Risk factors?
Acute trauma Female sex (after puberty) Hx of previous ACL injury Use of cleats
What blood test do you do before prescribing retinoids for acne?
B-hcg LFTs and serum lipids before treatment, 1 month after starting and then every 3 months
Which medication causes memory problems - bisphosphantes, bisoprolol, oxybutynin , rivoraxaban
Oxybutynin
Treatment of hypercalcaemia?
First record the patient’s weight. Stop drugs known to cause hypercalcaemia. Give 0.9% NaCl to render the patient euvolaemic, aiming to increase urine volume to 200 mL/hr.
Thoraco-lumbar Kyphosis investigations?
XRay
Diplegic spastic child already had baclofen+ physio. Next mx?
Surgery, physio, more baclofen, cast Baclofen 40mg/day max if still no improvement give botulin toxin type A injection
Lung ca central tumour on x-ray - Next investigation?
Bronchoscopy+biopsy
Sinusitis management?
Abx - Amoxicillin Steroids nasal spray (budesonide) Decongestant spray (oxymetazoline)
Vocal nerve damage investigation?
Laryngoscopy
Bilateral glue ear, hearing loss, speech deficit?
Grommet
Endometrial cancer staging investigations?
FIGO staging (surgical) Pelvic USS Biopsy and histology
Presentation of intussusception
Vomiting, colicky abdo px, male, 6-12mths, lethargy, red-currant jelly stool
Risk factors for vaginal prolapse
Vaginal delivery (forceps delivery) Older age High BMI Previous surgery for prolapse Genetic factors
1 core and 4 minor depressive management?
Cbt, anti-depressant
10 year old, limp, knee pain, no fever -groin or knee pain -bilateral hip px -trendelenburg’s gait -weight >90th ; obesity -endocrine disorders that cause obesity -puberty (12-13.5 boys) Diagnosis?
SUFE (Slipped capital femoral epiphysis
Osteochandroma (patient with swelling) investigation?
CXR, x-ray pelvis
Which drug would you give old man who was not sleeping + depressive symptoms?
Mirtazapine
HPV - high risk types and low risk types?
16&18 - high risk 6&11 - low risk
Colectomy of crohns pt, 2 days post-op asks nurse about feeding?
eat and drink normally to get gut moving
Paeds severe life threatening asthma, silent chest sats 88%?
O2 + admission + nebulised SABA (salbutamol) and anticholinergic (ipaproprium) + prednisolone
Hypokalaemia, hypernatremia, headache, muscle weakness
Conns (primary hyperaldosteronism)
Diet of patient with diabetic nephropathy already on ace-I, hypertensive
low salt diet
Patient on risperidone and has oligo-menorrhea which hormone?
Hyperprolactinemia
Leg claudication on exercise, pulses palpable and obs stable – what management?
Aspirin/clopidogrel+ exercise + risk factor modification (statin, b-blocker +/-ACEi)
Man presents as worried because dad died of colorectal ca – what screening should he be offered?
If strong fhx -> genetic testing for FAP or HNPCC; if -ve but strong hx then colonoscopy 35-45 (If 60-74 every two yrs offer fecal occult blood testing 55 one off flexi sigmoid -> full colonoscopy if polyp found)
Marfans presents with severe tearing chest pain radiating to back – TTE showed aortic dissection. Next investigation?
CT angiography
Man returning from india with jaundice had diarrhoea?
Hepatitis A
Baby jaundiced 6 weeks high unconjugated bilirubin and pale stool?
Biliary atresia
Keratitis appearance fluorescein stain showed branch like appearance so management? Diagnosis?
HSV Gancyclovir
Bilateral conjunctivitis itchy eyes - management?
Anti-histamine - epinastine, azelastine, pheniramine, alcaftadine
Dehydrated baby, poor feeding, irritable, dry nappies, what to do?
rehydration therapy
Acute HF management?
Freusemide
Ovarian cancer commonest type?
Serous
Patient had lucid interval secondary to trauma, fell off step ladder?
extradural haematoma
Death certificate 1a - what to write as reason of death?
WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which 5 produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain.
Patient had symptoms of raised ICP (early morning headache and change in personality, and headache worse on movement) mx?
Urgent referral to neurologist CT/MRI scanning to determine any underlying lesion.
ABO incompatibility jaundice test?
Coombs test
- Impetigo advice to miss school-
This practice is implemented by many schools as they exclude children from attending until until the affected child no longer has crusty or bullous lesions
Impetigo advice to miss school-
This practice is implemented by many schools as they exclude children from attending until until the affected child no longer has crusty or bullous lesions
Man had a fall, loss of motor on one side and loss of proprioception on same side. Loss of sensory on opposite. What is the diagnosis?
Brown-Sequard syndrome is a spinal cord hemisection. On the ipsilateral side there will be loss of motor function (Corticospinal tract) and loss of proprioception & vibration sense (dorsal column). On the contralateral side there will be loss of pain, temperature and crude touch.
Sudden onset severe headache. Ct scan normal. Next investigation?
MRI or LP
Young girl one eye facing inwards towards nose. What lesion?
CN IV esotropia
School exclusion for chicken pox?
5 days after first skin eruption
Best investigation for multiple sclerosis?
s MRI. (Sagittal)
HBeAg - what does it mean?
This means the person infected with Hepatitis B can likely transmit the virus on to another person
Child with otitis media. Treatment?
Abx (amoxicillin) if: Child with systemic features and no improvement > 4 days Immunocompromised Age <2 with bilateral otitis media Discharge from ear
Hernia that doesn’t go into scrotum. Medial and superior to pubic tubercle. What type of hernia?
Inguinal hernia – medial and superior to pubic tubercle Femoral hernia – lateral and inferior to pubic tubercle
Police picks up crazy guy from home. What section can they detain on? Time?
Section 135 Upo 24 hours
Patient has hypomania. What is the first line treatment?
olanzapine
Haloperidol. What drug gets rid of side effects of haloperidol?
procyclidine
Definitive management of endometriosis
Hysterectomy with bilateral salpingo.
Patient comes in she has urethretis, iritis, and joint pain. What investigation will you do?
ESR, CRP HLA-B27 “can’t pee, can’t see. can’t climb a tree - Reiter’s syndrome”
Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?
Post lumbar puncture headache (common in females with low BMI)
Vascular patient intermittent claudication. No pain at rest. Pulses are not palpable on right hand side but present on Doppler. How would you best manage this patient?
Risk modification (e.g. diabetes, obesity, smoking, hypertension) + Statin + Clopidogrel
Patient comes in 2 months old Turkish parents. Jaundiced and anaemic. Diagnosis? Blood film?
G6PD deficiency Heinz body
Patient comes in been treated. Got necrotising fasciitis. Next line of treatment?
Urgent surgical debridement 2) IV antibiotics (normally MRSA therefore give Vanc).
A woman is on epidural. What is her/her baby most at risk of?
Severe hypotension, leakage of spinal fluid (mom) severe respiratory depression & bradycardia (fetus)
Baby has vomiting then diarrhoea? What is the likely organism?
Rotavirus (non bloody diarrhoea) Oral immunisation at 2 and 3 months
Pericarditis ECG changes?
ECG changes: • Widespread ST elevation (saddle shapes) • PR depression (most sensitive marker!)
Patient comes in had a TIA. Blind in the eye temporarily. Doppler show one artery stenosed 40% and one 80%? What is the treatment?
Carotid endarterectomy
Treatment of cervical cancer with lymph node involvement?
Chemotherapy + Radiotherapy
Patient diagnosed and has mild cervical Dyskariosis. Next investigation?
HPV status If positive - Colposcopy
Boy leaning forward, taking deep breaths epiglottitis? Next line of treatment.
Oxygen and abx (ceftriaxone and ampicillin)
New born. Doctor says more likely to get UTI. Patient asks what symptoms to look out for if he gets UTI?
Irritability, fever, foul smelling urine, poor feeding
Patient has long term catheter. Patient does not want catheter anymore. What would you do?
Trial without catheter
Patient comes in intermenstrual bleeding. Smear is fine done two years ago. Speculum is normal. Next investigation?
Endocervical swab
Patient has come in. One vocal cord isn’t moving properly. What is the next investigation?
Layngoscopy
Patient has retinal detachment. What feature in history predisposes him the most?
Increasing age, previous retinal detachment, family history of retinal detachment, myopia, diabetes, vitreous haemorrhage, previous eye surgery (e.g. cataract).
Has an afferent pupillary defect. What nerve is it? Differential?
Optic
Young patient pain in hands. Stiff in the morning. What is the diagnosis? Management?
Juvenile Idiopathic arthritis MDT + lifestyle NSAIDs Long term - methotrexate and folic acid
Patient comes in been to GP several times complaining of hand pain, tummy aches, urinary problems etc. Diagnosis?
Somatisation disorder (multiple physical symptoms present for at least 2 years, patients refuses to accept reassurance or negative tests)
Dermoid cyst - Cell type?
aka mature cystic teratoma germ cell Epithelioid cell
Main advantage of breast milk over formula?
Reduces risk of sudden infant death syndrome, reduces infections, reduced DM1, reduced asthma, eczema
Patient doesn’t respond to anything apart from opening eyes a tiny bit and moves them. What is the diagnosis?
Locked in syndrome/ Pseudocoma/ brain stem infarct
In GUM clinic which infections can you test for and get results the same day?
HIV Chylamidia Gonorrhea
Hyperkalaemia. Tented T waves. First line treatment?
- 10% Calcium gluconate (and repeat until ECG normal) 2. Dextrose/insulin infusion (and repeat until normokalaemia) 3. Consider sodium bicarb if acidosis 4. Consider nebulised salbutamol
30 year old Abdominal distension, diarrhoea, vomiting. Doctor gives a list of differentials including appendicitis, crohns, mesenteric adenitis etc. What is the next line of investigations?
CT abdo pelvis
Upper motor neurone lesions symptoms
Weakness, spasticity, clonus, and hyperreflexia
Pt has a ‘nettle rash’ episodes lasting for 6h for the last 12 months. Most likely pathogenesis?
Allergy
Common diazepam side effect?
Allertness decreased Anxiety Confusion Depression Dizzy Drowsy GI disorder Resp depression
Pain at site, malaise and fatigue, local swelling, low grade fever with reduced range of movement and tenderness Diagnosis? Management?
Osteomyelitis Flucloxacillin (6 weeks)
Haemorrhagic stroke management
Beta blocker (Labetalol) DVT prophylaxis - heparin
Ischemic stroke management
Alteplase - only is before 4.5 hrs Aspirin Endovascualr intervention SALT assessment
A woman who smokes 10/d has started getting regular painful contractions at 31weeks and a bloody vaginal discharge.
Placental rupture
Placental abruption risk factors
Chronic HTN Pre-eclampsia Smoking Cocaine Trauma Choreamnionitis
Management of Pelvic Inflammatory disease (PID)
Ceftriaxone + doxycycline
Chronic demyelinating neuropathy
Progressive weakness and impaired sensory function in the legs and arms. Caused by damage to the myelin sheath of the peripheral nerves. CIDP is more common in young adults, and in men Tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. Diabetes HIV SLE
Chronic demyelinating neuropathy
Progressive weakness and impaired sensory function in the legs and arms. Caused by damage to the myelin sheath of the peripheral nerves. CIDP is more common in young adults, and in men Tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. Diabetes HIV SLE
Causes of early decelerations
Increased foetal intracranial pressure During labour Reduced amniotic volume Umbilical cord compression
A child presents with severe anaemia, pale, poor growth - recently stopped having breastmilk. What is the cause for the anaemia?
Beta thalassemia trait
2/5 palpable occipital posterior – which forceps to use?
Kielland forceps
The most common cause of LV dysfunction
IHD
Child abuse - investigations?
FBCs Clotting Dilated fundoscopy Photodocumentation Skeletal survey CT brain LFTs and amylase Serum calcium, phophate, ALP Parathyroid 25-hydroxy D3
Breast cancer, liver lung and 70% bone cortex in tibia mets – treatment? Post menopausal - HER2 -ve? Post-menopausal - HER2 +ve? Pre-menopausal - HER2 +ve?
a.If post-menopausal (HER2 –ve) – anatrozole+ palbociclib + bisphos+ calcium and vit d b.If post-menopausal (HER2 +ve) – pertuzumab+ trastuzumab+ docetaxel + bisphosphonates+ calcium and vit d c.If pre-menopausal – tamoxifen (and mab if HER2 +ve) ; then ovarian ablation ++bisphosphonates+ calcium and vit d
Pain in the abdomen- the pain is located either in the centre of the abdomen, or in the lower right-hand side of the abdomen (known as the ‘right iliac fossa’ area) - Fever (high temperature) >38.5 - Feeling generally unwell - Nausea and/or diarrhoea - Sore throat/ symptoms of a cold
Mesenteric adenitis
Commonest cause of preterm labour?
hx of premature labour hx cervical trauma hx of induced abortion maternal infections multiple pregnancies
Causes of infertility?
age >35 hx of STD BMI extremes smoking
Patient comes in with periorbital pain, loss of visual acuity with scotoma (blind spot), loss of color vision, and rapid afferent pupillary defect. Normal optic disc on examination. Diagnosis?
Retrobulbar neuritis
TIA prevention?
lifestyle modification statins BP control carotid endarterectomy or stenting clopidogrel
Hepatitis B treatment for positive surface antigen, + anti-HBc, + IgM, -antiHB, - anti HBe, +HBeAg
acute infection supportive care
Patient with +ve HbsAg , +ve anti-HBc, -ve IgM anti HBc, -ve anti HBs. Management?
chronic infection entecavir or peginterferon
Good prognosis MI medication (low ejection)
ACEi/ARBs B-blocker Hydralazine Spironolactone Vasodilators and Nitrates
Wernicke’s- Guy had confusion, nystagmus and ataxia
pabrinex
Minimal change disease - Presentation? Kidney biopsy?
More common in children Nephrotic syndrome - normotension, proteinuria Serum albumin loss Fusion of podocytes
Minimal change disease management?
Steroids - Prednisolone Fluid restriction and low salt diet (Steroid resistant - cyclophosphamide)
Uteric calculus, currently has infection. WCC raised. Treatment?
Hydration and pain killers Nephrostomy (>0.5 cm) Gent IV
Bilirubin in a neonate is high, baby has gone home, mom phones GP and mentions the baby was jaundiced at aged 14 hours. Management?
phototherapy (exchange transfusion only in encephalopathy or hypotonia or bilirubin >95%)
ABPI doppler criteria for critical limb ischemia
• >0.9 = normal • 0.4 – 0.9 = intermittent claudication • < 0.4 = critical limb and pain at rest
CHADsVASC2 - criteria
• CHF • Hypertension • Age > 75 (2) • Diabetes • Stroke (2) • Vascular – ischaemic heart disease and peripheral arterial disease • Age 65 -74 • Sex - female (If male then consider at 1, and if 2 offer anticoag - stop aspirin)
Women couldn’t dorsiflex - nerve damage
Common peroneal nerve
Thyroxine, long-term DM, control recently deteriorated thyroxine effects on diabetes.
Increase glucose in thyroxine
Infections with Argyll-Robertson?
Occurs in neurosyphilis and diabetes
Pt in alcohol outreach team has a convulsion what treatment do you give him?
Treat DT with Diazepam
Old ladies husband has passed away what features tell us that she is suffering from depression as opposed to normal grief: diurnal mood variation, agitation, auditory hallucinations of her dead husband
Diurnal mood variation
What is a somatic feature of depression?
headaches, backaches, general muscle pain and digestive pain like stomach pain, dizziness, dyspnea [Take, for example, a red and tender joint. The joint is objectively red. It’s a sign everyone can objectively measure or assess. But the pain (the symptom) is only something you can experience and put into context, and is therefore subjective.]
Drugs that cause depression
Vigabtrin, topiramte, primidone, phenobarbital, lacosamide, gabapentin
The patient comes in with manic episode what treatment should you give him?
Olanzapine Lithium Sodium valproate
Lady comes in who use to be heavy alcoholic has ‘echogenic liver’ what test do you do to confirm the diagnosis?
Biopsy liver - to identify why its dense
Patient who is 70, hx of MI, with AF -Initial management?
Beta-blockers (Propanolol) or CCB
Patient who is 50 with AF and CHF - Initial management?
Sotalol Amiodarone Flecainide
What is the definition of critical limb ischemia?
Critical limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that describes patients with chronic ischaemic rest pain, or patients with ischaemic skin lesions, either ulcers or gangrene
What is the common cause for dilated left ventricle in old ladies?
HTN
Pt after stoke suffers from double vision, he is very upset by this what do tell him to do?
Optometrists
What change occurs in proliferative diabetic retinopathy and not in nonproliferative?
New vessel formation
Builder comes in with tingling of hands whats differential, previous hx of neck trauma?
Cervical radiculopathy
Pt has food poisoning and develops loss of sensation in legs. Whats diagnosis?
Guilian barre secondary to campylobacter
2yr Baby boy with bloody stools?
Shigella (<5 + bloody)
Heart condition baby goes blue when feeds? What is likely diagnosis
Transposition of great arteries Tetralogy of Fallot
When hip is posteriorly dislocated- described as?
ANS = shortened, flexed, internally rotated, ADDucted
Guy has posterior triangle irregular lumps, and some other symptoms of cancer – where is his cancer?
Nasopharynx Other things that can be caused: -temporal bone -ear -skull base
Not passing meconium, put finger in and stool is expelled
Hirschprungs
Women comes in with incontinence that happens only when she laughs or coughs. What does she have?
stress incontinence
Bacterial vaginosis
metronidazole twice a day for 5 to 7 days.
Women comes in with incontinecne which occurs when she is laughing and also has urgency.
Mixed incontinence
Old man comes in because he has been leaking urine and feeling of incomplete emptiness.
Overflow incontinence
How does oxybutinin work?
used to treat incontinence 1st line by decreasing muscle spasms. (anti-cholinergic) But avoid in frail older women
- PV bleed, LMP 6 weeks ago, BHCG high, US shows no sac – Dx?
pregnancy of unknown location
5 year old girl wants pill, she threatens she is about to start shagging, what to do?
Give her the damn pill and do not tell her parents or social services cuz Gillick competent and Fraser guidelines
When do you refer depressed woman?
Agitation
Stroke patient has face and arm UM weakness, sensory loss and Broca’s aphasia where is the stroke?
MCA
UPM hemiparesis and apahsia where is the lesion?
MCA
Patient comes in with UMN weakness, behavioural abnormalities, where is the lesion?
ACA
left Hemineglect and behavioural abnormalities where is the lesion?
ACA
Homonymous hemianopia and hemisensory loss in both upper and lower limbs where is the lesion?
PCA
Patient who hit his head lost consciousness and then had consciousness right away and was normal. Now presents with headache and confusion. What is it?
Extradural haemorrhage
Old lady has confusion and fluctuating consciousness. Her son says that she bumped her head a few weeks ago. What is it?
subdural haemorrhage
70 year old man comes in with chronic back pain, leg and thighs. Dull pain that feels cramping. Also has numbness and tingling with claudication.
Lumbar spinal stenosis
Rx for lumbar spinal stenosis?
Drugs: NSAIDs, PGE1, gabapentin and vit B1. Physio may have epidrual steroid injections Surgical: traditional laminectomy, bilateral laminotomies
What is the next line ix for BPH?
USS CT abdo/pelvis
DDx for fresh, red rectal blood
anal fissures, haemorrhoids, cancers and polyps of the rectum and colon diverticulosis
CTPA vs d-dimer
Bait PE: CTPA unsure: d-dimer
man presents with pain in epigastrium. blood pressure is 200/100, what is it?
Hypertensive crises because bp is >180/110 Rx is labetalol
Sudden loss of vision ddx
Stroke TIA acute glaucoma retinal detachment anterior uveitis retinal occulsion
Features of innocent murmurs
Seven S: -sensitive (changing position) -short duration (jot holosystolic) -single -small (non-radiating) -soft -sweet -systolic
Pregnant first trimester UTI rx?
Nitrofuratoin
Pregnant 2nd or 3rd trimester UTI rx?
trimethoprim-sulfamethoxazole
Rx for abscence seizures?
clonazepam ethosuximide
tonic clonic/ partial seizure rx?
carbamezapine lamotrigine
myoclonic seizures rx?
clonazepam lamotrigine
Drugs that cause restrictive lung disease?
amiodarone methotrexate nitrofuratoin
Diabetic what is the BEST investigation for eyes
digital retinal imaging (put tropicamide first to dilate)
Same day STI test?
trichomonas
Prolonged (>3 wks) hoarse voice guy who is alcoholic, fat, and ugly. What is first line ix?
CT neck and chest
DDx sudden onset RAPD?
optic neuritis severe glaucoma retinal detachment severe macular degeneration
What is the bitchy snaky name for GBS?
acute inflammatory demyelinating polyradiculoneuropathy
patient long time immunosuppression, post-transplant. What dermatological condition is in the highest risk?
SCC
What is the most common cancer is HIV patients
Kaposi sarcoma and lymphoma
What is the management of endometrial cancer?
Complete treatment: total hysterectomy+ salphingoophorectomy+ node dissection
Types of ovarian tumours?
high serous carcinoma clear cell endometrioid low grade serous mucinous teratoma fibroma
At what gestation stage does the sucking reflex manifest?
32 weeks Therefore premature babies <31 wks old need ng tube
Cancers that cause osteoporosis
multiple myeloma breast cancer prostate cancer lung cancer
Boy comes in. Upper respiratory tract infection followed by red scaling plaques (salmon scaly plaques on back)
guttate psoriasis
Acute glaucoma managment?
urgent refer+ acetazolamide + pilocarpine
Most common viral meningitis in children cause?
herpes
Milestones of 6 wks?
– can smile (refer if cannot smile at 10 weeks)
Milestones of 3 months
3 months – good head control (e.g. no head lag, able to lie with head up, can be held sitting), laughs, reaches for objects
Milestones of 6mths
6 months – palmar grasp, can pass objects from one hand to another, coos
Milestones of 7 months
can sit without support (Refer if cannot sit at 12 months)
Milestones of 9 mths
– pulls to standing, crawls, shy but plays peek a boo, takes everything to the mouth (pincer), babble (inc mama, dada(
Milestones of 12 mths
12 months – cruises, walks with one hand held (refer if cannot walk at 18 months), good pincer, bangs toys, knows 2 to 6 words (refer at 18 months)
Milestones of 18 mths
plays alone (3 bricks)
Milestones of 2 yrs
plays near others (not with them) (6 bricks), 2 word sentence, 200 words
Milestones of 3 yrs
can ride a tricycle (9 bricks), 3 word sentence, count to 10
Milestones of 4 yrs
can hop on one leg, plays with other children, asks W questions
Rx for acute anxiety/ panic?
reassurance and benzo
Nicotine replacement that is most effective and reduces cravings?
varenicline
IgA nephropathy and post strep - a difference in urine dip
IgA has 2+ blood while post strep has 3/4+ IgA has 3+/4+ protein while post strep has 2+
Well’s score - used for PE?
Previous PE or DVT (1.5) Clin features of DVT (3) HR > 100 (1.5) Immobilisation for 3 days or surgery in last 4 weeks (1.5) Haemoptysis (1) Cancer (1) PE more likely than any other test (3)
not passing meconium, put finger in and stool is expelled
Hirschprungs
Baby born 36 weeks, good apgars - what is it?
Respiratory distress
Bacterial vaginosis
Metronidazole
Goserelin - mechanism of action? side effects?
GnRH agonist - Synthetic hormone. In men, it stops the production of the hormone testosterone, which may stimulate the growth of cancer cells. In women, goserelin decreases the production of the hormone estradiol (which may stimulate the growth of cancer cells) to levels similar to a postmenopausal state. Alopecia; arthralgia; bone pain; breast; depression; gynocomastia; headache; hot flushes
Management of pelvic inflammatory disease
Oral Ofloxacin AND metronidazole OR IM ceftriaxone + oral doxy + oral metronidazole
Paracetamol OD - liver transplant criteria?
pH < 7.3 or INR > 6.5 AND creatinine > 300 AND encephalopathy III or IV
Non Paracetamol OD - liver transplant criteria?
INR >6.5 (PT >100 seconds), or any 3 of the following: age <10 or >40 years; aetiology non-A, non-B hepatitis, or idiosyncratic drug reaction; duration of jaundice before hepatic encephalopathy >7 days; INR >3.5 (PT >50 seconds); serum bilirubin >300 micromol/L (>17.6 mg/dL)
Patient who has had a stroke -Is thrombocytopenic and has haematoma Management?
Give FFP/prothrombin complex AND cryoprecipitate Platelet transfusion
Taking anti epileptics, taking antidepressants has tremor. Reduced facial movements. What drug is causing side effect?
Carbamazepine Gabapentin Pregabalin Levoterazatam
Sudden onset headache and third nerve palsy - Differentials?
Mid brain strokes Cavernous sinus thrombosis Posterior communicating artery aneurysm SAH - due to uncal herniation
Focal neurological seizure followed by secondary generalisation lasted for 20 seconds - Next step?
Refer to neurologist
Other name for guillan barre syndrome?
Acute inflammation demyelinating polyradiculoneuropathy
Better prognosis for SZ
female acute onset of symptoms older age of first episode positive> negative symptoms presence of new symptoms good pre-illness function
Worse prognosis for SZ
Early onset FHX structural brain abnormalities
Side effects of diazepam?
drowsiness tiredness or fatigue muscle weakness inability to control muscle movements (ataxia) headache tremor dizziness dry mouth or excessive saliva nausea constipation
Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?
BPPV
FSH high, LH high, Prolactin normal, TSH high, Testosterone normal.
Premature ovarian failure
Baby has vomiting than diarrhoea? What is the likely organism?
Rotavirus Campylobacter Salmonella Shigella E coli Ebola - Guinea, Liberia, Sierra-leone
New born gets UTI - symptoms?
•fever •vomiting •lethargy or irritability •poor feeding or failure to thrive •jaundice •septicaemia or shock •offensive smelling urine •febrile convulsions
Child age 1-5 UTI - symptoms?
•dysuria and frequency •abdominal pain and loin tenderness fever +/- rigors •lethargy and anorexia •vomiting, diarrhoea •haematuria •offensive or cloudy urine •febrile convulsions
Child age >5 UTI - symptoms?
have symptoms that are classically described in the adult: •LUTI → dysuria, frequency, supra-pubic pain. Fever may be mild •UUTI → fever, loin pain
Risk factor of downs syndrome
Advanced maternal age Previous child with DS Parental karyotype
Main advantage of breast milk over formula
Reduces risk of sudden infant death syndrome
baby was feeding well for the first 6 hrs of life and then deteriorated - diagnosis?
Cyanotic heart disease
What further test do you need to do to make sure LP is safe?
•Cardiorespiratory instability •Focal neurological signs •Signs of raised ICP → coma, Cushing’s response (high BP and bradycardia due to compression of the brainstem) •Coaguloapthy •Thrombocytopenia •Local infection at the site of LP •Performing and LP would delay antibiotic therapy
Sickle cell kid with temp of 39 - management?
Ceftriaxone (Vancomycin if meningitis)
Man had nose bleed and INR of 4.5 and metallic heart valve what do you do?
Give vitamin K
Red painful eye with decreased visual acuity - what to do next?
Pupillary light reflex - Glaucoma (acute)
Guy had surgery, complaining of decreased visual acuity, double vision and nystagmus in left eye. - next line?
Patch
SLE - pathophys
Cell apoptosis
St elevation in leads 1 to 4. After troponin what would you do next?
PCI or thrombolysis
Chronic heart failure - management?
ACEi B blocker
Guy had AKI after surgery do you assess his fluid balance or saline over 1 hr or calcium gluconate?
Assess fluid balance
What is it called when the eye looks in?
Esotropia
Interpret this CTG
Late decelerations
Interpret the CTG
Early decelerations
Interpret this ECG
Inferolateral STEMI
Interpret this ECG
Pericarditis
Identify this ECG
1st degree Heart block
Identify this ECG
Type 2 Heart Block
Mobitz I
Identify this ECG
Type 2 Heart Block
Mobitz II
Identify this ECG
Complete heart block
Identify this ECG
Slow AF
Identify this ECG
Atrial fibrillation
Identify this ECG
Pulmonary Embolism
Identify this ECG
Ventricular Tachycardia
Identify this ECG
Torsades
Identify this ECG
AVNRT
Identify this ECG
Ventricular fibrillation
Identify this ECG
hyperkalaemia
Identify this ECG
Atrial flutter
Identify this ECG
Unstable angina
Identify this ECG
Atrial fibrillation
These white rashes found in newborn on the sole of hands and feet. What is this?
Congenital syphilis (rare in UK now)
Newborn with hydropcephalus, intracranial calcification, acute fundal chorioretinitis as shown below. What is this?
Congenital toxoplasmosis
A 35-year-old female patient presents to you in the cardiology department with a sharp, stabbing chest pain behind the breastbone. The pain does not radiate to any other region of the body and on questioning she refutes feeling sweaty and has not experienced any nausea and vomiting. She explains the pain is worse at night when she is lying flat in bed and improves somewhat once she sits up. She discloses that she has been diagnosed with systemic lupus and is taking regular medication for this. On auscultation you note scratchy, rubbing sounds loudest during systole.
Pericarditis
- widespread saddle shaped ST elevation
- PR depression: most specific ECG marker
*note that SLE or any rhematic disease is a risk of getting pericarditis
what is this?
Inferolateral STEMI
ST elevation in leads II, III and aVF
Progressive development of Q waves in II, III and aVF
Reciprocal ST depression in aVL (± lead I)
What is it?
Mongolian Blue spot
A 4-year-old boy develops multiple tear-drop papules on his trunk and limbs. He is otherwise well.
Hx of streptococcal infection 3 wks ago.
Guttate psoriasis
-Most cases resolve spontaneoulsy within 2-3mths
A middle aged man develops a non-pruritic rash after starting allopurinol therapy for gout. The rash develop within 24 hours and started on the back of his hands.
Erythema multiforme
- target lesions that starts in the back of hands and feet then spread to torso
- upper limbs affected more commonly
A 30-year-old man presents with a two-week history of a productive cough. Whilst examining him you notice a large number of atypical naevi over his torso. On his back you count between 20-25 moles. He reports no change in any of his moles, no bleeding and no itch. One particular mole is noted due to the irregular border. It is 6 * 4 mm in size.
Superficial melanoma
- mostly affects arms, legs, back and chest
- more in young people
*Remember changes in size, shape and color
What is this?
Squamous cell carcinoma
-characterised: raised, keratotic (scaly, crusty), ill-defined nodule, may be ulcerated
What is it?
Basal Cell carcinoma
- nodular is most common
- characterised: skin-colored, surface telangiectasia, pearly rolled edge, ulcerated center
What is it?
Actinic keratosis
*premalignant lesion–> SCC
-characterised:
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
What is it?
Bowen’s disease
*intradermal SCC
-characterised:
red, scaly patches
often occur on sun-exposed areas such as the lower limbs
-more common in older females
What is it?
Erythema nodosum
- seen in IBD (crohn’s, UC)
- characterised:
inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring
Patient comes in with persistent ulceration of the mouth, pain and sore throat.
O/E: neck lymphadenopathy and inside mouth (pic below)
Oropharyngeal cancer
What is it?
Systemic sclerosis
-Characterised: sclerodactyly, skin thickening, raynaud’s phenomenon, swelling of hands and feet
What is it?
Lentigo melanoma
what is it?
Acanthosis nigricans
what is it?
cause?
Red man syndrome
Vancomycin
What is it?
Subungal melanoma
Diagnosis?
Central Retinal Vein Occlusion
Diagnosis?
Central retinal artery occlusion
Diagnosis?
Papilloedema
Diagnosis?
Diabetes retinopathy
What is it?
Hypermetropia
Eye turn upwards
What is it?
Exotropia
Eye turns outward
What is it?
Anterior uveitis
What is it?
Diabetic non proliferative retinopathy
Diagnosis?
Signs?
Respiratory distress syndrome - ground glass
Diagnosis?
GI perforation
What is it?
Gottrons papules
Diagnosis?
Lupus pernio
CD4+ AIDS infections
:)
Identify bleed?
Vessel Affected?
MCA
Ischemic stroke
Identify bleed?
Vessels affected?
Subdural haematoma
Bridging veins
Identify type of bleed?
Vessel?
Extradural/Epidural haematoma
Middle meningeal artery
Identify the type of bleed?
Subarachnoid haemorrhage
Identify the type of bleed?
Intracerebral haemorrhage
Bilirubin graph for newborn
:)
Staging for colorectal cancer
Dukes criteria
