YSKT compile SH Flashcards
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)
Alcoholic patient with solid mass on liver imaging - 4cm, vascular?
Hepatocellular carcinoma
Guy who leans on the table gets ulnar neuropathy, where is lesion?
Cubital canal
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 management for relapsing-remitting MS?
beta interferon (glatiramer, teriflunomide)
55 year old new onset gastritis - treatment?
Test for H Pylori
Lady had a loss of sensation up to umbilicus and bad cough and significant pack years
Chest xray and thoraco-lumbar MRI
Pregnant women with Mania and presenting to A&E?
Olanzapine IM Stop depression
tonic clonic/ partial seizure rx?
carbamezapine lamotrigine
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
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
Which drug would you give old man who was not sleeping + depressive symptoms?
Mirtazapine
Simple humeral fracture presented 5 days after fracture, what next?
immobilisation collar and cuff
Risk factor of downs syndrome
Advanced maternal age Previous child with DS Parental karyotype
What symptom most likely to be found in meningococcal septicaemia?
Non-blanching rash
Small Bowel obstruction treatment.
Drip and suck - nasogastric decompression plus fluid resus
Management of Cervical spine fracture with pain?
NSAID and Follow Up can add temporary opioid
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)
Patient has fit, seen to have jerking movements, loses continence and bites tongue - what is it?
Generalised tonic clonic seizure
Parathyroid blood results: Raised calcium Very raised PTH decreased or normal phosphate Normal/low Vit D High ALP
Tertiary hyperparathyroidism
Patient with +ve HbsAg , +ve anti-HBc, -ve IgM anti HBc, -ve anti HBs. Management?
chronic infection entecavir or peginterferon
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
Osteopenia vs Osteoporosis
Male vs female Age (Younger = penia)
Section 35
remand for hospital for assessment
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.
Presentation of posterior humeral fracture
Wrist extension (wrist drop) Radial nerve fracture Loss of sensation in dorsal aspect of 1st+2nd
Paeds pneumonia - management?
Penicillin V or amoxycillin (In pneumonia associated with influenza, co-amoxiclav is recommended)
Acne treatment causing blue patch?
Minocycline
Cause of urticaria due to autoimmunity
Complement Phagocytes Immune deficiency (HIV)
Sinusitis management?
Abx - Amoxicillin Steroids nasal spray (budesonide) Decongestant spray (oxymetazoline)
What are Cluster C PD?
avoidant, OCD, dependent
33 year old comes for random test - has +ve RF, +ve anti-CCP, but no sx
RA
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*
Causes of early decelerations
Increased foetal intracranial pressure During labour Reduced amniotic volume Umbilical cord compression
What is the common cause for dilated left ventricle in old ladies?
HTN
Treatment of cervical cancer with lymph node involvement?
Chemotherapy + Radiotherapy
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)
Patient presents 35 weeks pregnant - bp 140/90 Diagnosis? Management?
Gestational hypertension B-blockers - labetalol
How to diagnose Hirschsprung’s? First line?
Rectal biopsy Plain abdo XR Contrast enema
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
Management of schizophrenia
Atypical antipsychotics (Respiradone, olanzapine, quetiapine, apriprazole)
11yr-old girl with 3mths hx of bloody diarrhoea, urgency to defacate, tenesmus?
UC
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”
CT show calcification in alcoholic patient?
Chronic pancreatitis
Bacterial vaginosis
Metronidazole
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
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
Wernicke’s- Guy had confusion, nystagmus and ataxia
pabrinex
Parathyroid blood results: High/normal calcium Normal/low PTH High phosphate Normal Vit D High ALP
Familial hypocalciuric hypercalcemia
Rheumatoid arthritis lung changes
Both restrictive and obstructive (fibrosis)
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
Down syndrome with failure to thrive
Coeliac disease
Urinary retention and pain in back of legs where was the lesion?
S234
ADHD - what would aid in the diagnosis?
Report from the teacher
Child presents with bruising, high lymphocytes
ALL
Bilateral glue ear, hearing loss, speech deficit?
Grommet
Dialysis patient 3day/week complains of tingling sensation, low power reflex, had diarrhea 2 weeks ago, which condition needs to be exclude?
Guillain Barre
XRay of rheumatoid
Early x-ray findings ● loss of joint space ● juxta-articular osteoporosis ● soft-tissue swelling Late x-ray findings ● Periarticular erosions ● Subluxation
Primary ovarian failure presentation
Low progesterone High LH
Epistaxis Telangiectasis Visceral lesions FHx (first degree)
3 or more - hereditary haemorrhagic telangiectasia
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)
Imaging ACL tear
MRI
Prostate symmetrically enlarged smooth on exam, raised PSA (1.0 over normal range), what do u do next?
Repeat PSA in 6 months
Test before starting azathioprine?
Thiopurine methyltransferase (TPMT)
What antibiotics do u give in pyelonephritis
Co amox +- IV gent
Trichomonas vaginalis treatment?
Metronidazole
Diet of patient with diabetic nephropathy already on ace-I, hypertensive
low salt diet
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)
Pt with right sided stroke with legs>arms and vision loss. What blood supply is affected?
ACA
Long term MI management?
Aspirin, B blockers (bisoprolol, metoprolol), Statin (atorvastatin)
The patient comes in with manic episode what treatment should you give him?
Olanzapine Lithium Sodium valproate
2 week of haematuria post URTI
Post Strep Glomerulonephritis
Patient with constant worries going out. Diagnosis?
Agorophobia
Patient with weight loss and UC. Primary sclerosing cholangitis or cholangiocarcinoma?
Primary sclerosing cholangitis
35 yr-old female with eye pain and vision problems, numbness and pain on limbs, headache and coordination problems?
Multiple Sclerosis
Pericarditis ECG changes?
ECG changes: • Widespread ST elevation (saddle shapes) • PR depression (most sensitive marker!)
Bulimia vs AN?
Bulimia= normal BMI -more impulsive than AN -weight fluctuation -parotid hypertrophy (sialadenosis)
Hypokalaemia, hypernatremia, headache, muscle weakness
Conns (primary hyperaldosteronism)
Baby with asymmetrical gluteal creases, what investigation do you do?
Ultrasound Developmental dysplasia of the hip
Pelvic X ray of osteoarthritis acetabulum, what do you do?
Total hip replacements
What is the acute management of mild/moderate asthma?
nebulise salbutamol
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)
MS patient on low dose baclofen, not experiencing side effects. How would you treat her pain?
Increase baclofen
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
Causes of Akathesia
SSRIs, CCBs, anti-emetics (metoclopramide), anti-vertigo
Management of pelvic inflammatory disease
Oral Ofloxacin AND metronidazole OR IM ceftriaxone + oral doxy + oral metronidazole
What is the management of aspiration pneumonia in post stroke + swallowing problem patient?
SALT referral Metronidazole
Glaucoma - lady used to wear glasses, had vomitted. Definitive test?
Gonioscopy (slit lamp examination)
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
At what gestation stage does the sucking reflex manifest?
32 weeks Therefore premature babies <31 wks old need ng tube
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
Side effects of respiridone
Depression Anaemia Anxiety Abnormal appetite Chest discomfort/Cough Conjunctivitis
What are Cluster B PD?
antisocial, borderline, histrionic, narcissistic
Diabetic brought into hospital hypernatremic, what will be given to him next?
NaCl Insulin IV (Glucose if low)
Causes of menorrhagia
PID Dysfunctional uterine bleeding Fibroids Anovulatory cycles Hypothyroid IUD
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
What are the causes of anterior shoulder dislocation?
falling in outstretched arm
What are the symptoms of paranoid PD?
SUSPECT Sensitive Unforgiving Suspicious Possessive and jealous Excessive self-importance Conspiracy theories Tenacious sense of rights
Baby has vomiting than diarrhoea? What is the likely organism?
Rotavirus Campylobacter Salmonella Shigella E coli Ebola - Guinea, Liberia, Sierra-leone
6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing no fetus, intrauterine mass with small cystic spaces (honeycomb)?
Hyaditiform mole (complete)
Cystocele first line management
Bladder training, Kegel exercises
Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?
BPPV
Most common cause pyelonephritis
E.Coli
Child with purpuric rash + splenomegaly
ALL
ABPI doppler criteria for critical limb ischemia
• >0.9 = normal • 0.4 – 0.9 = intermittent claudication • < 0.4 = critical limb and pain at rest
Milestones of 3 yrs
can ride a tricycle (9 bricks), 3 word sentence, count to 10
Lady trying to conceive with low progesterone, oligomenorrhoea, normal fsh and LH, normal TSH. What is the cause?
Premature menopause
Treat oligomenorrhoea in patient with BMI 30 with PCOS who desires fertility after advising weight loss?
Metformin
Hospital acquired pneumonia: Most common causes - Gram stain?
Pseudomonas aeruginosa primarily … gram -ve bacilli Staph aureus … gram +ve cocci also common cause of HAP
HELLP?
Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) . It’s a serious but rare pregnancy complication.
60 year old Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal - Management?
Temporal arteritis
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
Management of Cervical spine fracture, developed neurological symptoms?
immobilise + analgesia and immediate neurosurgical referral + IV methlyprednisolone
Presentation of intussusception
Vomiting, colicky abdo px, male, 6-12mths, lethargy, red-currant jelly stool
What is the management of endometrial cancer?
Complete treatment: total hysterectomy+ salphingoophorectomy+ node dissection
What to do before inducing labor
Cervical sweep
Patient who is 70, hx of MI, with AF -Initial management?
Beta-blockers (Propanolol) or CCB
Pregnant 2nd or 3rd trimester UTI rx?
trimethoprim-sulfamethoxazole
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
COPD, on salbutamol and ipratropium. FEV1 was 40%. What do start?
LABA + ICS combination inhaler (Seretide - salmeterol + fluticasone
Placenta praevia (placenta is low) - when do you do elective C section?
37-38 weeks
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
Lady is mad depressed, feels dead inside, her organs are rotting. What do you give?
Cotard syndrome fluoxetine + olanzapine
ABO incompatibility jaundice test?
Coombs test
55 year old new onset gastritis
1) Refer to urgent endoscopy
Child with red rash on Flexor aspects of elbows and on wrist
Atopic eczema
USS shows echogenicity (more dense) and hepatomegaly, ALT>AST
NAFLD
Prolonged (>3 wks) hoarse voice guy who is alcoholic, fat, and ugly. What is first line ix?
CT neck and chest
Rx for acute anxiety/ panic?
reassurance and benzo
Patient with migraines, experiencing them 2x a week, stressed with new job - what would you start?
Acute: triptan + NSAID/paracetamol Prophylaxis: propanolol
33 year old comes for random test - has +ve RF but no sx?
Doesn’t have RA
How to diagnose Hirschsprung’s? First line? Screening tool?
Rectal biopsy Plain abdo XR Contrast enema (most valuable)
HPV - high risk types and low risk types?
16&18 - high risk 6&11 - low risk
What is the most common injury with anterior dislocation of shoulder?
Axillary nerve and artery 95% Presentation in examination: humeral head visible, flattened deltoid
Same day STI test?
trichomonas
St elevation in leads 1 to 4. After troponin what would you do next?
PCI or thrombolysis
Pt with PET and has HELLP. 39 weeks pregnant, what is the best step in Rx?
Delivery + IV Dexamethasone MgSO4 If hypertensive: IV Labetolol
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
Baby born 36 weeks, good apgars - what is it?
Respiratory distress
Paeds severe life threatening asthma, silent chest sats 88%?
O2 + admission + nebulised SABA (salbutamol) and anticholinergic (ipaproprium) + prednisolone
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
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
Respiratory Distress Syndrome. After giving surfactant. Next treatment?
Another surfactant dose
Crohn’s - Drugs used to maintain remission?
- Azathioprine (1st line) - Methotrexate (2nd line)
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
Patient is delirious with diagnosis 80. Squamous cell lung cancer with liver mets diagnosed?
Hepatic encephalopathy
Child presents with bruising, high lymphocytes Reddish purple dots on the ankles and feet (petechia)
Immune Thrombocytic Purpura
Pain at site, malaise and fatigue, local swelling, low grade fever with reduced range of movement and tenderness Diagnosis? Management?
Osteomyelitis Flucloxacillin (6 weeks)
Pt started on clozapine and is told to come back on a weekly basis for Ix. Why?
Agranulocytosis
HBeAg - what does it mean?
This means the person infected with Hepatitis B can likely transmit the virus on to another person
ENT what is associated with polyps & post nasal drip
asthma & aspirin allergy
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
Man couldn’t close eye, facial and unilateral hearing loss - Investigation?
MRI Cerebellopontine angle
11yr-old girl with 3mths hx of recurrent diarrhoea, abdo pain, delayed puberty, and malnutrition?
Crohn’s
Parkinsons off symptom management
Levodopa + Entacapone
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)
Type of miscarriage? minimal pain; bleeding < bleeding equivalent to menstruation; cervix closed; uterine size = dates; ultrasound = Fetal Heart visualised
Threatened miscarriage
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
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
Types of ovarian tumours?
high serous carcinoma clear cell endometrioid low grade serous mucinous teratoma fibroma
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.
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
Surveillance for 4.8cm aaa
3 monthly
Placental abruption risk factors
Chronic HTN Pre-eclampsia Smoking Cocaine Trauma Choreamnionitis
Child abuse - investigations?
FBCs Clotting Dilated fundoscopy Photodocumentation Skeletal survey CT brain LFTs and amylase Serum calcium, phophate, ALP Parathyroid 25-hydroxy D3
Characteristic cystic fibrosis features?
Failure to pass meconium (meconium ileus), Failure to thrive, voracious apetite
What are CI for induction of labour?
-acute fetal compromise -abnormal lie -placenta praevia -pelvic mass/deformity -cephalopelvic disproportion
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
Antibodies for SLE - Most sensitive? Most specific?
Anti-nuclear antibodies (ANA) are autoantibodies to the nuclei of your cells. dsDNA and anti-smith antibodies
Milestones of 4 yrs
can hop on one leg, plays with other children, asks W questions
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
DVLA laws for stroke patient?
6months
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
Renal artery stenosis imaging?
Angiography
What are the side effects of oxybutynin?
anti-cholinergic -dry mouth, dizziness, drowsiness, blurred vision, dry eyes, N&V, constipation, diarrhea, weakness, runny nose
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+
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)
Guy had something that looked like psoriasis after coming back from Africa, what do you give?
Seborrheic dermatitis ketoconazole (steroid for flareups)
The most common cause of LV dysfunction
IHD
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
When hip is posteriorly dislocated- described as?
ANS = shortened, flexed, internally rotated, ADDucted
What medication for induction of dead fetus?
Misoprostal
Baby (8 months) with crying episodes where baby brings legs to tummy. Mother opened nappy to find red current stool
Intersussception
Vascular surgery man is awaiting angioplasty for intermittent claudication revascularisation, what do u give him in mean time?
Statin
Lady with pregnancy-induced HTN with bp at 146/something. Why do you control her bp?
To prevent superimposed pet
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
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
Patient with psoriasis – tried emollients and wants to avoid oral meds. What next?
1st line mod-severe = narrow band UVB. (Phototherapy)
Sudden chest pain Increased JVP SOB Low BP Tachypnea Discomfort relieved by sitting or leaning forward
Cardiac tamponade
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
Simple pain management already on nsaids, what next?:
Weak opioids - codiene, dyhydracodeine, tramadol Strong opioids - diamorphine, fentanyl
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
Biggest risk factor for completed suicide?
Age >65 Postnatal status Personal/FHx of depression Steroids IFN male
Focal neurological seizure followed by secondary generalisation lasted for 20 seconds - Next step?
Refer to neurologist
Acute glaucoma managment?
urgent refer+ acetazolamide + pilocarpine
Mechanism of urticaria due to IgE
Mast cell degranulation
Patient who has had a stroke -Is thrombocytopenic and has haematoma Management?
Give FFP/prothrombin complex AND cryoprecipitate Platelet transfusion
Minimal change disease - Presentation? Kidney biopsy?
More common in children Nephrotic syndrome - normotension, proteinuria Serum albumin loss Fusion of podocytes
Mechanism of action of COCP?
Suppress the secretion of gonadotropins (follicle stimulating hormone, FSH and luteinizing hormone, LH) through negative feedback inhibition.
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
Common diazepam side effect?
Allertness decreased Anxiety Confusion Depression Dizzy Drowsy GI disorder Resp depression
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
Main advantage of breast milk over formula
Reduces risk of sudden infant death syndrome
Milestones of 6mths
6 months – palmar grasp, can pass objects from one hand to another, coos
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
Good prognosis MI medication (low ejection)
ACEi/ARBs B-blocker Hydralazine Spironolactone Vasodilators and Nitrates
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.
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
Most common viral meningitis in children cause?
herpes
Management of stone that couldn’t be ERCP?
Emergency CBD exploration + Abx
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
Child with UTI. You do a USS. Parent asks why you chose to do USS?
vesicoureteric reflux
Chronic heart failure - management?
ACEi B blocker
Psoriasis question, gentleman doesn’t want to take anything oral, which of options has good evidence?
Topical corticosteroid (mild) Phototherapy (moderate to severe)
What is the gold standard investigation for endometriosis ?
Laproscopy
Girl with primary nocturnal enuresis - First line management?
Behavioural
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
Features of innocent murmurs
Seven S: -sensitive (changing position) -short duration (jot holosystolic) -single -small (non-radiating) -soft -sweet -systolic
What more likely to cause endometrial cancer?
Obesity Nulliparity Early menarche Late menopause Unopposed estrogen
Pt with T2 diabetes and keeps having hypos. What is the cause?
Glimeperide (Insulin/sulfonylureas (gliclazide and glimepiride)
Not passing meconium, put finger in and stool is expelled
Hirschprungs
Guy had surgery, complaining of decreased visual acuity, double vision and nystagmus in left eye. - next line?
Patch
RTA broken nose, abnormal chest movement, weirdly displaced leg, leg bleeding management?
C-spine/ airway/ chest drain
Rx for VZV in pregnant woman?
IVIG immediately
Migraine lady had really severe headache, neck stiffness, CT normal, photophobia
LP because meningitis
Man had nose bleed and INR of 4.5 and metallic heart valve what do you do?
Give vitamin K
Reasons for referral to psychiatry
superficial self-harm
What is rehabilitation?
the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.
SLE - pathophys
Cell apoptosis
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
Psoriasis question, gentleman doesn’t want to take anything oral, which of options has good evidence?
Topical corticosteroid
Necrotizing enterocolitis biggest risk factor
Preterm
Blood results showing HELLP syndrome.
Total Bili >1,2 LDH >600 GGT >70 Platelets <100,000
What are the signs of community acquired pneumonia?
increased vocal fremitus
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
Dyskaryosis
Multi nucleation Increased cytoplasm:nucleic ratio
Acute heart failure management
O2 therapy Loop diuretics - furosemide GTN spray
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
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
Child born at term and starts to seize. Weight is 4.8kg, what is the first investigation that should be done?
Glucose and electrolytes
What is the ix for 51yr-old woman, 14 months amenorrhoea, hot flushes?
menopause- none
APGAR score 0-3 management?
ABCDE on baby High flow O2 Adrenaline Compressions Monitor glucose
MS relapse management ?
IV methylprednisolone
What is the most common cancer is HIV patients
Kaposi sarcoma and lymphoma
Patient comes in with UMN weakness, behavioural abnormalities, where is the lesion?
ACA
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
Sudden loss of vision ddx
Stroke TIA acute glaucoma retinal detachment anterior uveitis retinal occulsion
Patient who is 50 with AF and CHF - Initial management?
Sotalol Amiodarone Flecainide
Lung ca central tumour on x-ray - Next investigation?
Bronchoscopy+biopsy
Causes of infertility?
age >35 hx of STD BMI extremes smoking
Paediatric non accidental injury
Bruising on back Mid-shaft transverse femoral fracture
Meningitis CSF - Opaque High pressure Mostly neutrophils Decreased glucose High protein Acid fast bacillus stain PCR
TB
Patient with past mitral valve replacement presenting with new pan systolic murmur and fever. What is most important investigation?
Blood cultures
Sickle cell kid with temp of 39 - management?
Ceftriaxone (Vancomycin if meningitis)
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
Patient on risperidone and has oligo-menorrhea which hormone?
Hyperprolactinemia
HbsAg - positive Anti-Hbc - positive IgM anti-Hbc - negative anti HbS - negative
Chronic hepatitis
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
Baby born developed grunting and subcostal recession - Diagnosis?
RDS
Guy had hep c and hep b - management?
Treat hep c interferon alfa and ribavirin.
Mechanism of Baclofen
Muscle relaxant and antispastic inhibiting both monosynaptic and polysynaptic reflexes at the spinal level
CURB-65 - Score 0 management?
Community care Doxycycline PO 200mg STAT then 100mg OD
Diagnosis of asthma
Reversibility
DM Type 1 nephropathy – patient has high hba1c and high protein in urine. What do you do?
Increase insulin
Teenager RTA with bruising on the chest and hypovolaemia. Resp exam is ok - first step?
Cannula Bloods - FBC, U&Es, crossmatch, clotting Fluid resus
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
Patient jaundice, fever, RUQ pain?
Ascending cholangitis (Charcot’s triad)
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
Pregnant first trimester UTI rx?
Nitrofuratoin
Commonest cause of preterm babies
Pregnancy with multiple babies Hx of preterm labour/birth Infection Diabetes/HTN
Treatment for glaucoma?
Medical - pilocarpine Surgical - Iridoplasty
Type of miscarriage? pain +/-; bleeding >>bleeding equivalent to menstruation; cervix = open; uterine size = or < dates; ultrasound = retained products/no fetal heart
Incomplete miscarriage
How to aid women with External cephalic version?
Tocolytic (Terbutaline) in primiparous women
Boy comes in. Upper respiratory tract infection followed by red scaling plaques (salmon scaly plaques on back)
guttate psoriasis
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
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)
Progressive hip pain (over weeks), Limp, stiffness and reduced range of movement in 7 year old, trendelenburg +ve - Diagnosis?
Perthes disease
Patient presents with one red eye that are: pain or photophobia no itching poorly reactive pupil irregularity of the pupil Diagnosis?
Anterior uveitis
What is oxybutinin?
Antimuscarinic
Guy had AKI after surgery - what do you assess?
saline bolus 250ml
myoclonic seizures rx?
clonazepam lamotrigine
Patient with post op, PE and calf swelling. What is the best IX?
CTPA
6wks pregnant woman with vaginal bleeding, shoulder tip pain, abdominal pain, bHCG >1500
Ectopic pregnancy
Pt after stoke suffers from double vision, he is very upset by this what do tell him to do?
Optometrists
What are the signs of community acquired pneumonia?
Increased vocal fremitus
DDx for fresh, red rectal blood
anal fissures, haemorrhoids, cancers and polyps of the rectum and colon diverticulosis
Patient with Graves – Whats the treatment? Side effects?
Carbimazole SE: Rashes, pruiritus. Serious SE: Agranulocytosis
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
Tia abcd2 calculation & management, if u worked it out he had a score of 6?
Admission + MRI
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
SLE with Antiphospholipid syndrome, what do you need to warn them about ?
Miscarriage
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
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
Pt with TB signs – what type of stain should be done on sputum?
Ziehl Nielsen
1 core and 4 minor depressive management?
Cbt, anti-depressant
What is the management of Guillain-Barre syndrome?
IVIg or plasma exchange
Loss of deterioration of central vision (can be sudden or gradual) Flashes of light
Retinal detachment
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
Meningitis CSF - Cloudy Pressure increase Neutrophils Decreased glucose High protein Gram stain culture
Bacterial
What are the signs of Hospital acquired pneumonia
Decreased vocal resonance
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)
New born baby and tests done. Levels of immunoreactive trypsin were found to be high. What does this point to?
Cystic fibrosis
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
What is the next line ix for BPH?
USS CT abdo/pelvis
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
Nicotine replacement that is most effective and reduces cravings?
varenicline
Police picks up crazy guy from home. What section can they detain on? Time?
Section 135 Upo 24 hours
Guy couldn’t find the right words for things, what is this?
Anomic aphasia
Patient with Phalen’s sign, thenar wasting, weakness of thumb?
Carpal tunnel
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
Jaundice in first 24 hours - cause, FH and spherocytic blood film
Spherocytosis
Melena and microcytic hypochromic anemia in older guy?
Anemia of chronic disease (cancer)
Dehydrated baby, poor feeding, irritable, dry nappies, what to do?
rehydration therapy
Management of Primary 8mm pneumothorax?
Aspiration
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 comes in intermenstrual bleeding. Smear is fine done two years ago. Speculum is normal. Next investigation?
Endocervical swab
Diabetic drug that causes hypoglycemia
Insulin, sulfonylureas (Glucoside)
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
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)
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
Jaundice in first 24 hours - cause? Mother is O+ve?
ABO incompatibility
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
First line management of angina
Exercise Diet Nitrates Antiplatelet therapy
A woman who smokes 10/d has started getting regular painful contractions at 31weeks and a bloody vaginal discharge.
Placental rupture
Haematuria 1 year ago, then painless haematuria
Renal cell carcinoma
Q of a guy who hit his head and had symptoms the next day in a rugby match?
CT scan
Secondary PPh, what initial investigation will show retained placenta?
TVUS–> will show endometrial thickness >10mm
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
Which following features would suggest Lewy body dementia?
In LWB, get visual hallucinations, parkinsonism and fluctuating cognition. Do a DaTSCAN
Section 36
remand to hospital for treatment
Worse prognosis for SZ
Early onset FHX structural brain abnormalities
Spirometry asthma vs COPD; FEV1/FVC
COPD <70% Asthma <80%
Pt with stroke that occurred 1 hr ago. What is the best Rx?
tpA intravenous
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
Sensory lost on medial 1 and a half finger, where is the lesion?
cubital tunnel syndrome
Scleroderma affects trunk and proximal limbs predominately Associated with scl-70 antibodies Hypertension, lung fibrosis and renal involvement seen
Diffuse cutaneous systemic sclerosis
What are Cluster A PD?
paranoid, schizoid, schizotypal
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)
Keratitis appearance fluorescein stain showed branch like appearance so management? Diagnosis?
HSV Gancyclovir
GCA management
Steroids
Depression admission criteria
Severe agitation Psychotic Suicidal Catatonia
Pt with severe unilateral headache, especially around one eye, lacrimation ?
Cluster headache
Section 17a
supervised community treatment -compulsory treatment for community patients -apply to patients under section 3 -last for 6 mths
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
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 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.
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.]
What are the croup ddx?
epiglottis foreign body peritonsilar abscess
Patient with renal transplant, lesion on lip - diagnosis?
Immunosuppression due to the transplant -> increased risk of SCC.
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)
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
Squamous cell carcinoma
-characterised: raised, keratotic (scaly, crusty), ill-defined nodule, may be ulcerated
Basal Cell carcinoma
- nodular is most common
- characterised: skin-colored, surface telangiectasia, pearly rolled edge, ulcerated center
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
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
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
Systemic sclerosis
-Characterised: sclerodactyly, skin thickening, raynaud’s phenomenon, swelling of hands and feet
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)
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
Squamous cell carcinoma
-characterised: raised, keratotic (scaly, crusty), ill-defined nodule, may be ulcerated
Basal Cell carcinoma
- nodular is most common
- characterised: skin-colored, surface telangiectasia, pearly rolled edge, ulcerated center
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
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
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
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
Staging for colorectal cancer
Dukes criteria
Bilirubin graph for newborn
:)
Identify the type of bleed?
Intracerebral haemorrhage
Identify the type of bleed?
Subarachnoid haemorrhage
Identify type of bleed?
Vessel?
Extradural/Epidural haematoma
Middle meningeal artery
Identify bleed?
Vessels affected?
Subdural haematoma
Bridging veins
Identify bleed?
Vessel Affected?
MCA
Ischemic stroke
CD4+ AIDS infections
:)
Diagnosis?
Lupus pernio
What is it?
Gottrons papules
Diagnosis?
GI perforation
Diagnosis?
Signs?
Respiratory distress syndrome - ground glass
What is it?
Diabetic non proliferative retinopathy
What is it?
Anterior uveitis
What is it?
Exotropia
Eye turns outward
What is it?
Hypermetropia
Eye turn upwards
Diagnosis?
Diabetes retinopathy
Diagnosis?
Papilloedema
Diagnosis?
Central retinal artery occlusion
Diagnosis?
Central Retinal Vein Occlusion
What is it?
Subungal melanoma
what is it?
cause?
Red man syndrome
Vancomycin
what is it?
Acanthosis nigricans
What is it?
Lentigo melanoma
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
