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148 Cards in this Set
- Front
- Back
What are the indications for stoma in IBD |
Crohns Failure of medical management Obstruction from strictures Fistulae Uc Toxic megacolon (uc) - panprotocolectomy |
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What are the indications for stoma in IBD |
Crohns Failure of medical management Obstruction from strictures Fistulae Uc Toxic megacolon (uc) - panprotocolectomy |
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What stoma will you see in Crohns |
De functioning loop ileostomy |
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What are the complication of ileoanal pouch |
Pouchitis anastomotic dehiscence soiling/seepage |
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How Parkinson treated |
L dopa Co beneldopa Apomorphine - dopamine receptor agonist Selegiline - MAO B Procyclidine - anticholinergic |
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What common causes of BRONCHIECTASIS |
Post infections : pertussis , measles Associations : sle, ra , systemic sclerosis Congenital : CF , kartagener associated with situs inversus Mechanical : foreign , obstructing tumpurb |
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What are the extra manifestations of IBD |
Eyes : episcelritis , posterior uveitis , scleritis Skin : pyoderma g. Erythema nododdim Clubbing oligoarthritis and anaemia |
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What are the complications of renal transplant |
Rejection Renal failure: esp of diabetes isn’t controlled Cushing syndrome Skin malignancy : SCC Ciclosporin : gum hypertrophy |
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What procedures will you see a rooftop scar |
Liver transplant Whipples procedure |
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What are the causes of right sided HF |
MI Pulmonary embolism Left ventricular failure Cor pulmonale |
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What are the causes of splenomegaly |
Chronic myeloid Myelofibrosjs Malaria EBV |
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What are the causes of splenomegaly |
Chronic myeloid Myelofibrosjs Malaria EBV Spherocytosjs ( Caucasians ) |
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Indication for renal transplant |
Diabetic nephew patty Glimerulonephritis PKD |
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What are the causes of hepatobsplenomegaly |
CML malaria EBV sarcoidosis |
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How Parkinson treated |
L dopa Co beneldopa Apomorphine Selegiline Procyclidine - anti cholinergic |
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What are some Parkinson plus syndromes |
Multisystem atrophy Corticobasal degeneration Progressive supranuclear palsy |
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How is a diabetic food disease managed |
Annual review Avoid risks - walking barefoot Orthotics and pressure relief Callus debridment Good glycaemic control Iv antibiotics MRI for abscess / osteomyelitis |
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How is a diabetic food disease managed |
Annual review Avoid risks - walking barefoot Orthotics and pressure relief Callus debridment Good glycaemic control Iv antibiotics MRI for abscess / osteomyelitis |
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What are the causes of chronic venous insufficiency |
? |
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How is a diabetic food disease managed |
Annual review Avoid risks - walking barefoot Orthotics and pressure relief Callus debridment Good glycaemic control Iv antibiotics MRI for abscess / osteomyelitis |
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How is chronic venous insufficiency treated |
Compression bandaging ABPI > 0.8 |
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What are the causes of chronic venous insufficiency |
? |
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What are the complications of goitre |
Thoracic outlet syndrome , Dysphagia Upper airway instruction Recurrent laryngeal nerve compression SVCO |
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What can caused bilateral facial palsy |
GBS Lyme sarcoidosis MG BILATERAL BELLS |
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What are some Parkinson plus syndromes |
Multisystem atrophy Corticobasal degeneration Progressive supranuclear palsy |
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How Parkinson treated |
L dopa Co beneldopa Apomorphine Selegiline Procyclidine - anti cholinergic |
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What are secondary causes of facial palsy do you know |
Ramsey hunt syndrome MG Lyme disease |
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How Parkinson treated |
L dopa Co beneldopa Apomorphine Selegiline Procyclidine - anti cholinergic |
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What are secondary causes of facial palsy do you know |
Ramsey hunt syndrome MG Lyme disease |
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What are some Parkinson plus syndromes |
Multisystem atrophy Corticobasal degeneration Progressive supranuclear palsy |
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What vessels are used in bypass grafting |
Great saphenous Internal thoracic vein |
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Indication for renal transplant |
Diabetic nephew patty Glimerulonephritis PKD |
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What are the indication foR CABG |
Left stem disease 2 or more vessel disease Failure of medical management Aortic valve replacement |
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How can you tell if a valve replacement has failed |
? |
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What anticoagulation is needed following a valve replacement |
Aortic prosthetic - nil just aspirin Mitral bioprosthetics: 2.5 warfarin Aortic and mitral prosthetic is lifelong warfarin 3.5 |
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What anticoagulation is needed following a valve replacement |
Aortic prosthetic - nil just aspirin Mitral bioprosthetics: 2.5 warfarin Aortic and mitral prosthetic is lifelong warfarin 3.5 |
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How can you tell if a valve replacement has failed |
? |
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How can you tell if a valve replacement has failed |
? |
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What anticoagulation is needed following a valve replacement |
Aortic prosthetic - nil just aspirin Mitral bioprosthetics: 2.5 warfarin Aortic and mitral prosthetic is lifelong warfarin 3.5 |
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How can you tell if a valve replacement has failed |
? |
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What are the indication foR CABG |
Left stem disease 2 or more vessel disease Failure of medical management Aortic valve replacement |
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What are the differentials for a groin lump |
Saphenous varix Femoral hernia Psoas abscess Lymphadenopathy Undescended testes |
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What The borders of hesselbachs triangle |
Lateral border of the rectus muscle Inguinal ligament Inferior epigastric artery |
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What the two complications of hernias |
Obstruction: resulting in colic pain, constipation , vomiting , distension Strangulation resulting in ischaemia then necrosis then peritonitis |
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What caused psoas abscess |
It can be primary origin or a result of spread from local sources such as pyelonephritis or IBD |
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What are the investigations for psoas abcess |
Bloods to evidence infection Plain radiographs are not useful Ct abdomen may identify an abscess But mri is gold standard |
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What will u see on examination with carpel tunnel syndrome |
1. weakness of thumb abduction (abductor pollicis brevis) 2. wasting of thenar eminence 3. tinels sign : tapping causes paraesthesia 4. Phalen's sign : flexion of wrist causes symptoms |
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What is the treatment for cts |
1. wrist splints at night 2. corticosteroid injection (25 mg hydrocortisone acetate) if this fails consider : 10-20 mg triamcinolone 3. surgical decompression (flexor retinaculum division ) |
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What are the causes for CTS |
anything that causes oedema : 1. diabetes mellitus 2. pregnancy 3. acromegaly 4, myxoedema 5. myeloma 6, RA |
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Describe the breast national screening programme |
All women aged 47-73 undergo a two view mammopgrahy if it is normal then : 3 year recall if abnormal - immediate recall if clear then recall in 6m or 1 year , if not clear : diagnosis of breast cancer |
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What are some causes of exudativr pleural effusion |
Infection Invasive : malignancy Inflammation : SLE or RA Infarction : Dressler’s syndrome |
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What are some features of an innocent murmur |
Soft Systolic Symptomless Short Standing sitting variation |
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What are some features of an innocent murmur |
Soft Systolic Symptomless Short Standing sitting variation |
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What are the two types of innocent murmurs |
Venous hum : this is due to turbulence bloodflow and the great veins returning to the heart Heard as a continuous blowing sound heard below the clavicles Stills murmur : Low pitch sound heard at the lower left sternal edge |
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What are 3 cardio causes of clubbing |
Atrial myxoma Endocarditis Cyanotic congential heart disease |
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What are some respiratory causes for clubbing |
Tb Bronchiectesis Lung carcinoma Asbestosis |
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What are some complications of diabetic neuropathy |
Ulceration Cellulitis Gangrene Chariots arthropathy Osteomyelitis |
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What is the triple swab |
Swab 1 “HVS” (charcoal) : tv, bv , candida Swab 2 “ECS” : gonorrhoea Swab 3 “ECS” chlamydia |
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Causes of aortic stenossi |
Bicuspid aortic valve Calcification degeneration |
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What are indications for surgery in aortic stenosis |
Symptomatic HF Means transvalvular pressure gradient of greater than 40 Valve area < 1 cm2 Concomitant CABG |
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How do you grade murmurs |
1 audible to expert 2 audible to non expert 3 clearly audible 4 clearly audible with palpable thrill 5 audible with stethoscope only lightlynapplied 6 audible without stetho applied to the chest |
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What are the types of valve replacements |
Metallic and tissue valves Tissue more common because metallic can cause increase risk of clots if warfarin is stopped the target is 3.5 Metallic has clicks and tissues have just an regurgitantnmurmur only |
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How long does a valve replacement last |
Aortic mechanical : life long Mitral mechanical : life long |
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How can you tell if a valve replacement has failed |
? |
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What anticoagulation is needed following a valve replacement |
Aortic bioprosthetic - nil just aspirin Mitral bioprosthetics: 2.5 warfarin Aortic and mitral prosthetic is lifelong warfarin 3.5 |
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What are the indication foR CABG |
Left stem disease 2 or more vessel disease Failure of medical management Aortic valve replacement |
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What vessels are used in bypass grafting |
Great saphenous Internal thoracic vein |
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What medication would u exprect some to take post CABG |
Dual anti platelets Clopidogreal for 12 months then aspirin alone Beta blocker Ace inhibitor |
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What are some differentials for pansystolic murmur |
Mitral regurg Vsd Tricuspid regurg ( COr pulmonale) |
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What are the causes of mitral regurg |
Chronic Degeneration LV dysfuntion Ehler danos Acute Infective endocarditis Papillary muscle rupture ( post MI)! |
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What are the causes of right sided |
MI Pulmonary embolism Left ventricular failure Cor pulmonale |
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Causes of LVF |
MI Ischaemic cardiomyopathy VALVULAR HEART DISEASE Hypertensive cardiomyopathy |
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When is spironolactone given in HF |
NYHA class 3 |
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What procedures will you see a rooftop scar |
Liver transplant Whipples procedure |
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What are some causes of pyoderma gangrenosum |
IBD RA haem malignancy Primary biliary cirrhosis |
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Causes of cirrhosis |
NAFLD HEP C ALCOHOL |
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What are the features of liver disease decompensation |
Coagulopathy Axterixis Ascites Worsening jaundice Hypoglycaemia |
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Complication of cirrhosis |
Encephalopathy Liver cancer Coagulopathy Portal htn Variceal haemorrhage SBP Thrombocytopenia |
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What are the causes of splenomegaly |
Chronic myeloid Myelofibrosjs Malaria EBV Spherocytosjs ( Caucasians ) |
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What are the causes of hepatobsplenomegaly |
CML malaria EBV sarcoidosis |
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What are the indications |
Traumatic rupture ITP spherocytosis - can have this down at 7 years old |
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What is the prophylaxis for splenectomy |
Pneumoccocal vaccine Meningiococcaln vaccin hib vaccine Pen V |
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Indication for renal transplant |
Diabetic nephew patty Glimerulonephritis PKD |
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What are the complications of renal transplant |
Rejection Renal failure: esp of diabetes isn’t controlled Cushing syndrome Skin malignancy : SCC Ciclosporin : gum hypertrophy |
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What the ddx for patient with stoma ? |
IBD esp if young DIVERTICULITIS - emergency situation Malignancy Urostomy - make sure you look at the contents |
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What are the extra manifestations of IBD |
Eyes : episcelritis , posterior uveitis , scleritis Skin : pyoderma g. Erythema nododdim Clubbing oligoarthritis and anaemia |
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What are the complications of IBD |
Crohns : strictures , obstruction and fistula Colitis : toxic mega colon , colonic carcinoms and PSC |
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What are the indications for stoma in IBD |
Crohns Failure of medical management Obstruction from strictures Fistulae Uc Toxic megacolon (uc) - panprotocolectomy |
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What stoma will you see in Crohns |
De functioning loop ileostomy |
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Which stoma will you see in UC |
End ileostomy ( from pan proctocolectkmy ) Diversion ileostomy with ileal pouch But can get pouchitis |
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What are the associayef of ADPCKD |
Hepatic and pancreatic cysts Berry aneurysm - subarachnoid ( assco with ehler danos and marfan) Mitral valve prolapse |
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What are causes of bilateral renal mAsses |
Autosomal dominant PKD Renal cyst Bilateral renal carcinoma Amyloidosis Tuberous sclerosis |
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What are the complication of ileol pouch |
Pouchitis ? ? Look at passmedicine |
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How do you manage COPD |
Conservative : smoking cessation Fev1 > 80 : salbutamol 50 to 70 : LABA or LAMA <50: LABA / LAMA plus inhaled steroid <30 : LABA PLUS LAMA PLUS STEROID Lung reduction surgery for large bullae |
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When do you give long term o2 |
Non smoker for 6 months PO2 < 7.3 kPA in air < 8 but any evidence of RHF, pulmonary oedema , pulmonary hypertension , polycythaemia |
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What are the causes of pulmonary fibrosis |
RA SLE systemic sclerosis Amiodorone Ankylosinf spondylitis Classes Hypersensitivity Extrinsic allergic alveolitis Silicosis Asbestosis Drugs Nitrofurantoin Sulfasalazine Amiodarone Association Idiopathic |
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What common causes of BRONCHIECTASIS |
Post infections : pertussis , measles Associations : sle, ra , systemic sclerosis Congenital : CF , kartagener associated with situs inversus Mechanical : foreign , obstructing tumpurb |
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When do you need a chest drain |
Empyema Massive harmothorax Pneumothoraces ( large or tension ) but in 2nd intercostal space) |
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What is lights criteria |
? |
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What signs indicate bulbar involvement |
? |
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How is power graded |
0 none 1 flicker 2 moves with gravity removed 3 moves against gravity 4 reduced power agasint resistance 5 normal |
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How Parkinson treated |
L dopa Co beneldopa Apomorphine Selegiline Procyclidine - anti cholinergic |
|
What are some Parkinson plus syndromes |
Multisystem atrophy Corticobasal degeneration Progressive supranuclear palsy |
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What are secondary causes of facial palsy do you know |
Ramsey hunt syndrome MG Lyme disease |
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What can caused bilateral facial palsy |
GBS Lyme sarcoidosis MG BILATERAL BELLS |
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How is PAD treated |
Smoking cessation and exercise Medical : ACEi clopidergril and statin Surgical : bypass / angioplasty / stent / amputation |
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What are features of critical ischaemia |
? |
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What are the complications of goitre |
Thoracic outlet syndrome , Dysphagia Upper airway instruction Recurrent laryngeal nerve compression SVCO |
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What are the complication of radio iodine |
Worsening of eye disease Late hypothyroidism |
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How is a diabetic food disease managed |
Annual review Avoid risks - walking barefoot Orthotics and pressure relief Callus debridment Good glycaemic control Iv antibiotics MRI for abscess / osteomyelitis |
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What are the causes of chronic venous insufficiency |
? |
|
How is chronic venous insufficiency treated |
Compression bandaging ABPI > 0.8 |
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How are varicose veins are treated |
Ultra sound especially for short saphenous Injection sclerotherapy Surgical stripping |
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What are some counselling point for POP |
Side effects: irregular vaginal bleeding is the most common problem If starting on any day you should use 2 days of other contraception Instructions : take at same time everyday without a pill free break Missed pills If less than 3 hours late then just continue as normal If more than 3 hours late then take missed pill as soon as possible continue with rest of pack Liver enzyme inducers such as carbamazepine , rifampicin , chronic alcohol and phenytoin |
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What are some counselling point for POP |
Side effects: irregular vaginal bleeding is the most common problem If starting on any day you should use 2 days of other contraception Instructions : take at same time everyday without a pill free break Missed pills If less than 3 hours late then just continue as normal If more than 3 hours late then take missed pill as soon as possible continue with rest of pack Liver enzyme inducers such as carbamazepine , rifampicin , chronic alcohol and phenytoin |
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How do you present a paediatric exam |
Age Boy/girl Comfortable at rest Dysmorphysms - Turner’s ? Environment - around them eg CReon FTT - I would like to weight them or plot their height |
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What important in asthma history |
How often the use their inhaler on a good day Does anything make it worse Have they ever been admitted to ITU Do they use a spacer ? - make sure you ask this Do you take the brown inhaler |
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What are the modifiable risk factors for asthma |
Smoking House condition ( any damp, mould or dust ) Pets |
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What do you ask in a diabetic type 1 history |
Child should be checking for BM at least 4-5 times |
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What do you ask at the beginning of neonatal exam |
Say you would measure height and weight Is baby passing stool and ironed fine How many weeks was baby born at Is there any congenital conditions that run in the family |
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What are the presenting symptoms of acromegaly |
Headache Patient normally notices poorly fitting clothes due to change in soft tissue mass Coarsening of facial features and spreading of teeth Impairment of vision |
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What are some complications of acromegaly |
Cardiomegaly Osteoarthritis Sleep apnoea Carpel tunnel syndrome |
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What is the difference between Cushing syndrome and disease |
Cushing syndrome refers to state of chronic cortisol excess in the body due to any cause The commonest cause being exogenous steroid treatment Cushings disease occurs due to specific cause : pituitary micro adenoma secreting ACTH |
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What is the difference between Cushing syndrome and disease |
Cushing syndrome refers to state of chronic cortisol excess in the body due to any cause The commonest cause being exogenous steroid treatment Cushings disease occurs due to specific cause : pituitary micro adenoma secreting ACTH |
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What are the complications of crohns - which u would want to operate |
fistula abscess formation strictures |
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What are the 4 signs of dependence |
Compulsion Impaired control of substance taking behaviours Withdrawal Tolerance Salience : prepccupane of use Persistence despite awareness of harm |
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HRT counselling |
Explain what HRT is Risk of breast cancer, stroke , VTE Transdermal patch - 3-4 days Side effects Nausea and vomiting Breast tenderness Contraindications Oestrogen dependent cancer Past pulmonary embolus Pregnancy Breastfeeding Untreated endometrial hyperplasia Annual check up But initially 3 month reviews to assess control of menopausal symptoms Regular check on BP, weight, CVD and family history Benefits HRT Control menopausal symptoms Osteoporosis Colorectal cancer
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What are some other treatments used in menopause other than HRT |
SSRI CBT clonidine (reduce flushed and sweats ) Topical vaginal oestrogen eg vagifem Testosterone gel |
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What are the red flag features of syncope that would require urgent further investigation |
ECG abnormalities History or signs of heart failure Transient loss of consciousness during exercise FH of sudden cardiac death New shortness of breath |
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What are causes of prolonged jaundice |
Breast feeding TORCH infection hypothyroidism Biliary atresia |
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In order to make a decision in a patients best interest the following should be considered |
Whether he has legally appointed power of attorney His past and present wishes Any beliefs and values that may influence the decision The opinion of his family, friends and carers Whether he requires an independent mental capacity advocate |
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What are the five key principles of the mental health act |
Presumption of capacity until proven otherwise People must be given all practical support to make decision Just because their decision is unwise doesn’t mean they lack capacity Any decision made on behalf of the person lacking capacity should be made in their best interest Anything done on behalf of a person who lacks capacity should be the least restrictive. |
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What are risk with twin pregnancy |
Maternal : Gestational diabetes and hypertension Preeclampsia Anaemia Fetal: Twins have greater mortality Preterm delivery IUGR |
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What are risk with twin pregnancy |
Maternal : Gestational diabetes and hypertension Preeclampsia Anaemia Fetal: Twins have greater mortality Preterm delivery IUGR Congenital abnormalities Malpresentation |
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What are the complication of monochroionicity |
Twin to twin transfusion syndrome IUGR |
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How is multiple pregnancy managed |
Iron and folic acid Increased surveillance for pre eclampsia , diabetes and anaemia Serial uss 28 32 and 36 MC : ultrasound fortnightly from 12 weeks for TTTS LASER TREATMENT |
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What are the investigations for MG |
Single fibre electromyography CT thorax CK Is usually normal Tension test : IV edrophonium reduces muscle weakness temporarily |
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What are the four factors considered in KOCHERS criteria |
Non weight bearing or pain with passive motion of the joint ESR >40 WCC >12 TEMPERATURE 38.5 |
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What are the subtypes of JIA |
Oligoarticular systemic Polyarticular - rheumatoid factor positive and negative Enthesitis related arthritis Psoriatic arthritis |
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What are the features of systemic onset juvenile idiopathic arthritis |
Evanecent rash Lymphadenopathy Organomegally Anaemia |
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What are some post gastrectomy syndrome |
Abdominal fullness Bilious vomiting Dumping Diarrhoea post gastrectomy Anaemia |
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What are the drugs used to delay labour |
Tocolytics - this baby AINT coming out Atosiban Indomethacin Nifedipine Terbutaline |
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What is the investigation and treatment for ankulosinf spondylitis |
Back (Definition) |
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What are the causes of radial nerve lesionsbaf ste so |
Saturday night palsy Fracture of humerus Lead poisoning |
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What are some causes of foot drop |
Stroke MS Marie Charcot Tooth disease |
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What the causes of secondary htn? |
Back (Definition) |
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Opioid counselling |
It is rare to get addicting to it The disease progression is what increases the pain not that the morphines isn’t working anymore - you will be given more pain relief when you need it Side effects Constipation - laxative are given Nausea |
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What are the potential risk of urethral catheterisation ? |
Trauma Infection Paraphimosis Bladder spasm |