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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

What are the indications for stoma in IBD

Crohns


Failure of medical management


Obstruction from strictures


Fistulae


Uc


Toxic megacolon (uc) - panprotocolectomy

What stoma will you see in Crohns

De functioning loop ileostomy

What are the complication of ileoanal pouch

Pouchitis


anastomotic dehiscence


soiling/seepage

How Parkinson treated

L dopa


Co beneldopa


Apomorphine - dopamine receptor agonist


Selegiline - MAO B


Procyclidine - anticholinergic

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

What are the extra manifestations of IBD

Eyes : episcelritis , posterior uveitis , scleritis


Skin : pyoderma g. Erythema nododdim


Clubbing oligoarthritis and anaemia

What are the complications of renal transplant

Rejection


Renal failure: esp of diabetes isn’t controlled


Cushing syndrome


Skin malignancy : SCC


Ciclosporin : gum hypertrophy

What procedures will you see a rooftop scar

Liver transplant


Whipples procedure

What are the causes of right sided HF

MI


Pulmonary embolism


Left ventricular failure


Cor pulmonale

What are the causes of splenomegaly

Chronic myeloid


Myelofibrosjs


Malaria


EBV

What are the causes of splenomegaly

Chronic myeloid


Myelofibrosjs


Malaria


EBV


Spherocytosjs ( Caucasians )

Indication for renal transplant

Diabetic nephew patty


Glimerulonephritis


PKD

What are the causes of hepatobsplenomegaly

CML


malaria


EBV


sarcoidosis

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

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

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

What are the causes of chronic venous insufficiency

?

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

How is chronic venous insufficiency treated

Compression bandaging


ABPI > 0.8

What are the causes of chronic venous insufficiency

?

What are the complications of goitre

Thoracic outlet syndrome ,


Dysphagia


Upper airway instruction


Recurrent laryngeal nerve compression


SVCO

What can caused bilateral facial palsy

GBS


Lyme


sarcoidosis


MG


BILATERAL BELLS

What are some Parkinson plus syndromes

Multisystem atrophy


Corticobasal degeneration


Progressive supranuclear palsy

How Parkinson treated

L dopa


Co beneldopa


Apomorphine


Selegiline


Procyclidine - anti cholinergic

What are secondary causes of facial palsy do you know

Ramsey hunt syndrome


MG


Lyme disease

How Parkinson treated

L dopa


Co beneldopa


Apomorphine


Selegiline


Procyclidine - anti cholinergic

What are secondary causes of facial palsy do you know

Ramsey hunt syndrome


MG


Lyme disease

What are some Parkinson plus syndromes

Multisystem atrophy


Corticobasal degeneration


Progressive supranuclear palsy

What vessels are used in bypass grafting

Great saphenous


Internal thoracic vein

Indication for renal transplant

Diabetic nephew patty


Glimerulonephritis


PKD

What are the indication foR CABG

Left stem disease


2 or more vessel disease


Failure of medical management


Aortic valve replacement

How can you tell if a valve replacement has failed

?

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

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

How can you tell if a valve replacement has failed

?

How can you tell if a valve replacement has failed

?

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

How can you tell if a valve replacement has failed

?

What are the indication foR CABG

Left stem disease


2 or more vessel disease


Failure of medical management


Aortic valve replacement

What are the differentials for a groin lump

Saphenous varix


Femoral hernia


Psoas abscess


Lymphadenopathy


Undescended testes

What The borders of hesselbachs triangle

Lateral border of the rectus muscle


Inguinal ligament


Inferior epigastric artery

What the two complications of hernias

Obstruction: resulting in colic pain, constipation , vomiting , distension


Strangulation resulting in ischaemia then necrosis then peritonitis

What caused psoas abscess

It can be primary origin or a result of spread from local sources such as pyelonephritis or IBD

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

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

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 )

What are the causes for CTS

anything that causes oedema :


1. diabetes mellitus


2. pregnancy


3. acromegaly


4, myxoedema


5. myeloma


6, RA

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

What are some causes of exudativr pleural effusion

Infection


Invasive : malignancy


Inflammation : SLE or RA


Infarction : Dressler’s syndrome

What are some features of an innocent murmur

Soft


Systolic


Symptomless


Short


Standing sitting variation

What are some features of an innocent murmur

Soft


Systolic


Symptomless


Short


Standing sitting variation

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

What are 3 cardio causes of clubbing

Atrial myxoma


Endocarditis


Cyanotic congential heart disease

What are some respiratory causes for clubbing

Tb


Bronchiectesis


Lung carcinoma


Asbestosis

What are some complications of diabetic neuropathy

Ulceration


Cellulitis


Gangrene


Chariots arthropathy


Osteomyelitis

What is the triple swab

Swab 1 “HVS” (charcoal) : tv, bv , candida


Swab 2 “ECS” : gonorrhoea


Swab 3 “ECS” chlamydia

Causes of aortic stenossi

Bicuspid aortic valve


Calcification degeneration

What are indications for surgery in aortic stenosis

Symptomatic


HF


Means transvalvular pressure gradient of greater than 40


Valve area < 1 cm2


Concomitant CABG

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

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

How long does a valve replacement last

Aortic mechanical : life long


Mitral mechanical : life long

How can you tell if a valve replacement has failed

?

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

What are the indication foR CABG

Left stem disease


2 or more vessel disease


Failure of medical management


Aortic valve replacement

What vessels are used in bypass grafting

Great saphenous


Internal thoracic vein

What medication would u exprect some to take post CABG

Dual anti platelets


Clopidogreal for 12 months then aspirin alone


Beta blocker


Ace inhibitor

What are some differentials for pansystolic murmur

Mitral regurg


Vsd


Tricuspid regurg ( COr pulmonale)

What are the causes of mitral regurg

Chronic


Degeneration


LV dysfuntion


Ehler danos


Acute


Infective endocarditis


Papillary muscle rupture ( post MI)!

What are the causes of right sided

MI


Pulmonary embolism


Left ventricular failure


Cor pulmonale

Causes of LVF

MI


Ischaemic cardiomyopathy


VALVULAR HEART DISEASE


Hypertensive cardiomyopathy

When is spironolactone given in HF

NYHA class 3

What procedures will you see a rooftop scar

Liver transplant


Whipples procedure

What are some causes of pyoderma gangrenosum

IBD


RA


haem malignancy


Primary biliary cirrhosis

Causes of cirrhosis

NAFLD


HEP C


ALCOHOL

What are the features of liver disease decompensation

Coagulopathy


Axterixis


Ascites


Worsening jaundice


Hypoglycaemia

Complication of cirrhosis

Encephalopathy


Liver cancer


Coagulopathy


Portal htn


Variceal haemorrhage


SBP


Thrombocytopenia

What are the causes of splenomegaly

Chronic myeloid


Myelofibrosjs


Malaria


EBV


Spherocytosjs ( Caucasians )

What are the causes of hepatobsplenomegaly

CML


malaria


EBV


sarcoidosis

What are the indications

Traumatic rupture


ITP


spherocytosis - can have this down at 7 years old

What is the prophylaxis for splenectomy

Pneumoccocal vaccine


Meningiococcaln vaccin


hib vaccine


Pen V

Indication for renal transplant

Diabetic nephew patty


Glimerulonephritis


PKD

What are the complications of renal transplant

Rejection


Renal failure: esp of diabetes isn’t controlled


Cushing syndrome


Skin malignancy : SCC


Ciclosporin : gum hypertrophy

What the ddx for patient with stoma ?

IBD esp if young


DIVERTICULITIS - emergency situation


Malignancy


Urostomy - make sure you look at the contents

What are the extra manifestations of IBD

Eyes : episcelritis , posterior uveitis , scleritis


Skin : pyoderma g. Erythema nododdim


Clubbing oligoarthritis and anaemia

What are the complications of IBD

Crohns : strictures , obstruction and fistula


Colitis : toxic mega colon , colonic carcinoms and PSC

What are the indications for stoma in IBD

Crohns


Failure of medical management


Obstruction from strictures


Fistulae


Uc


Toxic megacolon (uc) - panprotocolectomy

What stoma will you see in Crohns

De functioning loop ileostomy

Which stoma will you see in UC

End ileostomy ( from pan proctocolectkmy )


Diversion ileostomy with ileal pouch


But can get pouchitis

What are the associayef of ADPCKD

Hepatic and pancreatic cysts


Berry aneurysm - subarachnoid ( assco with ehler danos and marfan)


Mitral valve prolapse

What are causes of bilateral renal mAsses

Autosomal dominant PKD


Renal cyst


Bilateral renal carcinoma


Amyloidosis


Tuberous sclerosis

What are the complication of ileol pouch

Pouchitis


?


? Look at passmedicine

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

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

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

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

When do you need a chest drain

Empyema


Massive harmothorax


Pneumothoraces ( large or tension ) but in 2nd intercostal space)

What is lights criteria

?

What signs indicate bulbar involvement

?

How is power graded

0 none


1 flicker


2 moves with gravity removed


3 moves against gravity


4 reduced power agasint resistance


5 normal

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

What are secondary causes of facial palsy do you know

Ramsey hunt syndrome


MG


Lyme disease

What can caused bilateral facial palsy

GBS


Lyme


sarcoidosis


MG


BILATERAL BELLS

How is PAD treated

Smoking cessation and exercise


Medical : ACEi clopidergril and statin


Surgical : bypass / angioplasty / stent / amputation

What are features of critical ischaemia

?

What are the complications of goitre

Thoracic outlet syndrome ,


Dysphagia


Upper airway instruction


Recurrent laryngeal nerve compression


SVCO

What are the complication of radio iodine

Worsening of eye disease


Late hypothyroidism

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

What are the causes of chronic venous insufficiency

?

How is chronic venous insufficiency treated

Compression bandaging


ABPI > 0.8

How are varicose veins are treated

Ultra sound especially for short saphenous


Injection sclerotherapy


Surgical stripping

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

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

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

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

What are the modifiable risk factors for asthma

Smoking


House condition ( any damp, mould or dust )


Pets

What do you ask in a diabetic type 1 history

Child should be checking for BM at least 4-5 times

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

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

What are some complications of acromegaly

Cardiomegaly


Osteoarthritis


Sleep apnoea


Carpel tunnel syndrome

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

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

What are the complications of crohns - which u would want to operate

fistula


abscess formation


strictures

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

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


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

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

What are causes of prolonged jaundice

Breast feeding


TORCH infection


hypothyroidism


Biliary atresia

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

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.

What are risk with twin pregnancy

Maternal :


Gestational diabetes and hypertension


Preeclampsia


Anaemia


Fetal:


Twins have greater mortality


Preterm delivery


IUGR

What are risk with twin pregnancy

Maternal :


Gestational diabetes and hypertension


Preeclampsia


Anaemia


Fetal:


Twins have greater mortality


Preterm delivery


IUGR


Congenital abnormalities


Malpresentation

What are the complication of monochroionicity

Twin to twin transfusion syndrome


IUGR

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

What are the investigations for MG

Single fibre electromyography


CT thorax


CK Is usually normal


Tension test : IV edrophonium reduces muscle weakness temporarily

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

What are the subtypes of JIA

Oligoarticular


systemic


Polyarticular - rheumatoid factor positive and negative


Enthesitis related arthritis


Psoriatic arthritis

What are the features of systemic onset juvenile idiopathic arthritis

Evanecent rash


Lymphadenopathy


Organomegally


Anaemia

What are some post gastrectomy syndrome

Abdominal fullness


Bilious vomiting


Dumping


Diarrhoea post gastrectomy


Anaemia

What are the drugs used to delay labour

Tocolytics - this baby AINT coming out


Atosiban


Indomethacin


Nifedipine


Terbutaline

What is the investigation and treatment for ankulosinf spondylitis

Back (Definition)

What are the causes of radial nerve lesionsbaf ste so

Saturday night palsy


Fracture of humerus


Lead poisoning

What are some causes of foot drop

Stroke


MS


Marie Charcot Tooth disease

What the causes of secondary htn?

Back (Definition)

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

What are the potential risk of urethral catheterisation ?

Trauma


Infection


Paraphimosis


Bladder spasm