Medicine - Passmed 4

Front 1

Which one of the following conditions is most likely to result in secondary dysmenorrhoea?

Adenomyosis

Polycystic ovary syndrome

Hypothyroidism

Premature ovarian failure

Bacterial vaginosis

Back 1

Adenomyosis

Front 2

Adenomyosis describes the

Back 2

extension of endometrial tissue into the uterine myometrium

Front 3

Primary dysmenorrhoea def

Back 3

is physiological

affects up to 50% women usu within 1-2 yrs of menarche

thought to be assoc with too much prostaglandin production

Front 4

Primary dysmenorrhoea fxs

Back 4

pain typically starts just before or within a few hours of the period starting

suprapubic cramping pains which may radiate to the back or down the thigh

Front 5

Primary dysmenorrhoea mgmt

Back 5

NSAID works in 80% (block PG prodxn) = 1st line

COCs = 2nd line

Front 6

2o dysmenorrhoea - is it pathological or physiological

Back 6

pathological

Front 7

is 1o dysmenorrhoea pathological or physiological

Back 7

physiological

Front 8

Secondary dysmenorrhoea typically develops many years after

Back 8

menarche and is the result of an underlying pathology

pain usually starts 3-4 days before the onset of the period

Front 9

Secondary dysmenorrhoea causes

Back 9

endometriosis

adenomyosis

pelvic inflammatory disease

intrauterine devices copper coils ONLY not MIRENA

fibroids

Front 10

A 15 year old girl presents with amenorrhoea, having never started her periods. Which element of her history would lead you to reassure her that there is no need to investigate yet?

She has not developed breasts or axillary/pubic hair

Family history of late menarche

History of acne and scanty, dark facial hair

She is sexually active

Cyclical abdominal pain

Back 10

Family history of late menarche

Front 11

Primary amenorrhoea can be diagnosed in women:

Back 11

- above the age of 14 with no secondary sexual characteristics, or

- above the age of 16 with secondary sexual characteristics

Front 12

Primary amenorrhoea is commonly constitutional and has a familial distribution; in these cases there is no anatomical or physiological abnormality and patients will generally start menstruating by age

Back 12

18yo

Front 13

1o amenorrhoea can occur with no abn/path in women who have a

Back 13

fhx of late menarche

generally will start by age 18

Front 14

Cyclical abdominal pain associated with amenorrhoea may suggest an anatomical abnormality such as an

Back 14

imperforate hymen

Front 15

Lack of breast or body hair development suggests this is true

Back 15

primary amenorrhoea and so warrants investigation

Front 16

Acne and facial hair may suggest

Back 16

virilisation, e.g. in polycystic ovarian syndrome

Front 17

In a woman who is sexually active, pregnancy may be a cause of

Back 17

amenorrhoea and should always be excluded

Front 18

Amenorrhoea may be divided into

Back 18

primary (failure to start menses by the age of 16 years) or

secondary (cessation of established, regular menstruation for 6 months or longer)

Front 19

1o amenorrhoea def

Back 19

failure to start menses by the age of 16 years

Front 20

2o amenorrhoea def

Back 20

cessation of established, regular menstruation at least 6 months

Front 21

Causes of primary amenorrhoea

Back 21

Turner's syndrome

testicular feminisation

congenital adrenal hyperplasia

congenital malformations of the genital tract

Front 22

Secondary amenorrhoea causes

Back 22

hypothalamic amenorrhoea (e.g. Stress, excessive exercise)

polycystic ovarian syndrome (PCOS)

hyperprolactinaemia

premature ovarian failure

thyrotoxicosis/hypothyroidism

Sheehan's syndrome

Asherman's syndrome (intrauterine adhesions)

Front 23

Initial investigations of Amenorrhoea

Back 23

exclude pregnancy with urinary or serum bHCG

gonadotrophins: low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)

prolactin

androgen levels: raised levels may be seen in PCOS

oestradiol

thyroid function tests

Front 24

summary of initial inV of amenorrhoea

Back 24

urine/serum bHCG

gonadotrophins - FSH & LH

prolactin

androgen levels - (PCOS = UP testosterone)

oestradiol

TFTs

Front 25

gonadotrophin

Back 25

any of a group of hormones secreted by the pituitary which stimulate the activity of the gonads

Front 26

Progesterone is the dominant ovarian hormone secreted during the

Back 26

luteal (second) phase of the menstrual cycle

Front 27

Progesterone is the dominant ovarian hormone secreted during the luteal (second) phase of the menstrual cycle. Its main function is to

Back 27

prepare the uterus for implantation of an embryo, in the event that fertilisation occurs during that cycle.

If pregnancy occurs, human chorionic gonadotropin (hCG) is released which maintains the corpus luteum, which in turn allows progesterone levels to remain raised. At approximately twelve weeks gestation, the placenta begins to produce progesterone in place of the corpus luteum. Progesterone levels decrease after delivery and during breastfeeding.

Front 28

Progesterone levels are low in women after menopause

Back 28

true

Front 29

In males almost all progesterone is converted to testosterone in the testes.

Back 29

true

Front 30

testosterone func

Back 30

development and maintenance of male sexual characteristics

stimulates anabolic processes in non-sexual tissues

Front 31

In males, LH stimulates the Leydig cells in the testes to produce

Back 31

testosterone.

A small amount of testosterone in males is produced by the adrenal glands

Front 32

In females, the majority of testosterone is produced by

Back 32

peripheral conversion of androgen precursor steroids to testosterone,

with the remainder produced in the ovaries and adrenal glands.

Front 33

to confirm preg, what do you need to test

Back 33

bHCG serum/urine ONLY

Front 34

generally what hormone do you need to test for menopause

Back 34

usu. only FSH

Front 35

Oestradiol is the principal oestrogen in

Back 35

females who are ovulating and the dominant ovarian hormone during the follicular (first) phase of the menstrual cycle

The concentration of oestradiol varies throughout the menstrual cycle. Oestradiol is released in parallel to follicular growth and is highest when the follicle matures (prior to ovulation). Oestradiol production gradually reduces if the oocyte released by the follicle is unfertilised. Laboratory testing routinely measures E2 forms of oestradiol, most of which is bound to sex hormone-binding globulin (SHBG). Oestradiol levels decrease significantly during menopause.

Front 36

In males, oestrogen is an essential part of the reproductive system, and is required for

Back 36

maturation of sperm

Primary hypogonadism (impaired response to gonadotropins including LH and FSH) can result in increased testicular secretion of oestradiol and increased conversion of testosterone to oestradiol. Obesity may also increase oestrogen levels in males. 3 An increase in the ratio of oestrogen to androgens in males is associated with gynaecomastia (the development of breast tissue).

Front 37

MEDLAB NZ provides details on lab

https://cdr.medlabcentral.co.nz/handbook/

Back 37

tests

look under collection guide

other sites

lab plus nz

lab tests

Front 38

ruby is a

Back 38

german

rubella aka german measles

Front 39

Roseola infantum

Back 39

starts as high fever

when fever goes, rash starts on face and/OR body

+- runny nose, irritability, tiredness

mainly in infancy (rare in adults)

saliva via person to person transmission

Front 40

Roseola is a disease caused by

Back 40

human herpes virus type 6B (HHV-6B) and possibly type 7 (HHV-7)

Front 41

Roseola infantum key fx

Back 41

fever followed later by rash

Front 42

Roseola infantum also known as

Back 42

exanthem subitum, occasionally sixth disease

Front 43

Roseola infantum fxs

Back 43

high fever: lasting a few days, followed by a

maculopapular rash

febrile convulsions occur in around 10-15%

diarrhoea and cough are also commonly seen

Front 44

Other possible consequences of HHV6 infection

Back 44

aseptic meningitis

hepatitis

Front 45

A 24-year-old heroin addict is admitted following an overdose. He is drowsy and has a respiratory rate of 6 / min. Which of the following arterial blood gas results (taken on room air) are most consistent with this?

Back 45

pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa

This patient is likely to have developed a respiratory acidosis secondary to hypoventilation.

Front 46

opioid OD will cause what changes on ABG

Back 46

respiratory acidosis secondary to hypoventilation.

E.G. pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa

Front 47

Respiratory acidosis may be caused by a number of conditions

Back 47

COPD

decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema

sedative drugs: benzodiazepines, opiate overdose

Front 48

A 19-year-old female presents complaining of visual disturbance. Examination reveals a bitemporal hemianopia with predominately the lower quadrants being affected. What is the most likely lesion?

Back 48

Craniopharyngioma

Front 49

A 17 year old girl presents with a history of amenorrhoea, having never started her period. On further questioning she has developed secondary sexual characteristics, such as growth of breast tissue and pubic hair. She also complains of pelvic pain and some bloating.Which of the following is likely to be the cause?

Back 49

Imperforate hymen

Front 50

An imperforate hymen would

Back 50

block passage of menses, causing amenorrhoea without affecting development of secondary characteristics such as pubic hair and breast development. This can cause a build up of menstrual blood in the vagina (haematocolpos), causing pelvic pain and bloating through a pressure effect.

Front 51

IMPERFORATE hymen effect

Back 51

amenorrhoea

no effect on d/t of 2o sex. characteristics

build up of menstrual blood in the vag (haematocolpos) causes:

- pelvic pain

- bloating due to pressure effect

Front 52

Chemotherapy at a young age has the potential to damage the

Back 52

hypothalamic-pituitary-ovarian axis

Front 53

while Turner's syndrome can cause

Back 53

premature ovarian failure

Front 54

Excessive exercise and/or rapid loss of body weight can also cause

Back 54

a reduction in oestrogen secretion

Front 55

You are fast-bleeped to the respiratory ward to review a 70-year-old man with known chronic obstructive pulmonary disease (COPD) who has become 'unresponsive'. On arrival you note the following:Airwayoropharyngeal airway already in-situBreathingrespiratory rate 6/minoxygen saturations 99% on 15 l/min oxygenCirculationheart rate 96/minblood pressure 88/60 mmHgAnother doctor has already taken arterial blood gases (on 15 l/min oxygen):pH7.15pCO214.5 kPapO217.1 kPaBicarbonate34.5 mmol/lBase excess+10.6 mmol/lWhat do the arterial blood gases show?

Back 55

Acute-on-chronic respiratory acidosis with a partial metabolic compensation

Front 56

Overgrowth of which one of the following organisms is most likely to cause bacterial vaginosis?

Back 56

predominately Gardnerella vaginalis (anaerobe)

This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

Front 57

is bacterial vaginosis and STI

Back 57

no, but seen mainly in sexually active women

Front 58

fxs of bacterial vaginosis (BV)

Back 58

vaginal discharge: 'fishy', offensive

asymptomatic in 50%

Front 59

Amsel's criteria for diagnosis of BV - 3 of the following 4 points should be present

Back 59

thin, white homogenous discharge

clue cells on microscopy: stippled vaginal epithelial cells

vaginal pH > 4.5

positive whiff test (addition of potassium hydroxide results in fishy odour)

Front 60

MGMT OF BV

Back 60

ORAL metronidazole

Front 61

Bacterial vaginosis in pregnancy

Back 61

increased risk of:

- preterm labour,

- low birth weight and chorioamnionitis, late miscarriage

it was previously taught that oral metronidazole should be avoided in the first trimester and topical clindamycin used instead. Recent guidelines however recommend that oral metronidazole is used throughout pregnancy. The BNF still advises against the use of high dose metronidazole regimes

Front 62

A 65 year old gentleman with known multiple myeloma presents with abdominal pain, polydipsia and confusion. Some blood results are shown below.

px has hypercalcemia, hypernatremia

What is the most important initial management of his symptoms?

Back 62

IV 0.9% saline

he has polydipsia, and is likely to be dehydrated

he is also sxmatic

Front 63

Hypercalcaemia: management

Back 63

initial = normal saline (rehydration)

next +- bisphosphonates

other options

- calcitonin (quicker effect to bis)

- steroids in sarcoidosis

Front 64

organic vs non organic cause of dis/illness

Back 64

organic cause relates to a cause assoc with physical or physiological change to some tissue or organ of the body

non organic cause = psyc cause

Front 65

A conversion disorder causes patients to

Back 65

suffer from neurological symptoms, such as numbness, blindness, paralysis, or fits without a definable organic cause

thought that sxs arise in response to stressful situations affecting the pxs mental health

Front 66

A 18-year-old sprinter who is currently preparing for a national athletics meeting asks to see the team doctor due to an unusual sensation in his legs. He describes a numb sensation below his knee. On examination the patient there is apparent sensory loss below the right knee in a non-dermatomal distribution. The team doctor suspects a non-organic cause of his symptoms. This is an example of a:

Back 66

Conversion disorder

Front 67

Somatisation disorder fxs

Back 67

multiple physical SYMPTOMS present for at least 2 years

patient refuses to accept reassurance or negative test results

Front 68

Hypochondrial disorder fxs

Back 68

persistent belief in the presence of an underlying serious DISEASE, e.g. cancer

patient again refuses to accept reassurance or negative test results

Front 69

diffference b/w munchausen syndrome and malingering

Back 69

munchausen = making up sxs for psych gain of playing a sick role

malingering = making up or exaggerating sxs for material GAIN

Front 70

Dissociative disorder

Back 70

separating certain memories from normal consciousness

includes psyc sxs

Front 71

Dissociative disorder vs dissociative identity disorder (DID)

Back 71

dissociative identity disorder (DID) is the new term for multiple personality disorder

as is the most severe form of dissociative disorder

Front 72

A 35-year-old female who has recently being diagnosed with Grave's disease presents for review 3 months after starting a 'block and replace' regime with carbimazole and thyroxine. She is concerned about developing thyroid eye disease. What is the best way that her risk of developing thyroid eye disease can be reduced?

Back 72

Stop smoking

Front 73

most important modifiable risk factor for the development of thyroid eye disease is

Back 73

STOP SMOKING

Front 74

A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy is reviewed on the haematology ward. She has been admitted by her GP with a fever of 38.9ºC. Her blood count from two days ago was as follows:

low Hb, WBC, neutrophils and lymphocytes

elevated platelets

Blood pressure is 102/66 mmHg and the heart rate is 96/min. Respiratory examination is unremarkable. You insert an intravenous cannula and take bloods including cultures. What is the most appropriate next step in management?

Back 74

Start intravenous piperacillin with tazobactam (Tazocin)

dx = Neutropenic sepsis

Front 75

Neutropenic sepsis is a common complication of

Back 75

CHEMO for cancer

Front 76

Neutropenic sepsis def

Back 76

neutrophil count of < 0.5 * 109 in px getting anticancer chemo and one of the following:

- high fever >38 or

- other signs/sxs of clinically sig. sepsis

Front 77

in chemo cancer pxs suspected of having neutropenic sepsis - what can be given as prophylaxis

Back 77

fluoroquinolone

Front 78

Neutropenic sepsis mgmt

Back 78

Empirical Abx STAT (dont wait for WBC)

=piperacillin with tazobactam (Tazocin)

next specialist help

no response

= +- meropenem +- vanc

still no response

= inV fungal infxns

+- G-CSF

Front 79

whats the initial mgmt of neutropenic sepsis

Back 79

Empirical Abx STAT (dont wait for WBC) =

piperacillin with tazobactam (Tazocin)

Front 80

You are counselling a 24-year-old woman who has just found out she is pregnant. She currently smokes 20 cigarettes/day. Which one of the following is most associated with smoking during pregnancy?

Neonatal abstinence syndrome

Microcephaly

Pre-eclampsia

Increased risk of pre-term labour

Postnatal restricted growth

Back 80

Increased risk of pre-term labour

Front 81

Pregnancy and drugs

Smoking increases the risk of

Back 81

miscarriage

pre-term labour

stillbirth

IUGR

sudden unexpected death in infancy

Front 82

Alcohol in preg increases the risk of

Back 82

FAS

learning difficulties

characteristic facies:smooth philtrum, thin vermilion, small palpebral fissures

IUGR & postnatal restricted growth

microcephaly

Binge drinking is a major risk factor for FAS

Front 83

Cannabis in preg increases the risk of

Back 83

Similar to smoking risks due to tobacco content

Front 84

Cocaine in preg increases the risk of

Back 84

Maternal risks

= HTN incl preeclampsia

= placental abruption

Fetal risk

= prematurity

= neonatal abstinence syndrome

Front 85

Heroin in preg increases the risk of

Back 85

= neonatal abstinence sydrome

Front 86

Which one of the following patients should not automatically beprescribed a statin in the absence of any contraindication?

Back 86

A 47-year-old man with well controlled diabetes mellitus type 2 with a 10-year cardiovascular risk of 9%

Front 87

should you give a statin to this px

A 51-year-old man who had a myocardial infarction 4 years ago and is now asymptomatic

Back 87

yes

Front 88

should you give a statin to this px

A 57-year-old female smoker with a 10-year cardiovascular risk of 23%

Back 88

yes

Front 89

should you give a statin to this px

A 53-year-old man with intermittent claudication

Back 89

yes

Front 90

should you give a statin to this px

A 62-year-old man who had a transient ischaemic attack 10 months ago

Back 90

yes

Front 91

statin moa

Back 91

inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis

Front 92

Who should receive a statin?

Back 92

all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)

Front 93

Who should receive a statin?

Back 93

NICE recommend anyone with a 10-year cardiovascular risk >= 10%

Front 94

Who should receive a statin?

Back 94

patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins

Front 95

what does most of cholesterol synthesis take place in us

Back 95

at night as this is when the majority of cholesterol synthesis takes place

thus statin should be taken at night too

This is especially true for simvastatin which has a shorter half-life than other statins

Front 96

A 52-year-old woman presents with pruritus and lethargy. She has recently put on weight and is complaining about dry skin

Back 96

Hypothyroidism

Front 97

A 57-year-old woman presents with pruritus. She states she has been gaining weight despite eating less and complains of constant nausea. On examination she is pale

Back 97

Chronic kidney disease

Front 98

A 59-year-old man complains of pruritus and lethargy. On examination he has spoon shaped nails and a smooth tongue

Back 98

Iron deficiency anaemia

Front 99

main characteristics of the most important causes of pruritus

Back 99

liver dis

iron def anaemia

polycythemia

chronic kidney dis

lymphoma

Other causes:

hyper- and hypothyroidism

diabetes

pregnancy

'senile' pruritus

urticaria

skin disorders: eczema, scabies, psoriasis, pityriasis rosea

Front 100

Liver disease fxs

Back 100

History of alcohol excess

Stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynaecomastia etc

Evidence of decompensation: ascites, jaundice, encephalopathy

Front 101

Iron deficiency anaemia fxs

Back 101

Pallor

Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

Front 102

Polycythaemia fxs

Back 102

Pruritus particularly after warm bath

'Ruddy complexion'

Gout

Peptic ulcer disease

Front 103

Chronic kidney disease fxs

Back 103

Lethargy & pallor

Oedema & weight gain

Hypertension

Front 104

Lymphoma fxs fxs

Back 104

Night sweats

Lymphadenopathy

Splenomegaly, hepatomegaly

Fatigue

Front 105

elicit the triceps reflex by placing arm across her chest and striking the triceps tendon with a tendon hammer.

Which nerve (and its nerve root) are you testing?

Back 105

Radial nerve C7

Front 106

radial nerve info

Back 106

The radial nerve innervates the triceps muscle. It is primarily derived from the C7 nerve root.The radial nerve is the motor supply to the extensor compartments of the upper arm. The triceps muscle is the chief extensor of the forearm. Its name derives from its three heads of origin; the long, lateral and medial heads. It attaches into the olecranon of the ulna.It is these components which form the triceps reflex arc.

Front 107

Musculocutaneous nerve (C5-C7)

Back 107

MOTOR

Elbow flexion (supplies biceps brachii) and supination

SENSORY

Lateral part of the forearm

Typical mechanism of injury & notes

Isolated injury rare - usually injured as part of brachial plexus injury

Front 108

Axillary nerve (C5,C6)

Back 108

MOTOR

Shoulder abduction (deltoid muscle)

SENSORY

Inferior region of the deltoid muscle

Typical mechanism of injury & notes

Humeral neck fracture/dislocation

Results in flattened deltoid

Front 109

DOES musculocutaneous or axillary nerve injury lead to flat deltoid

Back 109

AXILLARY NERVE

Front 110

Radial nerve (C5-C8)

Back 110

MOTOR

Extension (forearm, wrist, fingers, thumb)

SENSORY

Small area between the dorsal aspect of the 1st and 2nd metacarpals

Typical mechanism of injury & notes

Humeral midshaft fracture

Palsy results in wrist drop

Front 111

Median nerve (C6, C8, T1)

Back 111

MOTOR

LOAF mus

Features depend on the site of the lesion:

- wrist: paralysis of thenar muscles, opponens pollicis

- elbow: loss of pronation of forearm and weak wrist flexion

SENSORY

Palmar aspect of lateral 3½ fingers

Typical mechanism of injury & notes

Wrist lesion → carpal tunnel syndrome

Front 112

*LOAF muscles

Back 112

Lateral two lumbricals

Opponens pollis

Abductor pollis brevis

Flexor pollis brevis

Front 113

Ulnar nerve (C8, T1)

Back 113

MOTOR

Intrinsic hand muscles except LOAF*

Wrist flexion

SENSORY

Medial 1½ fingers

Typical mechanism of injury & notes

Medial epicondyle fracture

Damage may result in a 'claw hand'

Front 114

Long thoracic nerve (C5-C7)

Back 114

MOTOR

serratus anterior

SENSORY = NON

Typical mechanism of injury & notes

Often during sport e.g. following a blow to the ribs. Also possible complication of mastectomy

Damage results in a winged scapula

Front 115

Erb-Duchenne palsy ('waiter's tip') PALSY

Back 115

damage to C5, C6

arm hangs by the side and is internally rotated, elbow extended

DAVID HAS ERBS

Front 116

Klumpke injury

Back 116

C8, T1 damage

Front 117

A 45-year-old man presents with a painful swelling on the posterior aspect of his elbow. There is no history of trauma. On examination an erythematous tender swelling is noted. What is the most likely diagnosis?

Back 117

Olecranon bursitis

Front 118

Olecranon bursitis

Back 118

Swelling over the posterior aspect of the elbow.

There may be associated pain, warmth and erythema.

It typically affects middle-aged male patients.

Front 119

The causes of clubbing may be divided into cardiac, respiratory and other

Back 119

Cardiac causes

cyanotic congenital heart disease (Fallot's, TGA)

bacterial endocarditis

atrial myxoma

Respiratory causes

lung cancer

pyogenic conditions: cystic fibrosis, bronchiectasis, abscess, empyema

tuberculosis

asbestosis, mesothelioma

fibrosing alveolitis

Other causes

Crohn's, to a lesser extent UC

cirrhosis, primary biliary cirrhosis

Graves' disease (thyroid acropachy)

rare: Whipple's disease

Front 120

A 3-year-old child is brought to surgery as her mother has noticed that she is 'cross-eyed'. The corneal light reflection test confirms this. What is the most appropriate management?

Back 120

Refer to ophthalmology

Front 121

Refer children with a squint immediately to

Back 121

ophthalmology

Front 122

squint aka

Back 122

strabismus

Front 123

Squint (strabismus) is characterised by

Back 123

misalignment of the visual axes IE CROSS EYED

Squints may be divided into concomitant (common) and paralytic (rare)

Front 124

Squints may be divided into

Back 124

oncomitant (common) and paralytic (rare)

Front 125

Concomitant SQUINT

Back 125

Due to imbalance in extraocular muscles

Convergent is more common than divergent

Front 126

Paralytic SQUINT

Back 126

Due to paralysis of extraocular muscles

Front 127

SQUINT DX

Back 127

made by the corneal light reflection test -

holding a light source 30cm from the child's face to see if the light reflects symmetrically on the pupils

Front 128

The cover test is used to identify the nature of the squint

Back 128

ask the child to focus on a object

cover one eye

observe movement of uncovered eye

cover other eye and repeat test

Front 129

SQUINT MGMT

Back 129

eye patches may help prevent amblyopia

referral to secondary care is appropriate

Front 130

A 27-year-old man presents with a nocturnal cough and a feeling of wheeziness when he plays football. He is a non-smoker and generally fit and well. He has no pets and works as an accountant. There is no history of asthma or any other respiratory problems as a child. Respiratory examination today is unremarkable.According to British Thoracic Society (BTS) guidelines, what is the most appropriate next step to investigate the possibility of asthma?

Give him a trial of a salbutamol inhaler

Arrange spirometry

Prescribe a peak flow meter and ask him to keep a diary

Back 130

Arrange spirometry

Front 131

The British Thoracic Society (BTS) recommend reversibility testing for adults and children with asthma

Back 131

reversibility testing for all adult patients with suspected asthma, regardless of the probability

children, tests of reversibility are generally only used when there is a low or intermediate probability of asthma.

Front 132

BTS recommend classifying pxs as either

Back 132

a high, intermediate or low probability of asthma

based on the presence or absence of certain symptoms:

Front 133

for adults dx of asthma

Back 133

hx then exam

then spirometry (or PEF if not available)

next +- reversibility testing

Front 134

Features which make a diagnosis of asthma more likely

Back 134

More than one of the following symptoms: wheeze, breathlessness, chest tightness and cough, particularly if:

-symptoms worse at night and in the early morning

-symptoms in response to exercise, allergen exposure and cold air

-symptoms after taking aspirin or beta blockers

History of atopic disorder

Family history of asthma and/or atopic disorder

Widespread wheeze heard on auscultation of the chest

Otherwise unexplained low FEV1 or PEF (historical or serial readings)

Otherwise unexplained peripheral blood eosinophilia

Front 135

Features which make a diagnosis of asthma less likely

Back 135

Prominent dizziness, light-headedness, peripheral tingling

Chronic productive cough in the absence of wheeze or breathlessness

Repeatedly normal physical examination of chest when symptomatic

Voice disturbance

Symptoms with colds only

Significant smoking history (ie > 20 pack-years)

Cardiac disease

Normal PEF or spirometry when symptomatic

Front 136

if px has many of the fxs which make a diagnosis of asthma more likely =

Back 136

high prob of asthma = start trial of tx aka reversability testing

- if good response = +ve revers. testing

- if poor response = further inV

intermediate prob = further inV + reversibility testing

low prob = further InV +- resp specialist referral

Front 137

whats the most important initial asthma tx?

Back 137

Patients should start treatment at the step most appropriate to the initial severity of their asthma

Front 138

indications for asthmatic using inhaled steroids

Back 138

exacerbations of asthma in the last two years

using inhaled β2 agonists three times a week or more

symptomatic three times a week or more

waking one night a week

Front 139

in terms of dx asthma adult pxs if px is low, intermediate, high risk what should you do

Back 139

low = further InV +- resp spec. referral

intermediate = further inV + reversibility testing

high = reversibility testing

Front 140

so for dx of asthma px you need to first take a history and exam so you can

Back 140

risk stratify ie low, intermed, high

after you risk stratify - follow the dx process

Front 141

in terms of reversibility what is considered sig

Back 141

> 400 ml improvement in FEV1 is considered significant

- in a px before and after inhaled salbutamon with dx uncertain and airflow obstrxn

- if they dont respond to inhaled salbutamol, and then you give ICS or oral prednisolone

Front 142

is this infective exacerbation of COPD

or is it LV failure

Back 142

Left ventricular failure

Front 143

pul edema fxs on CXR

Back 143

bat's wing appearance

alveolar oedema

interstitial oedem

aleft pleural effusion

upper lobe diversion

Front 144

pul edema is most commonly cause by

Back 144

Left ventricular failure

Front 145

A 25 -year-old female presents to her GP with heavy painful bleeding during menstruation. She does not wish to have contraception. Which of the following is most suitable?

Back 145

Naproxen

Front 146

Tranexamic acid would be effective for

Back 146

menorrhagia but not help the dysmenorrhoea.

Front 147

The intrauterine system is of course a very effective treatment for

Back 147

menorrhagia and is often used as first line treatment for this condition

Front 148

Norethisterone is useful for helping combat flooding for short periods of time

Back 148

true

Front 149

whats the first line tx for menorrhagia

Back 149

intrauterine system (Mirena) should be considered first-line

Front 150

2-month-old girl is brought to surgery with poor feeding and vomiting. Mother reports that her urine has a strong smell. A urinary tract infection is suspected. What is the most appropriate management?

Back 150

Refer immediately to hospital

Front 151

InV of UTI in infants/children

Back 151

urine sample - clean catch preferable

Front 152

mgmt of UTI in infants <3months

Back 152

should be referred immediately to a paediatrician

Front 153

mgmt of UTI in infants > 3 months upper UTI

Back 153

admit

if not admitted start oral abx (cephs/augmentum)

Front 154

mgmt of UTI in infants> 3 months lower UTI

Back 154

outpx tx with abx

trimethoprim, nitrofurantoin, cephalosporin or amoxicillin

Front 155

antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs

Back 155

true

Front 156

A 4-week-old child is brought to clinic with a red rash on her scalp associated with yellow flakes. What is the most likely diagnosis?

Back 156

Seborrhoeic dermatitis

Front 157

Seborrhoeic dermatitis is a relatively common skin disorder

Back 157

seen in children

Front 158

Seborrhoeic dermatitiscommon skin disorder seen in children. It typically affects the

Back 158

scalp ('Cradle cap'), nappy area, face and limb flexures.

Front 159

Seborrhoeic dermatitis in children whats one of the first signs of this

Back 159

Cradle cap is an early sign which may develop in the first few weeks of life.

It is characterised by an erythematous rash with coarse yellow scales.

Front 160

Seborrhoeic dermatitis in children

mgmt

Back 160

depends on severity

mild-moderate: baby shampoo and baby oils

severe: mild topical steroids e.g. 1% hydrocortisone

Front 161

Seborrhoeic dermatitis in children tends to resolve spontaneously by around 8 months of age

Back 161

true

Front 162

A 46-year-old woman presents to surgery complaining of a dry mouth and dry eyes for the past 6 months. She has also generalised arthralgia and is more tired than normal. Which one of the following autoantibodies is most associated with primary Sjogren's syndrome?

anti-RNP

Anti-Ro

Anti-smooth muscle

Anti-centromere

Anti-Sm

Back 162

Anti-Ro

Front 163

Sjogren's syndrome def

Back 163

autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces

Front 164

Sjogren's syndrome

Back 164

It may be primary (PSS) or secondary to rheumatoid arthritis or other connective tissue disorders, where it usually develops around 10 years after the initial onset.

Sjogren's syndrome is much more common in females (ratio 9:1).

There is a marked increased risk of lymphoid malignancy (40-60 fold)

Front 165

Sjogren's syndrome sig increases the risk of

Back 165

lymphoid malig 40-60x

Front 166

inV for sjogrens syndrome

Back 166

RF +ve in nearly 100% pxs

ANA +ve 70%

anti-RO 70%

anti-La 30%

Schirmer's test: filter paper near conjunctival sac to measure tear formation

histology: focal lymphocytic infiltration

also: hypergammaglobulinaemia, low C4

Front 167

mgmt of sjogrens syndrome

Back 167

artificial saliva and tears

pilocarpine may stimulate saliva production

Front 168

A newly qualified staff nurse at the local hospital undergoes vaccination against hepatitis B. The following results are obtained three months after completion of the primary course:

Anti-HBs10 - 100 mIU/ml

What is the most appropriate course of action?

Back 168

Give one further dose of hepatitis B vaccine

Front 169

px given hep b immunisation:

Anti-HBs level (mIU/ml)> 100

Back 169

Indicates adequate response, no further testing required. Should still receive booster at 5 years

Front 170

px given hep b immunisation:

Anti-HBs level (mIU/ml)10 - 100

Back 170

Suboptimal response - one additional vaccine dose should be given.

If immunocompetent no further testing is required

Front 171

px given hep b immunisation:

Anti-HBs level (mIU/ml) < 10

Back 171

Non-responder. Test for current or past infection.

Give further vaccine course (i.e. 3 doses again) with testing following.

If still fails to respond then HBIG would be required for protection if exposed to the virus

Front 172

Management of chronic hepatitis B in nz

Back 172

Peginterferon alfa first line

Front 173

Complications of hepatitis B infection

Back 173

chronic hepatitis (5-10%)

fulminant liver failure (1%)

hepatocellular carcinoma

glomerulonephritis

polyarteritis nodosa

cryoglobulinaemia

Front 174

The features of hepatitis B include fever, jaundice and elevated liver transaminases.

Back 174

true

Front 175

Meig's syndrome is a triad of

Back 175

ascites, pleural effusion and benign ovarian tumor

(fibroma,Brenner tumour and occasionally granulosa cell tumour)

Front 176

Pleural effusion

Back 176

Exudate (> 30g/L protein)

Transudate (< 30g/L protein)

Front 177

Pleural effusion

Exudate (> 30g/L protein) causes

Back 177

infection: pneumonia, TB, subphrenic abscess

connective tissue disease: RA, SLE

neoplasia: lung cancer, mesothelioma, metastases

pancreatitis

pulmonary embolism

Dressler's syndrome

yellow nail syndrome

Front 178

Pleural effusion

Transudate (< 30g/L protein)

Back 178

heart failure

hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)

hypothyroidism

Meigs' syndrome

Front 179

A 52-year-old female presents with weakness and pins and needles in her right hand. On examination she has wasting of the thenar eminence associated with sensory loss to the palmar aspect of lateral (radial) three fingers. Which nerve is likely to be affected?

Back 179

Median nerve

Front 180

Anterior interosseous nerve (branch of median nerve)

Back 180

leaves just below the elbow

results in loss of pronation of forearm and weakness of long flexors of thumb and index finger

Front 181

Patterns of damage of median nerve

Back 181

Damage at wrist

e.g. carpal tunnel syndrome

paralysis and wasting of thenar eminence muscles

sensory loss to palmar aspect of lateral (radial) 3 1/2 fingers

Damage at elbow, as above plus:

unable to pronate forearm

weak wrist flexion

ulnar deviation of wrist

Anterior interosseous nerve (branch of median nerve)

leaves just below the elbow

results in loss of pronation of forearm and weakness of long flexors of thumb and index finger

Front 182

One particular mole is noted due to the irregular border. It is 6 * 4 mm in size.

What is the most appropriate action?

Back 182

Refer under the two-week rule to dermatology

Front 183

Malignant melanoma: prognostic factors

Back 183

The invasion depth of a tumour (Breslow depth) is the single most important factor in determining prognosis of patients with malignant melanoma

Front 184

The invasion depth of a tumour (Breslow depth)

Back 184

true

Front 185

whatsthe single most important factor in determining prognosis of patients with malignant melanoma

Back 185

invasion depth of a tumour (Breslow depth)

Front 186

Breslow Thickness

< 1 mm

Back 186

Approximate 5 year survival

95-100%

Front 187

Breslow Thickness 1 - 2 mm

Back 187

Approximate 5 year survival80-96%

Front 188

Breslow Thickness2.1 - 4 mm

Back 188

Approximate 5 year survival60-75%

Front 189

Breslow Thickness> 4 mm

Back 189

Approximate 5 year survival50%

Front 190

A 78 year old lady with known type 2 diabetes presents with a 1 week history of polydipsia, feeling generally unwell and drowsy. On examination she looks very dehydrated and is difficult to rouse. She appears confused when she does talk to you.Admission bloods show: Na+149 mmol/lK+5.2 mmol/lUrea22.1 mmol/lCreatinine254 µmol/lHer blood glucose is 36 mmol/L. What's the most important first management step?

Back 190

Rehydrate with 0.9% Saline

Front 191

DM2 px with polydipsia, generally unwell and drowsy, dehydrated, confused, hypernatremic develops renal failure, sig raised serum glucose

dx and mgmt

Back 191

HONK

first mgmt step = REHYDRATE with 0.9 % saline

Front 192

HONK is

Back 192

hyperosmolar non-ketotic

Front 193

HONK is characterised by:

Back 193

1.) Severe hyperglaycaemia

2.) Dehydration and renal failure

3.) Mild/absent ketonuria

Front 194

HONK has a mortality of

Back 194

50%

Front 195

This partly because of its' insidious onset but also because many cases occur in newly diagnosed type 2 diabetics. The mortality of HONK occurs from complications of the hyperosmolar state namely;

Back 195

rhabdomyolysis, venous thromboembolism, lactic acidosis, hypertriglyceridaemia, renal failure, stroke and cerebral oedema.

Front 196

precipitants of HONK. Precipitants include:

Back 196

New diagnosis of type 2 diabetes

Infection

High dose steroids

Myocardial infarction

Vomiting

Stroke

Thromboembolism

Poor treatment compliance

Front 197

The central management of HONK is

Back 197

supportive care and slow metabolic resolution

Front 198

avoid rapid fluid r/t in HONK pxs why

Back 198

rapid osmolar shifts can cause cerebral oedema.

Front 199

mgmt of HONK

Back 199

fluid resus with 0.9% Saline

next insulin sliding scale

Front 200

Hyperosmolar hyperglycaemic state (HHS) is confirmed by:

Back 200

Dehydration

Osmolality >320mosmol/kg

Hyperglycaemia >30 mmol/L with pH >7.3, bicarbonate >15mmolL and no significant ketonenaemia <3mmol/L

Front 201

dx

Back 201

Left lower lobe collapse

left lower lobe collapses medially and posteriorly behind the heart.

The classic result is a triangular opacity giving the heart an unusually straight border.

Front 202

When assessing a patient with suspected chronic obstructive pulmonary disease, which one of the following is least relevant?

Back 202

Peak expiratory flow

Front 203

Peak expiratory flow is of no value in the diagnosis of

Back 203

COPD

Front 204

COPD dx

Back 204

clinical - SOB, CHRONIC COUGH, regular sputum prodxn

SPIROMETRY

CXR

FBC (exclude 2o polycythemia)

BMI

Front 205

A 64-year-old man with a history of Parkinson's disease is reviewed in clinic and a decision has been made to start him on cabergoline. Which one of the following adverse effects is most strongly associated with this drug?

Back 205

Pulmonary fibrosis

Front 206

Parkinson's disease: management

Back 206

delay treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist.

If the patient is elderly, levodopa is sometimes used as an initial treatment.

Front 207

Parkinson's disease: management

Dopamine receptor agonists

Back 207

Bromocriptine, ropinirole, cabergoline, apomorphine,pergolide

Front 208

ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide*) have been associated with

Back 208

pulmonary, retroperitoneal and cardiac fibrosis

The Committee on Safety of Medicines advice that an echocardiogram, ESR, creatinine and chest x-ray should be obtained prior to treatment and patients should be closely monitored

Front 209

Dopamine receptor agonists AE

Back 209

pulmonary, retroperitoneal and cardiac fibrosis

impulse control disorders and excessive daytime somnolence

hallucinations in elderly

nasal congestion and postural hypotension

Front 210

Levodopa

Back 210

is dopamine analog

usually combined with a decarboxylase inhibitor (e.g. carbidopa or benserazide) to prevent peripheral metabolism of levodopa to dopamine

Front 211

Levodopa AE

Back 211

dyskinesia (involuntary writhing movements), 'on-off' effect, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsiness

Front 212

MAO-B (Monoamine Oxidase-B) inhibitors

Back 212

e.g. Selegiline

inhibits the breakdown of dopamine secreted by the dopaminergic neurons

Front 213

Amantadine

Back 213

mechanism is not fully understood, probably increases dopamine release and inhibits its uptake at dopaminergic synapses

Front 214

Amantadine AE

Back 214

include ataxia, slurred speech, confusion, dizziness and livedo reticularis

Front 215

COMT (Catechol-O-Methyl Transferase) inhibitors

Back 215

e.g. Entacapone, tolcapone

COMT is an enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy

used in conjunction with levodopa in patients with established PD

Front 216

Antimuscarinics

Back 216

block cholinergic receptors

now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson's disease

help tremor and rigidity

e.g. procyclidine, benzotropine, trihexyphenidyl (benzhexol)

Front 217

if a px had a drug induced parkinsonism what would you give them

Back 217

?antimuscarinic

Front 218

You are called to see a 25-year-old 10 week pregnant lady in the Emergency Department complaining of abdominal pain and heavy vaginal bleeding. Her observations are normal and she is afebrile, on ultrasound a fetal heart rate is still present and the uterus is the size expected. On examination her cervical os is closed. How would you classify her miscarriage?

Back 218

Threatened

Front 219

miscarriage

MTIICR

MyTIICRuel

Back 219

missed = no bleeding & empty sac

threatened = bleeding & closed c. os

inevitable = open c. os

incomplete = preg. tissue partially expelled

complete = all preg tissue expelled

recurrent = >= 3 consec miscarriages <22 wees

Front 220

CREST syndrome is a subtype of

Back 220

Limited cutaneous systemic sclerosis

Front 221

Please look at the hands of this 50-year-old lady. She complains of tight, stiff fingers that turn white in the cold.

DX

Back 221

Limited cutaneous systemic sclerosis

Front 222

Limited cutaneous systemic sclerosis remember a subtype of this is

Back 222

CREST syndrome

Front 223

Systemic sclerosis is a condition of

Back 223

unknown cause characterised by hardened, sclerotic skin and other connective tissues

Front 224

There are three patterns of disease:

Back 224

Limited cutaneous systemic sclerosis

Diffuse cutaneous systemic sclerosis

Scleroderma (without internal organ involvement)

Front 225

Limited cutaneous systemic sclerosis

Back 225

Raynaud's may be first sign

scleroderma affects face and distal limbs predominately

associated with anti-centromere antibodies

a subtype of limited systemic sclerosis is:

CREST syndrome: Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

Front 226

Diffuse cutaneous systemic sclerosis

Back 226

scleroderma affects trunk and proximal limbs predominately

associated with scl-70 antibodies

hypertension, lung fibrosis and renal involvement seen

poor prognosis

Front 227

Scleroderma (without internal organ involvement)

Back 227

tightening and fibrosis of skin

may be manifest as plaques (morphoea) or linear

Front 228

scleroderma

Back 228

scleroderma

Front 229

Systemic sclerosis

InV of antibodies

Back 229

ANA positive in 90%

RF positive in 30%

anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis

anti-centromere antibodies associated with limited cutaneous systemic sclerosis

Front 230

breakdown CREST

Back 230

systemic sclerosis is the umbrella dis

- one type (of the 3 types) of this is:

Limited cutaneous systemic sclerosis

one subtype of this is:

- CREST syndrome

Front 231

Slipped upper femoral epiphysis

SUUUUUU FAT

Back 231

typically an overweight adolescent boy with knee / hip problems

Front 232

You review a 47-year-old woman who was diagnosed with breast cancer two years ago. She has been 'off her legs' since yesterday and cannot walk more than a few steps. What is the most common and early feature of spinal cord compression?

Constipation

Reduced sensation in the perianal area

Back pain

Urinary hesitancy

Leg weakness

Back 232

Back pain

Front 233

Spinal cord compression - whats the EARLIEST AND MOST COMMON SX

Back 233

BACK PAIN

Front 234

Spinal cord compression affects what proportion of met cancer pxs

Back 234

5%

It is more common in patients with lung, breast and prostate cancer

Front 235

Spinal cord compression fxs

Back 235

back pain +- worse on lying down and coughing

lower limb weakness

sensory changes: sensory loss and numbness

neurological signs depend on the level of the lesion.

Front 236

Spinal cord compression fxs

neurological signs depend on the level of the lesion

Back 236

lesion above L1 = usu. UMN

lesion below L1 = usu LMN signs in legs and perianal numbness

Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

Front 237

Spinal cord compression mgmt

Back 237

high-dose oral dexamethasone

urgent oncological assessment for consideration of radiotherapy or surgery

Front 238

You review a 42-year-old woman six weeks following a renal transplant for focal segmental glomerulosclerosis. Following the procedure she was discharged on a combination of tacrolimus, mycophenolate, and prednisolone. She has now presented with a five day history of feeling generally unwell with anorexia, fatigue and arthralgia. On examination her sclera are jaundiced and she has widespread lymphadenopathy with hepatomegaly. What is the most likely diagnosis?

Back 238

Cytomegalovirus

Front 239

Cytomegalovirus is the most common and important viral infection in

Back 239

solid organ transplant recipients

Front 240

A woman who is 8 weeks pregnant presents with abdominal pain and vaginal bleeding. On examination she is tender in the right iliac fossa and suprapubic region. Speculum examination shows an open cervical os. Ultrasound confirms an intrauterine pregnancy.

Back 240

This lady is likely to be having an inevitable miscarriage.

Front 241

A woman who is 33 weeks pregnant presents with vaginal bleeding, which she describes as being like a period. She also has constant, lower abdominal pain. On assessment her blood pressure is 90/60 mmHg and pulse is 110/min

Back 241

Placental abruption

Front 242

Placental praevia would not usually present with abdominal pain.

Back 242

true

Front 243

A woman who is 22 weeks pregnant presents with abdominal pain on the right side of her abdomen. On examination she has abdominal tenderness on the right side and urine dipstick is normal. White blood cells are raised at 18.5 * 109/l

Back 243

Appendicitis

nb Ovarian torsion should be considered but would not normally be associated with such a leucocytosis.

Front 244

whatis the single most important cause of abdominal pain to exclude in early pregnancy

Back 244

ectopic preg

Front 245

ectopic preg

Risk factors (anything slowing the ovum's passage to the uterus)

Back 245

damage to tubes (salpingitis, surgery)

previous ectopic

IVF (3% of pregnancies are ectopic)

Front 246

A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding

describes

Back 246

ectopic preg

Front 247

Abdominal pain early in pregnancy - causes

Back 247

ectopic preg

miscarriage

Front 248

Abdominal pain later in pregnancy - causes

Back 248

labour

placental abruption

symphysis pubis dysf

pre-eclampsia/HELLP syndrome

uterine rupture

Front 249

abdo pain at any point in preg - cause

Back 249

appendicities

UTI

Front 250

labour fxs

Back 250

Regular tightening of the abdomen which may be painful in the later stages

Front 251

placental abruption

separation of placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

Back 251

shock out of keeping with visible loss

pain constant

tender, tense uterus

normal lie and presentation

fetal heart: absent/distressed

coagulation problems

beware pre-eclampsia, DIC, anuria

Front 252

Symphysis pubis dysfunction

Back 252

Ligament laxity increases in response to hormonal changes of pregnancy

Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen

Front 253

Pre-eclampsia/HELLP syndrome

Back 253

Associated with hypertension, proteinuria.

Patients with HELLP also have haemolysis, elevated liver enzymes and a low platelet count.

The pain is typically epigastric or in the RUQ

Front 254

Uterine rupture

Back 254

Ruptures usually occur during labour but occur in third trimester

Risk factors:

previous caesarean section

Presents with maternal shock, abdominal pain and vaginal bleeding to varying degree

Front 255

key FX FOR UTERINE RUPTURE

remember it has the usu. abo pain, mum shock, and bleeding

Back 255

PREVIOUS C SXN

LATE IN PREG.

Front 256

UTI during preg is assoc with

Back 256

increased risk of pre-term delivery and IUGR

4% incidence

Front 257

whats themost common non-obstetric surgical emergency in preg

Back 257

appendicitis

Higher morbidity and mortality in pregnancy

Front 258

An 80-year-old gentleman on a care of the elderly ward has developed diarrhoea. Stool samples have isolatedClostridium difficile. The patient has been moved to a side room and is being barrier nursed. Which is the most likely medication contributing to his diarrhoea?

Clindamycin

Gentamicin

Vancomycin

Clarithromycin

Rifampicin

Back 258

Clindamycin

Front 259

Clostridium difficile is a gram positive, spore forming anaerobic bacterium which can cause

Back 259

colitis in susceptible individuals.

Front 260

Although any antibiotic can contribute to Clostridium difficile diarrhoea, which ones are the main culprits

Back 260

broad spectrum antibiotics (for example clindamycin, cephalosporins, penicillins and fluoroquinolones)

Front 261

broad spectrum antibiotics (for example clindamycin, cephalosporins, penicillins and fluoroquinolones) are the main contributing medications disrupting the normal bowel flora, and enabling

Back 261

clostridium difficile overgrowth

Front 262

define broad spec antibiotics

Back 262

acts against both gram +ve and -ve bact

Front 263

empirically def

Back 263

(i.e., based on the experience of the practitioner), prior to the formal identification of the causative bacteria, when there is a wide range of possible illnesses and a potentially serious illness would result if treatment is delayed

Front 264

broad spectrum antibiotics for example

Back 264

clindamycin, cephalosporins, penicillins and fluoroquinolones

Front 265

Vancomycin is frequently used in the treatment of clostridium difficile diarrhoea, along with metronidazole.

Back 265

true

give orally

Front 266

Proton pump inhibitors (for example omeprazole, lansoprazole) are another group of medications thought to contribute to clostridium difficile diarrhoea.

Back 266

true

Front 267

c. diffproduces an exotoxin which causes intestinal damage leading to a syndrome called

Back 267

pseudomembranous colitis

Front 268

whats the most common cause of c diff assoc with antibiotic use

Back 268

Second and third generation cephalosporins are now the leading cause of Clostridium difficile.

Front 269

dx of c diff

Back 269

stool sample

= detecting Clostridium difficile toxin (CDT)

Front 270

first line tx for c diff

Back 270

oral metronidazole for 10-14 days

unresponsive = try oral vanc

if life threatening you can use both

= IV met and oral van

Front 271

A 53-year-old man presents complaining of an itchy scalp and dandruff. On examination he is noted to have eczema on his scalp, behind his ears and around his nose.

He has tried 'Head and Shoulders' and 'Neutrogen T-gel' but with poor results. Which one of the following is the most appropriate treatment for his scalp?

Back 271

topical ketoconazole

Front 272

Seborrhoeic dermatitis in adults

aka dandruff mgmt - 1st line

Back 272

over the counter preparations containing zinc pyrithione ('Head & Shoulders') and tar ('Neutrogena T/Gel') are first-line

Front 273

Seborrhoeic dermatitis in adultsaka dandruff mgmt - 2nd line

Back 273

Topical ketoconazole

nb selenium sulphide and topical corticosteroid may also be useful

Front 274

Seborrhoeic dermatitis in adults

Back 274

is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale)

Front 275

Seborrhoeic dermatitis thought to be caused by

Back 275

malassezie furfur = fungus

Front 276

Seborrhoeic dermatitis in adults fxs

Back 276

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds

otitis externa and blepharitis may develop

Front 277

Seborrhoeic dermatitis in adults

Associated conditions include

Back 277

HIV

Parkinson's disease

Front 278

Face and body management

Back 278

topical antifungals: e.g. Ketoconazole

topical steroids: best used for short periods

difficult to treat - recurrences are common

Front 279

You see a 6 week-old baby boy for his routine baby check. You are unable to palpate the right testicle on examination, though the left is present. What should you do?

Back 279

Watch and wait

Front 280

Undescended testicles is a common finding on

Back 280

examination of the newborn

Front 281

Undescended testicles is a common finding on examination of the newborn

so what should you do if you dont find it

Back 281

Try to 'milk' the testis down the inguinal canal -

if it can be brought in to the scrotum it is retractile rather than undescended

Front 282

undescended testis is common in newborn examination, it will usu. descend by

Back 282

6 months of age

so arrange r/v towards end of their first year

Front 283

if px has undescended still by 1yo - whats the mgmt

Back 283

orchidopexy

Front 284

Bilateral impalpable testes at birth should raise suspicions of problems such as

Back 284

congenital adrenal hyperplasia and urgent paediatric review should be sought.

Front 285

Undescended testis fxs

Back 285

occurs in around 2-4% of term male infants.,

but is much more common if the baby is preterm.

Around 25% of cases are bilateral

Front 286

Complications of undescended testis

Back 286

infertility

torsion

testicular cancer

psychological

Front 287

Management of undescended testis

Back 287

orchidopexy: referral should be considered from around 6 months of age.

Surgical practices vary although the majority of procedures are performed at around 1 year of age

Front 288

dx

Back 288

Lentigo maligna

The asymmetrical nature of the lesion would however point away from a diagnosis of solar lentigo

Front 289

Lentigo maligna

Back 289

Lentigo maligna

Front 290

Dermatofibroma

Back 290

Dermatofibroma

Front 291

Dermatofibroma

Back 291

downlaod

Front 292

Solar lentigo

Back 292

Solar lentigo

Front 293

Solar lentigo

Back 293

Solar lentigo

Front 294

Solar lentigo

Back 294

Solar lentigo

Front 295

Bowen's disease

Back 295

Bowen's disease

Front 296

Bowen's disease

Back 296

Bowen's disease

Front 297

Bowen's disease

Back 297

Bowen's disease

Front 298

Lentigo maligna

Back 298

Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

Front 299

A 66-year-old woman presents to her GP with a 2 month history of abdominal bloating, early satiety, urinary urgency and symptoms of both constipation and diarrhoea. She has never experienced this before and has no past medical history. Her only family history is of breast cancer, of which both her mother and sister died. Abdominal examination is unremarkable. What is the next step in her management?

Back 299

Measure CA-125

Front 300

The National Institute for Health and Care Excellence (NICE) recommends that women with symptoms of ovarian cancer, especially if over 50 years, should have tests in primary care.

NICE defines symptoms as:

Back 300

persistent abdominal distension (bloating)

early satiety or loss of appetite

pelvic/abdominal pain

increased urinary frequency and/or urgency

Front 301

if px has abdo bloating, early satiety, urinary urgency and constipation and diarrhoea

with fhx of breast cancer of mother and sister

abdo exam normal - what next step in mgmt

Back 301

Measure CA-125

Front 302

so if px has sxs suggestive of ovary cancer + fhx, but exam normal, next

Back 302

Measure CA-125

if this is elevated next do:

- US abdo & pelvis

next if suggestive of ovarian cancer:

- 2 week wait referral to gynaecology should be made

Front 303

so if px has sxs suggestive of ovary cancer + fhx, but exam shows ascites and palpable mass

mgmt

Back 303

2 week wait referral to gynaecology should be made

Front 304

Ovarian cancer is the fifth

Back 304

most common malignancy in females.

Front 305

Around 90% of ovarian cancers are

Back 305

epithelial in origin.

Front 306

Ovarian cancer prognosis

Back 306

generally poor due to late dx

Front 307

Ovarian cancer risk factors

Back 307

fhx: mutations of the BRCA1 or the BRCA2 gene

many ovulations: early menarche, late menopause, nulliparity

Front 308

Ovarian cancer

Clinical features are notoriously vague

Back 308

abdominal distension and bloating

abdominal and pelvic pain

urinary symptoms e.g. Urgency

early satiety

diarrhoea

Front 309

ovarian cancer dx

Back 309

Diagnosis is difficult and usually involves diagnostic laparotomy

Front 310

A 19-year-old man presents with a compound fracture of his leg following a fall from scaffolding. Examination reveals soiling of the wound with mud. He is sure he has had five previous tetanus vaccinations. What is the most appropriate course of action to prevent the development of tetanus?

Back 310

Clean wound + intramuscular human tetanus immunoglobulin

Front 311

px has compound #, gets dirty, they've had tetanus vaccine in past - mgmt

Back 311

Clean wound + intramuscular human tetanus immunoglobulin

+- Abx

Front 312

fitzpatrick skin type classfication

Back 312

goes form white to darker

Front 313

A 17 year old male presents with a new skin condition which his mum noticed when they were on holiday in Spain. On examination, he has skin type V, with multiple small patches of depigmentation to the upper back. The patches appear mildly flaky but they are asymptomatic. He is usually well, and has never had this condition before. Which of the following is the most likely diagnosis?

Back 313

Pityriasis versicolor

Front 314

Pityriasis versicolor

Back 314

Pityriasis versicolor

Front 315

Pityriasis versicolor

Back 315

Pityriasis versicolor

Front 316

Guttate psoriasis

Back 316

Guttate psoriasis

Front 317

Guttate psoriasis

Back 317

Guttate psoriasis

Front 318

pityriasis rosea

Back 318

pityriasis rosea

Front 319

pityriasis rosea

Back 319

pityriasis rosea

Front 320

pityriasis rosea

Back 320

pityriasis rosea

Front 321

Pityriasis versicolor, also called

Back 321

tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

Front 322

Pityriasis versicolor mgmt

Back 322

topical antifungal

if extensive disease or failure to respond to topical treatment then consider oral itraconazole

Front 323

CURB65 what are the values

Back 323

ALL 1 POINT

Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less

Front 324

A 37 year old women presents to you in general practice. She has a one year history of right wrist pain. The pain is exacerbated by flexion and she rates it as 7 on the pain score. She has trialled pain medication with no great success. On examination there is no evidence of synovitis. A small effusion is present in the right wrist. Onycholysis is noted. There is purple plaques present over the extensor surfaces of the elbows bilaterally. What is the clinical diagnosis?

Back 324

Psoriatic arthritis

Front 325

Psoriatic arthritis strong associations with

Back 325

psoriasis.

remember it affects DIP

and has sausage fingers

Front 326

Psoriatic arthropathy MGMT

Back 326

tx same as RA

BUT BETTER PROGNOSIS

Front 327

a preg post term occurs when

Back 327

42 weeks

Postmaturity is the condition of a baby that has not yet been born after 42 weeks of gestation, two weeks beyond the normal 40

Front 328

A 60-year-old man asks you to have a look at a 'sore' on his right ear.

It has been present for around 6 months and is not painful. What is the most likely diagnosis?

Back 328

Actinic keratosis

Front 329

Actinic, or solar, keratoses (AK) is a common

Back 329

premalignant skin lesion that develops as a consequence of chronic sun exposure

Front 330

actinic keratoses fxs

Back 330

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

Front 331

Actinic keratosesManagement options include

Back 331

prevention - sun avoidance/cream

fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation

topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects

topical imiquimod: trials have shown good efficacy

cryotherapy

curettage and cautery

Front 332

Which one of the following statements regarding hepatitis A is false?

Back 332

It is a DNA virus

Front 333

true facts about hep A

Back 333

Has an incubation period of 2-4 weeks

Doesn't cause chronic hepatitis

May cause hepatosplenomegaly

A vaccine is available

RNA picornavirus

Front 334

are there any complications of hep A

Back 334

RARE

NO HEP CANCER

Front 335

A 33-year-old woman visits her general practitioner complaining of inability to conceive after two years of trying with a regular partner. She has a body mass index of 28 kg/m² and an existing diagnosis of polycystic ovarian syndrome. Which of the following drugs is most likely to help restore normal ovulation in this case?

Back 335

Metformin

Front 336

first line tx for PCOS pxs struggling to conceive

Back 336

lose weight

Front 337

if PCOS px fails to lose weight for trying to conceive - next tx

Back 337

metformin

nb

Thyroxine might help a hypothyroid patient conceive

Front 338

dx

Back 338

Black hairy tongue

Black hairy tongue is relatively common condition which results from defective desquamation of the filiform papillae. Despite the name the tongue may be brown, green, pink or another colour.

Predisposing factors

poor oral hygiene

antibiotics

head and neck radiation

HIV

intravenous drug use

The tongue should be swabbed to exclude Candida

Management

tongue scraping

topical antifungals if Candida

Front 339

first line tx for tinea pedis aka athletes foot

Back 339

topical imidazole, undecenoate, or terbinafine first-line

Front 340

A 27-year-old woman presents with painful genital ulceration. She has had recurrent attacks for the past four years. Oral aciclovir has had little effect on the duration of her symptoms. She has also noticed for the past year almost weekly attacks of mouth ulcers which again are slow to heal. Her only past medical history of note is being treated for thrombophlebitis two years ago. What is the most likely diagnosis?

Back 340

Behcet's syndrome

Front 341

Back 341

Behcet's syndrome

Front 342

Behcet's syndrome is a complex multisystem disorder associated with presumed

Back 342

autoimmune mediated inflammation of the arteries and veins

actual cause unknown

Front 343

Behcet's syndrome classic triad

Back 343

oral ulcers, genital ulcers and anterior uveitis

+- thrombophlebitis

Front 344

Behcet's syndrome epi

Back 344

tends to affect young men

30% +ve fhx

associated with HLA B5* and MICA6 allele

Front 345

Behcet's syndrome fxs

Back 345

classically: 1) oral ulcers 2) genital ulcers 3) anterior uveitis

thrombophlebitis

arthritis

neurological involvement (e.g. aseptic meningitis)

GI: abdo pain, diarrhoea, colitis

erythema nodosum, DVT

Front 346

Behcet's syndrome dx

Back 346

no definitive test

diagnosis based on clinical findings

positive pathergy test is suggestive (puncture site following needle prick becomes inflamed with small pustule forming)

Front 347

What is the most common identified trigger of anaphylaxis in children?

Back 347

food

Front 348

A woman presents to her GP complaining of bleeding after sexual intercourse. What is the most common identifiable cause of postcoital bleeding?

Back 348

Cervical ectropion

Front 349

Cervical ectropion is the most common identifiable cause of postcoital bleeding

Back 349

true

Front 350

Cervical ectropion

Back 350

(or cervical eversion) is a condition in which the central (endocervical) columnar epithelium protrudes out through the external os of the cervix

and onto the vaginal portion of the cervix, undergoes squamous metaplasia, and transforms to stratified squamous epithelium.

Front 351

Postcoital bleeding causes

Back 351

no identifiable pathology is found in around 50% of cases

cervical ectropion is the most common identifiable causes, causing around 33% of cases. This is more common in women on the combined oral contraceptive pill

cervicitis e.g. secondary to Chlamydia

cervical cancer

polyps

trauma

Front 352

A 42-year-old woman is admitted to hospital with pyrexia and a productive cough. Around 10 days ago she developed symptoms consistent with a flu-like illness. For around 4-5 days she was in bed with myalgia, fever and lethargy. Initially there was an improvement in her condition but over the past three days she has developed a cough productive of thick pink-yellow sputum. On examination there are scattered crackles in the right base. A chest x-ray confirms pneumonia. Which one of the following organisms is more common in patients who have recently had influenza?

Back 352

Staphylococcus aureus

Front 353

There is a high incidence of Staphylococcus aureus pneumonia in patients following

Back 353

influenza

Front 354

whats the most common cause of CAP

Back 354

strep pneumonia 80%

Front 355

if a px with a flu then gets CAP whats the likely cause

Back 355

STAPH AUREUS

Front 356

herpes labialis

Back 356

(also called cold sores, fever blisters, herpes simplex labialis, recurrent herpes labialis, or orolabial herpes) :

is a type ofherpes simplex occurring on the lip, i.e. an infection caused by herpes simplex virus (HSV).

An outbreak typically causes small blisters or sores on or around the mouth.

Front 357

Characteristic features of pneumococcal pneumonia

Back 357

rapid onset

high fever

pleuritic chest pain

herpes labialis

Front 358

low or moderate severity CAP mgmt

Back 358

oral amoxicillin outpx

+macrolide if admitted

Front 359

high severity CAP

Back 359

intravenous co-amoxiclav + clarithromycin OR cefuroxime + clarithromycin OR cefotaxime + clarithromycin

Front 360

Skin disorders affecting the soles of the feet

Back 360

Verrucas

Tinea pedis

Corn and calluses

Keratoderma

Pitted keratolysis

Palmoplantar pustulosis

Juvenile plantar dermatosis

Front 361

What is the single most useful test for determining the cause of her hypercalcaemia?

Back 361

Parathyroid hormone

Front 362

The most common causes of hypercalcaemia are

Back 362

malignancy (bone metastases, myeloma, PTHrP from squamous cell lung cancer) and

primary hyperparathyroidism

Front 363

other causes of hypercalcemia include

Back 363

sarcoidosis*

vitamin D intoxication

acromegaly

thyrotoxicosis

Milk-alkali syndrome

drugs: thiazides, calcium containing antacids

dehydration

Addison's disease

Paget's disease of the bone**

Front 364

A 21-year-old female presents for review. She is 14 weeks pregnant and has been seen by the midwives for her booking visit. There have been no pregnancy related problems to date. Tests taken revealed the following:Blood group:A Rhesus negative

What is the most appropriate management regarding her rhesus status?

Back 364

Give first dose of anti-D at 28 weeks

Front 365

Rhesus negative woman rule

Back 365

anti-D at 28 + 34 weeks

Front 366

A 2-month-old girl is brought in by her mother. She was breastfed for the first two weeks of life before being switched to formula. For the past six weeks she has experienced a number of problems including regurgitation, vomiting, diarrhoea and eczema. Despite these problems she has kept to the 50th centile for weight. Clinical examination is unremarkable other than some dry skin on her torso. What is the most likely diagnosis?

Back 366

Cow's milk protein intolerance

Front 367

The emergence of symptoms following the introduction of formula is very suggestive of

Back 367

cow's milk protein intolerance.

Front 368

Cow's milk protein intolerance/allergy

dx

Back 368

often clinical (e.g. improvement with cow's milk protein elimination).

Investigations include:

skin prick/patch testing

total IgE and specific IgE (RAST) for cow's milk protein

Front 369

Cow's milk protein intolerance/allergy

Back 369

severe = peds referral

Management if formula-fed

extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptomsamino acid-based formula (AAF) in infants with severe CMPA or if no response to eHFaround 10% of infants are also intolerant to soya milk

Management if breast-fed

continue breastfeedingeliminate cow's milk protein from maternal dietuse eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months

Front 370

A primiparous 31 year-old women who is at 14 weeks gestation has a cardiac arrest. What is the most likely cause of cardiac arrest in early pregnancy?

Back 370

Ruptured ectopic pregnancy

Front 371

What is the most likely cause of cardiac arrest in early pregnancy?

Back 371

Ruptured ectopic pregnancy causing hypovolemia

Front 372

Ectopic pregnancy

Back 372

Implantation of a fertilized ovum outside the uterus results in an ectopic pregnancy

Front 373

Ectopic pregnancyRisk factors (anything slowing the ovum's passage to the uterus)

Back 373

damage to tubes (salpingitis, surgery)

previous ectopic

endometriosis

IUCD

progesterone only pill

IVF (3% of pregnancies are ectopic)

Front 374

You review a 47-year-old man one year after he was diagnosed with prediabetes. Last year he had a HbA1c taken after being diagnosed as having hypertension. This was recorded as being 43 mmol/mol (6.1%). His most recent blood test is recorded as being 45 mmol/mol (6.3%) despite the patient reporting that he has changed his diet as instructed and exercising three times a week. His body mass index (BMI) today is 26.5 kg/m². Last year it was 27.5kg/m². What is the most appropriate course of action?

Back 374

Start metformin

Front 375

start metformin, even in pxs who are likely to get DM2

Back 375

DESPITE lifestyle changes

Front 376

which one of the following variables is not required by the Modification of Diet in Renal Disease (MDRD) equation?

Back 376

Serum urea

Front 377

eGFR variables

Back 377

CAGE - Creatinine, Age, Gender, Ethnicity

Front 378

Serum creatinine may not provide an accurate estimate of renal function due to differences in muscle.

Back 378

For this reason formulas were develop to help estimate the glomerular filtration rate

namely estimated GFR or eGFR

Front 379

The most commonly used formula is the Modification of Diet in Renal Disease (MDRD) equation, for measuring eGFR

which uses the following variables:

Back 379

CAGE

Factors which may affect the result

pregnancy

muscle mass (e.g. amputees, body-builders)

eating red meat 12 hours prior to the sample being taken

Front 380

CKD may be classified according to GFR:

Back 380

its in other cards

Front 381

A 2-year-old girl develops a rash on her legs. The next day she is brought to surgery, by which time the rash has spread to the rest of her body. dx

Back 381

Erythema multiforme

Front 382

Erythema multiforme

Features

Back 382

target lesions

initially seen on the back of the hands / feet before spreading to the torso

upper limbs are more commonly affected than the lower limbs

pruritus is occasionally seen and is usually mild

Front 383

Erythema multiforme causes

Back 383

viruses: herpes simplex virus (the most common cause), Orf*

idiopathic

bacteria: Mycoplasma, Streptococcus

drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine

connective tissue disease e.g. Systemic lupus erythematosus

sarcoidosis

malignancy

Front 384

Polymorphic eruption of pregnancy is not associated with blistering

Back 384

Pemphigoid gestationis does have blisters

Front 385

Polymorphic eruption of pregnancy is not associated with blistering

Back 385

Pemphigoid gestationis does have blisters

Front 386

A 30-year-old female in her third trimester of pregnancy mentions during an antenatal appointment that she has noticed an itchy rash around her umbilicus. This is her second pregnancy and she had no similar problems in her first pregnancy. Examination reveals blistering lesions in the peri-umbilical region and on her arms. What is the likely diagnosis?

Back 386

Pemphigoid gestationis

Front 387

A 38 year old man presents with a sudden onset rash. He is otherwise well in himself and has no notable past medical history. You see from his notes he has had a recent tonsillitis for which he received amoxicillin. On examination, there are multiple papules on his trunk and proximal extremities. There is a fine scale on several of these lesions. What is the most likely diagnosis?

Back 387

Guttate psoriasis

Front 388

Polymorphic eruption of pregnancy is not associated with blistering

Back 388

Pemphigoid gestationis does have blisters

Front 389

A 30-year-old female in her third trimester of pregnancy mentions during an antenatal appointment that she has noticed an itchy rash around her umbilicus. This is her second pregnancy and she had no similar problems in her first pregnancy. Examination reveals blistering lesions in the peri-umbilical region and on her arms. What is the likely diagnosis?

Back 389

Pemphigoid gestationis

Front 390

A 38 year old man presents with a sudden onset rash. He is otherwise well in himself and has no notable past medical history. You see from his notes he has had a recent tonsillitis for which he received amoxicillin. On examination, there are multiple papules on his trunk and proximal extremities. There is a fine scale on several of these lesions. What is the most likely diagnosis?

Back 390

Guttate psoriasis

Front 391

It can occur as the first presentation of psoriasis or as an acute exacerbation of plaque psoriasis, particularly after acute streptococcal infection (usually of the throat) or viral infection.

Which condition is this

Back 391

Guttate psoriasis

Front 392

violaceous border suggests

Back 392

Pyoderma gangrenosum

Front 393

A 62-year-old female is referred to dermatology by her GP due to a lesion over her shin. It initially started as a small red papule which later became a deep, red, necrotic ulcer with a violaceous border. What is the likely diagnosis?

Back 393

Pyoderma gangrenosum

Front 394

The differential diagnosis of shin lesions includes the following conditions:

Back 394

erythema nodosum

pretibial myxoedema

pyoderma gangrenosum

necrobiosis lipoidica diabeticorum

Front 395

The differential diagnosis of shin lesions includes the following conditions:

Back 395

erythema nodosum

pretibial myxoedema

pyoderma gangrenosum

necrobiosis lipoidica diabeticorum

Front 396

On examination the lesions are consistent with erythema nodosum. You arrange some baseline investigations. What is the most appropriate management?

Back 396

No active treatment, arrange routine follow-up

Front 397

Erythema nodosum is inflammation of the

Back 397

Subcut 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

Front 398

Erythema nodosum causes

Back 398

infection: streptococci, TB, brucellosis

systemic disease: sarcoidosis, inflammatory bowel disease, Behcet's

malignancy/lymphoma

drugs: penicillins, sulphonamides, combined oral contraceptive pill

pregnancy

Front 399

A 19-year-old female who has just started work as a cleaner presents with a rash on her hands. On examination there is a generalised erythematous rash on the dorsum of both hands. There is no evidence of scaling or vesicles. What is the most likely diagnosis?

Back 399

Irritant contact dermatitis

Front 400

2 types of contact dermatitis

Back 400

Irritant and allergic

Front 401

2 types of contact dermatitis

Back 401

Irritant and allergic

Front 402

Irritant dermatitis

Back 402

The strong alkalis and acids found in cleaning solutions are common triggers of irritant contact dermatitis

Front 403

Allergic contact dermatitis

Back 403

often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid is indicated

Front 404

Reactive arthritis skin manifestations

Back 404

skin:

circinate balanitis (painless vesicles on the coronal margin of the prepuce),

keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

Front 405

A 45-year-old woman presents for review. She has noticed a number of patches of 'pale skin' on her hands over the past few weeks. The patient has tried using an emollient and topical hydrocortisone with no result. On examination you note a number of hypopigmented patches on the dorsum of both hands. Her past medical history includes thyrotoxicosis for which she takes carbimazole and thyroxine. What is the most likely causes of her symptoms?

Back 405

Vitiligo

Front 406

Reactive arthritis skin manifestations

Back 406

skin:

circinate balanitis (painless vesicles on the coronal margin of the prepuce),

keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

Front 407

A 45-year-old woman presents for review. She has noticed a number of patches of 'pale skin' on her hands over the past few weeks. The patient has tried using an emollient and topical hydrocortisone with no result. On examination you note a number of hypopigmented patches on the dorsum of both hands. Her past medical history includes thyrotoxicosis for which she takes carbimazole and thyroxine. What is the most likely causes of her symptoms?

Back 407

Vitiligo

Front 408

Which one of the following medications is most likely to have exacerbated his psoriasis?

Back 408

Atenolol

Front 409

The following factors may exacerbate psoriasis:

Back 409

trauma

alcohol

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

withdrawal of systemic steroids

Front 410

The following factors may exacerbate psoriasis:

Back 410

trauma

alcohol

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

withdrawal of systemic steroids

Front 411

The following factors may exacerbate psoriasis:

Back 411

trauma

alcohol

drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

withdrawal of systemic steroids

Front 412

A diagnosis of pityriasis versicolor is suspected. Which one of the following is the most appropriate treatment?

Back 412

Topical ketoconazole

Front 413

Pityriasis versicolor, also called tinea versicolor, is a

Back 413

superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

Front 414

Pityriasis versicolor, also called tinea versicolor, is a caused by a

Back 414

Fungis

Just remember its tinea versicolor

So tx is topical ketoconazole

Front 415

A 32 year old lady attends with a facial rash for several weeks. She has an erythematous rash which looks greasy and has a fine scale over her face affecting her cheeks, naso-labial folds, eye brows, nasal bridge and scalp. What is the most likely diagnosis?

Back 415

Seborrhoeic dermatitis

Front 416

Acne rosecea vs Seborrhoeic dermatitis

Back 416

involvement of the naso-labial folds differentiates it from acne rosacea which typically spares this area and tends to include telangiectasia and pustules.

Front 417

Acne rosecea vs Seborrhoeic dermatitis

Back 417

involvement of the naso-labial folds differentiates it from acne rosacea which typically spares this area and tends to include telangiectasia and pustules.