16/6

Question 1

Give ddx for breast lump

Answer 1

Breast cancer

Fibroadenoma
Breast cyst
Fibrocystic changes
Ductal ectasia

Question 2

Surgery for endometrial cancer

Answer 2

Hysterectomy with bilateral oo-ophectomy

Question 3

What cancers does the COCP put you at increased risk of?

Answer 3

Breast and cervical - the ones they screen for

Question 4

What things are important to ask about when invx causes of palps

Answer 4

• Caffiene and alcohol
• Hyperthyroid - tremor, heat intolerance, agitated, weight loss, diarrhoea

Question 5

What meds to start in intermittent claudication?

Answer 5

Atorvastatin
Clopidogrel

(+ maybe HTN and diabetes meds)

Question 6

Investigation and management for angina

Answer 6

ECG
Cardio exam

Bloods for everything inc. TFTs

1. CTA

Aspirin and statin
Beta-blocker - bisoporol or CCB - verampil

Question 7

Risk factors for endometrial and cervical ca

Answer 7

Endometrial
- obesity
- nulliparty
- early menarche
- late menopause
- oestrogen-only HRT

Cervical
- COCP
- HPV
- Smoking
- multiple sexual partners

Question 8

What can cause post-coital bleeding

Answer 8

Cervical
- cervical ectropion
- cervical ca
- cervical polps

PID
STIs

Atrophic vaginitis

Question 9

Questions to ask in gynae

Answer 9

Gynae
- smears UTD?
- any abnormal findings
- periods ok? - regular? - how long? - painful/very heavy?
- anything you have seen gynae for in the past?
- any recent or lifelong STIs

Obs
- ever been pregnant before?
- any TOP or miscarriages?
- what were the births and pregnancies like?
- did you breastfeed?

Contraception
- on any contracpetion atm?
- any side effects from that?

Question 10

Graft rejection - when hyper, acute and chronic

Answer 10

Hyper - within minutes
Acute - <6 months
Chronic >6months

Question 11

How is felcainide taken?

Answer 11

Carry it with you and take when you feel symptoms coming on
for young pts with paraoxysmoal AF

Question 11

What causes steatorrhoea?

Answer 11

Fat malabsorption

• Pancreatic problem - not releasing the enzyme
• GI malabsorption
• Biliary tract problem - blockage etc

Question 11

Palps invx and management

Answer 11

Bedside
- cardio exam
- ECG

Bloods
- FBC, U+Es, LFTs, TFTs

Imaging

Special tests
- Holter monitoring (wearable ECG for 24hrs - will be fitted at the hospital - keep a diary alongside it)

Management
- dependant on cause

Paroxysmal AF = felcanide (pill in pocket) if CHADVAS - give DOAC

Episodic SVT = valsalva maneouver (popping ears technique)
- B-blockers can reduce episodes
- ablation

Question 11

What meds can cause gynaecomastia?

Answer 11

Spironlactone
Ketoconazole
Finasteride
Digoxin
Cannabis
Cimetidine
Oestrogens
Anabolic steroids

Question 11

Go over CHA2DS2VAS again

Answer 11

Congestive HF
HTN
Age >75 = 2
Diabetes
Stroke/TIA/Thromboembolism
Vascular disease
Age 65-74
Sex

Question 12

Can you do consent for operations?

Answer 12

No - consultant only

Question 12

What are the DDx for palpitations

Answer 12

Heart
- AF
- HF
- other premature ectopic beats

Hyperthyroid

Anxiety

Question 13

What kind of enema can be used to assess the patency of a reformed bowel anastomises post surgery

Answer 13

Gastrografin enema
- preferred over barium because it is less toxic in case there is a leak