1
Q
pMonitoring Lithium
A
Lithium levels weekly then 3/12 once stable.
TFT, UE, calcium every 6, 6, 12.
2
Q
Apixaban monitoring
A
Fba, U+E Lft 12m
6m if >75 or renal impairment
Clotting at start
3
Q
Methotrexate monitoring
A
FBC, LFT, U+E- every 2w for 6w
Every 1m for 3m
Every 3m
4
Q
Meds CI in pregnancy
A
SAFER WMT
Sulphonamide, statin
Aminoglycosides and ACEi
Fluroquinolones
Epileptics- pheno, barb
Retinoids
Warfarin
Methotrexate
Trimethoprim/tetra
5
Q
Mx of placenta abruption
A
Foetal distress- emergency CS
<37- CS
>37- induce
6
Q
Differentiating TS and VHL
A
TS- hypopigmentated skin, epilepsy- no phaeo
VHL- neuro, adrenal, kidney tumours
7
Q
Mx of PND
A
> 13
Mild to mod- self help or CBT
Mod-severe- high level CBT
SSRI if patient preference or CBT fails- sertraline, paroxetine
8
Q
Testing for vWD
A
PFA 100
9
Q
Ix for SAH
A
CT head - if within 6hrs no more required
If longer- LP
10
Q
Mx of GAD
A
Mild- mod- self help, group CBT
Mod- severe- individual CBT, SSRI
Continue SSRI 12m after symptoms resolve
11
Q
Mx panic disorder
A
Mild- self help
Mod- CBT or SSRI
Continue SSRI 6m after symptoms resolves
12
Q
Mx of BN
A
1st- BN focused self help
2nd- CBT ED
Children- family therapy BN
13
Q
Mx of AN
A
CBT ED
MANTRA
14
Q
Preoccupation with body image + normal eating pattern
A
Body Dysmorphic Disorder
15
Q
Mx of PTSD
A
1st- trauma focused CBT or EMDR
2nd - add sertraline or 1st if depressed
3rd risperidone
16
Q
Flashbacks nightmares 3 weeks from crash
A
Acute stress (if <4w, PTSD >4w)
17
Q
Scoring for depression
A
PHQ9
>/=16 severe
<16 less severe
18
Q
Mx of mania
A
Antipsychotic- if fails alternative
Then lithium 3rd
19
Q
Mx of bipolar
A
Either lithium or antipsychotic during manic episode
20
Q
Mx of drooling with clozapine
A
Hyoscine
21
Q
When to FU after starting SSRI in <30
A
1w
22
Q
Mx of OCD
A
Limited function risk-low intensity CBT with ERP
Moderate- high intensity with ERP or SSRI
Severe- both
23
Q
Management of Personality disorders
A
DBT
24
Q
Schizoid PD
A
Cold, lacks interest in relationships
25
Organism for meningitis by age
<25 N mening
>25 strep pneumoniae
26
Galactocele vs blocked duct
Galactocele- painless, express milk if squeezed
Blocked- white dot and tender
27
Mx of IBS
1st-Mebeverine
2nd- Low dose TCA
28
Mx of Whooping cough
Macrolides
29
Myelopathy vs radiculopathy
Myelo- bilateral, UMN, Lhmette - urgent decompression
Radic- LMH, uni, Spurling
30
Sickle cell organism in septic arthritis
Salmonella non typhi
31
APS mx if not pregnant
Warfarin +/- aspirin
32
Polyarthritis, myositis, Oesophageal dysmotility
anti-U1 ribonucleoprotein antibodies
Mixed Connective Tissue Disease (MCTD)
Sharps syndrome
33
Osteoma, Osteochondroma and giant cell tumour features
Osteoma
Benign skull overgrowth; seen in Gardner syndrome
Osteochondroma Most common; cartilage-capped bony projection
Giant cell tumour
Occurs at epiphyses of long bones; “double bubble” sign on X-ray
34
C6 impingement features
Reduced elbow flexion and bicep reflex
35
Mx and Ix for dermatomyositis
CS and ix for malignancy
36
Mx of De quervains tenosynovitis
NSAIDs and splint
37
Mx of carpal tunnel
Mild/mod- splint and CS injection
Severe- nerve studies and decompression
38
Features of flexor tendon infection and mx
Finger held in flexion
Fusiform swelling (uniform swelling along the finger)
Tenderness along the flexor tendon sheath
Pain on passive extension of the digit
Urgent -Surgical irrigation and drainage
39
Features of plantar fasciitis
Heel pain
Worse after rest and flexion of 1st MTP
40
Lump over DIP joint + clear fluid leakage
Myxoid cyst (associated with OA)
41
Test to confirm gout
Serum urate
42
Ix for SUFE
AP and frog leg XR
43
Osteopetrosis, Osteitis fibrosa cystica and osteogenesis imperfecta features
Osteopetrosis- thick bones, but fragile
Osteitis Fibrosa Cystica- osteopenia, cysts due to hyperPTH
Osteogenesis imperfecta- Recurrent childhood fractures, Blue sclera, Hearing loss / dental abnormalities
44
Pseudoxanthoma Elasticum features
Plucked chicken, upper GI bleed
45
Familial med fever sx
Fever, pleuritis, peritonitis, arthritis
Erysipeloid rash on legs
46
Mx of Pagets
IV zol
47
Mx of rheumatoid arthritis
Start metho- then add further DMARD, then biologic
Relapsing/remitting monoarthritis (large joints)
Tx: Hydroxychloroquine
48
SE of leflunomide
HTN
49
Mx of adult onset Stills
1st line: NSAIDs ± corticosteroids
Long term: DMARDs (methotrexate)
50
Mx of Sjogrens
pilocarpine for dry mouth, hydroxychloroquine for arthralgia and fatigue
51
Mx of spinal mets
Bisphosphonates if breast or myeloma
52
Photosensitive rash + scarring alopecia
Discoid lupus
53
Relapsing polychondritis
Recurrent painful swelling of the ears, saddle nose deformity, hoarse voice, and steroid responsiveness
54
Mx of SLE
Mild (skin/joints): Hydroxychloroquine ± NSAIDs
Moderate (serositis, cytopaenias): Add oral steroids ± immunosuppressants
Severe (renal, CNS): IV steroids ± cyclophosphamide
55
Polyarteritis Nodosa (PAN) features
Middle-aged man + Hep B
Mononeuritis multiple
pANCA
56
Differentiating MND
ALS- UMN, LMN
PMA- LMN
PLS- UMN
Bulbar- facial
57
Ix of MG
Anti AchR then Anti MUSK
EMG
CT thymoma
58
Mx of symptoms of MS
Fatigue MS- amantadine
Oscillopsia- gaba
59
Lateral medullary vs pontine
Both ipsi facial temp and pain
Contra- body temp and pain
Pontine- AICA- facial weakness
Medullary- PICA- dysphagia
60
Mx of IIH
Acetazolamide
61
Wernickes vs NPH
Wernickes- opthal, confusion, ataxia
NPH- incontinence, dementia, ataxia
62
Fredricks ataxia sx
Ataxia, HOCM, scoliosis
63
Ataxic telengiectasia
Recurrent infections, ataxia, telang
64
Myotonic dystrophy sx
Prolonged handshake and PR
Frontal balding
Weakness
65
Charcot marie tooth
Pes Cavus
Distal wasting
Foot drop
66
AB in GBS
Anti GM1/ganglioside
67
AB in Miller FIsher
Anti GQ1b
68
Mx of menstrual migraine
Mefenfamic acid
69
Mx of narcolepsy
Moldafinil
70
Mx of cataplexy
Sodium oxybate
71
SE of phenytoin
Peripheral neuropathy
72
Subacute degeneration of SC sx
Gradual onset of
Symmetrical
Gait disturbance
Loss of vibration and proprioception - balance issues in dark
UMN- Spastic weakness
73
Syringomyelia
Cape like pain and temp, LMN in hands
74
Ant spinal artery occlusion
Sudden, loss of pain/temp and bilateral spastic
Preserved proprioception and fine touch
75
Stroke vs TIA- medical mx
TIA- aspirin 300mg unless on doac, then seen in 24hrs if <7d- then aspirin and clopi 21d- clopi
Stroke- aspirin 300mg for 14d- clopi – thrombolysis if <4.5 thrombectomy if proximal anterior <6 hrs
76
Webers sx
CNIII palsy, conta hemiplegia
77
Medical vs surgical CN3
Pupil dilated- surgical- painful PCAA
Pupil not affected- medical
78
Adie pupil
Unlateral dilated, sluggish to light
79
Brachial neuritis
Pain and weakness following viral infection
80
Klumpke sx
Claw hand deformity (hyperextension of MCPs, flexion of IP joints)- C8-T1
81
Neonatal effects of pregnancy inf
CMV, toxo, VZV, rubella
Rubella- blueberry, eye, SN, heart defects
CMV- microcephalous, seizure, SN
Toxo- 3C
Hydrocephalus, calcifications, chorio
VZV- limb hypo
82
Orchitis mx
<35- Cef and doxy
>35- levo or Oflo
83
What SAAG is transudate
>1.1
84
Features of severe pre eclampsia
Severe hypertension – BP >170/110
Significant proteinuria
OR the following clinical features:
- Headache
- RUQ or epigastric pain
- Visual disturbance
- Hyperreflexia
- Papilloedema
85
Chronic suppurative OM
Non healing TM perf- otorhoea
Purulent discharge, not as foul smelling as Chole
86
When to dialyse with lithium toxicity
Seizure, renal failure with lithium >4, or >5
87
2nd line Ix for angina
Stress MRI, MP with SPECT, stress echo, exercise ECG
88
Target Hba1c for T2DM
Lifestyle/single non-hypo drug: target HbA1c < 48
Hypo-causing drugs/dual therapy: target HbA1c < 53
Measure every 6m
89
Imaging results from Subacute thyroiditis
Globally reduced uptake
90
When to refer 2ww for new diabetes
2ww if new onset diabetes and weight loss >60
91
Urianry Na for pre renal and renal
Pre renal – <20 Na urinary
Renal >40 urinary Na
92
Findings in urine ATN
Muddy brown casts
93
Ix for renal papillary necrosis
Cup and spill
Urogram
94
Causes of renal papillary necrosis
NSAIDs and sickle
95
Alport sx
Microscopic haematuria, progressive CKD, anterior lenticonus, and bilateral SNHL
Basket weave EM
ACE
96
Diabetic nephropathy EM
Kimmelsteil- Wilson
97
Mx of ADPKD
Tolvaptan
98
Organsim SBP with dialysis
Staph epidermis
99
Med mx of CKD
Statin, clopi
ARB or ACEi 1st line if:
ACR ≥ 3 + T2DM
ACR ≥ 30 without diabetes and HTN
Or if ACR >70
SGLT2 if diabetic
IF not diabetic but ACR >25
CI if <20 GFr
100
Fabry sx
F – Febrile episodes
A – Acroparesthesias- burning limbs, angiokeratomas
B – Boys affected more severely (X-linked inheritance)
R – Renal failure (proteinuria → CKD → ESRF)
Y – Young onset + Yellow eyes (corneal verticillata)
101
EM for Goodpastures
Linear deposition
102
EM for membranous
Spike and dome
103
Nephrotic and HIV/heroin
Focal segmental GM
104
SLE and kidney issues
Diffuse proliferative-
mixed nephrotic/nephritic
105
Kidney graft rejection timing and mx
Hyperacute- mins- hours- IgG - remove
Acute- <6m- steroids
Chronic- >6m, fibrosis
106
Complications of renal transplant
RAS- HTN, oedema- angioplasty
RAT- sudden anuria- intervention
RVT- graft swelling, haematuria- intervention
Urinary – peri graft collection
107
SE of ciclo/tacrolismus
Nephrotoxicity- both
Tacro- DM
108
SE of mycophenolate and sirolismus
Myco- BM supression
Siro- hyperlipids
109
Renal tubular acidosis
RTA = normal anion gap (hyperchloraemic) metabolic acidosis
Nephrocalcinosis + normal anion gap acidosis → Think Type 1 RTA
Fanconi + osteomalacia → Suggests Type 2 RTA
Diabetic with hyperkalaemia and mild acidosis → Think Type 4 RTA
110
Fibromuscular Dysplasia (FMD)
young female, treatment resistant HTN, pulmonary oedema
MR angio- beads
111
US for UTI kids
1st <6m
Recurrent >6m
112
DMSA for UTI kids
<3y atypical
Recurrent
113
Mx of allergic rhinitis vs conjunctivitis
Rhinitis- Oral or PRN mild mod
Severe- IN CS regular
Conj- PRN azelastine, sodium cromoglicate
114
Acanthosis vs Erythasma
Acanthosis- velvety
Erythasma- dry
115
Minor nail infection
Topical amorlifine
116
Short PR interval
<120
117
Mx of PCOS
Hirsutism and acne- COCP
Infertiily- clomifene
118
AB for membranous nephropathy
anti-phospholipid A2
119
Renal biopsy shows multiple areas of sclerosis and hyalinosis
Focal segmenting
120
Meds for acute glaucoma
IV acetazolamide, topical pilocarpine, timolol, apraclonidine
121
Mx of Essential thrombocytosis
Low risk (age <60, no history of thrombosis):
Aspirin monotherapy
Intermediate–high risk (age >60 or previous thrombosis):
1st line: Hydroxycarbamide
+ aspirin if arterial + AC if venous
122
Mx of polycythaemia
Venesection, aspirin for thrombosis
HC if >60 or thrombosis
123
When to give abx for OM
<2 bilateral
Otohorea
Systemically unwell
124
Urge incontinence and Alzheimers, failed bladder training
Mrabegon
125
Herpes keratins vs opthalmicus
Opth- trigeminal distribution
Keratitis- on cornea
126
Mx of restless leg
Gaba
Ropinorole
127
Meds causing low Mg
Amino
Cisplatin
Duretics
PPI
128
Mx of PMR
15mg Pred
129
Mx of dysmenorrhea
COCP or NSAID
2nd- both
130
BNP for HF
<400
400-2000 6w echo
>2000 2w echo
131
Mx of prolactinoma
1st line (dopamine receptor agonists - bromocriptine, cabergoline)
Surgery may be indicated if increasing tumour size or drug resistance.
132
When to give co-amox for cellulitis
Near nose or eyes
133
Med causing difficulty getting out of chair
Prednisilone
134
SE of steroids
MY CUSHINGOID
Myopathy
Cataracts
Ulcers
Striae
HTN
immuno
Necrosis of bone
growth restriction
OP
Increased ICP
DM
135
Screening for Addisons
Random cortisol
136
Meds causing Intensely itchy, blotchy rash consisting of widespread erythematous welts
ACEi
137
Sick sinus
atrial bradyarrhythmias, atrial tachyarrhythmias, and episodes of tachy-brady syndrome (alternating bradycardia and tachycardia).
138
Short stature, generalised leg pains and thickened wrists and ankles
Ricketts
139
Fear of flying mc
Flight anxiety course would be best or no prescription
Can do propanolol
?diazepam if only option
140
Normal day 21 progesterone for Ix infertility what next
Hysterosalpingography - if no comorbid conditions- not even if previous STI
Diagnostic laparoscopy with dye - if comorbid conditions - endometriosis / PID / previous ectopic pregnancy.
141
Deviated uvula with sore throat
Quinsy
142
When to 2ww sore throat and ulcer
>3w
143
Abdominal colicky pain, autonomic and neuro/psych
Acute porphyria
144
Drug causes of pancreatitis
DPP-4 inhibitors: sitagliptin
Azathioprine
Sodium valproate
Sulfonamides (co-trimoxazole)
Steroids - dexamethasone
Thiazide diuretics – hydrochlorothiazide
145
Ix for EBV
If < 12 or immunocompromised - EBV serology
If > 12 yrs and not immunocompromised - Monospot test
146
When to give steroids in sarcoid
Pulmonary infiltrates
Hypercalcaemia
Eye, heart, neuro involvement
147
High RF for aspirin in preg
History of of HTN or pregnancy induced hypertension/pre-eclampsia, autoimmune disease, CKD, diabetes mellitus
148
Sx of schistosomiasis
Pruritic papular rash - termed swimmer's itch following freshwater exposure
Fever, malaise, and eosinophilia.
Hepatosplenomegaly, and diarrhoea.
149
If >5 primary bedwetting and daytime symptom
Enuresis clinic
150
Mx of antrax
Cipro or doxy
151
Chikungunya sx
Recent travel Fever, headache, severe joint pain and swelling
152
Mx of OD enoxaparin
Protamine
153
Di George
Low Ca
Cleft palate
154
Mx of breast cancer
Palpable axillary LN- clearance
No LN-US uf clear- sentinel LN
Radiotherapy-whole breast if WLE or T3-4/>/=4 +ve LN in mastectomy
Tamoxifen (ER+ premenopausal): blocks oestrogen receptors
Aromatase inhibitors (postmenopausal – anastrozole, letrozole)
155
When to refer 2ww for breast cancer
>30 lump
>30 axillary lump
>50 with nipple change
156
When to refer breast cancer for FH
1st- <40
1st- male
1st bilateral
One BC and one ovarian cancer case in the family
Three 1st/2nd degree relatives with BC at any age
157
NMD vs SS
Rigidity and hyporeflexia- NMD
Hyperrefelxia and clonus- SS
158
Ix for autism
Applied behavioural analysis
159
Mx of ADHD
<6 ADHD parents training
>/=6 group education, individual- if significant impairment methylphenidate
Adults- methyl
160
Target glucose DM preg
Fasting 5.3
2hr- 6.4
161
Features of Primary dysmenorrhoea
Start just before periods last 2-3 days
Starts 6m after menarche
162
Malignant OE features and mx
Spread to bone- septic
IV abx 6w
163
Mx of blepharitis
Warm compress
Anterior –base of eyelash topical abx- staph
Posterior- caused by mebioan gland dysfunction – greasy margin, chalazion- oral tetra rosacea
164
Alternative for managing POAG
Lantoprost
165
How long to monitor glue ear
3m
166
Mx of impetigo
HPO
Fluclox if extensive
167
Progressively enlarging, painful ulcer that began as a small red papule and now has violaceous borders
Pyoderma gangrenosum
168
Scalp vs flexor psoriasis mx
Scalp- potent
Flexor- mild
169
Mx of sinusitis
>10d intranasal CS
170
Brian tumour features
Meningioma- slow growing tumours in adults- cause seizures no focal neurology
Glioblastoma- cause neurology
Children- medulloblastoma
171
Inhaled foreign object features
localised wheeze, monophonic
Afebrile
172
Longstanding cough- coarse creps, failure to thrive in child
Pneumonia
173
Mx of bile malabsorption
Cholestyramine
174
Def in coeliac
B12, iron
175
Transient vision loss with retinal artery emboli ix
US carotid- from atherosclerosis
176
Regular ibuprofen for knee osteoarthritis presents with 6 months of fatigue, pale-grey nails, and abdominal scratch marks
CKD
177
When is metformin CI
GFR< 30
178
Altert and hypoglycaemic
15-20g glucose
179
Anticoagluation with GFR <15
Warfarin
DOAC CI <15, daba <30
180
Treatment of phobia-
systematic desensitisation
181
Abdo pain, diarrhoea and anaemia
Iron def- coeliac
182
Sudden stopping meds, collapse
Steroids
183
Lower back pain, nocturia and haematuria
Prostate cancer
184
Sweating, dizziness after meal with gastrectomy
dumping syndrome – need smaller more frequent meals
185
Flusing and diarrhoea
Carcinoid
186
Mesenteric vs ischaemic colitis
IC- hypoperfusion (sepsis etc), acute pain, fresh blood
AMI- severe pain out of proportion- no guarding or rigidity, soft, AF
187
Dry patched on calves, each 5-10mm
Discoid eczema
188
Dots in vision, flashes of light, improve when wearing glasses
Posterior vitreous detachment
If curtain- retinal detachment
189
Cupping and pallor of disc, gradual vision loss
POAG
190
Heart skipping beat
Ventricular ectopics
191
POTS sx
Increase of 30 bpm on standing, low BP
192
South Asian hydrops fetalis
A thalassaemia
193
Marker for colorectal cancer and melanoma
CEA- CC
S100-melanoma
194
Weightlifter faints whist doing heavy sets
Valsalva syncope
195
Asthmatic on old mod dose steroids with other combo with exacerbations
Switch to medium MART
196
Who gets Pneumococcal vaccine
- >65, chronic resp, heart, liver, renal disease
197
Middle aged woman with jaundice
PBC
198
Mx of miscarriage
Medical if >14d
Oral mife, vag miso – missed
Incomplete- miso
199
SMA sx
lower motor, floppy, hypotonia, tongue fasciculations
200
Mx of cryptorchidism
Seen by urology 6m
Palpable- orchidopexy
Impalpable- laparoscopy
201
When does smoking CI COCP
Smoking >15 >35 age
202
IX for pyloric stenosis and duodenal atresia
Pyloric stenosis- US
Duodenal atresia- AXR
203
Mx of Kawasaki
aspirin, IVIG, echo
204
Priapism results for low Flow
<3 paO2, high lactate
205
Mx of anal fissure
Topical GTN then diltizem
206
OD Tinnitus, pulmonary oedema, hypoglycaemia, prolonged QRS
Quinine OD
207
Statin bloods
LFTs: at 3 months, then at 12 months
Lipid profile at 3 months
If non-HDL ↓ <40%, consider dose increase
208
Monitoring levothyroxine
TSH every 3 months until stable (2 similar results)
Then yearly TSH
209
Monitoring sodium valrpoate
After 6 months: FBC, LFTs, BMI
Then yearly
210
Mx of CO poisoning
O2 non re breath for 6 hours
211
Baseline tests amiodarone
TFTs, LFTs, UEs, CXR, ECG.
Need to do ECG annually
212
Adrenaline dosing anaphylaxis
Adults and children >12 years: 500 micrograms (0.5 mL)
Children 6–12 years: 300 micrograms (0.3 mL)
Children <6 years: 150 micrograms (0.15 mL)
213
Drug-induced impaired glucose tolerance
DiaBetic Nick’s Sugar InTolerance
Diuretics
Beta Blockers
Nicotinic acid
Steroid
IFN-alpha
Tacrolimus/ciclosporin
214
Mx paracetamol OD
Activated charcoal if within 1 hour and dose >150 mg/kg
Check bloods at 4hrs post
Attending 8–24 hours post-ingestion
Check bloods immediately
If dose >150 mg/kg → start NAC while awaiting results
If >24 hrs- NAC only if paracetamol detectable or ALTx2/INR
Staggered- NAC immediately
215
Common reaction to NAC and tx
Nausea, flushing
Antihistamine
216
Drugs causing pulmonary fibrosis
Nitrofurantoin
Ergot Da R agonists- bromocriptine, cabergoline, lisuride
Sulfasalazine
Cytotoxics ( Bleomycin)
Amiodarone
Rheumatoid (MTX, sulfasalazine)
217
Candida mx normal, preg and recurrent
1st line: Fluconazole 150mg PO stat
Alt: Clotrimazole 500mg pessary
Induction: Fluconazole every 3 days (x3 doses)
Maintenance: Fluconazole weekly for 6 months
218
Signs of leprosy
(1) Hypopigmented or reddish patches of skins with loss of sensation
(2) Thickening of peripheral nerves (e.g. ulnar) with loss of motor/sensory function
(3) Slit skin smear test is positive for acid-fast bacilli.
219
Mx of active and latent TB
Active - 2m RIPE, 4m RI
Latent- 3m RI
or 6m I (if R concern)
220
Differentiating genital ulcers
Painful ulcer
HSV
Chancroid- painful lymphadenopathy usually unilateral, ulcer has ragged borders
Painless
Syphillis -non tender LN
Lymphogranuloma- painful lymphadenopathy
221
Monitoring of ACEi
Baseline then 1-2w after
If stable 12m
222
Antibiotics to avoid in renal failutr
Tetracyclines
Nitro <45
223
Tx of threadworm in pregnancy
Hygiene only
224
Syphillis but pen allergic
Doxy
225
Mx of pubic lice
Permethrin
226
Organism causing HUS
E Coli
227
Mx of aneamia in CKD
(1) Check ferritin - ferinject if < 200 (guidelines vary)
(2) Consider EPO once iron replete.
228
When to offer SGLT2 in CKD
Add on to ACEi if
T2DM and/or
ACR ≥ 22.6 mg/mmol
229
Treatment for HIV
Backbone E+T
or A+L
Third- D/E/A/R
PEP should be started as soon as possible (ideally within 1–2 hours, and no later than 72 hours post-exposure)
Treatment course lasts 4 weeks
HIV serological testing is required at 12 weeks after completing PEP
230
When to be concerned of dehydration in infants
Reduced oral intake (<60% of usual feeds)
Decreased urine output: <2 wet nappies in 24 hours, or no urine output for 12 hours
231
Maintenance vs dehydration vs resus
Maintainance- 100ml first 10kg, then 50ml next 10kg, then 20ml/kg- over24hrs
>28d 0.9% sodium chloride + 5% glucose
<28d 10% dextrose
Dehydration= %dehydration x BW x 10
0.9% sodium chloride + 5% glucose
Resus= 10ml x BW
0.9% sodium chloride
232
Vaccination schedule
2m- 6in1, Men B, Rota
3m- 6in1, Men B, Rota
4m- 6in1, PCV
1yr- MMR, PCV, MenB Boost
18m- MMR, 6in 1
3- 4in1
233
Surgery for hydrocele, undescended este, hypospadius
Hydrocele- 1yr
Undescended- 6m uro, 1yr Surg
Hypo- 1yr
234
Mod, severe, life threatening asthma features
Mod- PEF >50
Severe- 33-50 PEF
HR>120
RR>30
Life- PEF <33
Normal CO2
Near- raised CO2
235
Pul HTN diagnosis
Right heart Cath
>25mmg
Echo is screening
236
Tx of pul HTN
Test to see if responds to vasodilators
Positive = fall in PAP ≥10 mmHg to <40 mmHg
If yes- nifedipine
No- sildenafil, iloprost
237
Persistent ST elevation after NSTEMI, tx
LV aneurysm - NOAC
238
Mx of CHADVASC
CHF
HTN
Age >65, 75 -2
DM
Vasc disease
Stroke- 2
2- anticoagulate
Man -1 consider
239
Sound of VSD vs ASD
Pansystolic- VSD
ESM, split S2- ASD
240
Tamponade vs constrictive pericarditis
Tamponade-
Puls Para- BP drops
Elec alternans
CP- Kassmaul
241
Cannon A wave and giant V waves causes
Cannon- irregular- HB, regular VT
Giant V- TR
242
Atropine dosing and max dose
500mcg
Max 3mg
243
Hypothermia ECG
Reduced HR, logn QTc, J waves
244
Digoxin ECG
Sloped ST
245
Additional meds can give in HF if maxed 4 pillars
Ivabradine- HR >75, <35 EF
Dig- AF
Hydr/Nitrate- Afro-carribean
246
HFpEF vs HFrEF
P- >50%
R- <40%
247
Mx of unstable tachy
3x shocks
Amiodarone 300mg over 20mins
248
HOCM, ARVC, Brugada, Long QT
HOCM- ESM, collapse jerky pulse, MR SAM ASH
ARVC- TWI V1-3, epsilon, collapse during exercsie
Brugada- Young SE asian men, ST convex V1-3
LQT- syncope whilst exercising or stressed (can be after emotional stimuli)
249
When to admit HTN
>180/120
Or if chest pain, HF, AKI
250
Sx of ARMD
Gradual or sudden visual acuity loss
Distorted vision (metamorphopsia) on Amsler grid
Central scotoma
251
Ix for ARMD
OCT
Optical coherence tomography
252
Cataracts sx
Haloes
Reduced colour
Reduced vision at night
253
Ix for cataracts
Slit lamp
254
Stye vs chalazion
Stye - tender
Chalazion non tender
255
Mx of conjunctivitis
Topical antihistamines or mast cell stabilisers (e.g. azelastine, sodium cromoglicate)
Refer- < 4 weeks
Chlamydia/gon- if STI
Topical chlor- bacterial
256
Diabetic eye disease
1- microaneurysm
2- exudates, cotton wool, blot haemorrhages
3- haemorrhages 4 quadrants
Proliferative- neovasc - vitreous haemorrhage
257
HTN retinopathy
Arteriolar narrowing
Arteriovenous (AV) nipping
Cotton wool spots, flame-shaped haemorrhages
Papilloedema (in malignant hypertension)
258
Levothyroxine dose in pregnancy
Increase by 50%
259
Mx of obs cholestasis
19-40- Deliver 40
40-99- deliver 38-39
>100- deliver 35-36
260
Mx of hyperemesis grav
1st - cyclone/promethazine
2nd- switch to meto/ondansetron
Combination therapy
3rd- steroids
261
Causes of hydrops fetalis
Rh incompatibility
A thalassaemia- south East Asian
Parvovirus
262
Fetal alcohol syndrome
Cranial facial
Microcephaly
Neurodevelopmental issues
263
When to induct labour and what with
41-42w
PROM
Gest HTN/Pre-ecl
Vag dinoproste- if Bishops <6
ARM +Oxy >6
264
Mx of threatened miscarriage if hx of miscarriage
Vag progesterone BD 16w
265
Monitoring TSH in pregnancy
Every trimester and 8w PP
266
Round ligament pain vs Pubic Symphysis Dysfunction
RLP- 2nd trim, Presents as sharp, stabbing groin pain triggered by movement.
Pubic Symphysis Dysfunction
Pain localised to pubic symphysis
Waddling gait
Aggravated by walking or hip abduction
267
Mx of uterine prolapse
Pelvic floor exercises (Kegel exercises)
Pessary
Surgical
268
Mx of allergic rhinitis
1st Line: PRN intranasal antihistamine (e.g. azelastine) OR
PRN Non-sedating oral antihistamine (e.g. cetirizine, loratadine)
🔴 Moderate to Severe Symptoms / Failure of 1st Line:
Regular intranasal corticosteroid: mometasone furoate, fluticasone propionate
269
Dengue fever sx
High fever, severe headache (retro-orbital pain), maculopapular rash, flushed face, and petechiae after a blood test
270
Mx of salmonella
Non typhi- cipro
Typhi- IV Cef
271
Differentiating acute graft rejection vs vein thrombosis
Throbmosis- painful and more haematuria
272
Mx of TTP vs ITP
TTP - plasma exchange
ITP-Prednisilone
273
Owl eyes on biopsy, with big lymph nodes
Reed Sternberg
Hodgkin
274
Bloods and mx of TLS
Hyperkalaemia
Hyperphosphataemia
Raised uric acid
Hypocalcaemia
Rasburicase, allopurinol 2nd line
275
Causes of AA amyloid
Bronchiectasis
Rheumatoid
SLE
IBD
276
Features of AA amyloid
Renal, hepatic, systemic
277
Features of AL amyldoi
Restrictive cardiomyopathy, neurological, renal - nephrotic
278
Long term mx of sickle
HC
Proph Pen B
Pneumococcal vaccine 5 years
279
Large lymph node with CD20 and CD79 positivity
Diffuse Large B-Cell Lymphoma
280
Causes of microcytic anaemia
Iron deficiency anaemia
Thalassaemia
Sideroblastic anaemia
Lead poisoning
281
Investigating haemolytic anaemia
Direct- positive- AI
Schumm Test: measures methemalbumin → increased in intravascular haemolysis
282
Intra vs extra vascular haemolysis
Intra- G6PD
Cold
PND
Extra- Warm
HS
Thala
283
Triggers of G6PD
Fava, cipro, Sulph- co trim
284
Sx and Ix for Paroxysmal Nocturnal Haemoglobinuria
Morning haemoglobinuria + thrombosis
Gold standard: Flow cytometry for CD59/CD55
285
Mx of vWD
Mild bleeding: Tranexamic acid
Procedural prophylaxis: Desmopressin (releases stored VWF)
Severe: Factor VIII concentrate
286
MGUS vs Waldenstroms
MGUS- asymtpomatic
Waldestrom
Headache
Blurred vision
Tinnitus
287
Recurrent flushing and abdominal pain, palpation of the skin results in localised urticaria ix and mx
Systemic Mastocytosis
Serum tryptase
H1 antihistamine
288
Aplastic anaemia features
Pancytopenia with fatty marrow and low reticulocyte count
289
Myelofibrosis features and tx
Pancytopaenia
Extramedullary- massive spleen
Tear drop
Ruxolitinib
290
Myelodysplasia features
Progressive pancytopenia
Bone marrow biopsy: Hypercellular marrow
Risk to AML 30%
291
When to further ix varicocele
If right sides- RCC
292
Mx of renal and ureteric stones
If < 5 mm: watchful waiting.
If < 10 mm - 1st Line: Shockwave lithotripsy (SWL)
If 10-20mm - consider SWL or ureteroscopy (URS)
If > 20mm - percutaneous nephrolithotomy
Ureteric stones:
< 10 mm: SWL
> 10 mm URS
293
Haematuria 2ww guidelines
>45 visible haematuria without UTI or persists after UTI tx
>60 with non visible haematuria and high WCC/dysuria
294
Further Ix for folate and B12 def
Folate- TTG
B12- anti IF, ?metformin
295
B thalassaemia features
Minor- microcytosis
Intermedia- anaemia during stress or preg
Major- Failure to thrive, hepatosplenomegaly
296
A thalassaemia features
Trait- microcytosis
HbH- microcytic, splenomegaly
Barts- Hydrop fetalis
297
Main test for haemachromotosis
Transferrin saturation
298
Burkitt presentation
Endemic (African):
EBV-associated
Maxillary or mandibular mass
Sporadic (Non-endemic):
Ileocecal or abdominal tumour
Often HIV-associated
299
Ix for bile acid malabsorption
Se HCAT
300
Staging for oesophageal and gastric cancer
Oeso- CT TAP, endo US for local
Gastric CT TAP, US for local
301
Differentiating types of AI hepatitis
Type 1 - anti-SMA - smooth muscle antibodies
Type 2 - children - anti-LKM - anti-Liver Kidney Microsomal antibodies- Little kids
Type 3 - anti-SLA/LP - anti-soluble liver antigen/liver pancreas antibodies- rare
302
Treatment of Hep B
Pegylated IFN-α
303
Oesophageal varices mx
Acute bleed: IV ABx, terlipressin, OGD etc.
Prophylaxis of bleed - propranolol,
304
Ix and mx of small bowel bacteria overgrowth
Hydrogen breath test
Rifazimin
305
Plummer Vinson
(1) Dysphagia due to oesophageal webs
(2) Iron deficiency anaemia
(3) Glossitis
306
GIT polyps, mucosal lesions and thyroid dysfunction
Cowdens syndrome
307
3 relatives with colorectal cancer, across 2 generations, 1 before 50 yrs
HNPCC- Lynch
308
Mx of positive urea breath test
A PPI twice-daily +
Amoxicillin 1 g twice-daily +
Either clarithromycin 500 mg BD or metronidazole 400 mg BD.
309
Mx of SBP
IV cefotaxime
Cipro/norfloxacin prophylaxis
310
History of asthma and strictures on OGD
Eosinophillic oesophagi's
311
When to repeat or double dose of emergency contraception
Vomit with in 3 hours- repeat
Double dose (3mg) is recommended if >70kg or >BMI 26kg/m2
312
Mx of MALT lymphoma
7d lansoprazole, amoxicillin, claro
313
Microscopic colitis and mx
A Triad of..
Watery diarrhoea
Normal colonoscopy
Inflammation of lamina propria, with intraepithelial lymphocytosis.
Caused by PPI, NSAIDs, cimetidine
Budesonide
314
Brown pigmentation colonoscopy
Laxative misuse
315
Swallowing issues both food and liquid, dilated oesophagus with fluid level
Achalasia- manometry and balloon dilation
316
Cancer screening programmes
Bowel- 50-74- FIT 2yrs
Breast- 50-70- 3 yrs
Cervical- 25-64- 5 yrs
If prev +ve recalled at 3yrs
317
Zollinger Ellison ix
Fasting gastrin
318
Alcoholic hepatitis ix and mx
AST:ALT >2:1
Prednisilone
319
Whipples vs sprue
Whipples- Malabsoprtion, chest pain, arthralgia, neuro involvement
Jejunal biopsy: PAS-positive macrophages, villous atrophy.
Co trim 1 year
Sprue
Malabsorption
Jejunal biopsy: Villous atrophy with mononuclear infiltrate.
Tetracycline (6 months) + Treat B12/Folate deficiency.
320
Breast lump gets bigger prior to menstruating
Breast cyst
321
When is HTN pre existing in pregnancy
<20 w
322
CI of COCP
(1) Postpartum: < 6 weeks and breastfeeding OR < 3 weeks with VTE RFs.
(2) PMHx of uncontrolled HTN (>160/100), vascular disease, IHD, AF, stroke, VTE, migraine with aura
(3) Mutation - thrombogenic or BRCA1/2
(4) Age > 35 and smokes > 15/day
323
SE of 5ASA and azathioprine/mercap
Sulphasalazine: Heinz body anaemia, oligospermia, lung fibrosis
Mesalazine: Pancreatitis, agranulocytosis
Aza/merc
Pancreatitis and BN suppression
324
IDA and ESM
OGD- angiodysplasia
325
Mx of amoebasis
Metronidazole
326
Mx of ascites
Spiro +/- furosemide
327
Mx of hepatic-renal syndrome
IV albumin
328
Surveillance of cirrhosis for RF
For HCC
6-monthly ultrasound surveillance ± alpha-fetoprotein (AFP)
329
Mx of short bowel syndrome
>100 cm remaining Small Intestine:
Oral intake adjustment: high-calorie
<100 cm remaining Small Intestine:
Total Parenteral Nutrition (TPN) usually required.
330
Mx of acromegaly
Surgery
Medical- if not candidate
Ocreotide
Pegvisomant
331
Colloidal filled follicles with pale empty nuclei on thyroid biopsy
Papillary thyroid
Orphan Annie eyes
332
Mx of MODY
Gliclazide
333
DM med causing weight gain
Gliclazide
Sulfonylurea
334
Meds causing hypercalcaemia
Lithium
Thiazides, Indapamide
335
Mx of obesity
Orlistat- BMI >30
or >28 with RF
Must >5% WL by 3m to continue
GLP1 BMI >35 and 1 weight relating comorbidity
336
When to consider familial hypercholesterolaemia
TC > 7.5 + family history CVD <60
TC > 9 or Non-HDL > 7.5
337
APS 1 + 2
APS 1- candida, Addisons, hypoparathyroid, vitiligo
AP2- Addisons, T1DM/Hashimotos
Vitiligo
338
Tx of RA in pregnancy
Sulfasalazine, Hydroxychloroquine (SHafe in pregnancy)
339
Mx of non specific lower back pain
NSAIDs
340
When to offer DEXA scan and bisph
Anyone >50 with a fragility fracture
Anyone <40 with a major risk factor:
Vertebral fracture
High-dose corticosteroids (≥7.5mg prednisolone daily ≥3 months)
≥2 fragility fractures
Tx can be started empirically
Bisph
If DEXA <-2.5
Or vertebral fracture
341
Anti myeloperoxidase, wheeze and burning pain in leg
eGPA
342
Mx of subclinical hypothyroid
Measure again 3m
TSH >10 and T4 normal on 2 occasions, 3-months apart → consider levothyroxine
TSH raised but <10 on 2 occassions and patient is <65 years and symptomatic → consider a trial of levothyroxine
343
Diferentiating between non secretory pit adenoma and prolactinoma
NSPA- cause visual feild defect
General hypopit
Prolactinoma- milky dishcarge in women
Earlier sexual symptoms
344
Elevated plasma aldosterone:renin ratio meaning
Most common bilateral adrenal hyperplasia
Second- Conn
345
FRII amont for DKA
0.1/kg
346
Mx of SIADH
Fluid restriction
347
Markers for thyroid cancer
Papillary- Thyroglobulin for monitoring
Medullary- Calcitonin
Mx by surgery then RI
348
Mx of bipolar depression
Quetiapine
Lamotrigine
Olanzapine
Olanzapine + fluoxetine combination
349
Strict dieting, binge then exercise
BN- purge can be exercising
350
Monitoring of antipsychotics
FBC, U+E, LFT- then annually
Lipids, Weight, BMI, baseline, 3m then annually
Glucose, Prolactin-
- 6m then annually
351
Scaly coin shapes plaque on scalp on removal- keratotic spike dx and mx
Discoid lupus
Topical steroids
352
Jobs causing infra vs pre patellar bursitis
Pre- housemaid, carpet layer, carpenter, plumber, gardener
Infra- clergymen, carpenter
353
Differentiating scl70 and centromere
Diffuse- breathing issues
Proximal limbs
CREST
354
Commonest cause of viral conjunctivitis
Adenovirus
355
GPA vs eGPA
eGPA- neuro involvement and asthma
356
Gold standard POAG
Application tonometry
357
Optic disc cupping ratio and IOP diagnosis of POAG
>0.7 ratio
IOP >21
358
Nuclear vs subcapsular cataracts
Nuclear- Common, age
Subcapsular- steroid
359
Wells score for imaging DVT and PE
>/=2 DVT for US
Should be conducted in 4hrs
If not within 24 and start on apixaban
>4 PE
360
Mx of IPF
Nintedanib, pirfenidone if FVC 50-80%
361
CXR shows lower zone fibrosis and multiple areas of pleural thickening
Asbestosis
362
Diagnosis of asthma
FeNO >50 adults
>35 children
Eosinophils raised
Reversibility 12% bronchodilators
363
Diagnosis of COPD
FEV% <0.7 with no reversibility
364
Organism causing otitis media and externa
Externa- pseudomonas
Media- H Influenzae
365
Mx of pneumonia with LowNa na deranged LFT
Macrolide
Same for myco
366
Spirometry of primary ciliary dyskinesia and bronchiectasis
Obstructive
<0.7
367
Occupational asthma ix
Serial PEFR and referral
368
Causes of erythema multiforme
HSV
Mycoplasma, strep
Allopurinol. sulf, carb
369
Mx of head lice
Dimeticone
370
Severity of eczema
Mild — areas of dry skin, infrequent itching (+/- small areas of redness)
Moderate — areas of dry skin, frequent itching, and redness (+/- excoriation and localised skin thickening).
Severe — widespread areas of dry skin, incessant itching, and redness (+/- excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation).
371
Antibody in IPF
ANA 30%
372
Switching from Older asthma guidelines
SABA-only users → switch to AIR therapy
Uncontrolled on low-dose ICS or ICS/LABA → switch to low-dose MART
Moderate-dose ICS-based treatment → switch to moderate-dose MART
373
Rosacea in pregnancy/breastfeeding
Erythromycin
374
High fever, rash, seizure kids
Roseola infantum
375
When to give fluclox for impetigo
If bullous- blisters
Fever
376
Mx of seb dermatitis
Local- topical clotrimazole
Widespread- ketocanzole shampoo
377
Mx of IE Bronch
Amox/clari/doxy 14d
IV abx if temp >38 or confused
378
RA, clubbing and SOB
Bronchiectasis
379
Small red papules on shins - enlarge into painless, shiny, yellow-red patches with telangiectasia.
Necrobiosis lipoidica diabeticorum
380
Options for severe acne
1st line: 12/52 of
(a) Topical adapalene with benzoyl peroxide
(b) Topical tretinoin with clindamycin
(c) Topical adapalene with benzoyl peroxide AND PO tetracycline
(d) Topical azelaic acid BD AND PO tetracycline/lyme/doxy
Azelaic acid and erythromycin for Pregnant
381
Criteria for asthma discharge
PEF >75% of best/predicted
Stable on discharge meds for 12-24hrs
Inhaler technique checked
382
Mx of ECOPD
Pred 30mg 5d
Abx if increased sputum
383
Acute asthma - to give O2 or salbutamol first
O2 if sats <94
Otherwise nebs
384
Mx of wheeze, cough, SOB, +ve RAST to aspergillus
Steroids
2nd- itraconazole
385
Mx of pneumothorax
If the patient is asymptomatic - manage conservatively with regular follow up
If the patient symptomatic, determine whether they have high-risk characteristics (see revision note).
If high-risk
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
pneumothorax - chest drain insertion is 1st line
If low-risk - consider the patient's preferences:
Rapid symptom relief - Needle aspiration or chest drain
Procedure avoidance - consider conservative management with follow up
386
Most common precipitants of TEN/SJS
Antiepileptics – Carbamazepine, Phenytoin, Lamotrigine
Sulphonamides – Co-trimoxazole, Sulfasalazine
Allopurinol
387
Differentiating Scarlett fever from Kawasaki
SF- circumoral pallor, sore throat
K- fever >5d
388
Hereditary Haemorrhagic Telangiectasia
recurrent nosebleeds and multiple telangiectatic lesion
FH
GI Bleed
389
Types of MND
ALS- U+L
PLS-U think alphabetical
PMA-L
Bulbar- worst
390
Essential tremor mx
Propanolol
Primidone 2nd
391
Carcinoid and ESM
PS
392
Additional meds for HF
If still symptomatic despite maximum tolerated doses of all 4 medicines:
Consider switching ACE inhibitor to an ARNI (e.g. sacubitril/valsartan)
Ivabradine if sinus rhythm, HR >75 bpm, and EF <35%
Hydralazine + nitrate if ACEi/ARNI/ARB not tolerated (seek specialist advice, especially if African or Caribbean ethnicity)
Digoxin if AF
393
When to treat HTN
Stage 1 (>140/90 clinic, 135/85 ABPM) and <80 with end organ, CVD, Q risk >10%, CKD, DM
Stage 2 (>160/100 clinic, 150/95 ABPM)
394
SE of valproate
Vomiting, Alopecia, Liver toxicity, Pancreatitis, Return Fat, Oedema, Ataxia, Tremor, Electrolyte disturbance
395
Med for MND
Riluzole
396
Commonest cause of encephalitis
HSV
397
Hypokalaemia vs hypocalcaemia
Low Ca- long QTc
Low K- TWI/flat, ST rep
398
Alternating strong and weak pulses
Severe LVF
399
Myeloma, low voltage ECG and LBBB
Restrictive cardiomyopathy
400
GRACE scoring meaning
<3% <72hr PCI
>3% outpatient evaluation (e.g. CTCA or functional testing)
401
Examples of thiazide like diuretics
Indapamide
chlortalidone
metolazone, and xipamide.
402
CT head 8 hr
History of loss of consciousness or Amnesia plus any one of the following:
65+ yrs
Clotting disorders - e.g. liver cirrhosis
Retrograde amnesia of > 30 minutes immediately before injury
Dangerous mechanism - bike/pedestrian vs motor vehicle, fall from >1m/5 stairs
403
Central line with fevers, Chest X-ray shows multiple peripheral nodular opacities, some of which appear to be cavitating.
Septic pulmonary emboli
404
Common ACEi SE
Cough
405
Missed COCP rules
If >24 hrs but less <48hrs- take pills carry on
If >48hrs since last pill
Week 1- EC if sex, barrier 7d
2- barrier
3- barrier, omit
406
Missed POP rules
>3hrs
EC if sex after that missed pill period, barrier 2 d
Desogestrel 12hrs, drosp 24 hrs
407
When to give NIV COPD
COPD exacerbations with persistent hypercapnic respiratory acidosis (pH <7.35, PaCO2 >6 kPa) despite optimal medical therapy.
408
Mx of COPD
MRC- 1 breathless on strenuous
2- quick walk
3- slower walking
4- 100m
5- can't leave house
1- Short acting
2- LABA/LAMA
3+- Long and pulmonary rehab
Start with SABA
If asthmatic features LABA+ICS
No- LAMA+LABA
Triple- persistent symptoms (trial 3m), exacerbations, asthmatic feature or eosinophils
409
Asthma not tolerating Mod MART
Measure FeNo and esoinophils- refer if elevated
If not LTRA or LAMA then alternate
If not controlled refer
410
Analgesic for liver mets
Dex
411
POP avoids VTE risks with COCP
412
Anti emetic in bowel obstruction EOL
Cyclizine
413
Mx of cyanide poisoning
Hydroxocobalamin
414
Rash after chest infection on allopurinol
Amox
415
Ix of syphillis
Dark-field microscopy or PCR of lesion exudate for Treponema pallidum if early
Serology later
416
Older patient cormorbid in contact with someone with Hep A
Immunoglobulin
417
Reversal of rivaroxaban and apixaban
Adenanet alfa
PCC if not available
418
Asthma patient, stung by wasp- SOB mx
Im adrenaline
419
GI infections
Campylobacter- prodromal before bloody diarrhoea
Staph- hours after food
Giardia- foul smelling diarrhoea
420
Difference between erisyplea and cellulitis
Cellulitis non defined borders
421
Lymph and neuts for csf
Lymph- viral +TB- ZN stain very poor sensitivity
Neuts- bacterial
422
Vitreous haemorrhage sx
causes: diabetes, bleeding disorders, anticoagulants
features may include sudden visual loss, dark spots
423
intensely itchy raised red swellings appearing on her trunk and limbs, each individual lesion resolving within hours but new ones forming elsewhere.
Urticaria
Antihistamine
424
Mx of PEP
Mild topical steroids
425
Over 75 with fragility fracture
Treat
If <75 DEXA
426
Mx of minimal displaced humeral fracture, sprained finger, acromioclavicular
Collar and cuff
Neighbour strap
High arm sling
427
80yo hip fracture, undisplayed intra, unable to walk far
Hemi
428
Meds for HFpEF
MRA, SGLT2, furosemide
429
HF max meds, cough with ACEi
Swap to ARNI
If angioedema swap to ARB
430
HF and low iron
IV iron
431
SVT and severe asthma
Verapamil
432
Maintaining remission in UC
Proctitis- rectal- add oral if needed
Left or extensive- oral
433
Treating UC flare
Rectal - rectal
If no remission in 4w add oral
Oral CS
Left and proctosigmoid-
If no remission in 4w add oral
Then if not switch to oral AS and CS
Extensive
Both
434
Ix for fibrosis in NAFLD
EFL
435
Mx of uncontrollable UGI on OGD and prophylaxis of bleed
Sengstaken-Blakemore tube
carvedilol is the agent of choice in patients with compensated cirrhosis
propranolol is generally used in patients with decompensated cirrhosis
436
Alcoholic, prolonged QT and seizure
HypoMg
IV Mg
437
Best marker for flares in Crohn's
CRP
438
Fregoli vs capgras
Fregoli- multiple are a single person
Frequent - individual
Capgras- single person replaced by imposter
Cap single imposter
439
Warfarin before surgery
Bridge if mechanical heart valves, recent stroke or venous thromboembolism
No bridging if AF
440
BP required for thrombolysis
185/110
441
Parkinsons in young adult
Wilson
442
Mx of seizure in alcohol withdrawal
IV Loraz
Remember in withdrawal chlor is first line, lorazepam better if hepatic failure
443
Mx of SE in child
2x benzo
Then IV phenytoin
444
Psych patient with thirst and passing lots of urine, high sodium
Lithium- DI
445
Indication to carotid endarectomy
Within 1-2 weeks if stroke and 50-99% stenosed
If <50 - clopi
446
Inadequate smear
3 months
447
When to repeat adrenaline in anaphylaxis
5 mins
448
Paeds BLS
5 rescue breaths
15:2
449
Levels for CKD
>90- 5
60-90- 4
30-60 -3
15-30- 2
<15 -5
450
HIV in delivery
Vaginally only if <50
Zido to child if <50 otherwise triple
451
When to excise fibroadenoma
>3cm
452
Urine culture with catheter +ve bacteria
Do nothing
453
Genital wart treatment
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
454
Unilateral glue ear in adult
2ww
455
What precipitate digoxin toxicity
Hypokalaemia
456
Microcytosis and raised A2
Thala trait
A trait has not got raised A2
HbH has more pronounced anaemia
457
Drugs CI in breastfeeding
BREAST CML
Benzo
Retinoids
Estrogen
Amiodarone, aspirin
Sulphomides, sulfonylurea
Tetracycline
Cipro, Chloramphenicol, Carbimazole
Methotrexate
Lithium
458
When does someone not require tetanus
5 vaccines last in last 10 yrs
459
What to start if SSRI and NSAID
PPI
460
Non shockable rhythm drugs
Adrenaline 1mg IV immediately then every 3-5 mins
461
Shockable rhythm drugs
3rd shock 1mg adrenaline and 300mg amiodarone
Repeat adrenaline every 3-5 mins
Further 150mg amiodarone after 5 shocks
462
Consider for liver transplant after paracetamol OD
pH <7.3
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
463
MSRA
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