1
Q
When to refer for recurrent miscarriage?
A
3 or more
2
Q
What investigations may women be offered following recurrent miscarriage?(4)
A
Thrombophillia
Lupus
Antiphospholipid syndrome (treat with haspirin plus heparin until K34)
TFTs
Check for chromosomal abnormalities
3
Q
Explain antiphospholipid syndrome
A
Disorder which causes an increased risk of thrombosis, recurrent fetal loss and thrombocytopenia.
4
Q
Ix (3) for antiphospholopid syndrome and mx (2)
A
Ix anti-cardiolipin, lupus, clotting
aspirin +/- warfarin
5
Q
How to manage hirsutism? (5)
A
- Weight loss
- Methods of hair removal
- Reassure - usually no additional rx is required
- Facial - topical eflornithine
- COCP - dianette - 6 months, if ineffective refer
6
Q
Counselling topical eflornithine (3)
A
- If no benefit after 4 months stop and refer
- Noticeable results take 6-8 weeks
- If effective - to continue otherwise hair growth will return to pretreatment state within 8 weeks
7
Q
Hyperhydrosis mx
A
- Avoid tight clothing and manmade fabrics
- Wear white/ black to minimise signs
- Underarm pads to absorb excess sweat
- Moisture wicking socks
- Avoid occlusive footwear
- Alternate shoes
- Aluminium salts/ 20% aluminium chloride roll on antiperspirants
8
Q
Aluminium salts/ 20% aluminium chloride roll on antiperspirants - how to apply (5)
A
- Apply at night before sleep to axilla, feet, hands
- Wash off in the morning
- Apply every day until symptoms improve
- Avoid shaving area within 12 hours of application
- Review in 6 weeks
9
Q
Advice on febrile seizures (6)
A
- Most grow out of it by age 6yo
- Risk of developing epilepsy is low
- Short seizures are not harmful
- 1 in 3 will reoccur
- No evidence for paracet/ ibuprofen intermittent use
- Nil indication for epileptics
10
Q
GORD when to suspect and age range
A
Up to 1yo with regurgitation AND at least one of:
1. Distressed behaviour
2. Chronic cough/ hoarse voice
3. Unexplained feeding difficulties
4. Faltering growth
11
Q
RF for GORD paeds (5)
A
prematurity, FH, obesity, hiatus hernia, neurodisability
12
Q
occurs in infants less than 3 months old and is characterised by bouts of excessive crying and pulling-up of the legs, often worse in the evening.
A
= colic
13
Q
How to tell the difference between colic and GORD?
A
Colic bouts of crying, GORD - regurg
14
Q
Reflux Paeds breastfed mx (4)
A
- Breastfeeding assessment and advice
- Trial 2 weeks of gaviscon then review
- If improvement continue, trial stopping every 2 weeks to see if it can be stopped.
- Trial PPI for 4 weeks if not effective refer
15
Q
Reflux formula fed mx (5)
A
- Reduce volume of feeds if total volume is >150mls/kg
- Trial two weeks of frequent but smaller feeds
- Trial feed thickeners 2 weeks
- Then stop 3 and trial gaviscon
- Trial PPI for 4 weeks if not effective refer
16
Q
Allergic rhinitis mx (5)
A
- Saline washes
- Allergen avoidance
- Intranasal steroids/ antihistamines (4 weeks)
- Check technique
- If failure and BG of asthma consider LTRA/ steroids
17
Q
Allergic rhinitis what to always ask
A
- Cocaine/ recreational drugs
- Decongestants
18
Q
BV management (1)
Three things to avoid
A
- Metronidazole BD for 5-7 days OR intravaginal gel OD for 5/7
- Avoid douching/ bubble baths/ smoking
19
Q
Vaginal candida recurrent mx
A
- PO fluconazole every day for 72 hours as induction
- Maintenance once a week for 6 months
20
Q
Pityriasis rosea - what is it?
A
Self limiting rash that starts with a herald patch, commonly after an URTI/ infection. Usually in young adults. Resolved in 6-10 weeks. Chest abdo and back usually affected. Salmon coloured, slightly raised.
21
Q
Mx pityriasis rosea (6)
A
- Self limiting
- Can get new lesions for first 6 weeks
- Hypo/hyperpigmentation can take months to resolve
- Emmolients/ soap substitute
- Can trial antihistamine if itchy
- Mild/mod steroid for 4 weeks if itching
22
Q
Pityriasis veriscolor what is it?
A
Fungal infection of the skin causing discoloured patches on chest, neck and back - not contagious. Usually asymptomatic.
23
Q
Mx pityriasis versicolor (2)
Relapse (1)
Prophylaxis (1)
A
- Ketoconoazole shampoo OD for 5/7 - lather on skin, leave on for 3-5 minutes before rinsing off.
- If small area - topical antifungal
- If relapse - repeat step 1/2 OR shampoo once every 1-2 weeks for 6 months
- Pre holiday OD for three days as prophylaxis
24
Q
Acne rosacea mx (4)
When to review and what to do?
A
- For flushing brimonodine gel PRN (works within 30 minutes and lasts 3-6 hours). Telangiectasia may be accentuated as erythema reduced.
- For mild- mod acne topical ivermectin/ metronidazole for 8-12 weeks
- For mod-severe acne - topical ivermectin with PO doxy OD for 8-12 weeks 40mg MR
- Inflamed phymatous disease - PO doxy for 6 weeks
Review at 8-12 weeks if not fully clear but effective continue for 12-16 weeks
25
What may dermatology offer for acne rosacea? (2)
1. Light therapy
2. Roaccutane
26
SE of roaccuatane (5)
1. Increased risk of suicidal ideation
2. Pancreatitis
3. Joint aches
4. Rash
5. Dry skin
27
Vasectomy counselling
Pro (3)
Cons (9)
Pros
1. Low failure rate (0.05%)
2. Permanent procedure
3. No increased risk of testicular cancer, impotence, or heart disease
Cons
1. Irreversible on the NHS
2. Risk of regret
3. Contraception cover for 12 weeks post procedure
4. Needs semen analysis at 12 and 16 weeks to confirm
5. Surgical procedure local anaesthetic
6. Risk of bleeding and infection
7. Risk of chronic pain 15% >3 months post op
8. No sex for 1 week post procedure
9. No protection against STIs
28
Tubal occlusion counselling (5)
1. Risk of failure 0.5%
2. Ectopic pregnancy
3. Surgery
4. No protection against STIs
5. Not reversibile
29
Whooping cough explained
Respiratory infection that has three stages to it - cold like sx (1-2 weeks)
- coughing gits (10 weeks)
- gradual improvement (3 weeks)
30
Vitiligo mx general (5)
1. Avoid triggers
2. Vitiligo society
3. Changing faces - camouflage services
4. Sun protection
5. Psychosocial
31
Medical mx of vitiligo when to offer and what would you offer?
Offer if <10% of body surface area
Topical steroid for 1-2 months then review
If not effective can refer and consider intermittent regime, break 2 weeks, steroids 3 weeks etc
32
Secondary care mx of vitiligo (3)
1. Topical tacrolimus
2. Phototherapy
3. PO steroids/ MTX/ ciclosporin
33
Varicose veins RFs (6)
Obesity
Pregnancy
Increasing age
Prolonged sitting/standing
FH
DVT
34
Varicose veins mx general/ counselling (6)
1. Discuss RF, eg obesity, prolonged sitting, increasing age
2. Discuss complications - bleeding, DVT, pigmentation, reduced QoL, ulcers
3. Lose weight
4. Regular exercise
5. Raise legs
6. Avoid triggers
35
When to refer varicose veins? (3)
1. Primary/recurrent VV with symptoms/ skin changes/ ulcers
2. Superficial vein thrombosis (hard, painful veins)
3. Healed venous leg ulcer
36
What to offer for VV if referral not offered? (Ix) (2)
1. Compression stockings
2. ABPI to r/o arterial insufficiency
37
What may be offered by the vascular team for VV?
1. Duplex USS
2. Endothermal ablation
3. Foam sclerotherapy
4. Surgery
38
How can you manage venous skin changes? medical mx (2)
1. BD emmolients
2. Topical steroids
39
Warts mx medical (6)
1. Sexual health clinic for STI screen and examination
2. Can do nothing - will resolve on its own usually after 6 months
3. Podophyllotoxin solution BD for three times per week for 5 weeks until wart has gone
4. Imiquimod - three times a week for up to 16 weeks
5. Cryo
6. Surgery
40
Podophyllotoxin counselling (4)
1 Make sure you have washed the area with water and pat dry first
2. Ensure Podophyllotoxin only touches area of the wart
3. You can use vaseline/ barrier cream to surrounding area to aid in this
4. Local irritation is common
41
Anogenital warts counselling (4)
1. Spread skin to skin contact/ sexually transmitted
2. Use condoms
3. Appears a few weeks to months after infection
4. Asymptomatic
5. Don't share sex toys
42
Explain varicocele
Scrotal swelling - varicose veins of the spermatic cord/ vessels in the spermatic cord. (Dilated veins). Caused by incompetent veins. Very common
43
Risks associated with varicocele (2)
1. Risk of reduced fertility
2. Pain
44
Mx varicocele (2)
Grade 1 - no treatment
Grade 2 annual examinations - refer to urology, risk of testicular growth arrest and therefore may need surgery.
45
General advice varicocele (3)
1. Recommend supportive underwear
2. Simple analgesia
3. 2/3 will not have fertility issues
46
Pain, dragging, heavy sensation, bag of worms =
varicocele - usually on left side
47
Mx inguinal hernia <18yo?
Refer urgently to surgeons to be seen within 2 weeks
48
Suspected testicular cancer mx
1. Refer under 2ww
2. Bloods AFP, LDH, hCG
49
Epididymo-orchitis Ix (3)
Urine dip, STI screen, check for mumps
50
Epididymo-orchitis Mx (4)
When will the lump resolve after treatment?
1. Condom use until STI screen
2. Cipro BD 14/7 (counsel)
3. Simple analgesia
4. Supportive underwear
5. Lump resolves by 3 months
51
FU Epididymo-orchitis
Review at 3/7 if no improvement
Review at 2 weeks to ensure resolution
52
Explain an epididymal cyst
Fluid filled cyst - nil treatment required
Usually asymptomatic
53
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
the swelling is confined to the scrotum, you can get 'above' the mass on examination
transilluminates with a pen torch
Hydrocele
54
Congenital hydrocele mx
Reassure, usually resolves by 1yo
55
Undescended testes counselling
Increased risk of testicular cancer therefore you should do regular testicular self checks
56
Undescended testes screening (3)
At birth
At 6 week check
Re-examination at 4-5 months if found to be undescended
57
When to refer for undescended testes at 6-8 weeks?
If bilateral - refer to be seen within 2 weeks
58
If unilateral undescended testes 6-8 week check what are the next steps?
What is done next?
1. Re-examine at 4 months to refer and to be seen at 6 months
2. Surgery orchidopexy
59
Teething mx (7)
1. BD brushing once teeth erupt
2. Dentist by 6 months
3. Gentle rubbing with clean hands
4. Bite on clean, cool object, teething rings
5. Sugar free products
6. OTC simple analgesia >3months
7. Bonjela > 5months
60
Enuresis
<5yo (5)
>5yo (3)
<5yo w/o day time symptoms
1. Reassure
2. Fluid intake - avoid caffeine
3. Encourage using the bathroom
4. Positive reward system
5. Avoid lifting and waking
>5yo w/o day time symptoms
1. General measures
2. Enuresis alarms - 4 week trial
3. Desmopressin if short term
61
When to refer bedwetting?
Anyone with day time symptoms
OR
Secondary betwetting (>6 months night sx free)
62
When to give desmopressin for bedwetting? (2)
If sleepover/ overnight event which requires a dry night.
Give once nightly for the week prior
OR
If they want it
Start low dose and review every 2 weeks, increasing as needed. Trial for four weeks.
62
CKD mx
1. ACE
2. Annual bloods and urine ACR, urine dip
3. BMI, nutritional status, BP, HBa1c, lipid profile
4. Check DH, renal USS
63
ACR interpretation
<3 no CKD
3-70 - repeat at 3 months
>70 significant proteinuria refer to renal
64
Age range viral induced wheeze -->
Age range croup -->
Age range bronchiolitis -->
6 months - 5yo
6 months - 3 years (parainfluenza)
<12 months (peak incidence 3-6 months) (RSV)
65
Asthma generalmx (9)
1. Peak flow
2. Avoid triggers/ symptom diary
3. Stop smoking
4. SABA with spacer
5. Inhaler technique
6. Vaccinations
7. Personalised action plan
8. Weight loss
9. MH
66
Name an ICS inhaler requiring a spacer -->
Name an ICS inahler dry powder-->
Clenil modulite (beclometasone)
Easyhaler OR Pulmicort (budesonide)
67
Name two combined ICA+LABA and what type is it?
Symbicort - dry powder. (budesonide/formoterol)
Fostair NEXT inhaler dry powder
Fostair with spacer (beclometasone/formoterol)
68
Asthma mx
1. SABA
2. SABA + ICS
3. SABA + ICS+LTRA
4. SABA + ICS +LABA +/- LTRA
5. SABA + MART low
6. SABA + MART mod (refer if paeds at this point)
7. SABA + MART high OR MART+LAMA/ theophylline
69
How to diagnose asthma <5yo
SABA
Trial of moderate ICS 8 weeks then stop
If return of symptoms within 4 weeks then restart low ICS
If sx resolves but didn't return after 4 weeks then repeat trial
70
Squint mx secondary care(5)
1. Corrective glasses
2. Occlusion therapy
3. Penalisation therapy (drops in one eye to encourage lazy eye to do more work)
4. Eye exercises
5. Surgery
71
Limping, but mobile, well and afebrile aged 3-9yo think?
Transient synovitis/ reactive arthritis
72
When might you give aciclovir for chickenpox?
>14yo or adult presenting within 24 hours of onset of rash - 7/7 800mg five times per day
73
General mx chickenpox (8)
1. Infective until all lesions have crusted over
2. Avoid itching
3. Antihistamines
4. Calamine solution
5. Keep nails short
6. Hydration
7. Cotton clothing
8. Avoid immunocompromised and school until crusted over
74
Exposure to chickenpox in pregnancy
If already had chickenpox then they are fine
If unsure then for blood test to check for antibodies and likely will be given immunoglobulin
If definitely haven't then can have immunoglobulin up to 10 days post exposure
75
PCOS what to discuss (8)
1. Weight loss
2. Smoking
3. Aim to get regular periods x4 times per year
4. Increased risk of CVD and DM and NAFLD
5. Difficulty in getting pregnant
6. Increased risk of endometrial cancer
7. Increased risk of pregnancy complications
8. Increased risk of psychiatric disorders
76
How to diagnose PCOS
2/3
1. Irregular periods
2. Acne/ hirsutism
3. PCOS on US
77
What can be used for PCOS?
1. COCP
2. Metformin
3. Clomiphene to induce ovulation
78
General advice heart failure
1. Avoid excessive salt
2. Stop ACE if unwell
3. Smoking
4. ETOH
5. Check DVLA
79
CP when to have same day assessment?
Within 72 hours
80
CP when to have assessment within 2 weeks?
If >72 hours
81
Suspected AF within 48 hours?
Refer in to hospital
82
AF > 48 hours?
HR aim
When to refer (no symptom control after X weeks?)
Start on:
1. BB/ rate limiting CCB (e.g diltiazem/ verapamil)
2. DOAC after CHADVASC
60-80 pulse
Otherwise add BB/CCB/dig
If sx not controlled within 4 weeks
83
Stable angina mx
1. GTN
2. BB/CCB
3. BB/CCCB
4. ISMN
Refer
Review at 2 weekly intervals
84
Extra medications for angina?
Aspirin +/- ACE +/- statin
85
Erectile dysfunction counselling and investigations (3)
1. Examination of external genitalia
2. Bloods to HbA1c, lipid profile, CVD, TFT, LFT, U+E, PSA
3. Lifestyle: smoking, ETOH, weight loss, exercise, cycling <3hrs
86
Counselling viagra (3)
50mg viagra - take one hour before sexual activity, dose can be increased to 100mg or decreased to 25mg
One per 24 hours
FU in 6-8 weeks
87
Which drugs can cause erectile dysfunciton? (6)
Think groups instead of specifics
BB
Thiazides
SSRIs
Opiates
Anti-histamines
Anti-HTN
88
HRT Risks (4)
Benefits (2)
1. Increased risk of CVD + stroke
2. Increased risk of breast ca
3. Increased risk of abnormal bleeding
4. Increased risk of VTE
1. Bone protection
2. Fixed menopausal sx
89
Gout acute mx (3)
1. Naproxen (750mg first dose, then 250mg TDS until 2/7 post flare) OR
2. Colchicine OR
3. Prednisolone 30mg OD for 5/7
90
Gout prevention
1. Allopurinol OR febuxostat - until urate level <360 - check levels monthly
Stop if rash
91
Gout general acute (3)
General prevention
Rest, ice, elevate
Reduce red meat, ETOH, fatty meals
92
Tension headache mx (8)
1. Simple analgesia - avoid overuse headache
2. Exercise
3. Stress
4. Hydration
5. Acupuncture
6. CBT
7. Amitryptilline 10mg ON increase every 1-2 weeks
8. Headache diary
93
Medication overuse mx (5)
1. Stop abruptly
2. May get SE for first few weeks
3. May take 2-3 months before symptoms resolve
4. If acute headache reoccurs after this take for 2/7 in the week max
5. Consider TCA as prophylaxis
94
Cluster headache mx
What is it
1. Triptans for acute attacks
2. High flow oxygen therapy
3. Verapamil as prophylaxis (neuro)
Usually lasts between 2 weeks and 3 months 1-3 attacks per day, occurs every 2-3 years
95
Non pharmacological mx migraines (7)
1. Exercise
2. Triggers/ diary
3. Stress
4. CBT
5. Mindfulness/ relaxation techniques/ meditation
6. Riboflavin (vitamin b2)
7. Acupuncture
96
Diabetes diagnosis counselling (8)
General stuff
1. Risks to eyes, kidney, feet - annual checks
2. Immunisations
3. Free prescriptions
4. Carrying identification
5. Increased risk of CVD - therefore annual bloods and CVD screen
6. Weight loss/ diet/ exercise
7. Structured education programme
8. Advise about sexual health/ pre pregnancy counselling
9. Sick day rules - stop metformin, gliclazide, SGLT2
97
What is polycythaemia?
Who to refer to and what will they do?
Sx (4)
Increased blood cells leading to higher risk of clots - and therefore heart attacks and strokes
Need to be referred to haematologist who will likely start them on daily aspirin
Can get sx of headache/ clots/ bleeding gums/ plethora (reddening of hands and feet)
98
Polycythaemia general counselling
1. Smoking
2. ETOH
3. Obesity
4. Stop thiazides as reduced plasma volume
99
Seb derm mx adults
1. Ketoconazole shampoo twice a week for four weeks then reassess
2. Soap free wash on affected areas
3. Avoid make up that blocks comedones
4. Betnovate if inflammation to the scalp OD for 5 days then review
100
Seb derm babies/ cradle cap
1. Emmolients + brushing to remove scale
2. Reassure
3. Topical clotrimazole for 4 weeks OD
4. Can give HC for 1-2 weeks if needed
5. Soap substitute
101
Hydradenitis mx (6)
1. Pain relief
2. PO abx if infected
3. PO steroids if severe
4. Octenisan as antimicrobial wash OD
5. Consideration of topical clinda OD for 3 months then review
6. I+D if severe
102
Sleep hygiene mx (7)
1. Avoid bright lights/ screens before bed
2. Warm bath a few hours before bed
3. Avoid exercise late in the day
4. Sleep schedule, same time in bed every night
5. Relaxation techniques/ read a book
6. Avoid caffeine
7. CBT-I
103
ADPKD explain (5)
Sx (5)
uncommon hereditary condition autosomal dominant --> 50% chance of inheriting the condition
Cysts form in the kidneys causing scarring and damage and risk of kidney failure
Can lead to HTN, headaches, haematuria, UTIs, and AP
104
ADPKD mx
1. Avoid caffeine
2. Monitor BP/ bloods/ urine etc
3. Hydrate
4. Refer
105
ADPKD extra renal manifestations (4)
1. Liver cysts
2. Pancreatic cysts
3. Berry berry aneurysms
4. Male infertility
106
Parkinsons disease sx/ what to ask (5)
1. Movement (bradykinesia
2. Depression
3. Constipation
4. Stiffness/ rigidity/ tremor
5. Sleep disturbance
107
Sciatica mx (6)
When does it usually resolve?
1. Simple analgesia +/- PPI +/- codeine
2. Physiotherapy
3. Group exercise therapy
4. Work adjusments
5. Local heat
6. Keep active
Usually resolves by week 6 - if not then refer
108
Ramadan rules meds
Metformin
Sulfonylureas
SGLT2
Switch metformin to BD dosing - heavier at the end of the day
Sulfonylureas - switch to evening only, or if BD reduce morning dose
SGLT2 take in the evening ++ hydration
Insulin will likely need to be modified/ reduced and switched to the evening dose.
109
Ramadan rules general (4)
1. Well balanced meal in the morning, and not to miss it. High fibre.
2. Ensure well hydrated in the day
3. Avoid fasting if unwell
4. Avoid strenuous exercise before sunset
SCA
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