1
Q
What are the results for primary hyperparathyroidism?
A
- Increased PTH + Ca (kidney stones)
- Decreased phosphate
- Some indication the kidneys are fine
2
Q
What are results for secondary hyperparathyroidism?
A
- Increased PTH + phosphate
- Decreased or normal Ca
- Decreased Vit D
- Kidney disease leads to decreased Ca so parathyroid gland becomes hyperactive to compensate
3
Q
What is tertiary hyperparathyroidism?
A
- Increased or normal Ca
- Increased PTH
- Decreased or normal phosphate + Vit D
- Increased ALP
- Kidneys correct, parathyroid overactive
4
Q
What medications are used for gout flare-up?
A
NSAIDs or colchine
5
Q
What is slipped upper femoral epiphysis (SUFE)?
A
- Early adolescence, usually obese
- Limp
- Hip, knee or groin pain (hip held in abduction and external rotation)
- Treatment: non-weight bearing + surgery
6
Q
What is the investigations for GCA?
A
Scan of temple and temporal artery biopsy
7
Q
What is osteoarthritis?
A
- Wear + tear
- Worse with exercise
- Not swollen and hot
8
Q
What is rheumatoid arthritis?
A
- Improves with exercise
- Morning stiffness
- Hot + swollen
- Might have systemic sx
9
Q
What is HLA-B27?
A
- Psoriatic arthritis and ankolysing spondylitis
- Young man, back stiffness, improves with exercise
- 1st line - x-ray
- 1st line - NSAIDs
10
Q
What do haematological results mean?
A
- ALWAYS replace B12 before folate
- Increased reticulocytes - blood loss
- Increased LDH - haemolysis
- If blood loss + increased urea - GI bleed
- In sickle cell disease always admit especially if >38°c or chest symptoms
11
Q
What are the pathological RBCs?
A
- Howell-jolly bodies (hyposplenism) - coeliac or sickle cell
- Target cells - sickle cell/thalassaemia, IDA, hyposplenism, liver disease
- Heinz bodies + bite cells - G6PH deficiency
12
Q
What are the signs and symptoms of multiple myeloma?
A
CRAB (calcium, renal, anaemia, bones)
- Bone pain, osteoporosis + pathological features, osteolytic lesions
- Lethargy
- Hypercalcaemia
- Renal failure
13
Q
What are investigations for multiple myeloma?
A
- X-ray - rain drop skull
- Monoclonal (serum paraprotein), urine paraprotein (Bence Jones)
- Increased plasma cells in bone marrow
- Bone lesions (MRI)
14
Q
Describe the acute leukaemias
A
- Anaemic, bleeding, infections
- BLAST cells: take over bone marrow
- ALL: hepatosplenomegaly
- AML: Downs
15
Q
Describe lymphoma
A
- Palpable LN, night sweats, weight loss
- Hodgkin’s: Reid steinberg cells
- Diagnosis biopsy LN
16
Q
What is psoriasis?
A
- Well defined areas of scale at sites of minor skin injuries - red, scaly
- Treatment: emollient 1st line, topical steroids + Vit D analogues
17
Q
What is melanoma?
A
- Increased UV
- Asymmetrical, borders are irregular, colour variations, diameter (>6mm), evolving (changing)
- Breslin stage (how deep it goes into skin 0-IV)
18
Q
What is SLE (lupus)?
A
- Anti-dsDNA antibody
- Butterfly rash, photosensitive, spares nose
19
Q
What are the investigations for TB?
A
- Active: sputum culture + smear, CXR, NAAT test
- Latent: Mantoux test/interferon gamma blood test
20
Q
What is the treatment for TB?
A
Rifampicin (orange body fluids)
Isoniazid (peripheral neuropathy, agranulocytosis)
Pyrazinamide (hyperuricaemia - gout, muscle pain)
Ethambutol (optic neuritis)
- Active: 2 months RIPE, 4 months RI
- Latent: 3 months RI or 6 months I
21
Q
What are common things to know about IE?
A
- Sepsis + prosthetic heart valves
- Common in IVDUs
- 3 blood cultures + echo
- Tricuspid valve most common
- Staph aureus most common
22
Q
What are management options for tachy/bradycardia?
A
- Regular narrow tachycardia (SVT) = vasovagal manoeuvre then adenosine
- VT (broad) = amiodarone
- Bradycardia = atropine (sometimes)
23
Q
What are the results for thyrotoxicosis?
A
- TSH receptor antibodies present 90-100% of Graves’ disease
- Decreased TSH
- Increased T4
24
Q
What are the results for primary hypothyroidism?
A
e. g. hashimotos
- Anti-TPO antibodies
- Increased TSH
- Decreased T4
25
What are the results for euthyroid syndrome?
- Decreased TSH
- Decreased T4
- Thyroid goes off when patient is ill
26
What are common hip pain pathologies in children?
- Irritable hip peaking at 3-8 yrs, treatment: rest and analgesia
- Septic arthritis (any age - peaking at 0-6yrs): systemically unwell, febrile, unable to weight bear, hot, swollen joint. Emergency: aspirate to confirm, surgical debridement and washout under GA, IV abx
- Perthes disease (3-12 yrs peaking at 5-7 yrs) - limited and painful rotation and abduction of ipsilateral hip. Treatment: rest, pain relief, orthoses or surgery may be required
27
What is the management for major bleeding?
- Stop warfarin
- Give IV Vit K 5mg
- Prothrombin complex concentrate - if not available give FFP
28
What is the management for minor bleeding + INR >8.0?
- Stop warfarin
- Give IV Vit K 1-3mg
- Repeat dose of VitK if INR still too high after 24 hrs
- Restart warfarin when INR <5.0
29
What is the management for no bleeding + INR >8.0?
- Stop warfarin
- Give Vit K 1-5mg by mouth, using the IV preparation orally
- Repeat dose of Vit K if INR is still too high after 24 hrs
- Restart when INR <5.0
30
What is the treatment for minor bleeding + INR 5.0-8.0?
- Stop warfarin
- Give IV Vit K 1-3mg
- Restart when INR <5.0
31
What is the treatment for no bleeding + INR 5.0-8.0?
- Withhold 1 or 2 doses of warfarin
| - Reduce subsequent maintenance dose
32
What are the ECG changes in pericarditis?
- PR depression
- Saddle shaped concave ST elevation
- ST + PR depression in aVR + V1
33
What parts of the heart do the ECG leads show?
- Anteroseptal (V1-V4) - LAD
- Inferior (II, III, aVF) - right coronary
- Anterolateral (V4-6, I + aVL) - LAD or left circumflex
- Lateral (I, aVL +/- V5-6) - left circumflex
- Posterior (tall R waves V1-2) - usually left circumflex, also right coronary
34
What are the signs and symptoms of Myasthenia Gravis?
- Antibodies against ACh receptors
- Symptoms worsen with muscle activity + lessen with rest - ptosis, diplopia, dysphagia, proximal muscle weakness
- Crisis: severe generalised quadraparesis or life-threatening respiratory muscle weakness, measure FVC, manage with plasmapheresis/immunoglobulins
35
What is the investigations + management for myasthenia gravis?
- 1st line: single fibre electromyography, autoantibody levels
- CT scan for thymoma
- Management: pyridostigmine + immunosuppression (prednisolone >> azathioprine etc)
36
What is Guillain-Barré syndrome?
- Rapidly progressing, but self-limiting polyneuropathy + muscle weakness
- Usually following a recent infection
- Most common type is ascending, affecting legs and then arms
- 5-10% suffer from respiratory paralysis, requiring FVC measurements
37
What are the investigations + treatment for Guillain-Barré syndrome?
- Anti-GMI (anti-ganglioside) antibodies
- LP + nerve conduction studies
- Treatment: IVIGI plasma exchange
38
How is neuropathic pain treated?
- Burning + tingling pain, out of proportion with tissue injury
- Monotherapy one of: amitriptyline, duloxetine, gabapentin or pregabalin
39
What are the features of multiple endocrine neoplasia type 1?
- Peptic ulceration
- Galactorrhoea
- Hypercalcaemia
- Parathyroid, pituitary, pancreas
Progress Test
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