1
Q
MC cause of nephrotic syndrome in adults
A
membranous nephropathy
2
Q
typical presentation of Rubella
A
Rubella typically presents in unvaccinated individuals with post-auricular and suboccipital lymphadenopathy followed by a pink maculopapular rash that spares the palms and soles
3
Q
define sensitivity
A
Sensitivity is the ability of a test to correctly identify those with the disease (True Positives) among all individuals who actually have the disease.
A test with high sensitivity is particularly useful for ruling out disease
4
Q
define specificity
A
This value measures a test’s ability to correctly identify individuals who do not have the disease (true negatives). High specificity is crucial for confirming a disease when the test result is positive
5
Q
electrolyte SE of SSRIs + mechanism
A
- Hyponatraemia
- SSRIs like sertraline are well known for causing SIADH, especially in older adults
6
Q
early non-motor sign of Parkinson’s disease
A
REM sleep behaviour disorder is often an early non-motor sign of Parkinson’s disease.
- Patients act out dreams, have disturbed REM sleep, and may injure themselves or their bed partner.
- It can precede the motor symptoms of Parkinson’s disease by years.
7
Q
what is Drug reaction with eosinophilia and systemic symptoms (DRESS) + its CFs
A
- DRESS is a rare, severe drug reaction that presents with:
- a morbilliform rash,
- fever,
- facial oedema,
- lymphadenopathy,
- potential organ involvement.
- It usually occurs 2-6 weeks after the offending drug and is associated with eosinophilia.
8
Q
What is Stevens-Johnson syndrome + its CFs
A
- Stevens-Johnson syndrome (SJS) is a severe mucocutaneous hypersensitivity reaction, most often triggered by meds such as antibiotics or anticonvulsants.
- SJS typically presents within 1-3 weeks of drug exposure and it is characterised by a prodrome of fever and malaise, followed by the rapid onset of painful, dusky macules or targetoid lesions that may blister.
- SJS involves mucosal membranes — most commonly oral, ocular, and genital.
- It is defined by epidermal detachment affecting less than 10% of the body surface area.
9
Q
What is Toxic epidermal necrolysis + CFs
A
- Toxic epidermal necrolysis shares similar triggers and clinical features as SJS, but the key difference lies in the extent of skin involvement.
- Abx + anticonvulsants
- Mucocutaneous involvement [mucosal = eyes, mouth and genitals]
- Prodrome of fever and malaise, followed by the rapid onset of painful, dusky macules or targetoid lesions that may blister.
- Typically presents within 1-3 weeks of drug exposure
- TEN is defined by widespread epidermal detachment involving more than 30% of the body surface area.
10
Q
besides AIDs pts, which other pt group are at risk of Pneumocystis jirovecii pneumonia
A
In immunocompromised patients, particularly within six months post-renal transplant, Pneumocystis jirovecii is a leading cause of pneumonia
11
Q
What is this and what are it’s CFs
A
- Dermatofibromas are benign fibrous skin lesions that often arise following minor trauma such as insect bites.
- The lesion is typically firm, hyperpigmented, and may be pink or brown in colour.
- A pathognomonic feature is the “dimple sign” - a central depression when the lesion is laterally compressed.
- These lesions are benign, do not transform into malignancy, and generally require no treatment unless symptomatic or for cosmetic reasons
12
Q
Indications for carotid endarterectomy
A
- symptomatic patients with significant stenosis
- considered in asymptomatic patients with high-grade stenosis >80%, provided they are fit for surgery and have a life expectancy of at least five years
13
Q
SCC Mx
A
- Surgical excision with 4mm margins if lesion <20mm in diameter.
- If tumour >20mm then margins should be 6mm.
- Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites
14
Q
what is Budd-Chiari syndrome
A
Budd-Chiari syndrome is a rare condition caused by hepatic venous outflow obstruction, leading to ascites, hepatomegaly, and abdominal pain
15
Q
what is associated woth myasthenia Gravis and how might it present on examination
A
- Thymoma
- presents with an anterior mediastinal mass
16
Q
In patients with liver failure, uraemia, and ascites, consider
A
hepatorenal syndrome (HRS)
- HRS is a type of functional renal failure seen in patients with severe liver disease, often in the setting of cirrhosis and ascites.
- It is caused by systemic vasodilation and splanchnic vasodilation, leading to a reduced effective renal blood flow, despite normal renal function.
- This leads to renal failure and uraemia
- Mx = haemodialysis
17
Q
spontaneous bacterial peritonitis
- CFs
- MC causative organism
- Mx
- prophylaxis
A
- Fever, ascites + abdo pain
- E.coli
- Mx = IV cefotaxime
- Prophylaxis = ciprofloxacin + is only given if pt has:
- Had an episode of SPB
- patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
18
Q
Ix for paralytic ileus
A
U+E: potassium, phosphate and Mg specifically
19
Q
cut off for urgent breast referral
A
> 30 yrs requires urgent
20
Q
VBAC
A
Planned Vaginal birth after Caesarean (VBAC) is an appropriate method of delivery for pregnant women at >= 37 weeks gestation with a single previous Caesarean delivery
CIs =
- ≥2 Csections
- prior uterine rupture
- vertical C-section scar
21
Q
antidote for lidocaine toxicity Mx
A
lipid emulsion
22
Q
BB Od / toxicity Mx
A
glucagon
23
Q
fibroadenoma Mx
A
They are usually treated conservatively, but they are referred for surgical excision if they are more than 3 cm in size, as in this case, due to discomfort
24
Q
depo provera Key side effects
A
- weight gain
- osteoporosis therefore not given for women >50yrs
25
dengue fever cause + CFs
Dengue is a common RNA virus of the genus Flavivirus transmitted by the Aedes aegypti mosquito in Southeast Asia and often presents with:
* high fever - sustained
* myalgia,
* retro-orbital pain/ headache,
* rash
* facial flushing
* pleuritic pain
26
yellow fever cause + CFs
* Yellow fever is a viral haemorrhagic fever caused by a flavivirus transmitted by Aedes mosquitoes.
* It is endemic to sub-Saharan Africa and parts of South America, but not Southeast Asia.
* The hallmark features of yellow fever include:
* jaundice,
* bleeding
* signs of systemic collapse,
27
carotid dissection CFs
* Unilateral neck pain or headache, often sudden in onset
* Ipsilateral Horner’s syndrome (ptosis, miosis, anhidrosis sparing the forehead)
* can present as partial Horner's syndrome = ptosis and miosis without anhidrosis
* Transient ischaemic attack or stroke symptoms, especially in young or otherwise low-risk patients
* Pulsatile tinnitus
* Possible preceding neck trauma or manipulation, including minor trauma
28
carotid dissection Mx
- antiplatelet - aspirin
- BP control
- vascular risk optimisation = lipid control, diabetic control, smoking cessation
- Neurology or stroke specialist input for all suspected cases
- Endovascular or surgical intervention only in rare cases
- Avoid high impact neck manipulation during recovery
29
HOCM Ix
- TTE showing: MR SAM ASH
- mitral regurgitation (MR)
- systolic anterior motion (SAM) of the anterior mitral valve leaflet
- asymmetric hypertrophy (ASH)
- ECG
- cardiac MRI
30
polycythaemia Vera Mx
- aspirin to reduce risk of thrombosis
- venesection
- chemotherapy: e.g hydroxyurea
31
AIDS is defined as
CD4 <200
32
what is the cavernous sinus and what does it contain
* The cavernous sinus is a dural venous sinus located laterally to the sella turcica.
* It's clinically significant as infection can spread here causing cavernous sinus thrombosis, and lesions may affect multiple cranial nerves simultaneously.
* The abducens nerve (CN VI) is particularly vulnerable as it runs freely within the sinus rather than in the lateral wall like the other nerves.
Mnemonic for structures running through = O TOM CAT
* O - Oculomotor nerve (CN III)
* T - Trochlear nerve (CN IV)
* O - Ophthalmic division of trigeminal nerve (CN V₁)
* M - Maxillary division of trigeminal nerve (CN V₂)
* C - Carotid artery (internal)
* A - Abducens nerve (CN VI)
* T - Trabeculated cavernous sinus
33
AAA screening +Mx
```
* All men in the UK are offered a one-off ultrasound scan at the age of 65 which determines the frequency of scanning if needed.
```
* Patients are usually asymptomatic unless the aneurysm has ruptured.
* Operative management is offered ≥5.5cm+.
* AAA's measuring 3-4.4cm are scanned every 12 months, and every 3 months between 4.5-5.4cm.
* high rupture risk pts are referred within 2 weeks to vascular surgery for probable intervention. Risks are 1 of:
* symptomatic,
* aortic diameter >=5.5cm
* rapidly enlarging (>1cm/year)
* treat with elective endovascular repair (EVAR) or open repair if unsuitable.
* Low rupture risk pts are surveilled according to the diameter for AAA [pic]
* Asymptomatic pts with diameter <5.5
34
What CTG findings are:
- reassuring
- non-reassuring
- abnormal
reassuring:
- Accelerations are generally reassuring
- No decelerations,
- Early decelerations
- < 90 minutes of variable decelerations with no concerning features
non-reassuring:
- Regular variable decelerations
- Late decelerations
Abnormal:
- Prolonged decelerations last between 2 and 10 minutes + a dip in foetal BP
- ALWAYS abnormal and concerning
35
Syringomyelia causes
a characteristic 'cape-like' distribution of pain and temperature loss due to compression of the spinothalamic tract in the spinal cord
- sPinoThalamic (Pain and Temp)
36
which organisms require a urinary antigen test for diagnosis in CAP
- Legionella
- Streptococcus pneumonia
37
Causes of hydronephrosis include:
**Unilateral causes – PACT**
* Pelvic-ureteric junction (PUJ) obstruction (congenital or acquired)
* Aberrant renal vessels causing extrinsic compression
* Calculi (ureteric stones)
* Tumours of the renal pelvis or ureter
**Bilateral causes – SUPER**
* Stenosis of the urethra
* Urethral valves (posterior urethral valves in males)
* Prostatic enlargement (benign or malignant)
* Extensive bladder tumour causing outflow obstruction
* Retroperitoneal fibrosis
38
cranial nerve brain stem locations
* Midbrain CN 1,2,3,4
* Pons CN 5,6,7,8
* Medulla CN 9,10,11,12
Key things to know:
- loss of gag reflex CN 9+10 = medulla brain stem damage
39
when is a blood transfusion required post ACS
Hb <80
40
scoring tool for pneumonia
41
Trastuzumab indication and common SE
- HER2 +ve BC
- heart failure is seen in 10% of pts t4 monitoring is required
42
common complication of renal transplant
Cytomegalovirus reactivation from latent infection of the donor organ is a common complication in renal transplant patients, often presenting with symptoms such as fever, fatigue, and abnormal liver function tests, and may lead to more severe systemic illness if not promptly managed.
usually presents within 6 weeks of transplant
43
essential Ix in peri/orbital cellulitis
contrast enhanced CT
44
flying post pneumothorax
With respect to 'Fitness to fly' rules the CAA suggest patients may travel 2 weeks after successful drainage if there is no residual air. The British Thoracic Society used to recommend not travelling by air for a period of 6 weeks but this has now been changed to 1 week post check x-ray
45
skin condition associated with HIV
seborrhoeic dermatitis
46
malignancy risk following renal transplant and immunosupression
increased risk of skin cancers and lymphoma; advise strict sun protection and regular dermatology follow-up
47
Falling hard onto a bent knee can injure the
posterior cruciate ligament
48
Direct blow to the knee can result in
patella dislocation
49
Hyperextension knee injury most commonly results in
anterior cruciate ligament rupture
50
most common mechanism of ankle sprain
Inversion of the foot is the most common mechanism of ankle sprain
51
DIC on blood film
Shistocytes
52
First-line treatment for ITP is
oral prednisolone
53
Dyskinetic cerebral palsy results from damage to
the basal ganglia and the substantia nigra
54
MC cause of resp distress in newborn + Mx + CXR findings
transient tachypnoea of the newborn
- uncomplicated cases --> supportive care + observation
- supplementary oxygen may be required to maintain oxygen saturations
- Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
55
when do post partum women need contraception
* Post-partum, women only require contraception 21 days from giving birth
* contraception can also be Lactational amenorrhoea method which works if they are exclusively breastfeeding for <6months
56
Absolute risk reduction =
Absolute risk reduction = (Control event rate) - (Experimental event rate)
57
FINALS - Passmed
flashcards
Decks in class (26)
# Cards
-
Endo56
-
Anaesthetics16
-
PSA notes40
-
cardio62
-
A+E89
-
Gerries21
-
Neuro73
-
Resp35
-
paeds59
-
Renal + urology46
-
infectious disease22
-
ENT13
-
Gastro and liver65
-
Women's Heatlh132
-
Rheum36
-
Derm24
-
Haem30
-
surgery, anaesthetics and pre-op19
-
ortho39
-
psych28
-
Sexual health79
-
public health/Ethics3
-
opthalmology13
-
Sexual health COPY69
-
MLA 1 MOCK correction62
-
MLA mock 257
