08/09 Flashcards
hypokalaemia + hypertension
primary hyprealdosteronism
blood test before carbimazole
FBC- can cause agranulocytosis
warfarin administration PT APTT bleeding time platelet count
PT- prolonged
APTT- normal
bleeding time- normal
platelet count- normal
aspirin administration PT APTT bleeding time platelet count
PT- normal
APTT- normal
bleeding time- prolonged
platelet count- normal
heparin PT APTT bleeding time platelet count
PT- often normal
APTT- prolonged
bleeding time- normal
platelet count- normal
DIC PT APTT bleeding time platelet count
PT- prolonged
APTT- prolonged
bleeding time- prolonged
platelet count- prolonged
thresholds for treansfusion
patients with ACS= 80g/L, target is 80-100
patients without ACS= 70g/L target 70-90
pneumonic for transfusion reactions
Got a Bad Unit
G raft vs host disease
O verload
T hrombocytopaenia
A lloimmunisation
B lood pressure unstable
A cute haemolytic reaction
D elayed haemolytic reaction
U rticaria
N eutrophilia
I nfection
T RALI
Hyposplenism causes
post-splenectomy
coeliac disease
hyposplenism blood film
target cells howell-jolly bodies pappenheimer bodies siderotic granules acanthocytes
iron-deficiency anaemia blood film
target cells
pencil poikilocytes
if combined with B12/folate deficiency a dimorphic film occurs with mixed microcytic and macrocytic cells
myelofibrosis blood film
tear-drop poikilocytes
intravascular haemolysis blood film
schistocytes
megaloblastic anaemia blood film
hypersegmented neutrophils
G6PD anaemia blood film
megaloblastic anaemia blood film
TIBC + transferrin levels are typically ______ in iron deficiency anaemia
raised
why must B12 deficiency be treated before folic acid deficiency
because replacing folic first can cause subacute degeneration of the cord
reed stenberg
hodgkin lymphoma
ALD bloods
thrombocytopenia and macrocytic anaemia
sudden anaemia and a low reticulocyte count
parvovirus
rouleax formation
stacking of RBCs- myeloma
where are spherocytes seen
autoimmune haemolytic anaemia and spherocytosis
patients with sickle cell should get the pneumococcal vaccine every
5 years
Mirror image nuclei
reed-stenberg
incubation period of gastroenteritis bugs
Staph aureus, bacillius cereus = 1-6 hours
salmonella, e. coli= 12-48hrs
shigella, campylobacter= 47-72 hours
> 7 days: giardiasis, ameobiasis
features of staphylococcal toxic shock syndrome
diffuse erythematous rash
desquamation of rash
swab site for chlamydia and gonorrhoea
vulvovaginal
investigation for mycoplasma
- mycoplasma serology
- positive cold agglutination test
treatment for mycoplasma
doxycycline or a macrolide (erythromycin/clarithromycin)
what is dengue fever
form of DIC
20-30% develop dengue shock syndrome
features of dengue fever
headache (often retro-orbital) fever myalgia pleuritic pain) facial flushing (dengue) maculopapular rash
treatment of dengue fever
symptomatic e.g. fluid resuscitation, blood transfusion
hepatitis A incubation
2-4 weeks
spread of Hep A
faecal- oral
features of hep A
flu-like prodrome abdominal pain: RUQ tender hepatomegaly jaundice cholestatic LFTs
who should be vaccinated for Hep A
travelling or residing in endemic area if >1 y/o
chronic liver disease
haemophilia
MSM
IVDU
lab worker, staff in residential institutions, sewage workers, people who work with primates
when should UTIs be tested for cure
in pregnant women- MSU culture
organism in central line infections
staph epi
treatment of legionella
macrolides- clarithromycin
features of typhoid
systemic upset bradycardia abdo pain, distension constipation rose spots on trunk
IVDU with descending paralysis
clostridium botulinum
features of botulism
fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy
treatment of botulism
antitoxin if given early
what is lemierre’s syndroe
spread of oropharyngeal infection to the carotid sheath- infectious thrombophlebitis of the IJV
what are the variations of leishmaniasis
cutaenous, mucocutaneous, visceral
describe cutaenous leishmaniasis
crusted lesion at site of bite
south or central america must be treated
describe mucocutaenous leishmaniasis
caused by leishmania braziliensis
spread to involve mucosae of nose and pharynx
describe visceral leishmaniasis
occurs in med, asia, south america, africa
causes fever, sweats, rigors
massive splenomegaly, hepatomegaly
poor appetite ad weight loss
grey skin
pancytopenia
diagnosis of visceral leishmaniasis
bone marrow or splenic aspirate
who will now be offered the HPV vaccine
girls and boys aged 12-13
live attenuated vaccines
BCG MMR influenza oral rotavirus oral polio yellow fever oral typhoid
inactivated preparations
rabies
hep A
influenza (intramuscular)
toxoid vaccines
tetanus
diptheria
pertussis
Complications of mycoplasma
- cold agglutins: haemolytic anaemia
- erythema multiforme, erythema nodosum
- meningoencephalitis, guillain-barree
- bullous myringitis
- pericarditis/myocarditis
- GI: hepatitis, pancreatitis
- renal: acute glomerulonephritis
management of genital herpes outbreak
oral aciclovir
investigation of herpes
NAAT
what is an aspergilloma
mycetoma (mass-like fungus ball) which often colonises an existing lung cavity ]
cough, haemoptysis
investigation of aspergilloma
CXE- crescent sign
high titres aspergillus precipitins
cause of gas gangrene
clostridium perfringens
features of c. perfringens
a-toxin, causing myonecrosis and haemolysis
tender, oedematous skim with haemorrhagic blebs and bullae
trimethoprim is contraindicated by
methotrexate
india ink stain
cryptococcus neoformans
treatment of gonorrhoea
IM ceftriaxone
incubation period of ebola
2-21 days
when are people with ebola infectious
not until they develop symptoms
symptoms of ebola
sudden onset of fever, fatigue, muscle pain, headache and sore throat
followed by; vomitting, diarrhoea, rash, internal and external bleeding
respiratory syncytial virus Associated condition
bronchiolitis
parainfluenza virus Associated condition
croup
rhinovirus Associated condition
common cold
influenza virus Associated condition
flu
streptococcus pneumoniae Associated condition
CAP
haemophilus influenzae Associated condition
CAP, bronchiectasis, acute epiglottitis
staphylococcus aureus Associated condition
pneumoina, particularly following influenzae
mycoplasma pneumonia Associated condition
atypical pneumonia
dry cough, haemolytic anaemia, erythema multiforme
legionella pneumophilia associated condition
atypical pneumonia
air-conditioning sytems, dry cough, lymphopenia, deranged LFTs and hyponatraemia
pneumocystic jiroveci Associated condition
pneumonia in HIV patients
few chest signs and exertional dyspnoea
mycobacterium tuberculosis associated condition
asymptomatic to disseminated disease
cough, night sweats and weight loss
e coli gram stain
facultative anaerobe, gram -ve rod
trichomonas vaginalis + bacterial vaginosis pH
> 4.5
what is hepatitis E common in
shellfish and pork
bloods in hep E
elevated bilirubin and significant transaminitis
incubation of hep E
3-8 weeks
management of gonorrhoea in needle phobia
oral cefixime + oral azithromycin
post-exposure prophylaxis hep A
human normal immunoglobulin or Hep A vaccine
post-exposure prophylaxis hep B
HBsAg +ve source: booster dose of vaccine, if in process of being vaccinated give Hepatitis B immune globulin (HBIG) and the vaccine
post-exposure prophylaxis hep C
monthly PCR - if seroconversion then interferon +/- ribavirin
post-exposure prophylaxis HIV
risk is small from bites/needlesticls
a combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
serological testing at 12 weeks following completion of post-exposure prophylaxis
reduces risk of transmission by 80%
post-exposure prophylaxis varicella zoster
VZIG for IgG -ve pregnant woman/immunosuppressed
HIV, neuro symptoms, widespread demyelination
progressive multifocal leukoecephalopathy
when should anti-retroviral therapy be started in HIV
as soon as diagnosed
what is antiretroviral therapy
2 x nucleoside reverse transcriptase inhibitors (zidovudine, abacavir)
and either protease inhibitor ( indi-navir) or a non-nucleoside reverse transcriptase inhibitor (nevirapine)
integrate- gravir
chlamydia management
doxycycline
most common cause of infective diarrhoea in HIV +ve patients
cryptosporidium
treatment of chlamydia in pregnancy
azithromycin, erythromycin or amoxicillin
treatment of pubic lice
malathion or permethrin cream
treatment of trichomonas vaginalis
metronidazole
cellulitis in pregnancy in penicillin allergy
erythromycin
s. pneumonia is a ____ ___ ______/_____
s. pneumonia is a gram +ve diplococci/chain
h. influenzae is a ____ ______ ________
h. influenzae is a gram negative coccibacilli
L. monocytogenes is a ____ _____ _____
L. monocytogenes is a gram +ve rod
neisseria meningitidis is a ____ ______ _______
neisseria meningitidis is a gram negative diplococci
bacterial meningitis CSF
cloudy
low glucose
high protein
10-5000 wcc polymorhps
viral meningitis CSF
clear/cloudy
60-80% of plasma glucose
normal/raised protein
15-1000 lymphocytes
tuberculous CSF
slightly cloudy, fibrin web
low glucose
high protein
30-300 lymphocytes
fungal CSF
cloudy
low glucose
high protein
20-200 lymphocytes
when are antibiotics indicated in sinusitis
if symptoms are present for prolonged period of time
antibiotic treatment of sinusitis
phenoxymethylpenicillin, doxycline or clari
management of prostatisi
ciprofloxacin
UTI in breastfeeding
trimethoprim over nitro- (nitro-G6PD)
farmer, fever, transaminitis
q fever
what is Q fever
caused by coxiella burnetti- from abattoir, cattle/sheep
features of Q fever
typically prodrome: fever, malaise pyrexia of unknown origin transaminitis atypical pneumonia endocarditis (culture-neg)
treatment of q-fever
doxycycline
amoebic liver abscess
anchovy sauce
itchy bumps of arms, torso or legs
bed bugs- topical hydrocortisone
hot-washing linen and using mattress covers
commonest most severe type of malaria
falciparum malaria
features of severe malaria
schizonts on blood film parasitaemia hypoglycaemia acidosis temperature > 39 severe anaemia
complications of malaria
cerebral malaria acute renal failure ARDS hypo DIC
treatment of uncomplicated falciparum malaria
artemether plus lumefantrine
treatment of complicated falciparum malaria
parasite >2% = parenteral treatment
IV artesunate
if parasite count >10% then exchange transfusion
shock = coexistent bacterial septicaemia
management of herpes in pregnancy
women who present with 1st episode of genital herpes in pregnancy (3rd trimester) should be managed with daily oral aciclovir 400mg until delivery- then c-section
BV organism
gardnerella
atypical lymphocytes
glandular fever
primary features of syphillis
chancrea
local non-tender lymphadenopathy
secondary features of syphillis
6-10 weeks after infection
- systemic symptoms: fevers: lymphadenopathy
- rash on trunk, palms and soles
- buccal snail track ulcers
- condylomata lata
tertiary syphillis features
gummas (granulomatous lesions of skin and bone) Ascending AA general paralysis of the insane tabes dorsalis argyll-robertson pupil
features of congenital syphillis
blunted upper incisors rhagades (linear scars at angle of mouth) keratitis saber shins saddle nose deafness
reinfection with syphillis
rpr rises by 4 fold or more
treat with benzathine penicillin G
1st line treatment for early lyme disesae
14-21 day course of oral doxy
management of early syphillis in pregnancy
IM benzathine penicillin G
If patients over 16 years need intravenous fluid resuscitation, use crystalloids that contain sodium in the range 130–154 mmol/litre with a bolus of ____ ml over less than 15 minutes.
500
commonest caus of encephalitis
herpes simplex
cause of mumps
RNA paramyxovirus - winter and spring
spread of mumps
- droplets
- respiratory tract epithelial cells -> parotid glands -> other tissues
- infective 7 days before anf 9 days after swelling starts
clinical features of mumps
fever
malaise, muscluar pain
parotitis
management of mumps
rest
praracetamol
notifiable disease
complications of mumps
orchitis
hearing loss
meningoencephalitis
pancreatitis
HAP
piptaz
most common cause of travellers diarrhoea
e. coli
management of pneumocystis jivroveci
co-trimoxazole
most worrying complication of chagas
cardiomyopathy
treatment of severe campylobacter
clarithromycin
what causes kaposi’s sarcoma
Human herpes virus 8
treatment of kaposi’s sarcoma
radiotherapy + resection
meningococcal sepsis management
benzylpenicillin
testing for HIV in asymptomatic patients should be done at _ ___ after possible exposure
testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure
LRTI causes in CF patients
pseudomonas aeruginosa
how does miliary TB spread
through the pulmonary venous system
immunocompromised patients with toxoplasmosis are treated with
pyrimethamine plus sulphadiazine
immunocompetent patients with toxoplasmosis
don’t usually require treatment
EBV associated malignancies
burkitt’s lymphoma
hodgkin’s lymphoma
nasopharyngeal carcinoma
testing after syphillis
cardiolipin tests- VRDL ad RPR
negative after treatment
treponemal specific antibody tests: TPHA remains +ve
ground glass hepatoxytes on light microscopy
chronic hep B
single lesion and +ve thallium SPECT
positive
genital wart treatment
multiple- topical podophyllum
solitary- cryotherapy
patients with haemachromatosis are at increased risk for
hepatocellular carcinoma
MSH2
MLH1
HNPCC
APC gene
FAP
PTEN gene
cowden
LKB1 STK11
peutz-jeghers
p53
li-fraumeni
sarcoma and leukaemia
who are DPP-4 inhibitors useful inn
obese patients
causes of hypoglycaemia
EXPLAIN
e xogenous drugs (sulfonylureas, insulin) p ituitary insUfficiency L iver failure a ddisons i slet cell tumours n on pancreatic neoplasms
glucocorticoid treatment can induce
neutrophilia
acronymn for thyroid ca
PFMAL
treatment of MODY
sulfonylureas- gliclazide
MODY inheritance
autosomal dominant
Diabetic drug contraindicated in HF
pioglitazone- thiazoledinedione