1/4/22 Flashcards
Why is it not useful to use D-dimer in pregnancy when investigating a suspected PE?
D-dimer is typically raised in pregnancy anyway - best step if clear CXR and no leg signs but high clinical suspicion is V Q Perfusion
Who suffers more from MS - men or women?
Men have a worse prognosis
What is Cushing’s Triad?
What is it a sign of?
- Increased BP
- Reduced HR
- Irregular breathing
Raised ICP
What kind of aneursym causes a CN III palsy?
Posteior communicating
What is the proper word for lung collapse?
Atelectasis (at-uh-LEK-ta-sis)
Give a profile on Cushing’s syndrome.
Caused by an increase in cortisol (cortisol production is driven by ACTH which is released by the anterior pituitary gland). Cushing’s disease is the pituitary disease causing Cushing’s features
What:
- ACTH driven - pituitary and ectopic (small cell lung cancer)
- Non-ACTH driven causes - adrenal
Present:
- moon face
- hump back
- thin skin and easy bruising
- big belly
- matchstick legs
- proximal muscle weakness
Diagnose:
failure to supress on an overnight dexemethasone supression test
- bloods to check ACTH and cortisol levels
- imaging to check pitutiary and adrenal glands
Manage:
- metyrapone - drug used to reduce cortisol and aldosterone levels produced
- remove mass causing the problem
How many new mums are affected by baby blues?
50-75%
Inferior MI affects what artery?
Right coronary artery
Do profile for PCOS in the same way did MS ones and in the manner you would present to paitent.
What is it? How have they most likely presented to clinic? What investigations? How will it affect patient's life? How will it be managed?
PCOS is a condition where women get an increased number of cysts developing in their ovaries. This comes along with a hormonal imbalance where you get more male hormone testoterone, this can explain why you may be having acne or have noticed thicker hair growing across your face. The extra cysts on your ovaries also makes it more difficult for you to release eggs so you may release less or none at all which will explain why your periods are irregular or sometimes don’t come at all. Unfortunately there is no way to cure PCOS - it something you have to learn to live with.
There are ways we can manage the symptoms that you get with it. I understand this can be pretty tough. There are some complications however that is important you are aware of. PCOS can cause fertility problems and also make you more susceptible to diabetes. We can discuss the best ways to manage these complications just now or later.
Acne Hiristism Obesity Irregular or no periods Infertility
TVUSS - with diagnostic criteria met Bloods to check hormonal profile - *high LH* - *high LH:FSH ratio* - high testoterone - high insulin Screen for dibaetes with oral glucose tolerance test
- COCP
- reduces acne and hirsitum - Weight loss
- increases fertility - Acne
- duac (clindamycin + benzoyl peroxide) - Hirstium
- laser hair removal or elfornithine (takes 6-8 weeks to see results)
How does PCOS appear on USS?
“String of pearls”
Diagnosis =
- 12+ developing follicles on one ovary
- ovarian volume >10cm3
Is aspirin an NSAID?
Yes
What drugs in someone’s who has been having recurrent falls could have caused:
- postural hypotension
- arrythmias
Loop diuertics - postural hypotension
Arrhythmias - digoxin
Management of all common skin conditions:
- eczema
- psoriasis
- acne
- seborrhoeic dermatitis
Eczema
- emollient liberally after bathing and when skin is itchy/dry
- topical steroid for flare up
Psoriasis
- vit D analogue (curatoderm) along with once-daily potent steroid (betnovate) for 8 weeks
- then steroid break for 4 weeks and 2x daily vit D
- if no improvement 2x daily steroids or coal tar prep
Acne
- Topical duac (clindamycin and benzoyl peroxide) for 3 months - if poor repsonse + oral antibiotic
- severe - refer to derm for accutane
Seborrhoeic dermatitis
- Anti-fungal - ketoconazole
What drug is used in the treatment of MG?
Pyridostigmine
How should a patient be advised to use an emollient?
Liberally - one person should go through 250-500ml of emollient a week
Very important to apply during/directly after washing - some experts believe this is best to do when skin is still damp
If skin very dry try to apply every 2-3hrs
Rub the emollient in in the direct of hair growth - smooth it down
Wait 15mins before applying steroid if have one
