15/06 Flashcards
tx of orthostatic hypertension
> fluid and salt intake
compression stockings
med review
Fludrocortisone or midodrine
status epilepticus mx
pre-hosp: PR diazepam or buccalmidazolam
hosp:
IV lorazepam, repeat after 5-10 min
levetiracetam, phenytoin or sodium valproate
GA to control airway
test pt for hep b
hbsag
early diastolic murmur
aortic regurgitation
high fever, rapid onset and herpes labialis
strep pneumo
pneumonia in COPD
haemophilus
pneumonia following flu
staph aureus
dry cough, atypical chest findings, AI haemolytic anaemia, erythema multiforme
mycoplasma
hyponatreamia, lymphopenia, air conditioning units
legionella
pneumonia follow up
repeat chest X-ray at 6 weeks
Varenicline caution
patients with a history of depression or self-harm
bupronion CI/caution
epilepsy, breast feeding/eating disorder
pregnancy smoking cessation
NRT only
upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes
silicosis
sarcoidosis bloods
hypercalcaemia
»ACE levels
»ESR
indications for steroids in sarcoid
chest x-ray stage 2 or 3 disease who are symptomatic
hypercalcaemia
eye, heart or neuro involvement
psoriasis 1st line
potent corticosteroid applied once daily plus vitamin D analogue applied at different time
severe hyperkalaemia
A sinusoidal/sine wave ECG pattern
sedative in delirium
haloperidol 0.5 mg
tx of delirium in parkinsons
< of parkinsons meds
atypical antipsychotics quetiapine and clozapine
mild to mod alzheimers and Lewy body tx
acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine
2nd line for alzheimers/Lewy body or severe disease
NMDA receptor antagonist - memantine
alzheimers pts at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress
antipsychotics
when is donepezil CI
bradycardia
donepezil SE
insmonia
path changes in alzeheimers
widespread cerebral atrophy, particularly involving the cortex and hippocampus
sudden or stepwise deterioration in cognitive function
vascular dementia
screen for pts at risk of pressure sores
waterloo score
mx of pressure sores
moist wound environment - Hydrocolloid dressings and hydrogels
tissue viability nurse
surgical debridement
frailty assessment
gait speed, self reported health status, PRISMA-7 questionaire
scan for lewy body
SPECT
falls blood screen
FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels
vaginal passage of faeces or flatus
colovaginal fistula due to diverticular disease
cardiac arrhythmia macrolides
torsades de pointes
acromegal invx
first line = serum IGF1
if this is»_space;, OGTT
tx of acromegaly
transphenoidal surgery
2nd line = somatostatin analogue eg ocreotide, GH receptor antagonist pegvisomat
commonest cause of addisons uk
AI destruction of adrenal glands
diagnosis of addisons
ACTH stimulation test, short synacthen test
if not available, 9am cortisol
addisons electrolyte abnormalities
hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis
mx of addisonian crisis
hydrocortisone 100mg im or iv
1 l saline infused over 30-60 mins or with dextrose if hypoglycaemic
continue hydrocortisone 6 hourly until the patient is stable
oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
CARBIMAZOLE adverse effect
agranulocytosis
congenital adrenal hyperplasia inheritance
autosomal recessive
congenital adrenal hyperplasia endocrine
affect adrenal steroid biosynthesis
in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH
ACTH stimulates the production of adrenal androgens
presentation of congenital adrenal hyperplasia
virilisation in females
precocious puberty in males
salt losing crisis
most common cause of congenital adrenal hyperplasia
21-hydroxylase deficiency
congenital hypothyroidism
prolonged neonatal jaundice
delayed mental & physical milestones
short stature
puffy face, macroglossia
hypotonia
Minimal glucocorticoid activity, very high mineralocorticoid activity
fludrocortisone
Glucocorticoid activity, high mineralocorticoid activity
hydrocortisone
Predominant glucocorticoid activity, low mineralocorticoid activity
prednisolone
Very high glucocorticoid activity, minimal mineralocorticoid activity
dexamethasone
betamethasone
sick day rules pt on long term steroids
double dose
when to take statins
last thing in evening
restless legs syndrome tx
dopamine agonists such as ropinirole
salicylate poisoning
iv bicarb
hypothermia ECG
J waves
afro carribean hypertension
CCB
when to co-prescribe in SSRI
when already taking an NSAID, give a PPI
valvulae conniventes extending across bowel
small bowel obstruction
Bone pain, tenderness and proximal myopathy
?osteomalacia
when can pts be tested for coeliac
when they have eaten gluten for 6 wks
why is nephrotic syndrome assoc with a hypercoagulable state
loss of antithrombin III by the kidneys
Stopping of voluntary movement or staying still in an unusual position
catatonia
TLCO in IPF
reduced
when is platelet transfusion indicated
platelet count <30 and clinically significant bleeding
CLL transformation
richters = non-hodgkins lymphoma
severe diverticulitis flare
72 hours, admission to hospital for IV ceftriaxone + metronidazole is indicated
critical limb ischaemia
pain at rest for greater than 2 weeks, often at night, not helped by analgesia
why is albumin prescribed in large volume ascites paracentesis
reduces paracentesis-induced circulatory dysfunction and mortality
parkinsons delerium
lorazepam
Rupture of the papillary muscle due to a myocardial infarction ->
mitral regurgitation
pH NG tube
safe to use if <5.5 on aspirate
what is reccomended after WLE breast cancer
whole breast radiotherapy
timolol eyedrops MOA
reduce aqueous secretion
gynae disease RF for ectopic
endometriosis
which other antidepressent do SSRIs interact with -> serotonin syndrome
MAOs eg phenelzine
prophylaxis for contacts of meningitis
Oral ciprofloxacin or rifampicin
most common MOA of ankle sprain
inversion
what should be checked prior to prescribing EPO in CKD
iron studies
when should lithium levels be checked
7 days, 12 hours post-dose
vision worse going down stairs
4th nerve palsy - trochlear
T1DM antibodies
anti-GAD
islet cell antibodies
insulin autoantibodies
symptomatic DM diagnosis
fasting glucose >= 7.0 mmol/l
random glucose >= to 11.1 mmol/l (or after 75g OGTT)
asymptomatic DM diagnosis
same applies but must be demonstrated x2
atypical features of T1DM - order C peptide or antibodies
age 50 years or above, BMI of 25 kg/m² or above, slow evolution of hyperglycaemia or long prodrome
HBA1C T2DM diagnostic
> =48 (repeat test to confirm diagnosis)
conditions where HBA1C cannot be diagnostic
haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected GDM
children
HIV
CKD
ptstaking medication that may cause hyperglycaemia (eg steroids)
pre-diabetes
HBA1C 42-47
fasting glucose 6.1-6.9
metformin MOA
Increases insulin sensitivity
Decreases hepatic gluconeogenesis
metformin SEs
lactic acidosis
GI upset
metformin CI
eGFR <30
sulfonylureas eg gliclazide, glimepiride
Stimulate pancreatic beta cells to secrete insulin
sulfonylureas eg gliclazide, glimepiride SEs
hypoglycaemia
wt gain
hyponatramia
Thiazolidinediones eg pioglitazone MOA
Activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake
Thiazolidinediones eg pioglitazone SE
weight gain
fluid retention
DPP4 inhibitors eg gliptins MOA
Increases incretin levels which inhibit glucagon secretion
DPP4 inhibitors eg gliptins potential but rare SE
pancreatitis
SGLT-2 inhibitors (-gliflozins) MOA
inhibits reabsorption of glucose in the kidney
SGLT-2 inhibitors (-gliflozins) SE
UTIs
SGLT-2 inhibitors (-gliflozins) benefit
wt loss
GLP-1 agonists (-tides) (SC) MOA
Incretin mimetic which inhibits glucagon secretion
GLP-1 agonists (-tides) (SC) SEs
Nausea and vomiting
Pancreatitis
how often HBA1C monitored in T1
3-6 monthly
blood glucose targets
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
hba1c target when taking drug which may cause hypo eg sulfonylureas
53
Already on one drug, but HbA1c has risen to 58 mmol/mol target
53
DKA path
uncontrolled lipolysis (not proteolysis) which results in an excess of free fatty acids that are ultimately converted to ketone bodies
DKA diagnostic criteria
glucose > 11 mmol/l or known DM
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick
what electrolyte should be added to fluid in DKA
potassium
DKA resolution
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
DKA resolution timeframe
should be within 24 hrs -> endocrinologist
diabetic peripheral neuropathy
SENSORY loss in a glove and stocking distribution
indicator kidney disease is chronic not acute
hypocalcaemia
how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome
3 months
lower than exptected HBA1C (due to <RBC lifespan)
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
higher than expected HBA1C (due to >RBC lifespan)
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
graves disease main antibodies
TSH receptor stimulating antibodies
CIs radioactive iodine tx
pregnancy
age <16
eye disease
hashimotos antibodies
anti-thyroid peroxidase (TPO) and also anti-thyroglobulin (Tg) antibodies
cancer assoc with hashimotos
MALT lymphoma
key invx for pts with hypercalcaemia
PTH
HHS features
hypovolaemia
hyperglycaemia
> serum osmolality
no sig ketones or acidosis
insulin in HHS
should not be given unless blood glucose stops falling when fluids given
complciations in HHS
vascular eg stroke or MI
tx of primary hyPOPTH
alfacalcidol
pseudohyperparathyroidism phenotype
low IQ, short stature, shortened 4th and 5th metacarpals
psuedohyperparathyroidism features
low calcium, high phosphate, high PTH
levothyroxine SEs
hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation
levothyroxine interaction
iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart
dermatophyte nail infection
terbinafine
candida nail infection
itraconazole
tx of MODY
sulfonylureas eg gliclazide
High uric acid + renal impairment following chemotherapy
tumour lysis syndrome
kallman syndrome
lack of smell in a boy with delayed puberty
kallman syndrome findings
everything low
klinefelters
tall but 2ndary sexual characteristics, small firm testes and infertile
klinefelters findings
fsh lh high
testosterone low
MEN 1 (MEN 1)
3 Ps
Parathyroid: hyperparathyroidism due to parathyroid hyperplasia
Pituitary
Pancreas: e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
MEN IIa (RET oncogene)
1M
Medullary thyroid cancer
2P’s
Parathyroid
Phaeochromocytoma
MEN IIb (RET oncogene)
2Ms
Medullary thyroid cancer
Marfanoid body habitus
1P
Phaeochromocytoma
Neuromas
raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels
neuroblastoma (adrenal tumour)
what is orlistat
pancreatic lipase inhibitor
anti-thyroid drugs in preg
propylthiouracil in first trim
switch back to carbimazole at start of 2nd trim
features of primary hyperaldosteronism
hypertension
hypokalaemia
metabolic alkalosis
when would starting plasma osmolality be low in water deprivation test
psychogenic polydipsia
modifiable RF thyroid eye disease
smoking
most common and best prognosis thyroid cancer
papillary
Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness
anterior inferior cerebellar artery
MSH2/MLH1 gene mutations
HNPCC
SAH mx
aneurysm coiling
early diastolic murmur
aortic regurgitation
when would you choose sputum culture over smear for TB testing
PLWH
PSC diagnosis
MRCP