15/4/22 Flashcards
How can you tell the difference between hypomania and mania?
What type of bipolar disorder is associated with each?
Hypomania is mania that is not affecting the patient’s daily life
Type 1 - mania
Type 2 - hypomania
What drug is used for alcohol withdrawl?
Chlordiazepoxide
What endocrine condition can paitents develop due to lithium toxicity?
Hypothyrodism
Nephrotic DI
What side effects can you get from clozapine?
Agranulocytosis
Constipation
Weight gain
Hypersalivation
Explain how you would counsel a patient who has missed
= 1 COCP
= 2 COCP (throught each week of the cycle)
1 pill = take yesterday and today’s pill together
2 pills = take yesterday and today’s pill together + use condoms until there has been 7 days of proper pill taking
Week 1: + EMERGENCY CONTRACEPTION
Week 2: No need for EC
Week 3: Finish pack of pills and omit the pill free interval
(due to hormonal protection being at a minimal level in week 1 so no pill could cause a chance of ovulation)
How does the Cu-IUD work?
Decreases sperm motility and survival (creates a hostile environment for sperm)
What is the relationship between cancers and the COCP?
Protective
- ovarian
- endometrial
Increased risk
- breast
- cervical
If a patient starts the following contraceptions halfway through their cycle when do they no longer need to use barrier methods?
- IUD
- POP
- COCP, injection, implant, IUS
IUD - immediately
POP - 2 days
COCP, injection, implant and IUS - 7 days
If POP is taken within how many days of the beginning of the cycle do they not need protection?
Up to and including day 5
After how long post birth do women not need protection?
21 days
POP and IUD/IUS can be started/inserted any time post birth. How does this change for COCP?
Can only be used after 21 days!!
Completely contradicted if breastfeeding <6weeks post-partum
Can be used in >6weeks and <6 months
Sytes and chalazion are both lumps of the eyelid. How can you tell the difference?
Styes are painful - staphylococcal infection of lash follicule
Unlike chalazion
How do you manage styes and chalazions and belpharitis?
Lid hygiene - warm compresses x2 day
Fluoxicillin if stye has cellulitis
Name 4 symptoms of optic neuritis
Red desaturation
Pain on eye movements
Decrease in visual acuity
RAPD - relative afferent pupil defect
How do you manage conjunctivitis?
Warm compress x2 day
Lid hygiene
HAND hygiene - to stop spread
If bacterial suspected - topical chloramphenicol drops
Cool compresses in viral
What clinical sign may you see outwith the eye in viral conjunctivits
Pre-auriclar lymphadenopathy
“Stormy-sunset” appearance on fundoscopy?
What else will they present with?
Central retinal vein occlusion
Sudden visual loss
Painless
What are you looking for on funduscopy?
- 3 C’s
- Peripheral retina
- Macula
C’s
1 - cup
2 - colour
3 - contour
DD list for blurred optic nerve disc
What clinical presentation can this cause?
Papillits - inflammation of optic nerve head - optic neuritis (seen in MS)
CRVO
Malignant HTN
Papilloedema
Increase in blind spot
What is the definition of papilloedema?
BILATERAL blurred disc margins in CONTEXT of raised ICP
Only if these conditions are met
Pale disc = bright/dark disc?
Bright disc = pale disc
What does - silver wiring - AV nipping - dot blots - blurred optic disc margain suggest?
HTN retinopathy
Scleritis vs episcleritis
Scleritis = deep boring pain as sclera is where intraocular muscles insert
- need oral steroids and immunosuppresion
Episcleritis - benign but can be more red
- need just NSAIDS
What is the management of acute closed angle glucoma?
What is the management of open angled?
Closed (due to fault in aqueous humor being able to get out through iris)
- IV acetazolamide
- pilocarpine = constrict pupil and pull out of closed angle
- lay patient flat
- BILATERAL peripheral laser iridotomy
Open (due to fault in trabecular network reabsorbing aqueous humour)
- latanoprost - prostagladin analgoue - decrease IOP - increase patency of trabecular network
- B-blockers - reduce aqueous production
How do acute closed angle glucoma present?
Red painful eye
Fixed oval shaped pupil
Loss of vision
Cloudy corneal oedema
What does an increased cup to disc ratio suggest?
Raised IOP
Appearance of glare from bright light = ?
Cataracts
What kind of vision loss happens in ARMD?
Central vision loss
What is the management of dry vs met AMD?
Dry - no cure
- smoking cessation
- v healthy diet with lots of omega-3 fatty acids
- vitamin supplements
Wet
- inject intra-vitreal anti-VEGF
A -ve perscription = what
What lens do you use?
What kind of sight loss is associated with retinal detachment?
-ve = shortsighted = can see things close up = need concave lens
+ve = longsighted = can see things far away = need convex lens
Shortsighted
Easy way to remember causes of sudden vision loss
ABCD
ARMD - wet
Blocked vessel/bleed
Closed angle glucoma
Detachement of retina
What is meant by endopthalmitis?
When is it normally seen?
Inflammation of whole eye
Post surgery
What eye sign is associated with Argyl-Robertson pupil?
What is it?
Tertiary syphilis
Accomodate but don’t react = ‘Prostitute’s pupil’
What is the term for pupils not the same size?
Anisocoria
Parasympathetic or sympathetic control pupil dilation?
Sympathetic = fight or flight = need as much light in eye as possible
What muscle is responsible for majority of eyelid elevation - what controls it?
What muscle is repsonible for rest and what controls that?
Relate this to ptosis
Majority (90%) - levator palpebrae superioris - parasympathetic - ptosis in CN3 palsy
Minority (10%) - Muller muscle - sympathetic innveration - Horner syndrome ptosis
How does anterior uveitis look like?
Causes?
Inflammation of the uvea - coloured part of the eye
Ciliary injection (redness around the iris) with hypopyon
Seronegative spondyloarthropathies
- AS
- Psoriasis
- Reactive (reiter triad - urethritis, arthriris, conjunctivitis - “can’t see, can’t pee, can’t climb a tree)
Bechets
Sarcoidosis
IBD
What is doxazosin used for?
BPH and HTN - alpha 1 antagonist
What is the best way to image a cervical neck fracture?
Why?
CT scan - makes it easier to see bony features
What kind of drug is oxybutynin?
Anti-cholingeric
Difference in presentation between a gastric and duodenal ulcer?
Gastric - worse when eating
Duodenal - better when eating
What is the management of gout?
Acute
- NSAIDS
- Colchine
- Steroids
Prophlyaxis = allopurinol
- can be continued in further acute flare-ups
- start 2 weeks after first acute bout
Where are changes most likely to be found in early Alzhiemer’s?
Temporal
What kind of hormone replacement should be offered to patients with premature menopause?
Combinded until 51
- need oestrogen to prevent bone breakdown
- need progesterone to prevent unopposed oestrogen from causing endo cancer
