17/06 Flashcards
diarrhoea with a long incubation period
amoebiasis
anchovy sauce liver abscess
amoebiasis
chloramphenicol adverse effect
aplastic anaemia
antibiotic causing long QT
macrolides especially erythromycin
undercooked or reheated rice, vomiting/diarrhoea within 6 hours
bacillus cereus
flaccid paralysis
botulism
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement
ulcers typically have a sharply defined, ragged, undermined border
chancroid
when should chalmydia testing be carried out
2 weeks after a possible exposure
profuse ‘rice water’ diarrhoea
cholera
GAS GANGRENE
c perfringens
spastic paralysis
tetanus
diarrhoea in immunocompromised/HIV
Cryptosporidiosis
Owl’s eye’ appearance due to intranuclear inclusion bodies
CMV
grey, pseudomembrane on the posterior pharyngeal wall
diptheria
only DNA virus that is single stranded
parvovirus
bradycardia, constipation and rose spots
typhoid
most common cause of viral meningitis
enteroviruses eg coxsackie, echovirus, rhinovirus
hairy leukoplakia
EBV infection
EBV malignancies
Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
severe, haemorrhagic, watery diarrhoea
contaminated ground beef
e coli 0157 -> HUS
travellers diarrhoea
e coli
acute food poisoning due to toxin
Staphylococcus aureus, Bacillus cereus or Clostridium perfringens
prolonged non bloody diarrhoea
giardiasis
Bloody diarrhoea
Vomiting and abdominal pain
shigella
Severe vomiting
Short incubation period
staph aureus
flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
campylobacter (can -> guillan barre)
multiple, non-keratinised warts
topical podophyllum
solitary, keratinised warts
cryotherapy
complication of giardisis
malabsorption and lactose intolerance
if needle refused in gonorrhea
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
disseminated gonococcal infection
tenosynovitis
migratory polyarthritis
dermatitis
septic arthritis YA
gonorrhea
ground glass hepatocytes
HEP B
what does hep d coninfect with
hep b
severe hep pregnancy
hep E
most commonly affected valve in endocarditis
mitral
Distal transverse or descending colon cancer
left hemicolectomy
herpes gingivostomatitis
oral aciclovir, chlorhexidine mouthwash
kaposis sarcoma cause
HHV8
single or multiple ring enhancing lesions HIV
Thallium SPECT negative
toxoplasmosis
single or multiple homogenous enhancing lesions HIV
thallium SPECT positive
primary CNS lymphoma
widespread demyelination HIV
Progressive multifocal leukoencephalopathy (PML)
diagnosis of HIV
combination tests (HIV p24 antigen and HIV antibody)
HIV testing
testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure
after an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at 12 weeks
glandular fever/infectious mononucleosis cause
EBV
sore throat, pyrexia and lymphadenopathy
infectious mononucleosis
differences in flu vaccine
children = intranasal live vaccine
adults and at risk groups = inactivated vaccine
tx of atypical pneumonia eg legionella
clari or erythromycin
patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss
leprosy
sewage workers/farmers/vets/tropics
leptospiriosis -> serology
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis
LGV
causes of false negative mantoux
immunosuppression (miliary TB, AIDS, steroid therapy)
sarcoidosis
lymphoma
extremes of age
fever
hypoalbuminaemia, anaemia
metronidazole SEs
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
pneumonia with erythema multiforme
mycoplasma -> serology
necrotising fasciitis T1
mixed anaerobes and aerobes
necrotising fasciitis T2
Streptococcus pyogenes
drug RF for nec fasc
SGLT2 inhibs
erythema infectiosum eg slapped cheek cause
parvivirus b19
splenectomy prophylaxis
pneumococcal, Haemophilus type b and meningococcal type C vaccines 2 weeks pre or post
annual flu
abx
chest infection cystic fibrosis
Pseudomonas aeruginosa
q fever from sheep or cattle
Coxiella burnetii
only double stranded RNA virus
Reoviridae
sepsis
life-threatening organ dysfunction caused by a dysregulated host response to infection
coagulase positive staph
staph aureus
coagulase negative staph
staph epidermidis
alpha (partial) haemolytic strep
strep pneumoniae
strep viridans
beta (complete) haemolytic strep
strep pyogenes
strep agalactiae
enterococcus
electrolyte effect of co-trimox
hyperkalaemia
syphillis
treponema pallidum
syphillis inc period
9-90 days
Positive non-treponemal test + positive treponemal test
active syphillis
Positive non-treponemal test + negative treponemal test
false positive syphillis result
Negative non-treponemal test + positive treponemal test
successfully treated syphillis
syphillis mx
IM bezathine penicillin
BV or trichomonas STI
trich
abx interaction with methotrexate
trimethoprim
sudden onset of high fever, rigors, nausea & vomiting Bradycardia
brief remission
jaundice, haematemesis, oliguria
yellow fever
when to send culture in UTI
pregnat
male
F aged > 65 years
visible or non-visible haematuria
recurrent
PE acute mx in pt at risk of bleeding
IV heparin
renal stones invx
NON-CONTRAST CTKUB
what glucose to use in unconscious hypoglycaemic pt
75ml of 20% by IV infusion
T2DM CKD
sulphonylureas + DPP4s
vestibular schwannoma invx
MRI of cerebellopontine angle
poisoning presentation within 1 hr
activated charcoal
when to give o2 in stemi
sats <94%
SSRI use during third trimester
risk of persistent pulmonary hypertension of the newborn
axillary freckles
nf1
night blindness + tunnel vision
retinitis pigementosa
black African or African–Caribbean taking a calcium channel blocker for hypertension, if they require a second agent
ARB eg losartan
ptosis
CN III
acute stress disorder tx
trauma focused CBT
benzos
alcohol withdrawal tx
long-acting benzodiazepines e.g. chlordiazepoxide or diazepam
lorazepam if hepatic failure
adults with anorexia tx
CBT-ED
Maudsley Anorexia Nervosa Treatment for Adults
specialist supportive clinical management
kids with anorexia tx
anorexia focused family therapy
typical antipsychotic examples
Haloperidol
Chlopromazine
atypical antipsychotic egs
Clozapine
Risperidone
Olanzapine
typical antipsychotics SEs
extrapyramidal SEs
hyperprolactinaemia
atypical antipsychotics SEs
metabolic SEs
hyperprolactinaemia
clozapine - agranulocytosis, reduced seizure threshold
acute dystonia
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
ACUTE DYSTONIA mx
procyclidine
akathisesia
severe restlessness
tardive dyskinesia
late onset of choreoathetoid movements
eg chewing and pouting of jaw
antipsychotic risk in elderly pts
> risk of VTE and stroke
clozapine monitoring
initally weekly FBC
baseline monitoring antipsychotics
FBC, U+Es, LFTs
lipids, wt
fasting blood glucose, prolactin
BP, ECG, CV risk assessment
antipsychotic with best SE profile, particularly for hyperprolactinaemia
aripirprazole
benzos MOA
enhance the effect of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels
withdrawal of benzos
dose should be withdrawn in steps of about 1/8 of the daily dose every fortnight
FREQuently BEnd - DURing BARbeque
benzodiazipines increase the frequency of chloride channels
barbiturates increase the duration of chloride channel opening
type I bipolar
mania and depression
type II bipolar
hypomania and depression
mania
severe functional impairment or psychotic symptoms for 7 days or more
hypomania
decreased or increased function for 4 days or more
antidepressant of choice in bipolar
fluoxetine
2nd line mood stabiliser
valproate
duration of symptoms for bulimia diagnosis
at least once a week for three months
bulimia mx
bulimia-nervosa-focused guided self-help for adults
CBT ED
bulimia mx kids
bulimia focused family therapy
charles bonnet syndrome
persistent or recurrent complex hallucinations occurring in clear consciousness
visual impairment
cotard syndrome
pt believes that they (or in some cases just a part of their body) is either dead or non-existent
declerambaults syndrome aka erotomania
pt, often a single woman, believes that a famous person is in love with her
factors favouring depression over dementia
short history, rapid onset
biological symptoms
pt worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss
less severe depression
PHQ-9 score of < 16
more severe depression
PHQ-9 score of ≥ 16
depression tx
guided self-help
group CBT
group behavioural activation (BA)
individual CBT
individual BA
group exercise
group mindfulness and meditation
interpersonal psychotherapy (IPT)
SSRIs
counselling
short-term psychodynamic psychotherapy (STPP)
more severe depression first line mx
individual CBT and an anti-depressant
depression screening qs
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’
depression scales
HAD
PHQ9
DSMIV
Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI
the first SSRI should be withdrawn before the alternative SSRI is started
Switching from fluoxetine to another SSRI
withdraw then leave a gap of 4-7 days before starting a low-dose of the alternative SSRI
Switching from a SSRI to a tricyclic antidepressant (TCA)
cross-tapering
Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine
cross-tapering
Switching from fluoxetine to venlafaxine
withdraw and start slowly
iliac claudication
buttock pain
femoral claudication
calf pain
absolute CI to ECT
raised ICP
anxiety mx
education about GAD + active monitoring
individual non-facilitated self-help or individual guided self-help or psychoeducational groups
cognitive behavioural therapy or applied relaxation or drug treatment
highly specialist input e.g. Multi agency teams
drug tx anxiety
sertraline
insomnia tx if severe daytime impairment
hypnotics - short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon)
lithium adverse effects
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
mild OCD
CBT + ERP
+ SSRI
mod OCD
SSRI or intensive CBT
?clomipramine
severe OCD
2ndary care for assessment
orthello syndrome
pathological jealousy where a person is convinced their partner is cheating on them without any real proof. This is accompanied by socially unacceptable behaviour linked to these claims.
cluster A PDs
odd or eccentric
Paranoid
Schizoid
Schizotypal
cluster B PDs
dramatic, emotional or erratic
Antisocial
Borderline (Emotionally Unstable)
Histrionic
Narcissistic
cluster C PDs
anxious and fearful
Obsessive-Compulsive
Avoidant
Dependent
mx PDs
dialectal behaviour therapy
PTSD tx
trauma-focused CBTor eye movement desensitisation and reprocessing therapy
PTSD drugs
venlafaxine or a SSRI
pseudohallucinations
hallucinations but the person knows not real eg when grieving
brief psychotic disorder
symptoms <1 month
risk of developing schizophrenia
monozygotic twin has schizophrenia = 50%
parent has schizophrenia = 10-15%
sibling has schizophrenia = 10%
no relatives with schizophrenia = 1%
RF schizophrenia
FAMILY HISTORY
black carribean ethnicity
migration
urban environment
cannabis use
schneiders first rank symptoms
auditory hallucinations
thought disorders
passivity phenomena
delusional perceptions
passitivity phenomena
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
poor prognosis schizophrenia
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
section 2
admission for assessment for up to 28 days, not renewable
tx can be given
section 3
admission for treatment for up to 6 months, can be renewed
tx can be given
section 4
72 hour assessment order in an emergency, often changed to section 2
section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
section 5(4)
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
section 17a
Supervised Community Treatment (Community Treatment Order), pt recalled to hosp if dont comply with tx
SSRI post MI
sertraline
citalopram and escitalopram issue
prolonged QT
SSRI interaction
NSAIDs - co prescribe PPI
triptans - inc risk of serotonin syndrome
MAOs -“’
warfarin - use mirtazapine instead
how should SSRIs be reviewed
after 1 week in pts <25
normally after 2 wks
how should SSRIs be stopped
gradually over 4 wks except fluoxetine
SSRI use first trim
small increased risk of congenital heart defects
paroxetine preg
AVOID as inc risk of congenital malformations
SNRIs
venlafaxine and duloxetine
SSRI electrolyte abnormality
hyponatraemia
problem with Z drugs
inc risk of falls in the elderly
Low serum calcium, low serum phosphate, raised ALP and raised PTH
osteomalacia
what drugs can cause malignant hyperthermia
Volatile liquid anaesthetics
the -FLURANES
halothane
when should nitrous oxide be avoided
?pneumothorax
which iv anaesthetic agent has anti-emetic effects
propofol
IV anaesthetic used if haemodynamic instability
Etomidate
anaesthetic for trauma (doesnt cause a drop in BP)
ketamine
IO access site
anteromedial aspect of the proximal tibia
mx of malignant hyperthermia
dantrolene
muscle relaxants
-IUMS
which muscle relaxant is the only DEpolarising neuromuscular blocker
suxamethonium
The muscle relaxant of choice for rapid sequence induction for intubation with the exception of eye injuries
suxamethonium
what can lead to post-op ileus
deranged electrolytes
OAB
oxybutynin aka antimuscarinic
which abx reacts with statins
clarithromycin/erythromycin
