20 December Flashcards
What should be done if clinic BP is 140/90- 179/119?
Offer ABPM or HBPM
Investigate for organ damage
Assess CV risk
If BP in clinic >180/120 on 2 readings in clinic- consider starting drug treatment with no ABPM and repeat BP in 7 days if no sign of organ damage
What is stasis dermatitis?
Discolouration and ulceration of the lower legs near the ankles
What are features of lateral epicondylitis?
Tennis elbow
Lateral elbow and forearm pain worse on use
Pain just distal to lateral epicondyle
Pain on wrist extension and supination
Treat
- rest
- elbow strap
- NSAIDs
- Steroid injections if severe
What is the management of urticaria?
Antihistamines are mainstay
Trial non sedation first
If not responding to treatment- double dose of antihistamines
Add sedating antihistamine at night if sleep disturbed
Topical anti-pruritic treatment
Severe- oral steroids with non sedating antihistamine
Omalizumab and immunomodulatory medication in refractory cases
How can you calculate units of alcohol drunk?
Volume in ml x %ABV divided by 1000
What are live vaccines?
MMR
BCG
Oral polio
Yellow Fever
VZV
Oral typhoid
When should live vaccines not be given?
Evolving neurological problems e.g. poorly controlled epilepsy
HIV severe immunity impairment
What is Freiberg disease?
Osteochondrosis affecting the toes- particularly 2nd or 3rd metatarsal heads
Seen in teen girls
Pain on weight bearing
Rest and metatarsal pad
Surgery in severe cases
What are 1st line abx for IECOPD?
1) Amoxicillin 500mg TDS for 5 days
2) Doxycycline 200mg day 1 then 100mg OD for 4 days
3) Clarithromycin 500mg BD for 5 days
What is Hypertrophic Cardiomyopathy?
Asymmetrical left ventricular hypertrophy due to septal hypertrophy
Can lead to impaired diastolic function and sudden onset death
What are investigations of HCM?
ECG- non specific changes
2) CXR can be normal
ECHO- first line imaging
Cardiac MRI- gold standard if ECHO inconclusive
Cardiac catheterisation- to determine degree of obstruction
What are risk factors for bowel cancer?
FH of cancer
Polyps
IBD
Genetic conditions- HNPCC
Hormonal factors- no children
- Diet- high in fat, red meet, folate
Smoking
Obese
Diabetes
What antibodies are seen in diffuse sclerosis?
Anti-Scl- 70
What antibodies are seen in limited sclerosis?
Anti centromere
Anti nucleolus
What is Behcets disease?
Chronic multisystem vasculitis
Genital ulcers
Skin lesions- erythema nodosum, folliculitis, acne in adults
Eye inflammation- iritis, uveitis
Behavioural changes
Arthritis
Treat with steroids in severe disease
Biologics
What is the most common lung injury following blunt chest trauma?
Pulmonary contusion
Present with dyspnoea, tachypnoea, chest pain, haemoptysis
What investigations are needed for multiple myeloma?
Blood film- rouloux formation
Serum/urine elctrophoresis- bence jones protein in urine
U&Es- renal impairment
Ca- Hypercalcemia
FBC- pancytopenia
What are ottawa rules for foot XR in suspected ankle fractures?
Bone tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus
Bone tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus
Inability to weight bear immediately after injury or in ED for 4 steps
What are ottawa rules for foot XR in suspected foot fractures?
Bone tenderness at base of 5th metatarsal
Bone tenderness at navicular bone
Inability to weight bear immediately after injury or in ED for 4 steps
What is milk-alkali syndrome?
Hypercalcaemia, renal failure and metabolic alkalosis due to excessive absorption of calcium
Due to widespread use of calcium carbonate (antacids or calcium replacement to prevent osteoporosis)
What are features of pinworm infection?
Enterobius vermicularis
Faecal oral contamination
Live in intestines- often asymptomatic but if symptoms
- pruritis ani, restlessness during sleep, excoriation around anus/vulva
Treat with mebendazole - one off dose and then repeated within 2-3 weeks
What are features of polymorphic eruption of pregnancy?
Pruritic condition seen in last trimester of pregnancy
Abdominal striae without excoriations sparing umbilicus
Lesions spread to trunk, thighs, arms
resolves following delivery of baby
Can use emollients and steroids if needed
