2015 Flashcards
rate limiting drugs AF
bb (not soltalol)
rate limiting CCB - diltiazem, verapamil. U FORGOT THIS!!
digoxin
rhythm control AF
soltalol
amiodarone
MOA amiodarone
Like other antiarrhythmic drugs of this class, amiodarone works primarily by blocking potassium rectifier currents
causes of facial nerve palsy
infection affecting nerve directly ramsey hunt lyme disease meningitis/encephalitis syphillis
COMPRESSION vestibular schwannoma cholesteatoma facial newrve tumour NF2 parotid tumour rhabdomyosarcoma
VASCULAR AV malformation carotid artery aneurysm haematoma temporal arteritis stroke
SWELLING FROM INFECTION
otitis media and externa
mastoiditis
GENERAL NEURO
guillain barre
MS
MG
sarcoidosis
2 things important to assess in #
open/closed
neurovascular status
stable or unstable
salter harris clarification
1 along metaphysis
through growth plate and physis
3-growth plate and epiphysis (into joint)
4-both
treatment of ramsey hunt
PRED WITHIN 73 HRS!!!!!!!!!11
acyclovir
symptoms of ramsey hunt
vertigo tinnitis HL/hyperacuisis facial nerve palsy otalgia
what do osteoclasts do
breakdown
blasts build
3 functions of PTH
- regulate serum Ca (increase osteoclast activity,, increases Ca reabsorption in kindey, stimulation of conversion of 25 hydroxyvit d to 1,25dihydroxy which stimulates uptake from the intestine)
- reduces resoprtion of phsophate from the proximal tubule of kindey. more phospate is excreted through the urine. phosphates bind with Ca and take it out of the circ so PTH stops this
- vit di synthesis
upregulates activity of 1 alpha hydroxylase which activitates vit d
complications of hyperpara
osteoporosis
kindey stones
CVS disease - HTN (mechanism unclear)
beta thalassaemia investigations
FBC serum iron (often elevated) ferritin raised DIAGNOSIS = Hb electrophoresis
child with beta thalass. what disease do parents have
beta thalassaemia minor/trait
public health intiatives to test for thalassaemia
screening of pregnant women
newborn blood spot test
screening of preg women and babies
MUM
screening for infectious diseases (hepatitis B, HIV and syphilis)
screening for inherited conditions (sickle cell, thalassaemia and other haemoglobin disorders)
screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome
screening for 11 physical conditions (20-week scan)
BABY
newborn physical examination
newborn hearing screening
newborn blood spot screening
treatment of beta thalassaemia major
Regular hypertransfusion Iron chelation (prevent iron overload symptoms)
consider spenectomy if hypersplenism
Folate supplements
iron overload sx
cardiac iron overload -> reduced exercise tolerance or R HF
cirrhosis
arthralgia
diabetes due to deposition in the pancreas
mechanism of hydrops foetalis
Compensatory mechanisms for maintaining homeostasis
anaemia -> hypoxia ->
a)redistribution of blood to brain/ehart/adrenal causing renal tubular damage
during hypoxia that results from underlying disease include increased efficiency of oxygen extraction; redistribution of blood flow to the brain, heart, and adrenals, thus causing renal tubular damage; volume augmentation to enhance cardiac output; and marked activation of the renin-angiotensin system. Unfortunately, these mechanisms also increase venous pressure and ultimately produce interstitial fluid accumulation and characteristic hydropic changes in the fetus.
type 1 hypersensitivity pathophysiology
B cells produce IgE specific to an antigen. The IgE binds the the surface of mast cells and basophils - they become sensitised.
when re-exposed to the antigen, the antigen binds to the IgE antibodies coating mast cells and basophils
This causes cell degranulation and release of histamine and other inflammatory mediators
3 main risk factors of head and neck Ca
Heavy smoking, heavy alcohol consumption (the two act synergistically) and poor dentition
others =
Cantonese-style salted fish
HPV16
oropharyngeal Ca Ix
With the exception of persistent hoarseness (urgent CXR to decide where to refer), investigations in primary care are not recommended, as they can delay referral.
LFTs - could suggest abdo mets
CXR - mets/hoarse
baseline - U+E, TFTs, pulm func
biopsy. fine needle aspiration is preferred?
CT/MRI of primary tumour and to stage for nodes/mets
PET if px w/ cervical lymph node mets and can’t find primary on CT/MRI
MRI instead of CT when in head and neck Ca
- oropharyngeal and oral tumours
- assessment of tumour involvement of the skull base, orbit, cervical spine or neurovascular structures.
NB all should have CT thorax
blood mixed in with stool ddx
infections, IBD, diverticula, or tumour
Ix to diagnose renal colic
non-enhanced CT
(replaced intravenous pyelogram)
plain X-ray is useful to see passage of stones but is not used for dx - remember suspected pt with stone in flexi clinic had to be admitted to have the CT that day
