22/05 Flashcards
age of onset of west syndrome
4 to 8 months
prognosis of west syndrome
poor
features of west syndrome
salaam attacks
progressive mental handicap
describe salaam attacks
flexion of head, trunk and arms followed by extension of the arms
investigation in west syndrome
EEG= Hypsarrhythmia in two-thirds
CT demonstrates diffuse or localised brain diseases
management of west syndrome
vigabatrin 1st line
ACTH used
side effect of hydroxychloroquine
severe and permanent retinopathy
is hydroxychloroquine safe in pregnancy
yes if needed
GCS scoring
Motor response
- Obeys command
- localises to pain
- withdraws from pain
- abnormal flexion to pain (decorticate posture)
- extending to pain
- none
Verbal response
- orientated
- confused
- words
- sounds
- none
eye opening
- spontaenous
- to speech
- to pain
- none
TAKE THE BEST SIDE
DIC classical blood picture
- thrombocytopenia
- low fibrinogen
- high PT & APTT
- increased fibrinogen degradation products
in homeostatic condition coagulation and fibrinolysis are _____
coupled
what is the central proteolytic enzyme of coagulation
plasmin
the activation of the coagulation cascade yields ______ that converts fibrinogen to ____; the stable fibrin clot being the final product of hemostasis. The fibrinolytic system breaks down fibrinogen and fibrin. Activation of the fibrinolytic system generates _____ (in the presence of thrombin), which is responsible for the lysis of _____ clots. The breakdown of fibrinogen and fibrin results in ______ (fibrin degradation products).
the activation of the coagulation cascade yields thrombin that converts fibrinogen to fibrin; the stable fibrin clot being the final product of hemostasis. The fibrinolytic system breaks down fibrinogen and fibrin. Activation of the fibrinolytic system generates plasmin (in the presence of thrombin), which is responsible for the lysis of fibrin clots. The breakdown of fibrinogen and fibrin results in polypeptides (fibrin degradation products).
critical mediator of DIC
tissue factor
how does TF play an important role in DIC
TF is present on the surface of many cell types (including endothelial cells, macrophages, and monocytes) and is not normally in contact with the general circulation, but is exposed to the circulation after vascular damage. For example, TF is released in response to exposure to cytokines (particularly interleukin 1), tumour necrosis factor, and endotoxin.
what does TF do
bind with coagulation factors that trigger the intrinsic pathway of coagulation
what is the extrinsic pathway
tissue damage causing formation of TF:VIIIa complec activating factor X to factor Xa
what is the intrinsic pathway
This pathway is slower than the extrinsic pathway, but more important. It involves factors XII, XI, IX, VIII.
warfarin bloods
prolonged PT
normal APTT
normal bleeding time
normal platelet coun
aspirin bloods
normal PT time
normal APTT
prolonged bleeding time
normal platelet count
heparin bloods
prolonged PT time
prolonged PT time
normal bleeding time
normal platelet count
action of unfractionated heparin
activated antithrombin III
forms a complex that inhibits thrombin, factors Xa, Ixa,XIA, and XIIIa
stops fibrin formation and thrombin from activating factors V, VIII and XI
reversal of unfractionated heparin
protamine sulphate
platelet threshold for transfusion for patients with severe bleeding or bleeding at critical sites
< 100 x10(9) /L
using hypotonic (0.45%) in paediatrics
hyponatraemic encephalopathy
women aged > 30 with unexplained breast lump
suspected cancer- two week wait referral to the breast clinic
what is HSMN
hereditary sensorimotor neuropathy
encompasses charcot-marie-tooth disease
types of HSMN
type I: demyelinating pathology (CMT)
type II: axonal pathology
features of CMT
- autosomal dominant
- due to defect in PMP-22 gene (codes for myelin)
- features start at puberty
- motor symptoms predominate
- distal muscle wasting, pes cavus, clawed toes
- foot drop, leg weakness
sickle cell bloods
low Hb, normal MCV, raised reticulocytes
moderate asthma PEFR
50-70%
average patient who is taking metformin for T2DM,:
you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of __ mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to __ mmol/mol (7.5%)
48, 58
dietary advice in diabetes
- high fibre
- low GI sources of carbs
- controlled intake of saturated fate & trans fatty acids
- discourage foods marketed at diabetics
- initial weight loss in overweight person 5-10%
HbA1c targets
lifestyle- 48mmol/mol (6.5%)
lifestyle + metformin - 48mmol/mol (6.5%)
any drugs causing hypo- 53mmol/mol (7.0%)
management of diabetes needing medication
- metformin
if HbA1c > 58
metformin + gliptin
metformin + sulfonylurea
metformin + pioglitazone
metformin + SGLT-2
if HbA1c > 58
triple therapy ; OR insulin
metformin + gliptin + sulfonylurea
metformin + pioglitazone + sulfonylurea
Metformin + sulfonylurea + SGLT-2 inhibitor
metformin + pioglitazone + SGLT-2 inhibitor
if this is not effective, not tolerated or contraindicated AND BMI still > 35
metformin + sulfonylurea + GLP-1 mimetic
metformin not tolerated
gliptin OR sulphonylurea OR pioglitazone
if HbA1c > 58
gliptin + pioglitazone
gliptin+ sulfonylurea
pioglitazone + sulfonylyurea
then insulin
names of sulfonylureas
DiaBeta, Glynase, or Micronase (glyburide or glibenclamide) Amaryl (glimepiride) Diabinese (chlorpropamide) Glucotrol (glipizide) Tolinase (tolazamide) Tolbutamide.
The initial management of open fractures
administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film.
The wound should only be handled to remove gross contamination.
The patient is then likely to require definitive skeletal and soft tissue reconstruction.
Surgery / metformin on day of surgery:
Surgery / metformin on day of surgery:
OD or BD: take as normal
TDS: miss lunchtime dose
assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure
Patients with a documented allergy to a sulfa drug (i.e. co-trimoxazole) should not take …
sulfasalazine
In the BNF section ‘Prescribing in dental practice’ it advises that patients in this situation should….
continue taking anti-platelets as normal
Chronic myeloid leukaemia treatment
tyrosine kinase inhibitor
presentation of yellow fever
present in two phases where the patient experiences a brief remission in between
- may cause mild flu-like illness lasting less than one week
- classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
- if severe jaundice, haematemesis may occur
- Councilman bodies (inclusion bodies) may be seen in the hepatocytes
associations with mitral valve prolapse
congenital heart disease: PDA, ASD cardiomyopathy Turner's syndrome Marfan's syndrome, Fragile X osteogenesis imperfecta pseudoxanthoma elasticum Wolff-Parkinson White syndrome long-QT syndrome Ehlers-Danlos Syndrome polycystic kidney disease
features of mitral valve prolapse
patients may complain of atypical chest pain or palpitations
mid-systolic click (occurs later if patient squatting)
late systolic murmur (longer if patient standing)
complications: mitral regurgitation, arrhythmias (including long QT), emboli, sudden death
Malaria prophylaxis (e.g. primaquine) can trigger ….
haemolytic anaemia in those with G6PD deficiency
features of G6PD deficiency
Features neonatal jaundice is often seen intravascular haemolysis gallstones are common splenomegaly may be present Heinz bodies on blood films. Bite and blister cells may also be seen
clues which point towards a diagnosis of motor neuron disease
fasciculations
the absence of sensory signs/symptoms*
the mixture of lower motor neuron and upper motor neuron signs
wasting of the small hand muscles/tibialis anterior is common
Ciclosporin side-effects
everything is increased - fluid, BP, K+, hair, gums, glucose
view demyelinating lesions
MRI with contrast should be used to view demyelinating lesions
spasticity in MS
Baclofen and gabapentin
left homonymous hemianopia
visual field defect to the left, i.e. Lesion of right optic tract
homonymous quadrantanopias
PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects
optic tract lesion; congruous defects = optic radiation lesion or occipital cortex
NICE advise that, as PSA levels may be increased, testing should not be done within at least:
6 weeks of a prostate biopsy 4 weeks following a proven urinary infection 1 week of digital rectal examination 48 hours of vigorous exercise 48 hours of ejaculation
Turner’s syndrome murmur
is associated with an ejection systolic murmur due to bicuspid aortic valve
Cerebellar hemisphere
finger-nose ataxia
Basal ganglia
Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)
Parietal lobe
sensory symptoms, dyslexia, dysgraphia
Frontal lobe
motor symptoms, expressive aphasia, disinhibition
Cerebellar vermis lesions
gait ataxia
feature of optic neuritis
central scotoma
Prostate cancer - more common in
afro-carribean population
cause of aplastic crisis
parvovirus
required by patients with beta-thalassaemia major
Lifelong blood transfusions
most common presentation of neonatal sepsis
Grunting and other signs of respiratory distress
Loss of corneal reflex
think acoustic neuroma
Osteoporosis is commonly associated with _____ blood test values (e.g. _____ ALP, ____ calcium, _____ phosphate, ____ PTH)
Osteoporosis is commonly associated with normal blood test values (e.g. normal ALP, normal calcium, normal phosphate, normal PTH)
contraindicated with any form of cardiovascular disease
diclofenac
criteria for liver transplantation
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Complications of Transurethral Resection: TURP
T ur syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostate
A _______ should be requested in those with multiple episodes of loss of consciousness with quick recovery times
24 hr ECG
Severe asthma RR
> 25/min
eGFR variables
CAGE - Creatinine, Age, Gender, Ethnicity
Once an ischaemic stroke is confirmed the patient should be given …..
aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term.
A statin should also be offered if the patient is not already on statin therapy.
how to know if chest drain is in pleural cavity
Rises in inspiration, falls in expiration
late sign of cauda equina
urinary incontinence
who gets leptospirosis
sewage workers, farmers, vets or people who work in an abattoir
however, on an international level, leptospirosis is far more common in the tropics so should be considered in the returning traveller
features of leptospirosis
the early phase is due to bacteraemia and lasts around a week
>may be mild or subclinical
>fever
>flu-like symptoms
>subconjunctival suffusion (redness)/haemorrhage
second immune phase may lead to more severe disease (Weil’s disease)
>acute kidney injury (seen in 50% of patients)
>hepatitis: jaundice, hepatomegaly
>aseptic meningitis
investigation of leptospirosis
- serology: antibodies to Leptospira develop after about 7 days
- PCR
- culture
> growth may take several weeks so limits usefulness in diagnosis
-blood and CSF samples are generally positive for the first 10 days
-urine cultures become positive during the second week of illness
management of leptospirosis
high-dose benzylpenicillin or doxycycline
irregular broad complex tachycardia
senior help
IV adenosine needs to be infused via ….
IV adenosine needs to be infused via a large-calibre vein or central route
