23 December Flashcards
What is the management of TIA?
1) Aspirin 300mg STAT
2) Following review by specialist for 1st 21 days= Aspirin and Clopidogrel
3) Long term post 21 days= Clopidogrel
What is the management of erectile dysfunction?
1) Oral Phosphodiesterase inhibitors e.g. slidenafil to improve smooth relaxation of muscles OR Vacuum devices
2) Intraurethral alprostadil- pellet inserted into penis for erection, Intracavernosal alprostadil inserted into corporus cavernosum to produce erection
3) Penile Prosthesis- devices inserted to cause a erection
What are side effects of Phosphodiesterase inhibitors? e.g. slidenafil
GI upset
Headache
Blue discolouration of vision,
Non arteritic anterior ischaemic optic neuropathy
Nasal Congestion
Flushing
Avoid if
- hypotension
- on nitrates
- recent stroke/MI
- unstable angina
What is Vasa Praevia?
Foetal vessels cross/close to inner cervical os
Antepartum haemorrhage post artifical rupture of membranes= highly suggestive
- High foetal mortality rate
What is the management of amoebic liver abscess?
Metronidazole
What is the management of tinea capitis?
If Trichophyton infection then terbinafine
If Microsporum infection then Griseofulvin
Topical ketoconazole shampoo for 2 weeks as well
What us UK MEC 4 for COCP?
> 35 yo smoking >15 a day
Migraine with aura
Uncontrolled HTN
Previous/current VTE
Postpartum <6 weeks (bf) or <3 weeks (not bf)
- AF
- History of stroke/IHD
- Current breast cancer
- Severe cirrhosis
- Cardiac problems- myopathy, valvular heart disease
- Anti-phospholipid antibodies present
- Major surgery
What is otic barotrauma?
Seen post flights/divers
Ear popping- in severe cases leads to epistaxis
May have haemorrhagic areas within in the ear drum
May get conductive hearing loss
What are features of Nasopharyngeal carcinoma?
Seen in SE asia esp Chinese
Assocaited with EBV
Presents late due to mets symptoms
- bilateral cervical node enlargement
- nasal voice
- epistaxis
- nasal obstruction
- deafness
- may get Cn involvement
MRI with gadolinium and fat suppression is gold standard
Treatment is external irridation
What is the management of stable angina?
1) BB or CCB
2) Add other in (if adding CCB must be amlodipine), long acting nitrate, nicrorandil (only if other meds unsuitable)
What is the first line management of RA?
1) Methotrexate
- NSAIDs, Steroids whilst DMARD working
What are features of retroperitoneal fibrosis?
Associated with autoimmune diseases, metastatic malignancy, drugs
Non specific symptoms (long time to diagnose)
- pain in flank/backk. scrotum, fever, HTN
Bloods- raised ESR, CRP, anaemia, uraemia
AXR- Maiden Waist sign (ureters brought in close)
Para aortic mass
Management
- steroids, tamoxifen, azathioprine
What is prophylaxis of tension headaches?
Amitryptilli8ne
What is Lichen Simplex Chronicus?
Thickening of the skin with variable scaling due to repetitive scratching or rubbing
Often caused by eczema, bites, scars
Localised demarcated plaque withscaling and excoriations overlying
Treatment- potent topical steroids, tar or ichthyol preparations
What are features of Rubeosis iridis?
Caused by retinal ischaemia due to diabetic retinopathy or CVRO
Painless and asymptomatic
Characterised by visible blood vessels on the iris
Treat with pain retinal photocoagulation to reduce vascularisation
What are features of Cryptococcosis?
Fungal infection seen in HIV people
Lungs primary infection
Can get meningoencephalitis
Treatment
-asymptomatic/mild disease oral fluconazole
Severe- Amphotericin B and Flucytosine
What are features of Colles fracture?
Due to FOOSH
Dorsal displacement of distal fracture fragment
Dinner form deformity may be seen
What are features of Gameskeeper thumb?
Tear of ulnar collaterol ligament of thumb
May get small avulsion fracture of the thumb
What are features of Lambert Eaton Syndrome?
Due to SC lung cancer
Progressive weakness that does not involve resp muscles or face
Symptoms tend to be worse in the morning and improve with exercise
Proximal legs and arms are affected
Reduced reflexes
Steroids, azathioprine, 3,4-diaminopyridine mainstay of treatment
What are features of Alport Syndrome?
X linked/ autosomal recessive
Sensorineural deafness
Pyelonephritis
Haematuria
Renal failure
Treat with dialysis of transplant
What are features of Balkan nephropathy?
People from Danube river
Only presents in adults
Normotensive
Bilirubin on palms and soles (tanchev sign)
NAnaemia
Slow progressive renal failure
What are features of paroxysmal nocturnal haemoglobinuria?
Haemolytic anaemia
- urine dark brown in colour worse in morning
- urine dipstick positive for blood but no red blood cells on microscopy
Thrombosis
Deficient haematopiesis- anaemia like Sob on exercise
Diagnosed via flow cytometry
Treatment
- blood transfusion
- meningococcal vaccination
- eculizumab
- anticoagulation
