8/06/22 Flashcards
how is pabrinex adminstered?
always IV
triad of dementia, gait disturbances and urinary incontinence?
why is this not alzheimers
Ix?
management?
normal pressure hydrocephalus
alzheimers presents with urinary incontinence later on
first kumbar puncture
ct/mri
ventriculoperitoneal shunting
what is the dose of lorazepam given in status epilepticus
diazepam?
8mg
10mg
what are the mainstay in treatment of stable angina?
Aspirin
Statin
Sublingual GTN
Beta blocker or rate limiting calcium channel blocker
in a patient with normal cholesterol levels after first stroke is a statin indicated?
yes shown to improve mortality
what is the criteria for asses pt for home oxygen requirements? COPD mx
FEV1<30% cyanosis polycythaemia peripheral oedema jvp raised o2 sats less than 92%
criteria for LTOT in COPD
what is timeframe for assessment?
abg 2 in 3 weeks
- pO2 <7.3
if pO2 is 7.3-8 then offer of they have one of the following
polycythaemia
oedema
pulmonary htn
routine maintenance first 24 hours
25-30 ml/kg/day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassium on day 1
when should hartmanns not be given?
in hyperkalaemia as it has K+
what is the risk of using large volumes of 0.9% saline ?
hyperchloraemic metabolic acidosis
what is in 0.9% saline?
154mm/l Na+
154mmol/l K+
HHS management goals?
normalise osmolality with 0.9 saline
replace fluid and elctrolytes 0.45 na+, cl-
normalise glucose
DKA management principles
fluid replacement
insulin
correction of electrolyte disturbance
long acting insulin continued and short stopped
what fluid in DKA?
isotonic saline
insulin administration in dka?
when should you infuse dextrose?
0.1unit/kg/hour
when glucose is <15mmol/l
5% dextrose
correction of electrolyte disturbancein DKA
serum potassium is often high on admission despite total body potassium being low
this often falls quickly following treatment with insulin resulting in hypokalaemia
potassium may therefore need to be added to the replacement fluids
if the rate of potassium infusion is greater than 20 mmol/hour then cardiac monitoring may be required
in acute management of dka what type of insulin
fixed rate whilst continuing regular injected long acting but stopping short acting
how is DKA resolution criteried
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
hypoglycaemia management
if awake?
if unable to swallow
10-20g oral glucose - short acting
like glucogel / dextrogel
IM glucagon
or IV glucose solution through large vein
how is specificity detected?
detection of true negative
= number of true negatives/ [true negatives and false positives] x100
what kind of ascites does nephrotic syndrome present?
low SAAG as albumin is lost through urine
low saag causes?
periotenal cancers - ovarian
chronic infection; tb
nephrotic syndrome
what parameters can diagnose DM
what common glucose is not a diagnostic measure?
fasting glucose >7
random glucose >11.1
urine dip
OGTT- when investigating impaired glucose tolerance
HBA1c
is HBA1C a good diagnostic measure fpr DM?
no
differentiating a malignant melanoma from a benign pigmented lesion
An irregular pigment network may be highly important in differentiating a malignant melanoma from a benign pigmented lesion
Intramuscular glucagon may not work in?
alcohol-related hypoglycaemia,
liver disease
prolonged hypoglycaemia.
which antibiotics do not interact with warfarin?
gentamicin
broad spectrum - amoxicillin?
how is alzheimers managed?
how does the drug work?
cholinesterase inhibitors - pyridistigimine
increases functional acetylcholine at synapses
travellers diarrhoea?
e.coli
how does HTN happen in conns?
aldosterone secretions lead to increased plasma sodium whihc leads to fluid retention = htn
features of constrictive pericarditis
occurs post Mi / dresslers
raised JVP
kussmaul sign - paradoxical rise in JVP with inspiration
pulsus paradoxus - cardiac output drop in inspiration
heart sounds quiet due to pericardial effusion
s3
what is kussmaul sign?
paradoxical rise in JVP on inspiartion
mx of rheumatic fever?
IV benzylpenicillin and
where is BNP secreted?
cardiac ventricles
what are the parameters for severe aortic stenosis
Peak gradient > 40 mmHg (note, in severe left ventricular dysfunction, a low peak gradient can be falsely reassuring)
Valve area < 1.0 cm^2
Aortic jet velocity >4 m/s
asbestosis features on xray?
pleural plaques
pleural thickening
respiratory causes of clubbing
malignancy
infection
inflammation
lung cancer - NSCLC
empyema
lung abscess
cystic fibrosis
bronchiectasis
pulmonary fibrosis
dorsiflexion of big toe?
l5
foot eversion
s1
foot inversion?
l4
hip flexion
L2
knee extension?
L3
foot drop
weakness or paralysis of dorsiflexion and eversion
if inversion is intact
peroneal nerve lesion
foot drop
weakness or paralysis of dorsiflexion and eversion
if inversion is lost
where is the lesion
what is the most common cause?
l5 lesion
lumbosacral disc herniation
which anti hypertensive drugs are a common cause of ototoxiticty
what other common drugs?
loop diueretics - furosemide
gentamicin
vancomycin - aminoglycoside
merlagia paresthetica
compression if lateral cutaneous nerve of the thigh underneath the inguinal ligament
weight loss adviced
weakness of hip flexion, knee extension and absent knee jerk reflex?
femoral nerve damage
loss of plantar flexion toe flexio and weakness of foot inversion?
tibial nerve damage
why might a parkinsons patient experience dykinesia?
because levodopa at peak dose causes dystonia
chorea
or involuntary writhing
what side effects are caused by parkinson medication?
sleepiness
hallucinations
impulse control disorders
for chemotherapy-induced nausea
ondansetron
nausea and vomiting associated with for gastrointestinal causes
metoclopramide
nausea caused by or for intracranial causes (raised ICP, direct effect of tumour)
Haloperidol
adverse effect of triptans?
tingling
tightness
of throat/chest
what is the cause of an acute peripheral neuropathy?
GBS
hoffman reflex-
UMN sign
thumb contracts when distal phalanx tapped
causes of upgoing planters and absent ankle reflex
cord compression
b12
MND
friedrichs ataxia
what is internuclear opthalmoplegia
what is a common cause of this?
R CN VI
L CN III
these communicate via MLF - conjugate gaze - horizontal
= diplopia
MS
crossed sign on neuro exam suggest where is the lesion?
left brainstem lesion
brainstem
left face / right arm/leg
what type of gait in parkinson
narrow based
what is a painless unilateral visual loss called
what is it caused by?
what would you see on opthalmoscopy
amaurosis fugax
painless unilateral visual loss
by a retinal artery emboli
cherry red macula
acute angle glaucoma
painful blurred vision
seeing haloes
prognosis of MS
<25 on diagnosis
optic neuritis or sensory as a first presentation > cerebeller features
long interval >1year
few lesion on MRI
in chronic kidney disease what should be treated straight away?
what are complications from this
whats the med called?
high phosphate
low calcium
high pth
hyperphosphataemia should be treated with phosphate binders - sevelamer
vascular calcification
Mx of chronic kidney disease
sevelemr - phosphate binder
then vit D
caclimimetics - cincalcet
how does ureteral stricture present?
painful
mass on flank- assymterical dilatation of one kidney
renal cancer characteristically presents with?
palpable flank mass with pain
if you hear bruits - 1st line investigation?
arteriography
what is detected on a urine dipstick of uti?
nitrites
leukocytes
what imaging modality for chronic kidney disease?
Ultrasound
then CT scan
MRI to see a cancer
imaging for ADPKD
USS
first line ix for renal failure?
u&e
how is hypercalcaemia investigated
measure serum calcium first
what medication is safe to use in pregnancy for uti
nitrofurantoin
cephalexin
leukaemia IX
how do you know it is axcute?
> 20% blasts cells
bone marrow aspirate under microscopy
what ix allows to differ between aml and all
flow cytometry
in iron deficiency anaemia
what increases?
transferrin
what stain differentiates between myeloblasta and lymphoblasts?
sudan black
what drugs can preciciptate haemolytic anaemia in G6PD?
dapsone
antimalarial
