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MBBS3 > ABDO SNIPPITS > Flashcards

ABDO SNIPPITS Flashcards

1
Q

What are the causes of drug induced jaundice which are due to drug induced hepatitis ?

A
  • paracetamol OD
  • sodium valproate
  • statins
  • halothane
  • MAO inhibitors
  • isoniazid, rifampcin, pyrazinamide
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2
Q

What are the causes of drug induced jaundice which are due to cholestasis?

A 
Flucloxacillin (may be weeks after)
Co amoxiclav 
Anabolic Steriods, the Pill 
Sulfonylureas
Procholreperazine 
Chlorpromazine
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3
Q

What are the causes of drug induced jaundice which are due to haemolysis?

A

Antimalarials eg dapsone

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4
Q

What type of liver failure has an onset of 5-26w?

A

Subacute

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5
Q

What is hyper acute liver failure?

A

Encephalopathy - within 7 days from onset of jaundice

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6
Q

What is fulminant hepatic failure?

A

Clinical syndrome resulting from massive necrosis of liver cells which leads to severe impairment of liver function

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7
Q

What are the signs if acute liver failure?

A 
Hepatic flap 
Fetor hepaticas (pear drop breath) 
Constructional apraxia (5 point star) 
Hepatic encephalopathy
Jaundice
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8
Q 
How do you treat the complications of acute liver failure? 
Bleeding 
Cerebral oedema 
Ascities 
Bleeding 
Encephalopathy
A

risk of cerebral oedema- 20% mannitol and ICU

Ascities- restrict fluid, low salt diet, weigh daily, diuretics (start Spirolactone and if not working add furosemide)

Bleeding- Vit K, FFP, blood as needed and endoscopy

Encephalopathy - avoid sedatives, sit at 20 degrees, lactulose and regular enemas to reduce numbers of nitrogen-forming gut bacteria. Aim for 2-4 soft stools/day

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9
Q

Which drugs are hepatotoxic?

A 
Paracetamol 
Methotrexate 
Isoniazid 
Azathoprine 
Phenothiazine 
Oestrogen 
6-mercaptopurine 
Tetracycline 
Salicylates
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10
Q

Which infections can cause deranged liver function tests?

A 
Avian flu 
Q fever
Legionella 
Mycoplasma 
Leptospirosis 
Rickettsial illnesses
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11
Q

What drugs cause TG accumulation, macro vesicular fat and cirrhosis?

A

AAM

alcohol
Amiodarone
Methotrexate

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12
Q

Which drugs cause fatty liver? Micro vesicular fat (Reys syndrome) due to mitochondrial B oxidation?

A

VAT
Valproate
aspirin
Tetracyclines

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13
Q

Which drug causes red man syndrome? (Erythroderma)?

A

Iv Vancomycin

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14
Q

Which drugs can cause severe hypotension on their first dose?

A

ACEi

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15
Q

Which drug can cause agranulocytosis?

A

Carbimazole- warm pt to report sore throat

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16
Q

Which drugs are carcinogenic?

A

Cyclosporin

Diethylstilbestrol

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17
Q

What commonly prescribed drugs can cause rhambomyolosis, myopathy and myositis

A

Statins

Especially simvastatin

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18
Q

Which drugs do you need to watch out with when someone is on warfarin?

A

Protein binding displacement-
-Salicylates /NSAIDS, sulphonamides

Inhibits metabolisms
SADFACES.COM

Inducers
COW PATS

cranberry juice increases INR/bleeding
Care with statins

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19
Q

What does iv verapamil and BB do?

A

Asystole

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20
Q

What does theophylline and B agonist do?

A

Arrhythmias

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21
Q

Prescribing a Loop diuretic and aminoglycoside is bad because?

A

Both ototoxic

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22
Q

Which drug potentiates the effect of adenosine?

A

Dipyridamole
-blocks adenosine uptake therefore increases levels

(Adenosine is used for narrow complex tachycardias ‘junctional tachycardia’ if vagal manoovers haven’t worked. Transiently blocks AV node) may unmask an underlying atrial rhythm

NB
Theophylline/caffeine reduces the effect

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23
Q

What is type I hypersensitivity reaction?

A
  • immediate

- anaphylaxis and urticaria with pens

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24
Q

What is type II hypersensitivity reaction?

A

Intermediate hypersensitivity
Cytotoxic AB
Eg methyl dopa-haemolysis
Thrombocytopenia with quinine

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25
Q

What is type III hypersensitivity reaction?

A

Intermediate hypersensitivity
Immune complex mediated
Interstitial nephritis with pens

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26
Q

What is type IV hypersensitivity reaction?

A

Delayed hypersensitivity
Steven Johnson syndrome with carbamazepine
Pseudoallergic rash with pens

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27
Q

Which abxs contain penicillin?

A

-cillins
AND SNEAKY ONES
-augmentin (amoxicillin and clavulanic acid)
-co amoxiclav (amoxicillin and clavulanic acid)
- imipenem (carbapenems)
-meropenem ( carbapenems)
-tazocin

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28
Q

What disease makes you more prone to pen rash?

A

Mononucleosis

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29
Q

What disease gives you high sensitivity to trimithoprim?

A

HIV

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30
Q

Which disease has a 30% chance of developing an allergy to one of these abx? piperacillin, ceftrazidime and ticarcillin

A

CF

repeated exposure to abx and immune hyper responsiveness

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31
Q

Which drug causes acute tubular necrosis?

A

Gentamycin

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32
Q

Which drug causes crystalluria?

A

Aciclovir

33
Q

Which drug causes interstitial nephritis?

A

Vancomycin

34
Q

Which drugs bind to albumin (therefore are altered in liver failure)

A

Phenytoin - monitor levels- adjust for albumin (only take free)
Prednisolone

35
Q

What drug gives you rebound hypertension if you withdraw it?

A

Clonidine - withdraw slowly

36
Q

What is methoxetamine?

A

Ketamine analogue
‘Legal high’
Can cause cerebellar toxicity that can last a week

37
Q

Which drugs do you need to withhold if high risk for aki?

A 
Diuretics, ACEi, antihypertensives (do not stop B blockers acutely) 
Metformin if creatinine is rising 
NSAIDS 
Nitrofurantoin, gentamycin 
NB opiates can accumulate
38
Q

What do you use to initiate immune suppression in kidney transplant??

A

IL 2 R Blocker- basiliimab

But many centers now use alemtuzumab which gives broad spec immunosuppression

39
Q

What do you give in benzo poisoning?

A

Flumazenil

40
Q

What do you give in b blockers poisoning?

A

Atropine

41
Q

What dies dignoxin toxicity cause?

A

Yellow visual halos
Hypokalaemia
Decreased cognition nausea anorexia

42
Q

Which drug reduces calcium and therefore good in stone prevention?

A

Thiazide diuretics

43
Q

What is good about radionuclide imagine and the kidneys?

A

Functional assessment of the kidney

But US is one of choice for urinsry tract obstruction

44
Q

What is periaortis? (Retroperitoneal fibrosis)

A 
Inflammation of abdominal Aorta 
T cell mediated vasultits 
Fibrosis under where the utreters lay which causes a stricture and obstruction 
CT/MRI 
mass- biopsy to exclude malignancy
45
Q

How do you treat urinary retension

A

1) tricks eg running Taps
2) a blocker- tamsulosin
To prevent give finasteride- decreases prostate size and retension risk

46
Q

What are the signs of post turp syndrome?

A

Low Na

Low temp

47
Q

After relieving chronic obstructive uropathy what is the danger?

A

Fluid depletion- kidneys go on to make lots so give fluid support and watch UO

48
Q

How do you treat bladder cx Tis/Ta/T1?

A

Turbt
Consider intravvesical chemo for small agents it small multiple tumours
Intravesicle BCG

49
Q

How do you treat bladder cx T2-3?

A

Radical cysecyomy and neoadjunct chemo
Can give radiotherapy and preserve the bladder but 5 year survival rate is lower

If T4 palliative chemo/radiotherapy

50
Q

Where is the fluid in a hydroceal?

A

Tunica vaginalis

51
Q

What is idiopathic scrotal oedema?

A

Usually occurs between 2-10yo

No pain or tenderness but DD for torsion

52
Q

WHO semen analysis

A

1.5 ml vol
15mil/ml concentration
32% progressive motility
4% normal forms

53
Q

What can you use duloxetine for?

A

Stress incontinance if exercises etc fail

INHIBITS NA uptake

54
Q

What medical therapy can help an overactive bladder?

A

Anticholinergics- oxybutymin, toiteride, solifebacin (CI Closes angle glaucoma)

55
Q

What is the disease?
Macro/microscopic haematuria, occasionally nephritic syndrome.
Young male with episodic macroscopic haematuria
C3 deposits and mesangial proliferation and immune complex formation.
BP may be high- worst prognosis

A

IgA Nephropathy
Type of GN
Tx- bp control ACEi
With nephritic presentation, immune suppression may slow decline

56
Q

What is a variant of igA Nephropathy and causes a small vessel vasultits?

A

Henoch-scholnlein purpura
Get rash on extensor surfaces, legs
Polyarthritus and abdominal pain (GI Bleed) and NEPHRITIS

15% ESRF
50% ESRF If both nephrotic and nephritic
Treat same as IG A Nephropathy. Basically this gone systemic

57
Q

Features of anti glomerular basement membrane (GBM) disease

A

Autoabs to type IV collagen
May have lung manifestations
Nephritic picture . AKi may occur within days if symptom onset
Tx- plasma exchange, Steriods and maybe cytotoxics

58
Q

Features of post streptococcal GN

A

Diffuse proliferative
1-12 weeks after sore throat or skin infection
Usually nephritic syndrome
Inflammation affecting mesangial and endothelial cells IGG And C3 deposits
Serology see high C3 and ASOT
95% recover function

59
Q

What are the features of rapidly progressing GN?

A

Most aggressive GN
Can cause ESRF in days
3 categories/causes but all have biopsy finding of crescents affecting most glomeruli
1) immune complex disease - 45%
2) pauci immune disease- 50% cases. Most ANCA positive
5 year survival 80%
3) anti GBM disease 3%

Features of AKI with pulmonary haemorrhage and haemoptysis. (Most common cause of death in ANCA pos pts.
Tx- aggressive immunosuppression- iv steroids, cyclophosphamide -/+ plasma exchange

60
Q

What are the 5 types of GN? (Nephritic synd)?

A 
Ig A Nephropathy 
Henoch schonlein purpura
SLE 
GBM 
Post streptococcal GN 
Rapidly progressive GN
61
Q

What are the manifestations of nephrotic syndrome?

A

Minimal change disease
Membranous Nephropathy
Mesangiocapillary
Focal segmental glomerulosclerosis

62
Q

What is the generic treatment for nephrotic syndrome?

A

Reduce oedema- loop duiretic eg frusemide

  • reduce proteinurua- ACEi
  • reduce hyperlipidenia- statin
  • anticoagulate if nephrotic range proteinurua
  • vaccinate to prevent infections
  • treat and find underlying cause
63
Q

What are the features of minimal change disease?

A
  • children
  • adults- NSAIDS or hodgkins paraneoplastic
  • remission with steroids but most relapse
64
Q

What are the features of membranous Nephropathy?

A

-most idiopathic but can be associated with malignancy- HBV, autoimmunity- thyroid, SLE

65
Q

What are the features of mesangiocapillary GN?

A
  • immune complexes circulate and deposit in kidneys - these activate complement via the classical pathway
  • biopsy see mesangial and endocapillary proliferation, thickened cap BM, double contouring of the cap walls (tramline)
66
Q

What are the features of focal segmental glomerulosclerosis?

A

IgM and C3 in IF

HIV, idiopathic, heroine use sickle cell

67
Q

What do loop diuretics do? (Frusimide)

A

Cl/Na/k co transporter block in ascending loop

Act in 1 hr PO
IV 30m

PO, Ascities, pitting oedema

68
Q

What do Thiazide diuretics do??

A

Inhibit na/Cl co transporter in DCT

HYPOKALAEMIA, low Na, mg, metabolic alkalosis. Increase uric acid so CI in gout.
HTN
Long term treatment HF

69
Q

What do K Sparing dietetics do?

A

Spirolactone aldosterone blockers - takes days
Amiloride - 12 hours and triamterene block Na channels in collecting tubules

SE HYPERKALEMIA and metabolic acidosis
Spirolactone - gyancomastia

70
Q

What causes mixed DILI?

A

Phenytoin and enalapril

71
Q

What causes heptocelluar DILI?

A

Fatigue dominates

Isoniazid and nitrofurantoin

72
Q

What causes cholestatic DILI?

A

Co amoxiclav, flucloxacillin, ciprofloxacin

Purist and jaundice features dominate

73
Q

What are auline inclusion bodies associated with?

A

CMV disease

Found on histology

74
Q

Which 2 biological therapies are good to treat severe fistulising Crohn’s?

A

Infliximab

Adalimumab

75
Q

Treatment of alcohol withdrawal

A

Chronic alcohol dependence- disulfiram

Acamprosate- intense anxiety helps

76
Q

What is the tumour marker for colorectal cx?

A

CDA

77
Q

What can you monitor patients with colorectal cancer with?

A

Carcinoembryonic antigen

78
Q

How do you measure the severity of pancreatitis?

A 
Modified Glasgow criteria 
PANCREAS 
PaO2 16 
Enzymes LDH >600 and AST >200 
Albumin 10

MBBS3 (6 decks)

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