Akt Flashcards
breast papilloma
Occurs in middle aged women and develops in the lactiferous ducts just below the nipple. Form a lumpy mass and associated with a bloody discharge.
Sumitriptan
5ht 1 agonist to regulate blood flow
Not for hemiplegic migraine or chd or uncontrolled htn
For aborting acute attacks
clonidine SE
Rebound hypertension following acute withdrawal.
verapamil + B-blocker
can precipitate complete heart block
hydralazine SE
A drug-induced systemic lupus erythematosus (SLE) is associated with hydralazine therapy and serology for the antinuclear factor (ANF) is negative
minoxidil SE
widespread hirsutism, which has been harnessed in the treatment of baldness (Regaine topical minoxidil solution).
alpha methyl-dopa SE
coombs positive haemolytic anaemia
necrotising fasciitis organism
group A strep
lymes org
Borrelia burgdorferi - erythema migrans
reactive arthritis orgs
Ureaplasma urealyticum and Mycoplasma genitalium
cat scratch disease rash and org
red papule and regional lymphadenopathy
bartonella henselae
mycoplasma pneumonia
autoimmune haemolytic anaemia
early diastolic murmur
pulmonary regurgitation
late systolic
mitral /tricuspid valve prolapse
mid diastolic
mitral stenosis
type 3 hyperlipidaemia
high total cholestrol and triglyceride
autosomal recessive
premature Cardiovascular disease and pancreatitis.
statin associated myopathy
exacerbated by the co-prescription of other drugs such as calcium channel blockers, macrolide antibiotics, fibrates, amiodarone and grapefruit juice.
occupational asthma causes
isocyanate ( foams and plastics)
coal workers disease
nodular interstitial lung disease
heart failure drug treatment
ACE inhibitor and bblocker therapy should be instituted in patients with heart failure due to left ventricular systolic dysfunction.
ACE inhibitor therapy should be initiated at the appropriate dose, and titrated upwards at short intervals (for example, every two weeks) until the optimal tolerated or target dose is achieved.
silica ( found in coal dust and paint sprays) leads to
causes pulmonary fibrosis/silicosis and contributes to pneumoconiosis
HRT for women who are 54 or older or any age and more than one year after the menopause.
continuous combined therapy
may get some bleeding but should settle in 6 months
acute severe asthma
inability to complete sentences
a tachycardia in excess of 110 bpm
a respiratory rate above 25/minute, and
a PEFR 33-50% of the predicted value
life threatening asthma
silent chest
bradycardia
hypotension, and
hypoxia.
laryngocoele
rare cause of neck lump in wind instruments players. High pressure in the larynx causes an out pouching of the laryngeal mucosa.
erythema multiforme
annular lesions, sometimes bullous and more common on the extrmeties. The commonest cause is infection with herpes simplex virus. Other infections that may cause it are vaccinia, infectious mononucleosis, hepatitis, mycoplasma and histoplasmosis.
(CA) 27.29
follow response to therapy in patients with metastatic breast cancer.
Combined AFP and b-hCG testing
?testicular ca
All patients who have had an acute MI should be offered treatment with
ACE inhibitor, beta-blocker, aspirin, statin.
coumarin metabolism inducers
rifampicin, carbamazepine. st johns wort also diminishes warfarin anticoag
slowing of warfarin metabolism
(so raising INR, miconazole)
heart murmurs louder on expiration
left heart side
serum urate level to aim for if gout treated by allopurinol
<0.3 (0.42 is upper limit of normal)
rheumatic fever
Flitting pains in the joints relieved by aspirin are typical. Carditis also occurs and a positive antistreptolysin is classical.
gliptin
dpp-4, eg sitagliptin, vildagliptin. consider instead of sulphonureas if risk of hypos / consequences
type 2 diabetes oral hypoglycaemic introductions
48mmol or 6.5%, add in dual if still not good, consider triple 58mmol/l or 7.5%
campylobacter
getting resistent to quinolones so erythromycin better
c.diff anitbiotic choice
vancomycin or metronidazole
addisons biochem
low sodium, hyperkalaemic acidosis
cushings biochem
Hypokalaemic alkalosis
conns
high BP and low potassium.. adrenal adenoma
FP10MDA
addiction prescribing
fw8
application for maternity exemption from prescription charges.
fp92a
application for medical exemption from prescription charges.
d4
application and medical report for group 2 driving licence.
gos18
A request for an ophthalmology opinion from an optician to the GP
hsa1
termination of pregnancy form
doxazosin risk
congestive cardiac failure
atenolol risk
increased incidence diabetes when using for HTN treatment
mitral stenosis
tapping apex, loud first heart sound, apical rumbling mid-diastolic murmur
mitralvalve prolapse
soft first heart sound, a mid-systolic click and an apical blowing late systolic murmur radiating to the axilla.
confidence interval
statistical range with a specified probability that a given parameter lies within the range.
relative risk
measure of how much a particular risk factor (for example, cigarette smoking) influences the risk of a specified outcome such as lung cancer, relative to the risk in the population as a whole.
glitazone
only one in UK poiglitazone
peroxisome proliferator activated receptor (PPAR)-gamma receptor agonist producing a therapeutic effect by improving insulin sensitivity. Peripheral oedema and fluid retention are reported side effects, which may exacerbate pre-existing heart failure, consequently this group of drugs are contraindicated in the presence of heart failure.Bladder cancer is a known side effect.
can cause weight gain but good for glycaemic control
exenatide
GLP-1 mimetic that may cause pancreatitis.
Z score
Standard deviation with age matched population
Normal distrib 34% over and under mean
sulphonureas
work by increasing beta cell sensitivity to glucose thus increasing insulin release at a given plasma glucose concentration. This leads directly to a reduction in hepatic glucose production and indirectly, via a lowering of plasma glucose concentration, to decreased peripheral insulin resistance
can cause weight gain and hypoglycaemia
biguanides e.g. metformin
main mechanism is reducign hepatic glucose production
GI disturbance common, also lactic acidosis serious SE.
alpha-glucosidase inhibitors e.g. acarbose
reversibly antagonise and slow the action of sucrase, glucoamylase, dextrinase, maltase and isomaltase enzymes within the intestinal tract. This hinders the production of absorbable monosaccharidases and so reduces the postprandial blood glucose concentration
meglitinides e.g repaglinide, nateglinide
lower blood glucose by stimulation of insulin release from the pancreas
gliptins e.g. sitagliptin
work via slowing degradation incretin hormones*
* incretin hormones - for example glucagon-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) - these hormones are secreted by specialised enteroendocrine cells in response to a meal. The incretin hormones promote insulin secretion and inhibit glucagon secretion when blood glucose is high; when blood glucose is low then insulin secretion is inhibited and glucagon secretion is promoted
dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor
dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor
haemochromatosis
pituitary and pancreatic deposition of excess iron causing both type 2 diabetes and hypogonadotrophic hypogonadism.
scc
ulcerated with everted edgepredisposing factors include:
radiation exposure
pre-malignant conditions - Bowen’s, senile keratosis, lupus vulgaris, Paget’s disease
inherited - xeroderma pigmentosum, albinism
chronic irritation - Marjolin’s ulcer, leukoplakia, varicose veins, osteomyelitis sinus
infection - HPV 5 & 8.
von Recklinghausen’s disease or neurofibromatosis type I
fleshy lumps which are neurofibromas and café-au-lait spotsMay be associated with: multiple endocrine neoplasia IIb (medullary carcinoma of thyroid and phaeochromocytoma), glioma, and meningioma. It is autosomally dominantly inherited. Symptomatic lesions can be excised. There is a 10% risk of malignant change.
de Quervain’s thyroiditis
weight loss and painful goitre,The ESR is typically grossly elevated, mild hyperthyroidism may be associated. The condition is typically self limiting and responds to NSAIDs and steroids.
chalazion
inflammation of the meibomian glands. Treatment includes the use of antibiotic ointments but if persistent then surgery may be indicated.
pinguecula
soft, yellowish patches over the sclera at 3 and 9 o’clock positions. The patient is asymptomatic.
pterygium
vascularisation nasal aspect of cornea
related to excessive sun exposure. It is benign but may be removed for cosmesis or if it threatens vision by extending centrally.
acute angle closure glaucoma
pain, circum corneal erythema, fixed, ovoid pupil, Miotic agents such as pilocarpine eye drops open the closed angle of Schlemm and improve drainage. Carbonic anhydrase inhibitors are also indicated, and topical beta blockers are also used.
feltys syndrome
pancytopenia and hypersplenism
haemolytic anaemia
raised reticulocyte count
seborrhaic dermatitis
which is caused by a yeast infection (Malassezia furfur), and is common in immunosuppressed patients such as this lady who contracted HIV through IV drug abuse. red, scaly, crusty, itchy eruption on her scalp line and around her nose.
HRT systemic oestrogens
for flushing and clonidine possible
tibolone
improve sex drive in meopause (due to loss of circulating androgens)
Graves’ disease that distinguish it from other causes of thyrotoxicosis include:
exophthalmos
pre-tibial myxoedema, and
a thyroid bruit.
DeQuervain’s thyroiditis
nflammatory condition of the thyroid associated with marked systemic features including weight loss, fever and a high erythrocyte sedimentation rate. The iodine uptake scan shows markedly reduced iodine uptake.
Increased blind spot
papilloedema, which may lead to optic atrophy.
Tunnel vision occurs in:
Glaucoma
Retinitis pigmentosa, and
Retinal panphotocoagulation.
systemic sclerosis
Facial telangiectasia Sclerodactyly Atrophic nails Raynaud's phenomenon. calcinosis finger tips
Thibierge-Weissenbach syndrome
diffuse skin calcification and atherosclerosis.
diabetic amyotrophy
associated with a painful asymmetrical myopathy affecting the quadriceps. Investigations are usually normal except for plasma glucose. Generally, symptoms improve with insulin possibly due to the anabolic effects of the latter.
pagets disease of the bone
Paget’s disease the continual repair process of bone is disturbed and ends at the stage of vascular osteoid bone. Bones are very weak.
Osteogenic sarcoma complicates 5% of cases.
asthma guidelines children 5-12 yrs
Step 1 - Inhaled short acting b2 agonist as required.
Step 2 - Add inhaled steroid 200-400 mcg/day.
Step 3 - Add long acting b2 agonist (LABA) then assess control. If good response to LABA, continue. If benefit from LABA but control still inadequate, continue LABA and increase steroid up to 400 mcg/day, if not already on this dose. If no response to LABA, stop and try other therapies, for example, leukotriene receptor antagonist or SR theophylline.
Step 4 - Persistent poor control: increase steroid up to 800 mcg/day.
Step 5 - Daily oral steroid.
children under 5 asthma guidelines
Step 1 - Beta-2 agonist.
Step 2 - Inhaled steroid 200-400 mcg/day.
Step 3 - In children age 2-5, try leukotriene receptor antagonist, in children under 2, go to step 4.
Step 4 - Refer to respiratory paediatrician.
osteoporosis
bone density >-2.5SD (T-score). can treat with calcium and vit D
teriparatide
recombinant human parathyroid hormone is a licensed anabolic treatment given by daily subcutaneous injection. It is appropriate in cases where other therapies for osteoporosis have failed.
standard deviation percentages
one is 68%, 2 is 95% 3 is 99.7%
non-live vaccines
Tetanus toxoid, hepatitis B and hepatitis A
hydradenitis suppurativa
condition affecting apocrine glands as opposed to eccrine glands. dopamine agonists and antibiotics can help
rett syndrome
developmental disorder, hand wringing, males die in utero
citalopram
ssri better for multi drugs ( less interactions)
alcohol abuse while pregnant
saddle-shaped nose, hypertelorism, a thin upper lip and absent philtrum.
growth restriction, cardiac abnormalities and developmental problems.
Gorlin’s sign
Gorlin’s sign is the ability to touch the tip of the nose with the tongue seen in Ehlers-Danlos syndrome and some in the general population
Carpet tack sign
In discoid lupus erythematosus the removal of scale reveals multiple horny plugs on the under surface of the scale giving the appearance of carpet tacks.
Auspitz’ sign:
in psoriasis where upon scraping with a glass slide the lesion reveals pin-point bleeding on account of supra-papillary thinning of the epidermis.
Favus
a form of tinea capitis, presents with lesions characterised by yellow cup-shaped crusts termed scutula, which surround the infected hair follicles.
Kerion
fungal abscess
liver enzyme inhibitors
kissace ketaconazole isoniazid sulphonureas sodium valproate allopurinol cimetinide erythromycin
liver enzyme inducers
crpb carbamazapine rifampicin phenytoin barbiturates
number needed to treat
1/absolute risk reduction
absolute risk reduction
1/NNT. calculation= (number harmed / total - intervention number harmed over total)
odd ratio
ratio of the odds of outcome(AD/BC)
confidence interval
large number = low confidence in the OR precision
normal sperm
> 2mls
50%motile
15% normal morphology
2 millions sperm / ml
UKPDS study
metformin reducing cardiovascular risk and insulin resitance if glucose reduced to 48mmol.
stye
minor infection base of eyelash
blepharitis
gritty oily tears. inflammed lid edge
diabetes diagnosis
symptoms + >11.1 random
>7.0 fasting
OGGT 11.1, 2 hrs after 75g glucose
impaired glucose tolerance
2 hr OGTT: 7.8-11.1
targets for gestational diabetes
tighter:
3.5-5.9. or < 7.8 one hr after eating.
MODY
maturity onset diabetes of young. monogenic diabetes parent with diabetes as AD inheritance. insulin might not work.
wolfram syndrom
DIDMOADDiabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness
LUTS
mod / severe voiding symtpoms IPSS > / =8
give alpha blocker ( eg doxasozin, tamsulosin)
enlarged prostate and risk of progression - give 5 alpha reductase inhibitor (finasteride / dutasteride) 6 months before symptoms improve.
pityriasis rosea
ovoid scaly herald patch, 2 weeks before christmas tree rash upper back / chest. ?HHV7.
pityriasis versicolor
yeast infection, antifungal shampoos.
bariatric surgery
First line BMI >50
6 months trying BMI >40 or
BMI >35 and co-morbidities (T2DM, HTN, mobility probs)
orlistat
BMI >30
BMI >28 with T2DM, HTN, dyslipideamia.
only continue over 3 months if over 5% weight loss.
stage 1 HTN
140/90 clinic or 135 / 85 average.
offer treatment if <80 and target organ damage, CVdisease, renal disease, 20% CV 10yr risk.
stage 2 HTN
160/100 or 150/95 average
offer meds any age
medical treatment HTN
A under 55 / C (over 55 / black)
add the other
( if B-blocker) add C not D (diabetes risk)
A+C+D, then
4th line increase D if K>4.5, or spironolactone.
acanthosis nigricans
sign of insulin resistance
diabetes intercurrent illness
admit if glucose over 20 sustained
ketosis sustained
not drinking / diarrhoae
on orals with intercurrent illness
increase monitoring frequescy
seek med advice if over 13
stop metformin if dehydrated
on insulin with intercurrent illness
22 increase 4 units each injection
targets for glycaemic control adults
4-7 pre eating
<9 1 hr post prandial
targets for glycaemic control children
4-8
<10 1 hr post prandial
HBA1C targets
<6.5% (48 mmol/mol)
type 1 error
rejecting null hypothesis when true
type 2 error
accepting null hypothesis when false
power of a study
probability of correctly rejecting null hypothesis when false.
1- probability of type 2 error.
still birth
over 24 weeks
parametric data tests
student’s T-test, pearsons
non-parametric
chi squared, wilcoxon matched pairs, spearmans rank
miosis
pupil constriction (helps acute glaucoma)
horners
damage to sympathetic pathway
miosis (constricted pupil)
anhidrosis
ptosis
acute glaucoma triggers
pupil dilated
hypermetropia ( long sightedness) / short
meds which dilate pupil
DM2 aims of treatment
antihypertensives for macro and microvascular complications
lower hba1c for microvascular comps
lipid lowering for macrovascular comps as main population
heart failure diagnosis
previous MI: echo
no MI :serum BNP, if raised then echo
echo normal, consider other cause for raised BNP, then treat
heart failure treatment ( all types)
diuretics,
calcium channel blockers amlodipine( not verapamil / diltiazem) for comorbid HTN / angina
anticoags, for sinus rhythm and hx of VTE, intracardiac thrombus, left ventricular aneurysm
aspirin 75-150mg with atherosclerotic arterial disease
amiodarone ? on specialist advice. needs 6 monthly clinical review for thyroid and LFT
left ventricular heart failure
one drug at a time
ACE eg if diabetic / fluid overload
BB eg if angina / HTN (bisoprolol, carvedilol nebivolol)
then specialist advice for hydralazine, nitrate, ARB, dig, ivrabradine
ARB
eg candesartan, losartan, valsartan
aldosterone antagonists
spironolactone, epleronone
stable angina
give b-blocker or calcium channel blocker.
if intolerant / not working consider long acting nitrate (ivrabradine, nicorandil, ranolazine)
assess every 2-4 weeks.
antiplatelet therapy: 75mg aspirin or if stroke / PVD clopidogrel
ACEi if stable angina and HTN, DM, heart failure,
anitplatelets for secondary prevention of CVD
in pts with angina MI stroke / TIA peripheral arterial disease AF ( usually anticoagulants)
MI
aspirin long term
non ST elevation: add clopidogrel for 12 months
ST elevation: clopidogrel for a month
intention to treat analysis
analyses all patients randomised to study eg patient fall out may bias things
Relative Risk Reduction
absolute risk reduction / control event rate
efficacy
effect in ideal / lab conditions
effectivenes
effect in real world
incidence
new cases over fixed time
prevelence
rate of a disorder in fixed population at a specific time
ancova
co-variance between populations
chi squared
comparing proportions
ANOVA
analysis of variance
ANOCOVA
analysis of covariance
t - test
compare means of 2 groups with continuous variables
phimosis
tight foreskin, ok up to 4 years. betamethasone cream
