Bits and bobs Flashcards
Which gram positive diplococci causes meningitis?
Strep pneumoniae
What are the causes of bacterial meningitis?
Neisseria meningitidis (meningococcus)
Strep pneumoniae (pneumococcus)
In neonates E.Coli, group B strep (strep agalactiae is an example)
What is the treatment of bacterial meningitis?
Benzylpenicillin
Ceftriaxone
After treatment given a course of
Rifampicin or ciprofloxacin (adults only)
This is to eradicate carriage of N. meningitidis from the nasopharynx
What are the features of a colles fracture?
Classical Colles’ fractures have the following 3 features:
Transverse fracture of the radius
1 inch proximal to the radio-carpal joint
Dorsal displacement and angulation
What are the risk factors for osteoporosis?
SHATTERED:
Steroid use (over 5mg a day of prednisolone)
Hyperthyroidism
Alcohol / tobacco use
Thin (BMI less than 22)
Testosterone decrease
Early menopause
Renal or liver failure
Erosive bone disease (such as RA or myeloma) Dietary calcium (decrease)
What are the thenar muscles supplied by the median nerve?
abductor pollicis brevis
Opponens pollicis
FLexor pollicis brevis
What are the complications of colles fracture?
Damage to the median nerve
Malunion
Finger stiffness
Rupture of extensor pollicis longus
What is the sensory supply of the median nerve?
What causes carpal tunnel syndrome?
Repetitive stress injury leading to infalmmation, oedema, fluid in the narrow space and compression of the structures
What are risk factors /causes of carpal tunnel syndrome?
TRAMP
Trauma (repetitive stess injury)
Rheumatoid arthritis
Acromegaly
Myxoedema
Pregnancy
Why is there no sensory loss in carpal tunnel syndrome?
Because sensory function is supplied by the palmar branch of the median nerve (does not go through the carpal tunnel)
What is the treatment of carpal tunnel syndrome?
corticosteroid injection
wrist splints at night
surgical decompression (flexor retinaculum division)
What are causes of post parum haemorrhage?
Tone - prolonged labour, multiple pregnancy
Trauma - Cesarean, instrumental delivery, episiotomy
Tissue - retained placenta, placenta accretta
Thrombin - coagulopathies (secondary to pre-eclampsia/sepsis/anticoagulants)
What are examples of drugs which increase uterine tone?
Oxytocin
Ergometrine / methylergometrine
Prostaglandins such as misprostol and carboprost
What are drugs that decrease uterine tone?
Terbutaline
Nifedipine
Indomethacin
What are the investigations for infertility?
Semen analysis
Chlamydia
Thyroid stimulating hormone
Mid luteal progesterone if periods are regular (day 21 of a 28 day cycle)
If cycle is not regular do a blood test to look for serum gonadotrophins
Rubella immunity
What are 3 tests for tubal patency?
Histosalpingogram
HyCoSy
Laparoscopy
What are initial investigations for amenorrhoea?
exclude pregnancy with urinary or serum bHCG
gonadotrophins: low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)
prolactin
androgen levels: raised levels may be seen in PCOS
oestradiol
thyroid function tests
What organisms can cause tubal damage?
Chlamydia
Gonorrhoea
Mycoplasma
What are causes of audotory hallucinations?
Delerium tremens
Depression with psychosis
Delerium
PTSD
Schizophrenia
What are characteristic findings on history for people with anorexia?
Weight loss: as a result of dieting, strict exercise, appetite suppressants and diuretics
Overactivity - such as obsessive housework
Cooling - keeping wondows open and not wearing sufficient clothing
Endocrine dysfunction (amenorrhoea / libido)
Potential for history of fainting, fatugie, cold intolerance
Body image disturbance
What are findings on investigation for anorexia?
Low blood glucose
Lanugo hair
Low BMI
ECG - arrhythmias
DEXA - reduced bone density
What are treatments for anorexia and bulimia?
Anorexia:
- Cognitive analytical therapy
- Cognitive behavioural therapy
- Interpersonal psychotherapy
- Family interventions
- Hospitilisation - symptom focussed weight restoration programme
Bulimia:
- Evidence based self-help programme
- CBT
- SSRI (fluoxetine)
What are causes of dehydration?
Fever
Vomit
Exercise
Heat exposure
Diabetes mellitus
What are the features of hypercalcaemia?
Confusion
Somnolence
Constipation
Nausea
Thirst
What is the possible treatment for multiple myeloma?
Chemotherapy
Immunomodulators such as thalidomide
Bisphosphonates to prevent bone loss
Antibiotics to treat infections
Glucocorticoids for hypercalcaemia (They increase renal calcium excretion and decrease gastrointestinal calcium absorption, resulting in reduced serum calcium)
What are diagnostic tests for multiple myeloma?
monoclonal proteins (usually IgG or IgA) in the serum and urine (Bence Jones proteins)
increased plasma cells in the bone marrow (over 30% plasma cells)
Protein electrophoresis - (shows monoclonal band)
X-Ray - skeletal survey looking for lytic lesions
What is the prognosis for multiple myeloma?
With treatment = 48% 5 year survivial
