Concepts Flashcards
What are the STEMI criteria
ECG features in two contiguous leads of;
- 2.5mm (2.5 small squares) ST elevation in leads V2-3 in men under 40 or >2.0mm in men over 50
- 1.5mm ST elevation in V2-V3 in women
- 1 mm ST elevation in other leads
- new LBBB
What drugs can be used to ease passage of a renal stone
a-adrenergic blockers
Management of prostatitis
quinolone for 14 days
ciprofloxacin
MEN 1
three P’s
Parathyroid
Pituitary
Pancreas
Men 2a
Medullary thyroid
hyperparathyroid
phaeochromocytoma
Men 2b
Medullary thyroid
phaeochromocytoma
Marfanoid body habitus
Neuroma
Characterisation of empyema
pH < 7.2
Low glucose (<3.4 mmol/L)
LDH > 200
What is a normal osmol gap
<10
How to calculate osmolalitty
2Na + 2k + urea + blood glucose
What rules out pseudohyponatraemia
normal osmolar gap
What are the causes of urinary sodium > 20
hypovolaemic
- diuretics: thiazides, loop diuretics
- addisons disease
- diuretic stage of renal failure
Euvolaemia
- SIADH
hypothyroidism
What are the causes of urinary sodium < 20
sodium depletion, extra-renal loss
- diarrhoea, vomitting, sweating
- burns, adenoma of rectum
water excess
- secondary hyperaldosteronism
- nephrotic syndrome
- IV dextrose
- psychogenic polydipsia
Treatment of choice for biliary atresia
Early surgical treatment
PSGN develops ________ after URTI
1-2 weeks
Management of VT
if BP <90mmHg systolic= cardioversion
drug therapy
> amiodarone
> lidocaine
> procainamide
Subacute thyroiditis causes ….
hyper then hypothyroidism
Hashimotos + viral infection
De quervains
Eosinophilic casts
Tubulointerstitial nephritis
Management of trigeminal neuralgia
Carbamazepine
Signs of supraspinatus tendonitis
Rotator cuff injury
Painful arc of abduction
Tenderness over acromion
Management of uveitis
Steroid and cycloplegic (mydriatic) eye drops
Drugs causing pupillary constriction
Acetazolamide and pilocarpine
Acute tubular necrosis =
urine osmolality < 350 mOsm/kg
Prerenal uraemia
kidneys hold on to sodium to preserve volume
brown granular casts
acute tubular necrosis
Management of acute reactive arthritis
NSAIDs
What is the mackler triad
Booerhave ( oesophageal rupture)
vomiting
thoracic pain
subcutaenous emphysema
What is kussmauls sign
JVP rising on inspiration- kussmaul’s sign
sign of constrictive pericarditis
mneumonic for cardiac tamponade
TAMponade= TAMpaX
absent Y descent
Gynaecomastia in lung cancer
adenocarcinoma
paraneoplastic syndrome from SCLC
SIADH
ectopic ACTH
lambert-eaton myasthenic
What is quincke’s sign
nailbed pulsation
aortic regurgitatoin
De musset sign
head bobbing in aortic regurgitation
features of ank spon
lower back pain and stiffness of insidious onset
stiffness worse in morning and improves with exercise
pain at night
Investigation of Lung cancer
1) CXR
2) non-contrast CT chest, liver adrenals
3) bronchoscopy
4) PET scanning
Hyponatraemia correction
osmotic demyelination syndrome
hypernatraemia correction
cerebral oedema
Correction of hyponatraemia rate
4-6mmol/l in 24 hr
secondary vs primary hypothyroid
primary- High TSH, Low T4
secondary- Low TSH, low T4
investigation for 2ry hypothyroidism
MRI
Management of primary pneumothorax with SOB or >2cm rim of air
aspiration
Murphys sign
acute cholecystitis
arrest of inspiration on palpation of RUQ
In 1ml of standard insulin there are ____ units
100
Diagnostic test for guillain barre
Lumbar puncture
guillan barre
autoimmune dymelination of PNS due to campylobacter jejuni
symptoms of guillan barree
back/leg pain in initial stages of illness
Presentation of placental abruption
constant pain
shock out of keeping with visual loss
tender and tense uterus
RF for placental abruption
chronic hypertension
dose of amiodarone in ALS
300mg
what should be stopped in acute c.diff infection
anti-peristaltic drugs
> opioids
antibiotics if possible
NICE criteria for reffering patients to 2ry care for treatment of varicose veins
- heavy or aching legs
- skin changes (venous eczema, haemosiderin deposition)
- superficial vein thrombosis
- venous leg ulcer
Measurement of PSA should be delayed for _____ after prostatitis
1 month
Features of focal seizures with impaired awareness
automatism
tiredness
Management of hypomagnesaemia
IV magnesium is usually given if <0.4 mmol/L or tetany, arrhythmias, or seizures
> 0.4 mmol/l
oral magnesium salts (10-20 mmol orally per day in divided doses)
diarrhoea can occur with oral magnesium salts
Recommendations for patients with CKD
prescribe ACEi if urinary ACR 70 +
statin therapy
try not to give NSAIDs
Causes of anterior mediastinal mass
4T'S Teratoma Terrible lymphadenopathy Thymic Mass Thyroid mass
What is the issue with st johns wort
P450 inducer, decrease ciclosporin levels, leading to transplant rejection
treatment for wilsons
penicillamine
disproportionate microcytic anaemia
beta-thalassaemia trait
management of sudden onset SNHL
high dose oral corticosteroids
anaesthetic for haemodynamically unstable patient
ketamine
sensitive scan for DAI
MRI
difference between SS and NML
ss presents over hours rather than days SS - profuse sweating - myocolonus -diarrhoea -hyperreflexia
features of NML
- pyrexia
- muscle rigidity
- autonomic lability
- agitated delirium with confusion
management of organophsophate insectiside poisoning
atropine
features of organophosphate poisoning
slud S- alivation L- acrimation U- rination D- efecatio/diarrhoea Cv- Hypotension, bradycardia small pupils muscle fasciculation
high risk of hepatotoxicity in paracetamol overdose
chronic alcohol use
HIV
anorexia
P450 inducers
elevated JVP
hypotension
tachycardia
despite resus
cardiac tamponade
lower than expected HbA1c
sickle cell
GP6D deficiency
hereditary spherocytosis
higher than expected HbA1c
vitamin B12/folic acid deficiency anaemia
splenectomy
postmenopausal woman has fracture
she should be put on bisphosphonates- no need for DEXA
hypercalcaemia
hydration
iv bisphosphonate if Ca above 3
Drugs causing galactorrhoea
NOT THE SAME AS GYNAECOMASTIA
- metoclopramide, domperidone
- phenothiazine
- haloperidol
- SSRI, opioids
Management of variceal haemorrhage
FFP, Vit K
terlipression
octerotide
prophylactic IV antibiotics
GPA serology
ANCA
management of perforated tympanic membrane
no treatment review in 2 weeks then in 6 weeks
presentation of TTP
fever neuro signs thrombocytopenia haemolytic anaemia renal failure
PTEN mutation
intestinal hamartomas
cowdens
intestinal hamartomas
pigmentation around mouth
peutz-jeghers
L5 radiculopathy
weakness of hip abduction and foot drop
no reflex lost
S1 nerve root compression
sensory loss of posterolateral aspect of leg and lateral aspect of foot
weakness of plantar flexion and reduced ankle reflex
L2 nerve root compression
back, groin, anterior thigh pain
L3 nerve root compression
sensory loss over anterior thigh, weakened quadriceps, reduced knee reflex
L4 nerve root compression
sensory loss over anterior aspect of knee, weakened quadriceps
reduced knee reflex
HRT in high risk of DVT
transdermal HRT doesnt increase VTE risk
Which of the following medications cant be used in pregnancy > paracetamol > lamotrigine > simvastatin > metformin >insulin
> simvastatin
treatment for bronchopulmonary aspergillosis
oral glucocorticoids
recommendation after WLE
whole breast radiotherapy
what is aplastic anaemia
characterised by pancytopenia and hypoplastic bone marrow
causes of aplastic anaemia
- idiopathic
- congenital- faconi, dyskeratosis
- drugs: cytotoxics, chloramphenicol, sulphonamides, phenytoin, gold
- toxins: benzene
- infectons: parvovirus, hepatitis
- radiation
management of acne vulgaris
- single topical therapy (topical retinoids, benzoyl peroxide)
-topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
-oral antibiotics:
>tetracyclines: lymecycline, oxytetracycline, doxycycline
tetracyclines
> erythromycin may be used in pregnancy
a single oral antibiotic for acne vulgaris should be used for a maximum of three months
-a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing.
> Topical and oral antibiotics should not be used in combination
- Gram-negative folliculitis may occur as a complication of long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs
-combined oral contraceptives (COCP) are an alternative to oral antibiotics in women
as with antibiotics, they should be used in combination with topical agents
-Dianette (co-cyrindiol) is sometimes used as it has anti-androgen properties. However, it has an increased risk of venous thromboembolism compared to other COCPs, therefore it should generally be used second-line, only be given for 3 months and women should be appropriately counselled about the risks
-oral isotretinoin: only under specialist supervision
pregnancy is a contraindication to topical and oral retinoid treatment
management of graves
carbimazole
Causes of bronchiectasis
CF
pertussis
hypogammaglobulinaemia
young syndrome
common presenting feature of wilms tumour
abdominal mass
what should be offered to all patients with HF anually
influenza vaccine
1st line in HF with stable impaired LV function
ACE + BB
reduces mortality in HF with ACEi
spironolactone
Primary dysmenorrhoea management
NSAID such as mefanamic acid
COCP
What differentiates vestibular neuronitis from labyrinthitis?
unaffected hearing in vestibular neuronitis
What is suggestive of nephrotic syndrome?
heavy proteinuria and gross oedema
hypoalbuminaemia from proteinurea causes increased oedema
Most common cause of nephrotic syndrome in kids
minimal change glomerulonephritis
Causes of MCG
- idiopathic
- drugs: NSAIDs, rifampicin
- Hodgkin’s lymphoma, thymoma
- infectious mononucleosis
Pathophysiology of MCG
- T-cell and cytokine-mediated damage to the glomerular basement membrane → polyanion loss
- the resultant reduction of electrostatic charge → increased glomerular permeability to serum albumin
Features of MCG
> nephrotic syndrome
normotension - hypertension is rare
highly selective proteinuria
–only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
renal biopsy
–normal glomeruli on light microscopy
—electron microscopy shows fusion of podocytes and effacement of foot processes
Management of MCG
80% steroid responsive
Cyclophosphamide if steroid resistant
what is candesartan
ARB
MOA of alteplase
activates plasminogen to form plasmin
how to diagnose ank spon
sacro-ilitis on pelvic X-ray
What is LES
rare autoimmune disorder in which antibodies are formed against pre-synaptic voltage-gated calcium channels in the neuromuscular junction. A significant proportion of those affected have an underlying malignancy, most commonly small cell lung cancer. It is therefore regarded as a paraneoplastic syndrome.
INR 5.0-8.0 (no bleeding) -
withhold 1 or 2 doses of warfarin, reduce subsequent maintenance dose
african patient taking CCB requiring second agent
ARB
persistent ST elevation following MI, no chest pain
left ventricular aneurysm
scaphoid abdomen + bilious vomiting
intestinal malrotation and volvulus
psoriasis exacerbating factor
> trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
confusion in asthma attack
life threatening
