Day 4 Flashcards
Antibodies in drug induced lupus
Anti-histone
Autoimmune hepatitis antibodies
Anti-smooth muscle antibodies
Marker of necrosis
Lactate dehydrogenase
Wegener’s granulomatosis autoantibodies
cANCA
Features of drug induced lupus
>arthralgia >myalgia >malar rash >pleurisy >ANA positive >dsDNA negative >anti-histone antibodies in 80-90%
Most common causes of drug induced lupus
Procainamide
Hydralazine
Less common drug causes of drug induced lupus
Isoniazid
Minocycline
Phenytoin
What is plagiocephaly
Parallellogram shaped head
What is craniosynostosis
Premature fusion of skull bones
What will autoimmune hepatitis show in LFTs
raised ALT/AST on LFTs
Antimitochondrial antibody
Primary biliary cirrhosis
Types of autoimmune hepatitis
Type 1
- ANA and/or SMA
- children and adults
Type 2
- anti-liver/kidney microsomal type 1
- children only
Type 3
- soluble liver-kidney antigen
- affects adults in middle-age
Management of autoimmune hepatitis
Steroids, immunosuppressants e.g. azathioprine
Liver transplantation
URTI symptoms + amoxicillin -> rash
Glandular fever
(EBV)
Haemorrhage 5-10 days after tonsilectomy
Wound infection, IV antibiotics
Worsening flu like symptoms + dry cough + erythema multiforme
mycoplasma pneumonia
left homonymous hemianopia with some macula sparing
right occipital cortex
family history of early blindness is concerned that he is developing ‘tunnel vision’
retina
A 3-year-old boy is referred to the clinic with a scrotal swelling. On examination the mass does not transilluminate and it is impossible to palpate normal cord above it.
indirect inguinal hernia
Use of 0.9% Sodium Chloride for fluid therapy in patients requiring large volumes
hyperchloraemic metabolic acidosis
Risk factors for graft versus host disease
- volume and age of transfused blood
- depressed immune function. E.G. hodgkin
- similar HLA haplotype sharing
adult patients with hydrocele management
ultrasound
treatment of primary herpes infections
oral antiviral therapy
Area most affected in ischaemic colitis
splenic flexure
What age of child have similar vital signs to an adult
children over 12
Diagnosis of chlamydia
nucleic acid amplification tests on first-catch urine sample
side effect of metformin
diarrhoea
side effect of pioglitazone
worsening of HF
side effect of gliclazide
hypoglycaemia
Management of asthma attack
nebulised salbutamol, nebulised ipatroprium bromide, oral prednisolone
Features of ramsay hunt syndrome
auricular pain facial nerve palsy vesicular rash around ear vertigo tinnitus
management of ramsay hunt syndrome
oral aciclovir and corticosteroids
ptosis + dilated pupil
third nerve palsy
ptosis + constricted pupil
horners
Presentation of IgA nephropathy
Visible haematuria following recent URTI
When does post-streptococcal glomerulonephritis occur?
7-14 days after URTI
Features of Wilm’s tumour
abdominal mass painless haematuria flank pain anorexia, fever unilateral metastasis (20%, lung common)
inheritance of HOCM
autosomal dominant
Common causes of urticaria
- penicillins
- NSAIDs
- opiates
marfan’s mutation
fibrillin-1
malignancy + raised CK
polymyositis
Acne rosacea treatment
mild/moderate = topical metronidazole severe/resistant = oral tetracycline
CA 19-9
pancreatic cancer
CA 125
ovarian cancer
CA 15-3
breast cancer
PSA
prostatic carcinoma
AFP
hepatocellular carcinoma, teratoma
CEA
colorectal cancer
s-100
melanoma, schwnanomas
bombesin
SCLC, gastric cancer, neuroblastoma
what is associated with arnold-chiari malformation?
syringomyelia
Drugs worsening glucose tolerance
Thiazides
Aspirin MOA
non reversible COX 1 and COX 2
Management of TTN
observation and supportive care
INR target venous thromboembolism
target INR = 2.5 , if recurrent 3.5
INR atrial fibrillation
2.5
black hairy tongue cause
tetracyclines
schistosoma risk
SCC of bladder
Primary sclerosing cholangitis is most associated with
Ulcerative colitis
intrahepatic cholestasis of pregnancy management
increases risk of stillbirth
induction of labour at 37-38 weeks
ursodeoxycholic acid
vitamin K supplementation
1st line for hypertension in diabetics
ACE inhibitors
red flags in chronic rhinosinusitis
- unilateral
- persistent treatments despite compliance with 3 months of treatment
- epistaxis
anticoagulation in heparin induced thrombocytopenia
direct thrombin inhibitor e.g. argatroban
Spasticity in MS
1st Baclofen/gabapentin
2nd diazepam
Antibiotic causing idiopathic intracranial hypertension
tetracyclines- doxycycline
where does bendroflumethiazide act?
proximal part of distal convoluted tubule- Na-Cl
charcots triad
ascending cholangitis- fever, jaundice, RUQ pain
what does TB cause?
upper zone fibrosis
factors exacerbating psoriasis
trauma
alcohol
drugs: (BLANAI) beta blockers, lithium, antimalarials (chloroquine and hydroxycholoquine), NSAIDS, ACE, infliximab
withdrawal of systemic steroids
Management strategy for AF
Offer rate control as the first‑line strategy to people with atrial fibrillation, except in people whose atrial fibrillation has a reversible cause
Management of AF with reversible cause
treat underlying cause
rhythm control
Migraine triggers
CHOCOLATE > chocolate > hangovers > orgasms > cheese/caffeine > oral contraceptives > lie-ins > alcohol > travel > exercise
Management of intertrochanteric hip fracture
dynamic hip screws
U waves
hypokalaemia
Management of whooping cough
azithromycin or clarithromycin
dislocation of the proximal radioulnar joint in association with an ulnar fracture
monteggia fracture
Monteggia ulna (Manchester United)
fracture of the distal radius with an associated dislocation of the distal radioulnar joint
galeazzi
Galeazzi radius (Galaxy rangers)
distal radius fracture with dorsal displacement.
colles
distal radius fracture with volar displacement.
smiths
fracture of the base of the first metacarpal, that extends into the carpometacarpal joint.
bennetts
Management of threadworms
> CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
What does schobers test <5cm suggest
ankylosing spondylitis
first line investigation for stable chest pain of suspected coronary artery disease aetiology
Contrast-enhanced CT coronary angiogram
Beta blockers have what impact on diabetics
disguise hypoglycaemia awareness
Signs of ecstasy poisoning
>neurological: agitation, anxiety, confusion, ataxia >cardiovascular: tachycardia >hypertension >hyponatraemia >hyperthermia >rhabdomyolysis
Management of life threatening risk in ICP
IV mannitol/frusemide
Patients with an uncertain tetanus vaccination history should be given …..
a booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old
What is a sinusoidal ECG pattern
severe hyperkalaemia
Features of bells palsy
> lower motor neuron facial nerve palsy - forehead affected*
>patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
What do SGLT2 inhibitors increase the chance of
UTI
Lithium use in pregnancy
ebstein’s anomaly- posterior leaflets of tricuspid valve are displaced anteriorly towards the apex of the right ventricle
Routine monitoring of azathioprine
FBC
LFT
Cyanotic congenital heart disease presenting at 1-2 months of age is ___
TOF
Cyanotic congenital heart disease presenting within the first days of life is ___.
TGA
What are those with turners more at risk of?
x-linked conditions
Features of duodenal atresia
high volume vomits which may or may not be bile stained. Abdominal distension is characteristically absent. Whilst under resuscitated children may be a little dehydrated they are seldom severely ill.
Target saturations in COPD are _____% if CO2 is normal on ABG
94-98
inducers of P450
- antiepileptics: phenytoin, carbamazepine
- barbiturates: phenobarbitone
- rifampicin
- St John’s Wort
- chronic alcohol intake
- griseofulvin
- smoking (affects CYP1A2, reason why smokers require more aminophylline)
inhibitors of P450
>antibiotics: ciprofloxacin, erythromycin > isoniazid > cimetidine,omeprazole > amiodarone > allopurinol > imidazoles: ketoconazole, fluconazole > SSRIs: fluoxetine, sertraline ritonavir > sodium valproate > acute alcohol intake > quinupristin
hypocalcaemia, renal failure, high total protein
myeloma
Alpha-_ _______ promote relaxation of the smooth muscle of the prostate and the bladder to reduce LUTS
Alpha-1 antagonists promote relaxation of the smooth muscle of the prostate and the bladder to reduce LUTS
sudden visual loss in diabetics
vitreous haemorrhage
Patients cannot drive for _____ following a first unprovoked or isolated seizure if brain imaging and EEG normal
6 months
Women with pyrexia >38 degrees during labour should get ….
benzylpenicillin as GBS prophylaxis
Head injury, lucid interval -
extradural (epidural) haematoma
midazolam reversal
flumazenil
an anaesthetic agent which has anti emetic properties
propofol
What is zero-order kinetics
metabolism which is independent of the concentration of the reactant
This is due to metabolic pathways becoming saturated resulting in a constant amount of drug being eliminated per unit time.
drugs exhibiting zero order kinetics
> phenytoin
salicylates (e.g. high-dose aspirin)
heparin
ethanol
Gaze in infants with hydrocephalus
impaired upward gaze
Treatment of toxoplasmosis
No treatment is usually required unless the patient has a severe infection or is immunosuppressed.
Immunocompromised patients with toxoplasmosis are treated with pyrimethamine plus sulphadiazine
What is chlorthalidone
Thiazide
Manaagement of HF
1st. ACE-inhibitor and beta-blocker
2nd aldosterone
3rd ivabridine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynch
An increase in serum creatinine up to __% from baseline is acceptable when initiating ACE inhibitor treatment
30
bleeding gums deficiency
Vit C
diarrhoea, confusion and eczematous skin deficiency
niacin
osteomalacia deficiency
vitamin D
An ? should be used first-line for black TD2M patients who are diagnosed with hypertension
angiotensin II receptor blocker
flu-like symptoms, RUQ pain, tender hepatomegaly and cholestatic LFTs
hepatitis A
side effect of thiazide-like diuretics
indapamide
Behcet’s syndrome is associated with which skin lesion
erythema nodosum
management of infant hydrocoeles
generally repaired if they do not resolve spontaneously by the age of 1-2 years
