Deck 2 Flashcards
Corneal ulcer - what findings?
Anisocoria ( unequal pupils)
Photophobia
Painful eyes on accomodation
Commonest cause of blindness ?
Age related macular degeneration (AMD)
Wet vs Dry AMD?
Wet/exudative = new blood vessels growth - sudden visual loss
Visual distortion - wavy/bent lines
Dry - Drusen detected without visual loss, slower progressive visual loss
Treatment for AMD?
Intravitreal injection - Anti-VEGF
Phototherapy with Verteporfin ( absorbed by new vessels and destroy the vessels)
Thermal laser photocoagulation
Which give thiamine before glucose in alcoholics?
If give glucose first - drives lactate acidosis
Give Thiamine first ( if not pyruvate cannot enter krebs cycle without thiamine so pyruvate change form into lactate to enter)
What is seen with DOWN-REGULATION of HPA axis and why?
Chronic fatigue symptoms - chronic neurons inflammation
Heat stroke common complication and risk factors
AKI
Risk factors
Humid air - sweat can’t evaporate
Hypotensive state - diuretics, salt restricted diet
Obese - retention of heat by adipose tissue
Pseudohypoglycemia mechanism of action?
Enhanced catecholamine release or increased sensitivity to catecholamine following food
Venous ulcers usually occurs where?
Arterial ulcers usually occurs where?
Neuropathic ulcers usually occurs where?
venous ulcer = medial/lateral malleoli
Arterial ulcer = pressure points, digits
Neuropathic ulcer = sole of foot/pressure points
When bandage compression therapy is contraindicated?
Ankle-brachial index < 0.6
Is oestrogen cleared by liver?
Yes
Transplant - Acute T cell mediated rejection = Tx?
Treat with IV Methylprednisolone then oral prednisolone, then commence immunosuppressant
ATG
Acute Antibody mediated rejection = Tx?
Chronic antibody mediated rejection = Tx?
Treat with IVIG + PLEX
Tocilizumab
ABO incompatibility in kidney transplant - outcome?
Good outcome, non-inferior to ABO compatible kidney transplant
Benefit of mTORI in transplant but side effects of?
Benefit - less SCC/BCC ( skin cancers)
Side effect - Delayed wound healing, lymphocele!
Highest risk of graft failures due to recurrence of?
IgA
FSGS
Membranous nephropathy
Fabry’s disease
ANZ paired kidney indication?
ABO incompatible Donor-Recipient pair
HLA sensitization from husband
HLA - better pairing
Donating kidney and pregnancy?
Higher risk of Gestational HTN/Pre-eclampsia - advise not to donate
NO increased risk with pregnancy associated renal disorders
Why transplant more prone to get NODAT?
Corticosteroids = insulin resistance mTORI = defective insulin secretion CNI = decrease glucose uptake by muscles - so they linger in plasma
Occipital headache - which facet joint most affected?
Cervical, axial + referred arm pain - which facet joint most affected?
Occipital - C2-3
Cervical, axial + referred arm pain : C5-6
Sarcopenia - treatment that shows benefit?
Testosterone - hypogonadism
Vitamin D - vitamin D deficient female
Vitamin C deficiency (scurvy) has bleeding - why?
Vitamin C needed to produce Collagen
Why vaccination including Covid19 is recommended in pregnancy?
Pregnancy = risk factor for severe influenza
Passive immunity for fetus
Asthma exacerbation and long term oral steroids use in pregnancy causes what?
Pre-term delivery, small for age gestation
Pre-eclampsia risk
Which AED is self-inducing enzymes and what’s so special in pregnancy?
Carbamazepine, Phenytoin/barbitol/Topiramate
-Give oral vitamin K to reduce oxidation ( last 4 weeks of pregnancy)
Pregnant woman - missed usual AED due to labor - what’s the next step?
Parenteral AED if missed it by > 12 hours
Certain drugs like Levetiracetam and Lamotrigine needs TDM in pregnancy - why?
LEV = increase REnal excretion
LTG = hepatic metabolism
increased volume distribution
Topiramate causes what birth defects?
Hypospadias
Cleft palate
In pregnancy what happens to Systemic vascular resistance?
Reduce SVR due to peripheral vasodilatation
Placenta produces which liver enzyme?
ALP
