fifth Flashcards
which antibiotic leads to tendinopathy ?
Ciprofloxacin
should never be prescribed with methotrexate
Co-trimoxazole contains trimethoprim
had a full course of tetanus vaccines, with the last dose < 10 years ago
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
full course of tetanus vaccines, with the last dose > 10 years ago
if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
If vaccination history is incomplete or unknown for tetanus
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
Indications for aortic endovascular stenting include in dissection ?
Rapidly expanding dissections (>1cm per year)
Critical diameter (>5.5cm)
Refractory pain
Malperfusion syndrome
Blunt chest trauma
Penetrating aortic ulcers
thyroid cancer TX ?
any lump greater than 1cm in size or has any signs of metastatic spread should undergo thyroidectomy instead of a lobectomy
thyroid lumps greater than 4cm in diameter regardless of extrathyroid disease; those with lumps between 1 and 4cm in diameter and extra-thyroid disease; and all with high-risk histology such as aggressive histological subtypes benefit from radioiodine ablation
known cirrhosis the management of varices
No varices
Rescope 2-3 years
Grade 1 varices
Rescope 1 year
Grade 2 or 3 varices or signs of bleeding
Non-cardio selective beta blocker
sympathetic or parasympathetic for trochlear or occulosmotr ?
surgical causes of third nerve palsy (eg the above, or a tumour - posterior communicating artery aneurysm
fixed dilated or sluggish pupil indicates that the parasympathetic fibres have been wiped out (eg by external compression from an aneurysm or tumour), leaving unopposed sympathetic tract flow within this nerve (dilating the pupil).
medical causes, eg diabetes or vasculitis
The blood supply to the nerve is within its internal portion, meaning medical causes like diabetes or vasculitis wipe out the sympathetic portion of the nerve, leaving unopposed parasympathetic flow and consequently a constricted pupil.
MELAS and CADASIL difference
MEALS : short stature,
recurrent migraines,
vomiting,
muscle weakness,
seizures and then
development of multiple strokes at an early age (normally before 40 for diagnosis to be considered) along with progressive dementia.
!!!!!!There is also a raised lactic acid level in the blood and skeletal muscle biopsy will show ragged red fibres
CADASIL would also present with migraines and stroke at an early age, lactic acidosis is not a feature and subcortical infarct would be more typical
CAH features
21- hydroxylase: 1 at back only so: no HTN, only virilisation
11-hydroxylase: 1 in both front and back- so both HTN and virilisation
17- only 1 in front- so only HTN,no virilisation
gastric carcinoma tx ?
3 cm ulcer in the body of the stomach. with penetration of the tumour into the subserosal connective tissue.
enlargement of the right and left gastro-epiploic lymph nodes
T3N1M0 gastric carcinoma (Stage IIB disease). Standard of care within the UK for stage II / III disease would be for neoadjuvant chemotherapy prior to radical surgery
Appropriate treatment of Pseudomonas positive bronchiectasis failing to respond to ciprofloxacin
IV tazocin, ceftazidime, aztreonam or meropenem
difference in ecg between brugada and arrythmogenic right
Arrhythmogenic right ventricular cardiomyopathy
V1-3, typically T wave inversion. An epsilon wave is a terminal notch in the QRS
convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave
3 groups of patients that tend to benefit from r lung volume reduction surgery in emphysema ?
Upper lobe emphysema and low exercise capacity
predominantly upper lobe emphysema and high exercise capacity.
non-upper lobe emphysema and low exercise capacity
Porphyria’s
Neurovisceral only====
Acute intermittent porphyria (AIP)
- autosomal dominant
- defect in porphobilinogen deaminase
-abdominal symptoms, -neuropsychiatric symptoms
hypertension and tachycardia common
-urine turns deep red on standing
Aminolaevulinic acid dehydrogenase porphyria
JUST PHOTOSENSITIVE ====
Porphyria cutanea tarda (PCT)
defect in uroporphyrinogen decarboxylase
classically photosensitive rash with bullae, skin fragility on face and dorsal aspect of hands
urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood’s lamp
manage with chloroquine
Congenital erythropoietic porphyria
Erythropoietic protoporphyria
========
BOTH
Variegate porphyria
autosomal dominant
defect in protoporphyrinogen oxidase
photosensitive blistering rash
abdominal and neurological symptoms
more common in South Africans
Hereditary coproporphyria
Early diastolic murmur is not just aortic regurgitation can also be ?
Pulmonary hypertension
Pulmonary regurgitation
Graham steel murmur
Lithium features of toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
Dialysis indication
A lithium concentration greater than 5.0 mmol/L in patients with acute lithium overdose and who are not prescribed lithium
A lithium concentration greater than 2.5 mmol/L in patients with chronic poisoning
thyroid nodules follow up
TSH normal/elevated → Thyroid USS → Suspicious features → FNA cytology
TSH suppressed → Thyroid uptake scan → Cold/iso nodule → FNA cytology
TSH suppressed → Thyroid uptake scan →Hot nodule → No FNA required
Which diabetic medication causes pancreatitis ?
GLP1!!!!!! Liraglutide
Endocarditis prophylaxis given to ?
HCOM
exacerbate myasthenia
Magnesium
Penicillamine
Quinidine
Procainamide
Beta-blockers
Lithium
Phenytoin
Antibiotics: gentamicin, macrolides, quinolones, tetracyclines
Anaerobic bacteria caused by aspiration
Bacteroides
Prevotella
Fusobacterium
Peptostreptococcus
Diagnostics used for phaeochromocyta?
MIBG scan - radioactive iodine as a tracer
