Finals Flashcards
What are some extra-articular manifestations of rheumatoid arthritis?
- Pulmonary fibrosis with pulmonary nodules (Caplan’s syndrome)
- Bronchiolitis obliterans (inflammation causing small airway destruction)
- Felty’s syndrome (RA, neutropenia and splenomegaly)
- Secondary Sjogren’s Syndrome (AKA sicca syndrome)
- Anaemia of chronic disease
- Cardiovascular disease
- Episcleritis and scleritis
- Rheumatoid nodules
- Lymphadenopathy
- Carpel tunnel syndrome
- Amyloidosis
How is methotrexate given and what are some side effects?
Methotrexate works by interfering with the metabolism of folate and suppressing certain components of the immune system. Mode of action is via blocking the action of the enzyme dihydrofolate reductase.
It is taken by injection or tablet once a week. Folic acid 5mg is also prescribed once a week to be taken on a different day to the methotrexate. It can be taken once weekly on the day after the methotrexate dose, or it can be taken once daily every day except on the day of the methotrexate dose.
Folic acid reduces the side effects of methotrexate. It can decrease mucosal and gastrointestinal side effects and may prevent liver toxicity. Folic acid should never be taken on the same day as methotrexate as it can impair the efficacy of the medication.
Notable Side Effects:
- Mouth ulcers and mucositis
- Liver toxicity
- Bone marrow suppression and leukopenia (low white blood cells)
- It is teratogenic (harmful to pregnancy) and needs to be avoided prior to conception in mothers and fathers
Common side effects of methotrexate include:
Loss of appetite
Nausea
Indigestion
Diarrhoea
Headaches
Tiredness
Hair loss
Rare but serious side effects of methotrexate include:
Liver toxicity: jaundice
Pulmonary toxicity: persistent cough, chest pain, dyspnoea
Renal toxicity: peripheral oedema, polyuria
Signs of infection: fever, chills, muscle aches, sore throat
Thrombocytopenia: bleeding gums, haematuria, unexplained bruising
Stevens-Johnson syndrome: severe skin rash or blisters on skin, mouth, eyes or genitals
When beginning treatment, full blood count, renal and liver function tests should be carried out every 1-2 weeks until the therapy is stabilised. Thereafter, patients should be monitored every 2-3 months.
What are the signs of respiratory distress in children?
Raised respiratory rate
Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis (due to low oxygen saturation)
Abnormal airway noises
Management of chronic asthma in under-5s
1) Start a short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
2) Add a low dose corticosteroid inhaler or a leukotriene antagonist (i.e. oral montelukast)
3) Add the other option from step 2.
4) Refer to a specialist.
Management of chronic asthma in 5-12 year olds
1) Start a short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
2) Add a regular low dose corticosteroid inhaler
3) Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). Continue salmeterol only if the patient has a good response.
4) Titrate up the corticosteroid inhaler to a medium dose. Consider adding:
- Oral leukotriene receptor antagonist (e.g. montelukast)
- Oral theophylline
5) Increase the dose of the inhaled corticosteroid to a high dose.
6) Referral to a specialist. They may require daily oral steroids.
Management of chronic asthma in over 12s
1) Start a short-acting beta 2 agonist inhaler (e.g. salbutamol) as required
2) Add a regular low dose corticosteroid inhaler
3) Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). Continue salmeterol only if the patient has a good response.
4) Titrate up the corticosteroid inhaler to a medium dose. Consider a trial of an oral leukotriene receptor antagonist (i.e. montelukast), oral theophylline or an inhaled LAMA (i.e. tiotropium).
5) Titrate the inhaled corticosteroid up to a high dose. Combine additional treatments from step 4, including the option of an oral beta 2 agonist (i.e. oral salbutamol). Refer to specialist.
6) Add oral steroids at the lowest dose possible to achieve good control under specialist guidance.
What antibiotics are given in neonatal sepsis?
Benzylpenicillin and gentamycin
What 9 genetic conditions does the newborn heel prick test look for?
- Sickle cell
- Cystic fibrosis
- Congenital hypothyroidism
- Phenylketonuria (PKU)
- Medium-chain acyl-coA dehydrogenase deficiency (MCADD)
- Maple syrup urine disease (MSUD)
Isovaleric acideaemia (IVA) - Glutaric acuduria type 1 (GA1)
- Homocysteinuria (HCU)
- Severe combined immunodeficiency (SCID)
What are the paediatric causes of a pan-systolic murmur?
VSD
Mitral regurg
Tricuspid regurgitate
What are the features of Tetralogy of Fallot?
-VSD
- Overriding aorta
- Pulmonary valve stenosis
- Right ventricular hypertrophy
What are some causes of clubbing in children?
- Hereditary clubbing
- Cyanotic heart disease
- Infective endocarditis
- Cystic fibrosis
- Tuberculosis
- Inflammatory bowel disease
- Liver cirrhosis
What are the features of Down’s syndrome?
- Hypotonia (reduced muscle tone)
- Brachycephaly (small head with a flat back)
- Short neck
- Short stature
- Flattened face and nose
- Prominent epicanthic folds
- Upward sloping palpebral fissures
- Single palmar crease
What are some complications of Down’s?
- Learning disability
- Recurrent otitis media
- Deafness. Eustachian tube abnormalities lead to glue ear and conductive hearing loss.
- Visual problems such myopia, strabismus and cataracts
- Hypothyroidism occurs in 10 – 20%
- Cardiac defects affect 1 in 3, particularly ASD, VSD, patent ductus arteriosus and tetralogy of Fallot
- Atlantoaxial instability
- Leukaemia is more common in children with Down’s
- Dementia is more common in adults with Down’s
What are the side effects of sodium valproate?
- Teratogenic, so patients need careful advice about contraception
- Liver damage and hepatitis
- Hair loss
- Tremor
What are the side effects of carbamazepine?
- Agranulocytosis
- Aplastic anaemia
- Induces the P450 system so there are many drug interactions
