Focused revision topics Flashcards
Which diabetes medications cause weight loss?
SGLT-2 (flozins)
Injectable GLP1-agonist (dulaglutide)
Which diabetes medications cause weight gain?
Insulin
Sulfonylureas (gliclazide)
Thiazolidinediones (pioglitazone)
Sulfonylurea (gliclazide) side effects:
Weight gain
Hypoglycemia
GI disturbance
Side effect of DPP-4 inhibitors (gliptins)
Headache
Acute pancreatitis
Treatment for absence seizures?
Ethosuxamide or sodium valproate
Paraesthesia is associated with a seizure arising from where?
Parietal lobe
First line to focal epilepsy?
Lamotrigine or carbamazepine
Generalised tonic clonic seizure management (chronic)
- First line:sodium valproate (unless woman of childbearing age)! Levetiracetam.
- Second line:lamotrigineorcarbamazepine
Treatment of infantile spasms:
Prednisolone
Vigabatrin
Side effects of sodium valproate
- Teratogenicso patients need careful advice about contraception
- Liver damage and hepatitis
- Hair loss
- Tremor
Carbamazepine side effects:
- Agranulocytosis
- Aplastic anaemia
- Induces the P450 system so there are many drug interactions
How is pericarditis differentiated from Dressler’s syndrome following an MI?
Pericarditis in the first 48 hours following a transmural MI is common(c. 10% of patients). The pain is typical for pericarditis (worse on lying flat etc), a pericardial rub may be heard and a pericardial effusion may be demonstrated with an echocardiogram.
Dressler’s syndrometends to occur around2-6 weeksfollowing a MI. The underlying pathophysiology is thought to be an autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination offever,pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.
How to differentiate left ventricular aneurysm from left ventricular free wall rupture following an MI?
Left ventricular aneurysm: The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevationand left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.
Left ventricular free wall rupture: This is seen in around 3% of MIs and occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.
How to differentiate VSD from acute mitral regurgitation following an MI?
VSD: Rupture of the interventricular septum usually occurs in the first week and is seen in around 1-2% of patients. Features: acute heart failure associated with a pan-systolic murmur. An echocardiogram is diagnostic and will exclude acute mitral regurgitation which presents in a similar fashion. Urgent surgical correction is needed.
Acute mitral regurge: More common with infero-posterior infarction and may be due toischaemia or rupture of the papillary muscle. Acute hypotension andpulmonary oedemamay occur. An early-to-mid systolic murmur is typically heard. Patients are treated with vasodilator therapy but often require emergency surgical repair.
What calcium channels need to be avoided in heart failure and when the patient already takes beta blockers?
Verapamil and diltiazem must be avoided.
Explain the use of dihydropiridine calcium channel blockers:
Indicated for: Hypertension, angina, Raynaud’s.
Affects the peripheral vascular smooth muscle more than the myocardium and therefore do not result in worsening of heart failurebutmay therefore cause ankle swelling.
Shorter acting dihydropyridines (e.g. nifedipine) cause peripheral vasodilation which may result inreflex tachycardia.
- Acute kidney injury
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
think…?
Haemolytic uraemic syndrome
What is the Coombs test used for?
Autoimmune haemolytic anaemia
Antiglobulin testing, also known as the Coombs test, is an immunology laboratory procedure used to detect the presence of antibodies against circulating red blood cells (RBCs) in the body, which then induce haemolysis.
What is seen on the blood film in HUS?
Schistocytes and helmet cells
Treatment of HUS:
- Treatment is supportive e.g. Fluids, blood transfusion and dialysis if required.
- There isno role for antibiotics, despite the preceding diarrhoeal illnessin many patients.
- The indications for plasma exchange in HUS are complicated
- As a general rule plasma exchange is reserved for severe cases of HUS not associated with diarrhoea.
- Eculizumab (a C5 inhibitor monoclonal antibody) has evidence of greater efficiency than plasma exchange alone in the treatment of adult atypical HUS.
Management of a Weber A fracture:
Weber A fractures - patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot.
What does PTH do?
PTH inhibits osteoblast activity and stimulates osteoclast activity leading to bone breakdown and calcium release. At the kidneys, PTH increases calcium reabsorption and blocks phosphate reabsorption from the tubules. PTH also acts at the kidneys to stimulate the formation of vitamin D.
What does PO2 actually mean on a blood gas?
The amount of oxygen dissolved in blood plasma.
As a general rule should be roughly 10 below the FiO2.
AKI diagnostic criteria:
- ↑ creatinine > 26µmol/L in 48 hours
- ↑ creatinine > 50% in 7 days
- ↓ urine output < 0.5ml/kg/hr for more than 6 hours
What antibiotics increases risk of C diff the most?
4 C’s
Clarithromycin
Clindamycin
Cephalosporins
Co-amoxiclav
Which antibiotic is associated with photosensitivity?
Doxycylcline
Why are tetracyclines contraindicated in children?
The affect bone development and cause permanent staining of teeth.
Statins are contraindicated with what antibiotic?
- why?
Clarithromycin
Clarithromycin, an antibiotic, is known to have potential interactions with statins. The interaction arises due to clarithromycin’s ability to inhibit cytochrome P450 3A4 (CYP3A4), an enzyme in the liver responsible for metabolizing various drugs, including statins.
Statins, such as simvastatin and atorvastatin, are also metabolized by the CYP3A4 enzyme. When clarithromycin inhibits CYP3A4, it can lead to increased levels of statins in the bloodstream.
Elevated statin levels increase risk of myopathy and rhabdomyolysis.
What clotting factors does warfarin inhibit?
1972 - 10, 9, 7, 2
Vitamin K antagonist, prevents the synthesis of these clotting factors.
What diabetic medication is associated with an increased risk of euglycemic diabetic ketoacidosis?
SGLT-2
Which antibiotic causes cholestasis?
Co-amoxiclav
Flucloxacillin (several weeks after)
Side effects of ciprofloxacin
Tendonitis
Lowered seizure threshold
Give what antibiotic for a human or animal bite?
Co-amoxiclav
Give what antibiotic for severe campylobacter enteritis?
Clarithromycin (macrolide)
1st line Downs syndrome screening test?
Combined test (1st line and most accurate):
- done at 11-14 weeks
- Measures nuchal thickness >6mm is abnormal
- BHCG - raised in Downs
- PAPPA - decreased in Downs
What is the Quadruple test in pregnancy?
The quadruple test is performed between 14 and 20 weeks gestation. It only involves maternal blood tests:
- Beta-HCG– ahigherresult indicates greater risk
- Alpha-fetoprotein(AFP) – alowerresult indicates a greater risk
- Serum oestriol(female sex hormone) – alowerresult indicates a greater risk
- Inhibin A - raised in Downs
Haemophillia shows what raised on coagulation bloods?
APTT
Platelets and PT are both normal!
This is as there is disruption to the intrinsic pathway.
Galeazzi fracture - what is it?
Galeazzi fracture is a radial shaft fracture associated with dislocation of the distal radioulnar joint.W
What is a Pott’s fracture?
A pott’s fracture is a bimalleolar ankle fracture that occurs when there is forced foot eversion.S
Scaphoid fracture management:
- Undisplaced?
- Displaced?
- Proximal scaphoid pole
Undisplaced fractures = cast for 6-8 weeks
Union is achieved in > 95%
Certain groups e.g. professional sports people may benefit from early surgical intervention.
Displaced = surgical fixation
Proximal scaphoid pole fractures = surgical fixation
When to iron supplement women?
115 for non-pregnant women, 110 in early pregnancy, 105 in later pregnancy, and 100 after childbirth
Haemochromatosis is a risk factor for pseudogout
Haemochromatosis is a risk factor for pseudogout`
Urea raised disproportionately to creatinine think…
Dehydration
A differential for AKI is dehydration - the latter is characterised by a urea that is proportionally higher than the rise in creatinine.
What medications are given in conservative NSTEMI management?(acute)
NSTEMI (managed conservatively) antiplatelet choice
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
Furosemide (loop diuretic) may cause what electrolyte abnormality?
Hyponatraemia
In young adults with septic arthritis, what’s the most common organism?
Neisseria gonorrhoeae
Common drug causes of urticaria
The following drugs commonly cause urticaria:
aspirin
penicillins
NSAIDs
opiates
C diff severity is determined how?
WCC count
- normal = mild
- under 15 = moderate
- wcc over 15 = severe
Non-dihydropyridines =
Verapamil and Diltiazem
Dihydropyridines =
Amlodipine
Nifedipine
