FORMATIVE 1 Flashcards
What causes a raised creatine kinase?
Rhabdomyolysis
Drugs - Statins, vibrates, anti gout meds, ARBs, BB, clozapine
Muscle trauma and overuse e.g. intensive exercise, crush syndromes, seizures, long lie
Myopathies
Compartment syndrome
Muscular dystrophies
Myocardial ischaemia
Endocrine - hypothyroidism, Cushing, hyperPTH, acromegaly
Pregnancy
How elevated should CK be to suspect rhabdomyolysis?
At least 5 times the upper limit of normal
Whats the most common presentation of amiodarone-induced pulmonary disease?
Interstitial pneumonitis
How does MDMA toxicity cause hyponatraemia?
SIADH
Some pts try to stop hyperthermia but risking large amounts of fluid
Tetrad of HSP?
Palpable purpura without thrombocytopenia and coagulates the
Arthritis
Abdominal pain
Renal involvement
Features of TTP?
Fever
Fluctuating neuro signs from micoemboli
Microangiopathic haemolytic anaemia = red cell fragments in blood film and raised bilirubin
Thrombocytopenia
Renal failure
MOA of chlorthalidone?
A thiazide diuretic - inhibition of the Na+/Cl- symporter in the cortical diluting segment of the ascending limb of the loop of Henle = reduction of sodium reabsorption = reduces ECF and plasma volume
Maximum dose of ramipril?
10mg OD
Maximum dose of amlodipine?
10mg OD
In a pt with aortic stenosis what test will pride the most information about the effect of the AS?
Exercise tolerance testing
What rate-control medication for AF has the quickest effect?
Beta blockers - metoprolol in particular
Best medication option for prophylaxis of meningococcal meningitis in a pregnant woman?
Still ciprofloxacin
Management of amphetamines overdoses?
Symptmatic support is best with IV fluids
First line management of painful peripheral neuropathy in DM?
amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain (except for trigeminal neuralgia!!)
What imaging is best for an acute flare of IBD to assess for things like toxic megacolon?
AXR
How to manage chronic hyponatraemia?
If you suspect hypovolaemia then give normal fluid as a trial.
If euvolemic or hypervolemic then fluid restrict to <1000ml a day and consider loop diuretics or vaptans (these are vasopressin receptor antagonists!)
(Note it’s in acute hyponatraemia when you give hypertonic saline!!)
Cancer levels greater than what may suggest a sinister cause?
3
What are the indication s for acetylcysteine in a paracetamol OD?
Is paracetamol concentration is on or above the Tx line
If a staggered OD or doubt over time of ingestion regardless of concentration
Presenting 8-24 hours after ingestion of >150mg/kg
Presenting >24 hours and jaundiced OR hepatic tenderness OR ALT is above upper limit of normal
What is considered “heavy proteinuria” as seen in nephrotic syndrome?
> 3.5g in 24 hours
Most common ype of bladder cancer?
Transitional cell carcinoma accounts for >90% of cases
Whats a common cause of squamous cell bladder carcinoma?
Chronic bladder inflammation arising from a schistosomiasis infection in countries where disease is endemic
Rare in the UK to see SCC!
RF for transitional cell carcinoma of the bladder?
Smoking
Exposure to aniline dyes - for example working in the printing and textile industry e.g 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide
Features of neuroleptic malignant syndrome?
Mental status change
Rigidity
Fever
Dysautonomia
What are the key clinical signs suggesting inferior vena cava obstruction in a patient with advances renal cell carcinoma?
Bilateral pitting oedema of the legs, scrotum, and lower abdomen - progresses slowly
Ascites and obvious venous distension across lower abdominal wall
What is the most likely cause of bilateral leg swelling, scrotal oedema, and abdominal venous distension in a patient with advanced renal cell carcinoma?
IVC obstruction due to invasion by RCC
Adverse effects of statins?
Myopathy
Liver impairment
Management of a TIA in a pt with AF?
Refer to TIA or stroke service within 24 hours or onset
CHA2DS2-VASc score to determine if anticoagulation is needed. If 1 in males or 2 in females give a DOAC. Start immediately after a TIA as soon as imaging has excluded haemorrhage!!
What do gram negative diplococci look like on a gram stain?
Red/pink and cocci are in pairs
What are examples of gram negative diplococci?
Neisseria meningitidis
Neisseria gonorrhoea
What are examples of gram negative diplococci?
Neisseria meningitidis
Neisseria gonorrhoea
What is the likely organism if a gram stain shows positive blood culture and gram positive cocci in clusters?
Staph aureus
