Friday 6th Flashcards
What are the three features of typical stable angina
- central heavy chest discomfort which may spread to face/ arms/ neck
- bought on by exertion
- Relieved by rest (<5mins) or GTN spray
What is the first line investigation of stable angina
CT coronary angiogram
what are second line investigations of stable angina?
functional testing- stress echo, myocardial perfusion SPECT, cardiac MRI
what is the third line and gold standard investigation of stable angina?
invasive coronary angiography
What is first line management of stable angina (excluding medications everyone should be put on)
beta blocker or calcium channel blocker
what type of calcium channel blocker should be used if used as monotherapy?
a rate limiting CCB such as verapamil
what is second line management of stable angina
combination of calcium channel blocker and beta blocker
what type of calcium channel blocker should be used if it is in combination with a beta blocker?
long-acting dihydropyridine calcium channel blocker (amlodipine or nifedipine)
What is third line management of stable angina (while also referring for revascularisation)
Beta blocker, calcium chanel blocker and addition drug:
- long acting nitrate
- ivabradine
- nicrorandil
- ranolazine
What two options for revascularisation are there?
precutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)
What medications should someone with stable angina be put on aside from the anti-angina medications?
atrovastatin
aspirin
GTN
What can trigger psoriasis attacks? (7)
- including which drugs (4)
- skin trauma
- infections (streptococcal)
- drugs: BALI- beta blockers, anti-malarias, lithium and indomethacin/NSAIDs
- withdrawal from steroids
- stress
- alcohol and smoking
- cold/dry weather
What different types of psoriasis are there?
chronic plaque psoriasis
flexural psoriasis
gluttate psoriasis
pustular psoriasis
scalp psoriasis
erythrodermic psoriasis
describe chronic plaque psoriasis
thickened erythematous plaques with silver scales, commonly on the extensor surfaces and the scalp.
plaques are typically 1-10cm in diameter
describe gluttate psoriasis
common in young people following streptococcal infection
- multiple tear dropped shaped plaques on the trunk
- typically resolves spontaneously within 3-4 months
-
desribe flexural psoriasis
smooth erythematous plaques without scales on the flexures and skin folds
describe eryhthrodermic psoriasis
A rare and severe form of psoriasis where there is extensive erythematous areas covering most of the surface of the skin.
The skin comes away in large patches.
Medical emergency
what is koebner phenomenon
the development of psoriatic lesions in areas of skin affected by trauma
What nail signs might accompany psoriasis
subungal hyperkeratosis
nail pitting
oil drop discoloration
leukonychia
onycholisis
What is the first line treatment of chronic plaque psoriasis?
potent topical corticosteroids (such as benovate) plue topical vitamin D (calcitriol, dovonex) used at alternate times
what is second line treatment of chronic plaque psoriasis?
just topical vitamin D applied twice daily (the corticosteroid is stopped)
what is third line treatment of chronic plaque psoriasis?
topical corticosteroid twice daily (the vitamin D is stopped)
If topical therapy does not work what intervention may be used for psoriasis?
phototherapy with narrow band UV B light
if topical treatments fail what drug treatment may be used for psoriasis?
systemic therapy-
1. methotrexate
2. ciclosporin
3. acitretin
then biologics
what are some side effects of ciclosporin
the 5 H’s
Hypertrophy of the gums
Hypertension
Hypertichosis
hyperkalaemia
hyperglycaemai
what biologics might be used in psoriasis?
infliximab
entanercept
adaliimumab
what autoantibodies are associated with rheumatoid arthritis?
anti-CCP and rheumatoid factor
what joint deformities are seen in rheumatoid arthritis?
z shaped deformity of the thumb
swan neck deformity (flexed DIP)
boutonniere deformity (flexed PIP)
ulnar deviation
what eye manifestations may be present in RA (3)
episcleritis
scleritis
keratoconjunctivitis
what extraarticular manifestations may be present in RA?
eye
pulmonary- pulmonary fibrosis, serositis
cardiac- pericarditis, myocarditis
renal- glomerulonephritis
neurological -peripheral neuropathy, carpal tunnel syndrome
Rheumatoid nodeules
What may be seen on x ray of rheumatoid arthritis?
joint space narrowing
bone erosions
periarticular osteoporosis
soft tissue swelling
1st line management of RA
DMARDs such as methotrexate (others- sulfasalazine, hydroxychloroquine)
what are some complications of RA?
Felty syndrome- splenomegary, RA and neutropenia
amyloidosis
1st line management of reactive arthritis?
NSAIDs
what cells do most testicular cancers arise from?
germ cells
what two types of germ cell testicular cancers are there?
seminomas and non-seminomas (mainly teratomas)
1st line investigation of testicular cancer?
scrotal USS
what are some tumour markers for testicular cancer?
alpha-fetoprotein (seminomas), beta HCG (seminomas and teratomas) and lactate dehydrogenase
1st line management of venous ulcers?
compression bandaging
what drug might be used to help venous leg ulcers?
oral pentoxyfylline
what medical therapy might be used in vasovagal syncope? (2)
fludocortisone
midodrine
How would Edwards and Patau’s differ from downs on quadruple test
their beta hCG will be down not up
They will also have normal inihibin A
what does ABG show in asthma attack?
initially there will be respiratory alkalosis then there will be acidosis (bad sign - means they are tiring)
how can tet spells be managed medically?
phenyephrine
How does a CT scan of someone with cystic fibrosis present?
finger in glove appearance (mucous plugging)
What does the blood spot test for to diagnose CF?
it will have raised immunoreactive trypsinogen
what value of chloride on the sweat test is diagnostic of CF?
above 60
What two key organisms may colonise CF?
pseudomonas aeruginosa and staph aureus
What may be given as prophylaxis for staph aureus infection in CF
oral flucloxacillin
How might ebstein anamaly present of examination
prominent A wave in JVP
pansystolic murmer due to tricuspid regurg
What medication may be used to treat pulmonary HTN in eisenmenger’s ?
sildenafil
What signs on examination are there of pulmonary hypertension in congenital heart defects?
RV heave
loud S2
raised JVP
peripheral oedema
what are some complications of whoopng cough?
bronchiectasis
subconjunctival haemorrhages
bronchiectasis
seizures
what are two specific types of innocent murmer that children might have?
venous hums - turbulent blood flow in the veins of the heart, heard just below the clavicles
still’s murmur - low pitched heart sound at left sternal edge
key features of innocent murmurs
soft
systolic
symptomless
situational
short
What are some signs that may indicate problematic reflux?
chronic cough
hoarse cry
distress after feeding
pneumonia
failure to thrive
first line treatment of GORD in infants?
thickened formula
second line treatment of GORD in infants?
gaviscon trial for 1-2 weeks.
third line treatment of GORD in infants?
PPI trial for 4 weeks
What are some risks of GORD
aspiration pneumonia
barrets oesophagus
dysphagia
How would you manage constipation in those under 6 months
give extra water between feeds
Order of management of constipation
1- paediatric movicol
2- stimulant laxative (Senna)
3- osmotic (lactulose)
