From Papers Flashcards
Shocked patient with evidence of fluid overload - next step?
Vasoconstriction - adrenaline
Terminal restlessness treatment
Midazolam by prn subcutaneous injections / continuous subcutaneous infusion via a syringe driver.
Early parkinsons brain area affected
Temporal lobe
treatment of the choice in patients with prolonged QRS complexes following a tricyclic antidepressant overdose.
Intravenous sodium bicarbonate
Diabetic nephropathy - best HTN management
ACE-I
PF diagnostic test
High resolution CT Chest
Typical features of delirium tremens
confusion, visual hallucinations, tachycardia and pyrexia on the background of heavy alcohol use
Chronic Alcoholic withdrawal management
Consider offering a benzodiazepine or carbamazepine. - Chlordiazepoxide for example
Delirium tremens management
oral lorazepam as first-line treatment
If symptoms persist or oral medication is declined, offer parenteral lorazepam or haloperidol
Alcoholic withdrawal seizures mx
quick-acting benzodiazepine (such as lorazepam)
Wernicke’s encephalopathy mx
Offer prophylactic oral thiamine (B1)
If presenting acutely ill or in an emergency setting, offer parenterally
Oral thiamine should follow parenteral
Helping chronic excess alcohol use
acamprosate ( to reduce cravings) with psychological interventions
Disulfiram for unpleasant reaction
naltrexone for reducing cravings
dilutional hyponatraemia cause
(Inappropriately concentrated Urine)
SIADH
ADH stimulates synthesis of aquaporin-2 in the apical membrane of the collecting duct which promotes water absorption
PE but also high bleeding risk mx
Unfractionated heparin - reversible
First line renal stone IVx
unenhanced CTKUB
classical presentation of diverticulitis
change in bowel habit, left iliac fosa pain and features of infection (ie pyrexia)
Cataplexy
classically presents with loss of skeletal muscle tone with strong (usually postive) emotions
De Quervain tendinopathy
The diagnosis of de Quervain tendinopathy usually has a history of atraumatic radial wrist pain with tenderness and enlargement at the first dorsal compartment over the radial styloid and pain at the radial styloid with active or passive stretch the thumb tendons over the radial styloid in thumb flexion (the Finkelstein test).
DMII patient with no CHF or hepatic failure Hx but Renal failure
A thiazolidinedione like pioglitazone
DMII ED treatment
phosphodiesterase‑5 inhibitor
CKD raised phosphate treatment
calcium acetate or r sevelamer carbonate
Diabetic CKD with proteinuria
if ACR >3 ACE or ARB titrated to highest tolerated dose
Then add SGLT2 inhibitor if ACR >3
Iron overload
Venesection or DFO (Deferoxamine, Iron chelator)
Lupus symptoms (aside form joint swelling)
Mouth ulcers
Hair loss
Photosensitive rash
Dry eyes
Chest Pain
Headaches
Lupus Signs
Pallor
Discoid rash
Alopecia
Raynauds
Dry pulmonary crackles
Why do SLE patients miscarry?
Concurrent APS
Two drugs/class for treating SLE
Hydrochloroquinine - DMARD
Prednisolone - Glucocorticoid
Management of hypercalcaemia
Fluids (IV)
Pemindronate - Bis
Symptoms of Cauda Equina
Saddle paraesthesia
Leg weakness or numbness
Sudden onset back pain
Urinary retention
Bowel control loss
Loss of deep tendon reflexes
Loss of rectal tone
Cauda equina Ivx
MRI spine
Plaque psoriasis features
Salmon pin, well demarcated
Extensor surfaces
silver scale
Itchy
What is RF?
Autoantibody against Fc portion of IgG
Is RF diagnostic of RA?
No, 70% not
Anti-CCP more specific
Need joint involvement pattern
Psoriatic vs RA
Psoriatic is RF -ve
Psoriatic is generally assymetrical
Psoriatic has DIPJ involvement - less common in RA
Pitting of finger nails/toe nails in psoriatic
Presence of psoriasis
Gout RF
Obesity
CKD
High protein diet
Metabolic syndromes
Gout triggers
Alcohol
Seafood
Infection
Starvation
Dehydration
Trauma
Surgery
3 acute treatments for gout
NSAIDs
Colchicine
Steroids
Coxib
How do glucocorticoids work as anti-inflammatory
Up-regulate anti-inflammatory proteins (ransactivation)
Prevents translocation of pro-inflammatory factors into the nucleus (Trans-repression)
Define osteoporosis
Bone density 2.5 sd below young adult mean
RF osteoporosis
Smoking, alcohol, low BMI, age, menopause, low activity
Wedge fracture detection
Xray or CT
Diagnosis or osteoporosis?
DEXA
Dual-Energy X-ray Absorptiometry
Attachment of tendon/ligament to bone
Enthesis
Name of inflammation of an entire digit
Dactylitis
Anatomical area inflamed in inflammatory arthritis?
Synovium
Hormones affecting Calcium regulation in serum.
PTH - raises
1,25-dihydroxy-vitamin D3 - raises by absorption and resorption
Calcitonin - decreases, opposing PTH
Bisphosphonate effects
Suppresses osteoclasts
Suppresses osteoclast progenitor
Hip pain in runner differentials
Femoral Acetabular impingement
Trochanteric bursitis
OA
RA
Gluteal tendinopathy
Labral tear
Daily calcium requirement
1g
Drugs causing raised uric acid
Thiazides
Aspirin
Cyclosporin
Levodopa
Allopurinal affects which enzyme?
Xanthine oxidase
Cause of avascular necrosis of head of femur?
Blood supply interrupted within femoral head capsule
Common osteoporotic fracture places?
Spine - vertebral crush fracture
Forearm
Vitamin D metabolism
Vitamin D - hydroxylation - Liver and then kidneys - 1,25-dihydroxyvitamin D3
Allopurinal MOA
Allopurinal - Oxypurinol - Decreased xanthine oxidase activity - hypoxanthine and xanthine not converted to Uric acid
Immediate management of fracture
Realign
Stabilise
Analgesia
Orthopaedic opinion
Priority assessment in fractures
Vascular supply to distal areas
Need for surgical intervention
Open or closed
Physeal fracture classification
Salter Harris
Salter Harris classification
SALTER
Straight Across
Above
Lower
Two/Through
Erasure of growth plate
Fibula fractures classification
Weber A- below the syndesmosis (Stable)
Weber B- At the level of syndesmosis (variable stability)
Weber C- above syndesmosis always unstable requiring ORIF
Loss of sensation in arm - patchy - loss of brachial reflex etc
Cervical rediculopathy
Cervical crush fracture
RSI
Previous humeral head fracture
Anaemia found in SLE
Normocytic and normochromic
Renal impairment in Lupus - Findings and name
Lupus nephritis
Reduced eGFR
Proteinuria
Blood
Red cell casts
Histological cause for Lupus nephritis
Membranoproliferative glomerulonephritis
Advantages of a box splint
Realignment
Pain reduction
Protects vasculature
Explain mechanism of compartment syndrome
Due to bleeding and local swelling there is microvascular and venous congestion, this leads to tissue hypoxia, cell death and more protein release, cause more fluid to extravasate further increasing compartmental pressure and it continues in a cycle.
Bones where fractures include significant risk of avascular necrosis
scaphoid bone, the femoral head, the humeral head and the talus, navicular and fifth metatarsal in the foot
Principles of fracture management
Mechanical Alignment
Relative stability
Mechanical Alignment methods
Closed reduction via manipulation of the limb
Open reduction via surgery
Relative stability methods
External casts (e.g., plaster cast)
K wires
Intramedullary wires
Intramedullary nails
Screws
Plate and screws
Early fracture complications
Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
Haemorrhage leading to shock and potentially death
Compartment syndrome
Fat embolism (see below)
Venous thromboembolism (DVTs and PEs) due to immobility
Late fracture complications
Delayed union (slow healing)
Malunion (misaligned healing)
Non-union (failure to heal)
Avascular necrosis (death of the bone)
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of the soft tissues)
Arthritis
Chronic pain
Complex regional pain syndrome
Fat embolism criteria
Gurd’s major and minor criteria
Signs of bulimia
Russel sign - Callous on back of hands
Parotid enlargement
Poor dental Hygiene
Electrolyte imbalance on Bulimia
Hypokalaemia
Symptoms of hypokalaemia
Weakness
Muscle pain
Constipation
Paralysis of limbs/GI muscles/ Resp Muscles
Tetany
Therapies for Bulimia
Counselling
Cognitive herapy
Behavioural therapy
Fluoxetine
Support group
Psychodynamic therapy
Staining test result for TB
Acid Fast Bacilli
Peripheral neuropathy TB drug
Isoniazid
Brain lobe affected in psychosis, and neurotransmitter
Dopamine
Temporal lobe - amygdala sits there
Opiate withdrawal neurotransmitter
GABA
Opiate withdrawal symptoms
nausea, vomiting, muscle aches, sweating, yawning, lacrimation, runny nose, anxiety, dilated pupils, blurred vision, tachycardia, HTN, goosebumps.
Cramps
GI disturbance
Galactorrhoea after antipsychotic - mechanism
Reduced dopamine means prolactin is less opposed
Post partum depression scale
Edinburgh post Natal Depression scale
PHQ9 function
Monitors depression severity
HAD9 function
Hospital anxiety and depression scale
Paracetamol overdose managent
Activated Charcoal is <1 hour
Gastric Lavage if <4 hour
NAC 150mg/kg in 200 ml 5% dex over 1 hr IV, if 4 hours after ingestion
Give NAC without delay if staggered dose or >15 hours since ingestion
Rash after NAC? Chlorphenamine
delusions seen in Paranoid schizophrenia
Persecutory delusions, paranoid delusions, delusions of reference
Delusions seen in depressive psychosis
nihilistic-Cotard syndrome, hyperchondriasis. Delusion of poverty
First rank symptoms of Schizophrenia
auditory hallucinations, thought broadcast, thought insertion, thought withdrawal and delusional perception
Term given for stiffness after antipsychotic
Acute Dystonia
Dystonia treatment
Procyclidine
Tests before Lithium presciption
ECG, TFTs, U&Es, GFR, pregnancy test
Symptoms of lithiu toxicity
dizziness, nystagmus, coarse tremor, ataxia, hyperrflexia, confusion, slurred speech
Lithium toxicity management
stop lithium, fluid therapy, normalise UO. Dialysis if severe.
Lithium CI
renal disease, heart disease, thyroid disease, Addison’s.
Features of OCD
Recognised as patient’s own thoughts, acts are repeated, acts are not inherently enjoyable
Treatment for OCD
CBT, exposure therapy
Definition of Wernicke’s
Ataxia, ophthalmoplegia, confusion (due to B1 defiency)
Definition of korsakoff’s
Amnesia, confabulation
Definition of Delirium tremens
Seizures due to acute alcohol withdrawal, peaks at 72 hours, tremor seizures, hallucinations.
Parkinsons disease pathology
Loss of dopaminergic neurons in the substantia nigra, with lewy body inclusions
Upper limb symptoms of PD
Resting tremor, cog-wheel rigidity, pill-rolling tremor
Treatments for PD
Co-careldopa, pramipexole
Drugs CI in pD
Metoclopramide, haloperidol
What does disulfiram act on?
Acetaldehyde Dehydrogenase
Neuroleptic Malignant Syndrome presentation
Recent antipsychotic medication
Over the course of hours develops sweats, disorientation, temperature
Treat with Dantrolene
Serotonin syndrome presentation
Hyperreflexia, sudden onset, temperature etc - treat with benzo
SSRI mechanism
Blockade of the re-uptake of serotonin (5-HT), Downregulate the number of 5-HT receptors, Pre-frontal cortex
TCA overdose features
Tachcardyia; Dilated pupils; Enlarged bladder
Three drugs and drug classes for depression
Ssris – citalopram
SNRIs – venlafaxine
MOAB inhibitors - seligiline
Symptoms of mania
Grandiose delusions, excessive spending, loss of inhibitions, decreased need for sleep, start multiple projects, high energy, reckless behaviour
Li side effects in normal limits
Nausea, weight gain, acne, hypothyroid, fine tremor
Li side effects outside normal limits
Coarse tremor, dizziness, seizures, ataxia, slurred speech, confusion, hyperreflexia
Peak timings for alcohol withdrawal symptoms
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
Short synactin test role
Tests ability of adrenal cortex to produce cortisol in response to ACTH (<200 is adrenal insufficiency)
Incremental rise - level over 600 by 30 min
MS eye nerve affected
Optic nerve
MS eye symptoms
Pain, worse with eye movement, red desaturation
(classic triad of reduced vision, eye pain on movement and impaired colour vision)
MS pupil signs
decreased pupillary light reaction in affected eye- RAPD or Marcus gunn pupil
MS Fundus signs
Swollen optic disc, disc pallor
MS Episode treatments
Methylprednisolone
Beta interferon with glatiramer acetate or Fingolimod for further episodes
Lymph node affected in quinsey
Jugulodigastric lymph nodes
Most common visual field defect in macula degeneration
Central scotoma
Microbial causes of sore throat
Group a B-haemolytic strep (strep pyogenes), strep pneumoniae, staph aureus
Ebstein Barr Virus
Muscles controlling hearing
Tensor tympani and stapedius
Ramsey Hunt syndrome - causative organism
Varicella Zoster virus. Within the dorsal root ganglion cells of the facial nerve
Retinal detachment - examinations and their signs
B-Scan (ultrasound)= bright reflective layers is the retina detached from eye wall
slip lamp examination=schafters sign, pigmented particles in anterior compartment, Bullous separation of the retina
Ocular coherence tomography= photoreceptor layers separated from RPE (retinal pigmented epithelia )
Signs of anterior uveitis
Cell and Flare (turbidity in aqueous humour), Keratic Precipitates, Hypopyon
Anterior uveitis treatment
Steroid eye drop – Prednisolone or Dexamethasone
Mydriatic eye drop (draws iris away from lens by dilating) Phenylephrine, Atropine
(helps with pain)
Anterior uveitis causative organism
Herpes Simplex
Artery in amurosis fugax
Central retinal artery
Cause of amurosis fugax
Thromboembolus of central retinal artery
Viral conjunctivitis symptoms
Gritty sensation, watery discharge, sticky in morning, swollen eyelids
Viral conjunctivitis signs
Preauricular lymph node enlargement, serous fluid weeping from eye
Intersusception Mx
Air insufflation
Theophylline drug type/uses
phosphodiesterase inhibiting drug
The main actions of theophylline involve:
relaxing bronchial smooth muscle
increasing heart muscle contractility and efficiency (positive inotrope)
increasing heart rate (positive chronotropic)[4]
increasing blood pressure
increasing renal blood flow
anti-inflammatory effects
central nervous system stimulatory effect mainly on the medullary respiratory centre
Also counters adenosine
severe end of a spectrum of skin disorders
Toxic epidermal necrosis, SJS, erythema multiforme
Threadworm Tx
Mebendazole
Features of Pellagra (Vitamin B3 Deficiency)
4 Ds
Diarrhoea
Dermatitis
Dementia
Death
Causes of Pellagra
Niacin deficiency
Isoniazid
Rosacea treatment
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline
Causes of COPD Bacterial exacerbations
H.Influenzae, Pneumococcus
Ipratropium Bromide mechanism
Anti-cholinergic
Legionella pneumophila treatment
Erythromicin, clarithromycin, doxycycline and rifampicin
Septic shock parameters
Hypotension (systolic < 90mmhg, mean arterial pressure (MAP) <65mmhg), despite resuscitation, with evidence of tissue hypoperfusion.
Tachycardic (HR>90bpm)
Oliguria (<400 mL/day or 15mL/h)
Prolonged capillary refill (>2seconds)
Tachypnoea (>20 cycles/min)
Raised blood lactate
CURB-65 score results
0 or 1 - Outpatient care
2 Inpatient/observation admission
=/>3 Inpatient admission
4 or 5 - consider ICU
Legionella pneumophila test
Urine antigen test
Obstructive spirometry result
Reduced FEV1/FVC<0.7
Asthma acute exacerbation treatment
O2 15L/min and sit up
Salbutamol 5mg NEB +/- Ipratropium 500 mcg and prednisolone 40mg/Hydrocortisone 200mg
Give NEB as O2 driven
Questions to assess Asthma control
In the last 4 weeks has your asthma caused nocturnal waking?
In the last 4 weeks has your asthma caused you to get less done than usual/interfered with ADLs?
In the last 4 weeks how many times have you used your blue inhaler?
In the last 4 weeks how often have you had shortness of breath/symptoms of asthma?
CAP Abx
Co-amoxiclav and clarithromycin
Klebsiella pneumoniae tratment
Cefotaxime
Angina prevention meds and mechanism
Beta blockers: bisoprolol 🡪 reduce force and rate of contraction 🡪 less O2 needed by heart myoctes.
CCBs 🡪 relax coronary arteries 🡪 increased blood flow to heart muscle.
Classes of anti-arrythmic drugs:
1 = Na channel blockers: lidocaine, procainamide 2 = beta blockers: propranolol, metopralol 3 = K channel blockers: amiodarone, dronedarone, ibutilide 4 = Ca channel blockers: verapamil, diltiazem
Peripheral vascular disease drug
naftidrofuryl oxalate
State the ECG features that would raise your suspicion of left ventricular hypertrophy.
R wave in V5 or V6 of over 25mm, S wave in V1 or V2 of over 25 mm, Sum of S wave in V1 plus R wave in V6 of over 35mm
STEMI criteria
clinical symptoms consistent with ACS (generally of ≥ 20 minutes duration) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of:
2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years
1.5 mm ST elevation in V2-3 in women
1 mm ST elevation in other leads
new LBBB (LBBB should be considered new unless there is evidence otherwise)
STEMI management algorithm
NSTEMI/ Unstable angina algorithm
Glycoprotein IIb/IIIa inhibitors
abciximab (abcixifiban) (ReoPro)
eptifibatide (Integrilin)
tirofiban (Aggrastat)
Glycoprotein IIb/IIIa inhibitors are frequently used during percutaneous coronary intervention
First line drug for ocular myasthenia gravis?
Pyridostigmine
Cushing’s triad
widening pulse pressure
bradycardia
irregular breathing
May happen with high ICP
histopathological of PD
lewy body inclusions, death of dopaminergic cells in substantia nigra
CT result in PD
atrophy of substantia nigra/usually normal
Motor neurone disease LMN signs (lower limb)
Hyporeflexia, flaccid weakness, fasciculations, wasting, Hypotonia (maybe – depends who you ask whether it’s a valid sign or not)
Motor neurone disease UMN signs (lower limb)
Upgoing plantars, hypertonia, clonus, hyperreflexia, spastic weakness, spastic gait
Pseudobulbar palsy vs bulbar palsy
A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII. A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII.
Pseudobulbar palsy symx
Facial muscle weakness, emotional lability, dysarthria (slowed or slurred speech), dysphagia (difficulty swallowing), dysphonia (vocal cord muscle spasms) and progressive immobility of the tongue
Bulbar palsy symx
difficulty swallowing and a lack of a gag reflex to inability to articulate words and excessive drooling. Bulbar palsy is most commonly caused by a brainstem stroke or tumor.
MS eye symptoms
Pain on eye movement, red desaturation, RAPD, central scotoma, retrobulbar pain
Further episodes of MS prevention
beta interferon/Glatiramir Acetate/ fingolimod
three cardinal signs of Parkinson’s
Rest tremor, bradykinesia, rigidity and loss of postural reflexes
PD drug associated with personality/behavioural changes`
Bromocriptine - dopamine agonist
non-infective causes of meningism
SLE, Behcets, malignancy, sarcoidosis, drugs-NSAIDS, Trimethoprim, Chemical meningitis
neurofibrillary tangles in Alzheimer’s
Aggregates of TAU proteins within cells within the cerebral cortex
Alzheimer’s disease drug
Donepezil, tacrine, rivastigmine, galantamine = Acetylcholinesterase inhibitors
memantine NMDA receptor antagonist
Meningitis drug given in primary care
Benzylpenicillin
Intravenous (or intramuscular)
Specific organism in bacterial meningitis
Group B Neisseria meningitidis (meningococcus)
Meninigitis types prevented by vaccines
Haemophilus influenzaeB (HiB)
Meningitis C (Men C)
Parkinsons drugs examples
Dopamine Replacement – levodopa
Dopamine agonist – pramipexol
MOA-B inhibitor – resigiline
Define epileptic seizure
Paroxysmal event with behavioural, sensation, cognition changes due to excessive hypersynchronous neuronal changes
4 symptoms with aura of temporal seizure
Dejavu, jamais vu, receptive dysphasia, automatisms(lip smacking), taste or smell hallucinations
Features of brainstem death
- fixed unresponsive pupils
- no corneal reflex
- no cough or gag reflex
- no respiratory effort
- no response to supraorbital pressure
- absent oculovestibular reflexes
Dysphasia areas
receptive aphasia (Wernicke’s aphasia) Wernicke’s speech area, Wernicke’s area is located in the temporal lobe.
Broca’s aphasia, also called expressive aphasia, inferior frontal gyrus
Lower limb signs MS
Increased tone, extensor plantars, brisk reflexes, clonus, weakness
Third nerve palsy signs
Eye pointing down and out, pupil dilated
Kernig’s sign
pain when straightening knee with flexed hip, photophobia, papilloedema, nuchal ridigity
Which abx Meningitis
Cefotaxime
CSF viral vs bacterial
Bacterial - turbid, low glucose, high protein, neutrophils
Viral - clear, normal/low glucose, normal/high protein, lymphocytes
TIA IVx
Carotid doppler, ecg and bloods already done)
Temporal lobe seizure
HEAD - Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)
Frontal lobe Seizure
motor - Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Parietal lobe
Sensory - Paraesthesia
Occipital lobe
Visual - Floaters/flashes
poorly controlled coeliac disease develops itchy vesicles on his elbows and buttocks
Dermatitis herpetiformis
Erythema nodosum characteristic features:
symmetrical, erythematous, tender, nodules which heal without scarring
most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)
Pretibial myxoedema characteristic features:
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin
Pyoderma gangrenosum characteristic features:
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders
Necrobiosis lipoidica diabeticorum characteristic features:
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
Cranial nerve reflexes
Cholestasis pruritus Tx
cholestyramine
Primary biliary cholangitis
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
dry mouth is this patient is due to sicca syndrome
L3 nerve root compression
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
peri-orbital and nasolabial scaly rash associated dandruff is a classical history for:
seborrhoeic dermatitis.
General antifungals
For nails, consider terbinafine.
For yeast infections consider fluconazole.
For systemic fungal disease consider itraconazole.
Which organism is more common in patients who have recently had influenza?
Preceding influenza predisposes to Staphylococcus aureus pneumonia
URTI symptoms + amoxicillin → rash
Infectious mononucleosis glandular fever
Whooping cough antibiotic therapy?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
Adjuvant hormonal therapy for ER +ve breast cancer in post-menopausal women
anastrozole
The three criteria for aneurysm surgery are:
An asymptomatic aneurysm larger than 5.5 cm in diameter.
• An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
• A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.
AAA screening outcomes
suspected TIA should have?
A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately (and be referred for specialist review within 24h)
Alcohol withdrawal features/timing
symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
peak incidence of seizures at 36 hours
peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
Acute reactive arthritis first line
NSAIDs
Management
symptomatic: analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months
c.diff management
First episode of Clostridium difficile infection
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
Recurrent episode
recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode
within 12 weeks of symptom resolution: oral fidaxomicin
after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
Life-threatening Clostridium difficile infection
oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered
Myxoedemic coma is treated with?
Hydrocortisone and levothyroxine
Thyrotoxic storm is treated with
beta blockers, propylthiouracil and hydrocortisone
Intrahepatic cholestasis of pregnancy treatment
Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
Joint British Diabetes Societies (2013) Diagnostic criteria Diabetic ketoacidosis
Key points
glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick
Patients with ascites secondary to liver cirrhosis, therapy
aldosterone antagonist like Spironolactone
Human bites, like animal bites, should be treated with which abx?
Co-amoxiclav
DVT management
