Gen Med Flashcards
Multiple myeloma features (CRABBI)
Calcium: hypercalcaemia
Renal: light chain deposition within the renal tubules
Anaemia
Bleeding
Bones (pain)
Infection
Falsely low HbA1C reading causes
Sickle cell anaemia
G6PD
Beta thalassemia
Falsely high HbA1C reading causes
Splenectomy, iron-deficiency anaemia, B12 deficiency and alcoholism
Eradication of h pylori test
Urea breath test
Lhermitte’s sign
Tingling of fingers when neck is flexed
Indicates disease near the dorsal column nuclei of the cervical cord
Treatment of broad complex tachycardia
IV amiodarone
Enzyme inducers (CRAP GPs)
CRAP GPs :*
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
Enzyme inhibitors
SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Torsades de pointes causes
Hypothermia
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Bacterial otitis media most common cause
H. Influenzae
Dermatomyositis cause
Malignancy
What artery is affected in amarousis fugax
Opthalmic/retinal artery
Management of HF
1st line: ACEi/BB(Bisoprolol, Carvedilol)
2nd line Aldosterone antagonist(Spironolactone, Eplerenone), reduced EF= SGLT-2 inhibitor
3rd line: involve a specialist for
-Ivabradine(SR, HR>75+ EF<35%)
-Sacubitril-valsartan( EF <35%+ Symptoms despite ACEi/ARB)
-Digoxin( if coexistent AF)
- Hydralazine+Nitrate( in Afro-Caribbean)
-Cardiac resynchronization therapy( Widened QRS e.g. LBBB)
Trigeminal neuralgia management
Carbamezapine
Management of acute seizures
Buccal midazolam
Rectal diazepam
Cushing reflex
Bradycardia and hypertension with a wide pulse pressure
Bell’s palsy management
Oral steroids within 72hrs of onset
Posterior stroke signs
5Ds: dizziness, diplopia, dysarthria, dysphagia, dystaxia
Ulcerative colitis management
Mild/moderate
Proctitis: topical (rectal) aminosalicylate
proctosigmoiditis and left-sided ulcerative colitis: topical aminosalicylate -4 wks later-> add a high-dose oral aminosalicylate OR switch to a high-dose oral aminosalicylate and a topical corticosteroid —> oral aminosalicylate and an oral corticosteroid
Extensive disease: topical (rectal) aminosalicylate and a high-dose oral aminosalicylate
ACS take home meds
STAAB
Statin
Ticagrelor (or Clopidogrel)
Aspirin
ACEi
Beta blocker
Long term prophylaxis of cluster headaches
verpamil
Fundoscopy signs of acut angle closure glaucoma
- Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
- Optic disc pallor - indicating optic atrophy
- Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
- Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
RA vs OA XR findings
OA (LOSS): Loss of joint space, Osteophytes, Subchondral cysts, Sclerosis
RA (LESS): Loss of joint space, Erosions, Subluxation, Extra-articular
Ostroporosis
Complications of MIs
1st 48 hours: Pericarditis
1-2wks: L ventricular free wall rupture (acute heart failure secondary to cardiac tamponade), VSD (acute heart failure associated with a pan-systolic murmur)
2-6wks: Dressler’s syndrome: fever, pain, pericardial effusion, raised ESR
Anti-platelets advice for ACS and PCI
Aspirin (lifelong) & ticagrelor (12 months)
Generalized tonic-clonic management
males: sodium valproate
females: lamotrigine or levetiracetam
Focal seizures management
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
Absence seizures management
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
Myoclonic seizures management
males: sodium valproate
females: levetiracetam
Tonic or atonic seizures management
males: sodium valproate
females: lamotrigine
Features of anti-phospholipid syndrome
Clots - veno/ arterial thrombus
L - livido reticularis
O - obstetric miscarriage
T - thrombocytopenia
Conditions that precipitate lithium toxicity
Hypomagnesaemia
Hypercalcaemia
Hypernatraemia
Hypokalaemia
Scleritis vs episcleritis
Scleritis is painful
Episcleritis is Pain free
Inferio-posterior infarct complications
Acute mitral regurg (acute hypotension and pulmonary oedema)
AV block
Most common cause of death following an MI
V fib
Anti-emetic for intracranial causes of N+V
Cyclizine -> dex
UC vs Crohn’s
UC: ileocaecal valve -> rectum continuous disease, no inflammation past submucosa, crypt abscesses, bloody diarrhoea, uveitis, CR cancer, Primary sclorsing cholangitis, pseudopolyps, LLQ tenderness
Crohn’s: Episcleritis, weight loss, mouth -> anus skip lesions, indlammation of all cells, goblet cells, bowel obstruction, non-bloody diarrhoea
Addison’s + vomiting
Im hydrocortisone until vomiting stops
Lacunar stroke site
Basal ganglia, thalamus, internal capsule
Good prognosis in RA
RF -ve
1st line treatment of Lyme’s disease
21 day course of doxycycline
Acute haemolytic reaction sx
Fever, abdo pain and hypotension post transfusion
Fever, abdo pain and hypotension post transfusion
Acute haemolytic reaction sx
Murmur man
Draw murmur man
Pre-endoscopy variceal haemorrhage meds
Terlipressin and Abx
Angina management
ABCD
Aspirin+GTN
Beta-blockers + Ca channel blocker (amlodipine)
Ca channel blocker mono= Verapamil/diltiazem
Nicorandil
Prophylaxis for contacts of patients with meningococcal meningitis
Oral cipro or rifampicin
Most likely cause of death in CK on haemodialysis
IHD
IgA nephropathy vs minimal change disease
Minimal change disease: nephrotic syndrome
IgA nephropathy: nephritic syndrome
Management of minimal change disease
Oral corticosteroids
Renal transplant increases the risk of which cancers
SCC, cervical cancer, lymphoma
Discharge advice post-penuothorax
No sea diving for life
Stop smoking
No flying until 1 week post check x-ray
Antii-CCP
RA
ANCA
Vasculitides
Anti-Jo1
Poly/Dermatomyositis
Anti-dsDNA
ANA
SLE
AntiRo/Anti-LA
Sjorgen’s
Treatment for wilson’s
Penicillamine
Monitoring tests for haemochormatosis
Ferritin and transferrin
Causes of raised prolactin
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
EGFR variables
CAGE
Creatinine
Age
Gender
Ethncity
AF electrical cardioversion, when to do
Haemodynamically unstable
Elective
Elective cardioversion, onset <48 hrs ago
Rhythm OR rate control
Rate control (Beta blockers or Ca channel blockers)
Heparinize + rhythm control
Anticoag in AF if onset <48 hrs, post cardioversion
No anti coag if no risk of stroke (CHADVASC)
Elective cardioversion, onset >48hrs ago
Anticoag for 3/52 OR TOE to exclude thrombus -> cardiovert immediately
Heparinize + cardiovert (electrical preferred_
Anticoag post electical cardioversion for 4 wks, then rv
AF pharmacological vcardioversion options
Amiodarone if structural heart disease
Flecainide if no structural heart disease
What medication should be avoided in HOCM
ACE i
Tumour lysis syndrome electrolytes
Hyperkalaemia
Hyperphosphatemia
Hypocalcaemia
Prophylaxis for TLS
allopurinol /rasburicase
Hodgkin’s lymphoma signs of poor prognosis
B symptoms
Increasing age
Male sex
IV disease
Lymphocyte depleted subtype
Sickle cell crises
Big spleen - mostly always sequestration crisis
Limb pain - mostly haemolytic/ischaemic/vaso-occlusive crisis
Hip pain - haemolytic/ischaemic/vaso-occlusive crisis (plus possible avascular necrosis head of femur)
Parvovirus infection should result in an aplastic anaemia (with pancytopenia of all cell lines)
How soon can you re-administer adrenaline in anaphylaxis
5 minutes
Cushing’s triad
Bradycardia
Irregular breathing
Hypertension + widening pulse pressure
Migraine acute management
triptain+NSAID/triptan+paracetamol
Causes of digoxin toxicity
Low: hypoK, hypoMg, hypoalbumin? Hypothermia/thyroidism
Potassium: drugs that cause hypoK (thiazides/loop diuretics)
Can: hyperCa, acidosis, hyperNa
Hurt/Heart: common heart drugs: amiodatone, diltiazem, verapamil, spiro
Causes of psoriasis exacerbation
BLANQ
Beta blockers
Lithium
NSAIDs
ACEi
Quinine
Infliximab
Short QT interval causes
Hypercalcaemia
Hyperkalaemia
Psoriasis management
Potent steroid + vitamin D analogue
BD vit D analogue
Potent steroid OR coal tar
Psoriasis management
Potent steroid + vitamin D analogue
BD vit D analogue
Potent steroid OR coal tar
Allergic reactions types
ACID
Anaphylaxis
Cell mediated
Immune complex
Delayed
Anti emetics in raised intracranial pressure
Cyclizine
Dex
Why are irradiated blood products used
Depleted T-cell lymphocytes to avoid transfusion associated host vs graft disease
Goodpasture’s syndrome triad
Diffuse pulmonary haemorrhage, glomerulonephtitud and anti GBM antibodies
Autosomal recessive vs dominant
Dominant is structural, except Gilbert’s, hyperlipideamia
Recessive is enzyme/metabolic related, except ataxias
Anorexia features
All low
Gs and Cs are raised: GH, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Wernicke’s encephalopathy
COAT
Confusion
Oculomotor dysfunction
Ataxia
Thiamine treatment
Korsokoff’s syndrome
CART (cart them off it’s incurable)
Confabulation
Anterograde and
Retrograde amnesia
Temperament altered
HHT 4 main diagnostic criteria
Epistaxis
Telangectasia
Visceral lesions
FHx
When to refer to specialist for molluscum contagiosum
patients with HIV
Eyelid margins or ocular region lesions
Adverse effects of adenosine
Chest pain
FLushing
Who to avoid adenosine in and why
Asthmatics -> bronchospasm
Witnessed cardiac arrest on monitor
3 successive shocks followed by CPR
Draw ALS algorithm
ALS
What can make clopidogrel less effective
Omeprazole
Hypokalaemia ECG
in hypok U have no Pot and no T, Long PR and long QTH
Hypothermia ECG
Brr Just Freeze Little Atriums
Bradycardia
J waves (hump at end of QRS)
First degree HB
Long QT
Arrthmias
Acute HF with shock management
Ionotropes
Vasopressors
mechanical circulatory assistance
Hypercalcaemia ECG
Short QTs love milk
HTN flowchart
HTN
ECHO findings of HOCM
MR SAM ASH
Mitral regurg
Systolic ant motion
Asymmetric hypertrophy
HOCM ECG
BIG QRS, Small Q, Twisted ST
HOCM management
ABCD
Amiodarone
Beta blockers
Cardioverted defib
Dual chamber pacemaker
HOCM drugs to avoid
ACEis, Nitrates, ionotropes
Valve affected in Infective endocarditis
mitral valve
Valve affected in Infective endocarditis in IVDU
tricuspid valve
Bradycardia management
IV Atropine 500 mcg (can have up to 3mg)
Trancutaneous pacing
isoprenaline/adrenaline infusion titrated to response
Transvenous pacing
Acromegaly testing
IGF1 first -> OGTT to confirm if levels raised
Management of acromegaly
Octreotide
Addison’s features
ADRENALS
Aldosterone deficiency
Dark skin
Refractory hypotension
Electrolyte imbalance (Hyponatraemia, hyperkalaemia)
No energy
Appetite loss
Low sodium
Shock risk
Addison’s investigation
Short synchathen test
Cushing’s syndrome
Excess steroid production
Hyperaldosteronism
Hypokalaemic metabolic acidosis
Management of cardiogenic shock post MI
inotropes or an intra-aortic balloon pump
Arrythmia associated with inferior MI
AV node block
Left ventricular rupture post MI
Ischemic damage weakens the myocardium, leading to aneurysm formation, persistent ST elevation, and risk of thrombus formation.
Min amount of time to observe anaphylaxis for
6 hours
Weber’s stroke
Midbrain stroke, ipsilateral CN III palsy and contralateral hemiparesis
Lateral medullary strokr
Wallenburg (ice-burg): loss of temp and facial paralysis
What can precipitate wernicke’s encephalopathy in thiamine deficiency
Glucose infusion
Cryoprecipitate ingredients
Fibrinogen
VWF
13, 8
