General mix Flashcards
how to remember NMS
FALTER
- Fever
- Autonomic isntability
- Leucocytosis
- Tremor
- Elevated (CK)
- Rigor
Missing one pill (less than 72 hours since the last pill was taken): COCP
- Take the missed pill as soon as possible (even if this means taking two pills on the same day)
- No extra protection is required provided other pills before and after are taken correctly
Missing more than one pill (more than 72 hours since the last pill was taken):
COCP
- Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
- Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
Missing more than one pill (more than 72 hours since the last pill was taken):
COCP
- Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
- Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
May have to take emergency contraception (see below)
The best way to understand the rules is to consider that theoretically women will be protected if they perfectly take the pill in a cycle of 7 days on, 7 days off. This will prevent ovulation.
- If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex
- If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
- If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period.
Missed pills POP
A pill is classed as “missed” if it is:
- More than 3 hours late for a traditional POP (more than 26 hours after the last pill)
- More than 12 hours late for the desogestrel-POP (more than 36 hours after the last pill)
Action required, if needed:
1) take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
2) continue with rest of pack
3) extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
Under which age is a child not able to consent to sexual intercourse
A child under the age of 13 is always considered to be unable to consent for sexual intercourse.
drugs for ADHD in children
First line: Methylphenidate (ritalin)
Second line: Atomoxetine
Atomoxetine is another stimulant medication. It is recommended for ADHD refractory to Methylphenidate or in those who it is not appropriate due to risk factors or development of side effects. Development of facial tics is an indication to change medications
what to always give with steroids and long term use of NSAIDs
PPI
ECOG
0- normal functioning
II- slight reduced functioning
II- >50% of time up and about
III -> 50% of time in bed
IV - bedbound
v- dead
chemo man
Cisplatin: otoxocity and nephrotoxicity
Bleomycin: pulmonary fibrosis
Cyclophosphamide- haemorrhagic cystitis
Methotrexate: bone marrow suppression
Vincristine- peripheral neuropathy
Transtuzuman and Doxorubicin- cardiotoxicity
malignant melanoma usually treated with
Mohs surgery
Immunotherapy
PD-1/PD-L1 immune checkpoint example
e.g. Nivolumab, Pembrolizumab
Used in melanoma, lung, renal cancers
Monitoring lithium
- Lithium levels in first 12 hours
- After 1 week untill stable
- every 3 months
after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable
Every 6 months
- Thyroid function test
- Renal function tests
Patients should be issued with an :
- information booklet
- alert card
- record book
adverse effects of lithium
- nausea/vomiting, diarrhoea
- fine tremor
- nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
- thyroid enlargement, may lead to hypothyroidism
- ECG: T wave flattening/inversion
- weight gain
- idiopathic intracranial hypertension
- leucocytosis
- hyperparathyroidism and resultant hypercalcaemia
Lithium toxicity
Lithium toxicity generally occurs following concentrations > 1.5 mmol/L.
Toxicity may be precipitated by:
- dehydration
- renal failure
- drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
Features of toxicity
- coarse tremor (a fine tremor is seen in therapeutic levels)
- hyperreflexia
- acute confusion
- polyuria
- seizure
- coma
Management
- mild-moderate toxicity may respond to volume resuscitation with normal saline
- haemodialysis may be needed in severe toxicity
atypical antipsychotic monitoring
Adverse effects of clozapine
- agranulocytosis (1%), neutropaenia (3%)
- reduced seizure threshold - can induce seizures in up to 3% of patients
- constipation
- myocarditis: a baseline ECG should be taken before starting treatment
- hypersalivation
Dose adjustment of clozapine might be necessary if smoking is started or stopped during treatment.
Autism definition
pervasive developmental disorder characterised by impairment in social interaction, communication and repetitive, stereotyped behaviour
ADHD definition
is characterized by an early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development, and are present in more than one situation. Children may present with difficulties at school and at home
4 types of melanoma
Superficial spreading
Nodular melanoma
Lentigo maligna
Acral lentiginous (black people, think feet and nails)
A 3-day-old neonate born prematurely at 34 weeks’ gestation has been slow to wean off the ventilator since birth. On examination, she has been found to have a continuous heart murmur.
An echocardiogram has detected a patent ductus arteriosus. No other structural heart abnormalities have been found. A chest x-ray shows cardiomegaly and mildly congested lung fields.
What initial treatment should be started to manage this condition?
Emergency surgery
Indomethacin
Beta-blockers
Intravenous fluids
Prostaglandins
Indomethacin or ibuprofen is used in patent ductus arteriosus to promote duct closure
A mother presents with her baby to the GP for review. She asks for advice regarding her milestones and explains that her son was born was born prematurely at 32 weeks gestation.
With the premature age in mind, when should this baby begin to show a responsive social smile?
5 to 7 weeks
8 to 10 weeks
11 to 13 weeks
14 to 16 weeks
17 to 19 weeks
14-16 weeks
The corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks
The corrected age is taken into consideration when looking at milestones until the age of 2.
management of bed wetting
desmopressin last line
An 8-year-old boy is brought to the attention of a psychiatrist by his mother with complaints of difficulty concentrating at home and at school. He is reported by the teachers to be easily distracted which is adversely affecting his learning. He also shows repeated outbursts of anger and his mother thinks he has ‘too much energy’. The psychiatrist diagnoses him with attention-deficit hyperactivity disorder (ADHD) and starts him on methylphenidate (Ritalin).
Which of the following parameters must be monitored every 6 months in this patient?
Full blood count (FBC)
Urea and electrolytes (U+E)
Thyroid function test
Weight and height
Visual acuity
Methylphenidate - monitor weight and height every 6 months