GP 4th Year Flashcards
What side effect needs to be monitored with prolonged use of oral anti-fungals such as fluconizole and terbinafine?
LFTs
Name the medication used for resistant obesity and weight loss. Name the side effect caused by this drug.
Orlistat (oral)
Pale stools
What medications can be used to treat and prevent osteoporosis?
Bisphosphonates (ex. Alendronic acid)
Vitamin D
Side effect to be aware of in bisphosphonates?
Ex. Alendronic acid
Osteonecrosis of the Jaw
Dysphagia/Oesophagitis/GORD
Side effect to be aware of in bisphosphonates?
Ex. Alendronic acid
Osteonecrosis of the Jaw
Dysphagia/Oesophagitis/GORD
Missed pill rules:
If pills are missed in week 1: _____
If pills are missed in week 2: ____
If pills are missed in week 3: ____
Week 1 : Use emergency contraception if she had UPSI in pill free interval for 1 week
Week 2: no need for emergency contraception
Week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.
Ellaone works by inhibiting ovulation. It can be taken within ____ days of UPSI.
It is contraindicated in ____ and ____. Breast feeding must be avoided for one week after taking the medication.
5 days
Liver disease and asthma
It can also cause painful periods, mood swings and back pain.
If the patient vomits within 3 hours, she will need to see the doctor again as the pill will not have been absorbed.
Which scoring system can be used to measure back pain severity?
Keele Start Back
Ipratropium and Tiotropium Bromide are short and long acting _____, used in asthma and COPD.
Anti-Muscurinic
What are the causes of vomiting?
_____ crystals with _____ birefringence confirm gout and differentiate it from pseudogout, and the fluid should also be sent for gram stain and culture to rule out septic arthritis.
Needle-shaped monosodium urate
Negative
*Remember P for Postive birefringence and Pseudogout*
Gout is managed in terms of the acute attack, and then the ongoing management.
____, ____, ____, and ____ may all be used acutely, according to the patient’s co-morbidities. The NSAID indomethacin is traditionally used first-line. For patients with a high risk of gastro-intestinal side effects, past medical history of chronic kidney disease or heart failure, _____ may be used.
NSAIDs
colchicine
steroids
paracetamol
colchicine
In the management of Gout, Colchicine can give which side effect?
Diarrhoea (remember 60 yr old man w/ charlotte)
If intolerable to patients, intra articular administration of steroids may be considered.
Mnemonic for conservative management of MSK injuries?
PRICED
Protection
Rest
Ice
Compression
Elevation
Drugs (Ibuprofen etc)
Adhesive Capsulitis is associated with which other medical conditions?
Diabetes
Thyroid disease
*both risk factors for developing adhesive capsulitis*
____ test can be used to test for lateral epicondylitis (i.e Tennis Elbow)
Mill’s Test
Passive flexion of the thumb right across the palm is painful in de quervain’s tenosynovitis. This is called ____ test.
Finkelstein’s
In a patient with a low B12 and a high MCV which investigations need to be done next?
Anti-Intrinsic Factor antibodies (beware low sensitivity 50-60%)
or
Anti-Gastric parietal cell antibodies (low specificity)
Which cancers are predominantly asscoiated with a thrombocytosis?
Lung
Oesophageal and Gastric
Endometrial
Other causes of thrombocytosis :
- Haematological/Clonal thrombocytosis e.g. Primary/Essential Thrombocytosis
- Reactive/secondary thrombocytosis (infection/inflammation/trauma/non-haem malignancy)
What dermatological complication is associated with Coeliac disease?
Dematitis Herpetiformis (itchy blistery rash on legs)
Complications of coeliac disease:
Dermatitis Herpetiformis ( itchy blistering rash on legs)
Osteoporosis
GI Lymphoma
______ can be measured alongside copper to aid the diagnosis of Wilson’s disease.
Caeruloplasmin
Serum copper and caeruloplasmin levels are usually low in patients with Wilson’s disease, however caeruloplasmin may also be normal or elevated in these patients due to to the acute phase response.
As such serum caeruloplasmin alone has a low positive predictive value in patients undergoing evaluation for liver disease. Acute hepatitis in Wilson’s disease can increase caeruloplasmin into the normal range due to the acute phase response. An equivocal test should be followed by analysis of 24hr urine copper. The majority of Wilson’s disease patients are diagnosed between the ages of 5 and 35 years, although it has been diagnosed in younger patients and in those their 70s.
_____ genotype, USS and refer hepatologist (fibrosis scoring (FIB4)/fibroscan/liver biopsy) aids in the diagnosis of Haemochromatosis.
HFE
The gene HFE, which contains two missense mutations (C282Y and H63D) was recently identified in patients suffering from haemochromatosis.
- C282Y homozygous (80%)
- H63D (compound heterozygote C282Y/H63D 5%)
Haemochromatosis is an _____ condition.
Autosomal recessive
Causes of acute confusion?
Drugs (opiates/ anti-cholinergics/Dopaminergics)
Electrolyte (dehydration, glucose, calcium, sodium), Endocrine (thyroid, adrenal)
Lack of drugs (withdrawal- ETOH/Dx, uncontrolled pain)
Infection (chest, urine, skin, CNS, sepsis etc)
Reduced sensory input (visual/hearing impairment)
Intracranial (stroke, haemorrhage, SOL)
Urinary retention/constipation
M I
Mechanism of Action of common antibiotics
What is the dose and route of Adrenaline given to adults in anaphylaxis?
0.5mg (500mcg) IM
*0.5 ml in 1/1000*
What route is adrenaline given in Cardiac Arrest?
IV
Anaphylaxis is a type ___ hypersensitivity reaction.
Type 1
What are the 3 core features of an anaphylaxis presentation?
Skin changes: Angiooedema/ Urticaria/ Erythema
Respiratory compromise (often because of larygeal oedema - stridor - involve anaesthetists early)
Hypotension
*remember it’s a rapid onset and history may have allergen exposure*
What are the 3 Skin changes in Anaphylaxis?
Urticaria
Angioedema
Erythema
*NB - up to 20% of anaphylactic patients will not have skin changes*
3 main allergens that cause anaphylaxis?
Nuts
Insect stings (wasps>bees)
Drugs (antibiotics/anaesthetic agents - remember local anaesthetic)
Anaphylaxis Management?
ABCDE (Sats/Oxygen/Cannula etc.)
0.5mg IM Adrenaline (repeat after 5 mins if no improvement)
then
Fluid Challenge (500-1000ml of crystalloid/Hartmann’s - to raise blood pressure)
Chlorphenamine (antihistamine) IM or IV (slow infusion)
*steroids no longer recommended*
- Monitor patient in hospital for 24hrs as up to 20% of patients can have 2nd reaction (biphasic)
- Can measure Mast cell tryptase at baseline and 2hrs later for diagnosis
- Counsel patient on allergy advice and seriousness of situation and discharge with epipen (X2)
A helpful mnemonic for remembering the causes of microcytic anaemia is ____ .
TAILS
T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia
The ____ score is used to assess the severity of pancreatitis. It gives a numerical score based on how many of the key criteria are present and can be remmebered with the mnemonic ____.
The Glasgow score is used to assess the severity of pancreatitis. It gives a numerical score based on how many of the key criteria are present:
0 or 1 – mild pancreatitis
2 – moderate pancreatitis
3 or more – severe pancreatitis
The criteria for the Glasgow score can be remembered using the PANCREAS mnemonic (1 point for each answer):
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)
This patient scores 5 due to age, calcium, enzymes (ALT), albumin and glucose. This indicates severe pancreatitis.
Patients with acute pancreatitis can become very unwell rapidly. They require admission for supportive management. Moderate or severe cases should be considered for management in the high dependency unit (HDU) or intensive care unit (ICU).
Causes of Pancreatitis
I GET SMASHED
What is courvoisiers law?
Courvoisier’s law states that a palpable gallbladder along with painless jaundice is unlikely to be gallstones. The cause is likely to be cholangiocarcinoma or pancreatic cancer.
What is charcots triad?
Fever
RUQ pain
Jaundice
Be wary of allopurinol in impaired renal function as it can lead to an accumulation of allopurinol and its metabolites
leading to ______.
Agranulocytosis
Aplastic anaemia
Thrombocytopenia.
Acronyms for presenting Chest X-ray:
You must always start by noting the patient details and the time of the x-ray.
The acronym RIPE can be used for the film quality:
Rotation - evaluate the position of the clavicular heads relative to the spinous processes of the vertebrae, if they are not equidistant then there may be an element of rotation.
Inspiration - you can count the visible anterior rib shadows and this should be at least 6 for an adequately inspired film.
Projection & Position - this could be PA or AP projection for a chest x-ray, and could be erect or supine.
Exposure - the vertebrae should be visible behind the cardiac silhouette for adequate exposure.
The acronym ABCDE can be used for the film’s contents:
Airways - comment on the position, whether it is central or deviated laterally
Breathing Fields (lung markings) - look for lung markings all the way to the peripheries of the thorax, any pure black space is likely a pneumothorax.
Cardiac Silhouette - evaluate the heart size for cardiomegaly (>50% of thoracic diameter), and the clarity of the left and right heart borders
Diaphragm - evaluate the clarity of the diaphragmatic borders, their vertical positioning, their positioning relative to each other (right is slightly elevated compared to the left), and the costophrenic angles for the presence of fluid
Everything Else - evaluate the remaining visible structures including ribs, clavicles, retrocardiac region, and any other foreign objects such as pacemakers or surgical clips.
Make sure you finish with a summary and by reiterating the most striking abnormality.
