Knowledge revision - Medicine Flashcards
Which investigation is essential after first seizure?
ECG
What are the first-line options for gen tonic-clonic epilepsy?
Lamotrigine, valproate (not if woman), carbamazepine
What are the first-line options for focal epilepsy?
Lamotrigine or carbamazepine
What are the first line options for absence seizures?
Valproate or ethosuximide
Which AEDs are enzyme inducers?
Phenytoin, carbamazepine and topiramate
Which methods of contraception can be used in women taking enzyme-inducing AEDs?
Mirena IUS/Copper IUD
Barrier methods
NO systemic hormonal contraception - reduced efficacy
Which common medications can lower seizure threshold?
Penicillins, quinolones, antipsychotics, chloroquines
Which clinical scoring system is used in ACS?
GRACE
Which scoring system is used in CAP?
CURB65
Which scoring system is used for VTE?
Wells’ score
Which scoring system is used to calculate the risk of stroke in AF?
CHADSVASC
Which scoring system is used to calculate the risk of stroke in AF?
CHADSVASC
Which scoring system is used to calculate bleeding risk in patients on anticoagulation?
HASBLED
Which scoring system is used in assessing severity of heart failure?
NYHA
Which scoring system predicts prognosis in chronic liver disease?
Child-Pugh score
Which scoring tool is used to predict risk of cardiovascular disease?
QRISK
Which scoring system is used to assess risk pre-endoscopy in UGIB?
Glasgow-Blatchford
Which scoring system is used to assess risk post-intervention in UGIB?
Rockall
What does CURB65 stand for?
Confusion
Urea > 7
RR > 30
BP < 90 / 60
> 65
What symptoms may be present in patients with CKD?
Itching, loss of appetite, oedema, nausea, fatigue
Which patients with CKD should be referred to a specialist?
o eGFR < 30 or ACR > 70
o Accelerated progression
o Unable to control BP despite 4 anti-hypertensives
What are the cornerstones of management of CKD?
Treat underlying causes
Optimise CVD risk - ACEI and primary prevention with atorvastatin
Treat complications eg. renal anaemia, bone disease etc
ESRD - dialsysis/transplant
What is the Hb target in CKD?
100-120
What does the renal diet include?
- Often fluid restriction
- Low salt
- Low potassium – no bananas, cooked greens/spinach, oranges
- Low phosphorous – greens/mushrooms, certain cereals, soft drinks like diet coke
When should patients with CKD start preparing for the possibility of requiring RRT?
eGFR < 30
Which patient group should not receive morphine?
reduced renal function
Which analgesics could you consider if pain persisting despite paracetamol?
Weak opioids eg. codeine, DHC, tramadal
What is the usual dose of codeine?
30-60mg every 4 hours if req
What is the usual dose of Morphine?
10mg up to 4-hourly initially
How do you convert from PO to SC Morphine?
Half the dose
How is heart failure managed?
o Refer to cardiology
o Advice re condition
o Medical treatments
ACEI & beta-blocker
Can add aldosterone antagonist
Loop diuretics if severe oedema
o Flu, COVID and pneumococcal vaccines
Which CXR findings are consistent with CCF?
A - Alveolar oedema (bat wings)
B - Kerley B lines (interstitial oedema)
C - Cardiomegaly
D - Dilated upper lobe vessels
E - Effusion (pleural)
What initial management can be started in DKA?
IV Fluids and 6 units/h Actrapid
What is the most sensitive marker of hepatocellular damage?
ALT
What fold increase in ALT suggests hepatocellular damage?
> 10
What fold increase in ALP suggests cholestasis?
> 3
Give causes of isolated hyperbilirubinaemia.
Gilbert’s syndrome/haemolysis
ALT > AST suggests…
Chronic LD
AST > ALT suggests…
Acute LD
What is the first-line treatment for stable angina?
PRN short-acting nitrate + beta-blocker and/or dihydropyridine CCB (Nifedipine, Amlodipine or Felodipine)
Give examples of antiemetics that could be prescribed
Cyclizine 50mg PO
Prochlorperazine buccal 3mg
