Medicine Flashcards
1
Q
Medication for metastatic hepatocellular cancer?
A
Sorafenib
2
Q
When is denosumab prescribed in cancer?
A
When 2 bisphosphonates have failed
3
Q
When is interferon-alpha used as a tx?
A
Hep B and C
Kaposi’s sarcoma
Metastatic renal cell cancer
Hairy cell leukaemia
4
Q
What is infliximab used for?
A
refractory and fistulating Crohn’s disease
5
Q
How is severity of UC flare graded?
A
mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
6
Q
Tx for mild to moderate proctitis?
A
Topical (rectal) aminosalicylate (mesalazine)
If remission is not achieved within 4 weeks + oral aminosalicylate
If remission still not achieved + topical or oral corticosteroid
7
Q
Tx for mild to moderate proctosigmoiditis or left-sided UC?
A
Topical (rectal) aminosalicylate
If remission is not achieved within 4 weeks, + high-dose oral aminosalicylate OR switch to high-dose oral aminosalicylate + topical corticosteroid
If remission still not achieved stop topical tx and offer oral aminosalicylate + oral corticosteroid
8
Q
Tx for mild to moderate extensive UC?
A
Topical (rectal) aminosalicylate + high-dose oral aminosalicylate:
If remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate + oral corticosteroid
9
Q
Tx for severe UC?
A
Admit
IV steroids
IV ciclosporin
10
Q
Maintenance tx for UC?
A
Oral/topical salicylates
If severe relapse/2+ exacerbations:
+ Azathioprine PO
+ Mercaptopurine PO
11
Q
Most common extra-colonic malignancy of HNPCC?
A
Endometrial
12
Q
Drugs known to induce TEN?
A
phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs
13
Q
What is a Curlings Ulcer?
A
Stress ulcers may occur in the duodenum of burns patients and are more common in children
14
Q
4 features of Horner’s syndrome?
A
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
15
Q
Causes of obstructive lung disease?
A
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
16
Q
Causes of restrictive lung disease?
A
Pulmonary fibrosis Asbestosis Sarcoidosis Acute respiratory distress syndrome Infant respiratory distress syndrome Kyphoscoliosis e.g. ankylosing spondylitis Neuromuscular disorders Severe obesity
17
Q
Tx for life-threatening Clostridium difficile infection?
A
ORAL vancomycin
IV metronidazole
18
Q
What is Conduction dysphasia?
Where is the defect?
A
speech fluent, but repetition poor. Comprehension is relatively intact supramarginal gyrus (parietal lobe)
19
Q
Why do patients with coeliac disease require regular immunisations?
A
functional hyposplenism
20
Q
Which organism most commonly causes peritonitis secondary to peritoneal dialysis?
A
Coagulase-negative Staphylococcus (Staphylococcus epidermidis)
21
Q
Indications for wide local excision of breast tumour?
A
Solitary lesion
Peripheral tumour
DCIS <4cm
Small lesion in large breast
22
Q
Indications for mastectomy?
A
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
23
Q
Tx for ascending cholangitis?
A
IV Abx (piptaz) ERCP after 24 - 48 hours
24
Q
Drugs to stop in AKI? (DAMN)
A
Diuretics
Aminoglycosides and ACE inhibitors
Metformin
NSAIDs
25
What tx for ascites?
Conservative: salt restrict
Medical: Spironolactone or amiloride +/- abx prophylaxis for SBP
Surgical: therapeutic abdominal paracentesis (if tense ascites)
TIPS in some cases
26
Light's criteria for transudate/exudate?
Only used if protein 25-35g/L
Protein >30g/L = exudate
Protein <30g/L = transudate
ALSO fluid is exudate if:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
27
What needs to be checked before starting terbinafine?
LFTs
28
Morphine conversions to know?
Weak Opioids are 10 TIMES WEAKER than Oral Morphine
Subcutanous Morphine is TWICE AS STRONG as Oral Morphine
Oral Morphine is TWICE AS STRONG as Oral Oxycodone (bnf uses 1.5)
Oral codeine is 10 TIMES WEAKER than Oral Morphine
PRN dose should be 1/6th dose of total daily dose
Morphine SUSTAINED release you should divide immediate release dose by 2
29
When to refer a burn to secondary care?
all deep dermal and full-thickness burns.
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury
30
What does the SAAG tell you in ascites?
If it is caused by portal HTN
| A raised SAAG (>11g/L) = portal hypertension
31
Causes of Budd Chiari syndrome?
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
COCP
32
How does myocarditis present?
ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness
33
What ix confirms C diff colitis?
Stool C diff Toxin
34
Causes of a normal anion gap or hyperchloraemic metabolic acidosis? ABCD
Addison's disease
Bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula, renal tubular acidosis, diuretics
Chloride: ammonium chloride injection, NaCl
Drugs: acetazolamide
35
Causes of a raised anion gap metabolic acidosis? MUDPILES
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
```
Methanol
Uraemia (in CKD)
Diabetic ketoacidosis
Paracetamol
Isoniazid/iron
Lactate
Ethylene glycol (antifreeze)
Salicylates
```
36
What QRISK score should tx be started?
10%
| Atorvastatin 10mg
37
What might cause a falsely low HbA1c?
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Blood donation
38
What might cause Higher-than-expected levels of HbA1c?
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
39
How much should once daily insulin be reduced the day before and on the day of surgery?
20%
40
Causes of drug induced cholestasis?
COCP
Abx: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine
41
Causes of erythema nodosum?
```
infection
- streptococci
- TB
- brucellosis
systemic disease
- sarcoidosis
- IBD
- Behcet's
malignancy/lymphoma
drugs
- penicillins
- sulphonamides
- COCP
pregnancy
```
42
SE of vincristine?
Peripheral neuropathy
43
SE of bleomycin?
Lung fibrosis
44
SE of doxorubicin?
Cardiomyopathy
45
Cause in young female patients who develop AKI after the initiation of an ACE inhibitor?
Fibromuscular dysplasia
46
Causes of secondary HTN?
```
ENDOCRINE
Cushing's
Conn's
Phaeo
Acromegaly
Hypothyroid
```
RENAL
Polycystic kidney disease
VASCULAR
Renal artery stenosis
Coarctation of aorta
47
Clinical signs of SVCO?
```
facial swelling and erythema
distended neck and chest wall veins (non-pulsatile)
arm swelling and distended arm veins
papilloedema (a late sign)
stridor (if severe)
cyanosis (less common)
```
48
Which antiemetic in opioid induced nausea?
Metoclopramide
49
Which antiemetic in chemo/radiotherapy induced nausea?
Ondansetron
50
What conditions are associated with osteosclerosis?
Prostate cancer mets
Sickle cell disease
Breast Ca mets
51
Initial tx for metastatic prostate Ca?
gonadotrophin-releasing hormones
52
When considering whether a patient should be referred for a chest x-ray, what do the NICE guidelines for the diagnosis of lung cancer define as the duration of a persistent cough/haemoptysis or other symptom?
>3 weeks
53
Causes of a cavitating lung lesion?
```
Cavitating pneumonia
Septic emboli (bacterial or fungal)
Wegener’s granulomatosis or pulmonary vasculitis
Pulmonary infarction
Infected bullae or cysts
Neoplasia: primary or secondary
```
54
1st line tx in prophylaxis of variceal bleeds?
Non-cardioselective beta-blockers
55
Duration of tx in autoimmune hepatitis?
At least 2 years after normalisation of LFTs
56
CIs to using loperamide?
Bloody stools
Fever
Abx associated colitis
57
Metabolic findings in tumour lysis syndrome?
Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
Hypocalcaemia
58
Indications for dialysis?
Uraemic encephalopathy
Refractory hyperkalaemia
Refractory metabolic acidosis
Pulmonary oedema with oliguria
59
1st line tx for patients with both hypertension and albuminuria?
ACEi
60
Most common cause of nephrotic syndrome in adults? What would you see on light microscopy and silver staining?
Membranous glomerulonephritis
Light microscopy: Thickened basement membrane
Silver staining: Sub-epithelial spikes
61
What should a recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with?
oral fidaxomicin
62
management of Crohn's patients who develop a perianal fistula?
Oral metronidazole
63
What verterbral levels do the coeliac trunk, SMA, IMA and ovarian/testicular arteries originate?
```
t12 = Coeliac trunk has 12 letters
L1 = SMA “S for Single”
L2 = testis/ovarian artery (we have two testis/ovaries)
L3 = IMA
```
64
What score is to assess risk of pressure sore?
Waterlow
65
What score is to assess risk of malnutrition?
MUST
66
Define malnutrition
BMI < 18.5
unintentional weight loss >10% within the last 3-6 months
BMI < 20 and unintentional weight loss > 5% within the last 3-6 months
67
Tx for achalasia?
Heller cardiomyotomy
68
Gene in FAP?
APC
69
Gene in HNPCC?
MSH2/MLH1
70
RFs for Focal segmental glomerulosclerosis?
```
idiopathic
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport's syndrome
sickle-cell
```
71
Cancers with raised platelets? LEGO-C
- Lung
- Endometrial
- Gastric
- Oesophageal
- Colorectal
72
What do we use to monitor tx in haemochromatosis and what is the characteristic iron study profile?
Ferritin and transferrin saturation (1st line)
| Would expect a raised transferrin saturation and ferritin, with low TIBC
73
Tx for haemochromatosis and aims?
Venesection
| transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
74
What do you see on xray in haemochromatosis?
Joint x-rays characteristically show chondrocalcinosis
75
Causes of cranial DI?
```
idiopathic
post head injury
pituitary surgery
craniopharyngiomas
histiocytosis X
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
haemochromatosis
```
76
Causes of nephrogenic DI?
genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes: hypercalcaemia, hypokalaemia
Drugs: lithium, demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis
77
most important HLA to match in renal transplantation?
HLA DR > B > A
78
When do NICE guidelines suggest referring to a nephrologist from primary care in CKD?
if eGFR falls below 30 or progressively by > 15 in a year
79
AKI Stage 1?
Increase in creatinine to 1.5-1.9 times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
80
AKI Stage 2?
Increase in creatinine to 2.0 to 2.9 times baseline, or
| Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
81
AKI Stage 3?
Increase in creatinine to ≥ 3.0 times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2
82
Causes of a raised TLCO (transfer capacity)
```
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
```
83
Causes of a lower TLCO
```
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
```
84
Some conditions may cause an increased KCO with a normal or reduced TLCO?
pneumonectomy/lobectomy
scoliosis/kyphosis
neuromuscular weakness
ankylosis of costovertebral joints e.g. ankylosing spondylitis
85
palliative pain relief in severe renal impairment?
egfr <10 = fentanyl/buprenorphine, 10-50 = oxycodone, >50 = morphine
86
What ix for PSC?
ERCP/MRCP (first line)
87
What does proteinuria on dipstick in context of aki mean?
Intrinsic renal injury
88
Anion gap formula?
Na+ K - (Bicarb + Cl)
89
Tx for proteinuria in CKD?
ACEi/ARB if they have an ACR > 30 mg/mmol
90
Acute interstitial nephritis presentation?
Fever and rash
Renal impairment
HTN
Urine dip: high white cells/eosinophilic casts
Bloods: raised serum creatinine and eosinophilia
91
Threshold for severe hypokalaemia for IV tx?
<2.5mmol/L
92
```
What disease gives this picture?
prolonged bleeding time
increased APTT
normal PT
normal platelet count
```
Von Willebrand
93
```
What disease gives this picture?
normal bleeding time
increased APTT
normal PT
normal platelet count
```
Haemophilia
94
Typical findings in type 2 renal tubular acidosis?
Hypokalaemia
| Osteomalacia
95
How to convert from oral morphine to diamorphine?
Total daily morphine DIVIDED by 3
96
What electrolyte abnormality does long term PPI tx cause?
Hypomagnesemia
97
the only recommended test for H. pylori post-eradication therapy?
Urea breath test
98
Why is nephrotic syndrome associated with hypercoagulability?
Loss of antithrombin III via kidneys
99
What does urine sodium > 40 mmol/L suggest?
ATN
100
Granulomatosis with polyangiitis features?
pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum)
101
SBP acute abx and prophylactic (ascites + protein<15) abx?
Acute: IV cefotaxime
Prophylactic: ciprofloxacin
102
Most common extra renal manifestation of ADPKD?
Liver cysts
103
Mx of severe alcoholic hepatitis?
Prednisolone
104
Why might you see hyaline casts in urine?
If a pt takes loop diuretics
105
causes of Rapidly progressive glomerulonephritis?
Goodpasture's syndrome
Wegener's granulomatosis
others: SLE, microscopic polyarteritis
106
causes of Exudative pleural effusion? (> 30g/L protein)
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler's syndrome
yellow nail syndrome
107
causes of transudative pleural effusion? (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs' syndrome
108
Which cancer leads to cannon ball mets in the lungs?
Renal cell carcinoma
109
Investigations of small bowel bacterial overgrowth syndrome?
Hydrogen breath test
Small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
Clinicians may sometimes give a course of antibiotics as a diagnostic trial
110
Risk factors for SBBOS?
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
111
Mx of SBBOS?
correction of underlying disorder
| antibiotic therapy: 1st line = rifaximin (Co-amoxiclav or metronidazole are also effective)
112
Causes of minimal change disease?
Idiopathic
Drugs: NSAIDs, rifampicin
Cancer: Hodgkin's lymphoma, thymoma
Infection: infectious mononucleosis
113
Urinary sodium and osmolality in pre-renal AKI?
Low urine sodium <20
| High urine osmolality
114
When do you see brown casts in urine?
Acute tubular necrosis
115
Urinary sodium and osmolality in ATN?
High urine sodium >40
| Low urine osmolality
116
Adenocarcinoma of the lung paraneoplastic syndromes?
Gynaecomastia
| Hypertrophic pulmonary osteoarthropathy
117
Causes of upper lobe pulmonary fibrosis?
```
C- Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
```
118
characteristic pleural fluid findings for glucose, amylase and blood staining?
low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
119
Ix for pleural effusion?
PA CXR
USS guided aspiration
Consider contrast CT
120
How do you know if it is cardiac pulmonary oedema?
pulmonary capillary wedge pressure raised
121
What does melanosis coli (pigment-laden macrophages) on colonoscopy histology suggest?
Laxative abuse
122
cholestatic jaundice, raised IgM and positive anti-mitochondrial M2 antibodies - dx?
PBC
123
1st and 2nd line tx in PBC?
```
Ursodeoxycholic acid (slows disease progression so give even if asymptomatic)
Obeticholic acid
```
124
When might liver transplant be considered in PBC?
If bilirubin >100
125
What is a Dieulafoy lesion?
abnormally large artery in the lining of the GI system - most common 6 cm from the O-G junction on the lesser curve of the stomach
126
What can aggressive fluid resus with NaCl cause?
hyperchloraemic metabolic acidosis
127
What sign may be seen on CT of pancreatic cancer?
Double duct sign
128
What is a patient's glucose requirement?
50-100 g/day irrespective of the patient's weight
129
What type of nephropathy is associated with cancer?
Membranous nephropathy
130
Tx of nephrogenic DI?
hydrochlorothiazide
131
Contraindications to lung cancer surgery?
SVC obstruction
FEV < 1.5
MALIGNANT pleural effusion
vocal cord paralysis
132
time taken for an arteriovenous fistula to develop?
6 to 8 weeks
133
Extra-renal features of ADPKD?
Hepatic cysts which manifest as hepatomegaly
Diverticulosis
Intracranial aneurysms
Ovarian cysts
134
Initial management of CKD-mineral bone disease?
Correct hyperphosphataemia first; start with dietary changes before starting a phosphate binder
135
Tx for Hiccups in palliative care?
chlorpromazine or haloperidol
136
6 tests to confirm brain death?
pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, and no spontaneous respiratory effort
137
Rhabdomyolysis value for it to cause AKI?
5x upper limit of normal
138
What to do if someone comes in with ascites with other symptoms e.g. fever/confusion etc and why?
Ascitic tap
| Rule out SBP
139
Tx of PE if recent bleeding history?
IV heparin (easier to reverse than SC)
140
When do we use IVC filter?
Recurrent PE
| PE despite anticoagulation
141
Rigler's triad for gallstone ileus?
Air in bile ducts
Gallstone visible outside gallbladder
Small bowel obstruction
142
How is liver cirrhosis screened for? What are the indications?
transient elastography (Fibroscan)
people with hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
people diagnosed with alcohol-related liver disease
143
How is hepatocellular carcinoma screened for? What are the indications?
Liver USS
patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
men with liver cirrhosis secondary to alcohol
144
Gold standard ix in achalasia? What would it show?
High resolution oesophageal manometry
- Elevated resting LOS pressure (>45 mmHg)
- Incomplete LOS relaxation
- Absence of peristalsis in smooth muscle portion of the oesophagus
145
what is carbohydrate-deficient transferrin used for?
very specific biomarker for heavy alcohol use
146
Indication for prophylactic abx in ascites and what would you give?
Oral ciprofloxacin
| Patients with cirrhosis + ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved
147
Grading of hepatic encephalopathy?
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma
148
Mx of CKD mineral bone disease?
reduced dietary intake of phosphate is the first-line management
phosphate binders: sevelamer
vitamin D: alfacalcidol, calcitriol
parathyroidectomy may be needed in some cases
149
Tx for allergic bronchopulmonary aspergillosis?
Oral Glucocorticoids
150
Indications for NIV?
COPD with respiratory acidosis pH 7.26-7.35, CO2 >6kpa
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
151
Criteria for dx of myeloma?
Monoclonal plasma cells in the bone marrow >10%
Monoclonal protein within the serum or the urine (as determined by electrophoresis)
Evidence of end-organ damage e.g. hypercalcaemia, elevated creatinine, anaemia or lytic bone lesions/fractures
152
What is PBC associated with?
Sjogren's
| Rheumatoid arthritis
153
Staging of sarcoid xray?
```
Stage 0: normal
Stage 1: bilateral hilar lymphadenopathy
Stage 2: bilateral hilar lymphadenopathy + lung involvement
Stage 3: lung involvement only
Stage 4: lung fibrosis
```
154
Tx in haemochromatosis?
1. Venesection
| 2. Desferrioxamine
155
Mesenteric ischaemia triad?
CVD, high lactate and soft but tender abdomen
156
Tx of Bile-acid malabsorption? Watery green diarrhoea after cholecystectomy?
Cholestyramine
157
What to do if dysplasia is found on biopsy in Barrett's oesophagus?
Endoscopic mucosal resection
158
Alcoholic ketoacidosis mx?
IV thiamine + 0.9% saline
159
What type of cancer does achalasia increase your risk of?
SCC of oesophagus
160
Investigation of choice for suspected perianal fistulae in patients with Crohn's?
MRI pelvis
161
2 scores for assessing risk in an upper GI bleed before endoscopy?
AIMS65 - risk of in-hospital mortality
| Glasgow-Blatchford - before a procedure to determine whether 'low-risk' patients need admission or not
162
What might sudden weight loss cause in patients with NASH?
An exacerbation - raised LFTs and bilirubin
163
Deficiencies in coeliac disease?
Iron
B12
Folate - big one
164
Gene in Wilson's?
| Findings on copper studies?
ATP7B gene on Chr13
Low serum copper
Low serum caeruloplasmin
increased 24hr urinary copper excretion
165
Mx of variceal bleed?
1. Terlipressin + IV Abx
2. Endoscopy: band ligation > sclerotherapy
3. Sengstaken-Blakemore if uncontrolled bleed
4. TIPSS
166
When to drain a pleural effusion in infection?
If diagnostic pleural fluid sampling shows:
Purulent/turbid fluid
Clear fluid with pH <7.2
167
Features of acute bronchitis?
```
cough: may or may not be productive
sore throat
rhinorrhoea
wheeze
No focal signs O/E
```
168
Tx of acute bronchitis?
Mainly conservative
Consider abx - doxycycline if:
systemically unwell
CRP >100 (consider delayed prescription if 20-100)
169
When to intubate in COPD?
When pH <7.25
170
Tx for type 2 resp failure in COPD?
controlled o2 therapy - 24% o2 [resp could be driven by hypoxic drive ie. resp centre insensitive to co2] Target spo2 88-92%
- recheck abg after 20 mins, if CO2 is lower or steady increase O2 to 28%
- if CO2 has risen >1.5kpa and patient is still hypoxic consider assisted ventilation or doxapram
- in rare case if this fails -> intubation
171
Who to start bisphosphonates in?
1. Anyone with a BMD 7.5mg for >3months)
172
Indications for surgery in bronchiectasis?
Localised disease
| Uncontrollable haemoptysis
173
Truelove and Whitt's criteria for severe UC flare?
```
Blood in stools and >6 stools per day AND
T - Temp > 37.8
R - Rate > 90
U - (Uh)naemia Hb < 105
E - ESR >30
```
174
Vit D supplement in end stage renal failure?
Alfacalcidol - doesn't require activation
175
Acceptable rise in creatinine/fall in GFR with ACEi?
decrease in eGFR of up to 25%
| rise in creatinine of up to 30% is acceptable
176
How to step down asthma tx?
aim for a reduction of 25-50% in the dose of inhaled corticosteroids
177
Diagnostic criteria for asthma?
Exhaled FeNO of >/= 40 parts per billion
Post-bronchodilator improvement in lung volume of 200 ml
Post-bronchodilator improvement in FEV1 of >/= 12%
Diurnal Peak Flow variability of >/= 20%
FEV1/FVC ratio <70%
178
Tx for hepatorenal syndrome?
Albumin + terlipressin
179
What needs to be co-administered when doing a a large volume paracentesis with an ascitic drain?
IV albumin
| Reduces paracentesis-induced circulatory dysfunction and mortality
180
definition of an Upper GI Bleed?
haemorrhage with an origin proximal to the ligament of Treitz
181
Tx for small bowel bacterial overgrowth syndrome?
Rifaximin
182
Relative contraindications for inserting a chest drain?
INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions
183
Indications for inserting a chest drain?
Pleural effusion
Pneumothorax not suitable for conservative management or aspiration
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
In some cases of penetrating chest wall injury in ventilated patients
184
When should tx with bisphosphonates be re-evaluated?
After 5 years of oral bisphosphonates
After 3 years for IV zoledronate
Repeat DEXA and FRAX
185
What platelet levels should be aimed for pre-op?
> 50×109/L for most patients
50-75×109/L if high risk of bleeding
>100×109/L if surgery at critical site
