Medicine Flashcards
Medication for metastatic hepatocellular cancer?
Sorafenib
When is denosumab prescribed in cancer?
When 2 bisphosphonates have failed
When is interferon-alpha used as a tx?
Hep B and C
Kaposi’s sarcoma
Metastatic renal cell cancer
Hairy cell leukaemia
What is infliximab used for?
refractory and fistulating Crohn’s disease
How is severity of UC flare graded?
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)
Tx for mild to moderate proctitis?
Topical (rectal) aminosalicylate (mesalazine)
If remission is not achieved within 4 weeks + oral aminosalicylate
If remission still not achieved + topical or oral corticosteroid
Tx for mild to moderate proctosigmoiditis or left-sided UC?
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
Tx for mild to moderate extensive UC?
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
Tx for severe UC?
Admit
IV steroids
IV ciclosporin
Maintenance tx for UC?
Oral/topical salicylates
If severe relapse/2+ exacerbations:
+ Azathioprine PO
+ Mercaptopurine PO
Most common extra-colonic malignancy of HNPCC?
Endometrial
Drugs known to induce TEN?
phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs
What is a Curlings Ulcer?
Stress ulcers may occur in the duodenum of burns patients and are more common in children
4 features of Horner’s syndrome?
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
Causes of obstructive lung disease?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
Causes of restrictive lung disease?
Pulmonary fibrosis Asbestosis Sarcoidosis Acute respiratory distress syndrome Infant respiratory distress syndrome Kyphoscoliosis e.g. ankylosing spondylitis Neuromuscular disorders Severe obesity
Tx for life-threatening Clostridium difficile infection?
ORAL vancomycin
IV metronidazole
What is Conduction dysphasia?
Where is the defect?
speech fluent, but repetition poor. Comprehension is relatively intact supramarginal gyrus (parietal lobe)
Why do patients with coeliac disease require regular immunisations?
functional hyposplenism
Which organism most commonly causes peritonitis secondary to peritoneal dialysis?
Coagulase-negative Staphylococcus (Staphylococcus epidermidis)
Indications for wide local excision of breast tumour?
Solitary lesion
Peripheral tumour
DCIS <4cm
Small lesion in large breast
Indications for mastectomy?
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
Tx for ascending cholangitis?
IV Abx (piptaz) ERCP after 24 - 48 hours
Drugs to stop in AKI? (DAMN)
Diuretics
Aminoglycosides and ACE inhibitors
Metformin
NSAIDs
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
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
What needs to be checked before starting terbinafine?
LFTs
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
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
What does the SAAG tell you in ascites?
If it is caused by portal HTN
A raised SAAG (>11g/L) = portal hypertension
Causes of Budd Chiari syndrome?
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
COCP
How does myocarditis present?
ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness
What ix confirms C diff colitis?
Stool C diff Toxin
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
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
What QRISK score should tx be started?
10%
Atorvastatin 10mg
What might cause a falsely low HbA1c?
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Blood donation
What might cause Higher-than-expected levels of HbA1c?
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
How much should once daily insulin be reduced the day before and on the day of surgery?
20%
Causes of drug induced cholestasis?
COCP
Abx: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine
Causes of erythema nodosum?
infection - streptococci - TB - brucellosis systemic disease - sarcoidosis - IBD - Behcet's malignancy/lymphoma drugs - penicillins - sulphonamides - COCP pregnancy
SE of vincristine?
Peripheral neuropathy
SE of bleomycin?
Lung fibrosis
SE of doxorubicin?
Cardiomyopathy
Cause in young female patients who develop AKI after the initiation of an ACE inhibitor?
Fibromuscular dysplasia
Causes of secondary HTN?
ENDOCRINE Cushing's Conn's Phaeo Acromegaly Hypothyroid
RENAL
Polycystic kidney disease
VASCULAR
Renal artery stenosis
Coarctation of aorta
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)
Which antiemetic in opioid induced nausea?
Metoclopramide
Which antiemetic in chemo/radiotherapy induced nausea?
Ondansetron
What conditions are associated with osteosclerosis?
Prostate cancer mets
Sickle cell disease
Breast Ca mets
Initial tx for metastatic prostate Ca?
gonadotrophin-releasing hormones
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
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
1st line tx in prophylaxis of variceal bleeds?
Non-cardioselective beta-blockers
Duration of tx in autoimmune hepatitis?
At least 2 years after normalisation of LFTs
CIs to using loperamide?
Bloody stools
Fever
Abx associated colitis
Metabolic findings in tumour lysis syndrome?
Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
Hypocalcaemia
Indications for dialysis?
Uraemic encephalopathy
Refractory hyperkalaemia
Refractory metabolic acidosis
Pulmonary oedema with oliguria
1st line tx for patients with both hypertension and albuminuria?
ACEi
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
What should a recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with?
oral fidaxomicin
management of Crohn’s patients who develop a perianal fistula?
Oral metronidazole
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
What score is to assess risk of pressure sore?
Waterlow
What score is to assess risk of malnutrition?
MUST
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
Tx for achalasia?
Heller cardiomyotomy
Gene in FAP?
APC
Gene in HNPCC?
MSH2/MLH1
RFs for Focal segmental glomerulosclerosis?
idiopathic secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy HIV heroin Alport's syndrome sickle-cell
Cancers with raised platelets? LEGO-C
- Lung
- Endometrial
- Gastric
- Oesophageal
- Colorectal
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
Tx for haemochromatosis and aims?
Venesection
transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
What do you see on xray in haemochromatosis?
Joint x-rays characteristically show chondrocalcinosis