Medicine Flashcards
What is thalassaemia
genetic defect in the protein chains that make up haemoglobin
What is the normal structure of haemoglobin?
2 alpha chains
2 beta chains
Why does beta thalassaemia have different severities?
gene can be abnormal or have deletion
ie. 1 abnormal 1 normal
2 abnormal or 1 abnormal 1 deletion
Most severe - 2 deletions
management of reactive arthritis?
ibuprofen
if contraindicated then steroids
what medication should be given to women with anti-phospholipid syndrome?
LMW heparin acutely
warfarin lifelong
when are nitrates contraindicated?
severe aortic stenosis - risk of profound hypotension
What disease causes erythema marginatum? Annular erythematous rash on trunk and inner arms/legs, non-pruritic
Rheumatic fever
Which valvular pathology is assoc with rheumatic fever?
Mitral stenosis - mid diastolic
Which bacteria causes typhoid?
Salmonella type - constipation not diarrhoea
what’s assoc with bence jones protein?
multiple myeloma
features of multiple myeloma
hypercalcaemia, renal damage, anaemia, thrombocytopenia, infection
on CXR, what does a widened mediastinum represent?
aortic dissection
what are the causes of dilated cardiomyopathy?
idiopathic
alcohol
coxsackie B virus
wet beri beri
doxorubicin
Features of tuberous sclerosis
ash leaf spots, fibromata underneath nails, cafe au lait spots, epilepsy, delay, learning difficulties, retinal hamartomas, polycystic kidneys
Features of dengue fever
retro-orbital headache, fever, facial flushing, rash, thrombocytopenia, recent travel
flavivirus spread by mosquitoes
typical feature of chagas disease
swelling of eyelids
features of malaria
prodrome = headache, myalgia, diarrhoea
cold stage
hot stage = fever, vomit, flushing
sweating stage
Pt had a PCI this afternoon, now experiencing severe chest pain again, management?
CABG
What is thoracic outlet syndrome?
compression of brachial plexus/subclavian artery/vein at thoracic outlet due to trauma or anatomical abnormality (cervical rib)
What is thoracic outlet syndrome?
compression of brachial plexus/subclavian artery/vein at thoracic outlet due to trauma or anatomical abnormality (cervical rib)
how is anion gap calculated?
(Na + K) - (bicarb+ Cl)
what is indapamide?
a thiazide-like diuretic
what are the fluid requirements for an adult?
25 ml/kg/day water
1mmol/kg/day K
50-100g/day glucose
signs of R heart failure
raised JVP, hepatomegaly, peripheral oedema
MEN type 1 features
3 Ps
Parathyroid (hyper)
Pituitary
Pancreas - insulinoma/gastrinoma (recurrent peptic ulceration)
MEN IIa
Parathyroid
Phaeochromocytoma
+medullary thyroid cancer
MEN IIb
Phaeochromocytoma
+ medullary thyroid cancer, marfanoid body, neuromas
Zollinger Ellison syndrome
gastrin secreting tumour in pancreas/duodenal wall
leads to increased HCl acid production -> recurrent peptic/duodenal ulcers
co-amoxiclav + deranged LFTs
cholestasis
How does Gilbert’s syndrome affect LFTs?
solitary raised bilirubin
How does Gilbert’s syndrome affect LFTs?
solitary raised bilirubin
Lyme disease treatment?
oral doxycycline
What causes Lyme disease?
borrelia burgdorferi - spirochaete spread by ticks
which causes of nausea is cyclizine appropriate for?
intracranial/vestibular
GI obstruction
raised ICP
Pneumonia after influenza, what’s the most likely organism?
Staph aureus
migraine medical management?
acute = NSAID + Triptan + paracetamol
prevention = topiramate or propanolol
which medication can be used for ER (oestrogen receptor) positive breast cancers?
if post menopausal -> anastrozole (reduces peripheral oestrogen synthesis)
which medication is used in HER2 positive breast cancers?
trastuzumab (Herceptin)
features of wernickes encephalopathy?
Confusion
Ataxia
Nystagmus
Opthalmoplegia
Peripheral Neuropathy
patient presents with TIA, which medication should be given?
300mg aspirin + specialist review within 24 hours (don’t drive until this)
which antibiotic can’t be prescribed with methotrexate?
Trimethoprim/co-trimoxazole - all folate antagonists -> myelosuppression means risk of life-threatening infection and severe bleeding
which contraceptive is assoc with weight gain?
depo-provera
how do you diagnose a miscarriage on USS?
Crown-rump length >7mm and no heart beat
what test is diagnostic for acromegaly?
OGTT + measurement of GH, MRI pituitary showing adenoma
back pain, weak hip abduction + foot drop = which dermatome?
L5
Cluster headache - long term prevention?
verapamil
