medicine Flashcards
DVT prophylaxis
rivaroxaban
prophylaxis = 10 mg orally, once daily after surgery
treatment = 15mg bd for 21 days and then 20mg daily thereafter
apixaban
prophylaxis = 2.5mg bd
treatment = 10mg bd for 7 days and then 5mg bd
needs dose adjustment when CrCl <25
Enoxaparin
prophylaxis 40mg SC (20mg for reduced renal)
treatment = 1mg/kg bd or 1.5mg/kg daily (1mg/kg daily for reduced renal)
Methods of mechanical prophylaxis for VTE include:
- graduated compression stockings providing 16 to 20 mmHg pressure at the ankle (stockings providing this pressure are also known as anti embolism stockings), which must be professionally fitted
- intermittent pneumatic compression devices
- pneumatic foot compression or pump
Fluid GI tract
Definition of:
Prevalence
Incidence
Mortality rate
Prevalence
Prevalence is the proportion of a population who have a specific characteristic in a given time period.
**Incidence **
The occurrence of new cases of disease or injury in a population over a specified period of time.
Mortality rate
A mortality rate is the number of deaths due to a disease divided by the total population.
TNM staging
CEA
Carcinoembryonic antigen
Label Caudate nucleus, putamen and substantia nigra in this picture:
3 medications for parkinson’s disease and their MOA
**Dopamine agonists: **
Levodopa/carbidopa MOA: stimulate dopamine receptors → stimulates direct pathway and relatively reduces the stimulation of the indirect pathway → allows more controlled movements
Side effects: Hallucinations, confusion, dyskinesia, impulse control disorders, NVD
Anticholinergics:
- Benztropine MOA: Block muscarinic actions of acetylcholine to produce a wide range of effects including reduction of relative excess of cholinergic activity that accompanies dopamine deficiency in Parkinson’s disease.
Side effects: Dry eyes, dry mouth, urinary retention, constipation
Amantadine:
MOA: Increases dopamine release and blocks cholinergic receptors; acts as a N‑methyl-D‑aspartate (NMDA) antagonist in the glutamatergic pathway from subthalamic nucleus to globus pallidus.
Side Effects: nervousness, depression, hallucinations, insomnia
Risk factors for TB
- <5yrs or >60years
- Chronic lung disease
- Exposure to an individual with known or suspected active TB
- Travel or exposure to high TB prevalence areas
- Exposure to high risk adults such as HIV infected, IV drug users, residents of congregate settings, migrant workers, homeless people
- Immunosuppressive medical conditions/ medications
- End-stage renal disease
- Diabetes
Importance of femoral head blood supply in NOF
The blood supply to NOF is retrograde, passing from distal to proximal along the femoral neck to the femoral head. This is predominantly through the medial circumflex artery, which lies directly on the intracapsular femoral neck. This blood supply is vulnerable to disruption if there is a displaced intracapsular fracture → leads to Avascular necrosis of the femoral head
4 criteria for Consent
- the patient giving consent must have capacity i.e. patient has to have capacity, they have to understand facts and choices, weigh up the consequences the decision and communicate the decision
- the consent must be freely given
voluntarily, consent is freely given i.e. not under coercion or duress - the consent must be sufficiently specific to the procedure or treatment proposed
- the consent must be informed i.e. ensure the patient has a genuine understanding of the nature of the condition being treated, the proposed procedure or treatment, the expected outcomes and the risks and benefits of the proposed treatment
Benefits of using DOAC instead of warfarin
- decreased major bleeding by 28% and intracranial bleeding by 50%
fixed dose, - no monitoring required,
- no interactions,
- equally effective as warfarin to prevent stroke,
- warfarin takes 5 days to reach therapeutic effect and all the DOACS have been proven for VTE prophylaxis
- rapid onset/offset of action,
- few drug interactions,
- predictable pharmacokinetics
- eliminating the requirement for regular coagulation monitoring
- ease of patient use with a standard dose
Features of osteoporosis on X-ray
- cortical thinning
- increased radiolucency
- Altered trabecular pattern (loss of trabeculae in proximal femur area) - Singh’s index
- Compression deformities (of the vertebra)
histology difference between Crohns and UC
Crohns: Transmural, cobblestone appearance, non-caseating granuloma, TH-1 mediated infiltration, bowel thickening, lymph node aggregates
UC: Mucosal and submucosal involvement only, friable mucosa, deep ulceration, crypt abscess, goblet cell depletion, bleeding, no granuloma, TH2-mediated immune infiltrates
Describe this
left proximal 1/3 mid shaft femur subtrochanteric,
closed,
oblique with lateral displacement, shortening and ~5-10% angulation
describe this
Left proximal subtrochanteric, spiral femur fracture, closed and laterally translated with a possible Avulsion fracture
neuroleptic malignant syndrome
Neuroleptic malignant syndrome is a rare but life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate.
Complications of neuroleptic malignant syndrome include dehydration from poor oral intake, acute renal failure from rhabdomyolysis, and deep venous thrombosis and pulmonary embolism from rigidity and immobilization
serotonin syndrome
Agitation or restlessness.
Insomnia.
Confusion.
Rapid heart rate and high blood pressure.
Dilated pupils.
Loss of muscle coordination or twitching muscles.
High blood pressure.
Muscle rigidity.
define sensitivity and specificity (and how to calculate True positive, false positive, True neg and False neg)
Sensitivity relates to the test’s ability to correctly detect patients who do have a condition. Sensitivity of the test is the proportion of people known to have the disease, who test positive for it
**Specificity **relates to the test’s ability to correctly detect patients without a condition.
Specificity of a test is the proportion of healthy patients known not to have the disease, who will test negative for it
About screening test
- Should accurately detect the target condition while it is still asymptomatic.
- The Test should have high Sensitivity and Specificity
- The Test results should be** reproducible** in a variety of settings
- The Test must be safe and acceptable to the target individual or population and
clinicians - The Test should be simple to perform and be cost effective
rectal bleeding diagnosis
Label circle of Willis
4 types of non-seminoma testicular tumours
types of ovarian cancer
Breast disease
PBC Vs PSC
UC Vs Crohns
cardiac murmurs
4 T’s of PPH
Paeds Dehydration
Mania Vs Hypomania
