Medicine Miscellaneous Flashcards
A person has begun taking amlodipine as part of their management of HTN. What type of drug is it and what side effect should the patient look out for that will be present on exam?
It is a calcium channel blocker (dihydropyridine => not cardioselective => can be given with beta blockers). The main side effect to note is ankle oedema
A person has begun taking amiodarone as part of their management of Atrial Fibrillation.
What type of drug is it?
What should you advise the patient when taking amiodarone (4)?
Amiodarone is a Class III anti-arrhythmic drug => works by blocking K+ channels
Patient must be advised of 4 things:
Thyroid function (can cause both hypo and hyperthyroidism)
Pulmonary fibrosis of the lower bases (drugs typically affect lower bases)
!! Grey Man syndrome: Advise patient to use sunscreen or protective clothing when in sunlight due to irreversible skin changes when sunlight interacts with its metabolites in the skin. (bluish-gray discolouration)
Eye sight due to optic neuropathy
The angle of louis is an anatomical landmark that indicates the X rib. What is X?
2nd
A 76-year-old woman is brought into the emergency department by ambulance after collapsing suddenly at home. Initial assessment revealed a heart rate of 42 beats per minute and she is treated according to bradycardia resuscitation guidelines whereupon she stabilises.
Her past medical history includes stable angina for which she is prescribed verapamil, however, she has recently been suffering from bouts of anxiety following a car accident, leading her sister to lend her some of the tablets she takes to ‘calm her nerves’.
What is the most likely medication this patient has taken thus leading to her presentation?
Beta blocker e.g. propanolol
When a patient says chest tightness, what can they mean?
Chest pain
SOB
You have a routine telephone consultation booked with Mrs McGoldrick, a 53-year-old lady who has been seeing the health-care assistant for blood pressure (BP monitoring). The health care assistant booked the appointment as readings have been consistently around 150/90mmHg. You look at the records and see she was commenced on amlodipine as she is of Caribbean origin, and she is taking 10mg once a day. Her only other medication is atorvastatin 20mg. The health care assistant has commented in the record that the patient confirms she does take her medications as prescribed. What is the next step up in management?
Afro-carribean origin => ARBs over ACE inhibitors
Afro-carribean people have less renin and ACE inhibitors block Ang1 -> Ang 2 which involves renin. If it already low, blocking it further would have less of an effect than if there was raised Renin levels
ARBs target Ang II directly => blocking what is already made
What are the investigations for any arrhythmia?
As for any arrhythmia: except ECG
Bedside:
ECG/!Holter monitor: looking for patterns consistent with NSVT, VT, or VF (specific questions will come) + screen for previous MI, BBB, or LV hypertrophy
Urine dipstick (sepsis)
Urinalysis (evidence of CKD to guide management between DOAC and Warfarin) + Toxicology (sympathetomimetics)
Bloods:
FBC - Anaemia, infection, low platelets if DIC, infection, sepsis)
CRP - raised in infl. + inf.
U&E - Hypomagnesia + hyper/hypokalaemia + medications
TFTs - hyperthyroidism
Troponin + CKMB (ischaemia as a cause or result of arrhythmia)
BNP - HF in severe arrhythmia
HbA1c and Lipid profile (RFs)
Imaging:
CXR - sx of HF (ABCDE)
ECHO - TTE - atrial/ventricular size (LA enlargement/LV hypertrophy), RV systolic pressure, valvular involvement, pericardial disease - TOE - LA (appendage) thrombus, Rule out vegetations in IE
Procedure: Exercise stress test - helps identify ischaemia (not rly done so not required for 5/5)
We know that to restore K+, you need to restore Mg levels first. What is the hierarchy of these electrolytes?
Phosphate (PO4 2-) - Recall PTH
Mg 2+
K+ and Ca2+
Na+
You are about to administer prophylactic clexane as DVT prophylaxis.
How is it administered?
You come back the next day and on inspection of the site, you note 3 findings. Assuming no infection, what are they?
Small, subcutaneous Hematoma (may mimic rash/telangiectasia)
Lipodystrophy from repeat injections (also insulin)
Quick bacteria vs viral infection on CSF findings?
Bacterial: Low glucose, high protein, raised PMN
Viral: High glucose, Low protein, raised lymphocytes
Patient with meningitis suspected. What antibiotics/antivirals will you give?
Ceftriaxone to cover meningococcal and pneumococcl
Vancomycin to cover penumococcus
Amoxicillin to cover listeria
Aciclovir to cover viral (given anyways just incase)
What 2 signs is indicative of meningococcal meningitis compared to other types?
What are these signs also used for?
Kernig’s and Brudzinski’s sign also used for SAH
Kernig
Patient lying supine, flex patients hip and knees to 90 degrees. then extend knee fully. Positive if patient experiences pain or resistance in the hamstrings or lower back
Brudzinski’s sign
Patient also lying supine, examiner gently flexes the patient’s neck, bringing the chin down toward the chest. If the patient’s knees/hips flex involuntarily, then it is positive.
Why? These basically irritate the meninges => the flexion relieves tension to ease the pain
What antibiotics are you going to use for an ENT infection?
G+ve
Amoxicillin/Co-amoxiclav
if penicillin allergy, Clarithromycin or azithromycin
A nursing home patient on their first day after moving gets sick. is this CAP or HAP?
What organisms are you looking for in each case anyways?
CAP. although a nursing home is consideref HAP, it still has not been 48 hours
CAP: Staph/strep
HAP: Klebiella, pseudomonas, MRSA
A patient with a chest infection, night sweats and weight loss. What is the most likely organism?
Tb
Give 3 medications that may cause C.Diff
Co-amoxiclav (beta lactam ab)
Clarithromycin (Macrolides)
Ciprofloxacin (fluoroquinolones)
What empiric antibiotics will you give for a GI infection (if you had to)
G-ve => Tazocin, Flagyl (Metronidazole)
Empiric antibiotic for skin infections
If this was complicated with Nec Fasciitis, what is the ideal antibiotic to start with?
Flucloxacillin (might also be able to say benzylpenicillin) -> Vancomycin for MRSA later
Nec Fasciitis -> Clindamicin
UTI top 3 antibiotics
Which one for pregnancy?
Nitrofurantoin
Trimethoprim
Cephalexin (pregnancy)
When someone says CPE, what bacteria are they referring to?
Also what does CPE stand for?
Carbapenemase-producing Enterobacterales
E.coli
Klebsiella
Enterobacter
NOT Enterococci (faecalis, faecium)
What is Waldeyer’s ring? Go through it
It is the ring of lymphoid tissue in the naso and oropharynx
Pharyngeal tonsil (Adenoid)
Tubal tonsils (next to ET tube)
Palatine tonsils (main ones)
Lingual tonsil
