Medicine passmed Flashcards
Bradycardia (Symptomatic)+shock treatment?
Atropine (IV) 500mcg = 1st line (can also use this for narrow complex tachy if cause due to AF)
- Bradycardia does not normally need treatment BUT if patient is unstable then needs!
- If needs an alternative treatment= Adrenaline/isoprenaline infusion
Supraventricular tachycardia(narrow complex) mx?
IV Adenosine
REGULAR broad complex tachycardia Mx?
Amiodarone IV: if patient has no adverse features
Standard post- MI medication? (after discharge)
4 in total
1) Dual antiplatelet therapy (aspirin+ clopidogrel/ticagrelor/prasugrel)
2) Beta blocker
3) ACE-inhibitor
4) Statin
Pericarditis signs?
- Kussmaul’s sign= JVP increases with inspiration
- CXR: pericardial calcification
Rheumatic fever presentation?
- Sore throat
- rash
- heart MURMUR
- arthritis (ankles and wrists aching)
Develops after infection with: Strep pyogenes
Mx: Abx- Oral penicillin V, Anti-inflammatories: NSAIDs are 1st line treatment of any complications eg. heart failure.
ACS poor prognosis indicator?
Cardiogenic Shock
Difference between narrow and broad complexes?
- Narrow: QRS complexes less than 100 ms (milliseconds)
- Broad: QRS complexes more than 100 ms (milliseconds)
Mx. for narrow complex tachycardia with no adverse effects?
- Try vagal manoeuvres eg. carotid sinus massage
A.F mx if haemodynamically UNSTABLE(if BP is unmeasurable/too low)
Immediate electrical (DC) cardioversion+ followed by thromboprophylaxis
‘Provoked PE’ caused post-op/after immobilisation, how long to keep anticoagulation for?
3 Months
Massive PE(Pulmonary Embolism)+unstable eg. hypotension?
Thrombolysis
NB: medical mx order:
1) DOAC eg apixaban/rivaroxaban
if neither suitable=
2)Low weight molecular heparin
3) add another DOAC
Ulcerative Colitis:
Presence of crypt abscesses, rectal bleeding. tenesmus (feeling to empty bowel but no stool passed)
- inflammatory bowel disease
- on endoscopy: pseudopolyps, loss of haustrations
-association more common: Primary Sclerosing Cholangitis
Crohn’s:
non bloody diarrhoea
-mouth to anus skip lesions
-goblet cells
-on endoscopy: skin lesions ‘cobble stone’ appearance
Coeliac disease patients should also receive which vaccine?
- Pneumococcal: as can cause hypo-splenism
- in Coeliac disease: bloods= Anti-tissue transglutaminase antibody is very raised.
- Management of coeliac: is a gluten free diet
coeliac foods to have and avoid?
-CAN have: gluten free: including rice, potatoes and corn(maize)
- CAN’T have: gluten for eg. rye bread, barley, wheat, couscous
Appendicitis:
- Abdominal pain migrated from umbilicus to right iliac fossa within last 12 hours.
- Rovsing’s sign: palpation of left iliac fossa= results in right iliac fossa pain
-Mx: Appendicectomy
What cancer does Pernicious anaemia predispose to?
Gastric cancer
Femoral hernias mx?
- Need to be surgically repaired, regardless of symptoms as there is a high risk of strangulation
Medication that is a risk factor for c. diff
- PPIs eg. Omeprazole
Management for severe flare up of Ulcerative Colitis:
- Admit the patient in hospital and treat with IV corticosteroid
Mx: for long term maintenance and remission: ORAL aminosalicylate
Complication of pancreatitis?
Acute Respiratory Distress Syndrome
- Pancreatitis: will have very raised serum Amylase
coeliac disease: what Ig should you look at?
Ig A
coeliac disease testing and making a diagnosis?
- needs a REintroduction of gluten for at least 6 weeks before further testing otherwise the tests will come back negative even if patient has coeliac disease.
- Gold standard for diagnosis: Endoscopic intestinal biopsy
- 1st line test: Tissue transglutaminase antibodies
Hypercalcaemia ECG finding:
- Shortening of QT interval
painful Diabetic neuropathy 1st line mx: (in the feet) for pain-
- Duloxetine; is a SNRI= enhances pain suppression
- Other 1st line med: Pregabalin, Gabapentin, Amytriptiline
Medication that can be a cause of nephrogenic diabetes insipidus?
Lithium
Medication that can be a cause of SIADH:
Fluoxetine
Aortic dissection presenting signs:
- Weak/absent pulse (either carotid, brachial or femoral)
- Variation in arm blood pressure
Mx. of heart failure with a reduced ejection fraction?
- In addition to: ACE-i, beta blocker, furosemide, also add 2nd line) Spironolactone(mineralocorticoid receptor antagonist), NB; contraindication to spironolactone is hyperkalaemia
3rd line) Digoxin and Ivabradine add
Prescribing anticoagulants post-surgery:
- For a PE: Prescribe DOAC for 3 months only if the PE is provoked (ie. after surgery), if is not provoked= prescribe for 6 months.
DOACs are offered 1st line over LWMH (low weight molecular heparin) - 1st line= Thrombolysis
Mx. of a single episode of paroxysmal atrial fibrillation:
Even if it is provoked= need to give anticoagulation: therefore give Apixaban.
2nd line) use Warfarin
What drug can cause Heinz Body anaemia?
- Sulphasalazine
- Can cause increased reticulocytes
- Presents with: SOB, dizziness, tiredness
Investigation to be able to differentiate between: IBS and IBD (Irritable Bowel Syndrome and Inflammatory Bowel Disease)=
Faecal calprotectin test .
- Colonoscopy is also correct, but this is a more invasive procedure therefore faecal calprotectin is preferred first line.
Pregnant woman who smoke: management?
- Nicotine patch is good!
- Buproprion and varenicline are contraindicated in pregnancy
Meningococcal Septicaemia in children? mx.
- IV fluids and Abx
- NB Do NOT give dexamethasone
Asthma diagnosis investigation in children?
- Peak Flow
- Spirometry and Bronchodilator reversibility: an increase of more than 12% is considired positive= to give salbutamol.
(FeNO is not used in children like it is used in adults)
what is a strange common feature in appendicitis in children?
- Anorexia / losing appetite and not eating
Pathogen causing: Eczema Herpeticum?
- Herpes Simplex Virus
- the way the rash can present: painful pruritic rash, with punched out lesions (monomorphic)
- Mx: is potentially life threatening= therefore admit children for IV Aciclovir
Patients (children) with active HSP(henoch schloein purpura) need what investigations?
-Need to monitor BP and urinalysis (especially in children without renal involvement)
- HSP is a type of vasculitis
- Around 1/3rd of patients have a relapse
Paeds BLS: life support 1st line before starting chest compressions?
- Give 5 rescue breaths
Asthma management in children?
- 1) SABA
2) SABA+ ICS
3) SABA+ICS+ LTRA(Monteluklast)- if less than 5, after this stage refer to a paeds asthma specialist
4) SABA+ICS+LABA (instead of LTRA)
5)then MART etc.
Classical presentation of HSP? (same as in children)
- Abdo pain
- arthritis
- haematuria
- purpuric rash over buttocks and extensor surface of arms and legs
- often follows a URTI and is most common in children.
- NB: need to monitor BP and Urine dipstick
Mx. of congenital inguinal hernias?
- Need to immediately refer for Paeds surgery: as there is a high rate of complications
What medication does Eczema Herpeticum require?
Antivirals eg. Aciclovir
Mx. of Testicular Torsion?
- Urgent BILATERAL orchidopexy (surgery involves fixing both testes to prevent torsion of the other testes)- treatment is with surgical exploration
