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02F > MEMORISE > Flashcards

MEMORISE Flashcards

1
Q

In anorexia nervosa what are part of the blood tests?

A

Most things are low C and G are raised
gh, glucose, salivary glands, coritsol, cholestrol and carotinaemia

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2
Q

Lithium side effects

A

nephrotxicity
hypothyroidism
hyperparathyrodisim
leucocytosisi

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3
Q

All tb patients musty have what test?

A

HIV test

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4
Q

Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?

A

osteomalacia

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5
Q

Third nerve palsy features and causes

A

down and out
ptosisi and dialated pupil (surgical)
Mydriasis

painful= PCA
Vasculitits
DM
Cavernous isnus thrombosis
Webers

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6
Q

chadvasc 0 and ready to discharge what must be done before this

A

transthoracic echo

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7
Q

what drugs should be stopped because the worsen renal function in AKI

A
  • NSAIDs (except if aspirin at cardiac dose e.g. 75mg od)
  • Aminoglycosides
  • ACE inhibitors
  • Angiotensin II receptor antagonists
  • Diuretics
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8
Q

what drugs should be stopped because they increase risk of toxicity in aki

A

Metformin
* Lithium
* Digoxin

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9
Q

TB drug management and 2 sx of each

A

RIPE 6622
Rifampicine- orange red tears, hepatitis
Isonazine- peripheral neuropathy have to give pyridoxine (b6), agranulocytosis
Pyrazinamide- gout and arthlagoa
Ethambutol- optic neuritis check VA before treasting

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10
Q

Jaundice in babies
causes in
24 hours
2-14 days
after 14 days

A

first 24 hours always pathological RAH g
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

2-14 physiological- It is more commonly seen in breastfed babies

prolonged - uncojugated= BA

biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
cmv

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11
Q

asthma attack management

A

Oh, shit, I, Hate, My, Asthma
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

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12
Q

normal CTG

A

Baseline fetal heart rate (FHR) is between 110-160 bpm * Variability of FHR is between 5-25 bpm * Decelerations are absent or early * Accelerations x2 within 20 minutes.

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13
Q

in Pneumonia what ABX managment is there

A

low severity- amoxicillin 5 day
Moderate severity- amoxicillin + erythromycin - 7-10
Severe co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia

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14
Q

by using irridated transfusion products what is prevented

A

graft vs host disease

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14
Q

by using irridated transfusion products what is prevented

A

graft vs host disease

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15
Q

What antibody is found in limited cutaneous systemic sclerosis

WHat antibody in diffuse cutaneous systemic sclerosis

A

ACA

Anti scl 70

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16
Q

what drugs cause urinary retention

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

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17
Q

how is hydrocortisone split in patients with addisons

A

2 doses majority in mornuing
ie 20 at 8 am

10 at 5pm

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18
Q

platelet level transfusions

A

no bleeding= 10x10^9
Active bleeding- haemesis, epistaxis- 30x10^9
critical bleeding eg cns- 100x10^9

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18
Q

platelet level transfusions

A

no bleeding= 10x10^9
Active bleeding- haemesis, epistaxis- 30x10^9
critical bleeding eg cns- 100x10^9

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19
Q

ATN vs prerenal causes

A

pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea

ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge

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19
Q

ATN vs prerenal causes

A

pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea

ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge

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19
Q

ATN vs prerenal causes

A

pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea

ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge

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19
Q

ATN vs prerenal causes

A

pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea

ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge

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20
Q

ATN vs prerenal causes

A

pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea

ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge

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20
Q

ATN vs prerenal causes

A

pre renal=
Urine sodium less than 20
Urine osmolality high - above 500
Good response to fluid challenge
Raised urea

ATN-
high urine sodium- above 40
low urine osmolality- less than 350
Poor response to fluid challenge

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21
Q

ways to measure synthetic liver function

A

albumin and prothrombin time
prothrombin time faster result

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22
Q

how many day course abx in women

A

non pregnant nitro/trimeth 3 days
pregannt 7 days nitro

catheter 7 days

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23
Q

when must a person have a ct scan immediately

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

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24
Q

when must a person have a ct scan within 8 hours

A

age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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25
Q

drugs avoided in breast feeding

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

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26
Q

significant pain and a tender lump
examination reveals a purplish, oedematous, tender subcutaneous perianal mass

A

thrombosed haemorroid
tool softeners, ice packs and analgesia. Symptoms usually settle within 10 days

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27
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

A

dengue fever

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27
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

A

dengue fever

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28
Q

webers syndrome

A

(branches of the posterior cerebral artery that supply the midbrain)

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

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29
Q

Lateral medullary aka wallenberg

A

Posterior inferior cerebellar artery

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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30
Q

bradycardia management if doesnt respond to initial management

A

atropine, up to maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response

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31
Q

true love and witts criteria for severe UC

A

more than 6 bowel movements a day containing blood and systemic upset

fever
tachycardia
abdominal tenderness, distension or reduced bowel sounds
anaemia
hypoalbuminaemia

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32
Q

gynaecomastia caused by spironolactone switch to which drug

A

eplerenone

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33
Q

patients not suitable for parathyroidectomy what should they be started on?

A

patients not suitable for surgery may be treated with cinacalcet, a calcimimetic
a calcimimetic ‘mimics’ the action of calcium on tissues by allosteric activation of the calcium-sensing receptor

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34
Q

haemochromatosis main complication

A

hcc

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35
Q

low T3/T4 and normal TSH with acute illness

A

sick euthyroid syndrome

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36
Q

Metabolic ketoacidosis with normal or low glucose

A

alcoholic ketoacidosis

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37
Q

iX for PAD

A

hand held arterial doppler/duplex us–> ABPI

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38
Q

pneumonia and recent bout of flu

A

staph aureus

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39
Q

primary pneumothorax management

A

If the patient is NOT short of breath AND the pneumothorax is <2 cm on a chest x-ray conservative management is sufficient. The patient can be discharged and reviewed in the outpatient department in 2-4 weeks.

If the patient IS short of breath OR the pneumothorax is >2 cm the pneumothorax should be aspirated with a 16-18G cannula under local anaesthetic. If this is successful the patient can be discharged. If this fails an intercostal drain is necessary (and the patient must be admitted).

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40
Q

primary pneumothorax management

A

If the patient is NOT short of breath AND the pneumothorax is <2 cm on a chest x-ray conservative management is sufficient. The patient can be discharged and reviewed in the outpatient department in 2-4 weeks.

If the patient IS short of breath OR the pneumothorax is >2 cm the pneumothorax should be aspirated with a 16-18G cannula under local anaesthetic. If this is successful the patient can be discharged. If this fails an intercostal drain is necessary (and the patient must be admitted).

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41
Q

secondary pneumothorax management

A

If the patient is NOT short of breath AND the pneumothorax is <1 cm on the chest x-ray they do not require further invasive intervention but should be admitted for observation for 24 hours and administered oxygen as required.

If the patient is NOT short of breath and the pneumothorax is 1-2 cm on the chest x-ray aspiration is required. If this is successful the patient can be admitted for 24 hours of observation. If this is unsuccessful and intercostal drain is necessary.

If the patient IS short of breath OR the pneumothorax is >2 cm on the chest x-ray an intercostal drain is necessary (and the patient should be admitted).

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42
Q

anyone who has engaged in anal sex prescribe?

A

post exposure prohylaxis

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43
Q

What is autoimmune hepatitis

A

ANA and anti smooth muscle antibodies attacking the liver

usual live symptoms

Raised ALT and bilirubin with normal/mildly raised ALP.

Management
steroids, other immunosuppressants e.g. azathioprine
liver transplantation

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44
Q

management of non insulin dependent diabetes in surgery

A

Hold all oral diabetic medication on the morning of the procedure.
If the patient is on insulin then switch to sliding scale infusion (restart when they can eat).
Restart all oral medication the morning after surgery.

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45
Q

Peri-operative Management of Insulin Dependent Diabetics

A

Peri-operative management principles of insulin use are:

Put the patient as early on the theatre list as possible minimising the amount of time the patient is nil by mouth.
If on long acting insulin this should be continued but reduced by 20%.
Stop any other insulin and begin sliding scale insulin infusion from when the patient is placed nil by mouth.
Continue infusion until patient is able to eat post-operatively.
Switch to normal insulin regimen around their first meal.

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46
Q

does chadvasc metter in valvular pathology?

A

no always anticoagulate

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47
Q

patients on warfarin going a emergency surgery?

A

Patients on warfarin undergoing emergency surgery - give four-factor prothrombin complex concentrate

but if surgery in 8 hours
If surgery can wait for 6-8 hours - give 5 mg vitamin K IV

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48
Q

blood tests in dic

A

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes due to microangiopathic haemolytic anaemia

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49
Q

causes of large bowel obstruction

A

tumour
diverticular disease
volvulus

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50
Q

generalised tonic clonic seizures treatment

A

sodium valporate first
lamotrigine second/carbemazapine

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51
Q

absence seizures treatment

A

ethosuxamide then sodium valporate

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52
Q

myoclonic seizures

A

codium valporate first
lamotrigine= second line

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53
Q

focal seizures

A

carbemazapine/lamotrigine

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54
Q

abx safe in pregnancy

A

1st trimester trimethoprim
last trimester= nitrofurnatoin

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55
Q

posterior mi ecg changes

A

Changes in V1-3

Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2

Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)

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56
Q

first line investigation for heart failure and what to do after

A

Nt Pro BNP

if levels are ‘high’ arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are ‘raised’ arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks

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57
Q

osteoporosis mx

A

bisphosphonates
BNF states them to be contraindicated if the eGFR is less than 35 mL/minute/1.73m

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58
Q

drugs to avoid in chronic renal failure

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

Drugs likely to accumulate in chronic kidney disease - need dose adjustment
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids

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59
Q

complications of type 1 neurofibromatosis

complications of nf2

A

optic glioma

bilateral vestibular schwannomas

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60
Q

under 90 af do we prescribe rate control

A

no but prescribe anticoagulation

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61
Q

ebv amoxicillin reaction known as

A

morbillifoprm eruption

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62
Q

peripheral neuropathy in crohns which medication

A

metronidazole

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63
Q

how do we work out absolute risk reduction

A

subtract the 2 numbers

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64
Q

how do we work out relative risk reducion

A

x/y

x= new control

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65
Q

in tachycardias if asthma and cant take adenosine what do we give

A

diltiazem

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66
Q

increased APTT, normal PT, and normal bleeding time?

A

haemophillia

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67
Q

Increased APTT, normal pt increased bleeding time

A

von willebrands disease

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68
Q

Increased APTT, PT, normal bleeding time

A

vitamin k deficiency

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69
Q

Serology of hep b

A

HBsAg= carrier status, present after 6 months= chronic infection
HBeAg= Marker of an infection
ANti-hbs= previous vaccination
anti hbc- past infection
if anti hbc is present and hbs, theyve got immunity from carrying it
Patients with acute infection have raised IgM to HBcAg, while this is negative in chronic infection (igG)

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70
Q

cor pulmonale effects which valve

A

failure of the right ventricle due to respiratory cause

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71
Q

what is creutzfeldt jakob disease

symptoms

A

a group of neuro-degenerative diseases caused by prions (mis-shaped proteins).

rapidly progressive dementia, psychiatric impairment, and myoclonus.

Diagnosis is by tissue biopsy. Tonsil/olfactory mucosal biopsy is less invasive and safer than brain biopsy. Supportive investigations include EEG (showing periodic sharp-wave complexes), MRI (showing basal ganglia hyperintensity), and lumbar puncture (showing abnormal proteins e.g. 14-3-3 protein).

mri to differentiate between sporadfic and variant

no cure

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72
Q

in a patient weith ppi whats the preferred method of induction

A

rsi

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73
Q

which artery may lead to bheart block

A

RCA

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74
Q

migraines in pregnancy

A

paracetamol 1g first
Nsaids safe in first and second trimester

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75
Q

symptoms of brown sequard syndrome

A

Ipsilateral spastic paresis
Ipsilateral loss of proprioception and vibration sensation
Contralateral loss of pain and temperature

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76
Q

subdural when is it acute vs when is it chronic

A

acute= under 72 hours
hypodense= chronic

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77
Q

neuro epileptic syndrome

A

antipsychotic medication/parkinsons
pyrexia, muscle rigidity, autonomic liability slower onset treated wiith iv fluids and dantrolene decreased reflex normal pupils

serotonin syndrome
maoi, ecstasy faster onset increase in reflexes, dialated pupils
treat with cyproheptadine and chlorpromazine

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78
Q

brain metastases which nerve usually affeced

A

abducens 6th nerve as thinnest

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79
Q

POST MI complciations
cardiac arrest
cardiogenic shock
chronic heartfailure
Tachyarrythmias
bradyarrythmias
Left ventricular anneurysm
Left ventricular wall rupture
VSD
acute mitral regurgitation

A

cardiac arrest= VF treat with defibrillator

Vtac- broad complex tachycardia

Bradyarrythmias- after inferior MI= av block

pericarditis= within 48 hours

dresslers syndrome- 2-6 weeks after

LV anneurysm= persistent st elevation

Left ventricular free wall rupture- featuures of cardiac tamponade- raised jvp, pulsus paradoxus and diminished heart sounds) need pericardiocentogeneisis

VS- pan systolic murmur

Mitral regurgitaton

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80
Q

name dopamine agonists

A

bromocriptine, ropinirole, cabergoline, apomorphine

Impulse control and pulmonary fibrosis

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81
Q

indications for rrt

A

acidosis
electrolyte abnormalities- hyperkalameia
Infection
O- pulmonary oedema
Uraemia- hepatic encephalopathy/ pericardiitis

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82
Q

do we treat asymptomatic bacteria in catheterised patients

A

no

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83
Q

what should be monitored in henoch schonlein purpura

A

blood press and urinalysis

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84
Q

how do we differentiate between syphilis and genital herpes

A

Genital herpes is mostly associated with painful ulceration, while syphilis presents mostly with painless ulceration

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84
Q

how do we differentiate between syphilis and genital herpes

A

Genital herpes is mostly associated with painful ulceration, while syphilis presents mostly with painless ulceration

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85
Q

severity of copd

A

mild= above 80%
moderate= 50-79%
Severe=30-49%
Very severe= less than 30%

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86
Q

clozapine side effects

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

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87
Q

hyperkalaemia causes and ecg features

A

acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison’s disease
rhabdomyolysis
massive blood transfusion

tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole

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88
Q

resection needed for caecal, ascending or proximal transverse colon

A

right hemicolectomy

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89
Q

resection needed for distal transverse, descending colon

A

left hemicolectomy

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90
Q

resection needed for sigmoid colon

A

high anterior resection

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91
Q

in emergency situations/ after hartmans what anastamosis required

A

end colestomy

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92
Q

aortic regurgitation features

A

Early diastolic murmur
collapsing pulse
wide pulse pressure
quincke’s sign - nailbed pulsation
de musst sign- head bobbing

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93
Q

aortic stenosis featuires

A

ejection systolic murmur radiates to
carotids
chest pain syncope
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

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94
Q

mitral stenosis

A

caused by rheumatic fever
dysponea
haemoptysisi
mid-late diastolic murmur (best heard in expiration)
loud S1, opening snap
low volume pulse
malar flush
atrial fibrillation

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95
Q

mr

A

The murmur heard on auscultation of the chest is typically a pansystolic murmur described as “blowing”. It is heard best at the apex and radiating into the axilla. S1 may be quiet as a result of incomplete closure of the valve. Severe MR may cause a widely split S2

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96
Q

toxic multinodular goitre

A

autonomously functioning thyroid nodules resulting in hyperthyroidism.

Nuclear scintigraphy reveals patchy uptake.

The treatment of choice is radioiodine therapy.

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97
Q

low likelyhood of dvt

A

2 points or more- us if negative then ddimer
if 1 point- ddimer

if us not available interim anticoagulation
if the scan is negative but the D-dimer is positive:
stop interim therapeutic anticoagulation
offer a repeat proximal leg vein ultrasound scan 6 to 8 days later

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98
Q

ssri interactions

A

Interactions
NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin: see above
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

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99
Q

most common ovarian cyst
choc cyst

A

follicular cyst.
corpus luteum cyst - more lilkely to bleed
dermoid cyst- contains hair teeth skin
seous cysteadenoma- benigbn epithelial tumur
mucous cystadenoma- ruptures= pseudomyxoma peritonei

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100
Q

oseteomalacia

A

low vit d, low calcium, phosphate raised ALP

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101
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

A

retinal vein occlusion

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102
Q

upper zone fibrosis

A

CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

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103
Q

lower zone fibrosis

A

idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis

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104
Q

drug induced urinary retention

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

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105
Q

person with addisons keeps vomiting how should we manage

A

im hydrocortisone

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106
Q

lithium can cause what on blood tests

A

benign leucocystosis

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107
Q

causes of avascular necrosis of the hip
IX of choice

A

long-term steroid use
chemotherapy
alcohol excess
trauma

MRI is the investigation of choice. It is more sensitive than radionuclide bone scannin

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108
Q

men and voiding issues

A

if its predominately vodiing issues
conservative measures include: pelvic floor muscle training, bladder training,
if the prostate is enlarged and the patient is ‘considered at high risk of progression’ then a 5-alpha reductase inhibitor should be offered
if the patient has an enlarged prostate and ‘moderate’ or ‘severe’ symptoms offer both an alpha-blocker and 5-alpha reductase inhibitor

if overactive bladder
anticholinergics
oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)

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108
Q

men and voiding issues

A

if its predominately vodiing issues
conservative measures include: pelvic floor muscle training, bladder training,
if the prostate is enlarged and the patient is ‘considered at high risk of progression’ then a 5-alpha reductase inhibitor should be offered
if the patient has an enlarged prostate and ‘moderate’ or ‘severe’ symptoms offer both an alpha-blocker and 5-alpha reductase inhibitor

if overactive bladder
anticholinergics
oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)

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109
Q

prohylactic treatment for cdiff

A

Bezlotoxumab is a monoclonal antibody which targets Clostridium difficile toxin B

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110
Q

water dep test

A
111
Q

Positive non-treponemal test + positive treponemal test

A

consistent with active syphilis infection

112
Q

Positive non-treponemal test + negative treponemal test

A

consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)

113
Q

Negative non-treponemal test + positive treponemal test :

A

consistent with successfully treated syphilis

114
Q

what is uhtoffs phenomenon

A

worsening of vision following rise in body temperature

115
Q

lhermittes syndrome

A

paraesthesiae in limbs on neck flexion

116
Q

lhermittes syndrome

A

paraesthesiae in limbs on neck flexion

117
Q

p450 inductor on warfarin

A

increases metabolism of warfarin so DECREASES INR

Inducers
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

Inhibitors
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin

118
Q

t wave inversion in v1-v3

A

Arrhythmogenic right ventricular cardiomyopathy

sotalol
and implantable cardiac defib

119
Q

Preceding influenza pneumonia

A

S aureus

120
Q

head rapidly accelerated and decelerated injury

A
  1. Multiple haemorrhages
  2. Diffuse axonal damage in the white matter
121
Q

reversible causes of dementia screening

A

FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate

122
Q

when should ebta blockers be stopped in a person with heart failure

A

beta-blockers should only be stopped if the patient has heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock

123
Q

haemodynamically stable ectopic management

A

Surgical - laparoscopic salpingectomy

OPEN ONLY DONE IF UNSTABLE

Surgical - open salpingectomy

124
Q

WHEN SHOULD WE DO SALPINGOTOMY

A

Salpingectomy is first-line for women with no other risk factors for infertility

Salpingotomy should be considered for women with risk factors for infertility such as contralateral tube damage

125
Q

if diagnosis of acute cholecystitis uncertain after US

A

technetium-labelled HIDA scan may be done

126
Q

open fracture first line

A

administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film.

127
Q

iscahemic collitis mainly affects the

A

splenic flexure

128
Q

dry age related macular degen management

A

beta carotene. vitamin A,C,E and zinc

129
Q

most common fracture in foot

most common fracture as a result of stress frcatures

A

The proximal 5th metatarsal is the most commonly fractured metatarsal

The most common site of metatarsal stress fractures is the 2nd metatarsal shaft

130
Q

contact lense wearers have 2 main infections

A

pseudomanas aeruginosa
and certain cases acanthamoebic keratitits

131
Q

organic causes of ED

A

Gradual onset of symptoms
Lack of tumescence
Normal libido

132
Q

organic causes of ED

A

Gradual onset of symptoms
Lack of tumescence
Normal libido

133
Q

athletes foot treatment

A

topical imidazole, undecenoate, or terbinafine first-line

134
Q

pityriasis vesicolour management

A

topical antifungal. NICE Clinical Knowledge Summaries advise ketoconazole shampoo as this is more cost effective for large areas
and oral itraconazole

135
Q

most aggressive malignant melanoma

A

nodular

136
Q

in temporal arteritis what eye nerve is affected

A

anterior ischaemic optic neuropathy- swollen pale disc and blurred margins

Ischaemia to anterior optic nerve

137
Q

Diverticulitis symptoms + vaginal passage of faeces or flatus

A

colovaginal fistula

138
Q

Diverticulitis symptoms + pneumaturia or faecaluria → ?colovesical fistula

A

colovesical fistula

139
Q

weight loss in t2dm

A

SGLT-2 inhibitors

140
Q

early shock

Late shock

A

early shock- Normal bp, tachycarsia, tachypnoea, pale skin, reduced urine output

Late shock- bradycardia, hypotension, acidotic, blue absent urine

141
Q

cherry haemangiomas

A

benign spots due to proliferation of capillaries

142
Q

Otalgia, fever, protruding ear and post-auricular tenderness

A

mastoiditis

143
Q

when should we give abx in acute bronchitis

A

are systemically very unwell
have pre-existing co-morbidities
have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
NICE Clinical Knowledge Summaries/BNF currently recommend doxycycline first-line
doxycycline cannot be used in children or pregnant women
alternatives include amoxicillin

144
Q

head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

A

LEARN

145
Q

mycoplasma features
IX
managemnt

A

haemolytic anaemia, thrombocytopenia
erythema multiforme, erythema nodosum

Mycoplasma serology

doxycycline or a macrolide (e.g. erythromycin/clarithromycin)

146
Q

dermatomyositis antibody

A

ANA

147
Q

complication of pelvic inflammatory disease in which the liver capsule becomes inflamed causing right upper quadrant pain. This leads to scar tissue formation and peri-hepatic adhesions. It usually occurs in women who have either chlamydia or gonorrhoea.

A

fitz hugh curtis syndrome

148
Q

shoudl aspirin be stopped in aki

A

not if cardio protective

149
Q

ace inhibitor significantly worsens renal function suspect

A

renal artery stenosis

150
Q

ace inhibitor significantly worsens renal function suspect

A

renal artery stenosis

151
Q

how are primary and secondary aldosteronism differentiated

A

Primary and secondary aldosteronism can be differentiated by looking at the renin levels. If renin is high then a secondary cause is more likely, i.e renal artery stenosis.

152
Q

ckd vs aki

A

bilateral shrunken kidneys and hypocalcaemia

153
Q

best investigation for hydronephrosis

A

us

154
Q

severe hepatitis in a women

A

hepatitis e

155
Q

tender goitre and hyperthyrodism

non tender

A

dequiverains thyroiditis

non tender= graves

156
Q

pneumoperitoneum occurs in which condition

A

bowel perforation

157
Q

rose spots on trunk after holiday

A

typhoid

158
Q

rose spots on trunk after holiday

A

typhoid

159
Q

upper gi bleed land mark

A

The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the ligament of Treitz

160
Q

which drugs reduce mortality in heart failure

A

ACE-inhibitors
Beta-blockers
Angiotensin receptor blockers
Aldosterone antagonists
Hydralazine and nitrates

161
Q

chicken pox ezposure before 20 weeks and after 20 weeks

A

before 20 wereks check antibodies and give vzig

after 20 weeks vzig or antivirals 7-14 days after exposure

162
Q

scalp psoriasis management

A

NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks
if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

163
Q

management of infectious mononucleosis

A

rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

164
Q

serotonin syndrome caused by

A

monoamine oxidase inhibitors
SSRIs
St John’s Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
ecstasy
amphetamines

165
Q

how do we monitor haemchromatosis

A

ferritin and transferrin sat
low tibc

165
Q

how do we monitor haemchromatosis

A

ferritin and transferrin sat
low tibc

166
Q

order of management in hyperkalaemia

A

Stabilisation of the cardiac membrane
IV calcium gluconate
does NOT lower serum potassium levels

Short-term shift in potassium from extracellular (ECF) to intracellular fluid (ICF)
compartment
combined insulin/dextrose infusion
nebulised salbutamol

Removal of potassium from the body
calcium resonium (orally or enema)
enemas are more effective than oral as potassium is secreted by the rectum
loop diuretics
dialysis
haemofiltration/haemodialysis should be considered for patients with AKI with persistent hyperkalaemia

167
Q

metclopromide should be avoided in

A

bowel obstruction

168
Q

causes of drug induced lupus

A

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

169
Q

when do we give abx in copd

A

They recommend giving oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’
the BNF recommends one of the following oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.

170
Q

non communicating hydrocephalus
headache
syringomyelia

A

Arnold-Chiari malformation

171
Q

Management of mania/hypomania in patients taking antidepressants

A

stopping the antidepressant and start antipsychotic therapy

172
Q

pkd associated with which valve abnormality

A

mitral valve prolapse

173
Q

lower than expected levels of hba1c caused by

A

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis

174
Q

higher than expected levels of hba1c

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

175
Q

diabetic neuropathy

A

sensory loss in a ‘glove and stocking’ distribution, with the lower legs affected first

176
Q

hypomagnasemia treatment

A

<0.4 mmol/L or tetany, arrhythmias, or seizures
intravenous magnesium replacement is commonly given.
an example regime would be 40 mmol of magnesium sulphate over 24 hours

> 0.4 mmol/l
oral magnesium salts (10-20 mmol orally per day in divided doses)
diarrhoea can occur with oral magnesium salts

177
Q

high risk baby

A

passmed Feverish illness in children

178
Q

hashimotos thyroiditis associated with which cancer

A

Hashimoto’s thyroiditis is associated with thyroid lymphoma

179
Q

all patients with mi should be given

A

dual antiplatelet therapy (aspirin plus a second antiplatelet agent-
ACE inhibitor
beta-blocker
statin

180
Q

non fasted patients emergency setting do not use

A

laryngeal mask as not safe against aspiration

181
Q

in heart failure which medication should we be careful with?

A

cyclizine as can reduce cardiac output

181
Q

in heart failure which medication should we be careful with?

A

cyclizine as can reduce cardiac output

182
Q

urinary incontinence
Urge incontinence

A

detrusor overactivity, urge to urinate followed by uncontrollable bladder emptying

bladder retraining
oxybutynin–> old= mirabegron

183
Q

stres incontinence

A

laughing/coughing
Pelvic muscle training and duloxetine

184
Q

functional incontinence

A

comorbid physical conditions impair the patient’s ability to get to a bathroom in time
causes include dementia, sedating medication and injury/illness resulting in decreased ambulation

185
Q

abx for whooping cough

A

clarithromycin, azithromycin or erythromycin

186
Q

ruptured AAA vs aortic dissection

A

ruptured aaa- hypotension

aortic dissection= raised bp

187
Q

keloid scars

A

sternum, shoulder, neck, face, extensor surface of limbs, trunk

steroids and excision

188
Q

causes of rapidly progressive glomerulonephritis

A

Goodpasture’s syndrome
Wegener’s granulomatosis
others: SLE, microscopic polyarteritis

formation of epithelial crescents on glomeruli

189
Q

SAH- electrolyte abnormalityu

A

SIADH - hyponatraemia

190
Q

blood product transfusion reactions

Non haemolytic febrile reaction

Minor allergic reaction

anaphylaxis

Acute haemolytic reaction

Tranfusion associated circulatory overload

TALI

A

Non haemolytic febrile reaction- fever chills- give paracetamol, slow and stop transfusion

Minor allergic reaction- pruritus and urticaria, temporary slow and stop transfusion and give antihistamines

anyphylaxis occurs when IgA deficiency and anti-IgA antibodies- stop supportive and IM adrenaline

acute haemolytic reaction- occurs due to human error- fever abdominal pain hypotension, stop transfusion and check identity send for cooms test

TACO- pulmonary oedema and hypertension- slow/stop transfusion give IV loop diuretic

TRALI- lung issue and hypotension= stop transfusion and give oxygen

190
Q

blood product transfusion reactions

Non haemolytic febrile reaction

Minor allergic reaction

anaphylaxis

Acute haemolytic reaction

Tranfusion associated circulatory overload

TALI

A

Non haemolytic febrile reaction- fever chills- give paracetamol, slow and stop transfusion

Minor allergic reaction- pruritus and urticaria, temporary slow and stop transfusion and give antihistamines

anyphylaxis occurs when IgA deficiency and anti-IgA antibodies- stop supportive and IM adrenaline

acute haemolytic reaction- occurs due to human error- fever abdominal pain hypotension, stop transfusion and check identity send for cooms test

TACO- pulmonary oedema and hypertension- slow/stop transfusion give IV loop diuretic

TRALI- lung issue and hypotension= stop transfusion and give oxygen

191
Q

heart failure not responding to ace i beta blocker aldosterone antagonist
next step IF

-Widended QRS complex

-Hr above 75 LVEF below 35%

A

widended qrs= Cardiac resynchronisation therapy

HR above 75- ivabradine

192
Q

nitrous oxide should be used in caution in?

A

pneumothorax

193
Q

classification of cerebral palsy `spastic-

A

increased tone from UMN

Dyskinetic- damage to basal ganglia and substantia nigra

Ataxic- cerebellum

194
Q

renal tubular acidosis

A

all of them have hypercloraemic metabolic acidosis normal anion gap

type 1- inability to secrete h+ ions in distal tubule, leads to hypokalaemia

Type 2- decreased hco3- reabsorption inpct= hypokalamaeia

Type 4= reduced production in aldosterone= hyperkalaemia

195
Q

in anayphylaxis after 2 doses opf IM adrenaline whaty dow e give

A

expert help should be sought for consideration of an IV adrenaline infusion

196
Q

discharge during anaphylaxis

A

fast-track discharge (after 2 hours of symptom resolution):
good response to a single dose of adrenaline
complete resolution of symptoms
has been given an adrenaline auto-injector and trained how to use it
adequate supervision following discharge
minimum 6 hours after symptom resolution
2 doses of IM adrenaline needed, or
previous biphasic reaction
minimum 12 hours after symptom resolution
severe reaction requiring > 2 doses of IM adrenaline
patient has severe asthma
possibility of an ongoing reaction (e.g. slow-release medication)
patient presents late at night
patient in areas where access to emergency access care may be difficult
observation for at 12 hours following symptom resolution

197
Q

discharge during anaphylaxis

A

fast-track discharge (after 2 hours of symptom resolution):
good response to a single dose of adrenaline
complete resolution of symptoms
has been given an adrenaline auto-injector and trained how to use it
adequate supervision following discharge
minimum 6 hours after symptom resolution
2 doses of IM adrenaline needed, or
previous biphasic reaction
minimum 12 hours after symptom resolution
severe reaction requiring > 2 doses of IM adrenaline
patient has severe asthma
possibility of an ongoing reaction (e.g. slow-release medication)
patient presents late at night
patient in areas where access to emergency access care may be difficult
observation for at 12 hours following symptom resolution

198
Q

causes of erythema nodosum

A

infection
streptococci
tuberculosis
brucellosis
systemic disease
sarcoidosis
inflammatory bowel disease
Behcet’s
malignancy/lymphoma
drugs
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy

199
Q

how does digoxin work

A

inhibits Na+ k+ ATPase pump
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

Percipitated by anything hypo

200
Q

globus hoarseness and no red flags

A

Globus, hoarseness and no red flags → ?laryngopharyngeal reflux

201
Q

HOCM managment

A

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

Drugs to avoid
nitrates
ACE-inhibitors
inotropes

202
Q

in renal artery stenosis how do we manageme bp

A

ccb

203
Q

reinfection with syphilis if

A

Reinfection with syphilis should be suspected if the RPR rises by 4-fold or more

204
Q

what is maddreys discriminant function

A

calculated by a formula based on the prothrombin time and serum bilirubin for alcoholic liver disease

205
Q

when is warfarin stopped before surgery

A

5 days before

206
Q

syphilis abxc treatment problem

A

the Jarisch-Herxheimer reaction is sometimes seen following treatment

just give paracetamol

207
Q

patients who are allergic to aspirin may also be allergic to

A

sulfazaline

207
Q

patients who are allergic to aspirin may also be allergic to

A

sulfazaline

208
Q

iniital investigations in incontinence

A

bladder diaries should be completed for a minimum of 3 days
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
urine dipstick and culture
urodynamic studies

209
Q

what is the msot specific and sensitive lab finding in cirrhosis, in those who have liver disease

A

Thrombocytopenia (platelet count <150,000 mm^3) is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease

210
Q

hep b post exposure

A

accelerated course of hep b vaccine and hep b immune globulin

211
Q

hep b post exposure

A

accelerated course of hep b vaccine and hep b immune globulin

212
Q

PSA levels may be raised by therefore should wait how long before testing

A

benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

213
Q

before starting bisphosphonates important to correct

A

hypocalcaemia and vit d deficiency

214
Q

antiphospholipid syndrome treatment

A

if no previous thromboses- low dose aspirin
if previous then give warfarin

215
Q

ankle ottawa rules

A

to know when to giev xray

bony tenderness at lateral malleolar zone
bony tenderness at medial malleolar zone
inability to walk four weight bearing steps

216
Q

supraspinatus tendonitis and subacromial impingement painfula rc features

A

Rotator cuff injury
Painful arc of abduction between 60 and 120 degrees
Tenderness over anterior acromion

217
Q

signs of sepsis and lower limb neurology

A

possible epidural abscess

218
Q

metabolic acidosis with normal anion gap

A

Normal anion gap between 10-18

gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

219
Q

metabolic acidosis with raised anion gap

A

actate:
shock
sepsis
hypoxia
ketones:
diabetic ketoacidosis
alcohol
urate: renal failure
acid poisoning: salicylates, methanol

220
Q

how should bisphosphonates be taken

A

Oral bisphosphonates should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking

221
Q

in billiary colic what happens to the lfts

A

in biliary colic there is no fever and LFTs/inflammatory markers are normal

222
Q

what is ludwigs angina

A

progressive cellulitis that invades the floor of the mouth

life threatening emergency
airway management and IV ABX

223
Q

what is ludwigs angina

A

progressive cellulitis that invades the floor of the mouth

life threatening emergency
airway management and IV ABX

224
Q

incisions

A

Midline incision
Commonest approach to the abdomen
Structures divided: linea alba, transversalis fascia, extraperitoneal fat, peritoneum (avoid falciform ligament above the umbilicus)
Bladder can be accessed via an extraperitoneal approach through the space of Retzius
Paramedian incision
Parallel to the midline (about 3-4cm)
Structures divided/retracted: anterior rectus sheath, rectus (retracted), posterior rectus sheath, transversalis fascia, extraperitoneal fat, peritoneum
Incision is closed in layers
Battle
Similar location to paramedian but rectus displaced medially (and thus denervated)
Now seldom used
Kocher’s Incision under right subcostal margin e.g. Cholecystectomy (open)
Lanz Incision in right iliac fossa e.g. Appendicectomy
Gridiron Oblique incision centered over McBurneys point- usually appendicectomy (less cosmetically acceptable than Lanz
Gable Rooftop incision
Pfannenstiel’s Transverse supra pubic, primarily used to access pelvic organs
McEvedy’s Groin incision e.g. Emergency repair strangulated femoral hernia
Rutherford Morrison Extraperitoneal approach to left or right lower quadrants. Gives excellent access to iliac vessels and is the approach of choice for first time renal transplantation.

225
Q

how are asymptomatic patients monitored in mitral stenosis

A

monitored with regular echocardiograms

226
Q

what should be stopped in cdiff infections

A

opioids

227
Q

obesity with abnormal lfts

A

non alcoholic fatty liver disease

228
Q

Psoriatic arthiritis worrying complication

A

cardiovascular disease

229
Q

management of lichen scleoriss

A

clobetasol propionate - a steroid

230
Q

most common central line infection

A

staphylococcus epidermis

231
Q

pathological fractures in bones prevented by

A

bisphosphonates if eGFR below 30 then denosumab

232
Q

osteroporosis in a man make sure to check

A

serum testosterone

232
Q

osteroporosis in a man make sure to check

A

serum testosterone

233
Q

urinary incontinence first line treatments

A

Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training

233
Q

urinary incontinence first line treatments

A

Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training

234
Q

klebsiella pneumonia can cause what lung pathology

A

pleural empyema

235
Q

bronchiecstasis most common organisms

A

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

236
Q

copd sympotms in a young patient think?

A

a1at

237
Q

Recurrent chest infections + subfertility

A

think cf if negative then

think primary ciliary dyskinesia syndrome (Kartagener’s syndrome)

238
Q

facial rash and lymphadenopaty

A

sarcoidosis

239
Q

high risk of post op vomiting give what?

A

propofol

240
Q

metronidazole and alcohol=

A

disulifram reaction

241
Q

mnd how do we feed

A

peg tube

242
Q

boerhaave syndrome IX and management

A

ct
Treatment is with thoracotomy and lavage

243
Q

red flag for lower back pain

A

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
thoracic pain

244
Q

bowel perforation first line iX

A

ax double wall sign

245
Q

contraindications to stroke thromolysis

A

active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension

246
Q

inhaler technique

A
  1. Remove cap and shake
  2. Breathe out gently
  3. Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply
  4. Hold breath for 10 seconds, or as long as is comfortable
  5. For a second dose wait for approximately 30 seconds before repeating steps 1-4.

Only use the device for the number of doses on the label, then start a new inhaler.

247
Q

in haemorrhage shock, BP does not fall until abou

A

30% blood loss

248
Q

managment of type 2 diabetes

A
249
Q

what does a p450 inducer do to cocp

A

reduces effectiveness

250
Q

for a bone fracture what do we do first

A

frax then dexa

251
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

A

dengue fever

252
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

A

dengue fever

253
Q

Management of mania/hypomania in patients taking antidepressants

A

consider stopping the antidepressant and start antipsychotic therapy

254
Q

chronic lithium toxicity leads to

A

hypothyroidism and high calcium and leucocytosis

255
Q

type 1 bipolar is associated with

A

mania
type 2= hypomania

256
Q

type 1 bipolar is associated with

A

mania
type 2= hypomania

257
Q

how do we tell if parvovirus or acute sequestration

A

acute sequestration and haemolysis have a high reticulocyte count

258
Q

threshold blood trasnfusions

A

70 in no acs
80 if acs

259
Q

cryoprecipitate constitutes of?

A

factor 8, fibrinogen, vwf, factor 13

260
Q

positive coombs test

A

autoimmune haemolytic anaemia

261
Q

cll assocated with

A

warm autoimmune haemolytic anaemia and transformation to high grade lymphoma

262
Q

large vessel vasculitis

A

temporal arteritis and takaysus arteritis

263
Q

medium vessel vasculitis

A

polyarteritis nodosa and kawasaki disease

264
Q

small vessel vasculitis

A

ANCA-associated vasculitides
granulomatosis with polyangiitis (Wegener’s granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis
immune complex small-vessel vasculitis
Henoch-Schonlein purpura
Goodpasture’s syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)

265
Q

what is eosinophillic granulamatosis with polyangitis churg strauss syndrome

A

PANCA mediated small vessel vasculitis
asthma
eosinophillia
sinusitis

266
Q

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

A

CANCA
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulon

steroids and cyclophosphamide

267
Q

what is buergers disease

A

thromboangilitis obliterans
leg ischaemia and rayndaud phenomenon associated with smoking

268
Q

what is anti glomerular basemenet membrane disease

A

good pastures
pulmonary haemorrhage and rapidly progressive glomerulonephritis

renal biopsy: linear IgG deposits along the basement membrane

plasma exchnage steroids and cyclophosphamide

269
Q

metformin MOA SX

A

biguanide
reduces hepatic gluconeogenesis and increases insulin sensitivity

Nausea and vomiting
GI discomfort
Acute kidney injury
Lactic acidosis

270
Q

sulfonylureas

A

gliclazide and glibenclamide
Bind to and close ATP-K+ channel on Beta cells causing depolarisation and insulin release

weight gain and hypoglycaemia

271
Q

Thiazolidinediones

A

pioglitazone
reduces insulin resistance
Weight gain
Fluid retention
Hepatotoxicity
Bladder cancer

272
Q

dpp4 inhibitors

A

linagliptin, sitagliptin
Prevent degradation of incretins and therefore promote insulin secretion

pancreatitis

273
Q

sglt-2 inhibitors

A

dapagliflozin, empagliflozin
Inhibit sodium-glucose co-transporter 2 in the proximal tubule causing urinary glucose excretion
utis

best for cardio risk

274
Q

GLP-1 mimetics

A

liraglutide

Incretin mimetic which stimulates insulin secretion

Causes weight loss

Reduced appetite
Nausea and vomiting
Pancreatitis

275
Q

uc management

A

Inducing remission:
first line if mild/moderate= topical asa if that doesn’t work then go for oral
if that doesnt work oral corticosteroid

If there is extensive disease then topical and oral asa

Severe - admit iv corticosteroids and iv ciclosporin

Maintenance of remission- Topical ASA or oral asa if severe
Oral azathiprine or mercaptopurine

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either oral azathioprine or oral mercaptopurine to maintain remission

276
Q

before starting azathioprine or mercaptopurine what should we do?

A

assess TPMT activity

277
Q

inducing remission in crohns

A

glucocorticoids

if moderate azathiprine/mercaptopurine

maintaining remission
1st line: Azathioprine or mercaptopurine

278
Q

inguinal hernia repairs

A

mesh repair is associated with the lowest recurrence rate
unilateral inguinal hernias are generally repaired with an open approach
WITHIN 2 WEEKS

279
Q

safest method of contraception in breast cancer

A

copper coil

280
Q

Ferritin is low in iron deficiency anaemia but high or normal in anaemia of chronic disease

A

02F (18 decks)

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