Misc. Flashcards
Stress incontinence - Tx?
(1) Pelvic floor exercises
(2) Duloxetine
(3) Colposuspension
(4) Intramural bulking agents
(5) nerve stimulation
Urge incontinence - Tx?
(1) Bladder re-training
(2) Anti-muscarinics
- Oxybutynin (IR)
- Tolterodine
- Solifenacin
- Darifenacin
(3) - If frail/elderly –> Mirabegron (B3-agonist)
(4) Botox into bladder
(5) Nerve stimulation
High QRISK 2 score. Started on Atorvastatin 20mg ON. 3 month follow up target?
In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%
Ethylene glycol overdose - Tx?
Bisoprolol overdose - Tx?
(1) IV Atropine
(2) IV Glucagon
DHx Warfarin. Started new TB drug. Now raised INR.
What drug?
Isoniazid
DHx Warfarin. Started new TB drug. Now decreased INR.
What drug?
Rifampicin
Which organelle does catabolism of long chain fatty acids?
Peroxisome
Dermatitis herpetiformis
Which HLA?
HLA-DR3
TCA overdose - Tx?
IV Bicarbonate
Conversion ratios
S/C morphine –> PO Morphine
PO Oxycodone –> PO Morphine
PO Codeine –> PO Morphine
PO Tramadol –> PO Morphine
Which opioid in renal impairment can you use
- If eGFR 30-60
- Oxycodone
- If eGFR < 30
- Buprenorphine patch
- Fentanyl parch
- Alfentanil (under specialist advice)
Bony metastases pain - Tx?
Tx: NSIADs
+/- Opiates
+/- Bisphosphonates (pain improves within 4 weeks)
+/- Radiotherapy (pain improves within 6 weeks)
How to titrate morphine
Starting dose
- PO Morphine sulphate 5mg every 4 hours (30mg/day)
- PRN Oromoprh IR 5mg for breakthrough pain
Up-titrating if pain is not > 90% relieved
- Method 1
- Increase dose by 30-50%
- Method 2
- Calculate total daily dose (including PRN doses)
- Divide into 2x 12 hourly doses as BD modified release
- Calculate new PRN dose (1/6 total daily dose)
Breakthrough pain
Tx?
Immediate release morphine sulphate (e.g. Oromorph)
Dose = 1/6 TOTAL daily dose
PRN every 4-6 hours
Palliative medications
Agitation + Anxiety
Agitation + Delirium
SOB
Secretions
Diffuse oral pain
Hiccups
Agitation + Anxiety –> Midazolam
Angitation + Delirium –> Haloperidol or Levomepromazine or Chlorpormazine
SOB –> Morphine
Secretions –> Hyoscine butylbromide or Glycopyrronium bromide
Diffuse oral pain –> Benzydamine mouthwash
Hiccups –> Chlorpromazine
Alcohol abstinence maintainence therapy
-
Disulfiram (unpleasant symptoms after drinking)
- MOA: Inhibits acetaldehyde dehydrogenase –> ↑ acetaldehyde –> ↑ N&V, mimics flush reaction
-
Acamprosate (↓ cravings)
- MOA: unknown –> ↑ GABA –> ↓ craving
- ↓ pleasurable effects of alcohol
-
Naltrexone
- MOA: µ-opiate receptor antagonist –> ↑ GABA –> ↓ DA
- ↓ pleasurable effects of alcohol
- Can safely drink
Aspirin overdose - Tx
IV sodium bicarbonate
If within 12 hours –> Oral activated charcoal
+/- Haemodialysis
Aspirin overdose - ABG
Mixed respiratory alkalosis + metabolic acidosis
hyperventilation –> respiratory alkalosis
salicylate –> metabolic acidosis
CO poisoning - Tx
Hyperbaric oxygen
“Brick-red skin”
Smell of “bitter almonds”
Headache
Confusion
Ataxia
Diagnosis? MOA? Tx?
Cyanide poisoning
Cyanide inhibits Cytochrome C
Tx: IV Hydroxocobalamin
or Combination of Amyl nitrite (inhaled) + IV Sodium nitrite + IV Sodium thiosulfate
Basophilic stippling
Abdominal pain
Confusion
Diagnosis? Treatment?
Lead poisoning
Tx: Dimercaprol
Benzodiazepine overdose - Tx
Flumazenil
S/E: Seizures
Methanol overdose & Ethylene glycol vose
Tx?
Fomepizole
Heparin overdose - Tx
Protamine sulphate
Iron overdose - Tx
Desferrioxamine
Lithium overdose - Tx
IV 0.9% saline
Haemodialysis
Local anaesthetic toxicity
Tx?
IV Lipid Emulsion 20%
Aflatoxin
Aniline
Risk factors for what cancer
Aflatoxin -> alpha fetoprotein -> liver cancer
Aniline -> urine -> bladder cancer
Bladder cancer
Most common type
Most common type associated with Schistosomiasis
Bladder cancer
- Transitional cell carcinoma (90%)
- Squamous cell carcinoma - associated with Schistosomiasis
- Adenocarcinoma (rare)
Once lung cancer is diagnosed, what Ix to assess suitability for surgical resection
PET scan:
to look for extent of primary tumour and any mets
Small cell + Squamous cell lung cancer
Paraneoplastic syndromes
Tx for neutropenic sepsis
Tazocin + Gentamicin
VIPoma presentation
Most arise from Pancreas
WDHA syndrome
- WD = Watery diarrhoea
- H = Hypokalaemia
- A = achlorhydia (absence of hydrochloric acid secretion)
Factors affecting PSA levels
Medical Tx for prostate cancer
GnRH agonist (Goserelin)
+ Anti-androgen (Cryproterone acetate)
- co-presecribed to prevent initial increase Testosterone
Thyroid cancer
Most common types
Most aggressive type
Most slow growing
Associated with MEN2A/2B
Associated with Hashimoto’s thyroiditis
Thyroid cancer
Most common types –> Papillary
Most aggressive type –> Anaplastic
Slow growing –> Follicular
Associated with MEN2A/2B –> Medullary (Parafollicular C cells)
Associated with Hashimoto’s thyroiditis –> MALT lymphoma
Unilateral sensorineural hearing los
Tinnitus
Facial palsy
Absent corneal reflex
Diagnosis?
Associations?
Most common location
Acoutstic neuroma = vestibular schwannoma
Associated with NF2
Most commonly located at the cerebellopontine angle
BPPV
Dix-Hallpike vs Epley
Dix-Hallpike manoeuvre is diagnostic
Epley manoeuvre is for treatment
Recurrent vertigo
Caused by movement
Diagnosis?
BPPV
Episodic vertigo
Sensorineural hearing loss
Tinnitus
Sensation of fullness (in affected ear)
Horizontal nystagmus
Diagnosis
Meniere’s disease
Recent viral illness
Vertigo (room spinning)
Horizontal nystagmus
+ve head impulse
Normal hearing
Single episode
DDx from BPPV and Vestibular migraine
which require recurrent episodes for diagnosis
Vestibular neuritis
Single episode –> DDx from BPPV and Vestibular migraine
which require recurrent episodes for diagnosis
Recent URTI
Sensorineural hearing loss
Vertigo
Diagnosis?
Labyrinthitis
Von Hippel Lindau
aetiology
presentation
Von Hippel Lindau
Autosomal dominant mutation in VHL gene
- Café au lait macules
- Haemangiomas
- CNS haemangiomas –> subarachnoid haemorrhage
- Retinal haemangiomas –> Vitreous haemorrhage [often 1st sign]
Alports syndrome
Aetiology
Presentation
Alports syndrome
X linked dominant
- Triad
- Haematuria –> Renal failure
- Sensorineural deafness
-
Ocular pathology
- Lens dislocation
- Retinitis pigmentosa
- Renal biospy: “baseket weave appearance” of GBM
Achondroplasia
Aetiology
Features
Achondroplasia
Autosomal dominant mutation in FGFR3 gene
- Short stature
- Long bone shortening
- Trident hands
- Flat nasal bridge with frontal bossing
- Narrow foramen magnum
Bartter vs Gitelman vs Liddle syndrome
Bartter (Barffer = Furosemide = Loop diuretic)
- Defect in Na-K-Cl co-transporter in LoH (similar to Furosemide)
- Hypokalaemia + Normotension
Gitelman (GiTelman = Thiazide = Na Cl in DCT)
- Defect in NaCl co-transporter in DCT (similar to Thiazides)
- Hypokalaemia + Normotension
Liddle (Liddle Conn / Little Kong)
- Defect in Na channels in DCT –> increase Na absorption (similar to Conn’s)
- Hypokalaemia + Hypertension
Pseudomembranes on the tonsils
Diagnosis?
Diphtheria
HIV and opportunistic infections
HHV 1-8
Itchy, maculopapular rash
Classicaly AFTER administration of Amoxicillin or Cephalosporin
Diagnosis?
Cause?
Investigations?
Infectious mononucleosis
EBV
Monospot test for Heterophile antibodies
Anti-EBV antibodies
Atypical lymphocytosis
HPV types and causes
Genital warts –> HPV 6 / HPV 11
Cervical cancer –> HPV 16 / HPV 18
Patches of hypopigmented skin + sensory loss
Diagnosis?
Cause?
Leprosy
Mycobacterium leprae
Painful genital ulcer
Ragged undermined border
Painful inguinal lymphadenopathy
Diagnosis?
Chancroid
Haemophilus ducreyi
MSM (Anal sex)
Painless genital ulcer
Balanitis / Proctitis / Cervicitis
Painful inguinal lympadenopathy
Diagnosis?
Cause?
Lymphogranuloma venerum (LGV)
Chlamydia
Diarrhoea
Weight loss, Arthralgia, Lymphadenopathy
Ophthalmoplegia
Jejunal biopsy shows Macrophages with Periodic acid schiff granlues
Diagnosis? Cause?
Whipple’s disease
Tropheryma whippelii
Tx for schistosomiasis
Praziquantel
Quadrantanopia
Tip: PITS (Parietal-Inferior, Temporal-Superior) for Pie in the Sky
Superior quadrantanopia ==> Lesion of Temporal lobe
Inferior quadrantanopia ==> Lesion of Parietal lobe
Homonymous hemianopia with macular sparing
Lesion?
Occipital cortex
Gradual reduce visual acuity
Glare + Halos
Loss of red reflex
Diagnosis
Cataract
Acute onset, painful red eye
Haloes
Fixed dilated pupil
Diagnosis?
Closed angle glaucoma
Asymptomatic
Peripheral visual field loss / Tunnel vision
Scotoma
Diagnosis?
Open angle glaucoma
Diabetic
Sudden, painless visual loss
New floaters
Blood on retina
Diagnosis?
Vitreous haemorrhage
Drusen
Dry AMD
Choroidal neovascularisation
Wet AMD
Painless deterioration of central vision
AMD
Sudden onset, painless vision loss
Pale retina
Cherry red spot
Diagnosis? Causes?
Central retinal arterial occlusion
Caused by Embolism or Giant Cell Arteritis
Sudden onset, painless loss of vision
Retinal haemorrhages
Diagnosis?
Central retinal vein occlusion
Floaters + Flashing lights
Normal vision
Diagnosis?
Posterior vitreous detachment
Floaters + Flashing lights
Visual field loss
Diagnosis?
Retinal detachment
Vertical diplopia
Patients head tilted to contralateral side
Diagnosis? Cause?
4th nerve palsy
Trauma
Horizontal diplopia
Diagnosis? Cause?
6th nerve palsy
Raised ICP
Horizontal diplopia
Failure of adduction (ipsilateral)
Abducting nystagmus (contralateral)
Diagnosis? Lesion? Cause?
Internuclear ophthalmoplegia (INO)
Lesion in medial longitudinal fasciculus (midbrain/pons)
Caused by MS
Causes of red eye
Holmes-Adie pupil
Features
Holmes-Adie pupil
- Reecent infection –> damage to parasympathetic to eye
- Dilated pupil
-
Slowly reactive to light
- Once constricted, it remains abnormally small for a long period of time
- +/- Absent knee or ankle jerks
Marcus Gunn pupil
Marcus Gunn pupil = RAPD
- MS
- Ischaemic optic disease
- Glaucoma
Hutchinson’s pupil
Hutchinson’s pupil
Compression of CN III by SOL
- Unilaterally dilated pupil
- Unresponsive to light
In contrast, Holmes-Adie is dilated + slowly constricts to light
Argyll-Robertson pupil
Features? Cause?
Argyll-Robertson pupil
Neurosyphilis = “prostitute’s pupil” –> “accommodates but doesn’t react”
- Bilaterally, small pupils
- Do NOT react to bright light
- Normal accommodation
