Misc Flashcards
antibiotic treatment for an animal bite
co-amoxiclav
doxycycline and metronidazole if pen allergic
indications for haemodialysis in salicylate OD
conc >700mg/dL coma seizures metabolic acidosis resistant to treatment pulmonary oedema AKI
features of a salicylate (aspirin) OD
> 2.5mmol/l (350mg/dl) indicates significant poisoning, >5.1 (700) is associated with death
pyrexia hyperventilation (centrally acting) tinnitus lethargy n&v seizures and coma
Rheumatoid arthritis HLA association
HLA DR4
- rheumatoid arthritis
- type 1 DM
HLA B27 associations
reiter’s syndrome (can’t see can’t pee can’t stand on 1 knee)
acute anterior uveitis
ank spond
cyclophosphamide:
mode of action
SEs - and how to prevent them
alkylating agent- causes crosslinking in DNA haemorrhagic cystitis (mesna binds urotoxic metabolites) myelosuppression, transitional cell carcinoma
methotrexate
mode of action
SEs
inhibits dihydrofolate reductase
myelosuppression, liver and lung fibrosis, mucositis
Vincristine
action
SEs
inhibits microtubule formation peripheral neuropathy (reversible), paralytic ileus
Features of Wegener’s Granulomatosis
upper resp: epistaxis, sinusitis, nasal crusting
lower resp: SOB, haemoptysis
renal: rapidly progressive glomerulonephritis
vasculitic rash
Ix for wegener’s granulomatosis
cANCA >90% positive
renal biopsy: epithelial crescents in bowman’s capsule
what is the most common infection in solid organ transplant patients?
Rx?
cytomegalovirus (CMV) - inclusion bodies seen
Rx with ganciclovir
Features of lead poisoning
abdominal pain peripheral neuropathy (mainly motor) constipation blue lines in gums (in 20%) fatigue microcytic anaemia
What is the cause of pellagra and what are the features?
B3 (niacin) deficiency
3 Ds: dementia, dermatitis, diarrhoea
can also be due to isoniazid Rx (stops conversion of tryptophan to niacin)
which complement levels are low in SLE?
C3 and C4
which SLE antibody is associated with congenital heart block?
anti-ro
Treatment of accidental adrenaline injection
Phentolamine (alpha 1 blocker) injection
Vasodilates the affected area
What is the indication for starting treatment for osteoporosis?
T score < -2.5 in post menopausal women or steroid induced
or woman >75 with clinical suspicion (DEXA not necessarily needed)
What is the treatment for osteoporosis?
bisphosphonate - alendronate 1st line, risedronate 2nd line
calcium and vit D supplements
features of severe pre-eclampsia
headache RUQ/epigastric pain papilloedema visual disturbance hyper-reflexia/clonus hypertension >170/110 platelets <100, abnormal LFTs or HELLP syn (Haemolysis, Elevated Lfts, Low Platelets)
What is the therapeutic range for lithium and when do you take bloods for monitoring?
0.4-1
take 12 hours post dose
What is the target range for digoxin and when do you take bloods for monitoring?
0.5-1
6 hours post dose
Indications for plasma exchange
neuro: acute guillian barre, MG, chronic inflam demyelinating polyneuropathy
haem: TTP, cyroglobinaemias, hyperviscosity syndromes, post transfusion purpura
renal: Goodpastures, ANCA positive nephritis
metabolic: hypercholesterolaemia, Refsum’s disease
reason for azathioprine toxicity in a patient
thiopurine methyltransferase deficiency
1 in 200 people
leads to pancytopenia
Features and pathology of Botulism
toxinogenic strains of Clostridium botulinum
usually caught from improperly tinned foods, meats seafoods and injecting abscesses.
Sx: diplopia, blurred vision, photophobia, bulbar palsy, ataxia, sudden cardioresp failure. No GI symptoms.
Dx and Mx of botulism
Dx: stool culture, blood test to identify toxin.
Mx: early intubation and Mx on ITU.
Give antitoxin asap to avoid cardiac arrest
Risk stratification for aspirin (salicylate) poisoning
> 125mg/kg - likely no effect
125-250mg/kg - mild
350 - 500 - moderate
500mg/kg - severe (eg 35g in 70kg man)
features of digoxin toxicity
arrhythmias - ventricular bi/trigeminy, atrial tachycardia with CHB
n&v and diarrhoea
confusion
yellowing of vision (xanthopsia), blurred vision and photophobia
Mx of digoxin toxicity
activated charcoal (within 6-8 hours of acute ingestion)
cholestyramine (binding resin, prevents enterohepatic circulation. Better for chronic toxicity)
If high K+, insulin/dextrose. AVOID calcium (as can precipitate VT/VF)
digibind (digoxin immune Fab)
Phenytoin (or lidocaine) for VT if digibind unavailable/ineffective
