misc medicine Flashcards
What are the different hypersensivity reactions according to the Gell-Coombs classifications?
Type 1-4, think ACID
A - Anaphlyaxis, asthma - IgE mediated eg atopy
C - Cell bound - cytotoxic antibody-mediated responses involving IgG or IgM antibodies eg hemolytic transfusion reactions, ITP, Goodpasture’s syndrome, Pernicious anaemia, Rheumatic fever, Pemphigus vulgaris / bullous pemphigoid
I - Immune Complex - between antigens and IgG or IgM antibodies eg SLE, Post-streptococcal glomerulonephritis, EAA
D - Delayed hypersensitivity - T lymphocytes eg contact dermatitis, MS, tuberculin skin reaction, Graft versus host disease, Allergic contact dermatitis, Scabies, EAA, GBS
IgG vs IgM positivity?
IgG positive & IgM negative - shows immunity
IgG negative & IgM positive - shows recent infection
What conditions tend to be AR vs AD inheritance?
Autosomal recessive conditions are often thought to be ‘metabolic’ as opposed to autosomal dominant conditions being ‘structural’, notable exceptions:
some ‘metabolic’ conditions such as Hunter’s and G6PD are X-linked recessive whilst others such ashyperlipidaemia type IIandhypokalaemic periodic paralysisare autosomal dominant
some ‘structural’ conditions such as ataxia telangiectasia and Friedreich’s ataxia are autosomal recessive
Mx of Ramsay Hunt syndrome
oral aciclovir + corticosteroids + eye protection
Dose of adrenaline in anaphylaxis for:
>12s
6-12 yrs
<6 yrs
> 12s - 500mcg
6-12 yrs -300mcg
<6 yrs - 150mcg
How often do you need one-off pneumococcal vaccination?
One off for most at risk groups
some need every 5 yrs - sickle cells, aspleenics
Skin patch vs prick test?
Patch - contact dermatitis, leave allergen on skin for 48 hrs
Prick - immediate hypersensivity (wheal) eg food or resp allergies
CI in anaphylaxis!! Use rast test instead
chadsvasc score?
CHF
HTN
Age (1 point for 65-74, 2 for >75)
Diabetes
Stroke/ TIA/ VTE - 2 points
vascular disease
sex
How do you calculate the anion gap? What should it be? Causes of raised vs normal anion gap?
The anion gap is calculated by:
(sodium + potassium) - (bicarbonate + chloride)
A normal anion gap is 8-14 mmol/L
It is useful to consider in patients with a metabolic acidosis:
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
Causes of a raised anion gap metabolic acidosis
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
What is the parkland formula/ how do you calculate?
for burns
Volume of fluid = total body surface area of the burn % x weight (Kg) x 4ml
How do you treat tetanus status for wounds?
Tetanus prone wound = contaminated environment, contain foreign bodies, compound fracture, sepsis, animal bite/ scratch. If not this eg cut hand in kitchen whilst cutting tomato → no need to tetanus administer
Patient has had a full course of tetanus vaccines (5 doses), with the last dose < 10 years ago
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
X linked recessive inheritance mech?
In X-linked recessive inheritance only males are affected. An exception to this seen in examinations are patients with Turner’s syndrome, who are affected due to only having one X chromosome. X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.
What are the main inhaled anaesthetic induction agents? Adverse effects?
volatile liquid eg isoflurane - can cause malignant hyperthermia
Nitrous oxide CI in pneumothorax
What IV agents are used for induction in anaesthetics? Adverse effects?
Propofol - causes hypotension, has anti-emetic properties
Thiopental- laryngospasm
Etomidate- myoclonus
Ketamine - hallucinations, not hypotensive
What is Varenicline?
a nicotinic receptor partial agonist
Start 1 week before stop smoking food r 12 weeks total
CI: depression, breast feeding, pregnancy
What is Bupropion? CI?
a norepinephrine-dopamine reuptake inhibitor and nicotinic antagonis
Start 1-2 weeks prior to stopping smoking
CI: epilepsy, pregnancy and breast feeding. Eating Disorders is relative CI
Which vaccines are live? How far apart do they need to be given?
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
Need 4 weeks between them
Vaccine schedule?
2 months: 6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
3 months: 6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
4 months: 6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B
12 months: Hib/Men C
MMR
PCV
Men B
2-8 years:Flu vaccine (annual)
3-4 years: 4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR
13 years: HPV
13-18 years: ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
DVLA instructions for:
Angioplasty
CABG
ACS
Angina
Pacemaker
ICD for ventricular arrhythmia
Catheter ablation
Aortic aneurysm
Heart transplant
angioplasty (elective) - 1 week off driving
CABG - 4 weeks off driving
acute coronary syndrome- 4 weeks off driving
1 week if successfully treated by angioplasty
angina - driving must cease if symptoms occur at rest/at the wheel
pacemaker insertion - 1 week off driving
ICD if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
successful catheter ablation for an arrhythmia- 2 days off driving
aortic aneurysm of 6.5 cm or more disqualifies patients from driving
heart transplant: do not drive for 6 weeks, no need to notify DVLA
DVLA instructions for:
Syncope
Stroke/ TIA
Multiple TIAs over 3 months
Craniotomy
Trans sphenoidal surgery
Narcolepsy/ cataplexy
Chronic neurological disorder eg MS
Syncope
simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit
multiple TIAs over short period of times: 3 months off driving and inform DVLA
craniotomy e.g. For meningioma: 1 year off driving
pituitary tumour: craniotomy: 6 months;
trans-sphenoidal surgery ‘can drive when there is no debarring residual impairment likely to affect safe driving
narcolepsy/cataplexy: cease driving on diagnosis, can restart once ‘satisfactory control of symptoms’
chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: inform DVLA
How long do you need to observe someone with anaphylaxis before d/c?
Need to observe people with anaphylaxis for 6 hrs before discharge
What is low in inherited angioedema?
Low complement c1 = inherited angioedema
Features of X linked dominant inheritance?
X linked dominant = no male to male transmission, all daughters of a man affected will have the trait
