Mixed practice 3 Flashcards
Which type of pneumonia can cause hyponatraemia
Legionella pneumonia
Symptoms associated with:
Posterior vitreous detachment
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
Symptoms associated with:
Retinal detachment
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
Symptoms associated with:
Vitreous haemorrhage
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
Acne vulgaris in pregnancy treatment:
Erythromycin
Chvostek sign and trousseau sign are positive in which electrolyte disturbance
Eye problem associated:
HYPOcalcaemia
Cataracts
Diagnostic criteria for AKI:
In young adults/children
Absolute rise of creatine >26mmol/l in 48 hours
Absolute increase in creatinine >50% in 7 days
Urine output <0.5ml/kg/hour for more than 6 hours
> = 25% fall in eGFR in children / young adults in 7 days
Which two commonly prescribed medications/supplements can cause malabsorption of thyroxine?
Iron
Calcium carbonate
Should be given 4 hours apart
Which common anti-hypertensive may exacerbate gout and thus, is contraindicated
Bendroflumethiazide
Which drugs may trigger an exacerbation of psoriasis
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
Alcohol
Suspected orbital cellulitis: Order of treatment
IV antibiotics
THEN arrange for urgent CT head
What will arterial gas show in pulmonary embolism?
RESPIRATORY ALKALOSIS
Secondary to hyperventilation
When should ACEis be stopped before surgery:
1 day usually. Is sometimes continued up until surgery
Anal fissure treatment step up:
soften stool
dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics,analgesia
GTN
Botoxm sphincterotomy last line - if GTN not effective after 8 weeks
Normal lithium level:
Which drugs may precipitate toxicity:
0.4-1.0
toxicity occurs when >1.5
Diuretics (especially thiazides)
ACE inhibitors/angiotensin II receptor blockers
NSAIDs and metronidazole.
What type of urinary incontinence may Amitriptyline precipitate:
Overflow incontinence
Management of acute flares of rheumatoid arthritis
IM or oral corticosteroids
Peripheral neuropathy secondary to diabetes:
1) Management:
2) What can be used as rescue therapy
1) Amitriptyline, duloxetine, gabapentin or pregabalin
2) Tramadol
Symptomatic aortic stenosis management:
Older person
Younger person
patients who are too high-risk for surgical intervention or as a bridge to definitive treatment
Bioprosthetic valve
Mechanical valve (tends to last longer)
Balloon valvuloplasty
Most common cause of primary headache in children:
Migraines
Decreasing vision over months with metamorphopsia, well-demarcated red patches on the retina and a central scotoma should cause high suspicion of
wet age-related macular degeneration
Main investigation required prior to starting herceptin:
Echocardiogram
Which disease is associated with Anti-jo1 antibodies:
What disease is associated with
Anti-scl antbodies:
Anti-centromere:
Polymyositis
Diffuse systemic sclerosis
Limited systemic sclerosis
Neuropathic drug to avoid in BPH:
Amitriptyline - increased risk of retention
Define syringomyelia
M/C cause:
Investigation:
Collection of fluid within spinal cord.
Results in spinothalmic loss in cape-like distribution - > loss of pain reception but preserved light touch, proprioception and vibration
Chiari formation
MRI spine - may need brain too to investigate Chiari formations
What is irradiated blood requested for:
Usually in states of immunocompromise -> lymphoma
Reduces incidence of graft versus host disease
Pain 4-6 cm down from lateral epicondyle:
symptoms may be worsened by extending the elbow and pronating the forearm
Radial tunnel syndrome
Other name for chondromalacia patellae:
Pattern of pain:
Runner’s knee
Anterior knee pain in adolescents and young adults. -> cartilage on the underside of the patella (kneecap) becomes softened and irritated, often due to overuse or poor alignment of the patella.
The pain worsens with activities that involve bending the knee.
Likely disease process for these symptoms:
Pruritis
history of peptic ulcer
Gout
‘Ruddy’ complexion
Polycythaemia
Which cancer is BRCA mutation also associated with in men:
Prostate cancer
Most common haemophilia
Factors affected in Haem A and Haem B
Haemophillia A
A = VIII (8)
B = IX (9)
Which anti-depressant should NOT be prescribed with warfarin
SSRIs
Can have Mirtazapine
When should SUs be stopped prior to surgery.
Omitted on day of surgery prior to op -> can have after
If afternoon operation and SU is taken twice per day, omit both doses
If a woman has a ‘higher chance’ results regarding Down-syndrome on her 11-13+6 week tests (combined test - NT, PAPPA, BCG etc.) , what are the further investigations?
Offered a second screening test (NIPT) or a diagnostic test (e.g. amniocentesis or chorionic villus sampling (CVS).
Dose of rectal diazepam in adults for refractory seizure:
10 mg
Common causes of drug induced lupus:
Hydralazine
Procainamide
Herpes causing cold-sores
Herpes causing genital herpes
HSV-1 (cold sores - 1 mouth)
HSV-2 (genital herpes - 2 balls)
If presenting with pre-eclampsia and greater 37 weeks gestation, what should be done ->
Plan for emergency delivery
Drugs causing acute interstitial nephritis
Penicillin
Rifampicin
NSAIDs
allopurinol
furosemide
What is there increased risk of when prescribing SSRI with a triptan
Serotonin syndrome
What term defines maternal mortality
Any death in pregnancy, during labour till, till 6 weeks post-partum
COPD severity scale:
FEV/FVC1 threshold
Mild - FEV1 > 80% (symptoms must be present to diagnose)
Moderate - FEV1 = 50-79%
Severe = FEV1 30-49%
Very severe = < 30%
<0.7 post-bronchodilator
Any person being considered for the BCG vaccine must first be given what ?
At what age is BCG vaccine given up till
Tuberculin skin test- > The only exceptions are children < 6 years old who have had no contact with tuberculosis
35 years - no evidence that it works past this age group
What investigation is important to start during phenytoin infusion
cardiac monitoring - arrhythmogenic
Further investigation to order in the diagnosis of staph aureus discitis
Echocardiogram -> Looking for endocarditis as primary disease process
Duct dependent congenital heart disease: what should be given prior to corrective surgery
Prostaglandin E2 (or 1) to maintain duct patency
Ophthalmia neonatorum:
What is it?
Infective organisms:
Management:
Conjunctivitis type symptoms at LESS THAN 30 days old.
Chlamydia
Gonorrhoea
Should be seen same day by Ophthalmology
MODY:
Define ->]
C-peptide?
Inherited?
Diagnosis of T2DM in a person <25 years
Normal C-peptide
Autosomal dominant inheritance
Describe discharge and cervix in trichomonas vaginalis
offensive yellow/green discharge, strawberry cervix
Flexural psoriasis management:
Differs to normal plaque psoriasis ->
Mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks
Acute otitis media:
When should antibiotics be prescribed?
Which antibiotic?
If unwell for more than 4 days
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
Amoxicillin
Osteosarcoma: appearance on XR
Ewing’s sarcoma: appearance on XR
most common primary malignant bone tumour: sunburst pattern
Onion-skin
When is Men B vaccine given:
2, 4 12 months
What is in 6 in 1 vaccine
Diptheria, tetnus, whooping, polio, HiB, Hepatitis B
When is oral rotavirus vaccine given:
Months 2 and 3
SSRI of choice post myocardial infarction ->
Sertraline
Gestation to refer if fetal movements have not been felt
24 weeks
Components of Bishop score
Bishop score meaning labour is unlikely to start without induction
NICE guidelines when to induce:
Score greater than X suggests high chance of spontaneous labour
Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station
<5
<6
> 8
Methods of inducing labour
NICE guidelines for inducing labour
Complication of inducing labour
Membrane sweep
Vaginal or oral Prostaglandins E1
Maternal oxytocin infusion
Amniotomy
Cervical ripening balloon
If <6 -> PO/PV PGLs or oral misoprostol
If > 6 -> Oxytocin infusion or amniotomy
Hyperstimulation -> remove any PGLs
Medical management of miscarriage
Mifepristone followed by misoprostol 48 hours later
2 common drugs contraindicated with sildenafil
Nicorandil and nitrates
Scarlet fever organism:
M/C complication:
Treatment:
Group A strep - Strep pyogenes
Otitis media
Penicillin V for 10 days
Difference between paroxysmal and persistent AF:
Paroxysmal self temrinates typically after 1-2 days -> persistent AF requires flecainide
Treatment for non-gonococcal urethritis
azithromycin or doxycycline
