MLA Flashcards
MI complications, left ventricular aneurysm
Persistent ST elevation
LV failure - pulm oedema
S3 sounds - LV larger
S4 sounds - LV stiffer
Anticoag as risk of thrombus
Left ventricular free wall rupture
1-2 weeks after
Acute HF 2ndry to cardiac tamponade, raised JVP, pulses paradox, HS muffled
Hypotension
Acute mitral regurg
More common in infero post infarction
Papillary muscle rupture
Acute hypotension, flash pulmonary oedema
Early to mid systolic murmur
Vasodilator therapy, surgery
MI complication, Ventricular septal defect
occur in 1st wk
new pan systolic murmur
Raised JVP
SOB, bibasal crackles
Dressler’s syndrome post MI
pleuritic pain, left, pericardia effusion
Saddle shape st elev on ecg
After MI 2-6wks
Tx - nsaids
MI complic, bradyarrhythmia
- AV block common after inferior MI -> HB
Drugs causing drug induced liver disease
Paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
drug induced cholestasis
COCP
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
P450 enzyme inducers (inc other drugs metabolism, reduce therapeutic conc)
Antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking
P450 enzyme inhibitors, inc therapeutic concentration
Ciprofloxacin, erythromycin
isoniazid
cimetidine, omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
Palliative med, what medication is started with
modified release morphine or standard release
laxative co prescribed
what is the breakthrough dose for morphine
1/6 of total dose
What is used for metastatic bone pain
opioids
bisphosphonates
radiotherapy
what is the drug conversion of oral codeine/tramadol to oral morphine
divide by 10
drug conversion oral morphine to oral oxycodone
divide by 1.5
what opioid is used in mild moderate renal impairment
oxycodone
what opioid is used in severe renal impairment
alfentanil,
buprenorphine,
fentanyl
conversion for oral morphine to s/c morphine
divide by 2
oral morphine -> subcut diamorphine
divide by 3
oral oxycodone -> subcut diamorphone
divide by 1.5
Mechanism of action metformin
Biguanide
Inc insulin sensitivity
Dec hepatic gluconeogenesis
DDP-4 inhibitor
Increase active incretin levels
Reduce peripheral breakdowns of incretins
Pioglitazone
inc insulin sensitivity
Sulfonyurea
Inc insulin release from pancreas
GLP-1 analogues
Inc insulin release
inhibit glucagon secretion
Mx of open angle glaucoma
360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg NICE
Prostaglandin analogue (PGA) eyedrops should be used next-line, Latanoprost
beta-blocker eye drops
carbonic anhydrase inhibitor eye drops
sympathomimetic eye drops
Latanoprost action and SE
Prostaglandin analogue
increasing uveoscleral outflow
Brown pigmentation of the iris, increased eyelash length
Beta blocker timolol action
Reduces aqueous production
Carbonic anhydrase inhibitors (e.g. Dorzolamide) action
Reduces aqueous production
Miotics (e.g. pilocarpine, a muscarinic receptor agonist) action
Increases uveoscleral outflow
Causes of gynaecomastia
syndromes with androgen deficiency: Kallman’s, Klinefelter’s
testicular failure: e.g. mumps
liver disease
testicular cancer e.g. seminoma secreting hCG
ectopic tumour secretion
hyperthyroidism
haemodialysis
drugs:
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
what drug most commonly causes gynaecomastia
spironolactone
Thiazide diuretics side effects
hypokalaemia
hyponatraemia
hypercalcaemia
impaired glc tolerance
gout
sexual dysfunction
Dehydration
Postural hypo
digoxin toxicity
What are the features of dengue fever
viral infection
- fever
- retro orbital headache
- facial flushing
- myalgia, bone pain
- rash
- haemorrhagic
- thrombocytopenia, raised AST
- travelling
- 7 day incubation period
Features of typhoid fever
salmonella typhi
initially, headache, fever, arthralgia
relative bradycardia
constipation, abd pain
rose spots - trunk
X-ray features of rheumatoid
- loss of joint space
- peri articular erosions
- juxta articular osteoporosis
- soft tissue swelling
- subluxation
X-ray fts of osteoarthritis
-osteophytes
-loss of joint space
-cyst formation
-subchondral sclerosis
Indications for urgent CT head (within 1 hour) in head injuries
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
When should you send a urine culture for UTI in non pregnant women
visible or non visible haematuria
over 65
Pleural effusion exudative causes
Protein >30
Infection
-pneumonia (most common exudate cause),
-tuberculosis
-subphrenic abscess
Connective tissue disease
-rheumatoid arthritis
-systemic lupus erythematosus
Neoplasia
-lung cancer
-mesothelioma
-metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome
Pleural effusion transudative cause
Protein <30
heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs’ syndrome
Empyema ph, glucose and LDH levels
pH <7.2
low glc
high LDH
features of limited systemic sclerosis
scleroderma of face and distal limbs (tightening and fibrosis of skin)
CREST
Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
anti centromere antibody
Diffuse cutaneous systemic sclerosis fts
anti scl-70 antibodies
resp involvement - interstitial lung disease
renal disease - use ACEI
hypertension
Metformin side effects
GI upset
Reduced vit b12 asso
Lactic acidosis w severe liver disease or renal failure
Sulphonyurea side effects
weight gain
hypoglycaemia
(siadh
DDP-4 inhibitor side effects
weight neutral
pancreatitis
nausea
nasopharyngitis
Thiazidolines side effects
weight gain
fluid retention - contraind HF
inc risk bladder cancer
inc risk fractures
GLP-1 analogues side effects
weight loss
nausea pancreatitis
SGLT2-inhib side effect
inc risk UTI
weight loss
Inc risk lower limb amputation
Contraind in active foot disease - skin ulcer
Necrotising fasciitis of genitalia
what does 4AT include
Alertness - name and address
4AMT - age, date of birth, place, current year
Attention - state months of year backward
Acute change or fluctuating course
What is the treatment for focal seizures
lamotrigine,
levetiractam
2nd line - carbemazepine
What drug is used to treat myoclonic seizures in females
Levetiracetam
What anti epileptics are contraindicated in pregnancy
sodium valproate - neural tube defect
phenytoin - cleft palate
Causes of interstitial nephritis
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
SLE, sarcoid
staph, hanta virus
What defines an exudate in pleural effusion
protein >30
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
what defines a transudate pleural effusion
protein <30
Causes of exudative pleural effusion
malignancy
pneumonia
Pulmonary embolism
Infection
Mesothelioma
causes of transudate pleural effusion
Heart failure
liver cirrhosis
Hypoalbuminaemia
Malabsorption
hypothyroidism
Meigs’ syndrome
Investigations for premature rupture of membranes?
sterile speculum exam
for fluid, if no pooling of fluid
PAMG-1 test
Management of preterm rupture of membranes
Admit, observe for chorioamniotiis
oral erythromycin 10 days
antenatal steroids, reduce risk of respiratory distress
Management of post partum haemorrhage
ABCDE
- crystalloid infusion
- empty bladder catheterise
- masssage umbilicus
- IV oxytocin
- ergometrine (not if hypertension)
- IM carboprost (not if asthma)
- misoprostal sublingual
surgical - intrauterine balloon tamponade
carcinoid syndrome fts
flushing (earliest symptom)
Abd pain
D+
Bronchospasm
Hypotension
Cushings syndrome
Right heart valve stenosis
carcinoid syndrome ix and mx
urinary 5-HIAA
ocreotide
Osteoarthritis x-ray features
LOSS
loss of joint space
osteophytes at joint margins
subchondral sclerosis
subchondral cysts
signs of vitamin C deficiency
Follicular hyperkeratosis and perifollicular haemorrhage
Ecchymosis, easy bruising
Poor wound healing
Gingivitis with bleeding and receding gums
Sjogren’s syndrome
Arthralgia
Oedema
Impaired wound healing
Generalised symptoms such as weakness, malaise, anorexia and depression
Amiodarone side effects
thyroid dysfunction
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval
beta blocker side effects
bronchospasms
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
ECG changes in trifasicular block
RBBB
LAD
1st degree HB
Causes od G6PD exacerbation
anti malarials - primaquine
ciproflox
sulphonamides
sulfonureas
infection
fava beans
drugs causing erythema multiforme
penicillin
sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
causes of erythema multiforme
HSV
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy
physiological abnormalities of anorexia nervosa
G’s and C’s raised
growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
hypokalaemia
low FSH, LH, oestrogens and testosterone
Hypercalcaemia ecg changes
short QT interval
Hypocalcaemia ecg
prolonged QT interval
What measurement is prolonged QT interval
> 450
Normal PR interval
120-200 (3-5 small squares)
Hypokalaemia ecg changes
widened P waves
Prolonged PR interval
Long QT
U waves (after T wave in V2/3)
T wave inversion, small or absent
Wolf parkinson white syndrome ecg changes
Broad complex tachycardia
short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
usually LAD - affecting right accessory pathway
Hyperkalaemia ecg changes
Tall tented t waves
Loss of p waves
Broad QRS
Neuroleptic malignant syndrome features
Muscle rigidity
confusion
hypotension
hyperthermia
Causes of warm haemolytic anaemic
CLL, lymphoma
SLE
methyldopa
idiopathic
Causes of cold haemolytic anaemia
mycoplasma
EBV
lymphoma
neoplasia
Most common cause of D+ in HIV
cryptosporidium parvum
What is the post exposure prophylaxis in HIV
up to 72hrs after exposure,
4 weeks antiretrovirals
How should asymptomatic patients be tested for HIV
test 4wks after exposure
if negative repeat at 12wks
How is HIV diagnosed
- HIV p24 antigen 1-4wks
- HIV ab 4wks-3mths
4th generation
if positive, repeat test
How is HIV disease progress monitored
using CD4+ cell count and viral load
HIV complications CD4 200-500
-oral thrush
-shingles
-hairy leucoplakia (EBV)
- kaposi sarcoma (HHV-8)
HIV complications CD4 100-200
- PJP pneumocystitis
- cryptosporidiosis (D+)
- cerebral toxoplasmosis
- progressive leukoencephalopathy (JC virus)
- HIV dementia
HIV complications CD4 50-100
- aspergillosis
- oesophageal candidiasis
- Cryptococcal meningitis - fungal, low glc, high protein, india ink staining
- primary CNS lymphoma (EBV)
HIV complications CD4 <50
- CMV retinitis
- mycobac avium intracellulare
Features of PJP pneumocystitis in HIV and CD4 count
100-200
pneumothorax common
- exercise induced desat
- cxr bilat interstitial pulm infiltrates
- mx oral co-trimox
IV pentamidine in severe
what should be given to HIV patients w CD4 count <200
prophylactic co-trimoxazole
Fts of cerebral toxoplasmosis and CD4 count
100-200
headaches, double vision
CT - mult ring enhancing lesions
negative thallium spect scan
- tx sulfadiazine, pyrimethamine
Fts of cerebral progressive multifocal lekoencephalopathy and CD4 count
100-200
- neuro symptoms, demyelination on MRI
- JC virus
Fts of CNS Lymphoma and CD4 count
50-100
EBV
- CT single enhancing lesions, SPECT positive
- tx steroids, chemo
Fts of cyptococcal meningitis and CD4 count
50-100
fungal, low glc, high protein, india ink staining
When is the combined test for downs syndrome and what does it include
11 - 13+6 weeks
nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A)
thickened nuchal
inc bcg
dec papp
When is the quadruple test done
15-20wks
quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
quadruple test positive results for downs
afp down
oestriol down
bhcg up
inhibin a up
renal cell carcinoma triad of fts
Flank pain,
Palpable abdominal mass,
Haematuria
Henoch Schloein Purpura or IgA vasculitis fts
palpable non blanching purpura on buttocks, lower limbs
abd pain
renal involvement
haematuria
polyarthritis
Alpha 1 antitrypsin deficiency fts
young p’s non smokers
panacinar emphysema, lower lobes
obstructive spirometry
Cerebral palsy dyskinetic fts
athetoid movements and oro-motor problems
- damage to basal ganglia and substantia nigra
Cerebral palsy spastic fts
most common
- damage to upper motor neurons in periventricular white matter,
hemiplegia, hypertonia
cerebral palsy ataxic fts
nystagmus, ataxia
Newborn screening hearing test
Otoacoustic emission test
newborn hearing test 2nd line
Auditory Brainstem Response test
hearing test at >3years old
Pure tone audiometry
features of posterior hip dislocation
90% of hip dislocations. The affected leg is shortened,
adducted, and internally rotated.
fts of anterior hip dislocation
abducted and externally rotated. No leg shortening.
Alport syndrome fts
X linked dominant
microscropic haematuria
sensorineural deafness
occular defects
progressive CKD
retinitis pigementosa
Causes of raised prolactin
prolactinoma
pregnancy
oestrogens
physiological: stress, exercise, sleep
acromegaly: 1/3 of patients
polycystic ovarian syndrome
primary hypothyroidism
metoclopramide, domperidone
phenothiazines
haloperidol
myxedema coma fts
- undiagnosed hypothy or poor compliance
hypothermia
Hypotension
Bradycardia
Confusion
myxedema coma management
IV thyroxine and hydrocortisone
Thyrotoxic storm management
IV propanolol, anti thyroid drugs, methimazole, hydrocortisone
Edward syndrome fts
trisomy 18
dysmorphic fts
rocker bottom feet
overlapping fingers
low set ears
microgathnia - small jaw
Patau syndrome fts
trisomy 13
microcephalic, small eyes
polydactyly
cleft lip/palate
Noonan syndrome features
autosomal dominant
short stature
broad forehead
downward sloping eyes
webbed neck
pectus excavatum
low set ears
pulmonary stenosis
wide set eyes
Prader willi syndrome fts
deletion of 15q11-q13
infantile hypotonia/ feeding problems
hyperphagia/ obesity
short stature
hypogonadism
developmental delay
Fragile X fts
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
Klinefelter syndrome fts
Males XXY
low testosterine
High FSH and LH
tall, infertility, gynaecomastia
lateral stemi ecg changes and artery affected
I, aVL +/- V5-6
left circumflex
Medications for focal seizure
Lamotrigine
Leviteraciteam
Carbemazepine
Medication for myoclonic seizure in females
Levitiracetam
Antiphospholipid syndrome antibody and blood results
anti-cardiolipin AB
prolonged APTT
thrombocytopaenia
Antiphospholipid syndrome fts
Clots, venous arterial thrombosis
Livedo reticularis (mottled skin)
Obstetric loss
primary thromboprophylaxis in antiphospholipid syndrome
low dose aspirin
Behcet’s triad
oral ulcers
genital ulcers
anterior uveitis
Rheumatic fever organism
strep pyogenes
Rheumatic fever
erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis
subcut nodules
what is Sydenham’s chorea
late complication of rheumatic fever
abrupt involuntary movements, muscle weakness
drug induced lupus antibodies and causes
procainamide
- hydralazine
- isoniazid
- phenytoin
- anti-histone antibodies
- ANA
Vitamin B12 deficiency, subacute degen of spinal cord symptoms
hyperreflexia
loss of proprioception, vibration
ankylosing spondylitis features, A’s
Reduced lateral and forward flexion of spine
Limitations of chest expansion
morning stiffness
back pain
Bilateral sacroiliitis
Apical fibrosis (lungs)
Anterior Uveitis
Aortic regurg
Achilles tendonitis
AV node block
Amyloidosis
Arthritis peripheral
And cauda equina
Type 1 hypersensitivity reaction
Anaphylactic
- IgE
- anaphylaxis
- atopy
Type 2 hypersensitivity reaction
Cell Bound
- IgG or IgM to antigen on cell surface
- autoimmune haemolytic anaemia
- ITP
- good pastures
- Pernicious
- Rheumatic fever
Type 3 hypersensitivity reaction
Immune complex
- free antigen and antibody combine IgG or IgA
- SLE
- post strep glomerulonephritis
Type 4 hypersensitivity reaction
Type 4
Delayed
- t cell mediated
- TB
- graft vs host disease
- allergic contact derm
- MS
- GBS
Post splenectomy infectious organisms
strep pneumoniae
haem influenza
meningococci
Capnocytophaga (dog bite)
Rivaroxaban + apixiban reversal agent
Andecanet alfa
Heparin reversal agent
protamine sulphate
How do u monitor unfractioned heparin
APTT
Lithium side effects
benign leucocytosis
- hyperparathyroidism -> hypercalc
- fine tremor
- N, V+
- nephrotoxicity
- polyuria
- IIH
- weight gain
- thyroid enlarge, hypothyroidism
Lithium toxicity precipitants
dehydration, renal failure, diuretics esp thiazides, ACEI, NSAIDs, metronidazole
Lithium toxicity mx if >3.5
haemodialysis
Palliative med for visceral/serosal (constipation) N+ and V+
cyclizine, levomeprozine
Palliative med for chemically mediated N+ and V+
- ondanestron
- haloperidol
Typical antipsychotics
haloperidol
chlorpromazine
Side effects of atypical antipsychotics
weight gain (most common)
hyperprolactinaemia
DM
dyslipidaemia
reed sternberg cells description
large B cells, multinucleated.
large cells with a bilobed nucleus and prominent eosinophilic inclusion-like nucleoli.
Acute myeloid leukaemia fts
anaemia, pallor, breathlessness
- thrombocytopenia, bruising, petechiae
purpura and mucosal membrane bleeding
-recurrent infection because of neutropenia
hepatomegaly
splenomegaly
gum hyperplasia
myeloid blast cells
Aur rods
Chronic myeloid leukaemia fts
Philadelphia chromosome 9:22
thrombocytosis
inc granulocytes at dif stages of maturation
high WCC
massive splenomegaly
anemia
weight loss
sweating
hyperleukocytosis - fundal haemorrhage and venous congestion
tx - imatinib
Acute lymphoblastic leukaemia fts
75% cases occur in children <6years
B-cell lineage
2-3 week history of bone marrow failure +/- rasied wcc
bone/joint pain
infection
night sweats
neutropenia
anaemia, soft systolic murmur and SOB
thrombocytopenia, easy bruising, petechiae
lead to DIC
splenomegaly
hepatomegaly
Blast cells
Chronic Lymphocytic Leukaemia fts on blood film
smudge cells
CLL fts
asymptomatic at presentation
- bone marrow failure - anaemia, thrombocytopenia
- lymphadenopathy
- splenomegaly
- fever and sweats
warm haemolytic anaemia
inc wbc
inc lymphocytes
PRV gene and pathophysiology
JAK2 V617F gene
too many red cells, blood thick, raised haematocrit, red cell count and Hb conc
PRV presentation
fatigue
headache
itch
ruddy complexion
gout
vas occlussion
TIA, stroke
splenomegaly
Raised Hb and haematocrit
PRV mx
venesection
aspirin
Idiopathic thrombocytosis presentation
raised platelet count
- asymp
- burning hands
- arterial venous thromboses
- bleeding
- digital ischaemia
- gout
- headache
- mild splenomegaly
Idiopathic thrombocytosis mx
aspirin and hydroxycarbamide or anagrelide
Myelofibrosis features
fatigue
massive splenomegaly
weight loss, night sweats
tear drop poikolocytes
testicular cancer teratoma blood marker
AFP and BHCG
non seminoma
Clozapine side effects
agranulocytosis, neutropenia
reduce seizure threshold
constipation
myocarditis, do baseline ecg
hypersalivation
Pityriasis Rosea organism and features
HHV 7
Herald patch, rash on trunk, first singular
raised erythematous, oval, scaly
fir-tree appearance
Pityriasis versicolour organism, fts, tx
Malassezia furfur
trunk
patches vary in colour, hyperpigmentation, pink, brown
scaling
sun make it more evident
topical ketoconazole
What is Trousseau’s sign
carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
wrist flexion and fingers are drawn together
in hypocal
what is Chvostek’s sign
tapping over parotid causes facial muscles to twitch
in hypocal
Anal fissure mx if <1wk
Soften stool, dietary advice, bulk forming laxative
Lubricant bfr defecation
Topical anaesthetic
Anal fissure mx if >6wks
topical GTN
If not effective >8wks, sphincterotomy or botulinum toxin
What is budd chiari syndrome, symptoms?
hepatic vein thrombosis
- abd pain
- ascites
- hepatomegaly tender
what types of shock causes warm peripheries
Neurogenic
Anaphylactic
Septic
what types of shock causes cool peripheries
cardiogenic
haemorrhagic
HIV toxoplasmosis tx
sulfadiazine, pyrimethamine
Metronidazole side effects/ interactions
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
genital wart tx if keratinised
crypotherapy
ascites SAAG >11 indicates?
causes
portal hypertension
Budd-Chiari
liver cirrhosis
Right HF
ascites SAAG <11 causes
Malignancy
Hypoalbuminaemia, nephrotic syndrome
Tuberculosis peritonitis
Pancreatitis
Biliary ascites
tetracyclines SE
discolouration of teeth: therefore should not be used in children < 12 years of age
photosensitivity - sunburn
angioedema
black hairy tongue
tx for telangiectasia in acne rosacea
laser therapy
tx for flushing in rosacea
topical brimonidine
cause of pseudohponatraemia
hyperlipidaemia (increase in serum volume)
Hepatitis E
RNA virus
undercooked pork
Shellfish
Signify mortality during pregnancy
Hepatitis A features
benign, self-limiting disease
flu-like prodrome
abdominal pain: typically right upper quadrant
tender hepatomegaly
jaundice
deranged liver function tests
which hepatitis has signif mortality in preg
hep E
who should be vaccinated for hep A
people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old
people with chronic liver disease
patients with haemophilia
men who have sex with men
injecting drug users
individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
what is TURP syndrome
Glycine toxicity
results in hyponatremia
Cisplatin side effects
otoxicity
- hypomagnesia
- peripheral neuropathy
Cyclophosphamide side effects
- myelosuppression
- haemorrhagic cystitis
- transitional cell carcinoma
Anthracyclines, Doxorubicin side effect
cardiomyopathy
Bleomycin side effect
lung fibrosis
Vincristine side effect
peripheral neuropathy, paralytic ileus
what is Brudzinski’s sign
hip and knee flex on passive flexion of neck
meningitis
what is kernig’s sign
pain on passive extension of knee
meningitis
Organism for meningitis <3mths
- group b strep
- e. coli
- listeria monocytogenes
Down’s quadruple test results
- low AFP
- low oestriol
- high hcg
- high inhibin A
Edwards quadruple test results
low afp
low oestriol
low hcg
inhibin normal
neural tube defect quadruple test results
high afp
normal oestriol
normal hcg
normal inhibin A
cephalhaematoma description
Develop after birth and do not cross the suture lines of the skull as the blood is confined between the skull and periosteum
neiseria gonorrhoea tx for needle phobic p’s
oral cefixime + oral azithromycin
Metoclopramide side effects
EPS - acute dystonia
D+
hyperprolactinaemia
tardive dyskinesia
parkisonism
avoid in bowel obstruction
levodopa side effects
dry mouth
anorexia
palpitations
postural hypotension
psychosis
dyskinesia at peak dose, dystonia, chorea, athetosis
dopamine receptor agonist side effects
impulse control disorders
excessive daytime somnolence
Amantadine side effects
ataxia, slurred speech, confusion, livedo reticularis
horners central lesion features and causes
anhidrosis of face, arm trunk
Stroke,
syringomyelia, MS, tumour,
encephalitis
Horner’s pre ganglionic lesion fts and causes
Anhidrosis of face
pan coast tumour
Thyroidectomy
Cervical rib
Horner’s post ganglionic lesion fts and causes
No anhidrosis
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache
Criteria for long term oxygen therapy in COPD p’s
2 ABG pO2 < 7.3
or
7.3 - 8 +
2ndry polycythaemia, peripheral oedema, pulmonary hypertension
organs that metastasise to Brain
lung (most common)
breast
bowel
skin
kidney
adrenaline induced ischaemia reversal agent
phentolamine
safe triangle borders
Latissimus dorsi,
pectoralis major,
line superior to the nipple
apex at the axilla
what conditions cause lower than expected Hba1c levels, (reduced rbc lifespan)
G6pd
sickle cell
hereditary spherocytosis
haemodialysis
what conditions cause higher than expected Hba1c levels, (increased rbc lifespan)
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
when doing PSA how long musy you wait after
- biopsy
- uti etc
6wks prostate biopsy
4wks UTI
1wk DRE
48hrs vigorous exercise or ejaculation
Opiate withdrawal symptoms
insomnia
- yawning
- dilated pupils
- muscle pain and cramps
- agitation
- anxiety, D+
MDMA (ecstasy) overdose signs
neurological: agitation, anxiety, confusion, ataxia
tachycardia, hypertension
hyperthermia
rhabdomyolysis
hyponatraemia
this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA
Cocaine side effects
hypertension n HR
- euphoria
- hyperthermia
- seizures
- coronary artery spasm
Ciprofloxacin side effects
QT prolong
reduce seizure threshold
tendon, cartilage damage
Renal tubular acidosis ABG effect
hyperchloraemic metabolic acidosis, normal anion gap
Type 1 renal tubular acidosis
distal
hypokalaemia
nephrocalcinosis, renal stones
causes
- idiopathic
- RA - SLE
- sjogrens
Type 1 renal tubular acidosis causes
- idiopathic
- RA - SLE
- sjogrens
Type 2 renal tubular acidosis
proximal
hypokalaemic
- osteomalacia
causes
- idiopathic
- fanconi
- wilsons disease
- carbonic anhydrase inhib
Type 2 renal tubular acidosis causes
- idiopathic
- fanconi
- wilsons disease
- carbonic anhydrase inhib
Type 4 renal tubular acidosis
hyperkalaemic
causes - hypoaldosteronism, DM
drug causes of pancytopenia
Cytotoxics
Trimethoprim, chloramphenicol
Gold, penicillamine
Carbimazole*
Carbamazepine
sulphonylureas: tolbutamide
Parkinson’s plus syndrome
Multiple system atrophy fts
autonomic CF
Postural hypotension
Incontinence
Erectile dysfunction
Cerebellar signs
Cortico basal degenerations fts
Parkinson plus
- spontaneous activity of limb or akinetic rigidity
cystic fibrosis diagnosis and value
sweat chloride test
>60
when are cleft lips repaired
first week of life to 3mths
when are cleft palates repaired
6-12mths
drugs causing IIH
combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium
causes of hypokalaemia w alkalosis
vomiting
thiazide and loop diuretics
Cushing’s syndrome
Conn’s syndrome
causes of hypokalaemia w acidosis
diarrhoea
renal tubular acidosis
acetazolamide
partially treated diabetic ketoacidosis
causes of hyperkalaemia
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
causes of hypercalcaemia
primary hyperparathryoidism
malignancy
sarcoid
vitamin D intoxication
acromegaly
thyrotoxicosis
thiazide diuretics
dehydration
addisons
how is severe hypocalcaemia managed
IV calcium gluconate 10%
treatment for severe hyponatraemia <120
Hypertonic saline (typically 3% NaCl)
statins contraindications
pregnancy
on course of macrolides
Levodopa side effects
dyskinesia at peak dose, dystonia, chorea, athetosis
Dry mouth,
end of dose wearing
palpitations,
N+ V+
Psychosis
Postural hypotension
dopamine agonist side effects
impulse control disorders, gambling, hyper sexuality, shopping, binge eating
Excessive daytime somnolence
drug treatment for N+ and V+ in parkinsons
Domperidone
Doesn’t cross blood Brain barrier
MAO-B inhibitor drug examples
selegiline, rasagiline, safinamide
when should pregnant women take folic acid
until 12th week of pregnancy
when do pregnant women require 5mg folic acid
partner has a NTD,
they have had a previous pregnancy affected by a NTD,
family history of a NTD
antiepileptic drugs
coeliac disease,
diabetes
thalassaemia trait
BMI >30
what causes false positive syphilis test
negative TPHA and positive VDRL
pregnancy,
HIV,
SLE,
TB
malaria
MEN1 features
hypercalcaemia
Parathyroid hyperplasia and adenomas
Pancreatic insulinoma, gastronoma, peptic ulceration
Pituitary adenoma
MEN 2 type 2a fts
RET oncogene
Parathyroid
Phaemochromocytoma
Medullary thyroid carcinoma
MEN 2 type 2b fts
Phaemochromocytoma
Marfanoid body
Neuromas
antibiotics used in brain abscess
IV 3rd-generation cephalosporin + metronidazole
common causes of meningitis <3mths
Group b strep
e.coli
listeria
common causes of meningitis
Neisseria meningitidis - gram neg diploc
Streptococcus pneumoniae
