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 metformin 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
