mla paper 2 Flashcards
PROCYCLIDINE
anticholingerics
block acetylcholine
–> decrease muscle stiffness, swating and production of saliva
placental abruption risk factors
ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
Factor V Leiden is an inherited condition which…
results in Factor V being resistant to degradation by activated Protein C; this predisposes affected individuals to development of clots.
Thrombopropylaxis in pregnant women
High risk women need antenatal and post natal prophylaxis (6 weeks)
LWMH!
Avoid
–> warfarin
–> DOAC
Which class of drug have the Medicines and Healthcare products Regulatory Agency warned may be associated with an increased risk of venous thromboembolism in elderly patients?
Antipsychotics in the elderly
clozapine, risperidone, olanzapine, and quetiapine
URTI symptoms + amoxicillin → rash ?
glandular fever
Epstein barr
diagnosed via monospot test
Type 1 vs Type 2 bipolar affective disorder
Type 1 - MANIA
Type 2 - hypomania
The pap smear shows
HERPES simplex virus
- multinucleation
- margination of the chromatin
- molding of the nuclei
Symptomatic bradycardia is treated with
atropine
If no response after titration up to 3 milligrams then TRANSUCTANEOUS PACING
THIS IS characterised by an acute, isolated, spontaneous, and prolonged episode of vertigo with gradual recovery over 2-6 weeks, as well as tinnitus and hearing loss
LABYRINTHITIS
THIS typically presents with gradual onset progressive symptoms of unilateral sensorineural hearing loss which may be associated with tinnitus and/or vertigo.
VESTIUBULAR SCHWANNOMA
This is a typical history of what:
- vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
- may be associated with nausea
- each episode typically lasts 10-20 seconds
BPPV
Aplastic vs sequestraton crisis
Aplastic crisis has reduced reticulocytes, whereas sequestration crisis has increased reticulocytes
Sequestration crisis
- blood pools in organs due to sickling occuring
Aplastic
- bone marrow suppression due to parvovirus infction
- rise in WBC as well as decrease in reticulocytes as RBC production lessened
Contralateral hemiparesis and sensory loss with the upper extremity being more affected than the lower, contralateral homonymous hemianopia and aphasia -
middle cerebral artery
You suspect a diagnosis of Bell’s Palsy. What finding would you expect if you asked the patient to raise her left eyebrow and why?
Inability to raise left eyebrow as Bell’s palsy due to a lower motor neuron lesion
Stroke spares the face
microcytosis is disproportionately low for the haemoglobin level. This combined with a raised HbA2 points to a diagnosis of
beta-thalassaemia trait
Major would present with anaemia, jaundice, failure to thrive, extramedullary erythropoiesis from early childhood.
The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex. Features can be predicted by the affected cranial nerves:
- cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
- cranial nerve V: absent corneal reflex
- cranial nerve VII: facial palsy
PHQ score of less than 15 indicates
Less severe depression
NICE treatments: may involve guided self help
Gliptins (DPP-4 inhibitors) work by
reducing the peripheral breakdown of incretins such as GLP-1
Other diabetic medications
1. metformin: increases peripheral insulin sensitivity and reduces hepatic gluconeogenesis
2. Sulfonylureas augment pancreatic insulin secretion
3. GLP mimetics (exenatide) augment pancreatic insulin secreiton, suppress glucagon release, slow gastric emptying and promote satiety
gene mutations are associated with hereditary non-polyposis colorectal carcinoma
MSH2/MLH1
Post partum and contraception:
- EC not required if UPSI w/i 21 days of birth
Aftre 21 days
–> progesterone only EC (levonelle or ellaOne) in breast feding and non breast feeding
Do not insert Cu-IUD before 28 days due to risk of uterine perforation
BISHOP SCORE
Score < 5 –> labour unlikely to start without induction
VAGINAL PGE2 indicated: for cervical ripening and labour induction
Addison’s patient with intercurrent illness →
double the glucocorticoids, keep fludrocortisone dose the same
……………. is the treatment of choice for all patients with a displaced hip fracture
Hemiarthroplasty or total hip replacement
Since the blood supply is threatened in intracapsular fractures, as a general rule:
* Intracapsular femoral fracture - hemiarthroplasty
* extracapsular femoral fracture - dynamic hip screw
A hemiarthroplasty is favoured over a total hip replacement in this situation as the patient is:
* frail, with a background of chronic health problems
* no history of hip osteoarthritis
If a 2-level DVT Wells score is ≥ 2 points then
arrange a proximal leg vein ultrasound scan within 4 hours
Surgery types:
Transverse colectomy - removal of transverse colon
Left hemicholectomy - removal or entire left hemicolon
Anterior resection - removal of rectum (may need temporary stoma to allow the join in the rectum to heal)
Hartmann’s procedure - sigmoid, upper rectum are removed and an end colostomy
Raised transferrin saturation, raised ferritin, low TIBC
characteristic iron study profile in haemochromatosis
first line treatment in otitis externa
Topical gentamicin + hydrocortisone drops
Widened QRS or arrhythmia in tricyclic overdose -
give IV bicarbonate
- helps reverse the metabolic acidosis
Vision worse going down stairs? Think
4th nerve palsy
To confirm ovulation: Take the serum progesterone level WHEN
7 days prior to the expected next period
Missed pill rules
Missed COCP (protects for 7 consecutive days unless 2 or more missed)
- If 1 missed (any time in cycle): take it and continue as normal
- If 2 or more missed: take it and use condoms for 7 days
- If 2 or more missed in week 1 and she has had sex this week or previous pill-free interval: + emergency contraception
- If 2 or more missed in week 3: start next pack as soon as she finishes current pack
Missed POP
- Traditional (micronor, noriday, nogeston, femulen): if > 3 hours late then action required
- Cerazette (desogestrel): if > 12 hours late then action required
- Action: Take the missed pill as soon as possible (take just one if >1 missed) and the next at the usual time. Use condoms for 48 hours
presents with flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
Hepatitis A
–> flu-like symptoms
–> RUQ pain
–> tender hepatomegaly
–> raised bilirubin
–> raised ALT/AST
–> normal or slightly raised ALP
Others
1. Acute cholecystitis
–> Triad (RUQ pain, fever, jaundice)
- Autoimmune hepatitis
–> fever, jaundice (more likely in females) - Pancreatic cancer
–> painless jaundice
–> palpable gallbladder
–> dark urine
–> pale stools
–> anorexia
–> weight loss
–> epigastric pain
Confusion, ataxia, nystagmus/ophthalmoplegia→
Wernickes encephalopathy
Give IV B/C
If untreated leads to Korsakoff’s
Type of tests you do for allergies
T1 hypersensitivity (immediate reaction) = Skin Pr1ck
T4 hypersensitivity (delayed reaction) = Skin P4tch
T1 hypersensitivity (immediate reaction) = Skin Pr1ck
T4 hypersensitivity (delayed reaction) = Skin P4tch
adult bradycardia mx
The following are risk factors for asystole. Even if there is a satisfactory response to atropine specialist help is indicated to consider the need for transvenous pacing:
* complete heart block with broad complex QRS
* recent asystole
* Mobitz type II AV block
* ventricular pause > 3 seconds
According to UK guidelines, patients who are found to be positive for Methicillin-resistant Staphylococcus aureus (MRSA) should be offered a decolonisation regimen that includes
nasal mupirocin and chlorhexidine wash for the skin.
Widened QRS or arrhythmia in tricyclic overdose - GIVE
give IV bicarbonate
Diagnosis + Mx
Multiple tear drop papules on trunk
Guttate psoriasis
Tx: reassurance + topical treatment if lesions are symptomatic
Mx
–> most spontaneously resolve w/i 2-3 months
–> topical agents
–> UVB phototherapy
–> tonsillectomy
A 7-year-old boy is brought to the ophthalmologist due to complaining of ‘blurry vision’. His mother has noticed he often bumps into things on the left side of him whilst walking.
On examination, right eye fundoscopy is normal. Fundoscopy of the left eye is shown below:
Optic nerve tumour
–> papilloedema
–> small haemorrahges surrounding optic disc
THIS is used to treat torsades de pointes
IV magnesium sulfate
Magnesium sulfate is the first-line therapy and is used to stabilise the cardiac membrane.
tdp can be precipitated by hypothermia
acute interstitial nephritis triad
Eosinophilia, Rash, Fever
otitis externa management
neomycin w/ dexamethasone ear spray
is a psychiatric condition where psychological distress is expressed through physical symptoms.
Conversion disorder
31 female
pc: unilateral painful eye , previous UTI 3 weeks prior.
Eye is water, mild photophobia. PEARL. no reduced visual acuity
SCLERITIS
- inflammation of slcera
- associated w/ sarcoidosis and SLE
A 54-year-old man presents with sudden onset visual loss. A systematic enquiry was otherwise unremarkable. On examination, you note that he has a loss of vision in the right upper quadrant of the visual field in both eyes.
Where is the lesion?
PITS for quadrant loss - parietal =inferior; temporal = superior
Opposite lobe
inferior optic radiations in left temporal lobe
first-line medication for primary biliary cholangitis
Ursodeoxycholic acid
MULTIPLE SCLEROSIS
Which baseline investigation is most appropriate?
MRI brain w/ contrast
Type of drugs causing torsades de pointes
MACROLIDES
treatment for a unstable patient in VT
displaying adverse signs (systolic BP <90, syncope, myocardial ischaemia and heart failure)
immediate synchronised cardioversion
IV amiodarone is only indicated in VT if the patients are not displaying any adverse features
REVISION CARD
CRASH and burn on a Kawasaki:
- Conjunctival injection
- Rash (polymorphous
desquamating)
- Adenopathy (cervical)
- Strawberry tongue (oral mucositis)
- Hand- foot changes (edema, erythema)
- Burn = Fever
CRASH and burn on a Kawasaki:
- Conjunctival injection
- Rash (polymorphous
desquamating)
- Adenopathy (cervical)
- Strawberry tongue (oral mucositis)
- Hand- foot changes (edema, erythema)
- Burn = Fever
BREAST CANCER SCREENING
Breast cancer screening is offered to all women aged 50-70 years (mammogram every 3 years)
given to reverse an overdose of heparin
IV protamine sulfate
Digoxin toxicity
Yellow vision, bradycardia, nausea and vomiting are symptoms suggestive of digoxin toxicity.
Thiazides may cause precipitation of digoxin toxicity
If a secondary pneumothorax > 2cm and/or the patient is short of breath then patient should be treated with
chest drain (not aspiration) as first-line
Most commonly associated conditions with secondary pneumothorax are:
- COPD
- Cystic fibrosis
- lung cancer
- pneumonia
Rosacea: first-line for patients mild papules and/or pustules
topical ivermectin
Acute closed-angle glaucoma presents with a fixed dilated pupil with conjunctival injection
Acute closed-angle glaucoma presents with a fixed dilated pupil with conjunctival injection
Oral codeine to morphine
divide by 10
Otitis externa in diabetics: treat with
ciprofloxacin to cover Pseudomonas
