Mon 26th Flashcards
Vertigo
false sensation that the body or environment is moving
Viral labyrinthitis
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Malaria
fever hepatosplenomegaly diarrhoea jaundice anaemia thrombocytopaenia rosetting of red blood cells auto-agglutination of RBCs
Severe signs: acidosis, parasitaemia >2%, hypoglycaemia
Propionibacterium acne
causes acne vulgaris, the skin condition
Bartonella quintana
trench fever
Malaria complications
- cerebral malaria: seizures, coma
- acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
- acute respiratory distress syndrome (ARDS)
- hypoglycaemia
- disseminated intravascular coagulation (DIC)
Pregnancy: DVT/PE
treat: sub-cutaneous low molecular weight heparin
- warfarin counter-indicated due to teratogenic effects
Primary herpes simplex virus infection
gingivostomatitis treat with oral aciclovir, chlorhexidine mouthwash
Wernicke’s encephalopathy
- neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics
- nystagmus (the most common ocular sign)
- ophthalmoplegia
- ataxia
- confusion, altered GCS
- peripheral sensory neuropathy
Wernicke-Korsakoff syndrome
If Wernicke’s encephalopathy not treated then Korsakoff’s syndrome may develop as well
- addition of antero- and retrograde amnesia and confabulation
Methotrexate = folate antagonist that inhibits dihydrofolate reductase - essential for the synthesis of purines and pyrimidines
**avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia»_space; myelosuppression and even pancytopenia
**high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion
Methotrexate toxicity
treatment of choice is folinic acid
Co-trimoxazole contains trimethoprim
folate antagonist
Takayasu’s arteritis
- Large vessel granulomatous vasculitis
- Results in intimal narrowing
- Most commonly affects young asian females
- Patients present with features of mild systemic illness, followed by pulseless phase with symptoms of vascular insufficiency
- Treatment is with systemic steroids
Aortic dissection
- Chest pain (anterior chest pain- ascending aorta, back pain - descending aorta)
- Widening of aorta on chest x-ray
- Diagnosis made by CT scanning
- Treatment is either medical (Type B disease) or surgical (Type A disease)
Cervical rib
- Supernumery fibrous band arising from seventh cervical vertebra
- Incidence of 1 in 500
- May cause thoracic outlet syndrome
- Treatment involves surgical division of rib
Subclavian steal syndrome
- Due to proximal stenotic lesion of the subclavian artery
- Results in retrograte flow through vertebral or internal thoracic arteries
- The result is that decrease in cerebral blood flow may occur and produce syncopal symptoms
- Increased metabolic needs of the arm then cause retrograde flow and symptoms of CNS vascular insufficiency
- A duplex scan and/ or angiogram will delineate the lesion and allow treatment to be planned
Patent ductus arteriosus
- Ductus arteriosus is a normal foetal vessel that closes spontaneously after birth
- Results in high pressure, oxygenated blood entering the pulmonary circuit
- Untreated patients develop symptoms of congestive cardiac failure
Coarctation of the aorta
- Aortic stenosis at the site of the ductus arteriosus insertion
- Most common in boys and girls with Turners syndrome
- Patients may present with symptoms of arterial insufficiency, such as syncope and claudication
- Blood pressure mismatch may be seen, as may mismatch of pulse pressure in the upper and lower limbs
- Treatment is either with angioplasty or surgical resection (the former is the most common)
- Weak arm pulses may be seen
- Radiofemoral delay is the classical physical finding
- Collateral flow through the intercostal vessels may produce notching of the ribs, if the disease is long standing
Digoxin
- increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve
- decreases conduction through the AV node which slows the ventricular rate in atrial fibrillation and flutter
- narrow therapeutic index
Digoxin toxicity
- generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
- arrhythmias (e.g. AV block, bradycardia)
- gynaecomastia
Precipitated by:
- digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
- drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in DCT therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
Management:
- Digibind
- correct arrhythmias
- monitor potassium
Statins + erythromycin/clarithromycin
- myalgia
+++ creatine kinase - statin-induced myopathy secondary to clarithromycin
Statins
inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
Adverse effects:
- myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase
- Liver impairment
- may increase the risk of intracerebral haemorrhage in patients who’ve previously had a stroke
Contra-indications:
- macrolides
- pregnancy
HSV-1
Sunlight is a common trigger for cold sores
Medullary thyroid cancer
only thyroid cancer that will cause a rise in calcitonin, as it originates from the parafollicular cells, which produce calcitonin
mAb: CA 125
Ovarian cancer
mAb: CA 19-9
Pancreatic cancer
mAb: CA 15-3
Breast cancer
Prostate specific antigen (PSA)
Prostatic carcinoma
Alpha-feto protein (AFP)
Hepatocellular carcinoma
Teratoma
Carcinoembryonic antigen (CEA)
Colorectal cancer
S-100
Melanoma
schwannomas
Bombesin
Small cell lung carcinoma
gastric cancer
neuroblastoma
Carotid endarterectomy
TIA with carotid artery stenosis exceeding 70%
