More Concepts Flashcards
What suggest downs syndrome on tests
Raised beta-HCG, low PAPP-A, thickened nuchal translucency
What are TSH receptor stimulating autoantibodies
Thyroid stimulating immunoglobulins
Almost diagnostic of Graves’ disease
What are the features of Graves’ disease?
Exopthalmos Opthalmoplegia Pretibial myxoedema thyroid acropathy > digital clubbing > soft tissue swelling of hands and feet > periosteal new bone formation
What are PDE5 inhibitors
used in treatment of erectile dysfunction and pulmonary hypertension
cause vasodilatation through an increase in cGMP leading to smooth muscle relaxation in blood vessels supplying the corpus cavernosum
Sildenafil- viagra
Tadalafil
Vardenafil
Side effects of viagra
blue discolouration of visiion
How does infectious mononucleosis present
fever, lymphadenopathy
How does leptospirosis present
influenza-like pyrexial symptoms
How does typhoid fever present
headache, fever, arthralgia
>relative bradycardia
>abdominal pain, distension
>constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
>rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
Fluctuating confusion/consciousness
Subdural haematoma
When should a second drug be prescribed in diabetes
If HbA1c is > 58
1st line treatment for most patients with a pituitary tumour causing acromegaly
Trans-sphenoidal surgery
2nd line for pituitary tumour causing acromegaly when surgery is not an option
Somatostatin analogues
Management of abdominal wound dehiscence
coverage of wound with saline impregnated gauze + IV broad spectrum antibiotics
When should migraine prophylaxis be offered?
More than 2 migraines a month
Migraine prophylaxis in women of child-bearing age
topiramate or propanolol
Where is aspiration pneumonia more common
right lung
visible peristalsis in stomach of neonate
pyloric stenosis
Which women need higher dose folic acid
> previous child with NTD > diabetes mellitus > women on antiepileptic > obese women > HIV +ve taking co-trimoxazole > sickle cell
WHen are nitrates contraindicated
BP under 90mmHg systolic
1st line management of acute pericarditis
Combination of NSAID and colchicine
What toxin is associated with c. diff
toxin B
what is prescribed for c. diff
bezlotoxumab
gram positive cocci=
staphylococci and streptococci
gram negative cocci=
neisseria meningitidis + neisseria gonorrhoea + morazella catarrhalis
pneumonic for Gram positive bacilli
ABCD L
> actinomyces > bacillus anthracis > clostridium > diptheria: corynebacterium diptheriae > listeria monocytogenes
Investigation in all patients presenting with AKI of unknown origin
renal ultrasound
Causes of metabolic acidosis with Normal anion gap
> GI bicarbonate loss: diarrhoea, fistula > renal tubular acidosis > drugs: acetazolamide > ammonium chloride injection >addisons disease
Causes of metabolic acidosis with raised anion gap
lactate: shock, hypoxia
ketones: DKA, alcohol
urate: renal failure
acid poisoning: salicylates methanol
causes of metabolic alkalosis
loss of hydrogen ions or a gain of bicarbonate. It is due mainly to problems of the kidney or gastrointestinal tract
> vomiting, cushings, primary hyperaldosteronism,
when is double duct sign seen?
pancreatic cancer
fever/back pain with pain on extension of hip
iliopsoas abscess
management of otitis externa
> topical antibiotic or a combined topical antibiotic with a steroid
if the tympanic membrane is perforated aminoglycosides are traditionally not used*
if there is canal debris then consider removal
if the canal is extensively swollen then an ear wick is sometimes inserted
HIT is a ________ condition
prothrombotic
which kind of heparin causes HIT
standard heparin
what is HIT
Heparin-induced thrombocytopaenia (HIT)
>immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin
> antibodies bind to the PF4-heparin complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors
> usually does not develop until after 5-10 days of treatment
> despite being associated with low platelets HIT is actually a prothrombotic condition
features of HIT
more than 50% reduction in platelets, thrombosis and skin allergy
Management of HIT
address need for ongoing anticoagulation:
direct thrombin inhibitor e.g. argatroban
danaparoid
Sodium valproate causes _______ of the P450 system
inhibition
Features of B-blocker overdose
Bradycardia
Hypotension
Heart failure
Syncope
Management of B-blocker overdose
If bradycardic= atropine
resistant cases= glucagon
Upper quadrant bitemporal hemianopia
Optic chiasm
lower quadrant defect
Inferior chiasmal compression
pituatary tumour
lower quadrant bitemporal hemianopia
> Optic chiasm
upper quadrant defect
superior chiasmal compression
craniopharyngioma
When should platelet transfusion be offered
platelet count of < 30 x 109
with clinically significant bleeding
what component has the highest risk of bacterial contamination
platelets
What are the two forms of trypanosomiasis
african trypanosomiasis= sleeping sickness
american trypanosomiasis= chagas’ disease
clinical features of sleeping sickness
chancre
intermittient fever
enlargement of posterior cervical nodes
CNS involvement: somnolence, headaches, mood changes, meningoencephalitis
management of sleeping sickness
IV pentamidine or suramin
if CNS involvement: IV melarsoprol
features of chagas disease
asymptomatic in acute phase
- changoma (nodule at site of infection)
- periorbital oedema
chronic chagas disease
- myocarditis- dilated cardiomyopathy (apical atrophy) and arrythmias
- GI : megaoesophagus and megacolon causing dysphagia and constipation
management of chagas disease
acute phase: azole or nitroderivatives such as benzinidazole or nifurtimox
how does salicylate poisoning present?
raised anion gap metabolic acidosis
if fetal movements have not been felt by __ weeks, referral should be made to maternal fetal medicine unit
24
how does APS present on bloods
raised APTT
normal PT
thrombocytopenia
anxiety level tool
HAD
liver cirrhosis scoring tool
child-pugh classification
hypoglycaemia with impaired GCS
give IV glucose if access
recommended investigation for all patients with suspected RA
x-ray hands and feet
what can be used to differentiate between true seizure and psueudoseizure
prolactin
what should be offered to ALL patients on long-term steroids
immediate co-prescription of alendronate
Gross motor milestones, 3 months
little or no head lag, lying on abdomen, good head control, held sitting, lumbar curve
Gross motor milestones, 6 months
lifts and grasps feet, pulls self to sitting, held sitting, back straight, rolls front to back
Gross motor milestones, 7-8 months
sits without support (refer at 12 months)
Gross motor milestones, 12 months
cruises
walks with one hand held
Gross motor milestones, 13-15 months
walks unsupported, refer at 18 months
gross motor milestones 18 months
squats to pick up toy
2 years
runs
stairs with rail
3 years
tricycle
stairs without rail
4 years
hops on one leg
presentation of syringomyelia
cape-like loss of pain and temperature sensation due to compression of spinothalamic tract fibres decussating in anterior white commisure of spine
causes of syringomyelia
a chiari malformation
trauma
tumours
idiopathic
what are the centor criteria
> presence of tonsillar exudate (1)
tender anterior cervical lymphadenopathy or lymphadenitis (1)
history of fever (1)
absence of cough (1)
0,1,2 = 3 to 17% streptococci
3 or 4= 32 to 56%
what are the FeverPain criteria
> fever over 38 > purulence > attend rapidly (3 days or less) > severely inflamed tonsils > no cough or coryza
when to give antibiotics in suspected tonsilitis
when 3 + centor criteria are present
codeine to morphine
divide by 10
when to do CT in head injury (within 8 hours)
> loss of consciousness or amnesia, and who are aged over 65 years old
when to do CT in head injury (within 1 hours)
> 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
treatment of ER +ve breast cancer
tamoxifen in pre/peri-menopausal
aromatase inhibitors post-menopausal
management of HAP in penicillin allergy
non-severe = doxycyline severe= co-trim + gent
