MRCP PCT Flashcards
Role of protein C
inactivate factor 5a and 8a
Meptazinol
mu opioid partial receptor agonist
low constipation rate
Antiemetics that cause prolonged QT
metoclopramide
ondansetron
prochloperazine
Zolendronic acid can be pain control for…
Bone pain with bone mets
Fentanyl patch useful in…
stable morphine who cannot take due to side effect or poor renal fx
Renal function for fentanyl patch
safe in eGFR <30
Diazepam acts on…
GABA-A
MND patients with respiratory distress at end of life…
NIV improves comfort
Glycopyrronium side effect
dry mouth
Cytotoxic agent that causes cardiomyopathy…
doxirubicin
herceptin
Anaplastic thyroid cancer (poor prognosis) spread to…
LUNGS mostly
Liver capsule pain can be managed by…
Dexamethasone
Gabapentin bings to…
alpha 2 delta of VGCaChannel
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serotonin syndrome vs neuroleptic malignant syndrome
hyperreflexia vs hyporeflexia
Side effect on ondasetron
constipation
Antiemetics contraindicated in PD
haloperidol
metoclopramide
Steroid side effect
psychosis
Side effect of amitriptylline
anti-cholinergic effects
Laxative for opiate induced constipation
First: Stimulant laxative (Senna)
Second: Osmotic (macrogol/lactulose)
Third: docusate if colic
Hyoscine (buscopan) side effect
dry mouth
anticholinergic
Breakthrough pain with synringe driver
subcut morphine
DNAR
medical decision
side effect of fentanyl…
generalised itching and sweating and rash
Option for local pain management in pancreatic cancer when PCM, ibu, MST does not work
coeliac plexus block
WHO pain ladder
Para –> ibu –> weak opioid (codeine/dihydrocodeine/tramadol) –> morphine
CKD patient pain relief
oxycodone not morphine
Drug that increases life expectancy in MND
Riluzole
240mg codeine to morphine
20mg morphine
Antiemetic receptors
Ondansetron= 5HT
Domperidone=dopamine antagonist
Metoclopramide=dopamine antagonist
Aprepitant = nk-1 receptor (chemo related N+V)
Morphine conversion
Oral morphine /2 : sc morphine , oral/sc oxycodone
Oral morphine /3 : sc diamorphine
Morphine 12 mg : buprenorphine 5microgram
Morphine 30mg : 12 fentanyl
Breakthrough ⅙ to 1/10th of regular morphine .
codeine/tramadol to oral morphine = divide by 10
Marie curie nurses
help those who wish to die at home
Prognosis discussion
if patient does not want to know do not inform
Treatment for Colicky pain
hyoscine
oral morphine –> subcut morphine
divide oral morphine by 2
(takes into account surpassing first pass metabolism)
Fluids in EOL
may cause fluid overload
does not affect rate / timing of death
Severe hyponatraemia <125
SEIZURES
Bleomycin toxicity
pneumonitis
non productive cough, SOBOE, bibasal creps
Adrenal metastasis
hypoadrenalism
abdo pain, vomit, weakness
low BP
low Na
high K
Side effect of amiodarone
hepatotoxicity
pulmonary fibrosis
thyroid issues
prolonged QT
pancreatitis
CORNEAL DEPOSIT
Cisplatin side effects
ototoxic
hypocal
hypomag
hypokal
nephrotoxic
FEV1 contraindicated for pneumonectomy
FEV1<2 in pneumonectomy
FEV1<1.5 for lobectomy
lorazepam low dose
useful in SOB
CPR with PE
continue CPR for 60-90 min post fibrinolysis (unless ROSC) to allow PE to dissolve
trastuzumab….
can cause dilated cardiomyopathy
hence HF
Antiemetic for hypercalcaemia
Haloperidol (D2 antagonist)
Second line: metoclopramide (acute dystonia side effect)
Chemo antiemetics
cyclizine
ondansetron
Diazepam
muscle spasm
Acinic keratosis management (atypical keratinocyte)
topical 5-FU
LBD
triad:
fluctuating confusion
persistent visual hallucination
spontaneous parkinsonism
note: extreme reaction to neuroleptics
What is nitrate tolerance
increases reactive oxygen spp from vascular oxidative stress–~> inhibiting activation of nitrate
Myeloproliferative diseases
- too many cells from bone marrow
Polycythaemia vera
CML
Myelofibrosis
Essential thrombocytosis
Lymphoproliferative disease
CLL
Follicular lymphoma
DLBCL
Myelodysplastic syndrome
- abnormal dysfunction cells from marrow - low counts
ring sideroblast
HIGH BLAST CELLS
Restless leg syndrome
discomfort in legs and urge to move
better with movement
crawling feeling
iron deficiency associated
P450 inducer - decreases INR
rifampicin
phenytoin
carbamazepine
st johns wort
P450 inhibitor - increases INR
erythromycin
metronidazole
ciprofloxacin
allopurinol
Legionella transmission via..
warm water source via aerosol
Management of LBD
rivastigmine (cholinesterase inhibitor)
Thiazide diuretic…
hypercalcaemia
worsening glucose tolerance
low potassium/sodium/magnesium
hypochloraemic alkalosis
squamous cell carcinoma of skin
ulcerated nodular lesion
surrounding parathesia and hyperkeratosis
Mx: surgical excision (risk of LN mets)
Reverse splitting of S2
AS
HOCM
LBBB
Giant v wave
tricuspid regurg
variable S1
CHB
Heparin induced thrombocytopenia
risk of venous thrombotic event
SIADH
urine sodium >40
urine osmolality HIGH
MI
LAD - anterior
LCx - lateral
RCA - inferior
Listeria meningitis
Low glucose
high protein
lymphocytic
TB management
RIPE for 4 months
RI to continue for 2 further
TB management in deranged LFT (liver friendly regimen)
streptomycin/moxifloxcin
What is creatitine
cation
drugs can interfere with creatinine secretion–> lead to self limiting and reversible rise in creatinine without changing eGFR
e.g trimethoprime and cimetidine
Normal pressure hydrocephalus
trial of CSF removal
Gait in parkinsons
NARROW short shuffling gate
Donepazil in alzheimers
acetylcholinesterase inhibitor
Rasagiline in parkinsons
MAO B inhibitor
Medication increasing risk of GOUT
diuretics
Mechanism of digoxin
inhibit sodium potassium ATPase in sarcomere
Why is there delay in digoxin action (few days)
digoxin binds to proteins and widely distribute in body tissues
Management for CLL
First: FCR combination therapy
- fludaraine,
- cyclophosphamide,
- rituximab
Second: Alemtuzumab (CD52)
Osteomalacia
low vit D –> low calcium –> PTH increase (secondary) –> trashing phosphate
High ALP in osteomalacia
due to increased osteoblasts
Delirium vs dementia
fluctuating impaired consciousness => acute delirium
age >65 vaccine
yearly influenzae
one off pneumococcal
Surgical management of aortic stenosis…
based on clinical sx - syncope chest pain worsening LVF
Potassium sparing diuretics
amiloride
spironolactone
homonymous hemianopia
contralateral occipital lesion (posterior cerebral artery)
note: macular sparing as macular collaterals from MCA
Empirical abx for meningitis in >65/immunocompromised
meningococcal and pneumococcal and listeria
cef, amox, aciclovir
causes of RBB
ASD
PE
HTN
causes of LBB
CAD
AS
HOCM
MI
Huntington disease
caudate nucleus
chorea
CC
Hippocampus
memory
temporal lobe epilepsy
schizophrenia
Thalamus
sleep regulation
eye saccade movement
Cirpofloxacin side effect
Tendo rupture
Stroke management
rule out haemorrhage with CT
past 4.5hr -> aspirin 300
switch to clopi 75 after 2 weeks
within 4.5hr -> alteplase
Common cause of TIA
carotid artery steonsis
Lacunar infarct
persistent focal deficits
no changes in initial imaging
commonest cause of AS
young- bicuspid
old- calcification
Amiodarone action
K channel antagonist
–> delay depol
–> increase refractory period
NaBKCa
Na - lidocaine, flecainide
B- bisoprolol
K- amiodarone, sotalol
Ca - verapamil, diltiazem
Halflife of amiodarine
long (up to 1 month)
therefore needs loading dose
Digoxin toxicity
vomiting
confusion
yellow visual field
Management of MSRA s.aureus
asymptomatic- topical decolonisation (risk of spread to others)
invasive -> IV vanc
Management of hallucination and agitation in parkinson
low dose atypical antipsychotic
- quetiapine
avoid typical antipssychotics (has anti-dopamine effect)
Entacapone (to prevent OFF)
COMT inhibitor
- prevent breakdown of levodopa in brain
Alzheimers management
Mild to moderate
- acetylcholinesterase inhibitor
donepezil
rivastigmine
galantamine
Severe (MMSE <10 and ADL)
- memantine
Irradiated RBC for…
on chemo (purine analogue)
–> reduced T cell
–> risk of transfusion associated GVHD
Weber syndrome
third nerve palsy
contralateral hemiparesis
midbrain lesion
at base!
basillar
anterior communication cerebral artery stroke
optic chiasm
visual field defect
Vertebral artery dissection (stroke)
PICA–> lateral medullary syndrome
Why is NIV contraindicated in hypotension
reduced venous return and cardiac output
–> due to high lung pressures
carcinoid syndrome common sx
Diarrhoe
fascial flushing
What medication can you add in parkinsons to reduce dyskinesia
amantadine
NMDA receptor
Side effects of levodopa
dyskinesia
loperamide
Exclude infective gastroenteritis first
Parkinsons plus
PD- tremor, asymetric, late postural instability
LBD
PSP- early falls + postural instability, verical supranuclear gaze palsy, symmetrical axial and limb parkinsonism
MSA- postural hypotension
