MRCP2 Flashcards
Nutritional support in alcohol misuse?
Thiamine
How to promote alcohol withdrawal?
BZD
Disulfram mechanism of action?
inhibition of acetaldehyde dehydrogenase
Contraindications of disulfram?
Ischaemia
Heart disease
Psychosis
Mechanism of acamprost?
NMDA antagonist
Action of acamprost?
Reduce cravings
Mechanism of amiodarone induced hypothyroidism?
High iodine content of amiodarone causing a Wolff-Chaikoff effect*
Pathophysiology of type 1 amiodarone induced thyrotoxicosis?
Excess iodine-induced thyroid hormone synthesis
Pathophysiology of type 2 amiodarone induced thyrotoxicosis ?
Amiodarone-related destructive thyroiditis
Differentiate between type 1 and type 2 amiodarone induced thyrotoxicosis?
Goitre –> type 1
No goitre –> type 2
Management of type 1 AIT?
Carbimazole or potassium perchlorate
Management of type 2 AIT?
Corticosteroids
Should amiodarone be stopped in amiodarone induced hypothyroidism?
No.
Should Amiodarone be stopped in amiodarone induced hyperthyroidism
Yes.
Side effects of amiodarone?
thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval
Amiodarone + warfarin
Decreases metabolism of warfarin
Elevates INR
Amiodarone + digoxin
Increased digoxin level
Problems with anabolic steroid use ?
Cardiac morbidity and mortality
hepatocellular carcinoma and hepatic adenoma.
Psychiatric illness
Coming off anabolic steroids, how do you wean?
Do not need to wean - Just stop
WHat is the effect of verapmil?
Highly negatively inotropic
Side effects of verapamil
Heart failure
constipation
hypotension
bradycardia
flushing
What is the effect of diltiazem?
Highly inotropic
Side effect of diltiazem?
Hypotension
Bradycardia
Heart failure
Ankle swelling
Sides effect of dihydropyridine calcium channel blockers?
Flushing
Headache
Ankle swelling
Features of canabinoid overdose?
CNS: agitation, tremor, anxiety, confusion, somnolence, syncope, hallucinations, changes in perception, acute psychosis, nystagmus, convulsions and coma.
Cardiac: tachycardia, hypertension, chest pain, palpitations, ECG changes.
Renal: acute kidney injury.
Muscular: hypertonia, myoclonus, muscle jerking and myalgia.
Other: cold extremities, dry mouth, dyspnoea, mydriasis, vomiting and hypokalaemia
Features of carbon monoxide poisoning?
headache: 90% of cases
nausea and vomiting: 50%
vertigo: 50%
confusion: 30%
subjective weakness: 20%
severe toxicity: ‘pink’ skin and mucosae, hyperpyrexia, arrhythmias, extrapyramidal features, coma, death
Typical caroxyhaemoglobin for non-smokers?
< 3% non-smokers
Typical caroxyhaemoglobin for smokers?
<10%
Caroxyhaemoglobin for
10 - 30% symptomatic: headache, vomiting
> 30% severe toxicity
Management of carbon monoxide poisoning?
100% high-flow oxygen via a non-rebreather mask
from a physiological perspective, this decreases the half-life of carboxyhemoglobin (COHb)
What is cathinone ?
NRG-1 is a synthetic cathinone drug
derivative of phenylpropanone which is a naturally occurring psychotrope in khat (Catha edulis).
Mechanism of cathinone?
increasing synaptic concentrations of noradrenaline, dopamine and serotonin
sensation of euphoria, detachment and wellbeing as well as upregulation of the sympathetic system.
What is seen in cathinone toxicity?
Hyponatraemia
Serotonin syndrome
Management of cathinone toxicity: Hyponatraemic + neurological compromise?
Infusion of 3% saline solution at a maximum rate of 1ml/kg/hour
Feautres of serotonin syndrome?
Liberated serotonin and causes agitation, confusion, muscle hyperactivity with fasciculations, hypertonia and clonus.
Creatine kinase and white cell counts are often raised and body temperature may be extremely high.
Mechanism of ciclosporin?
Decreases clonal proliferation of T cells by reducing IL-2 release
Adverse effects of ciclosporin?
nephrotoxicity
hepatotoxicity
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection
What immunosuppression is not myelid toxic?
Ciclosporin
Mechanism of cocaine?
cocaine blocks the uptake of dopamine, noradrenaline and serotonin
Cardiovascular effects of cocaine?
coronary artery spasm → myocardial ischaemia/infarction
both tachycardia and bradycardia may occur
hypertension
QRS widening and QT prolongation
aortic dissection
Neurological effects of cocaine?
seizures
mydriasis
hypertonia
hyperreflexia
Psychiatric effects of cocaine?
agitation
psychosis
hallucinations
Other features of cocaine overdose?
ischaemic colitis is recognised in patients following cocaine ingestion. This should be considered if patients complain of abdominal pain or rectal bleeding
hyperthermia
metabolic acidosis
rhabdomyolysis
Management of cocaine over?
benzodiazepines are generally first-line for most cocaine-related problems
Features of cyanide posioning?
‘classical’ features: brick-red skin, smell of bitter almonds
acute: hypoxia, hypotension, headache, confusion
chronic: ataxia, peripheral neuropathy, dermatitis
Management of cyanide poisoning?
supportive measures: 100% oxygen
definitive: hydroxocobalamin (intravenously)
+
combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)
dicobalt edetate
Mechanism of action of digoxin?
decreases conduction through the atrioventricular node
slows the ventricular rate in atrial fibrillation and flutter
increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase
stimulates vagus nerve
When does digoxin toxicity occur?
Toxicty can occur even if within therapeutic range
BNF advises that the likelihood of toxicity increases progressively from 1.5 to 3 mcg/l.
Features of digoxin toxicity?
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
Precipitating factors of digoxin toxocity?
classically: hypokalaemia
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
Why does hypokalaemia cause toxicity?
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
Management of digoxin toxicity?
Digibind
correct arrhythmias
monitor potassium
Indications for dopamine receptor antaongists?
Parkinson’s disease
prolactinoma/galactorrhoea
cyclical breast disease
acromegaly
Side effects of dopamine receptor antagonists?
nausea/vomiting
postural hypotension
hallucinations
daytime somnolence
DRESS syndrome typically affects?
Skin, liver, kidneys, lungs and heart.
Rash associated with DRESS?
morbilliform skin rash
exfoliative dermatitis, high fever, and inflammation of one or more organs
Features of dress syndrome?
Can develop any of:
raised and low white count, eosinophilia , thrombocytopaenia, anaemia, atypical lymphocytes
develop kidney disease which is usually mild (interstitial nephritis is common, renal failure is rare),
myocarditis, pericarditis,
liver enlargement, hepatitis and rarely hepatic necrosis with liver failure
lung disease (pneumonitis, pleuritis, pneumonia),
neurological involvement which may lead to meningitis and encephalitis, gastrointestinal symptoms
severe cases, acute colitis and pancreatitis can occur, and endocrine abnormalities may include thyroiditis and diabetes.
Diagnostic criteria for DRESS?
Hospitalisation
Reaction suspected to be drug related
Acute skin rash
Fever about 38ºC
Enlarged lymph nodes at two sites
Involvement of at least one internal organ
Blood count abnormalities such as low platelets, raised eosinophils or abnormal lymphocyte count.
Drugs that impair glucose tolerance?
thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics
Beta-blockers cause a slight impairment of glucose tolerance
Drugs that induce urinary rentetion?
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
Alpha agonists?
Alpha-1: Decongestants (e.g. phenylephrine/oxymetazoline)
Alpha-2: Glaucoma (e.g. topical brimonidine)
Alpha antagonist?
Benign prostatic hyperplasia (e.g. tamsulosin)
Hypertension (e.g. doxazosin)
Beta 1 agonist?
Inotropes (e.g. dobutamine)
Beta 1 antagonist?
Non-selective & selective beta-blockers (e.g. atenolol, bisoprolol
Beta 2 agonist?
Bronchodilators (e.g. salbutamol)
Beta 2 antagonist?
Non-selective beta-blockers (e.g. propranolol, labetalol)
Dopamine agonist?
Parkinson’s disease (e.g. ropinirole)
Prolactinoma
Dopamine antagonist?
Schizophrenia (antipsychotics e.g. haloperidol)
Anti-emetics (e.g. metoclopramide/domperidone)
GABA agonists?
Benzodiazepines
Baclofen
GABA antagonist?
Flumazenil
Muscarinic agonist?
Glaucoma (e.g. pilocarpine)
Muscarinic antagonist?
Atropine (e.g. for bradycardia)
Bronchodilator (e.g. ipratropium bromide, tiotropium)
Urge incontinence (e.g. oxybutynin)
Nicotinic agonist?
Nicotine
Varenicline (used for smoking cessation)
Depolarising muscle relaxant (e.g. suxamethonium)
Nicotinic antagonist?
Non-depolarising muscle relaxants (e.g. atracurium)
Serotonin agonists?
Triptans (for acute migraine, e.g. zolmitriptan)
Serotonin antagonists?
Anti-emetics (e.g. ondansetron)
Drugs that cause lung fibrosis?
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
What is the actual name of ectasy?
Ecstasy (MDMA, 3,4-Methylenedioxymethamphetamine
Features of ectasy pisoning?
neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
hyperthermia
rhabdomyolysis
Management of ectasy poisoning?
Dantrolene -may be used for hyperthermia if simple measures fail
Stages of ethylene glycol toxicity?
Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness
Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension
Stage 3: acute kidney injury
Management of ethylene glycol toxicity
fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
competing with ethylene glycol for the enzyme alcohol dehydrogenaseimits the formation of toxic metabolites
Haemofiltration
What type of drug is flecanide?
class 1c antiarrhythmic
QRS widening
Indications for flecanide?
atrial fibrillation
SVT associated with accessory pathway e.g. Wolf-Parkinson-White syndrome
Contraindications for flecanide?
post myocardial infarction
structural heart disease: e.g. heart failure
sinus node dysfunction; second-degree or greater AV block
atrial flutter
Adverse effects of flecanide?
negatively inotropic
bradycardia
proarrhythmic
oral paraesthesia
visual disturbances
Is gentamicin damage reversible to the ear?
No
Contraindication for gentamicin?
MYASTHENIA GRAVIS
Acute arsenic poisoning ?
garlic-like odour
hypersalivation
nausea, vomiting and diarrhoea, abdominal pain
oral burns, gastrointestinal bleeding
shortness of breath
muscle spasms
renal tubular acidosis
cardiomyopathy
jaundice
intestinal haemorrhage
seizure
coma
Chronic arsenic poisoning?
hardened patches of skin
hyperpigmentation of the skin
anorexia, weight loss
weakness
muscle aches
chills
polyneuritis, peripheral neuropathy
ataxia
Signs of arsenic poisoning?
oedema- subcutaneous and pulmonary
Mee’s lines (transverse white lines across fingernails)
jaundice
hypotension
exfoliative dermatitis
haemolysis
ventricular arrhythmia
Duration of action of heparin?
Short
Mechanism of action of heparin?
Activates antithrombin III. Forms a complex that inhibits thrombin, factors Xa, IXa, Xia and XIIa
Duration of action of LMWH?
Long
Mechanism of LMWH?
Activates antithrombin III. Forms a complex that inhibits factor Xa
Monitoring of heparin?
APTT
Monitoring of LMWH?
Anti- Xa
HIT antibodies?
antibodies form against complexes of platelet factor 4 (PF4) and heparin
PF4-heparin complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors
When is the onset of HIT?
5-10 days post treatment
How should patients be anticoagulated in HIT?
direct thrombin inhibitor e.g. argatroban
danaparoid
Complications in iron overdose?
Metabolic acidosis
Erosion of gastric mucosa → GI bleeding
Shock
Hepatotoxicity and coagulopathy
Management of ingesting overdose iron?
40mg/kg elemental iron and are asymptomatic can be observed at home.
> 40mg/kg elemental iron or who are symptomatic need medical assessment with serum iron levels measured 2-4 hours post-ingestion and abdominal x-ray.
decontamination procedure of choice and is performed on all patients presenting within 4 hours who have ingested > 60mg/kg elemental iron or have undissolved tablets on abdominal x-ray. (whole bowel irrigation)
Inidications for desferrioxime?
Patients with serum iron level > 90umol/l,
Patients with serum iron level 60-90umol/l, who are symptomatic or have persistent iron on abdominal x-ray despite whole bowel irrigation
Any patient with shock, coma or metabolic acidosis
Management of local anaesthetic overdose?
20% Lipid emulsion
Mechanism of malignant hyperthermia?
excessive release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle
Mutation in malignant hyperthermia?
chromosome 19 encoding the ryanodine receptor
Autosomal dominant
Drugs that can provoke malignant hyperthermia?
halothane
suxamethonium
other drugs: antipsychotics (neuroleptic malignant syndrome)
Management of malignant hyperthermia?
dantrolene - prevents Ca2+ release from the sarcoplasmic reticulum
Management of methanol poisoning?
fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
haemodialysis
cofactor therapy with folinic acid to reduce ophthalmological complications
Features of methanol poisoning?
alcohol (intoxication, nausea etc) and also specific visual problems, including blindness
Uses of ocreotide?
acute treatment of variceal haemorrhage
acromegaly
carcinoid syndrome
prevent complications following pancreatic surgery
VIPomas
refractory diarrhoea
Adverse effect of ocreotide?
Gallstones
Mechanism of ocreotide?
Longterm somatostatin analogue
Mechanism of organophosphate poisoning?
acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission.
Presentation of organophosphate poisoning?
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
Management of organophosphate poisoning?
atropine
the role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit
Management of paracetamol overdose?
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
Management of salicylate poisoning ?
urinary alkalinization with IV bicarbonate
haemodialysis
Management of BZD overdose?
Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.
Management of tricyclics overdose?
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
Management of lithium overdose?
haemodialysis may be needed in severe toxicity
Management of heparin overdose?
Protamine
Management of beta blocker overdose?
if bradycardic then atropine
in resistant cases glucagon may be used
Management of methanol overdose?
fomepizole or ethanol
haemodialysis
Management of organophosphate overdose?
Atropine
Management of lead overdose?
Dimercaprol, calcium edetate
Management of cyanide overdose?
Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
Inducers of P450?
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
Inhibitors of P450?
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
Indications for NAC in paracetamol?
- 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity
- staggered overdose
- patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol
- patients who present > 24 hours if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
Indicaitons for liver transplant?
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Drugs that worsen seizure control?
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid
Drugs to avoid in renal failure?
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
Drugs that accumulate in chronic renal failure?
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
Drugs to avoid in pregnancy?
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones: the BNF advises to avoid due to arthropathy in some animal studies
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents
Features of quinine poisoning?
VERY TOXIC
ventricular tachyarrhythmias or fibrillation
Hypoglycaemia
Looks similar to salicylate poisoning
leaves permanent neural damage, if the patient survives.
Mechanism of quinolones?
inhibit topoisomerase II (DNA gyrase) and topoisomerase IV
Adverse effects of quinolones ?
lower seizure threshold in patients with epilepsy
tendon damage (including rupture) - the risk is increased in patients also taking steroids
cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children
lengthens QT interval
Contraindications in quinolones?
Quinolones should generally be avoided in women who are pregnant or breastfeeding
avoid in G6PD
Features of salicylate overdose?
hyperventilation (centrally stimulates respiration)
tinnitus
lethargy
sweating, pyrexia*
nausea/vomiting
hyperglycaemia and hypoglycaemia
seizures
coma
Indications for dialysis in salicylate overdose?
serum concentration > 700mg/L
metabolic acidosis resistant to treatment
acute renal failure
pulmonary oedema
seizures
coma
Causes of serotonin syndrome?
monoamine oxidase inhibitors
SSRIs
St John’s Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
tramadol may also interact with SSRIs
ecstasy
amphetamines
Features of serotonin syndrome?
neuromuscular excitation
hyperreflexia
myoclonus
rigidity
autonomic nervous system excitation
hyperthermia
sweating
altered mental state
confusion
Difference between serotonin syndrome and neuroleptic malignant syndrome ?
Cause SSRI –> serotonin
Cause Antipsycotic –> neuroleptic
Fast onset –> serotonin
Slow onset –> neuroleptic
Hyperreflexia –> serotonin
Weak reflexes –> Neuroleptic
dilated pupils –> serotonin
Normal pupils –> neuroleptic
lead pip reptic –> neurleptic
Management of serotonin syndrome?
cyproheptadine and chlorpromazine
Management of neuroleptic?
Dantrolene
Mechanism of action of tacrolimus?
decreases clonal proliferation of T cells by reducing IL-2 release
binds to FKBP forming a complex which inhibits calcineurin, a phosphotase that activates various transcription factors in T cells
this contrasts with ciclosporin, which binds to cyclophilin rather than FKBP
Very similar to ciclosporin
Thallium poisoning?
painful polyneuropathy
mood change
alopecia
Side effects of trastzumab?
flu-like symptoms and diarrhoea are common
cardiotoxicity
more common when anthracyclines have also been used
an echo is usually performed before starting treatment
Side effect of rifampicin?
hepatitis, orange secretions
flu-like symptoms
Side effect of isoniazid?
Peripheral neuroapthy hepatitis, agranulocytosis
liver enzyme inhibitor
How to prevent peripheral neuropathy from isoniazid?
pyridoxine (Vitamin B6)
Side effect of Pyrazinamide?
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
Side effect of ethambutol?
optic neuritis: check visual acuity before and during treatment
VTE prophylaxis for elective hip?
Prophylaxis
Elective hip LMWH for 10 days followed by aspirin (75 or 150 mg) for a further 28 days
or
LMWH for 28 days combined with anti-embolism stockings until discharge
or
Rivaroxaban
VTE prophylaxis for elective knee?
Aspirin (75 or 150 mg) for 14 days
or
LMWH for 14 days combined with anti-embolism stockings until discharge
or
Rivaroxaban
Differentiate between Amiodarone induced hyperthyroidism type 1 and 2?
Colour flow doppler
Mechanism of cyproheptadine ?
(5-HT2 receptor antagonist)
Management of bad trip from LSD?
BZD
Management of adder bite?
Adder bites are rare, but when they occur may be extremely painful; the mainstay of treatment is analgesia and supportive therapy. Discuss the use of antivenin with NPIS and do not apply a tourniquet
When to stop NAC?
when INR <1.3, and ALT less than twice upper limit
Presentation of iron overdose?
RAISED GLUCOSE
direct corrosion on the gastrointestinal tract may be seen within six hours
neutrophil leucocytosis and significant haemolysis of samples due to the high plasma iron burden.
APTT tends to be prolonged in iron toxicity compared to the prolongation of prothrombin time in a paracetamol poisoning.
Severe iron toxicity presents with liver failure, gastrointestinal caustic damage and coagulopathy with raised APTT. Early hyperglycaemia and extensively haemolysed samples may also indicate significant iron burden
worst antipsychotic for hyperglycaemia?
clozapine and olanzapine
other than amiodarone… what drug cause hypothyroidism?
digoxin
Other option for anticoagulation in HIT?
Bivalirudin
What inhaled recreational drug can precipitate anaemia?
Inhaled Nitrous oxide
Which antibiotic best to avoid in patients with theophylline etc?
Ciprofloxain
strong enzyme inhibitor
GHB?
Grievous Bodily Harm’ is a colourless, odourless, bitter-tasting substance that acts as a CNS depressant
Date rape drug
Rapid recovery
Moderate change of HIT what test should be done?
Serotonin release assay
What type of arrhythmia do you get in tricyclics ?
Broad complex
Parkinsonism + Negative HIV +raised ferritin
Serum heavy metals
Tachycardia for lidocaine?
Broad complex
High output stoma tretment?
Ocreotide
What is folinic acid ?
fompeziole
Cocaine toxicity - avoid what?
Beta blockers
Difference between mthotaxime and GHB?
euphoria + coma –> GHB
Dissociative symptoms –> Methotaxime
Acute cerebellar syndrome –> methoxetamine intoxication.
Reversible side effects of anabolic steroids?
Increased appetite
Gastrointestinal dysfunction
Mood swings
Anxiety
Acne
Oedema
Libido change
Scrotal pain
Erectile dysfunction
Menstrual irregularities
Irreversible side effects of anabolic steroids?
Hirsutism
Voice pitch changes
Male pattern baldness
Skin striae or keloid scarring
Chest pain
Clitoral hypertrophy
Short stature due to premature fusion of growth plates
Tramadol + Sertraline?
serotonin syndrome
Drug to avoid in atrial flutter?
flecanide
Features of intrathecal baclofen withdrawal?
Intrathecal baclofen withdrawal syndrome is associated with severe spasticity, rhabdomyolysis, acute renal failure and multisystem organ failure
Hyerbacic Oxygen, when to use in carbon monoxide poisoning?
Severe cases
Or if they are pregnant
Drug that leads to increased digoxin level?
NSAID
Thiazides
Angiotensin-converting enzyme (ACE) inhibitors
Thallium poisoning?
painful polyneuropathy, mood change and alopecia. Treatment is chelation therapy with oral Prussian Blue
Hormone profiles in anabolic steroids?
Elevated testoestoner: low FSH and low LH
When not to use nitrofurantoin?
Nitrofurantoin is best avoided in patients with CKD stage 3 or higher due to the significant risk of treatment failure and occurrence of side effects due to drug accumulation
VTE prior to surgery?
Mechanical
If > 12 hours then dalteparin
How do you screen for paraquat overdose?
Urine dithionate testing
When can trimethorpim be used in pregnany?
Avoid in first 3 months
Overdose with NRG-1 causes what?
Cathinone toxicity
What is considered bisphosphonate failure?
failure is defined as two or more fractures on treatment, or one fracture with a reduction in bone density (as in this patient).
Osteoporosis: When is strontium contraindicated?
Presence of DVT
When can a bisphophonate holiday be considered?
can be considered for some patient’s after five years treatment.
patients less than 75 years old with a femoral neck T-score greater than -2.5 and who are defined as low risk by WHO Fracture Risk Assessment Tool (FRAX)
must repeat DEXA in 2 years though
Features of her dances syndrome?
elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks
Most definitive means of investigating sjorgen syndrome?
Salivary gland biopsy is the most definitive way of confirming the diagnosis of primary Sjogren’s syndrome - sections will show a typical lymphocytic infiltrate
Pain relief osteoarthritis?
- Paracetamol + opical NSAIDs are only appropriate for osteoarthritis of the hands and knees.
Second line treatment includes oral NSAIDs, codeine, capsaicin cream and intra-articular corticosteroids.
21-year-old male presents to his GP complaining of muscle cramps that prevent him from competing in his local park 5 km race. He has always had muscle pains when warming up with exercise but these gradually diminish after 20 minutes. There was no weakness and no abnormalities on neurological exam.
Creatinine kinase was elevated at 1215 IU/L and myoglobinuria was noted on urinalysis. The electromyography (EMG) demonstrated myotonic discharges and fibrillations.
mcardle syndrome
Drugs that cause pericarditis?
Periglide
Carbergoline
