MSRA 7 Flashcards
When are sulfonylurea CI?
Acute porphyria (glibenclamide, gliclazide, and tolbutamide).
Ketoacidosis.
Severe renal impairment.
If necessary, tolbutamide (a short-acting sulfonylurea) and gliclazide (which is principally metabolized in the liver) can be used at the lowest dose to provide blood glucose control.
Severe hepatic impairment — increased risk of hypoglycaemia.
Name the class of drug for Glibenclamide, Gliclazide, Glimepiride, Glipizide, Tolbutamide
Sulfonylureas
When are exenatide, liraglutide, lixisenatide, dulaglutide, semaglutide, tirzepatide CI?
Ketoacidosis.
Pancreatitis.
Renal impairment:
Severe hepatic impairment — avoid liraglutide.
Severe gastrointestinal disease
What do you do if you find a new diagnosis of T1DM?
If type 1 diabetes is diagnosed, refer the person immediately (on the same day) to a diabetes specialist team to confirm the diagnosis and provide immediate care.
When do you test for C-peptide
Type 1 diabetes is suspected but the clinical presentation includes some atypical features (for example age 50 years or older, BMI of 25 kg/m2 or above, or slow evolution of hyperglycaemia), or
Type 1 diabetes has been diagnosed and treatment started but there is a clinical suspicion that the person may have a monogenic form of diabetes, and one or both tests may guide the use of genetic testing, or
Classification of diabetes is uncertain and confirming type 1 diabetes would have implications for availability of treatment, for example continuous subcutaneous insulin infusion (CSII or ‘insulin pump’) therapy.
What are the CI for Ivabradine
Ivabradine should not be started in anyone with a resting heart rate less than 70 beats per minute
Define a threatened miscarriage
What happens to the type of bleeding and the cervical os?
Is there a foetal heart beat?
A process of miscarriage that has started but not yet progressed to a state from which recovery is impossible. Manifests before 24 weeks’ gestation with vaginal bleeding
No opening of the cervical os or expulsion of any products of conception
There is a foetal heartbeat
Define an inevitable miscarriage
What happens to the type of bleeding and the cervical os?
Is there a foetal heart beat?
A condition of vaginal bleeding and cervical dilation without expulsion of products of conception (POC) before 24 weeks’ gestation. Typically followed by partial or complete passage of POC.
The cervical os is open but there is no POC
There may or may not be a foetal heartbeat
Define a missed miscarriage
What happens to the type of bleeding and the cervical os?
Is there a foetal heart beat?
A death of a fetus before 20 weeks’ gestation without expulsion of any products of conception. Typically asymptomatic or results in cramping.
The cervical os is closed, there is no bleeding
An ultrasonography shows a gestational sac with products of conception and absent fetal cardiac activity.
Define an incomplete miscarriage
What happens to the type of bleeding and the cervical os?
Is there a foetal heart beat?
A condition in which products of conception are retained without continued embryonic or fetal cardiac activity. Clinical features may include vaginal bleeding and painful cramping without expulsion of fetal tissue. May occur after spontaneous or induced abortion.
The os is open, there is no foetus is dead.
Define a complete miscarriage
The complete passage of all products of conception (POC) before 20 weeks’ gestation.
The os is closed, there is no bleeding
What should be assessed in a misscarriage?
Diagnostic confirmation of fetal death prior to treatment is essential to avoid compromising a viable pregnancy.
Consider the diagnosis of septic abortion in patients with clinical features of pregnancy loss and fever.
What should theophyllines not be prescribed with
What is the reaction
What blood test need to be routinely performed when on theophylline?
Beta-2 agonists, corticosteroids, diuretics — hypokalaemia may be potentiated.
Check serum potassium levels regularly.
What are the causes of aortic regurgitation disease?
Causes of AR due to valve disease
rheumatic fever: the most common cause in the developing world
calcific valve disease
connective tissue diseases e.g. rheumatoid arthritis/SLE
bicuspid aortic valve (affects both the valves and the aortic root)
Causes of AR due to aortic root disease
bicuspid aortic valve (affects both the valves and the aortic root)
spondylarthropathies (e.g. ankylosing spondylitis)
hypertension
syphilis
Marfan’s, Ehler-Danlos syndrome
When do is bone-sparing treatment is recommended in those on steroids
People who are taking high doses of oral corticosteroids (more than or equivalent to prednisolone 7.5 mg daily for 3 months or longer
What is the reaction between a macrolide and a statin?
combination of erythromycin with simvastatin significantly increases the risk of statin-induced myopathy and potentially life-threatening rhabdomyolysis.
Which drugs should be avoided in pregnancy?
lithium
aspirin
benzodiazepines
amiodarone
carbimazole
ciprofloxacin
sulphonamides
sulphonylureas
methotrexate
tetracyclines
How is VW disease inherited?
It is mixed
How common is charcot marie tooth?
How do you get it?
What does it cause?
How does it present?
One of the most common inherited neurological diseases
Inheritance is usually autosomal dominant, but may be autosomal recessive or X-linked.
Various mutations cause impaired growth or function of the axons or Schwann cells (e.g., defects in axon or myelin sheath proteins).
Common clinical features include:
Distal muscle weakness and atrophy
Reduced or absent reflexes
Sensory deficits (e.g., decreased vibration, proprioception)
Associated with scoliosis and foot deformities (e.g., high arches, hammer toes)
How will you be able to tell the difference between Amoebiasis and Giardiasis diarrhoea?
Giardiasis causes smelly, fattym non blood diarrhoea that floats
Amoebiasis causes blood diarrhoea
What are the CKD stages from I to IIIb
1 Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)
2 60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)
3a 45-59 ml/min, a moderate reduction in kidney function
3b 30-44 ml/min, a moderate reduction in kidney function
IgA nephropathy and post strep nephropathy are different, how do they differ in their presentation?
IgA nephropathy presents within days of an infection with proteinuria being more predominant than haematuria
Sulfonamides are associated with SJS, name the sulfonamides
Diuretics (thiazide, furosemide, acetezolemaide)
Antibiotics sulfamethoxazole (SMX), sulfadiazine, sulfisoxazole
Sulfonylurea
Sulfasalazine
