MSRA 8 Flashcards
Which viral infection can be reactivated by strep pneumoniae pneumonia?
HSV-1 can reactivate after a Streptococcus pneumoniae infection, especially in the central nervous system (CNS
What is Pott’s disease?
TB of the spine
What is niacin deficiency the cause of?
Pellagra is a caused by nicotinic acid (niacin) deficiency. The classical features are the 3 D’s - dermatitis, diarrhoea and dementia.
What is P-ANCA associated with?
primary sclerosing cholangitis
ulcerative colitis
Churg-Strauss syndrome
What is the lithium mnemonic for side effects?
Leukocytosis
Increased weight, Impairment
Tremor, Hypothyroid, hyperthyroidism
Hyperparathyroidism
Insipidus, Nephrotoxic
Upset GI system
Malformations, Muscles breakdown
Which medications do you avoid with Lithium?
AND
ACEi/ARBs
NSAIDS
Diuretics, Dapagliflozin
Hypokalaemia, Prolonged QT, Carabmazepine, Antidepressants, Haloperidol
How is lithium monitored?
Lithium levels are normally measured one week after starting treatment, one week after every dose change, and weekly until the levels are stable. Once levels are stable, levels are usually measured every 3 months.
Lithium levels should be measured 12 hours post-dose.
Measure weight or Body Mass Index (BMI), urea and electrolytes estimated glomerular filtration rate (eGFR), calcium and thyroid function tests every 6 months (more often if there is evidence of impaired renal function).
If the person’s urea, or creatinine levels become elevated or if the eGFR declines over two or more tests, consider measuring lithium levels more frequently than 3 monthly.
What are the signs of lithium toxicity?
Signs of lithium toxicity include increasing diarrhoea, vomiting, anorexia, muscle weakness, lethargy, dizziness, ataxia, lack of coordination, tinnitus, blurred vision, coarse tremor of the extremities and lower jaw, muscle hyper-irritability, choreoathetoid movements, dysarthria, and drowsiness.
Lithium toxicity occurs at serum lithium concentrations of approximately 1.5 mmol/L and above, but may occur despite an apparently normal plasma level.
Severe lithium toxicity occurs at serum lithium concentrations of approximately 2 mmol/L and above.
How is hypothyroidism managed when caused by lithium?
May develop clinical goitre, hypothyroidism, or both; the risk appears to be greatest in the first 2 years of treatment. Although this may occur, it should not be a reason for stopping lithium treatment. Levothyroxine replacement is usually indicated. Thyroxine function tests usually return to normal when lithium is discontinued.
How are hand tremors managed in lithium treatment?
Avoid caffeine
Consider propranolol
What is impulsive control disorder in parkinsons?
Impulse control disorders (compulsive gambling, hypersexuality, binge eating, or obsessive shopping) can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease course particularly if the patient has a history of previous impulsive behaviours
How is pre-eclampsia managed at term?
pregnant women who have mild or moderate gestational hypertension, are more than 37 week pregnant, and are showing signs of pre-eclampsia, should be recommended to give birth within 24 - 48 hours.
What is the BFSoDAMP for drugs which cause pancreatitis
Bendroflumethiaide
Furosemide
Sodium valproate
Didanosine
Azathioprine
Mesalazine
Pentamidine
What is the treatment for scalp psoriasis?
Scalp psoriasis - first-line treatment is topical potent corticosteroids
Mr VPPK has what conditions
polycystic kidneys mitral valve prolapse
What can be used to treat labial adhesions?
Labial adhesions: if recurrent urinary tract infections, oestrogen cream may be tried
What eye lesions is seen in Down’s syndrome?
Brushfield spots
