Other Flashcards
What does IgM positive for rubella represent ?
Current / recent infection of rubella
What does IgG +ve for rubella represent?
Previous infection or vaccination
Classical symptoms of hypercalcaemia?
bones, stones (renal), groans (abdo) and psychic moans
how to calculate the anion gap?
(sodium + potassium) - (bicarbonate + chloride)
adverse effects of tamoxifen?
hot flushes
increased risk of endometrial cancer
menstrual disturbance
VTE
management of C.diff?
- oral vancomycin (10days)
- oral fidaxomicin - 2nd line
- oral vancomycin +/- IV metronidazole - 3rd line
ALT + AST in the 10000s - most likely cause?
paracetamol overdose
why is COCP + migraine with aura contraindicated?
both increase risk of stroke
rose spots in a traveller with fever and diarrhoea - suspicion of what?
Typhoid
common side effect of bisphosphonates?
oesophagitis
Alpha fetoprotein (AFP) is a tumour marker for….?
heptatocellular carcinoma, testicular and ovarian cancer
Salicylic acid causes which metabolic abnormality?
Metabolic acidosis (due to disruption of krebs cycle causing lactic acidosis and salicylic acid causing an increased anion gap acidosis)
AND
respiratory alkalosis (direct stimulation of the central respiratory centres causing increased respiration and ventilation.)
Signs and symptoms of salicylic acid toxicity?
N&V
Tinnitus
epigastric pain
sweating
haematemesis
tachypnoea
tachycardia
pyrexia
non-cardiogenic pulmonary oedema
reduced consiousness / seizures
Management of salicylic acid toxicity?
within 1hr - activated charcoal
<450mg/L level - oral hydration
450-700mg/L - urinary alkalisation (sodium bicarbonate)
> 700mg/L - haemodialysis
Indications for haemodialysis in salicylic acid toxicity?
- Plasma salicylate level >900mg/L (>700mg/L if symptoms suggest severe poisoning)
- Renal failure
- Non-cardiogenic pulmonary oedema
- Coma
- Seizures
- Severe metabolic acidosis (pH<7.2 / H+63 nmols/L)
- Persistently high salicylate levels despite urinary alkalinisation
Signs and symptoms of opioid toxicity?
o Pinpoint pupils (meiosis)
o Reduced respiratory rate (may lead to respiratory failure)
o Bradycardia
o Hypotension
o Reduced conscious level
Management of opioid toxicity?
Naloxone (400mcg vial and should be titrated to response)
Signs and symptoms of cocaine use?
o Mydriasis (dilated pupils)
o Tachycardia
o Hypertension
o Excitation
o Hyperpyrexia
- coronary artery spasms may cause MI
- pulmonary effects such as bronchospasm, haemorrhage or non-cardiogenic pulmonary oedema
Management of cocaine toxicity?
Benzodiazepine such as diazepam.
Signs and symptoms of Amphetamine, ecstasy and cathinones use?
o Mydriasis (dilated pupils)
o Tachycardia
o Hypertension
o Psychomotor excitation
o Hyperpyrexia - may cause heat stroke like effects such as reduced consciousness, seizures, muscle rigidity, rhabdomyolysis, jaundice, renal failure and DIC
Management of Amphetamine, ecstasy and cathinones toxicity?
Supportive to ensure adequate hydration, benzodiazepines can be used for treatment of excitation, agitation or convulsions.
Signs and symptoms of benzodiazepine toxicity?
o Reduced consciousness
o Bradycardia
o Hypotension
o Reduced respiratory rate and depth
o Meiosis (small pupils)
Management of benzodiazepine toxicity?
Supportive
Flumazenil (only if very severe as seizure threshold falls)
Presentation of tricyclic antidepressant overdose?
o Mydriasis (dilated pupils)
o Dry mouth
o Hot skin
o Urinary retention
o Tachycardia (usually sinus and narrow complex but can become broad complex e.g. v tach/fib)
o Hallucinations
- slurred speech, confusion, reduced consciousness, seizures and coma if severe.
Management of tricyclic antidepressant overdose?
- activated charcoal if within 1hr
- supportive
- IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
- Seizures should be treated with benzodiazepines such as lorazepam or diazepam
- treat hypotension by elevating feet
Presentation of SSRI overdose?
- mild GI, CNS and CVS symptoms including nausea, vomiting, abdominal pain, diarrhoea, lethargy, tremor, drowsiness, headache, nystagmus, ataxia, sinus tachycardia, hypotension and hypertension.
More severe toxicity can cause hypoglycaemia, convulsions and tachyarrythmias. Hypoglycaemia may be a cause of seizures and must be considered.
Treatment of SSRI overdose?
- activated charcoal if within 1hr
- supportive
- Agitation and seizures can be treated using benzodiazepines such as lorazepam or diazepam.
How does serotonin syndrome present?
- Agitation
- tremor
- hypertonia
- diaphoresis
- tachycardia
- hyperpyrexia.
- Severe cases may be complicated with severe hyperthermia, rhabdomyolysis, renal failure and coagulopathies.
Management of serotonin syndrome?
- supportive including IV fluids
- benzodiazepines
- more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
Presentation of anticholinergic drug overdose?
- ataxia
- confusion
- hallucinations
- psychosis
-seizures - coma and respiratory failure.
- tachycardia
- warm skin
- dry mouth
- mydriasis
- urinary retention
Management of anticholinergic drug overdose?
- Charcoal if within 1hr
- supportive
Presentation of Organophosphates poisoning?
o Salivation
o Lacrimation
o Urination
o Diarrhoea
o Gastrointestinal upset
o Emesis
- early symptoms = headache, anxiety, nausea, vomiting, diarrhoea and meiosis
- severe symptoms = pulmonary oedema, bronchospasm, respiratory failure, muscular weakness or paralysis, convulsions and coma
Management of Organophosphates poisoning?
o significant bronchospasm or bronchial secretions / oedema then atropine
o Pralidoxime mesylate can be given in moderate to severe poisoning
Presentation of CO poisoning?
- Shortness of breath
- tachycardia
- chest pain
- neurological signs
- reduced consciousness
- seizures
- headache
- lethargy
- nausea
Investigation for CO poisoning?
carboxyhaemoblobin concentration
Treatment of CO poisoning?
100% oxygen
hyperbaric oxygen if very severe >20% HbCO conc
Beta blocker overdose management?
- if bradycardic then atropine
- in resistant cases glucagon may be used
How do you monitor heparin / LMWH?
standard heparin - APTT
LMWH - anti factor XA (not routinely done)
When do children recieve the MMR vaccine?
1 + 3 years
What is a prospective study?
Cohort study where a group of individuals who differ in one or more factors are followed to determine how these factors affect the outcome.
What is a case-control study?
Finds individuals with a given outcome along with a suitable control group and looks back retrospectively at how many individuals from both groups had the exposure of interest.
What is a cross-sectional study?
Measurers prevalence in a population at a given point in time
what is a randomised clinical trial?
Tests the effects of a specific intervention against a control group
What is a retrospective study?
After the outcome has occurred and lacks back at exposure of interest.
How to calculate alcohol units?
[ABV (%) x volume (mls) / 1000]
What forms part of the 6-in-1 vaccine?
diphtheria, tetanus, pertussis, Hib and hep B
How to calculate serum osmolarity?
(2x serum sodium) + serum glucose + serum urea
isolated fever within 24 hours of surgery in previously well patient?
physiological response to surgery
Which antibiotics can cause torsades de pointes?
Macrolides (e.g. clarithromycin)
Breast cancer screening programme?
mammogram every 3 years to all woman aged 50-70y.
