p year Flashcards
GP what tool to use to assess chronic confusion?
MoCA/MMSE
main contraindications for COCP
Uncontrolled hypertension
migraine w aura
over 35 smoking 15+
surgery w prolong immobility
ischaemic heart disease, cardiomyopathy, af
liver cirrohsisi and liver tumours
SLE and antiphospholipid syndrome
bmi 35 pluus (ukmec 3)
Generalized muscle pain and weakness, along with dark colored urine?
. Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue, leading to the release of muscle proteins (myoglobin) into the bloodstream. One class of medications known to potentially cause rhabdomyolysis is statins.
Prophylaxis of bleeding in stable oesophageal varices involves:
- Non-selective beta blockers (e.g., propranolol) first-line
- Variceal band ligation (if beta blockers are contraindicated)
Ascites management
Management options include:
- Low sodium diet
- Aldosterone antagonists (e.g., spironolactone)
- Paracentesis (ascitic tap or ascitic drain)
- Prophylactic antibiotics (ciprofloxacin or norfloxacin) when there is <15 g/litre of protein in the ascitic fluid
- Transjugular intrahepatic portosystemic shunt (TIPS) is considered in refractory ascites
- Liver transplantation is considered in refractory ascites
Spontaneous Bacterial Peritonitis
The most common organisms are:
- Escherichia coli
- Klebsiella pneumoniae
Management involves:
* Taking a sample of ascitic fluid for culture before giving antibiotics
* Intravenous broad-spectrum antibiotics according to local policies (e.g., piperacillin with tazobactam)
hepatic encephalopathy management?
One toxin particularly worth remembering is ammonia
Management involves:
- Lactulose (aiming for 2-3 soft stools daily)
- Antibiotics (e.g., rifaximin) to reduce the number of intestinal bacteria producing ammonia
- Nutritional support (nasogastric feeding may be required)
Lactulose works in several ways to reduce ammonia:
* Speeds up transit time and reduces constipation (the laxative effect clearing the ammonia before it is absorbed)
* Promotes bacterial uptake of ammonia to be used for protein synthesis
* Changes the pH of the contents of the intestine to become more acidic, killing ammonia-producing bacteria
mediation used to treat IBS
Mebeverine is a medication that is commonly used to treat symptoms associated with irritable bowel syndrome (IBS), such as abdominal pain, cramping, bloating, and changes in bowel habits. It belongs to a class of medications called antispasmodics, which work by relaxing the smooth muscles of the intestines.
Uterine leiyomyoma vs unterine leiomysarcoma
Uterine leiyomyoma- fibroid not to be mistaken with unterine leiomysarcoma
Aysmetrical intra-uterine growth restriction- most common cause
pre-eclampsia
preferred treatment for urinary tract infections in patients with renal dysfunction.
Trimethoprim
Signs of molar pregnancy
Large for gestational dates
Abnormally Raised Beta HG
Uterine cavity is filled with multiple cystic sonoluscent areas – commonly described as snow storm appearance
rise in beta hcg after 48 hrs
ectopic - tiny bit
normal - double
molar- loadssss
following vaginal delivey baby develoops opthalmia neonatum, causative organism?
chlamidiya
reactive arthritis?
can’t see (conjunctivitis), can’t pee (urethritis), can’t climb a tree (arthritis)”.
treatment of chlamidya in pregnancy
give erythromycin not doxy
smoking increases or decrease risk of pre-eclampsia
deecreases
- Core symptoms of depression with appetite and weight loss - first line treatment?
Mirtazipine.
which murmurs have which sounds?
Aortic stenosis: ejections systolic
Mitral stenosis: mid diastolic
Mitral regurg: pan systolic (high pitch whistling)
Tricuspid regurg: pan systolic
different surgeries for hip fractures?
Non displaced hip fractures grade I, II = internal fixtation
Extra capsular-
Intertrochanteric fracture: dynamic hip screw
Subtrocanteric fracture: intramedullary nail
adhd meds
- Methylphenidate (“Ritalin“)
- Dexamfetamine
- Atomoxetine
treatments for diabetic retinopathy
- panretinal laser photocoagulation
- intravitreal VEGF inhibitors
- if severe or vitreous haemorrhage: vitreoretinal surgery
management for uterine atony
- Oxytocin (slow injection followed by continuous infusion)
- Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
- Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
- Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
- Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
TB drugs, what bloods to monitor routinely?
LFTs
How do you diagnose placental abruption?
clinical diagnosis
88) AF, other cardio risk factors, abdo pain, bleeding diagnosis?
mesenteric ischaemia
hypercalcaemia management?
The initial management of hypercalcaemia is rehydration with normal saline, typically 3-4 litres/day. Following rehydration bisphosphonates may be used. They typically take 2-3 days to work with maximal effect being seen at 7 days
Other options include:
- calcitonin - quicker effect than bisphosphonates
- steroids in sarcoidosi
tests for lateral and medial epidcondylitis and which is which?
lateral epicondylitis- tenis elbow = Mills test and cozens test
medial epicondylitis- golfers elbow = Golfers elbow test
90) High ALP, pruritis, dark urine, pale stools, (primary biliary cirrhosis), what antibody?
Anti-mitochondrial
Autoantibodies relevant to primary biliary cholangitis are:
* Anti-mitochondrial antibodies (AMA) are the most specific to PBC and form part of the diagnostic criteria
* Anti-nuclear antibodies are present in about 35% of patients
* TOM TIP: The two results for primary biliary cholangitis to remember are anti-mitochondrial antibodies and alkaline phosphatase. In your exams, a middle-aged white woman presenting with itching, a positive AMA and a raised alkaline phosphatase almost certainly has primary biliary cholangitis.
how is inersussception diagnosed?
ultrasound
causes pf raynauds phenomenum? + Management
scleroderms
RA/SLE
Leukemia
COPCP
Management: calacium channel blockers i.e nifedipine
treatment for cluster headaches and prophylaxis
acute treatment:
high flow oxygen and triptans e.g. sumaptiptan
prophylaxis: Verapamil
acute asthma management
Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
Nebulisers with salbutamol / ipratropium bromide
Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)
IV hydrocortisone
IV magnesium sulphate
IV salbutamol
IV aminophylline
chronic asthma management
saba
ics
laba (e.g. salmeterol)
or mart
acute exhacebation and causeative organism of exacerbation of COPD
The most common infective causes of COPD exacerbations are:
bacteria
Haemophilus influenzae (most common cause)
ncrease the frequency of bronchodilator use and consider giving via a nebuliser
give prednisolone 30 mg daily for 5 days
it is common practice for all patients with an exacerbation of COPD to receive antibiotics. NICE do not support this approach. They recommend giving oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’
the BNF recommends one of the following oral antibiot
Long term COPD management
Short-acting beta-2 agonists (e.g., salbutamol)
Short-acting muscarinic antagonists (e.g., ipratropium bromide)
no af
laba + lama
af
laba+ics
electrolyte imbalance in vomiting?
Hypokalaemic hypochloraemic alkalosis
how to calculate parkland formula?
4 x kg x total body surface area affected
81) 41 weeks, hadn’t started labour, how to induce her
VAGINAL progesterone e2
can do sweep too
Artificial rupture of membranes with an oxytocin infusion can also be used to induce labour, although this would only be used where there are reasons not to use vaginal prostaglandins. It can be used to progress the induction of labour after vaginal prostaglandins have been used.
how long do you treat DVT for and what do u give to pregnant folk
3 month if provoked
6 months in unprovoked
LMWH
Warfrin first line in patient with Antiphospholid syndrome
- Hospital acquired pneumonia - what do you make sure the abx cover against - anaerobes, gram negative rods, gram negative cocci, fungi
gram neg
tests for squint
cover test and corneal light reflection test
foreign body sensation in the eye what is the diagnosis and treatment?
corneal abrasion and chloramphenicol drops
- Watery, red eye - given eye drops…still persistent after 1 week. What is it? 6/6 unaided visual acuity both eyes
ripe side effects ( which most commonly causes hepatotoxicity?)
Side Effects of Treatment
Rifampicin can cause red/orange discolouration of secretions like urine and tears. It is a potent inducer of cytochrome P450 enzymes therefore reduces the effect of drugs metabolised by this system. This is important for medications such as the contraceptive pill.
Isoniazid can cause peripheral neuropathy. Pyridoxine (vitamin B6) is usually co-prescribed prophylactically to reduce the risk of peripheral neuropathy.
Pyrazinamide can cause hyperuricaemia (high uric acid levels) resulting in gout.
Ethambutol can cause colour blindness and reduced visual acuity.
Rifampicin, isoniazid and pyrazinamide are all associated with hepatotoxicity
TOM TIP: A common exam question starts with “a patient has recently started treatment for tuberculosis. They noticed … Which medication is most likely to be implicated?” It is worth remembering the common side effects to help you answer these questions. They start feeling numbness or unusual sensations in their fingertips or feet: isoniazide (“I’m-so-numb-azid”). They noticed difficulty recognising colours: ethambutol (“eye-thambutol”). They noticed their urine or tears are orange or red: rifampicin (“red-an-orange-pissin’”).
emergency management of opioid overdose
naloxone
Management of opioid dependence
methadone or buprenorphine
types of HPV linked to asthma
16 and 18
Which drug was causing memory loss and confusion or something – beta blocker, bisphosphonate, colecalciferol, oxybutynin
oxybutynin
- Anorexic – which of the following is diagnostic hypokalemaia, low cortisol, high tsh, anaemia
hypokalemia
treatment of keratitis
acyclovir or other antiviral
Neuroleptic malignant syndrome
seen in patients taking antipsychotic medication.
It occurs within hours to days of starting an antipsychotic (antipsychotics are also known as neuroleptics, hence the name) and the typical features are:
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
A raised creatine kinase is present in most cases.
stop antipsychotic
patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units
IV fluids to prevent renal failure
what tool is used to visualise the vocal cords
larygoscope
high prolactin can be caused by which drugs and what can it lead to
antipschotic drugs and infertility
how much blood loss is considered PPH
500ml after a vaginal delivery
1000ml after a caesarean section
Nephrotic syndrome is most common in ages 2-5 and is treated with?
- High dose Steroids
- Diuretics may be used to treat oedema
- Albumin infusions may be required in severe hypoalbuminaemia
Which steroid are acute flares of MS treated with?
methylpredisolone – 500mg daily 5 days
tripple a management
- Yearly for patients with aneurysms 3-4.4cm
- 3 monthly for patients with aneurysms 4.5-5.4cm
The NICE guidelines (2020) recommend elective repair for patients with any of:
* Symptomatic aneurysm
* Diameter growing more than 1cm per year
* Diameter above 5.5cm
Elective surgical repair involves inserting an artificial “graft” into the section of the aorta affected by the aneurysm. There are two methods for inserting the graft:
* Open repair via a laparotomy
* Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries
Treatment of trigeminal neuralgia?
Carbamazepine
Which of the following would be a contraindication to alteplase therapy?
Select one:
Blood pressure of 170/100
Cerebrovascular small vessel disease
Concurrent aspirin therapy
Neurosurgery to remove a meningioma 2 months ago
Self limiting nosebleed 3 weeks previously
Neurosurgery to remove a meningioma 2 months ago
What is the main drug used to treat hyperthyroidism
- carbimazole 2nd line Propylthiouracil, propananol can also be used for symptom control
What is a side effect of carbimazole to be aware of - Pancreatitis
- agranulocytosis
What is the most common cause of hypothyroidism in the developed world?
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the developed world. It is an autoimmune condition causing inflammation of the thyroid gland. It is associated with anti-thyroid peroxidase (anti-TPO) antibodies and anti-thyroglobulin (anti-Tg) antibodies.
typical vs atypical
typical
* Haloperidol
* Chlorpromazine
* Flupentixol decanoate (depot injection)
atypical
* Olanzapine
* Risperidone (depot injection)
* Clozapine
* Amisulpride
* Quetiapine
the established first stage of labour
- Regular, painful contractions
- Dilatation of the cervix from 4cm onwards
addisons electrolytes
hyperkalemia, hyponatremia, metabolic acidosis
foot drop, weakness in foot eversion-
Common peroneal nerve injury
s important to screen for HELLP syndrome in a woman with pre-eclampsia and thus FBC and LFTs are appropriate investigations
(Haemolysis, elevated liver enzymes, low platelets)
aspirin overdose symptoms
- Tinnitus
- Initial respiratory alkalosis (caused by activation of respiratory centres in the brain)
- Later metabolic acidosis (causes by wasting of bicarbonate ions due to the ingested acid load) - this is often mixed with the respiratory alkalosis
amitriptyline side effect
constipation
Cholestatic jaundice in pregnancy is a contraindication for
cocp
… is the commonest cause of septic arthritis in young, sexually active patients.
N. gonorrhoeae
investigation for infective endocarditis
blood cultures
an has inner feeling of restlessness (sczhio dude on long term antipsychotics)
akathesia
Treatment of infective endocarditis
flucloxacilin and gentamicin
how to manage uterine hyperstimulation?
Management of uterine hyperstimulation involves:
Removing the vaginal prostaglandins, or stopping the oxytocin infusion
Tocolysis with terbutaline
