Medicine Flashcards
CKD
0-
eGFR >60 and no markers kidney damage
1-
eGFR >90 but markers of kidney damage
2-
eGFR 60-90 with markers of kidney damage
3a-
eGFR 45-60 with or without markers
3b-
eGFR 30-45 with or without markers
4-
eGFR 15-30
5-
eGFR <15
Marker-electrolyte dist/proteinuria
eGFR variables
CAGE
creatinine
age
gender
ethnicity
factors that affect-
red meat 12 prior
muscle mass
pregnancy
diastolic murmur + AF =
?mitral stenosis
most common cause nephrotic syndrome children
minimal change disease (75%)
causes-
drugs
hodgkins lymphoma
thymoma
NSAIDs
glandular fever
only proteinurea not haematuria
steroids then cyclophosphamide
1/3 rule - never again/intermittent/frequent relapses
paracetamol poisoning best measure of liver failure
PT over ALP/ALT
travellers diarrhoea definition
3+ loose stools in 24 hours with or without cramps, fever, nausea, vomiting or blood in the stool
E. coli commonest cause
carbimazole monitoring
council on infections after starting die to agranulocytosis
T2DM A1c targets
lifestyle management - 48
lifestyle + MF - 48
any BSL lowering drug - 53
First line T2DM mangement
if HbA1c >48
assess CVS risk
if low risk –> MF
if high risk –> MF + SGLT-2 inhibitor
trial MR MF if GI upset
If MF contraindicated—–
SGLT-2i if CVD/CCF
DPP-4/pioglitazone/gliclazide
SGLT-2 inhibitors
dapa/empagliflozin
should give if
- QRISK >10
- CVD
- CCF
MF should be uptitrated prior to starting
second line T2DM management
already on MF
new target is A1c >53
metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)
DPP4i
GLIPTINS
sitagliptin
Third line T2DM management
aim A1c <53
metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
consider insulin therapy
Fourth line T2DM management
switch one of the drugs to GLP-1 mimetic
GLUTIDES - semaglutide,leraglutide
only continue if >11 and weight loss 3% reduction A1c at 6 months
starting insulin - stop all bar MF
most common drug cause gynaecomastia
spironolactone
primary biliary cholangitis
middle aged women
9:1 ration women:men
associated
- Sjogrens (80%)
- RA
- systemic sclerosis
- thyroid disease
presents-
fatigue, itch, lethargy, raised ALP, cholestatic jaundice, hyperpigmentation at pressure points.
AMA - antimitochondrial Abs in 98%
raised serum IgM
management-
urodeoxycholic acid
itch–> cholestyramine
liver transplnt if bili >100
20 fold Increase risk HCC
ECG normal variants
sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)
pericarditis
pleuritic CP relieved by leaning forwards
widespread ST elevation
PR depression most specific ECG finding
high risk patients with any trop rise/ fever should be inpatients
all get echo
NSAIDs/colchicine 1-2 weeks then tapering
haemochromatosis monitoring
ferritin and transferrin saturation
typical bloods results-
transferrin sat >55% in men >50% women
ferritin >500
raised iron
low TIBC/serum transferrin
