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Medicine and Surgery Mushkies > Passmed Gerry, Immuno, Metabolic, Oncology, and Palliative Mushkies > Flashcards

Passmed Gerry, Immuno, Metabolic, Oncology, and Palliative Mushkies Flashcards

1
Q

In anaphylaxis, how frequently can you repeat adrenaline?

A

Every 5 mins

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2
Q

Anaphylaxis defn?

A

A severe, life threatening, systemic hypersensitivity reaction

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3
Q

Most common anaphylaxis causes?

A
  1. Food
  2. Drugs
  3. Venom
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4
Q

Adult anaphylaxis doses?

A

500, 200, 10

  1. Adrenaline 500mcg (0.5ml 1 in 1,000)
  2. Hydrocortisone (200mg)
  3. Chlorphenamine (10mg)
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5
Q

Anaphylaxis biphasic reaction frequency?

A

20%

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6
Q

How long should anaphylaxis pts be observed for after?

A

6-12 hours

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7
Q

How long do serum tryptase levels remain elevated after anaphylaxis?

A

12 hours

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8
Q

What is the first line sedative for delirium?

A

Haloperidol 0.5mg

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9
Q

Acetylcholinesterase inhibitor examples?

A

Donepezil, Galantamine, RIvastigmine

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10
Q

NMDA receptor antagonist example?

A

Memantine

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11
Q

Alzheimers management?

A
  1. Non-pharm = range of activities, cognitiive stimulation therapy, group reminiscence therapy
  2. Pharm
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12
Q

Pharm management of Alzheimers?

A
  1. AChesterase inhibitors first line e.g. donepezil

2. NMDA receptor antagonist e.g. memantine add-on

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13
Q

S/e of donepezil?

A

Insomnia

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14
Q

Relative c/i of donepezil?

A

Bradycardia

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15
Q

Dx of orthostatic HTN?

A
  1. SBP drop of 20mmHg
  2. DBP drop of 10mmHg
  3. Drop to 90mmHg systolic
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16
Q

Time b/w lying and standing BP?

A
  1. 5 mins lying down
  2. 1st minute of standing
  3. 3rd minute of standing
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17
Q

Drugs that cause postural hypotension?

A

NDAAABL

  1. Nitrates
  2. Diuretics
  3. Anticholinergic medications
  4. Antidepressants
  5. ACEi
  6. BBs
  7. L-Dopa
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18
Q

Investigation of falls?

A
  1. Bedside = basic obvs, BP, glucose, urine dip, ECG (x5)
  2. Bloods = FBC, U&E, LFTs, bone profile
  3. Imagine = CXR, CT head, cardiac echo
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19
Q

When should Abx be given for pressure ulcers?

A

Only if there are signs of infection

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20
Q

4 RFs for pressure ulcers?

A
  1. Malnourishment
  2. Incontinence
  3. Lack of mobility
  4. Pain
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21
Q

Pressure ulcer risk scoring system?

A

Waterlow score

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22
Q

Pressure ulcer grading?

A
  1. Grade 1 = non-blanchable erythema of intact skin
  2. Grade 2 = partial thickness skin loss involving epidermis/dermis/both
  3. Grade 3 = full thickness skin loss to underlying fascia
  4. Grade 4 = Extensive destruction, tissue necrosis, or damage to muscle, bone or
    supporting structures
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23
Q

Mx of pressure ulcer?

A
  1. Moist wound environment encourages wound healing –> hydrocolloing dressing and hydrogels, use of soap discouraged to avoid drying out the wound
  2. Tissue viability nurse referral
  3. Surgical debridement for selected wounds
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24
Q

Pathologic features of Lewy body dementia?

A

Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas

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25
Percentage of alzheimers pts with lewy bodies?
40%
26
Features of Lewy Body Dementia?
1. Progressive cognitive impairment, may be fluctuating 2. Parkinsonism 3. Visual hallucinations
27
Scan for dx of Lewy Body Dementia?
DaTscan
28
Sensitivity and specificity of DaTscan for LBD?
90% sensitivity, 100% specificity
29
Pharm management of LBD?
1. Donepezil and Memantine | 2. Avoid antipsychotics as may develop irreversible parkinsonism
30
Medical mx of delirium in Parkinsons?
Oral lorazepam NOT haloperidol
31
Foods high in potassium?
BOKAST 1. Bananas 2. Oranges 3. Kiwis 4. Avocados 5. Spinach 6. Tomatoes
32
How can heparin cause hyperkalaemia?
Inhibition of aldosterone secretion
33
Causes of hyperkalaemia?
1. AKI 2. Drugs 3. Metabolic acidosis 4. Addison's 5. Rhabdomyolysis 6. Massive blood transfusion
34
Drugs causing hyperkalaemia?
1. K sparing diuretics, ACEi, ARBs, Spironolactone 2. Ciclosporin 3. Heparin
35
Mx of hyperkalaemia?
1. Calcium gluconate 2. Insulin/dextrose infusion 3. Nebulised salbutamol
36
Features of hypocalcaemia?
1. Tetany = muscle twitching, cramping and spasm 2. Perioral paraesthesia 3. Chronic = depression, cataracts 4. ECG = prolonged QT interval
37
Raised ALP and raised calcium?
1. Bone metastases | 2. Hyperparathyroidism
38
Raised ALP and low calcium?
1. Osteomalacia | 2. Renal failure
39
4 causes of hypernatraemia?
1. Dehydration 2. Osmotic diuresis e.g. hyperosmolar non-ketotic diabetic coma 3. Diabetes Insipidus 4. Excess IV Saline
40
Most useful test in determining the cause of hypocalcaemia?
PTH
41
Hypocalcaemia mx?
1. IV calcium gluconate 10ml 10% over 10 mins
42
Complication of too rapid hypo/hypernatraemia correction?
1. Hyponatraemia correction --> central pontine myelinolysis | 2. Hypernatraemia correction --> cerebral oedema
43
Mx of hyponatraemia?
1. Fluid restriction 2. Hypertonic saline 3. Vaptans (ADH receptor antagonists)
44
4 situations where fluid intake should be less than urine output?
1. HF/Cirrhosis 2. SIADH 3. Renal failure 4. Psychogenic polydipsia
45
How do SSRIs cause hyponatraemia?
SIADH
46
Vit B7 aka?
Biotin
47
Biotin deficiency (B7)?
Dermatitis, seborrhoea
48
Vit B9 AKA?
Folic acid
49
Vit E aka?
Tocopherol
50
Vit K aqa?
Naphthoquinone
51
Maximum rate of K infusion that can be conducted without monitoring?
10mmol/hour
52
Is tx of asymptomatic hyperuricaemia to prevent gout recommended?
No
53
When should we suspect familial hypercholesterolaemia?
1. Total cholesterol >7.5mmol/l AND/OR | 2. Personal/FHx of premature CHD < 60 y/o
54
Thiazides cause hypo or hyperkalaemia?
Hypokalaemia
55
Advice for hypercalcaemic pt secondary to malignancy?
Maintain good hydration (3-4L of fluid per day)
56
Suppression of N&V with intracranial tumours?
Dexamethasone
57
What anti-emetics should be used for N&V due to chemo?
1. Low risk = metoclopramide | 2. High risk = ondansetron +/- dexamethasone
58
Ondansetron MOA?
5HT-3 receptor antagonist
59
Cyclizine MOA?
H1-antagonist used to treat inner ear induced nausea
60
Metoclopramide MOA?
D2-antagonist
61
6 Cytotoxic agent classes?
1. Alkylating agents 2. Cytotoxic antibiotics 3. Antimetabolites 4. Microtubule inhibitors 5. Topoisomerase inhibitors 6. Others
62
Alkylating agent example?
Cyclophosphamide
63
Cyclophosphamide MOA?
Alkylating agent, causes cross-linking in DNA
64
3 s/es of cyclophosphamide?
1. Haemorrhagic cystitis 2. Myelosuppression 3. Transitional cell carcinoma
65
Cytotoxic Abs examples?
1. Bleomycin | 2. Doxorubicin
66
Bleomycin MOA?
Degrades preformed DNA
67
Bleomycin s/e?
Lung fibrosis
68
Doxorubicin MOA?
Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis
69
Doxorubicin s/e?
Cardiomyopathy
70
Antimetabolite examples?
1. Methotrexate 2. 5-FU 3. 6-MP 4. Cytarabine
71
Methotrexate MOA?
Inhibits dihydrofolate reductase and thymidylate synthesis
72
4 s/es of methotrexate?
1. Lung fibrosis 2. Liver fibrosis 3. Myelosuppression 4. Mucositis
73
5-FU MOA?
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
74
3 s/e of 5-FU?
1. Myelosuppression 2. Mucositis 3. Dermatitis
75
6-MP MOA?
Purine analogue that is activated by HGPRTase, decreasing purine synthesis
76
6-MP s/e?
Myelosuppression
77
Cytarabine MOA?
Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase
78
Cytarabine s/e?
1. Myelosuppression | 2. Ataxia
79
Microtubule inhibitor examples?
1. Vincristine/vinblastine | 2. Docetaxel
80
Vincristine/vinblastine MOA?
1. Inhibits formation of microtubules
81
Vinblastine s/e?
Myelosuppression
82
Vincristine s/es?
1. Peripheral neuropathy (reversible) | 2. Paralytic ileus
83
Docetaxel MOA?
Prevents microtubule depolymerisation & disassembly, decreasing free tubulin
84
Docetaxel s/e?
Neutropenia
85
Topisomerase inhibitor example?
Irinotecan
86
Irinotecan MOA?
Inhibits topoisomerase I which prevents relaxation of supercoiled DNA
87
Irinotecan s/e?
Myelosuppression
88
Cisplatin MOA?
Causes cross-linking in DNA
89
Cisplatin s/e?
1. Ototoxicity 2. Peripheral neuropathy 3. Hypomagnaesaemia
90
Hydroxurea (hydroxycarbamide) MOA?
Inhibits ribonucleotide reductase, decreasing DNA synthesis
91
Hydroxurea (hydroxycarbamide)
Myelosuppression
92
Ca-125?
Ovarian cancer
93
Ca 19-9?
Pancreatic cancer
94
Ca 15-3?
Breast cancer
95
AFP?
HCC, teratoma
96
PSA?
Prostatic carcinoma
97
CEA?
Colorectal cancer
98
S-100?
Melanoma, schwannoma
99
Bombesin?
1. SCLC 2. Gastric cancer 3. Neuroblastoma
100
Most common lung cancer in non-smokers?
Lung adenocarcinoma, although the majority of patients who develop lung adenocarcinoma are smokers
101
Typical location of lung adenocarcinoma?
Peripheral lesions
102
Squamous cell lung cancer paraneoplastic?
PTHrP --> hypercalcaemia
103
2 associations of Squamous cell lung cancer?
1. Finger clubbing | 2. HPOA
104
HPOA?
Hypertrophic pulmonary osteoarthropathy
105
Large cell lung carcinoma typical location?
Peripheral
106
Large cell lung carcinoma hormone secretion?
May secrete b-HCG
107
Li-Fraumeni syndrome cause?
Germline mutation to p53 TS gene
108
Germline mutation to p53 TS gene?
Li-Fraumeni Syndrome
109
HRas?
Bladder cancer
110
LiFraumeni inheritence?
AD
111
Li-Fraumeni syndrome features?
SBLA 1. Sarcoma = blood vessels, nerves, adipose, muscular 2. Breast 3. Lymph/leuk 4. Adrenal
112
BRCA 1 Chr?
Chr 17
113
BRCA 2 Chr?
Chr 13
114
BRCA2 association in men?
Prostate cancer
115
BRCA 1&2 also associated with?
Ovarian cancer (55% with BRCA1 and 25% with BRCA 2)
116
Lynch syndrome inheritence?
AD
117
Main feature of lynch syndrome?
80% will get colonic and/or endometrial cancer, often at a young age
118
What is Gardners syndrome?
AD familial colorectal polyposis
119
Features of Gardners syndrome?
1. Multiple colonic polyps 2. Skull osteomas 3. Thyroid cancer 4. Epidermoid cysts
120
Gardners syndrome mutation?
APC gene on Chr5
121
Features of SVCO?
1. Dyspnoea (most common sx) 2. Swelling (of face, neck and arms, conjunctival and periorbital oedema may be seen) 3. Headache (worse in morning) 4. Visual disturbance 5. Pulseless jugular venous distension
122
SVCO Mx?
1. general = dexamethasone, balloon venoplasty, stenting 2. Small cell = chemo + radio 3. Non small cell = radio
123
Carcinogenic HPV subtypes?
HPV 16, 18, 33
124
Raised b-HCG and raised AFP in a man?
Non-seminomatous testicular cancer, as raised AFP excludes a seminoma
125
Earliest and most common sx of spinal cord compression?
Back pain
126
3 most common cause of neoplastic spine lesions?
1. Lung 2. Breast 3. Prostate
127
Mx of neoplastic spinal cord compression?
1. High dose oral dexamethasone | 2. Urgent onc assessment for consideration of radiotherapy or surgery
128
MSSC?
Metastatic spinal cord compression
129
Ix for ?spinal metastases?
Whole spine MRI
130
FDG?
Fluorodeoxyglucose
131
Main use of PET scan?
Evaluating primary and possibly metastatic disease
132
Chemo agent causing cardiomyopathy?
Doxorubicin
133
Woman with bone mets, most likely source?
Breast
134
Most common cause of SVCO?
Small cell lung cancer
135
Lung cancer with greatest smoking association?
Squamous cell lung cancer
136
-mab?
Immune checkpoint inhibitor
137
Ipilimumab?
CTLA4 inhibitor for advanced melanoma
138
Nivolumab and pembrolizumab?
PD-1 inhibitor, for melanoma
139
Initial management of neoplastic spinal cord compression?
8mg oral dexamethasone BD
140
NICE palliative care pain guildelines?
1. When starting treatment, offer patients with advanced and progressive disease regular oral modified-release (MR) or oral immediate-release morphine (depending on patient preference), with oral immediate-release morphine for breakthrough pain 2. If no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain. For example, 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required 3. oral modified-release morphine should be used in preference to transdermal patches 4. laxatives should be prescribed for all patients initiating strong opioid 5. patients should be advised that nausea is often transient. If it persists then an antiemetic should be offered 6. drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered
141
What is the breakthrough dose of morphine?
1/6th the daily dose of morphine
142
Preferred palliative pain meds in CKD?
1. Fentanyl 2. Alfentanil 3. Buprenorphine
143
Metastatic bone pain palliative tx?
1. Strong opioids 2. Bisphosphonates 3. Radiotherapy 4. Denosumab
144
When increasing the dose of opioids, the next dose should be increased by how much?
30-50%
145
Opioid s/es?
1. Usually transient = nausea, drowsiness | 2. Usually persistent = constipation
146
Converting from oral codeine to oral morphine?
Divide by 10
147
Converting from oral tramadol to oral morphine?
Divide by 10
148
Oxycodone s/es vs. morphine?
1. Less sedation, vomiting and pruritis than morphine | 2. More constipation than morphine
149
Converting from oral morphine to oral oxycodone?
Divide by 1.5-2
150
Transdermal fentanyl 12ug patch equivalent?
30mg oral morphine daily
151
Transdermal buprenorphine 10ug patch equivalent?
24mg oral morphine daily
152
Converting from oral morphine to subcutaneous morphine?
Divide by 2
153
Converting from oral morphine to subcutaneous diamorphine?
Divide by 3
154
Converting from oral oxycodone to subcutaneous diamorphine?
Divide by 1.5
155
Why is oral morphine half as strong as subcutaneous/IV morphine?
First pass metabolism
156
Mx of hiccups in palliative care?
1. Chlorpromazine 2. Haloperidol, gabapentin also used 3. Dexamethasone also used if there are hepatic lesions
157
MST?
Morphine sulphate tablets
158
2 main types of syringe driver?
1. Graseby MS16A (blue): the delivery rate is given in mm per hour (blue hour) 2. Graseby MS26 (green): the delivery rate is given in mm per 24 hours (green day)
159
Commonly used drugs in syringe drivers?
1. N&V = cyclizine, haloperidol, metoclopramide 2. Resp secretions = hyoscine hydrobromide 3. Bowel colic = hyoscine butylbromide 4. Agitation/restlessness = midazolam, haloperidol, levomepromazine 5. Pain = diamorphine is preferred
160
Syringe driver for Respiratory secretions in palliative care?
Respiratory secretions = Hyoscine hydRobromide
161
Syringe driver for Bowel colic?
Bowel colic = Hyoscine Butylbromide
162
First line opioid in palliative pts in whom oral tx is not suitable?
Transdermal opioid patch formulations
163
What vitamins does Pabrinex contain?
B and C
164
What colour is Pabrinex?
Yellow
165
For what cells is thiamine essential?
Glial cells

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