PassMed Learning Flashcards
mx painful raynaud’s phenomenon
nifedipine
also stop smoking and keep hands warm
menorrhagia first line mx if not conceiving
mirena / IUS
diagnosing CKD
Chronic kidney disease is only diagnosed in this situation if supporting tests such as urinalysis or renal ultrasound are abnormal
c diff common trigger abx
clindamycin, cephalosporins, penicillins and fluoroquinolones (floxacins)
first line angina attack prevention
beta blocker or cal channel blocker depending on what already on
primary hyperparathyroidism
raised calcium, low phosphate
PTH may be raised or (inappropriately, given the raised calcium) normal!
bone protection decisions
Start alendronate in patients >= 75 years following a fragility fracture, without waiting for a DEXA scan
Bone pain, tenderness and proximal myopathy (→ waddling gait)
low calc, low phos, high ALP , low vit D
osteomalacia
metaclopramide
high prolactin and galactorrhoea
inducers of CYP450
PCBRAS
P – Phenytoin
C – Carbamazepine
B – Barbituates
R – Rifampicin
A – Alcohol (chronic use)
S – Sulphonylureas
CYP450 inhibitors
ODEVICES
O – Omperazole
D – Disulfiram
E – Erythromycin
V – Valproate
I – Isoniazid
C – Cimetidine + Ciprofloxacin
E – Ethanol (Acutely)
S – Sulphonamides
cavitating pneumonia alc diab
Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics
posterior vitreous detachement
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
retinal detachement
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
managing DVT
If a 2-level DVT Wells score is ≥ 2 points then arrange a proximal leg vein ultrasound scan within 4 hours
if can’t do quickly enough, cover with DOAC
if scan negative, do D dimer - rpt scan in 1 week if positive
if D dimer +ve with score <2, do scan in 4 hrs with Tx dose cover
GCS motor
Motor response
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
GCS verbal
Verbal response
- Orientated
- Confused
- Words
- Sounds
- None
GCS eyes
Eye opening
4. Spontaneous
3. To speech
2. To pain
1. None
back pain red flags
Thoracic pain
Age <20 or >55 years
Non-mechanical pain
Pain worse when supine
Night pain
Weight loss
Pain associated with systemic illness
Presence of neurological signs
Past medical history of cancer or HIV
Immunosuppression or steroid use
IV drug use
Structural deformity
back pain inv if red flag
Patients with red flags should have blood tests for FBC, ESR, Calcium, Phosphate, Alkaline phosphatase and PSA if appropriate. X-ray imaging should also be arrange
pain /sx often relieved by sitting down or leaning forward
Spinal stenosis
red-eye associated with slight watering and mild photophobia. He reports no pain or tenderness and vision is not affected
episcleritis
supplementary mx if cocaine induced ACS
IV benzodiazepine
emergency contraception levonorgestrel
must be taken within 72 hours of unprotected sexual intercourse (UPSI)*
single dose of levonorgestrel 1.5mg (a progesterone)
the dose should be doubled for those with a BMI >26 or weight over 70kg
hormonal contraception can be started immediately after using
emergency contraception ulipristal ellaone
30mg oral dose taken as soon as possible, no later than 120 hours after intercourse
use barrier contraception for 5 days post
can’t breastfeed til a week later, caution in asthma
copper IUD emergency contraception
must be inserted within 5 days of UPSI, or
if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date
subacromial impingement
Subacromial impingement often presents with a painful arc of abduction
if muscle weakness and injury hx more likely rotator cuff tear
paracetamol OD when to give NAC
if blood level >100 mg/L at 4 hours or > 15 mg/L at 15 hours
or if total taken is > 150mg/kg
or if staggered overdose/unsure on details
NB Paracetamol levels prior to 4 hours post-ingestion are inaccurate and therefore should not be used to assess the need for treatment.
treat antifreeze poisoning
Fomepizole
treat salicylate or TCA overdose
IV bicarb
what to treat first if deficiency in b12/folate
In patients with both vitamin B12 and folate deficiencies, the vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord
what infective process may mimick appendicitis
Campylobacter jejuni infection may cause marked right iliac fossa pain mimicking appendicitis
TIA aspirin decision making
give aspirin 300 mg immediately, unless:
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team
mx of TIA from GP setting
Specialist review
if the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
discuss the need for admission or observation urgently with a stroke specialist
If the patient has had a suspected TIA in the last 7 days:
arrange urgent assessment (within 24 hours) by a specialist stroke physician
if the patient has had a suspected TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days
differentiate hashimoto’s vs de quervain’s
Subacute thyroiditis can be distinguished from Hashimoto’s as a cause of hypothyroid or hyperthyroid vs graves (initial phase) by tenderness of the thyroid gland
when to excise fibroadenoma
if >3cm
mx mild flare UC
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates then oral corticosteroids are added
classify severity UC flare
mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
mx mild mod severe UC flares
mild/mod:
1. recetal mesalazine
2. oral mesalazine
3. oral steroids
severe:
1. admit, IV steroids
2. if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery
manage acute flare RA already on mx
Intramuscular steroids such as methylprednisolone are used to manage the acute flares of rheumatoid arthritis
frequency cervical ca screening
Routine recall is every 3 years for patients aged 25-49 years old, and every 5 years for patients aged 50-64 years old.
mx spont pneumothorax
If a secondary pneumothorax > 2cm and/or the patient is short of breath then patient should be treated with chest drain (not aspiration) as first-line
whenn to PCI NSTEMI pt
if GRACE score > 3%
COPD abx prophylaxis
NICE guidelines recommend prescribing azithromycin for patients with COPD who have had >3 exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year.
stroke mx
can thrombolyse within 4.5 hrs
if below 6 hrs do thrombectomy too
exclude haemmorhagic first on CT
NB For thrombectomy in acute ischaemic stroke, an extended target time of 6-24 hours may be considered if there is the potential to salvage brain tissue
diabetics who conceive need to take
Patients with diabetes (type 1 and 2) should take aspirin 75mg daily from 12 weeks gestation to reduce the risk of pre-eclampsia. They are also at higher risk of neural tube defects, therefore should take the higher dose of folic acid, 5mg daily, whilst trying to conceive until 12 weeks gestation.
