Passmed (Oct) Flashcards
How do you treat uncomplicated Chlamydia?
Doxycycline, 100mg BD, 7 days
If pregnant - azithromycin / erythromycin / amoxicillin
Trichomonas vaginalis - microscopy?
Flagellated protozoa
How do you treat Trichomonas vaginalis?
Metronidazole
Complication of shoulder dystocia (plus features)?
Erb’s palsy - damage to the brachial plexus
Presents as adduction and internal rotation of the arm.
RFs - foetal macrosomia (birth weight >4kg)
Child presents to GP with honey-coloured crusted lesions on chin - Dx? treatment? how long before can go back to school?
Impetigo
Rx - topical hydrogen peroxide 1%
Can go back to school when lesions crusted and healed or 48hrs after starting abx
PPI side effects??
Usual - GI, N+V, dizziness
Other - insomnia, hypomagnesia (leading to hypocalcaemia and hypokalaemia)
Patient presents with right-sided hearing loss, vertigo and tinnitus. O/e there is an absent corneal reflex - Dx?
Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma (acoustic neuroma) can affect which cranial nerves?
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
What are the features of acute tubular necrosis?
Urinary Na >40
Urine osmolality <350
Poor response to fluid challenge
Normal serum urea:creatinine ratio
Brown granular casts
Women presents with multiple non-healing leg ulcers. She reports feeling generally unwell for many months. Examination findings include a blood pressure of 138/72 mmHg, pulse 90 bpm, pale conjunctivae and poor dentition associated with bleeding gums. Dx?
Vit C deficiency (scurvy)
Features:
gingivitis, loose teeth
poor wound healing
bleeding from gums, haematuria, epistaxis
general malaise
Osteoarthritis - X-ray signs?
‘LOSS’
loss of joint space (joint space narrowing)
osteophyte formation
sclerosis
subchondral cysts
What is Felty’s syndrome?
Triad of rheumatoid arthritis, splenomegaly and low WCC
Rare complication of RA
Temporal arteritis - Rx?
No vision loss = high dose pred
VIsion loss = IV methylpred
Anterior uveitis - presentation? Associations? Treatment?
Acute onset, red eye, ocular pain/discomfort, photophobia
Associated with HLA-B27 (ank spond, reactive arthritis etc)
Urgent ophthalmology review, cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
Limited systemic sclerosis (CREST syndrome) - presentation?
Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
Telangiectasia
Patient presents with:
Pruritis (worst after taking showers or hot baths).
Tingling, burning, and numbness in arms, hands, and feet.
Headaches and lethargy.
Splenomegaly.
Elevated haemoglobin on full blood count
Dx??
Polycythaemia vera
Treatment of polycythaemia vera?
Venesection
Aspirin - reduce risk of thrombotic events
How do you treat hypomagnesaemia?
If <0.4 OR arrhythmias or seizures = IV magnesium
If >0.4 = oral magnesium salts (SE - diarrhoea)
What Ix should be carried out in someone with suspected multiple sclerosis?
MRI brain and spine without contrast
LP (oligoclonal bands)
If INR 5-8 - what do you do?
No bleeding - withhold warfarin for 1-2 says and restart on lower dose
Minor bleeding - stop warfarin, IV vit K, restart when INR below 5
What is the most common cause of infective endocarditis?
Staph aureus
What is the most common cause of infective endocarditis in a new valve replacement?
Staph epidermis
What to do if INR >8
No bleeding - stop warfarin, oral vit K, repeat dose if INR still high after 24hrs, restart warfarin when INR <5
Minor bleeding - stop warfarin, IV vit K, repeat dose if INR still high after 24hrs, restart warfarin when INR <5
Most commonly affected i]valve in infective endocarditis?
Mitral valve
Note: in IVDU is tricuspid
