PT 2.0 Flashcards
Clozapine monitoring
FBC- risk of atypical antipsychotics, neutropenia and agranulocytosis
-SE: reduced seizure threshold, myocarditis
Neuropathic bladder Sx+ Mx
Seen in MS: can lead to significant post-void residual urine volumes due to impaired bladder emptying
Mx: intermittent self-catherisation
BPH urinary incontinence
ɑ-Adrenoceptor blockers would relax muscles (inhibit sympathetic activation) to ease the flow and reduce sudden urges to empty the bladder
Exudate vs transudate
-exudates protein level MORE THAN 30 g/L
-transudates protein level LESS <30 g/L
Exudate is bcs of inflammation i.e. Cancer, Infection, Rheumatoid arthritis
Transudate is bcs of fluid moving across the membrane i.e. congestive heart failure, meig’s syndrome
TB diagnosis
Sputum microscopy and smear (using Ziehl-Neelsen stain to identify acid-fast bacilli (AFB))
Post wide local excision and axillary node clearance swelling
Seroma
Immunocompromised pneumonia causative agent
Pneumocystits jirovecci
Baby blues vs postnatal depression vs puerperal psychosis
BB: 3-7 days post birth, low mood, tearful etc
PND: typically peaks 3 months after, cardinal depression sx, SSRI
PP:Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)
Knee injuries
ACL: twisting mechanism, + ve drawer and lachman test
PCL: dashboard injury
MCL: usually skiing or valgus stress, abnormal passove abduction
Menisci: locking and giving way also twisting mechanism
Complete heart block artery occluded
Right coronary
Heparin and warfarin monitoring
Heparin: Activated partial thromboplastin time (APTT)
Warfarin: prothrombin time (PT)
JIA (Still’s disease)
-arthralgia
-elevated serum ferritin
-rash: salmon-pink, maculopapular
-pyrexia typically rises in the LATE AFTERNOON/ EVENING in a daily pattern and accompanies a worsening of joint symptoms and rash
-lymphadenopathy
Fibrocystic disease
benign changes in the breast tissue- development of cysts, fibrosis, and pain or tenderness that typically fluctuates with the menstrual cycle due to hormonal variations. The symptoms often worsen during the luteal phase (second half) of the cycle when estrogen and progesterone levels are higher.
Subarachnoid Haemorrhage Ix
- non-contrast CT head is the first-line investigation of choice
acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system.
-CT head is done within 6 hours of symptom onset and is normal
do not do a lumbar puncture
(consider an alternative diagnosis)
-if CT head is done more than 6 hours after symptom onset and is normal
do a lumber puncture (LP)
Zolpidem, zopiclone SEs
‘Z drugs’ make you zzzzz increase falls risk
Monitoring requirements aminophylline
continuous ECG- arrhythmia SE narrow therapeutic window
Non-shockable vs shockable rhythmns
- ‘shockable 100-200j’ rhythms: ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT)
- ‘non-shockable’ rhythms: asystole/pulseless-electrical activity (asystole/PEA)
hypocalcaemia MOA in CKD
Reduced 1-alpha-hydroxylation which catalyses conversion of 25-hydroxyvitamin D to its active form, 1,25-dihydroxyvitamin D (calcitriol)
Peripheral arterial disease mx
-Pt with established cardiovascular disease should be taking a statin. -Atorvastatin 80 mg.
Clopidogrel should be used first-line in patients with peripheral arterial disease.
Exercise training also recommend.
Breast cancer surgical management
women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery: if negative then they should have a sentinel node biopsy
in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery (SE: this may lead to arm lymphedema and functional arm impairment)
Von Willebrand disease Sx Ix Mx
Autosomal dominant- most common inherited bleeding disorder
Sx: epistaxis and menorrhagia
Ix: prolonged bleeding time (APTT)
Mx: tranexamic acid and desmopressin
Key feature of Haemophillia
haemoarthroses- bleeding into joint space (prolonged APTT)
Acne vulagris management
Mild to moderate:
12-week
1. topical adapalene with topical benzoyl peroxide
2. topical tretinoin with topical clindamycin
Moderate to severe: as above then
1. a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
2. a topical azelaic acid + either oral lymecycline or oral doxycycline
Erythromycin in pregnant women
Acne vulgaris referral guidelines
Refer if scarring or persistent pigmentary changes
Biggest depression predictor amongst elderly
Poor health
High risk influenza prophylaxsis
oral oselatamvir
Colorectal cancer surgical management site
Caecal, ascending or proximal transverse colon: Right hemicolectomy
Distal transverse, descending colon: Left hemicolectomy
Emergent e.g. perforated bowel- hartmann’s
Malaria vs Dengue vs Typhoid Sx
Malaria: recurring fever, chills, sweats, headache, muscle aches, fatigue, nausea, and vomiting.
Dengue: sudden high fever, severe headache, pain behind the eyes, joint and muscle pain severe abdominal pain, persistent vomiting, bleeding gums.
Typhoid: sustained fever, headache, weakness, stomach pain, constipation or diarrhea, and a rose-colored rash.
ABO incompatibility sx
if a Rh -ve mother delivers a Rh +ve child a leak of fetal red blood cells may occur this causes anti-D IgG antibodies to form in mother: in later pregnancies these can cross placenta and cause haemolysis in fetus
Sx: jaundice, anaemia, hepatosplenomegaly
Mx: transfusions, UV
Most common UTI cause
E. coli, gram negative bacteria, is a rod-shaped (bacillus).
