Quick recall 2 Flashcards
Drugs to give for neuropathic pain:
Don’t Get Pain Again
1. Duloxetine
2. Gabapentin
3. Pregabalin
4. Amitriptyline
Erythematous pustular rash, sunlight exacerbates symptoms: diagnosis
ROSCEA
Features: nose, cheeks, forehead
Late sign: Rhinophyma
Ocular involvement: blepharitis
Acne Rosacea: mx
- Sunscreen
- Topical brimonidine if predominant flushing
- Topical ivermectin (mild-moderate pustules)
- Topical ivermectin + oral doxy (moderate to severe)
Refferal consideration:
1. Prominent telangiectasia –> laser therapy
2. Rhinophyma
Urinary incontinence + gait abnormality + dementia :
Normal pressure hydrocephalus: wet, wobbly, wackly
Normal pressure hydrocephalus: mx
- Ventriculoperitoneal shunting
Dilatation of 3rd and lateral ventricles, absence of sulcal enarlgement
Head injury: NICE guidance on investigation
CT within 1 hour
* GCS < 13 on initial assessment
* GCS < 15 , 2hrs post injury
* open or depressed fracture
* basal skull fracture ?
* post-traumatic seizure
* focal neurological deficit
* > 1 episode vomitting
CT Within 8 hours
* 65 y/o <
* on AC, bleeding pmhx
* dangerous MOI
* > 30 mins retrograde amnesia
Types of MS
**1. Relapsing-remitting **
- most common!
- acue attacks (1-2 months) followed by periods of remission
**2. Secondary progressive disease **
- R-R pts who have deteriorated and have neurolgoical symptoms between relapses
- gait / bladder disorders
**3. Primary progressive **
- progressive deterioration from onset
Cytotoxic drugs
Presentation, investigation and Management of Meckels
Presentation:
- abdo pain
- painless rectal bleeding
- intestinal obstruction
**Investigation
**
- if haemodynamically stable –> meckel scan (99m technetium pertechnetate)
- mesenteric arteriography (severe cases)
Management
- removal if narrow neck or symptomatic
This condition usually presents with:
- paroxysmal abnominal colic pain
- sudden onset inconsolable crying
- pallor
- child may draw knees up to check
- 3-12 months of age
Intussception
What monitoring is important for a patient starting citalopram?
ECG
What monitoring is important for patients on SNRIs such as venlafaxine?
Blood pressure
- assocaited with HTN
Menopausal women suffering from vasomotor symptoms may be given:
SSRI
- fluoxetine
Clonidine may also be used
Contraindications for HRT?
- Current or past breast cancer
- Any oestrogen-sensitive cancer
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia
Risks of HRT
1. VTE:
- in oral, no increased risk with transdermal
2. Stroke
- slightly increased with oral oestrogen
3. Breast cancer
- increased risk with all combined HRT
4. Ovarian cancer
ECG changes and coronary territories:
Cluster headache Mx
- Bleep the neurologist!
- Acute
- 100% oxygen
- subcut triptan - Prophylaxis
- verapamil
Takotsubo cardiomyopathy
Bottom of heart does not contract therefore appears to balloon out.
Tx - supportive
AF post stroke: mx
- Exclude haemorrhage!
- Longer tern stroke prevention: warfarin
- Following TIA –> AC start immediately for AF
- In acute stroke –> AC start 2 weeks after. Give Antiplatelet therapy in the interrim
A wide-based gait with loss of heel to toe walking is called an
ataxic gait
Causes of ataxic gait
P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
R - Rare causes
I - Inherited (e.g. Friedreich’s ataxia)
E - Epilepsy treatments
S - Stroke
Immunisation schedule
Bilious vomiting within 24 hours of birth is most commonly caused by
intestinal atresia
72 Male: SOB, central chest pain, RR24, 102bpm, temperature 37.3 Likely diagnosis:
Pulmonary embolism:
- saddle embolus
Severe, sudden abdominal pain + out-of-keeping physical exam findings + AF?
may point to diagnosis of:
ACUTE MESENTERIC ISCHAEMIA
Management: immediate laparotomy
Diuretics revision
**1. Thiazide diuretics **
* increase excretion of [Na]
* excretion of [k+]
2. Loop diuretic **
* inhibits sodium reabsorption in ALOH
* increased excretion of sodium + potassium
** 3. Potassium sparing diuretic
* leads to hyperkalaemia
Important SE of hydroxychloroquine
Bull’s eye retinopathy
Antibodies in anti-phospholipid syndrome
-
antibodies
anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant - thrombocytopenia
- prolonged APTT
treatment of choice for Gonorrhoea
gram negative diplococcus
1st line - IM Ceftraizone 1g
OR
Oral cefizime 400mg + Oral azithromycin 2g (both single dose)
Key features of disseminated gonococcal infection
tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)
SGLT-2i : Important adverse effects include
- Increased risk of UTIs
- Fournier’s gangrene
- Normoglycaemic ketoacidosis
- Increased risk of lower limb amputation
Rule of thumb: LOAF muscles of the hand are median innervation, all other flexor hand muscles are ulnar.
L ateral two lumbricals
O pponens pollicis
A bductor pollicis brevis
F lexor pollicis brevis
The most common infective causes of COPD exacerbations are:
Bacterial:
Haemophilus influenzae (most common cause)
Streptococcus pneumoniae
Moraxella catarrhalis
**Viral **
- human rhinovirus
Acute exacerbations of COPD: mx guideline
- Increase bronchodilator use, consider nebs
- PREDNISOLONE 30mg 5 days
- Abx -** amoxicillin / clarithromycin** OR doxycycline
COPD: Severe exacerbations requiring secondary care mx
1. O2 –> aim 88-92% w/ 28% venturi @ 4l/min
2. Neb bronchodilator
a) Salbutamol (SABA)
b) Ipratropium (muscarinic antagonist)
3. Steroid
a) IV hydrocortisone > oral pred
4. IV theophilline
T2RF?
If Resp acidosis –> NIV , BiPap
2 Level PE Wells test
If ruptures may cause pseudomyxoma peritonei:
**Mucinous cystadenoma
Pseudomyxoma peritonei:
second most common benign epithelial tumour
Ovarian cysts?
The most common type of epithelial cell tumour
Serous cystadenoma
Diabetes drug which does not cause weight gain:
DPP-4 inhibitor (-gliptins)
‘the fat flows with the tides’
SGLT2- flozins
GLP-1 - tides
The FEV1/FVC of a normal healthy lung is
70-80%
What should be given before starting allopurinol and why:
NSAID or colchicine cover
Allupuronol –>xanthine oxidase inhibitor
–> reduces production of uri
Headaches, amenorrhoea, visual field defects →
prolactinoma
High levels of prolactin from prolactinoma –> hypogonadotrophic hypogon
Diagnosis: MRI
Management: dopamine agonist (cabergoline, bromocriptine) , or surgery trans-phenoidal approach
Anion gap interpreation
Elevated –> metabolic acidosis
Drugs which increase uvoscleral OUTflow
Pout
- Pilocarpine and prostaglandin analogues
Drugs that inhibit aqueous humour production
Hold aqueous humous production BAC
Beta blockers
Alpha 2 agonists (increase and block , non-selective!)
**Carbonic anhydrase inhibitors **
A 42-year-old woman presents with a goitre. On examination the goitre feels ‘lumpy’. The blood results reveal a TSH of 12 mu/l and a free T4 of 2 pmol/l. Antithyroid peroxidase antibodies are high.
Hashimoto’s thyroiditis
- goitre
- hypothryoidism
- anti-thyroid peroxidase
An elevated T4 and a low TSH should indicate this diagnosis.
Thyrotoxicosis
2 y/o F, 1 day hx rash on legs - now spread to rest of body
Erythema multiforme
- target lesions!
60 Male:
flushing, diarrhoea, bronchospasm, hypotension, and weight loss
classical hx of:
**Carcinoid tumours
- tumour will secrete serotonin
Ix = 5HIAA, plasma chromogranin A
Management:
- somatostatin analogues e.g. octreotide
- diarrhoea: cryp
drug induced lupus:
S: Sulfonamide - ABx
H: Hydralizine - heart failure
I: Isoniazid - TB
P: Phenytoin - seizures
P: Procainamid - arrhythmia
anti-histone antibodies positive
diabetes management algorithm:
Remember BP targets
< 80 –> 140/90 (clinic), 135/85 (home)
> 80 –> 150/90 (clinic) , 145/85 (home)
High-dose dexamethasone suppression test with a pituitary adenoma: results
Cortisol: suppressed
ACTH: suppressed
