Random Flashcards
Acute treatment of Menieres disease
prochloperazine
prophylaxis in menieres disease
betahistine
drugs causing sensorineural hearing loss
gentamicin
chemotherapy
NSAIDs/aspirin (in overdose)
inheritance of otosclerosis
autosomal dominant
bilateral vestibular neuromas
neurofibromatosis type 2
virus closely associated with nasal carcinoma
epstein barr virus
naseptin is contraindicated in patients with what allergy
peanuts
drug for chronic hyperkalaemia in dialysis patients
calcium resonium
what is dusulepin
TCA
results of high dose dexamethasone suppression test in patients with cushing’s disease (pituitary adenoma)
ACTH = suppressed
Cortisol = suppressed
(high dose exerts negative feedback on the ACTH producing tumour cells)
when in the fundus palpable at the umbilicus
24 weeks
when is the fundus palpable at the xiphsternum
36 weeks
what is pulsus paradoxus seen in
cardiac tamponade
diagnosis of mycoplasma pneumoniae
serology
what type of diabetes insipidus does lithium cause
nephrogenic
what genetic condition is associated with Hirschsprung’s
Down’s syndrome
what is reduced in wilson’s disease
caeruloplasmin
what is CREST a subtype of
limited systemic sclerosis
moderate asthma attack (4)
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
severe asthma attack (4)
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
life-threatening asthma attack (6)
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
ANY OF THESE SIGNS MEANS THIS IS LIFE THREATENING ASTHMA ATTACK
1st line anticoagulant for APS
warfarin
screening test for haemochromatosis
transferrin saturation
antidote for dabigatran
idarucizumab
treatment of schistosomiasis
praziquantel
gram -ves (15)
pseudomonas
legionella
neisseria meningitidis
neisseria gonorrhoea
haemophilius influenzae
bordetella pertussis
e.coli
klebsiella
proteus
salmonella
e.coli 0157
shigella
campylobacter
helicobacter
bacteroides
gram +ves (16)
strep pneumoniae (a-haemolytic)
strep viridans (a-haemolytic)
GBS (e.g. strep pyogenes) (b-haemolytic)
GAS (b-haemolytic)
enterococcus (non-haemolytic)
staph aureus (coagulase positive)
staph epidermidis (coagulase negative)
diptheriodis
corynebacterium diptheriae
listeria monocytogenes
bacillus cereus
bacillus anthracis
anaerobic streptococci
clostridium difficile
clostridium tetani
clostridium perfingen
most common cause of mitral stenosis
rheumatic fever
how do you assess the plasma concentration of digoxin
digoxin concentrations should be measured within 8-12 hours of the last dose to assess for the plasma concentration
primary prevention dose of atorvastatin
20mg
secondary prevention dose atorvastatin
80mg
drugs that cause long-QT
A - anti-arrhythmics (amiodarone, sotalol, flecainide)
B - Antibiotics (fluoroquinolones, macrolides, aminoglycosides)
C - antipsychotics (haloperidol, quetiapine, risperidone)
D - Antidepressants (SSRIs, TCAs)
D - Diuretics
E - antiemetics (ondansetron)
non-pharmacological causes of long QT interval (7)
hypocalcaemia
hypokalaemia
hypomagnesaemia
myocarditis
myocardial infarction
SAH
hypothermia
recommended treatment for aortic stenosis
valve replacement
big toe dermatome
L5
medial malleolus dermatome
L4
lateral malleolus dermatome
S1
INR target for DVT/PE and AF treated with warfarin
2-3
INR target for recurrent DVT/PE and mechanical heart valves
3-4
how many days before surgery should warfarin be stopped
5 days
management of major bleed + warfarin
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
management of INR > 8.0, minor bleeding + warfarin
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
management of INR > 8.0, no bleeding + warfarin
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
management of INR 5.0-8.0, minor bleeding + warfarin
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
management of INR 5.0-8.0, minor bleeding + warfarin
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
management of INR 5.0-8.0, no bleeding + warfarin
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
most common parasite in HIV patients with diarrhoea
cryptosporidium
which way does the tongue deviate in hypoglossal nerve injury
towards the side of injury
non-sedating antihistamines
acrivastine
cetirizine
fexofenadine
loratadine
sedating antihistamines
chlorphenamine (Piriton)
cinnarizine
diphenhydramine
hydroxyzine
promethazine
what is given with methotrexate to reduce side effects
folic acid
what are porphyrias
group of disorders caused by genetic or acquired deficiencies in one of the enzymes in the metabolic pathway for haem
Haem precursors (porphyrins) accumulate and react with light to produce skin problems
enzyme affected in porphyria cutanea tarda
Decreased uroporphyrinogen decarboxylase in the liver
enzyme affected in erytrhopoetic protoporphyria
Deficiency in ferrochelatas
enzymes affected in acute intermittent porphyria
Deficiency in porphobilinogen deaminase
(no skin symptoms)
drugs causing Steven Johnstone syndrome
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
opioids used in renal failure
oxycodone
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
what type of paediatric hernia should be surgically treated
inguinal
(umbilical usually resolve with time)
what drugs can be used to prevent pathological fractures in bone metastases
Bisphosphonates and denosumab
Causes pupillary dilatation in the Horner’s pupil
apraclonidine (alpha agonist)
Causes pupillary constriction in Adie’s pupil
pilocarpine
what is it called when one pupil is bigger than the other
anisocoria
Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion:
just face = pre-ganglionic lesion:
absent = post-ganglionic lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery
SSRI that most commonly causes prolonged QT
citalopram
management of orbital cellulitis
IV antibiotics and admit
symptomatic management in hyperthyroidism
propanolol
(e.g. in pregnancy induced thyroiditis)
calculation for urine osmolality
osmolality = 2 (Na+) + 2 (K+) + Glucose + Urea (all in mmol/L);
OR Calculated osmolality = 2 (Na+) + Glucose + Urea (all in mmol/L).
normal urine output
0.5 mL/kg/hour
patients should be urinating every 6 hours
what is the best investigation for biliary colic
ultrasound
what is the standard target hba1c
48 (for those taking one drug not associated with hypoglycaemia)
53 (for those taking more than one medication or taking a medication associated with hypoglycaemia)
criteria for bariatric surgery (5)
body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and a serious condition that might improve with weight loss (such as type 2 diabetes or high blood pressure)
all other weight loss methods, such as dieting and exercise have be unsuccessful
you agree to long-term follow-up after surgery
fit enough for GA
care from specialist obesity team
Do not use corticosteroids in children younger than _______ with suspected or confirmed bacterial meningitis
3 months
vaccines in the 6-in-1 vaccination
diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
diagnostic test for hirschprungs disease
anorectal biopsy
most important test in tumour lysis syndrome
urate
when is neonatal jaundice abnormal
within 24hrs of birth
lasts >14 days (full term)
lasts >21 days (preterm)`
when is neonatal jaundice normal
2-7 days of age
resolves by day 10
baby is well
what rate of insulin should be given in DKA?
the IV insulin infusion should be started at 0.1 unit/kg/hour
SSRI + NSAID =
GI bleed risk = give PPI
when do post-partum women require contraception
21 days after giving birth
rash involving the nasolabial folds
seborrhoeic dermatitis
(acne rosaecea involved nasolabial folds)
what does a bishops score of 5 or less indicate
A score of 5 or less suggests that labour is unlikely to start without induction
if angina is not controlled by beta-blocker
add CCB
in angina: if a patient can’t tolerate b-blocker or CCB what treatments can be considered
a long-acting nitrate or
ivabradine or
nicorandil or
ranolazine
blood stained nipple discharge
ductal papilloma
pus nipple discharge
duct ectasia
renal stones with hydronephrosis or signs of sepsis
nephrostomy
Nephrotic syndrome is associated with a hypercoagulable state due to loss of antithrombin III via the kidneys which can lead to
renal vein thrombosis
how long is fever in Kawasaki’s disease
5+ days
treatment in Kawasaki’s disease
aspirin
when can you attempt external cephalic version for a transverse lie
if the amniotic sac has not ruptured
Patients who have had an episode of SBP require antibiotic prophylaxis with…
ciprofloxacin
management of bilateral adrenal hyperplasia
spironolactone
widespread systolic murmur, hypotension, pulmonary oedema after MI
Acute mitral regurgitation due to papillary muscle rupture
what pH are NG tubes safe to use
pH <5.5 on aspirate
Heparin induced thrombocytopenia is a _________ state
prothrombotic
normal vaginal ph
3.8 and 5.0
vaginal ph in BV
alkali
endocrine side effect of atypical antipsychotics
Long-term atypical antipsychotics can lead to the development of glucose dysregulation and diabetes
prognostic scoring system in pancreatitis
P - PaO2 <8kPa
A - Age >55-years-old
N - Neutrophilia: WCC >15x10(9)/L
C - Calcium <2 mmol/L
R - Renal function: Urea >16 mmol/L
E - Enzymes: LDH >600iu/L; AST >200iu/L
A - Albumin <32g/L (serum)
S - Sugar: blood glucose >10 mmol/L
treatment if arrhythmia in TCA overdose
IV bicarbonate
staggered paracetamol overdose
NAC immediately
when do you check lithium levels
5-7 days after dose change, 12 hours post-dose
> = 75 years following a fragility fracture
start bisphosphonates
when to take progesterone level
7 days prior to the expected next period
what amount of paracetamol is considered an overdose
> 75mg/kg of paracetamol
criteria for transplant in paracetamol overdose
pH <7.3, 24hrs after ingestion
OR ALL of the following
PT >100
creatinine >300
encephalopathy
causes of haematospermia
UTI
Trauma
STI
Cancer (needs excluded)
Refer if more than >3 episodes or if persists for more than a month
when to give adrenaline in shockable rhythms
every 3-5 mins
when to give amiodarone in shockable rhythms
after 3rd shock
adrenaline dose in cardiac arrest
1:10,000 = 1mg in 10ml - IV (100 mcg in 1ml)
adrenaline dose in anaphylaxis (>12yrs)
Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000)
adrenaline dose in anaphylaxis (6-12yrs)
6-12 years 300 micrograms (0.3ml 1 in 1,000)
adrenaline dose in anaphylaxis (6 months - 6yrs)
6 months - 6 years 150 micrograms (0.15 ml 1 in 1,000)
adrenaline dose in anaphylaxis (<6 months)
< 6 months 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
ACEi are contraindicated in what valvular disease
moderate-severe aortic stenosis
treatment for prostatitis
quinolone for 14 days
when to give amiodarone in cardiac arrest
amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
when to give adrenaline in cardiac arrest
adrenaline 1 mg as soon as possible for non-shockable rhythms
during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
treatment of campylobacter
clarithromycin
massive PE + hypotension
thrombolyse
what is subclinical hyperthyroidism associated with
atrial fibrillation, osteoporosis and possibly dementia
antibiotics that can cause long QT
macrolides (clarithromycin
fluroroquinolones (ciprofloxacin)
most common side effect of POP
irregular bleeding
test for H.pylori eradication
urea breath test
unstable VT with a pulse
DC cardioversion
when is lactation a reliable form of contraception
amenorrhoeic, baby <6 months, and breastfeeding exclusively
red flags for back pain
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
how do you screen for coronary artery aneurysm in Kawasaki disease
echocardiogram
what antenatal steroids are given in preterm labour
dexamethasone
what type of stoma is flush to the skin
colostomy
bilious vomiting on the first day of life
duodenal atresia
criteria for postural hypotension
a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).
investigation for reflux nephropathy
micturating cystography
in SAH when should an LP be done
12 hours after onset of symptoms
how often are you invited for breast screening?
every 3 years
treatment of LA toxicity
IV 20% lipid emulsion
metabolic disturbance in salicylate overdose
respiratory alkalosis
then
metabolic acidosis
antibiotic for GBS prophylaxis
benzylpenicillin
elevation of testes worsens the pain (Prehn’s test)
testicular torsion
elevation of testes eases the pain (Prehn’s test)
epididymitis
can statins be given in pregnancy
no
don’t give in GDP6 deficiency
sulpha-containing drugs
metabolic disturbance in cushings
Hypokalaemic metabolic alkalosis
metabolic disturbance in cushings
Hypokalaemic metabolic alkalosis
what eGFR is metformin contraindicated
<30
worse on resisted wrist extension/suppination whilst elbow extended
lateral epicondylitis (golfer’s elbow)
Rosacea first-line for patients mild papules and/or pustules
topical ivermectin
patients with acute, severe, symptomatic hyponatraemia (< 120 mmol/L)
hypertonic saline
immediate management of acute angle closure glaucoma
lie flat
Pilocarpine eye drops (to constrict the pupil) and oral acetazolamide (to reduce aqueous humour production)
morphine is ___ times stronger than codeine
10
symptoms control in non-CF bronchiectasis
inspiratory muscle training + postural drainage
first line investigation for prostate cancer
Multiparametric MRI has replaced TRUS biopsy as the first-line investigation in suspected prostate cancer
treatment of otitis externa in diabetics
treat with ciprofloxacin to cover Pseudomonas
hydrocortisone dose in Addison’s disease
the hydrocortisone dose is split with the majority given in the first half of the day
when are nitrates contraindicated in ACS
if BP less than <90mmHg
is podophyllin safe in pregnancy
no, cryotherapy should be used for genital warts
most common thyroid cancer between 35-40yrs, more common in women
papillary thyroid cancer
1st line management for menorrhagia
IUS
spread of follicular thyroid cancer
haematogenous
spread of papillary and medullary thyroid cancer
lymphatics
spread of anaplastic thyroid cancer
local
when can women stop taking contraception
Women using non-hormonal methods of contraception can be advised to stop contraception after 1 year of amenorrhoea if aged over 50 years, 2 years if the woman is aged under 50 years
which CCBs do you avoid in heart failure with reduced ejection fraction?
diltiazem
verapamil
sudden-onset vertigo and vomiting, dysphagia, ipsilateral facial pain and temperature loss, contralateral limb pain and temperature loss, and ataxia.
posterior inferior cerebellar artery stroke
sudden-onset vertigo and vomiting, and ipsilateral facial paralysis and deafness
anterior inferior cerebellar artery stroke
5 Ds of posterior stroke
dizziness, diplopia, dysarthria, dysphagia, dystaxia
when is NIV indicated in COPD exacerbation
when a person’s arterial blood gases (especially the pH and carbon dioxide levels) are not responding (or worsening) despite optimal medical management.
