Random 15 Flashcards

1
Q

When would you use Fosfomycin?

A

As of my last update, NICE recommends considering fosfomycin as an option for treating uncomplicated lower urinary tract infections (cystitis) caused by susceptible bacteria. The usual recommendation is a single-dose oral treatment. The choice of antibiotic treatment depends on various factors, including local resistance patterns, patient factors, and individual preferences.

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2
Q

What is Trimbow?

A

Trimbow is a fixed-dose combination inhaler that contains three active ingredients: beclometasone dipropionate (a corticosteroid), formoterol fumarate (a long-acting beta2-agonist), and glycopyrronium bromide (a long-acting muscarinic antagonist).

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3
Q

What questions should you always ask in a palpitations history?

A
  • How long do the episodes last?
  • Syncope?
  • How frequent are the episodes?
  • Associated chest pain
  • Do they happen everyday?
  • Caffine
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4
Q

What is a cause of painless jaundice?

A

Carcinoma of the head of the pancreas

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5
Q

Why is tuberculosis known as the great mimicker?

A

It can appear as lots of different diseases all over the body, not just the chest.

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6
Q

Explain pemberton’s sign and why it is relevant in a thyroid examination?

A

Pemberton’s sign is when a patient raises both of their arms up above their head and their face goes red.

If the thyroid gland is enlarged and extends into the superior mediastinum, it may compress the SVC. Raising the arms exacerbates this compression, leading to impaired venous return from the head and neck.

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7
Q

Why do you percuss the thyroid in an examination?

A

In case the thyroid has move retro-sternally. Percuss the sternum moving downwards from the sternal notch to assess for retrosternal dullness.

Retrosternal dullness may indicate a large thyroid mass extending posteroinferiorly to the manubrium.

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8
Q

What is agranulocytosis?

A

A reduction in (neutrophils, eosinophils, basophils)

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9
Q

What is the first line drug in hyperthyroidism in pregnancy?

A

PTU
Propylthiouracil (PTU):

PTU is another antithyroid drug used to treat hyperthyroidism.
Like carbimazole, PTU works by inhibiting the synthesis of thyroid hormones.
PTU is sometimes used in certain situations, such as during the first trimester of pregnancy when carbimazole may be contraindicated.

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10
Q

What is De Quervain’s thyroiditis?

A

De Quervain’s thyroiditis, also known as subacute granulomatous thyroiditis, is believed to be caused by a viral infection.

De Quervain’s thyroiditis, also known as subacute granulomatous thyroiditis, is indeed an inflammatory disorder of the thyroid gland, as you correctly stated. This condition typically presents with symptoms such as painful swelling of the thyroid gland, fever, and sometimes an elevated erythrocyte sedimentation rate (ESR).

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11
Q

What is a myxoedema coma?

A

Myxoedema coma, also known as severe decompensated hypothyroidism, is the most severe form of hypothyroidism, typically triggered by an acute event such as infection, myocardial infarction or drug use. It is a rare but life-threatening condition characterized by profound hypothermia, decreased mental status, and systemic manifestations of severe hypothyroidism.

They have not been taking their levothyroxine

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12
Q

What is a thyroid storm?

A

Thyrotoxic storm, or thyroid storm, is a life-threatening health condition that is associated with untreated or inadequately treated hyperthyroidism. The defining signs and symptoms of the condition are severe hyperthyroid symptoms such as tachycardia, fever, and altered mental status.

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13
Q

How do you treat a thyroid storm?

A

Symptom control:
IV propanolol
IV digoxin if propanolol is contraindicated (e.g. asthma, low BP)
Reduce thyroid activity:
Propylthiouracil: preferred because it inhibits peripheral thyroxine conversion
Lugol’s iodine: administered 4 hours after propylthiouracil
Methimazole/carbimazole: considered second-line treatment
IV hydrocortisone: to reduce thyroid inflammation
Treat complications (e.g. heart failure, hyperthermia)

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14
Q

How do you treat myxoedema coma?

A

ITU/HDU care
IV T3/T4
50-100mg IV hydrocortisone
Mechanical ventilation and oxygen - if hypoventilation
IV fluid - to correct hypovolaemia
Correction of hypothermia
Correction of hypoglycaemia
Treatment of any heart failure

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15
Q

Describe the pathophysiology of Parkinson’s disease

A

It is believed to result from the accumulation of “Lewy bodies”, intracellular inclusions primarily composed of misfolded alpha synuclein. These bodies form and lead to neuronal death in the dopaminergic cells of the substantia nigra of the basal ganglia, thereby causing the characteristic symptoms.

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16
Q

What percentage of neurones do you have to lose in Parkinson’s disease to see symptoms?

A

50%

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17
Q

What is a DaTscan?

A

DaTscan is a drug that is injected into the bloodstream to assess dopamine containing neurons

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18
Q

How is Parkinson’s diagnosed?

A

Clinial judgement no on investigations.

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19
Q

What is the one symptom that everyone with Parkinson’s disease will have?

A

Bradykinesia

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20
Q

What tremor do patients with Parkinson’s have?

A

Pill rolling tremor

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21
Q

What is the triad of symptoms that patients with Parkinson’s have?

A

Bradykinesia
Asymmetric 3-5Hz “pill-rolling” tremor
Lead pipe rigidity

22
Q

What are the presenting features in an early onset of Parkinson’s?

A
  • Tremor
  • Stiffness
  • Joint pain/muscle cramps
  • Hypophonia (quiet voice)
  • Small handwriting
  • Constipation
  • Anosmia
23
Q

What are some non-motor features of Parkinson’s?

A
  • Apathy
  • Pain
  • Fatigue
  • Hypotension
  • Restless legs
  • Constipation
  • Sleep disorders
24
Q

What is REM sleep disorder?

A

When you act out your dreams.

Causes
- Parkinson’s
- Lewy body dementia
- Anti-depressants
- Withdrawl of alcohol

25
Q

Why do patients with Parkinson’s tend to drool and how can you treat it?

A
  • Decreased swallowing reflex
  • Reduced facial muscle control

Antimuscarinics- Glycopyrrolate is primarily used to reduce excessive saliva or drooling caused by certain medical conditions or medications. It works by decreasing the activity of the salivary glands.

26
Q

What scale is used to assess the severity of Parkinson’s disease?

A

Hoehn and Yahr scale

27
Q

What are some drugs that cause parkinsonism features?

A
  • Anti-psychotics
  • Anti-emetics
  • Lithium
  • Methyldopa
28
Q

What are some parkinson-pluse syndromes?

A
  • Multi-system atrophy
  • Progressive supranuclear palsy
  • Demential with lewy bodies
  • Corticobasal degeneration
29
Q

What is progressive supranuclear palsy characterized by?

A

Vertical gaze palsy.
MRI- shows mid-brain atrophy and hummingbird sign

30
Q

What are the three different imaging modalities you can do with Parkinson’s?

A
  1. CT/MRI
  2. PET with flurodpa
  3. DaTscan
31
Q

What are some side effects of Co-careldopa?

A
  • N+V
  • Hypotension
  • Loss of appetite
  • Anxiety and depression
  • Hallucinations
  • Sleep problems
32
Q

What is a parkinson Kinetigraph used for?

A

It tracks movement throughout the day. Used to determine whether someone is on too much parkinson med.

33
Q

What are some examples of MAO-B inhibitors?

A
  • Rasagiline
  • Selegiline
34
Q

What are some examples of COMT inhibitors?

A
  • Entacapone
  • Tolcapone
35
Q

What is an example of a glutamate agonist?

A

Amantadine

36
Q

What are some complications of Parkinson’s disease?

A

Motor
- Tremors
- Bradykinesia
- Rigidity
- Postural instability

Non-motor
- Depression and anxiety
- Sleep disturbances

Freezing of gait
Speech and swallowing difficulties

37
Q

How does urokinase work?

A

Thrombolytic agent used to break down clots, in a PICC line for example.

Urokinase works by converting plasminogen, a substance in the blood, into plasmin, which is an enzyme that helps dissolve blood clots.

38
Q

What is p mitrale?

A

Atrial enlargement produces a broad, bifid P wave in lead II (P mitrale) enlarges the terminal negative portion of the P wave in V1.

39
Q

What is p pulmonale?

A

Peaked p wave.
Indicates increased right atrial pressure
This elevated pressure in the pulmonary circulation can lead to changes in the right side of the heart, including right atrial enlargement.

40
Q

What are some medications that cause osteoporosis?

A
  • PPIs
  • Steroids
  • SSRIs
41
Q

How can you remember the risk factors for osteoporosis?

A

Osteoporosis risk factors can be remembered by the mnemonic SHATTERED FAMILY:

S – Steroid use
H – Hyperthyroidism, hyperparathyroidism
A – Alcohol and smoking
T – Thin (BMI<22)
T – Testosterone deficiency
E – Early menopause
R – Renal/liver failure
E – Erosive/inflammatory bone disease
D – Diabetes
FAMILY HISTORY

42
Q

What is a cod-fishing fracture?

A

Seen in hyperparathyroidism and severe osteoporosis
Biconcave vertebrae from compression
Weakened bone and stress compresses the bone

43
Q

What are diagnostic investigations for multiple myeloma?

A

Diagnostic investigations

Serum and/or urine electrophoresis – This will show a paraprotein spike (typically IgG)

Serum free light chain assay (Bence Jones protein) - Can be kappa or lambda - Serum-free light chain levels are high in myeloma

can be a useful test in the 1–2% of patients with nonsecretory multiple myeloma (ie. those who do not have a serum/urine monoclonal protein on electrophoresis)
Tissue diagnosis typically by bone marrow aspirate and biopsy

Myeloma is confirmed if there are >10% plasma cells in the bone marrow

44
Q

Simply, what is the difference between osteoporosis and osteopenia?

A

Osteoporosis
- Not enough bone, calcified well enough

Osteopenia
- Enough bone, not calcified well enough due to lack of vitamin D

45
Q

What investigations do you do for osteoporosis?

A
  • FBC, ESR, Ca, Phosphate
  • Us&Es
  • LFTs
  • TFTs
  • Testosterone
  • PSA
  • PTH

Diagnostic investigations for osteoporosis include:

  • DEXA scan (Gold standard) with a T-score of -2.5 or lower indicating osteoporosis
  • X-rays for suspected fractures
    MRI of the spine to assess vertebral fractures
    Blood tests to exclude metabolic bone diseases and assess vitamin D, calcium, and hormone levels

FRAX Score

46
Q

Explain the different values for a DEXA scan

A

DEXA Scan T-Score
Interpretation
Greater than -1.0 Normal
Between -1.0 and -2.5 Osteopenia (Low bone density)
Less than or equal to -2.5 Osteoporosis

47
Q

Explain the different values for a FRAX score

A

FRAX Score
The FRAX (Fracture Risk Assessment Tool) score is used to estimate the 10-year probability of a major osteoporotic fracture. Interpretation of FRAX scores:

Normal: 10-year probability <10%
Osteopenia (low bone density): 10-year probability 10-20%
Osteoporosis: 10-year probability >20%

48
Q

What are secondary causes of osteoporosis?

A
  • Hyperthyroidism
  • Hyperparathyroidism
  • T2DM- low level inflammation
  • Cushing’s
  • Leukemia
  • Lymphoma
  • Multiple myeloma
49
Q

Why are alendronic acid and adcal taken together?

A

Alendronic acid helps strengthen bones by inhibiting cells that break them down, and Adcal provides essential calcium and vitamin D to support this bone-building process.

Taking them together ensures optimal effectiveness in treating conditions like osteoporosis by addressing both bone density enhancement and nutritional requirements.

50
Q

What is a sign that hematuria is coming from higher up the urinary tract?

A
  • RBC casts
  • Dysmorphic RBCs (medulla has lower O2)