Random Flashcards
statins RFs
when to stop
who gets it
include advanced age, female sex, low body mass index and presence of multisystem disease such as diabetes mellitus. Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)
3x upper limit
Who should receive a statin?
all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
Diagnostic criteria for diabetes
If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/
C-peptides low
first line Mx for neuropathic pain
amitriptyline, duloxetine, gabapentin or pregabalin
tramadol is rescue therapy
organism after influenza A
staph aureus
most common bone mets place
The spine is the most common site for bone metastases due to its high content of red marrow, which contains many blood vessels that provide a suitable environment for tumor cells to grow. Additionally, the spine’s venous plexus allows for easy access of circulating tumor cells to the vertebral column.
In which conditions should uliprilsal be used in caution
severe asthma
Diagnosis of a mesothelioma
is made on histology, following a thoracoscopy
when to screen for diabetes in first time pregnant woman
All obese (BMI>30) women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks
worst prognostic factor for melanoma
Melanoma: the invasion depth of the tumour is the single most important prognostic factor
Meningitis in children < 3 months mX
give IV amoxicillin in addition to cefotaxime to cover for Listeria
CT changes for HSV encephalitis
medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
Mx of osteoporosis
1st line - oral alendronate
then denosumab - diarrhoea, dyspnoea
rare hypocalcaemia, URTI
HOCM sound
ejection systolic murmur, louder on performing Valsalva and quieter on squatting
First line treatment for leigonella
macrolide - clartihromycin
RF for adhesive capsulitis
Diabetes mellitus
granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis.
The combination of ENT, respiratory and renal involvement
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions
scarlet fever features
Group A haemolytic streptococci
2-6 years
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash - sandpaper
oral penicillin V for 10 days
complications
otitis media: the most common complication
rheumatic fever: typically occurs 20 days after infection
acute glomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
nitrogen washout test
differentiate cardiac from non-cardiac causes. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
Drug to maintain PDA
PG E1
Ix for coeliac disease
TTG IgA
Gold standard
Endoscopic intestinal biopsy
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes
renal transplant
fever
BL pneumonia, deranged LFT and lymphadenopathy
Ix for acromegaly
IGF 1 measurements
oral glucose tolerance test with serial GH measurements
adjuvant treatment in HER2+ breast cancer treatment
transtuzmab
at what age does children start walking at
13-15 months
when do you start antibiotics in whooping cough and what is given
when are pregnant woman given vaccinationa
ram-negative bacterium Bordetella pertussis.
an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
Women who are between 16-32 weeks pregnant will be offered the vaccine.
Discitis features
Back pain
General features
pyrexia,
rigors
sepsis
Neurological features
e.g. changing lower limb neurology
if an epidural abscess develops
six to eight weeks of intravenous antibiotic therapy
need to be assessed for endocarditis
features
Ix
abdominal pain - in acute mesenteric ischaemia this is often of sudden onset, severe and out-of-keeping with physical exam findings
rectal bleeding
diarrhoea
fever
bloods typically show an elevated white blood cell count associated with a lactic acidosis
CT
Hypercalcaemia features
Features
‘bones, stones, groans and psychic moans’
corneal calcification
shortened QT interval on ECG
hypertension
Types of heart block
First degree heart block
PR interval > 0.2 seconds
Second degree heart block
type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs
type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex
Third degree (complete) heart block
there is no association between the P waves and QRS complexes
Management of hyperthyroidism in pregnant woman
First trimester - Porpylurathicil
then carbimazole
Antibiotics used to treat MRSA
vancomycin
teicoplanin
linezolid
