The Web Flashcards
Shock, unresponsive to fluid boluses
Inotropic support:
Noradrenaline or dobutamine?
Noradrenaline
Acts on both alpha and beta adrenergic receptors, thus stimulates the heart and improves BP
NOT dobutamine
Acts selectively on beta receptors, thus stimulating the heart but causing vasodilation as well, worsening hypotension
B12 (cobalamin) or folate?
Which one do you fix first?
B12 must be investigated before administering folate.
Otherwise there is a risk of masking a B12 deficiency and causing neuropathy and/or dementia
Most common site of acute mesenteric ishaemia due to arterial thrombosis?
SMA
Nephrotic Syndrome
Three features
- Proteinuria of >= 3.5 g/24h
- Hypoalbuminaemia of =<30 g/L
- Oedema
Also, hyperlipidaemia and thrombosis
Myotonic dystrophy: ECG changes
Mild to moderate disease:
First-degree AV block
Left anterior hemiblock (LAD without strain pattern)
Severe:
AF / flutter
abnormal Q waves
ST and/or T wave abnormalities
Gold-top tube
Additive and use
Nothing/clotting agent/ gel
(the serum is of interest; additives can cause cells to clot and separate to the bottom)
Chemistry, serology and immunology
Troponin
Purple-top tube
Additive and use
Potassium and EDTA
(chalates calcium and prevents clotting)
FBC
ESR
HbA1c
Blue-top tube
Additive and use
Sodium citrate
(binds calcium and prevents coagulation)
Clotting
INR
D-dimer
Grey-top tube
Additive and use
Sodium fluoride
(inhibits glycolysis)
blood glucose
blood alcohol
lactate
1st line investigation for narcolepsy?
Multiple sleep latency EEGs
Contraindications to starting statins?
Pregnancy
Macrolides
Indications for statins?
3
Secondary prevention
QRISK >10%
T1DM for 10+ years
Which structure is cut in surgery for carpal tunnel syndrome?
Flexor retinaculum
Carpal tunnel syndrome: on examination (4)
Thenar wasting
Weak thumb abduction (abductor pollicis brevis)
Tinnel’s sign
Phalen’s sign
Open-angle glaucoma: medications and mechanisms
Latanoprost
prostaglandin analogue leading to increased outflow
Timolol
beta blocker leading to decreased aqueous production
Alpha2-agonists
MODY
epidemiology
mutation
treatment
Young (<25 years)
T2DM, ie not presenting with ketosis
Family history (autosomal dominant)
hepatic nuclear factor (HNF 1 alpha) is most common mutation
Sulphonylureas for best response
(since the mutation causes decreased insulin secretion and/or release)
Intrauterine device (IUD) for contraception: when to administer
Up to 5 days after intercourse
OR
Up to 5 days after estimated ovulation
HENCE: can give more than 5 days after last intercourse
Meniere’s disease: Treatment
Acute = buccal or IM prochlorperazine Prophylactic = betahisitine
Pyrexia of Unknown Origin (PUO)
Fever of more than 3 weeks
Malignancy
lymphoma, nephroma, leukaemia, or atrial myxoma
Infection
tuberculosis
abscess
Congenital adrenal hyperplasia mechanism
Autosomal recessive mutation
21-hydroxylase deficiency
Build up of 17-hydroxyprogesterone
AND
low cortisol
Increased ACTH secretion leading to hyperaldosteronism and raised sex steroids (thus virilization in females)
Otosclerosis: pathophysiology
Autosomal dominant mutation (FHx)
Typically 20-40y
Normal bone is replaced by vascular spongy bone (may cause ‘flamingo tinge’ on otoscopy)
Progressive conductive hearing loss as stapes fuses at oval window
Conjugate eye deviation in stroke:
Ipsi or contralateral?
Ipsilateral
R hemisphere innervates L lateral rectus and R medial rectus
Thus, lesions on R cause unopposed action of R lateral rectus and L medial rectus
Wellens Syndrome
Deep inverted or biphasic T waves in V2-3
Patient may be pain free at presentation
Cardiac markers may be (still) normal
Critical LAD stenosis
Poor response to Rx
High risk of LAD occlusion
Need surgery
Schistosomiasis treatment
Praziquantel
Increases capillary permeability to Ca2+
Thus, parasite paralysis
80% cure rate
