things i have learnt Flashcards
what are some signs of pernicious anaemia causing low B12 and what tests would you do for it?
carbot rings, Glossitis - inflammation of the tongue
Vitamin B12 Assays= low
Intrinsic Factor Antibodies
Parietal cell Antibodies
Bone Marrow Aspiration and Biopsy: May show megaloblastic changes in erythropoiesis.
ecg changes in hypokalemia (potassium of under 3.5, severe under 2.5)
PR prolongation, widespread ST depression / T wave flattening and prominent U waves.
management of hypokalemia
If potassium is >3mmol/L, the patient is asymptomatic, and there are no ECG changes, oral potassium replacement can be given
If potassium is <3mmol/L or ECG changes are present, intravenous potassium replacement is indicated. Consider cardiac monitoring, especially if ECG changes are present.
recheck the potassium level after 4-6 hours of iv replacement
drugs that cause hyperkalemia
spirolactone, ace inhibitor, arb
hyperkalemia (potassium over 5.5, severe over 6.5) ecg changes
peaked T waves, prolonged PR interval and widened QRS complexes, eventually sine wave pattern
management in severe hyperkalaemia (over 6.5)
Stabilise the myocardium with IV calcium chloride or calcium gluconate
Shift potassium intracellularly: insulin/dextrose infusion
then identify and treat underlying cause eg rhabdomyalisis
what are Nabothian cysts?
Nabothian cysts are on the cervix when the squamous-cell epithelium of the cervix slightly covers the columnar epithelium
The cysts contains yellow/amber mucous and located around epitheliums transition at the os. They are a normal finding, particularly in women who have had children
what is asherman’s syndrome?
intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction to the menstrual outflow
what is the management for Waldenstrom’s macroglobulinaemia which is a type of non hodgkins lymphoma
Plasmapheresis to get rid of viscous IgM
what electrolyte imbalance do you get in a panic attack
hypocalcaemia
Alkalosis promotes calcium binding to albumin, reducing the levels of free calcium and thus causing hypocalcaemia
what dermatology defect has small, painless, pearly lesions with an area of central umbilication
Molluscum contagiosum
how does methylphenidate work? (1st line ADHD medicine)
dopamine/ norepinephrine reuptake inhibitor
list the names of some epithelial ovarian tumours
- Serous *#- lines tubes
- Mucinous*- epithelial cells with mucin
- Endometrioid*
- Clear cell *
- Brenner*- transitional, lines bladder
- Undifferentiated carcinoma rare
list some ovarian germ cell tumours
teratoma (dermoid cyst, full of teeth and hair etc)
dysgerminoma
yolk sac
list some sex chord/ stromal cell ovarian tumors
fibroma
Sertoli-Leydig cell tumours, can produce androgens
Granulosa-theca cell tumour
what is a complication of a molar pregnancy
complete moles can go on to become choriocarcinoma (follow up involves checking HCG and not getting pregnant for a year after)
if someone is on drugs (such as alcohol, benzo…) that are liver enzyme inducers what emergency contraception can they have?
give copper coil and levogestrel
dont give u……
when do you use amniocentesis vs CVS?
from 11.5 weeks can use CVS and after 15 weeks can use amniocentesis (and unlike CVS can pick up neural tube defects)
what score decides if you should induce labour or not?
bishop score
looks at cervix consistency, position, dilation and baby station
what structures allow the transmission of oxygen and nutrients between maternal and fetal blood.
chorionic villi
what antiemetics should be used in pregnancy
Cyclizine first line
what UTI treatment should be given in pregnancy
1st and 2nd trimester= nitrofuratoin
3rd trimester= trimethoprim
what is the CUBS test?
‘Combined ultrasound and biochemical screening’ - to look for trisomies or other defects
Done at 11 - 13 weeks
Combines nuchal translucency + serum test (hCG + PAPP-A)
what do sertoli cells and leydig cells do?
The Sertoli cells are normally located in the male reproductive glands (the testes). They feed sperm cells. The Leydig cells, also located in the testes, release a male sex hormone
what organism often infect bartholian glands
ecoli
results from screening for down syndrome
results expected for trisomy 21 include low AFP, low oestriol, low PAPP-A, high human chorionic gonadotrophin beta-subunit (b-HCG), and thickened nuchal translucency
preferred test for Chlamydia in an asymptomatic female is
high vag swab NAAT
antibiotics for chlamydia
Doxycycline 100mg bd (7 days). If contra-indication: azithromycin 1g od day 1 then 500mg od for 2 days
when is the nuchal translucency screen for down syndrome done?
11-14 weeks
what do you give for vWF deficiency
desmopressin, stimulates endothelial cells to make it and release stores
what is used to reverse the effect of heparin
Protamine sulfate
how to remember where things are absorbed
Iron (I) = Duodenum (DO)
Folate (FUCK)= Jejunum (JOIN)
B12 (BEARS) = Ileum (IN)
what do you give in long qt
beta blockers
what drugs should be avoided in long qt
amiodarone
class 1 antiarrythmic drugs
tricyclides, SSRI particularly citalopram
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
what triggers long qt
hypokalemia
drugs that prolong qt usually due to blockage of potassium channels
exercise
loud noise/ emotional stress
what is brugada syndrome ecg apperance? (AD, males more effected)
ecg appearance shows ST elevation and RBBB in V1-V3 (can be intermittent)
wolf parkinson white ecg changes? (basically like af electric loop but in af it stays in the atrium but this spreads to the ventricles)
short PR interval, delta wave, AF, ventricular preexcitation.
heridatery spherocytosis=
G6DP=
haemphillias=
fanconi =
sickle cell=
huntingtons=
fredricks ataxia=
duchens muscular dystophy=
brac=
myotonic dystrophy=
heridatery spherocytosis= dominant
G6DP= x linked recessive
haemphillias= X-linked recessive
fanconi anemia= autosomal recessive
sickle cell= autosomal recessive
huntingtons= autosomal dominant
fredricks ataxia= autosomal recessive
duchens muscular dystophy= x linked recessive
von williebrand’s disease= autosomal dominant
brac= dominant
myotonic dystrophy= autosomal dominance
the abdominal aorta begins and ends at
T4/5
what are the accessory muscles of respiration?
the scalene, the sternocleidomastoid, the pectoralis major
names some gram positive rods
Bacillus, Clostridium, Corynebacterium, Listeria, and Gardnerella
most common cause of necrotizing fascitis
group a strep
what to give in necrotizing fascitis
give it all you got
fluclox for gram pos, clindamycin for antitoxin effect, gent for neg
how to diagnose c diff
stool toxin test
a patient with HIV presents confused, they have multiple ring-enhancing lesions in the basal ganglia
what is diagnosis and treatment?
cerebral toxoplasmosis
pyrimethamine and sulphadiazine
what is another name for a plasma cell?
Post-germinal B cell
is splenomegaly more common in CML or CLL or ALL
CML
what is conversion disorder?
A psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes). It is not an intentional process, and the symptoms real to the patient. It is linked to emotional stress.
what is a deterent medication in alcohol dependence that causes n and v with alcohol
Disulfiram (Antabuse)
trisomy screened for?
how?
when?
- Down’s syndrome T21
- Edward’s Syndrome T18 (heart and lung)
- Patau’s Syndrome T13 (cleft lip)
11-13+6 weeks
nuchal translucency thickness combined with PAPPA and HCG
(less than 3.5 is normal)
in neutropenic sepsis what are the antibiotics given?
news less than 7 give piperacillin/ tazobactam within an hour ( if pen allergic teicoplanin and aztreonam)
if news = to or more than 7 then give piperacillin/ tazobactam and gent
in autoimmune haemolysis what is the difference between warm and cold autoantibodies
warm= IgG
cold= IgM
management for lambert-eaton myasthenic syndrone?
3,4-diaminopyridine
what characterises schizoid personality disorder vs schizotypal personality disorder?
schizotypal- eccentric, magical thinking, lack of close relations, paranoid
schizoid- volunteer social isolation, not eccentric
what is the first line medication for medical assisted detoxification?
Chlordiazepoxide
what antibiotic should be given in preterm ROM
oral erythromycin for 10 dys
what nerve supplies serratus anterior which causes scapula winging?
the long thoracic nerve
what is the difference in presentation between an anterior inferior cerebellar artery infarct and a PICA
PICA= ipsilateral facial pain and temp loss, contralateral limb/ torso pain and temp loss, ataxia and nystagmus
AICA= as above + facial paralysis and deafness
what is webers syndrome?
branch of PCA infact that causes ipsilateral CNIII palsy and contralateral weakness of upper and lower extremitys
what are some scoring systems for depression?
- inventory of depressive symptomatology- self report 30 (IDS-30-SR)- good for getting patients to tick box of things they might not want to say outloud
- quick inventory of depressive symtomatology self report 16- shorter, can be done more often
- hospital anxiety and depression scale
- Montgomert-Asberg Rating Scale (madrs)- for a patient that is too unwell to complete other scores, a close observer to patient does this
what do you give in wilsons disease?
D-penicillamine= acts as a copper chelator, binding copper, and thus allowing it to be eliminated in the urine
what drug would you give that lower the EPSE of antipsychotics?
procyclidine which is anti-cholnergic so balances these things
what prophylactic treatment do you give in Polycythemia Vera?
aspirin
what antibiotic do you give in PROM?
Erythromycin
over what blood sugars is gestational diabetes?
Fasting- 5.3 mmol/l
1 hour after meals- 7.8 mmol/l, or:
2 hour after meals- 6.4 mmol/l
over 7 treat with insulin straight away
under then 2 weeks of lifestyle then add metformin
what drugs do you give for group b strep
benzylpenicillin as intrapartum antibiotic prophylaxis
(give if fever, preterm, gbs with previous baby)
features of Intrahepatic cholestasis of pregnancy?
management?
intense itch, jaundice, raised bilirubin
induction of labour at 37-38 weeks
medical is ursodeoxycholic acid
vit k supplements
PPH medical management?
IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH
PPH surgical management
intrauterine balloon first line
others include B-lynch suture, ligation of uterine arteries or internal iliac
last resort is hysterectomy
acute fatty liver in preg vs intrahepatic cholestasis of pregnancy
acute fatty liver= Abdopain and vom
intrahepatic cholestasis= Itch
what do you give in suspected endometritis?
intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)
what prophyactic treatment for VTE is given in pregnancy?
Low molecular weight heparin
alzheimers pathophysiology?
accumulation of beta amyloid plaques particularly found in hippocampus, parietal and temporal lobes, (the breakdown process is disrupted because the beta one acts first)= extracellular and hyperphosphorylated tau protien= intracellular
vascular dementia pathophysiology
lots of little infacts, stepwise progression
same risk factors as a normal ischemic stroke
lewy body dementia pathophysiology?
lewy bodies, little circles found in the cytoplasm of neurones (formed from synulein and ubiquitin)
also include symptoms of parkinsons, visual hallucinations and fluctuating cognition
Frontal temporal dementia pathopysiology
abnormal amounts of protiens TDP43 (DNA binding protien) and TAU protien form
pick bodys are the name for TAU fibrils in cytoplasm
some genetics to get early onset alzeimers
amyloid precursor protien on CH21
presenlin 1
presenilin 2
later onset
apolipoprotein E
cardiovascular changes in preganacy?
30-50% increase in cardiac output
40-50% increase in plasma volume but only 20-30% increase in RBC so anemia
HR increases
initial decrease in BP due to progesterone, 20% less SVR
what are the respiratory changes seen in pregnancy
40% increase in tidal volume
decrease in functional residual capacity
mild respiratory alkalosis with metabolic compensation
renal changes in a pregnant patient
increased GFR due to dilation of AA, hence increased urine production
increase in bacteria infection
what is used to stain the cervix during colposcopy
acetic acid is applied first and is taken up by abnormal cells and appears bright white
iodine solution is then applied which is taken up by healthy cells making abnormal cells white more clear
learn antibiotic moa
what drugs trigger haemolysis in G6PD deficiency
sulph drugs- sulphonamides, sulphasalazine and sulfonylureas
also antimalarials
ciprofloxasin
nitroferitoin
what is used to reverse rivaroxaban and apixaban?
andexanet alfa (recombinant factor Xa protien)
where is the CAG repeat in huntingtones
on chromosome 4p
leads to neuronal death in the putamen and caudate nucleus
what eye palsy based on what cranial nerve issues?
CN3= posterior com artery/ SAH
CN4= trauma/ congenital, in brain for longest
CN6= raised ICP
where would a bleed in the bridging viens cause blood to pool
between dura and arachnoid
where is the primary auditory cortex?
superior temporal gyrus
what drugs to you give acutely in an acute dystonic reaction?
procyclidine (can try benzatropine0
breast cancer chemo drugs?
HER2+ patients= trastuzumab
premenopausal= tamozifen
post menopausal= anastrozole
how to calculate TNM staging for breast cancer?
T1= 0-2 cm T2= 2-5 T3= more than 5cm T4= chest wall/ broke through skin
N0= no nodes
N1= less than 4
N2= 4-9
N3= spread to supra or infraclavicular lymphnodes
m0= none
m1= mets
when should you not give anti-cholinesterase inhibitors eg in dementia
long QT as it prolongs it further
when do you use tyrosine kinase inhibitors?
CML
what shows basophillic stipping of red blood cells?
sideroblastic anemia
why should topiramate be avoided in women of child bearing age to prevent migranes
teratenogenic, reduce effectivness of hormonal contraceptives
management of ITP? LOOK AT DIC AND TTP TOO
Emergency treatment:
life-threatening or organ threatening bleeding= Platelet transfusion, IV methylprednisolone and intravenous immunoglobulin
Platelet count >30109/L= Observation
Platelet count <30109/L= Oral prednisolone
mesolimbic vs mesocortical; which is responsible for positive and negative symptoms of schizophrenia?
mesolimbic= overactivity causes positive symptoms
mesocortical= underactivity causes negative symptoms
give some examples of MAO-B inhibitors used in parkinsons (often alongside levodopa later in disease)
Selegiline, Rasagiline
what is the most likely antipsychotic to cause neuroleptic malignant syndrome (high temp, increased tone and autonomic instability)?
haloperidol
most likely antipsychotic to cause metabolic syndrome?
olanzapine
what drugs do you give for focal seizures?
lamotrigine or carbamazepine
1st and second line disease modifying drugs in MS?
1st= tecfedaira, interferon beta
2nd= MAB or fingolimod
alternative tayside formulary for overactive bladder
tolteridone (antimuscrinic)
liscenced drug in huntingtons?
tetrabenazine
