Thurs revision Flashcards
What drug may patients who are allergic to aspirin also react to?
Sulfasalazine
What is reactive arthritis?
an arthritis that develops following an infection where the organism cannot be recovered from the joint.
‘Can’t see, pee or climb a tree’
What is the management for reactive arthritis?
symptomatic: analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months
Persistent fever lasting >5 days which has not responded to paracetamol, injected conjunctiva, dry and swollen mucosal linings around the mouth and red, swollen hands and feet are features of what?
Kawasaki disease
What is the treatment of choice for kawasaki disease?
high-dose aspirin alongside intravenous immunoglobulin
What are the components of CHA2DS2-VASc?
C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
Age 65-74 years 1
D Diabetes 1
S2 Prior Stroke, TIA or thromboembolism 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1
What is the threshold for treatment on a CHA2DS2-VASc score?
0 No treatment
1 Males: Consider anticoagulation
Females: No treatment (this is because their score of 1 is only reached due to their gender)
2 or more Offer anticoagulation
What treatment is indicated for non pregnant women with an uncomplicated UTI?
3 days trimethoprim or nitrofurentoin
What is first line for pregnant women with a UTI that are symptomatic?
nitrofurantoin (should be avoided near term)
What is second line for pregnant women with a UTI that are symptomatic?
amoxicillin or cefalexin
What is first line for pregnant women with a UTI that are asymptomatic?
nitrofurantoin (should be avoided near term), amoxicillin or cefalexin (7 days)
What is first line treatment for men with a UTI?
trimethoprim or nitrofurantoin 7 days
What is the recommended treatment for acute pyelonephritis?
broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 10-14 days
What is the most serious long term health risk for patients with turners syndrome?
Aortic dissection
Which of the following medications makes clopidogrel less effective?
Allopurinol
Amiodarone
Metronidazole
Omeprazole
Trimethoprim
Omeprazole
What medication(s) should be administered to patients with resolved TIA symptoms, awaiting specialist review within 24 hours?
Aspirin
What medication(s) should be administered to patients after a TIA who have been reviewed by a specialist, for their initial 21 days when at high risk of further events?
Aspirin + Clopidogrel
What medication(s) should be administered to patients
after a TIA for long-term secondary prevention after 21 days?
Clopidogrel
When should a carotid endarctectomy be considered?
After a stroke or TIA in the carotid territory and if the stenosis > 50%
What is the protein content of transudate?
Transudate is < 30g/L protein
What is the protein content of exudate?
Exudate is > 30g/L protein
What are the causes of a transudative pleural effusion?
heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs’ syndrome
What are the causes of an exudative pleural effusion?
infection:
- pneumonia (most common exudate cause),
- tuberculosis
- subphrenic abscess
connective tissue disease:
- rheumatoid arthritis
- systemic lupus erythematosus
Neoplasia
- lung cancer
- mesothelioma
- metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome
What is the treatment of choice for Chlamydia trachomatis in pregnancy?
Azithromycin, erythromycin or amoxicillin
What is the first line treatment indicated for non pregnant adults with Chlamydia trachomatis?
Doxycycline
What is the recommended treatment regime for pubic lice?
Malathion lotion or permethrin cream.
Both should be applied to the whole body and washed off after 12 hours. The patient should be advised to reapply the treatment 7 days after initial application to ensure that lice emerging from surviving eggs are eradicated.
What is the treatment of choice for Trichomonas vaginalis?
Metronidazole
If ST elevation is seen in leads II, III, aVF, what is the most likely affected coronary artery?
RCA (inferior myocardium)
If ST elevation is seen in leads V1-2, what is the most likely affected coronary artery?
Proximal LAD (septal myocardium)
If ST elevation is seen in leads V 3-4, what is the most likely affected coronary artery?
LAD (anterior myocardium)
If ST elevation is seen in leads V 5-6, what is the most likely affected coronary artery?
Distal LAD/ LCx/ RCA (myocardial apex)
If ST elevation is seen in leads I and aVL, what is the most likely affected coronary artery?
LCx (lateral myocardium)
If ST elevation is seen in leads V7-V9, with reciprocal ST depression V1-3, what is the most likely affected coronary artery?
RCA/ LCx (posteriolateral myocardium)
What are the rules surrounding warfarinised patients and emergency surgery?
If surgery can wait for 6-8 hours - give 5 mg vitamin K IV
If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex
Barrett’s oesophagus can predispose to what malignancy?
Adenocarcinoma of the oesophagus
Patient presents with red eye, photophobia, small pupil, reduced visual acuity and pus in the anterior chamber. What is the most likely diagnosis?
Anterior uveitis
The following features are seen in which disease?
flushing (often the earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis
Carcinoid syndrome - seretonin secreting tumor
‘onion skin’ appearance on X-ray is suggestive of what?
Ewings sarcoma
Which of the following medications can lower seizure thresholds?
Co-amoxiclav
Nitrofurantoin
Cefixime
Trimethoprim
Ciprofloxacin
Ciprofloxacin
What side effects are associated with metformin?
Gastrointestinal side-effects
Lactic acidosis
What side effects are associated with sulfonylureas?
Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
What side effects are associated with glitazones?
Weight gain
Fluid retention
Liver dysfunction
Fractures
What side effects are associated with gliptins?
Pancreatitis
Empagliflozin, dapagliflozin and canagliflozin are examples of which class of drug?
SGLT2 inhibitors
Sitagliptin, saxagliptin and alogliptin are examples of which class of drug?
DPP4 inhibitors
Exenatide, liraglutide and dulaglutide are examples of which class of drug?
GLP-1 analogues (incretin)
Gliclazide is an example of which class of drug?
Sulfonylurea
What is the best initial treatment regime for someone with T2DM?
Metformin first line
+SGLT-2 inhib if patient has pre-existing CVD, heart failure or QRISK > 10%
What is second line in T2DM?
add sulfonylurea, pioglitazone, DPP4 inhib or SGLT2 inhib
What is third line in T2DM?
Triple therapy with metformin + 2x 2nd line drugs
Consider insulin therapy
What is the first line management for patients with COPD?
a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA)
What is second line for COPD if the patient does not exhibit steroid responsiveness?
add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA)
if already taking a SAMA, discontinue and switch to a SABA
What is second line for COPD if the patient exhibits steroid responsiveness?
LABA + inhaled corticosteroid (ICS)
What is third line therapy for COPD?
triple therapy i.e. LAMA + LABA + ICS
if already taking a SAMA, discontinue and switch to a SABA
How is cor pulmonale managed?
use a loop diuretic for oedema, consider long-term oxygen therapy
What can be used to reverse dystonia that may be induced by haloperidol?
Procyclidine
If C. difficile does not respond to first-line vancomycin, what should then be administered?
oral fidaxomicin
What antibiotic is first line for c.diff infections?
Vancomycin
Which diabetic drug is useful in the management of obese type 2 diabetics?
DPP4 inhibitors eg a ‘gliptin’
