tx Flashcards
sle - renal
- steroids
- mycophenalate
- cyclophosmide
PMR -
steroid cannot betaken anymore
TOCLIZUMAB
SLE internal organ
prednisilone / cyclophosmaide
SLE - antibodies
- BELIMUMAB
graves disease eye
steroids
tociluzimab rituximab
radiotherapy
Good pasture mx
- plasma exchange
- IV immunoglobulin
- methyprednislone and cyclophospmide
guillan barr syndrome Tx
IV immunogloblins first
Myasthenia gravis Tx
- long acting acetylcholine inhibtors - pyridostigmine
- prednisilone
- azathioprine , cyclosporin , mycophenolate motefil
MYASTHENIA CRISIS
PLASMAPHORESIS
OR
INTRAVENOUS IMMUNOGLOBULINS
renal cancer
- mycophenolate motefil
multiple myeloma
- thalidomine / bortezomib
ankylosing spondylitis
NSAIDS
ANTI - TNF = etanercept / adalimumab
methotrexate/ sulfasalaizne
psoriatic arthirits
NSAIDS
methotrexate
anti - tif - infliximab / adlaimumab and etanercept
ustekinumab/secukinumab
apremilast - PDE4 inhibtor
Pulmonary fibrosis
pirfenidone
nintedanib
pemphigus vulgaris
prednisilone
azathioprine / cyclophosphomide
rituximab
adhesive capsulitis
NSAIDS
PHYSIO
ORAL / INTRARTIULAR STEROIDS
low esr found in ?
POLYCETHMIA - JAK 2
polycethmia rubra vera treatmnet
aspirin - prevent thromembolic events
venesection - first choice
hydroxyurea
recative arthritis tx
analgesia= NSAIDS
intrarticular steroids
sulfasalazine and mthotrexate if persistant
osteoarthritis
topical nsaids - first line - esp if hands and knees
oral NSAID
(do not recommend paracetamol or opiods )
intrarticular sterodids
if not = joint replacemnet
rheumatoid arthritis tx
flares - steroids - short course
maintenance = methotrextate / sufasalaizne / leflunomide / hydroxycholorquine
INAQEUATE REPSONSE TO TWO DMARD INCLUDING METHOTREXATE = TNF A INHIBTORS = adalimumab
rituximab
carpal tunnel syndrome
intrarticula steroids
brace
or surgery
yersinia
- quinilones / tetracylie / macrolides / /co-trimoxazole
animal bites resistant to amox
metrondazole and doxycylin
liver abscess
metronidazole + ciprofloxacin +amoxi
amox allergy = metro+ clinda
AUTOIMMUNE HEPATITIS
STEROIDS AND AZATHIOPRINE
Stills disease features
ana and rf negative
arthralgia
lymphadenopathy
rash - salmon pink
elevated serum ferritin
pyrexia
Stills disease Tx
= NSAIDS
steroids - does not mprove prognosis but improoves symptoms
methotrexate / anakinara - against IL1 /anti-TNF
CLL can cause
CAN CAUSE warm AUTOIMMUN HEMOLYTIC ANEMIA = need prednisilone if not responding rituximab
CLL- FCR not responding
(fludrabine , cyclophosphamide , rituximab)
if not working - irutinib / ALEMTUZIMAB (anti-cd52)
HUS tx
fluid replacemnt / blood transfusion / dialysis
plasma exchange and eculuzimab - for non diarrheal
PNH
Management
* blood product replacement- pancytopneia
* anticoagulation - thrombotic
* eculizumab, a monoclonal antibody directed against terminal protein C5,
sideroblastic anemia features
high ferrtin
iron sat
high iron
basophilic stippling
prussian blue or perls
sideroblastic anemia cause ?
myelodysplsi
alcohol
lead
ant-TB
Congenital cause: delta-aminolevulinate synthase-2 deficiency
pyoderma gangrenosum Tx
oral steroids
ciclosporin / infliximab
surgery to do with IBS delayed till this is managed
psoriasis exacerbation
- alcohol
- drugs: beta blockers,
- lithium,
- antimalarials (chloroquine and hydroxychloroquine), NSAIDs
- ACE inhibitors,
- infliximab
- withdrawal of systemic steroids
mycophenlate side effects
tremor / hypertonia / somnolence
evolocumab / ezetemibe
educed cholestrol
ezetimibe - reduces cholesterol from small intestine
disseminated gonoccoal infection = spread to knee
iv ceftriaxone
diabetic foot ulcer
co - amoxiclav
pneumocystic jirovecii prophylaxis =
trimethoprim sulfmethoxazole
SBP - Tx
iv pip/taz iv cefoaxim
cystine stones Tx
penicillamine
HLA-B58 related to ?
steven johnson syndrome
or drug rcausing eosinophilia and systemic symtoms
HLAB52= related to
TAKYASU ARTERITIS
ULCERATIVE COLITIS
allopurinol side effects with
azathioprine (as azathioprine is converted to 6 mercapturine = xanthine oxidase responsible to oxidate this
theophyline - as allopurinol is a CYP enzyme inhibtor
cyclophosmide = allopuirnol reduces its renal clearance
WASP
recurrent bacterial chest infection
eczema
thrombocytopenia
low IgM
heerfordt syndrome
parotid enlargemnet and fever - seocndary to sarcoidosis
what is thin basemnet mebrane disease -
perisiant micosopic heamturea
AD - disorder of collagen 4 / family history of microspic heamturea without kidney failure
normotension and creatinin levels
which abx causes agranulocytosis ?
trimethoprim
what is cetuximab
- epidermalgrowth factor inhibtor
what iswhat is nivolumab
programmed cell death inhibitor
used as chemotherapy
for T cells to alert other cells of cancerous cell
insulinoma tx
rapid weight gain
diplopia
hypoglycaemia
CT pancreas
surgery
diazoxide / somatostatin
BRUCELLOSIS TX and feature in clinical lab
WBC normal
Dry cough, fever , multiple joint pain
doxy + Rifampicin
erythromycin
shigella tx
none
unless immunocomprmised then ciprofloxacin
what has absent cornea reflex ?
vestibular shwanoma - tinitus and vertigo and abesnt corneal reflex
campylobacter
macrolides
then fluroquinilones
convex st segment elevation ?
burgada - v-v3 followed by t wave inversion
concave st elevation
pericarditis
what do we give in gas gangrene - clostridium perfingens
clindamycin and metronidazole
posterior cerebellar artery stroke feature
contralateral homonymous hemianopia - with macula sparing
visual agnosia
weber syndrome
branches of posterior after supplying midbrain
- ipsilateral cn3 palsy
-contralateral weakness of upper and lower extremity
anterior inferior cerebellar artery
same s wallenberg - put ipsilateral facial paralysis and deafness
drug for dermatitis herpetiformis
dapsone
diverticulosis feature and tx
LLQ
FEVER - RAISED WBC
MORE IN COPD AND INCREASED AGE
CAN HAVE DIARRHEA MIXED WITH BLOOD
RESPOND WELL TO iv fluids and IV co-amoxiclav
dominant temporal lobe affected ?
receptive aphasia
dyslexia
impaired VERBAL MEMORY
WORD AGNOSIA
INABILITY TO INTERPRET WORDS SAID
non dominant temporal lobe affected ?
impaired musical skills
impaired non verbal memory
lichen planus tx
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or azahioprin , ciclosporin
TX of whipple disease ?
2 weeks of IV therapy is must
1) ceftriaxoe or penicillin
co trimoxazole nd tetracyclines are alternatives
function of tociluzimab ?
IL6- INHIBTOR
USED IN RHEUAMTOID NOT CONTROLLED BY DMARDS AND ANT-TNF
PMR
AND ALSO TEMPORAL ARTERITIS
nephrogenic DI - failing to respond to solute or protein reduction is given?
hydrochlorothiazide
Oculogyric crisis tx
benztropine or procyclidine
Oculogyric crisis causes
restlessness, agitation
involuntary upward deviation of the eyes
Causes
antipsychotics
metoclopramide
postencephalitic Parkinson’s disease
membranous nidiopathic membranous nephropathy TX ?
idiopathic/ chronic - rituximab
rapidly progressive - steroids and cyclophosphamide
polyarteritis nods usually seen in ?
hep B
mononeuritis multiplex, sensorimotor polyneuropathy
LIVIDO RETICULARIS
ANA and p-ANCA stands for ?
ANA - anti-nuclear
ANCA - anti neutrophil
raloxifene- decrease the risk of
breast cancer
increase VTE risk
STRONIUM RANELATE - CONTRAINDICATED IN
IN SIGNIFICANT HEART DISEASE
Klinefelter’s syndrome dx?
elevated gonaditropin levels but low testosterone
xxy
difference between viral labrynthitis and vestibular neuritis
both have recent viral infection
viral labrynthitis - sudden onset vertigo
hearing loss may happen
vestibular neuritis - recurrent vertigo lasting days and and hours
NO HEARING LOSS
hyperparathyroidism
Indications for surgery
serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
TTP tx ?
abx worsen
plasma exchange
steroids/ immunosuppressants (rituximab)
vincristine
dermatomyositis not controlled by prednisolone ?
azathioprine
if co existing lung disease - cyclosporin and cyclophosmaide
Dx of guillan barre syndrome
LP - ISOLATED ELEVATED PROTEIN, normal white cell count
Nerve conduction studies - decreased velocity due to demyelination
Cause of which immunoglobulin deficiency makes blood transfusion reaction
IgA (most common immunoglobulin deficiency)
How is brugada syndrome different from HOCM AND long QT syndrome
Vfib occurs at night unlike HCOM and long qt syndrome which occurs more during the day and related to exercise
Resistant to anti arrythmia - ICD needed
AJMALINE and flecainide used to see the ECG changes
Difference between different dyslipidemia
Familial heterozygous hyperlipidemia
Total cholesterol rise mainly LDL
TG stay stable
Cardiovascular disease - same in homozygous however cardiovascular disease states at teenage years
Familial combined- increase in total cholesterol and triglycerides
Common cause of third nerve palsy
Posterior communicating artery aneurysm
Cavernous sinus thrombosis - usually 6th nerve palsy before and associated with sinusitis
Chest drain insertion location
5th intercostal space mid axillary line
Tension - The preferred insertion site is the 2nd intercostal space in the mid-clavicular line in the affected hemithorax.
Abx given in tetanus alongside tetanus immunoglobulin
Metronidazole
VOMITING LEADS TO
HYPOCHLORAEMIC acidosis
Difference between Becker and duchenne dystrophy
progressive proximal muscle weakness
Gower’s sign: child uses arms to stand up
Calf pseudohypotrophy
Duchenne - occurs from 5 years early
Becker from 10 years AND NO INTELLECTUAL IMPAIRMENT
Which juice is a potent inhibitor of CYP3A4
Grapefruit
Causes of drug induced lupus and investigations
Anti ANA positive
Anti-DS DNA NEGATIVE
Anti-histone POSITIVE
Anti-ro - POSITIVE
Anti- smith POSITIVE
Hydralazine
Isoniazid
Phenytoin
Procainamide
prophylaxis of CMV
valganciclovir
what antipsychotic is used in Parkinson when presented with schizophrenia ?
quetiapine / clozapine
TX for sagittal sinus thrombosis ?
enoxaparin
barrett oesophagus tx ?
metaplasia -endoscopy every 3-5 years
low grade dysplasia - endoscopy radio frequency ablation
SAAG > 11g/L
indicates ?
(indicates portal hypertension)
= cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
Cardiac
right heart failure
constrictive pericarditis
Other causes
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema
SAAG <11g/L
indicates ?
Hypoalbuminaemia
nephrotic syndrome
severe malnutrition (e.g. Kwashiorkor)
Malignancy
peritoneal carcinomatosis
Infections
tuberculous peritonitis
Other causes
pancreatitis
bowel obstruction
biliary ascites
postoperative lymphatic leak
serositis in connective tissue diseases
Pleural effusion: causes
Transudate (< 30g/L protein)
Transudate (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs’ syndrome
what can transform into AML ?
primary polycethmia
tx for resistant eczema to - topical steroids and tacrolimus ?
ciclosporin / azathioprine / mycophenolste
pytriasis resistant to ketaconazole ?
oral itraconazole
Tx for erythrodermic psoriasis ?
ciclosporin
