w/c 15/12 Flashcards
stable angina mx
beta blocker first line
if not tolerated rate limiting CCB eg verapamil or diltiazem
second line add the other one (non di hydropyrimadine CCB eg amlodipine, nifedipine)
if not tolerated add long acting nitrate/ ivabradine/ nicorandil
dont add a third drug unless waiting for PCI/CABG
hypertension 1/2/3/4 line drugs
Acei/ARB
CCB
thiazide diuretic
spironolactone/doxazosin or beta blocker
posterior MI ECG changes
ST depression
r waves
t waves normal
ST elevation in V7-9
amiodarone dosing VF
300mg after 3 shocks
150mg after 5 shocks
antithrombotic therapy for valve replacement
metallic= warfarin and aspirin
bioprosthetic= aspirin
what test is used to diagnose hereditary spherocytosis
EMA binding test
first line ocular myasthenia gravis
pyridostigmine
most common cancer causing brain mets
lung
radial nerve injury causes
inability to extend arm, forearm and fingers
lateral 3.5 digits sensory loss
triceps reflex nerve root
c7-c8
memantine moa
NMDA antagonism
donepezil moa
acetylcholinesterase inhibitor
where in the lung are adenocarcinomas found
peripherally
where in the lung are SCCs found
centrally
how to convert oral codeine to morphine
divide by 10
switch from oral to subcut morphine
divide by 1/2
divide by 1/3 for diapmorphine
what is used for palliative pain relief when there is renal impairment
buprenorphine or fentanyl
oxycodone over morphine if impairment is mild
what is used for nausea and vomiting in palliative when a gastric cause is suspected
metaclopramide
first line in palliative care for respiratory secretions
hyoscine hydrobromide
what type of visual loss does macular degeneration cause
central
what type of visual loss does primary open angle glaucoma cause
peripheral
if magnesium and potassium are low how is this managed
correct the magnesium then reassess both by doing bloods in 2 weeks
low mg causes low k
hyperkalemia QRS complex change
widened
how does respiratory alkalosis affect calcium, phosphate and ALP levels
low calcium
normal phosphate
how to differentiate 3rd nerve palsy from horners syndrome
3rd nerve palsy= dilated pupil
horners= constricted pupil
proliferative retinopathy mx
anti VEGF
pan retinal photocoagulation
how are drusen seen on fundoscopy
amber retinal deposits
when is propylthiouracil used over carbimazole
in child bearing age
what ix is done in subclinical hypothyroidism to see if they will progress to overt hypothyroidism
thyroid peroxidase antibodies
subclinical hypothyroidism TFTs
TSH high
T4 normal
subclinical hyperthyroidism TFTs
TSH low
T4 normal
over replacement of thyroxine causes what
osteoporosis
1st line for acromegaly from pituitary tumor
trans shpenoidal resection
what causes a false low HbA1c
decreased red cell survival
maximum metformin dose
1g BD
how many units of insulin in 1ml
100
T1DM minimum glucose monitoring
before each meal and before bed (4x day)
how often should diabetics on insulin check their blood glucose while driving
before they start then every 2 hrs
thyrotoxic storm medications
propylthiouracil
hydrocortisone
beta blockers
what steroid is given in thyrotoxic storm
hydrocortisone
what thyroid lowering drug is given in thyrotoxicosis
propylthiouracil
addisons sick day steroid rules
double glucocorticoids
keep mineralocorticoid the same
what test is used to diagnose cushings
low dose dexamthasone supression test
myxoedema coma mx and explain
IV thyroid replacement
IV hydrocortisone
if they have addisions, the thyroid replacement can precipitate a crisis so give hydrocortisone to avoid this
what is target blood pressure for a 56-year-old man with type 2 diabetes mellitus who has no end-organ damage, if using a clinic blood pressure reading?
<140/90
what is target blood pressure for a 56-year-old man with type 2 diabetes mellitus who has no end-organ damage, if using ABPM?
< 135/85
most likely adverse effect of radioiodine therapy
hypothyroidism
clinic reading BP target for hypertension in <80yrs
< 140/90
what medication causes proximal myopathy
steroids
acid base imbalance seen in cushings
hypokalemic metabolic alkalosis
TFTs in sick euthyroid
low t3/t4 but normal TSH (in acute illness)
most common thyroid cancer
papillary
most common complication of papillary thyroid cancer
spread to cervical lymph nodes
what blood test is most important in assessing response to levothyroxine in hashimotos
TSH
if someone is hypocalcaemic and not responding to replacement, what could be going on
magnesium deficiency
mutation for MODY
HNF-1 alpha
best medication for MODY
sulfonylurea
if there is renal impairment after starting an ACEi, what is the cause
underlying bilateral renal artery stenosis
when is unsynchronised vs synchronised cardioversion used
unsynchronised only in emergency situations where it cant be synchronised eg pulseless VT or fibrillation
otherwise synchronise it
most common cause of mitral stenosis
rheumatic fever
what valve problem causes AF
mitral stenosis
what test can indicate pre renal AKI
low urinary sodium
in hypovolemia the body will reabsorb sodium to encourage water to follow with it so urinary sodium will be low
water requirement for adults in IV fluids
25-30ml/kg/day
potassium sodium and chloride requirement for adults on IV fluids
1mmol/kg/day
glucose requirement for adults on IV fluids
50-100g/day
platelet levels in HSP
normal
purpura is non thrombocytopenic
what valve abnormality is a complication of adult PCKD
mitral valve prolapse
when is treatment for hyperkalemia commenced
everyone with potassium over 6.5
those with ECG chnages
what body type may have a low gfr
those with a high muscle mass
how does nephrotic syndrome affect thyroid levels
causes low thyroid hormones
what needs to be monitored in HSP
blood presssure and urinalysis
main side effect of bisphosphonates
oesophageal problems eg heartburn
what TB drug causes lupus
isoniazid
what ix should be done before starting anti TNF and why
chest x ray to look for TB as it can be reactivated
how is a diagnosis of ank spond best supported
pelvic x ray
sacroilitis is seen early
granulomatosis with polyangitis antibody
c ANCA
phosphate levels in tertiary hyperparathyroidism
high as kidneys cant excrete it
1st line mx for reactive arthritis
nsaids
when are bisphosphonates started immediately in a fragility fracture
> 75 yrs
what condition increases risk of pseudogout
haemochromotosis
ACA stroke sx
contralateral hemiparesis and sensory loss
lower limbs>upper
MCA stroke sx
contralateral hemiparesis and sensory loss
upper limbs>lower
PCA stroke sx
contralateral homonymous hemianopia with macular sparing
visual agnosia
PICA stroke
ipsilateral face pain and temp loss
contralateral pain and temp loss
ataxia, nystagmus
AICA stroke
ipsilateral face pain and temp loss
contralateral pain and temp loss
reduced hearing and facial paralysis
webers syndrome stroke
ipsilateral cn III palsy
contralateral limb weakness
webers syndrome stroke is what vessel occulsion
branches of the PCA that supply the midbrain
what is lateral medullary syndrome
aka wallenberg syndrome
PICA stroke
what is wallenberg syndrome
aka lateral medullary syndrome
PICA stroke
what is lateral pontine syndrome
AICA stroke
PICA stroke is also known as
lateral medullary syndrome
wallenberg syndrome
AICA stroke is also known as
lateral pontine syndrome
basilar artery stroke sx
locked in syndrome
retinal/ opthalmic artery stroke
amaurosis fugax
what is tinels test for
carpal tunnel
in a mid shaft humeral fracture what nerve may be at risk
radial
what does radial nerve palsy cause
wrist drop
isolated vertical diplopia is due to what cranial nerve palsy
trochlear
how does the uvula deviate in vagus nerve palsy
away from the side with the lesion
onsansetron moa
5 ht3 antagonist
degenerative cervial spondyloparthropathy imaging
MRI
ondansetron side effects
prolonged QT
VT
constipation
how to differentiate PSP from multisystem atrophy
in PSP there is impairment of vertical gaze
sx of a TIA resolve in
24 hrs
jacksonian movements indicate the seizure originated in what lobe
frontal
MS bladder dysfunction next step
US KUB to assess post void residual volume/ bladder emptying
in a bitemporal hemianopia what does the lower quadrants being affected more suggest
superior chaismal compression
more likely a craniopharyngioma
in a bitemporal hemianopia what does the upper quadrants being affected more suggest
inferior chiasmal compression
more likely a pituitary adenoma
what cranial nerves are effected in a vestibular schwannoma
V, VII and VIII
out of propanolol and topiramate for migraine prophylaxis what is preferred
propanolol in women of child bearing age
when is prothrombin complex concentrate given alongside vitamin K in reversal of warfarin
if there is a major bleed
minor bleed= give just vit K
where is pulmonary stenosis heard loudest
2nd ICS left sternal edge
for how long post MI can you not drive
4 weeks
when are rate limiting CCBs used instead of non rate limiting
when the patient has angine or heart block
rate limiting CCB examples
verapamil
diltiazem
when are adrenaline and amiodarone given in ALS
adrenaline every 3-5 mins, give asap in non shickable rhythms
amiodarone after 3 shocks in shockable rhythms and again after 5 shocks
post MI VSD sx
acute heart failure develops 5 days after MI with a pan systolic murmur
mx for regular VT
amiodarone
when does coarctation of the aorta present
at 2 days when the duct supplying the inferior aorta is cut off
nstemi mx
give aspirin 300mg
if grace >3% do PCI
if not give fondaparinux and ticagrelor
rheumatic fever mx
IM benpen
borad qrs complex
> 0.12 secs
statin plus what abx is bad and what happens
macrolide
causes rhabdo and hepatotoxicity
bisfriens pulse
2 systolic beats
seen in HOCM
if someone has an acute stroke and AF when should anticoagulation be started
after 7 days
most specific ECG finding in acute pericarditis
PR depression
time window for cardioverting new onset AF
48 hrs
primary hyperaldosteronism mx
spironolactone
what mx for graves disease worsens eye disease
radioiodine
which steroid is given acutely in an addisonian crisis
hydrocortisone
in hypercalcaemia due to malignancy what happens to PTH
PTH levels are low
PTHrP is high
what complication occurs in HHS if insulin is given rapidly
central pontine myelinolysis
