Writtens Flashcards
What is co-trimaxazole
Trimethoprim and sulfamethoxazole
What is co-trimaxazole used for?
- Pneumocystis jiroveci (PJP)
- Toxoplasmosis
How do you treat MS neuropathic bladder
Intermittent self catheterisation
1st line management of SCC
Primary excision
What is mohs micrographic surgery
excised samples are examined under the microscope and further samples are taken until the margins are clear on all of them. Used for high-risk recurrent lesions
Desribe typical apperance of scc
Ill-defined keratotic ulcerating (upward) lesions
Rifampicin side effects
Red/Orange secretions
Liver inducer (interactions esp with the COCP)
Hepatitis
Isoniazid side effects
Iron accumulation in mitochondria (sideroblastic anaemia)
Neuropathy (B6 deficiency)
Hepatitis
Pyrazinamide side effects
Hyperuricaemia, hepatitis, photosensitivity
Ethambutol side effects
optic neuritis (decreased acuity and colour blindness) - initially affects the myeinated cones more than the un-myelinated rods
ototoxicity
Drug co-prescribed with TB medication?
Pyridoxine (B6)
What medication contributes to hypothyroidism?
Amiodarone
The chemical structure is analogous to thyroxine and it contains large amounts of iodine
Therefore has a cytotoxic effect on thyroid follicular cells and inhibits the conversion of T4 to T3
Consequently hypothyroidism (Wolff-chaikoff effect) or hyperthyroidism (jod-basedow effects) can occur
TFTs should be checked before and every 6 months of therapy
What are the symptoms or limited cutaneous scleroderma?
Thickening and fibrosis of the skin in the distal limbs (elbows and knees) Beaked nose
small furrowed mouth (microstoma)
CREST syndrome
* Calcinosis
* Raynauds
* Esophageal dysmotility
* Sclerodactyly
* Telangietcasia
What is a common complication of limited cutaneous scleroderma?
Pulmonary hypertension
What Ix for scleroderma?
Anti centromere antibodies
What Ix for diffuse sytseic sclerosis?
Anti-SCL-70 antibodies aka anti-topoisomerase II
Goodpastures treatment
Plasma electrophoresis
Steroids
Immunosupression
Causes of atrial fibrillation
DEHYDRATED PIRATES
Dehydration
Pulmonary disease e.g. pulmonary embolism
Ischemia (hypertension, ischemic heart disease, heart failure)
Rheumatic heart disease
Anaemia, atrial myxoma
Thyrotoxicosis
Ethanol Abuse
Sepsis
Ix for GBS
Nerve condustion studies = decreased motor conduction speed with/without complete block
CSF shows raised protein but no cells and no oligoclonal bands
CSF picture of viral meningitis
Glucose normal
Protein normal/raised
Lymphocytes
What is becks triad? What is it seen in?
Muffled heart sounds, engorged neck veins, hypotension
Indicitive of cardiac tamponade
What is cushings triad? What is it seen in?
Bradycardia, hypertension, widening pulse pressure
Seen in riased ICP
What is Kussmauls sign? What is it seen in?
Paradoxical raised JVP with inspiration
What is a sign of acth-dependent cushings syndrome?
Tanned skin
What are the common signs/symptoms of cushings?
Weight gain (94%)
Fatiguability and (proximal) weakness (87%)
HTN >150/90 (82%)
Hirsutism (80%)
Amenorrhoea (77%)
Cutaneous striae (67%)
Personality changes (66%)
Ecchymoses (65%)
Oedema (62%)
What is mobitz type 1 heart block
P-R delay increase with time until a beat is miseed
What is mobitz type 2 heart block
P-R delay NOT increasing, where beats are missed in a ratio e.g. every 3rd beat is missed
What is a stokes adam attack?
syncope secondary to complete heart block due to reduced CO
What are the lung manifestations of SLE?
- Pleurisy
- Pleural effusion
- Pneumonitis
- Interstital lung disease
- Pulmonary hypertension
- Alveolar haemorrhage
DIagnostic criteria of HHS
Serum glucose >35mmol/L
Leads to osmolarities >320mOsm/Kg
Fluid correction in HHS
Defecit = 100-220 mL/kg
Aim to replace 50% of this deficit within the first 12 hours.
Targets for treatment in HHS
Reduce glucose concentration of 4-6 mmol/L/hr
Fall in sodium concentration of less than 10 mmol/L/day.
Management of HHS
Fluids (0.9% sodium chloride)
1 litre over 1 hour, 1 litre over 2 hours, 1 litre over 6 hours
Aim for fall in sodium of no more than 10mmol/l in 24 hours
Will also need potassium replacement (as per DKA guidelines)
Insulin 0.05units/kg/hour
Aim for fall in glucose of 4-6mmol/hour
Serum findigns in wilsons
Low serum caeruloplasmin
High urinary copper
Low serum copper (paradoxical)
Treatment for wilsons diseae
Penicillamine
X ray findings in rheumatoid
LESS
Loss of joint space
Periarticular erosions
Soft tissue swelling
Subluxation
Juxta-articular osteoporosis
X ray findgins in osteoarthritis
LOSS
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts
Causes of prolonger diarrhoea
Giardia
Omeprazole side effects
Osteoporosis
Fracture type in bisphosphonates
Atypical e.g. subtrochanteric femur fracture
Cause of tinea infections
Trichophyton rubreum
Anaemia in CKD management
Normal ferritin = EPO
Low ferritin = IV iron
TCA overdose symtpoms
Dilated pupils
Wide QRS
Sinus tachycardia
Urine retnetion
Constipation and nausea
Confusion
Statin targets
> 40% reduction in non-HDL cholesterol
Insulin adjustment in hsopital if still eating
Continue regular outpatient regime (consider 25% reductions)
Insluin adjustment if NBM
Continue basal insulin
Stop rapid/short acting if missing just 1 meal
If missing >1 meal or very ill and require tight control start sliding scale
Ischemic Stroke management
Must CT to rule out haemorrhagic
Formal swallowing assessment is essential
If <4.5 hrs:
300mg aspirin
Assess for Thrombolysis (IV Alteplase)
Thrombolectomy
If >4.5 hrs:
300mg aspirin
Thrombolectomy
Secondary prevention of stroke
With AF:
Warfarin/DOAC
Without AF:
Continue aspirin for 2 weeks
Life-long clopidogrel
Haemorrhagic stroke management
Haemorrhagic stroke
* Control BP, balance & review anticoagulation medication
Stop smoking
Control hypertension and hyperlipidaemia
Carotid endarterectomy thresholds
Symptomatic stenosis of 70-99% (ECST criteria)
Symptomatic stenosis of 50-99% (NASCET criteria)
Scoring systems in TIA
ABCD2 score to assess likelihood of stroke after TIA
* Age ≥ 60 years = 1
* Initial BP. Either SBP ≥ 140 or DBP ≥ 90 = 1
* Clinical features of the TIA (Unilateral weakness = 2
Speech imparment without weakness =1)
* Duration of symptoms (10-59mins = 1, >60 = 2)
* Diabetes = 1
Complications of stroke
Aspiration pneumonia
Cerebral oedema (↑ ICP)
Immobility
Depression
DVT
Seizures
Death
Features of secondary hyperparathyroidism
Low calcium
Normal kidney size
10-12cm
Renal artery stenosis findings
Displarity in kidney size >1.5cm
Hypertension
AKI
Other signs of vascular disease
Management of displaced intracapsular hip fracture
Total hip replacement: if can walk independently, no cognitive imparement, medically fit for anaesthesia)
Hemiarthroplasty: If not suitable for total e.g. old and frail
Most common parotid tumour
Pleomorphic adenoma
Management if not tolerating metformin side effects?
Modified release metformin
Causes of ‘end of stream’ haemturia?
Bladder cancer
Prostate cancer
Psoriasis management
Stress and alcohol avoidance
Emollients - soften the plaques
Topical drugs:
Vit D based creams
High dose steroids
Antihistamines for itching
Recalcitrant psoriasis management
1) UV light therapy
2) Oral drugs
○ Methotrexate
○ Cyclosporin
○ Acitretin
○ Hydroxycarbimide
If still unresponsive:
Monoclonal antibodies (Infliximab)
Vaccinations if had splenectomy
Men A&C
HiB
Pneumoccal
Seasonal Flu
GBS symptoms
- Lower motor neurone signs
○ Decreased power
○ Hypotonia
○ Absent reflexes EVEN WITH REINFORCEMENT- Ascending symmetrical weakness and paraesthesia
○ Lower>upper limbs - Cranial nerve involvement
○ Dysphagia, dysarthria (slowed/slurred speech)
○ Facial weaknesss (LMN pattern)
○ Signs of bulbar palsy - Can involve ANS e.g.:
○ Bladder dysfunction
○ Constipation
○ Sweating & Tachycardia
○ Dysthymias
Postural hypotension
- Ascending symmetrical weakness and paraesthesia
When to give antibiotics in surgery
within 60 minutes before the skin is incised and as close to time of incision as practically possible
Ix for food stuck in oropharynx
Lateral soft tissue x ray
How to statisfy the causes of ascities
Ascitic tap and Serum-ascites albumin gradient (SAAG)
High SAAG (>11g/l) - low protein (TRANSUDATE)
Low SAAG (<11g/l) - high protein (EXUDATE)
Criteria for exudate vs transudate
Transudate (protein content <30g/l)
Exudate (protein content >30g/l)
If equivocal (25-30g/l) use lights crtieria for diagnoiss
Exudate if:
* Pleural fluid:serum protein >0.5
* Pleural fluid:serum LDH >0.6
* Pleural fluid LDH >2/3 upper limit of serum LDH
Cause of transudative ascities
High SAAG (>11g/l) - low protein (TRANSUDATE)
* Heart failure
* Constrictive pericarditis
* Portal hypertension - most common
* ○ Cirrhosis
* ○ Alcoholic hepatitis
* ○ Portal vein thrombosis
* Budd-Chiari syndrome
Causes of exudative ascities
Low SAAG (<11g/l) - high protein (EXUDATE)
Peritoneal cause of ascites
* Malignancy
* Infections (inc TB)
* Pancreatitis
* Bowel obstruction
Exception = nephrotic syndrome
Loosing huge amount of protein in your urine
So very low serum protein as its all being lost
Therefore, although ascities protein content normal it is high relative to the serum levels
Pseudomonas antibiotcs
Ciprofloxacin
Gentamicin
Tazocin (pipercillin tazobactam)
Ix of chice in osteomyeltitis
MRI
Management of Ventricular arryhtmias if pt is conscious?
Sedate them and do synchronised DC cardioversion
What is pityriasis rosea
Pink rash appearing on the chest and back
intensley itchy
self limiting caued by virus
Rosacea management
Topical: metronidazole/ivermectin
Oral: if severe give tetracyclines e.g. doxycycline
Ix of choice in laryngeal pathology?
Laryngoscopy
Causes of ring enhancing lesions in HIV
Toxoplasmosis
Lymphoma
Symptoms of opiate withdrawal
- Chills
- Fever
- Myalgia
- Diarrhoea
- Insomnia
- Nausea
- Dilated pupils
Peaks 72 hours after last dose
