digoxin - monitoring, toxicity, causes of toxicity, management
not routinely monitored. if you suspect toxicity do it 8-12 hours after last dose
can be toxic at normal levels. toxicity presents as generally unwell, confusion, yellow-green vision, bradycardia, gynaecomastia
causes - hypokalaemia (and therefore diuretics), amiodarone, verapamil.
management - digibind
crohns - inducing remission
- oral or IV steroids
- mesalazine
things like azathioprine, mercaptopurine, infliximab, enteral diet can all be used as add ons
crohn’s - maintaining remission
- azathioprine or mercaptopurine
- methotrexate
remember TPMT before azathioprine or mercaptopurine
management of crohn’s - the exceptions
peri-anal disease : metronidazole
fistulating/ refractory crohn’s: infliximab
complications of crohn’s
small bowel cancer
colorectal cancer
osteoporosis
chronic plaque psoriasis management
- 4 weeks of steroid and vitamin D
- vitamin D X2
- Steroid X2 or Coal tar
secondary care of psoriasis
UVB 3 times weekly
PUVA
(remember ageing and SCC)
methotrexate is first line
scalp psoriasis management
- potent topical corticosteroid for 4 weeks
- switch to other type (like gel or shampoo)
face, flexural and genital psoriasis management
2 weeks of mild/ moderate topical corticosteroid
medication in psoriasis, what to be aware of
No long term use of steroids, needs 4 week break
8 weeks max of potent
4 weeks max of very potent
tell me more about vitamin D analogues
eg calcipitriol
not to be used in pregnancy
max 100g per week
reduces scale and thickness, not erythema
can be used long term
premature ovarian insufficiency - what is it, blood tests, management
menopause before 40
FSH and LH high, oestrodiol low
FSH has to be over 30 on 2 occasions, 4-6 weeks apart
HRT OR COCP until the age of 51
NAFLD - epidemiology, associated with, features, stepwise ix/ mx
most common cause of liver disease in the developed world
typical stuff, but also bypass and rapid weight loss
features - echogenicity increased, ALT>AST, hepatomegaly
- incidental finding of raised echogenicity on US
- ELF blood test, if unavailable use FIB4
- Fibroscan
- refer to specialist if fibrosis, otherwise diet/exercise/alcohol/GLP-1
management of preterm prelabour rupture of membranes, risks
- admission for monitoring
- oral erythromycin (10 days or until labour)
- dexamethasone if <34 weeks
- mag sulph if <30 weeks
- deliver at 37 weeks
risks: chorioamnionitis, fetal prematurity and infection
confirming PPROM
- pooling of amniotic fluid on speculum
- PAMG-1 or ILGFBP-1
- oligohydramnios on US
eGFR formula and what it includes. Factors that affect result
MDRD
age, ethnicity, gender, creatinine
pregnancy, muscle mass, red meat 12 hours before
APLS in pregnancy management
low dose aspirin straight away
LMWH once fetal heart seen, stop at 34 weeks
If previous VTE - higher dose LMWH until 6 weeks postpartum
epididymo-orchitis : causes, presents, ix, mx
chlamydia (then gonorrhoea) in young people
e-coli in younger people
presents - unilateral testicular pain and swelling, discharge
ix: STI screen, MSU
mx in younger: IM ceftriaxone and 2 weeks of docy
mx in older: 2 weeks of quinolone (-floxacin)
when are pregnant women screened for anaemia, cut-offs, management of anaemia
booking (8-10) and 28 weeks
110 in first trimester
105 in 2nd/3rd
100 post partum
ferrous sulphate or ferrous fumarate, for 3 months after it is corrected
drugs causing ocular problems
cataracts: steroids
corneal opacities: amiodarone, indomethacin
optic neuritis: amiodarone, ethambutol, metronidazole
retinopathy: quin (chloroquine, quinine)
sildenafil causes blue discolouration and non-arteritic anterior ischaemic neuropathy
advice after hip replacement
do physio, crutches for 6 weeks
no leg crossing
no flexing past 90 degrees
lie on back for 6 weeks
no low chairs
take VTE for 4 weeks after
sickle cell genetics
autosomal recessive
affecting beta-globin on chromosome 11
sickle cell crises
painful crisis: due to vaso-occlusion. environmental precipitants.
acute chest: vaso-occlusion in chest. infiltrates on XR
anaemic aplastic: parvovirus, bone marrow suppression, low reticulocytes
anaemic sequestration: high reticulocytes
