Name the common differentials for TATT
- VITAMIN DCE
- Anaemia
- Hypothyroidism
- Diabetes
- Depression
- Stress
- Post-viral
- Neoplasm
- Chronic inflammatory conditions
Describe the different types of headache and the main symptoms
Name some signs of iron deficiency anaemia
- Pallor
- Atrophic glossitis
- Angular cheilosis (ulceration in corners of mouth)
- Nail changes
- Longitudinal ridging
- Koilonychia (spoon shaped)
- Tachycardia, murmurs, cardiomegaly, heart failure if severe
Name the categories of anaemia and some examples for each
Microcytic = TAILS
- Thalassaemia
- Iron deficiency
- Sideroblastic anaemia
Macrocytic = FAT RBC
- Folate
- Alcoholism
- B12
- Myelodysplastic syndromes
Which antibiotic for bacterial tonsilitis?
Penicillin / erythromycin (7 days)
Which antibiotic for lower respiratory tract infection?
Amoxicillin or doxycycline (5 days)
Which antibiotic for uncomplicated UTI?
Trimethoprim or nitrofurantoin (3 days)
Which antibiotic for complicated UTI?
Trimethoprim or nitrofurantoin (5 days)
Which antibiotic for UTI in pregnancy?
Nitrofurantoin or Trimethoprim (7 days)
Which antibiotic for cellulitis?
Flucloxacillin (7 days)
Which antibiotic for meningitis?
- Refer to A&E immediately
- IV penicillin before
Describe the appearance and protein content of transudates and exudates
Transudate:
- Clear/pale yellow
- Protein < 30g/L
Exudate:
- Turbid/bloody
- Protein > 30g/L
Name some examples of transudate and exudate
Transudate = failure syndromes
- Heart failure
- Cirrhosis
- Nephrotic syndrome
- Hypothyroidism
- Meig’s
Exudate:
- Infection
- RA/SLE
- Malignancy
- Pancreatitis
- PE
Name some tumour markers in the blood
- Colorectal = CEA
- Ovarian = CA-125
- Pancreatic/bile duct = CA19-9
- Liver/germ cell = AFP
- Prostate = PSA
- Breast = CA27.29 / CA-125
- Germ cell = B-HCG
Name some classes of antibiotics and their mechanism of action
Name some enzyme inducers and inhibitors
Name the cranial nerves
Antibiotic for pyelonephritis?
Co-amoxiclav 14 days
What is a migraine?
Neurovascular disorder in a genetically predisposed (trigeminal network) characterised by episodic unilateral throbbing headache lasting 4-72 hours
- More common in young women
- May be preceded by visual aura
- Increase in serotonin
What are the clinical features of migraine?
- Nausea/vomiting
- Photophobia/Phonophobia/Osmophobia (smell)
- Unilateral (2/3) or bilateral (1/3)
- Behind or along inner angle of eye
- Radiates to occiput or neck
- Dull to throbbing
- May be preceded by focal neurological symptoms
- Aura
- Visual
- Parasthesia
- Hemiparesis
Describe the IHS criteria for migraine
Without aura:
- 4 hours - 3 days
- Nausea/vomiting/photophobia
- 2 of
- Unilateral
- Moderate/severe pain
- Aggravation by physical activity
- Pulsating
With aura (At least 3 of):
- Reversible brainstem/cortical dysfunction
- Aura > 4 mins or 2 auras in succession
- Aura lasts > 60 mins
- Headache < 60 mins after aura
How is acute migraine managed?
- Analgesia with antiemetics (aspirin 1g and metoclopramide 10mg)
- Triptans (sumatriptan/zolmitriptan) = serotonin agonists
- Avoid MAOI, propanolol, SSRI = serotonin syndrome
- Ergotamine tartrate if intolerant to 5-HT agonist
What is the prophylaxis management of migraines?
If at least 2 attacks per month or affecting lifestyle
- Avoid triggers - stress, lack of sleep, hypohylcaemia, exercise, heat etc
- If OCP/HRT - stop if migraine with aura
- Drugs
- Beta blockers
- Amitriptyline
- Verapamil
- Sodium valproate
- Topiramate
- Pizotifen
What are the features of tension headache?
Diffue ‘band-like’ dull headache
- May be accompanied by scalp tenderness
- May be aggravated by noise or light
- Lasts hours to days
- No physcial signs (vomiting, photophobia, throbbing etc)
- Can be exacerbated by analgesic overuse
