Misc. Flashcards by Richard Wu

Stress incontinence - Tx?

(1) Pelvic floor exercises
(2) Duloxetine
(3) Colposuspension
(4) Intramural bulking agents
(5) nerve stimulation

How well did you know this?

Not at all

Perfectly

Urge incontinence - Tx?

(1) Bladder re-training
(2) Anti-muscarinics
- Oxybutynin (IR)
- Tolterodine
- Solifenacin
- Darifenacin
(3) - If frail/elderly –> Mirabegron (B3-agonist)
(4) Botox into bladder
(5) Nerve stimulation

How well did you know this?

Not at all

Perfectly

High QRISK 2 score. Started on Atorvastatin 20mg ON. 3 month follow up target?

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%

How well did you know this?

Not at all

Perfectly

Ethylene glycol overdose - Tx?

How well did you know this?

Not at all

Perfectly

Bisoprolol overdose - Tx?

(1) IV Atropine
(2) IV Glucagon

How well did you know this?

Not at all

Perfectly

DHx Warfarin. Started new TB drug. Now raised INR.

What drug?

Isoniazid

How well did you know this?

Not at all

Perfectly

DHx Warfarin. Started new TB drug. Now decreased INR.

What drug?

Rifampicin

How well did you know this?

Not at all

Perfectly

Which organelle does catabolism of long chain fatty acids?

Peroxisome

How well did you know this?

Not at all

Perfectly

Dermatitis herpetiformis

Which HLA?

HLA-DR3

How well did you know this?

Not at all

Perfectly

TCA overdose - Tx?

IV Bicarbonate

How well did you know this?

Not at all

Perfectly

Conversion ratios

S/C morphine –> PO Morphine

PO Oxycodone –> PO Morphine

PO Codeine –> PO Morphine

PO Tramadol –> PO Morphine

How well did you know this?

Not at all

Perfectly

Which opioid in renal impairment can you use

If eGFR 30-60
- Oxycodone
If eGFR < 30
- Buprenorphine patch
- Fentanyl parch
- Alfentanil (under specialist advice)

How well did you know this?

Not at all

Perfectly

Bony metastases pain - Tx?

Tx: NSIADs

+/- Opiates

+/- Bisphosphonates (pain improves within 4 weeks)

+/- Radiotherapy (pain improves within 6 weeks)

How well did you know this?

Not at all

Perfectly

How to titrate morphine

Starting dose

PO Morphine sulphate 5mg every 4 hours (30mg/day)
- PRN Oromoprh IR 5mg for breakthrough pain

Up-titrating if pain is not > 90% relieved

Method 1
- Increase dose by 30-50%
Method 2
- Calculate total daily dose (including PRN doses)
- Divide into 2x 12 hourly doses as BD modified release
Calculate new PRN dose (1/6 total daily dose)

How well did you know this?

Not at all

Perfectly

Breakthrough pain

Tx?

Immediate release morphine sulphate (e.g. Oromorph)

Dose = 1/6 TOTAL daily dose

PRN every 4-6 hours

How well did you know this?

Not at all

Perfectly

Palliative medications

Agitation + Anxiety

Agitation + Delirium

SOB

Secretions

Diffuse oral pain

Hiccups

Agitation + Anxiety –> Midazolam

Angitation + Delirium –> Haloperidol or Levomepromazine or Chlorpormazine

SOB –> Morphine

Secretions –> Hyoscine butylbromide or Glycopyrronium bromide

Diffuse oral pain –> Benzydamine mouthwash

Hiccups –> Chlorpromazine

How well did you know this?

Not at all

Perfectly

Alcohol abstinence maintainence therapy

Disulfiram (unpleasant symptoms after drinking)
- MOA: Inhibits acetaldehyde dehydrogenase –> ↑ acetaldehyde –> ↑ N&V, mimics flush reaction
Acamprosate (↓ cravings)
- MOA: unknown –> ↑ GABA –> ↓ craving
- ↓ pleasurable effects of alcohol
Naltrexone
- MOA: µ-opiate receptor antagonist –> ↑ GABA –> ↓ DA
- ↓ pleasurable effects of alcohol
- Can safely drink

How well did you know this?

Not at all

Perfectly

Aspirin overdose - Tx

IV sodium bicarbonate

If within 12 hours –> Oral activated charcoal

+/- Haemodialysis

How well did you know this?

Not at all

Perfectly

Aspirin overdose - ABG

Mixed respiratory alkalosis + metabolic acidosis

hyperventilation –> respiratory alkalosis

salicylate –> metabolic acidosis

How well did you know this?

Not at all

Perfectly

CO poisoning - Tx

Hyperbaric oxygen

How well did you know this?

Not at all

Perfectly

“Brick-red skin”

Smell of “bitter almonds”

Headache

Confusion

Ataxia

Diagnosis? MOA? Tx?

Cyanide poisoning

Cyanide inhibits Cytochrome C

Tx: IV Hydroxocobalamin

or Combination of Amyl nitrite (inhaled) + IV Sodium nitrite + IV Sodium thiosulfate

How well did you know this?

Not at all

Perfectly

Basophilic stippling

Abdominal pain

Confusion

Diagnosis? Treatment?

Lead poisoning

Tx: Dimercaprol

How well did you know this?

Not at all

Perfectly

Benzodiazepine overdose - Tx

Flumazenil

S/E: Seizures

How well did you know this?

Not at all

Perfectly

Methanol overdose & Ethylene glycol vose

Tx?

Fomepizole

How well did you know this?

Not at all

Perfectly

Heparin overdose - Tx

**Protamine sulphate**

Iron overdose - Tx

**Desferrioxamine**

Lithium overdose - Tx

**IV 0.9% saline** **Haemodialysis**

Local anaesthetic toxicity Tx?

**IV Lipid Emulsion 20%**

**Aflatoxin** **Aniline** Risk factors for what cancer

**Aflatoxin** -\> alpha fetoprotein -\> **liver cancer** **Aniline** -\> urine -\> **bladder cancer**

**Bladder cancer** **Most common type** **Most common type** associated **with Schistosomiasis**

Bladder cancer * **Transitional cell carcinoma** (90%) * **Squamous cell carcinoma** - associated with Schistosomiasis * **Adenocarcinoma** (rare)

Once lung cancer is diagnosed, what Ix to assess suitability for surgical resection

**PET scan**: to look for extent of primary tumour and any mets

Small cell + Squamous cell lung cancer Paraneoplastic syndromes

Tx for neutropenic sepsis

Tazocin + Gentamicin

VIPoma presentation

Most arise from Pancreas **WDHA syndrome** * WD = **Watery diarrhoea** * H = **Hypokalaemia** * A = **achlorhydia** (absence of hydrochloric acid secretion)

**Factors affecting PSA levels**

Medical Tx for prostate cancer

GnRH agonist (**Goserelin**) + Anti-androgen (**Cryproterone acetate**) * co-presecribed to prevent initial increase Testosterone

**Thyroid cancer** Most common types Most aggressive type Most slow growing Associated with MEN2A/2B Associated with Hashimoto's thyroiditis

Thyroid cancer ## Footnote Most common types --**\> Papillary** Most aggressive type --**\> Anaplastic** Slow growing **--\> Follicular** Associated with MEN2A/2B --\> **Medullary** (Parafollicular C cells) Associated with Hashimoto's thyroiditis --**\> MALT lymphoma**

**Unilateral sensorineural hearing los** **Tinnitus** **Facial palsy** **Absent corneal reflex** Diagnosis? Associations? Most common location

**Acoutstic neuroma = vestibular schwannoma** Associated with **NF2** Most commonly located at the **cerebellopontine angle**

**BPPV** **Dix-Hallpike vs Epley**

****_D_**ix-Hallpike** manoeuvre is ****_d_**iagnostic** **Epley manoeuvre** is for **treatment**

**Recurrent vertigo** **Caused by movement** Diagnosis?

BPPV

**Episodic vertigo** **Sensorineural hearing loss** **Tinnitus** **Sensation of fullness (in affected ear)** Horizontal nystagmus Diagnosis

**Meniere's disease**

**_Recent viral illness_** **_Vertigo (room spinning)_** **Horizontal nystagmus** **+ve head impulse** **Normal hearing** **_Single episode_** DDx from BPPV and Vestibular migraine which require recurrent episodes for diagnosis

**Vestibular neuritis** ## Footnote Single episode --\> DDx from BPPV and Vestibular migraine which require recurrent episodes for diagnosis

**Recent URTI** **Sensorineural hearing loss** **Vertigo** Diagnosis?

**Labyrinthitis**

**Von Hippel Lindau** aetiology presentation

Von Hippel Lindau **Autosomal dominant** mutation in VHL gene * Café au lait macules * Haemangiomas * CNS haemangiomas --\> **subarachnoid haemorrhage** * Retinal haemangiomas --\> **Vitreous haemorrhage** **[often 1st sign]**

**Alports syndrome** Aetiology Presentation

**Alports syndrome** **X linked dominant** * Triad * **Haematuria** --\> Renal failure * **Sensorineural deafness** * **Ocular pathology** * Lens dislocation * Retinitis pigmentosa * Renal biospy: "**baseket weave appearance**" of GBM

**Achondroplasia** Aetiology Features

**Achondroplasia** **Autosomal dominant** mutation in **FGFR3 gene** * **Short stature** * **Long bone shortening** * **Trident hands** * **Flat nasal bridge with frontal bossing** * **Narrow foramen magnum**

Bartter vs Gitelman vs Liddle syndrome

**Bartter** (Barffer = Furosemide = Loop diuretic) * Defect in Na-K-Cl co-transporter in LoH (similar to Furosemide) * **Hypokalaemia + Normotension** **Gitelman** (GiTelman = Thiazide = Na Cl in DCT) * Defect in NaCl co-transporter in DCT (similar to Thiazides) * **Hypokalaemia + Normotension** **Liddle** (Liddle Conn / Little Kong) * Defect in Na channels in DCT --\> increase Na absorption (similar to Conn's) * **Hypokalaemia** + **Hypertension**

**Pseudomembranes on the tonsils** Diagnosis?

Diphtheria

**HIV and opportunistic infections**

HHV 1-8

**Itchy, maculopapular rash** **Classicaly AFTER administration of Amoxicillin or Cephalosporin** Diagnosis? Cause? Investigations?

**Infectious mononucleosis** **EBV** Monospot test for Heterophile antibodies Anti-EBV antibodies Atypical lymphocytosis

HPV types and causes

**Genital warts --\> HPV 6 / HPV 11** **Cervical cancer --\> HPV 16 / HPV 18**

**Patches of hypopigmented skin + sensory loss** Diagnosis? Cause?

**Leprosy** *Mycobacterium leprae*

**Painful genital ulcer** **Ragged undermined border** **Painful inguinal lymphadenopathy** Diagnosis?

**Chancroid** Haemophilus ducreyi

**MSM** (Anal sex) **Painless genital ulcer** **Balanitis / Proctitis / Cervicitis** **Painful inguinal lympadenopathy** Diagnosis? Cause?

**Lymphogranuloma venerum (LGV)** *Chlamydia*

**Diarrhoea** **Weight loss, Arthralgia, Lymphadenopathy** **Ophthalmoplegia** **Jejunal biopsy shows Macrophages with Periodic acid schiff granlues** Diagnosis? Cause?

**Whipple's disease** T*ropheryma whippelii*

Tx for schistosomiasis

**Praziquantel**

Quadrantanopia

Tip: PITS (Parietal-Inferior, Temporal-Superior) for Pie in the Sky **Superior quadrantanopia ==\> Lesion of Temporal lobe** **Inferior quadrantanopia ==\> Lesion of Parietal lobe**

Homonymous hemianopia with macular sparing Lesion?

**Occipital cortex**

**Gradual reduce visual acuity** **Glare + Halos** **Loss of red reflex** Diagnosis

Cataract

**Acute onset, painful red eye** **Haloes** **Fixed dilated pupil** Diagnosis?

Closed angle glaucoma

**Asymptomatic** **Peripheral visual field loss / Tunnel vision** **Scotoma** Diagnosis?

Open angle glaucoma

**Diabetic** **Sudden, painless visual loss** **New floaters** **Blood on retina** Diagnosis?

Vitreous haemorrhage

Drusen

Dry AMD

Choroidal neovascularisation

Wet AMD

Painless deterioration of central vision

AMD

**Sudden onset, painless vision loss** **Pale retina** **Cherry red spot** Diagnosis? Causes?

**Central retinal arterial occlusion** Caused by Embolism or Giant Cell Arteritis

**Sudden onset, painless loss of vision** **Retinal haemorrhages** Diagnosis?

**Central retinal vein occlusion**

**Floaters + Flashing lights** **Normal vision** Diagnosis?

Posterior vitreous detachment

**Floaters + Flashing lights** **Visual field loss** Diagnosis?

Retinal detachment

**Vertical diplopia** **Patients head tilted to _contralateral_ side** Diagnosis? Cause?

**4th nerve palsy** **Trauma**

**Horizontal diplopia** Diagnosis? Cause?

**6th nerve palsy** Raised ICP

**Horizontal diplopia** **Failure of adduction (ipsilateral)** **Abducting nystagmus (contralateral)** Diagnosis? Lesion? Cause?

**Internuclear ophthalmoplegia (INO)** Lesion in medial longitudinal fasciculus (midbrain/pons) Caused by MS

Causes of red eye

**Holmes-Adie pupil** Features

**Holmes-Adie pupil** * Reecent infection --\> damage to parasympathetic to eye * **Dilated pupil** * **Slowly reactive to light** * Once constricted, it remains abnormally small for a long period of time * +/- **Absent knee or ankle jerks**

**Marcus Gunn pupil**

**Marcus Gunn pupil = RAPD** * **MS** * Ischaemic optic disease * Glaucoma

Hutchinson's pupil

**Hutchinson's pupil** Compression of CN III by SOL * **Unilaterally dilated pupil** * **Unresponsive to light** *In contrast, Holmes-Adie is dilated + slowly constricts to light*

**Argyll-Robertson pupil** Features? Cause?

**Argyll-Robertson pupil** Neurosyphilis = "prostitute's pupil" --\> "accommodates but doesn't react" * Bilaterally, small pupils * Do NOT react to bright light * Normal accommodation

Misc. Flashcards

(79 cards)