Term
man presents with 36h of sudden onset pain in left big toe
what are your 2 DDX? |
|
Definition
Gout
septic arthritis
ix: uric acid levels (usually raised >600umol)
joint fluid microscopy: under polarised light, gram stain.
FBC: wcc for infection
check UE: impaired renal fx can be a cause of impair excretion |
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Term
| how would you treat a man for acute gout? |
|
Definition
NSAIDS , ibuprofen or naproxen.
colchicine if said in tolerated or ci
stop precipitating meds: thiazide diuretics |
|
|
Term
| name 6 organs involved in SLE and a feature of it |
|
Definition
joints: arthalgia
face: butterfly rash
renal: glomerulonephritis
lung: effusion
heart: endocarditis
CNS: depression, psychosis
vascular: vasculitis
GI: abdo pain, mouth ulcers |
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|
Term
| how might mild SLE be treated |
|
Definition
may no drugs
skin conditions: topical steroids
joint pain: nsaids
antimalarials may help mild skin disease |
|
|
Term
| what advice can you give to someone with sle |
|
Definition
avoid excess sunlight
rest where possible
control CVS risk factors
consider bone health |
|
|
Term
| during a flare up of SLE what is most likely to be prescribed? |
|
Definition
systemic corticosteroid either PO or depot
immunosuppresive drugs: azothiprine, MTX, RITUXIMAm |
|
|
Term
| what drugs should someone with SLE avoid as it can cause flare ups? |
|
Definition
sulphonamides
contraceptive steroids may both cause flare ups. |
|
|
Term
| long term implications of SLE? |
|
Definition
depression
increase risk of some cancers: lymphoma
increased risk of CVS disease: rx as primary prevention |
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|
Term
| differential diagnosis of back pain in a 23 year old trainee pe teacher? back pain gets better once he gets moving. |
|
Definition
mechanical pain
ank spondylitis
postural problem
trauma to back
disc prolapse |
|
|
Term
|
Definition
NSAIDS
steroid injection
sulfasalazine for peripheral disease
infliximab
joint surgery
steroid eye drops for uveitis
avoid smoking : reduced chest expansion and pulmonary fibrosis |
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|
Term
| describe the pathology of osteoporosis |
|
Definition
| there is an imbalance between osteoclastic activity and osteoblastic activity therefore more bone is being removed than being laid so gradually the bone thins. |
|
|
Term
| name 3 typical osteoporotic fractures |
|
Definition
|
|
Term
|
Definition
| PTH injection hormone used as a bone growing agent |
|
|
Term
| when shadow is shorter than height is when the most or least vitamin D is produced? |
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Definition
|
|
Term
| white thick discharge, itchy uncomfortable? |
|
Definition
|
|
Term
| thin homogenous greenish offensive smelly discharge? |
|
Definition
|
|
Term
| grey frothy PV discharge? |
|
Definition
|
|
Term
| yellow discharge plus irregular bleeding? |
|
Definition
|
|
Term
| mucopurulent yellow discharge? |
|
Definition
|
|
Term
| what are primary and secondary dyspareunia? |
|
Definition
primary: since onset of sexual activity
secondary: onset during sexual lifetime |
|
|
Term
| DDX of superficial dyspareunia |
|
Definition
vulvovaginitis
vaginismus
vulval cyst
imperforate hymen
HSV |
|
|
Term
|
Definition
PID
endometriosis
Fibroids
cervicitis
pelvic mass
ovarian cyst |
|
|
Term
| definitive test to diagnose endometriosis? |
|
Definition
|
|
Term
| herbal medications used for menopausal symptoms? |
|
Definition
black cohosh - hapatic toxicity reported with this
ginseng
red clover
evening primrose oil
st johns wort |
|
|
Term
| when to give cyclical and when to give continuous HRT? |
|
Definition
cyclical if LMP < 12 months ago
Continuous if LMP > 12 months ago and if age > 50 years at time of menopause. |
|
|
Term
| non HRT drug management for menopause? |
|
Definition
SSRI/SNRI
gabapentin
clonidine |
|
|
Term
|
Definition
| it is an alpha 2 adrenergic agonist |
|
|
Term
| for all women with an intact uterus and getting HRT they also need which other hormone ? |
|
Definition
| progesterone. this is to protect against unopposed oestrogen and increased risk of endometrial cancer |
|
|
Term
| risks associated with taking HRT? |
|
Definition
| increased risk of VTE, breast cancer, and CVA |
|
|
Term
| which selective oestrogen receptor modulator can help women with menopause with symptoms of low libido? |
|
Definition
| Tibolone - this has oestrogen and progesterone activity so you don't have to add in extra progesterone. |
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|
Term
| what is the link between USS of endometrial thickness of < 5mm and negative predictive value? |
|
Definition
| <5mm gives a 98% negative predictive value of endometrial carcinoma. |
|
|
Term
| risk factors for endometrial cancer? |
|
Definition
diabetes
PCOS (anovulatory cycles)
early menarche
late menopause
nulliparity
tamoxifen
unopposed estrogen
older age
FHx breast, endometrial or CRC |
|
|
Term
street names for
Ketamine
Cocaine
Ecstasy
Mathamphetamine
Mephadrone |
|
Definition
Ketamine: vitamin k, special k powerful GA
Cocaine: coke
Ecstasy: pilss, e
Mathamphetamine: meth
Mephadrone: meow meow |
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|
Term
|
Definition
| buprenorphine, it is an partial agonist antagonist. people can abuse this by crushing and injecting it. this is why suboxone was developed with is buprenoprhine with naloxone. |
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|
Term
| treatment options for Hep C |
|
Definition
combination of pegylated interferon alpha, ribavarin and protease inhibitor used.
cure rates approaching 90%
aim of cure is: sustained virological response (SVR), defined as undetectable
check serum HCV RNA six months after the end of therapy |
|
|
Term
| complications of Hep C rx? |
|
Definition
ribavirin - side-effects: haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic
interferon alpha - side-effects: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia |
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|
Term
|
Definition
|
|
Term
depakote is used to treat?
it is valproic acid |
|
Definition
| seizures and manic episodes in bipolar people |
|
|
Term
| what type of laxative is Bisacodyl? |
|
Definition
|
|
Term
|
Definition
| methenamine used in rx of recurrent UTI to suppress urinary bacteria. |
|
|
Term
| what kind of liver picture would u see in someone using anabolic steroids? |
|
Definition
cholestasis +/- hepatitis
hepatic tumours |
|
|
Term
what is the MOA of a statin?
when to check LFTS when using statins?
statins should be taken at night. |
|
Definition
inhibit the action of hmg-coA reductatse, the rate limiting enzyme in hepatic cholesterol synthesis.
check LFT on baseline, 3m and 12 months.
discontinue rx if LFT raise 3 x upper limit |
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|
Term
| myopathy is more common in lipophilic statins such as atorvastatin and simvastain. name some hydrophilic statins that are less associated with myopathy |
|
Definition
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|
Term
| a 62 year old women has an opportunistic BP of 170/100 what do you do? |
|
Definition
|
|
Term
| after ambulatory monitoring a 62 year old ladies BP is 166/98. how would you manage this HTN? |
|
Definition
grade 2 moderate HTN
start calcium channel blocker |
|
|
Term
| contraindications of calcium channel blockers |
|
Definition
amlidipine and nifedipine avoid in
Aortic stenosis
unstable angina
verpamil and diltiazem avoid in
poor LV fx
AV Nodal conduction delay |
|
|
Term
| SE of calcium channel blockers |
|
Definition
ankle swelling, flushing, headaches, palpitations
constipation, bradycardia, heart block cardiac failure. |
|
|
Term
|
Definition
abc
GTN
aspirin 300mg
o2 if sats < 94%
ECG |
|
|
Term
|
Definition
ECG to see signs of lV hypertrophy
CXR: cardiac enlargement or calcification of aortic valve
echo: diagnostic |
|
|
Term
| when is valve replacement recommended in aortic stenosis? |
|
Definition
when valve pressure is >50mmHg in a symptomatic pt
please note Abx prophylaxis is not recommended for dental procedures. |
|
|
Term
|
Definition
| inability of the CO to meet the bodes demand despite normal venous pressures |
|
|
Term
|
Definition
breathlessness
fatigue
ankle swelling
orthopnea
cough |
|
|
Term
|
Definition
1 no dyspnoea
2. dyspnoe on ordinary activities
3 dyspnoea on less than ordinary activities
4. dysnoea at rest. |
|
|
Term
|
Definition
heaving apex beat
bi basal crackles
pitting oedema
pulsus alternans
raised JVP
gallop s3 |
|
|
Term
| pathophysiology of signs in HF |
|
Definition
displaced apex from LV hypertrophy
RV heave from pulmonary HTN
bibasal crackles: cardiac asthma or fluid in lungs
pitting oedema: RH failure
gallop rhythm: due to ventricular dysfunction |
|
|
Term
|
Definition
endocrine: HTN, diabetes
Post MI: Mitral regurg
drugs: beta blockers, cytotoxics, cocaine, alcohol
valvular: degenerative calcification of aortic valve
lifestyle: smoking, obesity, lack of exercise
genetic: cardiomyopathies eg HOCOM
nutritional: malnutrtion, thiamine deficiency, selenium deficieny
infective: endocarditis, chagas disease, HIV
AI: Haemochromatosis |
|
|
Term
|
Definition
FBC: anemia, glucose, BNP levels, tropnin
ecg: LV hypertrophy
ECHO: gradient
CXR: cardiomegaly and pleural effusions
swan-Ganz catheter to measure end diastolic pressures. |
|
|
Term
|
Definition
| 50% of pts with severe HF dies within 2 years |
|
|
Term
| symptoms associated with IBS for 6months |
|
Definition
abdo pain
bloating
change of bowel habit |
|
|
Term
| prevalence of coeliacs in UK? |
|
Definition
|
|
Term
| what is the anaemia that presents in coeliacs disease? |
|
Definition
| iron, b12 deficiency anaemia |
|
|
Term
| which HLA associated with coeliacs? |
|
Definition
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