14/11/2024 Flashcards by Maddie YEAR 3 & 4

When in pregnancy does fibroid red degeneration typically occur?

In the first and second trimesters

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What % of testicular Cancer are germ cell tumours?

95%

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Types of germ cell tumours?

Seminomas
Non-Seminomas: embryonal, yolk sac, teratoma, choriocarcinoma

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Examples of non-germ cell testicular tumours?

Leydig cell tumours
Sarcomas

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Risk factors for testicular cancer?

Infertility
Cryptochordism
FHx
Klinefelters syndrome
Mumps orchitis

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Features of testicular Ca?

Painless testicular lump - painful in minority of men
Hydrocele
Gynaecomastia
Back pain
Dragging sensation in scrotum

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Why can testicular cancer cause gynaecomastia?

Increased oestrogen:androgen ratio
In germ cell tumours - they secrete hCG which increases testosterone but oestradiol to an even greater extent
In leading cell tumours they secrete more oestradiol directly

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Tumour markers for Seminomas in testicular cancer?

HCG
LDH

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Tumour markers for non-seminomas in testicular cancer?

AFP
Beta-hCG
LDH

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Does pregnancy cause hyperthyroidism/

In pregnancy, there is an increase in the levels of thyroxine-binding globulin. This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level - so no

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Which thyroid drugs are safe in pregnancy?

Thyroxine - may required an increased dose in pregnancy
Propylthiouracil - in first trimester
Carbimazole in second & third trimester

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Managing UTI in pregnancy?

7 day treatment of one of the following:
Cefalexin 500mg TDS
Amoxicillin 500mg TDS
Nitrofurantoin 100mg BD - NOT IN THIRD TRIMESTER
Trimethoprim 200mg BD - NOT IN FIRST TRIMESTER

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A MMSE score of what suggests dementia?

<24/30

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Most common causes of delerium?

Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment

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How can you confirm a diagnosis of delirium?

Do a cognitive assessment - either based on DSM-5, short-CAM or 4As

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Investigations for delirium?

Urinalysis
Sputum culture
FBC
Folate and B12
U&Es
HbA1c
Calcium
LFTs
ESR and CRP
TFTs
Drug levels if ?toxicity
CXR
ECG

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Moa of metochlopramide?

D2 receptor antagonist

it is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist
the antiemetic action is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone. At higher doses the 5-HT3 receptor antagonist also has an effect
the gastroprokinetic activity is mediated by D2 receptor antagonist activity and 5-HT4 receptor agonist activity

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Adverse effects of metoclopramide?

EPS e.g. acute dystonia - esp in children and young adults
Diarrhoea
Hyperprolactinaemia
TD
Parkinsonism

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Types of laxatives?

Bulk forming
Stimulant
Osmotic
Faecal softeners

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Example of bulk-forming laxative?

Isphagula husk
Methyl cellulose
Sterculia
Bran

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Example of stimulant laxative?

Bisacodyl
Sodium picosulfate
Senna
Co-danthramer and co-danthrusate - only in terminally ill pts due to potential carcinogenicity and genotoxicity
Docusate sodium

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Example of faecal softeners?

Study These Flashcards

Docusate sodium
Glycerol suppositories

Example of osmotic laxative?

Study These Flashcards

Lactulose
Macro goals

Can you use trimethoprim when breast feeding?

Study These Flashcards

Yes its present in milk but not known to be harmful

which antibiotic has cross sensitivity with penicillin?

Cephalosporins - have a 10% cross-reactivity

Tx of Ramsay hunt syndrome?

Oral aciclovir Corticosteroids

Moa of dobutamine?

Beta 1 agonist - its an inotrope

Moa of succinylcholine?

It’s a depolarising neuromuscular blocking drug - Binds to nicotinic acetylcholine receptors resulting in persistent depolarization of the motor end plate = muscle paralysis necessary for mechanical ventilation

Management of testicular torsion?

Immediate surgical detorsion & B/L orchidopexy - both testis should be fixed as the condition of bell clapper testis is often bilateral

What can trigger otosclerosis if you are genetically predisposed?

Pregnancy Measles virus is thought to trigger it also Age 20-40

What is otosclerosis?

the replacement of normal bone by vascular spongy bone causing progressive conductive deafness due to fixation of the stapes at the oval window

Sx of otosclerosis?

Conductive deafness and tinnitus in a pt 20-40 TM may be normal or have a flamingo tinge in 10% Likely have positive FHx

Management of a suspected PDA?

Observe for spontaneous closure in asymptomatic pts - normally in first 24 hours but definitely in first few weeks Symptomatic babies undergo an echocardiogram a few days after birth. Depending on the echocardiogram findings, the PDA is managed medically or surgically. Medical management involves giving indomethacin or ibuprofen to the newborn.

What is bowens disease?

Intra-epidermal squamous cell carcinoma, aka carcinoma in situ - precursor to SCC 5-10% chance of developing invasive skin cancer if left untreated

How is bowens disease treated?

Topical 5-fluorouracil BD for 4 weeks with topical steroids (as it often results in significant inflammation and erythema) Cryotherapy Excision

What are risk factors for spider naevi?

Pregnancy COCP Liver disease Thyrotoxicosis More common in childhood

What is club foot also called? How does it present?

Talipes equinovarus Inverted plantar flexed foot that is not passively correctable

Management of subacute thyroiditis?

Self-limiting but NSAIDs can be used for thyroid pain If very severe then steroids can be used

What % of pts with SCLC will have metastasis at diagnosis?

Up to 70%

Moa of thiazide diuretics?

Inhibit sodium reabsorption at the beginning of the DCT by blocking the thiazide-sensitive Na+CL- symporter = more Na+ loss = more water loss

Management of haemochromatoiss?

Venesection regularly Desferrioxamine may be used second line

What is pulses paradoxus?

an abnormal drop in systolic blood pressure during inspiration - can manifest as disappearing radial pulse during inspiration Often caused by pericardial effusions & cardiac tamponade

First line drug for generalised tonic-clonic seizures in males and females?

Males: sodium valproate Females: lamotrigine or levetiracetam

First line drug for focal seizures in males and females?

Lamotrigine or levetiracetam for males and females

First line drug for absence seizures in males and females?

Ethosuximide in males and females

First line drug for myoclonic seizures in males and females?

Males: sodium valproate Females: levetiracetam

First line drug for tonic or atonic seizures in males and females?

Males: sodium valproate Females: lamotrigine

What paraneoplastic syndrome is SCC lung cancer associated with?

PTHrP secretion -> hypercalcaemia

Paraneoplastic syndromes of small cell lung cancer?

ADH -> hyponatraemia ACTH -> Cushing sundrome LES

Which type of lung cancer is highly associated with cavitation?

squamous cell carcinoma

Precipitating events for thyroid storm?

Thyroid or other surgery Trauma Infection Acute iodine load e.g. CT contrast media

Clinical features of thyroid storm?

Fever >38.5 Tachycardia Confusion & agitation N&V Hypertension HF Abnormal LFTS & jaundice

Management of thyroid storm?

Treat precipitating event and Sx Tx e.g. paracetamol Beta blockers - IV Propanolol Antithyroid drugs Steroids - dexamethasone Lugols iodine

Whats the function of dexamethasone in the Tx of thyroid storm?

Blocks the conversion of T4 to T3

14/11/2024 Flashcards

(54 cards)