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MBChB4 > 18.02.24 > Flashcards

18.02.24 Flashcards

1
Q

Neuropathic pain:

A

Neuropathic arises due to damage to nerves and is commonly described in terms such as shooting, stabbing, electric shock and burning.
E.g. diabetic neuropathy, post herpetic neuralgia, trigeminal neuralgia, prolapsed intervertebral disc.

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2
Q

Treatments for neuropathic pain:

A

Amitriptyline, duloxetine, gabapentin or pregabalin.

Use as monotherapy.

Tramadol can be used as rescue therapy.

Topical capsaicin for localised neuropathic pain e.g. post herpetic neuralgia.

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3
Q

4 features of an anticipatory care plan:

A

Individual
Autonomous
May avoid crisis
Can change

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4
Q

5 inputs into the vomiting centre that can cause n+v?

A

Chemotactic trigger
Gut (chemical or stretch)
Limbic system e.g. emotion, pain, stress
Vestibular-cochlear system
SOL in brain directly on 4th ventricle

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5
Q

What details might an anticipatory care plan include?

A
  1. Preferred place of care
  2. Next of kin details and when to contact
  3. TEP/level of care preferred
  4. Resus status
  5. Wishes for care after death

+ POA/welfare guardianship etc.

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6
Q

Which tool helps to identify patients who’s health is deteriorating.

A

SPICT tool
Support and Palliative Care Indicators Tool

Assess them for unmet supportive needs and palliative care needs.

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7
Q

What are the 4 domains of palliative medicine?

A

Physical
Psychological
Social
Spiritual

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8
Q

Describe the M1a,b,c staging in prostate cancer:

A

M1a = mets in lymph nodes outside the pelvis

M1b = mets in bone

M1c = mets in other organs e.g. lungs

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9
Q

Side effects of androgen deprivation therapy:

A

Hot flushes
Reduced libido
Weight gain

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10
Q

Nociceptive pain features:

A

2 types, somatic and visceral.
Can be caused by injury, physical pressure or inflammation and detected by nociceptors throughout the body.

Somatic = injury or infiltration of skin, muscle, tendons or bone.

Visceral = infiltration, compression or distension of thoracic and abdominal viscera e.g. liver, bowel, heart, pleura.

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11
Q

Mechanism of opioids causing constipation:

A

Inhibit gastric emptying and peristalsis in the GI tract - delayed absorption of medications and increased absorption of fluid.
Lack of fluid in intestines leads to hardening of stool and constipation.

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12
Q

4 medicines included in anticipatory prescribing:

A

Opioid - morphine IM
Anxiolytic sedative - midazolam IM
Anti-secretory - hyoscine butylbromide
Anti-emetic - levemepromazine

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13
Q

Factors precipitating opioid toxicity:

A

Rapid dose escalation
Renal impairment
Sepsis
Drug interactions

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14
Q

Signs of opioid toxicity:

A

Hallucinations
Persistent sedation
Delirium
Hyperalgesia
Myoclonus
Vivid dreams / nightmares

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15
Q

Benefits of a syringe driver:

A

Pain stays well controlled
Patient doesn’t have to worry about swallowing oral meds esp if poor swallow etc.

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16
Q

Oral to IM morphine conversion:

A

Divide by 2
E.g. 120mg PO = 60mg IM.

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17
Q

PRN morphine dose:

A

1/6th to 1/10th of daily dose

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18
Q

Codeine to morphine OME:

A

Codeine divided by 10.

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19
Q

What is nearly always prescribed alongside Levodopa?

A

A decarboxylase inhibitor e.g. carbidopa.

This prevents peripheral metabolism of levodopa and can reduce side effects.

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20
Q

Adverse effects of levodopa::

A

Wearing off - symptoms worsen towards end of dosage interval, decline in motor activity.

On-off phenomenon - large variations in motor performance

Dyskinesia at peak dose e.g. dystonia, chorea, athetosis

Effect may worsen with time, so limit dose until necessary.

Do not stop acutely - if cannot take orally, should be given dopamine agonist patch as rescue medication.

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21
Q

Symptoms of spinal mets:

A

Unrelenting lumbar back pain
Pain worse on coughing, sneezing or straining
Any cervical or thoracic back pain
Nocturnal pain
Tenderness

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22
Q

Symptoms of Meniere’s disease:

A

Tinnitus
Vertigo
Hearing loss
Sensation of fullness or pressure in one or both ears

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23
Q

Definition of tinnitus:

A

Perception of sounds in the ears or head that do not come from an outside source. Described as ‘ringing in the ears’.

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24
Q

What test is used to detect streptococcal infection?

A

anti-streptolysin O titre to detect presence of group A strep e.g. strep pyogenes.

group A strep causes tonsillitis and can be hard to separate from glandular fever.

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25
Q

Post-exposure prophylaxis for HIV:

A

Oral anti-retroviral therapy for 4 weeks.
Includes truvada (tenofovir and emtricitabine) + raltegravir.

Serological testing at 12 weeks.

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26
Q

HIV indicator malignancies:

A

Cervical cancer
NHL
Kaposi’s sarcoma

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27
Q

How many doses of the tetanus vaccine confers life-long protection?

A

5

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28
Q

Features of tetanus prone wounds and high-risk tetanus prone wounds:

A

Puncture injuries in contaminated environment e.g. gardening.
Foreign bodies.
Compound fractures
Wound or burns with systemic sepsis.
Certain animal bites and scratches.

High-risk:
Heavy contamination e.g. soil or manure.
Wounds or burns with devitalised tissue.
Wounds or burns that require surgical intervention.

Patients with these factors will need reinforcing doses of vaccine +/- tetanus immunoglobulin depending on wound severity and whether they’ve had a dose in the last 10 years.

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29
Q

Features of mumps:

A

Spread by droplets
14-21 day incubation

Fever, malaise, muscle pain

Parotitis inc earache and pain on eating: unilateral and then becomes bilateral

Infective 1 week before and 9 days after parotid swelling starts

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30
Q

Features of disseminated gonococcal infection (3):

A

Tenosynovities
Migratory polyarthritis
Dermatitis

31
Q

Which combination of ART therapy is used in PEP?

A

Truvada (Emtricitabine and Tenofovir)

+ Raltegravir

28 DAYS

32
Q

Antibiotic for severe Salmonella jejuni:

A

Clarithromycin

33
Q

Features of C.diff:

A

Raised wcc
Profuse watery diarrhoea
Abdo pain
Typically after antibiotics
Severe = toxic megacolon

34
Q

Antibiotic management of C.diff:

A

No severity markers = Oral metronidazole 10 days

Any severity marker or first recurrence of CDI = Oral vanc 10 days (if oral route not available, then IV metronidazole)

35
Q

Risk factors for C.diff:

A

Antibiotics e.g. clindamycin and ceftriaxone.

PPIs

36
Q

Severity markers in CDI:

A

Temp over 38.5

WCC >15x10^9

CT or XR evidence of severe colitis

Pseudomembranous colitis, toxic megacolon or ileus suspected or confirmed

Acute rise in serum creat >1.5x baseline

37
Q

Management in life-threatening CDI, and what indicates life-threatening CDI:

A

Hypotension +/- ileus, need for vasopressors, significant abdo distension, mental status change, extremely high wcc or lactate or end organ failure.

SURGICAL REVIEW, admission to ICU.

If ileus, then IV met and vanc.

38
Q

Monitoring and management considerations in C.Diff:

A

Frequency and severity of diarrhoea
Stop/rationalise non CDI antibiotics
Stop anti-motility agents
AXR
Stop PPIs
Fluid resus

39
Q

Pathophysiology of C.Diff:

A

C.Diff develops when normal gut flora is suppressed by antibiotics.
Produces 2 exotoxins that act on intestinal epithelial cells and inflammatory cells causing intestinal damage termed pseudomembranous colitis.

40
Q

Type of bacteria of CDI and transmission:

A

Faeco-oral

Anaerobic g+ve, spore forming , toxin producing bacillus.

41
Q

Treatment of recurrent CDI:

A

1st recurrence = oral vanc // iv met

2nd or subsequent recurrence loose stool = Micro/ID advice.

If >8 weeks, treat as first recurrence

42
Q

Preventing CDI spread:

A

Isolation in a side room, until no more diarrhoea for >48 hours (5-7 on Bristol Stool Chart)

Gloves and apron during contact with patients.

HAND WASHING as alcohol gel does not kill CDI.

43
Q

MRSA infection management e.g. cellultis:

A

IV vancomycin

44
Q

Possible bacterial meningitis Abx:

A

IV ceftriaxone

+ IV amoxicillin if >60, immunosuppressed, pregnant, alcoholic, liver disease or listeria suspected.

If strongly suspected, add IV dex and refer to ID.
Do NOT give dex if meningococcal septicaemia suspected e.g. rash

45
Q

Meningitis prophylaxis Abx for close contacts:

A

Oral Ciprofloxacin

46
Q

Indications for delaying LP in bacterial meningitis:

A

Signs of raised ICP e.g. seizure, papilloedema, focal neurological signs, GCS<=12

Severe bleeding risk

Signs of severe sepsis or rapidly evolving rash

Severe resp/cardiac compromise

Cannot be done within 1 hour

47
Q

Gold standard investigation for Shistosomiasis:

A

Stool and urine microscopy: presence of terminal spined eggs.

Parasite enters body by penetrating through skin; causes a local hypersensitivity reaction.

48
Q

Symptoms and treatment of HZV opthalmicus:

A

Severe eye pain
Blistering rash
Redness, blurry vision, reduced visual acuity

Nasociliary nerve - tip of nerve.

Oral antivirals

49
Q

Classic features of dengue fever:

A

Mosquito bite
Facial flushing
Rash
Retro-orbital headache
Thrombocytopenia

50
Q

Herpes simplex keratitis presentation:

A

Red, painful eye
Photophobia
Dendritic corneal ulcer

51
Q

Mild cellulitis antibiotics:

A

Fluclox
Co-trimoxazole or Doxy if pen allergy

52
Q

Moderate / Severe cellulitis abx:

A

IV fluclox

IV vanc if allergy

Clinda if rapidly progressing

53
Q

Gold standard for HIV screening:

A

p24 antigen and antibody at 4 weeks and 3 months.

p24 could be positive by 1 week and will be positive by 4 weeks

antibody could be positive at 4 weeks, and will be positive at 3 months

54
Q

MRSA eradication:

A

Nasal mupirocin + chlorhexidine for the skin

55
Q

Kernig’s sign, and when it is seen:

A

Meningitis

Hip and knee flexed to 90 degrees. Extension of knee elicits pain.

56
Q

Brudzinski’s sign and when it is seen:

A

Meningitis

Passive flexion of neck elicits hip and knee flexion

57
Q

Complications of bacterial meningitis:

A

Partial or total hearing loss
Recurrent seizures
Memory and coordination problems
Focal neurological deficit
Sepsis/intracerebral abscess
Pressure - brain herniation, hydrocephalus
Partial or total vision loss
Kidney problems

58
Q

Treatment for schistosomiasis:

A

Praziquantel

59
Q

Drug management of HIV:

A

2x NRTI e.g. abacavir, emtricitabine
1x Protease inhibitor e.g. indinavir

(drugs ending in -navir = protease inhibitor)

60
Q

Protease inhibitor side effects:

A

Diabetes, central obesity, hyperlipidaemia, buffalo hump, p450 enzyme inhibition

61
Q

Mnemnonic for remembering CYP450 inducers:

A

Cyp450 Please Start Running:
Carbamazepine
Phenytoin
St John’s Wort
Rifampicin

62
Q

Mnemonic for remembering CYP450 inhibitors:

A

4 As Can Stop Signals:
Alcohol
Amiodarone
Antibiotics
Aspirin
Clopidogrel
SSRI
SNRI

63
Q

Acute presentation of schistosomiasis infection:

A

Swimmer’s itch
Fever
Urticaria/angioedema
Myalgia/arthralgia
Cough
Diarrhoea
Eosinophilia

64
Q

Triad of symptoms in typhoid + other symptoms:

A

Headache, fever, arthralgia

+ constipation, bradycardia, abdo pain and distension, rose spots in paratyphi

But can also present with classical ‘pea green’ diarrhoea

65
Q

Typhoid presentation timeline:

A

Within 21 days of return from travel

66
Q

Pathophysiology of Clostridium botulinum:

A

Gram positive anaerobic bacillus

Botulinum toxin producing, a neurotoxin which irreversibly blocks Ach release.

Flaccid paralysis
Diplopia
Ataxia
Bulbar palsy

67
Q

Treatment of botulism:

A

antitoxin, only effective if given early, as once the toxin has bound it cannot be reversed.

68
Q

When is neuroimaging indicated in meningitis:

A

Raised ICP e.g. postural headache, papilloedema, GCS 12 or less, continuous or uncontrolled seizures

69
Q

Discuss HIV seroconversion:

A

Seroconversion is when HIV antibodies first become detectable. The immune system is amounting a response to the virus.

It occurs 3-12 weeks after infection.

Severity of the seroconversion illness correlated with worse prognosis.
It is asymptomatic in 60-80% of patients.

Symptoms include sore throat, lymphadenopathy, malaise, myalgia, arthralgia, diarrhoea, mouth ulcers etc.

70
Q

Treatment for PJP:

A

Co-trimoxazole

71
Q

Most common pneumonia in alcoholics:

A

Klebsiella pneumoniae

72
Q

Centor criteria and what is it for?

A

If 3/4 then 40-60% chance there is presence of Group A beta-haemolytic strep:
History of fever
Absence of cough
Tonsillar exudate
Tender anterior cervical lymphadenopathy

73
Q

Mechanism of N-acetylcysteine:

A

Glutathione donor that binds to toxic metabolites

74
Q
A

MBChB4 (15 decks)

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