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ABDO SNIPPITS Flashcards

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1
Q

What are the causes of drug induced jaundice which are due to drug induced hepatitis ?

A
  • paracetamol OD
  • sodium valproate
  • statins
  • halothane
  • MAO inhibitors
  • isoniazid, rifampcin, pyrazinamide
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2
Q

What are the causes of drug induced jaundice which are due to cholestasis?

A 
Flucloxacillin (may be weeks after)
Co amoxiclav 
Anabolic Steriods, the Pill 
Sulfonylureas
Procholreperazine 
Chlorpromazine
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3
Q

What are the causes of drug induced jaundice which are due to haemolysis?

A

Antimalarials eg dapsone

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4
Q

What type of liver failure has an onset of 5-26w?

A

Subacute

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5
Q

What is hyper acute liver failure?

A

Encephalopathy - within 7 days from onset of jaundice

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6
Q

What is fulminant hepatic failure?

A

Clinical syndrome resulting from massive necrosis of liver cells which leads to severe impairment of liver function

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7
Q

What are the signs if acute liver failure?

A 
Hepatic flap 
Fetor hepaticas (pear drop breath) 
Constructional apraxia (5 point star) 
Hepatic encephalopathy
Jaundice
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8
Q 
How do you treat the complications of acute liver failure? 
Bleeding 
Cerebral oedema 
Ascities 
Bleeding 
Encephalopathy
A

risk of cerebral oedema- 20% mannitol and ICU

Ascities- restrict fluid, low salt diet, weigh daily, diuretics (start Spirolactone and if not working add furosemide)

Bleeding- Vit K, FFP, blood as needed and endoscopy

Encephalopathy - avoid sedatives, sit at 20 degrees, lactulose and regular enemas to reduce numbers of nitrogen-forming gut bacteria. Aim for 2-4 soft stools/day

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9
Q

Which drugs are hepatotoxic?

A 
Paracetamol 
Methotrexate 
Isoniazid 
Azathoprine 
Phenothiazine 
Oestrogen 
6-mercaptopurine 
Tetracycline 
Salicylates
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10
Q

Which infections can cause deranged liver function tests?

A 
Avian flu 
Q fever
Legionella 
Mycoplasma 
Leptospirosis 
Rickettsial illnesses
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11
Q

What drugs cause TG accumulation, macro vesicular fat and cirrhosis?

A

AAM

alcohol
Amiodarone
Methotrexate

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12
Q

Which drugs cause fatty liver? Micro vesicular fat (Reys syndrome) due to mitochondrial B oxidation?

A

VAT
Valproate
aspirin
Tetracyclines

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13
Q

Which drug causes red man syndrome? (Erythroderma)?

A

Iv Vancomycin

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14
Q

Which drugs can cause severe hypotension on their first dose?

A

ACEi

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15
Q

Which drug can cause agranulocytosis?

A

Carbimazole- warm pt to report sore throat

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16
Q

Which drugs are carcinogenic?

A

Cyclosporin

Diethylstilbestrol

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17
Q

What commonly prescribed drugs can cause rhambomyolosis, myopathy and myositis

A

Statins

Especially simvastatin

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18
Q

Which drugs do you need to watch out with when someone is on warfarin?

A

Protein binding displacement-
-Salicylates /NSAIDS, sulphonamides

Inhibits metabolisms
SADFACES.COM

Inducers
COW PATS

cranberry juice increases INR/bleeding
Care with statins

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19
Q

What does iv verapamil and BB do?

A

Asystole

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20
Q

What does theophylline and B agonist do?

A

Arrhythmias

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21
Q

Prescribing a Loop diuretic and aminoglycoside is bad because?

A

Both ototoxic

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22
Q

Which drug potentiates the effect of adenosine?

A

Dipyridamole
-blocks adenosine uptake therefore increases levels

(Adenosine is used for narrow complex tachycardias ‘junctional tachycardia’ if vagal manoovers haven’t worked. Transiently blocks AV node) may unmask an underlying atrial rhythm

NB
Theophylline/caffeine reduces the effect

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23
Q

What is type I hypersensitivity reaction?

A
  • immediate

- anaphylaxis and urticaria with pens

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24
Q

What is type II hypersensitivity reaction?

A

Intermediate hypersensitivity
Cytotoxic AB
Eg methyl dopa-haemolysis
Thrombocytopenia with quinine

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25
What is type III hypersensitivity reaction?
Intermediate hypersensitivity Immune complex mediated Interstitial nephritis with pens
26
What is type IV hypersensitivity reaction?
Delayed hypersensitivity Steven Johnson syndrome with carbamazepine Pseudoallergic rash with pens
27
Which abxs contain penicillin?
-cillins AND SNEAKY ONES -augmentin (amoxicillin and clavulanic acid) -co amoxiclav (amoxicillin and clavulanic acid) - imipenem (carbapenems) -meropenem ( carbapenems) -tazocin
28
What disease makes you more prone to pen rash?
Mononucleosis
29
What disease gives you high sensitivity to trimithoprim?
HIV
30
Which disease has a 30% chance of developing an allergy to one of these abx? piperacillin, ceftrazidime and ticarcillin
CF | repeated exposure to abx and immune hyper responsiveness
31
Which drug causes acute tubular necrosis?
Gentamycin
32
Which drug causes crystalluria?
Aciclovir
33
Which drug causes interstitial nephritis?
Vancomycin
34
Which drugs bind to albumin (therefore are altered in liver failure)
Phenytoin - monitor levels- adjust for albumin (only take free) Prednisolone
35
What drug gives you rebound hypertension if you withdraw it?
Clonidine - withdraw slowly
36
What is methoxetamine?
Ketamine analogue 'Legal high' Can cause cerebellar toxicity that can last a week
37
Which drugs do you need to withhold if high risk for aki?
``` Diuretics, ACEi, antihypertensives (do not stop B blockers acutely) Metformin if creatinine is rising NSAIDS Nitrofurantoin, gentamycin NB opiates can accumulate ```
38
What do you use to initiate immune suppression in kidney transplant??
IL 2 R Blocker- basiliimab But many centers now use alemtuzumab which gives broad spec immunosuppression
39
What do you give in benzo poisoning?
Flumazenil
40
What do you give in b blockers poisoning?
Atropine
41
What dies dignoxin toxicity cause?
Yellow visual halos Hypokalaemia Decreased cognition nausea anorexia
42
Which drug reduces calcium and therefore good in stone prevention?
Thiazide diuretics
43
What is good about radionuclide imagine and the kidneys?
Functional assessment of the kidney | But US is one of choice for urinsry tract obstruction
44
What is periaortis? (Retroperitoneal fibrosis)
``` Inflammation of abdominal Aorta T cell mediated vasultits Fibrosis under where the utreters lay which causes a stricture and obstruction CT/MRI mass- biopsy to exclude malignancy ```
45
How do you treat urinary retension
1) tricks eg running Taps 2) a blocker- tamsulosin To prevent give finasteride- decreases prostate size and retension risk
46
What are the signs of post turp syndrome?
Low Na | Low temp
47
After relieving chronic obstructive uropathy what is the danger?
Fluid depletion- kidneys go on to make lots so give fluid support and watch UO
48
How do you treat bladder cx Tis/Ta/T1?
Turbt Consider intravvesical chemo for small agents it small multiple tumours Intravesicle BCG
49
How do you treat bladder cx T2-3?
Radical cysecyomy and neoadjunct chemo Can give radiotherapy and preserve the bladder but 5 year survival rate is lower If T4 palliative chemo/radiotherapy
50
Where is the fluid in a hydroceal?
Tunica vaginalis
51
What is idiopathic scrotal oedema?
Usually occurs between 2-10yo | No pain or tenderness but DD for torsion
52
WHO semen analysis
1.5 ml vol 15mil/ml concentration 32% progressive motility 4% normal forms
53
What can you use duloxetine for?
Stress incontinance if exercises etc fail | INHIBITS NA uptake
54
What medical therapy can help an overactive bladder?
Anticholinergics- oxybutymin, toiteride, solifebacin (CI Closes angle glaucoma)
55
What is the disease? Macro/microscopic haematuria, occasionally nephritic syndrome. Young male with episodic macroscopic haematuria C3 deposits and mesangial proliferation and immune complex formation. BP may be high- worst prognosis
IgA Nephropathy Type of GN Tx- bp control ACEi With nephritic presentation, immune suppression may slow decline
56
What is a variant of igA Nephropathy and causes a small vessel vasultits?
Henoch-scholnlein purpura Get rash on extensor surfaces, legs Polyarthritus and abdominal pain (GI Bleed) and NEPHRITIS 15% ESRF 50% ESRF If both nephrotic and nephritic Treat same as IG A Nephropathy. Basically this gone systemic
57
Features of anti glomerular basement membrane (GBM) disease
Autoabs to type IV collagen May have lung manifestations Nephritic picture . AKi may occur within days if symptom onset Tx- plasma exchange, Steriods and maybe cytotoxics
58
Features of post streptococcal GN
Diffuse proliferative 1-12 weeks after sore throat or skin infection Usually nephritic syndrome Inflammation affecting mesangial and endothelial cells IGG And C3 deposits Serology see high C3 and ASOT 95% recover function
59
What are the features of rapidly progressing GN?
Most aggressive GN Can cause ESRF in days 3 categories/causes but all have biopsy finding of crescents affecting most glomeruli 1) immune complex disease - 45% 2) pauci immune disease- 50% cases. Most ANCA positive 5 year survival 80% 3) anti GBM disease 3% Features of AKI with pulmonary haemorrhage and haemoptysis. (Most common cause of death in ANCA pos pts. Tx- aggressive immunosuppression- iv steroids, cyclophosphamide -/+ plasma exchange
60
What are the 5 types of GN? (Nephritic synd)?
``` Ig A Nephropathy Henoch schonlein purpura SLE GBM Post streptococcal GN Rapidly progressive GN ```
61
What are the manifestations of nephrotic syndrome?
Minimal change disease Membranous Nephropathy Mesangiocapillary Focal segmental glomerulosclerosis
62
What is the generic treatment for nephrotic syndrome?
Reduce oedema- loop duiretic eg frusemide - reduce proteinurua- ACEi - reduce hyperlipidenia- statin - anticoagulate if nephrotic range proteinurua - vaccinate to prevent infections - treat and find underlying cause
63
What are the features of minimal change disease?
- children - adults- NSAIDS or hodgkins paraneoplastic - remission with steroids but most relapse
64
What are the features of membranous Nephropathy?
-most idiopathic but can be associated with malignancy- HBV, autoimmunity- thyroid, SLE
65
What are the features of mesangiocapillary GN?
- immune complexes circulate and deposit in kidneys - these activate complement via the classical pathway - biopsy see mesangial and endocapillary proliferation, thickened cap BM, double contouring of the cap walls (tramline)
66
What are the features of focal segmental glomerulosclerosis?
IgM and C3 in IF | HIV, idiopathic, heroine use sickle cell
67
What do loop diuretics do? (Frusimide)
Cl/Na/k co transporter block in ascending loop Act in 1 hr PO IV 30m PO, Ascities, pitting oedema
68
What do Thiazide diuretics do??
Inhibit na/Cl co transporter in DCT HYPOKALAEMIA, low Na, mg, metabolic alkalosis. Increase uric acid so CI in gout. HTN Long term treatment HF
69
What do K Sparing dietetics do?
Spirolactone aldosterone blockers - takes days Amiloride - 12 hours and triamterene block Na channels in collecting tubules SE HYPERKALEMIA and metabolic acidosis Spirolactone - gyancomastia
70
What causes mixed DILI?
Phenytoin and enalapril
71
What causes heptocelluar DILI?
Fatigue dominates | Isoniazid and nitrofurantoin
72
What causes cholestatic DILI?
Co amoxiclav, flucloxacillin, ciprofloxacin Purist and jaundice features dominate
73
What are auline inclusion bodies associated with?
CMV disease | Found on histology
74
Which 2 biological therapies are good to treat severe fistulising Crohn's?
Infliximab | Adalimumab
75
Treatment of alcohol withdrawal
Chronic alcohol dependence- disulfiram Acamprosate- intense anxiety helps
76
What is the tumour marker for colorectal cx?
CDA
77
What can you monitor patients with colorectal cancer with?
Carcinoembryonic antigen
78
How do you measure the severity of pancreatitis?
``` Modified Glasgow criteria PANCREAS PaO2 16 Enzymes LDH >600 and AST >200 Albumin 10 ```

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