Diagnostics and Therapeutics Flashcards
(385 cards)
1
Q
What is the cause of oral thrush?
A
Fungal infection from candida
- antibiotic use can cause
- incorrect inhaler technique can cause
- cancer patients and other immunocompromised groups
2
Q
Symptoms of oral thrush?
A
Red mouth with white patches
Can cause nappy rash in babies
3
Q
Is oral thrush contagious?
A
It is not contagious from oral to oral transmission but babies can pass it on the the nipple of breastfeeding mothers
4
Q
How to treat oral thrush?
A
First line: Miconazole gel 1.25ml QDS for seven days (2.5ml in two years plus)
Nystatin 100,000 units if miconazole not indicated
5
Q
Why would miconazole gel be contraindicated?
A
Licensed for 4 months plus, or 5/6 months plus in preterm. Choking risk in younger babies, so nystatin may be preferred.
Liver dysfunction
Drug interactions e.g. warfarin
6
Q
How to prevent oral thrush?
A
Good dental hygiene
Inhaler advice if appropriate
7
Q
What if oral thrush hasn’t resolved after seven days of miconazole?
A
If there was some response continue miconazole for a further seven days
If no response offer seven day course of nystatin
If still no response seek specialist advice
8
Q
What is the cause of hand, foot and mouth disease?
A
Coxsackie virus usually the A16 strain
9
Q
Symptoms of hand, foot and mouth disease?
A
Sore throat
Possible fever
Tender lesions in mouth and rash on body
10
Q
How it hand, foot and mouth disease spread?
A
Contact with nasal/throat secretions Contact with fluid from blisters Faeco-oral transmission Can spread from mother to foetus Transmissible immediately before and during acute stage of illness
11
Q
How to treat hand, foot and mouth disease?
A
Usually self limiting
Maintain fluids as dehydration can occur due to pain in mouth
Advise on possible soft diet with no salty, spicy, hot or acidic foods
Advise on analgesics- paracetamol/ibuprofen
12
Q
How to prevent hand, foot and mouth disease?
A
Good hand hygiene
Cover mouth and nose when sneezing
Take care when handling nappies
Do not share cups, utensils, clothes or bedding
Do not pierce blisters as fluid is infectious
13
Q
Other advice for hand, foot and mouth disease?
A
Avoid close contact with pregnant women
Children do NOT need to be excluded from school/nursery
14
Q
What is the cause of threadworms?
A
A parasitic worm called enterobius vermicularis which infests the human gut
15
Q
Symptoms of threadworms?
A
Perianal itching, usually worse at night
Worms may be seen on skin or in faeces
16
Q
How is threadworm spread?
A
Faeco-oral route when eggs are ingested
Once ingested eggs mature to adult worms in one to two months in the small intestine
Adult female worms migrate to the anus to lay thousands of eggs, usually at night
Threadworms survive for six weeks
17
Q
Treatment for threadworms?
A
Mebendazole 100mg stat for all of the household and two weeks or rigorous hygiene measures unless pregnant or under six months of age.
If mebendazole contraindicated then rigorous hygiene measures must be used for six weeks
18
Q
What rigorous hygiene measures are needed during threadworm treatment?
A
Good hand hygiene Cut fingernails regularly Shower each morning Change bed linen and night wear daily for several days after treatment- do not shake these items as may spread eggs around room Wash on a hot cycle Throughly dust and vacuum
19
Q
Do children need to be excluded from school/nursery if they have threadworms?
A
No
20
Q
What causes head lice?
A
Parasitic insects called pediculus humanus capitis infect hairs on the head and feed on blood from the scalp
21
Q
Life cycle of head lice?
A
Eggs are laid close to scalp surface, take 7-10 days to hatch
Baby lice hatch from eggs and take 7-10 days to mature to adult
Female lice lay 50-150 eggs a day
Lice have a 30-40 day life span
22
Q
How is head lice spread?
A
Crawling between hair shafts of hosts
23
Q
Head lice symptoms?
A
Itching on head
White spots in hair (empty eggs)
Sight of lice
24
Q
Head lice treatment?
A
Physical insecticides- silicone or fatty acid ester based products that coat the lice and suffocate them
Chemical insecticides- poisons lice (resistance can occur)
Wet combing- to remove the lice
Treatment depends on needs of the individual patient but dimeticone 4% lotion and wet combing are recommended first line for pregnant/breast feeding, ages 6 months to 2 years and patients with asthma or eczema
25
Other advice for patients with head lice?
No need to be excluded from school/nursery
26
What causes chickenpox?
Virus called varicella-zoster
27
What are the symptoms of chickenpox?
```
Fever
Rash (spots) all over body
Itchy
Crusting of spots within 5 days of the rash, crusts fall off in 1-2 weeks
Nausea
Headache
Tiredness
Loss of appetite
```
28
How is chickenpox spread?
Personal contact or droplet spread, very infectious as 90% of susceptible contacts contract disease
Incubation period of 1-3 weeks
Infectious from 1-2 days before rash appears until spots have crusted over
29
Chickenpox treatment?
```
Paracetamol for pain and pyrexia (licensed for three months plus)
Avoid NSAIDs- can cause skin complications
Calamine lotion to relieve itching
Chlorphenamine for ages 1 year plus
1-2 years: 1mg BD
2-6 years: 1mg 4-6h max 6mg daily
6-12 years: 2mg 4-6h max 12mg daily
12 years plus: 4mg 4-6h max 24 mg daily
```
30
Other advice to patients with chickenpox?
Exclude from school until blisters crust over
Also avoid pregnant women, babies less than 4 weeks old and the immunocompromised
Adequate fluid intake
Dress to avoid overheating or shivering
Smooth, cotton fabrics
Keep nails short
Advise on complications: bacterial superinfection, dehydration
31
What causes slapped cheek?
Parvovirus B19
32
Symptoms of slapped cheek?
```
Low-grade fever
Nasal discharge
Headache
Nausea
Diarrhoea
Rash on cheeks
Rash may also be present on trunk, back and limbs
```
33
How is slapped cheek spread?
Droplet spread through respiratory secretions
Incubation period of 14-21 days
Only infectious for a few days before rash appears
34
Slapped cheek treatment?
Adequate fluids
| Paracetamol or NSAID if needed
35
Do children with slapped cheek need to be excluded from school/nursery?
No
36
What causes measles?
A morbillivirus of the paramyxovirus family
37
Symptoms of measles?
```
Non-vaccinated
Cough and cold symptoms
Conjunctivitis
Fever of 39°C or more
Rash
Koplik’s spots: on buccal mucosa. 2-3mm red spots with blue/white centres
```
38
How is measles spread?
Airborne via respiratory tract- almost all susceptible contacts with contract disease
Incubation period of 10 days
Infectious when symptoms appear (four days BEFORE rash appears) and four days after the onset of the rash
39
Treatment for measles?
Adequate fluids
| Paracetamol/ ibuprofen for symptomatic relief
40
Other advice for patients with measles?
```
Excludes from school/nursery until at least 4 days after rash appears
Avoid contact with susceptible people
Urgent medical advice if:
Shortness of breath
Uncontrolled fever
Convulsions
Altered consciousness
```
41
What causes impetigo?
Staphylococcus aureus or staphylococcus pyogenes. Some is metacillin resistant
42
How is impetigo spread?
Close contact with infected person or contaminated object
Incubation period of 4-10 days
Infectious until lesions are crusted over
43
Symptoms of impetigo?
```
Lesions usually on face around mouth/nose. Usually have yellow crust
Itchy
Systemic symptoms may occur:
Fever
Diarrhoea
Weakness
```
44
How to treat localised impetigo?
1) Hydrogen peroxide cream 1% cream apply two/three times a day for five days
2) if not appropriate use fusidic acid 2% cream three times a day for five days
3) if fusidic acid resistant use mupirocin 2% three times a day for five days
45
How to treat wide-spread impetigo?
1) fusidic acid 2% three times a day for five days
2) if resistant use flucloxacillin QDS for five days (dose depends on age/weight)
3) if allergic or unsuitable use clarithromycin BD for five days
4) if unsuitable use erythromycin QDS for five days
For systemic infections higher doses may be required
46
Other advice for impetigo patients?
Good hygiene
Wash affected areas with soap and water
Avoid scratching
Avoid sharing towel, clothes, utensils etc
Exclude from school/nursery until lesions healed or 48 hours after starting antibiotics
47
What causes ringworm?
Fungal infection usually caused by trichophyton rubrum of interdigitale
48
How is ringworm spread?
Direct contact with infected human
Direct contact with infected animal
Indirect contact through objects
Contact with soil (rare)
49
Symptoms of ringworm?
Itchy, scaly skin
| Red ring shaped patches
50
Ringworm treatment?
In mild prescribe terbinafine or imidazole cream
Consider hydrocortisone 1% cream if inflammation
In severe disease prescribe oral anti fungal such as terbinafine
51
Topical anti fungal treatment for ringworm?
Terbinafine 1% cream (over 12 years): apply once or twice a day for up to 1-2 weeks
Clotrimazole 1% cream: apply two to three times a day and continue for at least 4 weeks
Miconazole 2% cream: apply twice a day continuing for 10 days after lesions have healed
Econazole 1% cream: apply twice a day until skin lesions heal
52
Oral anti fungal treatment for ringworm?
Terbinafine 250mg OD for four weeks
Contraindicated in hepatic impairment and severe renal impairment
Make sure to check LFTs
Itraconazole 100mg OD for 15 days or 200mg OD for 7 days
Contraindicated in ventricular dysfunction or heart failure
53
Other advice for ringworm?
Wear loose fitting clothes to keep moisture away from skin
Maintain good hygiene
Dry thoroughly after washing
Avoid scratching as this will cause spread
Do not share towels
Children do NOT need to be excluded from school/nursery
54
What causes scabies?
Infestation of a parasite called sarcoptes scabiei
55
Symptoms of scabies?
Pruritus particularly at night
| Wavy, thread-like white/grey lines 2-10mm in length which may have a small vesicle with a black dot at the end
56
How is scabies spread?
Close skin contact with an infected person
Symptoms via shared clothes and towels
Symptoms begin 3-6 weeks after primary infestation
Therefore contagious before rash develops
Usually linked to overcrowded living conditions
57
How is scabies treated?
For ages over 2 months:
1st line: permethrin 5% cream
2nd line: malathion aqueous 0.5% if permethrin contraindicated or not tolerated
May also prescribe anti-pruritic cream such as crotamiton 10% cream and a sedating antihistamine such as chlorphenamine or hydroxyzine
58
Other advice for scabies?
Product should usually be applied to the whole body chin downwards however the immunosuppressed, children and the elderly may also have to apply to the face and scalp
Second application required a week after the first
All household members and sexual partners from the last month should be treated
Bedding, clothes and towels should be decontaminated by washing at 60°C and drying in a hot dryer or by sealing in a plastic bag for at least 72 hours
Itching may persist for up to two weeks after successful treatment
Isolate from school or work for until 24 hours after first treatment
59
What is urticaria?
Superficial swelling of the skin that results in red raised, and intensely itchy rash
Angioedema is a deeper form of urticaria with swelling of the deeper layers
60
What causes urticaria?
Release of histamine and other inflammatory mediators from activated mast cells
Acute: less than six weeks, usually self-limiting. Can be spontaneous or in response to a trigger such as a viral infection or allergic reaction
Chronic: has the same causes but lasts longer than six weeks
61
How to treat urticaria?
Identify triggers if appropriate
Non-sedating antihistamine for up to six weeks
If severe offer a short course of steroids
Refer to specialist if appropriate
62
Paediatric warning symptoms? (13)
```
Loss of appetite
More than 24 hours without a wet nappy
Loss of weight
Persistently raised temperature
Breathing problems
Significant earache
Discharge from only one nostril
Temperature and sore throat
Persistent night cough
Blood loss from any orifice
Neck stiffness
Photophobia
Rash which does not blanch on pressure
```
63
What are three types of eczema in early years?
```
Atopic eczema
Seborrhoeic eczema (cradle cap/dandruff)
Nappy rash (contact dermatitis)
```
64
Symptoms of atopic eczema?
Usually starts before first birthday
Children can grow out of it
Skin becomes irritated, itchy, red, cracked and inflamed. It can be weeping, crusting and bleeding in severe cases
65
What cause atopic eczema?
The protect barrier is reduced
Increased moisture loss from the skin
Bacteria/irritants pass through easier
66
What is atopy?
Genetic tendency to develop allergic disease, capacity to produce IgE in response to common environmental proteins
67
What is flexural eczema?
Atopic eczema in sites of creases and skin folds
68
Common trigger factors of atopic eczema?
```
Soap and detergents
Skin infection
House-dust mites and their droppings
Animal dander and saliva
Pollen
Overheating
Rough clothes
```
69
Treatments for atopic eczema?
Mainly emollients and corticosteroids
70
What are emollients?
Topical treatments to help soothe, smooth, protect and hydrate the skin
Indicated for all dry disorders
They make the skin waterproof
Reduce itching/scratching to reduce secondary infection
71
Forms of emollients?
```
Creams
Ointments
Gels
Bath/shower oils
Sprays
```
72
Positives of aqueous cream?
Useful as a leave on emollient
73
Negatives of aqueous cream?
Can cause skin reactions
Causative agent may be the stabiliser and cleansing agent sodium lauryl sulphate (SLS)
Also contains other ingredients that may cause a reaction: chlorocrescol, cetostearyl alcohol and parabens
74
How should emollients be applied?
Liberally
As often as possible but at least three/four times a day
Apply immediately after bath or shower to trap in the maximum amount of moisture
Apply in downwards motion following the direction of the hairs
Do not rub as can lead to irritation from friction
75
Warnings with emollients?
Some are SLS contains so irritating
| Paraffin containing are flammable
76
Advice for bath/shower oils?
Do not have the water too hot as this can exacerbate itching
Use a bath mat to prevent slipping
Following the directions
Pat skin dry after use
77
What is complete emollient therapy?
A way of keeping your skin properly moisturised at all times by using a combination of products liberally and frequently
Do not stop suddenly once things get better as they can quickly get worse again
78
What does a standard complete emollient therapy include?
Emollient-based cleanser or soap substitute
Creams for any time application
Ointment which are usually preferred at night
79
How to know how much emollient should be prescribed?
Use section in BNF
80
How do topical corticosteroids work for eczema?
Suppress production of inflammatory mediators
81
Forms of topical corticosteroids?
```
Creams
Lotions
Gels
Mousses/foams
Ointments
Tapes
```
82
Four potencies of topical corticosteroids?
Mild
Moderate
Potent
Very potent
83
How often to apply topical corticosteroids?
Once or twice a day for one to two weeks to control flare ups
No benefits of applying more often
84
What is a finger tip dosage unit?
Length of cream/ointment from a tube squeezed from the tip of an adult index finger to the crease
Approximately 0.5g
85
How much does one finger tip dosage unit cover?
Two adult palms including the fingers
86
Advice for topical corticosteroid application?
Apply thinly to affected areas only
Apply no more than twice a day
Use least potent formulation that gives full effect
Apply up to 20 minutes after application of emollient
87
What does topical corticosteroid potency mean?
The degree of vasoconstriction they produce in the skin
88
Why should an emollient be applied up to 20 minutes before a topical corticosteroid?
Hydrates the skin and highlights areas of redness to make it easier to see where to apply corticosteroid
Removes scales which can affect corticosteroid absorption
Also plumps you the skin to increase the surface area for absorbing corticosteroid
89
Symptoms of seborrhoeic eczema?
Greasy, yellow or brown scaly patches
Usually on the scalps of young babies but can be face, ears, neck, nappy area, armpits and behind the knees of both children and adults
Usually does not itch or cause discomfort
Not contagious
Affects oily skin
90
Cause of seborrhoeic eczema?
Unclear but not poor hygiene or allergy
May be high levels of sebum on affected areas
Reaction to yeast called malassezia on the skin
91
Advice for seborrhoeic eczema?
Common in first two months of babies life and clears up in weeks to months without treatment
Do not pick the scales as can cause infection
Hair loss may occur but this will grow back
Scales can be soften overnight with baby oil, white petroleum jelly, olive or vegetable oil and shampoo in the morning
Gently brush with a soft brush
If this doesn’t work an emollient can be tried
92
When to refer a patient with cradle cap?
Itchy scalp
Swollen scalp
Bleeding scalp
Spreads to the face or body
93
What is nappy rash?
When the skin around a babies nappy area becomes irritated
| Contact dermatitis caused by urine and faeces
94
Nappy rash causes?
Mainly prolonged exposure to urine or faeces
| Can be a result of infection, trauma or rare skin condition
95
How to prevent nappy rash?
Keep babies skin clean and dry
| Use a barrier cream if needed
96
Trigger factors for nappy rash?
```
Weaning
Common cold
Teething
Antibiotics
First sleeping through the night
Change in diet
Diarrhoea
```
97
Symptoms of a secondary bacterial infection from nappy rash?
Marked redness with exudate
Vesicular and pustular regions
Pus-like drainage or yellowing coloured crusting
98
Treatment of a secondary bacterial infection from nappy rash?
Advise on skin care
Apply barrier cream every change
Refer to a doctor for oral antibiotics
Do not use talcum powder, vitamin A, topical antibiotics or oral antifungals
99
Symptoms of a secondary fungal infection from nappy rash?
Severe bright red patches with fine peripheral scale in nappy region
Especially in skin folds
No exudate
Sometimes co-exists with oral thrush
100
Treatment of a secondary fungal infection from nappy rash?
Advise on skin care
Antifungal cream such as clotrimazole
No barrier creams until infection has settled
101
When to refer a patient with nappy rash?
Spreading to other areas
Getting worse or refractory to treatment
Bacterial infection present or suspected
Fungal infection that co-exists with oral thrush
Systemic symptoms
102
Anaemia definition?
```
A haemoglobin level two standard deviations below the normal for age and sex.
Men: below 130g/l
Women: below 120g/l
Ages 12-14: below 120g/l
Pregnant women: 110g/l
Postpartum: 100g/l
```
103
What serum ferritin level confirms iron deficiency?
Less than 30mcg/l
104
Causes of iron deficiency anaemia?
dietary deficiency (rarely a cause on its own as it can take eight years to develop)
Malabsorption (coeliac, gastrectomy, H. Pylori infection)
Increased loss mainly from GI or uterus (NSAID use, colonic carcinoma, gastric carcinoma, gastric ulceration, menorrhagia)
Increased requirement (pregnancy)
Other causes (blood donation, self-harm, haematuria, nose bleeds, medication)
105
What is the most common type of anaemia?
iron deficiencycy
106
Complications of iron-deficient anaemia?
Cognitive and behavioural impairment in children
Impaired muscular performance
Heart failure
Adverse effects on the immune system
107
Complications of iron deficiency anaemia in pregnant women?
Increased morbidity (both mother and child)
Possible low birth weight
Preterm delivery
Maternal postpartum fatigue
Iron deficiency in infant for first three months of life
108
Symptoms of iron deficiency anaemia?
```
Dyspnoea
Fatigue
Headache
Cognitive dysfunction
Restless leg syndrome
Serious symptoms such as ankle oedema, worsening of pre-existing angina pain can occur if level less that 70g/l
```
109
Signs of iron deficiency (without anaemia?)
```
fatigue
Lack of concentration
Irritability
Pallor
Atrophic glossitis
Dry, rough skin and hair
Alopecia
Ulceration of corners of the mouth
Nail changes (ridges, spoon-like)
```
110
How to treat iron deficiency anaemia?
address any underlying causes
Prescribe ferrous sulfate, fumarate or gluconate (all equipment to 65mg iron) OD
Continue for three months after the iron deficiency is corrected to allow stores to replenish
If not tolerate changed to alternate-day dosing or consider alternative preparation
Consider parenteral iron if oral not tolerated, contraindicated or ineffective
111
Information to give patients taking iron supplements?
adverse effects usually settle down with time
Usually taken on an empty stomach, but if GI disturbances occur, then can try taking with or after food (but lowers absortion) or taking on alternate days
Explain monitoring requirements
Safe storage as overdose can be fatal
112
Side effects of iron supplements?
```
constipation
Diarrhoea
Epigastric pain
Faecal impaction
GI irritation
Nausea
Black stools
```
113
When may ongoing iron supplementation be appropriate?
```
recurring anaemia (elderly) and further investigations not indicated
Iron poor diet (vegan)
Malabsorption (coeliac disease)
Monnorhagia
Patient with gastrectomy
Pregnant women
Patients in hemodialysis
```
114
Oral iron supplements can reduce the absorption of?
Tetracyclines
Quinolones
Bisphosphonates
Zinc
115
What can reduce the absorption of oral iron?
```
Zinc
Magnesium
Calcium
Tannins (in tea, coffee, cocoa)
Phytates (cereal grains, legumes, nuts and seeds)
```
116
Common oral iron supplement interactions?
methyldopa (reduces antihypertensive effect)
Levodopa (bioavailability may be reduced)
Levothyroxine (effects of thyroxine may be reduced)
Penicillamine (absorption can be reduced by up to two thirds)
117
What is MCV?
mean corpuscular volume
| Average size of the red blood cells
118
Typing anemia due to MCV?
microcytic (<80fl)
Normocytic (80-100fl)
Macrocytic (>100fl)
119
Types of microcytic anemia?
iron deficiency
Chronic inflammatory disease
Thalassemia
120
What are reticulocytes?
premature RBCs
121
Types of normocytic anaemia with a high reticulocyte count?
Haemolytic anaemia
| Blood loss
122
Types of normocytic anaemia with a low reticulocyte count?
bone marrow disorder (aplastic anaemia)
123
What are megaloblasts?
large immature RBCs
124
Types of macrocytic anemia with megalobasts?
Vitamin B12 deficiency
Folate deficiency
Drug-induced (methotrexate etc.)
125
Types of macrocytic anemia without megalobasts?
alcohol abuse
Hypothyroidism
Pregnancy
126
Types of anaemia caused by decreased RBC production?
```
Aplastic anemia
CKD due to decreased erythropoietin
Hypothyroidism
Vitamin B12 deficiency
Iron deficiency
Chronic inflammatory disease
```
127
Types of anaemia caused by increased destruction of red blood cells?
Disseminated fragmented coagulopathy (DIG)
Thrombotic thrombocytopenic purpura (TTP)
Hemolytic uremic syndrome (HUS)
Mechanical heart valves
Hypersplenism
Inherited haemolytic anaemia (sickle cell)
Malaria
128
Bloods test results in hemolytic anaemia?
increased lactate dehydrogenase
Increased reticulocyte count
Increased bilirubin
Low haptoglobin levels
129
What are red blood cells broken down to?
```
lactate dehydrogenase
Globin
Free haemoglobin
Unconjugated bilirubin
Iron
```
130
What is MHC?
mean haemoglobin concentration
a measure of the concentration of haemoglobin
27-32pg is the normal range
131
What is a low MHC called?
hypochromic
132
What types of anemia have a low MHC?
Iron deficiency
Chronic disease
Thalassemia
133
What is aplastic anaemia?
when the bone marrow fails to produce RBC, WBC and platelets
134
Blood test results for aplastic anaemia?
low Hb
Low platelets
Low neutrophils
135
Causes of aplastic anaemia?
```
Congenital (very rare)
Idiopathic
Infections
Exposure to toxins
Drugs
Pregnancy
Sickle cell
Genetic factors
```
136
What drugs can cause aplastic anaemia?
chloramphenicol, sulfonamides, gold, penicillamine, indometacin, diclofenac, naproxen, piroxicam, phenytoin, carbamazepine, carbimazole, thiouracil, dosulepin, phenothiazines, chlorpropamide, chloroquine
137
Aplastic anaemia symptoms?
```
pallor
Headache
Palpitations
Dyspnoea
Fatigue
Ankle oedema
Skin/mucosal haemorrhage
Retinal haemorrhage
Petechial rashes
```
138
Aplastic anaemia treatments?
```
remove any underlying causes
Haemopoietic stem cell transplant
immunosuppressive drug therapies include: ATG (anti-thymocyte globulin) combined with cyclosporin
Alemtuzumab
Eltrombopag
```
139
What is AIHA?
autoimmune hemolytic anaemia
140
What is autoimmune haemolytic anaemia?
when the body produces antibodies again RBCs, so they are destroyed by the immune system
141
What causes autoimmune haemolytic anaemia?
```
idiopathic
Infections
Cancer
Autoimmune conditions
Certain drugs
```
142
Symptoms of autoimmune haemolytic anaemia?
```
dyspnoea
Fatigue
Palpitations
Chest pain
Headache
Pallor
Jaundice
Dark urine
Gallstones
Splenomegaly
```
143
What do blood test results show in AIHA?
raised bilirubin
Raised lactate dehydrogenase
A Coombs test is used to detect antibodies that act against the surface of your red blood cells
144
Treatments for AIHA?
treat underlying causes if secondary AIHA (drug-induced, cancer)
Steroids
Rituximab
IVIG
Other immunosuppressive drugs (azathioprine, mycophenolate, ciclosporin, cyclophosphamide)
Splenectomy
145
What is hematocrit?
percentage of a sample of whole blood occupied by intact red blood cells
146
Norma hematocrit ranges?
males 40-52%
| Females 37-47%
147
What is RDW?
RBC distribution width
| (Standard deviation of RBC volume/ mean cell volume) x 100
148
Normal range for RDW?
11-15%
149
What does a high RDW show?
Large variability in sizes of RBCs
150
How does CKD cause anaemia?
Damaged kidneys means a reduced amount of erythropoietin produces
Patients with CKD also use more iron to make the same amount of haemoglobin as others
151
Treatment options for CKD associated anaemia?
Use of erythropoietin stimulating agents such as epoetin or darbepoetin
IV iron supplementation
Both of these can be given during dialysis
152
What is a food allergy?
An abnormal reaction of the immune system to a particular food. It can be IgE mediated or non-IgE mediated
153
What is a food intolerance?
When the body has difficulty digesting certain substances in food or because certain substances directly affect the body somehow. The immune system is not involved
154
Time of onset of food allergy?
IgE mediated is immediate
| Non-IgE mediated is delayed
155
Time of onset of food Intolerance?
usually a few hours after eating the food
156
How much food do you need to experience intolerance symptoms?
Substantial amount
157
How much food do you need to experience allergy symptoms?
Even a tiny amount
Through kissing
Through eating food that has touched the allergen
158
What antibodies cause some food allergies?
IgE
159
Food allergy symptoms due to IgE reactions?
```
Tingling in mouth
Swelling of lips, tongue or throat
Rash and itching
Wheezing and breathlessness
Vomiting and nausea
Diarrhoea
Sneezing and runny nose
Itchy and watery eyes
Swelling of the face
Feeling lightheaded
```
160
Food allergy symptoms due to non-IgE reactions?
```
atopic eczema
Vomiting
Diarrhoea
Constipation
Blood/mucus in stools
Redness around anus
Fatigue
Pallor
Poor growth
```
161
Symptoms of food intolerance?
```
bloating and abdominal pain
Diarrhoea
Skin rashes and itching
Runny nose
Fatigue
Headaches
```
162
Top 14 foods that cause the most allergies?
```
Celery
Cereals containing gluten
Crustaceans
Egg
Fish
Lupin
Milk
Molluscs
Mustard
Peanuts
Sesame
Soya
Sulphites
Tree nuts
```
163
How to diagnose a food intolerance?
Keep a food diary
| Trial elimination diet
164
How to treat food intolerances?
Stop eating the food for a while
| A gradual introduction of small amounts of the food
165
What percentage of children in the UK have a peanut allergy?
2%
166
The two types of food allergy?
IgE mediated
| Non-IgE mediated
167
How to test for IgE mediated food allergy?
Skin prick test/blood test for specific IgE against the particular allergen
168
How to treat a cows milk allergy?
Avoid milk in ALL products
Prescribe a milk substitute
Gradual reintroduction through a specialist
169
Types of milk substitutes for lactose intolerance?
Lactose-free formula such as SMA LF or aptamil lactose free
170
Main types of medication used for food allergies?
antihistamines
| Adrenaline for anaphylaxis
171
Emerade and jext dosing for a child less than 15kg?
150mcg followed by 150mcg after 5-15 minutes as required
172
Emerade and jext dosing for a child between 15kg and 30kg?
150mcg followed by 150mcg after 5-15 minutes as required
| Although some children may require 300mcg
173
Emerade and jext dosing for a child and adults above 30kg?
300mcg followed by 300mcg after 5-15 minutes as required
174
Emerade dosing for ages 12 plus?
500mcg followed by 500mcg after 5-15 minutes as required
175
EpiPen dosing for a child below 15kg?
150mcg followed by 150mcg as required
176
EpiPen dosing for a child between 15 and 25kg?
150mcg followed by 150mcg as required
| Some children may require 300mcg
177
EpiPen dosing for a child above 26kg?
300mcg followed by 300mcg after 5-15 minutes as required
178
EpiPen dosing for an adult?
300mcg followed by 300mcg after 5-15 minutes as required
179
Advice to give patients prescribed an adrenaline auto-injector?
Two devices should be carried at all times
An ambulance should be called after every administration
The individual should lie down with their legs raised (unless they have breathing difficulties and should sit up) and not be left alone
180
Should pregant or breastfeeding women avoid peanuts?
no, there is no evidence this will cause the child to develop an allergy
181
What is lactose intolerance?
a lack of the enzyme lactase to break down lactose in food
182
Milk substitutes for both IgE mediated and non-IgE mediated cows milk allergy?
First line: hydrolysate formulas such as alimentum, aptamil pepti
Second line: amino acid-based formulas such as neocate, SMA alfamino
In IgE mediated allergy, if a child has severe symptoms such as anaphylaxis, oral angioedema or severe skin rashes, then amino-acid based formulas should be used first-line
183
What is a normal Hb level during the first trimester of pregnancy?
>110g/L
184
What is a normal Hb level during the second and third trimesters of pregnancy?
>105g/L
185
What is a normal Hb level postpartum?
>100g/L
186
What is a normal Hb level for men aged over 15?
>130g/L
187
What is a normal Hb level for women aged over 15?
>120g/L
188
What is a normal Hb level for children aged 12-14?
>120g/L
189
Why is anaemia more common in pregnancy?
Increased use of iron
| An increase in plasma volume that is disproportionate to the red cell mass
190
When should pregnant women be screened for anaemia?
At their first booking visit and at 28 weeks
191
Risk factors for developing anaemia in pregnancy?
```
Low iron stores pre-pregnancy
Preexisting blood conditions
Inflammatory disorders of the gut
Multiple births
Aged > 20
Previous birth less than 12 months ago
```
192
Why is iron important in pregnancy?
Maintain a healthy immune system
Decrease the impact of blood loss during delivery
Improve postnatal recovery
Avoid a decreased breast milk supply
193
How to prevent anaemia in pregnancy?
Provide dietary advice to maximise oral iron intake
194
Why are modified release iron preparations not recommended?
The iron is absorbed slowly through the GI tract and carried to the duodenum where absorption may be poor
195
Why is iron recommended to be given in divided doses?
The absorption is reduced as the dose increases
196
When may parenteral iron be used?
When oral therapy is unsuccessful
| After 36 weeks of pregnancy
197
What are the four main types of drug dyscrasias?
Haemolytic anaemia
Thrombocytopenia
Agranulocytosis/neutropenia
Aplastic anaemia
198
Main two mechanisms for drug-induced haemolytic anaemia?
Immune-mediated
| Oxidant injury
199
Cause of drug-dependent immune-mediated haemolytic anaemia?
The drug binds to the RBC cell surface and becomes part of the antigen which the antibodies bind to
200
Types of drug-dependent immune-mediated haemolytic anaemia?
Penicillin type
Immune complex type
Passive absorption
201
What is penicillin type drug-dependent immune-mediated haemolytic anaemia?
The drug remains present on the RBC surface and is needed for antibody binding
202
What is immune complex type drug-dependent immune-mediated haemolytic anaemia?
the drug causes formation of immune complexes that bind to the RBCs and cause complement activation
203
What is passive absorption type drug-dependent immune-mediated haemolytic anaemia?
IVIGs frequently contain alloantibodies that react with the recipient's RBC antigens producing haemolysis
204
Drugs that can cause immune-mediated haemolytic anaemia?
```
Cefalosporins
Penicillins
Anti cancer drugs
NSAIDs
Many others
```
205
How can oxidative injury cause haemolysis?
Oxidant injury can cause hemolysis via oxygen radical damage to RBC membrane components and cellular proteins
This damaged blood cells are the destroyed
206
Risk factors for developing oxidative injury related haemolytic anaemia?
G6PD deficiency
| Haemoglobin H disease
207
What is G6PD deficiency?
A lack of glucose-6-phosphate dehydrogenase
208
How can G6PD deficiency increase the risk of drug induced haemolytic anaemia?
Red blood cells are normally protected from oxidant injury by several enzymatic systems including glutathione and NADPH
generation of NADPH requires G6PD
Individuals with G6PD deficiency have increased susceptibility to oxidant drugs
209
Common drugs that can cause oxidative damage haemolysis?
Nitrofurantoin
Flouroquinolones
Dapsone
210
How to test for immune-mediated hemolytic anaemia?
Coombs test to test for antibody coating RBCs and circulating antibodies directed against RBCs
211
What is drug-induced neutropenia?
Neutrophil count of less than 1500/microlitre
212
Risk factors for drug-induced neutropenia?
women
| Impaired drug excretion
213
Drugs associated with neutropenia?
```
NSAIDs
Antithyroid drugs
Macrolides
Penicillins
Cefalosporins
Vancomycin
Clozapine
Valproate
Carbamazepine
Phenytoin
ACE inhibitors
Propranolol
Digoxin
Diuretics
Dapsone
Isotretinoin
```
214
Symptoms of drug-induced neutropenia?
sore throat
Malaise
Fever
Weakness
215
What are the four mechanisms for immune-mediated drug-induced neutropenia?
Hapten-type reaction
Innocent bystander phenomenon
Protein carrier mechanism
Auto antibody production
216
What is the hapten-type reaction associated with immune-mediated drug-induced neutropenia?
drug adsorped to neutrophil membrane
Drug-membrane complex acts as a hapten and stimulates antibody formation
Antibody attached to drug-membrane complex
Complement activation destroys WBC
Usually causes by penicillin
217
What is the innocent bystander phenomenon associated with immune-mediated drug-induced neutropenia?
The drug combines with a drug-specific antibody which absorbs to neutrophil membrane
Complement activated to destroy the cell
Such as quinidine
218
What is the protein carrier mechanism reaction associated with immune-mediated drug-induced neutropenia?
Protein carrier combines with drug and then attaches to neutrophil
Antibodies form which attach to complex and activate complement to kill cell
219
What is the autoantibody reaction associated with immune-mediated drug-induced neutropenia?
drug alter neutrophil membrane
| Formation of antibodies that attach to neutrophil and destroy cell
220
Types of drug induced neutropenia?
immune mediated
Toxic mechanism
Combination of both
221
Treatment of drug-induced neutropenia?
remove offending agent
Antimicrobial if infection present
GM-CSF and G-CSF
222
Types of drug-induced thrombocytopenia?
Drug-induced immune thrombocytopenia
Non-immune drug induced thrombocytopenia
Heparin induced thrombocytopenia
223
What is immune drug induced thrombocytopenia?
caused by drug-dependent antibody-mediated platelet destruction
224
Drugs that can cause immune drug induced thrombocytopenia?
```
Beta-lactams
Carbamazepine
Quinine
Rifampicin
Phenytoin
Co-trimoxazole
Vancomycin
Tirofiban
```
225
What is non-immune drug-induced thrombocytopenia?
Many drugs used as chemotherapy cause thrombocytopenia by bone marrow suppression. Other drugs can also cause moderate thrombocytopenia in some patients by suppression of platelet production.
226
Drugs that can cause non-immune drug-induced thrombocytopenia?
Daptomycin
Linezolid
Valproic acid
Valaciclovir
227
What is heparin induced thrombocytopenia?
unique drug reaction in which antibodies against complexes of platelet factor 4 and heparin cause both thrombocytopenia and platelet activation, resulting in venous and/or arterial thrombosis.
228
Management of drug-induced thrombocytopenia?
remove offending agent
Symptomatic treatment
Corticosteroids in severe cases
Possibly platelet transfusion
229
What is DITMA?
drug-induced thrombotic microangiopathy
230
What causes drug-induced thrombotic microangiopathy?
resulting from exposure to a drug that induces formation of drug-dependent antibodies or causes direct tissue toxicity that results in the formation of platelet-rich thrombi in small arterioles or capillaries.
231
Drugs that can cause DITMA?
```
Quinine
Anticancer drugs
Co-trimoxazole
Immunosuppressants
Valproic acid
Quetiapine
Clopidogrel
Ticlopidine
```
232
How to manage DITMA?
remove offending agent
| Some evidence for acetylcysteine
233
How to tell between DITMA AND TTP?
ADAMTS13 enzyme activity is normal in DITMA but reduced in TTP
234
What is drug-induced a plastic anemia?
the drug acts on the pluripotent stem cells causing pancytopenia
235
What drugs can cause aplastic anaemia?
chloramphenicol
| anticancer drugs
236
How to treat drug-induced aplastic anaemia?
```
remove offending drug
Treat infections
Blood/platelet transfusions
Bone marrow transplant (if severe)
Immunosuppression ATG, corticosteroids, cyclosporin
```
237
Why is otitis media more common in children?
The eustachian tube is shorter in children, which allows easy entry of bacteria and viruses
Facilitates direct extension of infections from the nasopharynx
238
Risk factors for otitis media?
```
Passive smoking
Air pollution
Breastfeeding for less than four months as the immunity will not be passed on
Infected or enlarged adenoids
Recent cold, flu, sinus or ear infection
Drinking whilst laying down in infants
Dummy use
```
239
Aetiology of otitis media?
```
Male
Caucasian
Poverty
Familial clustering demonstrated
Depressed immune system
Anatomic abnormalities
Vitamin deficiencies
Obesity
Other infections
```
240
Presentation of otitis media?
```
Earache
Pulling and rubbing the ear
Cough and runny nose
Eardrum red/yellow or cloudy on examination
The eardrum may be bulging
```
241
What is the tympanic membrane?
Eardrum
242
What bacteria can cause otitis media?
Streptococcal pneumoniae
Haemophilus influenza
Moxarella catarrhalis
243
Most common antibiotic for otitis media?
Amoxicillin
244
Why are macrolides only used for penicillin-allergic patients with otitis media?
Less effective against Haemophilus influenza
245
What is the dose of amoxicillin for otitis media in children?
1-11 months: 125mg TDS
1-4 years: 250mg TDS
5-17 years: 500mg TDS
For 5-7 days
246
Amoxicillin mechanism of action?
Inhibition of cell wall biosynthesis but is susceptible to degradation by B-lacatamases
Broad spectrum against gram positive and negative
247
What is the VD of amoxicillin?
0.2-0.4l/kg
248
What time does peak concentration of amoxicillin occur?
~2 hours
249
What is the half life of amoxicillin?
~1 hour
250
When should be amoxicillin be taken?
Spread out evenly through the day
| Food has no importance
251
How is amoxicillin excreted?
Renal
252
What are the common side effects of amoxicillin?
Skin rash, diarrhoea and nausea
253
Types of impetigo?
Bullous and non-bullous
254
What is the most common type of impetigo?
Non-bullous
255
Symptoms of bullous impetigo?
Fluid-filled blisters without redness on the surrounding skin
Face less commonly affected, usually in skin folds
256
Symptoms of non-bullous impetigo?
Crusts form
| Usually on the face but can spread to any area of the body
257
Who is most likely to have impetigo?
Children
| Adults with other skin conditions
258
Risk factors for impetigo?
```
Crowded conditions
Warm weather
Contact sport
Broken skin
Immunosuppression
```
259
Does impetigo leave scarring?
Not usually unless scratched
260
Complications of impetigo?
Ecthyma can develop, this is when the infection goes deeper into the skin
261
Symptoms of ecthyma?
Painful blisters
Blisters turn into deep open sores
Thick crusts develop often with redness on the surrounding skin
May leave scars
262
Differential diagnosis of impetigo?
```
Herpes
Scabies
Oral thrush
Eczema
Insect bites
Drug reactions
```
263
What bacteria causes impetigo?
Staphylococcus aureus
| Staphylococcus pyogenes
264
Oral antibiotics for impetigo?
Flucloxacillin
| Macrolide if penicillin allergy
265
Topical antibiotic for impetigo?
Fusidic acid
266
Features of fusidic acid?
```
Bacteriostatic
Protein synthesis inhibitor
Narrow spectrum
Gram-positive
Mainly active against staphylococcus aureus but also effective against streptococci, corynebacteria, Neisseria
```
267
How is fusidic acid excreted?
Mainly in bile
| Although minimal systemic absorption from topical treatment
268
Fusidic acid dose for impetigo?
Apply three-four times a day for seven days
269
Why should fusidic acid and not be used for longer than 10 days?
Development of resistance
270
Flucloxacillin mechanism of action?
```
Inhibits cell wall synthesis
Narrow spectrum
Not inactivated by B-lactamases
Staphylococcus aureus
Streptococcus
```
271
How is flucloxacillin excreted?
Renal
272
Possible side effect for up to two months after stopping flucloxacillin?
Cholestatic jaundice
Hepatitis
Risk factors: administration for more than two weeks, increasing age
273
BNF warning labels for flucloxacillin?
Label 9: space doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop.
Label 23: take this medication when your stomach is empty. This means an hour before food or two hours after food.
274
What is the conjunctiva?
A thin covering that covers the white part of the eye and the underside of the eyelids
275
What can cause conjunctivitis?
```
Allergens
Viruses
Bacteria
Contact lens use
Chemicals
Fungi
```
276
Most likely cause of hyper-acute conjunctivitis?
Chlamydia
| Gonorrhoea
277
What is acute conjunctivitis?
Less than three weeks
278
What is chronic conjunctivitis?
More than three weeks
279
Viruses that can cause conjunctivitis?
Adenovirus
Rubella
Rubeola
Herpes
280
How is viral conjunctivitis mainly spread?
```
Hand-to-eye contact by hands or objects
Infectious tears
Eye discharge
Faecal matter
Respiratory discharges/droplets
```
281
How to treat viral conjunctivitis?
Usually clears itself in 7-14 days
| Antivirals may be prescribed for more serious infections such as herpes simplex or varicella zoster
282
What bacteria can cause conjunctivitis?
Staphylococcus aureus
Haemophilus influenzae
Streptococcus pneumoniae
283
Symptoms of hyperacute conjunctivitis?
More severe and develops more rapidly
Often eyelid swelling, pain and decreased vision
Large amount of thick purulent discharge that returns even after wiping away
Vision loss if not treated promptly
Usually unilateral
284
What is ophthalmia neonatorum?
Conjunctivitis caused by chlamydia in neonates
Mother passes on
Symptoms develop 5-12 days after birth
May also have chlamydia elsewhere on the body
285
Ways to treat bacterial conjunctivitis?
```
Good hygiene
Don't wear contact lenses
Lubricant drops
Clean with warm water
Can use antibiotic drop
Systemic antibiotics but only if very severe
```
286
Chloramphenicol features?
Bacteriostatic
Broad-spectrum
Gram-positive and negative
Inhibits protein synthesis
287
Chloramphenicol eye drop dosing for conjunctivitis?
One drop every two hours then reduce the frequency as infection is controlled and continue for 48 hours after healing
For most infections three to four times a day is sufficient
288
Chloramphenicol eye ointment dosing for conjunctivitis?
Apply three to four times a day OR once at night if using alongside eye drops
289
Usual treatment length for bacterial conjunctivitis?
Five days
290
What is cancer?
It occurs when abnormal cells begin to grow uncontrollably. These cells may spread into other tissues
291
What is the primary tumour?
The site where are growing in an uncontrolled manner
292
What are the two types of tumours?
Benign
| Malignant
293
What are the five main categories of cancer?
```
Carcinoma cancer
Sarcoma
Leukaemia
Lymphoma
CNS cancer
```
294
What are carcinoma cancers?
Begin in skin cells
295
What are sarcomas?
Begin in connective tissue
296
What is leukaemia?
Cancer of the blood
297
What is lymphoma?
Begins in the immune system
298
What is CNS cancer?
Begins in the CNS
299
Features of cancer cells?
Reproduce even if not needed
Spread causing metastases
Do not specialise as they are immature cells
Do not repair themselves or die when damaged
Abnormal appearance
300
What is a proto-oncogene?
Genes that regulate the cell cycle
| Operate by stimulating cell growth and division
301
What is an oncogene?
Mutation in proto-oncogenes
| Cause upregulation of the cell cycle, thereby causing cancer
302
What is a tumour suppressor gene?
Restrict cell growth and division and induce apoptosis
| Inhibit cell cycle progression; they are involved in the maintenance of cell cycle checkpoints and initiate apoptosis
303
How to pass the G2 checkpoint?
Chromosomes successfully replicated
DNA is undamaged
Activated MPF is present
304
How to pass the G1 checkpoint?
```
Cell size is adequate
Nutrients are sufficient
Social signals are present
DNA is undamaged
Mature cells do not pass this checkpoint as they enter the G2 state
```
305
How to pass the metaphase checkpoint?
All chromosomes are attached to spindle apparatus
306
What determines the maximum growth rate of a tumour?
The cell cycle
307
How is cancer classified?
Type of tissue
Abnormality of cells
Extent if disease
308
Cancer treatment options?
```
Surgery
Radiotherapy
Chemotherapy
Hormone therapy
Biological therapy
```
309
How does radiotherapy work?
By damaging DNA in cells in a targeted area
310
How does chemotherapy work?
By killing dividing cells
311
What parts of the body are commonly affected by cytotoxic drugs?
Hair follicles
Gut
Bone marrow
312
Why are multidrug regiments usually used for chemotherapy?
Each drug has a different mode of action
Allows for lower doses
Reduces drug resistance
313
Pharmacokinetic resistance to chemotherapy?
Distribution of drug (e.g. Angiogenesis in the tumour)
Efflux pump
Inactivation or metabolism
314
Pharmacodynamic resistance to chemotherapy?
```
Mutation to P53 gene
Sensitivity to apoptosis
Changes to binding site
Improve DNA repair after cytotoxic exposure
Adverse extracellular environment
```
315
What is neoadjuvant chemotherapy?
Given before surgery
316
What is adjuvant chemotherapy?
Given after surgery
317
What is palliative chemotherapy?
Symptom control
318
Risk factors for childhood cancers?
```
Inherited diseases such as Down syndrome
Foetal development
Infections
Radiation exposure
Previous cancers
```
319
Childhood cancers?
```
Acute leukaemia
Lymphomas
CNS tumours
Neuroblastoma
Retinoblastoma
Renal tumours
Soft tissue tumours
Bone tumours
```
320
Sings and symptoms of acute lymphoblastic leukaemia?
```
Flu like symptoms
Pale skin
Tiredness
Breathlessness
Unusual bleeding
Raised temperature
Night sweats
Bone and joint pain
Swollen lymph nodes
Abdominal pain due to swollen liver or spleen
Unexplained weight loss and appetite
Unexplained seizures
Vision changes
Behaviour changes
```
321
How to diagnose acute lymphoblastic leukaemia?
FBC
Bone marrow biopsy
Lumbar puncture with CSF analysis
Peripheral blood smears
322
Treatment for acute lymphoblastic leukaemia?
Chemotherapy
Blood transfusions
Platelet transfusion
Antibiotics
323
Phases of acute lymphoblastic leukaemia treatment?
```
Remission induction (4 weeks): get rid of all cancer cells
Consolidation: stop cancer cells from returning
Maintenance: helps keep in remission
```
324
Systemic anti cancer drugs for acute lymphoblastic leukaemia?
```
Cyclophosphamide
Cytarabine
Daunorubicin
Dexamethasone
Vincristine
Intrathecal methotrexate
Oral methotrexate
Mercaptopurine
Pegaspergase
```
325
How to diagnose acute myeloid leukaemia?
Blood test
Lumbar puncture
Bone marrow biopsy
Chest X-ray
326
Treatment for acute myeloid leukaemia?
Mainly chemotherapy
Radiotherapy
Stem cell transplant
327
Phases of acute myeloid leukaemia treatment?
Remission: get rid of all cancer cells to put patient in remission
Consolidation: stop cancer from returning
328
Drugs used for acute myeloid leukaemia?
Cytarabine
Daunorubicin
Etoposide
Fludarabine
329
Side effects of cytarabine?
```
Tiredness
Soreness at injection site
Risk of infection
Bruising
Anaemia
```
330
Side effects of daunorubicin?
```
Allergic reaction
Rash
Itching
Lip swelling
Face swelling
Extravasation
```
331
Where do most CNS tumours begin?
Glial cells (called gliomas)
332
Examples of gliomas?
Astrocytoma
Ependymomas
Oligodendrogliomas
333
Signs and symptoms of CNS tumours?
```
Vomiting
Poor coordination
Abnormal eye movements
Behaviour change
Lethargy
Seizures
Abnormal head position
Increasing head circumference
Reduced consciousness
Excessive drinking
Abnormal growth
Persistent headache
Blurred vision
Delayed puberty
```
334
How to diagnose CNS tumours?
```
CT scan
MRI scan
Lumbar puncture
Biopsy
Blood tests
```
335
Aims of surgery for CNS tumours?
Biopsy
Relieve intracranial pressure
Remove tumour
336
Side effects of surgery for CNS tumours?
Brain damage
337
Side effects of radiotherapy?
Hair loss
Tiredness
Nausea
Poor appetite
338
Cytotoxic drugs used to treat CNS tumours?
```
Cyclophosphamide
Vincristine
Cisplatin
Etoposide
Carboplatin
High dose methotrexate
```
339
How common is a sore throat?
Very
| 6% of GP consultations but many do not actually have a consultation
340
Causes of a sore throat?
Viral
Bacterial
Non-infectious causes
341
Viral causes of a sore throat?
Rhinovirus, coronavirus, parainfluenza (25%)
Influenza (4%)
Herpes simplex (2%)
342
Bacterial causes of sore throat?
```
Streptococcal pyogenes (GABHS Group A Beta-haemolytic Streptococcus)
(15-30% in children, 10% in adults)
```
343
Another name for glandular fever?
infectious mononucleosis
344
What usually causes infectious mononucleosis?
Epstein-Barr virus
345
How is glandular fever spread?
Saliva contact, sexual contact, blood
346
Age range glandular fever is most common in?
15-24 year olds
347
Symptoms of glandular fever?
```
Fever
Lymphadenopathy
Sore throat
Possible whitewash exude on tonsils
Possible pharyngeal inflammation
Possible palatal petechiae
Fatigue
Splenomegaly
Hepatomegaly
Moderate bradycardia
```
348
How to diagnose glandular fever?
FBCs
Monospot test (heterophile antibodies)
Likely if monospot test is positive or FBC shows more than 20% reactive lymphocytes or lymphocyte count is more than 50% of total white cell count
349
How to treat glandular fever?
Admit to hospital if: stridor, swallowing difficulty or dehydration, serious complications
Analgesia: paracetamol or ibuprofen
Corticosteroids may be prescribed for persistent inflammation
350
Exclude from school with glandular fever?
No
351
Why should amoxicillin not be used in secondary infection in patients with glandular fever?
A non-specific rash usually occurs
352
Non-infectious causes of sore throat?
Irritation
Hayfever
ADR: Stevens-Johnson syndrome, oral mucositis after chemotherapy, blood dyscrasia from drugs such as carbimazole or clozapine
353
Sore throat complications?
Sinusitis
Otitis media
Quinsy
354
What is quinsy?
Peri-tonsillar abscess
| Collection of pus beside the tonsil in the peritonsillar space
355
Quinsy symptoms?
```
Severe pain
Fever
Dysphagia
Drooling
Hot potato voice
```
356
How to diagnose tonsillitis?
3 or 4 on Centor criteria (40-60% chance)
357
What are the Centor criteria?
Presence of tonsillar exude
Lymphadenopathy
Fever
Absence of cough
358
When to refer a sore throat?
```
Epiglottitis (999 ambulance transfer)
Hospital admission:
Breather difficulty
Clinical dehydration
Quinsy
Sepsis
Possible hospital admission:
DMARD
Carbimazole
Immunocompromised
```
359
How to treat viral sore throat?
```
Self-limiting 3-7 days
Analgesia
Fluid intake
Medicated lozenges
Difflam
Poor evidence for anything else
```
360
Antibiotic prescribing for tonsillitis?
Phenoxymethylpenicillin QDS for 5-10 days
1-11 months: 62.5mg
1-5 years: 125mg
6-11 years: 250mg
12 years +: 500mg
Clarithromycin BD for 5 days, dose depends on body weight mainly
Mainly delayed Rx unless other risk factors
361
Effectiveness of prescribing antibiotics in tonsilitis?
Reduction of 1 days illness, slightly more if higher centor score
362
Another name for ringworm?
Tinea
363
What causes ringworm?
Dermatophytes
364
How is ringworm transmitted?
Direct contact with infected person, direct contact with infected animal, indirect contact with fomites, contact with soil (rare)
365
Risk factors for ringworm?
```
Hot, humid climate
Tight-fitting clothing
Obesity
Hyperhidrosis
Immunocompromised
Very young or very old
African-Caribbean (scalp)
Type 1 diabetic
Past fungal infections
Atherosclerosis
Poor circulation, particularly venous insufficiency
```
366
Symptoms of ringworm on the body?
Single or multiple, red or pink, flat or slightly raised ring-shaped patches of varying size
Red, scaly edge with a clear central area
367
Symptoms of ringworm on the groin?
Skin lesions that are usually red to red-brown, flat or slightly raised plaques with active borders
Uniform scale without a clear centre
Typical scaly edge may be lost in moist flexures
368
Self-care management for fungal infections?
Wear loose-fitting clothing made of cotton
Wash affected areas daily
Dry thoroughly after washing
Avoid scratching as it can spread
Do not share towels
Wash towels, clothes and bed linen frequently
369
Exclude from school for ringworm?
No
370
Treatment for ringworm?
Topical antifungal, can use topical corticosteroids for inflammation but NOT alone
Oral antifungal
371
Application of topical antifungals for ringworm?
Terbinafine 1%: Thinly to the affected area once or twice a day for up to 1-2 weeks
Clotrimazole 1%: apply to affected area two-three times a day for at least 4 weeks. Half a centimetre strip is enough to treat size of a hand
Miconazole 2%: apply to affected area BD and continue 10 days after lesions heal
Econazole 1%: apply to affected area BD until lesions heal
372
Licensed age range for topical antifungals?
Terbinafine 1% 12 years plus
| All others for adults and children
373
Topical miconazole and econazole drug interactions?
Oral anticoagulants
| Monitor during concurrent use
374
Oral antifungal dosing for ringworm?
Terbinafine 250mg OD for 4 weeks for body infections, 2-4 weeks for groin infections
Itraconazole 100mg OD for 15 days, alternatively 200mg OD for 7 days
Griseofulvin 500mg OD increase to 1g if necessary. Continue for at least two weeks after lesions heal
375
Oral terbinafine contraindications?
Hepatic impairment
| Severe renal impairment
376
Monitoring for oral terbinafine?
LFTs 4-6 weekly
| Stop if deranged
377
Mechanism of action of clotrimazole?
Fungistatic: inhibition of sterol synthesis for the cell membrane.
Fungicidal: at higher concentrations, calcium and potassium channels are inhibited
378
Why can't clotrimazole be given orally?
High first pass metabolism
379
Clotrimazole side effect?
irritation or burning
380
Name of ringworm of the scalp?
Tinea capitis
381
Name of ringworm of the body?
Tinea corporis
382
Name of ringworm of the groin?
Tinea cruris
383
Name of ringworm of the nail?
Tinea unguium/ onychomycosis
384
Treatment for tinea capitis?
Oral antifungal: terbinafine or itraconazole
| Topical antifungal: ketoconazole
385
Treatment for onychomycosis?
Topical amorolfine 1%: apply once or twice a week (6 months for finger, 9-12 months for toe)
Oral terbinafine: 250mg OD 6/52 to 3/12 for fingers, 3-6/12 for toes
Oral itraconazole: 200mg OD 3/12 or more 200mg BD 7/7 and retreat after 21 days. Two courses for fingers, three courses for toes
