gen med Flashcards
what happens in ckd bone disease
raised phosphate low vitamin d low calcium high pth bone is broken down to release calcium needs treatment with phosphate binders, vitamin d and possibly a parathyroidectomy
what might blood results show in multiple myeloma?
- raised calcium
- renal failure
- high total protein
which beta blockers reduce mortality in stable heart failure?
bisoprolol
carvedilol
treatment of heart failure
1st line: ACEi and a Beta Blocker
2nd line: add aldosterone antagonist or ARB or Hydralazine with a nitrate
how can you treat metastatic bone pain
- opioids
- bisphosphonates
- radiotherapy
why should you not use verapamil in systolic heart failure?
as a rate limiting calcium channel blocker,
it reduces the hearts contractility and thus may increase symptoms such as pulmonary oedema or peripheral oedema
features of UC
- pseudopolyps on endoscopy
- bloody diarrhoea
- continuous disease : rectum to ileo-caecal valve
- primary sclerosing cholangitis
- inflammation does not extend beyond the submucosal layer
- can get tenesmus
features of crohns disease
-skip lesions , cobblestone appearance on endoscopy, increased goblet cells, granulomas
-full thickness of the wall
mouth to anus
-usually non bloody diarrhoea
treatment of crohns. ( acute and then remission)
Acute: Budesonide or 5ASA (Mesalazine) therapy
Remsission: azathioprine, mercaptopurine, or methotrexate
treatment of UC (acute and then remission)
acute: IV hydrocortisone and biologic eg infliximab or ciclosporin
IV fluids
could also give a topical 5 ASA
Remission: 5ASA therapy (mesalazine) or tnf inhibitors
drugs to avoid in renal failure
metformin
lithium
antibiotics- especially tetracycline and nitrofurantoin
nsaids
management of migraine acute
NSAID and triptan or
Paracetamol and triptan
migraine prophylaxis
propranolol or topiramate
headache red flags
- immunocompromised
- head trauma within last few months
- history of malignancy
- sudden onset severe headache
- headache which changes with posture
- headache associated with vomiting with no explanation
- heaahce with focal neurology
signs of raised intracranial pressure
- papilloedema
- hypertension
- bradycardia
symptoms of raised intracranial pressure
headache- worse with bending forward
blurring of vision
vomiting
altered consciousness level
what is the most common type of thyroid cancer?
papillary thyroid carcinoma
how should you investigate a neck lump?
USS and then FNA of the lump
what are the three most common causes of hyperthyroidism in the UK?
- graves
- toxic multi nodular goitre
- solitary toxic adenoma
treatment options for hyperthyroidism
- carbimazole
- ptu
- radioactive iodine
- thyroidectomy
treatment regimes for hyperthyroidism with carbimazole or ptu
- block and replace t4
- or just a constant dose
multiple endocrine neoplasia type 1
3 Ps: parathyroid pancreas tumours phaechromocytoma presents with hypercalcaemia
men type 2a
medullary thyroid carcinoma
2Ps and 1 T
phaeochromocytoma
parathyroid
men type 2b
medullary thyroid carcinoma and phaeochromocytoma
