MLA paper 2 Flashcards
What does the audiogram show:
- Is there anything below 20dB
yes = move to step 2
no = normal hearing
- If there a gap
yes = conductive or mixed
no = sensorineural hearing loss
- One below or both below 20db line
one = conductive
both = mixed
Left mixed hearing loss.
- air bone gap in left ear = conductive component
- decrease in bone conduction thresholds suggests a sensorineural component too
Methotrexate prescribing:
- weekly rather than daily
- Monitor: FBC, U&Es and LFTs (weekly until therapy stabilised then 2-3 months thereafter)
- Folic acid 5mg weekly co-prescribed
- starting dose = 7.5mg weekly
Methotrexate: interactions
Avoid trimethoprim or co-trimoxazole –> increase risk of marrow aplasia
High dose aspirin increases risk of methotrexate toxicity
Tx of methotrexate toxicity = FOLINIC ACID
the classical presentation of this condition involves:
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
Acute intermitten porphyria
- rare
- autosomal dominant
- defect in enzyme involved in biosythesis of haem
- toxic accumulation of delat aminolaevulinic acid and porphobilinogen
Management:
- avoid triggers
- IV haematin/haem arginate
- IV GLUCOSE if the above not immediately available
Polycythaemia vera: management
- Myeloproliferative disorder (clonal proliferation of marrow stem cell –> increase in red cell volume)
Key features
- hyperviscosity
- pruritus
- splenomegaly
Management
1. Aspirin: reduce VTE risk
2. Venesection
3. Chemotherapy
a) hydroxyurea
b) phosphorus 32 therapy
Prognosis
1. Thrombotic event
–> 5-15% of patients progress to myelofibrosis
–> 5-15% of patients progress to acute myeloid leukaemia
JAK 2 mutatio
Lower back pain: prolapsd disc management
- physio
- NSAIDS + PPI
If symptoms persist after 4-6 weeks then referral for consideration of MRI is appropriate
Site of compression and features
Bite and blister cells are typical of the blood film in
G6PD deficiency
Associations of G6PD deficiency:
Have a Bite of Heinz Fava beans.
=>
Bite cells. Heinz bodies. Fava beans.
Absent or weak femoral pulses are suggestive of a major defect such as
coarctation of the aorta
Cancer patients with VTE mx
6 months of a DOAC
is a risk factor for endometrial hyperplasia
tamoxifen
Management of endometrial hyperplasia: high dose progestogens w/ repeat samply in 3-4 months.
IUS
Atypia: hysterectomy advised
this is the most effective antipsychotic for dealing with negative symptoms of schizophrenia
CLOZAPINE
drug used for prophylaxis of sickle cell crises
hydroxycarbamide
Sickle cell crisis management
oxygen with IV analgesia and IV fluids
Cervical cancer screening: if 1st repeat smear at 12 months is still hrHPV +ve →
repeat smear 12 months later (i.e. at 24 months)
Referred to colposcopy if still HrHPV positive at 24 months
is a suitable method for contraception in breastfeeding mothers from 4 weeks and is the most appropriate option in this case.
The progesterone-only pill
Breast feeding is an absolute UKMEC contraindication for combined hormonal contraception
Nerve damage and clinical features
- femoral
- lumbosacral
- sciatic
- obturator
Glue ear treatment options
otitis media with an effusion
If child w/ first presentation of otitis media w/ effusion –> active observation for 3 months , no intervention required
or
–> grommet insertion (allow air to pass through middle ear)
–> majority stop functioning after 10 months
–> adenoidectomy
Cervical cancer management based on staging
Stage 1A tumours
–> gold standard = hysterectomy +/- lymph node clearance
–> fertility maintained? cone biopsy w/ negative margins
Stage A2
–> nodal clearance
–> radical trachelectomy
Management of stage IB tumours
–> radiotherapy (brachy or external beam) w/ concurrent chemo (cisplatin)
B2 tumours
–> radical hysterectomy w/ pelvic node dissection
Stage II and III tumours
–> radiation w/ concurrent chemo
–> Hydronephrosis? nephrostomy consideration
Management stage IV
–> radiation and/or chemo
Stage IVB
–> palliative chemo
Management of recurrent disease
–> surgical: chemo or radiotherapy
–> radiation: surgical therapy
SSRI discontinuation syndrome
- increased mood change
- restlessness
- difficulty sleeping
- unsteadiness
- sweating
- gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
- paraesthesia
Paroxetine increased risk of congenital malformations, particularly in the first trimester
Surgery / diabetes:
these drugs can be continud on day of surgery
DPP IV inhibitors (-gliptins)
and GLP-1 analogues (-tides)
Hyperemesis gravidarum: management
1st line:
–> antihistamines: oral cyclizine or promethazine
–> phenothriazine: prochlorperazine or chlorpromazine
–> combination: doxylamine/ pyridoxine (vitamin B6)
2nd line
–> odansetron: CLEFT/LIP palate risk
–> oral metoclopramide or domperidone: EPSe w/ metoclopramide not more than 5 days
ADMISSION –> IV HYDRATION
typically involves loss of motor or sensory function
Functional neurological disorder (conversion disorder)
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
present with a shortened and internally rotated leg
Posterior dislocation (everything goes INto the hip) - internally rotated, adducted, flexed and shortened
Anterior dislocation (everything goes out of the hip) - Externally rotated, abducted, normal/lengthened leg
Femoral neck fracture (the muscles of the hip pull the shaft of the femur up and out) - Externally rotated, and shortened limb
Posterior hip dislocations
ECLAMPSIA: management
Magnesium sulphate!
Monitor: UO, reflexes, RR, o2
If respiratory depression: calcium gluconate!
Tx continues for 24 hours after last seizure or deliver
> 20 weeks gestation, proteinuria
