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1
Q

Inverted P wave, right axis deviation, loss of R wave progression

A

Dextrocardia

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2
Q

PE ECG

A

sinus tachycardia, right bundle branch block if in R ventricle, T wave inversion, right axis deviation

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3
Q

kartagener’s syndrome

A

situs inversus, chronic sinusitis, bronchiectasis

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4
Q

causes of left axis deviation

A
  • left anterior hemiblock
  • left BBB
  • inferior MI
  • WPW syndrome
  • hyperkalemia
  • ostrium primum ASD
  • tricuspid atresia
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5
Q

causes of right axis deviation

A
  • right ventricular hypertrophy
  • left posterior hemiblock
  • lateral MI
  • chronic lung disease –> cor pulmonale
  • PE
  • ostium secundum ASD
  • WPW
  • normal <1y
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6
Q

Complications of chronic lymphocytic leukemia

A
  • anemia
  • hypogammaglobulinemia leading to recurrent infections
  • warm autoimmune hemolytic anemia
  • transformation to high-grade lymphoma
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7
Q

Tension pneumo sx

A
  • tracheal deviation
  • decreased air entry
  • hyper resonant
  • hemodynamic instability (tachy, hypotension,
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8
Q

tension pneumo tx

A

Aspirate (2 ICS, MCL)

Chest drain into triangle of safety ( 5th ICS, MAL, anterior ax line –>above rib)

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9
Q

Ix acute mesenteric ischemia

A

serum lactate

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10
Q

Mesenteric ischemia sx

A
  • Small bowel
  • Embolism usually
  • Sudden and severe
  • Urgent surgery
  • High mortality
  • Abdo pain out of proportion to exam
  • rectal bleeding
  • diarrhea
  • fever
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11
Q

Predisposing factors to bowel ischemia

A
  • increasing age
  • a fib
  • other causes of emboli (endocarditis, malignancy)
  • CVS disease rf (smoker, HTN, DM)
  • cocaine
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12
Q

Ischemic colitis

A

Acute but transient compromise in blood flow to large bowel, often at splenic flexure
See thumbprinting on XR

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13
Q

Chonic mesenteric ischemia - intestinal angina sx

A
  • severe colicky post prandial abdo pain
  • weight loss
  • abdominal bruit
    usually due to atherosclerotic disease in arteries
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14
Q

Whiteout lung with trachea pulled towards it ddx

A
  • Pneumonectomy
  • complete lung collapse
  • pulmonary hypoplasia
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15
Q

Whiteout lung with trachea central ddx

A
  • consolidation
  • pulmonary edema
  • mesothelioma
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16
Q

Whiteout lung with trachea pushed away ddx

A
  • Pleural effusion
  • diaphragmatic hernia
  • large thoracic mass
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17
Q

Early lyme disease (<30d) sx

A
  • erythema migrans (bulls eye 1-4 weeks after bite, painless, 80%)
  • headache, lethargy, fever, arthralgia
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18
Q

Late lyme disease (>40d) sx

A
  • heart block
  • peri/myocarditis
  • facial nerve palsy
  • radicular pain
  • meningitis
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19
Q

Lyme mgmt

A

Doxycycline if early (amoxicillin if contraindicated eg preg)
Ceftriaxone if disseminated

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20
Q

Live attenuated vaccines

A
  • BCG
  • MMR
  • Oral polio
  • Yellow fever
  • Oral typhoid
  • Intranasal flu
  • Oral rotavirus
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21
Q

Pansystolic murmur and low grade fever: dx

A

Infective endocarditis

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22
Q

Most common cause of infective endo

A

Staph aureus (particularly in acute presentation and IVDUs)
Staph epidermidis in those with indwelling lines and post prosthetic valve surgery
Strep viridans following dental procedure
SLE, malignancy

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23
Q

Golfers elbow

A

Medial epicondylitis

Pain aggravated by wrist flexion and pronation

Numbness/tingling in 4th/5th fingers from ulnar nerve

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24
Q

Tennis elbow

A

Lateral epicondylitis

Pain worse on resisted wrist extension with elbow extended OR supination of forearm with elbow extended

Lasts 6m-2y, acute pain for 6-12w

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25
Cubital tunnel syndrome
Compression of ulnar nerve 4/5th tingling fingers worse if elbow on hard surface
26
Radial tunnel syndrome
Compression of posterior interosseous branch of radial nerve, usually from overuse Similar to lat epicondylitis Pain 4-5cm distal to lat epi Worse by extending elbow and pronating forearm
27
SLE blood tests
+ Anti-dsDNA + Anti-smith antibodies low C3 C4
28
+ anti-centromere antibody
systemic sclerosis/scleroderma
29
positive ANA
autoimmune disease including lupus and certain meds.
30
SLE general ft
fatigue fever ulcers in mouth lymphadenopathy
31
SLE skin ft
``` Malar rash Discoid rash Livedo reticularis Raynaud's Non scarring alopecia Photosensitivity ```
32
SLE MSK ft
arthralgia | non erosive arthritis
33
SLE CVS ft
pericarditis (most common) | Myocarditis
34
SLE resp ft
pleurisy | fibrosing alveolitis
35
SLE renal ft
proteinuria | glomerulonephritis (diffuse proliferative most common)
36
SLE neuro ft
psychosis depression anxiety seizures
37
Fever + back pain w pain on extension of hip
iliopsoas abscess
38
Potts disease
TB seen in vertebrae
39
Iliopsoas abscess causes
Primary: Heamtogenous spread of bacteria (staph aureus) Secondary: Crohns, diverticulitis, colorectal cancer, UTI, GU cancer, vertebral osteomyelitis, femorath catheter, endocarditis
40
Iliopsoas abscess mgmt
Abx Percutaneous drainage Surgery
41
Antihistone antibodies
drug induced lupus | - hydralazine and procainamide
42
Anti-Mi-2
dermatomyositis | Myalgia and cutaneous changes (heliotrope rash, Gottron's papules)
43
Anti-Ro
Sjogren's syndrome - lymphocytic infiltration into exocrine glands Reduces exocrine functions (dry mouth, dry eyes, dry airways)
44
Osteochondritis dissecans sx
knee pain/swelling after exercise | locking and "clunking", giving way, loose bodies
45
Intracapsular hip fracture tx
- displaced: hemi or total hip replacement (young and fit--> internal fixation) - undisplaced: hemiarthroplasty or internal fixation
46
Extracapsular hip # (reverse oblique, transverse, subtropchanteric) and femoral shaft # tx
intramedullary nail
47
Extracapsular intertrochanteric proximal femoral # tx
dynamic hip screw
48
Ank spond associated gene
HLA-B27 | Seronegative
49
Ank Spond features
``` Reduced flexion: lateral and forward Reduced chest expansion -Apical fibrosis -Anterior uveitis -Aortic regurg -Achilles tendonitis -AV node block -Amyloidosis -Arthritis (peripheral) -Anemia -Cauda equina ``` ``` Dactylitis Enthesitis Aortitis Restrictive lung disease IBD **Bamboo spine ```
50
Ank spond Reactive arthritis Psoriatic arthritis
Seronegative
51
Schober's test
Back flexion test | L5 +10, -5, bend and should be >20cm
52
Ank spond tx
``` NSAIDS Steroids (oral, IM, joint) Tumour necrosis factor - anti-TNF - entanercept - monoclonal Ab (infliximan, adalimumab, certolizumab) Mono Ab via IL 7 - secukinumab ``` Physio Bisphosphonates No smoking Tx other comps
53
Hydroxychloroquine
RA, SLE, malaria Safe in preg SE: bulls eye retinopathy
54
Marfans and the heart
Associated with dilation of aortic sinuses which can lead to aortic dissection. Do echo.
55
Marfan's Ft
``` Tall high arched palate arachnodactyly pectus excavatum pes planus (flat feet) scoliosis mitral valve prolapse upward eye lens dislocation, blue scera, myopia dural ectasia ```
56
Malignancy + raised CK
? polymyositis
57
Drugs raising CK
Statins
58
Polymyositis ft
``` proximal muscle weakness +/- tenderness Raynaud's respiratory muscle weakness interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia dysphagia, dysphonia ```
59
Weekly prescriptions
bisphosphonates | methotrexate
60
Usually taken at night
statins | amitriptyline
61
carbimazole
anti thyroid
62
carbmazepine
anti epileptic
63
chlorophenamine
anthistamine
64
chlorpromazine
antipsychotic
65
carbocisteine
mucolytic
66
carboplatin
chemo
67
carbetocin
like oxytocin after birth
68
Ciprofloxacin in BF mom
no
69
Tetracycline in BF mom
no
70
Chloramenphenicol in BF mom
no
71
sulphonamides in BF mom
no
72
lithium in BF mom
no
73
benzos in BF mom
no
74
aspirin in BF mom
no
75
catbimazole in BF mom
no
76
methotrexate in BF mom
no
77
sulfonylureas in BF mom
no
78
cytotoxic drugs in BF mom
no
79
amiodarone in BF mom
no
80
penicillin in BF mom
yes
81
digoxin in BF mom
yes
82
warfarin in BF mom
yes
83
heparin in BF mom
yes
84
beta blocker in BF mom
yes
85
hydralazine in BF mom
yes
86
TCAs in BF mom
yes
87
antipsychotics in BF mom
yes
88
salbutamol in BF mom
yes
89
theophyllines in BF mom
yes
90
sodium valproate in BF mom
yes
91
carbamazepine in BF mom
yes
92
steroids in BF mom
yes
93
levothyroxine in BF mom
yes
94
trimethoprim in BF mom
yes
95
cephalisporins in BF mom
yes
96
clozapine in BF mom
no
97
paracetamol dose
1g qds
98
ibuprofen dose
200-400mg tds
99
codein dose
30-60mg qds
100
cyclizine dose (antiemetic)
50mg tds
101
metoclopramide dose (antiemetic)
10mg tds
102
Amoxicillin dose
500mg tds
103
Clarithromycin dose
500mg bd
104
lansoprazole dose (PPI)
15-30mg od
105
omeprazole
20-40mg od
106
Aspirin dose
75-300mg od
107
Clopidogrel dose
75-300mg od
108
Simvastatin dose
10-80mg on
109
Ramipril dose
1.25-10mg od
110
Atenolol dose
25-100mg od
111
furosemide dose
20mg od-80mg bd
112
amlodipine dose
5-10mg od
113
metformin dose
500mg od-1g bd
114
levothyroxine dose
25-200mcg od
115
co-codamol dose
2 tabs qds
116
Relative contraindications for COCP
``` >35 and smoking <15cig/day BMI > 35 Fhx thromboembolic disease first degree controlled HTN immobility known BRCA1/2 gallbladder disease DM >20y ago ```
117
Absolute contraindications for COCP
``` >35 smoking >15/d migraine w aura history of thromboembolic history of stroke/ischemic heart BF <6w postpartum uncontrolled HTN breast Ca major surgery w immobil DM >20y ago ```
118
Common issue w deranged LFTs in UC
Primary Sclerosing Cholangitis
119
PSC features
cholestasis (jaundice, pruritus raised bilirubin + ALP) right upper quadrant pain fatigue
120
Tx small bowel overgrowth syndrome
rifaximin
121
Pen V (phenoxymethylpenicillin) uses
ENT infections (tonsilitis), long term prophylaxis after splenectomy
122
Linezolid
for gram positive bacteria, used against MRSA
123
SBBOS diagnosis
- hydrogen breath test - small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce - clinicians may sometimes give a course of antibiotics as a diagnostic trial
124
SBBOS RF
neonates w congenital GI abnormalities scleroderma DM
125
SBBOS sx
chronic diarrhoea bloating, flatulence abdominal pain
126
Vit C deficiency
Scurvy - gingivitis, loose teeth - poor wound healing - bleeding from gums, haematuria, epistaxis - general malaise
127
Most common esophageal CA
adenocarcinoma More likely in those w GERD or Barrett's Lower third: adenocarcinoma Upper 2/3: squamous cell
128
Esophageal adenocarcinoma RF
``` GORD Barrett's Smoking Achalasia Obesity ```
129
Esophageal Squamous cell RF
``` Smoking Alcohol Achalasia Plummer-vinson syndome Diet rich in nitrosamines ```
130
Esophageal CA features
- dysphagia: the most common presenting symptom - anorexia and weight loss - vomiting - other possible features include: odynophagia, hoarseness, melaena, cough
131
Esopageal Ca tx
Surgical resection | Adjuvent chemo
132
Pharyngeal pouch sx
``` dysphagia regurgitation aspiration neck swelling which gurgles on palpation halitosis ```
133
Crohns features
``` Colonoscopy -features suggest of Crohn's include deep ulcers, skip lesions Histology -inflammation in all layers from mucosa to serosa -goblet cells -granulomas Small bowel enema -high sensitivity and specificity for examination of the terminal ileum -strictures: 'Kantor's string sign' -proximal bowel dilation -'rose thorn' ulcers -fistulae ```
134
Primary Biliary Cholangitis M rule
IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
135
PBC sx
fatigue and pruritus
136
high ALP and GGT but not ALT
cholestatic picture
137
How to induce Crohns flare remission
Glucocorticoids only
138
Crohns remission mgmt
1st Steroids 2nd Azathioprine/mercaptopurine/methotrexate 3rd Sulfasalazine 4th infliximab useful in refractory disease **** TPMT activity tests before aza or mercapto
139
Crohns stricturing location
Terminal ileum --> ileocecal resection
140
Crohns risks
Small bowel CA Colorectal CA Osteoporosis
141
H Pylori trip/quad therapy
Amoxicillin + clarithromycin or metronidazole + PPI QUAD Bismuth subcitrate potassium + tetracycline + metronidazole + omeprazole
142
Urgent endoscopy referal
Dysphagia Upper abdo mass consistent w stomach CA >55y w weight loss AND either upper abdo pain/reflux/dyspepsia.
143
Meds causing dyspepsia
``` alpha-blockers, antimuscarinics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, non-steroidal anti-inflammatory drugs (NSAIDs), theophyllines, tricyclic antidepressants ```
144
H Pylori test
Carbon 13 urea breath test or stool antigen test or lab based serology
145
Hemochromatosis bloods
High ferritin (>500) High transferrin saturation (>55%) low total iron binding capacity
146
Hemochromatosis genetics
C282Y and H63D mutations
147
Management of variceal hemorrhage
``` High flow O2 Fluids Blood products (FFP, vit K) Abx (ceftriaxone) Telipressin - reduces portal blood flow (or octreotide) ``` Endoscopy - variceal band ligation Sengstaken-Blakemore tube (if uncontrolled) TIPSS (connect hepatic to portal vein)
148
Upper GI bleed not caused by variceal - tx
Omeprazole IV
149
Warfarin reversal factors
2, 9, 10
150
Prevention of esophageal varices bleeding/re-bleen
Propranolol (non cardioselective beta blocker)
151
Non cardio selective b blocker works on:
vascular smooth muscle B2 | cardiac beta 1
152
Amlodipine works on
arterial vessels
153
Primary sclerosing cholanigitis assoc with
``` Ulcerative colitis - 80% PSC have UC - 4% UC have PSC Crohns HIV ```
154
PSC on Ix
MRCP - beaded appearance | p-ANCA might be positive
155
Carcinoid sydrome
mets present in liver, release serotonin into systemic circulation Can also happen w lung carcinoid
156
Carcinoid features
- flushing (often earliest symptom) - diarrhoea - bronchospasm - hypotension - right heart valvular stenosis (left heart can be affected in bronchial carcinoid) - other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing's syndrome - pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
157
Carcinoid test
Urine 5-HIAA (hydroxyindoleacetic acid) | plasma chromogranin A y
158
Carcinoid tx
``` somatostatin analogue (octreotide) cyproheptadine for diarrhea ```
159
Most common cause of hepatocellular carcinoma
Hep B worldwide | Hep C Europe
160
Hepatocellular CA RF
``` Hep B,C Alcohol Hemochromatosis PBC alpha-1 antitrypsin deficiency hereditary tyrosinosis glycogen storage disease aflatoxin drugs: oral contraceptive pill, anabolic steroids porphyria cutanea tarda male sex diabetes mellitus, metabolic syndrome ```
161
Hepatocellular CA Sx
tends to present late features of liver cirrhosis or failure may be seen: jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly possible presentation is decompensation in a patient with chronic liver disease raised AFP
162
HBsAg
ongoing infx | acute or chronic
163
HB core Ab
C = Caught it (negative if immunized) IgM in acute IgG forever
164
HBsAb
immunization
165
HBcAb pos + HBsAG neg
prev hep, not a carrier
166
HBcAb pos + HBsAg pos
prev hep, now a carrier
167
HBeAg
infectivity
168
Malnutrition definition
BMI <18.5 OR unintentional weight loss >10% within 3-6 months OR BMI <20 + weight loss >5% in 3-6 months
169
Definitive Ix for celiac disease
duodenal biopsy
170
Conditions assoc w celiac
dermatitis herpetiformis (vesicular, pruritic skin eruption) T1 DM Autoimmune hepatitis
171
Celiac duodenal biopsy findings
villous atrophy crypt hyperplasia increase in intraepithelial lymphocytes lamina propria infiltration with lymphocytes
172
Life threatening C Diff infection tx
ORAL vancomycin and IV metronidazole
173
Severe, non life-threatening C Diff tx
oral vancomycin first line usually oral metronidazole 10-14d
174
C Diff gram
gram positive rod
175
C Diff sx
diarrhoea abdominal pain a raised white blood cell count (WCC) is characteristic if severe toxic megacolon may develop
176
Caution when prescribing to pt with asthma
NSAID - bronchospasm B blocker - cause bronchospasm adenosine - bad for asthma and COPD. Use verapamil instead.
177
Lithium monitoring
12 hr post dose | Range: .4-1 mmol/l
178
Ciclosporin monitoring
trough levels right before next dose
179
Digoxin monitoring
at least 6 hr post-dose/just before next dose for ease monitor ventricular rate at rest U & E and renal func if tox suspected
180
Digoxin use in a fib
slows ventricular rate in pt where beta blocker contraindicated (Asthma)
181
Do not prescribe in epilepsy
- alcohol, cocaine, amphetamines - cirprofloxacin, levofloxacin - aminophylline, theophylline - bupropion - methylphenidate (in ADHD) - mefenamic acid p450 inducers/inhibitors
182
Antihypertensive CI in preg
Linisopril (ACEi)
183
avoid in heart failure
``` NSAID/glucocorticoid - fluid retention Verapamil - neg inotrope Thiazolidinediones -fluid retention (pioglitazone) Class 1 antiarrhythmics - flecainide ```
184
Lithium monitoring
serum levels U & E TFTs Can cause QT prolongation but dont need to re check.
185
Statin Monitoring
LFTs | -baseline, 3mo, 12mo
186
ACEi Monitoring
U&E | - prior, after increase dose, annually
187
Amiodarone Monitoring
TFT, LFT prior to tx, every 6 mo U&E and CXR prior to tx
188
Methotrexate Monitoring
FBC, LFT, U&E | - before, weekly until stabilised, 2-3 monthly
189
Azathioprine Monitoring
FBC, LFT - before tx, everyy 3 mo FBC weekly first 4 weeks
190
Sodium Valproate Monitoring
LFT - and FBC before tx LFT periodically in first 6 mo
191
Glitazones Monitoring
LFT | - before tx, regularly during tx
192
Psoriasis exacerbating factors
- trauma - alcohol - drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab - withdrawal of systemic steroids - strep --> guttate psoriasis
193
Verapamil indications
Ca Channel Blocker - Angina, HTN, arrhythmias - neg inotrope - NOT w BBlocker
194
Diltiazem indications
Ca Ch blocker - angina, HTN - caution w BB
195
Nifedipine, amlodipine, felodipine indications
Ca ch blockers - HTN. angina, Raynaud's - works on peripheral vascular SM, so not making HF worse but will cause ankle swelling
196
Verapamil SE/cautions
``` HF constipation hypotension bradycardia flushing ```
197
Diltazem SE/cautions
Hypotension bradycardia HF ankle welling
198
Nifedipine, amlodipine, felodipine SE/cautions
Flushing Headache Ankle swelling
199
HTN: <55 or T2DM
1: ACEi or ARB 2: Ace + CCB or ARB + thiazide 3: ACE/ARB + CCB + thiazide 4: K <4.5 --> spironolactone
200
HTN: >55 and no T2DM or Afro + no DM
1: Ca Ch Blocker 2: Ace + CCB or ARB + thiazide 3: ACE/ARB + CCB + thiazide 4: K>4.5 --Alpha or Beta blocker
201
Simvastatin in preg?
NO
202
Drugs to avoid in ischemic heart disease
NSAID Estrogens (COCP, HRT) Varenicline
203
Give acetylcysteine if:
staggered overdose or doubt about time of ingestion, regardless of conc. if plasma conc is on or about tx line
204
Gentamicin type
aminoglycoside abx, given IV or topical
205
Gentamicin SE
ototoxicity | nephrotoxicity (secondary to ATN)
206
Gentamicin CI
myasthenia gravis
207
Potentially toxic dose of paracetamol calculation
150mg/kg x weight = max dose.
208
Tamoxifen
Post estrogen positive breast CA (SERM) 5 yr after mastectomy SE: VTE and hot flush, menstrual disturbance (bleed, amenorrhea), endo CA Can cause fibroids
209
Lithium tox causes
dehydration renal failure drugs (diuretics, ACEi, ARB, NSAID, metronidazole)
210
Lithium tox sx
``` coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion polyuria seizure coma ```
211
NSAIDs and AKI/CDK?
NO
212
Tetracycline in renal failure
no
213
nitrofurantoin in renal failure
no
214
NSAIDs in renal failure
NO
215
lithium in renal failure
no
216
metformin in renal failure
no
217
warfarin in renal failure
yes
218
diazepam in renal failure
yes
219
erythromycin in renal failure
yes
220
rifampicin in renal failure
yes
221
Digoxin use
slow rate in AF and A flutter | Increases force of contraction
222
Digoxin tox
unwell, lethargy, N/V, anorexia, confusion, yellow-green vision Arrhythmias (AV block, brady) gynecomastia
223
Digoxin tox causes
HYPOKALEMIA Older Renal failure
224
Digoxin tox mgmt
Digibind correct arrhyth monitor K
225
Acute asthma attack mgmt
``` admit: if life threatening or not responding to initial tx O2: if hypoxemic, 15L Bronchodilate: SABA high dose (salbutamol). Nebulised better Steroid: prednisolone PO 5d Ipratropium bromide if still no resp IV MgSO4 IV aminophylline Intubation/ventilation/ECMO ```
226
Statin in established CVD
80mg PO, ON
227
Statin for primary prevention
20mg PO, ON
228
Starin SE
``` Myopathy Liver impair (LFTs baseline, 3mo, 12mo) ```
229
Statin CI
macrolides (erythromycin, clarithromycin) | Pregnancy
230
SVT tx
Vagal maneuvers (Valsalva, carotid massage) Adenosine 6mg IV stat (but not in asthma) Electrical cardioversion
231
Exacerbation of chronic bronchitis tx
Amox Tetracycline Clarithromycin
232
Uncomplicated community-acquired pneumonia tx
Amox (doxy or clarithro if allergic) | Staph --> add fluclox
233
Pneumonia possibly caused by atypical pathogens tx
clarithromycin
234
Hospital-acquired pneumonia tx
<5d: Co-amox or cefuroxime | >5d: piperacillin w tazobactam OR ceftazidime OR ciprofloxacin
235
L-UTI tx
Trimethoprim or Nitrofurantoin | alt: amox, cephalosporin
236
Acute pyelo tx
Broad spectrum cephalosporin (ceftazidime)
237
Acute protatitis tx
Quinolone or trimethoprim
238
Impetigo tx
topical hydrogen peroxide | oral fluclox or erythromycin if widespread
239
Cellulitis tx
Floclox (claruthro/erythro/doxy if allergy)
240
Cellulitis near eyes tx
co-amox | clarith + metronidazole if allergy
241
Erysipelas tx
fluclox | clarithro/erythro/doxy if allergy
242
Animal/human bite tx
co-amox | doxy + metronidazole if allergy
243
Mastitis tx
Flucloxacillin
244
Throat infx tx
Phenoxymethylpenicillin | erythro
245
Sinusitis tx
Pen V
246
Otitis media tx
Amox (erythro)
247
Otitis externa tx
fluclox (erythro)
248
Pariapical or periodontal abscess tx
Amox
249
Gingivitis tx
Metronidazole
250
Gonorrhea tx
IM ceftriaxone
251
Chlamydia tx
Doxy or azithromycin
252
PID tx
Oral ofloxacin + oral metronidazole OR | IM ceftriaxone + oral doxy + oral metronidazole
253
Syphillis tx
Benzathine benzylpen OR doxy OR erythro
254
Bact vag tx
Oral/topical metronidazole or topical clindamycin
255
C Diff tx
1st time: metronidazole | 2nd: vancomycin
256
Campylobacter enteritis tx
clarithromycin
257
Salmonella tx
Cipro
258
Shigellosis tx
Cipro
259
Abx causing C Diff
clindamycin, 2nd/3rd gen cephalosporins, PPI
260
CURB 65 score
``` Confusion Uremia (BUN > 20) RR (>30) BP (<90, <60) >65y 0-1: home tx 2: hosp tx 3: hops, severe ```
261
Most common first line antihypertensive in >55y`
CCB - amlodipine
262
Stage 1 HTN
140/90
263
Stage 2 HTN
160/100
264
Severe
180 sys or 110 dia
265
Meningitis empiric tx
Cefotaxime 2g IV | Ceftriaxone 2g IV
266
Meningitis from meningococci tx
IV benzylpenicillin or cefotxime/ceftriaxone
267
Meningitis suspected in GP
IM benzylpen and transfer to hospital
268
Meningitis <3mo tx
IV cefotaxime + amox (or ampicillin)
269
Meningitis >50y tx
IV cefotaxime/ceftriaxone + amox/ampicillin
270
Pneumococcal meningitis tx
IV cefotaxime/ceftriaxone
271
Hemoph influenza meningitis tx
IV cefotaxime/ceftriaxone
272
Listeria meningitis
IV amox/amp + gentamicin
273
Meningitis Ix
``` FBC CRP Coag screen Blood culture Whole bloos PCR Blood glucose Blood gas Lumbar punc if no raised ICP ```
274
Meningitis prophylaxis
1st: ciprofloxacin 2nd: Rifampicin
275
Esophagitis in edoscope yx
Full PPI 1-2mo, then low dose as needed | No resp--> double dose PPI x 1mo
276
Endoscopically neg refluc tx
full dose PPI x 1mo If resp --> PRN los dose No resp --> H2RA or prokinetic x 1mo
277
Croup tx
Dexamethasone 0.15mg/kg x 1 dose PO
278
Depression first line tx
Fluoxetine 20mg PO OD Citalopram 20mg (long QT) ``` Sertraline 50mg (good post MI) Paroxetine 20mg ```
279
Depression tx w warfarin or aspirin
mirtazapine
280
VTE prophylaxis
Dalteparin/Enoxaparin/Tinzaparin (LMWH) -2500-5000 units, SC, OD If renal failure - Unfractionated heparin
281
Incontinence Ix
bladder diary x 3d Vag exam - exclude prolapse Urine dip + culture Urodynamic studies
282
Urge incontinence tx
- bladder retraining - bladder stabilizing drugs - antimuscarinics first: oxybutnin (avoid in frail old women), tolterodine - mirabegron (b 3 agonist) if concern about anticholinergic effects in frail patients
283
Stress incontinence tx
- pelvic floor training - retropubic mid-urethral tape procedure - duloxetine if no surg. SSNRI
284
Common osmotic laxative - soften stool
Lactulose, macrogols
285
Stimulant laxative - increase motility
senna, docusate, glycerol
286
Bulk-forming laxatives - for diets low in fiber
Methylcellulose
287
Angina meds
B-Blocker (atenolol, 2nd line CCB - verapamil) Aspirin Statin GTN
288
Emergency contaception
Levonorgesterel 1.5mg PO stat (72h) | Ulipristal acetate 30mg PO stat (120h)
289
Achalasia sx
trouble swallowing both solids and liquids | regurgitation of food
290
Esophageal spasm sx
pain w swallowing
291
Bulbar palsy
weakness - drooling, weak and wasted tongue dysphonia problems articulating
292
Progressive dysphagia, weight loss
Esophageal CA, can compress laryngeal nerve
293
Causes of hepatomegaly
Cirrhosis - non-tender, firm Malig - mets or primary. Hard, irreg edge RHF - firm, smooth, tender liver edge. Can be pulsatile ``` Viral hep Glandular fever Malaria Abscess Hydatid disease Hematological CA Hemochromatosis PBC Sarcoidosis ```
294
Colostomy info
Flush to skin | Poop in bag
295
Ileostomy info
spouted | often right side but doesn't have to be
296
Monitoring bloods of hepatocellular CA
AFP
297
Pancreatic cancer marker
CA 19-9
298
Ovarian CA marker
CA 125
299
Bowel CA marker
CEA
300
Autoimmune Hep Ft
``` Fever, jaundice - acute (25%) Amenorrhea ANA/SMA/LKM1 antibodies Raised IgG Young females ```
301
Autoimmune hep tx
steroids +/- immunosuppression (azathioprine) | Liver transplant
302
TIPS (transjugular intrahepatic portosystemic shunt) dangerr
exacerbation of hepatic encephalopathy | - blood from portal system into systemic, bypassing liver --> no metabolism of nitrogenous waste like ammonia.
303
distal UC first line tx for moderate flare
rectal mesalazine or sulphasalazine (aminosalicylates) Oral if extensive disease 2nd line: oral/rectal steroids
304
UC proctitis induce remission
topical aminosalicylates (mesalazine) If not remit in 4w, add oral still not working - oral cortico
305
UC proctosigmoiditis + left sided UC remission induction
topical aminosalicylate 4 weeks nothing - add oral or switch to high dose oral and topical cortico Still not remit - oral amino + oral cortico
306
extensive UC induce remission
topical aminosalicylate + high dose oral amino | No remission in 4 w - oral amino + oral cortico
307
Severe ulcerative colitis tx
Hospital, IV steroids or if CI contraindicated
308
UC mod. flare maintenance
Proct - topical aminosalicylate OR oral + topical OR oral only Left sided/extensive: oral amino
309
UC severe flare maintenance
oral azathioprine or mercaptopurine
310
Acute cholecystitis tx
IV abx + laparoscopic cholecystectomy within 1 week
311
Acute cholecystitis sx
RUQ pain - radiate to R shoulder Fever + systemic upset Murphys sign LFTs normal
312
Acute cholecystitis Ix
US | HIDA scan
313
UC flare triggers
often w/o trigger stress meds (NSAID, Abx) quitting smoking
314
Thrombosed hemorrhoid
Pain and tender lump @ anus purple, edematous, subcut tender perianal mass Can do excision within 72 of onset - if not, stool softener, ice pack, analgesia
315
Perianal abscess
fever | cellulitis surrounding it
316
Viral hep sx
``` N/V, anorexia Myalgia Lethargy RUQ pain IVDU or foreign travel ```
317
Congestive hepatomegaly sx
congestive heart failure causes liver to stretch, can lead to cirrhosis. RUQ pain
318
Biliary colic sx
intermittent RUQ pain, sudden onset, slow to subside Often after eating Nausea Female,Fat,Forties,Fair
319
Ascending cholangitis sx
infected bile ducts secondary to gallstones | Fever, RUQ pain, Jaundice
320
Gallstone ileus sx
Abdo pain, distension, vom
321
Cholangiocarcinoma
Persistant biliary colic sx w anorexia, jaundice, weight loss Palpable mass in RUQ (Courvoisiers sign), periumbilical lymphadenopathy, left supraclavicular adenopathy (Virchow)
322
Pancreatic CA sx
``` painless jaundice (pale stools, dark urine, pruritus & cholestatic LFTs) Loss of exocrine func (steatorrhea) Loss of endocrine func (DM) can epi have pain anorexia, weight loss ```
323
Acute pancreatitis sx
``` Due to alcohol or gallstones Severe epigastric pain Vomiting Tenderness, ileus, fever Periumbilical discolouration (Cullen's) and flank discolouration (Grey-Turner) ```
324
Amoebic liver abscess sx
malaise anorexia weight loss mild RUQ pain
325
Defective bilirubin conjugation from deficiency in UDP-glucuronosyltranferase
Gilbert's syndrome
326
Gilbert's sx
high unconj bili in serum | jaundice during illness, exercise or fasting
327
Acute pancreatitis tx
Fluid resusc -crystalloids Urine output >.5mls/kg/h Analgesia - opioids Nutrition - normal diet
328
Pseudocyst
4+ weeks post acute pancreatitis retrogastric assoc w persistent raised amylase TX: observe x 12w
329
Liver abscess tx
abx (amox + cipro + metronidazole) and image-guided percutaneous drainage Staph aureus in kids, E Coli in adults
330
Non-urgent endoscopy ref for:
Hematemesis Pt >55 w: tx-resistant dyspepsia OR UAP w low Hb OR raised platelets with nausea/vom/weight/reflux/dyspepsia/UAP OR N/V with weight loss/reflux/dyspepsia/UAP
331
Causes of liver decompensation in cirrhosis
``` Constipation Infection Electrolyte imbalances dehydration Upper GI bleed Increased alcohol intake ```
332
H Pylori assoc with
Peptic ulcer disease Gastric CA B cell lymphoma of MALT (curing HP causes regression in 80%) Atrophic gastritis
333
Dark urine + pale stools
Cholestasis
334
Colicky RUQ pain postprandially, worse following fatty meal
Gallstones
335
Biliary colic Ix/Tx
Imaging (US) | If gallstones --> laparoscopic cholecystectomy
336
Dukes Staging: A
Limited to mucosa
337
Dukes Staging: B
outside mucosa, invading local tissue/muscular layer of colon, no nodes
338
Dukes Staging: C
Regional nodes
339
Dukes Staging: D
Distant mets
340
Celiac annual bloods
``` FBC Ferritin TFT LFT B12 Folate ```
341
Gluten-free foods
rice, potatoes, corn
342
Hemochromatosis + joints
Chondrocalcinosis
343
B12 and Folate Def sx
Fatigue, poor concentration, pallor Low B12, low Folate, anemia, polymorphs Peripheral neuropathy and ataxia
344
When to refer B12 deficiency urgently to hematology
If neuro sx (loss of sensation, weakness, optic neuropathy, psych issues, symmetrical neuropathy, urinary/fecal incont) If preggo
345
B12 or Folate first
B12 first, then folate. If not --> subacute combined degeneration of spinal cord
346
Pernicious anemia
Autoimmune dx affecting gastric mucosa leading to B12 deficiency
347
Causes of B12 deficiency
Pernicious anemia atrophic gastritis (from H Pylori) gastrectomy malnutrition (alcoholism)
348
B12 def RFs
female middle/old age assoc with autoimmune dx (thyroid, T1DM, Addisons, rheumatoid, Vitiligo) More common in blood group A
349
B12 def features
Anemia:lethargy, pallor, dyspnoea Neuro: - peripheral neuropathy: 'pins and needles', numbness. Typically symmetrical and affects the legs more than the arms - subacute combined degeneration of the spinal cord: progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia - neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritabiltiy Other: - mild jaundice - glossitis
350
Most common pancreatic CA
adenocarcinoma
351
Palliative pain relief in severe renal impairment
fentanyl buprenorphine oxycodone in moderate
352
Opioid use in palliation
oral MR morphine (20-30mg/day) + oral IR (5mg) for breakthrough + laxatives
353
Frontotemporal dementia (Picks)
personality change impaired social conduct hyperorality, disinhibition, high appetite, perseveration
354
frontotemporal dementia macro/micro changes
Macro: atrophy of fronto and temp lobes Micro: pick bodies (aggregation of tau protein), gliosis, neurofibrillary tangles, senile plaques
355
Frontotemporal dementia - CPA
chronic progressive aphasia non-fluent speech comprehension preserved
356
Fontotemporal semantic dementia
fluent progressive aphasia, speech is fluent but empty

My notes - med (14 decks)

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