second Flashcards
MS in pregnancy - reduced flare through pregnancy , then 3-6 months post party increases then goes to pre pregnancy levels of flare ,
what increases flare up unlike other autoimmune diseases ?
pregnancy increases the likelihood of a lupus flare. It is essential that a patients lupus is well controlled and quiescent for at least six months prior to pregnancy. Given that mycophenolate is teratogenic in pregnancy, it must be stopped. It is common practice to change to azathioprine,
hydroxychloroquine - is safe during pregnancy
In patients who do not undergo HBeAg seroconversion or who relapse what is given
pegylated interferon-alpha
tenofovir disoproxil is second line
Domperidone test:
Hyperprolactinemia and macroplolactinemia
IGF-1 test + Glucose tolerance test
Acromegaly
Insulin Tolerance test
Growth hormone deficiency
Arginine- GHRH stimulation test
Growth hormone deficiency for cardiac patients
Examples of anaerobic bacteria include for aspiration pneumonia
Bacteroides
Prevotella
Fusobacterium
Peptostreptococcs
Features suggesting restrictive cardiomyopathy rather than constrictive pericarditis
prominent apical pulse
absence of pericardial calcification on CXR
the heart may be enlarged
ECG abnormalities e.g. bundle branch block, Q waves,LVH
Two-dimensional and Doppler echocardiography can determine diastolic dysfunction and distinguish restrictive cardiomyopathy from restrictive physiology due to constrictive pericarditis. Normal ventricular size and systolic function usually are evident in cases of restrictive cardiomyopathy.
Theophylline poisoning presentation
hypokalaemia,
hyperglycaemia,
tachycardia and increased myocardial contractility
Pregnancy Causes what to thyroid levels
Raised total T4/T3
normal free T4 and T3
and would not suppress TSH
High amount of thyroid binding globulin
For Myxedema coma tx ?
give T3 (liothyronine) 5-20mcg/4-12h IV until sustained improvement (2-3d) then levothyroxine 50mcg/24h
IV steroids - until coexisting adrenal insufficiency has been excluded
Iv fluids
iv glucose
onchocerciasis presentation ?
adult worm lives in subcutaneous nodules and produces larvae, which become deposited in the skin and eyes
= clouding of both corneas
=pruritic rash and formation of a leopard-skin
onchocerciasis dx?
visualised by microscopy of skin snip
onchocerciasis tx and WHAT treatment should not be used ?
treatment of choice is ivermectin;
DEC should not be used because rapid death of the worms can exacerbate damage to surround tissues and even cause complete blindness.
Merkel cell carcinoma tx ?
often red or violet in colour and may initially be mistaken for other skin conditions such as a cyst or folliculitis.
cells are very close to nerve endings and help the skin sense light touch.
small round blue cells that can resemble small cell lung cancer or lymphoma
Vemurafenib and dabrafenib are selective BRAF inhibitors that increase overall survival in metastatic melanoma. These drugs paradoxically activates the MAPK pathway in keratinocytes and so can cause
squamous cell carcinomas, often within the first three months of therapy. The risk of squamous cell carcinoma with vemurafenib and dabrafenib is higher in older patients and they can occur in sun-protected sites.
True universal dOnar
O-ve
True universal recipient
AB+ve
absolute contraindications for renal transplant ?
active malignancy,
chronic infection,
overt proteinuria,
bilateral renal artery
atherosclerosis
sickle cell disease.
failure of three agents to control his blood pressure
peritoneal dialysis is the renal replacement therapy that would be in keeping with his wish of ‘least lifestyle-restricting’ option, his previous history of laparotomy and unrepaired abdominal hernia are contraindications
In individuals with extremes of muscle mass, estimated GFR calculations based on creatinine levels need to be interpreted with caution alternative marker of kidney function used to estimate glomerular filtration rate is?
cystatin C,
measurement of cystatin C in individuals with an eGFRcreatinine of 45-59 sustained for at least 90 days and no albuminuria (albumin:creatinine ratio < 3 mg / mmol) or another marker of kidney disease.
NICE guidance states that chronic kidney disease should not be diagnosed in individuals with eGFR creatinine of 45-59 ml and no other marker of kidney disease if eGFR cystatinC is greater than 60 ml / min / 1.73 m2.
