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What is exenatide?
- GLP-1 mimetic. inc. insulin production and inhibits glucagon breakdown. given when insulin would normally be given 60mins before breakfast and dinner.
- given with other T2DM drugs.
- causes weight loss.
Gliptins e.g. sitagliptin are DPP-4 inhibitors. also new class, can also be started second line.
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SSRI interactions?
- give PPI if with NSAID
- Dont give with triptans
- consider mirtazapine if taking warfarin or heparin.
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stopping SSRIs?
- 4 weeks ex fluoxetine.
- 2 week check-up when starting or 1 week for children.
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TB drug causing hepatitis and gout?
pyrazinamide.
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alkylating agent that can cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma?
cyclophosphamide
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immunosuppressant drug that can cause cardiomyopathy. acts by inhibiting DNA and RNA synthesis
doxorubicin.
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Drugs causing acute pancreatitis?
azathioprine, mesalazine, bendroflumeth, furosemide, steroids, sodium valproate.
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How is CV risk assessed in NSTEMI?
- GRACE score to get 6 month CV risk.
- >1.5% clopi for 12 months
- >3% add IIb/IIIa inhibitor e.g. tirofibran.
- give heparin unless going to angio in next 24h (considered if 6 months mortality risk is >3%).
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MOA of heparin?
activates antithrombin III which inhibits f Xa.
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Standard monitoring of lithium?
- TFT UAE prior to treatment
- TFT UAE every 6 months.
- weekly lithium levels until stabalised then every 3 months
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Standard monitoring of glitazones?
LFTs before starting and 'regularly' during treatment.
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monitoring of statins?
LFT at baseline, 3 and 12 months.
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Monitoring for methotrexate?
Monitoring of FBC LFT, UAE weekly until stabalized then every 2-3 months.
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How do you interpret Webers test?
- Sound localises to affected side in conductive loss (sound amplifyed on that side!).
- Sound localises away from affected side in sensorineural.
- Rinne's then shows:
- AC>BC = normal
- BC>AC = Conductive hearing loss.
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A doctor is exposed to hep C blood at work. What is the routine protocal?
monthly PCR and interferon +/- ribavarin if seroconversion occurs.
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Major criteria of RF?
- Carditis
- chorea
- polyarthritis
- erythema marginatum
- subcutaneous nodules
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Minor criteria of RF?
- raised ESR/CRP
- arthralgia
- fever
- prolonged PR.
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proportion of patients with condition who have a positive results?
sensitivity
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negative predictive value?
Chance that pt does not have condition if test result is negative.
correct false tests / total number of false tests.
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positive likelyhood ratio?
sensitivity/1-specificity
How much the odds of the disease increase when the test is positive.
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Drug used for severe resistent HTN?
- MINOXIDIL
- potassium channel activator given with a diuretic and beta blocker (as can cause fluid retention and tachycardia).
- SE: hypertrichosis, elevated creatinine and urea.
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pt presents with absent radial pulse, fainting and lethargy.
large vessel vasculitides?
- giant cell arteritis
- Takayasu's (young, female, asian)
- Behcets
- RA
- Syphilis
- TB
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restless leg syndrome?
ropinirole.
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antibody associated with limited cutaenous systemic sclerosis?
anti-centromere antibody
- This is the CREST varient with internal organs less involved.
- risk of pulmonary hypertension.
- ANA positive in 90% all types.
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anti Scl 70 antibody?
also called anti topoisomerase 1
- assocaited with diffuse cutaneous SS. (poor prognosis)
- inc. skin and organ involvement.
- inc. risk of lung fibrosis and renal disease if Ab present therefore.
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management of acute stroke?
- exclude haemorrhage.
- alteplase if within 3 hours.
- aspirin 30mg ASAP
- warfarin if in AF but wait 2 weeks.
- long term treatment = clopi for 12 months post ischaemic. or aspirin + dipyridamole if contraindicated.
- Don't lower BP.
- Start statin if >3.5
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Management of SAH?
- CT to confirm. LP after 12h if nothing found.
- oral nimodipine 4 hourly.
- No anti-fibrinolytics or anticoagulants!
- image cerebral vessels.
- repair aneurysms with endovascular ablation.
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How many squamous cancers can you think of?
- cervical
- skin
- lung
- head and neck
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beta blockers indicated in heart failure?
carvedilol and bisoprolol
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