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GP Academy > 07. AKT: Cancer/Heart > Flashcards

07. AKT: Cancer/Heart Flashcards

1
Q

What are some clinical manifestations of Marfan’s syndrome?

A
  • Aortic disease: aortic root disease, leading to aneurysmal dilatation, aortic regurgitation, aortic dissection
  • Cardiac: mitral valve prolapse
  • Skeletal findings: excess linear growth of the long bones and joint laxity, arachnodactyly, pectus carinatum
  • Ectopia lentis
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2
Q

Which class of antihypertensive is contraindicated in bilateral renal artery stenosis?

A

Angiotensin II receptor blockers

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3
Q

What are first line statin therapies for primary and secondary prevention of cardiovascular disease?

A
  • Atorvastatin 40 to 80mg daily PO
  • Rosuvastatin 20 to 40mg daily PO
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4
Q

What are the different diagnostic criteria for hypertension?

A
  • Clinic BP: S > 140 and/or D > 90
  • ABPM awake: S > 135 and/or D > 85
  • ABPM asleep: S > 120 and/or D > 70
  • ABPM 24 hours: S > 130 and/or D : 80
  • Home BP: S > 135 and/or D > 85
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5
Q

What are some indications for using ambulatory blood pressure monitoring?

A
  • Suspected white-coat hypertension
  • Hypertension despite appropriate treatment
  • Suspected episodic hypertension
  • Patients with a high risk of future cardiovascular events (even if clinic BP is normal)
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6
Q

Which blood pressure measures are recommended to be used in absolute CVD risk calculators?
- Clinic BP
- Home BP
- Ambulatory monitoring BP

A

Clinical blood pressure - due to risk of underestimation with other measures

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7
Q

What do you need to ensure for an accurate ambulatory blood pressure monitor dataset?

A
  • Atleast 2 measurements per hour during waking hours AND
  • Average consists of at least 14 daytime measures AND
  • 70% of readings obtained over 24 hour period
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8
Q

What is the definition of a “non-dipper” on ambulatory blood pressure monitoring and what is the significance?

A
  • Mean night-time systolic ambulatory blood pressure should be at least 10% lower than the daytime level
  • Non-dippers do not show a night-time lowering of blood pressure and are at increased CVD risk
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9
Q

What are the preferred DOACs for VTE treatment?

A
  • Apixaban 10mg BD PO for 7 days and then 5mg BD PO or
  • Rivaroxaban 15mg BD PO for 21 days and then 20mg daily PO
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10
Q

What are suggested timeframes for anticoagulant therapy for acute VTE in the following clinical situations?:
- Proximal DVT or PE that was unprovoked or associated with a transient (nonsurgical) risk factor
- DVT or PE associated with active cancer
- Proximal DVT or PE caused by major surgery or trauma that is no longer present
- Distal DVT that was unprovoked
- Distal DVT caused by a transient provoking factor

A
  • Proximal DVT or PE that was unprovoked or associated with a transient (nonsurgical) risk factor: 3 to 6 months and consider extended therapy
  • DVT or PE associated with active cancer: 3 to 6 months and consider extended therapy
  • Proximal DVT or PE caused by major surgery or trauma that is no longer present: 3 months
  • Distal DVT that was unprovoked: 3 months
  • Distal DVT caused by a transient provoking factor: 6 weeks
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11
Q

Order the options for angina prevention in terms of preference

A
  1. Beta blockers/Non-dihydropyridine calcium channel blockers
  2. Dihydropyridine calcium channel blockers
  3. Long acting nitrates
  4. Nicorandil
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12
Q

When should diltiazem or verapamil (non-dihydropyridine calcium channel blockers) be avoided?

A

Left ventricular dysfunction (ejection fraction < 40%)

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13
Q

What are some factors that increase the risk of statin-related adverse effects?

A
  • Pre-existing muscle, liver or kidney disease
  • Acute kidney injury (rosuvastatin)
  • High dose or high potency statin therapy
  • Concurrent drugs that cause myopathy (e.g. colchicine, gemfibrozil) or inhibit the metabolism of statins (e.g. amiodarone, diltiazem, clarithromycin)
  • Concurrent illness
  • Frailty and advanced age
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14
Q

What are some modifiable predisposing factors for muscle symptoms with statins?

A
  • Arthritis
  • Alcohol consumption
  • Diabetes
  • Hypothyroidism
  • Obesity
  • Strenuous exercise
  • Significant vitamin D deficiency
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15
Q

What are some features suggestive of statin-related muscle symptoms?

A
  • Bilateral pain
  • Aching or stiffness (rather than shooting pain or cramping)
  • Pain located in the large muscle groups (e.g. thighs, buttocks)
  • Onset 4 to 6 weeks after starting or increasing the dose of a statin
  • High-dose or high-potency statin therapy
  • Elevated serum CK concentration that decreases with statin withdrawal
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16
Q

Management of elevated triglycerides?:
- Mild (4mmol/L or less)
- Moderate (4mmol/ or more)
- Severe (>10mmol/L)

A
  • Mild: Statin, if not responding to non-drug measures
  • Moderate: Statin + fish oil +/- fenofibrate, if not responding to non-drug measures
  • Severe: Statin + fenofibrate + fish oil + non-drug measures
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16
Q

What is the blood pressure target for patients wtih diabetes and albuminuria/proteinuria?

A

<130/80mmHg

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16
Q

Which antihypertensive classes receive the rate of progression of albuminuria?

A
  • Angiotensin receptor blockers
  • Angiotensin converting enzyme inhibitors
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16
Q

Do fibrates improve cardiovascular outcome?

A

They do not, but may prevent progression to severely elevated triglycerides and the associated risks (e.g. pancreatitis)

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16
Q

What are the ideal conditions for screening of primary aldosteronism?

A
  • Ideally tested before starting antihypertensives
  • If on therapy, use verapamil SR, prazosin, moxonidine and/or hydralazine for atleast 6 weeks
  • Ensure normokalaemia
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17
Q

What is the most common cause of secondary hypertension?

A

Primary aldosteronism

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18
Q

When should renovascular hypertension be considered?

A
  • Significant hypertension before 30yo
  • Significant decline in renal function after ACEi
  • Hypertension with significant renal size asymmetry
  • Accelerated and severe progression of hypertensive state
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19
Q

Which clincial situations would you suspect and test for primary aldosteronism?

A
  • Sustained BP > 150/100mmHg on 3 different measurements
  • Hypertension resistant to three conventional antihypertensives
  • Controlled BP on 4 or more antihypertensives
  • Hypertension and spontaneous or diuretic-induced hypokalaemia
  • Hypertension and adrenal incidentaloma
  • Hypertension and sleep apnoea
  • Hypertension and a family history of early-onset hypertension or stroke at a young age (<40 years)
  • All hypertensive first degree relatives of a patient with primary aldosteronism
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20
Q

When should bupropion be considered for treating tobacco smoking and nicotine dependence?

A
  • Cannot tolerate varenicline or combination NRT or found them ineffective
  • Require concomittant treatment for depression
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21
Q

Contraindications for use of bupropion?

A
  • History of seizures
  • Eating disorders
  • On monoamine oxidase inhibitors
  • During abrupt withdrawal from alcohol or benzodiazepines (because seizure risk may be increased)
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22
Q

Management of oedema caused by dihydropyridine calcium channel blockers?

A

Combination of:
- Reduction in dose and/or
- Switch to non-dihydropyridine calcium channel blocker and/or
- Add RAS-blocking agent (venodilation helps reduce transcapillary pressure)

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23
Q

What are the definitions for the subclassification of heart failure?

A
  • Heart failure with reduced ejection fraction (LVEF < 41%)
  • Heart failure with mildly reduced ejection fraction (LVEF 41-49%)
  • Heart failure with preserved ejection fraction (LVEF >49%)
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24
Q

Drug classes that improve HFrEF (start all at the same time or within 2 to 4 weeks)

A
  • Renin-angiotensin system inhibitors
    – Angiotensin receptor neprilysin inhibitor
    – Angiotensin converting enzyme inhibitors
    – Angiotensin II receptor blockers
  • Heart failure-specific beta blockers
  • Mineralocorticoid receptor antagonists
  • Sodium-glucose co-transporter 2 (SGLT2) inhibitors
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25
Q

When is sacubitril+valsartan contraindicated in HFrEF?

A

Hypotension

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26
Q

Factors where you would consider reclassifying up a risk category for cardiovascular disease?

A
  • Coronary artery calcium score > 75th percentile for age and sex
  • First Nations people
  • Maori, Pacific Islander or South Asian ethnicity
  • Family history of premature CVD
  • Chronic kidney disease
  • People living with severe mental illness
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27
Q

What is the recommended therapy for individuals with a Coronary Artery Calcium score > 100?

A

Preventative therapy with aspirin and a statin

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28
Q

What are the clinical manifestations of this cause of chest pain?
- Muscle strain

A
  • Tenderness over the affected muscle is present and increases with stretching the muscle (e.g. taking a deep breath)
  • Particularly of the intercostal muscles
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29
Q

What are the clinical manifestations of this cause of chest pain?
- Costosternal syndromes (costochondritis)

A
  • Multiple areas of tenderness that reproduce the described pain, usually in the upper costal cartilages at the costochondral or costosternal junctions
  • There is no swelling
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30
Q

What are the clinical manifestations of this cause of chest pain?
- Tietze syndrome

A
  • Painful, nonsuppurative localised swelling of the costosternal, sternoclavicular, or costochondral joints, most often involving one joint in the area of the second and third ribs
  • Rare, primarily affects young adults
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31
Q

What are the clinical manifestations of this cause of chest pain?
- Lower rib pain syndromes

A
  • Pain in the lower chest or upper abdomen with a tender spot on the costal margin
  • Pain can be reproduced by pressing on the spot
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32
Q

Treatment options for isolated musculoskeletal chest wall pain?

A
  • Reassurance and explanation for all patients
  • Temporarily avoiding aggravating activities
  • Stretching
  • Application of heat for muscle spasm or ice for swelling
  • Simple analgesia
  • Consideration of formal physiotherapy if symptoms persist
  • Injection of local anaesthetic/corticosteroid
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33
Q

Main risk factors for melanoma are?

A
  • Multiple common melanocytic naevi
  • Dysplastic or atypical naevus syndrome
  • Family history of melanoma
  • Blistering sunburns as a child or adolescent
  • History of melanoma or non-melanoma skin cancer
  • Solarium use
  • Fair complexion and a tendency to burn
  • Marked sun exposure (e.g. during work and leisure time) and solar skin damage
  • Immunodeficiency
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34
Q

What are some non-pharmacological management steps for anxiety in palliative care?

A
  • Continuity of care and emotional support
  • Ensuring adequate explanation of current and future treatment needs
  • Addressing specific fears and concerns
  • Specific behavioural interventions for anxiety management (e.g. relaxation techniques)
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35
Q

Management for an individual with average or only slightly higher risk of breast cancer?

A
  • Mammogram every two years from 50 to 74 years of age
  • Breast awareness
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36
Q

Who is at average or only slightly higher risk of breast cancer?

A
  • No confirmed family history of breast cancer
  • One first degree relative diagnosed with breast cancer >/= 50 years of age
  • One second degree relative diagnosed with breast cancer at any age
  • Two second degree relatives on the same side of the family diagnosed with breast cancer >/= 50 years of age
  • Two first degree or second degree relatives diagnosed with breast cancer, aged >/= 50 years, but on different sides of the family
37
Q

Management for an individual with moderately increased risk of breast cancer?

A
  • Mammogram: atleast every two years from 50 to 74 years of age
  • Annual mammograms from 40 years of age may be recommended if the woman has a first degree relative aged <50 years diagnosed with breast cancer
  • Breast awareness
  • Consider referral to family cancer clinic for further assessment and management plan
38
Q

Who is at moderately increased risk of breast cancer?

A
  • One first degree relatived diagnosed with breast cancer <50 years (without the additional features of the potentially high risk group)
  • Two first degree relatives, on the same side of the family, diagnosed with breast cancer (without the additional features of the potentially high-risk group)
  • Two second degree relatives on the same side of the family diagnosed with breast cancer, at least one aged <50 years (without the additional features of the potentially high-risk group)
39
Q

Masculinising hormone therapy in transmen - what are some early changes with testosterone therapy? (<6 months)

A
  • Acne
  • Oily skin
  • Increased libido
  • Increase in clitoral size
40
Q

Masculinising hormone therapy in transmen - what are some changes with testosterone therapy over 6 to 12 months?

A
  • Amenorrhoea
  • Body fat redistribution
  • Muscle growth
  • Increase in body and facial hair
  • Voice deepening
41
Q

Who constitutes high risk for melanoma?

A
  • Previous history of melanoma
  • > 5 atypical (dysplastic) naevi
42
Q

What is recommended for people at high risk of melanoma?

A
  • Skin self examination every 3 months AND
  • Clinical skin examination every 6 months
43
Q

List some sun protection advice.

A
  • Use shade including broad-brimmed or bucket hats
  • Protective clothing
  • Sunglasses
  • Sunscreens with sun protection factor (SPF) >30 (which need to be reapplied every two hours)
44
Q

What is Koebner phenomenon?

A

The appearance of new skin lesions on areas of cutaneous injury in otherwise healthy skin. Psoriasis is the most-researched condition that exhibits the Koebner phenomenon. Plaques exhibiting the Koebner phenomenon can appear on any area of the body, even those not usually involved by psoriasis

45
Q

Factors that aggravate psoriasis?

A
  • Streptococcal tonsillitis and other infections
  • Injuries such as cuts, abrasians, or sunburns (koebnerised psoriasis)
  • Sun exposure in ~10% of psoriasis patients (usually is more often beneficial)
  • Dry skin
  • Obesity, smoking, excessive alcohol
  • Medications e.g. NSAIDs, beta-blockers, lithium
  • Steroid withdrawal rebound (stopping steroids)
  • Other environmental factors such as stressful event
46
Q

Describe the parameters for an excisional biopsy.

A

2mm lateral margin, preferably excised as an ellipse, with a deep margin in the subcutaneous fat, and repaired by primary closure.

47
Q

When should wide local excision be performed when a melanoma is confirmed but some lesion is left behind?

A

Ideally within 4 weeks

48
Q

When should be a melanoma be referred to a multidisciplionary specialist melanoma unit?

A
  1. If the melanoma is greater than 1mm thick OR
  2. Greater than 0.75mm thick with other high risk pathological features (e.g. ulcertation, mitotic rate > 1, Clark level IV or V, lymphovascular invasion)
49
Q

Main risk factors for melanoma are?

A
  • Multiple common melanocytic naevi
  • Dysplastic or atypical naevus syndrome
  • Family history of melanoma
  • Blistering sunburns as a child or adolescent
  • History of melanoma or non-melanoma skin cancer
  • Solarium use
  • Fair complexion and a tendency to sunburn
  • Marked sun exposure (e.g. during work and leisure time) and solar skin damage
  • Immunodeficiency
50
Q

Melanoma warning signs?

A
  • New or changing
  • “Ugly duckling” prominent
  • Rapidly growing
  • Particular concern to the patient
  • Atypical on dermoscopy (e.g. asymmetric pigmentation, blue-white veil, multiple brown dots, pseudopods, radial streaming)
  • Changed on sequential dermoscopy
51
Q

What are the clinical scenarios where beta-blocker therapy greater than 12 months after ACS is most beneficial?

A
  • Ongoing angina/ischaemia
  • Heart failure
  • Left ventricular dysfunction
52
Q

What is erythema nodosum?

A
  • It is a type of panniculitis, an inflamamtory disorder affecting subcutaneous fat.
  • It presents as tender red nodules bilaterally, usually on anterior shins, erupting over one to several weeks
  • Ill-defined, warm, oval, round or arciform, and without ulceration
  • Spontaneously resolve within eight weeks
53
Q

Causes of erythema nodosum?

A
  • Most are idiopathic
  • Infections: throat infections, primary TB, chlamydia, herpes, viral hepatitis, HIV, campylobacter
  • Drugs: Amoxicillin, COCP, NSAIDs, sulfonamides
  • Inflammatory: IBD, sarcoidosis, malignancy, lymphoma, leukaemia
54
Q

Investigations for erythema nodosum?

A
  • Diagnosis is usually clinical
  • Reasonable diagnostic tests: FBC, ESR, EUC, LFT, throat swab, streptococcal serology, chest XR
  • Biopsy is usually not required, but if needed, it needs to be deep and include fat. Biopsy of the lower limbs is usually associated with scarring and slow healing
55
Q

Management of erythema nodosum?

A
  • Bed rest + NSAIDs
  • May assist in recovery: leg elevation, compression bandages and stockings
  • If severe symptoms: prednisolone 25mg daily PO for 2 weeks, then taper dose according to response
56
Q

What is the difference between malingering and factitious disorder?

A
  • Both characterised by deceptive behaviour to simulate an illness
  • Malingering: illness falsification to obtain obvious external benefits such as money, medications, time off work, child custody, or avoiding criminal prosecution
  • Factitious disorder: deception is not fully accounted for by external rewards
  • Additionally, diagnostic and therapeutic procedures (especially those that are painful or invasive) are avoided in malingering but readily accepted in factitious disorder
57
Q

What is conversion/functional neurological disorder?

A
  • Both can involve neurologic symptoms that are inconsistent with neurologic pathophysiology
  • BUT conversion disorder has no evidence of deceptive behaviours or falsification of symptoms
  • Conversion disorder always involves symptoms related to the nervous system but factitious disorder can manifest with symptoms involving any organ system
58
Q

When should you suspect somatic symptom disorder?

A
  • Illness is vague and inconsistent
  • Health care concerns are rarely alleviated despite high utilisation of medical care; provides only temporary relief
  • Multiple courses of standard treatment fail to mitigate the symptoms
  • Attributing normal physical sensations to medical illnesses
  • Repeatedly checking one’s body for abnormalities
  • Unusually high sensitivity to medication side effects
  • Seeking care from multiple doctors for the same somatic symptoms
59
Q

Diagnostic criteria for somatic symptom disorder?

A
  • One or more somatic symptoms that cause distress or psychosocial impairment
  • Excessive thoughts, feelings or behaviours associated with the somatic symptoms
    — Persistent thgouths about the seriousness of the symptoms and/or
    — Persistent, severe anxiety about the symptoms or one’s general health and/or
    — The time and energy devoted to the symptoms or health concerns is excessive
  • Disorder is persistent (usually more than 6 months) but specific somatic symptom(s) may change
60
Q

Which side is a varicocele most commonly found?

A

Left side (left side also usually hangs lower)

61
Q

If a pregnant woman is due for her cervical screening test, when can it be done?

A
  • Anytime with the right sampling equipment
  • An endocervical brush should not be inserted into the cervical canal because of the risk of associated bleeding
  • Self-collection of a vaginal swab for HPV testing can be offered, with counselling about the small risk of bleeding
  • If HPV is detected -> advise for a healthcare professional collected cervical sample for LBC
  • Cyto-broom is recommended for use in pregnant women, NOT endocervical brush
62
Q

What is the recommended management of high-grade squamous intraepithelial lesions (HSIL) during pregnancy?

A
  • Conservative management of HSIL is recommended during pregnancy
  • Colposcopy is performed to exclude the presence of invasive cervical cancer, to confirm the presence of pre-invasive disease and reassure the pregnant woman that it is safe to continue with her pregnancy
  • When HSIL is diagnosed during pregnancy, treatment can be delayed until after delivery because progression of cervical intraepithelial neoplasia (CIN) to invasive disease during pregnancy is rare, with a range of 0-3% of cases
  • Postpartum regression of CIN lesions is common
63
Q

In the context of acute injury, when is an ankle x-ray required (Ottawa rule)?

A

Any pain in the malleolar zone and:
- Bone tenderness at the posterior edge or tip of the lateral malleolus OR
- Bone tenderness at the posterior edge or tip of the medial malleolus OR
- An inability to bear weight both immediately and in the emergency department for four steps

64
Q

In the context of acute injury, when is a foot x-ray required (Ottawa rule)?

A

Any pain in the midfoot zone and:
- Bone tenderness at the base of the fifth metatarsal OR
- Bone tenderness at the navicular OR
- An inability to bear weight both immediately and in the emergency department for four steps

65
Q

What is average weight gain in the first year of life for an infant?

A
  • 0 to 3 months: 150-200g/week
  • 3 to 6 months: 100-150g/week
  • 6 to 12 months: 70-90g/week
66
Q

Is there a difference between defecating frequency for breastfed vs bottle-fed babies?

A
  • Breastfed babies may have a poo following each feed, or only one poo each week
  • Bottle-fed babies and older children will usually have a poo at least every 2-3 days
67
Q

When do you refer an umbilical hernia for repair in infants?

A
  • 2 years of age (if still present) OR
  • Parental anxiety at the large size in infancy
  • Incarceration is very rare in childhood
68
Q

When is esotropia normal in a child?

A
  • When esotropia is intermittent/variable and before 3 months of age
69
Q

What is the blood pressure aim for all patients with chronic kidney disease?

A

< 130 / 80mmHg

70
Q

What organisms cause protracted bacterial bronchitis?

A
  • Nontypeable Haemophilus influenzae
  • Streptococcus pneumoniae
  • Moraxella catarrhalis
71
Q

Clincal features of protracted bacterial bronchitis?

A
  • Cough longer than 4 weeks
  • Cough is an isolated symptom, and child is otherwise well
  • Cough is wet or moist, with a rattly sound
  • Cough is present day and night; it worsens when changing posture
  • Coughing episodes can cause shortness of breath
72
Q

Management of protracted bacterial bronchitis?

A
  • Amoxicillin + clavulanate Q12hourly for 2 weeks
  • If symptoms improve, it confirms the diagnosis. Complete the full 2 week course because symptoms often return if the course is shortened
  • If the cough does not resolve within 2 weeks, extend antibiotic therapy for a further 2 weeks (4 weeks total duration)
73
Q

Complication of Kawasaki’s disease?

A

Coronary artery aneurysms

74
Q

Diagnostic criteria for Kawasaki’s disease?

A

Presence of prolonged unexplained fever >/= 5 days (fever > 38.5C) with at least 4 of the following criteria:
- Bilateral non-exudative conjunctivitis
- Polymorphous rash
- Cervical lymphadenopathy (at least 1 lymph node > 1.5cm in diameter)
- Mucositis - cracked red lips, injected pharynx or strawberry tongue
- Extremity changes - erythema of palms/soles, oedema of hands/feet (acute phase), and periungal desquamation (convalescent phase)

75
Q

Clinical presentation of chicken pox?

A
  • Short prodrome of fever, lethargy and anorexia followed by eruption of rash over the next 3-5 days
  • Rash: crops of small papules, quickly becomes vesicular and then crust over after vesicles have ruptured
76
Q

If you were suspecting a PE, what scores/rules could you apply?

A
  • Well’s score
  • PERC rule (used when low risk Well’s)
77
Q

Management choice for moderate to severe traveller’s diarrhoea without fever or bloody stools?

A
  • Rehydration
  • Azithromycin 1g PO STAT +/- antimotility drugs
78
Q

Management choice for moderate to severe traveller’s diarrhoea with fever or bloody stools?

A
  • Rehydration
  • Azithromycin 1g PO STAT and then 500mg daily for 2 days afterwards
79
Q

Differentials for flashes and floaters?

A
  • Retinal tear or detachment
  • Vitreous haemorrhage
  • Posterior vitreous detachment
  • Diabetic vitreous haemorrhage
  • Migraine
80
Q

Symptoms of vitreous haemorrhage?

A
  • Painless unilateral floaters or visual loss
  • Significant haemorrhage will affect acuity and visual fields
  • Vision worse in the morning (blood settled in the back, covering the macula)
81
Q

Indications for ophthalmologist referral for chlamydial conjunctivitis?

A
  • Pain
  • Photophobia
  • Reduced vision

Reason: corneal complications

82
Q

Complications of GORD?

A
  • Oesophageal ulceration
  • Stricturing
  • Bleeding
  • Metaplasia of the lower oesophageal mucosa
83
Q

Indications for upper GI endoscopy in patients with suspected GORD?

A
  • Alarm symptoms: anaemia, dysphagia/odynophagia, haematemesis or malaena, vomiting, weight loss
  • New symptoms in an older person
  • Changing symptoms
  • Severe or frequent symptoms
  • Inadequate response to treatment
  • Atypical symptoms
84
Q

Food restrictions for GORD symptoms?

A
  • High fat meals
  • Alcohol
  • Coffee
  • Chocolate
  • Citrus fruits
  • Tomato products
  • Spicy foods
  • Carbonated beverages
  • Stopping smoking

Only continue with limiting foods if they improve symptoms

85
Q
A
86
Q

When is PPI therapy most effective?

A

When taken 30 to 60 minutes before a meal

87
Q

Clinical features of acromegaly?

A
  • Acral overgrowth (enlarged extremeties e.g. nose, ears, jaws, hands, feet)
  • Increased sweating
  • Frontal bossing
  • Splayed dentition
  • Enlarged tongue
  • Skin tags
  • Oily skin
  • Arthritis
  • Sleep apnoea
  • Impaired glucose tolerance
  • Neuropathy
  • Hypertension
  • Cardiomyopathy
88
Q

How is acromegaly diagnosed?

A
  1. Increased serum growth hormone concentration that does not suppress during an oral glucose tolerance test
  2. Elevated plasma insulin-like growth factor 1 concentration (MOST important; as growth hormone has a pulsed release)
  3. Pituitary MRI (if caused by pituitary adenoma)
89
Q

Symptoms of bacterial vaginosis?

A
  • Malodorous vaginal discharge
  • Thin white or greyish homogenous vaginal discharge
  • Change from a Lactobacillus dominant state to one with high diversity and quantities of anaerobic bacteria
90
Q

Management of symptomatic bacterial vaginosis?

A
  • Metronidazole 400mg BD PO with food for 7 days
91
Q

Diagnostic criteria for bacterial vaginosis?

A

Amsel criteria - atleast 3 of the following features:
- Thin, white, homogenous discharge
- Vaginal fluid pH more than 4.5
- Clue cells (epithelial cells covered with small curved coccobacilli and mixed flora) on a wet preparation of a vaginal swab or Gram-stained smear
- Fishy odour when adding alkali (potassium hydroxide 10%) to discharge

92
Q

Differentials for bacterial vaginosis?

A
  • Candidal vulvovaginitis - itch, pain, red rash on vulva
  • Retained foreign body (e.g. toilet, tissue, tampon, condom)
  • Irritation (e.g. from over washing)
  • Dermatoses
  • Atrophic vaginitis
  • Trichomonas vaginalis
93
Q

Contraindications to oral estrogen or systemic HRT?

A
  • Risk factors for VTE including obesity, smoking, thrombophilia
  • Risk factors for cardiovascular disease including previous cardiovascular disease, insulin resistance, diabetes, obesity, hypertension (even if controlled), smoking
  • Elevated triglycerides
  • Liver disease or gallbladder disease
94
Q
A

GP Academy (23 decks)

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