17/10/21 Flashcards
Evaluation of osteoporosis is based on what measurement?
- The evaluation of osteoporosis is based on the lower T-score of either the lumbar spine, femoral neck or total hip
Relationship between thyroid disease and lithium?
- lithium can cause goitre and hypothyroidism
- TSH and AntiTPO antibody titres should be conducted prior to lithium treatment commencement
- TFTs shold be reevaluated every 6-12 months for several years.
Investigations in EBV (3 points + 1 bonus)
- Infectious mononucleosis (IM) test → heterophile antibody test or monospot test)
- if negative → repeat as test can be negative early in illness
- Epstein-Barr Virus Serology to confirm diagnosis
- FBE → lymphocytosis
Antibiotics in EBV? What happens?
- DO NOT prescribe antibiotics for EBV as if rash can result from ABx given to patient with EBV infection. Note that this is not a penicillin hypersensitivity.
Clinical Features of EBV? (8 points)
Presents with severe sore throat → purulent or exudative
Other clinical features:
- fever, nausea, lymphadenopathy, splenomegaly, hepatomegaly, rash and fatigue
Random complication of EBV. What practical implications does this have?
- Splenic Rupture → care when palpating the spleen and contact sports should be avoided in first 3 weeks.
Investigations in the context of Hereditary Haemochromatosis. (2 points)
- Recommended in individuals with suspected iron overload (ferritin >200 in females and >300 in males) and a transferrin saturation >45%
Cascade testing → all first degree relatives with HHC who are C282Y homozygous or C282Y/H63D compound heterozygous
Multi-organ consequences of Fe Overload secondary to Hereditary Haemochromatosis.
- Liver Fibrosis + Liver Cirrhosis
- Hepatocellular Carcinoma
- Cardiac Arrhythmias + Cardiomyopathy
- Diabetes
- Arthropathy
- Hypogonadism
- Skin Hyperpigmentation
Signs and Symptoms of Testicular Torsion (5,3 points
Symptoms
- Sudden Onset
- Severe Pain
- Associated Nausea and Vomiting
- Associated Trauma
- Possible Abdominal Pain
Signs
- Asymmetric, high-riding testes
- Negative Prehn’s Sign
- Absent Cremasteric Reflex
Investigations and Management of Testicular Torsion
Investigations
Bloods, U/S + Doppler U/s → NOT USEFUL IN ACUTE SETTING
U/S should only be considered after surgical assessment → only if a testicular torsion or irreducible hernia have been excluded then consider U/S.
Management
Immediate surgical exploration with detorsion (or orchidectomy) and fixation of both testes
Causes of Hyperkalaemia (6 categories)
- Pseudohyperkalaemia → haemolysis, blood sample handling error, thrombocytosis, extreme leucocytosis
- Kidney Failure → reduced potassium excretion
- Fluid Volume Depletion → reduced potassium excretion (secondary to reduced distal tubular water and sodium delivery)
- Hypoaldosteronism → hyporeninaemia (diabetes, interstitial kidney disease), primary adrenal insufficiency, adrenal enzyme defects, heparin, HIV, resistance to aldosterone action
- Drug-Induced - potassium-sparing diuretics, NSAIDs, potassium supplements, trimethoprim, ACEi, ARBs, pentamidine, cyclosporin
- Increased K+ release from cells → metabolic acidosis, insulin deficiency, tissue damage, rhabdomyolysis
Red Flags with Haematospermia (4 points)
- Patients Age ≥40yo
- Recurrent or Persistent Haematospermia
- Prostate Cancer Risk
- Constitutional Symptoms - weight loss, anorexia, bone pain
Causes of Haematospermia (7 points, give 4)
- Urinary Tract infection
- Sexually Transmitted Infection
- Prostatitis → pain on ejaculation
- Recent urological procedure
- Prolonged sexual intercourse or masturbation
- History of TB or schistosomiasis
- Anticoagulation or presence of bleeding disorders
Baseline investigations of haematosptermia (4 poitns)
Urine MCS
Urine Cytology
FBE
Coagulation Studies
Risk Factors for B12 Deficiency (3 points)
- autoimmune gastritis aka pernicious anaemia
- gastrectomy or significant small bowel resection or bariatic surgery
- vegan diet
Discuss relationship between Transcobalamin and B12.
Transcobalamin II → binds Vit B12 to form a complex called Holotranscobalamin (HoloTC) aka Active-B12
- HoloTC fall in B12 deficiency → therefore HoloTC can identify low Vit B12 status before total serum Vitamin B12 levels drop
What is pernicious anaemia?
Pernicious Anaemia → B12 deficiency caused by autoantibodies that interfere with Vitamin B12 absorption by targeting intrinsic factor (IF), gastric parietal cells or both.
Clinical Manifestation of B12 Defiency (4 categories, 12 individual points, give 4)
Haeamatologic
- Megaloblastic Anaemia
- Pancytopenia → leukopenia, thrombocytopenia
- Pernicious Anaemia → large immature RBC
Neurologic
- Parasthesias
- Peripheral Neuropathy
- Combined Systems Disease
Psychiatric
- Irritability + Personality Change
- Mild Memory Impairment + Dementia
- Depression
- Psychosis
- Alzheimer’s Disease
Cardiovascular
- Possible Increased Risk of MI
Treatment of B12 Deficiency
Hydorxycobalamin 1mg IM on alternate days for 2 weeks for severe anaemia or neurological symptoms
- can use less intesive therapy for patients without severe anaemia
Maintenance Therapy
- Hydroxycobalamin 1mg IM once every 2-3 minths
Causes of Salivary Gland Swelling (5 categories)
Inflammatory Causes → acute bacterial or viral (mumps, coxsackievirus, EBV) illnesses, Chronic infections, Sjögren Syndrome
Obstructive Causes → stones, trauma, mucus retention
Metabolic Causes → obesity, hypothyroidism, alcoholic liver disease, malnutrition
Tumours → Benign or Malignant
Drug or Food Hypersensitivity
Risk Factors for formation of salivary gland stones. (4 points)
- Dehydration
- Diuretics
- Anti-cholinergic Medication
- Trauma
Diagnosis of Sialalithiasis. DDx and clinical features.
DIagnosis
- characteristic history of swelling and pain associated with eating or anticipation of eating
- small rock hard mass palpable in the salivary gland or duct or visible at the os
DDx
- Acute Bacterial Sialadenitis → purulent discharge and systemic symptoms
Management of sialadenitis. (4 steps)
- Conservative Management → well hydrated, apply moist heat to area, massage the gland + milk the duct, suck on tart, hand candy to promote salivary flow
- Manage pain with NSAIDs - If concerned re: secondary infection → treat with antistaphylococcal ABx → dicloxacillin 500mg QID or cefalexin 500mg QID for 7-10/7
- if no improvement with conservative measures → for referral to ENT for sialoendoscopy (minimally invasive)
- if recurrent stones → consider sialadenectomy
Causative pathogens for Postpartum Endometritis
Usually a polymicrobial infection
- if late-onset endometritis (occuring more than 7 days after delivery) → suggests chlamydia trachomatis infection
Clinical Presentation of Postpartum Endometritis (4 points)
- Fever (>38)
- Lower Abdominal Pain
- Uterine Tenderness
- +/- purulent vaginal discharge
Severe vs Nonsevere Postpartum Endometritis. Management of Non-Severe Endometritis and Severe Endometritis.
- *Nonsevere Postpartum Endometritis** - no fever or other systemic features, localised infection
- amoxicillin + clavulanate 875+125mg BD for 7/7
- if hypersensitivity to penicillins → trimethoprim + sulfamethoxazole 160+800 PO BD for 7/7 + metronidazole 400mg BD for 7/7
Severe Postpartum Endometritis - systemic features, sepsis or septic shock
Start ABx within 1/24 of presentation to medical care
For uncomplicated infections:
- continue IV ABx for at least 24-48 hours after resolution of leucocytosis and resolution of clinical signs and symptoms (fever, uterine tenderness, purulent vaginal discharge)
For complicated infections → may require longer course of IV therapy with switch to oral therapy as needed once patient is stable.
