2014 Flashcards
why does obesity increase risk of clots
promotes a state of chronic inflammation that activates prothrombotic signaling pathways in platelets and other vascular cells
what is virchow’s triad
Virchow's triad = factors that contribute to thrombosiss. hypercoaguability haemodynamic changes (stasis, turbulence) endothelial damage injury/dysfunction
why is pregnancy a risk of VTE
Pregnancy is a state hypercoagulability - alterations of coagulation proteins + increased resistance to the antithrombotic factors (protein C and S)
also venous stasis
4 methods of thromboprophylaxis
mechanical - anti-embolism stockings or intermittent pneumatic compression
pharmacological - LMWH, NOAC
early mobilisation if possible?
what is included in the TWO LEVEL wells score
two level is the one talked about on NICE
active Ca
paralsysis, paresis or recent immooboilsitaion
recently bed ridde
majory surgery within 12 weeks
localised tenderness along deep veous system
entire leg swollen
calf sweeling >3cm than other side
pitting oedema only in symptomatic leg
collateral superficial veins (non-varicose)
previous DVT
what to do with Wells score
> =2 -> proximal leg USS within 4 h. if -ve -> d dimer
OR
d dimer and intermim 24 hr dose of parenteral anticoag if proximal USS not carried out within 4 hr. then do USS within 24 h
if <2 -> d dimer. if positive go to above
when to follow up the proximal leg vein USS if positive D dimer but -ve proximal elg vein USS
6-8 days
score for PE vs DVT
PE 2 level PE wells score
DVT 2 level Wells score
what is in the 2 levfel PE Welss score
clinical features of DVT alternative diagnosis less likely than PE hr >100 immobilisation for >3 days surgery in previous 4 wk hx VTE haemoptysis malignancy
what to do with PE score
> 4 = immediate CTPA or immediate interim parenteral anticoag followed by CTPA if it cannot be carried out immediately
if =<4 -> d dimer. if positive go to above
4 things to measure before prescribing LMWH
U+E + eGFR
weight
fbc - for platelets??
idk what last thing? clotting?
MOA of DOACs
reversible direct inhibitor of factor Xa
2 genetic mutations in Down’s
Robertsonian translocation (2-4%) - long arm of chromosome 21 is attached to another chromosome, often chromosome 14.
trisomy 21
GI malformations in Down’s
- duodenal atresia
- imperforate anus
- tracheoesophageal fistula (think if bubbling up milk feeds, frequent choking)
what does ABCDE stand for
asymmetry border irregularity colour diameter >6 evolving shape, colour, size
risk factors malignant melanoma
sun/UV exposure dysplastic naevi (atypical moles) lentigo maligna fhx hx immunosuppressed skin type 1
what skin cancer does phototherpay for psoriasis put you at risk of
BCC
risk factors for vid d deficiency
insufficient sunlight
malabsorption e.g. coeliac, IBD
CKD
describe vitamin d metabolism
light skin vitamin d3 liver 25 hydroxyvitamin d kidneys 1, 25 DIhydroxyvitamin D kidneys
= –>
obviously 1,25 DI - remember chemistry. if there are to OH attached it becomes di
effect of vitamin D on bone
INDIRECT
-increase Ca intestinal absorption, slight increase in kidney resorption –> more Ca deposited in bone because increase Ca in blood
also moves Ca out of bone by increasing number of osteoclasts (but this is less obvious)
why does vit d deficiency cause undermineralisation
normal mineralisation depends on availability of ca an phos
vitamin d is essential for normal absorption of ca from the gut
insufficiency of either ca or vit D can lead to prolonged secondary hyperparathyroidism
risk factors for gout
male thiazides CKD obesity psoriasis diabetes HF high alcohol consumption chemo CHD HTN
gout triggers
stress
illness
why does gout affecft distal joints
lower temperature
lower pH
subject to more trauma
uric acid crystalises more easily due to the above
