5/11/21 - 6/11/21 Flashcards
Differential Diagnosis of EBV (3 points)
- Group A Strep (unlikely to cause splenomegaly)
- CMV infection
- Acute HIV Infection
- Lymphoma or Leukaemia
- Toxoplasmosis
- Medication Induced - anticonvulsants such as phenytoin, carbamazepine, antibiotics such as isoniazid or minocycline
Clinical Manifestations/Complications of EBV (name 5)
- Can affect any organ system:
- pneumonia, myocarditis, pancreatitis, mesenteric adenitis, myositis, glomerulonephritis, genital ulceration
- Neurological Syndromes → Guillain-Barré Syndrome, Idiopathic Facial Nerve (Bell) Palsy, Meningoencephalitis, Aseptic Meningitis, Transver Myelitis, Peripheral Neuritis, Optic Neuritis
- Haematologic Abnormalities → Haemolytic Anaemia, Thrombocytopenia, Aplastic Anaemia, Thrombotic Thrombocytopenic Purpura/Haemolytic-Uremic Syndrome, Disseminated Intravascular Coagulation
- Airway Obstruction secondary to massive lymphoid hyperplasia and mucosal oedema
- Splenic Rupture → care when palpating the spleen and contact sports should be avoided in first 3 weeks.
- Chronic Active EBV Infection → rare, life-threatening lymphoproliferative disorder
- Oral Leukoplakia
Management of EBV (6 points)
- Supportive Measures → no specific treatment
- Rest → note that post-EBV, some young adults can remain debilitated and depressed for some months. Lassitude and malaise can extend up to a year or so.
- NSAIDs + Paracetamol
- Gargle soluble aspirin or 30% glucose to soothe the throat
- Advise against → alcohol, fatty foods, continued activity (contact sports - risk of splenic rupture)
- Corticosteroids reserved only for complications → if impending airway obstruction
Management points for Chlamydia (5 points)
- ABx - doxycycline 100mg BD for 7/7
- Contact Tracing for 6 months
- No sex with partners for the last 6 months until they have been treated and tested
- NO TEST OF CURE UNLESS PREGNANT OR RECTAL CHLAMYDIA
- Test of re-infection at 3 months
Differential Diagnoses for a DVT (6 points)
- MSK injury
- Lymphangitis or Lymph Obstruction
- Venous Insufficiency
- Baker’s Cyst
- Cellulitis
- Knee Pathology
Wells Score for DVT (criteria to do U/S)
- Active Cancer - Treatment of Palliation within 6 months
- Bedridden recently >3 days or major surgery within 12 weeks
- Calf Swelling >3cm compared to other leg
- Collateral (non-varicose) superficial veins present
- Entire leg swollen
- Localised tenderness along the deep venous system
- Pitting oedema - confined to symptomatic leg
- Paralysis, paresis or recent plaster immobilisation of the lower extremity
- Previous DVT
- Alternative diagnosis to DVT as likely or more likely (-2 points)
When is anticoagulant treatment required for distal DVT?
- There is thrombus extension more than 8cm
- The Thrombus involves a different vein
- The Thrombus extends into a proximal vein
Options for treatment of DVT and PE?
- apixaban 10mg PO BD for 7/7 then decrease to 5mg BD
- rivaroxiban 15mg PO BD for 21/7 then decrease to 20mg daily
How long do we treat a DVT or PE for?
- 6 weeks for provoked distal DVT
- at least 3 months for unprovoked distal or proximal DVT, for provoked proximal DVT and for PE
- 3 months for pr
In provoked distal DVT, other than anticoagulant therapy, are there any other options for management?
U/S surveillance if the patient is a high risk of bleeding with anticoagulant therapy
- 2-3 U/S over the 2 weeks following diagnosis → to detect and measure possible thrombus extension
When adjudging whether a DVT/PE is provoked or not, what circumstances count as provoking events?
Provoking Factors → major surgery, hospitalisation with immobilisation, oestrogen therapy, pregnancy and post-partum period
How do you manage post-thrombotic syndrome?
Wearing graduated compression stockings may reduce the risk of developing post-thrombotic syndrome and if patients do develop post-thrombotic syndrome, the stockings will reduce the patient’s symptoms
- Pressure → 30-40mmHg at the ankle and extend to just below the knee
Management of an Anal Fissure (5 points, Be Specific)
- Fibre
- Warm Sitz Baths
- Topical Analgesics
- Stool Softener
- Topical Vasodilators
- Topical Nifedipine Ointment 0.2-0.3% 2-4 times daily. Side effects: headache and hypotension
Diagnosis and Locations and Timeframe of Anal Fissure.
Located in the posterior midline of the anal canal in 90% of patients, anterior midline in 25% of female and 8% of male patients, and both anterior and posterior in 3% of patients. If fissures arise in atypical or lateral locations → raise suspicion for secondary aetiology.
Diagnosis is confirmed on physical examination by either directly visualising a fissure or by reproducing the patient’s presenting complaints (anal pain) by gentle DRE.
Acute Fissure (<8 weeks) → superficial tear Chronic Fissure (>8 weeks) → hypertrophied with skin tags and/or papillae
Probability Diagnosis of Low Back Pain? 3 points)
- Vertebral Dysfunction - non-specific lower back pain
- Musculoligamentous Strain/Sprain
- Spondylosis (degenerative OA)
