Additional Conditions

Question 1

Glandular Fever (Infectious Mononucleosis/ EBV)

Pathophysiology 
Risk Factors
Clinical Features
Investigations
Management 
Complications

Answer 1

1.) Pathophysiology - EBV infection, causing infection of B cells –> T cell activation

2. ) Risk Factors
   - young (15+), HIV (reactivates latency), immunosuppressed,
3. ) Clinical Features - lasts 4-7 weeks
   - sore throat, fever, ↓appetite, headache, malaise
   - lymphadenopathy (posterior cervical)
   - splenomegaly (3-8wks), hepatomegaly
4. ) Investigations
   - throat swab (exclude strep throat)
   - EBV viral serology, blood film (atypical lymphocytes)
   - Paul Bunnell test (sensitive antibody test)
   - FBC, LFTs (raised), HIV test
5. ) Management - self-limiting (4-7 weeks)
   - analgesia, hydration avoid Abx, steroids (severe)
   - avoid contact sports due to splenomegaly (3-8wks)
   - avoid close physical contact (can still work/school)
   - avoid alcohol as can worsen symptoms
   - follow-up to ensure resolution of acute symptoms
6. ) Complications
   - depression, thrombocytopenia, splenic rupture
   - viral meningitis, G-B syndrome, nasopharyngeal carc..
   - lymphoma: Burkitt’s, Hodgkins, gastric

Question 2

Migraines

Risk Factors
Clinical Features
Management
Referral

Answer 2

1. ) Risk Factors
   - young (onset <30), female, family history
   - triggers: light, sound, stress, lack of sleep, menstrual cycle, certain foods
2. ) Clinical Features
   - unilateral headache, pulsating/throbbing in nature
   - can be moderate to severe, lasting 4-72hrs
   - associated sx: photophobia, phonophobia, N+V
   - aura: transient focal neuro sx before or with the headache visual (zigzag lines, scotoma), paraesthesia
3. ) Management
   - avoid triggers, lifestyle changes
   - simple analgesia +/- triptan, anti-emetic if needed
   - preventative treatment if frequent or prolonged and not pregnant or breastfeeding (propranolol, topiramate)
   - headache diary: identify triggers, monitor treatment
4. ) Referral
   - serious cause of headache e.g. SOL,
   - migraine lasting for more than 72 hours
   - atypical sx, optimum treatment has failed

Question 3

Hypercholesterolaemia

Causes
Investigations
Management

Answer 3

1. ) Causes
   - familial hyperlipidaemia
   - obesity, alcohol excess, Anorexia Nervosa
   - chronic renal failure, uncontrolled hypothyroidism
   - medication: thiazide diuretics, ciclosporin
2. ) Investigations
   - lipid profile (requires fasting for >12hrs): TC >5mM
   - U+Es, LFTs: renal/hepatic impairment can be a cause
   - TFTs: hypothyroidism can increase cholesterol
   - fasting glucose: poorly controlled diabetes
3. ) Management
   - lifelong medication: atorvastatin or ezetimibe
   - total fat intake <30% of total energy intake
   - stop smoking, exercise 5 times a week

Question 4

5 features of using statins to reduce cholesterol levels

Drug Names x2
Drug Differences x2
Mechanism x2
Side Effects x3
Contraindications/Caution x3

Answer 4

1. ) Drug Names - atorvastatin and simvastatin
   - others: fluvastatin, pravastatin, rosuvastatin, lovastatin
2. ) Drug Differences
   - simvastatin is a prodrug and has a short half-life (2h)
   - atorvastatin is newer, has a much longer half-life (30h)
3. ) Mechanism - inhibition of HMG-CoA reductase
   - ↓intracellular cholesterol → synthesis of LDL receptors
   - promotes uptake/clearance of circulating LDLs
   - ↓intracellular cholesterol also ↓ secretion of VLDLs
4. ) Side-Effects
   - GI upset, nausea and headache
   - asthenia: physical weakness or lack of energy
   - myalgia (CPK > 10x normal) and rhabdomyolysis
   - development of diabetes
5. ) Contraindications/Caution
   - renal or liver impairment
   - pregnancy/breastfeeding (3mths before conceiving)
   - CYP3A4 inhibitors: macrolides e.g. clarithromycin, diltiazem, amiodarone, amlodipine, grapefruit, St John’s Wort

Question 5

4 features of prescribing statins

Primary Prevention
Secondary Prevention
Time Taken
Target x2

Answer 5

1. ) Primary Prevention - QRISK of >10%
   - atorvastatin (20mg) once daily
2. ) Secondary Prevention - had major CHD
   - HDL:LDL ratio is most important in determining
   - atorvastatin (80mg) once daily
3. ) Time Taken - taken at night
   - LDL receptor activity/synthesis increases at night
   - short half-life of simvastatin

4.) Target - < 2mM of LDL, <4mM of total cholesterol