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Lottie's Question Books > Cases book 3 > Flashcards

Cases book 3 Flashcards

1
Q

Fatigue, malaise, hepatosplenomegaly, trunkal obesity, RUQ pain. Dx?

A

NASH

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2
Q

List risks of NASH

A

Obesity, T2DM, HTN, high cholesterol
Hx rapid weight loss / paraenteral nutrition
LACK OF HEAVY ALCOHOL USE

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3
Q

List Ix and results of NASH

A

LFTs (raised AST, ALT, BR, ALP, GGT)
FBC (low Hb and platelets)
Metabolic and lipid panel
PT and INR

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4
Q

What is gold standard for diagnosing NASH?

A

Liver biopsy and histology

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5
Q

List Mx of NASH in the absence of end stage liver disease

A

Diet and exercise

Insulin sensitiser and statin

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6
Q

List Mx of NASH + end stage liver disease

A

Liver transplant

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7
Q

Sore throat, fever, fatigue, headache, malaise, anorexia, sweating, abdo pain. Dx?

A

Infectious mononucleosis

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8
Q

List signs O/E of mono

A

Creamy exudates on tonsils
Palatal petichae
Splenomegaly
Pyrexia

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9
Q

Ix of mono

A

FBC, LFTs
Blood film
Paul Bunnel / monospot test
IgG EBNA

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10
Q

What does blood film in EBV show?

A

> 20% atypical lymphocytes

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11
Q

Mx of EBV?

A

Bed rest, paracetamol, NSAIDs

Steroids if severe

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12
Q

What happens if given amoxicillin / ampicillin while pt has EBV?

A

Maculopapular rash all over body

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13
Q

What must you advise EBV patient to do for the next 2 weeks?

A

Avoid contact sports - risk of splenic rupture

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14
Q

Non blanching rash is a specific Sx to what?

A

BACTERIAL meningitis

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15
Q

How do viral meningitis Sx compare to bacterial?

A

Viral arent as severe and dont progress as quickly

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16
Q

What must be done prior to LP in meningitis?

A

Exclude raised ICP - otherwise brainstem herniation

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17
Q

Cloudy CSF with high protein and low glucose. Dx?

A

Bacterial meningitis

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18
Q

What cell is predominant in bacterial meningitis?

A

Neutrophils

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19
Q

Clear CSF with high protein and normal glucose. Dx?

A

Viral meningitis

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20
Q

Fibrinous CSF with high protein and low glucose. Dx?

A

TB meningitis

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21
Q

What cell is predominant in viral / TB meningitis?

A

Lymphocytes

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22
Q

What is cor pulmonale?

A

RHF due to chronic pulmonary HTN

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23
Q

List 3 categories for causes of cor pulmonale. Give an example for each

A

Chronic lung disease - COPD
Pulmonary vascular disease - PE
Neuromuscular disease - MG

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24
Q

List signs O/E of cor pulmonale

A

Cyanosis, raised JVP, hepatomegaly, oedema

TR or PR murmurs

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25
Q

Name the types of systemic sclerosis

A

Pre-scleroderma
Diffuse cutaneous SS
Limited cutaneous SS
Scleroderma

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26
Q

Raynauds, skin changes, joint contracture, organ dysfunction. Dx?

A

Diffuse cutaneous SS

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27
Q

Raynauds, nail fold capillary changes, anti nuclear ABs. Dx?

A

Pre-scleroderma

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28
Q

List Sx of limited cutaneous SS?

A

CREST

  • calcinosis
  • raynauds
  • oesophageal dysmotility
  • sclerodactyly
  • telangiectasia
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29
Q

List Sx of scleroderma

A

Internal organ disease, no skin changes

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30
Q

What AB is present in systemic sclerosis

A

anti nuclear AB

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31
Q

Haematuria and proteinuria 1-2 days after sore throat. Dx?

A

IgA nephropathy

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32
Q

Haematuria and proteinuria 1-3 weeks after sore throat. Dx?

A

Post strep GN

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33
Q

Haematuria and proteinuria. Raised urea and creatinine with oliguria. dx?

A

Rapidly progressive GN

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34
Q

Name 3 conditions that can cause rapidly progressive GN

A

Goodpastures
SLE
Vasculitides

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35
Q

Nephrotic syndrome in a child. Dx?

A

Minimal change disease

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36
Q

What causes minimal change disease?

A

GBM damage by T cells

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37
Q

Nephrotic syndrome in an Afro-Caribean HIV+ adult. Dx?

A

Focal segmented glomerular sclerosis

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38
Q

Nephrotic syndrome in an adult with cancer/infection/SLE. Dx?

A

Membranous glomerular disease

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39
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous glomerular disease

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40
Q

Nephrotic syndrome with apple green birefringence on congo red stain. Dx?

A

Amyloidosis

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41
Q

Mx of SVT?

A
  1. Vagal maneouvres
  2. Adenosine + cardiac monitoring
  3. DC cardiovert if haemodynamically unstable
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42
Q

Mx of fast AF?

A
  1. Rate control - beta blockers / digoxin
  2. Rhythm control
    a. ) <48hrs = DC cardiovert OR chemical cardiovert with flecanide or amiodarone
    b. ) >48hrs = anticoagulate (LMWH then warfarin) then cardiovert after 3-4 weeks
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43
Q

Mx of VT in stable pt?

A
  1. IV amiodarone
  2. Look for and treat cause
  3. ICD
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44
Q

Mx of VT in unstable pt?

A

Defibrillate

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45
Q

List the stepwise Mx of T2DM

A
  1. Diet and lose weight
  2. Metformin
  3. Dual therapy (metormin + gliptin / thiazolidinediones / sulfonylureas / gliflozins)
  4. Triple therapy (metformin + sulfonylureas + thiazolidinediones / gliptins)
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46
Q

What can be given if metformin is contraindicated?

A

Gliptin / sulfonylureas / thoazolidinediones

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47
Q

Which drug reduces peripheral insulin resistance?

A

Thiazolidinediones

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48
Q

Which drug stimulates beta cells to release insulin?

A

Sulfonylureas

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49
Q

Which drug is a biguanide that increases cell sensitivity to insulin?

A

Metformin

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50
Q

Which drug inhibits DPP-4 to increase insulin secretion and decrease glucagon?

A

Gliptins

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51
Q

Side effects of metformin?

A

N&V, stomach ache, decreased appetite, metallic taste in mouth

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52
Q

Side effects of sulfonylureas?

A

HYPOGLYCAEMIA

Abdo pain, diarrhoea, nausea

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53
Q

Side effects of thiazolidinediones?

A

Fractures, infections, numbness, change in vision, increased weight

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54
Q

Side effects of gliptins?

A

Headache

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55
Q

List cardiac causes of clubbing

A

Congenital cyanotic heart disease
Atrial myxoma
Bacterial endocarditis
Tetralogy of fallot

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56
Q

List resp causes of clubbing

A 
Lung cancer 
Empyema 
Interstitial lung disease 
Bronchiectasis 
CF
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57
Q

List gastro causes of clubbing

A

IBD
Cirrhosis
GI lymphoma
Coeliac / chronic malabsorption

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58
Q

List other causes of clubbing

A

Thyrotoxicosis or hereditary

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59
Q

Define AKI

A

Acute decline in kidney function leading to raised creatinine and low urine output

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60
Q

List pre renal causes of AKI

A

Hypovolaemia, low BP, renal artery stenosis, sepsis

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61
Q

List renal causes of AKI

A

GN, vasculitides, acute interstitial nephritis, acute tubular necrosis

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62
Q

List post renal causes of AKI

A

Renal calculi, strictures, pelvic cancer, BPH

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63
Q

List Sx / signs of AKI

A 
Metabolic acidosis
Oliguria
Hyperkalaemia 
Uraemia 
HTN 
Anaemia 
Secondary hyperparathyroidism
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64
Q

List Ix of AKI

A 
Metabolic screen (urea, creatinine, LFTs) 
FBC 
U&Es (K) 
Urinalysis 
ECG
CXR
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65
Q

List the 4 steps in AKI Mx

A
  1. Protect against hyperkalaemia
  2. Optimise fluid balance
  3. Stop nephrotoxic drugs
  4. Assess dialysis need
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66
Q

List nephrotoxic drugs

A

ACEi, NSAIDs, gentamicin

NOT BETA BLOCKERS

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67
Q

List indications for dialysis in AKI

A 
Refractory pulmonary oedema 
Persistent hyperkalaemia 
Severe metabolic acidosis 
Uraemia 
Overdose
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68
Q

List Sx of amyloidosis

A

Nephrotic syndrome, renal failure
Restrictive cardiomyopathy, HF, arrhytmia, angina
Neuropathy (inc autonomic), carpel tunnel
Waxy skin, brusining, perioribtal purpura
Shoulder pain, arthritis
Factor X deficiency (bleeding)

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69
Q

List Ix and results of amyloidosis

A

Tissue biopsy for congo red stain (apple green birefringance)
Urine dip (++ protein)
CRP, ESR, U&Es, LFTs, Ig levels

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70
Q

What inheritance pattern in neurofibromatosis?

A

Autosomal dominant

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71
Q

Sx of type 1 neurofibromatosis?

A 
Peripheral and spinal neurofibromas 
Cafe au lait spots 
Axillary freckling 
Optic nerve glaucoma 
Phaeochromocytoma 
Skeletal deformities 
Renal artery stenosis
72
Q

Sx of type 2 neurofibromatosis?

A 
Bilaterl acoustic neuromas 
Gliomas 
Cataracts 
(All schwanomas) 
Hearing loss, tinnitus, change in balance, headache
73
Q

Which chromosomes are affected in neurofibromatosis?

A 
1 = chr 17 
2 = chr 22
74
Q

Which condition is associated with neurofibromatosis type 1?

A

SAH

75
Q

What are erythema nodosum?

A

Inflammation of sub cut fat

76
Q

Describe apperance of erythema nodosum

A

Red/purple domed nodules on shin /thighs
Tender and warm
Systemic Sx

77
Q

List causes of erythema nodosum

A 
LOST BUSH 
Leprosy / leukaemia 
OCP / preg 
Sacroidosis / sulfonamides 
TB / toxoplasmosis 
Behcets 
UC / CD 
Salmonella / strep 
Histoplasmosis
78
Q

List causes of acute pancreatitis

A 
I GET SMASHED 
Idiopathic 
Gallstones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion bite 
Hypercalcaemia / hypothermia / hypertriglyceridaemia 
ERCP 
Drugs - azothrioprine / sodium valproate
79
Q

Sx / signs of acute pancreatitis

A

Severe epigastric pain, radiating to back, relieved on sitting forward
N&V
High HR/RR
Grey Turners / Cullens

80
Q

List Ix for acute pancreatitis with results

A

Amylase / lipase (raised)
FBC (raised WCC), BGC (raised), U&Es, LFTs, CRP
ABG
Abdo USS or erect CXR or AXR or CT

81
Q

What score is used to assess severity in pancreatitis?

A

Modified Glasgow

82
Q

List Mx of acute pancreatitis

A 
Fluids, electrolytes
Analgesia 
Catheter 
ERCP 
Complications & Mx
83
Q

List complications of acute pancreatitis

A

Necrosis, pseudocyst, abcess, ascites, low Ca, psueodaneurysm, VTE, sepsis, DM, chronic pancreatitis

84
Q

Define chronic pancreatitis

A

Chronic inflammation of the pancreas with irreversible parenchymal atrophy and fibrosis leading to impaired end/exocrine function

85
Q

What are the 2 main causes of chronic pancreatitis?

A

Alcohol (70%)

Idiopathic (20%)

86
Q

List PC of chronic pancreatitis

A

Recurrent severe epigastric pain, radiating to back
Worse with alcohol or food
Weight loss, bloating, steatorrhoea

87
Q

List Ix and results for chronic pancreatitis

A 
BGC (raised), amylase (NORMAL), IgG4 (raised) 
Faecal elastase (LOW) 
USS abdo 
ERCP 
CT
88
Q

List Mx for chronic pancreatitis

A

Sx relief - diet changes, avoid alcohol, DM Mx, enzyme replacement
Surgery - Whipples / drainage / resection

89
Q

List complications of chronic pancreatitis

A

Pseudocyst, strictures, obstruction, ascites, carcinoma

DM, low QoL, pain

90
Q

List causes of pancreatic carcinoma

A

Largely unknown

Some familial - MEN / BRCA2 / Peutz-Jeghers

91
Q

List risks of developing pancreatic cancer

A

Male, 60-80y/o

92
Q

List Sx of pancreatic cancer

A

Non specific - anorexia, weight loss, malaise

Later - jaundice, epigastric pain

93
Q

What is the classic finding O/E of jaundice?

A

COURVOISIERS LAW V- painless, palpable gall bladder in jaundiced patient

94
Q

Where in the pancreas are cancers most common?

A

Head/neck

95
Q

What type of cancer of the pancreas is most common?

A

Adenocarcinoma

96
Q

Where does pancreatic cancer spread to?

A

Locally - to liver

97
Q

List Ix for pancreatic cancer

A

CA 19-9
LFTs
USS + FNA
CT / ERCP

98
Q

What is Whipples procedure?

A

Removal of pancreas and duodenum

99
Q

What is the prognosis of pancreatic cancer?

A

Less than 5% 5 year survival

4-6 months median survival post diagnosis

100
Q

What is hydrocephalus?

A

Enlargement of cerebral ventricular system

101
Q

Which type of hydrocephalus has raised ICP?

A

Obstructive

102
Q

What is obstructive hydrocephalus?

A

Impaired outflow of CSF from ventricles

103
Q

What is non obstructive hydrocephalus?

A

Impaired CSF resorption in subarachnoid villi, but with NORMAL ICP

104
Q

What causes obstructive vs non obstructive hydrocephalus?

A

Obstructive = 3rdV/4thV/aqueduct lesion or aqueduct stenosis
Non Ob = tumour, TB, meningitis

105
Q

What is normal pressure hydrocephalus?

A

A type of non obstructive hydrocephalus where there is chronic ventricular enlargement

106
Q

List risks of hydrocephalus in young / old people

A 
Young = congenital or tumours 
Old = stroke or tumours
107
Q

List signs of obstructive hydrocephalus

A

Low GSC or LOC
Diplopia
Papilloedema
CN 6 palsy

108
Q

List signs of non obstructive hydrocephalus

A

Chronic cognitive decline, falls, urinary incontinence, shuffling gait, hyperreflexia

109
Q

Which type of hydrocephalus is chronic / acute?

A

Obstructive = acute

Non obstructive = chronic

110
Q

List Ix for hydrocephalus

A

CT head

LP / ventricular drain to remove CSF - MC&S

111
Q

When can you NOT do an LP in hydrocephalus?

A

Obstructive - raised ICP therefore will get brainstem herniation

112
Q

List risks of developing ascending cholangitis

A

> 50y/o

Hx gallstones / PSC / strictures / biliary surgery

113
Q

List Sx of ascending cholangitis

A

CHARCOTS TRIAD
- RUQ pain, fever, jaundice
Pale stool, pruritus

114
Q

List Ix for ascending cholangitis

A

FBC, urea/creatinine, LFTs
ABG
Abdo USS
ERCP

115
Q

Which Ix is gold standard for ascending cholangitis?

A

ERCP

116
Q

List acute Mx for ascending cholangitis

A

NBM
IV ABx, fluids, analgesia
ERCP

117
Q

What is the definitive Mx for ascending cholangitis?

A

Elective lap chole

118
Q

Define heart failure

A

Inability of CO to meet body’s demands despite normal venous pressures

119
Q

How can heart failure be categorised?

A

High vs low output

Left vs right

120
Q

List causes of low output left heart failure

A

IHD, HTN, cardiomyopathy, aortic or mitral valve problems

121
Q

List causes of low output right heart failure

A

Secondary to LHF, MI, pulmonary HTN, PE, lung conditions, constrictive pericarditis

122
Q

List causes of low output heart failure that can affect both sides

A

Arrhythmia, cardiomyopathy, drugs, toxicity

123
Q

List causes of high output heart failure

A

Anaemia, pregnancy, Paget’s, hyperthyroidism, AV malformation

124
Q

List signs of LHF

A 
High HR, high RR
Bibasal creps 
Displaced apex beat 
S3 
Mitral regurgitation 
Orthopnoea 
Paroxysmal nocturnal dyspnoea
125
Q

List signs of acute LHF

A

Tachypnoea, cyanosis, pulses alternans, S3&S4, wheeze, fine crackles

126
Q

List signs of right heart failure

A 
Raised JVP 
Hepatomegaly 
Ascites 
Pitting oedema 
Tricuspid regurgitation
127
Q

List Ix of acute LHF

A

ABG, troponin, BNP

128
Q

List Ix of heart failure

A

BLOODS: FBC, U&Es, LFTs, CRP, BGC, TFTs, lipids
CXR
ECG
Echo

129
Q

List CXR signs of LHF

A 
Alveolar oedema 
Kerly B lines 
Cardiomegaly 
Upper lobe diversion 
Pleural effusions
130
Q

List immediate complications of acute LHF

A

Cardiogenic shock

Pulmonary oedema

131
Q

List Mx for pulmonary oedema secondary to LHF

A 
Sit UP 
High flow O2 
Diamorphine 
GTN 
IV furosemide
132
Q

List Mx of cariogenic shock secondary to LHF

A

ITU for inotropes

133
Q

List Mx for chronic heart failure

A 
ACEi 
Beta blocker 
Loop diuretics 
Aldosterone antagonist 
ARB 
Digoxin 
\+/- ICD
134
Q

Why do you give ACEi in chronic heart failure?

A

Inhibit RAAS which can worsen hypertrophy

Aids survival

135
Q

Why do you give beta blockers in chronic heart failure?

A

Slow progression of disease and aid survival

Block effects of chronic SNS activation

136
Q

Why do you give ARB in chronic heart failure?

A

If beta blockers and ACEi aren’t enough

137
Q

Which drug do you give in heart failure does not improve survival?

A

Digoxin

138
Q

Which drugs should you avoid in chronic HF?

A

CCB and NSAIDs

139
Q

What causes Wernickes?

A

Thiamine deficiency resulting in biochemical changes to CNS

140
Q

List risks of developing Wernickes?

A

Alcoholics or chronic malnourishment

141
Q

List triad of Sx for Wernickes

A

Opthalmoplegia
Ataxia
Confusion

142
Q

List other Sx you can get as part of Wernickes

A

Memory loss, hallucinations, abnormal reflexes, hypothermia, low BP, weakness

143
Q

List Ix and Mx of Wernickes

A 
Ix = clinical as its a medical emergency 
Mx = IV thiamine
144
Q

List consequences of Wernickes

A

Korsakoffs

145
Q

Ix for Addisons?

A
  1. 9am cortisol
  2. short synacthen test
  3. long synacthen test / anti 21-hydroxylase / CT to find cause
146
Q

What are the results of the Ix for Addisons?

A
  1. 9am cortisol <100

2. short synacthen test <550

147
Q

List Ix and results for congenital adrenal hyperplasia

A
  1. 9am follicular phase 17OH progesterone (raised)
148
Q

List screening Ix for Conns

A

Serum K, Na
Urine K
Plasma aldosterone: renin ratio

149
Q

List positive result for Conns screening Ix

A 
Serum K (low)
Serum Na (normal) 
Urine K (high)  
Plasma aldosterone: renin ratio (high)
150
Q

List Ix and positive result for diagnosing Conns

A 
Salt load (failure to suppress aldosterone) 
CT adrenals
151
Q

List Ix for Cushings

A
  1. Serum K and BGC
  2. 24hrs urinary free cortisol
  3. Low dose dexamethasone suppression test
  4. Plasma ACTH
152
Q

List positive results for Cushings Ix

A
  1. Serum K and BGC –> low K, high BGC
  2. 24hrs urinary free cortisol –> high
  3. Low dose dexamethasone suppression test –> high cortisol still
  4. Plasma ACTH (low)
153
Q

What is high dose dexamethasone suppression test for?

A

Adrenal adenoma (Cushings disease) vs Cushing syndrome

154
Q

List Ix for phaeo

A
  1. 24hr urine cathecholamines / metanephrines

2. CT adrenals

155
Q

List Ix for Carcinoid syndrome

A
  1. 24hr urine 5-HIAA
  2. Plasma chomagraffin A&B
  3. CT / radioisotope
156
Q

List Ix for acromegaly

A
  1. Serum IGF1

2. OGTT

157
Q

List Ix for DI

A
  1. Urine and plasma osmolality
  2. Water deprivation test (to diagnose)
  3. High dose desmopresin (cranial vs nephrogenic)
158
Q

Flank pain, myalgia, flu like Sx, fever, N&V, LUT Sx. Dx?

A

Pyelonephritis

159
Q

List risks of developing pyelonephritis

A 
PMH UTIs 
DM 
Stress incontinence 
Pregnancy 
Immunosuppression 
Anatomical abnormality
160
Q

List Ix for pyelonephritis

A

Urinalysis
Urine MC&S
FBC, CRP, ESR, U&Es, creatinine
Renal USS if ? stones

161
Q

What would urinalysis results of pyelonephritis be?

A

++ leukocytes ++ nitrites ++ blood

162
Q

List Mx of pyelonephritis

A

IV ABx - cephalexin

Analgesia

163
Q

What is the inheritance pattern of MEN?

A

Autosomal dominant

164
Q

List disease that form MEN I

A

Parathyroid adenoma
Pancreatic islet cell tumour
Pituitary adenoma

165
Q

List diseases that form MEN 2a

A

Parathyroid adenoma
Thyroid medullary carcinoma
Phaeochromocytoma

166
Q

List diseases that form MEN 2b

A

MEN 2a
+ multiple mucosal neuromas of GIT
+ Marfanoid phenotype

167
Q

What is aplastic anaemia?

A

Pancytopenia and hypo plastic marrow

168
Q

Who gets G6PD deficiency?

A

Mediterranean patients

169
Q

What precipitates an oxidative crisis in G6PD deficiency?

A

Flava beans

Drugs

170
Q

What is the pathophysiology of G6PD deficiency?

A

Low G6PD —> low NADPH –> low glutathione –> RBCs exposed to oxidative stress

171
Q

List Sx of G6PD deficiency

A

Jaundice, anaemia

172
Q

What is seen on blood film of G6PD deficiency?

A

Heinz bodies

173
Q

Positive Coombs test. Dx?

A

Autoimmmune haemolytic anaemia

174
Q

What does the Coombs test show?

A

ABs to RBCs

175
Q

What is seen on blood film of autoimmune haemolytic anaemia?

A

Spherocytes

Lottie's Question Books (15 decks)

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