CBL Semester 1 Flashcards
NYHA functional classification of Heart Failure
- HF and no limitation to physical activity
- HF and slight limitation to physical activity
- HF and marked limitation to physical activity
- HF and inability to perform physical activity
Signs of HF on CXR
Alveolar oedema
B lines (kerley) - horizontal lines near base of lungs Cardiomegally
Dilated upper vessels
Effusions (pleural)
1st line Pharmacological HF management
Start
- ACEi (ARB if intolerant)
Once stable - Beta blocker
Still symptomatic - Aldosterone antagonist (spironolactone)
Still symptomatic - Digoxin
Clinical Features of Rheumatic fever
Effects everything apart from the heart only mildly or transiently.
· General - Fever, Recent sore throat
· CNS - Chorea
· Heart - Carditis
· Joints - Pain, migratory arthritis
· Subcutaneous tissue - nodules
· Skin - rash
Rheumatic fever diagnosis criteria
Jones Criteria
Required Criteria
• Evidence of preceding strep infection/ other bacteria that cause it
○ DNAase B
○ Anti-streptolysin O
○ Positive throat culture
○ Rapid Antigen test
Major Criteria - (1 from each involved system)
- Chorea
- Carditis
- Polyarthritis
- Subcutaneous nodules
- Erythema marginatum
Minor Criteria
- Fever
- Arthralgia
- Previous rheumatic fever/ RHD
- Acute phase reactions (CRP, ESR etc)
- Prolonged PR interval
Types of vegetations of RHD and IE
RHD: warty, small along line of closure of valve leaflet
IE: Large friable can extend on chordae tendinae
Clinical Manifestations of IE
- Constitutional - Fever, Malaise, Anorexia/ weight loss
- Emboli- Splinter haemorrhages, Splenic/ renal infracts, Petechiae
- Constant bacteraemia
- IC mediated Glomerulonephritis
Diagnostic Criteria for IE
Dukes Criteria
Major Criteria
· Positive blood cultures
· Echocardiographic changes that suggest IE
Minor
· fever
· predisposing factor: (IV drug use, cardiac lesion)
· emboli evidence: · immunological problems: ( glomerulonephritis)
· positive blood culture that doesn’t meet major diagnostic criteria
Complications of IE
Local - vavular, shunting, heart block
Emboli
Immunocomplexes
Mycotic abscesses
TB medication regime
Rifampicin - 6 months
Isoniazid + VB6 - 6 months
Pyrazinamide 2 months
Ethambutol - 2 months (or until susceptibility tests back) Or streptomycin
All taken orally, daily
TB Medication AEs
Isoniazid:
- Neuropathy - prescribe with vB6 to prevent this
- Hepatitis (<1%, can be fatal)
Ethambutol:
• optic neuritis (colour vision goes first)
Rifampicin:
- staining of body fluids
- P450 inducer
- flu like symptoms - bad
Pyrazinamide:
- Hepatic toxicity,
- Hyperuricaemia
Streptomycin
• Permanent damage to vestibular nerve
Clinical features of acute leukaemia
· Abrupt, stormy onset
· Decreased marrow function (from crowding, competition for growth factors, etc) ○ Anaemia ○ Neutropenia ○ Thrombocytopenia
· Neoplastic infiltration (more in ALL) ○ Lymphadenopathy ○ Bone pain ○ Splenomegaly ○ Hepatomegaly
· CNS involvement - meneingeal spread (> in ALL) ○ Headache ○ Vomiting ○ Nerve palsies ○ Meningism
ALL treatment
Chemotherapy
- induction
- consolidation
- maintainance
Supportive
- stop uric acid rise (fluids, allopurinol)
- Antimicrobials
- Anti-chemo (semen preservation, blood + growth factors, nutrition)
BPH Investigations?
Important
- Urinalysis
- PSA
- International prostate symptom score
- Global bother score
Consider
- Uroflowmetry (pee into a container)
- US - rule out cancer CT
- Urodynamics
- Cystoscopy
BPH Treatment
Depending on IPSS
- Watchful waiting
- Lifestyle management
- Review meds
- Fluid restrictions
- Constipation management
- Urination education
- Drugs
- Alpha Blocker - 1st line
- Alpha adrenergic receptor blockers, alpha 1 is the most common type in the prostate and inhibiting this leads to smooth muscle relaxation. Also effects bladder and sphincter muscles.
- 5- Alpha reductase inhibitors - decrease DHT
- NSAIDs - improve flow and urinary symptoms
- Alpha Blocker - 1st line
- Surgery
- TURP
Prostate Cancer Metastasis sites
- Bone - most common
- Lymph nodes
- Lung
- Liver
- Brain
Heparin MOA
Increases effect of antithrombin III
Inactivates thrombin.
Decreases the conversion of fibrinogen to fibrin.
Prostate cancer treatment (apart from watchful waiting)
Original - surgery, radation
metastatic - androgen deprication
- GNRH agonist (goserelin) + anti-androgen (bicalutamide)
- OR GNRH antagonist
Catrate resistant - Chemotherapy - anthrocyclines
Bone mets- bisphosphinates, RANKLi (denosumab)
HPV protein actions
- E5 - activates growth factors
- E6 - inactivates p53
- E7 - stops retinoblastoma
Sites of Prostate cancer occurance (and %)
- Transitional zone 10-20%
- Central zone 2.5%
- Peripheral zone 70-80%
Microbial causes of UTI in males
KEEPS
Klebsiella, E.coli, Enterococcus, Proteus
Morphology of SIL
Koilocytic atypia (nuclear enlargement and variations in size and peri-nuclear halo)
Hyperchromic (dark staining)
Presence of coarse chromatin granules
Principles of Screening
- Important health problem
- Disease should have recognisable latent or early symptomatic stage
- Well understood natural hx of disease
- Treatment avaliable for those with disease
- Suitable test or examination
- Test acceptable to population
- Agreed policy on who to treat
- Facilities for diagnosis and treatment avaliable
- Costs of screening/diagnosis/treatment economically balanced with other expenses on health care
- Case finding should be a continuing process
Natural Hx of Hep B
Acute: 95% adults, 5-30% children
Chronic: 3-5% adults, 70-95% children
