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Clinical Conditions (OSCE) > Clinical Conditions > Flashcards

Clinical Conditions Flashcards

1
Q

Describe the following for acute kidney injury:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – pharmacological
  • Differential diagnosis
A
  • Pathophysiology: abrupt decline in actual GFR, disruption of ECF volume, electrolyte and acid-base homeostasis
  • Aetiology: pre-renal failure (dehydration/hypotension), intrinsic renal failure (sepsis/glomerular disease/nephritis), post-renal failure (obstruction)
  • Clinical presentation: nausea, lethargy, hypotension
  • Diagnostic results: hyperuricaemia, high creatinine (hyperkalaemia, hyponatraemia, low HCO3-, proteinuria, haematuria)
  • Treatment – lifestyle factors: restrict water and Na+, stop K+ sparing diuretics (ACEi, ARB)
  • Treatment – pharmacological: dialysis, sodium bicarbonate tablets, calcium gluconate
  • Differential diagnosis: CKD, renal cancer, glomerulonephritis
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2
Q

Describe the following for chronic kidney disease:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: irreversible & progressive loss of renal function, renal injury leads to replacement of tissue by ECM
  • Aetiology: diabetes, hypertension, glomerulonephritis, pyelonephritis
  • Clinical presentation: elderly, co-morbid, ethnic minority, reduced appetitie, nausea & vomiting, pruritis, fatigue
  • Diagnostic results: low GFR, proteinuria, hyperuricaemia, metabolic acidosis, hyperkalaemia, anaemia
  • Treatment – lifestyle factors: exercise, stop smoking, lose weight, stop PPIs
  • Treatment – drug actions and side effects: sodium bicarbonate, ARBs (↑K+), ACEi (cough, ↑K+), iron tablets, dialysis, transplant
  • Differential diagnosis: Nephritic syndrome, AKI
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3
Q

Describe the following for alcoholic liver disease:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A

- Pathophysiology: acetaldehyde accumulation leads to liver damage and changes in liver metabolism (excess NADH & Acetyl-CoA)

- Aetiology: prolonged and excessive alcohol consumption

- Clinical presentation: jaundice, gout, fatigue, weight gain

- Diagnostic results: ​lactic acidosis, hyperuricaemia, ​hypoglycaemia, raised ALT, raised gamma GT

- Treatment – lifestyle factors: reduce alcohol consumption, support groups

- Treatment – drug actions and side effects: disulfram (hangover feeling)

  • Differential diagnosis: cirrhosis, hepatitis
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4
Q

Describe the following for cirrhosis:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: liver fibrosis produces a shrunken hard nodular liver, impaired excretion, portal hypertension and portosystemic shunting results
  • Aetiology: alcohol, fatty liver disease, viral hepatitis
  • Clinical presentation: fatigue, weakness, jaundice, weight loss, ascites, malaena, haematemesis
  • Diagnostic results: low albumin, raised bilirubin, prolonged PT (all may be normal)
  • Treatment – lifestyle factors: reduce alcohol intake
  • Treatment – drug actions and side effects: painkillers, symptomatic treatment, transplant (only cure)
  • Differential diagnosis: hepatitis, liver failure
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5
Q

Describe the following for anaemia:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
A
  • Pathophysiology: low haemoglobin (symptom of underlying condition)
  • Aetiology: splenectomy, acute blood loss, pregnancy, thalassaemia, SCA, anaemia of chronic disease, haemolysis, bone marrow failure
  • Clinical presentation: systolic murmur, pallor, tachycardia, dizziness, headaches, fatigue
  • Diagnostic results: low haemoglobin
  • Treatment – lifestyle factors: reduce coffee/tea intake, eat more citrus fruits
  • Treatment – drug actions and side effects: iron supplements (tarry black stools), therapeutic phlebotomy
  • Differential diagnosis: hypovolaemia, dehydration
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6
Q

Describe the following for atrial fibrillation:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: multiple atrial foci send chaotic signals to SAN, leading to uncoordinated atrial contraction and possible thrombus formation
  • Aetiology: mitral valve stenosis, left atrium dilation, AMI
  • Clinical presentation: 90% asymptomatic, dyspnoea, fatigue, palpitations
  • Diagnostic results: no p waves, wavy baseline, pulse and heart rate are irregularly irregular
  • Treatment – drug actions and side effects: quinidine/flecainide (GI effects), amiodarone (photosensitivity, thyroid disease), warfarin (teratogenic, bruising, epistaxis)
  • DIfferential diagnosis: supraventricular tachycardia, Wolff-Parkinson-White syndrome
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7
Q

Describe the following for cerebrovascular disease (TIA):

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: distant emboli temporarily disrupts blood supply to brain
  • Aetiology: diabetes mellitus, hypertension, hyperlipidaemia (risk factors)
  • Clinical presentation: loss of motor/sensory function, slurred speech, drooping face < 24 hours
  • Diagnostic results: clear CT
  • Treatment – lifestyle factors: stop smoking, exercise, lose weight, reduce alcohol intake, eat healthier
  • Treatment – drug actions and side effects: warfarin (teratogenic, bruising, epistaxis), statins (CNS & GI effects), ACEi (cough)
  • Differential diagnosis: stroke, hypoglycaemia
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8
Q

Describe the following for cerebrovascular disease (stroke):

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: haemorrhagic stroke (ruptured aneurysm) / ischaemic stroke (occluded vessel)
  • Aetiology: diabetes mellitus, hypertension, hyperlipidaemia (risk factors)
  • Clinical presentation: loss of sensory/motor function, slurred speech, drooping face
  • Diagnostic results: occluded artery / haemmorhage on head CT
  • Treatment – lifestyle factors: stop smoking, exercise, lose weight, reduce alcohol intake, eat healthier
  • Treatment – drug actions and side effects: thrombolytic therapy (< 4.5 hours), warfarin (teratogenic, bruising, epistaxis), statins (GI & CNS effects), ACEi (cough)
  • Differential diagnosis: hypoglycaemia, epilepsy, migraines
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9
Q

Describe the following for chronic lung disease (asthma):

  • Pathophysiology
  • Triggers
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: reversible airway obstruction, bronchoconstriction, mucosal oedema, airway hypersensitivity
  • Triggers: cold air, emotional distress, exercise, pollutants, pollen
  • Clinical presentation: wheeze, chest tightness, dyspnoea, cough, diurnal variation
  • Diagnostic results: obstructive defect on spirometry
  • Treatment – lifestyle factors: good inhaler technique, avoid triggers
  • Treatment – drug actions and side effects: β2 agonists (tachycardia, palpitations), inhaled corticosteroids, LTRA (dry mouth, fever)
  • Differential diagnosis: lung fibrosis, pneumonia, acute/chronic bronchitis
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10
Q

Describe the following for chronic lung disease (COPD):

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: loss of elastin, loss of surface area for gas exchange, enlargement of air spaces
  • Aetiology: smoking, alpha-1 antitrypsin deficiency, radon, asbestos
  • Clinical presentation: pursed lip breathing, barrel chest, productive cough, chronic breathlesness (worse on exertion)
  • Diagnostic results: hyperresonance on percusion, hyperinflation of lungs on CXR, irreversible obstructive deficit on spirometry
  • Treatment – lifestyle factors: stop smoking
  • Treatment – drug actions and side effects: external O2 therapy, lung transplant, β2 agonists (tachycardia, palpitations),
  • Differential diagnosis: emphysema, chronic bronchitis, lung cancer, bronchiectasis
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11
Q

Describe the following for lung cancer:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • DIfferential diagnosis
A
  • Pathophysiology: uncontrolled cell division in lung (NSCLC / SCLC)
  • Aetiology: smoking, asbestos/radon exposure, metastases
  • Clinical presentation: cough, breathlessness, haemoptysis, weight loss, fever, fatigue
  • Diagnostic results: mass/space occupying lesion on CXR, tumour markers, positive lung biopsy
  • Treatment – lifestyle factors: stop smoking
  • Treatment – drug actions and side effects: surgery, chemotherapy & radiotherapy (nausea, vomiting, alopecia)
  • Differential diagnosis: COPD, bronchiectasis
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12
Q

Describe the following for diabetes type I:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: auto-immune destruction of pancreatic β cells
  • Aetiology: absolute/relative insulin deficiency
  • Clinical presentation: polyuria, polydypsia, nocturia, weakness, fatigue, weight loss, visual disturbances
  • Diagnostic results: hyperglycaemia, ketonuria, ketoacidosis
  • Treatment – lifestyle factors: monitor sugar intake
  • Treatment – drug actions and side effects: insulin (hypoglycaemia, GI effects)
  • Differential diagnosis: chronic pancreatitis, endocrine disorders, Type II diabetes
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13
Q

Describe the following for diabetes type II:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: obesity and excess food intake leads to resistance of somatic cells to insulin
  • Aetiology: peripheral insulin resistance
  • Clinical presentation: polyuria, polydypsia, nocturia, weakness, fatigue, weight loss, visual disturbances
  • Diagnostic results: hyperglycaemia
  • Treatment – lifestyle factors: lose weight, exercise, reduce alcohol intake, stop smoking, eat healthier (more fibre)
  • Treatment – drug actions and side effects: metformin (GI effects), sulphonylureas (hypoglycaemia, GI effects)
  • Differential diagnosis: chronic pancreatitis, endocrine disorders, thiazide diuretics
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14
Q

Describe the following for epilepsy:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
A
  • Pathophysiology: abnormal firing of action potentials in regions of brain
  • Aetiology: genetic, head injury, auto-immune, drugs
  • Clinical presentation: convulsions, daydreaming, loss of consciousness
  • Diagnostic results: abnormal EEG
  • Treatment – lifestyle factors: avoid triggers
  • Treatment – drug actions and side effects: carbamazepine, sodium valproate (teratogenic, DDIs with warfarin & COCP) , lamotrigine
  • Differential diagnosis: stroke, TIA
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15
Q

Describe the following for anxiety:

  • Clinical presentation
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Clinical presentation: worry, stress, nervousness, irritability, insomnia (6 months)
  • Treatment – lifestyle factors: cognitive behavioural therapy, social support, activities & sport
  • Treatment – drug actions and side effects: pregabalin, SSRIs (nausea, vomiting, insomnia)
  • Differential diagnosis: PTSD, OCD, panic disorders, hyperthyroidism
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16
Q

Describe the following for depression:

  • Aetiology
  • Clinical presentation
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Aetiology: predisposing factors (genetics, female, childhood), perpetuating factors (financial strain, substance misuse, stressful job), precipitating factors (loss, poor health, break up)
  • Clinical presentation: low mood, anhedonia, weight loss, insomnia, suicidal thoughts
  • Treatment – lifestyle factors: cognitive behavioural therapy, exercise & social activities, community, eat more
  • Treatment – drug actions and side effects: SSRIs (nausea, vomiting, insomnia), TCAs, SRNI
  • Differential diagnosis: hypercalcaemia, hypothyroidism
17
Q

Describe the following for pneumonia:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: accumulation of inflammatory exudate in the alveoli of lung
  • Aetiology: bacterial/viral infection (Strep pneumonia / others)
  • Clinical presentation: cough, green sputum, breathlessness, fatigue, coarse crackles, chest pain
  • Diagnostic results: high neutrophils, consolidation on CXR, positive sputum culture
  • Treatment – lifestyle factors: no smoking
  • Treatment – drug actions and side effects: amoxicillin, clarithromycin, doxycline (allergy, DDIs, toxicities)
  • Differential diagnosis: pleurisy, TB
18
Q

Describe the following for meningitis:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: inflammation of the meninges
  • Aetiology: bacterial/viral infection (Neisseria meningitides)
  • Clinical presentation: purpuric rash, neck stiffness, photosensitivity
  • Diagnostic results: positive bacterial culture, positive lumbar puncture gram stain
  • Treatment – drug actions and side effects: ceftriaxone (GI effects), meningoccocal vaccine
  • Differential diagnosis: encephalitis, intracranial mass
19
Q

Describe the following for pyelonephritis:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: upper urinary tract infection
  • Aetiology: E.Coli, antibiotic use, unprotected sex, immunocompromised, diabetic (risk factors)
  • Clinical presentation: loin pain, dysuria, polyuria, urinary incontinence
  • Diagnostic results: positive bacterial culture, nitrites and leucocytes on urinalysis
  • Treatment – lifestyle factors: safe sex
  • Treatment – drug actions and side effects: co-amoxiclav for 14 days (toxicities, DDIs, allergy), antibiotic prophylaxis
  • Differential diagnosis: UTI, urinary tract obstruction,
20
Q

Describe the following for UTI:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: bacteria invades and forms biofilm in GU tract, forming a natural surface infection
  • Aetiology: E.coli, antibiotic use, unprotected sex, immunocompromised, diabetic (risk factors)
  • Clinical presentation: polyuria, dysuria, haematuria, suprapubic pain
  • Diagnostic results: positive bacterial culture, nitrites, blood and leucocytes on urinalysis
  • Treatment – lifestyle factors: safe sex, bodily hygiene
  • Treatment – drug actions and side effects: trimethoprim (rash, GI effects), nitrofuratoin , antibiotic prophylaxis
  • DIfferential diagnosis: BPH, prostatitis, urinary tract obstruction, bladder hypertrophy
21
Q

Describe the following for hypertension:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: persistent elevation of blood pressure
  • Aetiology: idiopathic, genetic, male, secondary to disease
  • Clinical presentation: 90% asymptomatic, chest pain, dyspnoea
  • Diagnostic results: BP > 139/89
  • Treatment – lifestyle factors: reduce salt intake, exercise, eat healthier, lose weight
  • Treatment – drug actions and side effects: ARBs (↑K+), ACEi (cough, ↑K+), CCBs, thiazide diuretics
  • Differential diagnosis: AMI, heart failure
22
Q

Describe the following for heart failure:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: one/both sides of heart unable to pump sufficient blood to meet demands of body despite adequate filling pressure
  • Aetiology: congenital defect, PE, pulmonary hypertension, diabetes, atherosclerosis, smoking, hypercholesterolaemia
  • Clinical presentation: cyanosis, dyspnoea, orthopnea, PND, oedema, chest pain
  • Diagnostic results: hypoxia, increased deoxyhaemoglobin, cardiomegaly, high cholesterol, atherosclerotic plaques, hypertrophy, hypertension
  • Treatment – lifestyle factors: exercise, lose weight, eat healthier (more fibre), stop smoking, less alcohol
  • Treatment – drug actions and side effects: ACEi (cough), loop diuretics, aspirin (GI effects), β2 antagonists (bronchoconstriction) , GTN spray
  • Differential diagnosis: AMI, angina, pericarditis, lung fibrosis
23
Q

Describe the following for gallstones:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
A
  • Pathophysiology: formation of gallstones obstructing the cystic duct
  • Aetiology: diabetes, genetics, COCP, IBS, age, female, obesity, Crohn’s disease
  • Clinical presentation: 70% asymptomatic, biliary colic (acute abdominal pain, right sided and hypogastric), worse with eating, jaundice, nausea, flatulence, constipation, steatorrhea, abdominal distension
  • Diagnostic results: positive on ultrasound
  • Treatment – lifestyle factors: healthy diet
  • Treatment – drug actions and side effects: monitoring, keyhole surgery to remove gallbladder
  • Differential diagnosis: peptic ulcer disease, pancreatitis, small bowel/stomach cancer
24
Q

Describe the following for hypercholesterolaemia:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: abnormally high levels of cholesterol deposit around the body
  • Aetiology: genetic, diet
  • Clinical presentation: xanthelasma, xanthoma, corneal arcus, obesity
  • Diagnostic results: high cholesterol levels (high LDL)
  • Treatment – lifestyle factors: eat healthier (less fats), exercise, drink less alcohol, less smoking, lose weight
  • Treatment – drug actions and side effects: statins (CNS effects, GI effects), bile salt sequestrants
  • Differential diagnosis: hyperlipidaemia, diabetes
25
Q

Describe the following for inflammatory bowel disease:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: inflammation leads to cryptitis / fistula formation
  • Aetiology: idiopathic, genetics, smoking
  • Clinical presentation: abdominal pain, abdominal distension, haematochezia, loose stools, fever, fatigue, weight loss
  • Diagnostic results: granulomas/fistulas on gram stains, fecal calprotectin,
  • Treatment – lifestyle factors: stop smoking, less alcohol, adhere to medication, lose weight
  • Treatment – drug actions and side effects: azathioprine (infection risk, hepatitis, anaemia), methotrexate (teratogenic, infection risk, hepatitis)
  • Differential diagnosis: Crohn’s disease, Ulcerative colitis, gastric/small bowel cancer, irritable bowel syndrome, Coeliac’s disease
26
Q

Describe the following for bowel cancer:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: uncontrolled cell division
  • Aetiology: genetic, idiopathic
  • Clinical presentation: abdominal distension, abdominal pain, weakness, weight loss, fever
  • Diagnostic results: adenocarcinoma on biopsy, tumour markers
  • Treatment – lifestyle factors: lose weight, eat healthier, stop smoking, drink less alcohol
  • Treatment – drug actions and side effects: chemotherapy (alopecia, mucositis), radiotherapy, surgery
  • Differential diagnosis: IBS, inflammatory bowel syndrome, gallstones
27
Q

Describe the following for ischaemic heart disease:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: formation of atherosclerotic plaque encroaches on coronary arteries
  • Aetiology: diabetes, hypercholesterolaemia, hypertension, AMI
  • Clinical presentation: breathlessness, chest pain, sweating, pallor
  • Diagnostic results: raised cholesterol, raised BP, hypoxia, hypercapnia, hypertrophy, stenosed arteries
  • Treatment – lifestyle factors: lose weight, exercise, less alcohol, stop smoking, eat healthier, reduce stress
  • Treatment – drug actions and side effects: β2 blockers (bronchoconstriction), GTN spray, ARBs (↑K+), ACEi (cough, ↑K+)
  • Differential diagnosis: pericarditis, costochondritis, angina, acid reflux
28
Q

Describe the following for osteoarthritis:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: increased wear and tear to joints, degenerative disease
  • Aetiology: idiopathic, age-related, trauma, secondary to disease
  • Clinical presentation: joint pain, stiffness, crepitis, grinding, swelling
  • Diagnostic results: no inflammation, osteophytes, subchondral sclerosis, subchondral cyst, decreased joint space on X-ray
  • Treatment – lifestyle factors: avoid vigorous exercise, only moderate exercise, stay on feet (avoid immobility)
  • Treatment – drug actions and side effects: painkillers, treat underlying condition
  • Differential diagnosis: RA, broken bone, osteoporosis
29
Q

Describe the following for rheumatoid arthritis:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: Rhematoid factor triggers autoimmune reaction at joints
  • Aetiology: auto-immune
  • Clinical presentation: joint swelling, stiffness, warmth, heat, pain
  • Diagnostic results: positive for Rheumatoid factor
  • Treatment – lifestyle factors: avoid vigorous exercise, adhere to medicine
  • Treatment – drug actions and side effects: methotrexate (teratogenic, hepatitis, infection risk), sulfasalazine (GI effects)
  • Differential diagnosis: osteoarthritis, spondylarthritis, psoriatic arthritis
30
Q

Describe the following for peptic ulcer disease:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: break down of mucosal layer, increase in gastric pH, production of ammonia
  • Aetiology: H.pylori infection
  • Clinical presentation: abdominal pain, worsened with eating, abdominal distension, nausea, vomiting, diarrhoea, weight loss
  • Diagnostic results: positive C-13 urease breath test, H.pylori on stool sample, ulcer on endoscopy
  • Treatment – lifestyle factors: avoid alcohol, eat healthier, avoid spicy food and coffee, lose weight, exercise
  • Treatment – drug actions and side effects: clarithromycin, amoxicillin, omeprazole/lansoprazole
  • Differential diagnosis: GORD, gastric adenocarcinoma
31
Q

Describe the following for pulmonary embolism:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: distant emboli lodges in pulmonary arteries
  • Aetiology: 90% DVT, immobilisation, surgery, hyperlipidaemia
  • Clinical presentation: cough, chest pain, SOB, haemoptysis, fever
  • Diagnostic results: hypoxia, emboli in pulmonary arteries, pulmonary hypertension
  • Treatment – lifestyle factors: weight loss, exercise, eat healthier, stop smoking, less alcohol
  • Treatment – drug actions and side effects: heparin, warfarin (bleeding, bruising, teratogenic)
  • Differential diagnosis: pericarditis, TB, pneumonia, pneumothorax
32
Q

Describe the following for deep vein thrombosis:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: thrombophlebitis of deep veins in legs
  • Aetiology: immobility, age, surgery, smoking, COCP, male, heart failure, pregnancy
  • Clinical presentation: 50% asymptomatic, tenderness, swelling, warmth, pain, congestion
  • Diagnostic results: positive on USS, positive D dimer
  • Treatment – lifestyle factors: weight loss, exercise, eat healthier, stop smoking, less alcohol
  • Treatment – drug actions and side effects: heparin, warfarin (bleeding, bruising, teratogenic)
  • Differential diagnosis: vascular/neurological claudication, vasculitis, cellulitis, ruptured Baker’s cyst
33
Q

Describe the following for hyperthyroidism:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: excessive thyroid hormone production increases negative feedback of TSH and enhances metabolism
  • Aetiology: autoimmune (TSI), thyrotoxicosis, excessive oral T4 therapy, functional pituitary adenoma
  • Clinical presentation: intolerance to heat, weight loss, palpitations, irritability, tachycardia, tremors
  • Diagnostic results: high levels of T4, low levels of TSH, positive on USS
  • Treatment – drug actions and side effects: carbimazole, thyroid surgery, radioactive iodine
  • Differential diagnosis: anxiety, phaeochromocytoma, Grave’s disease
34
Q

Describe the following for hypothyroidism:

  • Pathophysiology
  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Pathophysiology: insufficient thyroid hormone production decreases negative feedback on TSH and decreases metabolism
  • Aetiology: autoimmune destruction (TSI), thyroid surgery, anti-thyroid drugs, iodine deficiency
  • Clinical presentation: intolerance to cold, weight gain, low mood, bradycardia
  • Diagnostic results: low levels of T4, high levels of TSH,
  • Treatment – drug actions and side effects: oral T4 therapy, iodine supplementation
  • Differential diagnosis: depression, hypercalcaemia, Hashimoto’s disease
35
Q

Describe the following for tension headache:

  • Aetiology
  • Clinical presentation
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Aetiology: emotional distress, eye strain, hunger, physical tension in neck&back muscles
  • Clinical presentation: felt as a band / across the forehead, lasts for several days, worsens throughout the day, tiring, does not disturb sleep, sensitive to light/noise, does not limit physical activity
  • Treatment – lifestyle factors: stress, posture, exercise, warm bath, massage
  • Treatment – drug actions and side effects: paracetamol (overdose, toxicity), NSAIDs (Gi effects), amitryptilline (confusion, headache, nausea)

- Differential diagnosis: migraines, cluster headache

36
Q

Describe the following for migraines:

  • Triggers:
  • Clinical presentation
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Triggers: dieting, loud noises, strong smells, smoky rooms, depression, anxiety, stress
  • Clinical presentation: one-sided and throbbing, nausea, only relieved with sleep
  • Treatment – lifestyle factors: avoid triggers
  • Treatment – drug actions and side effects: paracetamol (overdose, toxicity), NSAIDs (Gi effects)
  • Differential diagnosis: cluster headaches, tension headaches
37
Q

Describe the following for cluster headache:

  • Triggers
  • Clinical presentation
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Triggers: alcohol, strong smells, raised temperature (hot bath, hot weather)
  • Clinical presentation: clusters, occur every day for weeks then disappear for months, severe, one-sided, adult male smokers, red watery eyes, ptosis, rhinorrhea, disturb sleep
  • Treatment – lifestyle factors: avoid triggers
  • Treatment – drug actions and side effects: triptans, corticosteroids, verapamil, lithium
  • Differential diagnosis: migraines, subarachnoid haemorrhage
38
Q

Describe the following for giant cell arteritis:

  • Aetiology
  • Clinical presentation
  • Diagnostic results
  • Treatment – lifestyle factors
  • Treatment – drug actions and side effects
  • Differential diagnosis
A
  • Aetiology: swelling and inflammation of the arteries in the temples and behind the eye
  • Clinical presentation: adults > 50, frontal headache, tender forehead, pain in jaw muscles, worsens with chewing & combing hair, can lead to sudden loss of eye sight
  • Diagnostic results: raised CRP indicating inflammation
  • Treatment – lifestyle factors:
  • Treatment – drug actions and side effects: prednisolone (hyperglycaemia, hypertension, weight gain, osteoporosis, opportunistic infections), aspirin (Gi effects), omeprazole (reduce likelihood of stomach ulcer)
  • Differential diagnosis: migraines, cluster headache

Clinical Conditions (OSCE) (1 decks)

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