Conditions Flashcards
Diabetes Mellitus Type 1
- auto immune disease
- absolute deficiency of insulin
- onset usually childhood, peak 11-13 years
- presents with history of illness past 1-4/52
- dehydration (cell), hypovolaemia
- polyuria, polydipsia, polyphagia
- weight loss
- altered LOC (late)
Treatment: insulin replacement
Diabetes Mellitus Type 2
- lifestyle diabetes
- risk increases with age
- obesity and inactivity high risk factors
- impaired insulin secretion and action
- gradual onset
- polyuria, nocturia, thirst, blurred vision
Gestational Diabetes
- develops between 24-28 weeks pregnant
- risk factors:
30+ y.o
Family Hx type 2
Overweight
Aboriginal and Torres Straight Islander
Vietnamese, Chinese, Middle East, Polynesian or Melanesian background
Gestational diabetes in previous pregnancy
Hypoglycaemia
- BGL <4mmol/L
- more common with type 1 diabetes
S&S: - decreasing LOC
- confusion
- headache
- drowsiness
- disorientation
- unresponsive
- seizures
- stroke like symptoms
Treatment: oral glucose/subcutaneous glycogen/ IV dextrose
What is Whipple’s triad?
Relates to hypoglycaemia
Includes patient having S&S of hypoglycaemia, a low plasma glucose level and resolution of symptoms once glucose level rises
Hyperglycaemia
BGL >8mmol/L (7.8 non-diabetic)
What are:
- Glycogenesis
- Glycogenolysis
- Gluconeogenesis
- Glycogenesis: creation and storage or glycogen
- Glycogenolysis: breakdown of glycogen into glucose
- Gluconeogenesis: generation of glucose from non-carbohydrate source
Diabetes Insipidus
Disorder of the posterior pituitary gland
Insufficiency of anti-diuretic hormone (ADH)
Can have neurogenic cause: head injury, brain tumour, infection. Leads to interference with ADH synthesis, transport and release
Nephrogenic cause: insensitivity of the renal collecting tubules to ADH. Genetic disorder or medications (inc. methoxy)
S&S:
- excretion of excessive volume of dilute urine (maybe 8-10 L/day)
- polydipsia
- dehydration
Cushings disease
Disease of the adrenal gland
Also called hypercortisolism
Hypersecretion of glucocortticoids (cortisol)
S&S:
- weight gain, fatty tissue deposits - particularly around the midsection and upper back, face and between shoulders
- striae (pink or purple stretch marks) on abdo, thighs, breasts, arms
- thinning, fragile skin which bruises easily
- slow healing of cuts, insect bites, infections
- acne
Addisons disease
Also called adrenal insufficiency Adrenal glands do not produce enough cortisol and often aldosterone. S&S: - weakness - weight loss - low BP, unresponsive to fluids - nausea, vomiting, diarrhoea - abdo pain - vitiligo (loss of skin colour in blotches) - hyperkaleamia (ECG changes) - hypoglycaemia - ALOC/ lightheaded
Hypothyroidism
Autoimmune disease which destroys thyroid gland Far more common in women Onset months to years S&S reflect lowered metabolic rate: - decreased heat production - cold intolerance - lethargy, tiredness - low temp - Myxedema (skin swollen and puffy)
What is Murphy’s sign and what could it indicate?
Tenderness on inspiration when pressure is placed under the costal margin on the right side. It can indicate cholecystitis (Inflammation of the gall bladder)
What is Grey Turners sign? What may it indicate?
It is bruising on the flanks and can indicate pancreatitis
What is Cullens sign? What can it indicate?
Hemorrhagic discolouration of the umbilical area suggesting intra abdominal haemorrhage
What is Rosving’s sign? What does it indicate?
It is pain in the right lower quadrant when palpating the left lower quadrant. It may indicate appendicitis.
What is psoa’s sign? What may it indicate?
Pain in the right lower quadrant when patient lifts there right leg against resistance. It can indicate appendicitis.
Pain Assessment
Site Onset Character Radiation Associations Timing Exacerbating/relieving factors Severity
What are the 5 B’s to consider for abdominal pain?
Bugs Bleeding Blockage Bursting Babies
What is Ulcerative colitis? What are the common signs and symptoms?
Chronic inflammatory disease causing ulceration of the colonic mucosa (sigmoid colon and rectum)
Pathophysiology: infectious, immunological, dietary, genetic
S&S:
- bloody diarrhoea
- colicky abdo pain (sharp, localised, abrupt, spasms)
- tenesmus (urgency)
- mild abdo pain
- rarely abdo distension
- can be dehydrated
What is appendicitis? What are the signs and symptoms?
Inflammation of the vermiform appendix
S&S:
- epigastric and right lower quadrant pain and guarding
- nausea and vomiting
- tachycardia
- fever
- maximal pain at McBurney’s point
- positive Rosving’s sign
- positive Psoa’s sign
What is cholecystitis? What are the signs and symptoms?
Inflammation of the gall bladder
Most often caused by cholelithiasis (gall stones)
S&S:
- Biliary colic (pain from gall stones - usually constant midline or right upper quadrant) may radiate to sub scapular. Onset hrs after eating
- nausea and vomiting
- fever
- Murphy’s sign positive
What are the four primary reasons for ALOC in adults?
- Inadequate supply of the brains metabolic needs (hypoxia, hypoglycaemia, hypotension, electrolytes)
- Chemically induced alteration of brain function (drugs, toxins, alcohol)
- Direct trauma to brain tissue (inc. CVA, cerebral infractions
- Alterations in brain function or structure (seizure, dementia)
Describe the following:
- afferent and efferent division of NS
- somatic and autonomic NS
- Sympathetic and parasympathetic divisions of NS
- afferent = sensory
- efferent = motor
- somatic = voluntary (skeletal muscles)
- autonomic = involuntarily (cardiac muscle, smooth muscle, glands)
- sympathetic = response during activity (fight or flight)
- parasympathetic = conserve energy, promotes recovery (rest and digest)
How much CSF is there within ventricles and subarachnoid space? What is considered a normal CSF pressure (horizontal position)
125-150 mls, 9-14 mmHg
What is cerebral perfusion pressure? What pressure must it remain between?
CPP is the net pressure gradient required to perfuse the cells of the brain. When CPP is between 50 and 160 mmHg cerebral blood flow remains constant
What is intracranial pressure? What should it remain between?
The pressure exerted by the contents against the skull. It should remain between 5 - 15 mmHg
What is considered a raised intracranial pressure?
When more “stuff” is inside the skull, either blood (haemorrhage), CSF, or tissue (tumour). Raised ICP is a sustained pressure above 20-25mmHg.
How is CPP determined?
MAP - ICP
Use highest numerical value for ICP (15)
How is MAP calculated? What does MAP need to remain above?
MAP = (SBP + 2(DBP)) / 3
MAP must be above 60
What is Cushing’s Triad? What does it indicate?
Cushing’s triad is:
- Systolic BP increase (with decrease or same diastolic BP = widening pulse pressure)
- Pulse rate decrease (bradycardia)
- Respiration rate decrease (Bradypnoea) preceding irregular respirations
Cushing’s triad indicates a decompensating raised ICP. It is a late sign and can indicate imminent death.
What is SIRS and what are the S&S? When does it progress to other classifications?
SIRS is a Systematic Inflammatory Response Syndrome
With two or more of the following S&S, a patient is considered to have SIRS:
- fever >38 or <36
- HR >90
- RR >20
- PaCO2 <32mmHg
When presumed or confirmed infection = Sepsis
With signs of 1 or more organ failure = severe sepsis
Multiple organ dysfunction syndrome (MODS)
What are the four types of primary headaches?
- Migraine
- Tension type
- Cluster and other trigeminal autonomic cephalagias
- Other primary headaches
What are the common S&S of a migraine?
Headache +
- predrome
- aura
- nausea and vomiting
- photophobia
- phonophobia
What is a seizure?
A transient alteration of brain function due to uncontrolled depolarisation of cerebral neurons
What is a convulsion?
The abnormal muscle motor activity experienced by some patients having a seizure
What is GABA?
Gamma-aminbutyric acid. The main inhibitory neurotransmitter
What happens during normal neuronal depolarisation and repolarisation?
Depolarisation: Sodium (Na+) enter cell through membrane channel.
Repolarisation: potassium (K+) moves out of cell
What do excitatory and inhibitory ions do?
Excitatory: allows positive ions to enter the cell
Inhibitory: allows negative ions to enter cell
How do changes in the brain cause a seizure?
Either with an increase in the release of excitatory neurotransmitters or a decrease in the availability of GABA
What is a generalised seizure? What are the five subtypes?
A generalised seizure occurs when there is simultaneous activation of the entire cerebral cortex
Sub types include:
- Tonic-clonic
- Absence
- Myoclonic
- Atonic
- Tonic
What are some of the general S&S of a seizure?
Abrupt LOC
Some have motor manifestations
May have a period of apnoea, resulting in cyanosis
Possible loss of bowel and bladder control
Describe a generalised absence seizure
- brief
- loss of consciousness without losing posture
- confused/detached/ withdrawn
- unresponsive to voice/stimulation
- no post ictal
What is tonic and clonic? Describe a generalised tonic/ clonic seizure
Tonic is the initial, muscle contraction phase. It results from the spread of excitement through to subcortical region, thalamus and brain stem.
The clonic phase is where there is alteration between muscle contraction and relaxation. It results from inhibitory neurons causing an interruption in seizure discharge
- prodrome hrs-days prior (such as concentration problems, mood changes)
- aura
- abrupt onset (maybe)
- LOC
- often apnoeic
- cyanosis
- incontinent
- post-ictal phase (confusion, fatigue, agitation) lasting hrs
How do you manage a person having a seizure?
- safety (yourself, patient, public)
- time seizure activity and note the characteristics
- provide sitrep
- stop seizure (midazolam)
- provide supportive care (oxygen, ventilation, position)
- aim to identify and manage cause of seizure (and prevent reoccurrence)
- ## reassess and transport
What is the cause and sub types of a focal seizure? Describe the characteristics
Cause: electrical discharge from localised area of the cortex. May remain local, or can spread to other areas.
Focal aware:
- remains localised
- conscious state unaffected
- memory preserved
Focal impaired awareness:
- remains localised
- conscious state affected (vague, confused, disoriented, amnesic)
- can have visual or gustatory disturbance
- can include hallucinations or repetitive motor activity (chewing, swallowing, fidgeting, taking clothes off)
What is status epilepticus?
When a seizure lasts more than 5 mins, or seizures occur close together without recovery (regaining consciousness) in between.
Common first presentation for epilepsy Evidence of some neural damage after 5 mins, permanent neurological damage after 20mins. Continued seizure leads to: - hypoxia - hypoglycaemia - hyperpryrexia (temp)
What is glomerular filtration and how much should be formed?
Glomerular filtration is the capillary fluid exchange which happens in the glomerulus of the nephrons in the kidneys. The glomerulus should filter approx. 180L/day for males and 150L/day for females. The glomerular filtration rate (GFR) is the amount of filtrate formed per minute should be 100-140mls/min.
What is a UTI?
Inflammation of the urinary epithelium (anywhere along urinary tract).
Cystitis: inflammation of the bladder
What is nephrolithiasis? What are the risk factors?
Kidney Stones.
“Stones” made of minerals: mostly calcium. Magnesium and Uric acid also.
Risk factors include:
- age (20-30)
- family history
- gender (males)
- dehydration: low fluid intake
- location (due to food/water minerals)
- urine pH
What are the S&S of nephrolithiasis?
- renal colic
- excruciating pain in lumbar-inguinal
- heamaturia (blood in urine)
- fever and rigors
What is pylonephritis? What are the S&S?
An infection of the renal pelvis. Inflammation of renal pelvis, medulla and cortex.
Similar to UTI but extend up to kidneys
S&S:
- increased frequency
- dysuria (painful/difficult urination)
- flank pain
- fever and rigors
- systemic S&S
What is glomerulonephritis? Describe the characteristics. What are the S&S?
Inflammation of the glomerulus. Most common cause of chronic kidney disease.
Common in children and young adults. Follows streptococcus infection 10-21 days post infection.
What are the S&S of glomerulonephritis?
- haematuria
- proteinuria
- decreased GFR
- oliguria (small amounts urine production)
- hypertension
- peripheral oedema
What is AKI? What are the three sub categories?
Acute Kidney Injury
Can be:
- pre-renal
- renal
- post renal
Describe pre-renal AKI
Most common AKI, Occurs from renal hypoperfusion. Eventual decline in GFR.
Patient has a history of:
- volume depletion: haemorrhage or dehydration
- cardiovascular impairment: hypotension, AMI, sepsis
- can also be medication related, ACE (treat high BP, heart failure), NSAIDs
Describe renal, or intrarenal AKI
Most common cause: ischaemic tubular necrosis as a result of hypoxic injury (death of tubular cells). Most commonly affects proximal tubule, results in tubule obstruction.
Describe post-renal AKI. What are the S&S?
Rare. Caused by blockage of urinary tract. Blocked catheter, UTI, bladder outlet obstruction. (Prostate)
S&S:
- oliguria/ anuria
- electrolyte imbalance (hyperkalaemia)
- oedema
- congestive cardiac failure pre cardiac disease
- nausea and vomiting
- fatigue
What is chronic kidney disease?
Progressive loss of renal function due to systemic disease (hypertension, DM, chronic kidney diseases)
Kidney damage occurs when GFR drops below 60 mls/min for 3 months
What are the S&S of chronic kidney disease?
- uraemia (high urea in blood): accumulation of nitrogenous wastes
- hypertension
- anorexia/ weight loss
- nausea and vomiting
- diarrhoea
- pruritus (severe itching of skin)
- neurological changes
Define the following:
- Haematuria
- Oliguria
- Anuria
- Uraemia
- Dysuria
- Haematuria: blood in the urine
- Oliguria: production of abnormally small amounts of urine
- Anuria: failure of kidneys to produce urine
- Uraemia: high levels of urea (nitrogenous waste) in blood
- Dysuria: painful or difficult urination
What is visceral pain?
Pain from internal organs and tissue. Often from stretching fibres.
Poorly localised, dull cramps, aches, pressure. Can be intermittent or constant. Often radiates.
What is parietal/somatic pain?
Pain in tissue such as skin, muscle, joints.
Often described as sharp, stabbing, intense, aching, cramping
Localised, constant, sensitive to movement.
What are the four broad causes of abdominal pain?
- Peritoneal
- Obstructive
- Hemorrhagic
- Non-specific
How will peritoneal pain generally present?
Inflamed organ.
Generalised, becomes more localised
Tenderness, guarding, rebound tenderness. Can lead to sepsis
How will obstructive causes of abdominal pain present?
Severe cramps/colicky pain. If untreated can cause perforation. High pitched bowel sounds, then none.
How do haemorrhagic causes of abdominal pain generally present?
Less common but rapid decline. Can be AAA, peritoneal and retro peritoneal bleed, ruptured spleen, ruptured ectopic pregnancy.
S&S of circulatory compromise. Distended abdomen, Cullen’s sign
What does non-specific abdominal pain mean?
Medically unexplained.
Generalised pain, colicky (abrupt start and stop)
What is pancreatitis? What are the S&S?
Inflammation of the pancreas. Usually associated with other disorders. leakage of pancreatic enzymes causes damage to pancreatic tissue, leaks to blood, damage to blood vessels and other organs.
S&S:
- poorly differentiated pain
- nausea and vomiting
- fever
- epigastric pain, radiate to back
- leucocytosis (high WBC in blood)
- grey turners sign
- cullens sign
- hypotension, hypovolaemia
What are the signs and symptoms of a bowel obstruction?
- poorly localised abdo pain, often colicky
- low/no bowel sounds
- vomiting (can be faecal)
- tachycardia
- fever
- guarding
- abdo distension
- dehydration
- vomiting, diarrhoea, constipation
Peptic (gastric) ulcer:
Peptic injury leads to breach of gastric mucosa. Often caused by inflammation caused by bacteria and long use of NSAID’s.
S&S:
- epigastric pain, normally after eating (1-3hrs)
- belching, bloating, distension
- may improve with eating
- may follow daily pattern
- increased risk: smoking, alcohol, stress, chronic diseases
Duodenal ulcer
More frequent than other types peptic ulcer. Often younger people.
Chronic, intermittent epigastric pain. Often during night, disappears by morning.
Relieved by food/antacids.
What are the terms for:
- Vomiting bright red blood?
- Vomiting digested blood?
- A black, tarry stool?
- Bright red blood from rectum?
- Haematemesis
- Coffee-ground vomit
- Malena
- Haematochezia
What is pancreatitis? What are the S&S?
Inflammation of the pancreas. Usually associated with other disorders. leakage of pancreatic enzymes causes damage to pancreatic tissue, leaks to blood, damage to blood vessels and other organs.
S&S:
- poorly differentiated pain
- nausea and vomiting
- fever
- epigastric pain, radiate to back
- leucocytosis (high WBC in blood)
- grey turners sign
- cullens sign
- hypotension, hypovolaemia
What are the signs and symptoms of a bowel obstruction?
- poorly localised abdo pain, often colicky
- low/no bowel sounds
- vomiting (can be faecal)
- tachycardia
- fever
- guarding
- abdo distension
- dehydration
- vomiting, diarrhoea, constipation
Peptic (gastric) ulcer:
Peptic injury leads to breach of gastric mucosa. Often caused by inflammation caused by bacteria and long use of NSAID’s.
S&S:
- epigastric pain, normally after eating (1-3hrs)
- belching, bloating, distension
- may improve with eating
- may follow daily pattern
- increased risk: smoking, alcohol, stress, chronic diseases
Duodenal ulcer
More frequent than other types peptic ulcer. Often younger people.
Chronic, intermittent epigastric pain. Often during night, disappears by morning.
Relieved by food/antacids.
What defines upper from lower GI?
The ligament of treitz
What is diabetic keto acidosis? What are the signs and symptoms?
type 1 DM emergency. Hyperglycaemia, metabolic acidosis, hyperketonaemia. S&S: - often Hx of recent illness/infection - polydipsia - polyphasia - nausea and vomiting - cramps - ALOC - kussmaul respirations (deep, laboured) - dehydration - postural hypotension
What is Hypersmolar Hyperglycaemic State?
A DM (usually type 2) condition S&S include hyperglycaemia and dehydration - polyuria - polydipsia - dehydration (hypotension, poor skin turgor, tachycardia) - vomiting - cramps - malaise (generally unwell feeling) - stupor/coma/seizures
What is hypothyroidism?
An autoimmune disease causing destruction of the thyroid gland.
Mostly women.
S&S = lower metabolic rate. (Decreased energy, cold intolerance, oedema of extremities) hypothermia, hypotension, hypoglycaemia, lactic acidosis.
onset Months-years
Severe form= myxedema. This is also the swollen, puffy look of skin associated with this condition
What is hyperthyroidism?
AKA thyrotoxicosis/ Graves’ disease More common women S&S: - weight loss - heat intolerance - palpitations - fatigue - tachycardia - nervousness - hyperreflexia
Very rare pts will develop thyroid crisis/ thyroid storm. Exaggeration of above S&S.
