Core conditions - difficult things Flashcards
what does PANCREAS stand for in glasgow scoring system for pancreatitis
P = pO2 A = age N = neutrophilia C = calcium R = renal urea E = enzymes (LDH) A = albumin S = sugar
5 drugs increasing risk of pancreatitis
thiazides azathioprine tetracyclines oestrogens valproic acid
why give PPI/H2 receptor antagonist in chronic pancreatitis
reduce HCO3 secretion
what is Ogilvie’s syndrome
intestinal pseudo-obstruction (massive dilation of colon)
type of drugs to give in severe IBD
immunosuppressant drugs
what is Rosvig’s sign
palpation of LLQ pain increases pain in RLQ in appendicitis
2 scoring systems for appendicitis
Alvarado
RIPASA
what is succussion splash a sign of
slow gastric emptying n PUD = distension
when to do an endoscopy in PUD
over 55, red flags
what is the triple therapy for H. pylori PUD
1 PPI and 2 antibiotics - e.g. omeprazole, metronidazole, clarithromycin
2nd line treatment for H. pylori PUD
H2 receptor antagonist (e.g. ranitidine) + 2 antibiotics
2 forms of treatment for NSAID PUD
8 weeks H2-receptor antagonist - raniditine, OR
2 months full dose PPI
2 antispasmodics to use in IBS
limetropium
hyoscine
4 drugs increasing risk of GORD
TCAs
anticholinergics
nitrates
CCBs
2 grading systems of GORD
Savary Miller
Los Angeles grading
treatment for GORD no RF symptoms
PPIs 1 month then step down
1 gene causing gastric adenocarcinoma
HDGC
what is Courvoisier’s sign
painless palpable gallbladder - sign of pancreatic cancer
what is Trousseau’s syndrome
migratory thrombophlebitis - sign of pancreatic cancer
2 LFTs in obstructive jaundice (can occur in pancreatic cancer)
increased ALP and bilirubin
3 electrolyte imbalances in pancreatic cancer
hyperglycaemia
hypercalcaemia
hypokalaemia
tumour marker in pancreatic cancer
CA19-9
what can Reye’s syndrome, Wilson’s disease and alpha-1 antitrypsin deficiency all cause
chronic liver disease
4 differential diagnoses for hepatic encephalopathy
- Wernicke’s encephalopathy
- ketoacidosis
- hypercapnia
- electrolyte imbalance
INR result in chronic liver disease
raised
bilirubin and ammonia result in chronic liver disease
raised
glucose result in chronic liver disease
low (give IV glucose)
2 drugs to decrease ammonia production in chronic liver disease
lactulose + neomycin
drug to decrease ICP in chronic liver disease
mannitol
2 serologic tests for coeliac disease
IgA antiboties to TTG
IgA/IgG to deactivated gliadin
which type of malnutrition is low energy
Marasmus
treatment of refractory ascites
therapeutic paracentesis
treatment of malignant ascites secondary to epithelial cancers
catumoxomab
antibiotic in infective pancreatitis
cefuroxime/aztreonam
LFTs in acute hepatitis vs gallstones
acute hepatitis = increased AST and ALP
gallstones = increased bilirubin, ALT and ALP
what is Dieulafoy’s disease
aneurysms in young people = gastric GI bleed?
cause of artoduodenal fistula
AAA repair - causes duodenal GI bleed
what can appendicectomy cause
CD
3 immunosuppressant drugs for IBD
cyclosporin
azathioprine
methotrexate
blood test for IBD
faecal calprotectin
treatment for GORD + oesophagitis
PPIs 2 months
most common location of pancreatic cancer
head
3 signs of pancreatic cancer
painless jaundice
pruritus
nausea
parasite increasing risk of CRC
schistosomiasis
drug protective for CRC
aspirin
what is Sister Mary Joseph nodule
nodule on umbilicus = sign of CRC
1 derm sign of coeliac
dermatitis herpetiformis
treatment of normal ascites
spironolactone, loop diuretics
2 leg signs of appendicitis
psoas sign - extend right thigh = pain RLQ
obturator sign - internally rotate flexed right thigh = pain RLQ
point of abdomen most tender in appenditicis
McBurney’s
gene increasing risk of CD
CARD15 (NOD2) gene
risk assessment for acute GI bleed
Rockall risk assessment
what is Murphy’s sign
painful RUQ on examination but NOT on LUQ = gallstones?
blood test for acute hep C
HCV
2 tests for acute hep A
lab IgM
serum aminotransferase + AST
3 stages in acute hep A
prodromal = flu and GI icteric = jaundice, pale faeces, hepatomegaly convalescent = weight loss, tenderness, muscle weakness
3 monoclonal antibodies to determine stage of breast cancer
ER
PR
HER2
biopsy to determine stage of breast cancer
Sentinel LN biopsy
4 presentations of ductal papilloma
bloody discharge
palpable mass within 4cm of nipple
inversion/retraction
microcalcification on mammogram
biopsy for non-palpable breast lump
core needle, open
biopsy for a palpable breast lump
FNA, core needle, excision (<4cm), incision (<4cm)
4 hormonal therapies for breast cancer if +ve for hormonal receptors
tamoxifen
SERMs
aromatase inhibitor
hormone antagonists e.g. anastrozole
thing increasing fibroadenoma
oestrogen
type of ductal papilloma more common in young women (usually in older women)
multiple (central types more common in older)
type of cardiomyopathy causing stable angina
hypertrophic
2 drugs increasing risk of AF
bronchodilators
thyroxine
syndrome increasing risk of AF
diabetes
2 drugs for thromboprophylaxis in AF
DOACs
vit K agonist - warfarin
monotherapy in AF
beta blockers or CCBs
what to do if monotherapy in AF is unsuccessful
either 2 of beta blocker, digoxin or dilimiazem
when to use UFH in DVT (usually use LMWH, fondaparinux and warfarin)
CKD 4/5
beta blocker to use in CCF
carvedilol
what is cardiorenal syndrome a complication of
CCF
what can IE cause
MI - from coronary embolus
3 signs on auscultation in MI
3rd and 4th heart sound
systolic murmur
pericardial rub
2 times there is a systolic murmur in MI
mitral regurgitation
ventricular septal defect
when to give GTN in MI
hypertensive
acute LVF
2 anticoagulants to inject in MI treatment
bivalirudin
enoxaparin (LMWH)
when to do immediate angiography in MI
STEMI or high risk NSTEMI (otherwise before 3 days)
when to give ACEi after MI
if LV dysfunction, hypertension or DM
2 conditions associated with severe postural hypotension
multiple system atrophy (Shy-Drager syndrome)
pure autonomic failure (Bradbury-Eggleston syndrome)
how to treat paroxysmal AF
monotherapy digoxin
what is post-thrombotic syndrome
chronic venous hypertension - may develop after DVT
when to give CCB or thiazide in 1st line hypertension treatment
if >55 or black (otherwise ACEi or ARB)
when to give thiazide instead of CCB in 2nd line hypertension treatment
heart failure
cause of delayed femoral pulses in hypertension
coarctation of aorta
what is graves
autoimmune TSH receptor stimulating antibodies = increased T3 and T4
what can increased iodine and smoking cause
graves
4 symptoms of thyroid storm
fever
D+V
jaundice
seizures
4 drugs to treat thyroid storm (thyrotoxicosis)
beta blockers
antithyroid drugs
potassium iodide
corticosteroids
what can palmar erythemabe a sign of
hypertyhyroidism
TSH and T4/T3 levels in hyperthyroidism
TSH low
T4/T3 high
result of Tc99m scan in GD vs multinodular goitre
GD = diffuse uptake MNG = nodular uptake
1st line antithyroid drug to use in hyperthyroidism
carbimazole - decreases action of perixodase enzyme = decreased output of T4/T3
2 types of hypothyroidism
atrophic (T cell mediated cytotoxicity)
Hashimotos (goitre)
what can iodine deficiency cause
hypothyroidism = goitre
what can hypopituitarism cause
hypothyroidism (isolated TSH deficiency)
2 causes of primary thyroid disease (causing hypothyroidism)
autoimmune
radio iodine damage
5 conditions associated with Hashimotos
T1 DM Addisons SLE CD pernicious anaemia
when is there increased levels TPO in blood
Hashimotos
what can deep voice and carpal tunnel be a sign of
hypothyroidism
TSH level in hypothyroidism
high
what is normal/low TSH and T4 deficiency a sign of
non-autoimmune hypothyroidism
2 drugs increasing risk of thyroid lump
amiodarone
lithium
type of thyroiditis occuring after a viral infectino
De Quervains
why do basal plasma calcitonin and carcinoembryonic antigen (CEA) test for thyroid lumps
medullary cancer
type of biopsy for thyroid lumps
FNA
3 antibodies for T1 DM
HLADR3
HLADR4
islet cell
drugs increasing risk of T2 DM
combined use thiazide + beta blocker
statins
2 derm symptoms of all types of diabetes
boils
pruritus vulvae
random and fasting plasma glucose levels in diabetes
random = >11.1 fasting = >7
only one needed in symptomatic, 2 fasting samples in asymptomatic
what is OGTT
2 hour venous plasma glucose >11.1 2 hours after 75g glucose
2 types of insulin if you dont want to inject much
2X daily (isoprene insulin) long-acting insulin analogues
3 features of DKA
acidosis
hyperglycaemia
ketonuria
3 treatments for DKA
fixed rate IV insulin infusion (FRIII)
IV 0.9% saline
replace K+ if 3.5-5.5
4th step in T2 DM treatment
lifestyle + metformin + secondary drug + insulin
add on each one with each step
secondary drug in T2 DM
sulphonylurea e.g. gliclazide
type of Cushing’s syndrome causing increased ACTH
ACTH-dependent
what is Cushing’s disease
ACTH-dependent Cushing’s - pituitary
2 other causes of ACTH-dependent Cushings (apart from cushings disease)
- ectopic ACTH-producing tumours e.g. lung cancer
- excess ACTH administration
2 causes of non-ACTH dependent Cushing’s syndrome
- excess glucocorticoid administration (most common)
- adrenal adenomas/carcinomas
ACTH levels in dependent vs non-dependent cushings syndrome
dependent = increased ACTH non-dependent = no ACTH but increased serum cortisol
2 types of endogenous Cushings i.e. ACTH-dependent but from inside body
corticotropin dependent (most common) corticotropin independent
2 types of corticotropin dependent Cushings
pituitary adenomas (Cushings disease - 80%) ectopic corticotropin syndrome (20%)
2 types of corticotropin independent Cushings
adrenal adenoma (60%) adrenal carcinoma (40%)
lipid profile in Cushings
decreased lipids
syndrome sometimes caused by Cushings
diabetes = thirst etc
3 diagnostic tests for Cushings
- 24hour urinary free cortisol (2+ collections, >3x upper limit)
- 1mg overnight dexamethasone suppression test
- late night salivary cortisol (11pm-1am)
4 tests for ACTH-dependent Cushings
- high dose dexamethasone suppression test
- inferior petrosal sinus sampling (IPS)
- MRI pituitary
- chest and abdo CT - ectopic?
result of dexamethasone suppression test in Cushing’s disease (pituitary adenoma) and ectopic ACTH
> 90% decreased
IPS result in ectopic ACTH
<1.8
IPS result in pituitary adenoma (Cushings disease)
> 2
2 drugs for Cushings to decrease cortisol
metyrapone
ketoconazole
complication of surgery to remove adrenal glands in Cushing’s disease
Nelson’s syndrome = enlargement of pituitary, development of adenomas
what is secondary HPT
hyperplasia + increased PTH in response to hypocalcaemia
usual cause of secondary HPT
renal failure
most common cause of primary HPT
single adenoma
calcium levels in primary HPT
high = osteoporosis, kidney stones, increase in 24 hour urinary calcium excretion
phosphate levels in HPT
low
3 syndromes associated with parathyroid adenoma (most common cause of PHPT)
MEN1
MEN2
jaw tumour syndrome
3 causes of primary addison’s disease
adrenal dysgenesis/destruction
autoimmune adrenalitis
TB
cause of secondary Addisons
decreased ACTH secretion
treatment of secondary Addisons
long term steroids
what can postural hypotension and hyponatraemia be a sign of
Addisons
what can decreased RBC synthesis cause
macrocytosis
what can decreased Hb production cause
microcytosis
3 signs of macrocytosis
high output HF
bounding pulse
systolic murmur
what can decreased B12/folate cause
megaloblastic anaemia (macrocytic - from decreased DNA synthesis)
drug causing non-megaloblastic anaemia
azathioprine (affects DNA)
4 other causes of non-megaloblastic anaemia
alcohol
liver disease
hypothyroidism
reticulocytosis
most common cause of B12 deflciency
autoimmune Addisonian pernicious anaemia
2 other causes of pernicious anaemia
diabetes
hypothyroidism
4 drugs causing folic acid deficiency
alcohol
anticonvulsants
methotrexate
trimethoprim
treatment of B12 deficiency
injection continued for life -(hydroxocobalamin)
why start B12 injections before folate if deficient in both
increases SCDC
Hb cut offs for ID anaemia
men = 13 (<11 = 2ww) women = 12 (<10 = 2ww if not menstruating)
4 drugs decreasing iron absorption
tetracyclines
quinolones
antacids
PPIs
2 head and neck signs of anaemia
glossitis
tinnitus
what is Paterson-Brown-Kelly syndrome
dysphagia from ID anaemia
nail symptom of ID anaemia
koilonychia
what is anisocytosis
variation in RBC size (ID anaemia)
what is poikilocytosis
abnormal RBC shape (ID anaemia)
poisoning showing symptoms similar to ID anaemia
lead poisoning
2 locations of mets in lymphoma
liver
breast
CXR in Hodgkin lymphoma
mediastinal widening (hilar LNs)
2 types of non-Hodgkin lymphoma
indolent (not curable)
aggressive
2 types of indolent nHL
follicular
marginal zone
2 types of aggressive nHL
DLBCL (B cell)
Burkitt
chemotherapy for low grade lymphoma
chlorambucil
CHOP chemo for aggressive nHL
cyclophosphamide
doxorubicin
vincristine
prednisolone
drug to treat DLBCL
rituximab (monoclonal antibody)
2 signs of nerve root compression
clonus
positive Babinski
what drug to use to reduce muscle spasms in prolapsed disc
benzodiazepines
most common organism causing septic arthritis
s. aureus
2 conditions showing similar symptoms to septic arthritis
lyme disease
IE
antibiotic for normal septic arthritis
flucloxacillin (clindamycin if allergic)
antibiotic for ?MRSA septic arthritis
vancomycin
antibiotic for gonococcal septic arthritis or gram =ve
cefotaxime
3 drug risk factors for gout (increase uric acid)
diuretics
chemotherapy
low-dose salicylate e.g. aspirin
4 condition risk factors for gout
hypertension
CHD
DM
hyperlipidaemia
1 derm condition risk factor for gout
psoriasis
what is chronic tophaceous gout
large crystal deposits produce firm nodules around extensor surfaces
what confirms diagnosis of gout
MSU crystals in synovial fluid or tophi
3 XR findings in chronic gout
tophi
sclerosis
punched out lesions
2 first line drugs for gout
NSAIDs
colchicine
when to use canakinumab in gout (inhibitor of IL-1)
if no response with 1st line drugs or 3+ attacks in 12 months
3 drugs for gout prophylaxis
allopurinol
febuxostat
uricosurics (increase secretion)
side effect of febuxostat
anaphylaxis
when to use drug prophylaxis for gout
NOT during acute attack - 2+ in 1 year, tophi, renal impairment, need diuretics
2 nerve complications of gout
nerve impingement
carpal tunnel
steroid dose increasing risk of osteoporosis
prednisolone >7.5 mg/day for >3 months
2 haematological causes of osteoporosis
myeloma
haemoglobinopathies
2 respiratory causes of osteoporosisq
COPD
CF
1 metabolic cause of osteoporosis
homocystinuria
4 drugs causing osteoporosis
heparin
ciclosporin
anti-convulsants
aromatase inhibitors (breast cancer)
1 anabolic treatment for osteoporosis
teriparatide (PTH analogue)
3 antiresorptive treatments for osteoporosis
SERMS e.g. raloxifine
bisphosphonates
RANK-L inhibitor e.g. denosumab
2 genes increasing risk of RA
HLADR1
DR1
3 hand deformities in RA
ulnar deviation piano key deformity (wrist) Z deformities (thumbs)
when is there a +ve ANA result in RA
if also has SLE
urinalysis result in RA
microscopic haematuria/proteinuria
4 drugs for RA
NSAIDs
DMARDs
corticosteroids
COX-2 drugs e.g. celexobib, etoricoxib
4 XR findings in OA
osteophytes
joint space narrowing
bone cysts
subarticular sclerosis
3 conditions DDs for OA (apart from obvious ones)
ankylosing spondylitis
sarcoidosis
IE
topical adjunct treatment for knee and hand OA
topical capsaicin
what is delirium tremens
delirium from alcohol withdrawal
type of seizures from alcohol withdrawal
tonic clonic
what type of drug is librium (for alcohol)
benzodiazepine - chlordiazepoxide
what can liver cirrhosis cause
diabetes
why can alcohol cause oedema
decrease albumin levels
5 consequences of alcohol on blood
atherosclerosis hypertension increased MCV folic acid and B12 deficiency BM damage
consequence of alcohol on heart
alcoholic cardiomyopathy (= AF?)
2 consequences of alcohol on nervous system
Korsakoff’s syndrome
peripheral neuropathy
what is Korsakoff syndrome
irreversible cerebellar damage from thiamine deficiency
type of diuretics to give in alcohol withdrawal
K+ sparing
CAGE questions for alcohol abuse
CUT down
ANNOYED you by criticising drinking
GUILTY about drinking
EYE-OPENER (needing a drink first thing in the morning)
5 features of dementia with Lewy bodies
fluctuations in consciousness hallucinations sleep disruption falls Parkinsonian features
6 treatable causes of dementia
substance abuse hypothyroidism SoLs normal pressure hydrocephalus B12 and folate deficiencies pellagra
what is pellagra
B3 deficiency
treatment for mild to moderate AD
AChE inhibitors e.g. donepezil
treatment for moderate-severe AD
NMDA antagonists e.g. memantine
2 treatments for somatisation
CBT
antidepressants e.g. duloxetine
2 antipsychotics sometimes used in delirium psychotics
haloperidol
olanzapine
NEVER in LB dementia or PD
6 drugs which can cause delirium
benzos analgesics anticholinergics anticonvulsants anti-parkinsonism steroids
4 toxic substances which can cause delirium
CO
alcohol
heavy metals
barbituate withdrawal
3 deficiencies which can cause delirium
B1 (thiamine)
B2
B3 (niacin)
3 diagnostic criteria for GAD
4+ symptoms with 1+ autonomic arousal symptom
anxiety more days than not for 6+ months
exclusion of panic disorder, phobic anxiety disorder, OCD
2 drugs for GAD
SSRIs (pregabalin if cant tolerate)
SNRI (venlaxafine)
3 self report symptom scales for depression
patient health questionnaire (PHQ-9)
hospital anxiety and depression (HAD) scale
Beck’s depression inventory
diagnostic criteria for depression
5+ symptoms 2+ weeks, one of which is a core symptom
2 core symptoms depression
feeling down
little pleasure
7 other symptoms of depression
fatigue worthlessness thoughts of suicide decreased ability to concentrate psychomotor changes insomnia/hypersomnia appetite increased/decreased
what is dysthymia
sub-threshold depression (2-5 symptoms) present >2 years
5 other types of antidepressants
NaSSA e.g. mirtazapine moclobemide reboxetine SNRI e.g. venlaxafine, duloxetine TCA e.g. amitriptyline
when to take antidepressants for >2 years (usually 6+ months)
2+ depressive episodes
3 types of partial seizures
simple
complex
secondary generalised
lobe of brain in complex partial seizures
temporal
2 features of simple partial seizures
conscious
weakness of limbs (Todd’s paralysis)
duration of complex partial seizures
> 30 seconds
consciousness level in complex partial seizures
decreased
4 symptoms of complex partial seizures
deja vu/jamais vu
vertigo
hallucinations
tachycardia
3 signs of tonic phase in tonic clonic
rigidity
incontinence
hypoxia
3 signs of clonic phase in tonic clonic
convulsing
eye rolling
tachycardia
ECG in absence seizures
3Hz spike
2 features of absence seizures
conscious but unresponsive
muscle jerking
why do do bloods for seizures
diabetes?
1st line treatment for status epilepticus
benzos
2nd line treatment for status epilepticus
phenobarbital
3rd line treatment for status epilepticus
phenytoin IV
2 drugs for absence seizures
ethosuximide
sodium valproate
what drug not to use for absence seizures
phenytoin
1st line treatment for partial seizures
carbamazepine
1st line treatment for generalised seizures
sodium valproate
definition of chronic migraine
15+ days per month, or 8+ if other symptoms, includes menstrual migraine
mnemonic for remembering triggers or migrinaes
CHOCOLATE
Ch = chocolate and cheese O = OCP C = caffeine/withdrawal Ol = alcohol A = relaxation T = travel E = exercise
4 diagnostic criteria of migraines if there is no aura
5+ attacks
no secondary cause
2+ of unilateral pain, pulsing, from decreased activity
1+ of N+V, photophobia, phonophobia
6 symptoms of migraine aura
depression tiredness stiff neck food cravings visual disturbance sensory symptoms (moving from hands to arms then face)
3 types of drugs for migraine during an attack
antiemetics e.g. metoclopramide
5-HT agonists
anticonvulsants e.g. lamotrigine
3 prophylactic drugs for migraines
antihistamines
propanolol
amitriptyline
most common cause of SAH
aneurysm rupture
3 complications of SAH
TIA/stroke (from vasospasm)
secondary hydrocephalus
re-bleeding (<7 days)
what is sentinel headache
headache prior to SAH in 6%
5 grades of SAH
1 = no signs 2 = neck, CN 3 = drowsy 4 = hemiplegia 5 = coma
3-5 = 50% mortality
CT result in SAH
star-shaped lesions
drug to use in SAH to decrease vasospasm
CCB - e.g. nimodipine
mnemonic for causes of peripheral neuropathy
DAVID: D - diabetes A - alcohol V - vit B12 deficiency I - infection/inherited D - drugs
drug causing peripheral neuropathy
isoniazid
2 inherited disorders causing peripheral neuropathy
Guillain Barre
Charcot-Marie-Tooth
2 biopsies for peripheral neuropathy
nerve
skin
4 treatments for peripheral neuropathy
anticonvulsants e.g. gabapentin
TCAs
elastic stocking
self-catheterisation
4 bacteria causing chronic cervical lymphadenopathy
non-TB mycobacteria
TB mycobacteria
Bartonella
toxoplasma gondii
what can connective tissue disorders cause in the neck
cervical lymphadenopathy
why do serology in cervical lymphadenopathy
cat scratch?
why do tuberculin test in cervical lymphadenopathy
TB - chronic
antibiotic for CL
clindamycin
what is Kernig’s sign (meningitis, SAH)
cant straighten leg when hip at 90 degrees
what is Brudzinskis sign (meningitis)
hips and knees flex when neck is flexed
4 viruses causing viral meningitis
herpes
mumps
echo
influenza
3 bacteria causing meningitis when 0-3 months
E. coli
group B strep
Listeria
3 bacteria causing meningitis when 3 months +
n. meningitidis (meningococcal)
s. pneumoniae
h. influenzae
2 features of meningococcal meningitis
cold peripheries
no fever or increased WCC
when to give prophylaxis for meningococcal meningitis
rifampicin to household contacts of patient
4 cancers causing malignant meningitis
leukaemia
lymphoma
breast (met)
bronchial (met)
lumbar puncture results in viral vs bacterial meningitis
viral = lymphocytes (colourless) bacterial = polymorphs
type of antibiotic for bacterial meningitis
3rd gen cephalosporin - e.g. cefotaxime, cephalexin IV
drug to lower risk of complications of bacterial meningitis
dexamethasone
4 complications of bacterial meningitis
hearing loss
vasculitis
cerebral infarct/abscess = epilepsy
hydrocephalus/subdural effusion
type of drugs causing drug-induced Parkinsonism
tranquillisers for psychosis
2 toxins causing Parkinsonism
CO
carbon disulphide
Hz of resting tremor in PD
4-6
gait in PD
festinating
what is PD dementia
1+ year after onset of PD
6 diagnostic criteria for PD alongside exclusion criteria
unilateral rest tremor progressive response to L-dopa hyposmia visual hallucinations
isotope scan for PD
daTSCAN
2 dopadecarboxylase inhibitors for PD
carbidopa
cocareldopa
example of a dopamine agonist for PD
apomorphine
2 MOA inhibitors for PD
selegiline
rasigiline
most common cause of infarct stroke
arterial embolism (usually carotid, sometimes heart valves)
drug causing infarct stroke
cocaine
5 other causes of infarct stroke
venous/fat/air infarct MS mass lesion migraine amyloidosis
inherited cause of stroke
cadasil (defective NOTCH3 gene)
what is a lacunar infarct
deep artery infarct stroke
4 symptoms of lacunar infarct
aphasia
hemiparesis
hemisensory loss
unilateral ataxia
what is Webers syndrome
infarct on one side of midbrain
2 symptoms of Webers syndrome
ipsilateral CNIII paralysis
contralateral hemiplegia
why do ESR for stroke
check for GCA
3 treatments for ischaemic stroke
thrombolysis OR aspirin
dipyridamole
carotid entarterectomy
3 optic signs of MS
neuritis
disc swelling
RAPD
what is Uthoffs phenomenon
MS symptoms worse on hot days
what is Lehrmitte sign
MS - electric shock on flexing head
CSF result in MS
oligoclonal bands
VEP result in MS
lesions in visual pathway
diagnostic criteria for MS
1+ attack and >1 plaque MRI
OR
1 attack, >1 plaque MRI and VEP etc.
3 drugs for preventing MS relapse
beta interferon
natatizumab
baclofen
drug to use during an acute MS attack to induce remission
steroids
what can spermicide, DM and pregnancy increase risk of
cystitis
2 postmenopausal syndromes which are DDs for cystitis in women
atrophic vaginitis
urethritis
when to do urine culture for cystitis
high risk
male
3 times to refer for cystitis
haematuria
women with recurrence
men 2+ 2 months
3 complications of asymptomatic bacteruria in pregnancy
UTI
preterm delivery
anaemia
1st line treatment for adults with pyelonephritis
ciprofloxacin/co-amoxiclav 7 days
1st line treatment children with pyelonephritis
co-amoxiclav
2nd line treatment children with pyelonephritis
cefixime
when to give prophylactic trimethoprim for pyelonephritis
women 3+ per year
USS result chronic pyelonephritis
thin and small
3 IV pyelogram results chronic pyelonephritis
small
dilatation
cortical scarring
t99m result chronic pyelonephritis
scars
what can secondary hypertension, CKD and pyonephrosis be a complication of
chronic pyelonephritis
urine test result hydropnephrosis
haematuria
definition of AKI
<0.5ml/kg/hr for 6+ hours
increased creatinine and urea
most common type of AKI
pre-renal
3 causes of pre-renal AKI from hypotension
septic shock
LVF
anaphylaxis
3 causes of pre-renal AKI from oedema
HF
cirrhosis
nephrotic syndrome
3 causes of pre-renal AKI from hypoperfusion
NSAIDs, ACEis, ARBs
AAA
renal artery stenosis
8 signs of AKI
increased BP large painless bladder postural hypotension oedema/pulmonary oedema increased JVP pallor/bruising vascular disease/emboli/DIC pericardial rub
what can be a cause of metabolic acidosis and hyperkalaemia
AKI
what can use of iodinated contrast agents increase risk of
AKI (if also unwell)
when to do doppler USS renal artery and veins
AKI
7 causes of CKD
arteriopathic renal disease hypertension high calcium glomerulonephritis SLE DM neoplasms, myeloma
drugs increasing risk of CKD
chronic NSAIDs
derm symptom of CKD
pruritus
4 groups of signs of CKD
- skin: pigmentation/pallor
- BP: hypertension, PH
- heart: LVH, peripheral oedema, pleural effusions
- neuro: PVD, peripheral neuropathy, RLS
Ca2+ result in CKD
decreased
Phosphate and PTH result in CKD
increased
5 urinalysis results in CKD
proteinuria haematuria glycosuria WCC decreased creatinine clearance
why use statins in CKD
for CVD
what is renal replacement therapy
dialysis + transplant
symptom score for BPH
international prostate symptom score (IPSS) - 0-7 = mild, 8-19 = moderate, 20-35 = severe
width of prostate in BPH
2+ fingers
cut off PSA values
40-49 = 2
50-59 = 3
60-69 = 4
70+ 5
screening 50+
e.g. of an alpha-adrenergic antagonist for BPH
tamsulosin for IPSS >8
2 e.g.s of 5-alpha reductase inhibitors for BPH
finasteride
dutasteride
gene increasing risk of prostate cancer
BRACA
what can haematospermia, symptoms of AKI/CKD, impotence and tenesmus be a symptom of
locally invasive prostate cancer
where can prostate cancer met to
bones = bone pain/sciatica
why can prostate cancer cause loin pain/anuria
LN obstruction of ureter if metastatic
what is palpable in DRE for prostate cancer
seminal vesicles
urine test for prostate cancer
PCA3
what does TRUS show in prostate cancer
hypo echoic area in preipheral zone
grading system for PC
gleason
gold standard anti-androgen therapy for PC
bilateral orchiectomy - castration
2 drugs for anti-androgen therapy for PC
enzalutamide
abiraterone + prednisolone
composition of struvite stones
magnesium ammonium phosphate
what can sarcoidosis cause
hypercalcaemia
when to do USS For kidney stones
pregnancy (otherwise non-contrast CT)
2 smooth muscle relaxants for kidney stones
alpha receptor blockers (tamsulocin)
CCBs (nifedipine)
treatment if kidney stones dont pass
extracorporeal shock wave lithotripsy
3 syndromes associated with RCC
cushings
hypercalcaemia (PTH)
polycythaemia (erythropoietin)
cancer syndrome associated with RCC
von hippel lindau
most common risk factor for RCC
smoking
why can RCC cause anaemia
tumour suppresses EPO = increased ESR
why can RCC cause hypertension
renin secreted by tumour
4 carcinogens for UCC
smoking
arylamines
cyclophosphamide
radiotherapy
most common sign of UCC
painless haematuria, negative for bacteria
treatment of bladder tumours depending on tumour size
pTa = transurethral resection pT1 = immunotherapy (intravesical BCG) pT2+ = radical cystectomy (<70), radiotherapy (>70)
2 bacteria causing HAP
gram -ve bacilli
s aureus
bacteria causing pleural rub in pneumonia
s. pneumoniae
CURB score
confusion (AMTS <8) urea >7 RR >30 BP <90/<60 >65
> 3 = severe, IV abx
4 lung complications of pneumonia
pleural effusion
empyema
lobar collapse
pneumothorax
cause of PSP
rupture of pleural bleb - congenital
connective tissue disorder increasing risk of PSP
marfans
3 signs of all pneumothorax
decreased breath sounds
hyper resonance
hypoxia no hypercapnia
complication of tension pneumothorax
cardiac arrest
3 haemodynamic signs of tension pneumothorax
hypotension
tachycardia
increased RR
type of alkalosis in pneumothorax
respiratory
treatment of PSP (>2cm and SOB) and secondary pneumothorax
O2
chest drain
aspiration then chest drain if unstable
treatment of tension pneumothorax
aspirate before CXR and chest tube ASAP
difference between transudate and exudate pleural effusion
transudate = not inflammation, protein <25m/L exudate = inflammation, protein >35g/L
determine using pleural aspiration/tap
4 causes of transudate pleural effusion
hypoalbuminaemia
Meig’s syndrome
hypothyroidism
cardiovascular (overload, HF, constrictive pericarditis)
3 causes of exudate pleural effusion
inflammation e.g. RA, SLE, infarction
malignancy
infection
1 infection causing chronic exudate pleural effusion
TB
horizontal pleural effusion?
coexisting pneumothorax
2 causes of high amylase in pleural effusion
carcinoma
pancreatic disease of oesophageal rupture
treatment for exudate effusion
treat cause and drain (dont drain for transudate)
surgical treatment for exudate effusion
pleurodesis - pleural spaces removed and stuck together with tetracycline, talc or bleomycin drugs
4 types of bronchial carcinoma
small cell
adeno
squamous
large cell
cells causing small cell BC
endocrine (Kulchitsky) - secrete polypeptides
cells causing adeno BC
mucous cells in bronchial epithelium
why does squamous BC cause infection and hypercalcaemia
obstructs bronchus
why does large cell BC met early
less differentiated version of SCC and adeno
3 endocrine complications of small cell BC
bad ADH secretion = hyponatraemia
ectopic ACTH = cushings
hypercalcaemia (PTH
3 neurological complications of BC
polyneuropathy
cerebellar degeneration
Lambert-Eaton
does small cell BC cause clubbing
no
2 signs OE if BC is in large bronchi
lung collapse
obstructive emphysema
when can’t you operate BC
if in the 1st 2cm of the main bronchi
chemotherapy for small cell BC
cyclophosphamide + doxorubicin + vincristine + etoposide
OR
cisplatin + radiotherapy
is T1 and T2 BC operable
yes
2 chemo drugs for T4 BC
gemcitabine
carboplatin
blood test result in acute asthma
peripheral blood eosinophilia
FEV1/FVC ratio in acute asthma
> 15% improvement + volume increase of >200ml after beta 2 agonist
2nd step in asthma treatment
inhaled steroid 200-800mcg/day beclomethasone (+ SABA)
3rd step in asthma treatment
add on therapy (LABA) not in addition to inhaled steroid - add steroid if doesn’t help
what to do if 3rd step asthma treatment doesnt work
leukotriene receptor antagonist or sustained release theophylline
4th step in asthma treatment
increase steroid to 2000mcg/day and/or add 4th drug (leukotriene receptor antagonist, SR theophylline or beta 2 agonist tablet)
5th step in asthma treatment
oral steroids + inhaled
investigation for Wells 2+
CTPA (D-dimer if <2)
what can chronic thromboembolic pulmonary hypertension (complication of PE) cause
HF
type of shock in PE
cardiogenic
why can PE cause pyrexia
WBC break down clot
3 heart sounds in PE
gallop heart rhythm
widely split 2nd heart sound
tricuspid regurgitant murmur
ECG in PE
might have ST depression
what is alpha-1 antitrypsin deficiency a risk factor for
COPD
spirometry result in COPD
FEV1/FVC <0.7 post-bronchodilator
FEV1 <80%
4 classifications of COPD
1 = mild - FEV1 >80% 2 = moderate - FEV1 50-79% 3 = severe - FEV1 30-49% 4 = very severe - FEV1 <30% or <50% and respiratory failure
dyspnoea scale for COPD
MRC (1-5)
what can secondary polycythaemia be a complication of
COPD
2 vaccines to give in COPD
pneumococcal
influenza
treatment for COPD if exacerbations despite SABA and FEV1 <50%
LABA + inhaled steroid (prednisolone 30mg/day for 7-14 days), or LAMA
if still = LAMA and LABA + inhaled corticosteroid
when to use theophylline for COPD
after SABA/LABA or can’t inhale
FEV1/FVC in pulmonary fibrosis
> 80% - decreased compliance (restrictive)
4 Ds in the symptoms of pulmonary fibrosis
dry cough
dyspnoea
digital clubbing
diffuse inspiratory crackles
2 treatments for pulmonary fibrosis
prednisolone - high dose 6 weeks then reduce
immunosuppression including azathioprine and cyclophosphamide and steroids
cause of secondary varicose veins
pelvic/abdominal masses
3 symptoms of varicose veins
prutitus
night cramps, heavy, aching
RLS
5 complications of varicose veins from venous hypertension
oedema venous ulceration pigmentation lipodermatosclerosis varicose eczema
2 examinations for varicose veins
cough impulse - saphenofemoral junction
trendelenbergs
investigation for varicose veins
colour doppler venous scans
screening for AAA
one USS for men 65+
weird risk factor for AAA
not having diabetes
what can hydronephrosis and limb ischaemia (embolism?) be a sign of
unruptured AAA
when to do AAA surgery
ruptured/rapid expansion or >5.5cm
4 drugs to reduce expansion/monitor AAA
doxycycline/erythromycin
ACEIs/ARBs
statins
low dose aspirin
4 infections causing AAA
brucellosis
salmonellosis
TB
HIV
2 inflammatory disorders causing AAA
Behçets
Takayaus
3 signs of AAA on CT
mural thrombus
crescent sign (imminent rupture)
para-aortic inflammation
what is Leriche syndrome
erectile dysfunction from PVD
main test for diagnosing PVD
doppler USS
ABPI values for PVD
0.6-0.9 = claudication
0.3-0.6 = rest pain
<0.3 = gangrene
2 tests to do for PVD if under 50 years old
thrombophilia screen
serum homocysteine levels
condition associated in 60% of people with PVD
CHD
most common valvular disease
aortic stenosis - hypertrophy + dilatation
murmur in aortic stenosis
ejection systolic
3 causes of aortic stenosis
<65 = calcified bicuspid valve
>65 = senile calcification
rheumatic fever/congenital
4 risk factors for aortic stenosis
age
congenital bicuspid valve
rheumatic disease
CKD
9 symptoms of aortic stenosis
angina exertional dyspnoea chest pain syncope plateau pulse narrow pulse low systolic BP heave apex systolic thrill + radiation to carotids
treatment for aortic stenosis stable vs unstable
stable = valve replacement unstable = valvuloplasty
why are most drugs contraindicated in aortic stenosis
vasodilatory effects
3 complications of aortic stenosis
CHF
prosthetic valve infection
thrombosis (mechanical valve)
murmur in aortic regurgitation
diastolic murmur
6 causes of aortic regurgitation
bicuspid valve (most common) infective endocarditis rheumatic fever arthropathies aortic stenosis Marfans
9 symptoms of aortic regurgitation
dyspnoea orthopnoea PND mottled extremities increased JVP lung crepitations head bobbing collapsing pulse wide pulse pressure
3 treatments for acute regurgitation
inotropes
vasodilators
aortic valve replacement
3 treatments for chronic regurgitation
reassure
vasodilator
TAVI (transcatheter aortic valve replacement)
murmur in mitral stenosis
diastolic murmur (more common than mitral regurgitation)
3 heart features in mitral stenosis
congestion
decreased cardiac output
right ventricular overload
5 risk factors for mitral stenosis
streptococcal infection female rheumatic fever small volume AF pulmonary hypertension
6 symptoms of mitral stenosis
malar flush dyspnoea on exertion orthopnoea PND cough haemoptysis
5 differentials for mitral stenosis
obstruction atrial myxoma cardiomyopathy atrial regurgitation tricuspid stenosis
3 treatments for mitral stenosis
valve repair
diuretic
anti-coagulants
3 complications of mitral stenosis
AF
stroke
IE
murmur in mitral regurgitation
pan systolic murmur (throughout systole - merge over 2nd heart sound)
5 casues of mitral regurgitation
rheumatic fever floppy valves (prolapse?) rupture after infective MI hypertrophic cardiomyopathy connective tissue disorders
6 symptoms of mitral regurgitation
exertional dyspnoea palpitations fatigue extremity oedema pulmonary oedema bibasal fine crackles?
5 DDs for mitral regurgitation
ACS IE mitral stenosis aortic stenosis atrial myxoma
5 treatments for. mitral regurgitation
surgery
diuretics
chronic = ACEis, BB, surgery
3 complications of mitral regurgitation
pulmonary hypertension
LV dysfunction
CHF
diagnostic criteria for infective endocarditis
Duke’s
most common organism in IE
staph aureus
3 organisms in IE if own valve
viridians group strep
S. aureus
enterococci
3 organisms in IVDU IE
s aureus
strep
gram negative bacilli
3 organisms in prosthetic valve IE
coagulase negative staph
s aureus
enterococci
symptoms in IE (FROM JANE)
F - fever
R - roth spots
O - oslers nodes
M - murmur (new)
J - janeway lesions
A - anaemia
N - nails (splinter haemorrhages)
E - emboli
blood cultures to do in IE
3 sets 1 hour apart before abx
3 differentials for IE
rheumatic fever
atrial myxoma
Libman-Sacks endocarditis (SLE)