Disease profiles Flashcards
How long should patient be in isolation for after diagnosis with C diff?
48 hours
Closure of which valves equates to which heart sound?
S1 = mitral and tricuspid closure S2 = aortic and pulmonary closure
What causes a third heart sound?
Physiological <30y/o (caused by diastolic filling of the ventricle)
Left ventricular failure
Constrictive pericarditis (pericardial knock)
What is the progression of treatment in Angina?
B-blocker GTN Isosorbide mononitrate Amlodipine PCI/CABG
What is the treatment for unstable angina?
Aspirin + clopidogrel
Nitrates
What pharmaceutical management is given post-MI?
Dual anti platelet therapy
ACEI
B-blocker
Statin
When does a patient receive PCI following an NSTEMI
GRACE score is calculated and based upon that either in the same admission or at a later date
What is the treatment of heart failure and how is it progressed?
B-blocker
ACEI
Loop diuretic
Increased:
Spironolactone
Digoxin
What is the investigations of arrhythmias?
ECG,
Exercise ECG,
24hr ECG
What is the treatment of coryza?
Bed rest and supportive management
What is sinusitis, how does it present, how is it investigated and how is it treated?
Bacterial or fungal infection of sinuses
Px: frontal headache/pain, fever, runny nose
Ix: CT of sinuses or MRI
Tx: nasal decongestants, broad spec antibiotics (co-amoxiclav)
How is rhinitis treated?
Antihistamines
Monteleukast
Sodium cromoglycate
What type of infection is pharyngitis?
Adenovirus
How does pharyngitis present and how is it treated?
Sore throat, fever, tonsillar enlargement
Tx: phenomethylpenicillin
What organism causes epiglottitis and how is it treated?
Haemophilus Influenzae
Tx: Endotracheal intubation, IV fluids, DO NOT inspect until airway clear
What is the difference between influenza A and influenza B?
Influenza A = pandemics
Influenza B = local outbreaks (epidemics)
How are mild and severe CAP and mild and severe HAP treated?
CAP:
Mild - amoxicillin/doxycycline
Severe - Co-amoxiclav + doxycycline
HAP:
Mild - metronidazole + amoxicillin
Severe - gentamicin + amoxicillin + metronidazole
How long after admission is pneumonia considered to be hospital acquired?
48 hours
What is the progression of treatment for COPD?
SABA/SAMA
FEV1 >50%
LABA/LAMA
LABA+ICS
FEV1 <50%
LAMA/ LABA+ICS
LAMA + LABA+ICS
What is the progression of treatment for asthma?
SABA ICS LTRA LABA Increase ICS
How is obstructive sleep apnoea diagnosed?
Epworth sleepiness scale
Overnight pulse oximetry
What are the symptoms of a lung abscess?
Swinging fever,
Persistent pneumonia
Malaise
How is CF diagnosed?
Sweat test (gene testing)
What are the side effects of the TB treatments?
Rifampicin: orange bodily fluids
Isoniazid: neuropathy
Pyranizamide: hepatic toxicity
Ethambutol: optic neuritis (colour blindness)
What is the treatment for sarcoidosis?
Oral prednisolone
What is Wegeners granulomatosis and how is it diagnosed?
Granulomas affecting small arteries
Dx: CXR (nodular masses)
What is Churg-Strauss syndrome, how does it present, how is it diagnosed and what is the treatment?
Eosinophillic infiltration - mainly 40y/o males
Px: cough, cold peripheries, SOB (asthma), fever/sweats/fatigue, difficulty passing urine
Dx: cANCA increased
Tx: prednisolone
What type of reaction is SLE?
Connective tissue disorder
Type III hypersensitivity
What is the treatment for idiopathic pulmonary fibrosis?
Prednisolone + anti-fibrotic
What is the treatment of hypersensitivity pneumonitis and how is it diagnosed?
Tx: Avoidance, Steroids, immunosuppressants
Dx: CXR (upper zone mottling/fibrosis/honey-comb lung/ground glass), restrictive spirometry
What is pneumoconiosis and how is it treated?
Occupational lung disease
No treatment: steroids help symptoms
How is an empyema treated?
Surgical drainage in 5th intercostal space mid axillary line
What is the difference between a transudate and an exudate?
Transudate (benign): <30g/L
Exudate (malignant): >30g/L
How are type I and type II respiratory failure treated?
Type I: 15L O2 non-rebreather
Type II: 24% O2 - check ABGs after 20 mins
What is ARDS and what is its treatment?
Stuff lungs - reduced pulmonary compliance
Tx: treat underlying condition, diuretics, NO (vasodilator)
What is cor pulmonale?
Right heart failure due to pulmonary hypertension
How is a PE treated?
If haemodynamically stable: anticoagulant
IF unstable: thrombolyse for massive PE (tPA/streptokinase)
How is pulmonary oedema diagnosed and treated?
Dx: CXR (ABCDE)
Tx: diuretics + O2
Which lung cancers produce which hormones?
SCLC: ADH and ACTH (increase cortisol)
SCC: PTH, hypercalcaemia
What are the classification software hypertension?
Stage 1: >140/90
Stage 2: >160/100
Severe: >180/110
What is the target blood pressure for under and over 80?
<80: 140/90
>80: 150/90
What is the investigations for angina?
ECG (to exclude anything worse)
Exercise ECG
What is the progression of treatment for angina?
B-blocker GTN Isosorbide mononitrate Amlodipine PCI/CABG
What is acute coronary syndrome and how is it investigated?
Unstable angina, NSTEMI, STEMI
Ix: ECG + cardiac troponins
What is the difference in ECG/troponins in different acute coronary syndromes?
Unstable angina:
No ECG changes and no changes in cardiac markers
NSTEMI:
ST depression, T wave inversion, elevated troponin
STEMI:
ST elevation, T wave inversion, Q waves, elevated troponin
What is the treatment for unstable angina?
Aspirin + clopidogrel
Nitrates
What are the different types of heart block?
Type 1: long PR interval Type 2 (I): progressive lengthening of PR interval until dropped QRS Type 2 (II): dropped QRS without change in PR Type 3: No associations between P and QRS (lonely P waves)
How is heart block treated?
Atropine
Pacing (temporary/permanent)
How are right and left bundle branch block identified?
Left: W in V1, M in V6
Right: M in V1, W in V6
(WilliaM MorroW)
When is anticoagulation given in AF?
CHAD-VASC score:
0 = none
1 = consider in males
2 = offer to both
What is the acute treatment of symptomatic AF?
DC cardio version and anticoagulation
How is the rate and rhythm controlled in AF?
Rate:
B-blocker
Ca channel blocker (diltiazem)
Digoxin
Rhythm:
Electrical cardioversion
Amiodarone
How is atrial flutter treated?
Curative = radio frequency ablation
Otherwise the same as AF (rate, rhythm and anticoagulation)
What are the ECG changes in ventricular tachycardia?
Broad monomorphic QRS or torsades de point
How is VT treated if pulseless or if cardiac output is acceptable?
Pulseless VT = defib
CO/BP fine = amiodarone
How does ventricular fibrillation appear on an ECG and what is the treatment?
Complete disorder with a wide QRS
Tx: defibrillator and implantable cardiac defibrillator (ICD) long term
Which murmur is not caused by rheumatic disease?
Aortic regurgitation
What are the factors you would want to know about a murmur?
Systolic or diastolic? Type (ejection/pansystolic) Where its loudest? Any radiation? Grade? Respiratory influence?
What is the treatment for Strep viridans, Staph aureus, Staph epidermidis and MRSA infective endocarditis?
Strep viridans: amoxicillin + gentamicin
Staph aureus: flucloxacillin
Staph epidermidis: vancomycin + gentamicin
MRSA: vancomycin + gentamicin
What is intermittent claudication and how is it investigated?
Chronic lower limb ischaemia
Ix: ABPI (ankle brachial pressure index), duplex ultrasound, CT angiography
What is the treatment for chronic and acute lower limb ischaemia?
Chronic: antiplatelets or surgery (if severe)
Acute: anticoagulation, angioplasty, surgery
How is supraventricular tachycardia treated?
Vagal manoeuvres, IV adenosine, Iv verapamil
What are the signs of acute lower limb ischaemia?
6P’s
Pallor, pain, pulseless, perishingly cold, paralysis, paraesthesia
What are the signs and investigations of an AAA?
Asymptomatic, abdominal pulsatile mass or severe pain radiating to the back if perforated
Ix: ultrasound
What is the treatment of an AAA?
<5.5cm: monitoring/lifestyle advice
>5.5cm: surgery/stenting
How is DVT investigated and treated?
Ix: doppler ultrasound, low D-dimers (exclusion)
Tx: anticoagulation, TED stockings
What causes varicose veins?
Back pressure due to incompetent valves causing pooling of blood in the superficial veins
What is the most common congenital heart malformation?
VSD
What re the general signs of congenital malformation?
Cyanosis and clubbing
What are the signs of coarctation fo the aorta?
Rib notching om CXR
Diminished lower pulses
How is a stroke investigated?
Non-contrast CT or an MRI
What is the treatment for an ischaemic or a haemorrhage stroke?
Ischaemic:
Thombolysis, aspirin/clopidogrel
Statin upon recovery
Haemorrhagic:
Supportive, stop any anticoagulation
What is the investigation and treatment of hypertrophic cardiomyopathy?
Ix: ECG (LVH and Q waves), Echocardiogram
Tx: ICD (defibrillator)
What are the investigations and results of myocarditis?
CXR (cardiomegaly)
Troponin (increased)
What is the treatment of myocarditis?
ACEI
B-blockers
Antibiotics where appropriate
What are the types are treatments of shock?
An Old Virign Hides, Cause Other Virgins Slag Adult Abstinence, Its Chilling
ABCDE Oxygen Vol replacement - Hypovolaemic Chest drain - Obstructive Vasopressors - Septic Adrenaline - Anaphylaxis Inotropes - Cardiogenic
Inotropes = digoxin/amiodarone
How is GORD treated?
Omeprazole, ranitidine, antacids (gavescon)
What is the investigation and treatment of gastritis?
Ix: H pylori breath test
Tx: omeprazole/ranitidine, lifestyle, surgery
What is gastroparesis and what are the signs, investigations and treatments?
Delayed gastric emptying not due to obstruction
Sx: bloating, abdo pain, N&V
Ix: OGD
Tx: pro kinetic agent (metoclopramide), anti-emetic
Where are peptic ulcers most commonly found and what causes them?
Duodenum
Caused by acid/pepsin attack
How are peptic ulcers diagnosed and treated?
Ix: OGD
Tx: antacids (gaviscon), omeprazole, ranitidine, H pylori eradication therapy
What is H pylori eradication therapy?
2 weeks of triple therapy - omeprazole + amoxicillin + metronidazole/clarithromycin
How is intestinal failure diagnosed and what is the treatment?
Ix: FBC, serum electrolytes
Tx: nutritional support
What is the treatment of small bowel obstruction?
Drip + suck: fluids and NG tube draining
What are the signs of meckels diverticulum?
Asymptomatic or malaena
How are campylobacter, salmonella, E coli 0157, norovirus and rotavirus investigated?
Stool culture: campylobacter, salmonella
Stool toxin: E coli 0157
Stool PCR: norovirus, rotavirus
What causes dysentry (bloody diarrhoea)?
Campylobacter, E coli 0157, shigella
What is the progression in treatment for IBD?
5-ASA (mesalazine) - UC only Corticosteroid (prednisolone) Immunosuppressant (azathioprine) Anti-TNF (inflixumab) Surgery
Where does diverticular disease mainly affect?
Sigmoid colon
What are the symptoms of diverticulitis?
Diarrhoea, abdo pain, fever, vomiting, altered bowel habit
What is the treatment for diverticulitis?
Drainage and antibiotics
Which inherited condition causes a carpet of polyps through the bowel?
Familial adenomatous polyposis (FAP)
What is the treatment for IBS?
FODMAP diet and loperamide
What is the difference between pre-hepatic, hepatic and post-hepatic jaundice?
Pre-hepatic; excess haemolysis (unconjugated bilirubin)
Hepatic: liver damage (conjugated + unconjugated bilirubin)
Post-hepatic: bile duct obstruction (conjugated bilirubin)
Which viral hepatitis is DNA rather than RNA?
HepB
What are the different tests which indicate current infection, natural immunity and highly infectious individuals with respect to HepB?
HepB s Ag: infection
HepB s Ab: immunity
HepB e Ag: highly infectious
Which types of viral hepatitis are acute and chronic?
Acute: HepA, HepE, HepB
Chronic: HepB, HepC
What is the treatment for HepA, HepB and HepC?
HepA: supportive management
HepB: adefovir, tenofovir, peg interferon
HepC: peginterferon, ribarvirin
What is haemochromatosis and what are its signs and treatment?
Autosomal recessive condition with abnormal iron absorption
Sx: hepatomegaly, slate grey, joint pain
Tx: venesection
What is Wilsons disease and what are its signs and treatment?
Excess copper due to autosomal recessive disorder
Sx: Kayser-fleisher rings, signs of liver disease
Tx: penicillamine
What is Budd-Chiari syndrome?
Hyper-coagulation in the hepatic vein (clotting means obstruction and thrombosis)
What is the investigation progression and treatment for gallstones?
LFTs Ultrasound MRCP ERCP Tx: ERCP or cholecystectomy
What is the treatment of acute pancreatitis?
NJ feeding
IV fluids
Analgesia
(supportive)
What are the clinical signs of acute pancreatitis?
Cullens and Grey Turners (bruising in umbilical and lumbar regions)
Fever
Severe pain radiating to back
N&V
What are the treatments of chronic pancreatitis?
CREON,
Insulin,
Surgery
What type of pancreatic cancer is the most common?
Exocrine (adenocarcinoma) - usually at ampulla of Vater
What are the endocrine tumours of the pancreas and what effects do they have?
Insulinoma (hypoglycaemia)
Glucagonoma (hyperglycaemia)
Gastrinoma (acid hypersecretion)
What group of people mainly get umbilical hernias and why?
Children - due to a weakness in the line alba
Which side of the inferior epigastric vessels are direct and indirect hernias and who gets them?
Direct: medial (old men)
Indirect: Lateral (young men)
What is the treatment of haemorrhoids?
Band ligation,
Asymptomatic = nothing,
Analgesia (gel/ice/cream)
What is a rectal prolapse?
A protruding mass from the rectum associated with defecation
What is an anal fissure and what is its treatment?
Tear in the anal margin distal to the dentate line - associated with massive pain upon defecation and bleeding
Tx: GTN ointment, topical diltiazem, botox injections
What is a fistula in ano and what is its treatment?
Abnormal connection between the anal canal and perianal skin causing abscess formation
Tx: drainage (cut it open)
What are the causes of liver disease?
ABCDEFGHI A - autoimme B - HepB C - HepC D - drugs (paracetamol) E - ethanol F - fatty liver disease G - growth (cancer/mets) H - haemodynamic (CCF) I - iron
What does raised cANCA indicate?
Granulomatosis with polyangiitis (Wegeners granulomatosis)
What does raised pANCA indicate?
Microscopic polyangiitis and eosinophilic granulomatosis (Churg-Stauss syndrome)
What is the difference between Wegeners granulomatosis and Churg-Strauss syndrome?
Wegeners = granulomas affecting small arteries
Churg-Strauss: Eosinophilic inflammation and granulomas
(both resp related)
What are the causes of abdominal distension?
6Fs Fat Faeces Fluid Flatus Foetus Fucking massive tumour
Causes of abdominal mass?
A CHEMICAL
A - AAA
C - Crohns H - hernia E - enlarged organ M - malignancy I - intersusception C - cyst/abscess A - appendicitis L - lymphadenopathy
Causes of bowel obstruction?
BATH VIPS (bowel = B)
B - bolus
A - adhesion
T - tumour
H - hernia
V - volvulus
I - intersusception
P -psuedoobstruction
S - stricture
What do amoxicillin, metronidazole and gentamicin target?
Amoxicillin: enterococcus (strep/staph)
Metronidazole: anaerobes
Gentamicin: enterobacteriacea