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SCP1 > Extra clinical notes (HD) > Flashcards

Extra clinical notes (HD) Flashcards

1
Q

Describe the physiology breast feeding

A

There are 2 parts: milk production and milk ejection.
Milk production is achieved through prolactin release from the anterior pituitary. Suckling of the baby on the nipple stimulates mechnoreceptors - this inhibits the release of dopamine from the hypothalamus therefore increasing prolactin release. Prolactin acts on milk gland cells causing milk synthesis.
When nipple mechanoreceptors are stimulated causing the release of oxytocin from the posterior pituitary gland, which causes the contraction of nipple myoepithelial cells, causing milk ejection.

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2
Q

What medications can be used to treat hyperprolactinaemia?

A

D2 agonists: bromocriptine, cabergoline

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3
Q

What is the difference between acromegaly and gigantism?

A

Both are caused by the over secretion of GH, the difference between gigantism and acromegaly is whether that occurs before or after the fusion of epiphyses respectively.

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4
Q

Describe bromocriptine

A

D2 agonist, used to treat hyperprolactinaemia or acromegaly

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5
Q

Describe cabergoline

A

D2 agonist, used to treat hyperprolactinaemia or acromegaly

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6
Q

Describe octreotide

A

Long lasting somatostatin, used to treat acromegaly

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7
Q

Describe pasireotide

A

Somatostatin, used to treat acromegaly and Cushing’s

SST5>SST2

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8
Q

Describe lanreotide

A

Somatostatin, used to treat acromegaly and Cushing’s

SST2>SST5

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9
Q

How can GH deficiency be treated

A

Recombinant hGH (somatropin) or recombinant hIGF-1 (mecasermin)

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10
Q

Describe somatropin

A

Recombinant hGH used to treat GH deficiency

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11
Q

Describe mecasermin

A

Recombinant hIGF-1 used to treat GH deficiency

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12
Q

Descrine an insulin tolerance test

A

Tests the hyopthalamus, pituitary and adrenal glands.

Hypoglycaemic episode induced by intravenous insulin, GH, ACTH and cortisol should be released with an intact HPA

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13
Q

What is the structure which joins the two lobes of the thymus gland

A

Isthmus

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14
Q

Which is the hormone and which is the prohormone in T3/4

A

T4 is the prohormone, which is converted to the active T3 hormone in the periphery.

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15
Q

Why do patients with hyperthyroidism have tachycardia

A

Binding of thyroid hormones causes an increase in the expression of beta-2 adrenergic receptors on the surface of cardiac myocytes increasing the heart rate

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16
Q

How is Hashimoto’s thyroiditis diagnosted serologically?

A

T3+T4 will be low (hypothyroidism)
TSH and TRH will be high (hypothyroidism)
Antiboidies to thyroglobulin or thyroid peroxidase will be present (autoimmune hypothyroidism)

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17
Q

How is Hashimoto’s thyroiditis treated?

A

Thyroxine 75-125 mcg o/d

or Levothyroxine 100 mcg p/o

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18
Q

Describe thyroxine + its dose

A

Used to treat hypothyroidism

75-125 mcg o/d

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19
Q

What is the pathology of myxoedema

A

Increase in size of thyroid gland due to presence of goitregens therefore causing hypertrophy and hyperplasia.
Goitrogens interfere with thyroid iodine uptake therefore causing hypothyroidism. This leads to an increased TSH and so the thyroid gland undergoes hypertrophy, while function does not improve as goitrogens still present.

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20
Q

How do you investigate suspected hyperthyroidism

A

Measure TSH, TRH, T3 and T4
Measure calcitonin
Do an ultrasound

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21
Q

How can you treat hyperthyroidism

A

Inhibit thryoid hormone synthesis:
Carbimazole (40mg o/d)
Propylthiouracil (200mg b/d)

Radioiodine therapy can be used, but usually causes hypothyroidism within 3-6 months.
Thyroidectomy can be considered if thyrotoxicosis is uncontrolled on anti-thyroid medication and there is a large goitre.

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22
Q

Describe carbimazole + its dose

A

Inhibits thyroid hormone synthesis given at 40mg o/d

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23
Q

Describe propylthiouracil + its dose

A

Inhibits thyroid hormone synthesis given at 200mg b/d

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24
Q

Causes of hyperprolactinaemia

A

1) excess production by pituitary
2) disinhibition by compression of pituitary stalk, reducing local dopamine levels
3) use of a dopamine agonist

Could be:
Prolactinoma
Stalk damage
Pituitary adenoma
Surgery, trauma
Hypothalamic issue
*Hypothyroidism + hyperprolactinaemia due to increased TRH*
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25
Q

What are the symptoms of hyperprolactinaemia

A

Women: Amenorrhoea; infertility; galactorrhoea; dec. libido; inc, weight; dry vagina

Men: Erectile dysfunction; dec. facial hair; galactorrhoea

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26
Q

How do you test for hyperprolactinaemia

A

PRL
Pregnancy test
TFT
U+E

MRI pituitary if needs be

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27
Q

What can be used to treat PRL

A

Cabergoline, bromocriptine (D2 agonist)

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28
Q

What are the symptoms of acromegaly

A 
Acroparaesthesia
Amenorrhoea
Dec. libido
Headache
inc. sweating
Snoring
Arthralgia
*Developing curly hair*
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29
Q

How do you test for acromegaly

A

Blood test: inc. glucose, Ca, PO4

Don’t rely on random GH tests as GH release is pulsitile and acromegalic and normal levels overlap
GH is also increased in stress, puberty, sleep and pregnancy giving a false positive

If basal serum GH is >0.4 mcg/l do an oral glucose tolerance test. If lowest GH value during OGTT is >1mcg/l acromegaly is confirmed (glucose inhibits GH secretion)

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30
Q

How do you treat acromegaly

A

1) Trans-sphenoidal surgery to remove tumour
2) If surgery fails to correct hypersecretion; somatostatin analogues are to be used (octreotide)
3) GH antagonist pegvisomant is used if intolerant to SSAs

Radiotherapy can be used instead of surgery if not suitable

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31
Q

What are the features of pheochromocytoma

A

head ache + sweating + tachycardia

Inc. HR, palpitations, VT, dyspnoea, headache, visual disorder, dizziness, tremor, anxiety, panic, hyperactivity. confusion, sweats, flushes, heat intolerance
(as with too much Red Bull)

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32
Q

How do you test for pheochromocytoma?

A

24hr urine test (adrenaline, noradrenaline)

CT/MRI abdomen

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33
Q

How is pheochromocytoma treated?

A

Surgical removal of tumour.
Catecholamines will be released during surgery so there is a pre-treatment with and alpha and beta blockade (phenoxybenzamine doxazonsin are alpha blockers)

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34
Q

What is asthma

A

Reversible airway obstruction which responds to bronchodilators

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35
Q

What are the symptoms of asthma

A 
Wheeze
Dyspnoea
SOB
dry cough
chest tightness
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36
Q

What are the signs of asthma

A 
Tachypnoea
Hyperinflated chest
hyper-resonance on percussion
decreased air entry
Resp rate >25
can't speak in complete sentances
peak flow 33-50% predicted
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37
Q

How do you test for asthma

A

Peak flow
Fractional exhaled nitric oxide (FENO) > 40 ppb in adults, 35 in children

For an acute asthma attack:
ABG: type 2 resp failure
Bloods: FBC, CRP (infection causing attack?)
CXR

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38
Q

Describe the long term management options for asthma

A

Beta 2 adrenergic receptor agonists (salbutamol short acting [SABA], salmeterol long acting [LABA])

Inhaled corticosteroids (ICS) (beclomethasone)

Long acting muscarinic antagonist (LAMA) tiotropium

Leukotriene receptor antagonists (montelukast)

Theophylline - relax brochial smooth muscle and reduce inflammation

  • In order*:
    1) SABA
    2) SABA + low dose ICS
    3) 2+LABA
    4) Stop LABA increase ICS
    5) try leukotriene receptor antagonist, high dose steroid
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39
Q

What are the grades for acute asthma attacks?

A

By PEFR

moderate 50-75%
severe 33-50%
life threatening <33%

Look for sats <92%; signs of becoming tired; silent chest for life threatening asthma

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40
Q

How do you manage a moderate asthma attack?

A

Nebulised beta 2 agonists (salbutamol 5mg repeated as often as needed)
Nebulised ipratropium bromide
Steroids: oral prednisolone or IV hydrocortisone for 5 days
Antibiotics if infection

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41
Q

What is prednisolone

A

A steroid given orally for 5 days following a moderate asthma attack

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42
Q

What is hydrocortisone

A

A steroid given IV for 5 days following a moderate asthma attack

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43
Q

How do you manage a severe asthma attack?

A

O2 keep sats 94-98%
Aminophylline infusion (relieves bronchial spasm)
IV salbutamol

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44
Q

How do you manage a life threatening asthma attack?

A

IV mg sulfate
Admission to ICU
Intubation if really severe, but needs to be decided early as difficult to intubate with severe bronchoconstriction

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45
Q

What do you need to monitor in the blood when you give salbutamol?

A

Serum potassium; causes absorption of K from blood into cells and can cause tachycardia

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46
Q

What is the respiratory differential diagnosis for someone presenting with a (dry) cough, wheeze, SOB, dyspnoea

A

Asthma
Acid reflux (GORD)
Allergic bronchopulmonary Aspergillosis (ABPA)
Churg Strauss Syndrome

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47
Q

What is GORD + symptoms

A

Gastro-oesophageal reflux disease

Dry cough, wheeze, sob, hoarse voice, dental erosion, chest pain

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48
Q

How is GORD treated?

A 
OTC antacids (Gaviscon)
Proton pump inhibitors (omeprazole)
H2 blockers (ranitidine)
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49
Q

What is ABPA + symptoms

A

Allergic bronchopulmonary Aspergillosis (ABPA)

Wheeze, cough, dyspnoea, sputum production

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50
Q

How do you test for ABPA

A

Raisied IgE in blood but not all patients have this

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51
Q

How do you treat ABPA

A

Prednisolone

Itraconazole too possibly

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52
Q

What is Churg-Strauss syndrome

A

Granulomatous vasculitis assoc. with adult onset asthma and eosinophilia

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53
Q

How do you test for Churg-Strauss syndrome

A

pANCA +ve and have raisied IgE levels

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54
Q

How is Churg-Strauss syndrome treated?

A

Steroids + immunological agents (Rituximab)

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55
Q

What defines the different stages of COPD

A

FEV1 as a % of predicted

stage 1: FEV1 >80%

2: 50-79
3: 30-49
4: <30%

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56
Q

What are the symptoms of COPD?

A 
Chronic SOB
Cough
Sputum production
Wheeze
Recurrent resp infections
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57
Q

How do you diagnose COPD

A

Clinical presentation + spirometry

Spirometry- FEV1:FVC <0.75

No response for a test for reversbility of symptoms with B2 agonists ruling out asthma

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58
Q

What do you rule out before diagnosing COPD and how

A

CXR - lung cancer
FBC - polycythaemia
BMI - to assess future weight change cancer and COPD will lead to weight loss and steroids weight gain
Sputum culture - chronic infection (Psuedomonas)
ECG + ECHO - heart function
CT thorax - fibrosis, cancer, bronchiectasis
Alpha 1 antitrypsin - early onset + increased severity for COPD

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59
Q

Describe the long term management of COPD

A

Short acting bronchodilators (salbutamol, terbutaline)
or short acting antimuscarinics (ipratropium bromide)

If no response add a long acting beta agonist and a long acting muscarinic antagonist

If there is a response to first step then use LABA + ICS

No response to 3rd LABA, LAMA and ICS

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60
Q

What is carbocysteine

A

Mucolytic treatement used in COPD patients

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61
Q

How do you investigate an exacerbation of COPD

A 
ABG
CXR - pneumonia
FBC (WBC) - infection
U+E's - electrolytes
Sputum culture - infection
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62
Q

What type of oxygen mask should be used for COPD patients?

A

Venturi mask - aim for 88 - 92% sat

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63
Q

What is community acquired pneumonia

A

Developed outside hostpital

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64
Q

What is hospital acquired pneumonia

A

Develops >48 hrs of hospital admission

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65
Q

What are the symptoms of pneumonia

A 
Fever
Malaise
Rigors
Cough
Purulent sputum
Pleuritic chest pain
Haemoptysis
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66
Q

What are the signs of symptoms of pneumonia

A 
Tachypnoea
Tachycardia
Hypotension
Cyanosis
Pyrexia
Confusion
Dull percussion of lungs
Crackles
Pleaural rub - pleurisy
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67
Q

How do you treat atypical pneumonia

A

Macrolides (clarithromycin)
Fluorquines (levofloxacin)
Tetracyclines (doxycycline)

Atypical pneumonias cannot be treated with penicillins

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68
Q

What is the scale used to judge treatment of pneumonia

A

CURB-65

C - confusion
U - urea >7mmol/l
R - resp rate >=30/min
B - BP <90/<60
65 age
Give one point for each
0-1 = home treatment
2 = consider hospitalisation
3-5 = consider ITU
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69
Q

How is pneumonia treated in hospital

A

O2 - sats >94%
Fluids
Analgesia for pleuritic chest pain (paracetamol 1g/6hrs max 4g in 24 hours)
Oral antibiotics, if nil by mouth give IV
mild CAP: 5 day course of antibiotics amoxicillin or macrolide
moderate/severe: 7-10 day course of amoxicillin and macrolide

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70
Q

What are the symptoms of pleural effusion

A

Dyspnoea
Chest pain
SOB
Reduced exercise tolerance

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71
Q

What are the signs of pleural effusion

A

Deviated trachea
Reduced chest expansion on affected side
Stony-dull percussion on affected side

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72
Q

What are the different types of pleural effusion?

A

Exudative and transudative

Difference is protein content of fluid >35g/l is exudative and is due to fluid to leak from tissues into pleural space; transudative is fluid moving across into pleural space

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73
Q

What causes exudative pleural effusion

A

Lung cancer, pneumonia, TB, rheumatoid arthritis
Acute pancreatitis
Pulm infarct
Trauma

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74
Q

What causes transudative pleural effusion

A

Congestive heart failure
Liver cirrhosis, nephotic syndrome, coeliac disease
hypoalbuminaemia
hypothyroidism
Meig’s syndrome (ascities, pleural effusion, ovarian tumour) right sided pleural effusion if tumour is malignant

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75
Q

What is ALT/AST ratio

A

Alanine aminotransferase:aspartate aminotransferase (conc of enzymes) is a liver function test of cirrhosis

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76
Q

How do you investigate a transudative pleural effusion

A

FBC
U+E’s - raised creatinine = renal impairment
LFT - low albumin + raised ALT:AST = cirrhosis
CXR - shows blunting of costophrenic angle + fluid in lung fissures
Glucose: low = rheum arthiritis, TB, malignancy
pH <7..2 = empyema (look for low glucose, high LDH)
Amylase - raised in pancreatitis

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77
Q

How do you manage a transudative pleural effusion

A

Intercostal drain
Pleural aspiration
Pleurodesis

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78
Q

What are the risk factors for a pulmonary embolism

A 
Immobility
Recent surgery
Long flights
Pregnancy
Polycythaemia
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79
Q

Symptoms of pulmonary embolism

A

Sudden onset SOB
Pleuritic chest pain
Haemoptysis

Big PE: syncope/shock
Small PE: asymptomatic?

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80
Q

What are the signs of PE?

A 
Tachypnoea
Tachycardia
Hypoxia
Fever
Hypotension
DVT*
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81
Q

What scoring system is used to grade pulmonary embolism

A

Well’s scoring system

3 pts if:
DVT
No other likely diagnosis

1.5 pts if:
Tachycardia (>100 bpm)
Immobility >3 days or surgery within month
History of PE/DVT

1 pt if:
Haemoptysis
Active malignancy

If score is <4 - measure D dimer then if low PE is exluded, if high do diagnositic imagine

If >4 diagnostic imagine + LMWH
CTPA or V/Q scan

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82
Q

How do you investigate pulmonary embolism

A

CTPA
VQ scan
ABG - resp acidosis due to tachypnoea

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83
Q

How do you treat pulmonary embolism

A

Anti-coagulation with LMWH (enoxaparin or dalteparin) start with a low dose in patients with DVT or suspected PE/there is a delay in scanning.

Switch to long term anticoagulation (warfarin) but LMHW is first line treatment in pregnancy or cancer

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84
Q

What is dalteparin

A

LMHW used to treat pulmoary embolism

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85
Q

What is salbutamol

A

SABA

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86
Q

What is an example of a LABA

A

Salmeterol

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87
Q

Give an example of an ICS

A

Beclomethasone

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88
Q

Give an example of a LAMA

A

tiotropium bromide

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89
Q

Give an example of a leukotriene receptor antagonists (LRA)

A

montelukast

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90
Q

What is theophylline

A

A bronchodilator used to treat asthma

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91
Q

What are the causes of primary hypothyroidism

A

Autoimmune:
Primary atrophic hypothyroidism
Hashimoto’s hypothyridism

Other:
Iodine deficiency
Post thyroidectomy or radioiodine
Drug induced

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92
Q

What are the causes of hypopituitarism?

A

Hypothalamic issue: tumour etc.
Pituitary stalk: trauma, surgery, lesion
Pituitary: tumour, irradiation, autoimmunity

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93
Q

What causes Grave’s disease

A

Circulating IgG autoantibodies binding to and activating GPCR thyrotropin receptors causing increased hormone production.

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94
Q

How is thyrotoxicosis treated

A

Drugs: Beta blockers (40mg/6hrs); or (a) carbimazole 20-40mgs/day for 4 wks titrate according to TFTs every 1-2 months or (b) carbimazole + levothhyroixine (block and replace, reduces risk of iatrogenic hypothyroidism)

Radioiodine
Thyroidectomy

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95
Q

How is Cushing’s disease treated?

A

Cushing’s is caused by an ACTH secreting pituitary adenoma; trans-sphenoidal removal of tumour or bilateral adrenalectomy

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96
Q

How do you test for Cushing’s disease

A

1) overnight dexamethosone test (1mg at midnight) do serum cortisol at 8am. Usually drops to <50nmol/L; no suppression in Cushing’s
2) 48hr dexamethosone test (0.5 mg/6hrs for 2 days) measure cortisol initial and 6hrs and after last dose - no suppression in Cushing’s
To distinguish between betweeen pituitary (suppression) and other causes (no/part suppression) do a high dose test (2mg/6hrs)
3) if 1+2 are positive; to find the lesion do an ACTH plasma test (if positive adrenal tumour likely)
If not do adrenal vein sampling.
If ACTH is detectable do a corticotropin releasing hormone test to see if it is a pituitary or ectopic cause of ACTH excess.
Give 100 mcg CRH IV, measure cortisol at 120mins.
Cortisol rises with pituitary disease but not with ectopic ACTH.

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97
Q

What are the symptoms of Addison’s disease

A

Low cortisol causes exhaustion, weight loss, postural hypotension, anorexia, GI symptoms, joint aches and pigmentation (due to an increase in ACTH precursors)

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98
Q

What is gastroparesis?

A

GI complication of diabetes related to poor glycaemic control - nerve damage to the ANS causing delayed stomach emptying

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99
Q

What are the symptoms of gastroparesis

A

Delayed gastric emptying, egg smelling burps due to bacterial over growth, early satiety, abnormal wall movements, morning nausea and fluctuations in blood glucose

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100
Q

How do you treat hyperthyroidism in the first trimester of pregnancy

A

Propylthiouracil 200mg bd

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101
Q

What is the best diagnostic test for diabetes ispidus

A

Fluid deprivation test - potential ADH insufficiency is tested here

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102
Q

What can cause cranial diabetes

A

Genetic or trauma, tumours, inflammatory conditions (sarcoidosis), cranial infections, vascular diseases (sickle cell)

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103
Q

What type of medications used to treat mental health issues may cause hyperprolactinaemia

A

SSRIs like fluoxetine

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104
Q

How do you test for excess adrenaline release, in a case which is unlikely to be Cushing’s?

A

Plasma metanephrines screen for exceess adrenaline metabolites

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105
Q

What medication are patients given preoperatively before the removal of a tumour for Cushing’s disease

A

Metyrapone, blocks steroidogenesis pathway reducing cortisol production

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106
Q

What would be a positive result in a water deprivation test for cranial diabetes isipidus

A

Low urine osmolality after water deprivation; normal after desmopressin IM injection (lack of vasopressin causes DI so giving it should fix the problem; if it remains low then it could be nephrogenic DI)

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107
Q

What is the presentation of a patient with SIADH = syndrome of inappropriate ADH secretion

A

Hyponatraemia
Euvolaemic
Low plasma osmolality

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108
Q

How does amiodarone cause thyrotoxicosis

A

Amiodarone is full of iodine

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109
Q

Loss of lateral side of eye brow is a sign of what?

A

Hypothyroidism

Leprosy

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110
Q

What is exophthalamos

A

Bulging of the eyes caused by Grave’s disease

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111
Q

What does metformin do

A

Increases peripheral sensitivity to insulin by encouraging peripheral glucose uptake

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112
Q

What is the target blood pressure for someone with diabetes

A

140/80

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113
Q

What are normal test results for a glucose tolerence test

A

Fasting <6

2h glucose <7

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114
Q

What is Fetid foot

A

Severe bone and soft tissue infection in patients with diabetes

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115
Q

Do potassium or sodium imbalances cause ECG changes

A

Potassium

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116
Q

In asthmatic patients, what drugs should be used/avoided to manage heart rate?

A

Beta blockers should be avoided, verapamil could be used

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117
Q

When should synchronised/unsynchronised cardioversion be used

A

Synchronised when there are signs of life, unsynchronised when there are no signs of life

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118
Q

How do you treat a tension pneumothorax

A

IV cannula places into 2nd intercostal space at mic clavicular line

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119
Q

How do you tell the difference between an obstructive and a restrictive lung disease

A

If FEV1/FVC is >0.7 then it is restrictive

If <0.7 then obstructive

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120
Q

What are the most common causes of metabolic acidosis?

A

Lactate, ketoacidosis, kidney failure

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121
Q

What are the types of shock?

A

Septic, hypovolaemic, cardiogenic, anaphylactic

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122
Q

How do you treat ventricular tachycardia

A

Class 1,2,3 anti arrhythmic drugs + radio catheter ablation

E.g flecainide, bisoprolol, amiodarone (1,2,3)

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123
Q

What diseases do you test for in pregnancy

A

HIV
Syphilis
Hep B

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124
Q

What are the signs of septic

A

High temp
High hr
Low blood pressure

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125
Q

What effect does digoxin have on an ECG

A

ST downsloping

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126
Q

How do you treat supraventricular tachycardia

A

Sinus massage and then adenosine

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127
Q

What are the symptoms of aortic dissection

A 
Central sharp chest pain
Aortic regurgitations (mid diastolic murmur)
Cardiogenic shock
Acute head failure 
Respiratory problems
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128
Q

What is the pleural fluid glucose that may be expected with an exudative pleural effusion

A

<3.3 mmol/L

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129
Q

What is sarcoidosis

A

A multisystem granulomatous disorder of unknown cause

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130
Q

How does acute sarcoidosis present

A

Fever
erythema nodosum
polyarthralgia
bilateral hilar lymphadenopathy

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131
Q

How do you test for sarcoidosis

A

Bloods: inc ESR, lymphopenia (low lymphocyte levels)
24hr urine: inc Ca2+
CXR usually normal but may show bilateral hilar lymphadenopahy
ECG may show arrythmias or BBB
Lung function tests - signs of restrictive lung disease

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132
Q

How is sarcoidosis treated?

A

Patients with bilateral hilar lymphadenopathy alone do not need treatment
Acute sarcoidosis:
Bed rest + NSAIDS (nonsteroidal anti-inflammatory drugs)

Prednisolone (40mg/24h) PO for 4-6 wks, then reduce dose over 1 yr, if cardiac, neuro involvment or if there is hypercalcaemia

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133
Q

What are the causes of bilateral hilar lymphadenopathy?

A 
Sarcoidosis
Infection (e.g TB)
Malignancy (lymphoma, carcinoma, mediastinal tumours)
Organic dust disease
Hypersensitivity pneumonitis
Histocytosis X
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134
Q

What are the clinical features of interstitial lung disease?

A

Dyspnoea on exertion, non productive cough

Restrictive spirometry

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135
Q

What is the most common cause of interstitial lung disease?

A

Idiopathic pulmonary fibrosis

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136
Q

What are the symptoms of intersitial pulmonary fibrosis

A 
Dry cough
exertional dyspnoea
malaise
weight loss
arthralgia
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137
Q

What are the signs of idiopathic pulmonary fibrosis

A

Clubbing,
cyanosis,
fine end-inspiratory crepitations

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138
Q

How do you investigate idiopathic pulmonary fibrosis

A

CXR = bilateral lower zone reticulo-nodular shadows

Blood: inc CRP, inc immunoglobulins

ABG: reduced O2, usually a normal CO2 but if severe then CO2 will be raised

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139
Q

How is idiopathic pulmonary fibrosis treated?

A

O2,
Palliative care
Pulmonary rehab

Nintedanib, pirfenidone are anitfibrotics they may slow the progression of the disease

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140
Q

What are the symptoms of pneumonia

A

Dyspnoea
Cough
Sputum +/- purulence
Fever

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141
Q

What are the signs of pneumonia

A 
Tachypnoea 
Tachycardia
Hypotension
Pyrexia
Whispering pectriloquy
Central cyanosis
Altered mental state/confusion
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142
Q

How would you investigate pneumonia

A 
ABG
CXR
FBC
U+E's, CRP, LFT
CRP is a good measurement of response to treatment, not necessarily diagnositically useful
Blood + sputum culture
Viral PCR
Atypical serology
Urine Ag for legionella + S. pneumoniae
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143
Q

What scoring system is used for pneumonia

A

CURB65

Confusion AMTS <= 8
Urea >7 mmol/L
Resp rate >= 30 bpm
BP <90/<=60 mmHg
65 years of age
0 = oral antibiotics at home
1 = consider hospital admission
2 = consider IV Abx
3 = consider ICU admission
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144
Q

How do you manage pneumonia

A 
A = ensure patient airway
B = O2 to 94%-98%
C = IV fluids if required
D = GCS
E = Analgesia, antipyretics, antibiotics
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145
Q

Describe antibiotic treatment in pneumonia

A

Abs should be given within 4 hours
Outpatient: penicillin derivative
Inpatient: penicillin derivative + macrolide
Inpatient (severe): Beta-lactamase resistance abx + macrolide

146
Q

In which patient groups is S.aureus pneumonia more common

A

Post influenza, ICU, IVDUs

147
Q

How does Legionnaire’s disease present?

A 
As a normal pneumonia:
Dyspnoea
Cough
Sputum +/- purulence
Fever
\+ extra neurological symptoms:
Ataxia
Agitation
Lethargy
148
Q

What are the symptoms of atypical pneumonia

A

Fatigue
Headache
Myalgia
Non-productive cough

149
Q

What are the causes of hypoxaemia

A 
V/Q mismatch
Impaired diffusion
Alveolar hypoventilation
Low partial pressure of inspired oxygen
Anatomical R-L shunt
150
Q

What is the oxygen level in the blood which defines hypoxaemia

A

PaO2 < 8 kPa

151
Q

What is the CO2 level in the blood which defines hypercapnia

A

PaCO2 > 6.0pKa

152
Q

What are the causes of hypercapnia

A

Imbalance in load, capacity or drive

153
Q

What is type 1 resp failure

A

Hypoxia with a normal or low CO2

154
Q

What is type 2 resp failure

A

Hypoxia + hypercapnia

155
Q

What are the symptoms of hypoxia

A

Dyspnoea, restlessness, agitations, confusion, central cyanosis

156
Q

What are the symptoms of hypercapnia

A

Headache, peripheral vasodilation, tachycardia, bounding pusle, tremor/flap

157
Q

What artery is an arterial blood gas taken from?

A

Radial artery

158
Q

What (IV) antibiotics do you give to treat a community acquired pneumonia

A

Co-amoxiclav + clarithromycin

159
Q

What (IV) antibiotics do you give to treat a hospital acquired pneumonia

A

Ciproflaxacin

160
Q

In a tension pneumothorax, in which direction does the trachea deviate?

A

Away from the affected side

161
Q

Why would a loud P2 appear in a patient with a pulmonary embolism?

A

It is a sign of right heart strain

162
Q

Where do you aspirate the pleural space in a tension pneumothorax

A

2nd intercostal space, mid clavicular line

163
Q

How do you test for tuberculosis

A

Ziehl-Nielsen stain for acid fast baccilli

164
Q

How do you test for cystic fibrosis

A

Genetic test

Or chloride level >60mmol/L in a sweat test

165
Q

What is the scoring system for pulmonary embolism

A

Well’s:
3 - signs of DVT, no alternative diagnosis other than PE
2 - tachycardia (>100bpm); immobile for 3 days or major sugery in past month, history of PE or DVT
1 - haemoptysis, active malignancy

if 4 or less measure d dimer (low d dimer excludes PE) if more than 4 give LMWH

166
Q

What would you expect to find on auscultation of a patient with COPD

A

hyperresonant percussion note

167
Q

What is the first investigation you would do to confirm bronchiectasis

A

High res CT

168
Q

What does a dull percussion note and increased tactile vocal fremitus suggest?

A

Pneumonia

169
Q

How do you treat TB

A

Rifampicin
Izoniazid
Pyrazinamide
Ethambutol (RIPE)

170
Q

What does aldosterone do?

A

Increases Na+ and water reabsorption; increased K+ and H+ secretion in urine

171
Q

Failure of which organs causes fluid overload?

A

Kidney, liver and heart

172
Q

Why would you give 5% glucose drip?

A

Glucose only there to make it isotonic; good way of giving water without adding electrolytes

173
Q

What is dextrosaline and why would you give it

A

NaCl 0.18% + 4% glucose good way of adding a bit of Na + Cl

174
Q

Why would you give a bag of IV saline

A

Has daily requirements of sodium

175
Q

When would you give a IV balanced crystalloids

A

Good for replacing large volumes if not hyperkalaemic

176
Q

What’s in an IV colloid bag

A

large molecules which do not cross semi-permeable membranes - therefore fluid remains in circulating space and doesn’t enter cells

177
Q

What is parenteral nutrition?

A

IV nutrition

178
Q

What is the sign for SIADH

A

Syndrome of inappropriate ADH secretion: hypervolaemia and hyponatraemia

179
Q

What are the classifications of hyponatraemia?

A 
Mild = 130-135 mmol/L
Moderate = 121-129
Severe = <120
180
Q

What are the symptoms of mild hyponatraemia?

A

Asymptomatic

181
Q

What are the symptoms of moderate hyponatraemia?

A

Cramps, weakness, nausea

182
Q

What are the symptoms of sever hyponatraemia

A

Lethargy, headache, confusion

183
Q

How do you treat hyponatraemia

A 
Hypovolaemia = correct volume depletion, IV 0.9% saline
Euvolaemia = treat underlying cause, fluid restriction
Hypervolaemia = underlying cause, fluid restriction, vasopressing receptor antagonists
184
Q

What is the maximum rate of change of serum Na that is safe

A

8mmol/day

185
Q

What is hypernatraemia

A

Na > 145 mmol/L

186
Q

What is severe hypernatraemia?

A

Na > 158 mmol/L

187
Q

What are the symptoms of hypernatraemia

A

Thirst, anorexia, weakness, stupor, seizures, coma

188
Q

How do you treat chronic hypernatraemia

A

Treat underlying cause, use hypotonic fluid (5% dextrose, slowly)
Lower Na by a max of 10 mmol/L/day

189
Q

How do you treat acute hypernatraemia

A 
Hypotonic fluid (5% dextrose)
lower Na by 1-2 mmol/L per hour
190
Q

What is hypokalaemia

A

K < 3.5 mmol/L

191
Q

What are the symptoms of hypokalaemia

A

Muscle weakness
ECG changes + arrythmias
Renal abnormalities if chronic

192
Q

How does pH of blood effect K+ levels

A

Increased pH causes drop in K+

193
Q

What are the ECG changes you would expect find in hypokalaemia

A

Prolonged PR interval
ST depressiong
Shallow T wave and raised U wave

194
Q

What is hyperkalaemia

A

K > 5.5 mmol/L

195
Q

What are the ECG changes you would expect in hyperkalaemia

A 
Flat T wave
Decreased R wave
Widened QRS
ST depression
Tall peaked T wave
196
Q

What are the symptoms of hyperkalaemia?

A

Paraesthesiae
Muscle weakness - paralysis
arrythmias

197
Q

How do you treat hyperkalaemia

A

IV calcium gluconate
IV insulin + glucose to cause K to move into cells
Remove K from body - loop diuretics; haemodyalisis
treat underlying cause

198
Q

Describe an AKI caused by glomerulonephritis

A

Happens secondary to an infection elsewhere in the body. Infection itself does not damage kidney, the insoluble antibody-antigen complex produced in the immune response deposits in the glomeruli - damaging the basement membrane.

Some regions of the basement membrane become blocked while some become excessively permeable - allowing proteins and red blood cells to permeate the membrane.

199
Q

Describe how tubular necrosis can cause an AKI

A

If there is prolonged severe ischaemia of the kidneys, epithelial cells on the inside of the nephron will slough off and block the nephron meaning there is no urine output. Even as blood flow returns to normal the nephrons my remain blocked.

200
Q

How do you biochemically define an acute kidney injury

A

increase in creatinine of more than 26 mimol/l within 48 hrs
creatinine increase >1.5x baseline within 7 days
urine output of <0.5 ml/kg/hr for >6 hrs

201
Q

What are the common causes of an AKI

A

Sepsis, surgery, obstruction, cardiogenic shock, hypovolaemia, drugs, hepatorenal syndrome

202
Q

What is digoxin used for

A

AF

203
Q

What is amiodarone used for

A

V tachycardia or V fib

204
Q

What is amlodipine used for

A

hypertension

205
Q

What is furosemide used for

A

Diuretic - useful when treating heart failure/to reduce blood pressure

206
Q

What effect can digoxin have on an ECG

A

ST depression/sloping

207
Q

Early diastolic murmur loudest when patient leans forward is a sign of?

A

Aortic regurgitation

208
Q

mid-diastolic murmur heard loudest at the apex. It is louder on expiration, and is exacerbated by the patient lying on their left side is a sign of?

A

Mitral stenosis

209
Q

Pan-systolic murmur radiating to axilla is a sign of?

A

Mitral regurgitation

210
Q

Pan systolic murmer louder on inspiration

A

Tricuspid regurgitation

211
Q

Murmers heard louder on expiration are on what side of the heart?

A

Left

212
Q

Murmers heard louder on inspiration oare on what side of the heart?

A

Right

213
Q

mid-diastolic murmur heard loudest at the apex. It is louder on inspiration is a sign of?

A

tricuspid stenosis

214
Q

ejection systolic murmur which does not radiate to the carotids

A

aortic sclerosis

215
Q

What does colicky vs continuous abdominal pain suggest?

A

Obstruction to hollow viscus

Inflammation of an organ

216
Q

What are the risk factors for gallstones?

A

Fat, fair, femail, fertile, forty

Family history, sudden weight loss, haemolytics, diabetes, oral contraceptive

217
Q

What causes biliary colic?

A

Gall stone intermittently obstructs cystic duct when the gall bladder contracts causing pain, then when the gallbladder relaxes, the stone falls back from the cystic duct

218
Q

What are the symptoms of bilibary colic

A 
Colicky pain
Pain in right hypochondriac region
Sudden onset
Radiates to right scapula
Lasts 1-4 hours
Relieved by analgesia and rest
219
Q

What is murphy’s sign

A

Place hand at R costal margin

Patient breathes in and diaphragm moves down - pain when inflamed gallbladder contacts palpating hand

220
Q

What is acute cholecystitis

A

Cystic duct blocked by gallstone - obstruction to secretion of bile from gallbladder - bile becomes concentrated and then causes chemical inflammation

221
Q

What are the complications associated with acute cholecystitis

A

Empyema of gallbladder = suparative cholecystitis
Gangrene of gallbladder
Perforation of the gallbladder

222
Q

What is Charcot’s triad?

A

Jaundice, fever and RUQ pain

Sign of cholangitis

223
Q

What is cholangitis

A

Inflammation of the bile duct

224
Q

What causes ascending cholangitis?

A

Obstruction of common bile duct; leads to infection/pus proximal to blockage

225
Q

What is the aetiology of pancreatitis

A 
IGETSMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypertriglyceridaemia/hypercalcaemia/hypothermia
ERCP (Endoscopic retrograde cholangiopancreatography)
Drugs
226
Q

How do you diagnose pancreatitis

A

Symptoms (epigastric pain + vomiting)

Serum amylase or lipase >3x upper limit of normal

227
Q

What investigations would you do for someone with suspected pancreatitis

A

Serum amylase/lipase
LFTs, U&E’s, WCC, glucose, calcium

ABG - oxygenation and acid-base status
AXR or CXR
CT - assess severity
USS or MRCP gallstones?

228
Q

How do you predict severity of pancreatitis

A 
PANCREAS
PO2 <8kPa
Age > 55
Neutrophilia
Calcium <2
Renal function (urea >16 mmol/L)
Enzymes - amylase >3x normal
Albumin <32
Sugar (glucose >10 mmol/L)
If 3 or more criteria then AP is severe
229
Q

How does appendicitis usually present?

A 
Central abdominal pain then migrates to RIF
Pain worse on moving, coughing etc
Nausea
Vomiting
Diarrhoea
Anorexia
Low grade fever
230
Q

Why does appendicitis pain move?

A

Initially when the inflammation is localised, visceral peritoneal pain is referred pain at the umbilicus. When inflammation gets worse, the pain will migrate to RIF as parietal peritoneum will get inflamed

231
Q

What investigations should you do for suspected appendicitis?

A

Investigations should be done to exclude other pathology

Urine ip and pregnancy test in premenopausal women to exclude KUB problems
If CRP, ECC, granulocyte count, proportion of polymorphonuclear cells are normal then acute appendicitis is much less likely
USS, MRI or CT with contrast (best)

232
Q

What is diverticulosis

A

Presence of diverticula without symptoms

233
Q

What is diverticular disease

A

Diverticula cause intermittent lower abdominal pain, without inflammation or infection

234
Q

What is diverticulitis

A

Diverticula become infected and or inflamed, causing marked lower abdominal pain, fever and mailase

235
Q

How does smoking affect ulcerative colitis vs Crohn’s

A

Relieves UC and exacerbates Crohn’s

236
Q

What is the presentation of ulcerative colitis

A 
Diarrhoea
Blood in stool
Cramping, colicky abdo pain
Faecal urgency + freq = tenesmus
Weight loss
237
Q

What is the presentation of Crohn’s

A 
Diarrhoea (+ blood?)
Weight loss
Cramping
Tenesmus
Anorexia
Malnutrition
Anal fissure
238
Q

What is IBD

A

Umbrella term for ulcerative colitis or Crohn’s

239
Q

How do you investigate IBD

A

Faecal calprotectin
Stool culture + microscopy
Bloods (FBC, UE, LFT, ESR, CRP)
Colonoscopy

240
Q

What are the symptoms of glandular fever?

A

Sore throat, swollen glands, maculopapular rash w/ amoxicillin, fatigue

241
Q

How do you treat glandular fever?

A

Caused by EBV so treatment is just symptomatic

242
Q

What advice should you give someone with glandular fever?

A

Caused by EBV so treatment is just symptomatic

Can cause transient viral hepatitis and splenomegaly so avoid contact sports for 6 weeks

243
Q

What are the symptoms of phaeochromocytoma?

A

Sweating, anxiousness, raised BP, palpitations

244
Q

Describe the presentation of fat necrosis as a breast lump

A

Secondary to trauma, surgery, radiation etc.

Painful

245
Q

What would a cancerous breast lump feel like?

A

Fixed position

246
Q

Describe the presentation of a breast abscess?

A

Secondary to infections mainly in breastfeeding women, red and warm skin
Patient is usually systematically unwell with a raised temp

247
Q

Describe the presentation of a fibroadenoma in the breast

A

Benign breast tumour, occurs in younger women in 20s and 30s, well defined with a smooth edge and are mobile (called breast mice due to their mobility)

248
Q

What woukd peripheral oedema in a child make you think

A

Nephrotic syndrome

249
Q

What are the symptoms of nephrotic syndrome

A

Proteinuria, hypoalbuminaemia, oedema

250
Q

What is nephrotic syndrome

A

Too much protein being passed into the urine

251
Q

What are the initial symptoms of pancreatic cancer

A

Weight loss and painless jaundice

252
Q

Whart score is used to judge treatment of a suspected pneumonia

A

CURB 65

Confusion
Urea > 7mmol/L
RR > 30
BP <90/<60
65 yrs

0-1 pt = home treatment
2 pts = consider inpatient
3-5pts = inpatient; consider ICU

253
Q

Give an example of a calcium channel blocker

A

Amlodipine

254
Q

What are one of the side effects of statins

A

Cramps

255
Q

How long after having a one off seizure can you begin to drive again

A

6 months

256
Q

White vaginal discharge is associated with which condition

A

Thrush

257
Q

How do you treat AF which is asymptomatic and picked up accidentally

A

You dont, but calculate the CHADVASC score

258
Q

How may HIV present

A

Flu like symptoms, maculopapular rash + opportunistic infections

259
Q

How do you calculate the number of units in an alcoholic drink?

A

Strength x Vol /1000

260
Q

What are the symptoms of a subarachnoid haemorrhage?

A

Sudden onset, occipital headache, photophobia and nausea/vomiting

261
Q

How does parathyroid hormone affect calcium and phosphate

A

Increases calcium

decreases phosphate

262
Q

What are calcium and phosphate levels like in hyperparathyroidism

A

Increased calcium

Decreased phosphate

263
Q

What are the calcium and phosphate levels like in chronic kidney disease

A

Low calcium due to vit. D deficiency

High phosphate as cannot be excreted

264
Q

What is the range of values of fasting glucose to diagnose a pre-diabetic patient/imparied fasting tolerance

A

6.1-7mmol/L

265
Q

What is the range of values of 2hr glucose to diagnose a pre-diabetic patient/imparied fasting tolerance

A

<7.8mmol/L

266
Q

What is indapamide

A

A thizide like diuretic

267
Q

What is malignant hypertension?

A

Severe HTN with end organ damage

268
Q

Why does malignant hypertension require a gradual lowering of bp

A

sudden drop in bp causes ischaemic stroke

269
Q

How do you treat malignant hypertension with hypertensive encephalopathy

A

IV labetolol and sodium nitroprusside

270
Q

How do you treat malignant hypertension with aortic dissection

A

IV labetolol and sodium nitroprusside

271
Q

How do you treat malignant hypertension with pul oedema

A

Dont use B blockers

IV GTN and sodium nitroprusside

272
Q

How do you treat malignant hypertension which is pregnancy induced

A

IV MgSO4 and labetolol

273
Q

How do you treat malignant hypertension which is due to phaeochromocytoma?

A

Alpha and beta blockade

274
Q

How do you treat regular bradycardia

A

atropine 500mg, blocks the vagus nerve increasing HR

275
Q

How do you treat a haemodynamically stable patient with symptomatic AF

A

LMWH and non urgent DC cardioversion

276
Q

How do you treat a haemodynamically unstable patient with symptomatic AF

A

Urgent DC cardioversion

277
Q

What drug would you give if cardiac ejection fraction was <35%

A

Spironolactone

278
Q

What is the point of birfurcation of the trachea called?

A

Carina

279
Q

What does CABG stand for

A

Coronary artery bypass graft

280
Q

What are the two types of shadows in a CXR

A

Airspace and interstitial

281
Q

What are batswings sometimes a sign of in a CXR

A

Pulmonary embolism

282
Q

How do you tell a middle lobe pneumonia from a lower lobe pneumonia on a CXR?

A

Middle lobe will cover the cardiac shadow

Lower lobe doesn’t

283
Q

What would you look for on a CXR to see a pleural effusion

A

Tracheal deviation
Airspace shadow with no lobar distribution
Meniscus of fluid

284
Q

What is the differential for crackles heard in the lungs

A 
Infection
Pul fibrosis
Bronchiectasis
Pul oedema
Heart failure
285
Q

What is the normal position of the diaphragm on a CXE

A

between the 6th and 7th rib anteriorly

286
Q

What is the differential for pleuritic chest pain

A

Pneumonia, pneumothorax, PE, MSK

287
Q

In a CXR, if you see a portion of a rib has been removied, what would you think?

A

Pneumonectomy

288
Q

What are staples in the axilla on a CXR evidence of?

A

Lymphatic removal

289
Q

How should the cardiac shadow look on a cxr?

A

1/3 on the RHS and 2/3 on the left

290
Q

What is acute AF

A

Onset within 48 hrs

291
Q

What is paroxysmal AF

A

Spontaneous termination within a week

292
Q

What is recurrent AF

A

2+ episodes, could have been paroxysmal or persistant and the arrythmia needed cardioversion

293
Q

What is persistant AF

A

7+ days, not self terminating

294
Q

What is permanent AF

A

1+ yr, not helped by cardioversion

295
Q

What are the common causes of AF

A 
Coronary heart disease
HTN
Valvular heart disease
Hyperthyroidism
Caffiene/alcohol
296
Q

How can you manage AF

A

Stop caffiene/alcohol
Rate control (beta blocker, calcium channel blocker - dilitazem)
Rhythm control - cardioversion if rate control not working
48+hrs electrical

297
Q

How do you treat AF with haemodynamic instability

A

Emergency electrical cardioversion therapy

298
Q

What is Addison’s disease?

A

Primary adrenal insufficiency, usually autoimmune

299
Q

What are the symptoms of Addison’s disease?

A 
Fatigue + weakness (common)
Diarrhoea
Constipation
Vomiting
Muscle cramps
Anorexia
Confusion
300
Q

What are the sign’s of Addison’s disease

A

Hyperpigmentation of buccal mucosa, lips, palmar creases.

Hypotension, postural hypotension

301
Q

What investigations would you do for someone with Addison’s?

A

U&E’s: low Na and high K
High calcium
FBC - anaemia
Cortisol, ACTH (high in 1* insufficiency, low in 2*)
High renin, low aldosterone
Synthacten test (give ACTH, cortisol won’t rise in adrenal insufficiency)
Adrenal autoantibodies - leading causes of Addison’s are autoimmune

302
Q

How do you tell primary adrenal insufficiency from secondary

A

ACTH is high in primary, and low in secondary

303
Q

What is/causes a catemenial pneumothorax

A

Pneumothorax at time of menstruation, usually in right lung.
Thoracic endometriosis causes necrotic holes to form in the diaphragm allowing air to move into pleural space from genital tract, when the cervical plug liquifies at time of menstruation

304
Q

What is ARDS

A

Acute respiratory distress syndrome

305
Q

What are the risk factors for ARDS

A 
gastric aspiration
sepsis
pneumonia
hypovolaemic shock
trauma w/shock or multiple transfusions
306
Q

What is the pathophysiology of ARDS

A

Damage to alveoli causes an increased permeability in capillary/alveolar membranes; proteinaceous fluis leaks into alveoli causing hypoxia

307
Q

What is the most common cause of mitral stenosis

A

95% of cases are caused by rheumatic fever

308
Q

How does leggionare’s disease present?

A

As normal pneumonia + confusion, agitation, ataxia (balance and coordination problems) + lethargy

309
Q

What are the symptoms of atypical pneumonia

A

Fatigue
Headache
Myalgia
Non-productive cough

310
Q

What can cause aspiration pneumonia

A

Alcohol excess, GORD, dysphagia, altered swallow

NG tube, tracheostomy etc.

311
Q

What is Meig’s syndrome

A

Benign fibroma + ascites + (usually right sided) pleural effusion

312
Q

Describe the staging of COPD

A

%FEV1:

1: <80
2: 50-79
3: 30-49
4: <30

313
Q

What is an acute exacerbation of COPD

A

Any two of:

inc. dyspnoea
inc. sputum volume/purulence

Or one above plus one of:
inc cough
wheeze
sore throat
cold
314
Q

What is asthma

A

Paroxysmal and reversible obstruction of airways

315
Q

What are the symptoms of asthma

A

Wheeze, breathlessness, chest tightness, cough

316
Q

How do you diagnose asthma

A

Peak flow
Wheeze
Hx or fhx of atopic condition
Spirometry

317
Q

What is the differential diagnosis for wheeze, breathlessness, chest tightness, cough

A

Adults:
COPD, HF, CHD, malignancy, GORD
Children:
Bronchiolitis, CF (since birth?), congenital heart defect, vomiting and aspiration, inhalation of a foreign body

318
Q

Why is spirometry preferred to peak flow in the diagnosis of asthma?

A

Less effort dependant and more repeatable. May give false positive if in asymptomatic period

319
Q

Describe the management of asthma

A

Stage 1: SABA (salbutamol)
Stage 2: ICS (meclomethasone)
Stage 3: LABA (salmeritol)
Stage 4: Leukotriene receptor antagonist (montelukast)

320
Q

What are the definitions of the severity ratings for asthma attacks?

A

(%FEV1):
Moderate = 50-75
Severe = 33-50
Life threatening = <33

321
Q

What bacteria causes scarlet fever

A

strep pyogenes

322
Q

What type of bacteria causes scarlet fever

A

strep pyogenes, GpA BHS

Group A, beta-haemolytic streptococci

323
Q

Describe the pathophysiology of scarlet fever

A

Strep pyogenes (GpA BHS) secretes enzymes and toxins and erthrogenic toxins causing the rash

324
Q

What is the incubation period of scarlet fever

A

2-5 days

325
Q

Describe the onset of the rash in scarlet fever

A

Onset of illness is sudden w/ fever. The rash follows 12-24 hours after.
Scarlatinform rash (red sandpaper) starts on neck, chest, scapula then will spread to trunk and legs later.
Rash can last for a few days, especially in skin creases. Skin can peel for a few weeks.

326
Q

What are the symptoms of scarlet fever

A 
Sore throat
Headache
Vomiting
Abdominal pain
myalgia
tachycardia with fever

Throat: tonsilitis
Tongue: white strawberry to red strawberry

327
Q

What investigations do you do for scarlet fever

A

Throat swap and culture
Antigen testing kits
FBC - polymorphonuclear lymphocytosis

328
Q

How do you manage scarlet fever

A

Abx - penicillin

Symptom management; ibuprofen or paracetamol (not aspirin!)

329
Q

What is SLE

A

Systemic lupus erythematosis

Inflammatory, multisystem autoiommune disease in which antinuclear antibodies occur

330
Q

What is the presentation of SLE

A

Vague symptoms:
Fatigue, malaise, fever, splenomegaly, lymphadenopathy, weight loss, headache, parasthesiae

Systemic symptoms:
Renal - nephritis (often asymptomatic, picked up via proteinuria and haematuria)
Pulmonary - pleurisy, fibrosing alveolitis, obliterative bronchiolitis
Neuropsychiatric - basically anything

331
Q

What investigations would you do for SLE

A 
FBC (anaemia?)
ESR inc
Antinuclear antibodies test
Investigate affected systems
Urine dipstick test (proteinuria, haematuria)
332
Q

How do you manage lupus?

A

Avoid sun exposure due to photosensitive rash
NSAIDS for inflammation, if not sufficient you can add in a corticosteroid but this can increase mortality
Hydroxychloroquine is useful for skin lesions, myalgia and malaise

333
Q

How does a venous leg ulcer present

A

On saphenous vein, red and oozing with irregular margins.

334
Q

How does an arterial leg ulcer present

A

Pale, painful and punched out. Occur with peripheral vascular disease.

335
Q

How does a neuropathic leg ulcer present

A

Occur on pressure areas, associated with sensory neuropathy and diabetes

336
Q

What amino acids are catecholamines usually derived

A

Tyr

337
Q

What is the most serious side effect of carbimazole

A

Sore throat, due to bone marrow suppression and immune suppression

338
Q

What type of lung disease is myasthenia gravis

A

Restrictive

339
Q

What is endothelin

A

strong vasoconstrictor, endothelin antagonists are usefull in primary pulmonary hypertension

340
Q

How does aminophylline work?

A

Binds to adenosine receptors, blocking adenosine mediated bronchoconstriction

341
Q

What is the level of the bifurcation of the abdominal aorta

A

L4

342
Q

What is ulcerative colitis

A

idiopathic chronic inflammatory disease of the colon

343
Q

What are the symptoms of ulcerative colitis

A

Bloody diarrhoea
Colicky abdominal pain, urgency, tenesmus

Disease limited to the rectum may present with constipation and rectal bleeding

General symptoms: fever, malaise, weight loss

344
Q

What are the signs of ulcerative colitis

A

If severe, pt may be pale, febrile and dehydrated. Tachycardia and hypotension may occur too.

On abdominal exam there may be tenderness, distension or masses.

If patient has abdominal distension and tenderness then admission to hospital is required - toxic megacolon

345
Q

How do you investigate ulcerative colitis

A

FBC, RFT, U+E, LFT, ESR, CRP, Fe, B12, folate

Faecal calprotectin (more to rule out IBD, IBS)

Sigmoidoscopy, colonoscopy

Imaging

346
Q

How do you manage ulcerative colitis

A

1) Aminosalicylates (mesalazine), maintenence
2) Corticosteroids, prevention of remission
If insufficient give thiopurines (azathioprine)

347
Q

What are th complications of ulcerative colitis

A 
Colorectal cancer (risk doubled)
Osteoporosis
Psychosocial issues, sexual dysfunction
348
Q

Give examples of nephritic conditions

A 
Rapidly progressing GN
IgA nephropathy
Alport syndrome
Also nephrotic:
Diffuse proliferative GN
Membranoproliferitive GN
Post-strep GN
349
Q

Give examples of nephrotic conditions

A 
Minimal change
membranous GN
focal segmental glomerulosclerosis
amyloidosis
Diabetic neuropathy
350
Q

What are the symptoms of lupus?

A 
Fever
Butterfly rash
Skin:
Malar rask
Discoid rash
Photosensitivity

Joints:
Arthritis

Brain:
psychiatric symptoms

Blood:
Anaemia
Thrombocytopaenia
Leukopaenia

Mucosa:
Ulcers of mouth and nose

Serosa:
pericarditis
pleuritis

Kidney:
renal problems

351
Q

What is the pathophysiology of rhabdomyalisis

A

damage to cell membrane(trauma, iscahemia), increased calcium in cell, apoptosis realease of contents (ca, k, creatinine kinase, myoglobin).

Calcium release causes more apoptosis

K release causes hyperkalaemia

352
Q

What are the symptoms of rhabdomyalisis

A

Fever, myalgia, weakness, swelling, anuric, tea coloured urine, vomiting

353
Q

What electrolyte disturbance would you expect in rhabdomyalisis

A

Inc K

Dec Ca

354
Q

How do you diagnose rhabdomyalsis

A

haematuria
creatine kinase >5x baseline
inc K, decreased Ca, inc PO4 3-
muscle biopsy

355
Q

How do you treat rhabdomyalsis

A

Fluid
Hyperkalaemia treatment (calcium gluconate then insulin-dextrose)
Treat low Ca, high po4 3-
diuretics if not hypovolaemic

356
Q

What are the complications of rhabdomyalsis

A 
Liver damage
Hyperkalaemia
hypocalcaemia
metabolic acidosis
AKI
compartment syndrome
liver damage
357
Q

What are the causes of acute pancreatits

A

I GET SMASHED

idiopathic
gall stones (2)
ethanol (1)
trauma
steroids
mumps
autoimmune
scorpion bite
hypercalcaemia, hypertriglyceridaemia
ERCP
drugs
358
Q

What is the presentation of acute pancreatitis

A

Sudden onset epigastric pain radiating to the back with vomiting, pyrexia, tachycardia
Jaundice may be present if gallstone in common bile duct; hypoxaemia

359
Q

What are the investigations for acute pancreatitis

A

Inc amylase (>3x baseline)
inc. lipase (more sensitive and specific)
inc. bilirubin/aminotransferase if gallstones
hypocalcaemia is common
calcification on imaging

360
Q

What are the causes of increased amylase

A 
renal failure
ectopic pregnancy
DKA
perforated duodenal ulcer
acute pancreatitis
361
Q

What treatment is contraindicated in pain relief in acute pancreatitis

A

Morphine -spasicity of sphinter of Oddi

362
Q

What is a SPINK-1 mutation

A

Can cause heriditary chronic pancreatitis; allows trypsin to be activated in the pancreas

SCP1 (37 decks)

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