Gastro-Intestinal Flashcards
1
Q
What test do you use to investigate H.pylori ?
A
- Helicobacter pylori urea breath test
- H pylori faecal antigen test
- FBC - Show Leukocytosis and reduced haemoglobin and haematocrit.
2
Q
When would you refer a patient with dyspepsia and acute gastrointestinal bleeding? and What is the gold standard diagnostic test for peptic ulcer disease?
A
Immediately and Endoscopy
3
Q
what is the first line diagnostic test for Peptic ulcer disease with h.pylori
A
Histology and/or urease testing (rapid urease test) or Stool antigen test.
4
Q
What test is used to confirm successful eradication of H.pylori
A
Carbon-13 urea breath test 6 to 8 weeks after starting treatment
5
Q
Is there an investigation available for diagnosing iBS?
A
NO
6
Q
What is a) the first line investigation and b) the diagnostic of coeliac disease?
A
Serology - IGA tissue transglutaminase antibody and total IgA - THIS IS NOT DIAGNOSTIC.
Endoscopic intestinal biopsy - Diagnostic.
7
Q
Diverticular disease is confirmed by:
A
Endoscopy, colonoscopy, or CT Colonography.
8
Q
When do you use a stool culture and sensitivity test for Infectious diarrhoea
A
Diarrhoea has not resolved by day 7
travelled abroad - 3 specimiens for ova/cysts and parasites (2-3 days apart)
All children under age 5 years - who are at risk of shiga toxin-producing e.coli)
contact with an affected person.
9
Q
What condition causes: Sudden-onset, constant, severe pain in the upper right quadrant, lasting several hours. It can radiate to the back, referred pain in the shoulder or interscapular region.
A
Acute Pancreatitis
10
Q
Confirmatory test for acute Cholecystitis?
A
Abdominal ultrasound
11
Q
Whats the key difference in symptoms between bacterial gastroenteritis and viral?
A
Bloody diarrhoea and fevers - Bacterial
Watery diarrhoea - Viral
12
Q
How long do you suffer from Gastroenteritis
A
2-7 days (usually self resolves after 2-3 days).
13
Q
what is a serious complication of gastroenteritis?
A
Dehydration (noted by increase na+ and creatinine in blood test) + pale motteled skin, hypotension, reduced skin turgor.
14
Q
Do you give antibiotics for gastroenteritis?
A
No - not usually. just practice hygiene do not go to public places until 48 hours after the last vomiting/diarrhoea episode Oral hydration and fruit juice sips introduce normal diet slowly.
15
Q
Whats the difference between gastroenteritis and gastritis?
A
Gastroenteritis - Watery diarrhoea, nausea and vomiting (Gastric irritation and small intestine irriation.
Gastritis - errosion or non errosive irritation of the stomach mucosa - Leads to dyspepsia and epigastric pain.
16
Q
When asking history question for gastroenteritis what is important?
A
Drugs history - Antibiotic use, or PPI treatment
Travel history - Foreign non western countries.
17
Q
What timeframe is considered chronic diarrhoea?
A
> 4 weeks
18
Q
what timeframe is considered acute diorrhoea?
A
< 4 weeks. less than,
19
Q
Whats the difference between organic and functional diarrhoea?
A
Organic - bloody, fevers, wakes you up at night, does not resolve on fasting, weight loss and severe abdominal cramps, nocturnal diarrhoeah (IBD, Coeliac disease, pancreatitis) large volume
Functional - triggered by stress, relieved on fasting, no weight loss, (examples - IBS, Lactose intolerance, food allergies, alcohol/drugs) small volume
20
Q
Whats the difference between diarrhoea from the small bowel vs large bowel?
A
Small intestine - yellow/gray - low frequency but high load
Large bowel - bloody/mucus - high frequency but low load
21
Q
Causes of chronic diarrhoea?
A
Coeliac (can occur when older)
IBD
IBS
Colorectal cancer
22
Q
Causes of bloody acute diarrhoea?
A
Bacterial - Campylobacter jejuni (this is most common isolated in gp), Shigella, E.coli, C.diff, Salmonella
Viral - Cytomegolovirus
Parasites- Schistosomiasis
23
Q
Most common infectious causes of acute diarrhoea?
A
Sapovirus
noravirus
rotavirus
Campylobacter infection
24
Q
What are the time differences for viral, bacterial and protoza based diarrhoea?
A
Viral diarrhoea lasts around 2–3 days.
Untreated bacterial diarrhoea has a duration of around 3–7 days.
Protozoal diarrhoea can be present for weeks to months without treatment.
25
types of diarrhoea caused by protozoa that can cause chronic diarrhoea?
Entamoeba histolytica, Giardia intestinalis and Cryptosporidium
26
What is IBS?
Irritable bowel syndrome -
| Diagnosis of exclusion
27
RF of IBS?
Age 20-30 years
sex - female
Gastroenteritis
STRESS!
28
Criteria of IBS?
```
Rome criteria IV
1 day a week for 3 months
releieved on defecation
change in frequency
change in FORM of stool
```
29
Symptoms of IBS
```
Abdominal pain
IBS with diarrhoea, constipation or MIXED
pain relieved on defecation
Urgency
fluctulence and urgency
```
30
Treatment:
- Diet
- High fibre
- No alcohol/caffeine/spicy and fatty foods
- probiotics
- CBT
Bulkforming laxatives - constipation
lopermide - diarrhoea antimotility
31
Diagnosis of IBS
symptoms persistent for 6 months
Abdominal pain, or
Bloating, or
Change in bowel habit.
change in frequency (increased/decreased)
change in form (lumpy, soft, loose, or watery)
Altered stool passage (straining, urgency, or incomplete evacuation)
worsened by eating
rectal mucus
32
what Constipation medication should you NOT give for IBS
Lactulose
33
what are the signs & symptoms of Pancreatitis?
- Sharp Epigastric pain
- radiates to the back or flank
- Vomiting/Diarrhoea
- Alleviated by moving forward or foetal position
- worse on movement
- rebound tenderness
34
Causes of acute pancreatitis?
```
I G E T S M A S H E D
Gallstones
Ethanol - alcohol misuse
Trauma
Drugs - Steroids,
Infection - Mumps, steroids
```
35
Diagnosis of Pancreatitis
```
Abdominal pain
Amylase/lipase (3 x upper limit)
Imaging ct abdomen/pelvis / ultrasound
(can see hypocalcemia - fat breaks down, free fatty acids bind to calcium)
Hyperglycemia
```
36
What is dyspepsia?
a range of Upper gastric symptoms etc: Bleching, vomiting and nausea, epigastric pain, reflux, heartburn that last for more than 4 weeks.
Post prandial - to do with food
Epigastric syndrome - improved on ingestion
Or both
37
Red flag symptoms of upper gI cancer?
```
Hemetemesis
Persistant vomiting
Dysphagia
unintended weight loss
Abdominal mass
```
38
What are the differentials of Dyspepsia?
```
GORD
Peptic ulcer - h.pylori test
Drugs (metformin, nsaids, bisphosphanates)
Inferior MI
Oesophagitis
```
39
What is barrest oesphagous?
Change of squamous cells to transitional columnar epithelial cells
40
How do you treat dyspepsia?
```
PPI for 4-8 weeks
NO food 3 hours before bed
elevate the head
avoid spicy foods, coffee and caffeine
frequent moderate food
weight loss
smoking cessatoin
```
41
what unusual ways can GORD present?
Asthma, Hoarseness, Dry cough, Dental Erosions
42
what is treatment of GORD vs Oeosphagitis
4 weeks PPI - oesphagitus
| 8 weeks PPI - oesphagitus
43
What are haemorrhoids?
veins - form haemorrhoid plexus in the anal canal. Can have internal haemorrhoids above the dentate or pectinate line. Or external haemorrhoids which is below the line.
44
What are the symptoms of haemorrhoid
1. Bright red streaks of blood
2. painful defecation
2. painful if external haemorroids
3. fullness and pressure, incomplete evacuation
4. itching/burning
45
Treatment of haemmoroids
```
stages 3 and 4 haemarrhoidectomy
topical creams - steroids and local. anaesthetic - used mornign and nigh and after bowel movement
good fibre intake, and drinking water
patching and keep clean anal region.
do not hold onto stool.
heavy lifting
straining when passing stool
```
Refer if sever pain.
46
Stages of haemmorhoids
1. they are larger than normal in anal canal
2. they protude pass dentate line on straining
3. they protude pass dentate line a reduce on manual pressure
4 they remain outside the dentate line and enlarged.
47
What is pneumonia?
Inflammation, infection of the aveoli sacs
48
I am an alcoholic - what organism will give me pneumonia?
Klebsiella
49
I am in college, in barracks, what organism will give me pneumonia, and ENT (pharyngitis symptoms)
Mycoplasma pneumonia
50
what organism from birds/bat droppings causes pneumonia
Histoplasmosis
51
What fungal pneumonia is found in HIV
Pneumocystitis jerviccie
52
What pneumonia is present in copd, asthma, cystic fibrosis patients?
Hemophillus influenza.
53
what is the most common bacterial pneumonia?
Streptococcas aeures
54
what bacterial pneumonia is found in HIV patients, or cystic fibrosis. (Bacterial)
Pseudonmas aurgenious
55
what pneumonia is found in air cons, or water source?
Legionelle - urine test, can also cause nausea and vomiting.
56
what is common VAP and IV users?
Staph.
57
What organism comes
58
```
Name the pneumonia organism for the following:"
Rusty - blood tinged -
Green sputum
foul smelling
Red current jelly
```
1 - Strep.
2. h.inflenza, pseudonomas
3. Anaerobes
4. klebsiella
59
would you see chest x-ray changes in acute bronchitis?
NO
60
Should you treat acute bronchitis?
NO - viral, self limiting 3-4 weeks.
| can use honey, over the counter cough suppressants
61
Which condition do you give antibiotics to?
Acute bronchitis
or
pneumonia?
Pneumonia
62
What antibitoics first line do you give for CAP
First choice oral antibiotic is amoxicillin 500 mg three times a day for 5 days
Patient should get better within 3 days if not then seek help
63
whats the timescale for CAP
1 week fever reduced
4 weeks chest pain and sputum production
6 weeks - cough and breathlessness resolved
3 months - Symptoms resolved but fatigued
6 months - all better
64
AN 18 year old boy has swollen parotid salivary glands, epididyorchitis and haematuria? what does he have?
```
MUMPS-
other symptoms can be glomerulonephritis.
orchitis
epididymitis
meningitis
encephalitis
pancreatitis
myocarditis
```
65
Is there a treatment for MUMPS?
no
patient keeps isolated 5 days after onset of symptoms.
Mumps is infectious 1 -2 days before onset of symptoms.
66
How are mumps spread?
Respiratory droplets.
67
how do you diagnose mumps
igm antibodies
68
prodromal fever, malasise, athralgia, headaches leads to what condition that causes parotitis?
MUMPS
69
Koplik spots also known a Enathems are seen in what condition?
Measels - red spots with white or bluish centre
70
Prodromal - cough, conjuntivitis, coryza leads to what condition?
Measels
71
Where does the rash exanthem begin in measels?
cephalocaudal- (head, behind ears to feet rash)
72
what complications can measels causE?
Ottitis media
pneumonitis
Convulsions, encephalitis, seziures. ]'.
73
whats is rubeola also known as?
Measels
74
What symptoms do you get with rubella
post auricular lymphadenopathy
fever
trunkal rash
last 3 days- rubella gets better after a week
arthritis
HIGHLY TETRAGENIC - causes eye, heart problems.
75
Rubella is from what virus family
TOGAvirus
76
Rubella must always be excluded in which group of patients?
Pregnancy
77
Feeling hopeless/worthless
and loss of interest
are what two core symptoms of what condition?
Depression
78
how many symptoms do you need for how long to diagnoise depression!?
2 core symptoms, with atleast 5 of the following for 2 weeks.
1. change in appetite
2. psychomotor change - agitation or slow movements
3. fatigue/tired
4. Concentration/memory problems
5. suicide thoughts/tendencies
6. changes in sleep
79
what is subthreshold depression?
2 core symptoms - hopelesness and anhedonia
| with none of the other symptoms.
80
what is mild depression? vs moderate and severe depression?
Mild - 2 core symptoms - hopelessness and anehdonia, but less that 5 other symptoms
moderate - more than 5 and effecting daily living
severe - allt he time
81
what is dysthymia?
Depression lasting longer than 2 years
82
what is seasonal affective disorder?
depression during winter, remitting in spring.
83
what is the difference between moderate and severe depression?
In severe you can get psychomotor symptoms.
84
Treatment of depression?
CBT! - low intensity CBT - self directed and guided by computer, group physical activity
Group therapy - for mild to moderate
high intensity - indivdual CBT, behavrioural therapy and couple therapy
psychodynamic therapy and counselling
SSRI = setraline, fluoxetine, paroxetine
Crisis resolution and home treatment services
85
what is the definition of bipolar 1 disorder?
Manic episodes for more than 1 week - DIGFAST
```
Distractibility
I
Grandiose
Flight of ideas
agitation
sleep deprived
Talks fast
```
86
what is the definition of biopolar II
Hypomania - without hallucinations and delusions last for 4 days only + depression
87
what is a bipolar disorder and how is it treated
FLUCTUATING between depression and Mania (lithium)
88
What symptoms you experience with acute stress?
Anxiety, Palpitations, nausea, dizziness, sweating, clammy, pale, chest pain, headaches, tummy pain and breathing difficulties
89
What can you offer for acute stress?
CBT - a type of talking therapy
Beta blocker - for palpitations (but it can cause more dizziness)
Diazepam-- although not used often anymore
90
How many causes of hypotension is there?
4
Hypovolemic - haemorrhage or non haemorrhage - GI bleeds, trauma, or Ectopic pregnancy + Aortic aneurysm, diorrhea, vomiting, sweating, diuretics.
Cardiogenic - Cardiac out put reduction - HF, ACS, Valvular disease, arrhythmia.
Decreased peripheral vasoconstriction and increased permeability - Sepsis /anaphylaxis
Obstruction - prevention of venous return i.e PE, cardiac tamponade or tension pneumothorax.
91
What is considered hypotension?
90/60
92
what is orthostatic/posturla hypotension?
When you have a drop in systolic disease 20mmhg or 10 diastolic.
93
what causes Orthostatic/postural hypotension?
Medications - Diuresis, CCB, ACE, NSAIDS, ALCOHOL
Chronic neurogenic conditions that interfere with the BP feedback loop to the brain - Parkinsons, Lewy-bodie dementia, neuropathy diabetes.
BP hypovolemia issues.
94
What are the symptoms of croup?
- Barking cough
- Inspiratory stridor
- tracheal tug, intercostal inhalation
cyanosis
Paroinfluenza virus 1 and 3 or RSV. Respiratory synctival virus.
95
What is croup also know as?
Laryngobronchotracheitis
96
does croup had a prodromal symptoms? and how long does it last four?
yes - coryzal symptoms, sore throat, malaise, fatigute, mild fever, cough... up to 72 hours before
self resolves within 48 hours
97
What is the treatment of croup?
1. - 1 dose oral dexamethason
2. Nebulised adrenaline
3. combined for severe
98
Asthma - is triggered by what cells?
T2 mediated -
Mast cells
IGE - inflammatory reaction type 1
Eosinophil
99
What are symptoms of Asthmai
Dyspnoea
chest tightness
diurnal coughing - worse at night and in the morning
Atopy - dermatitiis excema- allergic rhinitis, asthma
100
what is lateral epidcondylitis?
Tennis elbow - painful grip, worse on wrist extension- due to repetitive movements, or hand held drills, racquet sports, typing.
101
how many weeks can tennis elbow last forN
6 weeks start to get better, 6-12 months referral to surgery, can take up to 2 years to spontaneously resolve
102
What is the treatment for tennis elbow?
Ibuprofen gel
Hot and cold ice packs
not doing work for a while resting
steroid injections
103
what are differentials of elbow pain?
```
Lateral epicondyle
medial epicondyle
radial tunnel syndrome - pain is oftern worse at night, and not effected by wrist exetension
osteoarthritis
synovitis
```
104
What muscle is effected in lateral epicondyle?
Carpi radialis brevis
105
How do you diagnose strain
a tear or injury to the muscles (Tendon) can seen swelling, bruise, pain
106
How do you treat strain/spray
```
price
protection
rest for 72 hours
I. ice pack for 72 hours on and off for 15-20 mins not at nice
C - compression to prevent swelling
E - Elevate -
```
Then try and weight bear
107
What is a sprain
iNJURy to ligament that attaches bone to bone
108
First line treatment for sprian.strain
Ibuprofen gel
109
what is sprain?
tendon tearing - as its to the muscle, will get muscle spasms and cramps.
110
Back pains
```
Sciatica - straight legrise test
Cauda equina - saddle anaesthesia or urinary/fecal incontinence
Back strain
cancer
Ankylosing spondilitis
osteoporosis
infection
Shingles
```
111
What are the red flags for back pain?
Pain that wakes you up at night and is stiff in morning improves on movement and is less that 40 years old = Ankylosing spondylitis
Pain that is relieved when lying down and has point tendered over the vertebral body = Spinal fracture
Incontinence, bilateral pain, inability for straight leg rise (back pain) foot dorsiflex retention - Cauda equina
Unilateral shooting pains, pins and needles, muscle weakness - nerve compression or sciatica to the foot and toes, loss of tendor reflexes.
Pain that wakes you up at night, pain when coughing, straining, no improvement after 4 -6 weeks weight loss - cancer
112
what is BACK start?
a screening tool to assess prognosis of back pain
can be chronic more than 12 weeks
acute - better in 4 weeks
113
Osteomyelitits rf?
IV drug users
114
Management of backpain/
```
Referal if red flags
nsaids
benzodiazepams short course for spasms
Self care management - back exercises
heat compresses
movemenet
Physiotherpy
CBT and group exercises if bad
```
115
what is cervical spondylitis
Osteoarthritis of the cervical spine
116
what is osgood schlater disease?
Apopcytitis - of the tibial tuboristy is inflammed, causes swelling and pain when exercising or kneeling
117
How is osgood schlater managed/
Reducing or modifying activity
nsaids
cold ice packs
can take months to years until growth spurt has finished
118
what is chondromalacia patella
When the knee cap cartilage and space wears away - pain on walking up and dwon the stairs
119
what is bell's palsy?
when cranial nerve 7 - facial nerve, is inflammed and swollen, causing loss in function of closing eye lids, wrinking forehead, change of taste in mouth, otalgia and paralysis of face.
120
what is treatment of bell's palsy
Steroids - prednisalone 60mg for 10 days, after 5 taper down 10mg. Or 50mg for 10 days
Eye drops - OTC and eye ointmnet at night
tape the eyes to sleep
drink out of a straw
121
How long does it take to recover from bell's palsy?
3-4 months, can take up to 6 months. symptoms should start to improve after 3 weeks.
122
Red flags or differentials for bells palsy
Lymes disease - bilateral paralysis of face
stroke - forehead sparing
ramsay hunt disease - causes sensoneuronal hearing loss and rash on pinna
Ottitis media - otalgia and conductive hearing loss
tumour/cancer
123
Bilateral, symetrical tremour that can effect the vocal cords and is relieved by beta blockres is whatP
Essential tremor
124
whats the treatment for essential tremor?
Propanolol - but be weary of e.d and do not use in patients with heart blocks
125
Name some examples or primary and secondary headaches?
Primary - Migrain headache - pulsating, unilateral last up to 72 hours, phonophobia
Cluster headache - short duration 30 to 3 hours, lacrimination, rhionnear, cyclical
Tension headache - band like, dull pain, can get referred pain or tension in neck and shoulders
sinusitis - blockage and infection
Secondary - Intracranial hypertension, CSF leak, meningitis, carotid disection, haemorrhage, malginancies.SOL
126
red flag symptom
Morning headache and nausea
pain on changing postures - lying down SOL, standing CSF
thunderclap headache max within 5 mins
new onset headache
or headache/aura change - SOL
headache on contraceptive pills
progressive over weaks -SOL
menigismus symptms
aytipical aura - lasting longer than 60 mins
Check if anyone else in the house has these symptoms - Carbon monoxide poisoning
127
what do you give as a prevenative treatment for migraines?
Propanolol or amitrriptylian
128
what do you give to treat migrain?
Nsaids antiemetic and then triptan
129
what nerve can cluster headache also be associated with?
Trigeminal nerve!
130
symptoms of cluster headache?
Nasal congestion
horners syndrome - miosis and pitosis
lacrimination
restlesness
131
migraine without aura vs aura?
aura - scotoma, flashing lights, zig zags, pins and needles (all last 60 mins), tinitus vertigo, speach and labguage disturbances
WITHOut aura - photophobia, phonophobia
132
how many times do you have ot have a migraine?
5 attacks then = migraine
133
whats the classification of cluster headache?
up to 8 cluster headache attacks, happening one every other day for 2- 3 months time.
134
what is management for shingles?
oRAL antiviral within 72 hours of onset if they are immunocompromise, moderate pain/rash and if over 50
135
how long does it take for shingles to heal?
5-7 DAYS - reactviation of herpes zoster virus in dorsal ganglion
136
can you give a shingles vacination
Yes once over 70years
137
Can you get shingles from someone with chickenpox?
NO, but you can give chickenpox to someone if you have shingles
138
What are the three types of syncope?
1. Vasovagal - has a prodrome or sweating, pallor, feeling faint. reflex syncope.
situational syncope - reflex can be also from cough, micturiation, defecation etc.
2. orthostatic hypotension - volume depletion, dehydrated, medication, feel dizzy when standing up, lying standing BP
3. Cardiac causes - Arrythmias, aortic stenosis, MI's - SUDDEN Syncope, no cARDIOmyopathy
prodromal sign - 24 holter monitoring. Carotids barorecptros respond inappropriately when someone puts on a tie = carotid sinus syndrome- thinks the pressure is high, so drops the BP.
hypoxia - pe, aaa,
hypoglycemia, sugars.
PASS OUT
139
a person faints after turning their head to one side what is the investigation for this?
Carotid sinus massage - first line investigation
140
if you think someone has s seixure how long is referral
2 weeks
141
someone had a cardiovascular syncope how long is referral
24 hours!
142
non cardiovascular syncope what do you do?
HOLTER ecg and confirmation reading of test within 3 days
143
orthostatic hypotension what do you do?
Lying standing bP for 3 mins when standing
144
Treatment for Vasovagal
1. Increase Salt
2. Not in a hot room
3. small meals through the day
4. drinking lots of water
5. sitting down when feeling prodromal symptoms
6. not drinking lots of tea or coffees - make you pee more
avoiding alcohol
sitting before standing
145
What do you do if you see erythema migrans and facial palsy?
GIVE DOXCYLCINE for 21 days lyme disease
146
what test can you use if you suspect lyme disease without a rash?
ELISA antibody test
147
what infection is caused by Borriella burgdorferi
Lyme disease
148
what condition produces anti tpo and anti thyroglobulins?
Hashimotos disease
149
What condition causes antibodies to TSH receptors?
TSH Mimicry - and so get Graves disease
150
What can you monitor for primary hypothyrodism/hyperthyrodismY
Free t4
151
Can you get a goitre in hypothyrodism?
YES! as the T3 and T4 can't be released into the blood stream
152
symptoms of hypothyrodism?
Reduction in growth and metabolism
thus cold intolerance, short stature, weak muscles, fatigue, reduction in SNS pathway so depression, memory loss and brain fog, liver is not expressing LDL receptors so hypercholestremia, carpal tunnel syndrome and periorbital odema. TSH also stimulates FSH and LH, in hypothyrodism, can cause a reduction in lH - testosterone and FH - estrogen, thus low libido, menorrhagia etc.
153
What drugs can cause hypothyrodism?
Lithium
low iodine from diet
amiodarone
154
what is first line for hyperthyrodism
Carbimazole
155
What is first line for hypothyrodism
Levothyroxine
156
what is thyroditis?
Also know as quverine thyroditis - happens due to an viral infection, which causes swelling, pain, and pyrexia and increase in t3 t4 inilitally and then reduction in t3 and t4 - hypo.
157
why would you get thyroid storm?
to much levotyroxin
OR surgery, trauma, infection, pregnancy
can cause Increase in SNS. - leading to coma and also cardiac failure.
158
subacute vs acute thyroiditis
Subacute - viral
| acute - bacterial
159
Paroxsmyal change in BP, headache sweating and palpitations - what is this condition
Pheochromocytoma = Adrenal medulla tumour
160
explain what cholesterol is used for?
Cholesterol is used to make bile - which breaks down FATS into triglycerides
Used to celll membrane
used for steroids
161
what is role of vdl ldl and hdl
VDL - is endogenous cholesterol formation from liver,
LDL - is cholesterol carried from liver into tissues and cells to be used for energy, either as glycerol or atp.
HDL takes excess cholesterol from tissue back to liver where it is excreted as bile in stool or used to digest triglyceridesl from diet
162
what is lipoprotine?
Packaged fats and proteints (cholesterol, triglycerides, apoproteins)
163
what does GH do?
Needed if you have low sugar levels, and help with metabolism and providing energy source from skin, muscles and fats.
164
what is acromegaly
excess GH - tested by glucose tolerance test
165
what is diabetes insipidus
Does not respond to ADH - and so measure plasma and urine osmalitly which will be low and water deprivation test.
166
what is conns syndrome
hYPER ALDOSTERONe
aldosteron is used to increase blood volume and thus pressure, by increasing NA absorption and increaseing K secretion, thus water will follow increasing BP. too much of this can cause increase BP, hypertension as well as metabolic acidocis.
167
what is addisonian crisis
Not enough cortisol, and so cannot do fight or flight can go into shock! and collapse and death
168
what is cushings vs addisons
addisons is when you don have cortisol
| cushings when you have to much cortisol - dexamethasone supression test, if you give steroid should reduce cortisol.
169
symptoms of addisons diseasec
Hyperpigmentation!, fatigue, weight loss, hair loss, thining, salt craving!
170
what are the symptoms of paget disease?
Usualy asymptomatic bbut as it effects the skull, pelvic and lower limbs, it can impinge on nerves causing loss of hearing or vision. it can also cause bow legs. It is due to increase in osteolytic processes and is diagnoised by inccreased ALP and lytic erosions seen in xray
171
how do you diagnoise schizophrenia
1 POSITIVE symptom - hallucination, delusions, word salad, catatonic
or 2 of the following - negative symptoms (withdrawn, depressed, slow speech,, thought confusion, memory problems, flat affect.
Prodromal phase - withdrawn, active phase (must last more ttimes than not for 1 month) hallucinations/delusions, and regression --- withdrawn slightly.
172
what is rosacea?
tANGElectesisa, red conjuctiva/blepharitis, rinophyma (Granulma infiltration of nose) Flushing worse in sun, and is T shape on face. no comedomes.
Medication - metronidazole, and tetracycline if its bad (NO STEROIDS)
173
What is a prehn's sign used for?
Life up the testicule, and pain is relieved in epididymitius
174
what is cremesteric relfex?
Stroke the inner thigh and the testicle raises up, this does not happen in testicular torsion
175
Horizonal line - classiic bell clapper deformity is known as what condition - can also give you n&v.
Testicular torsion
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Epidymitis - is inflamation unilateral swelling, urethral discharge pain! iT IS an infection what are these?
Chlamydia/gonorrhoea - under 35
| over 35 e.coli
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differentials of painless unilateral swelling?
Hydrocele
| variocele
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What is a hydrocele?
Fluid filled cysts surround the testical can be communicating - where it communicates with the peritoneal cavity via the (not closed) processess vaginalis. (this one can increase in size when standing)
non comunicating - where it does not go up the tunica vaginalis and remains in the testical.
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how do you diagnoise hydrocele?
Transillluminate posterior - light should shine through.
180
what is a bag of worms iin the LEFT testicle!
pampiniform plexus - Left spermatic vein - inserts into the left renal vein, at 90 degrees rather than staight into the iVC that the right side does
Bag of worms
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Slow onset right sided painless scrotal mass?
lower limb ipsilateral swelling!
AFP - testicular tumour.
Testicular tumour
182
what is indictaive of a blue dot sign on testicles
Ischemic testicular on a appendix torsion - NOT testicular torsion.
183
Investigations for Testicular scrotum pain
Ultrasound - if hydrocele or unsure of diagnosis
acute scrotral pain - immediete referalt o hospital
gradual onset - Mid stream culture, dipstick - 2 week referral
184
what do you get whe you jave trauma of testicles
Hematocele
185
what happens when you cough or lie down for an inguinal hernia?
cough - iit comes out
lie down dissapears
Indirect - is in the scrotum
direct it is not!
186
Gradual onset, painless, soft, fluctuant, smooth round nodule palpated in the spermatic cord.
Spermatocele/epididymal cyst
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dragging sensation and dissapears when lying down
Variocele
| Inguinal hernia
188
Cholergic effects on body - ACTYLINE CHOLIEN stimulation
SLUDGE
```
Salivation
Lacrimation
Urine output
diorrhea
gastrointerinal upset
emesis
Anti-cholinergic = opposite to the above
```
189
what are the diagnostic criteria for PCOS?
Polycysitic ovaries - ultrasound more than 12 follcitles 2-9cm or the ovarian follicle is larger than 10 cm
Hyperandrogenism - hirtuism, acne
oligomenorrhea or amenorrhea
In adolescents they must have the last two
190
Differentials of PCOS?
- Cushings syndrome - excess cortisol can give you hirtuism
adrenal hyperplasia
hypothyrodism
prolactinoma - increase level of prolactin
191
Wha tis FSH and LH like in PCOS?
LH high levels! = more estrogen produciton, less progesterone
can cause insulin resistance and so obesity
endometrial hyperplasia
hyperandrogenism - more testeterone is being produce
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how is HIV diagnoised?
Combined HIV antibody and p24 antigen - 2 x readings (second being antibody or Viral DNA)
193
what is considered CD4 <200
AIDS
194
When do opportunistic infections in HIV occur?
CD 4 > 500
195
ECG terriories
v1 - v4 on ECG is anterior (lad)
V2-V5 st depression is posterior
I II AVF = inferior
196
What is the screening rules for hPV?
1. HPVrv check (cytology negative, repeat after 24 hours)
2. Cytology - look under microscope
3. coloscopy
197
what is placenta abrupta?
Bleeding after 20 weeks (same as pre-eclampsia) - when the placenta comes away from the uterus. and blood supply is compromised. manage or emergency c cessection
198
What is not a risk factor for cervical cancer?
ALCOHOL!
199
types of oesphagitis?
1. errosive oesphagitis - acid reflux, heartburn, and dysphagia or odnophyagia
(treatment - eat 3 hours before bed, raise the head of your bed up (not with pillows), avoid, caffiene, alchol, chocolate and spicy foods, drink lots of water.
2. pill induced - bisphosphanates, drink with a big glass of water, and stay upright for 30 minutes.
3. infection induced - most common in immunocompromised - chemotherapy, diabetes or hiv. Candida albicans - white plaques - red sores - nystatin mouth wash or fluconazole. treatment. or HSV - cowdry a on microscope - acyclovie. cmv - gancylovir
4. eosinophilia oesphagitis - usually with atopy (excema, asthma, food allergies) - causes inflammation - autoimmune.
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Symptoms of GORD
```
pyrosis - heart burn
regurgitation - food coming back
dysphagia - difficulty swallowing
dyspepsia
Dysphonia - hoarseness
cough
belching
```
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what is acalasia?
Loss of denervation of the ganglion cells
which leads to loss of perastalsis and also relaxation of the LES
so the oesphageous dilates
birds beak shape.
202
Differencves in symptoms between large bowel and small (mesenteric) bowel obstruction.
Small - early vomiting - bilious vomiting, Abdominal pain, coliky and higher up, Causes extramural - strictures, tumours, mural and intramural - gallstones,
large - Early constipation sign, lower abdominal pain and more constant - fecal impaction, or intusseption/volvus
abdominal distension
dehydration - as the large intestine is responsible for water absorption and electrolytes - na and k etc.
203
signs in Large and small bowel obstruction
Tinkling sounds
gaudring, tendor
microcytic anemia - colorectal cancer.
204
Influenza A,B and C
A is worse
B is milder
C is asymptomatic
can cause GI upsets (more likley in childrenP=) as well as coryzal symptoms, myalgia, neurological problems like encephalitis and meningitis!
Confirmed by lab tests, Rapid test in hospital to confirm, and treated with antivirals or given prophylaxis.
Worse in children, elderly over 65 and in pregnant woman mainly the third trimester.
Complications - sinusitis, ottitis media, pneumonia - mainly staph, and meningiits, rabdomyalisis.
HIGH fever - febrile convulsions
205
General Fever, myalgia, headaches (sometimes coryzal symptoms) = what conditioins?
```
TB
Malaria
HIV
Influenza
Hepatitis
```
206
Croup Managment:
Paracetamol/ibuprofen
fluids
calm
If admitted to hospital
1. dexamethason oral or iv or nebulised budesonide
2. Nebulised adrenalin
207
Tension pneumothoraz
1. tRAFFIC COLLISION
2. decreased breath sounds
3. trachea deviated away from impacted lung
4. emergnecy management - bore canula in the mid clavicul line 2nd intercostal space
208
Idiopathic pulmonary fiboris symptoms?
1. Exertional dyspnoea
2. dry cough
3. finger clubbing
Gold standard investgiation and diagnosis - CT Thorax.
no reason to it
209
what is the pneumococcal vaccine for?
Streptococcus pneumoniae - prevents, pneumonia and meningitis and sepsid
210
Pneumonia - what do you get after you get influenza virus?
Staphlycococcus pneumonia - bacterial
211
what pneumonia do you get commonly?
Streptoccous pneumonia
212
what pneumonia do you get that is common in COPD
Hemophillus pneumonia
213
what does horner syndrome suggest?
pANCOAST TUMOUR - found in the top left apex - coin lesion. pain in shoulder that radiates down the arm and hand.
Odema of the upper limb.
214
Venous vs arterial disease
Venous - insufficency of the valvue s- overstretched so unable to bring co2 back to the heart. odema, mottleed skin, ulcers medial and on shin, darker colured skin, irregular borders. get pe with this. risk factors, imbolity, statis, hypercoaguability, cocp, long flights surgery. Pain better when lifting leg up.
Arterials = ischemia, mi, due to atherscelosis, so obestity, smoking, DVT - doppler ultrasound
vasoconstriction causes. causes 6 p's, and pain. Pain worse at night and when puting leg u[, better when it goes down. ulcers on lateral malleous and punched out appearance. ABPi index less that 0.9 arterial disease.
215
Pulses:
```
Slow risiing - aortic stenosis
Collapsing - aortic regurtiation
Bounding - sepsis / hypercapnia
pulses paradoxes - PE, asthma
irregularly regular - Af
```
216
LUTS in men and treatment
BPH - hyperplasia of the cells in the stromal/glandular cells of the prostate.
It causes voiding symptoms and can cause obstruction symptoms after a while.
To diagnoise - do IPSS to see the effects on life, and a PSA.
Then if its more than 8 you start with an alpha blocker, with blocks alpha cells on smooth muscle cells of prostate allowing relaxation and ability to urinate - tamsulosin - review 4-6 weeks, modified ipss and then 6-12 months.
If this does not work and have obstruction symptoms - include finesteride - 5areductase inhibitor- so you dont mind dehidrotesterone - which causes hyperplasia.
If you have urinary incontience - stress incontinence, offer pads and pelvic floor training
Over active bladder - bladder training and oxybutocin
if its nocturia - offer furesomide (make sure it isnt to do with ms or diabetes or parkinsons)
if urinary retention then ovver - An alpha-blocker (modified-release alfuzosin 10 mg a day) and cathertisation may be needed
chronic then intermitten catherisaion and management infrequently
All patients - diet, exercise, body weight, alcohol, smoking, less fizzy drinks/sweeteners and caffeine.
fluid ristriction not important and can cause symptoms like UTI but preventing constipation can help,
217
treatment for gonorrhea
1mg stat dose of ceftriaxone
| for chlamydia its 100mg bd for 7 days of doxycyline.
218
epidydmorchitis
gonorrhea 1mg ceftriaxone plus 100mg of doxycycline bd for 14 days
for chkamyday doxycycline bd for 14 days
219
How does the PTH usually work?
usually the PTH responds to high Phosphate and low calcium.
if you have no vitamin d being produced because of renal failure= then you have low calcium as wlel as increased phosphate. Renals are responsible for vitamin d productiion, calcium resorbtion, and K and Phosphate excretion.
PTH then raises, inresponse to CKD - known as tertiary parahyperthyroidism
220
first line investigation for testicular cancer?
uLTRASOUND UNDER the two week rule.
221
pplacenta abruption vs placenta previa?
Previa - painless bleeding third trimester
| abruption - painful bleeding third trimester
222
Placenta previa vs anrupta
Abrupta - danger to baby - detatched from uterine wall, dark red bleeding, abdomen pain, hard tender uterus, contractions - RED FLAG ! DIC - where your body is clotting as well as fibronylsis same time and get depletion of clotting factors so bleed to!
previa - marginal partial or total, covers the Cervix. red vaginal bleeding ,post coital bleeding, soft uterus - risk of hameorrhage
rk: Multiparity, trauma, cocaine, smoking, hypertension
223
PMS?
Premenstural syndrome
always occurs in the luteal phase - triggered by the ovarian cycle, and progesterone. and subsides once you have mensturation with one week break.
Phsyiological and psychological symptoms - memory impairment, weight gain, headaches, back aches, inability to concentrate, food cravings, etc.
This must have an high impact on daily living for it to be diagnoised - A definitive diagnosis - gyane using gnrh.
However in primarys case use of the pms symptom diary and if cyclical.
Can have loads of types of pms. daily record of sevrity of problems for 3 cycles.
NSAIDS - first line
First line if not coveinving COC
or SSRIs during luteal phase
follow up 3 months to see whats ha;pening.
224
shingles
herpes zoster virus
reactivation of the varicella zoster virus
effects a dermatome does not cross the midline
predromal phase - burning, stabbing throbing, headache, malaise
rash vesicle erupt clustser - 3-7 days
until all crusted over then non infectious
post neuralgic pain possible for months
treatment acylovir within 72 hours
nsaids.gabapentin or ssris for pain
corticosteroids alongside antiviral if bad!
If hutchinsons sign
or herpes ottica - effect ears - refer immediatly.
225
Cholesteatoma
Cholesteatoma is an abnormal collection of epithelial tissue and keratin within the middle ear. It is associated with hearing loss/tinnitus, and there may be a purulent discharge which does not clear with antibiotic therapy. Facial nerve involvement typically signals a more advanced disease. Otoscopy will classically show crusting in the attic.
