General Flashcards
Side effect of correcting hyponatraemia too quickly
Central Pontine Myelinolysis = osmotic demyelination of the pons leading to acute paralysis, dysphasia, dysarthria
How do you differentiate syncope vs seizure
Seizure:
Post-ictal state
Tongue biting
Urinary incontinence
Often injuries associated
Side effect of systemic steroids
Hair thinning
Hirsutism
Psychosis
Cataracts
Plethora
Acne
Moon face
Hypertension
Peptic ulcers
Loss of height/back pain from compression fracture
Hyperglycaemia
Central obesity
Striae
Menstrual disturbances
Decreased skin thickness
Fractures with large calluses
Osteoporosis
Wasting of proximal thigh muscles
Bruising
Poor wound healing
Prone to infections
Complications of alcohol
Short term
>drowsiness
>hypoglycaemia
>euphoria
>dehydration
>loss of coordination
>ataxia and broad based gait
>blurred vision
>slurred speech
>slow reaction time
>impaired memory/judgement
>nausea and vomiting
>sedation
>analgesia
Long term
1)Nervous system
>mood and behaviour changes
>insomnia
>poor memory
>stroke
>peripheral neuropathy
>chronic fatigue
>wernicke Korsakoff (thiamine deficiency B1)
>seizures
2) cardiovascular
>cardiomyopathy
>MI
>hypertension
>anaemia
>arrhythmia
3) GIT
>gastritis
>oesophageal cancer
>peptic ulcers
>fatty liver
>alcoholic hepatitis
>inflammation of the intestines
>fibrosis
>cirrhosis
>pancreatitis
4) Reproductive
>erectile dysfunction
>infertility
>foetal alcohol syndrome
>breast cancer
Name some aids defining conditions
Pneumocystis pneumonia
Oesophageal candidiasis
Some tumors - Karposi sarcoma, primary lymphoma of the brain
Recurrent bacterial pneumonia
Presentation of SLE patient
Blood disorders (anaemia, leukopenia, lymph open IgA, thrombocytopenia)
Renal disorders
Arthritis
Immunologic disorders (Anti-native DNA AB, anti-SM antibody, antiphospholipid antibody)
Neurological disorders (seizures/psychosis)
Serositis (pleuritis, pericarditis)
Oral ulcers
Antinuclear antibodies (ANA) - vasculitis
Photosensitivity
Malar rash
Discoid rash
What is the preferred first line ARV regimen?
TLD
Tenofevir
Lamivudine
Dolutegravir
What are indications to defer ART in newly diagnosed HIV patient?
Signs and sx of TB
Diagnosed drug resistant or drug sensitive TB at a non-neurological site
Diagnosis of drug resistant or drug sensitive TB at neurological site
Diagnosis of cryptococcal meningitis
Positive cryptococcal antigen in absense of signs or symptoms
Signs and symptoms of meningitis
Clinical signs or sx of liver disease
Acute illness (Pneumocystis jirovecci, bacterial pneumonia)
What would you do before starting a patient on ARV’s?
Screen for TB
Nutritional assessment
Screen for danger signs needing urgent care
Screen for meningitis
Screen for mental health problems eg depression etc
Screen for non-communicable diseases eg diabetes
Screen for pregnancy
Screen for STI’s
WHO staging
Bloods to be done when starting ARV’s
CD4 (determine if co-trimoxazole prophylaxis needed)
GeneXpert (once screened)
CrAg
Urea and creatinine (TDF = nephrotoxic)
Hb
Cervical cancer screening
HBsAg
When is cotrimoxazole prevention therapy indicated in adults?
WHO 2,3,4
When CD4 is less than 200
Which HIV patients quality for TB preventative therapy and what is the drug and dose?
All new HIV pts not yet on tx or those on treatment who haven’t received preventative treatment yet. Ensure no active infection
Pyradozine 25mg PO dly
Isoniazid 300mg dly PO x12months
What are the drugs and doses in TLD?
Tenofevir 300mg
Lamivudine 300mg
Dolutegravir 50mg
What do you do if an HIV pt (on TLD) is diagnosed with TB and needs to start TB tx?
Double DTG dose (add 50mg to take 12 hours after TLD tablet dly) ie double DTG dose
Side effects of DTG
insomnia
GIT sx (diarrhoea)
Headache
CNS effects
Weight gain
Pros and cons of DTG vs Efavirenz
DTG pros
>fast viral suppression
>high genetic barrier to resistance
>side effects uncommon
>doesn’t interact with oral contraceptives
Cons
>neural tube defects in first 6weeks pregnancy
>interacts with Rifampicin
Efavirenz pros
>safe in pregnancy
>no interaction with TB meds
Cons
>neuropsychiatric side effects
>low barrier to resistance
>interacts with oral contraceptives
What drugs interact with DTG?
Rifampicin
Anti epileptics (carbimazepine, phenobarbital, phenytoin)
Multivitamins
Metformin (increases DTG conc therefore max metformin dose = 500mg 12hrly)
Which HIV drugs do Rifampicin interact with?
DTG
Lovirapine/rotonavir
Nevirapine
Side effects of tenofavir
Nephrotoxic
Affects bone mineral density
Side effects of Efavirenz
Neuropsychiatric symptoms
Cerebellar ataxia if toxic dose
Liver side effects
Side effects of AZT (zidovudine)
> anaemia
increased lipids
Side effects of Rifampicin
Hepatotoxic
Interacts with ARV’s
Orange sweat, tears, urine
Side effects of isoniazid
Hepatotoxic
Peripheral neuropathy
Side effects of pyrazinemide
Hepatotoxic
Hyperuricaemia (decreased renal excretion)
GI intolerance
Side effect of ethambutol
Optic neuritis
Define multidrug resistant TB
TB resistant to Rifampicin and isoniazid
Define extreme drug resistant TB
TB resistant to Rifampicin, isoniazid AND at least one fluoroquinolone AND one group A drug
Complications of TB
TB infection of other organs
Pleural effusion
Chronic pulmonary apergilloma
Post-TB bronchectasis
Haemoptysis
Cavitations
Mechanism of clubbing
Platelet derived growth factor released from megakaryocytes and platelet emboli (clumps of platelets) in the nail bed = fibrovascular proliferation (don’t normally reach nail bed but can in lung/heart conditions
What angles/measurements do you use to assess clubbing?
Phalangeal depth ratio
Lovibonds angle
Define jaundice
The yellow discolouration of the skin, conjunctiva, sclera, and other mucus membranes due to increased levels of serum bilirubin >40umol/L
Presentation of patient with organophosphate poisoning
SLUDGE DUMBELS
Salivation
Lacrimation
Urinary incontinence
Diaphoresis
GI upset
Emesis
Diarrhoea
Urinary incontinence
Miosis
Brachycardia, bronchospasm
Excess
Lacrimation and
Salivation
Rings around eyes in dyslipidaemia
Arcus senillis
Causes of increased ferritin
Iron overload (haemachromatosis)
Malignancy
Obesity
Inflammation (Rheumatoid arthritis)
Chronic liver disease
Ferritin/cataract syndrome
What is sickle cell crisis?
Sudden, unheralded veno-occlusive events that can have multiple symptoms commonly presenting with a pain crisis in limbs, lower back, chest or abdomen. Sometimes a specific organ is affected such as bone or spleen.
Morbidities associated with sickle cell disease
Pulmonary embolism
Acute chest syndrome
Splenic infarct at high altitude
Haematuria
Bacteraemia
Glaucoma
Anterior chamber bleeds
Sudden death after exertion
Complications of sickle cell disease
Acute chest syndrome
Ischaemic stokes
Painful episodes
Pulmonary hypertension
Splenic sequestration
Osteomyelitis
Osteomecrosis
Liver disease
Renal insufficiency
Hb values suggesting possible polycytaemia Vera
Male Hb >18,5
Female Hb >16,5
What is HIVAN?
HIV associated nephropathy
Common if CD4 <200 and VL >4000
Factors suggesting severe RA
Acute onset of multipoint involvement
High RF titre
Positive ANA
Presence of nodules
Low SES
Tests to request for haemolytic screen
LDH increase
Haptoglobin decrease
Hb decrease
Bilirubin increase
Reticulocytes increase
Smear = red cell fragments, helmet cells
