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PACES ellen > General > Flashcards

General Flashcards

1
Q

Difference between ARPKD and ADPKD

A

-AR PKD is more severe, comes on at a younger age. Is autosomal recessive
-AD PKD usually comes on in adulthood and is less severe. Autosomal dominant

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2
Q

How might a patient with PKD present

A

Incidental
Raised BP
Picked up on examination
Family screening
Abdo pain
Haematuria
Recurrent UTIs
May present with a haemorrhagic stroke

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3
Q

Extra renal manifestations of PKD

A

Liver/pancreas/ spleen/ovarian cysts
Cardiac valve disease
Aortic dilatation/ aneurysm
Cerebral aneurysms
Abdominal wall hernias

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4
Q

What is the most commonly affected valve in IE

A

Tricuspid

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5
Q

Commonly associated bacteria in IE

A

-Staph Aureus
-Streptococcus (usually of the viridians group)
-Enterococci

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6
Q

Other causes of enlarged kidneys

A

-PKD
-Hydronephrosis
-Infiltration (eg amyloid)
-Tumours
-Congenital

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7
Q

Management of PKD

A

1st- renoprotective lifestyle measures
-eg healthy diet/ BP optimisation/ excercise/ stop smoking / low salt
2st Tolvaptan (if rapidly progressing disease)
3rd Manage HTN / UTIs
4th Surgical intervention
-nephrectomy
-embolisation of bleeding cysts etc
5th RRT / Renal transplant

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8
Q

SPK indication

A

T1DM with nephropathy
Some T2DM if they meet certain criteria

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9
Q

SPK - are pancreas and kidney always done at same time?

A

No
Sometimes done simultaneously, other times may be done successively

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10
Q

Complications of SPK/ transplants

A

Acute
-Hyperacute rejection- needs nephrectomy
-Bleeding
-Infection
-Pain

Subacute
-Graft pancreatitis
-Peri-pancreatic collections
-Acute rejection (Mx steroids)
-PTLD
-Reactivation of infections eg BK virus
-Side effects from immunosuppression

Chronic
-gradual decrease in graft function (HTN/ proteinuria)
-recurrence of original disease

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11
Q

Where is the pancreas drained into in an SPK?

A

Drained into the duodenum /enteric drainage to avoid complications

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12
Q

How can you assess for encephalopathy?

A

-Check for the presence of asterixis
-Check constructional apraxia, e.g. ask the patient to draw a 5 pointed star

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13
Q

Scoring systems in cirrhosis?

A

Child Pugh
Meld (for transplant planning)

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14
Q

grading of encephalopathy

A

uses the west haven criteria
-Grade 0-4
0-some changes to memory
1- mild confusion
2-drowsiness/ lethargy
3-solomnent but rousable
4-comatose

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15
Q

complications of CLD

A

-varices, haemorrhage
-clotting disorder and abnormal bleeding/bruising
-hypoalbuminaemia leading to ascites/ peripheral oedema
-portal hypertension
-SBP
-Hepatorenal syndrome

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16
Q

management of ascites

A
  1. fluid restrict and diuretics
  2. ascitic drain with HAS
  3. refractory ascites-> TIPSS and liver transplant
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17
Q

Complications of TIPSS

A

-coagulopathy
-encephalopathy

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18
Q

causes of gynaecomastia

A

lack of androgens
-CLD
-Testicular atrophy or failure
-Klinefelters
-Drugs e.g. Mineralocorticoid agonists/ digoxin
-physiologically in puberty/ later life

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19
Q

Causes of decompensation in CLD

A

-ALcohol binge
-Sepsis / infection of other cause
-SBP
-Dehydration
-Constipation
-GI bleeding
-Reactivation of infection (eg Hep B) or new infection
-Drugs (eg paracetamol/ methotrexate)
-Clots (PVTs)
-HCC

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20
Q

management of decomposition CLD

A

-ABCDE
-Refer to the BASL guideline
-Identify and treat cause of decompensation

-Bloods , incl NILS, clotting, albumin, bilirubin
-Tap ascites (PMN/ albumin/ MCS)

-ETOH HX, put on CIWA and lorazepam if necessary and manage withdrawal
-monitor fluid balance
-Optimise nutrition / NG feeding / dietician
-Ensure opening bowels (lactulose / enemas)
-Manage electrolyte abnormalities
-Identify GI bleeding-> will need scope + mx this
-correct clotting
-LMWH prophylaxis
-get specialist input
-early referral to ICU if not improving

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21
Q

signs of chronic pancreatitis on exam?

A

fentanyl patches
abdo tenderness - particularly at epigastrium

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22
Q

complications of pancreatitis

A

-chronic pancreatitis and chronic pain
-pancreatic pseudocysts which may compress/ obstruct near by structures
-peri-pancreatic collections
-strictures
-thromboses
-pancreatic malignancy (chronic)
-SIRS (acute)

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23
Q

causes of pancreatitis

A

IGETSMASHED
I-idiopathic
G-gallstones
E-ethanol
T-trauma
S-steroids
M-mumps
A-autoimmune conditions/ genetics
S-scorpion stings
H-hypertriglyceridaemia/ hypercalcaemia
E-ERCP
D-drugs including azathioprine.

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24
Q

management of pancreatitis

A

Acute- pain, fluids
Supportive
Chronic
-pain management
-manage complications (eg check DM / pancreatic insufficiency/ manage strictures/ blockages etc)
-dietitian input (creon/ vitamins inc/ electrolytes - esp Magnesium. Vit D)

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25
Q

if you see a stoma on exam - to complete your examination you should say..

A

I’d like to examine the stoma in closer detail with the bag removed. And potentially perform a rectal examination of the stoma

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26
Q

What is glomerulonephritis

A

Inflammation in the glomeruli
-can cause a nephritic or nephrotic picture

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27
Q

Causes of glomerulonephritis

A

-Bergers disease (IgA nephropathy)- most common cause

-Membranous nephropathy- causes nephrotic syndrome (e.g idiopathic/ 2ry to malignancy/ SLE)

-Membranoproliferative glomerulonephritis

-post streptococcus glomerulonephritis

-cresenteric / rapidly progressive glomerulonephritis (can be caused by SLE/ p/canca)

Nephritis can be caused by systemic disease e.g.
-HSP
-p-anca and c-anca related vasculitis \

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28
Q

treatment of glomerulonephritis

A

treat underlying cause
supportive
immunosuppression
manage complications
RRT

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29
Q

Management of Addisons

A

Acute crisis-> High dose steroids

Intercurrent illness->double dose steroids

Long term -> glucocorticoid plus mineralocorticoid

30
Q

Investigation of Addisons

A

->9am cortisol
->short synACTHen test
->Urea and electrolytes
-> BM and BP

31
Q

Postural orthostatic tachycardia syndrome

A

Causes syncope- disorder of autonomic system
Causes tachycardia on standing

32
Q

How is HHT inherited?

A

Autosomal dominant

33
Q

How may HHT present?

A

Recurrent nose-bleeds
Anaemia
GI bleeding
Haemoptysis

34
Q

How is Friedreich’s ataxia inherited?

A

Autosomal recessive

35
Q

HHT complications

A

AV malformations
-Brain
-Gut
-Liver
-Lungs

Nosebleeds

36
Q

HHT investigations

A

Bedside- Obs

Bloods- Hb/ plt/ clotting /haematinics/ blood film

Special -
Gut- OGD/colonoscopy
Brain- CTA/ MRA
Chest- CT chest/ CXR / ABG
Liver- USS / LFTs
Genetic tests

37
Q

HHT management

A

Nosebleeds-
topical treatments
advise on humidification
ointments
refer to ENT

Gut
-Endoscopy-> ablation ?

Liver
-Screening. optimisation. if recurrent disease then ? liver transplant

Optimise iron stores
-iron replacement/ dietician
avoid tea after meals etc

38
Q

What is achalasia?

A

Failure of relaxation of the lower oesophageal sphincter

39
Q

achalasia management

A

-conservsative
(eg nitrates)
-surgical
(eg balloon dilatation/ cardiomyotomy)
-botox injections

PEG feeding

40
Q

management of C1 esterase inhibitor

A
  • give the enzyme inhibitor as a concentrate
  • avoid triggers + pt education
  • treat underlying disease (e.g. malignancy/ SLE)
    -treat as anaphylaxis
41
Q

LESS in RA

A

L- oss of joint space
E-periarticular erosions
S-soft tissue swelling
S-soft bones (osteopenia)

42
Q

LOSS in OA

A

L-oss of joint space
O-osteophytes
S-subchrondral cysts
S-subchondral sclerosis

43
Q

management of AIP

A

haemin
supportive care
patient education
genetic screening

44
Q

Features of Friedreichs ataxia

A

-Ataxia
-Loss of vibration and proprioception
-Hypertrophic Cardiomyopathy (may have ICD)
-Diabetes

45
Q

Signs of a common peroneal nerve palsy

A

Observe:
Foot drop/ high stoppage gait
Check fibula head / knee for scars

Power:
Weak dorsiflexion/ eversion

Sensation:
Check anterolateral leg and dorm of foot and 1st web space

46
Q

Origin of common peroneal nerve

A

L4/L5

47
Q

Causes of common peroneal nerve lesion

A

-> compression / trauma
->vasculitis
->any cause of peripheral neuropathy

48
Q

How to differentiate common perineal nerve palsy from L5

A

Check sensation at bottom of foot (L5 lesion would be lost)
Cannot SLR in L5 lesion

49
Q

sensory vs cerebellar ataxia ?

A

Sensory-
Rombergs
or Pseudoathetosis (fingers moving which gets worse when eyes closed)
Dorsal column involvement (loss proprioception/ vibration)

Cerebellar
-Scanning speech
-Truncal ataxia
-Nystagmus and other ocular signs

50
Q

CM1 and CM2

A

CM1 - demyelinating
CM2 - axonal

51
Q

Define bronchiectasis

A

obstructive lung condition characterised by dilatation and destruction of the bronchi caused by chronic infection or inflammation

52
Q

stages of diabetic retinopathy?

A

Pre-proliferative

Mild- micro aneurysms only
Moderate- micro aneurysms + hard exudates + cotton wool spots
Pre-proliferative / severe , features of moderate + intra-retinal microvascular abrnormalities + venous beading

Proliferative- neovascularisation / vitreous haemorrhage

53
Q

differentials for diabetic retinopathy

A

macular degeneration
vitreous haemorrhage
cataracts
hypertensive retinopathy
migraine
TIA

54
Q

ocular associations with diabetes

A

retinopathy
macular oedema
cataracts
vitreous haemorrhage
central retinal vein occulsion or central retinal artery occlusion
higher risk of glaucoma
TIA
stroke

55
Q

investigations in Myasthenia

A

Anti cholinesterase receptor antibodies
Anti MUSK antibodies
TFTS
emg

CT chest to check for Thymoma

FVC if acute

56
Q

what could trigger a myasethenic crisis?

A

infection
dehydration
stress
non compliance with medication
trauma
anaemia
drugs

57
Q

name some types of muscular dystrophies

A

-myotonic dystrophy
-limb-girdle muscular dystrophy
-Duchennes muscular dystrophy/beckers
-facioscapulohumeral dystrophy

58
Q

What is the PESI score

A

Pulmonary Embolism Severity Index score

Takes into account:
HR, BP, O2 ,Co-morbs including: lung disease/ cancer
Age

Can classify risk in patients who have a diagnosis of PE and highlight which ones may need to be escalated to higher levels of care (e/g ICU)

59
Q

grading of thyroid eye disease

A

NO SPECS
N-no signs or symptoms
O- only signs
S-soft tissue involvement
P-proptosis
E-extraoccular muscle involvement
C-corneal involvement
S-sight loss

60
Q

early signs of Parkinson’s

A

constipation
trouble sleeping
falls
tremor

61
Q

management of Parkinson’s

A

L Dopa w/ peripheral dopamine de-carboxylase inhibitors
Dopamine agonists
COMT inhibitors
Anticholinergics
MAO B inhibitors

MDT
SLT , dieticians, psychiatry, pt, ot

Surgical
Deep brain stimulation
Dopamine pumps

62
Q

Diagnosis of PD

A

clinical diagnosis
Structural brain imaging to rule out other causes EG stroke/ NPH / SOL/ parkinsons plus syndromes

63
Q

triad of Parkinsonism

A

Resting tremor
Bradykinesia
Rigidity

64
Q

how to present a PD case

A

This patient has a hypo mimic phase with hypophonia, there was a resting assymetrical tremor. There was lead pipe rigidity and cog wheeling in the arms
power and sensation and reflexes were normal
there was a stooped posture and reduced arm swing with walking. there was a shuffling gait

there were/ were not signs of a Parkinsons plus syndrome

65
Q

How to describe the movement of hands in PD

A

reduction in frequency and amplitude of movements

66
Q

NYHA scoring

A

Class 1- not limited
Class 2- limited on activity
Class 3- limited on light activity , only comfy at rest
Class 4- symptoms at rest

67
Q

a cushingoid appearance…

A

moon shape facies
abdominal straie
aganthosis nigricans
thinning of the arms and legs
central adiposity
gynaecomastia
buffalo hump
thin skin
bruising

68
Q

Scoring systems in TIA

A

ABCD2 score
Estimates risk of stroke after having a TIA
Takes into account
A age
BP
C clinical symptoms of stroke
D duration of symptoms

69
Q

Function of the spleen

A

Filtration of the blood
Iron metabolism
Extra medullary haematopoesis
Storage of RBCs and platelets

70
Q

Causes of central loss of vision

A

Macular degeneration
Macular disease (eg from DM)
Retinal vein occlusion
Hypertensive retinopathy
Optic neuritis or optic nerve disease
Cataracts

71
Q

What do you see on fundoscopy for retinitis pigmentosa?

A

Pigmentary bony spicules

72
Q

Differentials for a cranial nerve 7 palsy

A

Bell’s palsy
Ramsay hunt
Sarcoidosis
Cerebellar pontine angle lesion
Acoustic neuroma
Lesion at the cranial nerve nucleus (eg stroke / demyelination)

PACES ellen (2 decks)

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