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Phase 3A Revision > General Medicine (including COTE) > Flashcards

General Medicine (including COTE) Flashcards

1
Q

Renal causes of hypovolaemic hyponatraemia

A

Diuretics - thiazide + loop diuretics
Mineralocorticoid insufficiency e.g. Addison’s
Osmotic diuresis e.g. low glucose, urea
Nephropathy

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2
Q

Causes of euvolaemic hyponatraemia

A

SIADH
Abnormal ADH release e.g. hypothyroidism,
Psychogenic polydipsia
Other - high water, lower solute intake e.g. anorexia nervosa

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3
Q

Hypovolaemic causes of hyponatraemia

A

GI losses - diarrhoea, vomiting, pancreatitis
Skin losses - sweating, burns
Renal losses - diuretics, nephropathy
Other - Addison’s disease, sepsis

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4
Q

Hypervolaemic causes of hyponatraemia

A

Failures (heart, liver, renal)
Nephrotic syndrome

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5
Q

Clinical features of hyponatraemia

A

Headache
Confusion
N+V
Lethargy
Irritability
Seizures/LOC/Coma
Often asymptomatic

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6
Q

Outcome of urine tests in SIADH

A

High urine osmolality
High urine sodium
(Low serum sodium)

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7
Q

Management of SIADH

A

Stop offending medication if relevant (usualyl diuretics)
Fluid restriction
Tolvaptan - ADH receptor blocker

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8
Q

Potential complication of treating severe hyponatraemia too quickly

A

Central pontine myelinolysis (osmotic demyelination syndrome)

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9
Q

Medications that most commonly cause hyponatraemia

A

Diuretics - especially thiazide + loop diuretics
SSRIs esp citalopram
Antipsychotics e.g. haloperidol + phenothiazines
Carbamazepine
PPIs
ACE inhibitors

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10
Q

Blood tests in confusion screen

A

FBC: WCC for infection
CRP (infection)
U+Es (Uraemia + hyponatraemia)
Bone profile (hyper/hypocalcaemia)
B12/Folate (deficiency)
TFTs (hypothyroid)
Glucose
LFTs (hepatic encephalopathy)
Coagulation/INR (intracranial bleed)

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11
Q

What indicates a significant postural drop in hypotension

A

> 20 systolic drop
10 diastolic drop
Within 3 minutes from lying to standing

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12
Q

Post-ACS medications

A

Block An ACS
- Beta blocker
- ACEi
- Aspirin
- Clopidogrel
- Statin

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13
Q

Risk factors for dementia

A

Genetics - family history
Insulin resistance e.g. T2DM
Atherosclerosis
Hypothyroidism
Depression
History of head injury
HIV
PD

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14
Q

DSM-IV criteria for dementia

A

Decline in memory and learning (on tests)
One of:
- Aphasia
- Apraxia
- Agnosia
- Reduced executive function
Symptoms interfere with functioning
Gradual onset + continual decline
No known organic cause
Not due to delirium
Not due to mental health disorder e.g. depression

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15
Q

Differential diagnosis of dementia

A

Normal reduced cognition of advanced age
Delirium
Depression
Drug abuse/side effect
Medical disorders

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16
Q

Medical disorder differentials of dementia

A

Anaemia
Hypothyroidism
Cerebral tumours/metastases
Syphilis (neurosyphilis)
Amyloidosis
Creutzfeldt-Jakob disease
Poor nutrition

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17
Q

Features of Lewy-body dementia

A

Progressive cognitive impairment - persistent memory dysfunction not apparent in early stages
Cognition may be fluctuating, with lucid periods
Parkinsonism (typically develops after cognitive impairment)
Visual hallucinations (may have other symptoms e.g. delusions)
Depression + sleep disturbance

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18
Q

Pathology of Lewy-body dementia

A

Alpha-synuclein cytoplasmic inclusions (Lewy bodies)
In the substantia nigra, paralimbic + neocortical areas

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19
Q

Management of Lewy body dementia

A

Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine
or Memantine (NMDA receptor amtagonist)

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20
Q

Medications to be avoided in Lewy body dementia

A

First generation antipsychotics - may develop irreversible parkinsonism
e.g. haloperidol

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21
Q

Risk factors for Alzheimer’s disease

A

Increasing age
FHx
5% cases inherited autosomal dominant
Caucasian ethnicity
Down’s syndrome
Apoprotein E allele E4

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22
Q

Macroscopic pathological changes in Alzheimer’s disease

A

Widespread cerebral atrophy
Particularly cortex + hippocampus

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23
Q

Microscopic pathological changes in Alzheimer’s disease

A

Cortical plaques due to deposition of type A-beta-amyloid protein
Intraneuronal neurofibrillary tangles
Caused by abnormal aggregation of the tau protein

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24
Q

Pharmacological management of Alzheimer’s disease

A

Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, and galantamine - for mild to moderate disease
2nd line: memantine (NMDA receptor antagonist)
- Moderate AD if intolerant of, or acetylcholinesterase inhibitors contraindicated
- Add on in moderate or severe
- Monotherapy in severe disease

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25
Q

Contraindications/side effects of donepezil

A

Relatively contraindicated in bradycardia
Adverse effects include insomnia

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26
Q

What is Pick’s disease

A

Dementia caused by localised atrophy of the frontal and temporal lobes

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27
Q

Blood tests done in a patient with suspected dementia to exclude reversible causes

A

FBC
U+E
LFTs
Calcium
Glucose
ESR/CRP
TFTs
Vitamin B12 + folate levels

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28
Q

Features of frontotemporal dementia/Pick’s disease

A

Personality change
Impaired social conduct
Hyperorality
Disinhibition
Increased appetite
Perseveration behaviours
More common in patients under 65
Memory problems tend to occur later

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29
Q

Macroscopic changes in Pick’s disease/FTD

A

Atrophy of the frontal and temporal lobes

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30
Q

Microscopic changes in Pick’s disease/FTD

A

Pick bodies - spherical aggregations of tau protein
Gliosis
Neurofibrillary tangles
Senile plaques

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31
Q

Assessment tool for frailty status

A

PRISMA-7

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32
Q

What is frailty

A

State of impaired homeostasis –> increased vulnerability to minor stressor events

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33
Q

Elements of PRISMA-7 assessment

A

Age
Sex
Health problems
Help at home
Mobility
Social support

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34
Q

What is multimorbidity

A

The presence of two, or more, long-term health conditions

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35
Q

Causes of acute confusional state/delirium

A

PINCH ME:
- Pain
- Infection
- Nutrition
- Constipation
- Hydration
- Medication
- Environment
Metabolic causes
Alcohol withdrawal

36
Q

Features of delirium/acute confusional state

A

Memory disturbances (loss of short term > long term)
May be very agitated or withdrawn
Disorientation
Mood change
Visual hallucinations
Disturbed sleep cycle
Poor attention

37
Q

Non-pharmacological management of delirium/acute confusional state

A

Treat underlying cause
Modifcation of environment

38
Q

Pharmacological management of delirium/acute confusional state

A

Oral haloperidol 0.5mg
Oral olanzapine
Except in parkinsonism/PD: atypical antipsychotics e.g. quetiapine + clozapine

39
Q

Risk factors for vascular dementia

A

History of stroke/TIA
AF
Hypertension
Diabetes mellitus
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
FHx stroke or CVD

40
Q

Presentation of cognitive decline in vascular dementia

A

Several months/years of a history of a sudden/stepwise deterioration of cognitive function

41
Q

Features of vascular dementia

A

Focal neurological abnormalities
Difficulty with attention + concentration
Seizures
Memory disturbance
Gait disturbance
Speech disturbance
Emotional disturbance

42
Q

Management of vascular dementia

A

Reduction of vascular risk factors:
- Aspiring or warfarin therapy
- Controlling BP
- Anticholinesterases + memantine: may have some benefit

43
Q

STOPP tool

A

Screening Tool of Older Person’s Prescriptions
Aims to improve appropriateness of prescriptions, reduce occurence of adverse events, and reduce drug costs
Used to identify potentially inappropriate drugs in a patient >65 years

44
Q

START tool

A

Screening Tool to Alert doctors to the Right Treatment

45
Q

Tool used to assess risk of major bleeding in patients who are on anticoagulants

A

HAS-BLED

46
Q

Medications that may cause constipation

A

Codeine
Ondansetron

47
Q

Required level of understanding in capacity assessment

A

It is enough to understand salient details - must ensure level of understanding is not set too high and that the information is only relevant to the decision itself

48
Q

What is 6CIT

A

Six Item Cognitive Impairment test
Used as a brief test of cognitive function

49
Q

Medications that may cause delirium

A

Anticholinergic drugs e.g. TCAs, neuroleptics, oxybutynin
Opioids
Benzodiazepines
Antiparkinsonian agents
H2 receptor blockers
Cardiovascular agents e.g. beta-blockers, digoxin, or diuretics

50
Q

Anti-emetic for chemo-induced nausea

A

Ondansetron

51
Q

Anti-emetic for intracranial causes of nausea e.g. raised ICP/direct effect of tumour

A

Haloperidol

52
Q

Anti-emetic for vestibular causes of nausea

A

Prochlorperazine

53
Q

Anti-emetic for gastrointestinal causes of nausea

A

Metoclopramide

54
Q

Causes of primary hyperaldosteronism

A

Low renin due to high BP

Bilateral adrenal hyperplasia
Adrenal adenoma secreting aldosterone (Conn’s syndrome)
Familial hyperaldosteronism
Adrenal carcinoma

55
Q

Causes of secondary hyperaldosteronism

A

High renin –> more aldosterone
Generally happens when kidney BP disproportionately lower than rest of the body

Renal artery stenosis
Renal artery obstruction
Heart failure

56
Q

Investigations in hyperaldosteronism

A

Renin/aldosterone ratio;
- High aldosterone, low renin –> primary
- High aldosterone, high renin –> secondary
Serum electrolytes:
- Hypokalaemia (increased excretion)
- Hypernatraemia (increased absorption)
CT/MRI for adrenal tumour
Renal doppler USS, CT angioram or MRA for renal artery obstruction

57
Q

Management of hyperaldosteronism

A

Aldosterone antagonists e.g. spironolactone
Treat underlying cause:
- Surgical removal of adenoma
- Percutaneous renal artery angioplasty for renal artery stenosis

58
Q

First-line investigation for diagnosis of kidney stones

A

CT KUB

59
Q

Stage 1 of AKI

A

Creatinine 1.5-1.9x higher than baseline, or
Urine output <0.5ml/kg for >6 consecutive hours

60
Q

Stage 2 of AKI

A

Creatinine 2-2.9x higher than baseline, or
Urine output ,0.5ml/kg for >12 consecutive hours

61
Q

Stage 3 of AKI

A

Creatinine >3x higher than baseline, or
Urine output <0.5ml/kg for >24 consecutive hours

62
Q

Stage 1 of CKD

A

eGFR >90

63
Q

Stage 2 CKD

A

eGFR 60-89

64
Q

Stage 3 CKD

A

3a eGFR 45-59
3b eGFR30-44

65
Q

Stage 4 CKD

A

eGFR 15-29

66
Q

Stage 5 CKD

A

eGFR <15
End-stage renal failure

67
Q

Features of steroid-responsive COPD

A

Asthmatic features
Atopic illness
Variation in FEV1

68
Q

Management of steroid-responsive COPD

A

Step 1: SABA or SAMA
Step 2: SABA + LABA + ICS (discontinue SAMA and start SABA if prev using)
Step 3: SABA + LABA + ICS + LAMA

69
Q

Features of non-steroid responsive COPD

A

No asthmatic features
No atopic illness
No variation in FEV1

70
Q

Management of non-steroid responsive COPD

A

Step 1: SABA or SAMA
Step 2: SABA + LABA + LAMA (discontinue SAMA and start SABA if using previously)

71
Q

Features of multiple myeloma

A

Bone disease: pain, osteoporosis (+fractures), osteolytic lesions
Lethargy
Infection
Hypercalcaemia
Renal failure

72
Q

What is genetic anticipation

A

Hereditary diseases have an ealrier age of onset through successive generations

73
Q

Examples of diseases exhibiting genetic anticipation

A

Trinucleotide repeat disorders e.g.
Huntington’s disease
Myotonic dystrophy

74
Q

Score used to identify patients at risk of pressure sores

A

Waterlow score

75
Q

First line pharmacological management of COPD

A

SABA e.g. salbutamol
Short antimuscarinics e.g. ipratropium bromide

76
Q

Why is heparin contraindicated in acute bacterial endocarditis

A

Patients are believed to be susceptible to haemorrhagic transformation of embolic lesions

77
Q

Immediate management of cardiac event

A

MONA
Morphine
Oxygen therapy
Nitrates
Aspirin

78
Q

Investigations in heart failure

A

BNP (brain natriuretic peptide) - raised
CXR (ABCDE)
- Alveolar oedema
- kerley B lines
- Cardiomegaly
- Dilated pulmonary vessels
- pulmonary Effusion
Echocardiogram: reduced ejection fraction, LV dilation
ECG: LV hyertrophy (tall QRS)

79
Q

Management of heart failure

A

Diet
Education
Pneumococcal + flu vaccinations
Diuretics = furosemida 20-40mg OD
1st line for LV systolic dysfunction = ACEi + beta-blocker + furosemide

80
Q

End-organ damage in hypertension

A

Left ventricular hypertrophy - tall QRS on ECG
CKD - creatinine on U+Es
Hypertensive retinopathy - fundoscopy

81
Q

Target BP in hypertension management

A

140/85
In diabetes, CKD or CVD –> 130/80

82
Q

Antibiotic for exacerbation of chronic bronchitis

A

Amoxicillin, tetracycline or clarithromycin

83
Q

Antibiotics for uncomplicated community-acquired pneumonia

A

Amoxicillin (doxycycline or clarithromycin if allergic to penicillin)
Add flucloxacillin if staphylococci suspected

84
Q

Antibiotic for potential atypical pneumonia

A

Clarithromycin

85
Q

Antibiotics for hospital-acquired pneumonia

A

Within 5 days of admission: co-amoxiclav or cefuroxime
>5 days after admission:
- Piperacillin with tazobactam; OR
- Broad-spectrum cephalosporin e.g. ceftazidime; OR
- Quinolone e.g. ciprofloxacin

86
Q

Presentation of malignant hypertension

A

Papilloedema - must be present
Retinal bleeding
Increased cranial pressure –> headache + nausea
Chest pain (due to increased cardiac workload)
Haematuria (kidney failure)
Epistaxis

87
Q

Definition of malignant hypertension

A

Hypertension with acute end-organ damage
>/=180/120

Phase 3A Revision (12 decks)

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