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Phase 2 > GenMed > Flashcards

GenMed Flashcards

1
Q

List some scoring systems used in acute GI bleeding

A

Rockall score - predict risk of rebleeding and mortality (>6 is indication for surgery)
Glasgow Blatchford score - to consider admission

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2
Q

List the gastro red flag symptoms

A 
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset
Malaena
Swallowing difficulty 
\+ recurrent vomiting, epigastric mass, >55 years old
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3
Q

What are the contraindications for liver transplantation

A 
Extrahepatic malignancy
Multiple tumours
Severe CVS/Resp disease
Systemic sepsis
HIV infection
Non compliance with drugs
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4
Q

What are some complications of liver transplantation?

A 
Sepsis (G-ve, CMV)
Hepatic artery thrombosis
Chronic rejection
Graft vs host 
Disease recurrence
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5
Q

Why is microalbuminuria relevant in people with diabetes?

A

30-300mg albumin/24h
Early warning of impending renal problems and progression of disease, strong risk factor for CVD
Patient should be started on ACEi/ARB irrespective of blood pressure

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6
Q

List the diabetic eye complications and their signs

A

Background - microaneurysms (dots), haemorrhages (blots), hard exudates (lipid deposits)
Pre-proliferative - cotton wool spots (infarcts), haemorrhages, venous bleeding
Proliferative - new vessels form

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7
Q

Suggest some retinopathy treatments

A

Laser
Intravitreal steroids
Antiangiogenic agents
Aspirin

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8
Q

Define diabetic neuropathy

A

Decreased sensation in ‘stocking’ distribution (test with a 10g monofilament fibre with just sufficient force to bend it)
Absent ankle jerks
Neuropathic deformity - pes cavus, claw toes, loss of transverse arch, rocker bottom sole)
Foot ulceration - painless, punched out ulcer in an area of thick callus +/- super added infection

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9
Q

How do you assess the diabetic foot?

A
  1. Neuropathy - clinically
  2. Ischaemia - clinically, doppler +/- angiogram
  3. Bone deformity - Charcot joint + X-ray
  4. Infection - swabs, blood culture, X-ray
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10
Q

What is a Charcot joint and how is it treated?

A

Loss of pain sensation leads to increased mechanical stress and repeated joint injury, collapse of medial longitudinal arch –> swelling, instability, deformity,
Treatment - offload all weight, immobilise, bisphosphonates

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11
Q

List some conditions associated with Charcot joint

A

Diabetic neuropathy, tabes dorsalis, spina bifida, syringomyelia, leprosy, paraplegia, spinal osteolysis/cord atrophy (systemic sclerosis)

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12
Q

Discuss the treatment of diabetic neuropathy

A
  1. Paracetamol
  2. TCA e.g. amitriptilline
  3. Duloxetine, gabapentine/pregabalin
  4. Opiates
    Avoid weight bearing
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13
Q

Define IBS

A

Abdominal pain relieved by defecation/altered stool AND urgency/incomplete evacuation/bloating/worse after food
No organic cause

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14
Q

List the red flag symptoms of dyspepsia

A

Unintentional weight loss
Recurrent vomiting
Dysphagia
Evidence of GI bleeding

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15
Q

Describe Duke’s staging of cancer

A

A - limited to muscularis mucosae
B - extension through muscularis mucosae
C - involvement of regional lymph
D - distant metastases

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16
Q

List some diseases associated with hypothalamus and pituitary disorders

A

Hypothalamus - kallmann’s syndrome, tumour, inflammation, infection, ischaemia
Pituitary stalk - trauma, surgery, meningitis, carotid artery aneurysms
Pituitary - tumour, irradiation, inflammation, Sheehan syndrome

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17
Q

What hormones are released from the pituitary?

A

Anterior - FSH/LH, ACTH, TSH, GH, prolactin

Posterior - oxytocin, ADH

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18
Q

List some causes of hyperthyroidism

A 
Graves' disease
Toxic multinodular goitre
Toxic adenoma
Ectopic thyroid tissue
Exogenous iodine
Drugs (amiodarone, lithium)
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19
Q

List some causes of hypothyroidism

A 
Primary trophic hypothyroidism
Hashimoto's 
Iodine deficiency 
Post thyroidectomy/radioiodine
Drugs (amiodarone, lithium)
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20
Q

What is the function of the parathyroid glands?

A

Secrete PTH in response to low calcium

–> increase osteoclasts activity in bones, increase calcium reabsorption in kidney

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21
Q

Describe different types of hyperparathyroidism

A

Primary - high calcium (stones, groans, bones, psychiatric overtones), high blood pressure. Treatment = increase fluid intake, excise adenoma/glands, cinacalcet
Secondary - low calcium, high PTH due to low vitD intake, CKD. Treatment = phosphate binders, vitD, cinacalcet
Tertiary - high calcium, very high PTH due to prolonged secondary, CKD
Malignant - high calcium, low PTH due to PTHrP produced by some squamous cell lung cancer/breast/renal cell carcinoma

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22
Q

Describe different types of hypoparathyroidism

A

Primary - low calcium, high phosphate due to gland failure (autoimmune/congenital DiGeorge). Treatment = calcium supplements, calcitriol
Secondary - low calcium, high phosphate due to radiation, surgery, hypomagnesaemia
Pseudo - failure of target cell response to PTH –> short metacarpals, round face, short stature, calcified basal ganglia, low IQ
Pseudopseudo - as pseudo but with normal biochemistry

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23
Q

List some causes, signs and symptoms and treatment of hyperkalaemia

A

Causes - oliguric renal failure, K+ sparing diuretics, rhabdomyolysis, metabolic acidosis, Addison’s disease, massive blood transfusion, burns, drugs (ACEi)
Signs and symptoms - fast irregular pulse, chest pain, weakness, palpitations
Treatment - treat underlying cause, calcium gluconate, IV insulin and dextrose, salbutamol, calcium resonium

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24
Q

List some causes, signs and symptoms and treatment of hypokalaemia

A

Causes - diuretics, diarrhoea and vomiting, pyloric stenosis, rectal colloid adenoma, intestinal fistula, Cushing’s syndrome/steroids/ACTH, Conn’s syndrome, alkalosis, liquorice abuse, renal tubular acidosis
Signs and symptoms - muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, constipation
Treatment - oral K+ supplement (mild), IV K+ (severe)

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25
Q

Describe the ECG changes seen with potassium disturbance

A

Hyper - tall tented T wave, small P waves, wide QRS, VF

Hypo - small/inverted T waves, prominent U waves, increased PR interval, low ST segments

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26
Q

List signs of hypocalcaemia

A 
Spasms
Periorsl paraesthesia
Anxious
Seizures
Muscle tone increase
Orientation reduced
Dermatitis
Impetigo herpetiformis 
Chovstek's sign
Cardiomyopathy
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27
Q

List some reasons for urgent dialysis

A

Hyperkalaemia unresponsive to treatment
Pulmonary oedema unresponsive to treatment
Uraemic complications (pericarditis, encephalopathy)
Severe metabolic acidosis (pH <7.2)
Drug overdose (BLAST - barbiturates, lithium, alcohol, salicylates, theophylline)

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28
Q

What cancers metastasise to bone?

A 
Thyroid
Breast
Lung 
Kidney
Prostate
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29
Q

Define AKI staging

A

Stage 1 - increase serum creatinine >26umol in 48h OR <0.5ml/kg/hr >6h
Stage 2 - increase serum creatinine 2-2.9x baseline OR <0.5ml/kg/hr >12h
Stage 3 - increase serum creatinine 3x baseline OR <0.3ml/kg/hr >24h OR anuria 12h

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30
Q

Define CKD staging

A

Stage 1 - GFR >90 + renal damage >3 months
Stage 2 - GFR 60-89 + renal damage >3 months
Stage 3a - GFR 45-59 +/- renal damage
Stage 3b - GFR 30-44 +/- renal damage
Stage 4 - GFR 15-29 +/- renal damage
Stage 5 - GFR <15 +/- renal damage

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31
Q

List some complications of CKD

A

Normocytic anaemia (treat with EPO)
Acidosis –> high urea, platelet dysfunction
Hyperkalaemia
CCF
Renal bone disease (osteitis fibrosa cystica)
Treatment - viD/calcium, bisphosphonates, parathyroidectomy/cinacalet

32
Q

List the functions of the kidney

A

Regulatory - fluid, acid
Endocrine - EPO, vitD
Excretory - phosphate
Metabolism - drugs

33
Q

What is nephrotic syndrome and what are some primary causes?

A

Oedema, proteinuria (>3.5g/24h), hypoalbuminaemia (<25g/L), hyperlipidaemia
Causes - membranous glomerulonephritis, minimal change, FSGS, mesangiocapillary glomerulonephritis

34
Q

What is nephritic syndrome and what are some primary causes?

A

Haematuria, high BP, low GFR

Causes - IgA nephropathy, mesangiocapillary glomerulonephritis

35
Q

What are some secondary causes of nephrotic/nephritic syndrome?

A 
Diabetes
SLE
Amyloid
Hepatitis (B/C)
Post streptococcal
Vasculitis
Anti GBM disease
36
Q

Describe the presentation and treatment of polycystic kidney disease

A

Presentation - pain, haematuria, E. coli infection, stroke (berry aneurysms)
Treatment - low BP, increase fluids, low salt diet, tolvaptan (vasopressin antagonist stops cyst growth)

37
Q

What is Cushing’s syndrome?

A

Chronic glucocorticoid excess and loss of normal feedback mechanisms

38
Q

List some causes is Cushing’s syndrome

A

ACTH dependent - pituitary adenoma (Cushing’s disease), small cell lung carcinoma, carcinoid tumour, thyroid/prostate cancer
ACTH independent - adrenal adenoma, adrenal nodular hyperplasia, iatrogenic (steroids)

39
Q

What is Addison’s disease?

A

Destruction of adrenal cortex leading to glucocorticoid/mineralocorticoid deficiency

40
Q

List some causes of Addison’s disease

A

Autoimmune, TB, adrenal metastases, lymphoma, long term steroid use

41
Q

Define male and female hypogonadism and list some causes

A

Male:
Failure of testes to produce testosterone, sperm or both
Primary = testicular failure (local trauma, torsion, chemo, post orchitis, alcohol excess, kleinefelter’s, renal failure, cirrhosis)
Secondary = decreased LH/FSH (hypopituitarism, prolactinoma, Kallmann’s, COPD, HIV, Pradee-Willi)
Female:
Underactivity, developmental failure or absence of the ovaries –> low oestrogen
Primary (Turner’s, surgical removal, menopause)
Secondary = HP axis problem (pituitary adenoma, viral encephalitis, excessive exercise, sudden weight loss)

42
Q

What is a multiple endocrine neoplasia (MEN)?

A

Autosomal dominant functional hormone producing tumours in multiple organs.
MEN 1 - parathyroid hyperplasia/adenoma, pancreas (insulinoma, gastrinoma, somatostatinoma), pituitary prolactinoma
MEN 2a - thyroid (medullary carcinoma), adrenal (phaeochromocytoma), parathyroid hyperplasia
MEN 2b - mucosal neuromas, marfanoid appearance

43
Q

List the red flag symptoms of back pain

A 
Age <20, >55
Acute onset (in elderly)
Constants or progressive
Nocturnal
Worse when supine
Fever, night swears, weight loss
Malignancy history
Abdominal mass
Thoracic
Morning stiffness
Bilateral/alternating in legs
Neurological disturbance
Sphincter disturbance
Current or recent infection 
Immunosuppression
Leg claudication/exercise related weakness
44
Q

List differentials for joint pain

A

Local + swelling + 1 joint = septic arthritis, gout, seronegative spondyloarthropathies, RA
Local - swelling = OA, tendonitis/bursitis
General = malignancy, SLE, fibromyalgia

45
Q

Describe the presentation, signs and management of RA

A

Presentation - symmetrical, swollen, painful stiff small joints on hands/feet, worse in morning
Signs - swollen MCP, PIP, wrist, MTP joints, ulnar deviation of fingers, dorsal wrist subluxation, boutonnière/swan neck deformity of fingers, Z deformity of thumbs
Management - DAS28, DMARDs (methotrexate, sulfasalazine, hydroxychloroquine), biologics (infliximab), steroids for flares, NSAIDS, PT/OT, surgery

46
Q

Describe the presentation, signs and symptoms and management of OA

A

Presentation - female:male 3:1, >50 years old, localised large joint, pain on movement, crepitus, worse at end of day, stiffness after rest <30 mins, heberden’s nodes at DIP, Bouchard’s nodes at PIP, decreased range of movement
Management - exercise, weight loss, paracetamol +/- topical NSAID, codeine/oral NSAID + PPI, topical capsaicin, intraarticular steroid injection, PT/OT (walking aids, hot/cold packs), surgery (replacement)

47
Q

Describe the X-ray changes in RA and OA

A

RA - loss of joint spaces, erosions, soft tissue swelling, soft bones (osteopenia) = LESS
OA - loss of joint spaces, osteophytes, subarticular sclerosis, subchondral cysts = LOSS

48
Q

Describe the presentation, investigations and management of ankylosing spondylitis

A

Presentation - male, young <30, Caucasian, lower back pain, worse at night, spinal morning stiffness relieved by exercise, radiates to hip/buttocks, enthesitis, acute iritis
Investigations - bamboo spine, sacroiliitis, erosions, sclerosis, ankylosis, calcification, modified Schober’s test (<5cm), wall tragus
Management - exercise, physiotherapy, NSAIDs, anti TNF, local steroid injection, bisphosphonates

49
Q

Describe the presentation, investigations and management of psoriatic arthritis

A 
Symmetrical polyarthritis (arthritis mutilans), asymmetrical oligoarthritis (dactylitis, nail changes)
Management - NSAIDs, sulfasalazine, methotrexate, ciclosporin, anti TNF
50
Q

Describe the presentation, investigations and management of reactive arthritis

A

A sterile arthritis precipitated by a distant infection e.g. chlamydia, shigella, salmonella typically affecting lower limb (knee)
*Reiter’s syndrome - can’t see (conjunctivitis), pee (urethritis) or bend the knee (arthritis)
Management - splint, NSAIDs/steroid injection, sulfasalazine, methotrexate

51
Q

What rheumatoid antibodies do seronegative spondyloarthropathies have in common?

A

RhF -ve

HLA B27 +ve

52
Q

Describe the causes, symptoms, diagnosis and treatment of gout

A

Causes - increased uric acid crystals in blood and decreased excretion by kidneys, alcohol, low vit.C, fructose drinks, medication (diuretics, aspirin, chemo), obesity, high BP, diabetes
Symptoms - attack acute,y develops over a few hours, severe pain in one joint (big toe = pedagra), swollen, red, inflamed joint
Diagnosis - -ve birefringence needle shaped under polarised light
Treatment - RICE, NSAID (diclofenac, naproxen), steroid tablet/injection, allopurinol, lifestyle (loss weight, less alcohol, less fructose intake, avoid dehydration)

53
Q

Describe the causes, symptoms, signs and management of SLE

A

Causes - drug induced (isoniazid, procainamide, hydralazine, quinidine, phenytoin), EBV infection
Symptoms - malaise, fatigue, myalgia, fever, weight loss, migraine, alopecia, history of miscarriage, DVT/PE
Signs - lymphadenopathy, nail fold infarcts, reynauds, retinal exudates, mouth ulcers, malar/discoid/photosensitive rash
Management - NSAIDs (ibuprofen, naproxen, diclofenac), hydroxychloroquine, steroids, immunosuppressants (azathioprine, ciclosporin, cyclophosphamide, methotrexate, mycophenolate), belimumab

54
Q

List some important things a patient with SLE should be informed of

A

Increased long term risk of CVD, osteoporosis
Beware of the sun (wear sunblock, long sleeves, hat)
Pregnancy counsel re methotrexate
Counsel re autoimmune conditions
Risk of bladder infertility with cyclophosphamide
Check retinal fields and acuity yearly with hydroxychloroquine

55
Q

List the diagnosis criteria for SLE

A 
A RASH POIN MD (4/11)
Arthralgia
Renal abnormality 
ANA +ve
Serositis
Haematological abnormality
Photosensitivity
Oral Ulcers
Immunological abnormality
Neurological abnormality
Malar rash
Discoid rash
56
Q

Describe the presentation and management of Sjögren’s syndrome

A

Female:male 9:1, 40-50 years old
Dry eyes and mouth, vaginal dryness
Lymph enlargement, parotitis, increased risk of lymphoma
Investigations - schirmer’s test, ANA/ENA, gammaglobulinaemia, RhF +ve
Treatment - NSAIDs/hydroxychloroquine, artificial tears

57
Q

Describe the presentation of Behçet’s disease

A

HLA B5
Mediterranean (Turkish) male
Recurrent oral/genital ulceration, uveitis, erythema nodosum, arthritis
Diagnosis - pathergy test, needle prick = papules (48h)

58
Q

Describe the presentation and monitoring necessary for systemic sclerosis (Scleroderma)

A

CREST - calcinosis, raynaud’s, oesophageal/but dysmotility, sclerodactyly, telangiectasia
Monitor BP, renal function

59
Q

Describe the presentation of polymyositis and dermatomyositis

A 
Progressive symmetrical proximal muscle weakness, striated muscle inflammation, myalgia/arthralgia, paraneoplastic syndrome (lung, pancreas, ovarian, bowel)
Macular rash (shawl sign), heliotrope rash, nail fold erythema, gottron's papules 
*beware malignancy (ovary, myeloma, prostate, bowel)
60
Q

What is vasculitis?

A

Inflammatory disorder of blood vessel walls
Large - giant cell arthritis
Medium - polyarteritis nodosa
Small - wegeners granulomatosis aka granulomatosis with polyangiitis

61
Q

Describe the features and treatment of giant cell arthritis and polymyalgia rheumatica

A

GCA - elderly, white, male, acute onset, headache, scalp tenderness, morning stiffness (of shoulders), jaw claudication, amaurosis fugax, sudden blindness
Temporal artery biopsy
Treatment - steroid (60mg if visual loss, 40mg if no visual loss)
PMR - no muscle involvement, very quick response to 15mg steroid (1 week)

62
Q

Describe the features and treatment of Wegener’s granulomatosis

A

Necrotising granulomatous inflammation and vasculitis of small and medium vessels
ENT (saddle nose deformity), Resp (fluffy infiltrates), urinary (protein, blood +ve)
Treatment - steroids, cyclophosphamide/rituximab, azathioprine/methotrexate, co-trimoxazole prophylaxis against pneumocystis jiroveci, staph infections

63
Q

Why is antiTNF given parenterally?

A

Degrades in stomach

64
Q

How should bisphosphonates be taken?

A

Taken while standing >30 mins

Beware oesophagitis

65
Q

What monitoring and caution in necessary with azathioprine

A

Measure TPMT

DDI with allopurinol

66
Q

What should a patient be counselled anout when taking cyclophosphamide?

A

May cause infertility
Haemorrhagic cystitis
Bladder cancer

67
Q

List some indications for an AXR

A 
Suspected bowel obstruction
Suspected perforation (+erect CXR)
Moderate to severe undifferentiated abdo pain 
Suspected foreign body 
Renal tract calculi follow up
68
Q

What is Rigler’s sign?

A

Gas on both sides of the bowel wall

69
Q

What is a bowel sentinel loop?

A

Single dilated loop due to localised ileus from nearby inflammation causing local paralysis and accumulation of gas in the intestinal loop

70
Q

What is Rigler’s triad?

A

Pneumobilia + SBO + gallstone RIF

71
Q

What are the features of toxic megacolon on AXR?

A 
Lower bowel dilatation >6cm (usually transverse)
Inflammatory pseudopolyps (mucosal islands)
Thumbprinting and mucosal oedema
72
Q

List the likely conditions for different autoimmune antibodies

A 
RhF
ANA/ENA - SLE, sjogren's, polymyositis
ANCA - vasculitis (system involvement) 
anti CCP - RA
HLA B27 - seronegative spondyloarthropathies 
HLA B5 - behçet's
73
Q

List some causes of osteoporosis

A 
Increased age
Menopause
Low vitamin D
Hypogonadism
Liver/kidney failure
74
Q

What is the Child-Pugh score used to determine?

A

Grading of cirrhosis and risk of variceal bleeding (>8)
Grade A = 5-6, grade B = 7-9, grade C >10
Can predict mortality and quantify need to liver transplantation
Bilirubin, albumin, PT time (s>normal), ascites, encephalopathy

75
Q

What monitoring and caution is necessary with methotrexate

A

Once weekly dosing
Regular FBC monitoring
Importance of contraception/birth control (teratogenic)
CI - trimethoprim, aspirin/warfarin
ADR - nausea, convert to parenteral preparation, pneumonitis, oral ulcers, hepatotoxicity

Phase 2 (11 decks)

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