GP Flashcards

Question

DDx Bladder cancer

Answer 1

Haemorrhagic cystitis Renal cancer UTI Urethral Trauma

Answer 2

Cystoscopy and biopsy - **GS!!** CT urogram - staging, also GS!! Urine dipstick and microscopy Urinary tumour markers CT/MRI pelvis

Answer 3

Non-muscle invading (Ta or T1) : > **Trans-urethral resection of bladder (TURB)** - must include some muscle to stage > Mitomycin (chemo) - to reduce recurrence > BCG Muscle invasion (T2 - T3) : > **Radical cystectomy** - GS! post op chemo = M-VAC (methotrexate, vinblastine, adriamycin, cisplatin) > Radical radiotherapy +/- chemo - if not fit for surgery T4 - palliative chemo and radiotherapy

Answer 4

Bladder tumour

Answer 5

Simple - MC, benign Polycystic - multiple cysts Hydronephrosis - when ureter is blocked, kidneys dilate and get bigger Dysplasia - not formed properly Medullary sponge - dilation of collecting ducts Acquired cystic disease - 2 types : medullary uraemic and dialysis cystic -- go look at a diagram

Answer 6

Mostly inherited Genetic disorder in which kidney is covered w cysts (sacs of fluid)

Answer 7

1. Autosomal dominant PKD 2. Autosomal recessive PKD

Answer 8

ADPKD = adult ARPKD = infancy or before birth

Answer 9

Found incidentally on US exam Often asymptomatic (but can present!)

Answer 10

Simple - develop over time Acquired - CKD Drugs - lithium! Genetics Syndromic - Tuberous sclerosis

Answer 11

To treat depression

Answer 12

If one parent = 50% of transmission If both parents = 50% of being affected, 25% normal, 25% homozygous but these babies will die in womb

Answer 13

20 years onwards

Answer 14

Mutation in PKD1 gene (85%) on chromosome **16** - more severe, earlier onset Mutation in PKD2 gene (15%) on chromosome **4**

Answer 15

Acute loin pain! - cyst haemorrhage or infection, or urinary tract stone formation Abdo discomfort - renal enlargement Nocturia Haematuria Renal colic - bc clots HTN Bilateral kidney enlargement UTI - pyelonephritis **Extra-renal manifestations!** Sub-arachnoid haemorrhage Liver cysts Mitral valve prolapse

Answer 16

Sodium Valproate Unless female 15-45 years - Lamotrogine

Answer 17

Carbamazepine

Answer 18

Combined contraceptive pill Induces CYP450 ∴ faster metabolism ∴ advised to use other forms of contraception

Answer 19

YES Epilepsy damage is greater then potential foetal risk To compensate, high dose folate supplements

Answer 20

Weight gain Hair loss Liver failure

Answer 21

Maculopapular rash Blurred vision Vomiting

Answer 22

Leukopenia, Thrombocytopenia Hyponatraemia Hepatic impairment Diplopia Rash Impaired balance Drowsiness

Answer 23

EPILEPTIC : Tongue biting Head turning Muscle pain Incontinence Cyanosis Post-ictal syndrome NON-EPILEPTIC : Situational Longer duration Mouth/eyes closed during tonic-clonic movement Pelvis thrusting Ictal crying +/- speaking

Answer 24

Inhibits COX-1 (normal cells) AND COX-2 (inflamm cells)

Answer 25

Recurrent GI bleeds Active ulceration Previous NSAID-induced ulceration Severe HF Aspirin allergy Renal failure

Answer 26

CVD Cerebrovascular disease Elderly Crohn's + UC Impaired renal function Asthma Allergy Hx

Answer 27

Depend on ratio of COX-1 : COX-2 inhibition Causes BRONCHOCONSTRICTION in 8-20% - ∴ maybe fatal in asthmatics Could cause acute interstitial nephritis after many months of use

Answer 28

NON-OPIOIDS e.g. NSAIDs or paracetamol +/- adjuvants

Answer 29

WEAK OPIOIDS e.g codeine, dihydrocodeine, tramadol +/- adjuvants

Answer 30

STRONG OPIOIDS e.g. morphine, oxycodone, methadone, fentanyl AND non-opioids +/- adjuvants

Answer 31

1. Oral meds whenever possible 2. Taken at regular intervals w/ dose and duration matching Px pain 3. Pain should be judged by patient, not clinician 4. Start at lowest dose/duration and adapt 5. Consistently administer for effective pain management