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Danny's Phase 3A Medicine > GP > Flashcards

GP Flashcards

1
Q

AF

Presentation?

types?

A

Dyspnoea
IRREGULARLY IRREGULAR PULSE
Chest pain
Palpitations

Permanent- Cardioversion ineffective
Persistent - >7 days
Paroxysmal - <7 days

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2
Q

AF

Investigations?

management?

A

ECG

1) Rate and rhythm control
2) Reduce stroke risk

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3
Q

AF

Ways of controlling rhythm/rate?

A

Rhythm- Cardioversion

Rate- BB, Diltiazem (CCB), Digoxin

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4
Q

AF

What is the risk of Cardioversion?

A

Increased risk of embolism,

Only attempt if there is symptoms for over 48 hours of symptoms and long period of anticoags

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5
Q

AF

How to measure Stroke risk for patients with AF?

A

CHA2DS2VASc

CCF - 1

HTN - 1

Age 75 - 2

Diabetes- 1

Stroke or TIA previously - 2

Vascular disease - 1

Age 65-74= 1

Sc- Sex- Female - 1

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6
Q

AF

Types of Cardioversion?

A

Electrical DC

Pharmacological- Amiodarone, Flecanide

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7
Q

Tx for AF post CVA?

A

Warfarin

Thrombin or Factor 10A inhibitor

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8
Q

HYPERTENSION

What is it?

A

Clinical reading persistently 140/90

24hr > 135/85

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9
Q

HYPERTENSION

How to assess for end organ damage?

A

Fundoscopy- Hypertensive retinopathy

ECG - LVH or IHD

Urine dip - Renal disease

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10
Q

Side effects of ACEi?

A

Cough
Angioedema
Hyperkalaemia

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11
Q

Side effects of CCB?

A

ankle swelling
headache
flushing

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12
Q

Side effects of thiazide diuretics?

A

Hyponatraemia
Hypokalaemia
Dehydration

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13
Q

Side effects of ARB?

A

hyperkalaemia

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14
Q

HYPERTENSION

Stages of HTN?

A

1 =
clinical- >140/90
ABPM - >135/85

2=
clinical- >160/100
ABPM - >150/95

3 =
clinical- >180/110

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15
Q

HYPERTENSION

How to do ABPM?

A

2 per hour during usual waking hours

Average at least 14 readings a day

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16
Q

HYPERTENSION

How to do HBPM?

A

Two consecutive measurements 1 minute apart

Patient seated

Twice a day (morning and evening)

for at least 4 days (prefer 7)

DO NOT INCLUDE 1ST DAY MEASUREMENTS (INACCURACY)

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17
Q

HYPERTENSION

What to do if patient reaches stage 4 of management

A

Resistant HTN:

Confirm elevated BP

Assess for postural Hypotension

Discuss Adherence

Potassium <4.5 add low dose spironolactone

Potassium >4.5 add AB or BB

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18
Q

Causes of paediatric HTN?

A

80% renal parenchymal disease

CoA
renal vascular disease

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19
Q

Secondary causes of HTN?

A

5-10% primary hyperaldosteronism

Renal disease

  • Glomerulonephritis
  • Pyelonephritis
  • Adult PKD
  • Renal artery stenosis

Endocrine

  • Pheochromocytoma
  • Cushing’s
  • Liddle’s
  • Congenital adrenal hyperplasia
  • Acromegaly

Drugs

  • Steroids
  • MAO-I
  • Combined OCP
  • NSAIDs
  • Leflunomide

Pregnancy

CoA

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20
Q

CHEST PAIN

Features of:

Myocardial Infarction?

A

Heavy central chest pain

Radiation to neck or left arm

Sweating

N/V

No pain in elderly or diabetics

CVD risk factors

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21
Q

CHEST PAIN

Features of:

Pneumothorax?

A

History of asthma

Sudden dyspnoea

Pleuritic chest pain

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22
Q

CHEST PAIN

Features of:

PE?

A

Sudden dyspnoea

Pleuritic chest pain

Calf pain/swelling

Combined OCP

Malignancy

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23
Q

CHEST PAIN

Features of:

Pericarditis?

A

Sharp pain

RELIEVED BY SITTING FORWARDS

Pleuritic chest pain

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24
Q

CHEST PAIN

Features of:

MSK?

A

Worse on movement

Worse on palpation

Precipitated by trauma or cough

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25
Q

CHEST PAIN

Features of:

GORD?

A

Burning retrosternal pain

Regurgitation

Dysphagia

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26
Q

CHEST PAIN

Features of:

Shingles?

A

Pain precedes rash

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27
Q

CHEST PAIN

Features of:

Dissecting aortic aneurysm?

A

Tearing chest pain

Radiation to the back

Unequal upper limb BP

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28
Q

Typical presentation of aortic dissection and how is it diagnosed?

A

Male 50-70 tearing intrascapular pain

Diagnosed by: Widened mediastinum, CT angiography

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29
Q

PE

Presentation?

A 
Haemoptysis 
Previous DVT
SOB
Chest pain sudden onset
Hypoxia
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30
Q

PE

Diagnosis?

A

CT pulmonary angiography

ECG:

1) S waves in Lead I
2) Q waves in lead III
3) Inverted T wave in lead III

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31
Q

How can be pathological Q waves be identified?

A

Pathological Q waves occur if they are 25% or more of the height of the partner R wave and/or they are greater than 0.04 seconds in width

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32
Q

PE

Management?

A

Anticoags

Thrombolysis

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33
Q

Typical MI presentation?

A

Px- Crushing chest pain radiating to arm/neck, Dyspnoea

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34
Q

MI Diagnosis?

A

Dx- ECG (NSTEMI/STEMI), Tall t waves, LBBB

Raised troponin/ creatine kinase

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35
Q

MI Management?

A

1) PCl in under 120 mins and Thrombolysis
2) Start GPIIb/IIIa antagonist (abciximab)

Long-Term: statin, aspirin, clopidogrel, B blocker, ACE-I, (for 12 months)

CABG/ Coronary Angioplasty

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36
Q

Immediate tx of suspected ACS?

A

GTN
Aspirin
O2 if sats <94
ECG ASAP

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37
Q

Referral Guidance for chest pain:

A
  • Chest pain current or within 12 hours + abnormal ECG = EMERGENCY ADMISSION
  • Chest pain 12-72 hours ago = REFERRAL FOR SAME DAY ASSESSMENT
  • Chest pain > 72 hours ago = FULL ASSESSMENT, ECG + TROPONIN
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38
Q

Pathophysiology of ACS?

A

1) Endothelial damage (smoking, HTN)
2) Endothelial inflammation (macrophages, lymphocytes, phagocytes)
3) Foam cells produced
4) death of cells = further inflammation and smooth muscle proliferation (fatty plaque)
5) Formation of fibrous capsule over fatty plaque
6) reduced O2 and blood flow
7) Rupture of capsule = complete occlusion

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39
Q

ACS

STEMI ECG changes?

A

ST ELEVATION
▪ II, III, aVF = RIGHT CORONARY
▪ V1-V4 = LAD
▪ I, V5-V6 = LEFT CIRCUMFLEX

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40
Q

ACS Management?

A 
M- Morphine
O- Oxygen
N- Nitrate
A- Aspirin
T- Clopidogrel/ Ticragelor (second antiplatelet for STEMI)
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41
Q

Secondary prevention of NSTEMI/STEMI?

A 
Aspirin 
ACE-I
Beta Blocker
Clopidogrel (2nd antiplatelet)
Statin
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42
Q

Cause of hyperglycaemia in

T1DM?

T2DM?

A

T1DM- AI disorder, insulin producing B-cells in Islets of Langerhan are destroyed- Absolute Insulin Deficiency

T2DM- Insulin resistance/deficiency due to XS adipose tissue

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43
Q

DM symptoms?

A

Polydipsia
Polyuria
Weight loss

DKA:
Abdo pain
vomiting
Reduced LOC

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44
Q

DM investigations?

A
  1. Finger-prick
  2. BM – Fasting or non-fasting
  3. HbA1c – Average BM over 2-3 months
  4. Glucose tolerance test
    a. Fasting BM
    b. 75g glucose
    c. Second BM 2 hours later
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45
Q

DM diagnostic criteria?

A
  1. Symptomatic…
    a. Fasting BM > 7.0
    b. Random or post GTT BM > 11.1
  2. Asymptomatic…
    a. Same as above on TWO SEPARATE OCCASIONS
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46
Q

Management of:

T1?

T2?

A
  • TYPE 1
    o Supplementary insulin to control BM
  • TYPE 2
    o FIRST LINE METFORMIN

o SECOND LINE…
▪ SULFONYLUREAS
▪ GLIPTINS
▪ PIOGLITAZONE

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47
Q

Dx of TB?

A

Ziehl- Neelsen Stain on Lowenstein Jensen medium

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48
Q

Screening of TB?

A

MANTOUX TEST - Screens for latent TB
o Inject 0.1ml of 1:1000 purified protein derivative intradermally
o Read result 2-3 days later
o < 6mm – Negative – No hypersensitivity – Give BCG
o 6-15mm – Positive – Hypersensitive – Do not give BCG
▪ May be due to TB infection or BCG
o > 15mm – Strongly positive – Strongly hypersensitive – TB infection

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49
Q

Management of active TB?

A 
- INITIAL PHASE - FIRST 2 MONTHS = RIPE
o RIFAMPICIN
o ISONIAZID
o PYYRAZINAMIDE
o ETHAMBUTOL
  • CONTINUATION PHASE – NEXT 4 MONTHS = RI
    o RIFAMPICIN
    o ISONIAZID
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50
Q

management of latent TB?

A
  • 3 MONTHS ISONIAZID + PYRIDOXINE + RIFAMPICIN

- 6 MONTHS ISONIAZID + PYRIDOXINE

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51
Q

Side effects of Rifampicin?

A

Hepatitis
orange secretions
flu-like symptoms

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52
Q

Side effects of isoniazid?

A

Hepatitis

Agranulocytosis

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53
Q

Side effects of Pyrazinamide?

A

Hyperuricaemia – GOUT

Arthralgia
Myalgia
Hepatitis

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54
Q

Side effects of Ethambutol?

A

Optic Neuritis- check acuity

Adjust dose in renal impairment

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55
Q

What is the BCG vaccine?

A
  • Limited protection against TB

- Protects against leprosy

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56
Q

Who is the BCG vaccine for?

A
  • At-risk groups…
    o Children in areas where TB incidence > 40/100000
    o Children with a parent/grandparent born in a country where TB > 40/100000
    o Unvaccinated contacts of respiratory TB patients
    o Healthcare workers
    o Prison staff
    o Care home staff
    o Those who work with the homeless
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57
Q

Contraindications of BCG vaccine

A
  • Previous BCG vaccination
  • PMH of TB
  • HIV
  • Pregnancy
  • Positive tuberculin test
  • NO EVIDENCE FOR EFFICACY >35
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58
Q

CROHNS VS UC

Features?

A

Crohns-

  • Non bloody diarrhoea
  • weight loss
  • upper GI symptoms
  • mouth ulcers
  • perianal disease
  • RIF mass

UC

  • bloody diarrhoea
  • LIF mass
  • tenesmus
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59
Q

CROHNS VS UC

Extra-intestinal symptoms and complications?

A

Crohns-

Gallstones (reduced bile reabsorption)
obstruction, fistula, CR cancer

UC-

PSC
increased risk of CR cancer

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60
Q

CROHNS VS UC

Pathology?

A

Crohns-

Skip lesions and mouth to anus

UC-

Inflammation rectum to IC valve

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61
Q

CROHNS VS UC

Histology?

A

Crohns-

transmural, increased goblet cells, granulomas

UC-

submucosa only
inflammatory cells in lamina propria
crypt abscesses 
goblet cell depletion
infrequent granulomas
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62
Q

CROHNS VS UC

Endoscopy?

A

Crohns-

deep ulcers
skip lesions
cobble stone

UC-

widespread ulceration
adjacent mucosa preserved
Pseudopolyps

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63
Q

CROHNS VS UC

Radiology?

A

Crohns-

Small bowel enema
High sensitivity and
specificity
Kantor’s string sign
Proximal bowel dilation
ROSE THORN ULCERS
Fistulae

UC-

Barium enema
LOSS OF HAUSTRATIONS
SUPERFICIAL ULCERATION
PSEUDOPOLYPS
Colon narrow and short –
‘Drainpipe colon’
64
Q

Ix of Crohns?

A
  • Inflammatory markers – CRP
  • FAECAL CALPROTECTIN
  • Anaemia
  • B12 and folate
65
Q

Extra-intestinal features of Crohns?

A 
o ARTHRITIS
o Erythema nodosum
o Episcleritis
o Osteoporosis
o Uveitis
o Pyoderma gangrenosum
o CLUBBING
o Primary sclerosing cholangitis
66
Q

Management of Crohns?

A

Inducing remission

  • FIRST LINE = PREDNISONE
  • SECOND LINE = MESALAZINE
  • Add on – AZATHIOPRINE
  • Refractory disease – INFLIXIMAB
  • Peri-anal disease – METRONIDAZOLE

Maintaining remission

  • FIRST LINE = AZATHIOPRINE
  • SECOND LINE = METHOTREXATE
  • Previous surgery = MESALAZINE
67
Q

extra intestinal features of UC?

A 
o ARTHRITIS
o Erythema nodosum
o Episcleritis
o Osteoporosis
o Uveitis
o Pyoderma gangrenosum
o CLUBBING
o PRIMARY SCLEROSING CHOLANGITIS
68
Q

management of UC?

A
  • TOPICAL AMINOSALICYLATE – MESALAZINE
  • 4 weeks – ADD ORAL AMINOSALICYLATE
  • No remission – TOPICAL OR ORAL CORTICOSTEROID
  • Maintenance – TOPICAL AMINOSALICYLATE AND ORAL AMINOSALICYLATE
69
Q

COELIAC

Presentation?

A
  • Chronic or intermittent diarrhoea
  • Failure to thrive
  • Persistent unexplained GI symptoms
  • N/V
  • Fatigue
  • Abdo pain
  • Weight loss
  • Iron-deficiency anaemia
  • FHx
70
Q

COELIAC

Immunology?

A
  • TTG IgA – TISSUE TRANSGLUTAMINASE ANTIBODIES

- Endomysial IgA

71
Q

COELIAC

What will the duodenal biopsy show?

A
  • Villous atrophy
  • Crypt hyperplasia
  • Intraepithelial lymphocytes
  • Lamina propria infiltration
72
Q

COELIAC

Associated conditions?

A

IBS
Dermatitis herpetiformis
DMT1
AI Thyroid Disease

73
Q

COELIAC

Management and complications?

A

Management : Gluten free diet

Complications:
- ANAEMIA
o Iron
o Folate
o B12
- Hyposplenism
- Osteoporosis / osteomalacia
- LACTOSE INTOLERANCE
- Subfertility
74
Q

HAEMATURIA

Causes of transient non visible haematuria?

A
  • UTI
  • Menstruation
  • Vigorous exercise
  • Sexual intercourse
75
Q

HAEMATURIA

Causes of persistent non visible haematuria?

A
  • Cancer
  • Stones
  • BPH
  • Prostatitis
  • Urethritis
  • Renal – IgA nephropathy
76
Q

HAEMATURIA

cause of Red/orange urine – but blood NOT PRESENT ON DIPSTICK

A
  • Beetroot
  • Rhubarb
  • RIFAMPICIN
  • DOXORUBICIN
77
Q

HAEMATURIA

Tests?

A
  • URINE DIP
  • Persistent = 2/3 samples 2 weeks apart
  • Renal function
  • Albumin:creatinine ratio – ACR
  • Protein:creatinine ratio – PCR
  • Urine microscopy
78
Q

HAEMATURIA

When should you urgently refer?

A 
> 45 YEARS AND…
o Unexplained visible haematuria
o Visible haematuria persisting after UTI management
> 60 YEARS AND…
o Unexplained non-visible haematuria
o Dysuria
o ^^ WCC
79
Q

HAEMATURIA

Give examples of causes due to trauma, infection or malignancy?

A 
Trauma:
Direct injury to renal tract
Renal trauma due to blunt injury
Ureter trauma – iatrogenic???
Bladder trauma – RTA or pelvic fracture

Infection:
TB

Malignancy:
Renal cell carcinoma
Urothelial malignancies – 90% TCC
Squamous cell carcinoma
Adenocarcinoma
Prostate cancer
Penile cancers
80
Q

HAEMATURIA

iatrogenic causes?

A

Catheterisation

Radiotherapy

81
Q

HAEMATURIA

Causes due to renal disease, stones or structural abnormalities?

A

Renal disease:
Glomerulonephritis

Stones:
Microscopic haematuria

Structural abnormalities:
BPH – Hypervascularity of prostate
Cystic renal lesions – PKD
Vascular malformations
Renal vein thrombosis due to RCC
82
Q

HAEMATURIA

What drugs can cause this?

A 
Aminoglycosides
Chemotherapy
Penicillin
Sulphonamides
NSAIDs
Anticoagulants
83
Q

HEART FAILURE

Presentation?

A
  • Dyspnoea
  • Cough – PINK FROTHY SPUTUM
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • WHEEZE
  • Weight loss
  • BIBASAL CRACKLES
  • Right sided…
    o Raised JVP
    o Ankle oedema
    o Hepatomegaly
84
Q

HEART FAILURE

What BNP ranges indicate referral?

A 
>400 = high urgent 2 referral 
100-400 = 6 week referral 
<100 = normal
85
Q

HEART FAILURE

Causes of increased BNP?

A 
LVH
Ischaemia
Tachycardia
RV overload
Hypoxaemia – PE
GFR < 60
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
86
Q

HEART FAILURE

Causes of decreased BNP?

A 
Obesity
DIURETICS
ACE-I
BB
A2RB
ALDOSTERONE ANTAGONISTS
87
Q

HEART FAILURE

Management?

A
  1. ACE-I + BB
  2. ALDOSTERONE ANTAGONIST (spironolactone)
  3. DIGOXIN
88
Q

HEART FAILURE

What does ABCDE stand for in treatment of HF?

A

Antiplatelet therapy (ACE-I, aldosterone antagonists)
BP control (Beta blockers)
Cholesterol lowering therapy (statins), cigarette cessation
Diet and diabetes prevention/ treatment, digoxin
Exercise and weight management

89
Q

What is the cycle of the production of Thyroxine from the thyroid gland?

A

1) Hypothalamus secretes thyrotropin- releasing hormone (TRH)
2) Anterior pituitary secretes thyroid-stimulating hormone (TSH)
3) Thyroid releases T3 and T4

90
Q

Most common cause of Hypothyroid?

A

Hashimoto’s Thyroiditis

Autoimmune

Iodine deficiency

Drugs (Lithium/ Amiodarone)

91
Q

Most common cause of Thyrotoxicosis?

A

Graves Disease

Thyroid Eye Disease

Amiodarone

92
Q

Compare Hypothyroid features to Hyperthyroid features

(Hyperthyroid)

General 
Cardiac
Skin
GI
Gynae
Neuro
A

General: Weight loss, manic restlessness, heat intolerance

Cardiac: Palpitations

Skin: Increased sweating, pretibial myxoedema, lesions above lateral malleoli, thyroid acropachy, clubbing

GI: Diarrhoea

Gynae: Oligomenorrhoea

Neuro: Anxiety, tremor

93
Q

Compare Hypothyroid features to Hyperthyroid features

(Hypothyroid)

General 
Cardiac
Skin
GI
Gynae
Neuro
A

General: Weight gain, lethargy, cold intolerance

Cardiac:

Skin: Dry, cold, yellow skin, non pitting oedema, dry coarse scalp hair, loss of eyebrows

GI: Constipation

Gynae: menorrhagia

Neuro: Decreased deep tendon reflexes

94
Q

What antibodies can be found in:

Hashimoto’s?

Grave’s?

A

Hashimoto’s - Anti-TPO

Grave’s- TSH receptor

95
Q

Management of Hypo/hyperthyroid?

A

Hypo- Levothyroxine

Hyper-

Propanolol (control symptoms),

Carbimazole (reduces thyroid production)
May cause agranulocytosis (acute&severely low neutrophils)

Radioiodine

96
Q

CKD

What are the eGFR variables and what factors can affect the eGFR?

A

eGFR VARIABLES

  • Serum creatinine
  • Age
  • Gender
  • Ethnicity

Factors affecting eGFR

  • Pregnancy
  • Muscle mass
  • Red meat
97
Q

CKD

Causes?

A
  • Diabetic nephropathy
  • Chronic glomerulonephritis
  • Chronic pyelonephritis
  • HTN
  • Adult PKD
98
Q

CKD

Methods of renal replacement therapy?

A

haemodialysis

Peritoneal dialysis

Renal transplant

99
Q

CKD

Symptoms of inadequate management?

A
  • Breathlessness
  • Fatigue
  • Insomnia
  • Pruritus
  • Poor appetite
  • Swelling
  • Weakness
  • Weight gain/loss
  • Abdominal cramps
  • Nausea
  • Muscle cramps
  • Headaches
  • Cognitive impairment
  • Anxiety
  • Depression
  • Sexual dysfunction
100
Q

IDA

Causes?

A
  • Excessive bleeding
    (menorrhagia. GI bleed)
  • Poor dietary intake
  • Malabsorption
  • Increased requirements (growth spurts, pregnancy)
101
Q

IDA

Presentation?

A
  • Fatigue
  • SOBOE
  • Palpitations
  • Pallor
  • Nail changes
  • Hair loss
  • Atrophic glossitis
  • Post-cricoid webs
  • Angular stomatitis
102
Q

IDA

Investigations?

A 
- HISTORY
o Dietary changes
o Medication
o Menstruation
o Weight loss
o Bowel habits
  • FBC – HYPOCHROMIC MICROCYTIC ANAEMIA
  • Serum ferritin – May be raised during inflammation
  • ^^^ Total iron-binding capacity
  • Endoscopy to rule out malignancy
103
Q

IDA

Management?

A
  • TREAT UNDERLYING CAUSE
  • ORAL FERROUS SULPHATE
    o May cause N/D/V, abdo pain, constipation
  • Iron rich diet
    o Meat and dark green vegetables
104
Q

VTE

Risk factors?

A
  • Medical patients – Significant reduction in mobility > 3 days
  • Surgical/trauma patients
    o Hip/knee replacement
    o Hip fracture
    o GA or surgery > 90 minutes
    o Pelvic or lower-limb surgery under GA >60 minutes
    o Acute surgical admission with inflammatory or intra-abdominal condition
    o Surgery which leads to reduced mobility
- General
o Active cancer/chemotherapy
o Aged > 60
o Known clotting disorder
o BMI > 35
o Dehydration
o 1+ significant comorbidities
o Critical care admission
o HRT
o OCP
o Varicose veins
o Pregnant or < 6 weeks post-partum
105
Q

Pharmacological prophylaxis of VTE?

A
  • FONDAPARINUX SODIUM – Subcutaneous
  • LMWH – ENOXAPARIN
  • UNFRACTIONATED HEPARIN – with CKD
106
Q

List the clinical features compromising the Well’s Score

A
  • Previous DVT
  • Active cancer
  • Paralysis/ immobilisation
  • Bedridden (surgery)
  • tenderness
  • leg swelling
  • unilateral calf swelling 3cm more
  • pitting oedema
  • collateral superficial veins
107
Q

What investigations are done if the Wells score is:

2 or more

1 or less

A

> 2 = USS within 4 hours + D-Dimer

<1 = D-dimer (if positive do USS within 4 hours)

108
Q

What should be given if the USS is delayed when diagnosing a VTE?

A

LMWH

109
Q

Management of a VTE?

A
  • LMWH
    o 5 days OR INR >2.0 for 24h
    o 6 months if active cancer
  • FONDAPARINUX
  • WARFARIN
    o 3 months then reassess
    o 6 months if unprovoked
110
Q

If the VTE is unprovoked what should be done?

A

Test for Malignancy:

CXR
Bloods (FBC,Ca,LFTs)
Urinalysis
Abdo CT or mammogram if >40

111
Q

PE

Presentation?

A
  • Pleuritic chest pain
  • Dyspnoea
  • Haemoptysis
  • Tachycardia – 44%
  • Tachypnoea – 96%
  • Crackles – 58%
  • Fever – 43%
112
Q

PE

Investigations?

A
  • PE likely…
    o CPTA
    ▪ LMWH if delayed
  • PE unlikely
    o D-DIMER
    ▪ Positive – CPTA
    ● LMWH if delayed
  • RENAL IMPAIRMENT = V/Q scan
113
Q

PE

Signs on ECG?

A

SINUS TACHYCARDIA

(rare)
S1 Q3 T3

Large S in lead I
Large Q in lead III
Inverted T in lead III

114
Q

What may affect a V/Q scan?

A

o Previous PE
o AV malformations
o Vasculitis
o Radiotherapy

115
Q

PE

Management?

A
  1. WARFARIN within 24h
    Continue for 3 months
    Continue for 6 months if unprovoked
  2. LMWH for 5 days OR INR > 2.0
    Continue for 6 months if active cancer
  3. THROMBOLYSIS IF CIRCULATORY FAILURE
116
Q

HODGKIN’S LYMPHOMA

Lab signs?

A

Lymphocyte proliferation

Reed-Sternberg cells

117
Q

HODGKIN’S LYMPHOMA

Presentation?

A

30s and 70s

  • Lymphadenopathy – 75%
    o Painless
    o Non-tender
    o Asymmetrical
- Systemic – 25%
o Weight loss
o Pruritus
o Night sweats
o Fever
- Alcohol induced node pain
- Normocytic anaemia – Eosinophilia
- LDH raised
118
Q

Name the types of Hodgkins Lymphoma

Rank their prognosis

State the percentage of frequency

A

Nodular Sclerosing- 70% - Good prognosis (mainly seen in women- lacunar cells)

Mixed Cellularity- 20%- Good prognosis (Reed-Sternberg cells)

Lymphocyte predominant- 5%- Best prognosis

Lymphocyte depleted- rare- worst prognosis

119
Q

LYMPHOMA

What features may suggest a poor prognosis?

A

B-symptoms

  • Weight loss >10%
  • Fever >38
  • Night sweats

Poorer:

  • Age > 45
  • Stage 4
  • Haemoglobin < 10.5
  • Lymphocytes < 600 or 8%
  • Male
  • Albumin
  • WCC > 15000
120
Q

What is Non-Hodgkin’s Lymphoma?

A

Malignant proliferation of lymphocytes

more common than Hodgkin’s

121
Q

NON-HODGKIN’S LYMPHOMA

Risk factors?

A
  • Elderly
  • Caucasians
  • History of viral infection
  • FHx
  • Chemical agents
  • Past chemo or radiotherapy
  • Immunodeficiency
  • AI disease
122
Q

NON-HODGKIN’S LYMPHOMA

Symptoms?

A
  • Painless lymphadenopathy
    o Non-tender
    o Rubbery
    o Asymmetrical
- Constitutional symptoms
o Fever
o Weight loss
o Night sweats
o Lethargy
- Extranodal disease
o Gastric
▪ Dyspepsia
▪ Dysphagia
▪ Weight loss
▪ Abdo pain

o Bone marrow
▪ Pancytopenia
▪ Bone pain

123
Q

NON-HODGKIN’S LYMPHOMA

Signs?

A
  • Weight loss
  • Lymphadenopathy – Cervical, axillary, inguinal
  • Palpable abdo mass – Hepatomegaly, splenomegaly, lymph nodes
  • Testicular mass
  • Fever
124
Q

Difference between Hodgkin’s and Non-Hodgkin’s in terms of:

  • Histology
    B-symptoms
    Extra-nodal disease
A

Hodgkins- Reed-Sternberg cells

B-symptoms-
Hodgkins = Early
Non-Hodgkins = Late

Extra-nodal disease-
Hodgkins = Less common
Non-Hodgkins = More common

125
Q

LYMPHOMA

Investigations?

A 
Investigations
- EXCISIONAL NODE BIOPSY
o Burkitt’s = Starry sky
- STAGING CT
- HIV test – RF for non-Hodgkin’s
- FBC
- ESR
- LDH
126
Q

LYMPHOMA

Staging?

A

ANN-ARBOR SYSTEM

  1. One node affected
  2. More than one node
    Same side of the diaphragm
  3. One node either side of the diaphragm
  4. Extra-nodal involvement

+ A if no B symptoms
+ B if B symptoms present

127
Q

LYMPHOMA

Management?

A
  • Chemo/radiotherapy
  • Flu/pneumococcal vaccines
  • Abx prophylaxis if neutropenic
128
Q

LYMPHOMA

Complications?

A 
- Bone marrow infiltration
o Anaemia
o Neutropenia
o Thrombocytopenia
- SVC obstruction
- Metastasis
- Spinal cord compression
129
Q

Signs and Symptoms of Tonsillitis?

A

Symptoms

  • Painful throat >48 hours
  • Pain on swallowing
  • Painful ears
  • Abdominal pain in small children
  • Headache
  • Voice changes
Signs
- Red throat
- Tonsils inflamed
- Fever
- Swollen regional lymph glands
- STREP…
o Acute onset
o Headache
o Abdo pain
o Foul smelling breath
130
Q

Signs on Examination of Tonsillitis?

A
  • Erythema of tonsils and pharynx
  • Yellow exudate
  • Tender enlarged anterior cervical glands
131
Q

Signs of Tonsillitis differentials:

Viral
Coxsackie’s
EBV

A

Viral = milder symptoms

Coxsackie’s = Blisters

EBV = unwell, lethargic teenagers

132
Q

What is the Centor Criteria?

A

Cervical lymphodenopathy

Exudate (Tonsillar swelling)

No cough

Temperature (fever)

OR

133
Q

Medication for Tonsillitis?

A
  • Antipyretics – Paracetamol and Ibuprofen
- Abx indications…
o Marked systemic upset
o Unilateral peritonsillitis
o History of rheumatic fever
o ^^^ Infection risk
o CENTOR > 3
134
Q

What is the Antibiotic treatment for Tonsillitis?

A

Phenoxymethylpenicillin
for 5-10 DAYS

  • Clarithromycin or erythromycin are alternatives
135
Q

Criteria for Tonsillitis referral?

A 
Difficulty breathing
Clinical dehydration
Abscess
Systemic illness/ sepsis
Suspected sinister cause
136
Q

When would a Tonsillectomy be considered?

A

After over 7 episodes of Tonsillitis

137
Q

COPD

What is it?

A

Chronic bronchitis + Emphysema

138
Q

COPD

Possible causes?

A
  • Smoking
  • Alpha-1 antitrypsin deficiency
  • Cadmium, coal, cotton, cement, grain
139
Q

COPD

Features?

A

Chronic productive cough with sputum

Dyspnoea

Wheeze

Right HF

140
Q

COPD

Stages?

A

All FEV1/FVC ratio of <0.7

FEV1 (% of predicted)

>80 = Stage 1  
50-79 = Stage 2
30-49 = Stage 3
<30 = Stage 4
141
Q

COPD

Bronchodilator therapy?

A

1st- SABA or SAMA (Salbutamol/ Ipratropium)

2nd- Assess for asthmatic features or steroid responsiveness

No asthmatic features = Add LABA + LAMA
(Salmeterol/ Tiotropium)

Asthmatic features =
Add LABA + ICS (Salmeterol + Beclamethasone)

then add LAMA Tiotropium

142
Q

COPD

Asthmatic features?

A

o PMH or asthma or atopy
o Higher eosinophil count
o Substantial variation in FEV1 (400ml)
o Substantial diurnal variation in PEF (20%)

143
Q

COPD

What is cor pulmonale?

Management?

A
  • Peripheral oedema
  • ^^^ JVP
  • Parasternal heave
  • Loud P2

Management - Loop Diuretic Furosemide
Consider long term O2

144
Q

COPD

Features of an acute exacerbation?

A
  • ^^^ Dyspnoea
  • ^^^ Cough
  • ^^^ Wheeze
  • ^^^ Sputum
  • Hypoxia
  • Confusion
145
Q

COPD

Exacerbation organisms?

A

Haemophilus Influenzae

Strep Pneumoniae

Moraxella Catarrhalis

146
Q

COPD

Management if acute exacerbation?

A

Increase Bronchodilator

Prednisolone for 7-14 days

Oral Abx if purulent sputum or signs of pneumonia

  • Amoxicillin
  • Tetracycline
  • Clarithromycin
147
Q

COPD

When should long term oxygen therapy be offered?

A
  • pO2 < 7.3
  • OR pO2 7.3 – 8 AND…
    o Secondary polycythaemia
    o Peripheral oedema
    o Pulmonary hypertension

Dont offer to continuous smokers

148
Q

GOUT

What is it?

A

Hyperuricaemia and intra articular sodium urate crystals

149
Q

GOUT

Cause of hyperuricaemia?

A

Increased production- psoriasis, genetics, diet (shellfish, red meat, alcohol)

or

Decreased excretion from the kidneys - (CKD, NTN, thiazides, alcohol)

90% IS IDIOPATHIC

150
Q

GOUT

Signs?

A

50% occurs at 1st MTPJ

Acute severe pain with swelling and redness

151
Q

GOUT

Precipitants?

A

Diuretics
Cold
Alcohol

152
Q

GOUT

Investigations?

What do the investigations show?

A
  • Joint aspiration- shows urate crystals in synovial fluid
  • X-ray shows:
    1) Soft tissue swelling
    2) Peri-articular erosions
    3) Norma joint space
153
Q

GOUT

Management?

A
  • NSAIDs, Colchicine, Steroids (prednisolone injection)

- Allopurinol

154
Q

GOUT

Lifestyle Management?

A

Lose weight

stop drinking

avoid meats with high purines (red meat, shellfish)

155
Q

Difference between pseudo-gout and gout?

A

Pseudogout = Positive birefringent
calcium pyrophosphate rhomboid crystals
(chondrocalcinosis typically in the knee treated with corticosteroid injection)

Gout = Negative birefringent urate needle shaped crystals

156
Q

What Drugs can cause Hypothyroidism?

A

Lithium

Amiodarone

Danny's Phase 3A Medicine (10 decks)

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