Guidlines Flashcards

Question

DM1 tx: DIFFICULTY distinguishing DM1 from other types of diabetes. Ix? Recommended HbA1c ? / measure ?m -account for: ? BM measure how often? - before ?/? - ? = b4 meals - ? = @wake - ? = after meals 90mins (? @surg illness) ``` R/V: B? ?mental health issues Cx? Other Ai dx? Stop what? ? @foot exam ``` Insulin ? DM2 + CVD = ?Atorva DM2 - CVD = ?Atorva @: - ? ``` Insulin -m? daily Basal-Bolus -fail-> cont ? @ ? /+ yr -twice daily ? basal -? b4 meals -? @BMI 25/+ __________ ``` Metabolic Syndrome?

Answer 1

DM1 tx: DM1 v OTHERS = C-Peptide ``` Recommended HbA1c 48 / measure 3-6m -account for: Cx/Comorbidities Hypo risk ADLs Occupation ``` BM measure QDS - before meals/bedtime - 4-7 = b4 meals - 5-7 = @wake - 5-9 = after meals 90mins (5-8 @surg illness) ``` R/V: BMI/BM-hba1c Anx/Dep/Eat dx Neuropathy + Micro/MacroVasc dx Thyroid + coeliac/addison/pernicious StopSmoke -10g monofilament + ABPI @footexam ``` ``` Insulin: Mixed B-B daily -fail-> cont SC @ 12/+ y/o Twice daily injections RA b4 meals Metformin @BMI 25/+ ``` ``` DM2 + CVD = 80 Atorva DM2 - CVD = 20 Atorva @: -CVD established -Age >40 -Nephropathy -DM >10yrs ``` ``` Insulin DM1 -multiple daily Basal-Bolus -fail-> cont SC ins @12/+ yr -twice daily Detemir basal -RA analog b4 meals -metformin @BMI 25/+ _____________ ``` ``` WTH-G Waist size high Triglyc high HTN/HDL low Glucose high ```

Answer 2

DM2 tx: Recommended HbA1c targets: / measure 3-6m/6m @stable 1. Lifestyle - d/e = HbA1c target 48 2. HbA1c 48/+ = maintain 48 - Metformin SR/MR @ GI dx - U+E/Titrate up=lower p(GI dx) - GFR <45=lower dose; <30 = stop ``` 3. HbA1c 58/+ = maintain 53: GlipDPP4I Pio SU SGLT2i ``` DM + FAT PEOPLE: - GlipDPP4s - SGLTFlozins ``` 4. HbA1c 58/+ = maintain 53 Glip DPP4i NOT Pio Pio + SU SU + SGLT2i GlipDPP4i + SU Pio + SGLT2i (not dapaglif) GlipDPP4i + SGLT2i = Ertuglif @Pio/SU CI ``` DM + FAT PEOPLE: - GlipDPP4s - SGLTFlozins 5a. HbA1c 58/+ = maintain 53 - Metformin - SU - GLP-1 ag*@: BMI <35 + insulin = work issues/WL benefit obesity cx BMI >35 + obesity cx (med/psych) *Continue GLP-1 ag if: -HbA1c Lower by 11/+ AND -WL 3% BW/ 6m ``` 5b. Insulin: NPH=SA @HbA1c 75/+ Detemir/Glargine Pre-mixed w/ SA analogue ``` ``` DM2 + CVD = 80 Atorva DM2 - CVD = 20 Atorva @ - 84/- + Q10+ - 85/+ __________________ ``` Metformin intolerance? 1. GlipDPP4i/Pio/SU/SGLT2i 2. GlipDPP4i/Pio/SU/SGLT2i = any 2 - SGLT2i > GlipDPP4 @Pio/SU CI ``` 3. Insulin DM2: NPH=SA @HbA1c 75/+ Detemir/Glargine Pre-mixed w/ SA analogue _______ ``` WHAT TO GIVE IN DM+FAT PEOPLE?! -GlipDPP4s -SGLTFlozins #Gliptins/Flozins/Gliptins/Flozins/Gliptins/Flozins/Gliptins/Flozins

Answer 3

GDM - booking appt: - Prev 1. macrosomia 4.5kg /+ 2. GDM -> selfBM/OGTT @booking - -ifNormal--> OGTT @w24-28 -Urine BM ++ / + x2 ``` -BMI >30 + Birth <40+6w recommended + Anesthetic r/v @obesity/auto neuropathy + steds/tocolysis @fetal lung mat -BAME/GDM FDR ``` --> do 2hr-OGTT: FPG 5.6/+ OR OGTT 7.8/+ -GDM ANC + HbA1c <1wk / 1-2wks FPG 6.1-6.9 = 1. Lifestyle d/e -2wk/fail-> 2. Metformin a. --cant tol-> Insulin alone b. --CAN tol but BM control fail-> + Insulin c. -Insulin --can't tol/fail-> Gliben (?discontinued) FPG 7.0/+ // PolyHydramnios/Macrosomia+6.1-6.9 = INSULIN ± Metformin + d/e measure: -Fasting + Post Meal-1hr @DM2/GDM NOTTTTTT@multiple daily injections -Fasting, Pre + Post Meal-1hr, Bedtime @DM1 / DM2/GDM @multiple daily injections ``` cap BM target: -Fasting 5.3, AND -1hr Post Meal 7.8 -2hr Post Meal 6.4 Hba1c 48/+ = HRisk _____________ ``` ``` Pre-Existing DM @preg 1a. Renal Assx: Creat > 120 Urine A:C >30 --> >220 #VTEproph TProt >0.5g/d -> 5g/d #VTEproph ``` 1b. Retinal Assx: 16, 28 digital image w/ mydriasis w/ procainimide @1stANC--DiabRetinopath--> w16-20 --> w28 2. Anomaly scan @w20 + 4-chamber heart view = 28 w28-36 / USS/4wk 3. WL @BMI >28/+ ``` 4. Birth @37 - 38+6w recommended Anaesthetic r/v @obesity/auto neuropath Steds/Tocolysis @fetal-lung-mat -FPG @6w post-natal check (6-13 w PP) ```

Answer 4

Hypovol ) Normal Osmo >320 ) pH+HCO3 >15 BM >30 ) Ketones ``` BP <90 = 500ml NaCl / stat -> - >90 = 1L / 1 2 2 4 4 6hrs = slower @y/o/preg/HF-LF-RF prev c.oed/cerebral pontine mylineolysis - <90 = senior/icu/repeat ``` Insulin 0.05 u/kg/hr @ -Keton uria 2/+ / gen >1 U+E, obs, Fluids-UO EWS, LMWH, ABG, NG @obtunded/vomit, ECG BM FBC, U+E, MCS(blood), ECG MSU Hx = vasc/infection Ex = dehydration FOOT EXAM 1-6hrs = <3L+FB - high Na + osmo: 1. dec by <3/inc = check +FB - legit = 0.45% NaCl - not legit = inc 0.9% rate 2. dec by 3-8 mosmol/kg/hr = 0.9% Nacl 3. dec by >8 = dec 0.9% rate +/- FRIII Na dec by 10mmol/L/d K <3.5 = senior / 3.5-5.3 = 40mmol/L ``` BM dec BY <5/hr -Aim 10-15 -Aim 4-6/hr --> +FB: -legit = FRIII 0.05u/kg/hr -> 0.1 u/kg/hr if already on -not-legit = 0.45% / inc 0.9% rate if osmo dec by <3/inc w/ +FB ``` 6-12hrs = <6L +FB -BM <14 = DexSaline 10%/0.9% @125ml/hr Aim = Avoid Hypo Aim 10-15 in 1st 24-hrs >12hrs: Drink+Eat/Senior if not IV->SC @Resolve/Ready2eat -30min-> stop IV Check K+ high/low / Oed cerebral/pul / BM low FOOT CHECK ______________ ``` Lactic Acid Oed cerebral/pul Stroke-VTE Triglyc Rhabdo RF-AKI ```

Answer 5

DKA: ``` 0-1hrs 1. BP <90 = 500ml NaCl/stat -> - >90 = 1L/1 2 4 4 6 hrs slow @ y/o/preg/ HF LF RF prev c.oedema/CPMyelinolysis ``` - <90 = senior/ICU/repeat K <3.5 = senior K 3.5-5.3 = 40mmol/L -1hr later for kids 2. ACTRAPID 0.1 u/kg/hr = 50u/50ml -FIXED-RATE -IM stat @delay + LONG ACTING continue -stop SA BM FBC U+E MCS (blood) ECG MSU __________ ``` 1-6-hrs: check hourly BM Dec - 3 mmol/L/hr Ketone Dec - 0.5 mmol/L/hr HCO3- Inc - 3 mmol/L/hr _ K <3.5 / >5.3 = check hrly AVOID HYPO ``` U+E, obs, Fluid-UO EWS, LMWH, ABG, NG @obtunded/vomit, ECG -FAIL-> 1. check Pump Connected Working 2. Inc insulin by 1u/hr __________ 12-24hrs: BM <14 = DexSaline 10%/0.9% -Aim=Avoid Hypo + -Aim 10-15 @1st 24hrs ``` --> Cont FRIII till resolve: pH >7.3; HCO3 >15 Ketones <0.6 Drink+Eat/Senior if not #VRIII __________ ``` DKA RESOLUTION: - Drink+Eat/Senior if not #VRIII - IV -> SC @Resolve/Ready2eat -30mins-> Stop IV - Check K+ high/low, Oed cerebral/pul, BM hypo - FOOT EXAM ``` DKA pathphys: Uncontrolled catabolism -> -Lipolysis = high ketones -HyperGlyc = high: serum osmo + osmo diuresis --> dehydration/hypovol ________ ``` Hyperglyc >11 HyperKal > 5.3 --> <3.5 @severe Acidosis met - pH<7.3 --> <7.1 @severe* - HC03 <15 --> <5 @severe* Keton - breath - uria +2 - gen >3 --> >6 @severe* Amylase/Abdo pain Infection ``` *severe: HR >100 / <60 Anion-gap 17/+ SpO2 <92 low GCS 11/- BP <90 ```

Answer 6

What to do if: HypoT AFTER antithyroid drugs? ?reduce doses RAI -6m-> still HyperT = ?suboptimal tx -> AT drugs till 6m appt TSH >20 for 1/+m = ?LTX TSH <0.1 x2/3m = just refer ffs ________ Drug monitoring: TSH/T43 / - 6w --until range--> - 12w till stop --after stop--><8w --> - 12w for 1yr -> annually TSH/T43 / - 6w -6m-> till TSH in range -> - HyperT=?suboptimal tx=ATd till 6m appt - HypoT=?LTx Euthyroid @ -6m = TSH @9m+12m -12m = TSH/6m _________________ HypoT: Dry hair-coarse/skin Menorrhagia HyperT: Pretib myxoed Oligomenorrhoea Lat malleoli oed lesions Grave = - Acropachy clubbing, - Exophthalmos - Ophthalmoplegia, - Pretibial Myxoedema

Answer 7

Bblock 4 Adr Syx -> AT drugs = preferred substrate 4 iodination by TPase T-B: Carbimazole #Agran #Pancreatitis #T2+3preg PTU #T1preg #ThyroToxCrisis B-R: Carbimazole + LTx @T4 in range Thyrotoxicosis V HyperT Thyrotoxicosis: TransientThyroiditis #supportiveB-block HyperT: Graves V Toxic = TRUst TSHrAB, Radionuclide scan, USS Thyroid doppler 1. RAI CI @ comp syx, orbitopathy, malignancy, preg <6m/father <4m/close-contact kids preggers <3w 2. AT drugs @high p(remission) 12-18m 3. TT @: - HT @nodule - Malignancy - RAI CI - Comp syx

Answer 8

HypoT: FBC/HbA1c/AntiTPO #/grave75% / Lipids/ TgAB#-TSHrAB=graves Overt TSH >10 + T4 low Subclin TSH >10 + T4 fine x2/3m -for subclin MEASURE AGAIN @3m you fkn idiot i.e. x2/3m !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! : LTx / RV TSH-T4,3 = 3months -adjust acc Syx reduce+reduceTFTs-> Stable TSH-T4,3 x2/3m in range / RV TSH 12m +/- ?lipids ``` Subclin: -Syx, Age <65, TSH 4-10 --> LTx 6m -> Syx NOT improve -> -TSH NOT improve = ?overt tx -TSH improve = stop LTx + ?ddx ``` Untx subclin/Stop LTx -> TSH check: - annually @ Thyroid dx, anti-TPO, RT/chemo - 2-3yrs @ no thyroid dx

Answer 9

Causes HypoT: VI: viral -> SadQT: 1. HyperT <6w 2. Euthryoid <3w 3. HypoT HypoT @10-20yrs l8r + 2. Thalidomide, Rifamp, Amiod, Li + 3. 2ndary HypoT #MRI pit/brain = TITS SHAT -Trauma/RAI/Surg -Infarction pit -Tumour pit -Sheehan/Hypothal dx +SystScler/Sarcoid, HChr, Amyloidosis, TB ``` I: RAI, iod def LEDCs, Preg-PPT C: underdevelopment > hypoplasia Ai: Goitre: -Y=Hashimoto -N=Atrophic/Myxoed _______________ ``` HypoT: Dry hair-coarse/skin Menorrhagia HyperT: Pretib myxoed Oligomenorrhoea Lat malleoli oed lesions Neuro, eyes, ears, tongue dx CHD, HF. DM/Dyslipidema Miscarriage, Anemia, Pph/PreEcl/PlacAbruption, Infertiliy, Neonate: congen dx/hypoT, low BW, ARDS, preterm delivery

Answer 10

Diabetes insip: If you get rid of Water via Wee, blood becomes SALTIER Urine 3L/day -> 8hr Deprivation Test Measured-Calc*<10 = true hyponat *2(Na+K)-(BM+Urea) --> PO >300 - conc UO<600 - dilated --> Respond 2 Desmopressin 2mic #ADHanalog --> Y - Cranial: PO<300 , UO>600 = Desmopressin N - Nephrogenic: Ax tx, Bendro, NSAID* *NSAID=COXi=lowPGs=Inc kidney ADH response ``` DI Ax: V-hemorrhage I-MeningoEnceph N-cranipharyngioma=LQ.BT.HA/mets/pituitary dx Demeclocycline+Li #nephrogenic I Hypophysectomy C DIDMOAD Ai - Hypophysitis/SARCOID Trauma E: HYPERCalc/hypoK+ /RF ``` ``` Pathphys: Cranial: Dec ADH @postpit Nephrogen: Dec kidney ADH response --> lowADH=lowH2O absorption/highH20secrete -HYPERnat, polydipsia/uria/thirst ```

Answer 11

Addison's tx? Androgens: DHEA Glucocort: Hydrocort=AM10mg, PM5mg, PM5mg -resemble nat c.sted cycle Mineralocort: Fludrocort=inc @inc Na loss in humidity -prevent postural hypoTN Self-care: - Medic-alert/Sted card/Crisis letter - Other Ai dx screen - Syringes - IM teach @vomit/emergency - Travel - Extra meds, Emerg Hydrocort Kit Doses: 5-10mg -strenuous ex (low=hike, high=marathon - x2 fluids, glucocort, mineralo) 20mg -major injury/nausea x2 dose - illness/fever/surg-endo - dental-GA = double 1hrb4 procedure = cont 24hr only

Answer 12

``` Bone pain (all 3 bone dx - OM/OPet/Paget) Deformity (all 3 bone dx - OM/OPet/Paget) + HSM - (JUST Petrosis) -OMRicKIDS Tx: Ca+Vit D -OPetrosis:Tx: BMT, alpha-IFN, EPO -Pagets:Tx: Bisphosphonates ___________ ``` Bone pain+Deformity: -OMRicKIDS Myopathy/Myalgia ``` RicKIDS - apophysis NOT fused Vit D resistance OsteoDystrophy LF Tumour ``` X-ray sign? - LOOSERs Pseudo# Tx: Ca+Vit D ______________ ``` Bone pain, Deformity + HSM: -OPetrosis: OC dx -> bone expands = BM narrow -> ExtraMedHematopoeisis HSM Tx? BMT, alpha-IFN, EPO ______________ ``` Pagets: XS OB/C activity -> Pain+deformity Tx: Bisphosphonates

Answer 13

``` OA syx? Weakness Effusions Instability ROM low Deformity Swelling/synovitis ``` ``` Ix: MDT - pSych/pOdiatry/pAin team Education TENS Hot-Cold comp ``` ``` Tx: Paracetamol Capsaicin Opioids IA injections NSAID top(hand knees)/oral Surg - THR/HR Spine stuff ```

Answer 14

St 1: 140/90 -ABPM-> 135/85 St 2: 160/100 -ABPM-> 150/95 St 3: 180/120 ________ 180/120/+ w/ PapOed/RetHaem/LT syx* *Confusion/ChestPain-CCF/AKI ``` NO = -CVD RF - Lipid profile/Q10 -Lifestyle -EODx Assx = HUria/HbA1c, Urine ACR/U+E, Fundoscopy, ECG: Y = Tx-ABPM N = BP 7d repeat ``` YES = 1. 999 Malig Acc HTN 2. Suspected Phaemo: - 1. Rest, Atenolol, Nitroprusside/Labetalol, DBP drop <100/12-24hrs ``` - 2. Suspected Phaemo: HA/HTN, Anxiety, Sweat + pHoresis, pALlor/pALp, pOst HypoTN ________ ``` 160/110 / 2/+ PUria = refer @preg -@PPartum BP > 150/100 start anti-HTN tx = E/NAm ENAtLab 160/100 -ABPM-> 150/95 = St 2 160/90 = Isol Syst HTN 150/90 -ABPM-> 145/85 St 1 >80y 140/90 = gHTN/PreEcl 140/90 -ABPM-> 135/85 St 1 <80y 140/90 CKD + ACR <70 130/80 CKD + ACR >70 130/80 DM = AlbuminUria + 2/+ WTHG ___________________ BP tx when? 1. <40 = 2ndary cause find* 2. <60 + Q10/- 3. <80 + - CVD established - DM - EODx - Renal dx - Q10/+ = 20mg Atorva 4. >80 >150/90 ``` *Ix: CVD - Coarc/RAS Renal dx = LUMP* Eye dx Keith Wagner ECG Endo - Thyroid/Acromeg/GFR** dx Drugs ``` ``` * Lump - RCC Urine: PUria/AlbUria = DM / HUria = g.nephritis Mass = obst uropathy/RCC @loin Pyelo ``` ``` **G(Ald:Renin/synACTHen) F(DexaSuppTest) R Catechol (urine metaneph/CT-AP/meta-IBG) _____________ ``` Age<55/DM Age>55/Black 1. ACE/ARB C/D @ccb-CI e.g.CCF 2. A+C > A+D 3. A+C+D 4. K 4.5/- = Spiro / 4.51/+ = alpha/beta-block 5. Refer specialist

Answer 15

Gout tx? Weight loss, Hydrate, Alco, Meat (fish kidney liver), Smoke -> 1. RICE 2. Colchicine (slower acting) < NSAID+PPI (quicker) Csteds - IA IM PO -Cont Allop/Febuxo if already on --DCT = fail =max dose/switch--> f/u 4-6wks - Uric Acid level - BP, Lipids, U+E, HbA1c, CVD/Kidney assx/year - Pri/2ndary Prev d/w --> ULTx @: - Two/+ attacks/yr // Tophi/joints - Urate stones - RF GFR <60 - Proph @cytotoxics/diuretics/pyrazinamide the British Society of Rheumatology Guidelines = advocate offering ULT to all patients after their FIRST BASTARD attack of gout - Offer allopurinol TWO weeks AFTER attack with colchicine cover - -> Allopurinol (GoutAttackRisk)/Febuxo(LFT) - start low -> titrate/4w -> Aim <300 - > ``` ULT for yeeeeears: Titrate to 300-360 Stop @: Norm uric acid low RFs Cure = acute attacks stop + no tophi Explain no guarantee of syx return ``` Person has gout but is TAKING Diuretic for: - BP, what to do? - switch - HF what to do? - continue!!

Answer 16

``` Rheumatoid arthiritis -pain/swelling/stiff -AM/inactivity -MCP squeeze -Joint swell -Ulnar deviation -Boutonniere(dip ext, pip flex), Swan-neck (dip flex, pip ext) -Z-deformity = IPJ=HExt, MCP=Flex similar to boutonnire ____________ ``` ``` Suspected basically give NSAID/Coxib -Small JOINTS ) -1/+ JOINTS ) Refer <3d -Delay in: ) sx onset/docs = 3m) + NSAID/Coxib LD+PPI Perisistent synovitis -refer 3WW ``` ``` Confirmed #flare basically give csteds -Exclude Septic Arth -IA IM PO csteds ± NSAID/Coxib LD + PPI -Pneumo-one off/Flu annual ____________ ``` ``` Single/ 1/+ joints, Delay sx/docs 3m = refer <3d PT/OT Aim - reduce remission/activity Tx <3m --> ``` ``` Persistent Prog Worsening = Surg assx @: Bone - stress # SA/DCM exclude Nrve - compression TENdon - rupture ____________ Tx: 1. cDMARDS ± csteds IA IM PO 2. MTX-FA + Biologics @DAS > 5.1 * ** *-single @mtx CI -switch @ rituximab CI ``` 3. MTX-FA + Rituximab - CD20i/6m ``` ** Sarilumab - IL6i ____ Adalimumab Certo TNFi-TB/cancer Etanercept EULAR 6m Inflix #monitor ________ Tocolix - IL6i + Baricitinib - JAKi Abatercept - TCo ```

Answer 17

``` CRP, DAS >5.1, ESR, FBC LFTs, U+E, RhF-IgM, Anti-ccp, X-ray -Loss of JS -Osteopenia -Soft tissue swelling -Erosions -Deformity ``` Widespread Relapse-Remit Sudden/systemic Extra-Art ``` Cx: Cardio: Pericarditis, Effusion-pericardial, IHD Lung: Pleuritis, Effusion-pleural, BOOP Eye: SiccaKC > Scleritis > Conjunctivitis Felty: RA, Neutropenia, SMeg __________ MTX Mucositis MyeLosupp LF/Lung dx FA 1/wk IM/PO - @diff-times Avoid Trimeth ``` Leflunamide LF + HTN Lung dx ``` SulfaSperm motility SJS-rash Heinz body Hb low #G6PDavoid Avoid Asp/Sulfonamides Lung dx ``` (lung dx basically @MLS: MTX, Leflu, Sulfasal) (LF basically @ML: MTX + Leflu) HOHchloroquine - eyes ProtUria = Penicllamine/gold Penicllamine --> MGravis ________ 'Can't see, pee or climb a tree' NSAIDS Csteds IA -MTX/Sulfasalazine Pencil in cup, fucked nails - Tx done by rheum - Tx as RA - arthritis mutilans (severe deformity fingers/hand, 'TELESCOPING fingers')

Answer 18

HLA-B27 -NEED IMAGING TO CONFIRM!!!!!! FUCK THE GENE SHIT!!! MSPEAQ-APICES-BLOCKERS ``` -MSPEAQ Males Spine dx + lig-vertebrae esthesis fuse Pain-LBP @BUM Extra-Art* Anklyosis Question-mark posture -LBP < 35 -improve @NSAID/moving -Night pain @2nd half -Burn + Psoriatic/Enthesitis/Arthiritis/Recurrent flares #biologics #LINB PEAR ``` -APICES: *Amyloidosis/Aortitis Pul fibrosis Iritis-uveitis Costochondritis/Conduction dx=AVN Enthesitis-> SynDesmoPhytes FUSE-> Ankylosis ``` -BLOCKERS Bamboo spine LOrdosis Loss Compensatory Kyphosis Enthesitis Radiate SI joint -> Hips Schober <5cm ``` ``` Tx: (summary of the shit below) 1. NSAIDs/coxib+PPI + PT/OT --fail--> Paracet +/- cod 2. ?Bisphosphonates 3. Uncontrolled = TNFi =(TB/Cancer) -SECU-KINAB 4. Surg: Hip-THR/HA, Spine #/deformity 5. Ensure that a person with axial spondyloarthritis receives an assessment for OSTEOPORISIS every 2 years. ``` ``` Scran Meal Buses: Syx variation Cure X Refer rheum Ant Uveitis refer NSAIDs/coxib + PPI --fail--> Paracet +/- cod ``` ``` MDT - pt/ot Education - swim/stretch ADLs Life Quality Assx -pain/mood/sleep -ExtraArt dx -Adverse drug effects ``` ``` Bisphosphonates Uncontrolled = TNFi-TB/Cancer -secukinab Syndesmophytes Enthesitis Surg: Hip-THR/HA, Spine #/deformity ```

Answer 19

``` SL3 S high CRP~ T3HSR AB v AutoAG ``` ``` Tx: HOH Mycophenolate Mild: csteds/sunblock Mod: DMARDs Severe: Rituximab/Cyclophosph/Sted HD Maintenance: NSAID/Azo/MTX/bElumimab ``` ``` Ix: RhF U1 RNP Ds-Dna ENA ANA Smith Histone* ``` Ds-dna low c3/4 -> high c3d/4d ESR high, CRP norm ``` * TNFi-TB/Cancer Tetracylc-mino Epileptic - phenytoin AntiArryhtmics - Procainimide Chlorpromazine Hydralazine ``` ``` Syx? Rash - malar/discoid Arthralgia Serositis - percard/pleuritis/myocarditis Haem ANT ``` OroPharyngeal ulcers Renal g.nephritis PS ANA IC T3HSR Neuro dx APLS- Cardiolipin/Coagulant/gp12b - Clots VTE - Livido Reticularis - Obst Cx = miscarriage - TCP/APTT high paradox

Answer 20

op 'Long-term Csted' definition = Sted HD for 3m ``` Before diagnosing OP Exclude non-OP # Ax -mets/met bone dx/MM + Frag # Assx ``` --> 1. DEXA or 2. QFrac/FRAX: 1a. DEXA @: >50 + frag # < 40 + RFs Bisphosphonates 3-5 yrs #AtypFem# 1b. -75/+ + already on -> cont tx Hip frag # Spine frag # --> Tx w/out doing DEXA 2. QFrac / FRAX: ``` QFrac >10 ~10 / FRAX R O: DEXA T-score BMD: ( -1, -2.5) = Penia = modify RFs + stop bisphosph if already on + DEXA < 2yrs (< -2.5) = Porosis = BSC Surg* - (< -1.5 + steds) --(PMP, Men >50, Sted HD) + --(4cm height loss/kyphosis #vertebral f# Assx) ``` Porosis -> BSC Surg: -Bisphosphonates + PPI @GFR > 30!!!!!!! = r/v 3 (zolend)-5(alend and others) years = QFrac + DEXA - 75/+ + already on -> cont tx - Hip frag # - Spine frag # - -> Tx w/out DEXA = Alend 10yrs / Rised 7yrs Bone mets = Bisphosphonates + Denosumab used to prevent Pathological # -GFR < 30, denosumab is preferred SERM / Strontium: - PMP 2ndry prev frag# = Raloxifene/Teriparitide - PMP Pri/2ndry prev frag# = Denusomab -PreMP = HRT ASAP to reduce p(frag #) ``` Ca intake: -legit = 10 mic Vit D @low sun-exposure -shit = 10 mic Vit D + Ca 1g/d 20 mic @Old + Ca 1g/d ``` Surg: VertebroPlasty / Kyphoplasty @ UNhealed AND pain _________ ``` Low Risk = QFrac < 10 / FRAX G -MDT -Education -Weight-bear ex -SUN exposure ________ ``` HRisk groups: women ''50 - 64 w/ RFs'' OR ''65/+'' __ men ''50 - 74 w/ RFs'' OR ''75/+'' Sun exp low / Burqa = 10units / 20units @Old Vit D + Ca 1g/d <50 -> <40 - Steds --40-> HD steds - Hx of frag # --40-> arm/spine/hip / 2/+ - Early MP untx --40-> HRT ASAP = reduce p(frag #)

Answer 21

``` Pre Renal AKI ax: CO low = HF LF RF + sepsis Vol low = burns/3rd space loss/vomit Drugs: Pain-NSAID aHTN-ACEi/ARB Diuretics-Loops DiMLi: Digox, Metformin, Lithium ``` ``` Intrinsic: V: isch/chol emboli IND: nephrotoxics/RadioIodContrast IC: glomerulonephritidies Ai: vasculitis Trauma E: gout ``` Post renal: Inside, on tube, outside ``` Inside: stones, sloughed renal papillae, clots On: cancer / fibrosis Outside: -BPH, PC -Aneurysm -Nodes ______________ ``` ``` What causes f+ for AKI i.e. rises in creatinine but aren't actually AKI? -Trimeth = f+ -CKD prog = f+ -Preg = f+ ``` ``` Baseline V Creat: St1 St2 St3 x1.5 / 7d x2 / 7d x3 / 7d 26/+ /2d St1+354 Pre-test probablitiy: 1. low 2. high 1. 3d 1d 6hr 2. 1d 6h now ``` CKD + low Hb = Bone ache, FLU, Rashes - EPO started on !!! _________________ Refer - nephro for RRT - uro for ObstUropathy - RRT= HD > PeritD ISCHAEMIC HEART DX HD: iHD/Fistula/ low BP/ Syndrome Disequil-DIC/ Time lots PD: Hernia/ Infection/ Peritonitis ``` -Met Acidosis Anemia = EPO, Anorexia @uremia, RBC life low @HD, Stress Ulcer UGIB DysLIPIDemia -High K+ = patiromer/zirconium @gfr<45 -Uremia = pericarditis/encephalo/asterixis -Na/H20 retention = POed/Overload Growth low EPO=Anemia RODystrophy ``` OR ``` Refer @ A - Acidosis, E - Electrolyte HIGH K, I - dIalysis, O - Overload, U - Uraemia _________________ ``` ``` ADPKD (1=chr 16; 2=chr 4) AUSS @FHx <30 = 2/+ 30-59 = 2/+ B/L >60 = 4/+ B/L ``` Tx: Tolvaptan @CKD 2/3 Prog fast Extra-renal manifestations of AD-PKD: - Brain - Berry -> SAH - Heart - Aort Sinus Dilation/ MVP - Liver - cysts/ LF

Answer 22

CKD: 3m GFR<60 + ACR>3 MDRD equation? Creat, Age, Gender, Ethnicity ``` 90/+ 1 60/+ 2 45/+ 3a 30/+ 3b 15/+ 4 0/+ 5 ``` ``` <3 = A1 3-30 = A2 >30 = A3 ``` ``` Refer: *GFR: 30/- Drop 25/+ % / yr Drop 15/+ /yr *Dodgy @ Arny/Steak/Preggers ``` -ACR 70/+ -ACR 30/+ @ HUria 1/+ 2/3 exclu UTI RAS suspect - Poor HTN control - GFR drop >25/+ % < 3m of ACE-ARB start/dose-inc - Pul Oed - Refractory HTN - RENAL BRUIT Cx: - Anemia=EPO, Anorexia @uremia, RBC life low @HD, Stress ulcer @UGIB - Renal ODystrophy Genetic PKD Poor HTN control @ 4/+ meds ____________ - RRT= HD > PeritD HD: Fistula/ low BP/ Syndrome Disequil-DIC/ Time lots PD: Hernia/ Infection/ Peritonitis STAPH EPIDERMIS !!!!!!!!!!! _______________ APlts + Atorva 20mg @CKD Pri/2ndary prev of CVD >40/+% drop in non-HDL -> Statin dose inc PROVIDED GFR 30/+ -if GFR 30/- then refer to specialist b4 increasing dose ``` -When give ACEi/ARB in CKD? CKD + -ACR 3/+ + DM -ACR 30/+ + HTN -ACR 70/+ --> ACEi/ARB ``` -Drop + Rise in what is norm @ACE/ARB starting? Drop GFR 25%/- = norm Inc Creat 30%/+ = norm BP targets: ACR <70 = <140/90 ACR >70 = <130/80

Answer 23

Dizzy SOB Palp/CP -> AF Ix? - Pulse / - ECG -if parox-> 24 Holter / - Echo TTE excl valve dx ``` Pt w/ AF + HD unstable -(shock, hf, MI syncope) --> Sync DC Shock -Sync DC shock:--x3--Repeat -Amiod:--300mg---900mg _____ /10-20mins_ /24hr ``` @VF=NONsync-DC shock __________ ``` AF = acute/NLT Heparin start + cont till full assx --> ``` 1. < 48hr: Rate/Rhythm + PO AC -SR not restored -HR AF* -Prev stroke *Recurrence/CardioVertFails/StructHD#exclTTE-valve dx/Time >12m 2. >48hr/? Rate -consider 4 LTRhythmControl-> 3w AC / 4wk ?Amiod** (CI @CCF) -> CardioVert = TOE guided/conventional -> ``` ?Amiod <12m (CI @CCF) + LTRhythm control -BetaBlock/Dronederone @ CHADSVASC 1/+ LADiam >5/+mm Not CCF --> ``` LAAblation/Pace AVN Ablation @perm AF/CVDx **If there is a high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion ______________ 1. Rate - B/CCB/Dig - verap/dili* /Dig @non-parox+sedentary a. -single - combo ``` b. CI to rate control tx: Reversible Ax AF -> HF AFlutter, New onset AF ``` c. *(B+Verap/Dili=CI @: - HB HF/ObstOutflow - HR-low/AF/Flutter) 2. Rhythm = E > Pharm struc HD = Amiod No struct HD = Amiod/Flec 3. -LAAblate -Pace AVN Ablation ____________ CardioThoracic Surg --> AF - Rhythm = E v P - AC - Prev = B/Dili/Amdio - Electrolyte/Hypoxia correct For stroke prev: - AC: DOAC/DabigaTHROMBINi/Warf - no AC = LA Appendage Occlusion

Answer 24

Stroke Thrombectomy <6hrs Thrombolysis <4.5hrs @pre-stroke \ func status <3\NIHSS>5 ``` @AIS + ProxAntCirc @CT/MR angio + CTperf/MRd-w = ?save brain tissue -> Thrombectomy @6-24hrs/wake up stroke ``` ``` <24hrs/wake up stroke: @AIS + ProxPostCirc -basilar -PCA @CT/MR Angio + CTperf/MR d-w = ?save brain tissue _______ ``` Thrombolysis < 4.5hrs - Hypo/Bleed exclude = CThead @BIGHAM - BP <185/110 --> ``` Asp 300mg -2w-> -Clopidog -Dyp+Asp -AC @AF ________ ``` ``` Exclude hypo/bleed FAST outside Rosier inside Homeostasis: -BM 4-11 -BP high + AIS + PANIC* = BP tx --> ``` ``` CT-head exclude bleed: Bleed tendency ICP high GCS <13 HA AC Meningism -> CT/MR angio CT Angio / MR d-w = ?save brain tissue ``` ``` *Pre-Eclampsia ADiss Nephro/Encephalopathy ICH <6hr/BP150-220 -> -BP tx** lower = Aim 130-140 <1hr 7d CCF/MI ``` ``` **Fucked struct GCS <6 Hematoma -major = poor prog -neurosurg evac ```

Answer 25

ICH (subdural/extradural) -neurosurg/stroke docs -HYDROCEPHALUS-> ``` SURG: MCA infarct - Decomp HemiCraniotomy @ -MCA >50% territory -NIHSS >15 -GCS dropping _______ ``` ``` PTC @emergency Warfarin reveal <1hr = Stop Warf PTC + Vit K FFP @unavail _______ ``` ICH <6hrs/BP 150-220 -> BP Tx* = Aim BP 130-140 <1hr 7d ``` *Fucked struct GCS <6 Hematoma -major = poor prog -neurosurg evac _________ ``` IF HAVE ICH + VTE? -AC / IVC filter _______ ``` TCP - Inc p(bact infect) = ROOM TEMP: <10 + no (bleed/surg / TCP dx) <30 + bleed <50 + surg <100 + CNS-bleed/procedure ``` No major hamorrhage: - PT/APTT >1.5 / Surg - ----Fibrinogen = clot/plasma prots - Fibrinogen <1.5 / Surg 1.0 - ----Cryo = f8+13 / fibrinogen + vWF - WARFARIN Stop warfarin Vit K IV @minor bleed >5 Vit K PO @NO bleed >8 Restart @< 5.0 No bleed + 5-8 = withhold dose, reduce dose -bleed @ therapeutic lvl? Ix cause..?renal/gastro dx

Answer 26

1. If suspect TIA, initial mx? - 300mg + REFER <24hr TIA clinic 2. What do they do at the latter of above answer? - MR diff-weighted + carotid imaging/doppler 3. What to do is MR d-w confirms? - Statin @48hr - Clopi > MR Dyp + Asp 4. What does the latter answer of q2 entail? @Carotid Doppler Imaging -Stable Neuro + Stenosis >50% NASCET = Carotid Endarterectomy - Stenosis <50% / <70% ESCT = 2ndary Prev ________ Venous Sinus Thrombosis = LMWH -5d-> Warf 2-3 Art Diss = AP/AC Prosthetic valve --> stroke AND ICH risk --> Stop AC, Start AP ``` HR bleed (surg) + HR stroke (AF/prev stroke) --> Stop AC, Start LMWH ``` Stable CVD + AF --> Stop AP, Start AC Isch stroke --> AF = Asp 300 mg 2w --> AC For stroke prev: -AC: DOAC/DabigaTHROMBINi/Warf -no AC = LA Appendage Occlusion ____ iF HAVE ICH + VTE? -AC / IVC filter

Answer 27

Wernicke Receptive - SUP Temp gyrus - Fluent + NO Sense + Comp FUCKED - Repetition Normal Broca Expressive - INF Frontal gyrus - NON-Fluent + Sense + Comp NORM - Repetition fucked ``` Conduction aphasia -Arcuate Fasciculus -Fluent + Sense + Comp NORM -Repetition fucked ______ ``` Dexa @Oed from tumour Mannitol @Raised ICP Nimodipine @SAH to reduce vasospasm ______ Gait ataxia = cerebellar vermis lesions -Vermillion Gate Cerebellar hemisphere = finger-nose past-pointing ataxia -hemisPhere=PastPoint Basal ganglia - Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington's) Parietal lobe - sensory symptoms, dyslexia, dysgraphia Frontal lobe - motor symptoms, expressive aphasia #BrocaInfFrontGyrus, disinhibition ________ suspected stroke. unable to speak BUT able to follow instructions - do not know the handedness of the patient - percentage of right and left handed individuals - with a dominant left hemisphere is 90% and 60% respectively, - making the left always the most likely affected side - MCA on dominant side supplies both Wernicke's (sup Temp Gyrus) and Broca's (inf Frontal Gyrus) areas - which are responsible for understanding and production of speech.

Answer 28

Malaria!!! Giesma thick and thin blood films ___________ Parasaitemia = 999+PHE: >2% - severe/cx -IV Artesunate > Quinine >10% - exchange transfusion <2% non-severe/UnCx: -ACT* > Atovaquone-proguanil Doxy-Quinine ACT = AL-ArM: - ArteMether+Lume - ARteSunate+Mefloquine Non-falciparum -oral ACT / Chloroquine -Tx vivax/ovale -> dormant HYPNOZOITES @Liver? Primaquine-G6PD beware Avoid what drugs with following: - HA - chloroquine - Seizures - chloroquine/Mefloquine - GI dx - proguanil - Folate dx - proguanil - Psych dx - Mefloquine

Answer 29

``` Tetanus: Clean: non-penetrating <6hrs TetProne: Puncture, Fract/FB, Burn/Bite HRisk: Contaminated/FUCKED Ask pts 5vacc <10yrs OR 5vacc >10yrs OR ?/Not vacc ? ``` 5Vacc <10yr + Clean = CLEAN+CHILL 5Vacc <10yr + TetProne = CLEAN+CHILL 5Vacc <10yr + HRWound = CLEAN+CHILL -5Vacc <10yr + any wound = CLEAN+CHILL 5Vacc >10yr + Clean = CLEAN+CHILL 5Vacc >10yr + TetProne = bVacc 5Vacc >10yr + HRWound = -bVacc + Tet Ig ``` ?/Not vacc + Clean = bVacc ?/Not vacc + TetProne = -bVacc + Tet Ig ?/Not vacc + HRWound = -bVacc + Tet Ig ___________ ``` bVacc @: 1a) Clean wound + ?/Not vacc 1b) TetProne + 5Vacc >10yr bVacc + Tet Ig @: 2a) TetProne + ?/Not vacc 2b) HRWound + 5Vacc >10yr 2c) HRWound + ?/Not vacc

Answer 30

STIL: NSHhh, DTaP, RAHIM: Subunit conjugate = -Neisseria, S.pneu, H.flu + Hep-B/HPV Toxoid = DTaPertussis Inactivated = R A-H IMflu -Rabies/A-Hep/IMflu Rest live attenuated Rabies: Animal in UK - NO risk = -WASH + ?CoAmox ``` Animal bite elsewhere - HR = -WASH + ... -Already immunised: 2 further doses -NotPrevImmunised: HRIg+Fullcourse __________________ ``` Fragile X -big brain, big balls, long face/ears ``` Sotos= XS Phys Growth MacroDOLICHOcephaly -head>expected __________ ``` PEP: Hep A: HNIg / HepA vaccine Hep B - risk of needlestick transmission - 20-30% look at source - HBsAg Pos+ OR unknown? 1. HBsAg Pos+ : - known responder = booster - non-responder = HBIg + vaccine - being vacc = HBIg + vaccine 2. Unknown source: - known responders = booster - non-responders = HBIg + vaccine - being vacc = accHBV vaccine ``` In summary: 1. Booster @ known responders 2. HBIg + Vacc: @non-responders+beingVaccHBsAgPOS 3. AccHBV+Vacc: @unknown+beingVacc ``` Hep C - PCR/monthly --> @seroconversion = IFN +/- Ribavirin Exp to Varicella @ preggers: - NOT had chickenpox = check 4 ABs + VZIg - IC = VZIg

Answer 31

Hep A tx? -nothing -> f/u/2w LFTs/3m ____________ General Mx 4 hep b/c? Refer: -Gastro, -GUM 4 Sex-screen, -PHE=Cont-Trace Bloods + AFP-HCC Specific Hep B tx? -Peg IFN alpha > tenof/entac ``` Specific Hep C Ix? Tx? -Acute? - 15-45% ppl resolve in 6m -Chronic? - DAAS=Direct-Acting AntiviralS ___________ ___________ ``` Latent TB screening: - New NHS employees - IC / Immigrants - Contact w/ pul/laryngeal TB pt - CXR=TB scarring/Untx fibrotic changes -> Mantoux/IGRA -> -RIpyridox 3m @34/-/high LFTs -Ipyridox 6m @IC __________ __________ Active TB: Ix? Tx: -? -> ? #?m-RIp #?m @TB-men -DOT @?

Answer 32

``` UTI 4w Biopsy 6w Ex 48hr Ejac 48hr DRE 7d ``` vHU, LUTS, ED Age 50/+, FHx, Obesity, Black/Back-bone-WL -> DRE (hard/nodular) PSA 3/+ (age 50/+) -2ww-> SUSPECT=mpMRI -> 1. Likert 1/2 Systematic biopsy = NO TRUS/Tp-template / TRUS/Tp-template -PSA @3-6m -low p(PC)=GP PSA referral level + PSA/6m-yearly-2yearly@neg-biopsy -TRUS/Tp-template @FHx/PSAhigh 2. Likert 3 mpMRI biopsy -@neg=d/w MDT ± repeat biopsy -@PIN/PGIN/ainar = d/w pt high p(PC) -----Gleason....PSA LR ^ ^ IR 7............10-20 HR V V LR= AS + Radical HIFU/Cryo -> Prostatectomy/RT(EBR/BT) IR/ HR-LAPC/ highPSAafterProstatectomy-RT = Radical (HIFU/Cryo): Prostatectomy/ RT(EBR/BT) -LAPC=DEGARELIX-LRHRblocker @HDependent --> PSA @w6/6m @2yrs/12m after Mets=HRelapsed: - Docetaxel - ADT = orchidectomy > Goserelin LHRHag - -want boners? = Bicalutamide a.androgen - fail-> back to ADT HRelapsed: - Abiraterone(a.blocker)/ Enzalut(a.androgen)/ DEXAMETH @3rd-line - Cabaz - Docetax/ Abiraterone(a.blocker)/ Enzalut(a.androgen) ``` Mets: Spinal-MRI @Spinal Mets -LHRHblocker = Degarelix -Zolend @bone-protection -Bisphosphonates @pain -Radium/Strontium __________ ``` AS: - PSA /3m @Y1; 6m @Y2 - DRE /12m - mpMRI @12m WW @older/slow-tumour/comorbidities/elderly: -high PSA/ bone-pain + LPC -> Urology MDT Hot-flushes = MedroxyProg/ CyproAcetate Hot-flushes = ? TUMOUR FLARE RISK -Goserelin + Cyproterone acetate 1st 3wks

Answer 33

Renal Stones @PUJ/ Pelvic Brim/ VUJ NC helical CT <14-24hrs / NSAID-diclofenac50mgPR AE MET @distal ureteric stone < 1cm - alpha-blocker - if <0.5cm + Aysyx = WW - >1cm = UNLIKELY 2 pass -> Tx <4w Remove @pain/not-passing: - Lithotripsy <2cm - Ureteroscopy <2cm + preg - Nephrolithotomy >2cm/staghorn-struvite/prox ureter-lowerpole - Stent/Surg = nephrostomy ABx @sepsis SO-Cysteine-low pH L-Uric-Xanthine-low pH O-Struvite Staghorn-high pH -Urea -ProteusHydrolysis> NH3 Mg PO4 O-Ca Oxal / Phosph-high pH oXal=spiky > phosphate=smooth __________ -Non-semi=Choriocarc.Embryonic.Teratoma.Yolk-sac #germ -Seminoma #germ -Non-germ=Leydig-Lymohoma.Sertoli-Sarcoma _______________ ........(NSemi......Semi)....NGerm AFP/ hcg: high ..................... Age: .....(20-30......40).......50 Prognosis:............good) ``` FHx Undesc Crypto-Orchid Kleinfelter Infertility TIN --> size/shape/texture change = 2WW + USS TESTES !!! ```

Answer 34

yellow/green -strawberry cervix -smelly Dx? Trichomoniasis Tx? Metro ``` Chlamydia= Doxy /Azithro 7d//////2d, respectively Refer for: -GUM -Repeat infection @25/+ y/o = high p(re-infection) -Avoid sex after ABx end/Azithro +7d -STD screen/ Safe sex -Sex-abuse < 18yrs ``` Gonorrhoea=Ceftriax IM /Cipro - Asyx = NAAT 2/+w after ABx end - Syx = C+S 3/+d after ABx end Syx men = C+T: - all partners < 2w - most recent partner if >2w The rest i.e. Asyx men /Women - C+T all partners <3m _______ PID: Mycoplasma genitalium -moxifloxacin / ceftriax -> Azithro Gon high risk = Ceftriax+Doxy+Metro Gon low risk = Ceftriax/Oflox

Answer 35

``` When to USS testicle? Hematocele @non-trauma -if < x3 V contralat = chill Hx of pain/ persistent/ trauma Hydrocele = 20-35 Uncertain ddx Testicle = ETvTesticle ? _________ ``` ``` Varicocele - Refer: -Sudden pain -Not drain @supine -R-sided varicocele -TGA = low volume _________ ``` ``` When 2 refer for Urology: -Torsion -AEOrchitis -StrangHernia -Hematocele TRAUMA _________ Dx = Hydrocele ``` For CONGEN hydrocele: -Reassure < 2yrs -when 2 refer for paeds: Hydrocele @SCord /Abdo-Scrotal Hernia Hernia = Inguinal /Strang For non-CONGEN hydrocele: -Surg/Sclero/Asp __________ Varicoceles - how 2 manage: G1/subclin -Reassure, Analgesia, Infertile 33.3%, Supportive underwear -@G2/3 Symmetrical - Annual exam Asymm = Urology ref Syx OR Abnormal semen = Urology ref Asyx AND Normal semen = Semen analysis __________ ``` Congenital inguinal hernia – paediatric surgery ASAP incarceration risk <6w - surg <2d <6m - surg <2w <6y - surg <2m _____________ ``` ``` Infanta UMBILICAL hernia No tx - resolve <3yrs -Assoc with HypoT !!! If Syx/ Large = Surg @2-3yr -If Asyx+Small = ?Surg @4-5yr ```

Answer 36

EOrchitis 3 causes: - E.coli - (anal sex/ catheter) -> Cipro - STD - (Age <35) -> Ceft+Doxy /Cipro - Mumps - (supportive) - MSU/dipstix --f/u2w-> f/u = ?ABx change + Refer @UTI/ STI/ Fail ___________ WPW = AL BRt A - left sided RAD = dom R wave @ V1 B - right sided LAD = no dom R wave @ V1 Assoc: MESH MVP, Ebstein anomaly, Secundum ASD, HOCM/HyperT Tx: radioFreq ablation of acc pathway FAPS Avoid sotalol @AF cos it - prolongs refractory period @AVN -> - inc transmission rate through acc pathway -> - Inc vent rate = VF

Answer 37

L-UTI = bladder infection (aka cystitis) UnCx UTI — Typical pathogens @normal UT + kidney function + no predisposing co-morbidities -> UTI Cx UTI — UTI + incr p(Cx e.g. Persistent/Recurrent infection, Tx failure) -Cx UTI RFs = S+F dx, catheters, virulent/atypical organisms and co-morbidities (DM or IC) Upper UTI = Ureters + kidneys infection #(pyelonephritis) Recurrent = Relapse/Reinfeciton - UTI 2/+ / 6 m - UTI 3/+ /12m - Relapse — same strain infection - Reinfection — different strain infection Catheter-UTI = UTI + catheter inserted last <48hr Bacteriuria = bacteria @urine = asyx/syx

Answer 38

``` UTI 4w Biopsy 6w Ex 48hr Ejac 48hr DRE 7d ``` vHU, LUTS, ED Age 50/+, FHx, Obesity, Black/Back-bone-WL -> DRE (hard/nodular) PSA 3/+ (age 50/+) -2ww-> SUSPECT=mpMRI -> 1. Likert 1/2 Systematic biopsy = NO TRUS/Tp-template / TRUS/Tp-template -PSA @3-6m -low p(PC)=GP PSA referral level + PSA/6m-yearly-2yearly@neg-biopsy -TRUS/Tp-template @FHx/PSAhigh 2. Likert 3 mpMRI biopsy -@neg=d/w MDT ± repeat biopsy -@PIN/PGIN/ainar = d/w pt high p(PC) -----Gleason....PSA LR ^ ^ IR 7............10-20 HR V V LR= AS + Radical HIFU/Cryo -> Prostatectomy/RT(EBR/BT) IR/ HR-LAPC/ highPSAafterProstatectomy-RT = Radical (HIFU/Cryo): Prostatectomy/ RT(EBR/BT) -LAPC=DEGARELIX-LRHRblocker @HDependent --> PSA @w6/6m @2yrs/12m after Mets=HRelapsed: - Docetaxel - ADT = orchidectomy > Goserelin LHRHag - -want boners? = Bicalutamide a.androgen - fail-> back to ADT HRelapsed: - Abiraterone(a.blocker)/ Enzalut(a.androgen)/ DEXAMETH @3rd-line - Cabaz - Docetax/ Abiraterone(a.blocker)/ Enzalut(a.androgen) ``` Mets: Spinal-MRI @Spinal Mets -LHRHblocker = Degarelix -Zolend @bone-protection -Bisphosphonates @pain -Radium/Strontium __________ ``` AS: - PSA /3m @Y1; 6m @Y2 - DRE /12m - mpMRI @12m WW @older/slow-tumour/comorbidities/elderly: -high PSA/ bone-pain + LPC -> Urology MDT Hot-flushes = MedroxyProg/ CyproAcetate Hot-flushes = ? TUMOUR FLARE RISK -Goserelin + Cyproterone acetate 1st 3wks maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour,

Answer 39

Catheter UTI = TANP 7d -do NOT Tx Asyx bacteria @catheter pts Recurrent UTI = TANC (TN>AC) proph SD @: - expose2trigger - ON Preg: - Asyx BU == NAC 7d - UTI @preg = NAC 7d Bog-standard UTI w/ no catheter/preg -man = NT 7d -woman = NT-PF 3d _________ Kids: 1. UTI < 3m = Refer asap + ABx + C+S 2. UTI > 3m = dipstick -> - nitrite POS AND leukocyte POS = ABx - nitrite POS + leukocyte NEG = ABx - nitrite NEG + leukocyte POS = UrineMCS --@infants and toddlers, sample = Clean Catch Urine -fail-> Suprapubic Kids >3m Upper-UTI #fever + flank-pain - Pyeloneph = Cefalexin/ Co-amox Kids >3m Lower-UTI - TANC (TN>AC) - Even recurrent = -TANC (TN>AC) /6m-r/v Kids < 3m U or L-UTI = Refer asap + ABx + C+S _______ ``` USS-KUB @: Flow dx / Mass Atyp org Sepsis Tx fail Recurrence, USS-KUB@: - acute infection if < 6m/o @recurrent - <6w if > 6m/o @recurrent ``` Acute infection @Recurrent /Atyp< 3y --4-6m-> DMSA #parenchymal dx For reflux = MCUG