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Foundation MD2 > Learning Objectives > Flashcards

Learning Objectives Flashcards

1
Q

What is the pathogenesis of T1D AND T2D?

A

T1D - autoimmune beta islet cell destruction in pancreas, causes insulin deficiency T2D - acquired insulin resistance due to beta cell fatigue, presents later in life due to poor health

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2
Q

How is diabetes control assessed?

A

Regular FBG HbA1c - glycosylated haemoglobin 3 monthly (should be under 7% < 53)

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3
Q

What lifestyle factors can be used for diabetes management?

A

Healthy diet (reduced sat fats, low GI CHO) Exercise Smoking cessation RBG monitoring

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4
Q

What are the oral hypoglycaemics available for diabetes treatment?

A

Metformin (biguanides): First line treatment, inhibits hepatic glucose production and increases insulin sensitivity, does not cause severe hypoglycaemia, contraindications: renal impairment –> perpetuates lactic acidosis, SE: nausea, diarrhoea (avoid this by using slow release drug) Sulphonylureas: Stimulate beta cell insulin release, may cause weight gain, risk of hypoglycaemia (use with care in drivers, pilots etc.) Add if HbA1C is above target on maximum metformin tolerated, Gliclazide is drug of choice Alpha-Glucosidase Inhibitors: Acarbose, blocks starch digesting enzymes, no weight gain or hypoglycaemia, SE: flatulence, must be used with food Thiazolidinedione’s: Reverse insulin resistance, no hypoglycaemia, SE: weight gain, fluid retention, CCF, fractures, bladder cancer DPP4 Inhibitors: Advantage in overweight patients, no hypoglycaemia or weight gain, prolong GLP-1 action, increase insulin secretion, decrease glucagon secretion, inhibits in retina breakdown, SE: nausea, hypersensitivity (rare) GLP-1 Analogues: Advantage in overweight patients, no hypoglycaemia, slow gastric emptying, improve glucose sensing, weight loss, requires injection, SE: nausea, vomiting, pancreatitis SGLT2 Inhibitors: Promote glycosuria to lower blood glucose, mild weight loss, SE: candida infections

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5
Q

What is the investigation for palpitations or syncope?

A

12 lead ECG Blood glucose U&E

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6
Q

What is the pattern of AF on ECG?

A

No P waves Irregularly irregular rhythm

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7
Q

What is the pattern of supra ventricular tachycardia on ECG?

A

Wide QRS complexes, retrograde P waves

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8
Q

What is the pattern of VT on ECG?

A

Wide QRS (greater than 120msec)

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9
Q

What is the management for AF?

A

Cardioversion Catheter Ablation (ablate part of heart that is out of rhythm) Beta Blockers Calcium Channel Blockers Digoxin Anti-arhythmics Anticoagulation - warfarin, heparin

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10
Q

What is the score to determine stroke risk in AF patients?

A

C - chronic heart failure H - hypertension A - age >75 D - diabetes S - stroke V - vascular disease A - age >55 S - sex (female)

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11
Q

What is the management for SVT?

A

Adenosine (induce AV block to allow SA node to take over rhythm control) IV Verapamil

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12
Q

What is the management for VT?

A

Cardioversion Amiodarone (if hemodynamically stable)

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13
Q

What is a stroke?

A

Ischaemic infarct of the brain, lasting over 24 hours, brain damage

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14
Q

What is a TIA?

A

Brief neurological episode, usually lasting under 24 hours with no permanent brain damage

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15
Q

What is ischaemic penumbra?

A

Area surrounding the infarcted brain that is also affected by relative ischaemia (but not yet permanently damaged)

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16
Q

What are the types of hemorrhagic stroke?

A

Deep: hypertensive rupture of deep penetrating arteries, putamen, thalamus, brainstem, cerebellum Lobar: superficial, secondary to amyloid angiopathy, tumour, aneurysm

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17
Q

What are the types of iscahemic stroke?

A

Large artery thromboembolism (>50% stenosis) Cardiogenic embolism (AF, LV thrombus) Small vessel infarct

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18
Q

What are the major causes of SAH?

A

Berry aneurysm rupture AVM

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19
Q

How is a stroke diagnosed?

A

CT (ischaemic vs. haemorrhagic - may not see clot in first few hours but will see haemorrhage)

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20
Q

What is acute stroke management?

A

Thrombolysis - tPA (ateplase) - under 4.5 hours Anticoagulation Clot Retrieval Mannitol - relieve ICP

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21
Q

What is stroke secondary prevention?

A

NOAC (dabigatrain, rivaroxaban, apixaban) Warfarin Aspirin Clopidogrel Antihypertensives Statins

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22
Q

What are the common risk factors for stroke?

A

Age Gender (female) Family History HTN Diabetes Smoking AF Hyperlipidaemia Alcohol TIA/Migraines OCP/HRT OSA Sedentary/obesity

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23
Q

What are the common signs of stroke?

A

F - facial weakness A - arm weakness S - speech difficulty T - time

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24
Q

What happens if a patient develops a rash 24 hours into penicillin admin?

A

Change to cephalosporin - ceftriaxone

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25
Q

What is the side effect of ciprofloxacin?

A

Achilles tendon swelling and tearing

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26
Q

What is the treatment for C.diif?

A

Metronidazole or vancomycin

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27
Q

What is the treatment for klebsiella UTI and bacteriuria?

A

Gentamicin

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28
Q

What is the treatment for MRSA?

A

Vancomycin

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29
Q

What is the likely pathology: Recent haemoptysis, bright red blood mixed with cream coloured sputum, occasional night sweats, 4kg weight loss (1 month)?

A

TB - mycobacterium tuberculosis

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30
Q

What is the initial management of TB?

A

Isolation, bronchoscopy and washings, organism culture

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31
Q

What is the epidemiology of IHD?

A

3% of all Australians, accounts for 17% of all deaths

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32
Q

What are the risk factors for IHD?

A

Male Increasing Age Family History Hyperlipidaemia Hypertension Diabetes Obesity Smoking Poor diet and exercise CKD

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33
Q

What is the common presentation of IHD?

A

Chest Pain SOB Nausea Diaphoresis Palpitations Lethargy

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34
Q

What is AMI?

A

Acute myocardial infarct - diagnosed by at least 2 of: - ST segment changes, Q waves or inverted T waves - CK, troponin rise - MI Symptoms

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35
Q

What is acute coronary syndrome?

A

Caused by coronary thrombosis in association with ruptured atherosclerotic plaque - leads to narrowing or occlusion of coronary artery

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36
Q

What is the in hospital management of IHD?

A

PCI - cath lab, under 60 mins Fibrinolysis - early presentation Oxygen Morphine Nitrates Aspirin Heparin/clexane

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37
Q

What are the common complications of AMI and their management?

A

Angina, reinfarction, infarct extension - Revascularisation Heart failure, cardiogenic shock, mitral valve dysfunction, aneurysm, cardiac rupture - Surgical intervention Arrhythmic: atrial or ventricular, SA/AV node dysfunction - Anti-arrhythmic, pacemaker, implantable defibrillator Embolic: CNS, peripheral - Anticoagulants, antiplatelet (clopidogrel) Inflammatory: pericarditis (sharp inspiration pain) - Anti-inflammatory Pulmonary oedema (treat with diuretic - look for weight change in patient - and oxygen)

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38
Q

What is the post hospital management of AMI?

A

Medication - Aspirin - Beta Blocker - ACEi - Statin - GTN - Antiplatelet Additional - Antacid - Exercise - Vitamin B1 - Diuretic - Smoking cessation - Healthy diet - Weight loss - Alcohol reduction - Stress reduction - Regular cardiac monitoring

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39
Q

What are the typical insulin regimens for diabetes?

A

Basal bolus - rapid acting dose with meals (bolus - nova rapid, apidra) and long acting insulin once or twice a day for maintenance (deter, glargine)

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40
Q

What is the venous anatomy of the lower limb?

A

External iliac - common femoral - deep femoral - femoral - popliteal - anterior tibial and peroneal - posterior tibial - plantar metatarsal Great saphenous and small saphenous and dorsal venous arch

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41
Q

What are primary and secondary varicose veins?

A

Primary - rope like, present in superficial and perforating veins Secondary - deep vein incompetence due to recanalization of past DVT OR venous obstruction OR genetics

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42
Q

What are the complications of varicose veins?

A

Pain (relieved by elevation) Swelling (indurated hard) Thrombophlebitits Bleeding Ulcers Varicose Eczema Lipodermatosclerosis (inflammation of subcutansou fat, champagne bottle leg) Atrophie Blanche (white depressed scars)

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43
Q

What is the treatment for varicose veins?

A

Leg elevation, movement, ulcer care, compression stockings, sclerotherapy (inject into vein to shut it down), open surgery (vein stipping), EVLT (laser therapy), radio frequency ablation

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44
Q

What are the features of arterial ulcers?

A

Painful Claudication CV risk factors Punched out edges Ulcer base poorly developed, grey Little bleeding Foot cool Nail thickened

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45
Q

What are the features of venous ulcers?

A

Venous insuffiency - varicose, thrombophlebitis, DVT, surgery Large irregular edge Shallow Common over medial malleolus Moist Stasis dermatitis (darkened surrounding skin)

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46
Q

What are the features of neuropathic ulcers?

A

Painless Diabetes or peripheral neuropathy Deep Pressure points and calluses Neuropathy signs - loss of sensation Distorted foot architecture (charcouts - fractures leading to loss of foot arches, hyperextended MTP, hyper flexed IP)

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47
Q

What is the management of venous ulceration in the lower limbs?

A

Bed rest Elevation IV antibiotics Dressings Debridement Split skin graft Revascularisation Compression stockings

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48
Q

What structures can cause chest pain?

A

Heart (pericardium, myocardium) Pleura Aorta Oesophagus MSK Skin Abdominal Organs

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49
Q

What are the ECG changes in AMI?

A

ST elevation or depression Q waves Inverted T waves U waves (old infarct)

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50
Q

What is the typical presentation with pleuritic pain?

A

Worse with inspiration and coughing, sharp stabbing pain

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51
Q

What is the presentation of aortic dissection?

A

Tearing pain radiating to the back, BP different in each arm

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52
Q

What is the presentation of reflux?

A

Burning pain in the central chest, usually worse after meals and when lying down

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53
Q

What are the features of a migraine?

A
  • Women - Genetic - Slow spread of reduced activity - Aura, scintillatinf scotoma, monochromatic vision pattern, semi or quadrantonopia - Usually starts in occipital lobe - Buildng pain, pulsating, throbbing, unilateral behind eye - Aggravating - stress, exercise, menstruation, OCP, fatigue - N&V, photophobia, vertigo, irritable, trigeminal pain, allodynia in scalp
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54
Q

What are the features of a tension headache?

A

Bilateral, band wrapping around head, may also involve neck and shoulders Worse with stress Usually relieved by analgesia

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55
Q

What is a chronic headache?

A

Present most days of the week for most of those days May be caused by medication overuse (opioids, triptans)

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56
Q

What is evident on a LP looking for SAH?

A

Xanthochromia - yellow spinal fluid 12+ hours after bleed

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57
Q

What are some possible symptoms of raised ICP?

A

Pappiloedema 6th nerve palsy Nausea Headache (morning) Better with standing

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58
Q

What are the diagnostic criteria of acute kidney injury?

A

Increased creatinine 150-200% Reduced urine output < 500mL in > 6 hours

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59
Q

How do you differentiate AKI from CKD?

A

AKI has acutely elevated serum creatinine and chronic kidney disease has creatinine elevation over time. 24 hour urine study for creatinine would demonstrate level of renal function.

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60
Q

What are the aetiologies of AKI?

A

Pre-renal: ATN, hypovolemia, haemorrhage, sepsis, hepatorenal syndrome (REDUCED PERFUSION) Intra-renal: ATN, glomerulonephritis, interstitial nephritis, thrombus Post-renal: fibrosis, tumour, stricture, BPH, renal calculi, pyelonephritis (OBSTRUCTION)

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61
Q

What is the treatment for AKI?

A

Fluid Overload - diuretics (frusemide), renal replacement therapy Avoidance of nephrotoxic agents

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62
Q

What is the pathophysiology of AKI?

A

Impaired renal perfusion leads to increased sodium and water retention. ATN is most common cause and causes microvascular endothelial injury and tubular ischaemia in proximal tubule. Hypoxaemia causes released of ROS and cell death.

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63
Q

What are the common antibiotic resistant organisms and their treatment?

A

MRSA - vancomycin VRE - linezolin Clostridium Difficile - metronidazole

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64
Q

What are the presenting features of meningitis and encephalitis?

A

Fever Neck Stiffness N&V Rash Headache Neurological Symptoms

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65
Q

What are the investigations for CNS infections?

A

LP (with no increased ICP) CT CRP (often takes 24 hours to raise so normal level may not be true)

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66
Q

What are the CSF findings of meningitis?

A

Bacterial - cloudy, elevated protein, low glucose, increased pressure Viral - clear, normal/high protein, normal glucose, normal pressure TB - increased pressure, clear, low glucose, high protein Cryptococcal - increased pressure, clear, low glucose, high protein

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67
Q

What are the common organisms that cause meningitis?

A

Neonates: group b strep, E.coli, listeria Infants & Kids: strep pneumoniae (GPC), Neisseria meningitidis (GNC), H. influenzae B (GNR) Adolescents: Neisseria meningitidis, strep pneumoniae Adults: strep pneumoniae (more likely with no rash and recurrent otitis media), Neisseria meningitidis Older Adults: listeria (GPR)

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68
Q

What is the treatment for meningitis?

A

Dexamethasone - anti-inflammatory (at the same time or before antibiotics is ideal) Ceftriaxone - strep pneumoniae, Neisseria Benzylpenicillin - listeria Vancomycin - beta lactam resistant strep pneumoniae

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69
Q

What are the common causes of encephalitis?

A

HSV-1 Listeria

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70
Q

What is the most common cause of spinal abscess and what are the risk factors?

A

Staph aureus Risk Factors - IVDU - Endocarditis - Sepsis - Bacteraemia - Immunosuppression - DM

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71
Q

What are some common causes of brain abscess?

A

Sinusitus Lung abscess Strep Staph aureus

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72
Q

What are the signs and symptoms of hyperglycaemia?

A

Dehydration Coma/LOC Headache Trouble concentrating Blurred vision Fatigue Urinary frequency

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73
Q

What are the signs and symptoms of hypoglycaemia?

A

Unconscious Confused Palpitations Fatigue Sweating Anxiety Hunger Shaky Pale Tingling Irritability

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74
Q

What are the signs and symptoms of diabetic foot?

A

Pale Cold Poor capillary refill Pedal pulses not palpable Ulcers Gangrenous

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75
Q

What drug can cause hyperglycaemia?

A

Corticosteroids

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76
Q

What is the treatment for DKA?

A

Resuscitation Rehydration - saline then dextrose Correct potassium imbalance Insulin (once potassium level is known)

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77
Q

What is the treatment for hyperglycaemic hyperosmolar state?

A

Glucose > 25-30 Treat with fluids - 2L hypotonic saline over 1-2 hours, monitor urine, insulin, potassium, low molecular weight heparin

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78
Q

What are some causes of acute agitation?

A

Infection Dehydration Drugs Trauma Waiting

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79
Q

What are means of sedation?

A

Benzos - diazepam, midazolam (risk of respiratory depression) - Avoid in dementia due to paradoxical reaction Neuroleptics: olanzapine (increases QT interval, dystonic reaction including laryngospasm) Combination - lower combined doses may decrease agitation occurrence

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80
Q

What is the presentation of AAA?

A

Collapse Sudden onset back pain Pulsatile mass in lower abdomen Hypovolemia - dehydration, pallor, fatigue, LOC, SOB

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81
Q

What is the investigation for AAA and lower limb ischaemia?

A

Ultrasound

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82
Q

What is the conservative management for lower limb ischaemia?

A

Lifestyle modifications - reduce cholesterol, stop smoking, increase exercise, healthy diet, reduce alcohol, control blood pressure and diabetes Surgical - stenting, endarterectomy, bypass

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83
Q

What is the management for AAA?

A

Aortic surgery - give prophylactic antibiotics for GN organisms

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84
Q

What is hypertension?

A

BP > 140/90 on 2 or more occasions

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85
Q

What are the secondary causes of HTN?

A

Renal disease, renal artery stenosis, adrenal tumours (secreting aldosterone, cortisol, catecholamine’s - phaeochromocytoma), sleep apnoea, pregnancy, Cushing’s, hyperaldosteronism

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86
Q

What is absolute cardiovascular risk?

A

Sex Age SBP Smoking Cholesterol Diabetes ECG LVH

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87
Q

What is the management of HTN?

A

Lifestyle - lose weight, improve fitness, avoid salt, moderate alcohol, stop smoking Medication - ACEi - < 55, dry cough, renoprotective - ARBs - < 55 - Calcium Channel blockers - > 55, black, avoid non vascular selective (verapamil) in heart failure - Diuretics- thiazide first - Beta blockers - used if ACEi not tolerated, weight gain and insulin resistance, reduced exercise capacity, NOT IN ASTHMA

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88
Q

What are the approaches to resistant HTN?

A

Most common cause is poor medication compliance Add spironolactone (potassium sparing diuretic), beta blocker, centrally acting agent (methyldopa, clonidine, moxonidine), alpha-blocker, vasodilator

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89
Q

What does this image show?

A

Free gas under diaphragm

90
Q

What does this image show?

A

Lobar consolidation

91
Q

What does this image show?

A

Pneumocystis jirovecci - butterfly pattern

92
Q

What does this image show?

A

Subdural haemorrhage

93
Q

What does this image show?

A

Extradural haemorrhage

94
Q

What does this image show?

A

Subarachnoid haemorrhage

95
Q

What does this image show?

A

Pneumothorax

96
Q

What does this image show?

A

Heart failure - with kersey B lines and pleural effusion

97
Q

What disease processes can produce diffuse lung disease?

A
98
Q

What are the red flags in joint disease?

A

IVDU

Previous cancer

Fatigue, weight loss, night sweats

Pain not relieved by rest or standard analgesia

Steroid use

< 20, > 50

99
Q

What are the features of osteoarthritis?

A

Cartilage damage - non uniform loss and osteophyte growth

Causes - obesity, age, heavy joint use, female

Features - worse with movement, asymmetrical, deep ache, reduced ROM, crepitus, bouchard nodes (PIP), heberdens nodes (DIP), reduced quads mass, tender joints

Diagnosis clinical, can do x-ray and see loss of joint space and osteophytes

Treatment - NSAIDs, cortisone injection, joint replacement

100
Q

What are the features of rheumatoid arthritis?

A

Autoimmune destruction of synovium - destruction of cartilage and bone - symmetrical - hands and feet first

Features - pain worse in the morning, pain better with movement, nodules, warm swollen joints, symmetrical, dry eyes and mouth (Sjrogens), fatigue, fever, weight loss

Investigations - rhuematoid factor, CRP, ESR, FBE, ANA, CCP

Treatment - NSAIDs, corticosteroids, methotrexate

101
Q

What are the features of gout?

A

Aggravating Factors - dehydration, thiazide diuretics, alcohol, diet high in purines, obesity, aspirin, male, HTN, age

Features - intense peripheral joint pain, systemic symptoms, inflammation, rubour

Investigation - negative birefringence of monosodium urate crystals on tophous aspirate, urate levels not the best measure as they are altered by other processes in the body

Treatment - allopurinol, corticosteroids, NSAIDs, colchicine

102
Q

What are the metabolic changes that occur during surgery or acute medical illness?

A

Surgery is a stressful event - causes elevation of catecholamines, growth hormone, glucagon, cortisol and ACTH, and depression of insulin and insulin resistance

Raised blood glucose levels, protein and fat breakdown, increase FFA and ketone production

103
Q

What is the rationale for achieving glycameic control in perioperative period?

A

Hyperglycaemia increases the risk of infection and reduces healing capacity and induces osmotic diuresis which impacts hydration and electrolye balance

Hypoglycaemia may cause coma induction

104
Q

What is the perioperative management of diabetic patients?

A

Assess for metabolic disturbance, microvascular and macrovascular complications and neuropathy

HbA1c level to assess control over last 3 months

105
Q

What is the post op management for diabetics?

A

Monitor BSL

HbA1c

Record hypoglycaemic episodes and when they occur

Checking feet and seeing podiatrist

Seeing optometrist yearly

CV health screening

106
Q

What are the most common causes of bowel obstructions?

A

Large - volvulus, malignancy

Small - hernia, adhesion

107
Q

What are the features of biliary colic pain?

A

RUQ - referred to back and b/w scapula

Intermittent

Nausea

After fatty meal

108
Q

What are the features of acute cholecystitis pain?

A

RUQ sharp pain with nausea, vomiting and anorexia

Fever

Tachycardia

Murphys sign (inspiratory pain on palpation)

Possible gallstone ileus causing absent bowel sounds

109
Q

What are the features of acute pancreatitis pain?

A

Central - radiating to the back

Nausea and vomiting

IGETSMASHED (causes)

Grey Turners sign or Cullens Sign - due to retroperitoneal haemorrhage

Elevated lipase

110
Q

What are the pain features of choledocolithiasis?

A

RUQ

Obstructive jaundice

Stone in the bile duct

Fever and tachycardia

111
Q

What are the features of peptic ulcer pain?

A

Epigastrium (central)

Relieved by PPIs

May experience haematemesis and melena if ruptured ulcer

112
Q

What are the features of intestinal ischaemia pain?

A

Pain out of proportion to clinical findings

Generalised pain

May have history of AF or coagulopathy

113
Q

What are the features of IBD pain?

A

Chron’s and Ulcerative Cholitis

Central recurrent pain worse with oral intake and associated with other GI sumptoms

Associated with primary sclerosing cholangitis (anal beads on ERCP), iritis/uveitis, akylosing spondylitis

114
Q

What are the presenting features of a ruptured AAA?

A

Central sudden tearing pain radiating to the back

Pale, hypotension, unwell

115
Q

What are the presenting features of acute appendicitis?

A

Tenderness at Mcburnies point

Psoas sign - pain when flexing right hip

Rovsings sign - right sided tenderness when palpating left side

Pale, ketotic breath (due to anorexia, N&V)

116
Q

What are the presenting features of diverticulitis?

A

LIF

Altered bowel habit and rectal bleeding

More common >50

May also get volvulus due to outpouching - sigmoid (coffee bean), caecal (kidney bean)

117
Q

What are the presenting features of ectopic pregnancy?

A

IF pain

Sudden onset

Amenorrhea

Shock symptoms

118
Q

What are the presenting features of ovarian cyst?

A

Iliac fossa pain

Altered menstrual pattern

119
Q

What are the presenting features of salpingitis?

A

Iliac fossa pain

PID history

120
Q

What are the presenting features of testicular lesion?

A

Scrotal pain

Nausea

121
Q

What is intersusception of small bowel?

A

Ileocaecal, seen in children (3-18m) - due to peyer patch inflammation, infection causes hypertrophy (polyp like) - bowel obstruction and eventually ischaemia (treat with gas enema)

122
Q

What is required for diagnosis of metabolic syndrome?

A

Abdominal obesity + 2 or more of:

  • Elevated TG ( > 1.7mmol/L)
  • Low HDL ( < 0.9mmol/L - male, < 1.3mmol/L - female)
  • Hypertension ( > 130/85mmHg)
  • Hyperglycaemia (FPG >5.6mmol/L or T2DM or IGT)
    • Pre-diabetes
      • IFG: 5.6-7
      • IGT 2 hour: 7-11.1
      • HbA1c: 39-47
  • Waist Circumference
    • European > 94cm male, > 80cm female
    • Asia > 90cm male, > 80cm female
123
Q

What are some steps to reduce cardiometabolic risk?

A
  • Diet - reduce salt
  • Exercise (30 mins per day)
  • Smoking cessation
  • Reduce alcohol consumption (more alcohol free days)
  • Weight loss
  • Address dyslipidaemia Targets
    • LDL < 2mmol/L
    • HDL > 1mmol/L
    • Triglycerides < 1.5mmol/L
    • Non-HDL Total Cholesterol < 2.5mmol/L
  • Treat HTN (statin, ACEi, aspirin, fibrates)
  • Diabetes control
124
Q

What is dyspnoea?

A

Subjective sensation of breathing discomfort

125
Q

What are some mechanisms of dyspnoea?

A

Drive for ventilation

  • Exercise
  • Metabolic acidosis (clear CO2)
  • Hypoxia
  • Anxiety

Load/increased WOB

  • Resistive load (consolidation, mass)
  • Elastic load (asthma)

Reduced strength of respiratory muscles

126
Q

What are the common features on examination of eczema?

A

Patchy scaly lesions worse on flexor areas - thin skin

Skin looks aged

Asthma, hayfever

Lichenification - normal skin lines exaggerated due to constant rubbing and scratching

127
Q

What is the treatment for eczema?

A

Avoid soap, regular sorbolene, warm (not hot) showers, topical steroids (mild for face), systemic antibiotics, wet dressings, phototherapy, short term oral prednisolone, long standing (methotrexate, cyclosporin)

128
Q

What are some complications of eczema?

A

Bacterial Superinfection - skin lacks antibaterial peptides, staph aureus infection, golden crust

Eczema Herpeticum - secondary infection with HSV, sudden worsening of eczema, corneal scarring

Contact Dermatitis - response due to an allergen

129
Q

What are the common presenting features of psoriasis?

A

Extensor surfaces

Scaly

Age 20-50

Nail - onycholysis (yellow nail lifts off bed), psoriatic change - pitting of nail

Arthritic pain

130
Q

What is the treatment for psoriasis?

A

Topical: steroids, tars (breaks down scale), calcipotriol, dithranol, keratoltics, emollients (sorbolene)

Phototherapy: UVB treatment

Systemic: oral acitretin, methotrexate, cyclosporin A, biologic treatment

131
Q

What medications may cause acne?

A

Medication - topical corticosteroids, lithium, anabolic steroids, OCP

132
Q

What are the features of rosacea?

A

More common in women and middle aged, occurs due to sun damage

Redness and facial flushing, papules and pustules

Long term - telangiectasia, rhinophyma

133
Q

What are the features of a scabies infection?

A

Starts between digits on hands and feet, itch worse at night, spread to genital areas, usually spares face and head in adults

134
Q

What are some signs of major depression?

A

Worse in the morning

Early morning waking

Agitation

Weight loss (not dieting or exercising)

Excessive guilt

Fatigue - loss of energy

Insomnia or hypersomnia nearly every day

135
Q

What is the diagnosis of depression?

A

Low moos impairing ability to function leading to substantial stress, ongoing for at least 2 weeks on most days

136
Q

What are some tests to outline severity of diabetic complications?

A

ECG - MI, LBBB

HbA1c

Urinalysis - protein, glucose, blood, creatinine

Neurovascular Exam - peripheral pulses and sensation

137
Q

What are the microvascular complications of diabetes?

A

Retinopathy

  • Non-proliferative: normal, no symptoms, microaneurysms, macular oedema
  • Pre-proliferative: changes starting
  • Proliferative: vitreous haemorrhage from neovascularisation can be prevented by laser treatment, new vessels, increased growth of blood vessels increases vitreous haemorrhage risk and blood vessels grow over retina impairing vision
    • Can give anti-VEGF drugs, but often don’t work beyond 18 months
    • See cotton wool spots, flame haemorrhages and dot-blot haemorrhages
    • Cataracts and glaucoma more common in diabetes patients

Nephropathy

  • World leading cause of end stage kidney disease is diabetes - persistent eGFR < 60m/min/1.73 OR increased albuminuria (albuminuria in 2 out of 3 tests)
  • Enough nephropathy for proteinuria - ACEi is renoprotective
  • Albuminuria
    • 2.5mg/mmol males
    • 3.5 mg/mmol females
138
Q

What are the macrovascular diabetic complications?

A

CVD - silent MI (impaired pain response in diabetics)

PVD - medial surface 1st MT head, lateral surface 5th MT, secondary infections (staph aurea, strep)

Cerebrovascular Disease - stroke, TIA, multi infarct dementia

139
Q

What are the neuropahic diabetic complications?

A

Peripheral - neuropathy (glove and stocking), amputation required

Autonomic - gastroporesis (slowed gastric emptying - vagal nerve damage), postural hypotension, erectile dysfunction

140
Q

What are some treatment/management options for diabetic complications?

A

Eyes - optometrist visits, laser treatment, glucose control, smoking cessation, anti-VEGF

Kidneys - BP control (130/90), glucose control (7%/53mmol), early detection and treatment of UTIs, avoid nephrotoxic agents (contrast, gentamicin), glucose lowering agent (SGLT2i)

Nerves - glucose control, antidepressants/antiepileptics for neuropathic pain (pregabalin, amytriptyline, venlafaxine, tramadol), prevent ulcers with regular foot checking and podiatry visits

Heart - BP management (ACEi, ARBs), lifestyle modification, statins (atorvastatin), fenofibrate (lower HDL levels)

141
Q

What are the red flags in dermatology?

A

Skin pain

Blisters or pustules - esp. if widespread

“Punched out” lesions - may be malignancy

Mucosal involvement - usually implies more generalised skin disease

Rapid change in any presentation

Purpura - meningococcal ecchymosis, serious vascular bleeding disorfer

Confluent erythema

Facial swelling, tongue swelling, hoarse voice, difficulty swallowing or breathing

Urticaria

Purpura

Blistering

Skin pain

Mucosal involvement

Change in size, shape, colour of a lesion

142
Q

What are the types of tinea?

A

Corporis - polycyclic, scaly rash, AKA ringworm

Pedis - interdigital and sides of feet

Unguium (onychomycosis) - nails

Cruris - genitals, jock itch, also look at feet and nails

Capitis - scarring on the scalp, bald spots

143
Q

What are the features of HSV?

A

Chickenpox in kids

Reactivation as shingles (dormant in DRG) - vesicular rash in dermatomal pattern

Can cause chronic neuropathic pain

144
Q

What are school sores and how are they treated?

A

Staph aures infection

Flucloxacillin or cephalexin

145
Q

What causes cellulitis?

A

Group A strep (strep pyogenes) and staph aureus

146
Q

What is the treatment for tinea?

A

Cortisone gets rid of redness and itch, but promotes growth

Skin: imidazole, terbinafine - bd topical treatment for 3-4 weeks

Extensive skin infections respond to oral griseofulvin for 4 weeks or terbinafine, itraconazole or fluconazole

147
Q

What are the features of paracetamol?

A

Acetaminophen

Acts in the CNS to inhibit peripheral prostaglandin receptors - for analgesia and antipyrexia

Causes hepatic necrosis in overdoes (need to give N-acetyl-cysteine)

148
Q

What are the features of NSAIDs?

A

Inhibit COX to prevent prostaglandin formation

Adverse effects - anti-platelet, kidney damage, peptic ulcers (reduced gastric mucous secretion), bronchospasm (PGD2 blocked - bronchospasm)

149
Q

What are the features of opiods?

A

Block opiod receptors for analgesia

Side Effects - nausea and vomiting, respiratory depression, euphoria, urinary retention, bradycardia, miosis

150
Q

What factors reduce fracture healing?

A

Diabetes

Smoking

Poor nutrition

151
Q

What is primary fracture management?

A

Biers block - IV regional anaesthesia

Numb limb with tourniquet to manipulate fracture

Wash with saline

Intramuscular analgesia

Dress with sterile gauze

IV antibiotics

Tetanus prophylaxis

152
Q

What ions are in the extracellular and intracellular volumes?

A

Extra - sodium, chloride

Intra - potassium, organic anions

153
Q

What happens if plasma sodium is low?

A

ICV is high

154
Q

How can you tell if body sodium is high?

A

Signs of fluid retention - raised JVP, peripheral oedema, pulmonary oedema, weight gain

155
Q

What would make ECV low?

A

Vomiting and diarrhoea - fluid loss

156
Q

How does saline change ECV and ICV?

A

Only increase in ECV - as sodium is retained and water collects in ECV

157
Q

How does water change ECV and ICV?

A

Increases both due to distrubution

158
Q

What are the signs and symptoms of an intracranial mass/raised ICP?

A

Headache

Papilloedema

Nausea and vomiting

Visual disturbances

Neurological deficit

Behavioural changes

Confusion/hallucinations

6th cranial nerve palsy - eyes turned in

Seizures

159
Q

What are the investigations for a person with suspected intracranial mass?

A

FBE

U&E

CT

CXR

MRI

160
Q

What are the features of a glioma?

A

Tumour starting in brain parenchuma (astrocytoma, oligocytoma)

Glioblastoma multiforme (astrocytoma) - rapid aggressive tumour (chronic spastic paraparesis)

Headaches, visioon loss, pain, numbness

161
Q

What are the features of a meningioma?

A

Benign brain tumour - common in middle aged women

Compressive rather than infiltrative - may be asymptomatic due to lack of damage to brain tissue

Causes raised ICP - seizures, papilloedema, diplopia, facial twiting, neurological deficit, incontinence, weakness

Slow growing

CSF protein elevated

162
Q

What are the features of brain metastases?

A

More common than primary brain tumour

From lung, breast, melanoma, GIT, kidney

Present with rasied ICP deficit/seizures

163
Q

What are the features and treatment of pituitary adenoma?

A

Bitemporal hemianopia

May secrete hormones leading to cushings, acromegaly, prolactinoma etc

Micro <10mm, macro >10mm

Treat with surgical resection (likely recur due to delicate surgery) - treat hormone imbalances

164
Q

What are the features and treatment of an acoustic neuroma?

A

Schwann cell origin - cause unilateral hearing loss, headaches, bells palsy

Diagnose via MRI

Treatment - surgical resection, radiation, observation

>4cm can cause hydrocephalous

165
Q

What is the treatment for a glioma?

A

Steroids - dexamethasone and mannitol

Resection

Adjuvant Therapy - temozolomide

166
Q

What is the treatment for meningioma?

A

Resection

Radiotherapy

167
Q

What is the treatment for brain metastases?

A

Steroids - dexamethasone

Resection (unlikely)

Primary tumour diagnosis and adjuvant therapy

168
Q

What distinguishes between diastolic and systolic heart failure?

A

Reduced EF: less than 40% –> heart failure due to systolic dysfunction of LV

Heart failure with preserved EF (50-75%), diastolic failure

169
Q

What are the signs and symptoms of heart failure?

A

SOB - worse with exercise and lying down (orthopnea), PND

Fatigue

Peripheral and sarcal oedema

Hypotension (low CO) - reduced muscle perfusion and strength

Chest pain - angina on exertion

Left

  • Pulmonary oedema
  • Tachypnoea
  • Increased WOB
  • Crackles
  • Cyanosis
  • Displaced apex beat
  • Orthopnea
  • Low exercise tolerance
  • Fatigue
  • Confusion
  • Dizzy
  • SOB

Right

  • Elevated JVP
  • Peripheral oedema
  • Hepatomegaly
  • Ascites
  • Parasternal heave
  • Sacral oedema
  • Nocturia
  • Jaundice
  • Coagulopathy
170
Q

What are the common underlying conditions of heart failure?

A

Coronary artery disease

MI

HTN

AF

Valvular heart disease

Rheumatic fever

Excess alcohol use

Infection

Cardiomyopathy

Congenital heart disease

Endocarditis

Myocarditis

Diabetes

Alcohol, cytotoxicity - cardiomyopathy

Lung disease: COPD, asthma, cystic fibrosis, pulmonary fibrosis

Cor pulmonale

Coxsackie causing pericarditis

PE

171
Q

What is needed for heart failure diagnosis?

A

Framingham Criteria –> 2 major criteria or 1 major criteria and 2 minor criteria Major criteria include the following:

  • Paroxysmal nocturnal dyspnoea
  • Weight loss of 4.5 kg in 5 days in response to treatment
  • Neck vein distention
  • Rales
  • Acute pulmonary oedema
  • Hepatojugular reflux
  • S 3 gallop
  • Central venous pressure greater than 16 cm water
  • Circulation time of 25 seconds
  • Radiographic cardiomegaly
  • Pulmonary oedema, visceral congestion, or cardiomegaly at autopsy

Minor criteria are as follows:

  • Nocturnal cough
  • Dyspnoea on ordinary exertion
  • A decrease in vital capacity by one third the maximal value recorded
  • Pleural effusion
  • Tachycardia (rate of 120 bpm)
  • Bilateral ankle oedema

Based on history of symptoms

BNP investigation better for long term heart failure patients

Confirmed by echocardiography

Note: blood tests, ECG and CXR may be useful in determining the underlying cause

CXR Changes (erect PA film)

  • Pleural effusion
  • Heart enlargement
  • Kerley B lines - horizontal lymphatic lines, base of lungs
  • Pulmonary vessel enlargement
  • Per-hilar shadowing
172
Q

What is the treatment for heart failure?

A

Lifestyle modifications - smoking, exercise, diet

Medications - ACEi, ARB, beta blocker, vasodilator, diuretics, nitrates, digoxin, anticoagulants

Interventions - pacemaker, implanted defib, VAD, heart transplant

173
Q

What are the presenting symptoms and signs of PHTN?

A

Symptoms

  • SOB
  • Syncope - don’t rouse quickly, reset circulation
  • Lassitude (weariness)
  • Ankle swelling
  • Abdominal distension
  • Cough
  • Pleuritic chest pain
  • Haemoptysis

Signs

  • Right ventricular heave
  • Loud P2
  • 4th heart sound
  • Prominent V wave in JVP
  • Elevated JVP
  • Tricuspid regurgitation
  • Ascites
  • Pulsatile liver
174
Q

What are the presenting symptoms and signs of PE?

A

SOB (unexplained)

Hypotension

Inspiratory pleuritic pain

Collapse

Widened Aa gradient

Pulmonary HTN

DVT

Tachypnoea

Pleural rub/effusion

Cough

Haemoptysis

Fever

175
Q

What are the risk factors for PE?

A

Stasis - flight, hospital inpatient, obesity, surgery

Hypercoaguability - cancer, infection, protein C deficiency, thrombophilia, factor V leiden, dehydration, OCP/HRT

Vessel Injury - cannula, trauma, varicose veins, age, DVT

176
Q

What are the investigations for a PE and the findings?

A

CXR - usually normal OR pulmonary oedema, raised hemidiaphragm, atelectasis

D-Dimer - not specific, good for diagnosing negatives (positive is not indicative of pathology)

ECG - T wave inversion, sinus tachycardia

Troponin - elevated in large PE

VQ Scan - can rule out PE

CTPA

ABG - oxygen low, CO2 low, hyperventilation, metabolic acidosis

177
Q

What are common causes of PHTN?

A

Increased LA pressure

  • Mitral stenosis, LVF, diastolic dysfunction

Increased pulmonary blood flow

  • Left to right shunts, high flow states, excess central volume

Increased pulmonary vascular resistance

  • Vasoconstriction, obstruction, obliteration
178
Q

What is the treatment for PE?

A

Resp and haemodynamic suppoty

Thrombolytic therapy

Anticoagulation - heparin, warfarin, NOAC

179
Q

What is the treatment for PHTN?

A

Oxygen

Diuretics

Blood thinners

Treat underlying disease

180
Q

What are the red flags for a skin lesion?

A

Change in size, shape, colour

Itch, pain bleeding

Asymmetry

Border irregularity

Colour variability

Diameter >5mm

Evolution and elevation (changes)

New lesion or ugly duckling

181
Q

What are the investigations for a skin lesion?

A

Punch biopsy - may miss most important part of lesion

Shave biopsy - sample, may get false negative

Excisional biopsy - can see margins

182
Q

What is the treatment for SCC, BCC and melanoma?

A

SCC - excision, radiotherapy (high risk lesion)

BCC - cryotherapy, excision, MOHS, curettage, topical chemotherapy (imiquomid)

Melanoma - surgical excision, adjuvant therapy

183
Q

What is this lesion and what are it’s features?

A

Basal Cell Carcinoma

67% of NMSC, common, slow growing, pearly nodule with central ulceratio, telangiectasia, usually found on head and neck, rarely metastasise

184
Q

What is this lesion and what are it’s features?

A

Squamous Cell Carcinoma

33% of NMSC, aggressive, scaly bleeding lesion, can progress to cancerous lesion

Can arise from actinic keratosis –> SCC in situ (bowens - ulcerated legs) –> SCC

Most common on hands, forearms, head and neck

Smoking is a risk factor for SCC on mouth

Rapidly growing in immunosuppressed patients (can lead to death)

185
Q

What is this lesion and what are the features?

A

Melanoma

5% of skin lesions, less common and more lethal

Can metastasise

Arises from melanocytes

Risk factors - +5 dysplastic naevi, >100 naevi, previous melanoma, hx blistering sunburn, immunosuppression, red hair, fair skin, blue eyes

More common in legs in women and trunk and head in males

NEVER USE CRYOTHERAPY OR SHAVE BIOPSY ON PIGMENTED LESION

186
Q

What is this lesion and it’s features?

A

Seborrheic Keratoses

Can progress to SCC (through bowens disease)

Warty stuck on appearance, common in elderly, may grow over time

187
Q

What joints are commonly affected by osteoarthritis?

A

Knee

Shoulder

Hands and feet

Hip

188
Q

What are some risk factors for osteoarthtitis?

A

Overweight

Overuse

Injury

Genetics

189
Q

What imaging evidence is there of osteoarthritis?

A

X-ray: scotty dog (overlapping lumbar vertebrae, narrowed joint space, sclerosis)

MRI: nerve impingement, disc pathology

190
Q

What is the management of osteoarthritis?

A

Pharmacological

  • Muscle relaxants
  • NSAIDs - better for early OA when its still inflammatory
  • Paracetamol - first line

Non-pharmacological

  • Stay active
  • Heat wrap
  • Spinal manipulation
  • Surgery - joint replacement (not permanent solution)
  • Physio
  • Spinal manipulation
  • Rest
191
Q

What are the types of respiratory failure and their features?

A

Hypoxemic - Type I

  • PaO2 lower than 60mmHg (< 90% oxygen saturation) with normal or low CO2 level
  • Most common
  • V/Q mismatch - Shunting - Widening of Aa gradient (normally less than 15mmHg)
  • Can be associated with most acute lung diseases - Oedema, Pneumothorax, PE, ARDS, Obesity, Pneumonia, Pulmonary haemorrhage

Hypercapnic - Type II

  • PaCO2 greater than 50mmHg
  • Decreased alveolar ventilation - CO2 build up
  • Over time pH will become acidic, and levels of bicarbonate will increase in compensation for respiratory acidosis
  • Common causes - Drug overdose, Neuromuscular disease, Chest wall abnormalities, COPD, Asthma, Myasthenia gravis
192
Q

What is the triad for normal pressure hydrocephalus?

A

Dementia

Urinary Incontinence

Ataxia

193
Q

What is the acute management for delirium?

A

Treat underlying cause

Keep patients with same medical team in well-lit room

Minimise sensory deficits

Can use sedatives but avoid these if possible as they can prolong delirium

194
Q

What is the treatment for allergic disease?

A

Avoid allergens

Allergen specific immunotherapy

Non-specific Treatments

  • Antihistamines
  • Corticosteroids
  • Adrenaline
  • Leukotriene antagonists
  • Anti-IgE antibodies (omalizumab

Action plan

195
Q

What is the treatment for insect venom allergy?

A

Immunotherapy

196
Q

What is the treatment for food allergy?

A

Avoidance and adrenaline

197
Q

How does paracetamol dosing become toxic and how is this treated?

A

Too much paracetamol saturates glutathione pathway (CYP2E1) so there is toxic NAPQI build up which leads to widespread hepatocyte necrosis

N-acetyl-Cysteine - re-establish glutathione to metabolise NAPQI (continue until ALT starts dropping)

198
Q

What is the treatment for organophosphate poisoning?

A

Atropine

199
Q

What is the treatment for opiod overdose and what is the presentation?

A

Naloxone

Pupil constriction, respiratory depression

200
Q

What are some causes of delirium?

A

CNS - stroke, abscess, tumour, subdural haematoma

Drugs - withdrawal, steroids, antipsychotics, benzos, digoxin, alcohol, opioids

Endocrine - hyperparathyroidism, hypo/hyperthyroidism

Infection - UTI, burns, encephalitis, meningitis, sepsis, pneumonia, hypothermia

Metabolic - acid base disturbance, hepatic encephalopathy, uraemia, hypo/hyperglycaemia, electrolyte disturbance, thiamine/vitamin B12 deficiency

Other - post-op stress, mental disorder, sleep deprivation, surgery, anaesthetics, dehydration, organ failure, hypoxia

Environment - insomnia, new environment, catheter, restraint, no sensory aids, immobility, pain

201
Q

What are the risk factors and symptoms of OSA?

A

Risk Factors - age, obesity, male, alcohol, sedatives, nasal obstruction

Symptoms - heavy breathing, snoring, excessive daytime sleepiness, apnoea

202
Q

What are the features of central sleep apnoea?

A

Reduced respiratory drive - problem with rhythm of breathing (cardiac failure, high altitude, CNS disorder, idiopathic)

203
Q

What are the causes of sleep hypoventilation?

A

Reduced drive, neuromsucular disease, chest wall deformity, obesity, increased ventilation requirements

204
Q

What are the features of insomnia?

A

Trouble getting to sleep or maintaining sleep - daytime symptoms of functional impairment

Primarily due to anxiety and hyperarousal

Treat with benzos (temazepam), relaxation, sleep hygiene

205
Q

What are the features of restless leg syndrome?

A

Desire to move extremities - often associated with paraesthesia or dysesthesia - improved with movement

Treatment - opiods, benzos, pregabalin, dopamine agonists, iron replacement

206
Q

What are the types of primary sleep disorder and their features?

A

Narcolepsy - disorder of sleep regulation, REM occurs during waking time, deficient in orexin, sleep attacks (+/- paralysis or cataplexy)

Idiopathic Hypersomnia - prolonged unrefreshing naps, trouble waking, treat with stimulants

207
Q

What is the presentation, cause, risk factors, investigation and management for cellulitis?

A

Presentation - erythema, tender, chills and fever, unilateral, vesicles

Causes - group A strep (pyogenes), staph aureus

Investigation - swab, CRP, FBE, US (doppler - rule out DVT)

Risk Factors - trauma, IVDU, ulcers, wounds, derm infection (tinea), peripheral oedema, lymp stasis

Management - flucloxacillin, cephalexin, clindamycin

208
Q

What is the presentation, cause, risk factors, investigation and management for chronic lymphedema?

A

Presentation - bilateral chronic swelling and erythema

Risk Factors - trauma, cancer, obesity, inflammatory disorder, chronic venous insufficiency

Management - exercise, compression, massage, meticulous skin care

209
Q

What is the presentation, cause, risk factors, investigation and management for Necrotising Fasciitis?

A

Presentation - pain, swelling, fever, blisters, tight skin, infection

Risks - surgery, ulcers, DM, PVD, immunocompression

Causes - strep pyogenes, clostridium, vibrio, MRSA

Management - antibiotics, surgery, debridement

210
Q

What is the presentation, cause, risk factors, investigation and management for osteomyelitis?

A

Presentation - pain, fever

Causes - direct, haematogenous

Risks - prosthesis, trauma, bite, penetrating wound, vascular insufficiency

Investigations - bone sample

Management - analgesia, IV Abx

211
Q

What is the presentation, cause, risk factors, investigation and management for septic arthritis?

A

Presentation - pain, swelling, fever

Risks - trauma, RA, prosthesis, skin infection, IVDU

Investigation - joint aspirate, blood cultures

Management - joint washout, IV Abx, fluclox, cephazolin

212
Q

What are the major causes of acute and chronic travellers diarrhoea?

A

Acute - E.coli, cholera, shigella, salmonella, campylobacter, entamoeba histolytica

Chronic - giardia

213
Q

What is the management for travellers diarrhoea?

A

Rehydration

Antidiarrhoeal - loperamide

Empiric Abx - azithromycin, quinolone, ciprofloxacin

214
Q

What are the important features of malaria?

A

P vivax may cause late relapse due to liver residement

P falciparum commonest cause of death, should be considered in all travellers returning from endemic areas

Symptoms - fever, chills, pain, faituge, malaise, nausea, vomiting, diarrhoea, cough

Diagnosis via thick and thin blood smear

Treat with chlorowuine then primaquine for vivax and artemetherlumafantrine for falciparum

215
Q

What are the important features of enteric fever?

A

Salmonella and paratyphi

Non-specific febrile illness

Can cause bowel perforation and GI bleeds

Diagnosis with FBE (normal WCC with left shift), LFT (abnormal), blood (gram negative bacilli)

Treatment: ceftriaxone, azithromycin

216
Q

What are the important features of dengue fever?

A

Flaviviruses from mosquitoes

Undifferentiated fever

Early neutropenia with subsequent lymphocytosis

Low platelets and elevated transaminases = severe disease

Management - supportive

217
Q

What is this pathology and what are the main features?

A

CHRONIC MYELOID LUEKAEMIA

Signs & Symptoms - mass, hepatosplenomegaly, fatigue, loss of appetitie, weight loss, night sweats

Investigations - leukocytosis, hypercellular blasts in bone marrow, philadelphia chromosome (9:22) - BCR-ABL

Management - imatinib (tyrosine kinase inhibitor)

218
Q

What is this pathology and what are the main features?

A

CHRONIC LYMPHOCYTIC LEUKAEMIA

Signs & Symptoms - fatigue, weight loss, appetitie loss, lymphadenopathy, splenomegaly

Investigations - lymphocytopenia, smear cells, B cells expressing CD5

Management - chemoimmunotherapy

219
Q

What is this pathology and what are the main features?

A

ACUTE MYELOID LEUKAEMIA

Signs & Symptoms - bruising, bleeding (DIC, thrombocytopenia), fatigue

Investigations - low haemoglobin, pancytopenia, high INR, blasts nad promyelocytes with auer rods and faggot cells

Management - platelet transfusion, trans retinoic acid, arsenic and idarubicin

220
Q

What is this pathology and what are the main features?

A

ACUTE LYMPHOCYTIC LEUKAEMIA

Signs & Symptoms - kids, dizzy, SOB, weight loss, fatigue, flushing

Investigations - low Hb, high urate, LDH, calcium, phosphate, potassium, CXR (wide mediastinum, lymphadenopathy)

Management - chemotherapy

Foundation MD2 (1 decks)

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