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Lecture Random Points Flashcards

1
Q

Otalgia

Secondary Causes

A

C2/3 – arthritis/cervical spondylosis, soft tissue injury
CN V – Dental, TMJ dysfunction, nasopharyngeal
CN IX – Oropharyngeal infection, tongue malignancy
CN X – laryngeal/pharyngeal malignancy

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2
Q

Vitamin A

A

Vision by maintaining a clear cornea
Component of rhodopsin

Xerophthalmia is a progressive eye disease which begins with night blindness.

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3
Q

Vitamin D

A

Calcium

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4
Q

Thyroid bruit

Carotid bruit

A

(Grave’s thyroiditis)

carotid stenosis

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5
Q

Head & Neck Investigations

A 
FNAC - Fine Needle Aspiration Cytology
CT/MRI/PET scan
US scan
Plain X-ray
Contrast Swallow
Endoscopy
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6
Q

Neck Lump Examination

A

How long?
Fluctuates?
Site, Size, Shape, Sore, Soft, Skin, Stuck
Symptoms?

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7
Q

Reactive lymph node appearance

Can Turn to Non Hodgkins Lymphoma
+night sweats and loss of apetite

A 
*Oval
Soft
Smooth
*Mobile
*Tender
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8
Q

Malignant neck node appearance

Squamous Carcinoma Commonest

A 
*Round
Firm
Irregular
*Fixed
*Non-tender
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9
Q

Bacterial Tonsillitis – Offer Tonsillectomy if?

A

Pus covering neck nodes, fever, no cough

6-7 attacks in 1 year
(5 per year over two years, 3 per year over three years)
Disrupting daily activities
More than 1 quinsy

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10
Q

Necrotising otitis externa common causative organism?

A

Pseudomonas Aeruginosa

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11
Q

Post thyroidectomy patient presents with a hoarse voice and is found to have a paralysed right vocal cord. Which nerve has been damaged?

A

Reccurent Laryngeal Nerve

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12
Q

Family history of MEN (multiple endocrine neoplasia) Presents with an anterior neck swelling and WL.
She is found to have a high calcitonin on blood tests.

A

Medullary thyroid cancer

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13
Q

A 5 year old girl presents with a 3 week history of foul smelling unilateral nasal discharge. She is afebrile and otherwise asymptomatic. What is the likely diagnosis?

A

Retained foreign body

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14
Q

Anterior 2/3rd of Tongue

Posterior 1/3rd of Tongue

A

From 1st branchial arch
Sensation by lingual nerve (branch of CN V3)
Taste by chorda tympani (branch of CN VII)

From 3rd branchial arch
Supplied by CN IX

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15
Q

A 30 year old woman presents with episodes of severe pain above the left eye, associated with photophobia and visual disturbance and not improved by a nasal steroid spray. Treatment?

A

Amitriptiline - tricyclic antidepressant.

Lower doses are also widely used to block the long-term (chronic) pain of some rheumatic conditions

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16
Q

Thyroid gland produces Calcitonin which?

A

Calcitonin acts to lower calcium and raise phosphate

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17
Q

Thyroglossal cyst

A

Dilatation of thyroglossal duct remnant
Moves on tongue protrusion
Need ultrasound scan prior to removal

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18
Q

THYROID LOBECTOMY

A

tissue required for histological diagnosis

FNAC cannot distinguish bw Follicular Adenoma/Carcin

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19
Q

Thyroid cancer

A

Papillary - Lymphatic metastasis

Follicular - Haematogenous metastasis

Medullary - 10% familial, arise from *Parafollicular C cells

Anaplastic - aggressive, local spread, old, poor progn.

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20
Q

Colloid goitre

A

Gland hyperplasia
Iodine deficiency
Puberty, pregnancy, lactation

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21
Q

Multi-nodular goitre

A

GRAVES
Middle aged Women
Over activity→hyperthyroidism
Pre-tibial myxoedema

TOXIC GOITRE
Older, No eye signs,
Atrial fibrillation

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22
Q

Stridor

Clinical sign of airway obstruction and Treatment

A

Inspiratory - laryngeal
Expiratory - tracheobronchial
Biphasic – glottic/subglottic

O2, Nebulised Adrenaline, IV Dexamethasone

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23
Q

Branchial cyst

A

Remnant of fusion failure of branchial arches
OR lymph node cystic degeneration

Transilluminates

Anterior to sternocleidomastoid at Junction bw U+M 3rd

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24
Q

Pharyngeal pouch

A

Herniation of pharyngeal mucosa between
thyropharyngeus and cricopharyngeus muscles of the
inferior constrictor of the pharynx

Voice hoarseness Regurgitation
Dysphagia Weight loss
Aspiration pneumonia Neoplasia 1%

Barium swallow;
Excision (endoscopic or open)

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25
Epidermis Layers
``` Stratum Croneum Lucidium Granulosum Spinosum Basale ```
26
Acne Vulgaris Medication
Mild Acne - Salicylic Acid, Benzoyl Peroxidase Moderate - Tetracycline Abx, Spironolactone Severe - Isotretinoin (Vit A derivative, impacts sebum secretion)
27
Pyoderma Gangrenosum
IBD, Myeloma
28
Acanthosis Nigricans
Malignancy, Acromegaly, Scleroderma, Wilson's Disease (excess copper - genetic)
29
Erethyma Nodosum
Infection: Streptococcus, TB Sarcoidosis IBD Sulfonamides - Furosemide (loop diuretic)
30
Dermatitis Herpetiformis
Coeliac Disease
31
Psoriasis Symptoms Management Index Risk Factors
Chronic, Autoimmune, Non Contagious Polygenic Prodisposition + Environmental triggers (Infection, Drugs, Trauma, Sunlight) *Sharply defined erythematous plaque (Salmon colour) Inflamed red from blood vessels - angiogenesis Numerous small, widely disseminated papules, plaques Scalp and Behind the ear *Nails - Onycholysis, pitting, oil spots Koebner Phenomenon - Occur over trauma sites Psoriasis Area Severity Index (PASI) Surface area, plaque colour, thickness, scale Dermatology Life Quality Index (DLQI)
32
Types of Psoriasis
Chronic Plaque Psoriasis - symmetric, extensor surfaces Scaly plaques on both *elbows, Hypertension Large salmon coloured plaques on his arms, legs and back with thick scale. Guttate psoriasis - Children, adolescents. Can be *triggered by viral or bacterial infections. Pustular Psoriasis - Sterile pustules, sometimes systemic symptoms - Pregnancy, rapid taper/stop steroids, hypocalcaemia, infection Erythrodermi Psoriasis - Fire-red scales
33
Psoriasis Treatment
Emollients - Creams vs Ointments, Soap substitutes (clear plaques and minimise itchiness) Vitamin D3 analogues: inhibit epidermal proliferation Coal Tar creams Topical Steroid Salicylic acid (keratolytic) UV Phototherapy (damage karatynocytes DNA) Systemic Retinoid - Acitretin (Teratogenic, LFTs, lipids) Immunosuppression - Ciclosporin (Renal cancer risk) Biologic Therapies - Anti-TNF (Infliximab)
34
Aetiology Mechanism of Psoriasis
T cells (epidermal: CD8, dermal CD4&8) Stressed keratinocytes Activation of dermal dendritic cells (dDCs) by interleukins, TNF alpha (cause Inflammation) Differentiation into Th (T helper) Associated with cardiovascular disease, smoking, alcohol, the metabolic syndrome, depression
35
Eczema - Atopic Dermatitis
Allergic Skin Inflammation - Type 1 Hypersensitivity Inherited *Atopy related (Asthma, Allergic Rhinitis) Itchy, il-defined erethymatous scaly patches on flexor surfaces, oedema, vesicles Emollients, Frequent Moisturising Oral Antihistamines
36
Leukocoria
Physical exam finding of a white pupillary reflex. Retinoblastoma and cataract formation are the most common causes in children.
37
DM and COPD - difficulty with driving at night. He sees halos around lights and has difficulty with the glare. He is far-sighted and reports that over the last year, his vision initially seemed to be improving as he no longer required his glasses for distance vision. However, his vision has since deteriorated.
Cataracts can result from high levels of galactitol in the lens, due to a deficiency in galactokinase.
38
Eczema Aetiology
``` Filaggrin gene Atopic family history Epidermal barrier dysfunction Environmental factors Immune system dysregulation ``` Spongiosis (intercellular oedema) within the epidermis. Acanthosis (thickening of the epidermis). Inflammation - Superficial perivascular lymphohistiocytic infiltrate
39
Embryology of Head and Neck
Skull = mesenchyma Face = mesenchymal process Neck, Thyroid, Parathyroid Tongue = Branchial + Pharyngeal arches 1st Arch - V3, Anterior Digastric, Maxillary Process 2nd - VII and all the muscles supplied by it 3rd - Cr.N IX 4th - Superior Laryngeal Nerve - part of vagus 6th - Recurrent Laryngeal Nerve
40
Benign Tumour
Face Lump, Painless No change in size/colour commonest is PSA (Pleiomorphic Salivary Adenoma) Ix: FNAC, Rx: Lumpectomy, Partial Parotidectomy
41
A 56 year lady with 1 year history of type 2 diabetes, 7 month history of hypertension, complains of increasing central obesity and tiredness. (normal ranges in parentheses) Urinary free cortisol markedly elevated (5 X normal upper limit) Early morning cortisol 2000 nmol/l (138- 690) Midnight cortisol 1500 nmol/l (138- 690) Early morning ACTH 0.4 pmol/l (1.3 to 16.7) Midnight ACTH 0.2 pmol/l (1.3 to 16.7)
Adrenal Carcinoma (ACTH Independent)
42
Nephron Renal corpuscles (blood-filtering component of the nephron of the kidney)
Renal corpuscles + renal tubules Glomerulus + bowmen’s capsule
43
Nephrotic syndrome
Minimal change disease | Membranous nephropathy
44
Nephritic state
Anti-neutrophil cytoplasmic antibody (ANCA) associated | Post-infection glomerlunephritis
45
Post-infective glomerulonephritis: Treatment
``` Loop diuretics such as frusemide for oedema Vasodilator drugs (e.g. amlodipine) for hypertension ```
46
IgA nephropathy
IgA deposition in mesangium + mesangial proliferation | Most common in 2nd and 3rd decade in males
47
Nephrotic syndrome-management
Treat oedema: salt, fluid restriction and loop diuretics. Hypertension: Renin-Angiotensin-Aldosterone-blocker Reduce risk of thrombosis: Heparin or Warfarin. Reduce risk of infection e.g. pneumococcal vaccine. Treat dyslipidemia e.g. statins.
48
Minimal Change Nephrotic Syndrome
Commonest form in children Sudden onset of oedema - days Complete loss of proteinuria with steroids (Prednisolone) Subsequent relapses treated with Cyclophosphamide Cyclosporin Tacrolimus
49
Transplanted kidney is placed into? Indications for native nephrectomy
Iliac fossa and anastomosed to the iliac vessels Size (polycystic kidneys) and infection (chronic pyelonephritis)
50
Types of hormonal therapy for prostate cancer
Surgical castration (i.e. bilateral orchidectomy) ``` Chemical castration (LHRH analogue – goserelin) Down regulates androgen receptors by -VE feedback ``` Oestrogens (i.e. diethylstilboestrol) Inhibits LHRH and testosterone secretion and has direct cytotoxic effect on prostatic epithelial cells Anti-androgens - inhibits androgen receptors
51
Acute Kidney Injury (AKI) (ARF)
Risk - Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours Injury - Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours Failure - Increase in serum creatinine level (3.0x), or decrease in GFR by 75%, or serum creatinine level >355μmol/L with acute increase of >44μmol/L; or UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours Loss - Persistent ARF or complete loss of kidney function >4 weeks End-stage kidney disease - complete loss of kidney function >3 months
52
Chronic urinary retention Acute urinary retention
Defined as ‘painless, palpable and percussible bladder after voiding. Mainly due to detrusor underactivity Defined as ‘painful inability to void with a palpable and percussible bladder’ RF is Benign Prostatic Obstruction
53
Types of renal replacement therapy
Renal transplant Haemodialysis Peritoneal dialysis - Continuous ambulatory peritoneal dialysis (CAPD) - Intermittent peritoneal dialysis (IPD) Conservative Kidney Management
54
Dialysis
Solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane Diffusion and Ultrafiltration
55
Types of renal replacement therapy
Renal transplant Haemodialysis Peritoneal dialysis - Continuous ambulatory peritoneal dialysis (CAPD) - Intermittent peritoneal dialysis (IPD) Conservative Kidney Management
56
Haemodialysis Access
Permanent (Arteriovenous fistula, AV prosthetic graft) Temporary (Tunnelled / Temporary venous catheter)
57
Restrictions for dialysis patients
Fluid restriction - Dictated by residual urine output - Interdialytic WG Dietary restriction - Potassium, Sodium, Phosphate
58
Peritoneal dialysis fluids
The dialysate contains a balanced concentration of electrolytes Glucose is the most common osmotic agent for ultrafiltration of fluid
59
Indications for dialysis in ESRD
Advanced uraemia, (GFR 5-10 ml/min) Severe acidosis (bicarbonate <10 mmol/l) Treatment resistant hyperkalaemia (K >6.5 mmol/l) Treatment resistant fluid overload
60
Dialysis Related Drugs
``` Anaemia Erythropoietin injections IV iron supplements Renal Bone Disease Activated Vitamin D (eg calcitriol) Phosphate binders with meals (CaCo3) Heparin Water soluble vitamins Antihypertensives ```
61
Complications of haemodialysis
Cardiovasular problems Intra-dialytic hypotension and cramps Arrythmias Coagulation Clotting of vascular access Heparin related problems Allergic reactions to dialysers and tubing
62
When to suspect a systemic disease with renal involvement?
CVS - Hypertension, murmur Chest - Crepitations, haemoptysis Locomotor - Joint swelling, tenderness CNS - Stroke, encephalopathy

Revision Year 2 (14 decks)

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