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Y4 - Finals Edition > Lectures : Med C > Flashcards

Lectures : Med C Flashcards

1
Q

4 Geriatric giants

A
  1. Mobility impairment
  2. Falls
  3. Confusion
  4. Incontinence
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2
Q

Examples of surrogate measures that were used to identify frailty:

A

BOURNEMOUTH CRITERIA
1. Patients over 90 years of age

  1. aged 75-89 w/ 2 or more of the following
    a) Immobility
    b) incontinence
    c) instability
    d) intellectual impairment
    e) iatrogenesis
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3
Q

What is pseudomembraneous colitis?

A
  • inflammatory condition of colon
  • C. DIFFICLE
  • volcanic-like eruption with superficial pseudo membrane formation
  • raised yellow white plaques that coalesce to form pseudo membrane on mucosa
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4
Q

How might biopsy location affect the pathology:

A
  1. Samples from subcapsular cortex
    • may give overestimation of glomerular sclerosis
    • this is area in kidney most affected by aging, HTN or non-specific scaring
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5
Q

What classification is used for Acute Kidney Injury?

A

KDIGO Classification

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6
Q

Drugs with narrow therapeutic index

A

Careful, Watch Drugs Possessing Low Therapeutic Indexes

Carbamazepine
Warfarin
Digoxin
Phenytoin
Lithium / levothyroxine
Theophylline
Immunosuppressants (tacrolimus / cyclosporin)

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7
Q

Give examples of two drugs which are eliminated via biliary excretion:

A
  1. Rifampicin
  2. Fucidic acid
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8
Q

Drugs that affect renal perfusion

A
  1. NSAIDs
  2. ACEi
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9
Q

Instead of LMWH what might be better to give to patients who have renal impairment:

A

unfractionated heparin
- greater molecular weight
- not filtered

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10
Q

Drugs which increase risk of spontaneous bacterial peritonitis in patients with ascites ?

A

PPI
- leads to reduction in gastric acidity
- increase in intestinal permeability
- promotes bacterial translocation and colonization of mesenteric lymph nodes

H2 receptor antagonists
- decrease gastric acid secretion
- reversibly binding to histamine H2 receptors on gastric parietal cells

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11
Q

When might Paracetamol toxicity occur:

A
  1. When glucuronidation and sulfation pathways are saturated
    • increases proportion converted to toxic metabolite NAPQI
      ——–>HEPATOCYTE NECROSIS
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12
Q

When should a medication review be carried out in elderly patients?

A

1-3 drugs
- every 12 months

4 drugs or more
- every 6 months

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13
Q

Churg-Strauss Syndrome aka

A

Eosinophilic granulomatosis with polyangiitis

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14
Q

What is Berger’s disease?

A

Type of glomerulonephritis
- IgA1-IgG complex deposition in mesangium

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15
Q

Two differential diagnoses for IgA nephropathy

A
  1. Thin membrane disease
    • inherited, thinning of glomerular basement membrane by gene mutations of type 4 collagen a3 or a4
  2. Alport disease
    • disease which damages tiny blood vessels in kidney, attacks glomeruli
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16
Q

What histopathologic scoring system is used for prognostic staging in IgA nephropathy:

A

OXFORD classification - MEST-c SCORE

M-mesangial hyper cellularity

E-endothelial hyper cellularity

S-segmental glomerulosclerosis

T-Tubular atrophy / interstitial fibrosis

C- crescent formation

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17
Q

Management of IgA nephropathy (non-immunosuppressive)

A
  1. Lifestyle
  2. BP < 130/80mmHg
  3. ACEi
  4. Lipid lowering therapy
18
Q

Sjogren’s syndrome characterised by:

A
  • Dry eyes
  • Dry mouth
  • Dry vagina
  • Dry skin
19
Q

What antibodies are associated with Sjogren’s syndrome?

A

Anti Ro / Anti La

20% have ANA

20
Q

Key features of giant cell arteritis

A
  • diplopia
  • amaurosis fugax
  • visual loss
  • tongue / jaw claudication

associated with polymyalgia RHEUMATICA

21
Q

Management of GCA

A

No visual disturbance –> 40mg OD pred

Visual disturbance –> 60mg OD pred

Visual loss –> IV methylpred 500-100mg up to 3 doses

REFER TO OPTHAL and RHEUM

Think about gastroprotection, bone prophylaxis and diabetes

22
Q

Key investigations for GCA

A
  1. ESR
  2. Temporal artery USS
  3. Temporal artery biopsy
23
Q

Long term management of GCA

A
  1. Methotrexate
  2. Azithorpine
  3. Leflunomide
  4. Mycophenolate mofetil
24
Q

Antibodies associated with SLE

A

dsDNA

anti-Smith

25
Q

Systemic sclerosis limited antibodies

A

anti-centromere

26
Q

Systemic sclerosis (diffuse) antibodies

A

Scl-70

27
Q

Steroid sparing management of GCA

A

TOCILIZUMAB
- interleukin 6 receptor antibody
- for relapsing / remitting

28
Q

Case 1: 45 Female

PC: 6/52 joint pain and swelling. Stiffness lasting for at least 45 mins. Minimal relief with paracetamol and ibuprofen.

HPC: started in MCP now in wrist and PIP.

PMH: Graves disease, previous thyroidectomy

DH: levothyroxine 100 micrograms daily

Most likely diagnosis:

A

Rheumatoid arthritis

29
Q

Case 1: 45 Female

PC: 6/52 joint pain and swelling. Stiffness lasting for at least 45 mins. Minimal relief with paracetamol and ibuprofen.

HPC: started in MCP now in wrist and PIP.

PMH: Graves disease, previous thyroidectomy

DH: levothyroxine 100 micrograms daily

Risk factors for diagnosis

A
  1. Female
  2. Smoking
  3. FH - HLA DRB1
  4. Obesity
  5. Diet and alcohol
30
Q

Case 1: 45 Female

PC: 6/52 joint pain and swelling. Stiffness lasting for at least 45 mins. Minimal relief with paracetamol and ibuprofen.

HPC: started in MCP now in wrist and PIP.

PMH: Graves disease, previous thyroidectomy

DH: levothyroxine 100 micrograms daily

INVESTIGATIONS

A

Investigations

  • FBC (anaemic / chronic disease)
  • renal and liver profile
  • ESR and CRP
  • Rheumatoid factor
  • Urine dip
  • Plain XR hands and feet
  • ANTI-CCP
  • CXR
31
Q

Pharmacological treatment for Rheumatoid arthritis summarised:

A

NSAID +/- simple analgesia
- naproxen
- COX-2 selective: celecoxib, etoricoxib

Steroids
- intermittent for active disease
- IM methylpred –> intrarticular if single joint

DMARDS
–> methotrexate
–> sulphasalazine
–> hydroxychloroquine
–> leflunomide

Targetted
- anti TNF
- anti IL6
- anti CD20
- JAK inhibitors

32
Q

If a patient has a prosthetic joint, what is important to remember:

A
  • NEVER ASPIRATE A PROSTHETIC JOINT
  • done by orthopaedics
  • don’t forget blood cultures
33
Q

What criteria is used to indicate whether a joint may be septic:

A

KOCHER CRITIERA
- Probability depending on score
- 1 = 3%
- 2 = 40%
- 3 = 93%
- 4 = 99%

  • non-weight bearing
  • temp > 38.5
  • ESR > 40mm
  • WBC > 12000
34
Q

Management of septic joint :

A
  1. aspiration before ABx
  2. ABx per local pathway
    a) IV
    b) usually: Flucloxacillin 2g QDS
  3. If Gonorrhoea
    a) gram negative –> ceftriaxone
35
Q

What bacteria is the cause of most septic joints:

A
  • staph aureus
    • forms gram positive clusters
    • hence flucloxacillin can be used
  • if gonorrhoea
    • ceftriaxone
36
Q

Gout risk factors:

A
  • alcohol
  • CKD
  • medication
  • genetics
  • high purine diet
  • metabolic syndrome
37
Q

Acute gout management:

A

1. Colchicine
–> 500mg QDS (beware of diarrhoea)
–> use with caution in liver disease and low eGFR
2. NSAIDS
–> caution! if previous GI bleed
–> PPI in addition
3. Prednisolone
–> if colchicine and NSAIDs contraindicated then pred can be given with PPI

38
Q

Acute pseudogout treatment:

A
  • Colchicine
  • NSAIDs
  • prednisolone
39
Q

Antibodies for rheumatoid arthritis

A

anti-CCP

HLA-DRB1

40
Q

What is an important side effect to be aware of when prescribing allopurinol?

A

Steven Johnson Syndrome

Y4 - Finals Edition (40 decks)

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