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BPT Clinical > Long Case > Flashcards

Long Case Flashcards

1
Q

What investigations should be ordered for resistant hypertension?

A 
electrolytes
glucose
creatinine
urine ACR
ambulatory blood pressure monitor 
screen for primary aldosteronism
image for renal artery stenosis
sleep study
urinary catecholamines
investigations for cushing’s
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2
Q

What did the sprint study show?

A

intensive blood pressure management (SBP 120) had reduced death from any cause compared with standard management (SBP 130-140)

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3
Q

NYHA classes?

A

NYHA I: no symptoms even during exercise
NYHA II: symptoms with moderate exercise
NYHA III: symptoms with slight exercise
NYHA IV: symptomatic at rest

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4
Q

First line therapy for all heart failure patients?

A

treat iron deficiency (if ferritin < 100 and tsats < 20%)
lifestyle modification: exercise, weight loss, reduce salt and fluid intake, smoking cessation, reduce EtOH intake
education
avoid exacerbating drugs
manage comorbidities - sleep apnoea, depression

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5
Q

Which heart failure patients qualify for cardiac resynchronisation therapy?

A

LVEF < 35% and QRS > 150

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6
Q

Which heart failure patients qualify for ICD?

A

LVEF < 35% and NYHA class II to III

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7
Q

What are the causes of pulmonary hypertension?

A 
pulmonary arterial hypertension
due to left heart disease
due to lung disease
CTEPH
unclear
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8
Q

What investigations should be done for pulmonary hypertension?

A 
CXR
ECG
TTE
right heart catheterisation
RFTs
V/Q scan
HRCT
sleep study
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9
Q

What management may be beneficial for all types of pulmonary hypertension?

A

diuretics
oxygen (mortality benefit if group 3)
exercise training
transplantation

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10
Q

What are the lipid targets for IHD?

A

LDL < 1.8 and TC < 4

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11
Q

Complications of long term steroids?

A 
infections 
osteoporosis
hyperglycaemia 
skin thinning
moon facies
buffalo hump
ecchymoses
obesity 
cataracts
glaucoma 
fluid retention
hypertension
premature atherosclerotic disease
atrial fibrillation 
myopathy 
mood disorders
psychosis
leukocytosis 
avascular necrosis
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12
Q

First line investigations for cushings?

A

late night salivary cortisol
24 hour urinary free cortisol
low dose dexamethasone suppression test

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13
Q

What are the anterior pituitary hormones?

A 
GH
FSH
LH
ACTH
TSH
prolactin
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14
Q

What is the definition of osteoporosis on T score?

A

osteopaenia -1 to -2.5

osteoporosis < -2.5

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15
Q

If T score not < -2.5 and no minimal trauma fracture what is the indication for osteoporosis treatment?

A

using FRAX calculator hip fracture risk > 3% or any fracture > 20%
OR T < -1.5 and on prednisolone > 7.5mg for 3/12

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16
Q

How often should DEXA scans be repeated?

A

2 yearly once diagnosed

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17
Q

What tests should be done for a secondary osteoporosis screen?

A

FBE, UEC, SPEP, serum FLCs, UPEP, LFTs, CMP, vitamin D, PTH, TSH, ESR, CRP, testosterone
consider: coeliac antibodies, oestrogen/LH/FSH in women, hypercortisolism screen

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18
Q

What is the MOA of bisphosphonates?

A

binds hydroxyapeptite in bone and act as osteoclast toxin

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19
Q

Side effects of bisphosphonates?

A

GI irritation (oral)
flu like symptoms, hypocalcaemia (IV)
atypical femoral fracture
osteonecrosis of the jaw

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20
Q

What is the MOA of denosumab?

A

antibody that binds RANKL to prevent osteoclast bone resorption

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21
Q

What is the general HbA1c target?

A

<1%

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22
Q

What did the DAPA-HF study show?

A

reduced risk of worsening heart failure or death from cardiovascular disease in HFrEF patients regardless of whether they had diabetes

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23
Q

What are the relative contraindications for SGLT2 inhibitors?

A

general thrush infections, recurrent UTI, ketosis prone, frail elderly, prone to dehydration, immunocompromised, active foot ulcer

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24
Q

When are DPP-4 inhibitors contraindicated?

A

previous pancreatitis

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25
Q

What are the side effects of GLP1 agonists?

A

nausea (usually transient), ?pancreatitis, ?neuroendocrine tumours, injection site nodules

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26
Q

To what GFR can SGLT2 inhibitors be used?

A

according to AMH < 30 as at this level will have reduced glycaemic lowering effect but may still have benefits for CV risk and BP control

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27
Q

What investigations should be ordered in a liver screen?

A 
hepatitis serology (A/B/C)
EBV CMV
Anti-mitochondrial antibody
Anti-smooth muscle antibody 
Anti-liver/kidney microsomal antibodies 
Anti-nuclear antibody 
p-ANCA
Alpha-1 Antitrypsin
Serum Copper 
Ceruloplasmin 
Ferritin
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28
Q

What investigations should be done for coeliac disease?

A

tTG-IgA (tissue tranglutaminase antibody) + total IgA level
OR
tTG-IgA and DPG-IgG (deamidated gliadin peptide)

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29
Q

What other tests should be done in a new diagnosis of coeliac disease?

A 
DEXA
TSH
fasting BSL
LFTs
nutrition assessment: iron, B12, folate, vitamin D, magnesium, zinc
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30
Q

What are the extra intestinal manifestations of IBD?

A 
oral ulcers
erythema nodosum 
large joint arthritis
episcleritis
primary sclerosing cholangitis 
ankylosing spondylitis
uveitis
pyoderma gangrenosum
kidney stones, gallstones
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31
Q

Which medications are used for crohn’s?

A

corticosteroids
thiopurines
methotrexate
biologics

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32
Q

Which biologics are used for crohn’s?

A

infliximab/adalimumab (anti TNF)
vedolizumab
ustekinumab

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33
Q

What pharmacotherapy options are available for fatty liver disease?

A

none on PBS
metformin - but doesn’t improve histology
pioglitazone - but risk of weight gain, CCF, osteoporosis
vitamin E - but risk of haemorrhagic stroke
liraglutide

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34
Q

What are the complications of fatty liver disease?

A 
fibrosis
cirrhosis
HCC
CVD (independent risk factor)
mortality (all cause)
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35
Q

What are the extra hepatic manifestations of hepatitis C?

A 
membranoproliferative GN
porphyria cutanea tarda
cryoglobulinaemia 
lymphoproliferative disorders
lichen planus
thyroid dysfunction
diabetes
sjogren’s syndrome
polyarthritis
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36
Q

What issues need to be considered for direct acting antiviral therapy for hepatitis C?

A 
genotype
presence of cirrhosis
concomitant medications/drug interactions (PPIs, statins, amiodarone, anti epileptics) 
HBV HIV serology
eGFR
avoidance of pregnancy
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37
Q

What investigations should be done in a patient with chronic hepatitis B?

A 
HBeAg
HBV DNA
hep A IgG, Hep C Ab, Hep D Ab, HIV
LFTs
INR
AFP
liver US
fibroscan
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38
Q

Which patients with HCC are eligible for transplant?

A

a single nodule < 6.5cm or up to 3 nodules the largest of which is < 4.5cm

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39
Q

What is the treatment for PBC?

A

ursodeoxycholic acid

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40
Q

What is PSC associated with?

A

UC

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41
Q

What additional treatments are available for UC but not crohns?

A

5-aminosalicylates

cyclosporin

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42
Q

How often should patients with UC have a colonoscopy to monitor for bowel cancer?

A

every 3 years after 9 years

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43
Q

What are the treatment related complications of UC?

A

infections
lymphoma
non melanoma skin cancer (thiopurines)
melanoma (anti TNF)

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44
Q

What are the causes of microcytic anaemia?

A 
iron deficiency
thalassaemia
anaemia of chronic disease
sideroblastic anaemia
lead poisoning
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45
Q

What are the causes of normocytic anaemia?

A 
bleeding
haemolysis
anaemia of chronic disease
renal failure
bone marrow failure
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46
Q

What are the causes of macrocytic anaemia?

A 
B12 deficiency
folate deficiency
drugs
alcohol
chronic liver disease
reticulocytosis
hypothyroidism
MDS
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47
Q

What are the elements of the child pugh score?

A 
encephalopathy
INR
ascites
albumin
bilirubin
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48
Q

What diet should chronic liver disease patients be on?

A

high protein low salt

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49
Q

What are the complications of chronic liver disease?

A 
oesophageal varices
ascites +/- SBP
hepatic encephalopathy 
malnutrition
sarcopaenia
osteoporosis
coagulopathy
thrombocytopaenia
hepatorenal syndrome
hepatopulmonary syndrome
HCC
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50
Q

When should patients with chronic liver disease have gastroscopy?

A

screening gastroscopy then annually if small varices and second yearly if no varices

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51
Q

What is the primary prophylaxis for oesophageal varices?

A

non selective beta blocker or endoscopic band ligation

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52
Q

What is the secondary prophylaxis for oesophageal varices?

A

variceal banding and non selective beta blocker

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53
Q

What is the pharmacological treatment for ascites?

A

spironolactone 100mg daily +/- frusemide 20mg daily

max dose spironolactone 400mg daily

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54
Q

How is spontaneous bacterial peritonitis diagnosed?

A

> 500 leuks or > 250 PMN in ascitic tap

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55
Q

When is primary prophylaxis indicated for SBP?

A

if low protein < 10g/L or bili >50 with impaired renal function

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56
Q

What are precipitating factors for hepatorenal syndrome?

A

sepsis/bleeding, acute on chronic liver failure, NSAIDs, paracentesis without albumin replacement, recent TIPS

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57
Q

What is the treatment for hepatorenal syndrome?

A

avoid nephrotoxic drugs, treat underlying precipitants, withhold diuretics, albumin, terlipressin

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58
Q

What are the precipitants for hepatic encephalopathy?

A

infection, bleeding, constipation, diarrhoea, metabolic/electrolyte derangement, drugs (opioids, benzos)

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59
Q

What is the treatment for warfarin reversal if life threatening bleeding?

A

vitamin K infusion
prothrombinex
FFP

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60
Q

What are the common sites affected in graft vs host disease?

A

skin, GIT, liver, lungs, mucosal surfaces

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61
Q

What is the treatment for graft vs host disease?

A

steroids

calcineurin inhibitors

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62
Q

What are the complications of multiple myeloma?

A 
hypercalcaemia
hyperviscocity
spinal cord compression
tumour lysis
renal disease
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63
Q

What are the complications of thalassaemia?

A 
renal disease due to hyperuricaemia
cardiomyopathy due to iron toxicity
diabetes due to iron toxicity
infections
osteoporosis
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64
Q

What are the treatment options for von willebrands disease?

A

DDAVP during any interventions
TXA
human plasma derived VWF

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65
Q

What is required for a thrombophilia screen?

A 
factor V leiden
antiphospholipid antibodies
antithrombin
protein C, protein S
prothrombin gene mutation
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66
Q

What are the complications of CVID?

A 
immune cytopaenia - ITP, AIHA
thyroid disease 
pernicious anemia
polyarthropathy
polymyositis
vitiligo 
lymphoma
gastric cancer 
amyloidosis 
impaired lung function/interstitial lung disease/bronchiectasis 
lymphoproliferation: lymphadenopathy, splenomegaly 
granulomatous disease
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67
Q

What are the live vaccines?

A 
MMR
MMRV
oral poliovirus
yellow fever
varicella
HSV
rotavirus
smallpox
adenovirus
BCG
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68
Q

What are the major and minor duke criteria for infective endocarditis?

A 
major:
positive BC with typical organism in 2 seperate cultures or positive C. burnetii serology
evidence of endocardial involvement
minor:
predisposition
fever
vascular phenomena
immunological phenomena
microbiological evidence
increased ESR, CRP
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69
Q

What are the indications for valve surgery in infective endocarditis?

A 
IE with signs/symptoms of heart failure
paravalvular extension of infection
infection with difficult to treat pathogens
persistent infections
complete heart block 
\+/- large vegetations (>10mm)
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70
Q

What is the management for CIDP?

A 
steroids
steroid sparing agent
IVIG
PLEX
rituximab for nodal disease
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71
Q

What lifestyle advice should be given to patients with seizures?

A

consider occupational safety
driving - usually need to be 6 months seizure free
good sleep patterns
avoid alcohol
no baths, when having a shower turn cold tap on first
no ladders
medical alert bracelet

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72
Q

What is the McDonalds criteria in MS?

A

to decide if this is a clinically isolated syndrome vs MS

2 lesions disseminated in time AND space

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73
Q

What tests should be done to exclude MS mimics?

A

ANA/ENA, vasculitic screen, anti-aquaporin 4 and anti MOG antibodies, syphillis serology

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74
Q

How can you manage bladder dysfunction in MS?

A

oxybutinin
betmiga
botox
pelvic physiotherapy

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75
Q

How can you manage spasticity in MS?

A

baclofen
gabapentin
physiotherapy

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76
Q

How can you manage fatigue in MS?

A 
treat concurrent depression
review sleep hygiene
amantadine
modafanil
OT assessment
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77
Q

What tests are used to investigate myasthenia gravis?

A

antibodies - AChR, MuSK
repeated nerve stimulation study
single fibre EMG
CT chest (thymoma)

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78
Q

What are management options for myasthenia gravis?

A 
pyridostigmine (cholinesterase inhibitor)
steroids
steroid sparing agents
IVIG
PLEX
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79
Q

What are some “pre symptomatic” signs of parkinsons?

A 
anosmia
constipation
REM sleep behavioural disorder
mood changes
increased fatigue/daytime sleepiness 
urinary symptoms
80
Q

Which levodopa sparing agents can be used to treat parkinsons?

A 
COMT inhibitors
MAO inhibitors
dopamine agonists
amantadine
anticholinergics
81
Q

What advances therapies are available for parkinsons?

A

DBS
apomorphine infusion
intraduodenal levodopa

82
Q

What are the contraindications for DBS in parkinsons?

A

severe non motor symptoms (dementia), active psychiatric disorders, structural abnormalities on MRI

83
Q

What investigations should be done for a peripheral neuropathy?

A 
UEC
TFT
B12, folate 
HbA1c 
ESR
CRP
ANA
SPEP 
nerve conduction studies
LP
84
Q

What are the complications of peritoneal dialysis?

A

peritonitis
pleuroperitoneal leak
membrane sclerosis
catheter malfunction

85
Q

What are useful signs of dialysis adequacy?

A

symptoms
nutritional
fluid balance and blood pressure control

86
Q

What are the indications for biopsy in IgA nephropathy?

A

persistent proteinuria > 1g/day
elevated Cr
new onset hypertension or significant elevation from stable baseline

87
Q

What is the management of IgA nephropathy?

A

persistent proteinuria (>0.5-1g/day) and normal/slightly reduced GFR:
- ACE inhibitor/ARB
if urinary protein excretion >1g/day continues for 3-6 months after ACE/ARB:
- 6 months of glucocorticoid therapy
rapidly declining eGFR:
- glucocorticoids and cyclophosphamide

88
Q

What is the general management for nephrotic syndrome?

A 
BP control
RAAS blockade
treat dyslipidaemia (statin) 
anticoagulation
dietary sodium/fluid restriction
diuretics
89
Q

What is the non pharmacological management for ADPKD?

A 
smoking cessation
salt restriction
moderate protein intake
BMI < 25
increase fluid intake > 3L per day
90
Q

What is the PBS indication for tolvaptan for ADPKD?

A

need eGFR < 90 and decline > 5 per year or more than 2.5 per year for 5+ years

91
Q

What are the targets for renal anaemia?

A

Hb 100-115
TSAT > 20%
ferritin > 200

92
Q

What is calcitriol?

A

The active form of vitamin D

93
Q

What is cinacalcet?

A

a calcimimetic - binds to PTH receptors

94
Q

What does vitamin D do to calcium and phosphate?

A

increased absorption of both from gut/kidneys

95
Q

What does PTH do to calcium and phosphate?

A

increase calcium decrease phosphate

96
Q

What are the causes of early worsening renal graft function?

A 
graft thrombosis
acute rejection
CNI toxicity
renal artery stenosis
obstruction/leak/collection
BK nephropathy
CMV
recurrent disease
97
Q

What are the risk factors for chronic allograft nephropathy?

A 
prior episodes of acute rejection
delayed graft function at transplant
HTN 
excess calcineurin inhibitor
inadequate calcineurin inhibitor 
presence of DSAs
98
Q

What is the main side effect of valgancyclovir?

A

neutropaenia

99
Q

What additional investigations should be done in bronchiectasis?

A 
aspergillus precipitins
serum immunoglobulins
CF genotype
TTE
bronchoscopy
immune tests including HIV
nasal brushings
upper GI endoscopy
100
Q

What is the management for bronchiectasis?

A 
treat the cause
smoking cessation
vaccination 
improve airway clearance
azithromycin 
inhaled hypertonic saline
treat airway obstruction
101
Q

What are the elements of the BODE index for COPD?

A

BMI
obstruction (FEV1)
dyspnoea score
exercise capacity

102
Q

What did the IMPACT study for COPD show?

A

in patients with a history of exacerbations triple therapy gave a lower rate of exacerbations/hospitilisations

103
Q

What are the indications for referral for lung transplantation in IPF?

A

refer if DLCO < 40, FVC < 80, dyspnoea/functional limitation, SpO2 < 88%

104
Q

What are the features of obesity hypoventilation syndrome?

A

awake hypercapnoea
BMI > 30
sleep disordered breathing

105
Q

What is the diagnostic criteria for OSA?

A

AHI > 5 + symptoms

AHI > 15 +/- symptoms

106
Q

What are the complications of OSA?

A 
MVA
AF (no effect on mortality)
CAD
heart failure
stroke
systemic HTN
pulmonary HTN
metabolic dysregulation 
increased all cause mortality
CKD
GORD
NASH
107
Q

What pharmacotherapy is used for pulmonary arterial hypertension?

A

calcium channel blockers
endothelin receptor antagonists
PDE5 inhibitors

108
Q

What are the features of a spondyloarthropathy?

A 
inflammatory back pain
sacroilitis
enthesitis
uveitis
dactylitis
psoriasis
crohn’s/colitis
good response to NSAIDs
family history
HLA-B27
elevated CRP
109
Q

What are the cardiac and pulmonary extra articular manifestations of spondyloarthropathy?

A 
aortitis
aortic regurgitation
pericarditis
conduction disturbances
heart failure
IHD
stroke
VTE
pulmonary apical fibrosis (1.3-15%) 
restrictive lung disease due to diminished chest wall and spinal mobility
110
Q

What are the complications of ankylosing spondylitis?

A 
osteopaenia/osteoporosis
transverse fracture through a fused spine 
spinal cord injury
atlantoaxial subluxation
cauda equina symptoms 
nephropathy
111
Q

What is the pharmacological management of ankylosing spondylitis?

A 
NSAIDs 
glucocorticoid injections
DMARDs for peripheral arthritis
TNF blockers
IL-17 blockers
112
Q

What are the complications of antiphospholipid syndrome?

A 
vascular thrombosis
pregnancy complications
thrombotic microangiopathic syndromes
autoimmune haemolytic anaemia
pulmonary hypertension
livedo reticularis
113
Q

What is the management of antiphospholipid syndrome in pregnancy?

A

positive antibodies only and no clinical manifestations: aspirin during pregnancy
venous/arterial thrombosis: LMWH + aspirin
if recurrent miscarriages: aspirin > add LMWH > add prednisolone
all require LMWH in post partum period

114
Q

What are the TNF inhibitors?

A

infliximab
certolizumab
adalimumab
golimumab

115
Q

What are the contraindications for TNF inhibitors?

A 
previous untreated TB 
recurrent chest infections/bronchiectasis
septic arthritis within 12 months
infected prosthesis
indwelling IDC
MS/demyelinating illness
malignancy within 10 years
heart failure (NYHA class III-IV) 
chronic cutaneous ulceration
active/chronic infection e.g. osteomyelitis
116
Q

What are the side effects of methotrexate?

A 
GI upset
fatigue
mental clouding
mouth ulcers
hair thinning
cytopaenias (monitor FBE) 
deranged LFTs
pneumonitis
117
Q

What are the side effects of leflunomide?

A 
diarrhoea
dry mouth
mouth ulcers
hair thinning
HTN
dizziness
cytopaenia
deranged LFTs
pneumonitis
peripheral neuropathy 
shingles
118
Q

What are the side effects of azathioprine?

A

bone marrow suppression
hepatitis
fever
increased malignancy (skin - SCC, cervical cancer)

119
Q

What are the side effects of mycophenolate?

A

GIT symptoms
cytopaenia (uncommon) - monitor FBE
alopecia

120
Q

What are the side effects of cyclophosphamide?

A 
bone marrow suppression
gonadal suppression
alopecia
infections
GIT effects
haemorrhagic cystitis
bladder fibrosis
bladder ca
lymphoma/leukaemia
121
Q

What tests should be done before starting immunosuppression?

A 
check FBE, UEC, LFTs
quantiferon
consider CXR
HBV and HCV serology
HIV
varicella
122
Q

What are the features of dermatomyositis?

A 
symmetrical proximal myopathy
heliotrope rash
gottron's papules
poikiloderma
arthirits
raynaud's
ILD
myocarditis
associated malignancy
123
Q

What investigations should be done for dermatomyositis?

A 
CK
myositis specific antibodies
EMG
MRI
muscle biopsy
TTE
RFTs
HRCT
oesophageal motility studies
124
Q

What is the target serum urate in gout?

A

< 0.36 or < 0.30 in tophaceous gout

125
Q

What is the non pharmacological management of RA?

A 
education 
smoking cessation
maintain active lifestyle 
physiotherapy
occupational therapy
126
Q

What titre of ANA is significant?

A

1:320

127
Q

What are the extra pulmonary sites that can be involved in sarcoidosis?

A 
skin
ocular
upper respiratory tract
cardiac
lymph nodes
hepatosplenomegaly
musculoskeletal
neurologic
renal
128
Q

What non blood tests should be done in scleroderma?

A 
barium swallow
TTE
XR hands
HRCT
RFTs
gastroscopy
right heart catheter
urinalysis
129
Q

What is the non pharmacological management for raynaud’s phenonmenon?

A

keep warm, avoid caffeine, smoking cessation

130
Q

What is the pharmacological management for raynaud’s phenomenon?

A 
CCB (nifedipine)
angiotensin II receptor antagonist
PDE5 inhibitors
topical or systemic nitrates
alpha blockers
SSRI
antiplatelet/statin
IV prostacyclin
131
Q

What is the pharmacological management of ILD?

A

mycophenolate 3g/ day

if unresponsive consider cylclophosphamide or azathioprine

132
Q

What is first line management for scleroderma renal crisis?

A

captopril

133
Q

What is the PBS criteria for teriparatide?

A

“3-2-1” - T score < 3, 2 fractures, at least one fracture while treatment for > 12 months

134
Q

What investigations should be done for chronic diarrhoea?

A

iron studies, B12, folate, albumin, FBE, vitamin D, INR, faecal fat estimation, faecal elastase, faecal calprotectin, stool MCS, carbohydrate breath test (SIBO), gastroscopy, colonoscopy, coeliac serology

135
Q

What are the complications of IBD?

A 
toxic megacolon
perforation
fistula 
strictures/obstruction 
bowel cancer
PSC
anaemia
thromboembolism
gallstones/renal stones
osteomalacia
depression
136
Q

What investigations should be done for IBD?

A

stool culture, AXR, FBE, ESR, CRP, faecal calprotectin, LFTs, colonoscopy, mucosal biopsies, antibody testing (ASCA - crohn’s, pANCA - UC), small bowel MRI

137
Q

What is the management for an acute flare of IBD?

A

check stool MCS, IV steroids, infliximab, IV abx, surgical mx

138
Q

How often should screening for HCC be done in chronic liver disease?

A

6 monthly US and AFP

139
Q

What are the contraindications for liver transplant?

A

active sepsis, metastatic malignancy, cholangiocarcinoma, continuing alcohol consumption, advanced cardiopulmonary or renal disease, life limiting co-morbidities, smoking, IVDU

140
Q

What are the indications for liver transplant?

A 
MELD > 15
HCC
sarcopaenia
diuretic refractory
hepatorenal syndrome
refractory hepatic encephalopathy
fulminant liver failure
141
Q

What should you examine for in a patient with falls?

A 
cognitive assessment 
postural blood pressure 
romberg's test
gait
timed up and go 
parkinsonism 
visual acuity 
cerebellar testing
peripheral neuropathy
142
Q

What are management strategies for falls?

A 
review medications
correct electrolytes/Hb
footwear
gait aids
strength and balance training
vitamin D
rehabilitation/physiotherapy
home assessment
cataract operation 
education on getting up after a fall 
personal alarm 
ix and mx of osteoporosis
143
Q

What is the usual infection prophylaxis used in bone marrow transplants?

A

anti fungal - posaconazole, fluconazole - stopped at 2-3 months
PJP - bactrim for 6/12
HSV, VZV - valacivlocir for 1-2 years
CMV - valganciclovir

144
Q

What vaccinations should HIV patients have had?

A

hepatitis A/B, meningococcal, pneumococcal, influenza

145
Q

What regular investigations should HIV patients have?

A 
CD4 count
viral load
HIV genotype 
STI tests
pap tests (3 yearly) 
HbA1c, lipids 
bone mineral density 
liver function/renal function
146
Q

What are common side effects of HIV medications?

A

renal disease, osteoporosis, dyslipidaemia, GI side effects, obesity

147
Q

What vaccinations are required for splenectomy?

A

pneumococcus, meningococcus, Hib, influenza

148
Q

What are the treatment targets for hypertension?

A

<140/90 is usual target

<130/80 if CKD/T2DM/stroke

149
Q

What are the contraindications for hydrotherapy?

A

open wounds, incontinence, severe COPD/heart failure, extreme obesity

150
Q

What are the side effects of pregabalin?

A

dizziness, drowsiness, weight gain, peripheral oedema, depression/anxiety

151
Q

What is the mechanism of action of tapentadol?

A

opioid agonist and noradrenaline reuptake inhibitor

152
Q

What are some non pharmacological management options for chronic pain?

A 
pain education
resetting expectations
CBT
referral to chronic pain clinic
heat packs 
TENS 
physical therapy 
hydrotherapy
153
Q

What questions should ask for an obesity history?

A

timing of weight gain, heighest and lowest weight as an adult, dietary pattern and exercise

154
Q

What pharmacotherapy can be used in obesity?

A

GLP-1 agonists, SGLT2 inhibitors, orlistat, phentermine, topiramate

155
Q

What is an appropriate target for weight loss?

A

aim reduction of 10% of body weight in 6 months

156
Q

What is the MOA and CI for phentermine?

A

MOA: sympathomimetic agent to reduce appetite
CI: severe HTN, CV disease

157
Q

What is the MOA, SE and CI for orlistat?

A

MOA: inhibits pancreatic and gastric lipase to reduce fat absorption
SE: steatorrhoea, faecal incontinence, vitamin deficiency
CI: pregnancy

158
Q

What is the MOA and CI for liraglutide?

A

MOA: GLP-1 agonist to reduce appetite
CI: severe renal or hepatic disease, phx pancreatitis

159
Q

What is the main side effect of topiramate and the contraindications?

A

side effect: cognitive

contrainidcations: glaucoma, renal stones, pregnancy

160
Q

What are the criteria for bariatric surgery?

A

BMI > 40 or > 35 with obesity-related contraindication

161
Q

What should you look for on examination to assess nutrition?

A

BMI, muscle bulk, pallor, glossitis, angular stomatitis, bruising, peripheral oedema, peripheral neuropathy, bone pain/proximal weakness (vit D)

162
Q

How should nutritional issues be managed?

A

investigate for nutritional deficiencies, investigate for reversible contributors (TFTs, endoscopy, malignancy), dietician, optimise other medical conditions, supplementation, MOW, shopping assistance

163
Q

What are the DSM criteria for depression?

A 
depressed mood
anhedonia
weight loss or gain
insomnia or hypersomnia
psychomotor agitation or retardation
fatigue
worthlessness/guilt
decreased concentration
suicidal ideation
164
Q

What is the MOA and CI for varenicline?

A

MOA: blocks nicotinic AcH receptor
CI: previous SI/psychiatric illness

165
Q

What is the MOA and CI for bupropion?

A

MOA: dopamine/NA reuptake inhibitor
CI: seizure disorder

166
Q

What examination features should you look for in a patient with alcoholism?

A 
wasting
jaundice
dupuytren's
palmar erythema
peripheral stigmata of chronic liver disease
parotiditis
cerebellar/peripheral neuropathy
cognitive impairment
167
Q

What is the MOA, SE and CI for naltrexone?

A

MOA: opioid antagonist
CIL in liver disease
SE: HA, nausea, dizziness, LFT derangement

168
Q

What is the MOA and SE for acamprosate?

A

MOA: GABA agonist to reduce craving
SE: diarrhoea

169
Q

What is the MOA and CI for disulfiram?

A

MOA: interferes with breakdown of alcohol
CI: CVD/DM/HTN/CVA
note not on PBS

170
Q

Template for opening statement

A

X is a “social statement”. Statement about why they are a long case then in the setting of their other issues. Their main concern is x

171
Q

Template for closing statement?

A

adjusted well/poorly, good/guarded prognosis, struggles with…, their health and wellbeing will largely be governed by….

172
Q

Approach to questions?

A

why is it important
confirm/establish diagnosis
assess current severity/control
establish usual target/goal +/- modifications for this patient
discuss management options to achieve goal in this patient
discuss follow up

173
Q

What should you examine for in MS?

A 
spastic paraparesis
posterior column sensory loss
cerebellar signs
cranial nerve examination 
RAPD
174
Q

What are the complications of tamoxifen?

A

VTE
endometrial cancer
hot flushes
cataracts

175
Q

What are the complications of aromatase inhibitors?

A

osteoporosis

arthralgia

176
Q

What are common complications of chemotherapy?

A 
nausea
vomiting
alopecia
cardiotoxicty
myelodysplasia
peripheral neuropathy
177
Q

What are the stages of CKD?

A

1: eGFR > 90
2: eGFR 60-90
3: eGFR 30-59
4: eGFR 15-29
5: eGFR < 15

178
Q

What is the non pharmacological management of CKD?

A 
fluid restriction 
salt restriction
low protein/potassium diet 
smoking cessation
avoid nephrotoxics
179
Q

What are the complications of CKD?

A 
HTN
renal bone disease
renal anaemia
hyperkalaemia
acidosis
fluid overload
CVD
uraemic pericarditis
uraemic encephalopathy
180
Q

What is required in a transplant workup?

A 
HLA typing
DSA typing 
infections - CMV, EBV, hepatitis, strongyloides, TB 
skin check 
FOBT/pap smear/mammogram 
TTE/stress test
181
Q

When is home oxygen indicated in COPD?

A

indicated if PaO2 < 55mmHg

182
Q

Which COPD patients are a candidate for lung transplant?

A

only a candidate if < 65, stopped smoking, without other serious comorbidities

183
Q

What are symptoms of sarcoidosis?

A

fever, weight loss, LOA, malaise, cough, dyspnoea, erythema nodosum, arthralgia, uveitis, sicca symptoms

184
Q

What issues should always be considered in a rheumatology case?

A 
disease activity
irreversible damage
impact on function 
complications of disease and treatment
cardiovascular risk
185
Q

Which patients with RA qualify for a biologic?

A

if failed MTX + one other DMARD

186
Q

Complications of RA?

A

raynaud’s
sicca symptoms
ILD
CKD (either due to medications or amyloid)
ischaemic heart disease
peripheral neuropathy/mononeuritis multiplex
anaemia of chronic disease
felty’s syndrome - leukopenia + splenomegaly
serositis

187
Q

What are the elements of the DAS28 score for RA?

A

tender joint count
swollen joint count
ESR
global health

188
Q

What are the common symptoms of SLE?

A

rash, oral ulcer, arthritis, serositis, renal disease, neurological disease, haematological disease, constitutional symptoms

189
Q

What opportunistic infections should be considered in transplant patients?

A

PJP, aspergillus, TB, nocardia, CMV, VZV, strongyloides

190
Q

What are the driving restrictions for syncope?

A

Unknown cause – conditional license after 6/12 (or 12/12 if 2+ episodes separated by at least 24h)
CV cause – 4 wks

191
Q

What are the driving restrictions for IHD?

A

PCI – 2 days
AMI – 2 weeks
CABG – 4 wks

192
Q

What are the driving restrictions for arrhythmia?

A

Cardiac arrest – 6/12
ICD insertion – 6/12
PPM insertion – 2 wks

193
Q

What visual acuity is required to drive?

A

At least 6/12 vision in one eye

194
Q

What are the driving restrictions after stroke?

A

At least 4 weeks

TIA – 2 wks

195
Q

What are the driving restrictions for epilepsy?

A

6 months seizure free

BPT Clinical (10 decks)

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